Friday, June 09, 2017

Surely This Reveals That The ADHA Is A Little Detached From Reality?

There have been some responses to a some FAQs on the Strategic Interoperabilty Tender.
The following caught my eye.
Question: Can the Agency confirm the timeframe of the proposed work? The RFQ states the following: Any resultant contract is expected to commence on 17th of July 2017 and conclude on 30th of August 2017. Could you please clarify the dates are 17th July to 30th August 2017, i.e. 5 weeks?
Answer: Yes, the timeframe is 5 weeks in line with the outlined dates, 17th of July 2017 to 30th of August 2017. It is expected that the successful tenderer will have extensive experience in this area and therefore would be able to provide the Strategic Interoperability Framework within this timeframe.
Here is the link to the FAQ page.
Given the scope is as follows:
                         “Strategic Interoperability Framework Program Scope
A digitally interoperable environment for the Australian health and care system is a key enabler needed to support the delivery of the core requirements for raising Australia's standards of health and well-being. In order to achieve this, the major domains to consider when developing interoperability principles include the prediction and prevention of illness; improvements in health and care outcomes; higher quality, safer and more effective health and care systems; and achieving financial sustainability in Australia's health system whilst demonstrating value for money.
Underpinning these requirements for improved health and well-being is the concept that a timely and accessible modern health care service will hold the principle of equity at its core, being accessible to all Australians and reducing the variability in safety and quality of health and care services. Interoperability within health and care systems may be defined as the ability of two or more systems to share, communicate and co- operate. The ambition to achieve interoperability within Australia's health system recognises that its successful delivery serves people rather than systems, by ensuring that the care and support of Australians is paramount, both when well and unwell, and regardless of their ability to pay at the point of service. Defining, developing and measuring the success of a system’s digital health maturity requires a range of interoperability considerations beyond its technical underpinnings. Ultimately, an interoperable health system will provide a seamless service experience for a person using health services. The Agency’s recent consultation with the community, including over 1000 survey responses and written submissions, revealed that over 65% of respondents said the Australian healthcare system is difficult to navigate. People want to know the cost, quality, and availability of services, and experience a more integrated service experience.
A key theme of the National Digital Health Strategy will be to “support me in making the right healthcare choices, and provide me with options”. Achieving this goal will require an interoperable environment, supported by digital technology and standards.
Internationally there has been mixed experience in attempts within health systems and other industries to achieve an interoperable environment, and it is important to recognise and learn from these whilst considering the unique context of the Australian health care system. Interoperability of Australia's health systems is a key driver of social justice in health care. The challenge for the Australian health care sector is to recognise the opportunities and challenges of sharing data for its citizens through achieving a digitally interoperable environment, whilst ensuring the protection and confidentiality of their personal health information.
Although technical considerations are fundamental to the definition of interoperability and to enabling an interoperable environment, the concept of interoperability should be considered in the broader social and economic context, noting its role as the major foundation element of a system which has achieved digital health maturity.”
It really is hard to see how that scope could be usefully addressed in six months, let along six weeks or am I missing something here? There are a heck of a lot of organisations and systems to connect and have interoperate!
David.

55 comments:

Anonymous said...

It's toss David, clearly written by someone with no vision and no understanding. It is evident this material has been borrowed from a number of unrelated sources and badly stitched together.

Do they even know there are standards and principles around this that are based on community agreements? Why is the ADHA throwing those agreements in the bin and sticky a finger up to the community.

Really begs the question what is the national strategy if interoperability is no progressed through the strategy implementation.

How are they going to deal with semantics, clinical interoperability, funding, social contracts.... this lot is an embarrassment.

Anonymous said...

Had that been updated? Seems more bizarre and funnier than the first time. I am still not sure what value this delivers that does not already exists? Be interesting who will be shameless enough to accept this and be forever scared.

Anonymous said...

