Tuesday, January 03, 2017

ScoMo Advised To Stop The myHR Program! Hard To Disagree.

Sorry, it’s the silly season so I could not ignore the chance for a fun headline!
This appeared earlier today:
  • Updated Jan 2 2017 at 11:45 PM

Scott Morrison needs to go micro if he wants big results 

by Stephen Anthony

Treasurer Scott Morrison needs to find a policy breakthrough from somewhere if he is drive Australian growth against rising global headwinds
The Australian economy suffers low competitiveness and productivity when compared with most other developed economies. It lacks a hard core advanced manufacturing and services sector. It lacks leadership and a game plan for jobs and growth. Sadly, the Australian government has not achieved a major micro-economic reform since Humphry B. Bear last made regular appearances on national television screens.
Australian households are facing low wages growth and rising mortgage interest rates due to a rise in wholesale lending costs, depressing discretionary spending and raising pressure on highly indebted homeowners. A glut of high-density apartment building in Sydney and Melbourne could risk a massive build-up of non-performing loans or banks and non-bank lenders.
But there are positive measures that Morrison can take to help grow the economy and jobs in 2017.
First, he should follow the advice of audit commissioner Tony Shepherd and move "carefully, incrementally and fairly" to put fiscal policy back on a sustainable path by overcoming the confidence-sapping budget deadlock in the Senate. He needs to stop the fixation on the winners and losers from individual budget measures by announcing a complete budget repair and taxation reform "package" where the pain is carried more by those who benefit from the measures contained there.
Second, the Treasurer should pursue a ruthless strategy targeting waste reduction and productivity in government and the broader economy. We need to apply a simple metric to each and every government spending program and tax expenditure – "why it is in place and what does it deliver?" If the answer is, "not really sure", then probably a good time to abolish it.
There are 5 more suggestions in the full article found here:
If the last paragraph is not referring to the myHR it is hard to imagine what might be a more obvious target!
“We need to apply a simple metric to each and every government spending program and tax expenditure – "why it is in place and what does it deliver?" If the answer is, "not really sure", then probably a good time to abolish it.” This fits the myHR perfectly.
I will just pop off back to sleep again now!
Have a great 2017!
David.

11 comments:

Bernard Robertson-Dunn said...

Well spotted David.

I suggest that in the case of MyHR the question should be extended to include the states. After all they are the ones who should be reaping the benefits of improved health care at lower costs, by using MyHR.

Suggestion: All on-going costs for MyHR and a proportion of sunk costs should be borne by the states on a population, pro rata, basis - if they see value in retaining it.

Simple - the states pay for the value obtained. If there is no value, they won't pay. Takes all the decisions about MyHR out of the hands those self serving, conflicted public servants.

Happy New year to you, David, and all your readers.

Anonymous said...

While he is at it can ScoMo please get rid of the department that allows a 5 star health rating to sugar laden "Up and Go" for breakfast. There appears to be a general failure of management in the department. They are stuffing lots of things up and causing damage to the health system and peoples health. In retrospect this US President seems sane...

The most terrifying words in the English language are: I'm from the government and I'm here to help. Ronald Reagan

Anonymous said...

Maybe just replace Minister Ley.

She's probably quite entitled to use an RAAF plane, but why did she and the Pharmacy Guild schedule an appointment on the Gold Coast on the last sitting day of the autumn session?

SBS news:
Turnbull Government Minister, Sussan Ley, reportedly spent more than $12,000 chartering a plane from Canberra to the Gold Coast last year to attend a function with the Pharmacy Guild.

Ms Ley and an adviser traveled from Canberra to Coolangatta on an Royal Australian Air Force plane last March, the Herald Sun reports.

The RAAF deploys five "Special Purpose Aircraft" - two Boeing 737 Business Jets and three CL-604 Challengers - which are only to be used by ministers when commercial arrangements make official schedules impossible.

Minister Ley's travel took place on 17 March 2016 which her office said was a "ministerial portfolio commitment" on the last sitting day of the autumn session.

"Before Minister Ley departed Canberra, she was required to attend another ministerial portfolio commitment that morning which had been called at short notice," a spokesperson for Minister Ley said.

"This meant any commercial flights out of Canberra on that day would have had Minister Ley arrive into Coolangatta after her scheduled commitment with the Pharmacy Guild was due to commence."

