Sunday, March 26, 2017

AusHealthIT Poll Number 363 – Results – 26th March, 2017.

Here are the results of the poll.

Innovation and Science Australia Chair Bill Ferris says the Health Department's myHR "can become a valuable resource for better service delivery, prognosis, diagnosis and the basis for a whole pile of new business applications, including precision medicine." (AFR Mar 16, 2017) Do You Agree?

Yes - Its a great innovation 3% (6)

No - He's on the Kool Aide 84% (147)

I Have No Idea 13% (23)

Total votes: 176

I think it would be fair to say readers believe Mr Ferris should stick to talking about what he has expertise in.

A really great turnout of votes!

Again, many, many thanks to all those that voted!



Andrew McIntyre said...

In the latest "Secure Messaging Project" there is a move to use PDF to move documents between providers rather than actually try and get some atomic data on medications, past history etc. That would dumb down eHealth to the level of the PCEHR and great the equivalent of a fax network. It would also stop the transfer of atomic pathology (which is in V2 format), the only real atomic data we have currently.

While I appreciate the powers that be are very hungry for some sort of win, not really having any runs on the $2B score board, This would be short sighted and locks us into a system that can't add any real value above what fax already does. Its sad that there is no vision in the leadership. The high level grand plans need to be backed up with real measures the get us on to the path again. I fear that superficial "pat on the back" commentary like this just perpetuates the illusion that we are on the path to somewhere rather than off the track in the weeds in the dark. eHealth in Australia has no compass, there are cliffs everywhere. We need to be on the road to meaningful decision support, even if we accept a rough track as a starting point.

Anonymous said...

Could not agree more Andrew, however with crusade statements like 'bonfire of the faxes' we are having a hole dug for us at a huge expense to remove a technology that would retire gracefully on its own.

Anonymous said...

Really? PDF? Is that just the P2P format but the PCEHR contribution is level 3a 3b CDA?

It is to early for April Fools so I am struggling here Andrew to understand or is there something in FHIR that has been poorly articulated?

Anonymous said...

@Andrew: the name of the games are "milking the taxpayer" for "jobs for mates". There is plenty of "vision in the leadership" for that.

What is you need is a "meaningful democracy" - starting with a diverse, funded, accessible media and participation in decision making - as a precondition for "meaningful decision support". Otherwise continue with the rants in splendid isolation for many years to come, whilst we have to continue working outside the 'system' with alternative solutions both past (paper) and whatever else is available in the present.

Anonymous said...

It fell to the leadership of the ADHA in one of the supreme crises of the world to be contradicted by events, to be disappointed in his hopes, and to be deceived and cheated by a narrow view that we the people are enslaved to the wicked fax machine. But what were these hopes in which he was disappointed? What were these wishes in which he was frustrated? What was that faith that was abused? They were surely among the most noble and benevolent instincts of the human heart-the love of big open data, the toil for open data, the strife for personal information, the pursuit of open data as a currency, even at great peril, and certainly to the utter disdain of popularity or clamour. Whatever else history may or may not say about these terrible, tremendous years, we can be sure that The ADHA leader in 2017 acted with perfect sincerity according to his lights and strove to the utmost of his capacity and authority, which were powerful, to save the world from the awful, devastating struggle to use the personal health information of citizens to suppress and undermine the ethics of the medical profession . This alone will stand him in good stead as far as what is called the verdict of history is concerned.

Anonymous said...

Well, he is a history graduate, specialising in Turkey. What a delicious irony.

Anonymous said...

Andrew is medical objects heavily co-involved? Surely co-design means medical objects is directly responsible for the long term implications of what is done now?

If we are to live with PDF then all involve share that strategic direction.

Anonymous said...

Co-design, I think you should consult your doctor or pharmacist before swallowing anything from the CEO or Executive General Managers

Andrew McIntyre said...

Well medical-objects is involved, and we are pushing for something clinically useful, that's what I want, a medication list in a referral so we can create a proper record for a new patient. The pressure is on to accept pdf, and this is part of the fight against it! I would rather work in isolation than join the lemmings running in the direction of the cliff.

Dr David More MB PhD FACHI said...

I think the response to the original post on a Sunday emphasizes the importance of the point being made.


Anonymous said...

Thanks Andrew, I could understand some debate over V2 vs CDA, or tension between what a GP wants and. Specialist wants, that's all good health information debating, but PDF? Who on earth benefits from a PDF? If it is not CDA then PCeHR cannot accept it. Medical Objects has my support for what it is worth.

