Tuesday, May 10, 2016

Some Background On The 2016 Budget And The Australian Digital Health Authority. Some Useful Information.

This information appeared in the 2016 Budget Papers.
Here is the direct link:
The parts I found interesting were as follows:
Australian Digital Health Agency
Health Portfolio Entity
Section 1: Entity Overview and Resources
1.1     Strategic Direction Statement
The Australian Government is committed to the delivery of a national shared digital health record system to deliver safer, more efficient and effective quality health care.
In the 2015-16 Budget, $485 million was announced for the redevelopment and operation of the national digital healthcare system in Australia and delivery of the My Health Record program. A significant part of the program is the establishment of the Australian Digital Health Agency (Digital Health Agency) for the ongoing development and operation of the national digital healthcare systems. The Digital Health Agency will become operational from 1 July 2016.
The Digital Health Agency is the national body which will have responsibility for the strategic management and governance responsibilities for the national digital health strategy and the design, delivery and operations of the national digital healthcare system. The Digital Health Agency will provide the leadership, coordination and delivery of a collaborative and innovative approach to utilising technology to support and enhance a clinically safe and connected national health system to improve health service delivery and health outcomes for the Australian community.
The Digital Health Agency will perform the following functions:
·         coordinate and provide input into the ongoing development of the National Digital Health Strategy;
·         implement those aspects of the National Digital Health Strategy that are agreed or directed by the Council of Australian Governments (COAG) Health Council;
·         develop, implement, manage, operate, continuously innovate and iteratively improve specifications, standards, systems and services in relation to digital health, consistent with the National Digital Health Work Program;
·         develop, implement and operate comprehensive and effective clinical governance, using a whole of system approach, to ensure clinical safety in the delivery of the National Digital Health Work Program;
·         develop, monitor and manage specifications and standards to maximise effective operation between public and private sector digital healthcare systems;
·         develop and implement compliance approaches in relation to the adoption of agreed specifications and standards relating to digital health; and
·         liaise and cooperate with overseas and international bodies on matters relating to digital health.
The Digital Health Agency is a Corporate Commonwealth Entity under the Public Governance, Performance and Accountability Act 2013. The functions of the Digital Health Agency are set out in the Public Governance, Performance and Accountability (Establishing the Australian Digital Health Agency) Rule 2016.
1.2     Entity Resource Statement
Table 1.1 shows the total funding from all sources available to the entity for its operations and to deliver programs and services on behalf of the Government.
The table summarises how resources will be applied by Outcome (Government strategic policy objectives) and by Administered (on behalf of the Government or the public) and Departmental (for the entity’s operations) classification.
For more detailed information on special accounts and special appropriations, please refer to Budget Paper No. 4 – Agency Resourcing.
Information in this table is presented on a resourcing (i.e. appropriations/cash available) basis, whilst the ‘Budgeted expenses by Outcome’ tables in Section 2 and the financial statements in Section 3 are presented on an accrual basis.
Funds Available for 2016/17
Table 1.1: Digital Health Agency Resource Statement – Budget Estimates
for 2016-17 as at Budget May 2016

2015-16
Estimated
actual
$'000
2016-17
Estimate

$'000
Opening balance/cash reserves at 1 July
-
-
Funds from Government


Annual appropriations


Ordinary annual services1


Outcome 1
-
110,303
Other services2


Equity injection
-
10,589
Total annual appropriations
-
120,892
Amounts received from related entities3


Amounts from the Portfolio Department
-
-
Amounts from other entities
-
-
Total amounts received from related entities
-
-
Total funds from Government
-
120,892
Funds from other sources


Interest
-
1,200
Sale of goods and services
-
-
Other
-
34,400
Total funds from other sources
-
35,600
Total net resourcing for Digital Health Agency
-
156,492




2015-16
2016-17
Average staffing level (number)
-
51

-----
Budgeted Expenses for the Digital Health Agency
This table shows how much the entity intends to spend (on an accrual basis) on achieving the Outcome, broken down by program, as well as by Administered and Departmental funding sources.
Table 2.1.1: Budgeted Expenses for the Digital Health Agency

