Monday, March 20, 2017

This is The Question I Really Think ADHA Has To Address.

The question, after 5 years of the myHR program is, given we are having a having a digital health reset with a new strategy what are the key strategic choices that should be decided on. In summary we need to be clear:

1. Would we decide to build and continue to build on what now exists as the myHR? or

2 Would we face up to reality and use more modern technologies to create a more sensibly architected  and designed solution with a clearer agreed purpose? or

3. Would we accept that the cost and value vs. benefit of national EHR system simply is not there and work to develop much better local / regional solutions? With the Internet and the cloud national systems may just be unnecessary?

To address these it seems to me the first question to be addressed is just what is the purpose of the myHR?

1. Is it to facilitate access to critical clinical information when the patient is away from their usual doctor? or

2. Is it to improve the coordination of care for patients receiving complex care ? or

3. Is it to provide a data-base for the DoH to mine? or

4. Is it to do something else.

As it is unlikely all these purposes can be successfully met in the one system the issue becomes what, if anything, should be done locally vs. regionally vs. nationally.

What has to be done flows from properly addressing these issues above IMVHO.

What do others think?

David.

19 comments:

Paul Fitzgerald said...

David, to answer those questions, the ADHA (and its predecessor) would need to admit that they got it wrong in the first place, and squandered over a billion dollars. Pigs may fly as well.

Dr David More MB PhD FACHI said...

Paul,

This comment from the earlier blog prompted me...

"Kelsey has openly admitted on numerous occasions and Paul Madden has also said that NEHTA had lost its way and a fresh start was needed. Logic suggests that this means there is no value in harping back over 5 years like a broken record about something that hasn't worked. And because it hasn't worked there is no evidence that myHR (PCEHR) has made a positive difference. Surely David, you of all people, would find this admission reassuring, given your consistent criticism of NEHTA and more recently of ADHA, that "we need a fresh start and new insight into digital health, old ways of thinking is not going to work." They cannot say it any more clearly. Forget the past David and look to the future. In other words you just have to accept that $2 billion has been wasted and has to be swept under the carpet and written off while "we make (need)a fresh start".

Maybe the question is - how do you hide a $2.0B stuff-up?

David

Anonymous said...

Maybe the question is - how do you hide a $2.0B stuff-up?

Now we are seeing why Kelsey was brought in, that sort of tax payer wastage is small change.

Anonymous said...

Experienced, pragmatic, objective, deep thinking eHealth practitioners with an abundance of nous would answer thus:

1. No we would not.
2. We should but we won't.
3. We should but we won't.

Answers to your questions on the purpose of the myHR should be perfectly obvious.
1. Not a primary purpose of the myHR but could be a secondary reason.
2. YES, YES, YES.
3. It might be but that won't happen in the absence of 2.
4. It might be but it shouldn't be to the detriment of 2.

Anonymous said...

@4.37 .... "how do you hide a $2.0B stuff-up"?
Keep repeating the lies, concealing the facts, distorting the truth.

Anonymous said...

And apply the rule - one positive comment from someone who has never been involved cancels all previous comments. This is why the ADOHA will be rushing out press statement referencing Mr Ferris who ever he is.

Anonymous said...

I note a nice shoot over the bow from the AMA today.

Anonymous said...

I am happy for the tweets and the horaays and the sound of hooves and hounds. I am though calling the ADHA out, show me the architecture thinking, where is the informatics where is the design thinking. A little more co-ncreate and a little less co-ndescending

Anonymous said...

Labor and the greens need to block the opt out, simply on the grounds eHealth is to important and the government has clearly demonstrated IT projects are a disaster waiting to happen, no matter how many times they use the words, innovation, Agile, Digital, when this pattern of failure is evident it is time to put the brakes on and take time to have a good think.

Anonymous said...

The time has come to avoid continuing to wrestle with how to get the bureaucracy (Kelsey, Madden, COAG, Health Minsters, and Health De3partment Secretaries) to acknowledge a new approach is required. Leave them alone to muddle along singing their song.

The time has come for Industry to step back and plan a new way forward for advancing Digital Health to allow the private sector to exploit and build upon its strengths, skills and resources, unimpeded by the debilitating encumbrances of the bureaucrats' enthusiasm to tell industry what to do and how to do it.

The time has come.

Anonymous said...

We are, the trick is keeping them focused elsewhere, which my boss seems pretty talented at doing

Anonymous said...

The only sector the ADHA is likely to threaten is the one PulseIT operate in, albeit the ADHA will take a more propaganda type spin, sweeping up success stories from the sector and stamping government success on it, and of coarse the tales from civil society and how they get a rough deal from the clinical Marfia.

I agree let them muddle along, the cracks and flaws will appear soon enough Mr Madden

Paul Fitzgerald said...

See, we are so conditioned to government stuffing up, that it is expected we will just accept that $2B was wasted, and we should all just take a teaspoon of cement, and harden up!
The media, and the politicians (advised by the Mandarins), spoon feed us this clap trap and expect us to be good little children and not raise a fuss. The whole notion they would have us swallow is that it's "only" $2B, so not to worry. To paraphrase the late Sir Joh, feeding the chooks (the media), "don't you worry about that!"

Andrew McIntyre said...

Yes, it appears that money is cheap and wasting $2B is not a big deal! Its quite outrageous when you consider the overall budget position and what $2B could have done in terms of actually delivering health care. I can't see any real savings in sight and the current system takes time away from talking to patients for no return, so the real cost of the failure is actually higher than $2B. Given what we know about the failure of large IT projects and the world experience with eHealth you would have to think that whats happened was highly predictable and a prudent manager would have pulled the pin long ago. Governments should be sure that safety is the first priority and impose some quality requirements on what is in use via consensus standards, but not try and be a player, especially when health $ are in short supply. Being complacent about and comfortable with failure is a worrying sign for our society.

Anonymous said...

David do you or any fellow readers now if the results and unfettered narrative from the your health, our way surveys are available for "research purposes"?

Dr David More MB PhD FACHI said...

@9:01.

I do not know...why not just e-mail Tim Kelsey and ask him what is available. (Tim.Kelsey@digitalhealth.gov.au)

David.

March 22, 2017 9:08 AM Delete

Anonymous said...

Indeed Andrew, this truly is the nub of the problem:
“a prudent manager would have pulled the pin long ago. It’s quite outrageous when you consider the overall budget position and what $2B could have done in terms of actually delivering health care.” …. and …. “the real cost of the failure is actually higher than $2B”

As I reflect on the fact that this equates to $100 for every man, woman and child in Australia. I despair when I think how that $100 dollars could have been so much betters used many times over.

What would the carers, the pensioners, the disabled and so many others living on struggle street think if they but knew. I find it almost inconceivable that even our Prime Minister and Bill Shorten would not be incredulous if they but knew the truth; partisan politics aside.

Yes, Andrew - “a prudent manager would have pulled the pin long ago."

Dr David More MB PhD FACHI said...

@8:33pm

"I note a nice shoot over the bow from the AMA today. "

What was that, I must have missed it..

David.

Anonymous said...

More a reminder of previous hints - https://ama.com.au/ausmed/national-e-health-strategy-–-don’t-give-us-high-level-give-us-down-earth-ama-says

Perhaps there is concern