Where is the ADHA board in all this? I thought they were suppose to be skills based

Bernard Robertson-Dunn said...

Which clinical document(s) are we taking about?

It's not just the content that matters, it's who can upload what. e.g if your dentist, hospital or a GP other than your nominated healthcare provider prescribes or gives you something, they can't upload it.

Anonymous said...

Good points Bernard, for context SMD exchange is based on three use cases at present, that was my constraining factor.

Andrew McIntyre said...

You can put pdf into CDA or V2. For some reports its probably ok for now, but not any sort of referral. The pathology in PCEHR might be CDA but its level 1 with a report image as pdf and no atomic data. I am not aware that has started as yet. If it does it will be a big test for PCEHR scaleability!

For PMS systems most already support REF messages, which can contain atomic V2 pathology/radiology and atomic medication/allergies and can contain atomic summary data. We have standards for all that, it just needs to be done, agreed to and tested by PMS systems.

Not having atomic data for referral means that the receiver has to start a patient record from scratch. REF messages would work for all the use cases. We are talking about messages going between providers and not data heading to the PCEHR.

The important thing is that all recipients can reliably receive and render the content, without that its pointless. Certainly getting everyone to support pdf would be easier but we enshrine a glorified fax network and once done many would be happy but its a dead end wrt adding value to patient care above an beyond what could be achieved by a fax machine.

In my view CDA is legacy, narrow (Purpose specific), poorly modeled and generally not atomic enough. FHIR is not mature enough and there is limited existing support meaning major implementation. We need to get the bugs out of the existing V2 and make it reliable, which is basically a bug fixing task. It makes including V2 pathology, without loss of atomic data very easy. Its making what should work now actually work.

Anonymous said...

Does PCEHR support V2? Like it or not the PCEHR is the constraining platform for innovation. If it can't be a conformant document for the PCEHR then why would we invest in it?

I am simply interested as I also thought Victoria was championing CDA in their referral projects

Anonymous said...

I just did some checking on SMD, the Executive running it LOL, don't hold your breath waiting for anything of value to come about. Remember the specification having to be recalled in 2011, that is only the tip of the iceberg.

Anonymous said...

@ 4:05 PM "Where is the ADHA board in all this?

The Board is involved in high level strategy. They are not involved in operational and product development detail. Regardless, they don't have the depth of knowledge and experience to do anything other than accept what they are told by Board sub-committees, the CEO and his General Managers. As for bending to political pressures from the jurisdictions - Yes Minister's, of course Minister, again notwithstanding the fact that the Ministers depend on their bureaucrats for guidance and advice. The circle is closed, the wheel revolves and the poor little mice keep run, run, running getting no, no nowhere.

Andrew McIntyre said...

The PCEHR has nothing to do with inter-provider communication which is what we are talking about with SMD. There is no constraint, V2 has a display segment which could go to the PCEHR. Labs convert V2 to a pdf. Constraining eHealth to the PCEHR capabilities is not a wise choice! That would eliminate all the atomic data we have.

Anonymous said...

@.03 pm - "We are talking about messages going between providers and not data heading to the PCEHR."

You may well be but hey, ADHA's, Paul Madden's and Tim Kelsey's overriding and abiding interest is first and foremost getting messages (stuff) from providers into the PCEHR (don't you mean the MyHR?). Getting stuff to flow back and forth between providers is your problem not theirs; although the ADHA might not readily admit to that. Don't forget Mr Madden set this pathway up for the Department, he laid out the strategy (superficial though it was - at least the public version) and drove the establishment of the ADHA and the MyHR pilot sites. He has a huge amount riding on this not falling over and he doesn't understand why it will fall over.

Anonymous said...

7:58pm Mt understanding is the GovHR (sorry it is definitely not myHR) is the strategy and only game in town. That is clear from the discussion tweets and other narrative in the public domain. A key question for SMD is how accomodating and easy is it for a new SMD provider to enter the market?

I would be very careful the current providers are not being setup to be taken out of the market, they only need two of you to start the ball rolling. If only one does the ADHA bidding then you have a chance

Anonymous said...

7:56 pm Bang on. Andrew you are dealing with contentbfree people because they are safe hands, will not rock the boat, because they are career APS and will be rewarded as they have in the past. The MyHR is the information exchange, was always meant to be and remains so. Can it do the job? That is yet to be seen, but Telstra can fill the void if required. Bug fixing standards is not something that will be supported, they made that quite clear.

Anonymous said...

