Greenhalgh: troubling view of Australian ehealth

Having been lured away from her new post setting up and leading the Healthcare Innovation and Policy Unit at Queen Mary, University of London and an apparently unrelenting schedule of projects and committees and book writing and editing and innovating and setting or examining health policy, it was clear that as the lead act at HISA’s HIC 2010 conference this week, Professor Trisha Greenhalgh was not so much going to have to sing for her supper as deliver an entire operatic performance.

It was always going to be a dialogue. One of the things that is immediately apparent about Greenhalgh is that she doesn’t just talk. She also asks penetrating questions, and continually checks her navigation points. “Am I miles off?” she’ll ask, after making a comment. Or, “I’d be interested in what you think about that.”

When she wasn’t exchanging information with the media, participating in the conference Q&A panel or delivering her keynote, she was in and out of meetings, and uploading and downloading information over lunch and at the bar with health department bureaucrats, NEHTA officials, clinicians, industry representatives and even patients.

Over four days, she would complete a cook’s tour of ehealth in Australia, viewing it  from a uniquely informed and intelligent perspective. This, after all, is the woman who wrote How to Read A Paper; the woman who was lead author of the devastating evaluation of the English Summary Care Record called “The Devil’s in the Detail”. One can’t imagine too many devils evading her pursuit.

I managed to anchor her to a table at Cino’s coffee shop in the Hilton Melbourne South Wharf, adjoining the conference centre, long enough for what I called an “exit interview”. I wanted to hear what she thought of the state of ehealth in Australia … what her preconceptions had been, and whether they had been confirmed. What she had to say raises a few alarm bells for anyone involved in ehealth in this country, and possibly particularly for NEHTA, which sponsors this blog.

For one thing, after spending “a whole morning” with NEHTA people, she confesses: “To be honest, I am bloody confused about what NEHTA’s role is. I wonder if it’s because NEHTA is confused about its own role. That’s pretty strong stuff to report, but then again, I don’t need to come back here.”

One reason for her confusion: “I spent the whole morning with them, and they say ‘Right, we’ve got this summary health record and it’s going to happen.’ So then I meet with Fran [Thorn, secretary of Victoria's Department of Health] and I said to her ‘I gather you’re getting a summary health record. It’s just been signed off and it’s happening and she said, ‘Load of rubbish. No we’re not. What are you talking about?’

“So I’m thinking OK, I’ve just spent four hours with a bunch of people who think they’ve got a business plan together for it. Right. So is it happening or is it not happening?” A good question, that.

It’s no surprise that Greenhalgh would compare NEHTA with the NHS’s Connecting for Health, an organisation which clearly has not impressed her, nor for that matter the new British government, and  which therefore seems unlikely to survive for much longer in its current form. She describes it as “having an extreme Gantt chart culture”. That’s the polite form.

She also describes it as “disappearing up its own arse writing all its guidelines and protocols”.

“A typical thing they do is that every time there is an attempt to do something they have a requirement that somebody has to produce an Excel spreadsheet with lessons learnt, which sounds like a great idea except that the lessons learnt are in one little box of the spreadsheet and actioning those means that the individual who wrote that spreadsheet has to send it to somebody. So it’s continually generating bits of paper or the electronic equivalent and then sending attachments to somebody saying these are the lessons learnt.”

Greenhalgh says that she thinks in some ways NEHTA is a bit more agile than Connecting for Health, but she is clearly alarmed by a suspicion that in other ways it might be “aspiring to become more like Connecting for Health”.

After her morning with the organisation, she was left with the impression that NEHTA might be tempted to generate a rigid, if not deadly “standard operating environment”.

Her advice for NEHTA: “On the one hand you do need metrics. You do need to capture data. You do need to have the standards and guidance and protocols. On the other hand, it is so easy to slip in and start to define your role as  ‘Let’s generate these standard procedures’. I’m a bit worried about that.”

TO BE CONTINUED