reflections on reflections

Whilst we linger in the doldrums of the post-election impasse, there have been some interesting media articles regarding e-health in Australia, furnished particularly during the Health Informatics Society of Australia’s annual conference. Although I didn’t attend this year, two particularly disturbing reports have drawn my attention – one by England’s Professor Trisha Greenhalgh, worried (according to Charles Wright in this blog posting)  that NEHTA might follow the NHS’s Connecting for Health example in “disappearing up its own arse writing all its guidelines and protocols”, and the second attributed to Fran Thorn in an article by Karen Dearne in the Australian wherein Ms Thorn purportedly suggests that the $500 million recently allocated in the federal budget for personally controlled electronic health records might buy us a prototype, and moreover, “Signalling a tightening of control over the work program, Ms Thorn, who is secretary of the Victorian Department of Health, said the nation was in the second year of a 10-year strategy commissioned by the advisory body she chairs, the National E-Health Information Principal Committee, and adopted by health ministers through the Council of Australian Governments. ”

Several concerns leap from the article on Ms Thorn’s address at HIC2010. Firstly, whilst there is certainly far less spin from Ms Thorn than those Federal government politicians who have painted a picture in electors’ minds of widespread patient-controlled electronic health records within 2 years, there is nevertheless still spin regarding timeframes, strategy and money.

The nation is not in “the second year of a 10-year strategy” !! Ms Thorn might wish that the nation were there. And why would she proclaim that the next step is “to establish a personally controlled national e-health record that contained everyone’s medical history” ? when according to her own strategy,  [under  Recommendation R2-4, my emphasis]

“The first step in the journey towards the building of national IEHR capability is to connect care providers across the Australian health care system so that they can effectively access and share consumer health information. This step requires the implementation of national E- Health foundations such as consumer and care provider identifiers, standards, rules and protocols for information exchange and protection, and underlying physical computing and networking infrastructure. Current plans are to implement an initial set of these core information exchange building blocks at a national level by 2010.

The next step should be to enable the flow of priority sets of information between care providers to provide a base of comprehensive and reliable information on which IEHRs can be built. These priority information flows include referrals, event summaries, prescriptions, test orders/results and care plans and should incorporate consumer health datasets such as demographics, current health profiles and current medications lists. This step will involve the definition of national standards to facilitate the exchange of this information and changes to patient, clinical and practice management systems to support the flow of these priority information sets between care providers.”

Given we are way behind on the first step, why would any sane, responsible group suggest leap-frogging the 2nd step, when it is a stated pre-requisite for IEHRs? If you are going to spend $1.3M on a national e-health strategy, then it is unwise to trash it and at the same time pretend you are adhering to it!!  If she has been misquoted, then perhaps we do not need to fear. If she did say this and it was due to political pressure, then it needs to be countered. It is important that politicians (of any colour) be reminded that it is simply not possible to just turn on electronic health records of any value at the flick of a switch, not in one year, nor two. Especially when those (I presume) tasked with much of the work are busy  elsewhere, writing their own internal guidelines and protocols or filling positions such as these [ one of 5! positions under Organisational Capability [sic] in the careers page on the NEHTA site ] . I now see that Prof. Greenhalgh has every right to be worried.

Process Integration Lead, Organisational Capability

The purpose of this role is to lead the design, build of the NEHTA Delivery Framework and its associated capabilities. To provide on-going support the initial and subsequent implementations of the NEHTA Delivery Framework.

Key responsibilities include:

• Strategic leadership and development of the NEHTA Delivery Framework within a program enviornment.
• Providing specialist knowledge to the Project Manager on processes and method integration for the developmet of NEHTA’s Delivery Framework.
• Resolving process conflicts within the project and across dependent projects.
• Working as a project team member on multiple projects to facilitate process improvements involving multiple sites or business areas, often as a project specialist.
• Determining and priortising process improvement opportunities within the wider NEHTA organisation.
• Providing consulting to re-engineer and strengthen business processes as required by the organsiation.
• Developing an approach for analysing effectiveness of key processes and provision of impact assessment of process gaps.
• Overseeing and providing leadership to team members in project execution.
• Using experience and interpersonal skills, coach team members to assure consistent, high quality project performance.
• Assessing process strengths and weaknesses utilizing complex analysis techniques, including senior & operating management focused interviews, analytical procedures, transaction testing, bench marking of best practices across the business; and external research to determine optimal techniques for improving effectiveness and efficiency of business operations.
• Eliciting cooperation and support from key process owners in development of the NEHTA Delivery Framework.
• Establishing on-going communication to share with process owners and senior management issues & improvement recommendations and outcomes throughout the life of the project.
• Working with management to define risk mitigation action plans to resolve process gaps.
• Serving as a catalyst for positive change across the business.
• Influencing senior management to champion process improvements and establish ownership of action plans at the appropriate point within the organisation.
• Preparing formal reports for senior management on process improvement, risks and opportunities and incorporating agreed solutions to process gaps.
• Determining the current process mapping and technical problems and solutions in relation to the current, as well as the future business environment.

Tags: nehta | politics | strategy