Sunday, March 05, 2017

The ADHA Releases A Four Year Corporate Plan Which Lays Out Part Of What Is Planned. I Don’t Recognise The Country It Is Apparently For!

This appeared a day or so ago.

Corporate Plan 2016 - 2017

Created on Thursday, 02 March 2017
The Australian Digital Health Agency is committed to achieving a world-leading national digital health capability, which will advance the efficiency, quality and delivery of healthcare provision to improve the health outcomes of all Australians.
Read more about the Agency’s work and how we’re ensuring that the work we do is shaped around the needs, wants and aspirations of the Australian healthcare community.
The Australian Digital Health Agency commenced operations on 1 July 2016.  The Public Governance, Performance and Accountability (Establishing the Australian Digital Health Agency) Rule 2016 sets out the functions and governance of the Agency. This corporate plan covers a four year reporting period, 2016-17 to 2019-20, as required under paragraph 35(1)(b) of the Public Governance, Performance and Accountability (PGPA) Act 2013 and in accordance with section 16E of the PGPA Rule 2014.
Here is the link:
A minor point but this all seems a little back to front – would you not develop your Strategy first? And then craft the Corporate plan to fit the Strategy? (I suppose they had to do it this way by law – which is cited after the plan?)
There are two parts of the document worth highlighting.
First here:

1.3 Our principles

The following principles guide our work:
  •  Creating capability to transform the Agency – creates the ongoing capability and provides adequate focus on transparency, engagement, clinical governance and innovation and strategy.
  •  Consumer focused – puts consumers at the centre of their own healthcare, and better health outcomes for consumers as the ultimate goal for all initiatives. It supports consumers to be active in the management of their own health and wellbeing, and provides appropriate support for healthcare providers to achieve better healthcare outcomes for their patients.
  •  Supports clinicians – clinicians have safe, useful and usable solutions that support improved health outcomes for consumers.
  •  Strategic – delivers solutions in full knowledge of the benefits and implications for all sectors of the health community, rather than focusing on a specific provider type. Solutions are holistic and cover the end to end solution not just one component, or just the government elements.
  •  Outcomes and evidence based – can demonstrate outcomes that are accepted as achievable broadly by the health community, and deliver real measurable benefits as assessed through robust evaluations by the broader health community.
  •  Co-design – solutions are co-designed and tested through involvement of the various skill groups in the Agency (clinical, consumer, industry, technology design) and external users – both consumers and healthcare providers.
  •  Open innovation – provides a level playing field where innovation is encouraged and successful products deliver what the users (consumers and healthcare providers) want and are willing to pay for, and they facilitate holistic outcomes for the health system as a whole, not just for their own closed community of users.
  •  Sustainable – Results in systems and services where the core systems and infrastructure provided by governments are limited in scope to the standards, secure and private storage and appropriate sharing across the health community in accordance with legal and patient consent. They are efficient and cost effective, and facilitate interoperability. Third party systems that are sustainable in the Health ecosystem are interoperable and do not require initial and ongoing investment by governments in order to innovate and develop and keep the momentum.
  • Transparent – exposure of all Agency commitments and operating costs, proposed plans, activities and projects to proceed as well as those to not proceed, are made available for decision by the Board, and are visible to all staff in the Agency, and the Advisory Committees.
  •  Operational – systems and services that are in use and depended upon by the health community perform their functions to the agreed performance level and provide the required and agreed level of security and privacy.
And then we have this second section:


2. 1 Australia’s health system

Australia’s health system ranks as one of the best in the world and has led to extended life expectancy, improved quality of living and better wellbeing.
 However, there is a growing demand for healthcare reform to prepare Australia for the future and maintain the high standards we have and require.
Demographic and health trends, such as an ageing population and increasing rates of chronic disease, compounded by system issues such as workforce shortages and persistent health outcome and access inequalities, are stretching the financial, physical and human resources of our healthcare system.
The value of digital health initiatives is in how they can improve information sharing between individuals and their healthcare providers, to support better health outcomes, reduce adverse events, eliminate duplications, and improve the coordination and quality of healthcare.

