Monday, August 07, 2017

An Uncomfortable Truth: Digital Health In Australia Is Trapped By Politics And Its History.

I think it is time to point out how trapped the ADHA and Tim Kelsey are:

The situation is this:

1. The myHR is not anywhere near a good solution to support Digital Health as it is insecure, clunky, evidence free and not liked by clinicians. If it was useful for them they would have adopted it - as would have the public but they have shown their indifference by needing to be dragooned into having a health record compulsorily.

2. Politically over a billion dollars has been spent and neither side is prepared to recognise the truth and can (abandon) it - even if they could understand what the issues are. We are thus stuck with it.

3. The Digital Health industry is struggling with all the money and focus being on the myHR, which they realise is badly flawed.

All this means we have a second class and largely doomed Digital Health program which money will continue being spent on to very little effect. Worse still, the ADHA is forced to continue to say all is well and we are going forward at a great rate when they know - I suspect - that they are basically stuck with an inferior route forward. What a bind!

It is awful but these are 'the facts on the ground' and it is hard to know how we can break out of this impasse and move forward. An audit that shows how useless it is maybe?

Heavens it is depressing to be stuck in this awful nowhere land!



Anonymous said...

I also believe that the whole transition was used by some inside the Agency and beyond to silence many and to some extent remove completely. This leaves the ADHA with a huge strategic black hole, a large percentage of the ADHA are not overly experienced in eHealth. Tim has another problem, who in the ADHA can actually architect and negotiate a better way forward and relieve the tax payer of this burden?

Anonymous said...

Well summed up David. How they now dig themselves out of this is a really good question. I guess the first step would be co-designing options?

Anonymous said...

8.11 AM The first step is to freeze the project and conduct a thoroughly comprehensive independent audit as the highest priority.

Bernard Robertson-Dunn said...

"The first step is to freeze the project and conduct a thoroughly comprehensive independent audit as the highest priority."

Why would ADHA do that? They never have (not an independent one - too many vested interests). A really independent one would start with the question "How much and what has the government (or anyone else) got for $1.5 billion?".

Politicians and public servants won't/don't understand the ins and outs of IT systems or health care, but they do recognise government waste when it's staring everyone in the face. The hard headed procurement folks at Finance might ask the question "what did Health say in the business case the benefits would be and have they been delivered?"

Finance have never been impressed with Health. Just do a search for Department of Health and IBM. I'm sure you can guess who from Health was involved in the contract arrangements.

Anonymous said...

Can anyone help explain what this means please,

However, there is currently no overarching standard in place to govern the sharing of data, with a public consultation on draft interoperability standards to determine an agreed vision and roadmap for implementation of interoperability slated to occur "by the end of 2018".

I have read it a few times and don't get the one standard bit or how a standard governs. What does implementing interoperability even mean?

This really screams STOP to me

Bernard Robertson-Dunn said...

And while we are asking for explanations how about this quote from the strategy:

“To rapidly accelerate the impact of digital health, the Strategy should specifically recognise that the role of government is to facilitate private sector development of innovative digital products and services – through establishing the right infrastructure and environment for innovation, rather than attempting to develop new products or services itself.
BUPA submission"

As Asher Wolf points out in her Crikey article

"Perhaps it’s an old-fashioned notion, but traditionally the role of government is to serve its citizens first, as opposed to insurance agencies. So it’s odd that a government department should have seen fit to include such a corporately aligned quote in it’s national strategy."

And an observation I'll add - doesn't "through establishing the right infrastructure and environment for innovation, rather than attempting to develop new products or services itself" argue that the government shouldn't be delivering a product/service such as MyHR?

Please explain.......

Anonymous said...

Bernard, yeah but no but yeah but anyway big data so there.

If you had the misfortune of working at the ADHA under him you would better appreciate how he can misrepresent facts and completely dissolve himself from reality, people are simply there to be harvested for his own personal ego trip. The strategy is all very well but the ADHA is not in a position to lead anything, it could not even pay me properly.

Anonymous said...

Sperating the boy from the ball. If nothing else this document lays out enough to have a good insight into those positioning themselves as leaders in digital healthcare, it also lays out just enough to allow suffient lenses onto an age old set of problems. This work I see has two possible uses, either a frame for which tough discussions can be hung and worked through sensibly in an open and accountable way or act as a new carpet to sweep the hard stuff under for another five years.

