David More wrote: > 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?
What happened was that funding was provided for a lot of pilots, but without clear plans for how those pilots were to be rolled out nationwide if they were a success. The golden rule of pilots: if you aren't sure how to extend a pilot if it turns out to be a success, then don't fund the pilot. Some of the pilot funding also went into development of software infrastructure, which could have been re-used, except that the funders failed to think about IP licensing issues, and some of that is now proprietary (eg the openEHR-related implementation developed by DSTC and now sold as a commercial product) and others were left to rot in a filing cabinet somewhere. But the main problem was that funds and commissions to do the hard slog work of standards development, codeset development, re-usable reference implementations and so on were not forthcoming. Pilots are much sexier than standards, but they generally don't have much long-term impact and have a very low "value multiplier". Standards and codesets etc have huge value multipiers. > 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. A lack of understanding and costs a lot of money - yeah, bit those are truisms - `twere always so. > 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. Well, the building blocks need to be funded properly, and on an ongoing basis because they are never finished - they need to be continuously maintained and improved and extended. They are urgently needed. And they can't all be done out of the little NEHTA office in Brisbane, nor by volunteers meeting every few months at Standards Australia. > That - and a credible business case has been missing I reckon - hence the > inertia. Everyone accepts the general business case. Specific business cases for specific projects and funding streams, sure, but a general one for health IT - nuh, waste of time in my opinion. What will impress the politicians and senior bureaucrats is some actual, concrete progress, not Yet Another Business Case document. They see several of those every day. Generate teh evidence that health IT makes a difference, don't just write about the paucity of evidence in teh literature. > 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. There are certainly health outcome and health system efficiency opportunity costs of going slowly. IT people (including NEHTA, I suspect) focus on the opportunity costs of implementing systems and writing software "too early", meaning before standards are set in concrete or before strategies are neatly aligned and so on. Two problems with this: a) the systems they delay because all is not ready are dynamic and perpetually changing anyway, and will never be completed or finished - the lifecycle is continuous, or ought to be, not one of "install now, replace in a decade" - because health care and medicine are subject to continuous change so unless IT systems also change continuously they will be by definition irrelevant or inadequate within a year of installation; and b) the opportunity costs of having to upgrade software and implementation on a rapid cycle are piddling compared to the foregone efficiency gains in our $80 billion per annum health system caused by delaying implementation. IT people need to see beyond their small IT budgets to the entire health system expenditure. > Another point is, of course, that the conduct of all the trials was deeply > flawed as far > as one can tell. One can't tell, because trials are so rarely reported, either in the peer-reviewed "black" literature or in the "grey" literature as report monographs. They are just filed away in a cabinet in Canberra and elsewhere, it seems. Tim C _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
