Sunday, May 14, 2017

It Is Really Worth Going To The Source To See What Is Happening and What Is Claimed.

Here is the Budget 2107-18 announcement on the myHR.

My Health Record – continuation and expansion

This measure supports the continued and improved operation of the My Health Record system, which allows individuals to access and control their own medical history and treatments – such as vaccinations. This follows unanimous support at COAG for a national rollout of My Health Record with every Australian able to have a record, unless they prefer not to.
Page last updated: 09 May 2017

Why is this important?

A transition to opt-out participation for My Health Record will bring forward benefits many years sooner than the current opt in arrangements. Opt-out is the fastest way to realise the significant health and economic benefits of My Health Record for all Australians including through avoided hospital admissions, fewer adverse drug events, reduced duplication of tests, better coordination of care for people seeing multiple healthcare providers, and better informed treatment decisions.
Opt-out participation is supported by an independent evaluation of two opt-out trails undertaken in Northern Queensland and Nepean Blue Mountains Primary Health Network areas. The evaluation showed a high level of support for automatic creation of My Health Records by both healthcare providers and individuals. Across the two opt-out trial areas, the opt-out rate was just 1.9 per cent.
This measure allows the Australian Digital Health Agency to implement plans that will increase efficiency and sustainability and reduce the ongoing operational costs of the system in the longer term through the transition of Department of Human Services’ support functions to the Agency, the re-tender of the national infrastructure operator and delivery of a new, more flexible platform.
The system is a key plank of health infrastructure and connects key parts of the health system such as general practices, pharmacies, private and public hospitals, specialists and allied health professionals.
My Health Record Registration processes for healthcare provider organisations will be online and fully automated by May 2018, which will reduce the processing time from weeks to hours. This will replace the current time-consuming, paper-based registration processes and will cost less than supporting the existing system.

Who will benefit?

My Health Record allows individuals to access and control their own medical history and treatments – such as vaccinations.
This measure positively impacts all Australians, especially people with chronic conditions, or living or travelling in regional, rural and remote Australia.

How much will this cost?

The Government will spend $374.2 million on My Health Record – continuation and expansion from 2017–18 to 2018–19, with a net fiscal impact of $68.7 million.
Here is the link:
Just a few comments.
1.Why is there an emphasis on vaccinations when that is information that is probably more fragmented than most with the patient, GP, school clinic all having partial records and many over 40 having no relevant records?
2. The last para seems to suggest the cost for 2 years will total $68.7 million while $374 million will be spent. That seems to be claiming about $150 million each year in cash, realisable benefits. I wonder where that figure came from and if we could see the workings? Given opt-out is still a year or two away this is a big claim for mostly use of the present system.
3. Moving the system to the Agency seems like a good idea but why is the myHR still costing so much money. It would be good if the ADHA could break down the costs. (Surely $20-30 million is enough to redevelop and 20 or so to operate each year?)  Remember this does not cover the running costs etc. of the ADHA!
So basically it looks like the investment in the myHR rushes through a total of $2 billion and we still do not have any clinical evaluation and it is pretty universally agreed it will be technically obsolete before it is re-developed.
What a total, and astonishingly expensive, fiasco!


Anonymous said...

For your information I went here last week -

I found this statement, pretty sure it says if you do not want a record provide your email address? I was wondering how the know my email against my health record? anyway in good faith I provided the same email I use with Govex. Expecting an option to opt out my children I got nothing. The next day I get an email, not saying a record will not be created, but I will receive an email in June. Really so now we know there is a high likelihood that malicious emails will be targeted to Australian who like me are no expecting an email related to the GovEHR.

I guess none of the $ 374 million is going towards employing people with brains. Anyone know if any law firms are lining up to sue the Government around this?

A stuff up and a lie before they even start.

Would you like more information? We can email* you about the My Health Record system, the automatic record creation process occurring in 2018 and details about what you need to do, and by when, if you do not want a record automatically created for you. Please enter your email address below:

* Your email address:

Anonymous said...

