Tim,
Just read what I say... I want some real action just as you do..but without an articulated and agreed plan it is all - as a mate of mine says. "Brownian Motion"
This initiative is underfunded and non strategic in my view - you have not offered any evidence to refute that other than your opinion. I have offered some figures that certainly suggest both the terminology and patient ID projects are quite underfunded.
I have suggested to NEHTA (directly) they establish an e-mail list and e-mail alert system.. that would be a good first step to see how real they are prepared to be.
We will see.
Cheers
David
---- Dr David G More MB, PhD, FACHI Phone +61-2-9438-2851 Fax +61-2-9906-7038 Skype Username : davidgmore E-mail: [EMAIL PROTECTED] On Sat, 11 Feb 2006 21:19:16 +1100, Tim Churches wrote:
> David More wrote:
>> See Comments in Message
>>
>> On Sat, 11 Feb 2006 19:51:14 +1100, Tim Churches wrote:
>>> David More wrote:
>>>> Hi Tim,
>>>>
>>>> Let me try and answer your questions as best I can.
>>> ...snip...
>>>> Re Use of Medicare Number - it is not an adequate ID for medical records nationally.
>>>>
>> Remember
>>>> there are more medicare number by about 20% than people in the populations (see recent
>>>> productivity commission report - it mentioned that I recall)
>>>>
>>> Yes, yes, and if you re-read my post, you will noted that I said:
>>>
>>> "One has to ask the question: why not just jump directly
>>> to a national health care identifier, particularly when we are already 80% of the way there
>>> with the Medicare number. Yes, it would take some (minor) legislative change to allow the
>>> Medicare number to be used universally, yes, Medicare numbers would need to be made unique to
>>> each person, and yes, those not eligible for Medicare would need to be accommodated, but
>>> these are all feasible extensions to the current Medicare card/number. It all depends on
>>> timing. Hmmm, if left in the hands of HIC, it could take decades..."
>>>
>>
>> You missed the main point - the cost of real ID.
>>>> Tim, it is simply not enough to do anything that will make a difference I believe. And
>>>>
>> its goes
>>>> to 2009 - then what - no recurrent funds committed.
>>>>
>>> No, but these NeHTA-led initiatives will supplant a lot of
>>> already-funded activity to do somewhat more limited versions of the same things (eg statewide
>>> or regional unique patient identifiers, health care provider directories). The task for NeHTA
>>> is to convince State and
>>> regional health authorities to disinvest in those and to re-invest the money saved into these
>>> national initiatives instead. If NeHTA succeeds in doing that, then there will be enough
>>> money.
>>>
>>
>> What chance that, given the warring tribes?
>>
> David, if one's outlook is one of unrelenting pessimism, as yours seems
> to be, then there is Buckley's chance of anything ever bearing fruit.
> But not all of us are so pessimistic. Otherwise the only kind of health
> informatics which would be of interest would be the kind pursued by
> Philip Nitsche (see http://news.bbc.co.uk/2/hi/health/778139.stm ).
>
>>> Wanting a confirmed budget beyond 2009 is unrealistic. (DM - Why its not that far away?)
>>>
>> If it works as
>>> promised, or looks like it will work, then funding will be continued. If it doesn't work
>>> (like just about every other national scale health IT
>>> project, or pilots thereof, that I can think of), then the funding plug will be pulled. I am
>>> sure you are familiar with the phenomenon of
>>> funding being pulled from large health IT projects which don't deliver results within a 3 or
>>> 4 year time frame, aren't you, David (what is that rattling sound?).
>>>
>>
>> Your cynicism and preparedness to just give up I reckon!
>>
> My cynicism and preparedness to give up? Nuh, I have a realistic
> outlook, informed by the historical performance of various players, but
> I remain cautiously optimistic. And I haven't retired to join the ranks
> of the health informatics commentariat - not yet, at least. I still do
> real work on useful stuff, as do many other contributors to this list.
>
>> Tim, if you love what NEHTA is doing..just say so.. if you think they are not quite up to it
>> say that.. or if you like me find an absence of transparency and clear planning a travesty -
>> say that - or anything in between.
>>
>
> I have expressed disquiet in this forum (or its predecessor, before you
> joined us) about NeHTA's lack of transparency and often rather
> peremptory consultative processes, and about the time lag between
> issuing some vague hints about their intended direction and issuing some
> more substantial documents clarifying exactly what they meant. This has
> happened with respect to secure messaging, and has caused small players
> like ArgusConnect some grief as would-be customers for their products
> and services have sat on their hands waiting for NeHTA's pronouncements.
>
> However, I do think that NeHTA have indeed, perhaps for the first time
> for a high-level health IT body, specifically identified the correct
> cornerstones - discrete, feasible initiatives of urgent and practical
> importance - which together (and in isolation, to some degree) will
> facilitate progress to be made on a wide range of fronts by a wide
> range of players. This is a pleasant change from the grand,
> all-encompassing but ultimately impractical visions such as those
> espoused by the late HealthConnect project. And recent NeHTA documents
> identify specific technical means to the identified ends. I may not
> agree with every one of those technical means, but it is refreshing to
> have a health IT authority which worries about HOW things are to be
> done, not just hand-waiving about what they wish might be done, somehow.
