Monday, January 30, 2017

Brief Report On The ADHA Consultation Webinar Conducted 30 January, 2017

The discussion and questions ran for 1.5 hours.

The most interesting thing I gleaned was that the emphasis of the new - approximately 5 year - Strategy would be to get what Tim Kelsey referred to as the 'foundations' in place and that the foundations now included the myHR - along with SMB etc. (So this is really an admission that from 2008 (The old Strategy) to 2016 we were spinning our wheels and now is the time to move boldly forward.)

The process will be that now we have all been consulted  (ends tomorrow) there will be the creation of a Strategy, this will be approved by the COAG health ministers and then will be made public along with a four year work plan and, presumably, some funding.

Interestingly it seems the opt-out evaluations are virtually complete - and have apparently been successful - and that the new Strategy will be focused on the collection of evidence of benefit of all this new investment going forward. Apparently no evidence has been gathered of benefit to date - or at least it was not mentioned that I heard.

I guess we all just wait and see what happens next.



Bernard Robertson-Dunn said...

If anyone is interested, here is a link to the Australian Privacy Foundation's submission to ADHA.

It is based upon a few simple assumptions.

* Improved healthcare will come from a patient centric approach.

* Privacy of patient data and its management should also be patient centric.

* The risk to a patient's privacy must be worth the risk.

Anonymous said...

Put together David’s illuminating observation, Tim Kelsey’s “we don’t yet understand what the stages are between here and there”, Leanne’s observation about “how hard it is to write a strategy”, Tim’s comment “digital health has nothing to do with technology” and one could reasonably conclude that the panel were living a dream. They had plenty of rhetoric and lots of buzz words (apps, apps, fitbits, AI, genomics, telehealth) but little of substance.

I expected to hear one of the panelists provide at least five solid criteria which could be measured relating to functionality and business processes within a few niche sectors. Instead, I heard the age old motherhood claims rolled out once more like “better patient care”, “improved health services”, etc, which are quite meaningless unless they can be measured.

The session concluded with the most perceptive question of the session “How do you define success”? The panel’s response was dismal. I was stunned by their inability to clearly specify what constituted success and how it could be objectively measured. They seemed to have a shallow insight into the health system – their feet were way off the ground – ‘oh what a feeling’.

Anonymous said...

I thought Steve Hambleton and Meredith Makeham came across as two who understand the issues and needs, Tim I am afraid and with the greatest respect came across like someone who has run out of steam, having heard him speak many times, it is the same script time and time again and in many cases either does not fully believe or understand what he is saying, even for a salesman he is not very innovative.

I noted that the question of the MyEHR had to be forced into the conversation. It seems now it is a platform that everyone can build apps for and open up. It was not clear how this will happen or if the big end of town will simply open up the technology and stored data for anyone and everyone to play with.

There still seems to be some delusion of access controls.

I had no real sense there is a valued business case for the MyEHR especially in the area of collecting and analysing vast amounts of data from personal devices, the age of big central systems is over, open API is the key.

On a positive note I have great hopes for the Medicine Safety Program if the likes of Meredith are behind it, NEHTA struggled with leadership in Clinical Terminology and Information architecture, I certainly will not miss the past as this is such an important space. I also liked the investment the Home Care program has made, as always funding models will be key, but it has been provided the time and space to get off on a good start.

john scott said...

Colleagues, the concept of measurement lies at the heart of the strategic abyss for Australian digital health.

We have all manner of technology and new knowledge (e.g. genomics, AI, etc.) but we have not really grasped the measurement question.

Digital health is not about the technology and evidently this is something Tim Kelsey and I can agree upon.

Our starting point has to be care. Here we need to make a clear distinction between the relationship, interactions and supporting information flows at the human level and the relationships, interactions, and supporting information flows at the electronic level.

We equally need to make the distinction between the relationships, interactions and enabling information flows among clinicians and those between clinicians and patients and carers.

So when we return to the critical measurement question, we find it actually turns on the quality of cooperation, coordination and collaboration. This in turn is anchored in Trust.