2.2 Digital health in Australia

Digital health is a broad term that refers to adoption of technology in healthcare, including concepts such as eHealth, health IT, clinical and corporate information systems, consumer health, and telehealth. It includes information and communication technology infrastructure, mobile devices and applications, the way these are used, and the integrity and security of information that they capture, store, share, communicate and display.
Over the last decade, Australian governments and the private and not for profit sectors, including the primary and secondary healthcare sectors, have worked together with the aim of delivering a coordinated digital health ecosystem, including building the My Health Record system, the Healthcare Identifiers service and national specifications and standards to support the implementation of digital health solutions.
We are on the path to having a world-class digital health capability that provides new options for how Australians manage their own health and interact with the health system across geographic and health sector boundaries.
----- End extracts.
A point or two.
In the section on Outcomes and Evidence Based we have claims of the delivery of real measurable benefits. Has anyone actually seen any of this at the national level. Please pass on the link if you have!
The last paragraph has me in fits of laughter. If we are on the path now we have only recently found it! The last decade or two have largely been wheel spinning and undertaking ill thought-out nonsense for vast sums of money.
The basis and assumptions of this ‘so called’ plan are not really grounded in evidence or reality. The forthcoming Strategy had better be a whole lot better!


Anonymous said...

Shame I had to find out about this through external sources rather than my supposed employer!. Never even new about this or asked for comment or input.

Anonymous said...

If I were an academic the first thing I would do with this document is put it through "turn-it-in" to be sure it hasn't been plagiarized from another source.

Anonymous said...

David your headline says 4 year plan, did you mean 4 month as this seems to be 2016-2017. Seems rather late in the day I would have preferred 2017-2018. It reads like some in Tims team is less the equal to the task and someone has had to pick it up and get something out to meet some KPI. Not good enough ADHA, the honeymoon period is over. On a positive note there is some heartening insights

Dr David More MB PhD FACHI said...

Read more closely. It is meant to be a 4 year plan!


Anonymous said...

Of course it's a 4 year plan, getting ready for COAG is September where ADHA will ask for another $500 Million to take it through the next triennium. It's the money Tim and the ADHA want, nothing else matters.

Anonymous said...

I might not be as young as I used to be, but how is this a plan, even a corporate plan? What is missing is more telling than to poor content included. Not the standard I expect for Government, how much do these people get a year in funding?

Anonymous said...

ADHA wants evidence based results - how about addressing this dis-benefit then -

Bernard Robertson-Dunn said...

How about some credible evidence that MyHR has actually been used in the delivery of healthcare and/or saved any money?

How about some logical, evidence based explanation as to how any future version of MYHR would be used, how it would deliver value and what that value would be?

The medical research community claims $3 return on every $1 invested in research. If that's the case then this government has lost out on the potential return of $6billion of medical research that could have been achieved if the $2billion had not been wasted on a dumb database system that's never been used.

Anonymous said...

I would expect you could identify the savings and reinvest the ROI to continue it's operation and improvements. Oops *MISSING DATA* .....
After $2Billion spent and several years of operation I would expect to see a ROI that could help pay the past and future costs. The past big Consulting Firm reports of predicted ROI are not real world based and cannot be relied upon for continued faith (ie. no evidence) in the My Health Record system.
The application of the scientific method and evidence based decisions should start with the ADHA and their plans for the future. Asking people for their opinions and vision of the future provides a list of ideas to be tested but does not validate the popular ideas as being better for the future. In the world of marketing you can follow the popular view but in the scientific world you must validate your assumptions and test your ideas (statistically significant).

Anonymous said...

This "plan" seems to be out of sync with what Martin Bowels PSM, was stating very clearly in the recent - The Future of Digital Health, which he was clear on the need for Standards and a strong emphasis on Architecting a new future. This seems to cut that out and goes from Clinical get-togethers straight to developing software, a complete and dangerous mis-understanding or appreciation of the challenges ahead. Most if not all ATS that the government called for to be developed under IT 014 are up for revision based on the standards life cycle. Much has been learned and much needs to be reviewed. Why is this not a strong theme? I believe government has certain obligation under various treaties and policies.

Sounds like an open invitation for disaster!

Bruce Farnell said...

My expectations were not high and I am still disappointed. Is this the best they can do. Really!!!

My understanding is that a corporate plan is much the same as a strategic plan except its scope is reduced to a particular business unit. I am not sure what this is but I am fairly sure it is NOT a corporate plan.

It needs more than motherhood statements for a start. Where is the analysis? Was there any analysis done at all? I suspect not. It is a total disgrace.

