Tuesday, March 28, 2017

The AMA Points Out Some Home Truths On What Is Needed From The National Digital Health Strategy.

This appeared last week.


17 Mar 2017
The proposed national digital health strategy should be a simple, straightforward list of proposed projects and their benefits, rather than a high-level strategy document, Australia’s peak doctors’ body says.
In its submission to the Australian Digital Health Agency (ADHA), the AMA says it has long advocated for a strategic plan for digital health.
But it warns that clinicians must be involved in both the development of the proposed National Digital Health Strategy (NDHS) and its implementation, saying too many e-health projects around the world have failed because they were developed without consultation with the people who had to use them.
“The AMA is aware of the long track record, both locally and internationally, of e-health projects falling over for failing to consider the social aspects of development and implementation,” the AMA says.
“If no other lessons have been learnt from Australia’s approach to e-health, clearly a ‘build it and they will come’ approach, without coalface clinical involvement, will fail.”
Clinician involvement must not stop at the ‘strategy’ level.
“There is a need for co-produced development and operational plans so providers can see where critical services are heading, over what time frame, and what this means for them,” the AMA said.
“Many doctors and other healthcare providers have a level of scepticism about high level strategy documents, preferring instead to have access to a simple, clear, prioritised and costed list of projects, with tangible products and benefits able to be understood by the non-technocrat.”
The AMA also said that the strategy should have a more balanced and complete coverage of all health practitioners’ needs, compared to the historic over-emphasis on patient-controlled health records – the My Health Record (MyHR) - and support for e-health in general practice.
“This must include specific support for medical specialists other than GPs to take up digital health, including but not limited to the MyHR,” it said.
“The NDHS should also clearly acknowledge that digital health has important and direct implications for the way health care is organised, for health financing and funding, and for existing payment models.
More here:
You can read the full submission from this link:
It is really useful to read the AMA’s summary of their seven page submission. The points made on the directional and clinician related aspects seemed pretty good to me, including their point on the rather overbalanced emphasis currently in evidence regarding the myHR. (Comments on the commercial aspects of digital health  I will leave to others).
I also note their frustration as well as the recognition of just how difficult all this all is!


Bernard Robertson-Dunn said...

Don't forget that until Donald Trump told us in February, "Nobody knew health care was so complicated"

Now we all know, maybe things will change.

And if you believe that, you'll believe anything.

There's hopefully two Trump/ADHA parallels. You can't fool all the people all the time.

Anonymous said...

The AMA rightfully wants specific projects with measurable benefits. My concern is a list of projects is just that a list, if it comes out as a list of stuff with not logic model and relationships between list items it will be a mess. My advice to ADHA - Never value innovation over discipline. Health is complex, don't make it complicated.

Anonymous said...

Mr. Trump would have more correctly said: "I had no idea that health care was so complicated".

This is another example of the Dunning-Kruger effect at work:


"The Dunning–Kruger effect is a cognitive bias in which low-ability individuals suffer from illusory superiority, mistakenly assessing their ability as much higher than it really is. Psychologists David Dunning and Justin Kruger attributed this bias to a metacognitive incapacity, on the part of those with low ability, to recognize their ineptitude and evaluate their competence accurately. Their research also suggests corollaries: high-ability individuals may underestimate their relative competence and may erroneously assume that tasks which are easy for them are also easy for others."

Anonymous said...

Kelsey is no Beverley Bryant, repeating her 'made is jest' comments does not make a replica. Sadly we paid for and thought we were getting a Beverley Bryant, we end up with a minor league director from the NHS who like others at ADHA have few if any original ideas or vision.

Peter said...

I am coming to believe government activities in eHealth are suffering from Conway's law: "System designs will follow the communication structures of the organization that produces them".
Governments are, by nature, large centralised institutes with a strong preference for a command and control paradigm and big splashy projects (q.v. Victoria's desalination plant). Hence the focus of AHDA & NEHTA on a big centralised system which runs everything from Canberra.
The core relationship in health is between practitioner and patient. It is naturally very decentralised with a lot of power and most of the responsibility existing at the edge. A better model would be multi-level hub and spoke. Practitioners link to clinic or surgeries etc. which have associations with hospitals that control regions that are grouped by state... - you get the idea.
Under this model the most important point is ensuring that each piece can handle its own responsibilities and share/delegate to other parts as required. That means common standards and shared infrastructure/support.

I also note that the IT industry has been heading in this direction since the 1980s. Progressing from Object Oriented Programming, to Modular Design, to Service Oriented Architectures, to Composable Applications and APIs.
In other words, the approach already exists but needs to be adapted for the purpose. Clinicians are the key stakeholders, dictating priorities and providing context. IT architects provide the common principles and practices for successful construction.

Anonymous said...

I wonder if the AMA might do well to start conversations like this - https://www.ghdonline.org/tech/discussion/project-spotlight-interoperability-in-australia-ma/

It seems odd that with everything going on we see little debate and information sharing from Australians who think being a singleton, it is a shame we cannot get the medical professions engaged with people of this caliber in the public discussions.

Anonymous said...

We share many aspects of healthcare with other countries, none more so than in this field - http://www.bbc.com/news/health-39341411
I can fully appreciate where the AMA is coming from, although at the same time list of things are not good practice running large scale programs.

Peter said...

The involvement of government agencies in eHealth to date seems to be a great example of Conway's Law: The design of a software product follows the communication patterns of the organisation that created it.
Governments, by their very nature, are large and centralised with a 'command and control' mentality. This is exactly the approach they are applying with the centralised Health Records.
Medicine, on the other hand, as an industry is mostly decentralised and the primary relationship is between practitioner and patient. Even in the large hospitals, it is that connection that drives the business and associated activities are all about supporting it. Any digital solution that works will need to start with support for that relationship and build outward. Otherwise you are trying to alter the basic structure of the industry.
Other connections - between doctors and associated professions, between clinics and hospitals, between regional health networks and state government - provide a hub and spoke model of services and relationships that the IT systems need to align with. The role of technology is always to automate the repetitive work and reduce cognitive overhead - which in this case means streamlining the support network, leaving the healthcare to the professionals. In short, this is the part the government should be focussing on.
Obviously (and back to the point), the clinicians need to be involved at all stages to identify what is, and is not, overhead and what is core. To determine WHAT needs to be done.
But none of this is unique to healthcare. The problems are new but the *class* of problems have all been solved before in other industries. And experience with those other industries is essential in deciding HOW to best approach them in area of eHealth.

Anonymous said...

AnonymousMarch 29, 2017 11:56 PM. Thanks for the link, I got more insight reading this over a coffee than I have from any ADHA has produced in 8 months. Where are these people in all the 'conversations and preaching', those three certainly come across as leaders with vision.

While some need to do posters and bring in consultants and there template Toolkits to give an impression of open, transparent, inclusive and innovation, this clearly demonstrates what that looks like when it is part of inderviduals very DNA.

I hope these three fine Australians are busy working together on our future interoperable health system fully funded by us the tax payer, I would be happy to see them get $ 550,000 each a year even if it is just to hold community engagements

Anonymous said...

AnonymousMarch 29, 2017 11:56 PM. You may find it interesting that Tim sacked one of these esteemed gentlemen. I don't believe this kind of insight is welcomed at the ADHA.

Anonymous said...


Thanks but no thanks, the last thing the big end of town wants are people who know what they are talking about, keep the clinicians iscolated from these people at all costs, there is no value in allowing each customer segment from sharing their viewpoints, that would result in success.