I think they have laid out the obvious and predictable things well, the hard and more valuable things they have done less well and in some cases exposed a lack of domain and subject matter appreciation.

Anonymous said...

Good pickup Bernard, that does appear to be a contradiction. It also raises two questions:

How can the Agency remain technology neutral and still develop valid standards under internal and national standards development principals, or even stay true to international trade agreement relating to standards?

How can the government avoid being seen as interfering in the market, constraining innovation and not be seen as picking winners?

Wonder how many lawyers will do well out of this?

Anonymous said...

On the government picking winners - They would be homeless now if they were betting on horses!

Anonymous said...

10:16 PM. The ADHA may not be thinking SSO type standards but more towards what the RACGP or ACSQHC term standards. Perhaps they are looking to harmonise technical stands in iscolatiin of the international community, perhaps they simply mean depleting and replacing specifications, and god forbid distilling there information models into something less than a PDF or contradictions and misalighnement, there is so much value to be gained in that area but seem leaderless and stuck in a bygone age.

What ever the ADHA is up to there is a risk that non-transparent and discriminatory conformity assessment procedures can become effective protectionist tools.

ADHA has demonstrated a reluctance to be transparent. They are burdened with the MyHR, wedded to Oracle and the NCTS is locked into proprietary technologies. I find it hard to see how ADHA can allow the market to be competitive and still stay dominant.

Anonymous said...

You mentioned ORACLE. Others have mentioned ORION, and ACCENTURE. What is not clear to me is what exactly do each of these large powerful technology providers actually do in regards to the MyHR?

And a secondary question is Who is actually doing the development of the My Health Record? Is it being developed or is it an off-the-shelf package?

Anonymous said...

And I would also ask that with the huge expenditure, ?? > $1.5 Billion, what are each of these three companies contracted to deliver and how much has each been paid annually since their respective contracts were executed?

Anonymous said...

What Accenture Orion and Oracle contribute would be in public ally available architure, costs for functionality and features along with licensing would be a dark secret, after all it's only tax money and the public has no right to see it. That would be transparency.

Anonymous said...

Give it a year and things will fall back to APS BAU. The DTA tried innovative and agile and that lasted how long?

Bernard Robertson-Dunn said...

It's worth having a look at the Digital Transformation Agency's Digital Service Standard

"The Digital Service Standard ensures digital teams build government services that are simple, clear and fast.

All services which were designed or redesigned after 6 May 2016 fall within the scope of the standard and must be assessed against it."

This puts ADHA in an awkward position. If they redesign the system to make it usable and appropriate for opt-out, then they need to assess MyHR against the standard.

My reading of the standard is that MyHR doesn't have a hope in hell of meeting it.

These are the criteria:

Government agencies will be expected to:

1 Understand user needs

Understand user needs. Research to develop a deep knowledge of the users and their context for the service.

2 Have a multidisciplinary team

Establish a sustainable multidisciplinary team to design, build, operate and iterate the service, led by an experienced product manager with decision-making responsibility.

3 Agile and user-centred process

Design and build the service using the service design and delivery process, taking an agile and user-centred approach.

4 Understand tools and systems

Understand the tools and systems required to build, host, operate and measure the service and how to adopt, adapt or procure them.

5 Make it secure

Identify the data and information the service will use or create. Put appropriate legal, privacy and security measures in place.

6 Consistent and responsive design

Build the service with responsive design methods using common design patterns and the style guide.

7 Use open standards and common platforms

Build using open standards and common government platforms where appropriate.

8 Make source code open

Make all new source code open by default.

9 Make it accessible

Ensure the service is accessible to all users regardless of their ability and environment.

10 Test the service

Test the service from end to end, in an environment that replicates the live version.

11 Measure performance

Measure performance against KPIs set out in the guides. Report on public dashboard.

12 Don’t forget the non-digital experience

Ensure that people who use the digital service can also use the other available channels if needed, without repetition or confusion.

13 Encourage everyone to use the digital service

Encourage users to choose the digital service and consolidate or phase out existing alternative channels where appropriate.

Anonymous said...

8:22 AM - and god forbid distilling there information models into something less than a PDF or contradictions and misalighnement, there is so much value to be gained in that area but seem leaderless and stuck in a bygone age.

Fresh from some great presentations and discussion at HIC, the ADHA really needs to think strongly about there health informatics capability it is requirements modelling at best and nowhere near informatics. I agree though there is so much to be gained through a proper health informatics discipline in the ADHA.