David More wrote: > Tim and Tom, > > Good to see you early in the morning. > > Just a few points: > > Tom - sure the money is just under our noses - but lets see the politicians > or who ever > actually divert some of it into forward looking activities (as you suggest) > that will make > a difference. There have been calls for "health reform" for years now - and > the last > budget, yet again, did not make any major moves toward it I could detect.
It is chicken-and-egg, isn't it. Show a govt Treasury real, documented evidence of efficiency gains of a few percent in health and they'll throw money at system-wide implementation. But very few projects or pilots are set up to be able to show such things - the rigour of the evaluation frameworks and mechanisms - evaluation of not just improvements in quality or safety of care but also economic evaluation of improvements in efficiency - tend to be very sadly lacking. The typical PIR (post-implementation review) for health IT systems focus on whether they actually worked or not, not on how much time and money they might save or what improvements in patient outcomes they might bring. Efficiency and quality gains are always mentioned in the business cases for health IT pilots, projects and initiatives, but are hardly ever (never?) measured (i.e. quantitatively) afterwards. > Tim - I recognise all the issues with "big IT". I am not wanting a plan of > that sort at > all. I just want clarity about how each of the NEHTA initiaitves (ID, > Provider ID, SNOMED > etc) are to be undertaken and how they will fit with what currently is in > place and > planned. OK, fair enough. keep writing to Ian Rienecke asking where the plans are at, then. > I have no illusion about the need to start small and work up - just as > Brailer has > realised is the way to go in the US. > > However with that said, unless there is a reasonably clear view of the > desired "future > state" all the small initiatives will be little more than "Brownian Motion" > as we have had > to date. David, you clearly subscribe to Intelligent Design when it comes to health IT. I'd rather put my faith in blind watchmakers (http://www.simonyi.ox.ac.uk/dawkins/WorldOfDawkins-archive/Dawkins/Work/Books/blind.shtml) > Working from the ground up without a plan is likely to result in a very > collapse prone > skyscraper - and I see health reform as needing to be enabled by better than > that. Yeah, but it is not a skyscraper which is being built - skyscrapers are the sort of project beloved of old-style "big IT". What is being constructed is more akin to a city, and cities tend to extend horizontally, more than vertically, which makes them much less prone to sudden and catastrophic collapse, even when the inevitable mistakes and lack of planning become evident. Tim C > 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 >> _______________________________________________ >> Gpcg_talk mailing list >> [email protected] >> http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk >> >> __________ NOD32 1.1530 (20060510) Information __________ >> >> This message was checked by NOD32 antivirus system. >> http://www.eset.com > > > ------------------------------------------------------------------------ > > _______________________________________________ > Gpcg_talk mailing list > [email protected] > http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