Personally I don't think this means anything other than an excuse to subtly inform Australians through some narrative that we are seen by Mr Nice to be a disconnected backwater colony unable to communicate or move beyond a fax machine. I cannot believe this thoughtless leadership dribble is coming from an agency with such responsibility.

Anonymous said...

Don't be to critical of Tim, he largely inherited this mess and needed to quickly get out and about amongst the people, he has in parts a fair team, it's also fair to say he probably unbeknown to him lost some great contributors as he enters a period where he would need them the most.

Perhaps this is a wake up call, f nothing else he seems to have a track record of repairing bridges and knows when people get things wrong. But then perhaps not.

Anonymous said...

Why is this classed as a program? Have we provided to much money to this inexperienced organisation? I notice one the roles advertised through Austin Carter is an EL2 project manager, seems pretty high up the APS ladder.

Anonymous said...

It would be classed as a program because it is misunderstood by some who obviously cannot run operations and the Communication department does not want to observe them so only option left is to create a role that justifies the paying of a GM with no branch to run.

Can't run operations, does not understand PPM, probably mistaken interoperability for inability. Don't mean to be harsh but this is our money they are playing with.

Anonymous said...

Perhaps this is a reflection of those who believe it's is their destiny to impose eHealth on the sector through draconian compliance to a strict set of unmovable compliance regimes, which is out of step of the market which is more customer focused and moving in such a way that as opertunities for interoperability present themselves they move to harness this for everyone's benefit. It would appear the ADHA is still close minded and looking at the command and control model that worked so well when they were the eHealth branch.

On another note, now the golden goose of pathology and diagnostic results are being uploaded to the GovHR, anyone know what they intend to do with it all?, I recently went through MRI and could not find a single point where those treating me where not able to have all my relevant facts, reports and images at hand? Are we solving a problem long since lost its currency?

Anonymous said...

I went into hospital recently for a fairly invasive test. My health record now has a discharge summary that says that I had a test. No reasons given for the test. No results of the test. No indication what other tests, if any, I may have had or might be due to have, and which might be relevant. Pretty useless really.

Anonymous said...

Pretty useless really. I have discovered the benefit of the myeHR. It role is to remind everyone just how good the rest of eHealth is.

Anonymous said...

Useless or not, it is a dangerous wept that has been let out of the box. There are many with good intentions but we need to have the public in on exactly what the future holds.

http://jenpersson.com/nhs-patient-data/

They smile and make promises but they care not

Anonymous said...

Oops that dangerous weapon not wept, although I am sure it will end it tears for inderviduals at some stage

Peter said...

As I said in the previous post on this topic, based on admittedly light information available, I would guess about 12 weeks work for 2-3 people to deliver the request. And that would be very high level, abstract guidelines which would have to be interpreted for application in any real usage.
In five weeks, I think you could probably just about gather the necessary details to create a current state view and, possibly, a high level gap analysis. There would not be time to start outlining the target state and certainly not to document the activities necessary to get there.

I have done a 5 week engagement to develop an integration strategy for a client. But that is for a single organisation, with two very specific case studies to be used as examples and subject matter experts readily available at any time. And it was an integration strategy - interoperability is a considerably wider and fuzzier concept.

Anonymous said...

Yes Peter this work would be very much different, you would need to be very artistic on implementation winners. It is from my experience more complex when you cannot describe a physical solution as the target. You can be all means go out there and tell each and every stakeholder they must conform to a black and white set of rules.

Even in the prescribed engagement, you would be lucky to have engaged in any meaningful way with stakeholders, I see no evidence this engagements have been planned on the consultants behalf.

You then have the sponsor of the work, it will be extremely difficult when the sponsoring party does not understand the community model nor the subject.
The Agency had some very skilled people, what was the driver Perkins the departures, smells a lot like rotting fish to me. Heads that are not rolled should be hung in shame.

Anonymous said...

