Last week the blog revealed that in March, 2009 there had been serious doubts about just how well the project to provide Health Identifiers was going.
This blog can be read here:
http://aushealthit.blogspot.com/2010/02/nehta-is-leaking-like-sieve-symptom.html
The key paragraph is here (from the Executive Summary):
“Review Approach
This report details the results of a project health check undertaken of the Unique Health Identifier (UHI) project at nehta. The project review was undertaken over 10 days and involved in-depth interviews of project team members, suppliers and senior managers and a review of key project artefacts. The report assesses the UHI project’s health in 14 key elements, notes any exceptions to these findings and makes recommendations for improving the health of the project. Annex A outlines the approach to interviews and questionnaires used in the review.
Using the intelligence gathered through the project health check (scored in Annex B), an assessment has been made of the project’s ability to deliver. Overall, the Unique Health Identifier project is rated as RED. Unless significant changes are implemented, this project will not deliver agreed scope within timeline or quality tolerances. There are critical issues and concerns that exist within the project that require management intervention by the project sponsor, programme management and other senior management.”
---- end quote
The one line summary is that the project is a major mess and that without major intervention the whole thing has a high likelihood of failure.
The review project took 10 days and so, and – having reported on March 13, 2009 – was probably actually undertaken in mid to late February. Even if not written up what had been found would certainly have been made clear, in broad terms, to NEHTA senior management at that time.
Consider now this post.
http://aushealthit.blogspot.com/2009/03/senate-estimates-questions-on-e-health.html
This blog reported on the proceedings of a Senate Estimates hearing.
STANDING COMMITTEE ON COMMUNITY AFFAIRS ESTIMATES
(Additional Estimates)
WEDNESDAY, 25 FEBRUARY 2009
CANBERRA
BY AUTHORITY OF THE SENATE
2 key items in the transcript is the following exchange:
----- Begin Quote
Blogger Comment at the time: Next there was this explanation of the NEHTA work program.
“Ms Morris—Sorry, Senator, I am just getting the list. It is a long attachment because there is a lot of good stuff in here, as Ms Halton said. What I will run through is what they have got in their current 2008-09 work program, which is delivering a lot of really useful outcomes and, as Ms Halton said, getting to the stage where people are hopefully understanding and seeing how it all will build up to a picture of an individual electronic health record. Development of e-health capabilities: I always have to try and translate this into English. Within that, they have things called domain packages, which can be broken down into discharge summaries. For instance, when a patient is discharged from hospital, an electronic summary of what happened to them in hospital, what medications they are on, what procedures were undertaken, what diagnostic imaging, whatever—“
Blogger Comment at the time: This really does not inspire much confidence. Does anyone think that discussion betrayed a deep understanding of what NEHTA is doing and why?
Then there was discussion of the IHI as discussed previously in the blog. It was here we learnt:
“Senator BOYCE—So by the end of the year we should have the unique identifier?
Ms Halton—Yes, we should.
Ms Morris—Yes.”
Blogger Comment at the time: I think somehow the pilot idea somehow slipped through the cracks! The timeframe looks a trifle adventurous also – but we shall see!
This was then followed by this:
“Ms Halton—Yes, that is right. The other thing that is going to be delivered by the end of the year is secure messaging. In other words, not only do you want to know who it is you are talking about but also you want to be able to say quite confidently to patients that the information that goes via this mechanism to this other party is not going to disappear into cyberspace and cannot be in some way tampered with or siphoned off by somebody else. It has to be secure. We all think that privacy in respect of health is incredibly important, and so secure messaging—which again is in this timetable—is one of these key things to be delivered.
So when I talked at the beginning about this then enabling patients to start to see these things actually happening, you need all of these things before you can start moving your pathology results around electronically. Before enabling you to manage the medications electronically, you need to know what the medications are, you need to be able to code them consistently, you need to know it is you who is taking them and not Senator Moore or whoever else, and you need to know who has prescribed what and if it has been dispensed. Does that make sense?
Senator BOYCE—Yes.
Ms Halton—With these what we call ‘foundation parts’ of e-health, COAG agreed that we would continue with this investment to keep building on each of these elements that are all moving towards an integrated, electronic health record. Part of the work is a little nebulous. When you say that one of the things we are working on is engagement or policy or privacy or whatever else, we still need to fund those things, because we need to able to assure consumers that their privacy will be protected. We also need to ensure that we manage change with the professions.”
Blogger Comment at the time: Ms Halton does not seem to be at all clear that to move from the foundations to an actual EHR or whatever form is big and probably not cheap. To her that is ‘nebulous’. A bit of a worry!
Note privacy is important – but no plan to manage it is mentioned. Need to keep it simple I guess. If there was legislation being prepared I am sure it would have been mentioned.
----- End Extract from Old Blog.
At the time these two senior bureaucrats were briefing the Senate – presumably under oath – we now know that NEHTA was sufficiently worried about the HI Service project to get a paid review and almost certainly had a good idea of what the review would say. Somehow this news just did not seem to make it to those fronting Senate Estimates – who were happy to state, for the record, it was all wonderful and December was looking good for identifiers.
We now know that both messaging and identifiers were not delivered in December (whatever delivery actually means) and still haven’t as far as one can tell.
Seems to me all this shows, at best, is an unacceptable lack of curiosity to actually find out what was going on, knowing there would be specific e-Health questions at Senate Estimates, and at worst a blatant misleading of the Senate.
However you look at it there is no reason I can see to ever believe anything we are told again! Do you?
David.
Addendum:
It is worth noting the issue of failure of communication between NEHTA and DoHA has been around for a while. See here:
http://aushealthit.blogspot.com/2009/03/nehta-ceo-disagrees-with-secretary-of.html
Really this lot would struggle to lie straight in bed!
D.
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