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- Issue 81: April 2009
- Issue 80: March 2009
- Issue 79: February 2009
- Issue 78: December 2008
- Issue 77: November 2008
- Issue 76: October 2008
- Issue 75: September 2008
- Issue 74: August 2008
- Issue 73: July 2008
- Issue 72: June 2008

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As the Years Condemn

Pat Gallagher
An IT Consultant Perspective

Issue 79: February 2009
Page: 1 of 1 Author's Profile | Send to a Friend | Printer Version
Is this the end of a seven year cycle or the beginning?
Are you superstitious?
Believe in good luck and bad luck cycles?
Is 2009 the start of someone special, or not?

I was cogitating on this, as you do over the silly season, as a way of trying to ignore the daily grind in the press regarding the GFC (that is the Global Financial Crisis) and the pontificating and platitudes from our current commentators.
All of whom are in short pants when it comes to economic management.
And that is just the journalists, the pollies are even worse.

Frankly, if the latter believe in that returning to the days of union involvement in the economy, is smart policy, then we will all be "rooned" (just look at NSW as a precursor for what can happen when the "bruvvers" take control).
And let us not start talking about a new TAX, yes a flat-out tax on carbon and farting cows, as a way of leading us all into salvation.

But that’s the big picture.
What about the health informatics slice of the economy – will we actually see some change (for a change), or more of the same muddle headed thinking from expert procrastinators.
Over this past weekend there were more stories of third world outcomes in rural NSW; one where hospitals could no longer obtain meat to feed patients due to an overdue and unpaid bill. Can you believe this stuff?

Then, in contrast to this, in a national newspaper today (27 January), is a story about -
‘Uniform health systems in the mill’
With a leading paragraph announcing, drum roll,
“Large-scale production pilots of a nationwide e-health system will start this year, with the National E-health Transition Authority set the task of making this happen as quickly as possible’, unquote.
We will somehow manage huge ICT investments and project management of spending the "moolah" on uniform systems, but we cannot find the money to pay for patient nourishment.
As I read the headline above it seems that our planets are not aligned with some people prepared to attempt large scale projects to sit upon and be based on cracked and rotten systems collateral where a myriad of little things are ignored to the point of systemic failure.

Can anyone see there can be a turnaround so we enjoy some good news for healthcare?
Has the last seven years, since 2001, been the dog days, and now we are entering the salad ones?
Or, can it get worse?
Well, as a decode of the headline above, this is worth thinking about:
“Uniform health systems” –
this has been the stated goal of our ‘leaders’ since the year 2000, when a ‘Health Online Summit’ was held.
So in eight, going on nine, years this is considered to be NEWS?
Spare me days.
“Large scale production pilots” – an oxymoron if ever there was one.

‘Large scale’ and reality are "polls" apart.
Because PRODUCTION infers ready-to-go, tried and tested, working system; while PILOTS describes the opposite.
As in, a test, to debug, in doubt and she’ll be right.
This is guaranteed crash and burn stuff.

What about –“set the task of making this happen as quickly as possible”.
Hullooooo. I think ‘as possible’ is almost impossible until several other things actually change so that a possible dream becomes a probable deliverable.

Why is this (as I believe) so?
Our infrastructure is kaput and our mind set is turgid and outdated.
We do not have a underlining foundation of integrated ICT systems and we do not have any financial control at a micro or a macro level, in terms of common reporting systems.
The GFC might be a current malaise in the banking sector but it has been a way of life in our hospitals for ages.
How can we have a uniform health system, which is code for clinical and patient records deliverables when:
a) hardly any of the information can be exchanged through common pipes in a common manner
b) no health jurisdiction has more than a dick ‘n jane financial system that, at best, delivers just yearly results in arrears (pardon the pun) - which is too late and too broad to fix problems as they occur on a daily, weekly and monthly basis, as it should be in this day and age
c) there is no compulsion to pay the piper by being responsible for monies spent and how these monies are spent
Would the butcher’s bill remain unpaid for months (as mentioned above) if the system knew where funds were at the touch of a button?
Of course not.

