With Dr Fernando’s permission I reprint a note sent via the Australian College of Health Informatics E-Mail List.
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I was really surprised by Peter Fleming's Plenary session at HIC 2009.
I was horrified when he guaranteed that eHealth security and privacy frameworks posed *NO RISK* with regard to information privacy. All informaticians and IT experts understand no such guarantee currently exists and none is in development. Adding insult to injury, I recently met a series of experts from NEHTA and DOHA in Canberra about the proposed IHI (names, details and a contemporaneous record of meeting can be supplied on request) where expert staff agreed that my view of risk management and eHealth security accorded with their professional views. Mr Fleming's address greatly exacerbated the serious concern of the many in the audience who were already sceptical about the security claims made by Australian Health authorities.
Mr Fleming also spoke about the 13 % of Australians who (on the basis of research conducted on behalf of government health authorities) he said are opposed to the introduction of an IHI. It is vital that this research be published, together with detail about the research framework applied to this study. In the absence of published information, the study, and hence the claims, have no credibility.
One speaker at the conference, from a hospital in Northern Queensland, explained the circumstances under which his hospital works. Plagues of termites interfere with microwave signals and hence with the communications that enable eHealth systems. Power failures frequently cut off electricity at the hospital for more than 12 hours at a time, while their generator only functions for 10 hours. Moreover, the hospital will be excluded from the planned national broadband roll-out (because the town has a population of several hundred below the declared threshold of 1000), despite the hospital being the primary health care service for many hundreds more people living within many hundreds of kilometres of country.
Mr Fleming failed to even address the issues confronting rural Australians. This failure was exacerbated by his response to a question from the audience with regard to plans to measure the health and well-being of the population as a consequence of the eHealth implementations. His response referred to a small task group that may be established to examine and measure the outcome in the future – but the task does not yet appear on their worklist.
Mr Fleming also suggested that 6 or more private companies may manage the SIEHR (or PHR perhaps?) process and that while a SIEHR implementation is possible, the implementation is not definite. Finally, he spoke of national eHealth roll-out from 2010. How is this possible given the vast amount of work required on the legal frameworks, the security and privacy protocols, and the widespread training required for clinicians across the country?
The session accomplished one thing. It consolidated scepticism among the conference audience. Were I a member of the Australian government, I'd be perturbed by the electoral fallout from this session.
As is constantly reiterated, trust is the key foundation of successful eHealth implementations. Transparent and publicly available, evidence-based best practice is fundamental to advancement in eHealth in Australia. I think Mr Fleming's address has instead deepened stakeholder mistrust and scepticism of eHealth plans.
Juanita
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Dr. Juanita Fernando
Academic Convenor BMedSc (Hons), Faculty of Medicine, Nursing and Health Sciences
Chair, Health Sub-Committee, Australian Privacy Foundation
Foundation Committee Member, Australian Health Informatics Education Council
Mobile Health Research Group,Faculty of Information Technology
Monash University Vic 3800
I have had a look at the presentation that is found here:
http://www.hisa.org.au/system/files/u2233/hic09-2_MrPeterFleming.pdf
The presentation title was:
A strategic roadmap for e-health in Australia
This 13 page presentation is really a little sad. It actually just reflects just how Australia lacks any entity that is actually capable of serious strategic thinking and leadership and then the subsequent planning, funding and implementation.
Also very sad is the profile e-Health has in Australia.
Modern Medicine in the US has just published its list of the 100 Most Powerful People in Health in the USA.
Here are the first six.
100 Most Powerful People in Healthcare (text list)
Posted: August 24, 2009 - 5:59 am EDT
Modern Healthcare's 100 Most Powerful People in Healthcare in 2009:
1. Barack Obama, President of the United States, Washington
2. Kathleen Sebelius, Secretary, HHS, Washington
3. Nancy-Ann DeParle, Director, White House Office of Health Reform, Washington
4. Max Baucus, U.S. senator (D-Mont.) chairman, Senate Finance Committee, Washington
5. Chuck Grassley, U.S. senator (R-Iowa), ranking member, Senate Finance Committee, Washington
6. David Blumenthal, National coordinator for health Information technology, Washington
The full list is here (free registration required) :
http://www.modernhealthcare.com/article/20090824/REG/908219994
Health IT leadership at this level, might give us a chance! Getting e-Health happening in Australia will be a serious complex multiyear project and we should not even begin until we have the leadership, team and skills that can operate at this sort of level!
The other issues raised in the e-mail are also important and need a serious airing. Comments welcome.
David.
4 comments:
All credit to Dr. Juanita Fernando for saying it as it is. My concern is that there is an abundance of evidence to show government does not listen and there is no reason to believe it will listen any more now. Even so, as Juanita said, "Peter Fleming's address has deepened stakeholder mistrust and skepticism of eHealth plans". How can we sheet the message home to the government that until major changes are made in NEHTA and on NEHTA's Board ehealth will continue to flounder as it has done for the last many years.
Reviewing the HIC09 slide presentation referred to above one can summarize the messages as follows: no constructive new thinking evident, no understanding of problems past and lessons learnt, no evidence that anything different will happen moving forward from what has gone before, in short a 'parroting of motherhood statements' based on a slide set authored by Andrew Goodchild. Surely it is time that these people came to realize that the audience had heard all that same old same old stuff numerous times before and were wanting some reassurance that there was new, enlightened, creative, courageous, informed, problem solving leadership at the helm. They would have been sorely disappointed. Check the slides and tell us if you think we are wrong.
Sadly I have to agree. The most interesting slide is the Strategic Priorities and Initiatives. Interesting because it is so very basic and pretty useless because there are no follow-through slides of any substance. And when one examines the 'boxes' one is prompted to say 'so what'.
Look at column 2 - Enable the progression of the priority E-Health processes. Now it might be possible to be a bit more forgiving if the 4 boxes that followed led to some sizzle, some facts, and some clarity of understanding that conveyed HOW these enabling steps would be implemented. The operative word is HOW-WHAT. What is involved? What is the delivery mechanism? What resources will be used? What skill sets are required? What is the time table for each? What are the outcomes for each step?
Tragic.
It is interesting that the background to the last slide is the exit from the Vatican Museums in Vatican City. Does this mean we being asked to take everything on faith?
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