You may well be but hey, ADHA's, Paul Madden's and Tim Kelsey's overriding and abiding interest is first and foremost getting messages (stuff) from providers into the PCEHR (don't you mean the MyHR?)

Absolutely and Accenture will build and run it. When yet again it is highlighted that is is not being used, the answer is to blame the culture as is the golden rule in consultancy and management alike. And of course once blame has been allocated we end up with a visitation from the cultural change specialists with their tool kit of communication plans, key drivers, motivational posters, games and the like.

SMD is part of the smoke and mirrors.

Anonymous said...

Surely no one is suggesting SMD was funded simply to provide the perception that certain stakeholder cohorts were being engaged for meaningful purposes? I think taking the MSIA, RACGP and Secure messaging community for a ride is far to creative

Anonymous said...

"Does PCEHR support V2? Like it or not the PCEHR is the constraining platform for innovation. If it can't be a conformant document for the PCEHR then why would we invest in it?"

Has big brother spoken? No one can do anything that the MyEHR can't do? really

Bernard Robertson-Dunn said...

IMHO, many (most?) people are ignoring the elephant in the room when it comes to health records – the reliability and accuracy of the data.

If you are in hospital and/or receiving ongoing care from a specialist, then the data in their health records are likely to be up-to-date, accurate and fit for purpose.

However, data in a GP’s HR or the MyHR is of a totally different type. That data is, by definition, historical. It might be wrong (Poor diagnoses. See recent reports of the misdiagnosis of a patient with tuberculosis), the patient will have aged, the patient may have developed an illness or disease, the patient may not be taking the medications they have been prescribed, they may have changed their behaviour (e.g. gone on a diet, given up smoking) etc. People are dynamic; health records need to recognise this and deal with it.

Data standards and good management of data in a health record are necessary but not sufficient for a health record to be of value. What is most important is that it can be relied on and accurately reflect the status of the patient. Achieving this goal is very, very difficult but is not recognised at all in the MyHR documentation or its implementation.

The number one rule of health records is that they can’t be trusted. The government themselves say this on their website.

Health professionals are often accused of conducting un-necessary tests. More often than not, they are probably trying to get at the most current tests they can. Even then the data could have aged.

IMHO, what health professionals need to make good decisions is not historical, health record data, it is data on the patient in front of them when the decision is being made. This data is most likely going to come from the realm of medical Internet of Things – real eHealth.

Most certainly it won’t come from some government owned data dump in the sky, full of old, unreliable, and potentially inaccurate information.

Andrew McIntyre said...

I often see patients once, for an opinion or procedure and creating a full health record from scratch is not really viable. I usually go through the text based medication list in the GPs letter and usually put a line through 50% of whats there as its everything they have ever taken. Actually getting the atomic data in a referral would make doing this easy and having it in an electronic format would allow decision support.

We need to aim for atomic data in referrals which can then be amended when they are reviewed and potentially sent back with the updated information. We are continually going from text to atomic and then back to text. Its the events that cause an update to information and the primary flow is from provider to provider. We need that flow to be digital and stop doing the analogue to digital conversion at every stop. PDFs enshrine this inefficient lossy workflow which stops smart decision support being even considered.

Because referrals involve patient contact the information is likely to be the most current. Who knows when the MyEHR was last updated or reviewed.

Bernard Robertson-Dunn said...

I mostly agree that a referral is better than MyHR, however, if a referral is more than a month or so old, it can be just as unreliable.

And I doubt that you need most of the data in a full health record, only what is relevant to you at the time you see the patient.

However, knowing what is relevant is not an easy problem to solve. In some respects its a no win situation. Too much and you might miss something critical, too little and something critical may be omitted.

IMHO, these are the sorts of problems that should be debated first.

Anonymous said...

I find the GP or specialist a great interpreter and judgement caller, perhaps we should ask them. I fear the professions in all this are treated the same as the Matron was all those years ago by little bean counters who do not understand value, surplus to requirement

Andrew McIntyre said...

The referrer is in a position to judge what is relevant to the person who is getting that patient. A basic summary and list of medication is probably always relevant. What other tests are included is a matter of judgement best made by sender. To much information is as bad as to little and that is a problem with MyEHR. Somewhere in all that info is an important fact that you should have seen but didn't because you were overwhelmed with useless dribble.

Anonymous said...

I got a bit lost amounts all this. Andrew is it now just a case of PDF vs something a little more forward looking?

Does that now mean that all the infrastructure is agreed and in development?

