With the electoral target of 76 seats for an absolute, if shaky majority continuing to elude the Coalition, it’s becoming increasingly obvious that ehealth and the National Broadband Network will emerge as crucial issues in determining which party will get the support required to form a minority government.
One of the triumvirate of independents, New England’s Tony Windsor, made that very clear on last night’s special edition of the 7.30 Report, and Rob Oakeshott hinted that communiations were very high on his agenda.
I’d be prepared to bet that Tony Abbott will very quickly announce that his policy on a dumbed-down broadband network and less-than-enthusiastic support for a PCEHR were “non-core issues” in the best Howard Government traditions.
He’s likely to have other problems on his hands too, with the Financial Review’s Julian Bajkowski reporting this morning that “Labor states are preparing for an immediate dogfight over funding for electronic health reforms in the event the Coalition strikes a deal to form government”.
Some states don’t seem to be convinced that the off-balance-sheet backflip by shadow health minister Peter Dutton that we reported on Friday bind the Libs to funding for the initial stages of a PCEHR, and consequently, according to the Fin, “they are preparing contingent costings to deliver to Canberra if funding for regional improvements for telecommunications and other e-health initiatives is withdrawn”.
While Bajkowski reports that a Coalition victory would see the money for the pilot projects reallocated to mental health, he writes that “clinicians claim that a significant portion of the $467 million has been earmarked to integrate new unique patient identifier numbers from Medicare into the primary health sector, which has experienced difficulties with new technology”.
The story also describes as a complication reports that shadow treasurer Joe Hockey has pledged to use the new ehealth numbers to help relaunch a national identity scheme to improve public sector productivity, although it says it is less clear whether such a move would have wider party backing.
Another unknown is whether the Coalition will support Medicare rebates for consultations over video-conferencing links that Labor promised to fund in its official campaign launch, which have been backed by the AMA and health-care providers including St John of God have backed the proposal.
Meanwhile, I’ve had the best compliment I can imagine, in the form of a couple of comments suggesting that I should shut eHealth Central and leave it to blogs like that of the “much more credible” Andrew McIntyre to push their agenda, without the irritating intrusion of inconvenient truths from Yours Truly.
The suggestion is particularly amusing right now, because over on the Medical-Objects blog, Andrew is declaring that NEHTA, and for that matter State health departments, should also vacate the field of setting standards, on the grounds that “standards have to be created by consensus, as then the industry will engage with the painful standards process in order to prevent silly ideas becoming a standard and to fix errors where they occur. They will only engage when they know they have a duty to comply with the standards and this is where the lack of governance is failing us”.
Even more amusing: according to Andrew, “There does need to be funding of the standards process and there needs to be a mechanism for providers of healthcare to pay to buy standards compliant software, which if built properly, will be more expensive than they are paying now”. We get the picture, Andrew.
Do these people really think we’d vacate the field, just when things are getting even more interesting?
{ 6 comments… read them below or add one }
I would like the State and Federal Health Departments to actually join the field and do something based on standards. They need to join the process.
You obviously feel that providers should not be buying software that complies with Standards and in that scenario we will never see eHealth progress. The Internet runs on standards and has improved significantly as the browsers have become more standards compliant. There is no shortcut to success, no matter how hard you try and spin it.
That you find these things “silly and amusing” is the root of the problem.
Standards are the fundamental building blocks that are required to create interoperability this is what the universities are teaching our ehealth graduates. Its is proven that standards work that’s why they exist. Some times I feel the wheel gets reinvented to justify government funding when standard based solutions already exist and work.
A consensus approach to setting standards is not a silly solution and it needs to involve public and private sectors. Its just that the communication just doesn’t exist. There are smart private businesses in this country that have solutions that should be given more attention from government. These solutions have been built and achieved more on a minuscule budget in comparison to public projects. Public and Private sectors need to communicate in order to understand the playing field. Most of the time government solutions are fired from the hip with little knowledge of the real world and how it actually works out there.
