Tuesday, November 15, 2016

ADHA Needs To Fund Some Serious Research As Part Of Its Strategy Development Process. We Need Much More Than Talk And Individual Opinions!

Note: This is a DISCUSSION DRAFT!

In the last few days I have been closely watching the ADHA as it consults on the planned new National Digital Health Strategy.
Thus far what we have seen has been a very short positioning paper - which I have commented on here:
and conduct of a rather limited questionnaire which I have mentioned here:
as well as Tim Kelsey visiting a wide range of actors within the e-Health ecosystem and some presentations / town-hall meetings.
Here is the link to the consultation web-site.
Here is the CEO’s message:

Message from the CEO

People want to take advantage of the opportunities that new technologies offer. Many patients want to be more informed and involved with their own care and learn how to prevent illness and improve wellbeing. Clinicians and carers want to be able to securely share information so they can provide safe, high quality services that are better co-ordinated around a person’s needs.

"This is an opportunity for the whole community to decide how it wants to engage with new technologies to support better health and care. It is not just about us – but for future generations as well".

Tim Kelsey - CEO, Australian Digital Health Agency

The Australian Digital Health Agency was created in July by the Australian Government to drive the development and delivery of Australia’s digital health.
Australia needs a new National Digital Health 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. We’re engaging with all areas of the community – including consumers, clinicians, healthcare providers, peak and advisory bodies, research and science, industry, and technology – to ensure the work we do is shaped around their needs, wants and aspirations. The findings from the national consultation will be used to develop a national digital health strategy for delivery to Government in 2017.
There are a number of ways you can get involved. We’ll be holding a series of community-based town halls, meetings with health and care stakeholders, providers and funders. The face-to-face events will be supported by this website and an online survey to help drive the development of the strategy.
I encourage you to have your say - what do you want from a modern healthcare system?
Tim Kelsey
CEO, Australian Digital Health Agency
Follow Tim on Twitter @tkelsey1
Here is the link:
Having reviewed all this material and listened to recent ADHA presentations there is one glaring gap / deficiency in this process.
The issue is that, to be honest and sadly elitist, the public simply ‘do not know what they don’t know!’
The way to address this gap it to have the ADHA develop / sponsor a range of in-depth discussion / research / option / future papers that can inform public discussion.
Among the topics that need to be addressed (in no particular order) are:
1. A review of just what makes sense as the national objectives for Digital Health over the next decade. This should be determined and scoped by a realistic and in-depth review of the national and global evidence for what works, what doesn’t and what makes a positive difference to health outcomes and patient safety. This needs to be new research and not based on all the ‘hand waving’ earlier studies which have never actually delivered on expectations.
2. A review of what organisational capabilities, at what scale, are optimal for delivery of e-health capabilities, support, services etc.
3. An in-depth review of the governance and operational delivery of all the Commonwealth and State entities that need to interact and co-operate for e-Health to be successful. We need to be clear-eyed regarding what has been done well and what has not – and to try and understand why what has worked has and vice versa.
4. A frank review of just where we are up to overall in the e-health ecosystem nationally in both clinical, hospital, pharmacy, allied, diagnostic and consumer areas and how well what we have is working, what it is costing and delivering, and where improvement is needed. This is the base information that is needed to plan forward.
5. A thorough and comprehensive review of private sector activity within the e-health ecosystem and what solutions and capabilities they offer and how their skills and capabilities can be best utilised in the national effort while at the same time recognising the commercial needs of the private sector.
6. A review that aggregates the information needed for education and development of both the users of and the deliverers of e-health. Having a skilled and responsible workforce is crucial.
In summary there is a great deal of work to be done to objectively work out what is feasible, worthwhile and needed to serve the technology needs of the health sector and to assess just where we are now and how to move from here to where, it is agreed, we need to be.
We don’t want to get to the end of a consultation process to discover that ‘If I wanted to get there I would not start from here!’.
Please let me know what your research list would look like…
David.

13 comments:

Anonymous said...

They can't look at it to closely or else they would realize they and their parents have been a destructive force in eHealth and shut themselves down.

Terry Hannan said...

David, 10/10 for a concise summary list and this is just the tip of the iceberg. Terry

Anonymous said...

I would like to see the following:

ADHA value proposition. Based on the rules that underpin its creation.