Are we on track to deliver a working equitable secure messaging platform for Australia that also allows new players to enter the market?

AnonymousMarch 26, 2017 11:49 AM. That sounds like a good discription of the problem.

Dr Ian Colclough said...

March 27, 2017 5:10 PM Andrew said "Too much information is as bad as too little and that is a problem with MyEHR. Somewhere in all that info is an important fact that you should have seen but didn't because you were overwhelmed with useless dribble."

Andrew has summarised the problem perfectly.

It should not be all that difficult to develop and deploy the essence of what the clinician wants to receive in a referral. Yet, time and again, it is made so complex and so difficult to give the clinicians what they want and need.

The solution will never be developed by committees.

Unless the right people are engaged to develop the solution the problem will not be solved.

Andrew knows what he wants and needs and so do many of his colleagues. But as individuals we are not in a position to develop and deliver such a solution, let alone deploy it on a large scale once developed. Yet, all the ingredients required to do the job are there, ready and waiting. Only two elements are lacking - leadership and resources.

As Churchill said - 9 February 1941 - "Give us the tools and we will finish the job."

Anonymous said...

You will need to move fast, it will be another five years before another opportunity comes around.

Andrew McIntyre said...

"Does that now mean that all the infrastructure is agreed and in development?

Are we on track to deliver a working equitable secure messaging platform for Australia that also allows new players to enter the market?"

The number one precondition is a message that can reliably be imported and rendered by all recipients without tweaks. There is no messaging market until that is done. What we have is standards checker/interface engine/bug fixer/format converter/rtf simplifier (oh and messaging) Market.

On top of that we need to actually transport something clinically useful that adds value. That is not a pdf document wrapped in any standard you like. Perhaps we could just transfer Tiff files? A cheap reliable solution to that is called a fax machine.

john scott said...

Colleagues, the above conversation chain demonstrates well the critical need for a solution framework that separates the human communications taking place in healthcare from the digital sphere of contribution.

We need this separation to enable doctors, nurses and allied health professionals to work out how they want and need to work together and the information flows necessary to support this preferred behaviour. This is normative territory and the health communications norms have to be established by health for health. This is the domain of Duty of Care.

In order to complete the connection with the digital sphere we need to ensure there is sufficient focus on semantics. The meaning has to be the same at both ends of an information flow. Absent this, we violate the points made by Bernard at 9:58AM.

The conversation also demonstrates clearly why we have to distinguish between health communications and the various electronic health record repositories. We need to be clear what purposes they serve and the different imperatives they operate under.

Finally, Ian's comments at 6:57PM home in on the absence of an independent, trusted collaboration mechanism. We don't have an absence of knowledge; we have an absence of organized, purposeful cooperation and collaboration focused at the point of care delivery and able to facilitate the clinical journey toward a better way of working together.

Anonymous said...

There is also another program starting, how does this support SMD and Andrews needs - Pulse IT - Program reset to restart diagnostic imaging report uploads to My Health Record

Anonymous said...

As a patient and consumer (a tax paying one) exactly how does this deliver value to me, my care team and the broader community?

Anonymous said...

As a patient and consumer (a tax paying one) exactly how does this deliver value to me, my care team and the broader community?

Good question, perhaps the RACGP would like to answer that? They insisted this was the answer to our woes

Anonymous said...

How does this deliver value to you and your care team? Not sure it does am not convinced that was the intension. It has certainly placed some vocal parts of the community in a tight spot. I think other wiser ones worked that out and have been somewhat silent for many months. Rolled and bowled comes to mind.

Dr Ian Colclough said...

@ 9.23 pm, March 27, moving fast is not the answer; quite the contrary - moving fast will cause mistakes to be made and lead to more disasters. That is to be avoided at all costs. It’s a Catch 22. Better to err on the side of caution to contain and minimise risk.

You seem to be advocating the need for a ‘first mover advantage’. Mmmmm - the road is littered with plenty of first mover disasters.

You suggest, “it will be another five years before another opportunity comes around” that’s ludicrous. The opportunity is here now and it won’t be going away; until someone comes up with ‘a new way of thinking’ about how to address these ‘wicked problems’.

Anonymous said...

Ian, I agree, however if you read the comment slightly differently then perhaps if something is not done quickly to address Andrews concerns we will be stuck with something not better than a fax network. That may then become the norm until a new strategy is developed in five years, so probably seven years to move forward.

There is always the chance that making SMD a less than optimal outcome the MyHR can then claim a role in fixing that and becoming the only exchange option.

