Tom,
While I heartily support NeHTA's general direction (especially SOA), I
hesitate to be quite so categorical about their methodology being
"absolutely" anything. This suggests that their word must be embraced as
gospel by those of us out here who are confronted daily by practical
implementation issues, not just grand theory and eloquent designs. IMO,
this is all we have received so far from NeHTA: death by a thousand
standards and definitions.
Any activity in this area that can show solid, practical implementation
examples deserves our diligent attention. Such practical, working
implementations have been amply demonstrated by the IHE connectathons.
Tom Bowden wrote:
Hi fellow listers,
It is so refreshing to hear some commonsense once in a while. I
would like to echo some of Michael Tooth's comments. As a service
provider involved in the Hobart HealthConnect project and a number of
similar projects around the Pacific rim, I can say without fear of
contradiction that the typical EHR project problems Michael has
described are totally accurate.
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!
Over here in the far Eastern state of NZ (where the sun rises first)
we have for 12 years had a topdown/bottomup strategy; Government has
paid for and built key infrastructure, NHI, HPI, national systems with
SOA architecture/ standardised interfaces: The private sector practice
system vendors in collaboration with Integration partners etc such as
HealthLink have built services that have delivered value and created
momentum. It is a symbiotic environment and one that has enabled us to
gain an international lead in this area (along with Scandinavia).
Over here, are engaged in a patient summary initiative (at a similar
stage to that being deployed in Scotland) where we are now developing
a Summary Patient Record (GP/Primary Healthcare Organisation held)
that will be accessible to provide continuity of care (eg Emergency
Department ).
We believe the same approach is now filtering westward, thanks to
sound, pragmatic leadership and strategic thinking now emerging.
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.
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. Have a listen to Philip Davies, he
understands very clearly what needs to happen and what he is saying is
directly in line with what NeHTA is doing. I understand one of his
papers is on the AMA website and another will be on the NEHTA website.
Kind regards to all
Tom Bowden CEO HealthLink
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Andrew N. Shrosbree B.Sc, B.Ec
Technical Director
ArgusConnect Pty Ltd
http://www.argusconnect.com.au
Suite 4, Greenhill Centre, Mt Helen
Victoria, Australia
Tel: +61 (0)3 5335 2214
Mob: +61 (0)415 645 291
Skype: andrewshroz
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