A complete Audit from the ACS of the MyHR, NASH, HI
An indeependant analysis of the AMT, why it has progressed little in ten years, why they elected to break away from IHTSDO tooling development to risk investing in their own propriety workbench rather than investing into a global shared effort.
An inderpendant review of their internal development practices and quality control measures for everything from requirements to information modelling out to sample and run time code. Why there is so much variation in guidance material and conflicting guidance
Why CCA was turned off
Why Architecture has been pushed to one side
What is being done to repair the standards communities in Australia and ensure we as a nation have a voice internationally by supporting at arms length those how work tirelessly in the health IT standards worlds.
Stop baggging the medical professionals! they are people, and work tirelessly to care for us.
Use the adanvancement in science and technology made by the medical world to better protect and treat us, as a benchmark for ADHA to facilitate the digitalisation of the administrative side of things.
Perhaps consider not building and operating systems in an already cash strapped software industry
Make entry into the health software industry easier.
Employ executives and leaders who actually have a background in computer science, broad experience in business negotiation where enterprises need to work together to deliver outcomes.

Basically sort your house out before you come knocking if you want to be taken seriously

Bernard Robertson-Dunn said...

Adding to what has already been said:

If the intention is to maintain a focus on the my health record, justify the statement/claim that giving people (potentially every Australian) access to their health data will allow them to better manage their health.

As an aside/analogy, people already have total access and control over their financial information. Do people manage their finances well because of this access/control? Do they still spend money on gambling, smoking, poor food choices; do they get into debt? etc etc. If they don't manage their finances very well, what is the basis for the claim they will manage their health better?

And is it the intention to support the healthcare profession as it exists today or to facilitate and encourage new models of health care that disrupt the existing models? If the latter, how will they manage the inevitable resistance/scepticism?

Peter said...

In other words - a true Enterprise Architecture. In the sense of designing the Enterprise (ADHA) to achieve its corporate goals...

Actually, no. As I write that, I realise that what you are saying is that it needs to identify its corporate goals (and strategy) first. THEN design the organisation in such a way as to achieve them.

Bernard Robertson-Dunn said...

Peter, correct.

Unfortunately the ADHA has been designed already. Its structure and functions are defined in the legislation that created and enables it.

It is now the role of the board to come up with the objectives. A bit backwards, in my view.

It's almost as though the ADHA has been designed by a project manager who doesn't understand the untapped potential of healthIT or where eHealth is actually heading.

And that a records management system like My Health Record is a blind alley.

IMHO.

Anonymous said...

Re 12:48 PM "It's almost as though the ADHA has been designed by a project manager who doesn't understand the untapped potential of healthIT or where eHealth is actually heading."

http://health.gov.au/internet/main/publishing.nsf/Content/health-profile-madden.htm

The buck stops with the Deputy Secretary and Special Adviser, Strategic Health Systems and Information Management, with the Department of Health Mr Paul Madden.

Anonymous said...

Malcolm Turnbull has no health policy, says architect of the GP co-payment

http://www.smh.com.au/federal-politics/political-news/malcolm-turnbull-has-no-health-policy-says-architect-of-the-gp-copayment-20161124-gsx3wc.html

and Australia has a health minister with no knowledge of medicine or health care.

What's wrong with this picture? Everything.

john scott said...

Colleagues, I suggest we are talking about the trees rather than the forest.

What do I mean?

I mean that each of us in our own way is caught up in our perspective and attempting to add value. And there is definite value we can each bring --if only there was a collaboration mechanism that could identify, organize and then invite contributions of value.

What is really needed is a paradigm shift at the conceptual level. For too many years, decades really, health has been pummeled by the technology optimists arguing that if banking and finance and entertainment, etc. can obtain large productivity gains by deploying ICT then why hasn't health got the message? The latest version of this technology-based mantra is so-called BIG DATA.

And so, we have had a long fixation on two major themes; first, the design and deployment of IT using the organization chart as the basis for scope and scale, including up to whole of public health system; and second, what can only be called the infatuation with Electronic Health Records and Electronic Medical Records.

I am not questioning their value of electronic health records. I am questioning whether we ever bothered to look strategically at which types and which ones we really need and how they can best support an evolving healthcare system. And by evolving I mean moving from organization-centric to network-centric thinking and acting as, for example, in enabling and supporting co-management of chronic conditions and diseases.