That might sound ludicrous but perhaps that sort of thinking is not ludicrous in the minds of those in charge of setting the agenda.

Anonymous said...

March 27, 2017 6:57 PM If all the ingredients required to do the job are there, ready and waiting how do we identify them and how do we put them together to finish the job?

john scott said...

Colleagues, there is agreement in these recent comments which point to the critical question: is there anyone in the Federal Government, Minister or Bureaucrat, that recognizes we have a real problem and is willing to hear a new way forward?

Ian is absolutely correct when he states that we need to move with caution. The connection between the physical human sphere of health and the electronic sphere necessarily has to start with the Duty of Care and delivery of information at the point of care.

Anonymous at 9:57PM is also right, IMHO, we need at least a signal of a move away from the present strategy.

Anonymous at 3:12PM is equally right that we do have all the necessary knowledge ingredients. When I say this I include a mature solution framework focused on enabling and supporting care delivery using digital pathways.

Importantly, a new and different approach would save us a shed-load of money and not a little political good will and trust.

So, we are left with the critical question: is there anyone who wants a different and productive approach? Or, will our digital health / e-health strategy be another case, as Dr Martin Parkinson describes, of ignorance and arrogance?

Anonymous said...

A new and different approach, YES YES, and not simply because of money, the current solution and approach has no part in a modern world and to a great extent I wonder if SMD does. The problem and requirements remain, reliable useable clinical information, consumer access to there own information, all secure and shareable in a trusted community.

They claim health needs to be like other industries, all very good, so why champion a centralised hard drive for stuff?

I listen to the newspaper boy and the girl from MTV and wonder if it is all a dream and I will wake up with an anaesthetist staring at me.

We need standards and policy to drive innovation and interoperability, what do we get, year 1 inability.

Anonymous said...

John Scott, I am wondering if we have any other choice but to start again, the landscape has changed, technology allows us to do things differently and if quite amazing ways that ten year ago when the MyHR was first conceived. Like servers in a converted broom cupboard are no longer around neither does a centralised big target have a role. People will work around it and money will keep getting poured into it, I am not convinced as Clinical systems of all shapes and sizes continue to get more feature rich and complex that the MyHR will be able to adapt. We need to build the policies, standards, architecture and distribute code repositories to enable a front foot assurance to the sector

Dr Ian Colclough said...

John 7:15 AM asks “is there anyone who wants a different and productive approach?”
It’s evident there are many well informed commentators who do. So too does the AMA.

But I rather suspect the issue is not “whether or who” or even “how”, it is more one of whether the necessary funds can be harnessed and deployed to underwrite a ‘different and productive approach’. Politically the evidence suggests that would most likely not be warmly embraced by the ADHA, or even the Department, given the reluctance over a long period of time to meaningfully engage (despite numerous approaches for them to do so) in exploring the merits of considering alternate ways of approaching what has so often correctly been described as ‘wicked problems’.

A few well resourced private sector entities have been closely monitoring the progress (or lack thereof) of Digital Health (eHealth) in Australia for a considerable while. In doing so they have been asking among other things:
“Why has it all been made so difficult?”,
“Where is the clarity of vision?”,
“How could we contribute in way which would shift aside the barriers to progress?”,
“What would be in it for us?”,
“Are we prepared to accept the risks?”,
“How much money would we need to stump up?”,
“How would the money be used?”,
“Will a viable business emerge at the end if we succeed?”.
"What would the business model be?"

Bernard Robertson-Dunn said...

Tell me again who's doing the cost benefit analysis on MyHR

A Report in today's SMH:

"PwC dragged into Vocation class action Litigation Firm accused of audit failures

Sarah Danckert

It’s alleged PwC did not have reasonable grounds for revenue representations.

One of Australia’s largest accountancy firms, Pricewaterhouse-Coopers, has been accused of misleading or deceptive conduct over its audits of failed training college owner Vocation Limited.

PwC last week was named as a defendant in the class action brought against Vocation.

The statement of claim against PwC makes serious allegations about the conduct of the firm and partner Steve Bourke during the audit of Vocation’s 2014 financial statements.

A spokeswoman for PwC declined to comment on the matter as it was before the courts.

"We will be vigorously defending the allegations," she said.

She confirmed Mr Bourke was continuing to conduct audit work on ASX-listed companies."

etc etc .....

Anonymous said...

