Tuesday, January 17, 2017

I Think It Is Important We All Express Our View On This. Time Is Running Out.

This appeared a little while ago.

National Digital Health Strategy consultation: What have we learned so far?

Created on Friday, 13 January 2017
How should Australia take advantage of the opportunities that new technologies offer to improve health and care? What do Australians want and expect from a modern healthcare system?
Over 600 online submissions have been received and more than 2,500 people have attended meetings, forums, workshops, webcasts and town halls across Australia – watch the video below to see what the Australian community has been saying!

Survey and written submissions

Our survey provides you or your organisation the opportunity to have your say about the future of digital health in Australia.
Alternatively, you are also welcome to send us a written submission. To provide us a written submission, email your feedback directly to yoursay@digitalhealth.gov.au.
Submissions will be collected until Tuesday 31 January 2017, 5pm AEDT.
For more information and how to have your say on the future of digital health, visit https://conversation.digitalhealth.gov.au or follow our hashtag #YourhealthYoursay
Have any further questions? Please contact us on 1300 901 001 or yoursay@digitalhealth.gov.au.
Here is the link:
As you watch the video there are some interesting issues raised.
1. Lots of people want to be able to request repeat scripts (myHR can’t do this)
2. Clinicians want, among other things, communications with patients before and after consults (myHR not designed for this)
3. Clinicians want high quality, complete information on which to base decisions. (Enough said.)
4. Clinicians want technology to save them time…(in their dreams navigating the myHR!)
5. Clinicians want better Standards and for them to be used to enable interoperability. (What a good idea after 10 years of NEHTA beating up on Standards Australia.)
6. Privacy and security need to be a focus for clinicians.
Amazingly from all this they seem to conclude that putting technology and data to work safely will improve the lives of citizens and foster happier and healthier lives! To me, and my recent poll supports the idea, this is quite a big leap.
See here:
The bottom line is that those who are interested, no matter what their view, should put something in!


Terry Hannan said...

David, I checked the video and completed the survey. The video confirms what we already know. There is now reference to the how in solving our current health care issues.
There is now mention/acknowledgement that the current tools are not working and there is no uniformity of health care delivery through standardisation and interoperability.
The answers and culture of 'sharing' health care information are not simply solved by saying 'we want'.
We need to ask 'why' after decades and billions of $ we remain with a costly, error-prone, highly variable and poor access health care system.
Anyhow these points wer the focus of some of my survey responses.

Bernard Robertson-Dunn said...

Terry, re: "There is no(w) reference to the how in solving our current health care issues."

Can I suggest there is no analysis of exactly what "our current health care issues" are?, other than hand waving such as "help!!! it's all costing too much, we must do something or we'll go broke!!"

You can't solve a problem (other than by accident and good luck, which is not a reliable strategy) unless you understand the problem. Asking people what they want, is not identifying a problem, it's asking for symptoms.

In healthcare, of all professions, it's obvious that a symptom (e.g. a headache, a pain in the chest) is not the same as the cause. And even if you identify the cause, you don't necessarily understand the problem - which is to address the cause (i.e. solve the problem)

Chest pain -> emphysema -> smoking. OK, we know the symptom, we know the cause of the symptom, how do we fix it? a) cure the emphysema (if possible) b) stop the patient smoking (if possible) and b) improve their lifestyle/diet (if possible).

There's a big big gap between data and health outcomes. ADHA at least has to acknowledge this simple fact. At the moment ADHA doesn't even have heath outcomes on its radar.

CCNet said...

I have always had it instilled in me to take small steps [in the right direction], yet the discussion paper promises the earth. Little is about the immediate problem - creating and sharing health information within the clinical setting for the good of patients and thereby clinicians.
Measurement of safety and useage data, quality measures set in collaboration with those who could use them if they were appropriate can follow when we get that first step right within clear principles and standards

Terry Hannan said...

Bernard and others, firstly Bernard thank you for comprehending the meaning behind my typo errors.
I agree with all your comments.
You are perfectly correct it is not just about the costs it is about patient quality and outcomes which of course are directly linked to costs as clarified by Brent James in his QMMP study. "Quality and costs are two sides of the same coin…..
Anything you do to one affects the other. (similarly, costs control access.
Excluding the USA our health costs as a % of GDP are the same as all other OECD nations regardless of the health care models of delivery so we need to look at why. For some the answer lies at the core of health care delivery-unsupported Clinical Decision Making within a Federated model of care where there is no coordinated system of national health care delivery that makes it standardised and interoperable. Even the infrastructures such as hospitals e.g. Fiona Stanley and Royal Adelaide Hospitals seem not to even get the basics right.
Add to this we have a national eHealth model (MyHealth Record vx.x) that is simply unable to meet the nations needs. I could go on and I am happy to be contested on my points of view.

Bernard Robertson-Dunn said...

No problem. This blog is a relative haven of sanity and tolerance (apart for an intolerance of incompetence and self serving behaviour - IMHO).