2015-16
Estimated actual
$'000
2016-17
Budget

$'000
2017-18
Forward
Year 1
$'000
2018-19
Forward Year 2
$'000
2019-20
Forward Year 3
$'000
Program 1.1: Digital Health





Revenue from Government





Ordinary annual services
-
110,303
114,124
4,159
-
Amounts from related entities
-
-
-
-
-
Revenues from independent





sources
-
35,600
35,600
-
-
Expenses not requiring appropriation




in the Budget year1
-
41,183
-
-
-
Operating deficit (surplus)
-
(18,730)
-
-
-
Total for Program 1.1
-
168,356
149,724
4,159
-
Total expenses for Outcome 1
-
168,356
149,724
4,159
-







2015-16
2016-17



Average staffing level (number)
-
51




3.2     Budgeted Financial Statements Tables
Table 3.1: Comprehensive Income Statement (showing net cost of services for the period ended 30 June)

2015-16 Estimated actual
$'000
2016-17
Budget

$'000
2017-18 Forward estimate
$'000
2018-19 Forward estimate
$'000
2019-20
Forward estimate
$'000
EXPENSES





Employee benefits
-
39,082
40,414
-
-
Supplier expenses
-
119,142
98,945
4,159
-
Depreciation and amortisation
-
10,132
10,365
-
-
Total expenses
-
168,356
149,724
4,159
-
LESS:





OWN-SOURCE INCOME





Own-source revenue





Sale of goods and rendering of





services
-
-
-
-
-
Interest
-
1,200
1,200
-
-
Other revenue
-
34,400
34,400
-
-
Total own-source revenue
-
35,600
35,600
-
-
Gains





Other
-
41,183
-
-
-
Total gains
-
41,183
-
-
-
Total own-source income
-
76,783
35,600
-
-
Net cost of (contribution by)





services
-
91,573
114,124
4,159
-
Revenue from Government
-
110,303
114,124
4,159
-
Surplus (deficit)
-
18,730
-
-
-
Surplus (deficit) attributable to





the Australian Government
-
18,730
-
-
-
OTHER COMPREHENSIVE INCOME




Changes in asset revaluation





reserves
-
-
-
-
-
Total other comprehensive





income (loss)
-
-
-
-
-
Total comprehensive income (loss)




attributable to the





Australian Government
-
18,730
-
-
-

Interesting points:
1. Outline of just what the ADHA is expected to do.
2. The staffing is planned to be 51 people - which is a lot less than NEHTA.
3. An majority of the outgoings are to suppliers (($100M p.a.)
4. It is not clear what has happened to the old NEHTA reserves and who is paying for all this - States / Commonwealth etc.
Other ideas on what is seen here are welcome.
David.

11 comments:

Anonymous said...

I am guessing the 51 staff are the public servants, NEHTA staff are probably treated as employees, that out they have been very misled. I guess based on this assumption not much will change, NEHTA's bull in a china shop executives will remain and we will simple have a layer placed on top with a general manger title.

Bernard Robertson-Dunn said...

I've seen nothing in terms of goals and/or objectives - i.e. what they are to achieve and how they will be measured.

In the legislation that creates the agency it does say the ADHA can sue and be sued. Could be interesting in terms of medical and other liabilities.

Anonymous said...

May 10, 2016 6:26 PM - the NeHTA staff are to be eased out over the next 12 months, their work is finnished, it is all about building and operating the national infrastructure. This will be achieved through existing suppliers and moving other services like AMT to DHS to run.

Anonymous said...

Who are the ‘existing suppliers to whom you refer?

Anonymous said...

That would be the likes of Accenture, Orion etc, based on the MHR focus, probably see Telstra coming into the fold would be my guess, along with other Government commissions, departments and agencies.

What exactly would a NEHTA like function do? Dribble on putting out specs no one uses, terminology that could be done elsewhere, perhaps move into shipping software directly in order to compete with global providers?