And how do they explain the "depreciation?" AKA waste of money already spent building something they are now effectively throwing on the scrap heap. Because the previous design just was not meant for opt-out, or the instant creation of 24 million+ records for individuals, basically to be kept forever. So it just has to be back to the drawing board or it will never work.

Anonymous said...

Clearly it is no longer about savings 6000 lives. And the savings are tiny is comparison to overall health expenditure, IT is no cheap and maintaining it is just getting more expensive. Recent events demonstrate it is not an investment to be taken lightly.

Anonymous said...

Forgive me, I must be really naïve but I am reading this announcement quite differently. Permit me to step through it for you.

(1) The Department will aggressively promote the national roll-out of the opt-out MyHR as a high priority.

(2) The ADHA will implement plans to transfer support functions for the MyHR from the Department of Human Services to the ADHA.

(3) The Department or the ADHA (it’s not clear which) will call a tender for the National Infrastructure Operator for the MyHR. Awarding the tender will enable the Department of Health to free itself of responsibility for the MyHR and allow the “successful tenderer” to introduce a “new and more flexible platform” to underpin the “revamped” MyHR. This will all be in place by May 2018.

(4) The “successful tenderer” will introduce a “fully automated registration process” as part of their ‘new’ ‘revamped’ MyHR by May 2018.

(5) At this stage the Department of Human Services and the Department of Health will no longer have responsibility (legal, operational, governance) for the MyHR.

(6) The ADHA will be downsized, expect eHealth staff (standards, etc) to be transitioned out of the ADHA (made redundant).

(7) The rest of the ADHA will be absorbed into the operational arm of the “successful tenderer”. The end result?

(8) The Department of Health will have extracted itself from a hugely complex and politically embarrassing IT disaster, the ADHA will be closed down, the senior bureaucrat overseeing eHealth in the Department will be promoted, and the private sector (via the successful tenderer) will have taken over the ongoing development and deployment of the (its) MyHR based on its own proprietary solution (the “new and more flexible platform”), and the Government will finally be able to draw a line under its decade long $2+ billion failed foray into eHealth.

Anonymous said...

WTF! No benefits have ever been justified or demonstrated.
These guys are living in cloud-cuckoo land.

This MyHR wouldn't "voom" if you put four million volts through it!

'E's bleedin' demised!

ADHA: No no! 'E's pining!

'E's not pinin'! 'E's passed on! This MyHR is no more! He has ceased to be! 'E's expired and gone to meet 'is maker! 'E's a stiff! Bereft of life, 'e rests in peace!

If you hadn't nailed 'im to the perch 'e'd be pushing up the daisies! 'Is metabolic processes are now 'istory! 'E's off the twig! 'E's kicked the bucket, 'e's shuffled off 'is mortal coil, run down the curtain and joined the bleedin' choir invisible!!


Anonymous said...

Oracle and Accenture will win, why? It will be to hard and expensive to remove their systems. oracle will update to a FHIR version of its current RIM CDA machine and combine the brand power of FHIR with the modern slick terms of cloak based platform thus sending the ADHA naive Management into blubbering idiots, of course they will be provide slides and key words and tickets to all the industry events around the world.

Anonymous said...

11:10 - What? Help me out here I don't quite follow

Bruce Farnell said...

So the benefits are meant to be:
1. avoided hospital admissions
2. fewer adverse drug events
3. reduced duplication of tests
4. better coordination of care for people seeing multiple healthcare providers
5. better informed treatment decisions

Fantastic. Where is the evidence that this is happening? Where are the metrics supporting this assertion?

The measures do not exist and the stated benefits have not been realised. Nor will they ever be realised under the myHR.

Yes David, a fiasco sums it all up.

tygrus said...

About 84% of Adverse Drug Events experienced by GP patients were caused by a recognised side-effect or drug sensitivity (Britt et. al, the BEACH program). Having a list of patients' allergies will not stop them from occurring the first time. There will always be the first time an adverse effect occurs before any allergy or intolerance can be noted. Clinical staff are still waiting for functionality and processes that deliver the expected benefits mentioned by Bruce Farnell (the comment above). Even having a fully digital process from prescribing to dispensing will only focus on the remaining 10% of ADE's (when ignoring some of unknown cause or the patient was responsible for the overdose).

