Losing faith in the UK

According the Times of London (http://business.timesonline.co.uk/tol/business/economics/pbr/article6946336.ece), parts of the ambitious National Programme for IT may be scrapped.   According to the article, Alistair Darling, Chancellor of the Exchequer, is quoted as sayiing that the UK National Health Service (NHS) “has quite an expensive IT system that, frankly, is not essential for the front line. That’s something we do not need to go ahead with just now.

Equally damning are comments from the opposition.  Norman Lamb, the Liberal Democrats’ health spokesman,  is quoted in the article “This whole programme has been disastrously flawed from the start. It has held back the development of IT at a local level, cost billions and is running years behind schedule. Labour has been in denial for years and this is a belated and partial recognition of the scale of their failure. The truth is that the national programme should be abandoned in its entirety, subject to existing contractual obligations, and instead we should start building from the bottom.”

What lessons can Canada learn from the UK experience?  Australia, for example, is considering a major changes in their eHealth strategy that would see a shift away from a centralized EHR to extensive use of personal health records to store longitudinal health information.  As I argued in a recent Health Information  Management & Communications Canada article, the Canadian health sector is an ecosystem,  in which multiple healthcare delivery organizations and individuals operate, each with their own mandate and agenda.  While there is clearly a need for these organizations and individuals to interact and exchange information, they do so as distinct entities driven by their own needs and agendas and not as members of the same corporate entity.  Canadian eHealth strategy needs to reflect this reality.

eHealth Ontario, the much maligned agency responsible for development and delivery of electronic health records in Ontario, seems to grasp the ecosystem concept. At a recent eHealth Ontario briefing session, acting Senior Vice President (A) Strategy / Development / Delivery used the word “ecosystem” several times and explained that the organization intends to pursue a “bottom up, top down” approach to rolling out a Health Information Access Layer (HIAL) strategy to more effectively deal with the ecosystem reality .

What are your thoughts on Canada’s eHealth strategy?  Are changes needs?  If so, what elements of the current strategy should we retain and what needs to be revisited?

Mike

One response to “Losing faith in the UK

  1. I think we need to start with a clean slate on the leadership side for Ontario e-Health.

    From the start, one of the main concerns has been security. It appears security has eaten up a big chunk of the spending while starving the actual component of e-Health.

    The private/managed network at Smart Systems for Health has cost us $800 million dollars of the $1 billion dollars. Plus, it has an annual operating budget of $70 million.

    This approach is “less secure” and more costly than SSL encryption. Scrapping the managed network and replacing it with SSL encryption will dramatically reduce the $70 million annual budget. In fact, the saving can probably be used for a ready made EHR system from Microsoft, Google, or others in the industry. I would think it also fit into the eco-system culture of Canada described in your post.

    OHIPA is also dissappointment when compared to HIPAA in the states. HIPAA seems to make things black and white. This became apparent to me when Healthscreen was dealing with a privacy controversy.

    To deal with it, the CEO had to invite the Privacy Commissioner to review his operations. She obliged him.

    In the US, all this CEO would need to do, is pull out his copy of the latest SAS 70 Type 2 audit to prove everything is in order. HIPAA requires billing clearing houses, a service provided by Healthscreen ($1.5 billion annually in transactions), to have these types of audits.

    In Canada, the Section 5970 report is the equivalent to SAS 70 Type 2 audit. However, OHIPA does not require this from billing clearing houses.

    I thought the process to be unfair to both Healthscreen and the public.

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