As such, governance stands at the crossroads. And the metric of governance is its ability to achieve a revolution in the quality of collaboration. This has been notably absent from the beginning.

Bernard Robertson-Dunn said...

I agree with John re meausrement.

IMHO there are only two meaningful measurements, both of which are patient centric:

1 Improved health outcomes as experienced by people; patients and potential patients.

2 More efficient healthcare, as perceived by patients. This includes government expenditure, after all government funds come from taxes.

How ADHA performs according to these measurements is up to them, but it will take more than motherhood statements to convince me.

Anonymous said...

The trick will be establishing the legacy baseline from which improvement or maturity can be measured from. It will most likely need to be different measures for difference roles and entities, defaulting to some simple numer or icon is my guess as they are simple management speak, easily obtained through massaging and not very imaginative and will not priorities where this should occurs or the impacts of not balancing maturity across the sector. I can see ISO 9001 for health

Anonymous said...

If they can't establish a baseline and measure their success or otherwise, they should say so and let everyone know they are working on hope, guesswork, blind faith and witchcraft. At least we'd know.

Dr Ian Colclough said...

I thought Andrew asked the most important question of the day: "How can Australian healthcare companies / software developers get involved?" I thought the panel skirted around the essence of Andrew's question.

Anonymous said...

What I found telling was who was front and centre and who was sitting on the sidelines.

Anonymous said...

Formally announcing for and on behalf of the tax paying stakeholder that we the Agency is moving forward on hope, guesswork, blind faith and witchcraft.

This has been a public serpent announcement.

Anonymous said...

AnonymousJanuary 31, 2017 1:09 PM. I don't think even the ADHA or Doha would be so naive to think some sort of rating index would provide value, the complexity and cost alone would have it laughed out of the room.

Anonymous said...

Re 3.26 pm "How can Australian healthcare companies / software developers get involved?" The ADHA wants all developers to interface their software with MyHR and send information to it.

I think the panelists were obliquely saying ...... we (ADHA) have made the MyHR infrastructure available and all that is now needed is for doctors, pathologists, radiologist and pharmacists to send patient data to the MyHR and the only thing stopping that from happening is the reluctance of software developers to interface their systems to it.

Bernard Robertson-Dunn said...

Pouring large amounts of random, unorganised data into a big bucket does not make a health record. In fact, the more data in it, the less use it becomes. Other than for surveillance, data matching and invasions of privacy, of course.

Anonymous said...

February 01, 2017 1:15 PM surely Doctor Hambleton and Dr Makeham both understand that. Are they misguided? Ill informed? Have they been seduced by the task, or by their egos, or by the remuneration or by something else?

Anonymous said...

Weaved through these comments is a burning question, how as a community do we better understand what we want, why we want it, and how in different scenarios can we obtain it and then how can we measure it to understand when we get there and detirmine if that is enough or we want more/ or something different.

The ADHA has a role here, provide frameworks that allow us to determine the journey we want to go on with any number of partners and guide us in obtaining realisation, develop and support key skills that we can equally utilise to reach those goals. Become a hub of reason, knowledge and thought not a single minded competitor. We need meritocracy not dictatorship.

Payment for services will drive the market through innovation and competition, if the government tries to compete against the market as it is apparently doing, no one wins. Success is not necessary a shiny widget

Bernard Robertson-Dunn said...

There are lessons to be learned from the Industrial Revolution in England in the period from about 1760 to 1830.

Compare England with France. Short version: In England, the government encouraged and facilitated innovation without getting directly involved. In France, the government and national academies insisted on directing initiatives and endorsing those they considered as "worthwhile".

The Result? England succeed and went on the create an empire that covered the world. France failed miserably, even though they had access to the English machines and practices which they could have copied and improved.

What do we have in the Department of Health and ADHA? The equivalent of the French approach.

What do we need? IMHO, for there to be a revolution in healthcare and eHealth, the innovation that is needed is much more likely to come from people who work directly with patients and with health professionals than from bureaucrats in their ivory towers. The French experience rather suggests the validity of this statement.

