Implementing a national Personally Controlled Electronic Health Record (PCEHR) system through grant funded proposals submitted by interested parties seems to me a strange way to implement national infrastructure of any kind. It might be a common mechanism for funding projects in the arts, and for scientific research, where we don’t know what we might end up with. But something ostensibly so fundamental to achieving better healthcare would seem to me, to require targetted engineering projects of the kind we frequently see in transport, telecommunications, energy utilities, etc. We don’t build bridges, for instance, by asking the community to suggest where, why, and how big a bridge the community would like to build, and then give them a pot of money to build it. We analyse existing traffic flows, and a whole range of parameters, predicting into the future, with careful economic analyses, and environmental and social impact assessments before entering into a detailed engineering planning phase for the identified priority projects.
In April 2008, the Australian Government passed the Infrastructure Australia Act, 2008. and established the agency Infrastructure Australia, a new national body tasked with “developing a blueprint for unlocking infrastructure bottlenecks and modernising the nation’s transport, water, energy and communications assets”. In June, 2010, Infrastructure Australia published a report to the Council of Australian Governments, entitled “Getting the fundamentals right for Australia’s infrastructure priorities”. This report includes a Reform and Investment Framework, which steps through seven stages of a process for which required components and rationale are provided. The seven stages are:-
- goal definition
- problem identification
- problem assessment
- problem analysis
- option generation
- option assessment
- solution prioritisation
For each stage, the corresponding components (somewhat abridged) are:-
1. goal definition
- formalised, comprehensive and agreed goals, objectives, targets and indicators
- specific and quantified goals, objectives and targets
- outline how the initiative fits within existing infrastructure plans
- outline how goals and objectives align with those of other parties ( e.g. national, state, regional, local, cross-sectoral )
2. problem identification
- situation assessment – a review and analysis of the current status
- scenario assessment – a review and analysis of the future status
- a list of problem statements that can be accurately defined and quantified
3. problem assessment
- accurate and objective assessment of the economic/ environmental/social impacts of these problems
- priorities identified which reflect the scale of impacts
4. problem analysis
- for each deficiency, analysis of why those problems have developed.
- covers both immediate and underlying causes
5. option generation
- identify the full range of options for each problem from the domains of reform, e.g. independent pricing, regulation, approvals, coordination; and investment, e.g. better use through demand management, capacity increases.
6. option assessment
- qualitative and quantitative analysis including strategic analysis and rapid analysis
7. solution prioritisation
- a structured and objective evaluation framework – that reflects the primacy of Cost Benefit Analysis along-side the strategic value and deliverability risk – is used to make decisions on the long-term infrastructure pipeline.
- a review of the solution is made against the fundamental goals/problem identification.
Whilst perhaps not all activities in these seven stages are directly applicable to the PCEHR, nevertheless it would be desirable for further work on the PCEHR to include at least this level of due diligence as a precursor to a proper engineering phase befitting the infrastructure nature of the PCEHR investment.