Only my thoughts and I don't know the answer, they certainly have made themselves irrelevant

Bernard Robertson-Dunn said...

The ADHA could start by doing what NEHTA failed to do - update its publicly available documentation.

For example in the High-Level System Architecture, PCEHR System, Version 1.35 — 11 November 2011, it says:

"It is based on the April 2011 PCEHR System Concept of Operations and was written to provide input to the National Infrastructure Partner tender. It will be updated to reflect the PCEHR design developed by the National Infrastructure Partner.

The document provides the next level of detail below the PCEHR System Concept of Operations [PCEHR_CON_OPS], and includes a description of the solution, with a focus on key concepts, system functionality, dependencies and interfaces. This design provides conceptual and logical views of the system and it is expected that significant further implementation specific elaboration will be required.

As different components of the PCEHR System may be designed and implemented by different parties, the high level PCEHR System architecture is intended to provide the high level definitions required to ensure consistency between each of the sub-component specifications and implementations.

Note that this draft high-level system architecture portrays a possible design. Alternative designs are possible where they deliver the same key concepts, system functionality, dependencies and interfaces."

After all, they are looking to make the system opt-out and the original concept and solution were predicted on opt-in. It really ought to be updated with its current status and its proposed status if they do make it opt-out.

Unless they just intend using an opt-in system in some sort of bodged opt-out way.

Unless they have something to hide.

Anonymous said...

Re "The ADHA could start by doing what NEHTA failed to do - update its publicly available documentation.".

That seems fairly impracticable now that NEHTA is being dissolved and its staff moved on.

Anyway the existing suppliers will have their own agendas, their own architectures and their own ways of deploying the solution. They will advise the ADHA what they can deliver within the overall scope of the ADHA's plan. The ADHA will not have the technical knowledge base to dictate to the suppliers. The Suppliers will dictate to the ADHA. So whatever documentation NEHTA has to hand over (current or out of date) will only receive lip service from the suppliers - we do it this way will be the new mantra.

Basically the ADHA is an interim step in the whole scheme of things. It is the mechanism which underpins the eventual full privatization of the NEHTA-PCEHR-MYHR fiasco and the passing of control over to private sector interests.

Anonymous said...

May 11, 2016 4:57 PM nailed it with a Hole in One.

1. Basically the ADHA is an interim step in the whole scheme of things. It is the mechanism which underpins the eventual full privatization of the NEHTA-PCEHR-MYHR fiasco, the passing of control over to private sector interests ..... and a washing of the hands by the Department.

2. Existing suppliers will have their own agendas, their own architectures and their own ways of deploying the solution.

3. Suppliers will dictate to the ADHA. They will advise the ADHA what they can deliver within the overall scope of the ADHA's plan. The ADHA will not have the technical knowledge base to dictate to the suppliers.

This is a repeat scenario from years gone by mirroring how the Department extracted itself from its HealthConnect disaster. Nothing changes, nothing will. It's the way we do things round here - we start, we facilitate, we 'innovate' then we exit to leave market forces to pick up the pieces.

Bernard Robertson-Dunn said...

Who's going to buy something that nobody uses? Still no reports of anyone downloading or using a MyHR.

They may make it opt-out but if no data is put into it, it will be useless.

IMHO, the fate of the MyHR lies with GPs. The way the government is treating GPs at the moment isn't going to encourage much in the way of participation.

Anonymous said...

The problem is they spent a kings ransom buying a virtual gold mine and will find it is full of fools' gold. The benefits and the value of their EHR data is worth far less than they expect. Benefits of $M's based on real usage has not been published. A few select GP's and hospitals say it has provided benefits but the total numbers (and savings) are very small. ~~~~ Tim

Anonymous said...

You missed the point. The big suppliers will not have to buy anything!. They will 'takeover' via some kind of 'outsourcing' arrangement (for which they will receive $$) then 'replace MY HR with their own 'solution' probably under another brand name, then be contracted to provide a national solution for huge $$.