Of 783 adverse drug events, GPs indicated that in 75% the cause was a recognised side-effect.
Drug sensitivity was the reported cause in 9.5%, and allergy in 8.4%. Just 0.8% indicated
drug interaction as the cause, and contraindication was recorded in only one case (0.1%).

SAND Abstract 111: Adverse drug events in general practice patients

Anonymous said...

Wonders never cease - now it’s an about-turn for the Royle Review!

Recommendation 11 (page16) said “Centralise the system operation of the MyHR to the Department of Human Services (DHS), under contract from the ACEeH (since renamed the ADHA). DHS should run all MyHR related infrastructure services and maintenance, performance reporting, contact centres, management of NASH, and the Health Identifier service. ACeH to work with DHS to assess which components of the service should be contracted out to private partners, with DHS remaining the overarching government department responsible for service delivery.”

Well I never!

The Budget 2107-18 announcement on the MyHR said “This measure allows the Australian Digital Health Agency to implement plans that will increase efficiency and sustainability and reduce the ongoing operational costs of the system in the longer term through the transition of Department of Human Services’ support functions to the Agency, the re-tender of the national infrastructure operator and delivery of a new, more flexible platform.”

Perhaps 9:24 PM as hit the bullseye!

Anonymous said...
This comment has been removed by a blog administrator.
Anonymous said...

This all seems confused. In a rush to get points I cannot help wondering if the ADHA has lost its way through very short sightedness. If indeed we as a nation are haemorrhaging skilled people, many with highly evolved understandiing of HIT, then who is there to ensure standards are idiots and adapted in a way that enables vendors to develop in wa y that allows some standardisation to support safe sharing of information and more importantly ensure we as tax payers have people watching our investments? It was never the people at the coal face that were less than accomodating, and certainly not over priced wind merchants.

Anonymous said...

The really sad thing about this is that in reality, the emerging National eHealth Strategy has been killed off. We now know what the Government will be doing and investing in. We know to a large extent that evidence is in the eye of the beholder and can be twisted to serve anyone's purpose.

I am sure the Strategy will be a nice shiny document laced with statements targeting future funding requests from the vacuum, that is ADHA. Beyond that it is ( Strategy) now somewhat pointless.

Very expensive ruse to change from a standards and specification house to a call centre.

Anonymous said...

The potential for UX to spiral out of control should be a very real concern and something the board should carefully monitor. Industry standard indicates UX done late in the roll out result in 10x the timelines and 100x the original estimated cost. That said I am still not sure if the ADHA is address the interface of just the MyHR or every interface to every clinical system.

Anonymous said...

@ 2.25 PM said "Perhaps 9:24 PM as hit the bullseye!" Well, if one reade Jeremy Knibbs' Article on the MyHR I would say 9:24 PM is right on the money and I reckon Accenture would find it hard to disagree. In a nutshell - the time has come, the game is up and the $522,000 p.a. CEO has probably been briefed to wind the organisation down preparatory to getting rid of it.

Anonymous said...

I am willing now to sign over my health information on one condition, the ADHA just stops all the speeches and presentations. I understand the need for consistent messages but please please stop the unimaginative, repetitive and in some cases condescending dribble it really is starting to become embarrassing.

Anonymous said...

How much more money will be requested to support the age care sector? Seemed a very low success rate in the opt out trials, in both willingness to participate and confirm any systems. Taking into account the work and financial incentives up to now, this target group will not come cheaply now they have the Health Minister by the short and curly.

Perhaps our elders are more tech savvy and wise than the middle aged give them credit for?

Bernard Robertson-Dunn said...

IMHO, the MyHR is totally inappropriate for use in aged care.
It doesn't contain the risght information, it is totally disorganized and it looks and works nothing like a point of care system.

Far too many people are in favour of MyHR without understanding what it is and how it works. As in many cases the devil is in the detail and these people don't have the foggiest about any of the detail. And neither are they inclined to listen to those who do.

Anonymous said...