Despite already missing question time, the Minister's office said it was expected Parliament would sit late that evening, and it was "imperative" Ms Ley return to Canberra as quickly as possible.

"As with all Minister Ley’s portfolio and electorate travel commitments, commercial flight arrangements were investigated, but in this particular situation deemed not suitable," Minister Ley's spokesperson said.

http://www.sbs.com.au/news/article/2017/01/03/sussan-ley-chartered-private-jet-because-commercial-flights-not-suitable

Bernard Robertson-Dunn said...

And it also occurred to me that the states should pay for all of ADHA's activities, and take away from the Health Minister the power to direct ADHA.

If the Federal government opposes the principle of making those who gain the benefit from paying the cost, maybe the Federal government sees some benefit in spending above $1.5b on something they (and nobody else, for that matter) gets any value out of. Some benefit they are not telling us about.

Or it could just be an example of the old advice, when deciding between conspiracy and incompetence, pick incompetence.

Anonymous said...

Replacing the minister has changed nothing in the past, I doubt replacing Ley would make much of a difference. The States funded the old model, the only ones who will benefit is Canberra and NT, both fixated by large centralised data storage solutions. Maybe a change of the ADHA board and C-Level might allow some forwarding thinking people to move things towards the modern world, not ones that go weak at the knees over shiny widgets.

Anonymous said...

@January 04, 2017 10:36 AM
"Replace [person]..."

Won't change anything systemically. The same consultants and corporates who provided and profited from the big eHealth solutions will remain.

@January 03, 2017 9:51 PM

Just as terrifying: "I'm from [a big corporate (the privatized bit of government)] and I'm here to help..." [myself to never ending amounts of taxpayer money...]

Bernard Robertson-Dunn said...

Most significant changes come from outside and are disruptive of the old.

Cottage industry -> industrial revolution, industrialisation, automation.

Horse draw vehicle -> internal combustion engine -> electric power.

POTS -> 2/3/4/5G smartphone/wifi.

IBM/BUNCH (Who remembers what that stood for?) -> Microsoft -> Internet/Google/Facebook

IMHO, significant change will only come to the practice of health care when something brand new comes along. What that will be, or even if there ever will be anything brand new is not known, I certainly can't predict it.

That doesn't stop lots of other people trying, though. Vendors of eHealth, IoT, big data analytics, Watson, Machine Learning, AI, etc

The hard bit is going to be stopping people proposing changes that result in things getting worse.

On a totally separate and unrelated subject, how's Australia's education system doing?

This is what the SMH had to say in May 2015:
OECD education rankings show Australia slipping, Asian countries in the lead.
http://www.smh.com.au/national/education/oecd-education-rankings-show-australia-slipping-asian-countries-in-the-lead-20150525-gh94eu.html

"Concerning to some, Australia's performance in the PISA tests, held every three years, has shown a steady decline. In 2000, when the first tests were held, Australia ranked 6th for maths, 8th for science and 4th for reading (out of 41 countries), dropping to 19th for maths, 16th for science and 13th for reading in 2012 (out of 65 countries)."

This is from the BBC in December 2016
Poor Australia education ranking prompts soul-searching
http://www.bbc.com/news/world-australia-38178763

"... an international schools study released this week has fuelled fears that after years of neglect and ill-conceived strategy, the country is steaming towards an education crisis, which could leave future Australians lagging behind the rest of the world."

The methodologies/conclusions of the studies are probably arguable, but health and education do have one thing in common in Australia. The Federal government sets the policies, strategies and the agenda.

Coincidence?

The other thing they have in common is that they are very important to the well-being of most Australians and are the two areas that they most come into contact with government throughout their lives.

Sad ain't it?

Dr David More MB PhD FACHI said...

Bernard,

You wrote:

"IMHO, significant change will only come to the practice of health care when something brand new comes along. What that will be, or even if there ever will be anything brand new is not known, I certainly can't predict it.

That doesn't stop lots of other people trying, though. Vendors of eHealth, IoT, big data analytics, Watson, Machine Learning, AI, etc

The hard bit is going to be stopping people proposing changes that result in things getting worse."

I may have this all wrong but it seems the biggest problem we have is the assumption that eHealth and technology are 'good' and should be applied to health in the absence of any solid evidence of efficacy and safety for many initiatives.

The idea that because it seems sensible and logical - therefore it will obviously work has a lot of the 'post-truth' about it - but that is what we are all expected to accept and believe regarding e-Health. I think there is a high risk it is all wrong!!