From the information slides and narrative coming out it is very much about MyHR with some things thrown in. A real tactic to reset the language and a more shift towards what I take as using the public as some sort of leverage against the medical profession. I do not get a real sense this is going to resolve much or advance eHealth. A lot of innovation with no purpose. Far to much emphasis on jaz induced dribble IMHO. I need summary Government has forgotten their role.

Bernard Robertson-Dunn said...

Looking at this slide:

which Tim has retweeted so I guess it is either his or is endorsed by him,

it would appear that NEHTA never existed and that they are developing a new business case for MyHR.

And how connecting people will deliver anything is a mystery to me. Have they not heard of the telephone? People have been connected for decades. Vagueness still reigns.

Anonymous said...

Bernard and just I wonder will lead the work? None other than.....RR

I understand the need to put a patient at the centre but I feel uneasy about the singularity nature of the word me, has all the hallmarks of dictotships that use the word democratic in their nation title. All rather weak and fake if you ask me.

john scott said...

Anonymous 7:56 asked about starting again. Yes, is my short answer.

It has little to do with the technology and all to do with our way of thinking about the challenge and indeed opportunity.
Specifically, it has to do with the way we approach engaging with the two critical spheres. The first is the physical human sphere, particularly the doctors, nurses and allied health professionals. We are fundamentally talking about them getting things done safely, with quality and efficiency.
But we have to get rid of the notion that healthcare is a production system. It is not.
It is a service sector where value and indeed wealth are created through mutuality--not maximizing scarce resources.

In regard to citizens/patients/carers, they require equally special, although different consideration. This is not some simple market choice function.
My and other other patients' decisions and actions or inaction are intimately tied up in the relationships we have with our clinical care team(s).
Yes, booking could be easier.
Yes, it is valuable to have an up-to-date health summary record.
But such a record should never be considered an alternative or replacement for effective clinician to clinician communications, particularly where they are trying to work in harmony together. I want to see them working together for me and with me.

Ian, raised the issue of funding. It is most definitely not an issue of funding.
First, because you certainly do not need a bucket load of funds.
And, you want funds allocated against a proper business case with a means of accountability for the use of the funds.
And, as Ian points out, there is more than enough money sitting on the sidelines, including in government coffers.

Ian's list of challenges can all be answered in a manner that results in forward movement.

The real issues in regard to forward movement are:

1. We are not selling off the health sector to commercial interest.
We are dealing with public values and the future of Australian society.
The collaboration structure that is critical has to be Independent and Trusted and most assuredly kept safe from capture by various interests, including the private sector as well as the government sector.
Our health system is a purposeful mix of public/private, Federal/State/Territory service provision seeking to meaningfully connect with the electronic sphere.
We need to be able to engage effectively cross all these boundaries.

2. We are in fact dealing with what is increasingly called New Public Goods. These New Public Goods create an ecosystem of public and private service and technology provision.

3. We want to create a virtuous cycle investment environment for value and wealth creation delivering social and economic benefits.

And, we are not alone in this journey.

Anonymous said...

Yes everyone says they want change but nobody wants to change. The vendors are betrothed to the ADHA will unlikely do anything other than the ADHA bidding, to gullible to question, and too scared to break away. Sad but as was mentioned the other day in a meeting I afraid you (small to medium Vendors) are owned by ADHA Government and Industry executive and her MSIA mate.

Anonymous said...

@ 6.49 pm
"betrothed to the ADHA" ... you mean entrapped by.
"too gullible to question" ... you mean too naive to question
"too scared to break away" ... you mean insecure and lacking confidence self"
"(small to medium Vendors) are owned by ADHA Government" ... you mean completely vulnerable and exposed, lacking in the courage of their convictions, rendered irrelevant
"Industry executive and her MSIA mate" ... what do you mean?

Anonymous said...

6.49 PM & 9.15 AM The MSIA is hopelessly conflicted. It is intimidated by ADHA Government, it wants to demonstrate that it can lead but it can't be effective because it is undermined by having to address the needs of its many members - ie. large and small vendors and therein lies the rub.

The big vendors have a strong voice and are financially robust able to do their own thing, the small vendors scramble to be relevant with their timid voices and limited resources.

The MSIA could lead a revolution but it is scared witless by the thought of doing so. It's previous President took a strong stand about all that was wrong with NEHTA and got squashed in the process. The MSIA has always been on a hiding to nothing - dammed if you do and dammed if you don't. Rubbing noses with the ADHA in the hope that all will be well is all it can do. From the Government ADHA perspective it is more an unwelcome nuisance to be patted on the head when it feels a bit irrelevant.