Sunday, November 20, 2016

Here Are A Few More Areas It Might Be Interesting To Get Some Facts On To Feed Into The National Digital Health Strategy.

I just have been thinking some more about what else might be usefully researched to assist the strategy development. Among the ideas I came up with are:
1. What are the Digital Health Strategies of The other G20 countries and have we fully considered with is good and bad with each of them and what may / may not suit Australia? (Links please!)
2. Is there an agreed National Health Strategy for Australia and how does digital health fit into it? (The last one I recall was way back when in the Rudd era – anyone know of serious updates?). The new push into the new so called Medical Homes is clearly an element but it is clear the myHR is by no means an ideal tool to support that activity
3. Are there current overarching Strategy documents (other than responses to requests for comment that have largely been ignored) for Australian digital health from the Health Informatics Society, the Australasian College of Health Informatics and the Health Information Management Association of Australia (I seem to have missed them if they exist)?
4. There is a need to understand just how best to manage the collaboration / cooperation between the private and public sector and to clarify what roles and activity should be undertaken by each. How this is managed is critical and global experience should inform how it is done. Best practice in this area is vital if any national strategy is to succeed. We need research on how this can be optimised.
5. Relevant Health IT Standards need to be catalogued and gaps etc. identified. Global research is also needed here to ensure we don’t re-invent any wheels and we need to be proactive in terms of what is recommended / adopted to ensure we avoid obsolescence. Newer approaches such as FHIR need to be fully evaluated and deployed as relevant.
6. It would be useful to understand just what Australia has in terms of skills and skills gaps, as well as what educational capabilities are available. ACHI maintains a directory of courses in the domain.
7. There needs to be research / audit of the current major Federal and State programs to confirm that they are working as they should and that the maximum benefit is being extracted. Unless these programs can show they are providing some real value some hard decisions need to be made.
8. Research is needed additionally by way of an expert Technology Sweep (maybe from Gartner or equivalent) so we can factor in the obviously useful trends.
9. We also need to assess the  Organisational Structures and frameworks that have been successful in supporting the desired e-Health outcomes and see what we can done to ensure ADHA has all the necessary capabilities.
10. We need to know what the best planning / knowledge management techniques are for developing the plan we need, given the breadth and scope required.
Note: For reference I maintain a collection of useful historical files for Australian E-Health.
Here is the link:
The purpose here is to document and remember the history – so we don’t do it again with the same result!
It is also vital to be clear from the outset that Digital Health is an enabler and not the be all of health service improvement.
I am sorry this all seems a bit random but there is a huge knowledge base to be assembled to enable quality forward planning of any value.
Extra ideas more than welcome!
By way of seeing how badly a dramatically improved evidence base is needed is the draft strategy produced earlier this year – which had an embarrassing lack of evidence and research.
See here:
David.

18 comments:

Anonymous said...

Point 2 David I believe is critical, it's like having various business strategies without a corporate strategy, or simply having a bunch of product managers defining problems and business ess direction

The other aspect to consider is how much longer do we go forward bases digital solutions on existing workflows, perhaps we need a long hard look at existing practices and re-engineer them towards a more holistic and digitally enabled future.

Anonymous said...

Perhaps stop trying to get a bunch of managers and consulting companies to come up with a solution to a wicked problem and encourage vendors to get together and develop standards and introduce mandatory compliance with those standards?? The government never asks the opinion of people who have lived and breathed eHealth for decades, or at least they ignore it. So they regard people who have technical knowledge and built viable businesses on having a useful product as beneath them? It would appear so. Generic management is so destructive to good science and pushes technical expertise away. They are defending themselves from the charge that they are clueless. Given the current attitudes we are likely to go backwards.

john scott said...

David, I agree with Anonymous that question 2 is the most important. I do so primarily because it is where we tackle the human as opposed to electronic issues relating to shared understanding and intent.

The issues as I see them are:

1. There is a fundamental difference between developing a National Health Strategy for a fully public system and one such as ours which has a large private sector element; You simply can't avoid surfacing and addressing the issue of where mutual interest lies when you have hybrid systems.

