Sunday, October 23, 2016

I Think It Is Time For The ADHA To Start Lifting Its Game. We Have Seen A Few Rather False Starts I Believe.

A little while ago the Australian Digital Health Authority (ADHA) announced it had established a blog to provide expert comment on e-Health.
Here is the link:
We have had two posts in the last month, both of which have rather reflected a detachment from reality and the e-Health environment.
First we had this (written by Tim Kelsey):

How to harness the power of the modern information revolution: reflections from Perth

Wednesday, 12 October 2016
Nine years ago, Fiona’s husband Peter was diagnosed with a brain tumour. It was benign and they were told that it wouldn’t kill him, but would be ‘a bit of a nuisance’. Peter, who worked as a business consultant in Western Australia, went into hospital for surgery – and then their world was shattered. There was a complication after his second operation and Peter, vulnerable to infection, contracted meningitis. He suffered brain damage and has required around-the-clock care ever since. What initially seemed like something Peter and Fiona could live with, now consumes their whole lives.
Fiona is one of a group of carers and patients who have kindly given up their morning to share insights with me on how health services can be improved with better access to patient information. We are in the community training room of the Health Consumers’ Council in Perth, on the campus of the Royal Perth Hospital. Outside it is bright and blustery; inside everyone is silent and focussed as Fiona describes, with extraordinary dignity, the journey she, Peter (now 49) and their two-year-old daughter have travelled since.
Peter routinely requires hospital treatment. Fiona collects the paper forms from his care facility, which are passed on to the ambulance paramedics, and then to the triage nurses in the Emergency Department (ED), and then they wait – often for hours – for him to be admitted to a ward. Although his information travels with him, Fiona says that it is not always obvious to the treating team what the priority health concerns are. Peter’s medical needs are complex and there are quite a few critical health issues that Fiona has asked to be kept on his file at the hospital as she isn’t always available to attend ED. ‘We are not medical people’, she says. ‘We don’t know how to find our way around the health system. I can show you the letters to the hospital I’ve written asking them to improve their process. I’ve seen my husband go through so much. Even when we pre-agree an admission with his specialist, I still have to go through the ED. I just find it remarkable – ridiculous.’
Fiona wants her husband’s history to be available electronically to his entire treating team, and she would like this to happen without having to repeat herself or intervene. On one occasion, because his record is not shared digitally, his specialist wasn’t made aware of a drug that a hospital doctor had prescribed – and that could have been dangerous for him. ‘It just fell through the cracks’, she says.
There is a great deal more here:
I was rather taken aback by this paragraph:
“Western Australia has a distinguished record of technology innovation in healthcare. The University of Western Australia is a field leader in proton magnetic resonance research and has spun off a business – Resonance Health – that provides specialised diagnostic imaging services to hospitals across the world including London, Philadelphia, Morocco and Vietnam.”
Sadly the truth is that WA has a long track record of making a really substantial mess – over the last few year with its acquisition and implementation of e-health in the public hospital sector.
The following output from Google says it all:
Search: “ problems technology Fiona Stanley”
About 2,000,000 results (0.67 seconds) 

Search Results

Warnings about problem-plagued digitisation of WA hospitals 'ignored ...
Australian Broadcasting Corporation
Feb 27, 2016 - The problems first became apparent at the $2 billion Fiona Stanley Hospital, where technology was supposed to replace paper records.

AMA delivers devastating critique of Fiona Stanley Hospital in Perth ...
Australian Broadcasting Corporation
Aug 18, 2015 - Photo: There are still major problems at Fiona Stanley hospital, ... was delayed due to major problems with its initial information technology and ...

Long list of problems at Perth's Fiona Stanley Hospital: Report | Perth ...
The Sunday Times
Jul 22, 2015 - A LONG list of problems at Perth’s new Fiona Stanley Hospital, including urgent patient cases not being given priority over routine surgery, have been detailed in an independent report. ... The report also detailed problems relating to service provider Serco, including its porters ...

Crisis meeting called for Perth's Fiona Stanley Hospital as WA doctors ...
The Sunday Times
Feb 15, 2016 - Doctors have complained about problems at Perth's Fiona Stanley ... SICK SYSTEM: WA doctors warn Perth's Fiona Stanley Hospital is 'putting ...

Fiona Stanley Hospital still struggling to stabilise IT systems - Software ...
Nov 26, 2015 - Western Australia's Fiona Stanley Hospital is still struggling to ... still struggling to overcome technological issues with platforms ranging from ...