Most health professionals themselves are probably too well trained in existing methods to see radically different ways of "doing" healthcare. As I've quoted before, Henry Ford is reputed to have said, "If I'd asked people what they wanted they would have said - faster horses."

Tim Kelsey, that well known historian and journalist, of all people, should know this.

However, as Upton Sinclair (1878 – 1968) is quoted as saying, "It is difficult to get a man to understand something when his job depends on not understanding it."

ADHA has a role to play in eHealth policy, regulation, safety and standardisation but not healthcare service delivery and most certainly not in gathering duplicate copies of patient health data with the stated aim of linking it to other government data. Nor in picking or trying to create winners.

Anonymous said...

How apt - "It is difficult to get a man to understand something when his job depends on not understanding it." Upton Sinclair (1878 – 1968,

Having recently been to my GP my hammer and nail specialist and my urologist I decided to have a look at My Health Record. I concluded the MyHR developers haven't made any improvements to the system in the last 6 months. The reason I am sure is because they don't know what needs to be done to improve the system even though they have been told numerous times about some of its glaring deficiencies.

Anonymous said...

I assume SMB is meant to be SMD (Secure Message Delivery). There are lots of challenges to getting this up and running, both business and technical.

Anonymous said...

I guess we get to now see if Tim has the solution, documents released on ADHA website tenders section to fix it once and for all. Is it a win or more wind

Anonymous said...

What did the webinar of 13 February achieve? NOTHING of any note. It was all top-down thinking from outer-space peering down on the masses below.

Well done to Ellen Fanning who asked the rhetorical question:
"Whose role is it anyway"? "Is it Government's role to just get out of the way?"

Dr David More MB PhD FACHI said...

I have to say I got the same feeling - there was a little too much in the stratosphere and not much practicality or reality given how hard we all know this is.

Interested in other comments!


Bernard Robertson-Dunn said...

Did any one ask or tell, how many times MyHR has been used? And/or how much money it has saved?

Anonymous said...

Re: 3:55 pm David said -- Interested in other comments!

They certainly didn’t have any clear idea about who was the target audience. They were all over the shop (spaceship). ….. “now moving to genotype and phenotype of data”, “nudging”, We know we’ve “got to have the whole shebang working together”. “We still have to figure out how to makes it all work.”

“We don’t want a loss of confidence”. !!!


Anonymous said...

I was less than impressed they way Tim Kelsey cut short Professor Meredith Makeham, it was less than professional and more than rude. On top of that he came across the weakest of the lot and continues to force the My Health Record, but ignores open standards, Architecture and sciences.

I did get a feeling that the road ahead does not necessarily include the current My Health Record.

Anonymous said...

The conversation was well underway and My Health Record hadn't even been mentioned UNTIL Tim Kelsey slid it into the conversation. I too was less than impressed with what Tim tried to say - it lacked substance, perhaps that's because he was tired. His tie was all skew-whiff, his shirt looked like he'd slept in it and the shirt cuffs were curling up at the corners. By comparison Martin Bowles well presented - he spoke well too with some credibility around Digital Health (unlike his predecessor Ms H.)

Anonymous said...

Yes I noted Tims rude interruption or stealing the limelight, which was a shame as I was interested in what was being said, but alas Tim the crusader trotted of down some mobile blah blah myhr rabbit hole

Bernard Robertson-Dunn said...

Sounds as though nothing much has changed. The Federal government is determined to get its hands on patient data of some sort, is willing to spend huge amounts of money, the bureaucrats have a very simplistic view of eHealth and health data, no benefits or value are being created, opportunities to do things better are lost and time is wasted.

My guess is that some outsider with authority, probably an economist or bureaucrat from a different department (PM&C? Finance/Treasury?), or the State governments will come along and ask the hard question: What are we getting for all this money? A combination of the elephant in the room and the emperor's new cloths.

Until then it will be like watching children at play.

