As mentioned on the blog over the weekend it seems that over the next few months there may be a few positive steps taken to commence funding implementation of the National E-Health Strategy.
The details of recent discussions are found here:
http://aushealthit.blogspot.com/2009/05/are-there-green-shoots-appearing-for.html
If this is to happen then it is vital that the investment be got right and funds be spent on the right things – especially in the light of the ever-present Global Financial Crisis (GFC).
At its broadest the National E-Health Strategy suggests that we need much improved co-ordination and governance of the national e-health efforts, an incremental and balanced approach, new investment channels and continuation of work on basic e-Health infrastructure.
It has been clear for some time that while work in areas such as identifiers, messaging, authentication and terminology has been progressing there is little or no understanding outside NEHTA as to just where things are up to and what has actually been developed via the very substantial funds (hundreds of millions) that have been invested over the last five years (yes it is now over 5 years!). NEHTA should be releasing, at a minimum, at least quarterly, if not monthly, public progress reports on each of the major work streams. Good heavens even most major privately owned public companies manage that sort of frequency of reporting!
It is also clear that there is a lack of balance in just what NEHTA is addressing there being too much emphasis on servicing the State Public Hospital Sectors (hardly a surprise given that is the background of virtually all its directors) and not enough on GPs, Specialists and the Private Hospital Sector.
An example of this issue is seen here:
NEHTA ‘lacks primary care focus’
29-May-2009
By Sarah Colyer
The long-awaited rollout of electronic health records could be undermined by a public hospital focus among those in charge, AGPN warns.
The network is calling for GP representation on the board of the National E-Health Transition Authority, which it says is dominated by state and territory health department interests.
AGPN CEO David Butt told Australian Doctor: “It’s no good NEHTA providing a strategy that everyone is supposed to buy into when at the governance level NEHTA is still very much representational of the public hospital sector.
“It needs to include general practice and the private sector.”
Mr Butt said the AGPN welcomed the National E-Health Strategy, developed by independent consultants Deloitte, but was concerned it would be implemented by an “unbalanced” board.
Of the 10 members of the NEHTA board, all except the chairman – businessman Mr David Gonski — are state and territory health department executives.
But Dr Mukesh Haikerwal, a consultant to NEHTA as its clinical lead, downplayed the concerns.
More here (subscription required)
http://www.australiandoctor.com.au/articles/f6/0c0612f6.asp
There is also evidence that NEHTA and the NHHRC are definitely not on the same page as far as Individual EHRs and Personally Held PHRs with as recently as the last week or two NEHTA giving presentations on the IEHR as a core part of their work.
See here for example:
http://www.nehta.gov.au/component/docman/doc_download/729-physicians-week-michelle-bramley
and here:
NEHTA is yet to develop and release a National E-Health Architecture – Just why is that I wonder?
It is also clear that how NEHTA is to interact with external entities is still by no means sorted internally. As an example we have one group internally attempting to broaden access to its thoughts among an informed e-Health readership and not being able to execute this in a way that satisfies NEHTA’s need to get the broadest possible feedback or that of many of the external stakeholders.
NEHTA has also totally failed to broaden its board, despite that being a key recommendation of the Boston Consulting Review of NEHTA in 2007 that was acknowledged as a necessary change in the 2007/8 Annual Report.
See here:
http://www.nehta.gov.au/component/docman/doc_download/588-nehta-annual-report-2007-2008
Directors Report – Page 28
Significant Changes in State of Affairs
As required under its Constitution, a review of NEHTA was undertaken by the Boston Consulting Group during the financial year. The review resulted in agreement that the company continue operations and resulted in an amendment to the Constitution permitting the appointment of up to three independent directors to the NEHTA Board.
All that has happened in 18 months is a new independent chairman and zilch else.
The key to NEHTA’s success, and the success of e-Health in Australia in general, is that we establish proper broad based governance of the overall effort with the funds, skills and mandate to drive forward with a reasonable chance of success.
After five years it is clear that NEHTA is not structured, skilled, staffed or motivated to undertake the required reform and improvement on its own. If there is to be funding of the National e-Health Strategy it is not getting the business case right but rather getting National E-Health Governance right that is fundamental to success.
If AHMC / COAG are indeed going to invest they had better make very sure they get the governance right or they will be sending good money after bad. The Deloittes report makes this fact crystal clear and they should be ignored at all our peril.
David.
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