WA govt admits to "systemic" IT issues at Health department - Strategy ...
Feb 22, 2016 - WA govt admits to "systemic" IT issues at Health department ... to serious problems with the IT systems and infrastructure at Fiona Stanley Hospital ... "It not as though the information and communications technology risk was a ...
I guess this just reflects being a newcomer. All that is really needed is the local patient GP who can print out the patient’s detailed summary for the patient which the wife can carry to present to all those involved as needed – until of course WA has made some progress with its systems.
Second we have this:

Privacy – enabling trust and confidence in digital health

Monday, 17 October 2016
What’s the collective noun for a group of healthcare providers? A horde? A congregation? Certainly not a gaggle. I think it should be an orchestra – just as an orchestra is made up of distinctive yet harmonious sections, so too is the healthcare industry.
Recently, at the Sydney North PHN workshop, an orchestra of healthcare providers watched expectantly, waiting for me to pick up my baton, set the tempo and begin:
“The vast majority of people in this room did not get into the healthcare industry to work with computers. Your priority is your patient. Am I right?”
The pharmacists nod their heads, the general practitioners give a bit of a chuckle, and the practice nurses smile. Good, we’re in agreement.
I’ve been a privacy advisor for digital health for five years, and no presentation I make is ever the same. Yet, there is one consistent element with every audience: privacy is a priority. I see that as one of the reasons why some providers have not dived head first into adopting digital health. Those providers want to be absolutely sure that the trust their patients already have in them to uphold privacy is not eroded.
Lots more here:
Rather the some rather time worn anecdotes and cute comments, maybe, the approach the ADHA recommends to manage health information privacy – or a link or two etc.  - would have been of rather more use.  I think those reading the ADHA blog need to be reassured that the ADHA experts really know their stuff in depth. This really does not show that.
There are a lot of people hoping for a new start with the ADHA and much greater understanding and depth from ADHA. Thus far the omens are a little worrying…I hope this changes – and soon!

In passing - I wonder where the new National E-Health Strategy is up to and when we will all get to comment on it.


Anonymous said...

David, based on many years of extensive practical eHealth expertise I have to say the Tim Kelsey stuff reflects his roots as a journalist - spin the words and puff the stuff. It is clear there is no evidence of any truly practical insight into the root of the problems in eHealth and how to go about fixing them. I should also add that if the ADHA's strategy fails to provide a truly practical insight then another wasted decade lies ahead. Someone needs to tell the journalist in charge of the ADHA that he needs real help with this stuff and not from Accenture.

Anonymous said...

So what did Mr Richard Royle and his band of merry men get paid for? Were they not developing an eHealth strategy for the ADHA? Extending that thought, was not a draft did not the ADHA ask for feedback on the draft strategy? After all that what have we got?

Anonymous said...

So what did Mr Richard Royle and his band of merry men get paid for? While I was there they did merge the entities under a new name, brought some change consultants, had some executive values workshops and produced a work plan that was a list on unconnected dribble, the place was a maze of confusion, remained isolated and disconnected set of state based locations. Did any of them adhere to the values, one or two of the new entrants seemed to but the old crew just became more arrogant and clueless than previously, some took long holidays (not long enough). I left in dismay.

Ask for Richards power point business architecture, the quality and thought behind it sums it up perfectly, should be retrievable under FOI

Anonymous said...

arhhh, that brings back memories. "Healthconnect" - remember that, decided it was all just a problem of change management. It would make more sense if they just said the answer to the problem is "42"

Anonymous said...

Re 8:44 PM & 12:05 AM which once more confirms that bureaucratic thinking remains narrow and a captive of a dead-wood culture stagnating in the past.

This says it all "... produced a work plan that was a list on unconnected dribble, the place was a maze of confusion, remained isolated and disconnected .....
the old crew just became more arrogant and clueless than previously .... I left in dismay...."

Re 10:41 AM "... another wasted decade lies ahead".

john scott said...

David, the 'Beyond Wachter' news clip you referred us to includes this interesting line:

"we don’t see any sign of the radically different approach that is required if digital technology is going to enable the radical transformation the NHS requires."

I suggest this litmus test should be our measure of the value of the next e-Health / Digital Health Strategy created by the Commonwealth / ADHA and submitted to COAG for endorsement.

Anonymous said...

I do agree in part that the ADHA seems to be off to a chaotic start and I do wonder if the CEO is all smoke and mirrors, however I think we could agree at some level that the how landscape is broken and it will take a major effort to turn things around, not just nationally but also internal to the agency, legacy is always the curve ball in any system. My asvice to Tim would be to ensure there is a balance between talkers and people who live and breath complexity.

I believe the commitment for the national strategy was January 2017. I won't be surprised if this is extended as there is only a few months and it is well known December Januarary is never a good time for major consultation with either government, industry or the public.

