Sunday, January 08, 2017

It Seems To Me There Is Something Somewhat Dishonest At The Core Of the ADHA Consultation On Digital Health.

A day or so ago we were all reminded to get going and respond to the ADHA Consultation. I have reproduced the whole thing so you can respond to the request.

How do you see the future of digital health? Your health. Your say. Survey and written submissions.

Created on Friday, 06 January 2017
The Australian Digital Health Agency wants to hear from you. Whether you’re a patient, a member of the public, a healthcare provider, scientist or researcher, entrepreneur or technology innovator. Tell us what is important to you so that what we do is shaped around what you need.
There’s nothing more important than our health and the health of those we care about. Putting data and technology safely to work for patients, consumers and the healthcare professionals who look after them can help Australians live healthier, happier and more productive lives.
How should Australia take advantage of the opportunities that new technologies offer to improve health and care? What do Australians want and expect from a modern healthcare system?

Survey and written submissions

Our survey provides you or your organisation the opportunity to have your say about the future of digital health in Australia.
Alternatively, you are also welcome to send us a written submission. To provide us a written submission, email your feedback directly to yoursay@digitalhealth.gov.au.
Reminder: Submissions will be collected until Tuesday 31 January 2017, 5pm AEDT.
Have any further questions? Please contact us on 1300 901 001 or yoursay@digitalhealth.gov.au.
Here is the link:
Now in the post-truth / false news era it rests with all of us to wind up our falsity checking meter to the maximum and keep on at that level of scepticism.
In that vein it the second paragraph that stands out.
“There’s nothing more important than our health and the health of those we care about. Putting data and technology safely to work for patients, consumers and the healthcare professionals who look after them can help Australians live healthier, happier and more productive lives.”
I am sure all who read here will be well aware of the risk of making ‘sweeping generalisations’, and that somehow glossing over detail a false impression can be created. When this impression leads to government expenditure on a grand scale then we all have a problem.
So stepping back, obviously, appropriately used data and information is crucial for the proper operation of the health system in most aspects from research to patient care etc. Think everything from research management systems to patient management and scheduling systems. Trying to do without these systems would clearly be a waste of time and money – if not impossible – think the management of major clinical trials to the optimisation of patient flow in a major hospital – all basic stuff that, if it did not work, no one would pay for and use it!
Equally there are a zillion technologies that are vital from MRI Scanners and drug discovery to the various monitoring systems that track our patient’s progress. The evidence that these technologies do / have make a positive difference is well documented.
But the ADHA is not interested, as far as I know, with all this. Their interest is in patient specific information and how it is shared and communicated by digital systems and this is where we hit a problem with evidence as well as all the other issues of safety, privacy and so on.
There is no doubt that a well-designed GP System can improve the quality and safety of what the GP does with and individual patient and make it easier to follow a patient’s clinical journey and treatment. There is good evidence to this as well as much evidence that current systems are by no means perfect and still need more work.
This makes the point very recently:

Engineering technology resilience through informatics safety science

Enrico Coiera, Farah Magrabi, Jan Talmon
DOI: http://dx.doi.org/10.1093/jamia/ocw162 First published online: 31 December 2016
With every year that passes, our relationship to information technology becomes more complex, and our dependence deeper. Technology is our great ally, promising greater efficiency and productivity. It also promises greater safety for our patients. However, this relationship with technology can sometimes be a brittle one. We can quickly cross a safety gap from a comfortable place where everything works well, to one where the limits of technology introduce new risks. Whether it is through a computer network failure, applying a system software patch, or a user accidentally clicking on the wrong patient name, it is surprisingly easy to move from safe to unsafe. As the footprint of technology across our health services has grown, so to by extrapolation, has the associated risk of technology harms to patients.1 It is the potential abruptness of this transition to increased risk of harm, this lack of graceful degradation in performance, and the silence accompanying degradation, that remain unsolved challenges to the effective use of information technology in healthcare.
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The link in the text gives access to the lucky few paid subscribers only for some reason.
What we lack is evidence that national systems such as the myHR are really offering both benefit and value for money.
What the consultation process should be doing is surfacing and making available this evidence and not be trying to run a consultation on the value of motherhood!
Surely part of the process need to be to explain what works and what doesn’t and why and to then propose what is planned for comment – based on evidence not vague feelings and assumptions.
I will nod off now for another week and, God willing, will be back up and rolling from next week.
David.

3 comments:

Anonymous said...

I think everyone should revisit the follow https://www.health.gov.au/internet/budget/publishing.nsf/Content/2016-2017_Health_PBS_sup3/$File/2016-17_Health_PBS_4.03_Digital_Health.docx

The consultations are an excise in we care.not, simply a smoke screen IMHO, others may think otherwise, however coming from the UK I can confirm the selected the right person to deceive us all.

Bernard Robertson-Dunn said...

IMHO That budget document just adds evidence to the belief that the consultation is all about giving the impression of useful engagement, not about achieving anything useful

It's a typical project management approach that fails for anything harder than very simple problems. I've lost count of the number of failed government IT projects I've seen (and worked on) that start with a project manager saying "lets run a few workshops to gather requirements"

Unfortunately, the real questions are more in the areas of what should be done, not how they should be done. A project manager in DoH has already decided what should be done but has no real understanding of the complexities, unknowns and difficulties.

The most telling omission from that whole document is any measure of the real intended outcomes.

Under "Strategic Direction Statement" it says

"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."

But there are no measures or targets for "health service delivery and health outcomes". The document is all about "utilising technology" not health outcomes.

As such ADHA cannot fail because it's not being measured on anything useful. However, neither can it succeed, for the same reason.

The really sad thing is that government (politicians and public servants) just doesn't learn. Or listen. Or properly understand.

Anonymous said...

Re: 9.40 am "A project manager in DoH has already decided what should be done but has no real understanding of the complexities, unknowns and difficulties."

Paul Madden is the Health Department's most senior representative controlling the budget and setting the agenda. He sits on the ADHA Board where the puppets do the Department's bidding. The ADHA CEO does the Board's bidding and liaises with the Department. Nothing has changed since NEHTA; other than the name.

"The really sad thing is that government (politicians and public servants) just doesn't learn. Or listen. Or properly understand." Whilst that is absolutely correct the real truth is the politicians do listen ..... they listen to the bureaucrats and they believe what the bureaucrats tell them, and in so doing they genuinely believe they therefore understand.

You say "it is really sad". It's far worse than that as the grass roots of the health IT industry knows - it's outright pilfering of the public purse on a grand scale and it will will continue well beyond the $2+++ billion spent to date and Mr Morrison, Mr Corman and the Prime Minister will, by default and neglect, allow this to continue unabated.