From interpreting Andrew’s blog, I think he’s saying that the existing standards are suitable, and essentially all that is needed is a government mechanism to ensure compliance. In other words, trust vendors, because only they have the expertise, and compel recalcitrant vendors to play ball.
That is true in one sense. Without doubt, no one else is better at delivering HL7 v2 messages than those who are being paid by their customers to do it. Only by doing, can true expertise be attained.
But as we’re all aware, vendors on their own have so far failed to give us interoperability. This is an entirely predictable situation. Industry-wide standards cannot be developed by vendors without a respected body to guide them. Companies are structured around a business model, and business models are hard to change. Besides, any change threatens the financial bottom line, not least because of the huge expense in re-coding the existing product range.
This is not true of governments. Their first priority is to convince voters that they are acting in their best interests. In a competitive marketplace vendors are not likely to act in the interest of their competitors (without benefit to themselves), and the more dominant companies may even try to undermine others.
Also, the very expertise of vendors is an inhibitor to change. Existing patterns of practice create a worldview that is a barrier for effectively assessing other options.
Governments should not be joining the process, they should be leading it. While a government body (or suitable alternative) won’t have all the expertise, it is the only one with a sufficient motivator to be as objective as possible. As long as it does so with input from vendors, academia and other experts in the broad technology field. Because “… no-one actually knows what the perfect standards-based world looks like. There’s no really great way to do this; it’s this balance between a lot of things.” – John Lilly, CEO of Mozilla.
> Most of the time government solutions are fired from the hip with
> little knowledge of the real world and how it actually works out
> there.
That’s so funny! In fact its much more a case of the private sector solutions that are the ones ‘fired from the hip’, and later having to be fixed to comply with public policy and legislation that determines what can ‘actually work out there’ on a sustainable basis in the ‘real world’.
Vendor organisations in the private sector were also caught out in promoting *withdrawn* ‘standards’ that suited what had built in the past to Senate committees, rather than being prepared to move up to contemporary standards which promote true sustainable interoperability.
The bottom line for me is that private sector vendors in Australia need to be much more aware of the public interest aspects of eHealth than they have been to date. This means being *genuinely* proactive in engagement with the Governments over interoperability initiatives, instead of just protecting and milking their existing cash cows.
It might be possible to follow if there was leadership, but alas there is none. It’s hard to engage people who do not have a clue what they are doing. Can you please point to one successful Nehta standard that is out there in real use – I mean this top down “Government Led” eHeath initiative has been going for 10 years and spent 5 Billion so there must be things out there working that we can attribute to it….. I struggle to find anything. It’s time to stop throwing good money after bad.
We’re 2 years into a 10 year National Ehealth Strategy (building on lessons learned and systems developed from previous efforts such as HealthConnect).
NeHTA, clinicians, vendors, health departments, public and private hospitals, industry bodies, health consumers and academics are all involved.
Some things are now moving into place such as interoperable secure messaging (of which one component, the SMD specification published by Standards Australia, is in use in NT and being incorporated into other products across Australia), identification (HI Service – now live, interface specifications in development) and safe medication identification (AMT – now live at Box Hill Hospital). Also, NeHTA is working on the adoption of national specifications of critical healthcare processes such as continuity of care by working with the state systems to bring about alignment.
More info at http://www.nehta.gov.au/about-us/nehta-blueprint. No need to struggle to find out!
Are we seeing improvements to healthcare quality, safety and efficiency from all this effort? Arguably yes in smaller ways, but if we continue to follow the Strategy we’re likely to see ever increasing improvements (e.g. the dramatic impact of the HI Service should it become embedded into practice).
None of the above could have been created overnight. The broad timeline of the Strategy appears to be largely on schedule. It seems some things are going smoother than others, but what else would you expect? None of this is easy (a good reason to get involved and help out, because money, and governments, alone won’t solve the problems).