David More wrote:
> 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.
Those are all questions for NEHTA about NEHTA - I am not an apologist
for them, nor can I (nor Tom) pretend to speak for them. If you asked
me what I would do if I were CEO of NEHTA.... but I'm not and that's not
what you asked (and enough idle commentary from me for now - there's
work to be done).
Tim C
> ===================================================
>
> 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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