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Standing Committee on Infrastructure and Communications
28/04/2011
Role and potential of the National Broadband Network

BROWN, Mr Peter, Convenor, Consumers e-Health Alliance

CHAIR: I now welcome a representative of the Consumers e-Health Alliance to today's hearing. Although the committee does not require you to give evidence under oath, I should advise you that the hearing is a legal proceeding of the parliament and therefore has the same standing as proceedings of the respective houses. We have a submission from you, included with some supplementary submissions and items for exhibit that we have received today. You might have observed that the committee is very keen to ask questions, so I will ask for a six- or seven-minute introduction. Would that be okay for you?

Mr Brown : That would be fine.

CHAIR: Do you want me to give you a wave when you reach that time? And then we will go on to questions and answers. Thanks so much.

Mr Brown : Thank you very much for the opportunity. I found some of the earlier submissions that were made here today very interesting in that they are leading into the sorts of situations that we have experienced in the e-health area and that we are keen to see avoided. We want e-health to pick up as we go along, because e-health and tele-health are really the same thing. With new technology being added, we are looking to see great changes being made in this field. As we said, we have made a number of submissions and I do not really need to go over them, particularly as Anna Williamson made an excellent presentation some time ago.

Back in November I attended the global tele-health conference in Fremantle. That was a very eye-opening experience for me in that something like 30 different products in this area were presented at that conference. It sort of brought me out of thinking of NBN in a way that much of the community does today as a help to us with our entertainment interests or whatever via the TV. I think there is a tremendous challenge for NBN Co., and the retail communities and so on around it to think strategically about what the NBN will produce. The previous presenter from Shellharbour, Mr Peter O'Rourke, made excellent reference to all of that. The job of doing that is, of course, tremendous. I do not think it is really recognised by the people who are involved in it.

There was a government health inquiry that reported in 1997 and the commentary on it was rounded off by about 2002. We think it was pretty much spot on about the way things ought to go. The key advice that it gave at that stage has largely been ignored. That advice dealt with governance and management and who owns the product—all of those sorts of things. What we are saying is that all the interested parties should sit at the same table at the same time and with a view towards team work so that all of their needs are understood by everybody. What Mr O'Rourke from Shellharbour said was spot on about what needs to be done. Your invitation to learn from their cooperative approach is very much that. There have been some previous experiences where that has been done anyway. A structure known as 'sustainable communities' has already been operating. The CSIRO is a major manager of this project. Our view—and it is not a Johnny-come-lately view; we have been putting it for the last three years—is that, that style of approach is what is required here. We need the industry to organise on that basis. The government has said that they want to collaborate with the community; they want to join with the community. It is our view that the bureaucracy just does not know how to do that, not only in e-health but with any other of those sorts of things. But here is a big opportunity for them and the community at large to learn how to go about doing that.

As I said, I was not aware of the full capabilities of tele-health, and I think that is what needs to be brought home to the community so that they are not debating digging trenches and connecting houses and all that sort of thing but rather debating the much bigger picture that is emerging— which is where we sit with this. E-health, in conjunction with education—they are both tied together in many ways—can lead this country into the change that must happen from where we, at 23 million people, sit with the 2.6 billion people who live above us. We have to work out how to adjust to the changes that they are making. We are saying that the health and education need to be brought together because in this field we will need to re-educate and retrain a whole range of people. The health community comprises something like 850,000 people in employment and 80,000 individual businesses dealing with 23 million people. All of those people will have to adjust in some way to the new techniques that are involved. That will not all be required by the critical date of 1 July next year for e-health—that will be a progressive matter. But it will be going at a pace that will still pose a considerable challenge for us to do that, particularly as we have not yet actually started on that particular project.

I think the substance, and how it is expressed, was very well put together in the New South Wales health department's submission to this group, and I would like to read into the record what they had to say about it. They are talking about the optimal capacity and technological requirements of a network to deliver the targeted outcomes:

A number of recent reports highlight the importance of user engagement as early as the design phase, including a report by Deloitte Australia which stated that the current top-down approach to technical planning should make way for more open discussion about applications; in particular, the report suggests that end-users should now ‘be more heavily factored into the public debate and planning of Australia’s NBN. Above all else, these groups will drive the success or failure of the NBN. They need to be considered from the outset and not at the conclusion of the building of the NBN's infrastructure’.