They are happy to remove them from the ADHA though, even at the same time as they bring in new equivalent role, but without perhaps the insight and experience. This was always going to happen though, ADHA failed to cut the septic infection out of upper management, tried to define a cultural state but failed to understand or acknowledge the actual root causes and seemingly have turned on staff as the problem.

Bernard it is worse than you could imagine, this new lot can't even lo into a conferencing system or flick between slides. It is a national disgrace, I drive a car but that does not qualify me to build a fuel efficient high performance engine.

Anonymous said...

We can only bit wait until June, the Strategy should finally be out and the roadmap for MyHR must surely be available by then. I have great faith that MSIA will insist and drive this in order to provide its memebers some basis to form there own four year plans and funding needs.

It is clear the MyHR needs more than a face light and needs to go right back to the fundamental underlying platform and information design, Aged Care will need to be accommodated as will agreements between current clinical workflows and practices against technology and new operations models.

The ADHA has spent a fortune in new blood and community engagements, something tangible must emerge along side a slick, committed and silo/faction free organisation that can and will provide value not as the past demonstrates ever changing milestones, objectives and intentions.

If Tim cannot by June and be judged by the community to have done so, then ADHA should be scraped and started again IMHO.

Bernard Robertson-Dunn said...

We know the outline of the strategy from the budget. There is little or no money for a major revamp.

The system is, and will remain fundamentally flawed. It's a secondary system that doesn't achieve the stated goal of reducing data fragmentation, neither can the data be relied upon for clinical use.

Furthermore, the system is not guaranteed to be available 24/7 - that would cost at least as much to deliver as it cost to develop. Continuous availability does not come cheap. We know it's not 24/7 from the original RFT and the fact that they have scheduled downtime.

The MyHR we've got is what they intend to make opt-out, in spite of all the problems identified in the Royle review and all the feedback Health has been given over the years.

Few if any of those problems will get solved. They are probably just making it worse by adding to the system more and more documents with little or no clinical value. I suspect they don't realise that they are making life difficult for GPs who are supposed to ensure that SHS they upload are consistent with, and take into account, all the data that's in the patient's MyHR already.

The promise of eHealth in Australia will be just that - a promise - for years to come. Those of use involved in the Australia Card, Whole of Government Outsourcing, The Human Service Access Card have seen it all before. It's a pity that nobody at ADHA lived through all that lot. The lessons they taught have not got through to today's wide-eyed, but naive, managers.

You can always tell someone trying to solve a complex problem simplistically and in the same way its failed in the past but you just can't tell them much.

Anonymous said...

You can though Bernard start to tell that there is no cohesion in the ADHA and that there are 10-12 people with very different views on eHealth taking the organisation in 15 different directions for no apparent reason other than for self serving purposes and a self belief they know the answer, sadly it is probably to an incomplete question.

Forgive them for they know not what they do and they have no leader.

Anonymous said...

Maybe everyone should simply mark the 30 June 2018 in their calendars to celebrate the successful implementation of theOptout trails where everybody has at least one health record created for them and it is accessible by someone.

I really don't see the problem and will again see us ranked number one it the digital health leadership table.

Anonymous said...

Anon 4:48 - where everybody has at least one health record created for them and it is accessible by someone.

I am guessing that is taken directly from the projects acceptance criteria?

I have been reflecting on this GovHR as it is becoming known. I don't believe there is much to concern people about. Why? Well the EHealth Branch has never delivered much before and never on time, even when they sucked the life out of NEHTA and burned a million dollars a day. They may still have the money but not the intellect pool to draw on. There are also the other bigger and brighter initiatives like the Medicare system, CHC, and some interesting work in the Jurisdictions and private sector, all who pay more and are far more disciplined (well maybe not SA).

So ADHA will be scrapping the bottom of the barrel, it seems apparent they have already have fallen apart as an entity, leaving themselves fully exposed to organisations that are masters of extracting money from poorly defined contracts.

As for the compacts, well I am not sure the Government can be trusted to honour those, they have been poor in the past.

So while it will fail to meet the June 2018 target and take 3 years to get agreement to change the platform, life will have past them by. A few good peoples careers and souls will have been crushed and a few callous manipulators will move up a notch.