ehealth.

From the IT section of The Australian newspaper
The world according to Peter Fleming | October 13, 2009

IT is about a year since Peter Fleming became Australia's e-health boss with a mandate from the nation's health ministers to speed up electronic reform of the notoriously fragmented health sector, and enable doctors to securely send and receive patient health information.

Set up in 2004 as a not-for-profit company, the National E-Health Transition Authority is developing the technical standards and regulatory frameworks to underpin the widespread adoption of e-health systems.

Fleming's experience in large technology projects in retail, banking and pharmaceuticals was seen as a welcome balance to the organisation's earlier academic focus, and he has been out talking to doctors, software developers and consumers ahead of a shift towards delivery.

Now that you have released NEHTA's strategic plan for the next three years, what happens from here?

First, the strategic plan should not take anyone by surprise. It's really just enunciating things we've been talking about for a while.

It's still fairly high-level, I accept that, but we're trying to follow a process and avoid confusing people. While we will publish the detail, we want to articulate the big-picture stuff first, so that when people do look at the detail it's in context.

The overall plan obviously will be influenced by feedback from stakeholders but I'm expecting to present that to the NEHTA board when it meets on the October 27.

We have been doing quite detailed work on the business and technical architectures, talking to the software people about the technical issues and helping clinicians understand the business architecture and process issues.

As part of defining the strategy for each of our audiences, we're producing a series of documents that puts things in context for a general practitioner or a consumer representative.

It's an iterative process and clearly that dialogue is starting with the peak bodies.

Phase one is already well under way. I was working through a draft of the business architecture last week, and we're ready to take it to stakeholders for feedback.

I can't give you a date for its public release, but I expect it will be this year.

I saw a draft of the GP document late last week. There's a lot more work to be done there but it should be released within the next two months.

The other aspects involve the more detailed timelines you'd expect to see for each of our main projects, as well as who is responsible for doing what. Clearly that also has to be linked into planning by each of the jurisdictions.

Much of NEHTA's program to date has been based on the needs of the public sector. Consumer groups have expressed frustrations over being left out of the process. How are you addressing that, and involving those in the primary care, aged care and private sectors?

There's never going to be a perfect system. There are 850,000 people working in health care and they are represented by any number of bodies.

But we created the Stakeholder Reference Forum to include all the key groups, and we have regular meetings with that forum, as well as individually with the members.

The forum has formed six sub-committees based on our key projects, and the people involved really do have a very strong say in terms of the requirements, the specifications, the ongoing testing and process implications.

Under Mukesh Haikerwal, the clinical leads team has been expanded to include all of the future users of e-health systems, not just GPs but specialists and allied health professionals as well.

We recognise that this process needs to be inclusive: the technology is just the tip of the iceberg and we've got to get all these other things right if we're to be successful.

Federal Health Minister Nicola Roxon has indicated personal e-health records offered by providers such as Google and Microsoft could be a quick way to give patients access and control over their own health information. Would this be useful, and how would you ensure availability and confidentiality over a range of commercial products?

The key here is what architecture we will end up with for an e-health record, and there has only been minimal work on that front because the Council of Australian Governments has not yet approved the business case for electronic health records.

From the discussions we've been having, though, a number of scenarios could play out.

Initially I would expect a number of e-health records in the market, and the role of government in that context would be to ensure standards and privacy rules are all met, but it will probably be necessary to build an indexing service, as a person's records will likely be scattered across various providers.

So the indexing service would firstly say where the records are located. For example, an MRI scan may be held at the location where the image was taken.

We also think a summary health profile should be attached to that indexing service, so that if you are rushed into an emergency department in the Northern Territory the summary will provide everything a physician needs to know, such as medications or allergies.

That would be held centrally, not a huge database but just the key information required in an emergency.

Once, and if, COAG gives a tick on e-health records, we will engage widely in terms of the architecture, but I think that's the reality we'll see.

Are you getting pressure from IT vendors to just get on with it?

Interestingly, it's predominantly the larger vendors offering health records at the moment, but we're seeing a lot of dialogue between potential consortiums looking at how they would bring this together.

Those parties are trying to get a sense of how we think the standards will develop over time. I wouldn't define it as pressure, it's a constructive dialogue.

While the work with Medicare on healthcare identifiers is complete, it's still unclear whether the enabling legislation will be passed by next July, as planned. What happens if there is a delay?

Well, we can take advantage of the fact the systems are built and begin testing with industry and the health community to ensure the processes are right.

Ideally, we'd like to see the legislation in place by middle of next year, but all sorts of things can happen to move that forward or backwards that we can't control.

We'll continue down the development path. For instance, we're working with Medicare on a group of projects that start linking with and using identifiers, such as discharge referrals.

As soon as the legislation is enacted, we'll be ready to run with it.

One area where the industry has definitely got ahead of your work and the government's thinking is electronic prescribing, where we are seeing a land grab by two very determined players - MediSecure, backed by the Royal Australian College of General Practitioners, and eRx supported by the Pharmacy Guild. Are you reasonably optimistic that the two systems can be made to work together?

Oh, I believe so, one way or another. Next week I am sitting down with the chief executives of those organisations (to discuss) our very strong view on the need for open and interoperable systems.

Both groups have committed to go down that path at the initial discussions I've had with them, and both understand that there has to be a sharing.

Now, it's early days, and we'll need to work through that.

If we can make this work, it's absolutely brilliant. We've got two competitors out there building these systems, and potentially there will be others down the track.

So, e-prescribing is happening, it's something we don't have to go out and build; this is the sort of things we want to encourage - providing it's done to standards, the systems are interoperable and the data is being shared effectively, and the privacy components are being met.

That means software certification and accreditation processes, and you have suggested this could be done through existing facilities such as Australia's National Association of Testing Authorities (NATA). Does accreditation advantage larger firms, and how can we retain local players in an international marketplace?

Look, I hope there are any number of ways of ensuring we retain local players.

We need those small, innovative organisations that bring to light things we may not have thought about, or things larger companies haven't been able to drive through.

In terms of certification and accreditation, we've started that dialogue.

This is not necessarily something we would build internally.

Clearly the medical software industry is a key participant, while as a clinician you want to know that what you buy is fit for purpose.

We also have to consider the cost and the infrastructure required, so we are looking at existing groups, such as NATA, and how we can leverage them going forward.

We need to understand the divergence of opinions within the industry, so input from the Medical

Software Industry Association is a good starting point.

And there won't be one solution that makes everyone happy, I know that, but we'll work through the issues.