Tuesday, June 14, 2016

This News Has Two Aspects To It And Needs A Quality Response From The New ADHA.

This appeared a few days ago.

Announcement of NEHTA’s Transition to the Australian Digital Health Agency

Created on Monday, 06 June 2016
On 1 July 2016 NEHTA’s assets and liabilities will by law become the assets and liabilities of the Australian Digital Health Agency (Agency), a new Commonwealth corporate entity.
The Agency is created by the Public Governance, Performance and Accountability (Establishing the Australian Digital Health Agency) Rule 2016 (PGPA Rule). The transition will occur by operation of Section 74 of the PGPA Rule. In accordance with Section 73 of the PGPA Rule, the Commonwealth Minister for Health has specified the “transfer day” for the transition to be 1 July 2016. On 1 July 2016 all the assets and liabilities of NEHTA will statutorily vest in the Agency.
A link to this PGPA Rule can be found at https://www.legislation.gov.au/Details/F2016L00070
A link to the Ministers notification of the “transfer day” can be found at http://www.health.gov.au/internet/ministers/publishing.nsf/Content/5973595577926D9DCA257FA800231933/$File/SL034.pdf
Here is the link:
So it seems we are in the last few days of an organisation I have to say I will certainly not miss!
On the positive side there is now an opportunity for the new Australian Digital Heath Agency to do better.
For this to happen the following is needed in my view.
First we need an honest, in depth review (as opposed to the joke NEHTA published a few weeks ago - see here http://aushealthit.blogspot.com.au/2016/05/nehta-delivers-itself-its-own-scorecard.html ) to establish what is useful out of what has been done by NEHTA, what should be retained, what needs to be redone and improved. Additionally we need to ensure all the relevant stakeholders are properly represented by competent and experienced representatives to ensure the maximum value is preserved while the strategic errors are corrected where needed.
Second - after this is done a full report and new strategy for the ADHA should be published - after proper consultation - which defines exactly what the ADHA should be involved in and do and what they should not do - as well as how the ADHA interacts with the private sector, the clinical sector, HI experts, the consumers and the jurisdictions and federal government. There should, of course, be an evidence based review of the myHR program - not that I expect that to happen.
Third we need a total cultural transformation in those staff who come over from NEHTA so they understand just who it is they work for and to whom they are accountable and what they should be doing to advance quality use of technology within the health sector. (That the ADHA is subject to FOI might help - but I would much prefer prompt publication of working papers and minutes so FOI is hardly ever needed). I would also like the see the CEO producing a public monthly summary of just what is happening within ADHA so we can all understand the progress on each agreed work streams and so on.
Fourth I think we need a permanent CEO to be appointed ASAP.
Last I would like to see all meetings of reference and advisory committee committees (as well as the Board meetings) be made available via recorded web-casts so we can all understand just what is driving the decision making if we are concerned.
The response to these suggestions will drive how I judge the ADHA in making the cultural shift from NEHTA.


john scott said...

David I agree and would suggest one additional point.

The healthcare system wants the benefits from advances in electronic technology. To capture these benefits, the health sector needs a way to describe what information it would like to share across organisations and professional silos and to describe the constraints under which the information can be exchanged. Healthcare people are not experts in information technology and telecommunications (IT+T). Healthcare people want to describe these flows of information in a manner that speaks to healthcare not to the needs of IT+T.

Equally, IT+T people do not have much understanding of the healthcare system, nor do they wish to become embroiled in its politics. IT+T organisations need healthcare to describe its requirements in terms that the IT+T vendors can understand so that they can build “product” for use in the healthcare sector.

How will the new ADHA help address this requirement?

Grahame Grieve said...

"IT+T organisations need healthcare to describe its requirements"

there's a fair number of people who understand both informatics and healthcare. I think it's more urgent for 'healthcare to agree on it's requirements'... and I say that as lead of one of the more prominent processing around getting agreement. Until we can agree about what we're trying to do, we won't get it. (btw, in terms of agreement, it's interesting to consider John Halamka's comments here: http://geekdoctor.blogspot.com.au/2016/06/why-i-disagree-with-snake-oil-analogy.html)

Dr Ian Colclough said...

John makes an excellent point. It has always been the case that communication and comprehension barriers between healthcare people and IT+T people have been major problems to be overcome when developing and applying useful electronic technology to deliver lasting and useful benefits to the healthcare system.

When the bureaucracy seeks to be heavily involved in these developments the resulting politics overlay an array of complexity across the entire process smothering initiatives which, more often than not, undermine project viability. The caliber of leadership required to obviate against such an occurrence is uncommon.

Anonymous said...

I agree with Ian whilst qualifying his comment - "When the bureaucracy seeks to be heavily involved."

The dilemma here is that Government and bureaucrats do have a role to play but not one which is heavily involved in architecting, designing and dictating system design. Rather, their role should be to support and facilitate industry to design, develop and deliver the required solutions.

Bernard Robertson-Dunn said...

ADHA could well read and try and understand the USA's AMA CEO Madara.
This address "Outlines Digital Challenges, Opportunities Facing Medicine", especially "ineffective electronic health records"

Nothing he says hasn't been said in David's blog.

Maybe, just maybe, AHDA will listen to an outsider, with no axe to grind re the PCEHR/MyHR. Not that many of David's contributors have much of an axe to grind - just expertise and a concern about wasted money and opportunities.


But today, I'd like to provide thoughts on the emerging digital
environment we find ourselves in: and what we might do to move toward
digital tools that lead to professional satisfaction and improvements to
care, rather than to further practice disruption.

... we have really remarkable tools—robotic surgery, new forms of
radiation treatment, emerging biologics; and we live in a time of rapid
development in the digital world—telemedicine as an example, as
discussed in detail by this House.

But you know something, appearing in disguise among these positive
products are other digital so-called advancements that don't have an
appropriate evidence base, or that just don't work that well—or that
actually impede care, confuse patients and waste our time.

From ineffective electronic health records, to an explosion of
direct-to-consumer digital health products, to apps of mixed quality.

This is the digital snake oil of the early 21st century.

Even those digital products that might be helpful often lack a way of
enriching the relationship between the physician and the patient. It's
like trying to squeeze a 10-gallon product idea into a 2-gallon health
care knowledge base.

More and more we're seeing digital tools in medicine that, unlike
digital tools in other industries, make the provision of care less, not
more, efficient. And these digital tools often don't connect with each
other—interoperability remains a dream.

We were told that interoperability was the future; we didn't expect that
it would always be in the future.

Grahame Grieve said...

Bernard - he's hardly an objective outsider. Check Mr Histalk's commentary here: http://histalk2.com/2016/06/14/news-61516/

Bernard Robertson-Dunn said...

Firstly, my point was that, in terms of the Australian PCEHR/MyHR, he's an outsider.

Secondly, the critics of his address don't actually disagree with his main thesis in the area of eHealth Records.

Madara states that much progress has been achieved but many of the promises made have never been achieved. His critics seems to say exactly the same thing.

I haven't seen anyone who disagrees with this statement: "But you know something, appearing in disguise among these positive products are other digital so-called advancements that don't have an appropriate evidence base, or that just don't work that well—or that actually impede care, confuse patients and waste our time."