Ian Colclough said ludicrous as this might seem, after an extensive review of all available evidence, I have reluctantly concluded that from the very outset the single most important stakeholder who should have been deeply involved in the design and development of the personally controlled my health record has been excluded from the equation and it is too late to rectify this omission without a major change in thinking about how to design such a system.

Bernard Robertson-Dunn said...

The trouble with a quick engagement to develop an interoperability strategy is that you end up automating what is currently being done and in the way it is currently being done. A bit like automating health records - all you get are all the faults of the old system plus some new ones. Or, as the old saying goes, when you computerise manual things, all that happens is that they go wrong faster and make a worse mess.

If we want a real improvement in healthcare, what is needed IMHO are radically new ways of achieving significantly better outcomes more effectively and more efficiently.

People have been trying to do just that for decades. A 5 week consultancy has little to zero chance of doing anything useful other than making it even harder to achieve progress.

Anonymous said...

Completely agree Bernard, this to me is a classic case of it all looks so easy when you are in your infancy and a novice or have spent time looking externally through a very narrow window.

9:21, you leave me hanging? I would though table that making any one stakeholder and their viewpoint more important than other stakeholders is a less than profitable proposition, it is a partnership, one where the views of all stakeholders must be considered and any solutions must clearly reflect back those community agreements. To make one more important than another lays a foundation for resentment and disunity.

Anonymous said...

Reading this RFT, some postings and a reasonable understanding of Australian eHealth, I am not sure who they are insulting the most. Blimey Tim if this is the best you can manage the Digital Health Strategy is looking like it will be a Mills and Boon classic carefully crafted with a large supply of editor-in-chief hand tissues.

Anonymous said...

10.37 AM said "9.21 you leave me hanging?"

There was no suggestion that other stakeholders should be excluded, rather, if you read 9.21 again, the suggestion was that the single most important stakeholder should not have been excluded.

That which you cannot see will be obvious when you can. Keep hanging until your vision and perception improves.

Anonymous said...

3:59 - you reference 'the single most important stakeholder' that by definition means all other stakeholders are of a lessor importance. That is my only point. Please explain what you mean.

Anonymous said...

4:19 PM The other stakeholders are important but not as important as the single most important stakeholder. That should be clear.

Anonymous said...

And that is who exactly and under what scenario?

Anonymous said...

10.37 AM said "To make one more important than another lays a foundation for resentment and disunity."

This occurs when the stakeholders' competing vested interests cause them to embrace multiple agendas which are not fully aligned and compatible with the interests of the single most important stakeholder.

Anonymous said...

Anon 11:20, I would say they are insulting pretty much everyone, but then some have no shame in waltzing around with other people's medals on.

Anonymous said...

9:21am not sure what Ian Colclough opinion piece you refer to, however without the context against which this snippet is based I agree with 4:19 pm. I am sure this RFT needs justifying, grasping anyone who may suggest a specific stakeholder is the centre of the universe further exposes the shallow understanding.

Anonymous said...

Oh I see the bureaucracy, got you, and you would support the attorney general shaping privacy based on facebooks business model?

Anonymous said...

6:00pm Brilliantly subtle.

Anonymous said...

Assuming the stakeholder is 'ME' as the latest narrative suggests and I am the most important stakeholder, what are the implications around ownership of my information, the use of my information and my choice regarding the Governments EHR?

Anonymous said...

@6.17 PM This stakeholder discussion raises some challenging issues. I don't see anything in the above suggesting a specific stakeholder is the "centre of the universe".

Putting 'egos' to one side (heavens knows there are plenty of them)let's make a list of 'some' stakeholders.

1. Doctors - GP's
2. Doctors - Specialists
3. Federal Gov't & Health Department
4. State Gov'ts & State Health Departments
5. Peak bodies - AMA, RACGP, RDAA, PGA, PSA
6. Software Vendors
7. Consumer / Patient
8. Patients' Carers
9. Service Providers - Pathology &Imaging
10. Pharmacists
11. Consumers Health Forum
12. MSIA
13. ADHA
14. .... and various others

While all stakeholders must be satisfied is there any one stakeholder which must be more satisfied than all the others?