Bernard Robertson-Dunn said...

Every government agency I've worked with to develop a plan has required:

A work breakdown (i.e. tasks) specifying actions and outcomes.
Other resources needed,
Critical success factors,

The "High level work plan" (section 5.1) isn't a work breakdown, it's a list of headings, not actions/outcomes.

Of the rest, the only two mentioned are resources and risks. Without the rest, even these are meaningless.

A corporate plan provides details of how the corporate strategy is going to be achieved. Like so many things in this government's eHealth initiatives, it's backwards. The corporate plan says they will develop a strategy, and do lots of other things that seem to have no justification or relationship to a the strategy, which hasn't yet been developed.

The one thing that could have been included in the work plan is the usually last phase of most government IT project plans. "Then A Miracle Happens".

As a government agency corporate plan, it's an embarrassment.

Anonymous said...

12:18. Standards and adherence to such is a requirement under the Finance depart Procurement rules, the MyHR and ADHA will have to have a strong underpinning in standards and their use.

Bernard, the risk is even weak, there is no mention of work health and safety risk, but yet they claim they care about the workforce.

Bernard Robertson-Dunn said...

A risk analysis/register can be very revealing. It can show the level of thought that has gone into a plan and if they have thought through the potential consequences (from the mitigating actions).

Two risks I have never seen listed in any plan, even though its they are the biggest risks are:

1. we are doing the wrong thing,
2. we are doing the right thing but the wrong way.

I won't bore you with my opinion of how these risks might apply to MyHR/ADHA.

Anonymous said...

Anon 2:37. With the greatest respect that statement is rubbish. Anyway we have gone passed the standards usefulness stage and what a waste of time that seems to have been. Standards are too slow for innovation and we are moving toward a more agile and fast delivery stage working with clinicians to deploy software in record time.

Anonymous said...

Ahh 5.42 deliver and deploy in record time. Take shortcuts. Be first mover. Win the race, take the money and run while what you leave behind collapses in a screaming heap. Not to worry - let's do it all again, but faster and see if we can get it right next time!

Anonymous said...

We have gone past standards usefulness?? Health is built on standards, perhaps we should do away with clinical workflows too, while we are it let's just use twitter and instagram.

Anonymous said...

I note the Organisational Excellence section includes a stream of work call 'Making the Organisation Hum'. Is that because they don't know the right words?

Anonymous said...

The phrase comes from VERVE. It goes something like this: When we understand what makes a culture hum, we can focus our energy to build on the valuable stuff , diminish that which drag us down, and consciously design an organisation that connects and contributes to successful business goals; … energetic and creative teams, focused on innovation, flexibility and a real sense of empowerment and ownership of outcomes.
- Recognise change as a constant … a ‘way of life’ … embrace it
- Encourage new and ‘outside-the-box’ ideas from their people
- Involve their people in change processes … every step … with sufficient led-up time before major change events.
- This takes the right workplace culture … the right people in the right roles, and more importantly doing the right stuff in the right way … attracting, developing and retaining the right people.

(Sourced from the internet)

Sounds all very nice in a slide, sadly the execution requires skill and selfless leadership. They gave it to the wrong people to lead and let most saying ummmm. I left and so have a lot of others, some by choice and some victims of old scores to be settled.

Anonymous said...

Bland management consultant motherhood.
And we all know (or should know) what happened to the management consultants in the Hitch Hikers guide.

Anonymous said...

March 06, 2017 12:18 PM. Just clarity although you are so negative I doubt this will help. We have in Brisbane and Standards and Interoperability team, so I can assure you both subjects are staffed and on the work plans for this year and next year. Please give us a chance we have only just started and things are settling down.

Anonymous said...

Perhaps someone in the agency would like to explain why the standards position has just been made redundant?

Anonymous said...

"Please give us a chance we have only just started and things are settling down."
OMG, are you saying NEHTA didn't exist, didn't do anything of any use and you are starting again? Madness.

Anonymous said...

Perhaps someone in the agency would like to explain why the standards position has just been made redundant?

Really! Just what sort of message is the board sending, are we divorcing ourselves from standards? This is madness or is it something more sinister?

David I think we as a community and a tax paying community deserve some answers.

Anonymous said...

Re 11:12 AM - "are you saying NEHTA didn't exist, and you are starting again? Madness."

