|
Magnificent summary David. Thanks for
sharing From:
[EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of David More HealthConnect is dead -
So now what? By: David More 1 February 2006 Six months ago I wrote a short piece in New Matilda
suggesting that a major review of HealthConnect, the Commonwealth's e-Health
strategic plan and implementation program, was required. I was concerned that,
among other things, there needed be a full and frank review of the whole
program otherwise major failure and money wastage seemed inevitable. It seems that I was right. A few weeks ago The Australian
reported that the Director of e-Health Implementation had been moved to a new
position (covering e-health, safety and quality) and that his staff were unsure
who their new leader would be and what their future would hold. More bad news followed a week later when the same paper
reported that the lead implementation team had warned of the need for 'the Federal
Government to hose down consumer expectations about electronic health records
in the wake of its 'changed vision' for HealthConnect'. This all appears to be the final step in killing off any
concerted federal e-health initiative aimed at significant transformation of
patient healthcare delivery and improvement of health outcomes. It now also
appears that there is to be a complete passing of the baton to state
jurisdictions and to their e-health co-ordinating and standards setting entity,
the now corporatized National E-Health Transition Authority (NEHTA). Sadly, as NEHTA is 'owned' by the stakeholder state
jurisdictions and the commonwealth, and many state Health IT projects are
delayed or problematic, there has been little public comment from the NEHTA
board on the overall state of e-health. Furthermore, recently NEHTA disbanded
its technical advisory board. It is now obvious to all that the concept of a life-long
shared electronic health record to assist in the care of the Australian
population is simply not going to happen as it was envisaged in 1999. In my
opinion, the whole project was overly-complex, poorly researched and piloted,
politically and culturally naive, over-hyped as to its potential, built around
unrealistic timeframes and costing and not designed to address the actual
urgent needs of the health sector. Following the failure of the trial and the implementation
projects to deliver useful clinical outcomes, the goal posts and expectations
of useful clinical outcomes have been changed and federal expenditure has been
largely withdrawn, with costs shifted to the States as much as possible. This
is made clear by the recent re-branding of HealthConnect as now being a 'Health
Market Change Management Strategy' - whatever that means! Why does this matter? It matters for two major reasons. Firstly, there is a
compelling business case for the successful implementation of information
technology in the health sector. (Confirmation of this lies with the fact that Secondly, if we do not successfully implement e-health,
achievement of the other objectives of quality, efficiency, safety and
consistency of care for our health system become impossible. What is at stake? Without national leadership on e-health, Firstly, if it is left to state jurisdictions, we will
continue to have a 'multiple railway gauge' problem as occurs in other aspects
of life. This is where information flows and interpretation between jurisdictions
are profoundly problematic. Secondly, we will see a worsening of information flows
between the primary, secondary and tertiary sectors - as each is funded by a
different tier of government. This will interfere with progress towards
improvements in the quality, safety and efficiency of patient care. Thirdly, we will continue to see waste and duplication as
lessons are not learnt and mistakes are replicated across the nation. What has also happened recently? There are other worrying portents of the Commonwealth
Government vacating the e-health space. Firstly, the formal role of the
Australian Health Information Council to undertake national e-health planning
was withdrawn after the AHMAC meeting in late 2005. Secondly, the Health Minister failed even to attend the AMA
e-health forum in December 2005. Thirdly, it is clear that all planned
HealthConnect implementations have been drastically scaled back in both cost
and likelihood to meet the goals of the original plan upon on which upwards of
$100M has reportedly already been spent. Current implementations are now simply e-mail notification
to GPs schemes for patient hospital discharges and the like. What are now being
implemented are trivial and un-standardised endeavours, far removed from the
original HealthConnect concept of a life-long shared medical record. What is likely to happen next? The answer to this question lies with the various state
jurisdictional Health IT initiatives. NSW is currently having substantial
delays in making system selections for core systems. Little progress in any of these states is likely any time
soon and if progress is made it will be largely Hospital-centric, as that is
what state health departments care about. Developing links to the community and
GPs is not a priority while you are still trying to get the hospitals online. What is to be done? The worrying pattern described above must be reversed. First, there needs to be a proper national business case
developed to establish the costs and benefits of deployment of appropriate
Health IT and the opportunity cost to the community of not doing so. This needs
to be sponsored at Cabinet level, done by the most competent and credible advisors
that can be found, and needs to convince the government of the need to invest.
(The same exercise has happened in the This is predicated on finding a suitable sponsor in
government who understands both the benefits and the opportunity costs. In the Second, if this business case reflects similar studies elsewhere
and is supportive of action, a national e-health plan which is properly funded
and properly resourced needs to be jointly developed with the states. It should
cover what needs to be addressed in all sectors (acute, chronic and aged care)
and for all participants (consumers, health professionals, etc). This plan needs to be genuinely national in scope, standards
driven, and above all, practical and able to be implemented in small
co-ordinated steps that deliver progressive benefit for the costs incurred.
There also needs to be the recognition that a paradigm shift employing newer
technologies and approaches may very well be required. The 'same old, same old'
will not work. It also needs to be recognised that there has been some
excellent work (especially in the areas of information management and standards
produced by NEHTA) done as part of the HealthConnect program (along with some
disappointing work) and the baby should not be thrown out with the bathwater. Any plan will need to recognise that those who incur the
costs are often not those who reap the benefits. Mechanisms to address
imbalances and the somewhat perverse set of incentives and barriers will be
critical to develop. These exist elsewhere and can be adapted to our situation. Careful and ongoing consultation of all stakeholders will
also be vital for success. Lastly, it seems clear that the bottom-up, standardised,
connectivity-driven approach which avoids major privacy and security concerns
(as is being deployed in the Doing nothing is not a real option. We need to bury the
past, but not before we learn the lessons of what was done well, and then start
afresh. About the Author Dr David More is an Independent Consultant in the domain of
Health Information Technology. References HealthConnect - A Major Rethink Required, New Matilda, 29
June 2005 Health IT chief on the move. The Australian, 11 January
2006. Health e-records 'changed vision', The Australian, 17
January 2006 PM backs off e-health, The Australian, 24 January 2006 Hospital software upgrade on sick list, Australian Financial
Review, 30 January 2006. PM sidesteps into e-health minefield, The Australian, 31
January 2006 |
_______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
