Tuesday, August 30, 2011

It Looks Like The NEHTA CEO Recognises He Has a Tiger By the Tail. Well Done - Now To Let Go!

The following article appeared a few days ago.

It's like putting a man on the moon

Published on Tue, 23/08/2011, 03:02:31

By Yasmin Noone

No goal is too big when you have inspiration.

CEO of the National E-Health Transition Authority (NEHTA), Peter Fleming, has likened the once thought impossible but successful job of putting a man on the moon to one other major task currently at hand – the creation of the Personalised eHealth Record (PCEHR) system for all Australians.

During the Health Infomatics Conference in Brisbane, earlier this month, Mr Fleming described the establishment of the eHealth system as a massive “challenge”. But, he said, once overcome, it will significantly change the world in which we live and make a huge difference to the health care system of the future.

“With an ageing population and increasing costs, we do have to do something to address where we are at today,” Mr Fleming said.

"The world doesn’t remain stagnant and nor can we.”

Developing and implementing the new eHealth system is a “dive in the sand”, likened “to putting a man on the moon”.

“We are getting to a point where we can realise the dream. It is for all of us to pick up on that [goal] and make it successful. This is our big chance to make a difference.

“…We must aim towards that. We can’t do it as an individual. We must do it together.”

PCEHR’s are expected to be a secure, electronic record of an individual’s medical history, stored and shared in a network of connected systems. It will make information such as test results, discharge summaries, vaccination and medication histories and compressive medical records available to a range of health and care professionals.

The record is also meant to be accessible from anywhere throughout Australia.

It's a matter of privacy

The looming eHealth d-date that NEHTA is working towards is the 1 July 2012. This is when consumers will be able to register for a PCEHR.

However, despite the excitement circulating, many civil libertarians have expressed concern that the new system will free up the channels of information at the expense of an individual’s privacy.

Mr Fleming quelled the issue during his presentation, saying that the consumer will be able to control their own eHealth record as they will decide what information it contains, what information it should exclude (for example, mental or sexual health details) and who as access to it.

“There are also a number of controls and legislative controls that would ensure privacy as well. The consumer will be at the centre of the [eHealth record] and have access to the record but so will the professionals who have been given access to it.”

Small steps towards a big goal

One of the key steps which moved NEHTA closer towards its 2012 goal was the creation of the Healthcare Identifiers (HI) Service last year.

Lots more is found here:

http://www.australianageingagenda.com.au/2011/08/23/article/Its-like-putting-a-man-on-the-moon/YFBNQDGARA

It is really amazing to see this sort of stuff being sprouted by someone who should know a great deal better.

“During the Health Infomatics Conference in Brisbane, earlier this month, Mr Fleming described the establishment of the eHealth system as a massive “challenge”. But, he said, once overcome, it will significantly change the world in which we live and make a huge difference to the health care system of the future.

“With an ageing population and increasing costs, we do have to do something to address where we are at today,” Mr Fleming said.

"The world doesn’t remain stagnant and nor can we.”

I have just one question. Just what is the evidence that introduction of the PCEHR will make the least difference to these macro trends.

What is needed is the improve the quality, efficiency and safety of the care delivered by our hospitals, practitioners and the allied health sector. This involves putting in place systems to support all their care and business activities and facilitating communication of relevant information between these groups.

NEHTA would do a great deal more good in reaching the goals cited above focussing on getting the infrastructure in place to have all this work well.

With that done a provider to provider Health Information Exchange makes considerable sense as does allowing patients who are related to a specific practice or organisation access to information that can improve their involvement in their care in their care. This can only work however if a consumer is stably associated to a particular provider, otherwise the risk of confusion rises to unacceptable levels as does accountability and transparency.

There is simply no need to a large centralised system in following this model - unless it is to store a very basic emergency care record for those who want one.

A progressive, incremental and planned approach can skin this cat! A ‘big bang’ politically driven rush at an ill-defined goal is just not sensible.

Whether any sense actually prevails we are expecting to see any day now with the release of the updated and revised PCEHR ConOps.

It will be very interesting to see just how much improved the new version is and if it appears by the end of the month.

David.

8 comments:

Anonymous said...

Its an insult to the Scientists, Engineers and Astonauts that worked so hard to actually get a man on the moon, with the computing power of a pocket calculator.

To compare Nehtas role to them is laughable as Nehta can't get anything of the ground in a much longer period than the NASA Moonshot program.