Dear Madness, I am not saying that.

Let me be very clear - under NEHTA we lost our way and came to a grinding halt for a couple of years until Ian Reinecke was replaced by Peter Flemming. Then we got going again until we lost our way for another couple of years before being rebranded as the ADHA. As we now have a new leader we have had a lot of personnel changes and the new people who have (and are) come on board are finding their feet so we can get going again using a lot of the good work that NEHTA did before losing its way.

Salvaging NEHTA's good work and disposing of the less than useful work is quite a big ask, but we think we are making progress. Things are settling down so we should be able to get really going again in a few months ready for a new round of funding followed by lots of new deliverables for industry to use." Please be patient.

Anonymous said...

I know of those involved in keeping the standards light burning in the Agency. I cannot believe that the were not assigned to other duties. There is something very fishy going on. I hope the board is not being mislead or manipulated, this seems more like workplace bullying or someone has dared asked ' are you sure that is in the best interests of the health community'

Caterpellias undergo transformation, Australia government HIT bodies do not they just get nastier

Anonymous said...

If this is true regarding Agency redundancies and the removal of any direct relationship with standards, then this is very serious and undermines everything. Dr Bond was one of the few people over the years that you could sit down and have an insightful and rewarding conversation with, always keen to listen and learn and very generous with his own time and knowledge, there are few about that you sense are driven by willingness and natural instinct to be open honest and transparent (which we are lead to believe is what the new agency is about) Dr Bond is from my experience is one of those. If this is a statement from Tim Kelsey and the new Board on what we should expect from the future the Australian Digital Health Agency we may well have lost an impartial leader. Clinicians, researchers, vendors, governments, patients and the community as a wholeI are poorer for this assumed situation. I wonder if in all these conversations Tim and others have taken time out to have a conversation with the likes of Dr Bond?

I think a statement from the Board in Standards and interoperability future is needed. Trust is something lost and won through actions.

I do this anonomously as May faith and respect for the ADHA has faded.

Anonymous said...

I doubt the CEO or Board even know or care, after all any culture that is bent on releasing health information to belittle people who complain would have any care factor in them other than their own selfish needs.

Anonymous said...

The NEHTA legacy is alive and kicking, looking at the string of failures with the Executive responsible I would be asking a lot of questions around SMD before it is to late. Asking people is simply a diversion IMHO. Like they say it's not what you know it is who you knot

Anonymous said...

Confusing signals abound, it was only a few months ago the ADHA was meeting various standards chairs and things were looking promising, then some less the open discussions began, then a few weeks ago one SDO Chair was concerned the ADHA was going to set-up as an SDO albeit the information I believe, came via someone inside the ADHA and not a direct position from the standards team.

Now the closing down of standards within the ADHA?

If this is the case and AD$A is taking a more wait and see approach, it might be more down to the state of SA, HL7 Australia and IHE. SA being the only professional outfit amongst them, IHE website looks a run down mess, HL7 Australia has been in decline for many years and its has been asleep for months by the look of it. Perhaps the aim is to let them wither on the give. The politics of standards is something to behold and for me to avoid in future.

That or people are being played, either way eHealth standards in Australia is not being steen in a good light and does not reflect well on ADHA. Perhaps the AMA should refresh there 2006 position on eHealth standards and give the ADHA some direction.

Grahame Grieve said...

These comments about SA, IHE, and HL7 demonstrate why you should not judge a book by it's cover. I'll restrict myself to comments about HL7 Australia.

HL7 Australia is a volunteer consensus organisation; it can only act when there is motivation by a small number of people to do something, and clear agreement to do that. In the last few years, very little has met those criteria, for a number of reasons.

One of those is my fault: there's been little motivation to work on anything but FHIR, and the time hasn't been right for FHIR. Now it is, and the work is starting to happen. But slowly.

"The politics of standards is something to behold and for me to avoid in future"

yes, I understand why you'd want to avoid it. However as long as everyone avoids it, we won't make any progress away from where we are. The effect of the problem is being under-estimated: right now we have no established consensus process for publishing Australian e-health standards.

Anonymous said...