Instead, we have had an obsession with a massive centralized collection of personal health records, purportedly to support care but without any of the tangible safeguards that care and medical liability require.

We have made limited progress and this limited progress is really highlighting the shortcomings our our perspective. We don't see the doctors, nurses and allied health professionals let alone the patients and carers. WE SEE DATA and we see COST.

We don't see the very longstanding and intrinsic inter-relatedness and inter-connectedness of healthcare delivery and hence we struggle to understand the strategic implications of the Journey Flow as a unifying perspective.

If we did see healthcare in this fashion we would never exclude the private sector and we would not be limiting our governance in the fashion we have over at least the past 15-20 years. We would equally be recognizing that the physical human sphere of health care is separate from but necessarily connected to the electronic sphere. Our discussion about a sugar tax and our collaborative efforts to bring smoking levels way down prove the point.

Equally, some electronic / digital issues can only be addressed beyond the narrow bounds of healthcare.

Most fundamentally, we have to come to realize that we need to figure out how to work together and that will necessarily entail a higher level of trust be created than is present today.

Is this is possible?

I believe it is, but...

In my view however, it will only be possible to begin this journey when the is an openness to hear about new knowledge and new tools making possible a new paradigm. The journey can only begin with this first step.

john scott said...

I would also like to comment about the Anonymous comments stating that: "Malcolm Turnbull has no health policy, says architect of the GP co-payment."

This speaks volumes about why Commonwealth Health took it upon themselves to write to Health CEOs in 2014, as I have previously mentioned.

The author of the comment suggests that health is a MARKET and that people are guided in the decision making by price. You simply can't put a price on pain and suffering.

Further, there is abundant academic literature, if the architect wants to look, that details why SERVICES are so different from PRODUCTS. And guess what, Services are so much bigger a component of our economy as to render such advice to say the least anachronistic.

Unfortunately, this notion of markets and price signals is all too prevalent a force in both Treasury and Finance and equally well-rooted in the Productivity Commission.

So, having a health policy that addresses the need for a massively more productive healthcare system is a very serious ask for a Prime Minister when the economic fundamentals upon which it is supposed to be founded are so wrong and demonstrably wrong.

Anonymous said...

The current strategy consultation is ill-fated if the people they are asking cannot answer the first question correctly. The first question was "What is digital health?". It wasn't even a question up for debate but sounded rhetorical for the introduction. It seems like atleast 9 out of 10 would incorrectly answer this question and instead give an answer to a different question and add commentary.
The questions that they may have been answered in substitution are:
* Give an example of digital health?
* What problems need to be fixed that digital health may solve?
* What is required for "good" implementations of digital health?
* What are the outcomes we hope digital health implementations will have?
* Anything else but answer "What is digital health?"
These are University trained professionals (mostly clinical) with an interest in digital health and we have had eHealth promoted for more than 10 years. If these people cannot answer the most basic of questions correctly, then how can we hope to rely on the rest of their answers? I would expect even fewer consumers\patients would understand the correct answer.

BTW:
"Digital health is the electronic management of health information to deliver safer, more efficient, better quality healthcare." according to the Government http://www.health.gov.au/ehealth

Sorry, but it's more than the management of information. The desired outcomes phrase "to deliver safer, more efficient, better quality healthcare" belongs in your implementation strategy or definition of "the requirements of good digital health technology". Digital health also applies to sensors, diagnostics, analytics, patient treatment and the management of the health care system (including the changing of human actions based on the computer output).

So, what is an answer to the first question? What is 'Digital Health' ?
Finally some heard "..the application of digital technologies to the health care system; its management, delivery, information sharing, analytics and diagnostics" from one person in the audience. Now that sounds like a definition you could use or edit. We hope someone doing the report is able to select and remember the right answers among the noise of wrong answers.

Anonymous said...

My only comment on that excellent post is - right, it is the same as how they use 'best' - for who? The right answer for who? The best ..... for who?

Either way it is clear no matter what the outcome of all this, they have made up their minds already, this is simply smoke and mirrors

Anonymous said...

Yes, next we will here that we are going to just send pdfs around to solve the interoperability issue, just like the PCEHR does with pathology. Somewhere else they will claim savings due to decision support... Really, with a glorified fax system?

The ADHA is spinning the consultation and social media just like NEHTA and I am yet to here any deep technical analysis or understanding. Perhaps we could tweet our medications to the doctor?