>
>> You can sit on the fence and snipe for as long as you like - we all would like to know - given
>> some influence - just what your plans are - mine are clear.
>>
>
> I am sorry if I have been guilty of sniping, but don't worry, I only
> have a pea-shooter. But you want to know what I would do if I ruled the
> world (or were king for a day)? Well, just like Woody Allen did when he
> became dictator of San Marcos in his wonderful spoof "Bananas" (see
> http://www.imdb.com/title/tt0066808/ ), I would order everyone to wear
> their underpants on the outside.
>
> Tim C
>
>>>> On Sat, 11 Feb 2006 10:54:10 +1100, Tim Churches wrote:
>>>>> David More wrote:
>>>>>
>>>>>> Progress Towards Electronic Health Records
>>>>>>
>>>>>> To underpin the efforts in refocusing the health system to promote better health and
>>>>>>
>>>> community
>>>>>> care for all Australians, COAG agreed to accelerate work on a national electronic
>>>>>>
>>>> health
>>>>>> records system to build the capacity for health providers, with their patient's
>>>>>>
>>>> consent, to
>>>>>> communicate quickly and securely with other health providers across the hospital,
>>>>>>
>>>> community and
>>>>>> primary medical settings. The Commonwealth will contribute $65 million and the States
>>>>>>
>>>> and
>>>>>> Territories $65 million in the period to 30 June 2009.
>>>>>>
>>>>> That sounds less like the former HealthConnect vision of huge, shared, central
>>>>>
>> repositories
>>>>> and much more like a vision of a far more
>>>>> distributed electronic health record (or rather, an "electronic health record system")
>>>>> enabled by quick and secure communication. OK, I have just restated the preceding
>>>>>
>> paragraph -
>>>>> but my point is that the emphasis is on secure communication (implying between
>>>>>
>> distributed
>>>>> clinical information systems or repositories), not on shared central repositories.
>>>>>
>>>>> Is that correct?
>>>>>
>>>>>> Comment - This is a funding of $43.3M p.a.
>>>>>>
>>>>>> From February 2006, governments will accelerate work on a national electronic health
>>>>>>
>>>> records
>>>>>> system to improve safety for patients and increase efficiency for health care
>>>>>>
>> providers
>>>> by
>>>>>> developing the capacity for health providers, with their patient's consent, to
>>>>>>
>>>> communicate
>>>>>> safely and securely with each other electronically about patients and their health.
>>>>>>
>>>> This
>>>>>> requires:
>>>>>> developing, implementing and operating systems for an individual health identifier, a
>>>>>> healthcare provider identifier and agreed clinical terminologies; and promoting
>>>>>>
>> compliance
>>>>>> with nationally-agreed standards in future government procurement
>>>>>>
>>>> related
>>>>>> to electronic health systems and in areas of healthcare receiving government funding.
>>>>>>
>>>>> Goodness me, that actually seems like a sensible programme of work. Now if it can just
>>>>>
>> be
>>>>> implemented in a sensible, cost-effective fashion...
>>>>>
>>>>>> Comment
>>>>>>
>>>>>> The best estimate of the cost of Patient ID, Provider ID and Terminology Services
>>>>>>
>> Costs
>>>> when
>>>>>> operational is at least $100M p.a. to do it half way properly
>>>>>>
>>>>> David, where is this estimate published so we can examine its basis and assumptions? A
>>>>>
>> great
>>>>> many cost estimates for health IT initiatives are produced by large IT consultancy
>>>>>
>> firms who
>>>>> hope to pick up fat contracts to implement those same inititaives, and teh estimates
>>>>>
>> are
>>>>> based on rather flimsy evidence or questionable (or at least highly arguable)
>>>>>
>> assumptions.
>>>>> Thus all such figures need to be carefully scrutinised before being given any
>>>>>
>> credence.
>>>>>> Again I believe we are being dudded big time! This is again tinkering at the edges -
>>>>>>
>>>> and of
>>>>>> course there is no public plan about what is intended other than these few lines.
>>>>>>
>>>> Anyone know
>>>>>> any more detail?
>>>>>>
>>>>> The key question is how this relates to existing and planned State
>>>>> health dept facilities and planned projects to create state-wide unique patient
>>>>>
>> identifiers
>>>>> and health service provider directories, often by amalgamating existing regional
>>>>>
>> medical
>>>>> record number systems and GP
>>>>> directories etc. One has to ask the question: why not just jump directly to a national
>>>>>
>> health
>>>>> care identifier, particularly when we are already 80% of the way there with the
>>>>>
>> Medicare
>>>>> number. Yes, it would take some (minor) legislative change to allow the Medicare
>>>>>
>> number to be
>>>>> used
>>>>> universally, yes, Medicare numbers would need to be made unique to each person, and
>>>>>
>> yes,
>>>>> those not eligible for Medicare would need to be accommodated, but these are all
>>>>>
>> feasible
>>>>> extensions to the current Medicare card/number. It all depends on timing. Hmmm, if
>>>>>
>> left in
>>>>> the hands of HIC, it could take decades...
>>>>>
>>>>> Tim C
>>>>> _______________________________________________
>>>>> Gpcg_talk mailing list
>>>>> [email protected]
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