This is also emphasised by commentary from the United States which suggests that ‘The first rule of technology investment is you spend time understanding the end user, what they need and the conditions under which they will use the technology...’

New South Wales health are very much aware of the consequences of the e-health program not having followed the advice given by the similar House of Representatives inquiry into health information management and telemedicine. Telemedicine was on the agenda 10 years ago. It reported in October 1997, and in actual fact, we are not much further advanced today in spite of having spent many billions of dollars on well-intended but fruitless, unguided ventures. E-health Australian Health Ministers' Advisory Council has a chance to correct that situation when it next restructures NEHTA—the National E-Health Transition Authority—out of transition by 30 June 2012. That is their timetable. The consumers hope that they bite the bullet.

NBN policy makers have the opportunity to adopt this advice up front and to develop a strategic management structure not only for end users, as New South Wales health proposes, but for all the affected community interests so that we can tackle this great national project in the spirit and context of actuality of genuine and inclusive teamwork.

CHAIR: Thank you. I am particularly interested in the point you were making about engagement with the end user groups. We have had some evidence earlier this morning from the university on some of the research work they are doing around developing new applications and so forth that would run over the new network. I am just trying to clarify: is your view about engaging peak stakeholder groups, or is it about research based end user models or is it both? Can you just clarify for me what sort of model you are looking at?

Mr Brown : Out of the discussions that have been going on recently, DOHA—the Department of Health and Ageing—have said that they would like to see a four-pillar arrangement developed—and they were not talking about the banks on this occasion. They are talking about government agencies, the commissions in health, the IT people who are writing the software and consumers all sitting at the one table. I think we are all agreed on that principle, but what we have not got around to yet is how to do that. That is the challenge that we have at the moment.

CHAIR: Does your organisation have a view, from the consumer pillar, on what might be a model that you would like this committee to recommend or look at?

Mr Brown : Yes. Certainly we could send that to you.

CHAIR: That would be most useful because we are going to put a view to government on some options for models. The challenge we have seen in much of the evidence we have received is that many people have said that it should be evidence based. Certainly we had evidence in Tasmania on the Irish situation from a gentleman who said similar sorts of things to what you are saying as an organisation about whether they put monitoring into homes. He very quickly found that, for example, with video based monitoring they had to very severely adjust how and what they were doing according to people's tolerance for that level of intrusion into their home.

For us your point is well made about the end user engagement affecting the technology. If you have some advice that you would like to give to us about what model might be a good way to do that, please do. If you could do it so that you are not getting a captured view of one group and so forth that would be very useful.

Mr Brown : In my work-life experience, which is fading into the past somewhat now, I was involved in the import-export business as a freight forwarder. We had a very similar issue with documentation and that sort of thing during one of the waterfront disputes—the one before last, actually. Out of all that we approached this sort of problem. The principles are exactly the same. We are looking at a networking arrangement as part of the infrastructure. We are not in the health business. This is an enabler to health. The main feature about that is that we often hear at the seminars about what we have been doing with the banks for all this time. We have made efforts to say, 'Well, you are on the wrong track looking at that because health is different.' The difference is that the basic means of operation throughout the community, with organisations like banks or gas companies or tax departments or whatever, is a one-to-many situation. You have somebody who is controlling the design of the system and then they have many—

CHAIR: Mind you, many of those may have been better designed with a bit of end user feedback as well.

Mr Brown : We certainly do not want our health records to be like getting money out of the national banks, for example.

CHAIR: Exactly.

Mr Brown : In this we are dealing with a many-to-many situation. In health you will have a diagram of document flow that will look something like the document I have here, generally referred to as a 'spaghetti chart'.

CHAIR: It is a very complex connection of circles with lines.

Mr Brown : You do not have to learn the detail.

CHAIR: That will be useful.

Mrs PRENTICE: Peter, how many members does the alliance have?

Mr Brown : It breaks down into grouping situations. It really is not a formalised body. It arises out of the e-health situation. The basic approach of all the chronic illness groups or the disability groups or the local consumer groups in the states has been: 'We're all in favour of e-health and it is a great thing. The people who understand all that had better get on with the job.' That is going back 10 or 15 years. A new style of chronic disease has developed over that time and there is frustration with the situation. While we were talking philosophically about e-health it did not matter much because nothing was going to happen. But once the money was on the table and implementation time had arrived it became necessary to say, 'We have to be involved.' Consumers had not been involved at all up to that point. It was obvious that a number of factors in e-health are common to all the diseases. There are a great number of differences as well in the treatments.

