Thursday, July 26, 2012

What Do You Notice Is Wrong With This? No Wonder The HI Service Has Very Real Problems With Adoption and Use.

In a presentation in late June (released a few days ago) David Bunker (NEHTA’s Head of Architecture) showed this slide - Slide 6.

Update – national foundations

NEHTA has made significant progress in designing, operationalising and enhancing the essential foundations required to enable eHealth:
·         Built and implemented the Healthcare Identifiers Service. As at December 2011 there are 24,350,000 IHIs, 526,000 HPI-Is and 624 HPI-Os issued.
·         More than 2 million IHIs downloaded into clinical systems, including 1.3 million in the Lead eHealth sites and in the TAS and ACT Patient Administration Systems
·         Built and implemented the National Clinical Terminology and Information Service; including Australian Medicines Terminology and SNOMED CT, the National Product Catalogue, and the Security and Access Framework. The NPC is being used by NSW, WA, SA, VIC, QLD and the ACT. VIC has begun limited AMT rollout.
·         Designed the National Authentication Service for Health – currently being built.
The full presentation is found here:
Referring to the Australian Bureau Of Statistics to population of Australia is - as of today - 22,677,692 souls.
See here for the latest figure:
This means there are 1,672,303 more Individual Health Identifiers than there are people. Even allowing for those who have died between December 2011 and now (say 50,000) and the suggestion that visitors from overseas who get a prescription or service stay on the system for ever it seems to me there is a very big information integrity problem here.
To me the problem is that there has never been the needed money spent to initiate and maintain the IHI system in a way that is really fit for purpose and this claim ‘bells that cat’ well and truly. Basically we have a Health Identifier Service which was started on the cheap and now seems to be drifting.
I wonder what the clinical safety implications of all this are. Can’t be positive.
No wonder NEHTA keeps talking about the number of identifiers issued and not about the number that are actually using their IHI with the service. I wonder what having ‘downloaded’ the identifiers into local systems actually means?
It’s interesting to note that after more than five years we are still only seeing a ‘limited rollout’ of the AMT. Again hardly a strong endorsement of what has been done.
I note, in addition, that NASH is still being built rather than implemented. I wonder when that will actually start and how much it will wind up finally costing?
NEHTA’s record would have to be described as ‘patchy’ at best. Separately the Australian is reporting the forward agreements on NEHTA’s funding have not been signed off and  we do know of considerable job losses - especially among contractors.
See here:
“Meanwhile, the National Partnership Agreement on E-Health, under which COAG funds NEHTA, expired at the end of last month.
Mr Madden (DoHA CIO) said a new intergovernmental agreement was "still being developed".
NEHTA's role was to develop the specifications and standards needed to support e-health systems under a COAG program set more than three years ago, he said.
"They don't develop clinical software and put that in the hands of practitioners to use, but the jurisdictions are using products based on their work," he said.”
Dear oh dear - looks a bit messy.