Anonymous has outdone him/her self!
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David,
I haven't worked within NEHTA but have participated in a number of their consultations and do have some friends that work there. It's very sad but I think your correspondent's reflections are true. I'm writing this blog posting anonymously because my employer is working with NEHTA, and I know that the kind of 'falling out of favour' that your writer describes doesn't just apply to employees, it also applies to the suppliers who are contracted to work with NEHTA.
One rule of working with NEHTA - frank and fearless advice is most certainly not welcome in NEHTA. Not from employees, not from consultants, not from vendors, not from anyone.
I saw a chain of small consultancies engaged to provide advice on the NASH program. I won't say their names. The amazing thing was as each consultancy was engaged, they gave very solid advice that the course of action that the NEHTA folks were taking with regard to NASH was impractical, unnecessary and grossly more expensive than estimated. Unfortunately, as each provided advice, their advice was rejected and then their consultancy was terminated. Step in the next consultancy to be asked the same question. The NASH program is now at the point of either collapse or rebirth - but don't hold your breath. My understanding is that it's about to be turned into a specification project, not a delivery project. That is, NEHTA will specify the contents of digital certificates, key management processes etc, not implement any national infrastructure. NASH has already spent a bucketload of money though so like I said don't hold your breath. Vendors participating in the secure messaging program (PIP) have been told not to expect NASH to be operational anytime in the future so the specs have instead assumed the use of the existing Medicare HESA certificates.
Which brings me to what I thing is the most damning change that has come about in NEHTA over the last six months. They don't care one bit anymore about the outcomes of eHealth, their focus out of fear is on the process. The mantra has become: "if we deliver a documented specification, ram it through an arbitrary consultation process, then get it legitimised by some group or standards body", then we're successful. It is irrelevant to the management of NEHTA that the specifications are not used or adopted in any way by the industry. Their job is done - they've produced the document.
Take one spec as an example:
NEHTA have a team of people working on the Australian Medicines Terminology. This is an important piece of work and we really do need a common medication vocabulary adopted in Australia. It would save lives and enable better quality care through medication management.
But look at the AMT specs. They've gone through 2 major and 20 minor revisions since 2007. But almost three years later who's using them: No one - not one single vendor, not one single healthcare provider. No one.
Now I would think NEHTA would take that as feedback to get engaged in actual adoption, stimulate and foster adoption, drive education, skill up other participants in eHealth, invest in industry partners who want to adopt AMT. Is NEHTA doing any of that? NO. They're succesful (by their definition) - the document has been produced.
We now have NEHTA publishing another raft of specifications on the electronic transfer of prescriptions. Excruciating detail on how an electronic prescription exchange must work! Is AMT mentioned - only as an eventual goal at some point in the future. The horse has already bolted - eRx and MediSecure are operational exchanges and NEHTA's writing a spec for how their web services should appear!!! But again, NEHTA are delivering a document.
NEHTA's also still talking about the Identifiers service (UHI, IHI) being operational by December. Remember Peter Fleming's remark : "2009 is The Year of Delivery"
Reality is a vague and abstract concept. Adoption is irrelevant.
David, I think you're right. It is well past time that this issue was critically reviewed by the Auditor General, and I think you are right to question the leadership provided by Peter Fleming and David Gonski.
I think it sad that 18 months ago, many of us were vaguely hopeful of progress - that some fresh blood and particularly someone with the previous stature of David Gonski.
( I just did a google search on David Gonski and found his wiki page: http://en.wikipedia.org/wiki/David_Gonski. Kind of curious that it makes reference to his chairmanship of CocaCola, Investec and others, but not a single reference to his chairmanship of NEHTA. Perhaps it's in his best interest to keep that one quiet)
I don't want to come across as entirely critical of NEHTA. There are some passionate, talented, dedicated people there who really believe in what they are doing. It's just very sad that:
(a) they are unsupported by effective management and attacked for voicing contrary opinions to the group consensus. Dissenting voices are removed, unqualified yesmen are promoted
(b) despite bringing in some good people, they've broken links with the people who are really delivering change in the health provider community. They're working in a vacuum, ignoring reality but somewhat mindlessly progressing to simply deliver document after document of tedium
(c) they're poorly governed. The Boston report said so three years ago. The DeLoitte strategy said so last year, but no substantive changes ever get made.
(d) they are surrounded by apologists. Jane Halton's remarks to the Senate estimates a few weeks ago were appalling and misleading. She has no idea of the true state of eHealth and made so many deceitful half-truths in that hearing that she should be reprimanded for contempt of the senate.
(e) they have taken a view that style is more significant than substance. Just once, I would love to hear that just one (only one) product of NEHTA's has been incorporated into a single working system in Australia, anywhere.
Come to think of it, can any of your readers point to an example. Just one, anywhere, any product (AMT, SNOMED, identifiers, secure messaging, NASH). After almost five years, surely there is one????? I'm sure Peter Fleming and Jane Halton would be happy to pay you a finder's fee, as they clearly don't know of any examples.
If it is the case that they haven't been deployed anywhere, then I'd like to ask for my $200million in taxpayers money back. If they have been, then that would give me such tremendous hope. Anyone know?
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Posted without comment. None is needed!
David.
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