We’re waiting and waiting for a national e-health network

The Federal Government first announced its plans for an all-encompassing national e-health network midway through the naughties. Fast-forward to 2010 and Australia is still waiting. Andrew Collins takes a look at the e-health roadblocks and the consequences of a long development time.

Despite what the name may suggest, the proposed national e-health network is not an IT system. Instead, it’s an attempt to link up the nation’s disparate e-health systems via a set of interoperability standards, allowing them to talk to one another much more easily. In other words, it will build bridges between the islands that are our health organisations and practitioners.

In 2005, the Australian federal, state and territory governments formed NEHTA (Nation E-health Transition Authority) - a group tasked with paving the way forward for the national scheme.

Slow or steady?

A national e-health network sounds promising. But recently the project has come under fire for taking too long to return results. Detractors point at the finance industry, which undertook wide-scale process automation decades ago, and ask why so long for health?

Firstly, it’s worth noting that individual nodes in this scenario - the healthcare providers and organisations – have, by and large, already adopted software and hardware to increase the speed and quality of health services. The big problem is that the glue that should bring these disparate nodes together - the national e-health network - is taking too long to emerge.

The problem isn’t due to a lack of capable products. Lots of vendors already have dedicated solutions on the market, and there are a bunch of systems integrators that are ready to or already have deployed e-health systems around the world.

Janette Bennett, head of e-health at BT, says: “The technology is available. There are plenty of us that know how to do this stuff.”

Steve Hodgkinson, research director at analyst firm Ovum, believes that the national e-health network is being delayed by governmental turf warfare.

“[The development process] just gets caught up in federal and state politics,” he says. “Many people in the system Â… are frustrated with what they would regard as weak leadership from Canberra on getting these problems resolved.

“Everyone’s looking for more leadership in this area to actually provide practical and useful ways forward which recognise the fact that the power resides with the providers at the state and territory level,” he says.

“It’s a question of, at a federal level, doing useful and constructive things to lubricate the activities which, in truth, are already going on. It’s a matter of how they can be made to happen more quickly and more effectively.”

But not everyone believes governmental fisticuffs are to blame. Andrew Howard, Head of Architecture and Strategy at NEHTA, says: “For the last couple of years - since I’ve been involved in NEHTA - there’s been a very strong alignment of state and federal views around the e-health agenda, and I don’t see anything in the political environment at the moment that would suggest otherwise.”

Instead, Howard says the biggest stumbling block has been the development of the most fundamental piece of the national e-health network - the identification service - which will help manage information on the identity of the patients, clinicians and organisations involved in the system. The service has now been built, and is awaiting the legislative thumbs up from parliament.

“Once that legislation is passed, then we’ll be able to switch on the service - hopefully in July of this year,” he says. “Once that foundation is in place, then you should see take-up of the other types of standards and services enabled through that core communication foundation.”

The project has also been slowed by frequent claims that it will threaten patient privacy and confidentiality, since it involves the electronic transmission of patient records. But Ovum says that these concerns shouldn’t be that much of a worry.

“None of the issues with regards to privacy and security are in any way unsolvable; in the same way that you don’t really have an issue with the fact the tax department and the bank know more than enough information about you to do terribly damaging things to you. But you trust them,” Hodgkinson says.

In fact, Hodgkinson believes these privacy concerns are often used as a form of politicking.

“The privacy issues around the health record are important - the success of any form of health record rests entirely on people trusting the privacy of the information - but effectively it’s being used as a red herring to divert attention from the real problems and issues,” he says.

Acceptance

Regardless of matters political, it seems the process is bound to be time-consuming. According to Howard, the extended development is unavoidable when “getting an entire sector to work together”. And although other industries have managed to do it, the economic drivers are different in healthcare.

“In the supply chain, the consumer is king, so they drive the behaviour of the people in that industry, so they force collaboration to reduce cost,” he says.

But in healthcare, there’s no financial pressure for, say, a GP to expedite a referral to a specialist. No one is suggesting GPs don’t want the best for their clients - they undoubtedly do - but there just isn’t the same sort of financial pressure like there is in the consumer environment.

Therefore, some entity - like NEHTA - must gather all the well-meaning clinicians together in the same place at the same time to gather their thoughts, so they can act as a unit to drive change in the health sector. And this is a time-consuming undertaking.

Ovum agrees that the process will be long. The issue of an e-health network is technically complicated, as well as complicated in a governance sense, due to the sheer number of opinionated individuals involved, combined with the complexities of federal, state and local jurisdictions and funding.

“So why would you be surprised, then, that it’s taking a long time to get anything done, or to get any decisions made?” Hodgkinson asks.

NEHTA’s Howard, however, is willing to put a timeframe on some elements of the e-health network: “We’re probably looking at 3-5 years before we get any major widespread penetration of interoperability across the nation,” he says.

The price of lethargy

Given the time taken for the national e-health network to reach fruition, many healthcare organisations are going it alone, implementing e-health technologies before the national network’s standards are set in stone. This may seem premature, but waiting would be detrimental for the quality of the healthcare they provide.

Bennett says: “These guys just don’t have an option - they have to march on in the absence of anything more structured from a federal perspective.”

These organisations will simply have to amend their systems to be interoperable with the rest of the country once the standards are set.

There are other risks that stem from a long development period. When a large and public system like this seems to be taking too long to develop, some party - be it a political party attempting to curry favour with voters or a vendor motivated by the promise of a big government contract - will sometimes propose a seemingly simple and powerful silver bullet solution.

The party in question will claim their silver bullet will be cheap and easy to implement, it will sweep all the problems under the rug, and everyone will be happy. While this rarely is the case, it’s sometimes worth pursuing, Hodgkinson says.

“But it’s a real problem when [the silver bullet] causes the other approach to stop. The practical, modest, moving-forward-with-interoperability approach should be proceeding regardless, as a critical activity. Because the silver bullet approach is very high risk. A lot of those big bang-type initiatives crash and burn and deliver nothing,” Hodgkinson says.

NEHTA’s Howard has seen a few silver bullets shot at the national e-health problem in his time at the organisation.

“A number of players have tried to get into this market, and throw solutions out there. They do have short-term success in small markets - the business cases look great - but as you soon as you try and step it up [to a national level], it doesn’t come together,” he says.