Rephrasing that question. Can these stakeholders be listed from 1. to 14. in 'any' order of 'importance'?

Bernard Robertson-Dunn said...

Having multiple stakeholders with competing interests and perspectives is just one characteristic of a wicked problem. And if anyone remembers, the head of NEHTA (in)famously said that eHealth isn't a wicked problem.

I wonder if anyone at ADHA understands what a wicked problem is.

Anonymous said...

I can't say I am sold on all this ME, I, My, apart from it being a rehash or a rehash or a theme in 90's Britain. I cannot help wondering if this change in messaging from clinically led for the benefit of patients to be about ME is as ruse to seperate out both the medical professions and the Consumer? It is easy to makes these claims on behalf of ME without actually involving me, by singling out and separating consumers to be inderviduals I cannot help notice this weakens the collective. Claims that this is what the collective wants are easy to claim and harder to disprove. Look at the claims they make - x% say this, say that, by their own admission that is only a few thousand at most and less than a thousand online, hardly polling of the century.

The other nasty taste in my mouth is those chosen to run the ADOHA, other than the two imports who have a publicly recorded track record of having been more than happy to flog off citizen data to anyone and everyone, there are also less than honest persons of a more localised nature.

For the record, no one has asked ME or responded to MY requests.

Anonymous said...

7:01 am, it is a sign of the times I am afraid, everything is done on the back of an apocalyptic alternative outcome. It is a common thread across policy these days, the people running Government are scared of their own shadows, but use 'in the name of the people' as an excuse for their weakness and misguided beliefs.

Anonymous said...

Does this interoperability work contribute to increased data in the MyHR? Probably not so therefore probably a red hearing IMHO. The goal is to create the perception it is such that it cannot be turned off.

The senate committee in 3 years times will read - replatforming is delayed by x years and requires Addison all nnn millions because we did not anticipate how hard it would be to replatform a system with this type of legacy data or understand the costs to feeder systems.

Anonymous said...

Ahh, I now think I understand why only a few weeks are needed for this. It was sitting there in plain sight all along.

If we only have PDFs stored in the myEHR, and the myEHR is the centrepiece of our nation digital health strategy, then we already have the majority of an interoperability strategy, right? PDFs already are interoperable across all software platforms.

Problem solved.

Anonymous said...

Compliments secure messaging perfectly, we will be done by Christmas and time to spare for tea and cucumber sandwiches.

Anonymous said...

@ 6.17 PM June 11 said “9:21am not sure what Ian Colclough opinion piece you refer to” …..

Apologies - I should have referenced ,y quote which I took from his comment (which I thought was particularly prescient)in The Medical Republic article of 21 April 2017 when he said:-

“The key stakeholders are not the doctors and not the government. The key stakeholder is the person about whom health information is being recorded and exchanged by and between health service providers and agencies. Accepting that as the starting point is the first step towards understanding how to tackle the problem.”

Here is the link:
http://medicalrepublic.com.au/sonic-primary-sitting-digital-health-progress/8562?utm_source=TMR%20List&utm_campaign=5f1730c7f3-Newsletter_April_21_04_17&utm_medium=email

Bernard Robertson-Dunn said...

re: "The key stakeholder is the person about whom health information is being recorded and exchanged by and between health service providers and agencies. Accepting that as the starting point is the first step towards understanding how to tackle the problem.”

It's called patient-centric healthcare. The problem is - what does that mean. followed closely by more problems:

How do we implement it? how do we transition to it? how do we stop vested interests sabotaging it? etc etc.

There is no one problem. There are many problems.

Anonymous said...

The old emergent complexity delma of health. Hard one now the Government is a market competitor

Anonymous said...

I agree totally with June 12, 2017 2:28 PM and June 12, 2017 2:37 PM that the patient / consumer lies at the heart of a patient-centric healthcare system. Consequently I see the patient / consumer as the most important stakeholder, for without the patient there would be no need for any of the other stakeholders.