A reality check is in store for Mr Fleming as I think he will be remembered more like Mr Magoo....

Anonymous said...

Why am I reminded of that spaceship in the HitchHikers Guide to the Galaxy - the one where we wave goodbye to the real-estate agents and used care salesmen? (We'll follow you in the next ship...:) Is there room for Nehta? So long and thanks for all the fish...

B said...

It's interesting that Peter Fleming compares the PCEHR to putting a man on the moon.

I am systems engineer who had lecturers who worked for NASA and I worked as an R&D engineer during the moonshot years. I have a few observations.

President Kennedy specified a "goal of landing a man on the Moon and returning him safely to the Earth" and a timefame "by the end of the decade". There was no mention of cost.

The first thing NASA did was to work out the full mission plan, a job which took years but which was ultimately implemented successfully.

NEHTA has a goal set by government "a personally controlled eHealth Record" a timeframe, and a budget. They know when it's to be implemented and how much it is going to cost, but not what it is. Classic signs of a project heading for failure.

NASA knew what they were building and why, they knew when it had to be done by. They were not constrained by cost.

The first thing NEHTA seems to have done is to start building stuff, without understanding the full lifecycle of the eHealth Record. The full life cycle should include the definition and behaviour of the information in the eHealth record, the roles and responsibilities of the major participants and many other things which do not seem to have been settled. I say this because the ConOp document has not been finalised and I doubt that it will be complete when finalised.

So, NEHTA has started building National Infrastructure (equivalent to NASA's rockets and capsules) and other components (e.g. NASH)without understanding the full problem or coming up with a plan for a complete solution.

The contracts seem to be fixed price. So - fixed price, fixed time, the only variable is functionality. The system will get descoped, or done in a hurry and badly.

Not the NASA way.

NEHTA is assuming that all the components are as needed and will work together when assembled. This is not the sort of systems approach NASA adopted. It is an approach based upon hope. And hope is not a good strategy.

Senator Dan Quayle once compared himself with J.F. Kennedy. Lloyd M. Bentsen's reply was: "I knew Jack Kennedy. Jack Kennedy was a friend of mine. Senator, you’re no Jack Kennedy.”

I say to Peter Fleming, "I saw what NASA did, I saw how they did it, NEHTA, you're no NASA"

B said...

and while I'm at it.....

The PCEHR and getting to the moon are two totally different types of problem.

First, the moon shot was, essentially a one-off technology problem. The PCEHR is an on-going, evolving, social system.

Secondly, the stakeholders are completely different. NASA only really had one, the US government. With the PCEHR, being a social system, there are many and varied stakeholders, some of who may wish not to participate (i.e it is opt-in).

The disagreements between the stakeholder will introduce a degree of complexity which, with other factors, makes the PCEHR several orders of magnitude more difficult - in addition to being well wicked.

The moonshot took nine years and an unlimited budget. The Government has allocated two years and $466.7 million.

I hope that Peter Fleming was just using hyperbole, and actually understands how much more difficult PCEHR is going to be, but I doubt it.

Anonymous said...

Actually, I think that biggest difference is that the moon shot had unambiguous success criteria.

Anonymous said...

For me the recent decision of the US government to halt space exploration calls into question whether putting all that effort into landing a man on the moon was a good idea at all? I suppose some good did come out of it, but the enormous resources expended probabably could have been put to many better uses.

That prompts me to ask the question of whether creation of a personally controlled record should actually be a top priority when GPs can't even get a consistent set of lab results from two or more laboratories, nor a useable discharge summary that can become part of a patient's medical record from their local hospital. Just because the PCEHR rolls off the tongue as a politically attractive BHAG (big hairy audacious goal) does not mean that it is one worth pursuing to the exclusion of solving important day-to-day problems - or does it?.

Anonymous said...

The other big difference is that NASA used administrators to assist Scientists and Engineers to do their job. Post moderism means that the Hollow Men are calling the shots and there is a big PR department with lots of funding and those pesky engineers are out their in their cubicles somewhere doing politically incorrect nerdy stuff while the "important people" are getting the image and change management right. Trouble is there is nothing to change to as no actual engineering worth speaking about gets done. Many clever IT people have tried to work at NEHTA but left because the culture meant they never had a voice in the things that matter. The ones that have been there long term appear to have evolved into Ivory Tower Architects...

Anonymous said...

I hear on the grapevine that the consultants evaluating the PCEHR will be working out of the same movie studio where the moon landings were shot.

Napolean