Sunday, February 07, 2016

Article Draft: E-Health in 2016. What Can You Expect For This Year? It Will Be One to Watch!

As this is the first article for 2016 I thought it might be useful to lay out some expectations for the rest of the year ahead in National E-Health.
I think it would be fair to say that 2015 wrapped up quietly with those interested in the e-Health domain expecting a lot of back-room activity to be happening after the passage of new PCEHR (now officially called My Health Record (mHR after Jan 16, 2016) legislation causing waves in 2016.
This legislation, among other things, has enabled the conduct of trials of an ‘opt-out’ approach to your personal information being held in the Government mHR system and has enabled a new Australian Digital Health Agency (previously the ACeH) to replace some Department of Health functions and the National EHealth Transition Authority (which is seen as having lost clinician and technical confidence).
The mHR change was seen as necessary by the Department because, after two years, clinician and consumer interest and use in the PCEHR was very low with less than 10% of the population having a record and very few patients or clinicians actually accessing the record. The change was seen as the last throw of the dice to have the system become relevant and useful. If the change is seen as successful, the legislation authorises extension of the record to the whole population.
At the time of writing we have seen the expected activity begin to  manifest. The present announced plan is that there will be two trials of the ‘opt-out’ consent approach conducted. The first will involve about half a million people in Far North Queensland and the second trial will be conducted in Far Western Sydney and the adjacent Blue Mountains.
What the trials will involve is the creation of a health record for each individual with the record then being populated with data held in the Medical Benefits and PBS systems for the individual concerned.
So far there have been consultations with a variety of different health professionals (GPs, Allied Health etc.) where the Government’s plans have been outlined, as discussed above. It is planned that over the next period there will be an educational program conducted to inform the relevant populations of what is happening and to offer anyone who is concerned to not have their record made accessible - although a record will apparently still be created.
Clearly before any trial can begin it will be necessary for GPs, Allied Health and Hospitals to have access to systems where the records are integrated into their present  systems.
If there is no slippage in the time-table (which seems pretty unlikely) it is intended that the records of those who have not opted out will be made available to the individual, so they can set up the access controls they desire for their mHR and then the system will be made available for access by clinicians - around the end of June 2016.
An evaluation team has been funded ($1.4M) until the end of November 2016, which seems to be an extremely short time to complete an evaluation and report on the trial(s).
There have been no criteria made public as to how success of the trials will be determined and, as it is clear that the Department wants to develop a clinical database for additional research purposes rather than direct patient care and safety, it seems likely the system will just proceed - useful clinically or not. The Government has invested close to a $1.0Billion in the system which has so far failed - and committed an additional $0.4Billionover the next few years - so simply walking away - sadly - seems unlikely.
The new Australian Digital Health Agency is intended to commence operations on July 1, 2016 and is the other major e-Health activity for 2016 that we are presently aware of.
The functions of the Agency - as set out in the enabling regulations, is as follows:
(a) to coordinate, and provide input into, the ongoing development of the National Digital Health Strategy;
(b) to implement those aspects of the National Digital Health Strategy that are directed by the Ministerial Council;
(c) to develop, implement, manage, operate and continuously innovate and improve specifications, standards, systems and services in relation to digital health, consistently with the national digital health work program;
(d) to develop, implement and operate comprehensive and effective clinical governance, using a whole of system approach, to ensure clinical safety in the delivery of the national digital health work program;
(e) to develop, monitor and manage specifications and standards to maximise effective interoperability of public and private sector digital health systems;
(f) to develop and implement compliance approaches in relation to the adoption of agreed specifications and standards relating to digital health;
(g) to liaise and cooperate with overseas and international bodies on matters relating to digital health;
(h) such other functions as are conferred on the Agency by this instrument or by any other law of the Commonwealth;
(i) to do anything incidental to or conducive to the performance of any of the above functions.
Essentially the Agency is to become the Operator of the mHR and the co-ordinator and facilitator of national e-Health initiatives.
As with all entities of this type, the selection of the CEO and Board and the quality of those appointed to the various advisory committees which will cover clinical and technical issues, privacy and security issues, consumer issues and jurisdictional issueswill determine how likely success is. One key concern is all the activity on the opt-out trials etc before the agency responsible even exists. One can’t but wonder how sensible this is.
Left out of this discussion is the very wide range of State and private sector initiatives, some of which seem to me to show very considerable promise. They will have to form the basis of a future article.
All in all, 2016 looks to be a pretty big year in National E-Health. At this point it is impossible to know how things will turn out and if the public will receive value for the money being spent. Nevertheless it will be fun to watch!
Comments welcome!

1 comment:

Anonymous said...

I must be getting old, because, more than ever I don't enjoy watching public money being wasted on daft ideas.

What is it with bureaucrats that they have to keep throwing money at failures, while anything looking remotely successful is de-funded on the basis that it will carry on without funding, by some miracle or other.

The PCEHR or MHR, or whatever it gets called next, is not an example of the application of ICT in health failing, it is just yet another example of the lack of competence of government departments to innovate successfully.

Not to mention, of course, it being a prime example of the desire for a cow producing a camel instead, owing to the control of the process by the camel dealers.