Dr Ian Colclough said...

If they repeat the same old same old way of approaching the strategic planning process via consultation with all stakeholders across the length and breadth of Australia they will simply waste more time, money and resources, not to mention destroying any credibility they might have. That approach has been done to death repeatedly.

As the first step I would propose enrolling a small group (approx 10) of pragmatic health industry experts from among the vendor community with practical experience in strategic planning and business and market development and well versed in the many complex domains of health ICT to develop the base level strategy document. If there was any genuine interest I would be pleased to nominate some individuals who should be approached and who I believe have the credentials and capacity to maintain maximum objectivity throughout the exercise.

Anonymous said...

Out of interest why only the vendor community?

Dr Ian Colclough said...

Out of interest why only the vendor community?

Thank you Anon 1.32 PM for the question. It's a starting point for the discussion and thank you for starting it. There are also people outside the vendor community who could equally well make a valuable contribution so perhaps I should have said ... "... from among the vendor community and beyond ...".

The first step is to compile a list of names of those individuals who have the appropriate background with the depth and breadth of practical experience to participate in such an exercise and who would be prepared to do so.

Anonymous said...

One wonders if as mentioned earlier this week, that a national health strategy needs to be place first. What is the 50'year journey the states territories and private sector see healthcare taking? and what does it look like? From that Heath and well being strategy, computer scientists and other scientists, business architects, policy makes etc can work out what workflows and systems need to be created to support the long term trajectory. Better holistic and transformation plans at a nation level might then be agreed, funded and supported, as such endive table change can be better understood and accommodated. Such a long term plan could then incorporate not just today's legacy but future legacy issues in both technologies and digital information. It might also provide a means to explore new and improved workflows and better practices. To me these 5 years plans created in isolation of each other do nothing to resolve a fragmented healthcare landscape, we just keep putting sticky tape over sticky tape.

Andrew McIntyre said...

I have no confidence that government can develop a national strategy that makes any sense and that is not their role. Their role is governance to ensure that any technology that is in use is safe for patient care. Currently much of it is not. If they have a role in funding development it should be at a university R&D level where the results of such research are available to all.

They have failed miserably to ensure that the quality of implementations is high enough to actually enable inter-operability and is often dangerous. Since when have government come up with a road map for the future that was sane and actually implemented. If they actually made sure that government systems supported standards and participated in electronic communication that would be a start as would an insistence that data that moved between providers complied with standards and that standards compliant data could be reliably received and displayed by systems we would be on the road to a better place. They are incapable of creating standards, they just need to ensure that existing standards are used safely.

They have spent $2 Billion on trying to develop systems and standards with no progress. If they spent $10M on a compliance program that made sending compliant messages a requirement and made sure systems could actually process compliant messages we might get somewhere. We need government that sees its role as governance, and tries to get out of the way of innovation. Forcing GPs to use the PCEHR through pip payments, when they see little value in it is a desperate measure to save face. If GPs saw value in the "MyEHR" they would use it, the only value they see is the $ value of the pip payments.

While they fiddle in things they don't understand they are distracted from the real need to actually update there own systems. By outsourcing for years they are in a position that despite 30 years of "progress" they can't replace their own 30 year old systems and don't have enough internal expertise to even know how to even approach that problem. If they can't solve their own IT problems why would you think they could create a road map to solve the problems of public/private hospitals, labs, GPs, specialists, pharmacy and allied health. No one can come up with a solution to solve that overnight, but while we are trying whats done should be done using standards and compliance to ensure safety. Looking to government to solve it is silly. Government needs to ensure that while we try to solve its done in a safe manner, and solved by the people who have a deep understanding of the landscape, not generic managers or experts in "change management".

Anonymous said...

Quite agree, let's keep it with inward focused protectionism based vendors who have no interest beyound profit in making the system interoperable outside of an enterprise or product set. Who are also more than happy to cast stones but do little actual visionary work themselves. I think the current vendor mafia would soil themselves if we let proper software engineering companies into the game.

Anonymous said...

"Proper software Engineerong companies" - what like the Queensland health payroll or MyEHR?

Anonymous said...

Tim Kelsey's speech in Perth "How to harness the power of the modern information revolution: reflections from Perth ". Spare me please. There is no HOW TO HARNESS anywhere in this speech it is simply a whole lot of aspirational verbiage which as been bandied around in similar formats and stories for the last decade.

The real revelation here is that by heading a speech like this under the "HOW TO HARNESS" label one can confidently conclude that the presenter is bereft of any HOW TO HARNESS ideas in relation to eHealth. Please Mr Kelsey put some creative and constructive HOW TO substance into your speeches or remain silent.