CHAIR: I assume you are like a draw-down organisation with an e-health focus on behalf of a number of others. Would you give us an idea of who those others are.

Mr Brown : We actually lodged the membership of it in a document with the committee.

CHAIR: That must be one of the ones we got today.

Mr Brown : No, it was done earlier. I can repeat it, but I think it is pretty well all the major chronic illness people—hearts, strokes, cancers, arthritis, Alzheimer's and all that are there. We are a communication channel, really.

Mrs PRENTICE: That is what I was getting to. If you surveyed that membership, how far would it reach out? Have you undertaken that sort of activity?

Mr Brown : No. There has been nothing really to research them about. What we are looking to do is for the implementation of e-health to be created by the doers. We are the customers of that. We see that it has to be looked at as a business overall and run in that way. There is $467 million allocated by the feds, plus you could almost double that if you take in the jurisdictions and so forth. As far as we are aware, there is not a business plan on what that is all about. I know there are claims that there is one, but we have not actually been able to sight it or get any detail about it.

We are saying that we need to have a body that can sit at the table in the way that we are talking about and communicate back to people and do the gradations of that. We obviously cannot bring 23 million customers into the thing, so that has to be organised in basically the same way that it was organised in what we call Tradegate in the import-export arrangements. You are really condensing the thing in layers such that you have working parties dealing with particular issues, so you bring the representatives that are concerned with a particular issue into each of those working parties—and they will not all be the same people. We will draw on those. We will not do that as an organisation; we will organise for that to happen and to spread out a steering committee that does that sort of work.

The clinicians are in the same boat. They really have not been consulted about how they will go about delivering e-health services. In many respects, consumers are actually more informed about e-health than a whole range of the clinician community at this time. We have had discussions with clinicians and GP groups. The other day at the AMA we and other interested attendees met with Mike Quigley of NBN Co in a roundtable discussion. We, the AMA and various other groups said, 'We'd better get ourselves together to deal with this thing.' It is so obvious that that is what needs to be done. Otherwise we will finish up with the silos that we have in e-health extending over into here. That would be a disaster.

Mr FLETCHER: Reading your very interesting submissions, it seems that one of the things you are cautioning against is the risk that attends on any grandiose, big-bang project in the IT world. Is that a fair statement?

Mr Brown : Yes, that is definitely a fair statement.

Mr FLETCHER: Would you agree that in organisations and communities there can be a great temptation to think, 'Everything will be much better once we get the new IT system in place'?

Mr Brown : Yes, that is generally the approach. It goes beyond that. If you attempt to discuss IT with management—though this might be changing now—they say, 'We'll introduce you to our IT man,' and he deals with all that. So the combination of the needs of the business and how the IT people think about what it would be nice to do. We very rarely have a meeting in minds or understanding of each other in detail.

The IT people like to get the greatest amount of technology and IT skills into all those things. Well, that is what the world has been doing with e-health, actually; it is not just Australia that has a problem. They have spasmodic bits of product around the place, but nobody—no country in the world that I am aware of—has a national scheme.

Mr FLETCHER: Do you think it is fair to conclude that—if we have seen that very spasmodic performance in the e-health world, which involves big-bang IT projects—there is an even greater risk with a big-bang IT project of the scale of the NBN?

Mr Brown : I would not measure it as to whether it is bigger or smaller, but it is much the same and, whatever it is, it is a disaster.

Mr FLETCHER: We have heard a lot of evidence from people who argue that, in essence, all you need to do is roll out a new broadband network and there will be a brave new world of telehealth and remote consultations and so on. Do you think that is a reasonable assumption?

Mr Brown : I think it is out of touch with reality. In the meeting that we had with Mike Quigley he was able to explain to us that the role of the NBN was really as the wholesaler and he could not step over that line. A number of the questions were over the line, because that is what the community is interested in: they are not really interested in trenches and pipes; they want the products that are going to arise out of this thing. I think we left it on that day that we had better have some more discussions about this, because we were not expecting them to step beyond their wholesaler role. That is their role and we understand all that. But we do think that there is a new industry arising here, and it had better be that all the components of that industry—all the participants—get their act together: know their positions and know how they relate to each other. And, as New South Wales health said—and it was a surprise to me that they would say it—they had better understand what the end-user needs. That is really the situation that we are in now. We have got the chance to not repeat the mistakes of e-health.