2, Healthcare is a very large, interconnected and interdependent human system yet we keep thinking and acting in organization-centric terms, particularly when we address the digital contribution. Patients with chronic conditions move almost continually across our organizational boundaries as much as our professional silos. Yet we still think and act in terms of organization charts.

3. Finally, the truly missing piece is the question of how we understand the issue of productivity in services, especially large service industries such as healthcare. Value and wealth creation in services are based on mutuality, not the maximization of scarce resources. The obvious corollary is that we need to commit more time and effort to better understanding workflows and how improvements in the quality of cooperation, coordination and collaboration can be achieved and where the embrace of digital pathways makes a positive contribution.

Oliver Frank said...

Well said, John Scott.

Terry Hannan said...

David, Anonymous and John, this is delightful reading (and sane) and the content of the postings has substance. Well done.

Bernard Robertson-Dunn said...

Who has the authority to create a National Health Strategy? At least one that has teeth?

The Federal Minister for Health has responsibility for policy, standards, safety (via the TGA) and funding. The Federal government has very little to do with health care delivery. There are many other bodies such as the States, the AMA etc involved in the delivery of healthcare.

The ADHA is the responsibility of the Federal Minister - with a few nods to COAG. That's why its remit is restricted to eHealth and Digital Health - which are vague terms at best.

IMHO, the difficulty with creating a National Health Strategy that has value is that nobody has the authority to develop it and ensure it is followed.

Herding cats, is a phrase that springs to mind.

Dr David More MB PhD FACHI said...

COAG was the point of approval for the 2008 National E-Health Strategy - but they never funded it - so it went nowhere!

I assume the National Health Ministers Committee are now the responsible entity - if such is possible!

David.

Bernard Robertson-Dunn said...

David,

Has there ever been a National Health Strategy? (not eHealth)

Dr David More MB PhD FACHI said...

The most recent overall one was the National Health and Hospitals Reform Commission (NHHRC) conducted under the Rudd Government. It had e-Health as an afterthought (they forgot about the area until reminded as far as I can tell).

Here is the link:

http://www.health.gov.au/internet/nhhrc/publishing.nsf/Content/nhhrc-report

David.

john scott said...

Colleagues,

I suggest we need to separate the concept of a National Health Strategy for separate consideration because we are asking challenging questions that have constitutional and fundamental structural aspects that need to be very carefully considered.

Reform of any human (socio-technical) system can be considered at three levels:
1. Operating
2. Idealized
3. World View

Much of what we see and discuss and experience occurs at the 'operating' level.

Reforms, such as the creation of regional health authorities (e.g. Local Health Districts), Divisions of General Practice, etc. are at the 'idealized' level. This is the level where we also see the focus on the Patient Journey and questions about the role of digital technology. Our so-called National e-Health Strategies--that leave out the private sector and fail on governance--are a product at this level.

The 'world view' is where constitutional, economic and ideological views come into sharper focus.

The concept of productivity with its close attachment to production as well as the neo-classical economic view of the role of markets and government are inhabitants of the world view level.

The 'world view' level is in turmoil right now in western developed nations because our economy are now dominated by services. Official estimates from the likes of the ABS suggest that 75+% of GDP and Employment are now in services.

An obvious question is how appropriate are the concepts and tools from the production economy and the neo-classical view of the economy to an economy dominated by knowledge-intensive services?

Commonwealth Health took a first step to challenge the ruling world-view in a submission to AHMAC. The paper entitled: "Efficiency and Productivity in the Australian Health Care Sector" was authored by David Cullen and Henry Ergas. It was made public on 3 April 2014 as: AMHAC CEOs Strategic Discussion 10 April 2014 - Agenda paper - Attachment 1.

We need new knowledge and tools to enable us to properly diagnose our systems and provide a base for design decisions for new or revamped systems. In services, productivity has effectively left production behind.

A new concept for productivity and an appropriate tool set would provide the basis to properly connect the physical human sphere of healthcare with the electronic sphere--to the benefit of all parties.

Bernard Robertson-Dunn said...

I think a very fundamental question is this:
What type of eHealth strategy is even possible given the amount of uncertainty in the medical/healthcare industries?