To add to my thesis and your contention "we have a national eHealth model ...", this is from:

"Clinical information you find within your patient’s My Health Record should be interpreted in much the same way as other sources of health information. It is safest to assume the information in a patient’s My Health Record is not a complete record of a patient’s clinical history, so information should be verified from other sources and ideally, with the patient."

In other words it is unreliable and potentially unsafe. And if the government thinks that the patient can verify things like diagnoses, treatment plans etc, then they are even more naive than I thought.

Bruce Farnell said...

Thanks for alerting us all to this David.

For my part, I did complete the form. My comment regarding the myEHR is that it should be dumped immediately. My key point was that it fails any patient safety test that could be applied. The only reason that no-one has died (that we know of) as a result of a clinician relying on this incomplete record was that no clinician would use or trust the information presented.

I could be wrong of course. I hope no-one has died.

Anonymous said...

I completed the questionnaire and did not mince my words. The problem with it is that it was worded in such a way as to entice (seduce) (trick) most unwitting respondents into giving ADHA the answers they wanted which they could subsequently use to support their ongoing activity and in so doing justify their existence.

Also I noted that some of the questions were targeted at the health care 'consumer' and then suddenly further on I got the distinct impression the questions were targeted at 'the health practitioner'.

This indicated to me that the people who constructed the questionnaire were clearly confused about their target audience and I respectfully venture to suggest that the reason for this was because the designers of the questionnaire were poorly briefed and conflicted.

As a useful questionnaire I rated it with a score of 2 out of 10. Basically a waste of time and deceptive to boot.

Anonymous said...

Bride I think your remark to dump the GovHR begs the question - how many others have also stated this and will it get a mention, what is the criteria for feedback to be used as informed feedback, what will they do if enough ask for it to be dumped. What is an alternative to allow the evolution of an open digital health system into the future based on innovation, policy and standards?

Anonymous said...

+1 for dumping it, and getting rid of the ADHA, but felt like a waste of time. They won't listen and the CEO's history with the UK system is a concern. Clearly they want it to appear to be working and couldn't care less about making anything actually work. This is a swamp that needs draining.

Anonymous said...

Re: 12:12 and previous contributors – “dumping it (My Health Record) and getting rid of the ADHA”. Are you delusional or are you right, or both? ADHA (Kelsey) is delusional and the delusion is self perpetuating if today’s PulseIT article on the Telstra Health strategy is any indication.

“ …… Telstra Health hopes to bring out in near future is its patient interactive platform, which Ms Whelan said is at a working prototype stage. The platform will bring together elements from Telstra Health's stable of technology applications such as electronic referrals, secure messaging, electronic prescriptions and appointment bookings into a smartphone-based app that will also be able to interface with the My Health Record.”.

….. “Ultimately it is our intention to plug in to My Health Record, so you bring together the patient health record as well as access to those various capabilities.”

….. “It will be a standalone app that you have on your phone and it will have an API that plugs in to My Health Record so it can access information from it but it can also put information back up to My Health Record.”

So a smartphone-based app will be the eHealth panacea. It will talk back and forth to My Health Record. Interoperability – eat your heart out.

How delusional is that?

Anonymous said...

8:46 am. I think you confuse intergration with interoperability, especially open interoperability in a health care sector

Integration is a process of getting disparate technology, such as medical devices and an EMR system, to send and receive intelligible data by the simplest means possible. Interoperability, on the other hand, is far more complex. It is a means of connecting patients, a variety of medical devices and IT systems in a way that brings about new meaning, context and clinical insights through the combination of diverse sources of data. True interoperability should be the catalyst for improved patient care and safety, and real-time clinical workflow by providing an entire suite of functions and meaning from each device, not just a limited set, or constrained to a single platform or vendor product stack. Seeing interoperability as a technology issue is perhaps the biggest disservice that has been achieved to date.

Anonymous said...

8:46 AM said "So a smartphone-based app will be the eHealth panacea. It will talk back and forth to My Health Record." Delusional is an understatement Has anyone tried to tell Telstra Health?

Anonymous said...

Excellent clarification 10:55 AM. In the PulseIT article Telstra uses ‘interoperable’, ‘integration’ and ‘interface’ in the following context:

1. Telstra Health plans to release new interoperable products and platforms built upon the foundational technologies it has acquired, including an app-based patient interactive platform that will plug into the My Health Record.

2. looking at integrating the different companies and brands into one Telstra Health whole

3. The strategy is to offer platform-based technologies that will be open and interoperable,

4. Healthcare is so fragmented that if you create closed platforms and they are not interoperable, there is absolutely no way you can actually bring about a seamless transfer of information. That is ultimately what we are seeking to deliver

5. One of the new platforms Telstra Health hopes to bring out is its patient interactive platform currently at a working prototype stage. The platform will be a smartphone-based app that will also be able to interface with the My Health Record.

Bernard Robertson-Dunn said...

Anonymous January 23, 2017 10:55 AM defined Integration and Interoperable exactly opposite to my understanding of the terms.

That worries me because either I’ve misunderstood the terms or the health industry has a different view of them, or both, or something else.

