Contemporary Issues in Medical Informatics: Good Health IT, Bad Health IT, and Common Examples of Healthcare IT Difficulties
(Note: This article on some of the health IT issues “Down Under” is posted with the permission of its author, Dr David G More MB, PhD, FACHI, a Health IT consultant in Sydney, Australia, and author of the Australian Health Information Technology Blog, h

(Note:  This article on some of the health IT issues “Down Under” is posted with the permission of its author, Dr David G More MB, PhD, FACHI, a Health IT consultant in Sydney, Australia, and author of the Australian Health Information Technology Blog, ). 


The AusHealthIT blog felt it would be useful to award the “Blog Looney Health IT Awards” or BLHITAs – pronounced Blights (as in “Blight on the Landscape”)

Please hand over the envelopes, and to a drum roll, we announce the following awards:

The Grand Blight for 2007 goes to the Commonwealth Department of Health and Ageing (DoHA) – for managing to totally lose control of the National E-Health Agenda and for failing to ensure Australia has a National E-Health Strategy that the overall health system understands and supports.

The State Blight Award was shared in 2007 between NSW and South Australia. NSW earned its award for failing to recognise the importance of ensuring proper privacy standards in an e-Health Implementation (HealtheLink). South Australia achieved its award for its 'back to front' approach to system procurement where it plans to issue a tender for a Care Planning System before having even an interim evaluation of a Pilot Project.

The Stealth Blight Award for excessive discretion and information retention in the e-Health Domain is shared between DoHA and NEHTA. They both appear obsessed with unnecessary confidentiality / secrecy. DoHA wins the award for re-constituting the Australian Health Information Council without letting the public know. Even after two meetings those interested in these matters do not know who its members are, what they are doing and what their terms of reference are. NEHTA wins for its continuing use of stealth committees and consultants to provide it with advice rather than using the more traditional consultative processes when issues are of significant public interest and deserve transparent handling. DoHA also get a second dishonourable mention for its failure to report on the evaluation outcomes of the Eastern Goldfields Broadband Trial in Western Australia. A lot of public money went into that trial – and what do we hear of the outcomes – zip!

The “Can't See the Wood for the Trees” Blight is awarded to NEHTA for planning to allocate citizens a health identifier based on numbers allocated by Medicare Australia (which is part of the Department of Human Services) instead of using the identifier provided by the Access Card Division of the same department which is doing much the same thing. Worse, NEHTA claims the two projects don't intersect even though the major role of the Access Card is to replace the Medicare Card.

The “Creative Denial of Reality” Blight is awarded to DoHA for continuing to pretend there is any life in – or plans to seriously invest in – HealthConnect. SA Health are runner up for never explaining – when asked on the blog in public - how the security controls on their OACIS systems provide the level of security granularity and control most South Australians would expect.

The “Exaggeration of Importance of Influence” Blight is awarded to NEHTA for seemingly imagining it has the same level of influence (and is delivering as effectively) on the global E-Health stage as The US ONCHIT, The UK Connecting for Health Program and Canada's Health Infoway. The decision for HL7 last week – following the US, UK, Canada, Holland and Denmark makes it perfectly clear we are peripheral at best – and the delay in decision making confirms us as a ‘slow follower’ not a ‘fast follower’ as some have misguidedly claimed.

The “Tolerance in the Face of Extreme Provocation” Blight (or maybe it is an Anti-Blight) is awarded to the members of all the IT-14 Committees of Standards Australia for continuing to contribute despite a considerable level of side-lining, rail-roading and provocation by all sorts of external forces.

The “Failure to Grasp The Place of Health IT in the Health Sector” Blight goes to the proponents of Shared EHRs for attempting to progress projects of this type without continuing an in-depth public consultation with the total Australian Health Sector especially around the issues of privacy, consent, decision support and the location of functionality. This dooms them to failure I believe.

The “Silliest E-Health Presentation of the Year” Blight goes to NEHTA for suggesting there is $50+ Billion in benefits in health IT available without laying out what will be invested in to harvest these benefits and who will pay. Without a clear presentation of all the assumptions underlying these “models” it is just fantasy. It all may be true the case for major investment in Health IT is true (indeed I believe it is) – but how can anyone know without all the information? To publish half complete material like this just damages the credibility of those who work in the field in the eyes of the economic 'hard heads', who will not invest unless the full case is presented and is compelling.

The “Most Prolonged Gestation of an e-Health Concept” Blight is awarded to the proponents of the concept of archetypes for failing to explain, despite repeated requests from those who are somewhat sceptical, just how archetypes will be sustainably managed through their various versions, multiple iterations and inevitably large numbers over time. Just how the required infrastructure will be developed, funded, governed and supported into the future must be explained before archetype based systems can evolve beyond being a R & D projects and implementation of very limited scope – albeit very interesting ones.

The “Life is Cheap” Blight for failure to appreciate the need to urgently move on deployment of proven technology is awarded to all those who see progress in this area as a job rather than a passion and feel unnecessary deaths and suffering is not their problem. This Blight is shared with the Western Australian Health Department which also appears to have a very relaxed time-line in proceeding with updating the (presently quite limited) Health IT in that State.

All in all a sad list. I hope it might be better next April. All the points raised here can and should be addressed by those responsible and none are ‘rocket science’. I wonder what progress we might see.

For the sake of balance I am currently developing a list of awards for Health IT Stars (HITS). HITS will be awarded for exceptional contributions and efforts in a positive direction in e-Health. Nominations are welcome either as a comment or by e-mail. Please let me know about anything you know that seems to be useful, valuable and making a difference. I hope we can find a reasonable list.