With rapid advances in medical science and information/device based technology can a strategy be anything other than broad brush motherhood, especially when combined with the vagaries of the Australian politico-medico environment

IMHO, the MyHR is about to be overwhelmed by a deluge of data and data types it just can't handle. It has always been somewhat irrelevant, medical practitioners have their own eMRs. In the world of big data, IoT devices and patients doing their own thing, the MyHR doesn't have a role to play.

That's not to say that patients are equipped to manage their own health or make important healthcare decisions - that claim has often been made but AFAIK, never been justified. However, it won't stop a lot of patients trying to do things themselves.

One of the planks of the strategy should be how to deal with unintended consequences and stupid decisions that result from non-mainstream eHealth.

eHealth might help with better prescription manage1ment, but it could well create far worse, new problems.

Or maybe the strategy should to be to not have a top down strategy and let competition and bottom up innovation drive progress.

Andrew McIntyre said...

I will have to admit I don't quite understand what John Scott is saying but I am concerned that when policy decisions reach that level of rarefied air the lack of oxygen makes the results incomprehensible to people at sea level. Perhaps the answer to eHealth is 42?

I do not think you can direct the environment from that level but should work like hell to make things work better on the ground at the coalface. I do not think anyone is able to plan the future, but just look after the pennies and let the pounds look after themselves. Its a bit like a dot com startup, all hype and ideas without any real plan to actually make it work or testing to see if it might work. We are in bubble territory.

Dr Ian Colclough said...

Andrew, I agree with you absolutely. "I do not think you can direct the environment from that level but should work like hell to make things work better on the ground at the coalface."

I have strongly advocated that approach since HealthConnect and MediConnect were first mooted. Even so, the bureaucrats and policy makers either do not want to listen, or do not want to enquire about how that can be made to happen, or do not have the nous to comprehend the powerful forces that such thinking could bring to bear on the problem. C'est la vie.

john scott said...

Andrew, Ian, we are in agreement that you cannot 'direct' the environment from the 'world view' level --if the ideas at that level make no sense on the ground. That is the problem we have today. The current crop of ideas held by Treasury and Finance about the way an economy works need to change and that is what the Health CEOs paper referred to in my earlier comment was beginning to address.

Healthcare is a service industry where value is created through mutuality and to a much lesser extent competition. We actually don't have a mechanism to enable the right kinds of cooperation, coordination and collaboration across our healthcare system to occur. And such a mechanism has to separate the human from the electronic so that the issues specific to each can be resolved responsibly and responsively.

You see this in Ian's comment about 'connecting' in his references to HealthConnect and MedicConnect.

I agree also with Ian that bureaucrats and policy makers struggle with listening and making things happen. They are not dumb nor are they disinterested. They are constrained by certain ways of thinking about a problem. One of the hallmarks of this dilemma is the inability to call a spade a shovel in regard to the current strategy for Electronic Health Records. Risk aversion is a very real and at the moment well-entrenched feature of government and big business.

It will take new knowledge and new tools that make real sense to people on the ground for this to change. And healthcare is the service sector that is in most desperate need of such change.

Anonymous said...

We are listening and dreaming of a MyHR. The common thread is MyHR, we now there are problems that only MyHR can fix. Just use it and give us feedback so we can continue with MyHR.

We will also use SMD as proof that only MyHR can intergrated all that stands before us

Anonymous said...

Re- 10:34 AM "Just use it and give us feedback so we can continue with MyHR."

That alone epitomizes what others have been saying. It demonstrates how little they understand about how to develop, test and deploy a highly complex system whilst maintaining credibility, encouraging co-operation and engendering confidence in the system under development. Put another way - do not push a half-baked, untried and unproven, system into the marketplace and expect any semblance of co-operation to be forthcoming from people (doctors) whose first priority is to operate their businesses (practices) for and on behalf of their patients with minimal disruption.

Anonymous said...

Less an example of where the Community gets in wrong than where the supposed leadership gets it wrong. So much ill informed dabbling by ministers, department heads and agency newbies looking for their next big announcement.

jbeltman said...

What are the Digital Health Strategies of The other G20 countries ... (Links please!)

http://www.who.int/goe/policies/en/

http://www.who.int/goe/policies/countries/en/

This is what you are looking for right?