Let us recap, the ADHA leadership states it is a new era of innovation, research and development, interoperable and safe systems, co-production, openness and transparency, and one would assume consensus wherever possible to deliver better health outcomes for citizens etc. etc…
Standards and the process by which standards are created is founded on these principles. Regardless of what the perception of these institutions might be from the surface, the ADHA and by proxy the government is sending the wrong message here. Yes it is a fine line between supporting and being seen to be impartial, but that just requires the right people leading.

Standards create a common framework for innovation that encourages the sharing of knowledge, for example by defining common vocabularies, by establishing essential characteristics of a product or service, or by providing a means to disseminate results of research and development.

They minimise duplication during research and development, thereby increasing efficiency

They maximise the ability of a product to be used in conjunction with others.

They reduce unnecessary variance.

They can provide a framework for moving from the development bench into production, through defining essential parameters, safety considerations, testing, prototyping and scale-up.

Perhaps we are investing in the wrong institutions I am struggle to find what ADHA is and what purpose it serves.

I would also like to state that no disrespect or harm is intended towards those magnificent people who give up there time to support standards.

Bernard Robertson-Dunn said...

Is it better to standardise on things that work, or before things are developed?

Many years ago there was a big debate/competition between well engineered and standards based OSI/GOSIP and suck-it-and-see/just-do-it TCP/IP.

TCP/IP (the basis of the internet) won. Yes there were some standards, in fact there were many, but only those that had value and worked were retained.

Is there a lesson in this?

IMHO the problems with MyHR are a) there's only one of them so there are no competing solutions and b) it's not well engineered.

Grahame Grieve said...

Bernard, the answer to this is a little of each. Developing standards in advance of finding out what works is risky, in that you're running a start up with a high chance of failure. On the other hand, there's things that you can't develop as a community (a market) without having the standards on which to build them.

My argument - and the basis on which I try to guide FHIR - is innovation and standardization are like 2 ends of a slinky dog: they can't get too far apart, but you need to be clear about which is which

Bernard Robertson-Dunn said...

Another question:
How far have we come in 16 years?

Have a look at this document:
Issues Arising from Analysis of the Health Connect Business Architecture v1.9

It refers to this document:
HealthConnect Business Architecture version 1.9

Has much improved? Have the concerns been addressed? Is My Health Record any better than HealthConnect was supposed to be?

More importantly, will the ADHA strategy address the issues raised in the analysis document?

Hint: Don't build a passive, secondary system that adds little or nothing to clinical, point-of-care systems. If you really want a national, summary system that is of use to people with chronic problems and/or who travel and are concerned about emergencies, just use the model of DropBox - a place in the cloud for GPs or patients to put a simple, pdf describing their situations, needs and/or wishes. Ad-hoc format, content up to the patient/GP.

Use encryption and serious two factor access controls for patient/GP access. In an emergency the care team would have privileged access. All the patient would need to carry is their identifier in their wallet, purse, or on a bracelet/necklace.

Anonymous said...

That is a fair question Bernard, however, I suggest that this places standards as some sort of one off investment, something you start with and is a moment in time agreement. This is not the case, have a look at the various standards models, ISO takes a develop publish and gain implementation experience, update. OMG takes a develop implement, learn, revise approach. IHE takes another slice. FHIR takes yet another blended approach and is as close to a meratocracy as we have possibly taken to date. I also think it has started a fresh look at conformance approaches and emerging a number of perspectives and concerns to achieve a more cohesive and appreciative way forward. Grahame this is view of someone who is not a developer but an interested observer of what FHIR is in total and more importantly someone who benefits from the work undertaken by all SDO's.

Next time you drive past an infrastructure or building site, or sit in a ministers office, ask yourself how many standards surround me? not simply the building standard but all the bits and pieces and bits you don't see, and what would this look like without any standards..then ask is a good investment in people? Is this worth supporting?

Eric Browne said...

Anonymous 6:05 PM said "Next time you drive past an infrastructure or building site, or sit in a ministers office, ask yourself how many standards surround me?"

And a corollary question is: Are the standards being regularly checked? - Did the concrete meet ASxxxxx? Was the steel certified to ASyyyy? In healthcare IT there is little checking against the standards. If we were to be sharing clinical information as much as many of us would wish, then both these questions need to be addressed, lest we do more harm.

Bernard Robertson-Dunn said...

As a professional engineer I know the value of standards - they are absolutely critical. And I totally agree with Eric Browne - a standard that isn't checked and enforced is worthless.

