Oh, and by the way,
Would be good it Tim and Tom could let us know what they think are the answers to the questions I asked.
===================================================
There are a few small issues it would be fun to hear answers on.
The ones I am keen on are:-
What is NEHTA's overall strategy for e-health in Australia? Who does, who pays, what are the costs and benefits etc (or has NEHTA been going two years and it is still not done?)
What funds does NEHTA expect to mobilise to implement this strategy we hope it has?
Where does GP fit in all this?
What sort of efforts in NEHTA planning to support and fund GP computing over the next few years until all the benefits (if they happen) of provider ID, Patient ID and SNOMED are actualised?
I note the current budget had not an additional cent for e-health other then the COAG money (just renamed HC money) announced a few years ago and that stops in 2009/10. Are there plans for more later and when will we hear about it?
I hear implementations of SOA etc in the health sector are both complex and expensive.Why is NEHTA not adopting a walk before run strategy given the 1997 Health On Line stuff has resulted 8 years later in e-mailed notifications of discharged initiated by ward clerks as I understand it and little else. As I hear it, behind the barrier of secrecy and government obfuscations there not ONE proven case of a Government initiative showing any positive clinical outcome.
Love to hear how all this is wrong.
Get them to start chatting and letting us know here!
I am sure others have all sorts of other questions - fire away team!
=======================================================
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 Thu, 11 May 2006 07:09:54 +1000, Tim Churches wrote:
> Tom Bowden wrote:
>> Furthermore, I agree with Michael that the NeHTA approach of sorting out the fundamentals {key
>> infrastructure components; NHI (National Health identifier Index), HPI (Health Provider Index);
>> terminology/coding and architecture, messaging standards and fit for purpose standards setting
>> mechanism} is absolutely the way to go. Having those in place will allow those of us with an
>> interest in building solutions and services to get on with it unimpeded. Without fundamental
>> infrastructure and an architectural strategy, it has been very hard to make
>> worthwhile progress and deliver value to the Australian health sector. Now, even with the
>> promise of these key pieces of enabling infrastructure, we can already feel the brakes coming
>> off!
>>
>
> Dear oh dear! I find myself agreeing with Tom on these sentiments.
>
> The other bit of national infrastructure which we we need is a proper PKI. Not HeSA, but a
> proper, open, standards-based PKI which is closely integrated with the open, standards-based HPI
> we are all looking forward to.
>
>> David M; A comment to you; in Australia, "health" consumes approx $80 billion of GDP and is
>> growing very quickly. We know from first hand experience that there is a 2-3% saving available
>> simply through greater productivity; having less paper changing hands and there are similar
>> savings opportunities available from more efficient primary- secondary integration, use of
>> targeted disease management systems and finding the right EHR strategy (one that everyone
>> trusts is the key). So it is extremely clear where the funding is; right in front of our noses
>> I believe.
>>
>
> Shock! Horror! I agree completely with Tom on this point as well!
>
> I get the sense that David More (and perhaps others) want to see a numbered, step-by-step, fully-
> funded plan. I doubt that such a plan could ever be drawn up - health IT is just too complex,
> with too many players and too many wildcards. If such a plan were to be drawn up, it would be
> sure to be wrong in important aspects. The solution? As Tom (and Michael, and others) have been
> saying: get the fundamental infrastructure and standards right, then chill out, relax and do some
> stuff instead of obsessing over plans (or lack thereof) for doing stuff, and before you know it,
> it will happen.
>
>> In my view NeHTA is doing exactly the right thing.
>> Throwing money randomly at automation projects won't do it, as previous efforts have surely
>> shown us, it is complex. To fix IT/it government needs to incent/disincent health providers to
>> exhibit the correct behaviours and deliver appropriate outcomes. In order to gain incentives/
>> avoid disincentives healthcare providers will naturally engage with people/organisations that
>> are prepared to back their ability to solve these problems to invest in solutions and fix them
>> and will be rewarded if their investment decisions are good ones. I realise that this may not
>> be a forum for debate on economic theory, however, to
>> solve the problem, an understanding of supply side vs. demand side management is what is needed.
>>
>
> Geeze, I don't disagree with any of that either. What is the world coming to?
>
> I think that David More's discomfort stems from a an older worldview in which IT needed to be
> centrally planned - a Soviet style system, with rigid five year plans, predetermined and
> centrally administered funding, lots of bureaucratic checks and hurdles, and anything which
> doesn't fit in the plan is either ignored or sent to the Gulags.
>
> Soviet style management of IT can and does work in many organisations, but only up to a certain
> size (and that size is often much smaller than people expect). But it doesn't work for a entire
> health system, especially one made up of many diverse cultural and social affinity groups as our
> health system is.
>
> We know that laissez-faire doesn't work either - look at the mess the US health IT system (and
> the US health system in general) is in. Much better is approach which NEHTA seems to be taking,
> which is a form of social democratic Fabianism, in which key infrastructure is funded from
> central funds (taxpayers' money) and standards are agreed upon (often with a fair degree of
> unilateralism when it comes to the agreement bit - don't be fooled by the "democratic" in "social
> democratic" - its is only democratic in the sense that there is no absolute compulsion to abide
> by announced standards, only strong incentives to do so). But the model is one of a mixed
> economy (of which even Vladimir Illich was in favour, just before his death), with room for
> entrepreneurs (of all persuasions, including open source ones), start-ups and lots of competition
> to prevent monopolies from forming and to keep costs down.
>
> But the critical thing is whether NEHTA can actually deliver on any of the key infrastructure
> components: the NHI (National Health identifier Index), the national HPI (Health Provider Index),
> a national SNOMED-CT license and support infrastructure, and not to forget, a proper, workable
> national health PKI (or federation of health PKIs). Whether NEHTA succeeds overall is contingent
> entirely on whether it can cause these infrastructure components to actually happen in our
> lifetimes. COAG gave NEHTA sufficient funds over three years for this infrastructure, so lack of
> money is not an excuse. Let's see what happens.
>
> Tim C
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