Mr FLETCHER: Clearly, in the e-health world, one important class of end-users is patients, but another—a very, very important one—is medical practitioners.

Mr Brown : Absolutely.

Mr FLETCHER: How would you describe their general approach to the notion that they should be ready to change their operating practices as soon as a new connection is made to their surgery or their consulting rooms?

Mr Brown : I think they are the same as anybody at any time in history faced with a cultural change. They are not welcoming it, in great mass. But we might also say there is a sleeper within that situation, and that is that, within the clinician community, there is great fear that the change in data recording will also increase the liability that they will be sued for performance. That is an issue that we believe has to be faced up front; it is no good saying, 'We will deal with that when we get to it,' because I do not think it is of that nature.

Mr FLETCHER: So what advice would you have for this committee, then, as we seek to assess the benefits that might be expected from e-health and telemedicine by virtue of the rollout of an NBN?

Mr Brown : I am not quite sure of the point of the question.

Mr FLETCHER: The question I am asking is this. One of the heads of benefit which is said to arise from the NBN is in the area of health. Perhaps I could put the question this way: the impression I am getting from you is that, based upon your expertise in the specific area of health records and electronic health records and so on, your view is that there are many end-to-end steps which need to be completed before you achieve a transition to a new world of electronic health. I think it is a fair summary of your views, therefore, that it would not be correct to assume that, just because there is a new network there, those benefits will flow.

Mr Brown : That is true, and it is also, I believe, the view of the clinicians and the software writers, with whom we have come to some sort of informal discussion as well.

Mr STEPHEN JONES: I want to follow up on a few of the observations you make. I just want to make sure that I have not misunderstood you. You said there is opposition from the clinicians in relation to e-health.

Mr Brown : No, I did not say opposition; I said there was fear. Concern; let us put it as concern.

Mr STEPHEN JONES: I talk to my local division of general practice, as does my colleague Sharon Bird, and we certainly do not get that feedback from them. In fact, I get a sense that they welcome the benefits of e-health. You have made a number of similarly fairly broadly cast criticisms of e-health. I am not sure I follow each and every one that you have made. Perhaps if you could help me by, in a nutshell, explaining what your concern is about e-health and how it relates to the NBN.

Mr Brown : Yes. Our major concern with e-health is that it is not being implemented. We welcome it, there is no question about all of that, but it needs to be done on a basis that it will work. We should look around the world, not just here, where they have done it. It has not fully succeeded anywhere, largely because it has been a top-down approach to introducing it and that is not the way to do it. It is not the way that the government's own committees of 10 or 15 years ago recommended. So you do not have to take my word; go back to the expert advice you have had.

Mr STEPHEN JONES: I understand. So is the force of your submissions today and the thing that you want us to bear in mind as we go away that the benefits of NBN, as they apply to e-health, will not be realised unless we take into consideration the needs and views of end users?

Mr Brown : No, it will be realised, but it will not be maximised.

Mr STEPHEN JONES: Maximised, I understand. Thank you.

CHAIR: Thanks, Peter. Certainly there is an opportunity for us to have a further look at the other documents that we got today, which would be particularly useful. But as I stated with my original question, if there is a particular model you have seen somewhere where engagement with end users has been particularly effective, or elements of a model that the organisation thinks would be particularly effective, could you send that through to the committee as a specific suggestion? That would be useful to us. I take your point. Many of us have looked at e-health initiatives around the world, and while I take your point that it has been 10 years, given that the technology rolls out a bit behind the concepts, ideas and dreams that that can be a fairly short time frame. I think it is a useful point to say let us not reinvent the errors that may have occurred elsewhere, but have a look at them. It would be useful to us if you are able to get that through to us. We would appreciate that.

Thank you for your attendance here today. If you have been asked to provide any additional information, would you please forward it to the secretariat, the same way the original submissions came in. You will be sent a copy of the transcript of your evidence, to which you can make corrections of grammar and fact. And once again thank you very much for your time and for participating in the inquiry today.

Resolved (on motion by Mr Husic):

That this committee authorises publication, including publication on the parliamentary database, of the transcript of the evidence given before it at public hearing this day.

Committee adjourned at 15.59