I for one do not believe we have a lack of money in our hospitals, we have a lack of visibility of where the money is, at and on, any one day of the week.
How can we talk about uniform health systems when the management of the basics is so appalling and there is no accounting or responsibility for husbanding the funds.
You know a fundamental issue is paper.
Stop the paperwork as much as possible and the online replacement systems will slowly, over seven years or so, bring the control over the spending of tax dollars in line with industry accounting norms.
I am as passionate as the next person when it comes to achieving e.health systems and benefits; spruiking the need for e.scripts for more than ten years.
But then we are not alone in this.
A USA report came across the desk last week –
“E-prescribing and its expanding role in Healthcare”.
Usual guff, well written and touches all the points.
However this line jumps off the page:
“Despite PILOT (my emphasis) programs, since 2001, current utilisation is low – only six percent of prescribers used systems linked to pharmacies, and the increase is to only go to seven percent in 2008”.

I would argue is that there still are real people issues, method of financial returns, policy and infrastructure issues to resolve, here in Australia, between prescribers, dispensers and payers in community pharmacy land.
Not to mention standards and so forth.
But inside a hospital all of these barriers are theoretically easier to overcome.
Yet there is no large scale pilot program in the works to introduce this much needed tool inside our hospital systems.
And when there is a plan it will be based on shifting sands until the information pipes are integrated and the financial links are in place and are all under some form of collaborative control.

We can pretty much say that the GFC and "whatnot" indicate that the last seven years will become known as the good old days, and we are in for bad times for the foreseeable future.
If that is so, could the health sector buck the trend and start the much needed re-building of basic systems and attitudes ahead of actually achieving small steps towards e.health platform. It is not unheard of to have bad times deliver selected good times.
If ‘we’ can’t buy meat it is surely time to say ‘enough’.
We just have to do better.

Of course this is a very broad landscape.
We have national economic gloom and in some hospitals, in one State at least, it seems to be as bad as it can get.
Yet not all the States are universally crook.
So let us go back to the article mentioned above, because there are also some good words in the text that one hopes can be turned into some sort of reality:

“mandate to create a uniform (read universal) IT infrastructure, starting with an incremental build-out (think it should say ‘up’) of existing clinical and communication platforms”

This will be terrific as long as it is based on ALSO addressing the need for universal data collection and reticulation systems, most notably in accounts payable and accounts receivables. And doing so in an accurate, timely and useful manner in reporting on these financial numbers.
Because it is the only way we can pay for change in an equitable and grown up manner.
“an end to years (that word again) of under-investment and fragmentation as parties pursued their own technology agenda”:
Well that is a Federal issue.
Has anyone seen a published plan on what they will do with taxpayer monies to, presumably, evenly-invest, or more likely over-invest?
That is a State issue.
The common lament from all the States is a lack of Federal funding.
It may be the case that a lack of a grown up attitude to responsible accounting practices is the real problem.
Boils down to money and systems being reasonably structured in much the same way in terms of interoperability and reporting outcomes across all jurisdictions.

But the "billy blue corker" (it was Australia Day yesterday) is this line –
“Legislative changes are needed”:
Too bloody right mate.
Someone has to have the intestinal fortitude to say the ‘M’ word – Mandate.
For while arguments for fixing basic IT infrastructure platforms and communication links are valid until blind Freddy sees that the need for proper financial control regimes, are all to the collective good, we might then get somewhere and the luck will change.
Otherwise it will all fade away in fragmentation unless and until forceful leadership is present.

The fact is, the federal regime pays for all healthcare.
Whether it is direct or indirect, at the end of the day they pay and subsidize it all.
If the days of wine and roses are gone for a few years in the general economy what better time to invoke that there is a price to be paid for change (to make things better).
By demanding universal and uniform health sector systems, in terms of technology interoperability and financial reporting, be in place, or else.

So rather than the coming years turn out to condemn us to even worse shenanigans perhaps we can use the next cycle to buy some good luck.
That said, do we believe in luck?
Most of us would agree that you can make luck happen by other means; such as hard work and notably, planning.
Years ago, a wise person said –
“not to plan and not to work to a plan, is a plan to fail”.
As far as I can see we have no plan in place to make some luck happen by mandating, a level of control and discipline over the fundamentals of best business practice, in return for funding.

Once that happens we may in fact get truly lucky and start to enjoy the benefits of health informatics in a clinical services and electronic health record keeping environment.

Have a happy and prosperous 2009.

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