I can’t understand why this fundamental fact is so hard for some to comprehend (particularly June 11, 2017 10:37 AM and June 11, 2017 4:19 PM ) to comprehend.

Once you’ve got to that point as Bernard said (June 12, 2017 2:37 PM ) “that’s the first problem solved” which will now be “followed closely by more problems”.

I hope 10.37 AM your mind is now at rest and you are no longer “hanging”.

Anonymous said...

6:31. So what does that mean in real tangible terms, as the prime stakeholder what does the paint/consumer actually get? You could argue that the medical professions are equally the most important, without them where would we be? Perhaps they are the consumer?

I do not necessarily disagree with you just interested in how you see that contract and how the Stakeholder (22 million plus) play that role?

Anonymous said...

June 12, 2017 6:31 PM. I do not believe many would argue and the medical profession has the patient at its core. That said as a consumer and developer I do think either of me is best placed to reflect the art and science of medicine, when it's comes to clickable thought and Cilicial workflows, terminology etc, it is far safer and rewarding to let those stakeholders take the lead, the same applies to architects, scientists, informatics people. I have found it extremely rewarding when as a group we work together as equal partners, anointing each role as a lead depending where we are in the modelling of ideas process. I do not disagree with your position but I do agree creating a hierarchical model will come with consequences. I guess may biggest issue is Government seems to think it can take the patient/consumer stakeholder role. On and that is a recipe for disaster.

It's a good debate and glad it is taking place somewhere, the ADHA seems to have the position of dictating the views of others.

Bernard Robertson-Dunn said...

It seems to me that Health IT and Health Informatics is rather like the drunk at midnight looking under the street lamp for the front door key he dropped, even though he dropped them in the dark behind the bushes - because the light is better.

Health IT and Health Informatics are easy compared with the real problem which is better healthcare decision making. Diagnoses and treatment are what healthcare is all about. Data and technology are both important but only as enablers.

Major improvements in healthcare require step changes in the processes of diagnoses and treatment, or in Information Systems terms, better models and algorithms.

By talking only about eHealth and health records, ADHA demonstrates, IMHO, that it still doesn't get it. They are living in the past, desperately trying to deliver faster horses.

Anonymous said...

Perhaps Bernard it is the ADHA has been pushed into the Nags stable? The ADHA seems excluded for anything other than filling up the HR system. From the outside and my own opinion this looks like Tim has failed the Agency. There is certainly nothing transformational or innovative spewing forth, even if it wanted to do I do not believe they have the depth or knowledge left to conduct anything of value. Even the Digital Jealth Strategy has run out of steam and currency. Seems all they can do is put out small cash incentives in a bid to have people talk to them.

Looking at Care homes and Cancer Screenings registries, the nation sure could have done with an inderpendant standards and specifications body, shame Tim killed that off.

Drunk who posts their keys, more like the drunk that won't stop annoying everyone in the bar with tales of grandeur and exploits beyond belief

Anonymous said...

June 12, 2017 8:10 PM “I do not necessarily disagree with you just interested in how you see that contract and how the Stakeholder (22 million plus) play that role?”

There is a semblance of hope in the knowledge that “I (you) do not necessarily disagree with you (me)”

The viable business model provides a ‘win’ for every stakeholder and a ‘penalty’ for stakeholders who are either disruptive, non-cooperative or intentionally subversive.

The rules of engagement are unambiguous.

The milestones are realistic, achievable and measureable.

The ‘environment’ in which all stakeholders participate is totally different from the sewer-like sludge which ‘today’s stakeholders’ are gallantly trying to swim though.

The “22 million plus” stakeholders are a figment of your wild imagination.

There are no 'drunks under street lamps" or "in the dark behind the bushes"; they have all been sent back from whence they came.

Anonymous said...

"Hope is not a strategy" Rudy Giuliani

Anonymous said...

