Sunday, November 06, 2016

A Globally Recognised Health IT Expert Makes It Clear The New ADHA Strategy Needs To Be Very Different!

This blog popped up a few days ago.
Wednesday, November 2, 2016

On the Road

Over the past few months, I’ve been in England, China, Denmark, New Zealand, and Canada.
Each of them is rethinking their healthcare IT strategy and is not entirely satisfied with past progress.
I’m often asked by senior government officials to help harmonize IT strategy at the country level.   That I can do.    I’m also asked to discuss the US Presidential campaign, but that defies rational explanation.
I frequently say that healthcare IT issues are the same all over the world.  Here’s a few common observations
1.  Top down never works
In every country I’ve visited (there are 195 in the world right now and I’ve been to about half), I’ve never found a healthcare IT program that succeeds by disenfranchising stakeholders and imposing a solution from above.   Asking users what the want/need, then working collaboratively to deliver a workflow solution that enables them to practice at the top of their license tends to overcome any resistance to technology implementations.
2.  A single EHR for a state, province our country never works
The VA, Kaiser, and Department of Defense are completely vertically integrated which means that payers and providers in all sites of care (inpatient, outpatient, emergency, urgent care, long term care) are part of the same organization and management structure.    A single EHR platform works in those circumstances.   However, when a country has private payers, private providers, or a mixture of a public payer with private providers, there is not a single command and control structure.   There will be heterogeneity in requirements and care processes.    A single EHR vendor cannot support all use cases.  Similarly having 50 different EHRs is unlikely to provide the data integration and care coordination needed by a regional group of healthcare organizations.    The right answer is a parsimonious approach - the fewest number of EHRs and technology tools to meet the needs of the region - not 1 and not 50.    In Eastern Massachusetts we use about 6.
The other conclusions are:
3.  Interoperability needs a business case, a workflow and good policies
4.  There may not be a measurable return on a healthcare IT investment
5.  The experience of past patients can inform the care of future patients.
First, just who is this blogger who is agreeing with so much of what I have written in this blog – but sadly not as succinctly as him!
Here is a basic bio:
John D. Halamka, MD, MS, is Chief Information Officer of Beth Israel Deaconess Medical Center, Chairman of the New England Healthcare Exchange Network (NEHEN), Co-Chair of the HIT Standards Committee, a full Professor at Harvard Medical School, and a practicing Emergency Physician.
Enough said – a genuine expert – who is well known globally…
Second it is my view that any Strategy that does not fully face up to the realities that are outlined above is doomed to fail!
The team at the ADHA are now well and truly on notice!
The next day – (last Thursday) the ADHA released its discussion paper regarding a new National Strategy :
It is found here:
The key parts of the discussion paper shown below:

The foundations for success

Digital health is a broad term that reflects adoption of technology in healthcare, it is inclusive of concepts such as eHealth, Health IT, clinical and corporate information systems, consumer health, telehealth, ICT infrastructure, and the use of mobile devices and applications, the way these are used and the integrity and security of information that they capture, store, share, communicate and display.
Over the last decade, Australian governments and the private and not for profit sectors, including the primary and secondary healthcare sectors, have worked together with the aim of delivering a coordinated digital health ecosystem, including building the My Health Record system, the Healthcare Identifiers service and national specifications and standards to support the implementation of digital health solutions.
State and Territory governments have made considerable progress in the implementation of information and communications technology infrastructure, as well as clinical and corporate information systems across their health services. This includes electronic medical record systems, diagnostic imaging and pathology systems, community health systems, adoption of telehealth solutions, and workforce management systems.
The primary healthcare sector is well advanced in the use of technology to deliver health services, and has made significant investments that enable practices to collect, record and store comprehensive patient data to help them to improve health outcomes and support quality care in Australia.
With the introduction of the My Health Record system in 2012, Australians have for the first time a secure way of sharing their health information online. With a My Health Record, both a patient and their healthcare professional could gain immediate access to important health information on-line. Access to information is crucial for delivering safe and high quality care.
A solid foundation has been created from which innovation in digital health can now flourish. We have an opportunity to learn from past experiences and place the nation clearly at the centre of global digital healthcare excellence and innovation.
With a focus on helping people to live healthier, happier, and more productive lives, it is time to make a real difference to people’s health by empowering them to have greater control and better access to information.



Co-producing a national strategy for digital health

Tasked with improving health outcomes for Australians through the delivery of digital healthcare systems and the national digital health strategy for Australia, the Australian Digital Health Agency exists to support digital innovation across Australia to give people more access and control of their health and care – when they wish it, to support the care professionals who serve them, and to build on Australia’s distinguished leadership in the discovery of new medicines and treatments.
Early consultation with key health, government, and technology industry stakeholders has guided the Agency towards facilitating a comprehensive and inclusive community engagement process in the development of the National Digital Health Strategy for Australia.
The community and stakeholder engagement process will provide the opportunity for all members of the public, including patients, their families and carers, healthcare providers, scientists and researchers, entrepreneurs and technology innovators, and state and territory health service providers and funders, to participate in co-producing the National Digital Health Strategy.
To deliver a Strategy that meets the needs and expectations of the community, the Agency is leading a national consultation that encourages all members of the public to have a role in co-producing the vision, objectives and areas of focus for the national digital health agenda. This is about having an open and authentic process whereby we design a new horizon for and with the community.
The Agency will use the insights to develop a Strategy which will set out the priorities for national coordination and investment in the digital health solutions that will shape the future of our health system.
----- End Extract of the full seven page document:
Here is the direct link:
If you take the points from Dr Halamka and what the ADHA has written it seems to me that what is being reflected is some ‘locked in and constrained’ thinking by ADHA as to what is either needed or possible.
I hope I am wrong but the only hope I see into the future is that we really go back, research globally in depth regarding what works, have no assumptions and start with a blank sheet of paper (to mix all sort of ideas and metaphors) for a new Strategy. Minor tweaks to the present plans will not just ‘cut the mustard’.
To actually do this will require real courage and energy and  I suspect most of those who read here will be watching closely and if they do not see major steps in this sort of direction they will again feel betrayed and ignored.
David.

1 comment:

Bernard Robertson-Dunn said...

"Over the past few months, I’ve been in England, China, Denmark, New Zealand, and Canada.

Each of them is rethinking their healthcare IT strategy and is not entirely satisfied with past progress."

Why have so many nations got it wrong?

Could it be that "old eHealth" thinking was at fault? By "old eHealth" I mean that which was implied in the RAND report "Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, And Costs" from 2005. http://content.healthaffairs.org/content/24/5/1103.full

They made some bold claims:
"The adoption of interoperable EMR systems could produce efficiency and safety savings of $142–$371 billion."

"What if health care could produce productivity gains similar to those in telecommunications, retail, or wholesale?"

The fatal assumption was that these industries are similar to Healthcare.

They are not. These industries are highly procedural driven, highly repeatable (so you can use Lean and Six Sigma techniques) and can (relatively) easily be automated.

Healthcare is not like that. In fact the introduction of IT often increases healthcare benefits but at increased costs.

My advice:

Stop making the same old bad assumptions. You need to start thinking in new ways.

Unfortunately that requires a degree of knowledge beyond most health policy makers.

In all these consultations there is a danger, similar to that expressed in the quote supposedly from Henry Ford that I've used before:

“If I'd asked my customers, they would have told me they want a faster horse...”