What do others think about billions being spent on some e-Health programs because they 'make sense and so are sure to work etc'?

Assumption ridden magical thinking is my view!

David.


Bernard Robertson-Dunn said...

David, I totally agree.

IMHO it all started with this paper:

Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, And Costs
RAND corporation.
http://content.healthaffairs.org/content/24/5/1103.long

The big wrong assumption is embedded in this section:

"What Can We Learn From Other Industries?

We examined a range of industries to understand IT’s effects on productivity and related enabling factors. During the 1990s, many industries—most notably, telecommunications, securities trading, and retail and general merchandising—invested heavily in IT.13 Consumers saw the fruits of this investment in bar-coded retail checkouts, automated teller machines, consumer reservation systems, and online shopping and brokerages. During the late 1990s and continuing into this century, these industries recorded 6–8 percent annual productivity growth, of which at least one-third to one-fourth annually can be attributed to IT. But dramatic productivity improvements did not follow automatically from IT investments. For example, the hotel industry, which underused its IT investment in the late 1990s, did not see sizable productivity increases.

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


The bad assumption being that healthcare (not health administration or finance, but point of care health practices) is highly repetitive, can be standardised and that the workings of the human body and mind are fully understood such that cause and effect of treatment can be predicted with a high degree of confidence.

This assumption is totally wrong, and don't think you (David) or I are are alone in holding this opinion.

Looking at this article from 2011:

Will health IT increase productivity in health care
http://theincidentaleconomist.com/wordpress/emr/

It says, in part:


The authors advise caution in interpreting the estimated effects of EMR adoption, stressing they are reporting “potential savings,” by which they mean those “assuming that interconnected and interoperable EMR systems are adopted widely and used effectively.”

I’ll add my own word of caution: the study is not based on anything like a comparison (randomized or otherwise) between systems that have and have not implemented EMRs of the type assumed for analysis. This is, as is essentially admitted by the authors, a thought experiment about a world not like the one in which we currently live. (There’s nothing wrong with that. But it does threaten the generality of the findings.)


It's worth reading this second paper, it debunks maany of the assumtions MyHR seems to have been predicated on.

If I can easily find such references, why didn't the Department of Health, Deloitte or NEHTA?

Anonymous said...

Bernard Robertson-Dunn said "If I can easily find such references, why didn't the Department of Health, Deloitte or NEHTA?"

I think it fair to assume Bernard that they did read these references. However, their agendas differ from what you, I, David and many, many others in the health software industry see the agenda should be.

We are interested in seeing a more efficient, collaborative, integrated system emerge which enables the exchange of information between service providers and their patients all the while maintaining appropriate high levels of privacy and security over the information being exchanged and shared.

Whilst the government promotes this vision it does so for political expediency in order to achieve its own ends which are in conflict with this vision.

The government's agenda is massive data capture, vacuuming up any and all available data to create a huge bank of data which it can mine and analyse at will, to monitor and watch what is occurring in the health space and to use that information to exert control over service providers and their patients.

At the highest level 'our' vision is of little relevance to government and bureaucrats. Their vision on the other hand is paramount. The conflict of interest between the two visions is obvious and while the government's vision is permitted to dominate huge amounts of money will continue to be expended all to no avail.

Bernard Robertson-Dunn said...

Which is why I suggested that the States pay. a) they don't have huge amounts of money and b) they are far more interested in the efficient/effective delivery of health care than the Feds.

And just to be absolutely clear, I am a great supporter of automation, the use of Information Systems and better use of health data in research and delivery of health care.

What I strenuously object to, and have done since I started making comments on this site, is the stupidity of uninformed managers and IT people trying to solve the wrong problem and to compound things, by doing things the wrong way.

The RAND report set the wrong agenda. They essentially said, in their ignorance and arrogance, - apply IT to health care in the same way it has been used in other industry.

A much better approach, then as now, would be to say - what problems does health care have that Information Systems can help solve and thus improve and transform health care?

The problems come first and there is no mention of technology solutions at all.

There's a really old cartoon that shows a manager telling his programmers "I'll go up and find out what they want and the rest of you start coding".

There's a version here:
http://image.slidesharecdn.com/requirementsengineering-140224082604-phpapp01/95/requirements-engineering-2-638.jpg?cb=1393238168