"Hope is not a strategy" - no-one here has a strategy based on hope.

Anonymous said...

12:43 - okay thanks, that was interesting, now where were we?

Anonymous said...

2:39 PM "where?" !!! about $2 billion down the drain and still going strong.

Anonymous said...

The “22 million plus” stakeholders are a figment of your wild imagination

Can you clarify, was this not about the patient being the most important stakeholder? We have a population of over 22 million, each one a patient at some stage, so is it now that in the most important stakeholder group there are some citizens that are more important than others? Should healthcare be a privilege for the few not a universal right of all? Not sure my grand parents would see it that way.

Anonymous said...

June 13, 2017 4:41 PM “Can you clarify, was this not about the patient being the most important stakeholder?”
Yes

We have a population of over 22 million, each one a patient at some stage, so is it now that in the most important stakeholder group there are some citizens that are more important than others?
No. All citizens are important including you.

Should healthcare be a privilege for the few not a universal right of all?
No not for a few, it should be a universal right of all. But a right is not a compulsion.

BUT vee do live in a democracy and vee do ave zer right of choice as to vever vee vish to ave a govt controlled and run medical record. You seem to prefer zer dictatorial approach vich is your right. But please do make make zer 22 million bend to your vishes. Vee do not live in a dictatorship – yet, Every patient should have zer freedom to choose including you. Every patient is a unique person – zer DNA says so.

Sorry to hear about your grandparents. Give them my best wishes.

Anonymous said...

That is probably enough now Berne you are getting a little close to to crossing the line of decent debate, someone is simply wanting an explaination to your many riddles.

Anonymous said...

I think that's quite unfair for June 13, 2017 7:23 AM to say "Even the Digital Health Strategy has run out of steam and currency."

That's purely hypothetical until ADHA releases their version of the Digital Health Strategy. It would probably be advisable for them to circulate a DRAFT VERSION for comment just in case it can be improved before setting it in 'concrete'.

Anonymous said...

Which digital health strategy? Each state and territory seems to have a fair one in place and progressing well, a couple have had set backs but overall they are in good stead to take advantage of the natural evolution of technology and people's ever growing acceptance of it.

ADHA strategy if it is one is pretty clear, own and operate the National EHR, ensure they keep momentum going to ensure the hard work of the last ten years continues to ensure more feeds into the system.

Anonymous said...

It seems perfectly reasonable that each state should have its own Digital Health Strategy. The ADHA will develop a National Digital Health Strategy which should not dictate to the states, but rather support the work of the states; in other words it should not attempt to smother work underway at state level.

However, having said that, there are some fundamental 'elements' which the states need to come together and reach agreement on and these 'elements' should be 'delegated by the states' to the ADHA to deliver.

Whether ADHA, partly funded by the states, will accept such direction from the states and support them in their endeavors is another matter altogether. If it does not, the states should cut themselves loose and just get on with the job.

In addition to the 'fundamental elements' the ADHA may also choose to find a 'specific' niche in which it can occupy its energies and develop / deliver something that will be useful to all the states (its constituents).

One would hope to see this thinking reflected throughout the ADHA Digital Health Strategy which is why a DRAFT VERSION of the strategy should be circulated before it is finalised and "set in concrete"; lest it sink to the bottom of the ocean like a dead weight.

Anonymous said...

You raise a good point(s) it is a national strategy, the ADHA may have been commissioned to manage its development but it would be far broader than the ADHA remit or capability. It does though still beg the question as to why an interoperability strategy is needed if the national strategy when implemented does not create interoperability?

Anonymous said...

I am sure the strategy will have interoperability strewn throughout it. Hopefully they will finally manadste a small set of standards and remove all the numerous terminology and replace with AMT. The age of building systems on so many standards has to end surely. We put so much investment in CDA and SNOMED why do we continue to put up with V2 MiMs Multum and now heaven forbid this FHIR, another example of slipping interoperability into a marketing headline