My question was about the development process of standards.

No, standards are not fixed in time, they have a life cycle of their own. Even things as fundamental as the measurement of mass, length, time, Ampere, Kelvin and Mole have changed over the years and there are proposals to change them again.

They can also co-exist - 240v/50hz vs 110v/60hz being a well known example.

Yes, standards are a good investment but you need to make sure that the standards have value and are not designed to favour one particular interest over another.

One final point, standards should not be an end in themselves, they, like IT, are of most use when they are enablers.

Anonymous said...

Totally agree Bernard, that is what is so concerning about the sacking of the standards office at the Agency. Tim is sending a clear message and it is not a good message.

I think it is time nice but dim stepped down before he cusses more damage to australia.

Anonymous said...

Could there be some satisfaction and emotional reward in creating a destabilized work environment and creating confusion. Perhaps a careful analysis of the personality will provide insight and answers. We've been there before. There are builders and wreckers. Both get enormous satisfaction from doing their job really well. Both have quite different personality traits.

Anonymous said...

If you look at the research literature on self-serving biases, it’s little surprise that critical thinking – much needed in today’s world – is such a challenge. Consider these three commonly acknowledged human biases:
Most of us think we’re better than average at most things (also known as illusory superiority or the Lake Wobegon Effect);

We are also prone to “confirmation bias”, which is favouring evidence that supports our existing views; and

We’re also susceptible to the “endowment effect” which describes the extra value we place on things, just as soon as they are our own.

Studies have shown that simply asking participants to imagine that a theory is their own biases them to believe in the truth of that theory – a phenomenon that the researchers have called the Spontaneous Preference For Own Theories (SPOT) Effect.

Ladies and gentlemen I present Tim Kelsey and the board of vested interests

Anonymous said...

There is a strong possibility March 10, 2017 9:18 AM may be very close to the mark. If so a fast talking smoothie has cleverly conned the decision makers with a questionable track record and is now driving an organizational culture of behaviour into place which an occupational sociopath would be proud of. One would only know if that is the case if / when disaffected staff from within have the courage to expose such behaviour. That we have seen it before in the old NEHTA doesn't mean it can't happen again.

Anonymous said...

I would not be so quick to push the CEO, Richard Royale did the right thing as an interim CEO and stepped out of the organisation and spotlight, not all previous CEO's did, there is a visable and concerning alternative organisation within our office, it is not one that is intent on making the actual CEO look great or for that matter certain other executive general manager, the coffee club is on a wrecking mission with one aim in sight. You are witnessing the dumming down of the Agency skills base already, there are also a significant number of highly valued inderviduals leaving or have left key positions.

Brood parasites are here and doing well. But our leader is no fool and we wait for his return.

Anonymous said...

Anon 10:17. I'll second that, it is not an open and comfortable set of floors to work in, the staff are great but middle management are paranoid and you have to be extremely careful of who is within earshot

Anonymous said...

Specific responsibilities as outlined in the 2016-17 budget papers

coordinate and provide input into the ongoing development of the National Digital Health Strategy;
implement those aspects of the National Digital Health Strategy that are agreed or directed by the Council of Australian Governments (COAG) Health Council;

develop, implement, manage, operate, continuously innovate and iteratively improve specifications, standards, systems and services in relation to digital health, consistent with the National Digital Health Work Program;

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;

develop, monitor and manage specifications and standards to maximise effective operation between public and private sector digital healthcare systems;

develop and implement compliance approaches in relation to the adoption of agreed specifications and standards relating to digital health; and

liaise and cooperate with overseas and international bodies on matters relating to digital health.

So it would seem that during the current 2 year funding agreement the relationship with standards is mandated. Not a great start, who can trust this lot in any dealings.

I think someone's head is required or a good proportion of money is returned to the finance department. I question if it is in the powers board to make such a significant change especially so early.

Anonymous said...

If you look at the board papers released for January and February 2017, and then look at positions vacant, it would seem this is a move to consolidate locations to Sydney and Canberra then by June 2019 further reduce to the required 51 APS staffers. The MyHR is simply a contract management concern as it the funnelling of project support money to the states. All this will be supported by a communication and marketing arm that will provide the evidence of user engagement. Most new Digital (insert) Agencies are a Sydney/ Canberra model, Victoria might survive but it is clear QLD is gone.