To me interoperable is a technical/interface, data exchange issue whereas integration is the more complex task of combining and using that data in a meaningful way.

I went looking for some clarification/definitions. Here are some I came across.


What is Interoperability?

Interoperability describes the extent to which systems and devices can exchange data, and interpret that shared data. For two systems to be interoperable, they must be able to exchange data and subsequently present that data such that it can be understood by a user.

And on this page:


Normalized and Integrated Data

Pulled from multiple clinical, financial, and operational system sources and integrated within each of these and across all of these sources.

Integrated claims from all payers (access to an all payer database)
Encounter data for all settings within organization
Structured clinical data available from multiple sources within organization, including patient supplied
Structured clinical data available from providers external to organization

I then looked at Guide to Health Informatics, Third edition by Enrico Coiera, where I get these definitions

Data integration: The process of combining disparate data and providing a unified view of these data.

Interoperate: that is, to share information in a structured way that is understandable by all.


Interoperability standards typically define either the syntax (structure) of a message or the semantics (allowed intended meanings) of a message, but make no assumption about how a message is to be used. Standards can however operate at a higher level, specifically defining the purpose for which a message is to be applied.

All of these definitions align with my understanding. If there is a widespread use of the terms in a diametrically opposite manner, then I think we've all got a big communication problem.

john scott said...

Colleagues this conversation is the type that we have long wished for. Lots of knowledge and willing contributions.

For my part, I have always seen the MyHR as an utter waste of taxpayer's money and a serious threat to the health and well being of individual Australians. Fortunately, as far as we know no one has died from a clinician relying on the information contained in a MyHR record.

All of which means that we have to return to the fundamental challenge: How do we achieve a revolution in the quality of collaboration?

As I have suggested in earlier comments, in our solution architecture we need to:
1. purposefully separate the physical human sphere of health from the digital sphere;
2. establish a collaboration mechanism that can sit beneath and between these two spheres to enable issues to be resolved in the relevant sphere and where the challenge requires a joint solution to facilitate that; and finally,
3. demonstrate how we can engage with government acknowledging that government has to work out how to act responsibly and responsively.

This is all doable.

But we need to first identify and seriously address the absence of a way to work together. All else pales into insignificance.

Anonymous said...

Bernard you are both correct and incomplete, you reference technical or technology interoperability, I would suggest you look at the European interoperable framework, ONC interoperability or even the eHealth interoperability framework or the Australian standard version, you also require legislative/policy, business agreements processes etc..

If we cannot agree to work together or legally able to then the best technology in the world won't make a blind bit of difference.

Bernard Robertson-Dunn said...

Anonymous said..." Bernard you are both correct and incomplete ..."

I certainly wasn't trying to be complete, I was trying to confirm (or change, if I turn out to be mistaken) the difference between interoperability and integration.

Neither was I trying to limit the full scope of either to technology.

Looking at the European Interoperability Framework for Pan-European eGovernment Services

1.1.2. Definitions and objectives

Interoperability means the ability of information and communication technology (ICT) systems and of the business processes they support to
exchange data and to enable the sharing of information and knowledge.

Which seems to agree with my understanding of interoperability - the ability to exchange data.

And, yes, there are far more problems associated with both interoperability and integration than just technology.

In fact, that's probably one of the reasons PCEHR/MyHR is doomed to fail. It didn't (and hasn't and doesn't seem likely to) address the non-technical issues.

Anonymous said...

The lack of interoperability is a business problem. It is a policy problem. It is a political problem. It is a healthcare problem. It is a vendor designed proprietary system problem. It is social problem. It is a personal problem. It is a moral problem. It is NOT a technology problem – we have all the technology available right now we need to make it work!

I know what some of you will say, I am naive, I don’t understand the issues. That’s nonsense! I understand the issues perfectly. What I don’t understand is why we all seem to buy the rhetoric spewed forth by those that need to protect market share, now Tim seems to use good people and I am sure he is consulting with experts in this field

Bernard Robertson-Dunn said...

Re Anonymous January 24, 2017 9:42 AM

I don't think anyone is disagreeing with you. The discussion (at least the comments I've been making) has been on the difference between integration and interoperability.

Yes, ineroperability is far more than (but does include) technology, but what is more important is the way the data and processes are integrated.

If all secure messaging ends up doing is transferring pdfs from one health service provider to another, then ADHA might claim that it has delivered interoperability.

What it won't have done is do much for integration.

IMHO, interoperability is a necessary but not sufficient enabler (as is technology) and is mainly a cost issue.

Value comes from well architected, designed and implemented integration of data and processes, which has very little to do with technology.

And re ADHA, looking at the legislation that created the agency, Integration and Interoperability are mentioned once each.

Under Functions of the Agency
1) The Agency has the following functions:
(e) to develop, monitor and manage specifications and standards to maximise effective interoperability of public and private sector digital health systems;

Under Functions of Clinical and Technical Advisory Committee, which has the following functions:
(b) to provide advice to the Board about the architectural integration of digital health systems;

My interpretation is that the ADHA values interoperability (an agency function) much more than integration (a committee advisory role)