Anonymous said...

Basically, the entire webinar achieved nothing as 3:51 PM said.
How many people were signed in?

I doubt one could glean much useful information about them from the sign-in but it might be informative to know how many - 100, 500, 1,000?

Dr David More MB PhD FACHI said...

Towards the end there were about 5-600 on line according to some tweets from the ADHA at the time.

Of course I can't confirm that figure directly!


Anonymous said...

Someone said “We have to start from scratch to work out what Digital health is and what it will do”.
How’s that for building confidence?

Anonymous said...

I think Prof. Brian Schmidt summed it up perfectly “Standing in a field of cowpats”. and someone else said “Care of the health system is ‘Trust’ = Trust is the currency”

Anonymous said...

Even better was “we need to find efficiencies in the way we do things already”. Hello!

Anonymous said...

How about the low hanging fruit comment – more jargon. Low hanging fruit has been hanging for a decade – no-one ever says what it is but everyone seems to know it is there just hanging on the vine. mmmm

Anonymous said...

I couldn’t recommend it to anyone. There was no focus on the really important pragmatic stuff. No understanding of the commercial realities. I felt they were so far removed from where health “happens” that they were unable to convey any real understanding of how the system works, instead they parroted the same old stuff we have been hearing for over a decade.

Anonymous said...

I heard “time to scale first gives advantage” and wondered if that was a warning to everyone else to close up shop.

john scott said...

Anonymous 1:09 PM : "We have to start from scratch to work out what Digital Health is and what it will do".

Anonymous 1:11 PM: "care of the health system is 'Trust' - Trust is the currency".

Anonymous 1:37 PM: "we need to find efficiencies in the way we do things already."
Efficiency is one metric. Safety and Quality are equally if not more important--because they embrace Outcomes as opposed to Outputs. We are all too aware of the cost of making efficiency the overarching metric of success.

Anonymous 1:58 PM: "Low hanging fruit has been hanging for a decade--no one ever says what it is but everyone seems to know it is there just hanging on the vine."
AGREE with qualification.
The opportunities are most definitely there IF YOU ASK and IF YOU WORK WITH THE CLINICIANS to convert them into delivered and on-going improved services. We have had enough of demonstration projects, etc.

Overall, the Commonwealth has failed to establish a basis of trust; it has instead attempted to dictate how we should identify, confirm and convert the opportunities.
The opportunities the Commonwealth sees don't accord with the view of clinicians and patients who seek apparent value for all the taxpayer funds invested.

It is time we started afresh.
We could start the re-think, re-design with a few overarching principles:
1. Trust--a higher level of trust is required to succeed;
2. Care at the Centre--clinical leadership is necessary for reform and safer, higher quality and more efficient patient journeys the focus;
3. Embrace of Digital Pathways;
4. Purposeful, organized collaboration--to achieve a revolution in quality of collaboration connecting the physical human sphere of health with the electronic sphere.

I do really like Professor Brian Schmidt's comment regarding 'standing in a field of cowpats' as a telling commentary on our current dilemma.

Anonymous said...

John, nothing conveyed to me a sense they understood the doctor, nurse, patient relationship and interactions. There was little evidence they have any deep understanding the health system and how it works. I thought their feet were well off the ground. In the main what I heard was superficial perspectives wrapped up in aspirational futuristic chatter which no doubt will be used to secure a lot more funding for …….. ? By all means feel free to disagree.

Bernard Robertson-Dunn said...

My reading of all this is that they are trying to automate what is already there. All they will do is entrench existing practices, not develop innovative ways to do things (old and new) better.

And asking people what they want from eHealth is vacuous. As Henry Ford is supposed to have said, "If I'd asked people what they want they would have said faster horses." And I know Tim is aware of this quote - I said it to his face and I'm sure he'd heard it before. He listened but didn't hear.

To be fair to ADHA and the government, I haven't seen any place in the world that has made major, step-change improvements to the practice of medicine. IMHO, what this lot is guilty of though is thinking they know the answers - hubris.