Doctors & DoHA in eHealth crisis talks

The AMA has held crisis talks with the head of the Department of Health & Ageing, Professor Jane Halton, over the unprecedented walkout of clinical advisors from the National eHealth Transition Authority (NeHTA)

Above: AMA president, Dr Steve Hambleton

By Julian Bajkowski [editor, Government News]

The Australian Medical Association (AMA) has held crisis talks with the head of the federal Department of Health and Ageing (DoHA), Professor Jane Halton, over the unprecedented walkout of clinical advisors from the nation’s decade long $1 billion effort to build a functional eHealth system.

Held on Tuesday, the meeting followed calls by AMA president Dr Steve Hambleton for Professor Halton to intervene and take a “personal focus” on why highly respected eHealth clinical advocate Dr Mukesh Haikerwal and several other medical advisors suddenly parted company with National eHealth Transition Authority (NeHTA) after a decade of attempting to make eHealth an everyday reality.

The situation that is emerging is that DoHA, assisted by contentious technology consulting and services firm Accenture, are poised to take on far more control and work to finally deliver software end-products to doctors and hospitals leaving an existential question mark over the future of NeHTA.

Dr Hambleton told Australian Ageing Agenda’s sister publication, Government News, that the meeting with Prof. Halton was “extraordinary.”

“Clinical utility will drive this thing,” Dr Hambleton said. “If we can’t get it from NeHTA let’s get it from somewhere else. We have got a railway line … we just don’t have any trucks.”

“We can’t be driven by the techos,” he said.

The metaphor of rail lines, and the attendant headaches they have caused the Australian Federation, appears to be a highly prescient one.

It is understood that a major driver for greater federal involvement is that state governments, particularly those held by the Coalition in Victoria, New South Wales and Queensland are now far less willing and financially able to plough in the cash resources required to make a doctor-friendly front-end appear.

A system within reach

Ironically, the latest hiccup comes despite much of the back-end infrastructure for eHealth already being in place.

“It’s not a big jump. We just have to make it happen,” Dr Hambleton said.

Either way, the support of what some Canberra bureaucrats cheekily refer to as the “doctor’s union” is essential for any eHealth scheme to work because state and federal governments simply cannot, nor want to, compel clinicians to use it.

Relations between DoHA, NeHTA and the doctors have been strained now for some months over apparent difficulties in providing a usable system interface that provides what clinicians term “clinical utility” – or the ability for the system to be used for practical work by doctors.

A number of informed sources have suggested that the reluctance of the big states to keep ploughing long-term financial resources into NeHTA through the Council of Australian Governments has effectively left Prof. Halton and DoHA in control of the wider eHealth delivery agenda by default.

“It’s a pretty desperate lot that they are left with,” one government source said.

Queensland’s health budget in particular has been left reeling after a payroll upgrade project based on SAP software delivered by IBM went feral and chewed through an estimated $1.2 billion of taxpayer’s money and helped push the sunshine state into deficit.

In October 2012 it was confirmed that IBM was also ingloriously let go from a separate eHealth project to design, build and operate the National Authentication Service for Health (NASH).

But there is also wariness among public sector technologists over Accenture’s eHealth delivery record, especially in Britain where it was at the centre of a high-profile dispute with the government there over the delivery of public eHealth systems for the National Health Service.

The AMA’s big push for urgent remedial action from Canberra on eHealth follows the professional group last week issuing a terse public statement that expressed serious concern over the exit of Dr Haikerwal and other clinicians from NeHTA.

It is believed that the tipping point for doctors came after DoHA and Accenture started gradually taking more control over the direction of what had previously been NeHTA’s domain, ultimately triggering an ultimatum that clinicians simply would not be prepared to work in an environment where bureaucratic and technological tactical warfare hamstrung project outputs.

Professor Halton is clearly attuned to heeding strong medical advice, even if she, Dr Haikerwal and NeHTA are still not commenting publicly.

“When the secretary of the Department [of Health and Ageing] steps in, it gives us some hope,” Dr Hambleton told Government News. “[Prof. Halton] went out of her way to meet us.”

High drama

Diplomatic niceties aside, the big question that many are still asking is why clinicians so committed to the eHealth cause ultimately walked-out of a cornerstone project that means so much to their professional and the wider Australian health agenda.

At least part of the answer to that question is starting to resemble an omnibus episode of the Channel 4 television series ‘Grand Designs’ where multiple clients, project managers, architects and trades specialists all start to bicker over what they are building, how it is built … or even what it is meant for.

One technology source said that there were two dozen government agencies that “look after eHealth and none of them talk to each other.”

NeHTA, which is a product of the multijurisdictional Council of Australian Governments, was supposed to be leading the build. However much of the high level decision making on end-product delivery, especially around the Personally Controlled Electronic Health Record, has gravitated back towards DoHA following the election of the first Rudd government in 2007.

It has been reported that a DoHA spokesperson issued a statement that said the department would be “taking the lead” from NeHTA in dealing with medical and health technology interests and would take “a fresh look at the design of the PCEHR system.”

Given that there is a freeze on federal policy decisions pending the election, any fresh look will certainly come after the 7th September election.

In the event that a government led by Tony Abbott is elected is elected, eHealth will be familiar territory for the former health minister.

In July 2005 Mr Abbott attacked the slow pace of eHealth delivery saying that it had gone through more pilots than Qantas.

Mr Abbott went on to say said that both he and the Department of Health and Ageing would have failed if patients did not see a difference from eHealth in a year.”

“Maybe I should make some federal public servants’ pay dependent on outcomes,” Mr Abbott warned at the time.

That idea could once more gain currency from the top if there is a change of government.

Tags: accenture, ama, dr-mukesh-haikerwal, ehealth, ibm, jane-halton, nehta, pcehr, steve-hambleton,

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