Hi Ken,

"My own view is that the last 10 years of reports (starting with NHIMAC's
Health On Line, Electronic Health Records, Electronic Decision Support,
etc.) adequately laid out the grand plan of where we wanted to go.

It was also self evident, without needing "lessons" from expensive
Health Connect trials, that key building blocks were required to get
there, such as standard terminologies, national identifiers, etc. I have
no argument with NEHTA's agenda in this regard."

Ken I think the question we need to address is..If we had an OK plan - in 2000 
or so -
what happened?

I would suggest it is due to a lack of understanding of the approach required 
to actually
have something happen - combined with realization in Government it might cost 
some money
and so had to be resisted.

Hence - while we need the building blocks - we also need an approach to 
implementation and
funding that suits our health system, clinicians, business conditions, benefits 
flows and
so on.

That - and a credible business case has been missing I reckon - hence the 
inertia.

Also the arguments regarding the safety of our health system have not bitten 
here in the
way they seem to have in the US..hence the relaxed go slow approach adopted by 
NEHTA and
the lack of urgency.

My 2cents

David.

Another point is, of course, that the conduct of all the trials was deeply 
flawed as far
as one can tell.

D.

 ----
 Dr David G More MB, PhD, FACHI
 Phone +61-2-9438-2851 Fax +61-2-9906-7038
 Skype Username : davidgmore
 E-mail: [EMAIL PROTECTED]
 HealthIT Blog - www.aushealthit.blogspot.com


On Wed, 06 Jun 2007 09:15:00 +1000, Ken Harvey wrote:
> David More wrote:
>
>> Up to you all to say what should happen next.
>>
> My own view is that the last 10 years of reports (starting with NHIMAC's 
> Health On Line,
Electronic Health Records, Electronic Decision Support, etc.)
> adequately laid out the grand plan of where we wanted to go.
>
> It was also self evident, without needing "lessons" from expensive Health 
> Connect
trials, that key building blocks were required to get there, such as
> standard terminologies, national identifiers, etc. I have no argument with 
> NEHTA's
agenda in this regard.
>
> Like others, I believe our failure to progress with clinically relevant 
> innovation over
the last few years is largely because there has been no funds for
> practical clinical informatics projects that would work in parallel with 
> NEHTA to
implement their building blocks in the real world.
>
> One example will suffice; for years I and others have been arguing that if we 
> are to
integrate Australian evidence-based information resources such as
> Therapeutic Guidelines, RCPA Manual, etc. into clinical software to provide
best-practice decision support then we needed:
>
> 1. A National Health Information Plan to prioritise the required resources 
> and sort out
copyright and funding models;
>
> 2. Project funds to:
>
> 2.1 Assist knowledge distillers to atomise their information and make it 
> machine, as
well as human, readable;
>
> 2.2 Add standard terminologies (SNOMED-CT, Medicines terminology, etc.);
>
> 2.3 Devise a standard interface that would enable disparate knowledge 
> resources to plug
and play with a variety of clinical software operating in both
> hospital and general practice.
>
> Funding applications were put to DoHA and AHIC and bounced back and forth 
> without any
decision. Then NEHTA was created and I was told it's now their
> responsibility. I went and discussed the above with Ian Reinecke soon after 
> he was
appointed in 2004. He suggested I come back in three years (which will be
> later this year)!
>
> In my view there was absolutely no reason why the above work could not have 
> proceeded in
parallel with NEHTA's activity to serve as a practical, real world
> test-bed for their "standards" and also provide some clinically useful 
> products. All
that was required was some decisions and small start-up funding.
>
> I suspect that when I knock on Ian Reinecke's door later this year (after the 
> three
years are up) I'll be told to come back in another three years when the
> medicines terminology and other building blocks are ready! By then, I'll have 
> completely
retired and the postgraduate students who were interested in such
> projects will all be overseas!
>
> Cheers
> Ken
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