Sunday, July 23, 2017

The Medical Observer Offers An In Depth Interview With Tim Kelsey. Worth A Read.

This appeared a few days ago:

Can this man turn around one of Australia's costliest policy disasters?

20 July 2017

NEWS REVIEW

Can Tim Kelsey resuscitate the moribund My Health Record system?
Time Kelsey doesn’t smile much when you meet him. But then his job probably means he doesn’t have much to smile about. 
He is the man tasked with rescuing Australia from one of the most expensive policy disasters in the nation’s history — the My Health Record system.
Ten months ago, the Federal Government hired Mr Kelsey, a former journalist and one-time Telstra Health bigwig, to head up the newly created Australian Digital Health Agency.
No faceless bureaucrat, the animated and garrulous Brit immediately attracted plenty of media attention.
There were references to his time in the UK when, in 2014, the boss of NHS England posted a parody Downfall video that satirised concerns about patient data being sold off to insurers, casting Mr Kelsey in the role of a manic Adolf Hitler.
There were also plenty of references to his $500,000 salary, which the tabloids were quick to compare with the less substantial pay packet of Prime Minister Malcolm Turnbull.
But there is an argument that Mr Kelsey’s day job is a little tougher than running the country. He took up the post shortly before the government declared that all 23 million-odd Australians would be automatically signed up to a system that doctors long ago had concluded was clinically useless.

Getting GPs onboard

Sitting down with Medical Observer last month, Mr Kelsey laid out his plan to change the medical mindset — and it appears to place a heavy focus on finding ways to inspire GPs, the people who need to create and curate the millions of patient shared health summaries that will form the system’s backbone.
“We are talking about scientists who base their decisions on evidence,” he says of GPs.
“When a clinical professional has reservations about digital healthcare, it’s not because they’re against digital, it’s because the benefits of digital are not evident to them.
“In digital health, the evidence is not always conclusive. In telehealth, for example, it may seem obvious that telehealth may reduce hospital admissions, but hardcore evidence to support that is thin on the ground.”
As the famous line goes, the first step to success is to admit the failures. Mr Kelsey appears to hold no illusions about the lack of enthusiasm GPs have had for the task.
“We have a history, let’s be honest. The system we inherited was clunky and not that useful.
“People are not holding back. A lot of GPs have been clear that it’s not helping them in the way they hoped it would be.”

The big picture

A big reason for sinking endless dollars to prevent the My Health Record entering the crowded graveyard of IT failures has been the belief it will drastically cut medication errors, and along with that, the human misery and substantial cost of avoidable hospital admissions and unnecessary deaths.
The problem? The My Health Record was not actually built to hold a comprehensive list of dispensed medications.
Mr Kelsey has pledged to fix it. And that holds out the possibility that GPs could eventually use the system to monitor real-time prescribing and help deal with the doctor-shopper challenge.
Mr Kelsey says the other “callouts” on the system are the lack of pathology reports and lack of imaging reports.
So, his agency has been spending its dollars to entice pathology providers and imaging providers to upload their results.
The dollars, according to Mr Kelsey are not huge, just enough to cover costs. Two subsidiaries of pathology behemoth Sonic signed on before the agency released an open ‘partnership offer’.
Mr Kelsey claims that this principle — being able to look up pathology, imaging and medication information in one place — is so sound that no doctor has argued against it. Again it’s a way to entice doctors into using the system.
A lots more is found here:


It is an interesting interview with a few slightly new insights into where the myHR is going.

It was interesting to hear the claim of both being evidence based while at the same time saying that in many areas the evidence for the myHR’s value and utility was pretty thin on the ground.

The most important paragraph in this section – in my mind - is this:

“A big reason for sinking endless dollars to prevent the My Health Record entering the crowded graveyard of IT failures has been the belief it will drastically cut medication errors, and along with that, the human misery and substantial cost of avoidable hospital admissions and unnecessary deaths.”

I would suggest that ‘drastically cutting medication errors’ and reducing hospital admissions are outcomes the myHR is uniquely architected NOT to be able to deliver! These outcomes are best delivered by live point of care systems and not a secondary, incomplete Government database.

It is really an evidence free perspective to keep thinking the myHR is a really useful tool that can return even a tiny fraction of the massive billion dollars of funds invested in benefits in the areas cited or, indeed, any others. Benefits for Health IT largely flow from provision of current up to date information at the point of care, supported by interactive decision support. The myHR does not, and never will, provide this type functionality.

More importantly cloud based real-time solutions can do all the myHR was ever imagined to do while adding the missing functions, doing it more cheaply, securely and safely. Time to cut the Government’s losses. In a recent poll most who read here felt the ‘pile of .pdfs’ approach was basically obsolete.

Sorry Tim, the sooner you look harder at the evidence and change course to a more sensible architecture the better. Right now I believe you are on a hiding to nothing! I am also happy to publish any evidence you have that convincingly demonstrates I am wrong. What about it Tim?

David.

6 comments:

Anonymous said...

But wait, there’s more register now for your new life saving budget busting My Health Record. But wait, there's more! Register in the next 5 minutes and we will double your exposure to identity theft. That is a complete set of personal medical information insurance companies dream of and a rich data set of personal details that can be used by any shop on the dark web for the price of one Registration. Sign over now.

But wait, there's more for me to tell you about my dumb meaningless PDF store that no one cares about.

But wait there's more, work for us and you get a free set of steak knives for when things go wrong

Anonymous said...

What an informative interview. A few more twitters and job will be almost done. "The system we inherited was clunky and not that useful." Oh, is that the problem?

"Mr Kelsey has pledged to fix it. And that holds out the possibility that GP's could eventually use the system to monitor real-time prescribing and help deal with doctor-shopper challenge." Oh thank you Tim - that means us doctor-shoppers won't have anything to worry about for a very very long time.

Anonymous said...

David - agree totally.
Tim - you don't know it, but you are naive to the extreme.

Anonymous said...

Yes I have to agree, very naive. It seem increasingly suspicious various very experienced people across complex areas are being sacked and replaced by unqualified but with business links to Tim and others. In the past month Tim has cleared out a bunch of experienced people who also represented the nursing cohort. Seems out of step with the community - http://www.healthcareit.com.au/article/health-minister-appoint-nurse-board-overseeing-my-health-record-after-nurses-called-their

Anonymous said...

6:04. To be fair Tim is probably powerless to do anything. It is the same with the closed shop mentality which seems at odds with his usual style. I suspect Mr Madden and the eHealth Branch still reign supreme. I can not understand why the Exec overseeing Government and Industry survived otherwise.

Anonymous said...

@ 5:27 PM Tim Kelsey‏ @tkelsey1 Jul 22
Sunset over the Blue Mountains #valleyoffallingwaters

You don't know it Tim but oohhhh what a lovely shot, thanks for sharing.