Sunday, August 06, 2017

I Think I Have Worked Out What Is Wrong With The National Digital Health Strategy – It Is Far Too Incomplete To Really Assess!

Late on Friday we were all given access to the new Digital Health Strategy For Australia.
For those who have snoozed over the weekend here is the link where you can obtain the document. I have published this blog early to foster as much discussion as possible!
The document is a nicely produced 63 page document which, sadly, is only about half the job. These two paragraphs show what I mean:
From page 15.
“The Agency will operate as a leader and facilitator, supporting and empowering health consumers, healthcare providers and industry. Given the Agency’s ongoing commitment to co-production, the next step in implementation is to co-design a Framework for  Action with the broader health and care sector to agree an implementation plan. This co- design is imperative to ensure that the national priorities of this Strategy complement existing investment in digital health initiatives by industry and state and territory health departments and the broader health sector.”
So we have to wait to see any concrete plans with their associated costs, benefits, timetables and so on. It is this implementation plan that will be the making (or not) of the total package of which I would argue we have now a good deal less than half I would suggest. The timeframe for all this to be done is vague but 2018 – 2022 seems to be intended.
Another key section is this (page 6):
“By the end of 2018, a public consultation on draft interoperability standards will confirm an agreed vision and roadmap for implementation of interoperability between all public and private health and care services in Australia. Base-level requirements for using digital technology when providing care in Australia will be agreed, with improvements in data quality and interoperability delivered through adoption of clinical terminologies, unique identifiers and data standards. By 2022, the first regions in Australia will showcase comprehensive interoperability across health service provision.”
To me this para puts real interoperability off a fair way into the distance.
Bluntly we are to wait a fair while to see some really concrete plans and costs – and what we have to date is a marketing document (largely for the myHR) for politicians to keep their interest up.
We all remember how the 2008 National E-Health Strategy was agreed and approved by COAG but never funded so it never went anywhere. That plan actually had some real projects and objectives. I wonder will this vaguer one be easier to swallow. We have been running around this track for a fair while already without getting anywhere much nationally while GP, and the States are making real progress. (Another big gap in the plan we have to date is a proper analysis of where we are with Digital Health – save for a pile of anecdotes. Among other things missing are a decent technology scan and I have to say a real downplaying of the importance of GP Digital Health for some reason). Along these lines I believe we will all be disappointed to see that there is still no evidence provided on the value and impact provided by the myHR - just how long can this level of expenditure go on in the evidence free way we see at present?
For my last comment I offer the principles section:

Principles

The following guiding principles have underpinned the development of Australia’s National Digital Health Strategy:
          Putting  users  at  the  centre The Strategy has been developed to deliver on the needs of patients and health professionals as articulated in the national consultation process (and through ongoing user research). User needs and their context of use are placed at the centre of decision making, supporting improved prioritisation and user experience.
          Ensuring privacy and security Australians expect strong safeguards to ensure their health information is safe and secure, respected, and their rights protected. They expect that their health data is only used when necessary and with their consent. The strategic priorities consider security, privacy and protection of sensitive personal information, balanced with safe information sharing and maintaining consumer and clinician trust.
        Fostering  agile  collaboration The strategic priorities recognise that appropriate co-design and co-production methodologies are important for ensuring that digital health solutions developed for use in Australia meet the evolving needs of users and stakeholders.
      Driving a culture of safety and quality The safety and quality of digital health solutions and services are of critical importance. The Strategy seeks to embed a systems approach to safety, quality and risk management throughout the design, development, implementation and use of digital health solutions and services.
          Improving equity of access Digital health solutions and services have the potential to empower and to address longstanding barriers to equity of access in healthcare. The Strategy is developed based on the principle that all Australians deserve to benefit from the opportunities presented by digital health, and strategic priorities are aimed at improving health system accessibility across the socio-economic spectrum.
          Leveraging    existing  assets  and  capabilities Australia is making significant advances in the delivery of digitally enabled health and care across Australia, through the development and operation of national digital health foundations. This Strategy was developed with respect to existing assets and capabilities and aims to avoid duplication.
          Judicious   use   of   tax payer  money Development of strategic activities is based on sound investment of funds to eliminate waste, deliver value for taxpayers, and ensure that investments are assessed on the basis of delivering the best health and care outcomes for all Australians.
I will leave it to the reader to decide how many of these principles are actually being followed through.The lop sided valuing of patients over their GPs etc. and the known issues around security are hard to ignore.
I await the second half of the Strategy with more than passing interest. Informally I have been told that the work to fill in at least some of the gaps I (and others) have identified will be underway pretty soon. Will be good to see that happen!
David.

18 comments:

Anonymous said...

this Strategy complement existing investment in digital health initiatives by industry and state and territory health departments and the broader health sector.

Could be interpreted as - sod off you drop the ball and we realised it is achievable without you, but happy for you to be an ATM.

The interoperability bit, gee if it was as simple as the intergration layer, still if they can successfully and universally take care of the semantics that would be nice. Don't sense they understand the problem or considered the consequences of interoperability. i recall they closed down standards and interoperability? Seems Tim comes with a set of steak knives. Who else and what businesses will be knifed in the next few years?

Anonymous said...

Many stakeholders had strong supporting opinions on shaping the direction of this strategy despite the fact we provided no useful contextual data. In keeping with this theme through the strategy we have sprinkled cherry picked snipes as proof everyone thinks I am gods gift to humanity and pass me a match I see a fax.

Having mostly read this I can see why it has been approved. For no other reason than there needs to be something with the title Strategy on it. The States and Territories are simply playing polite politics I don't see how this will impact them much and keep Paul Madden busy.

Anonymous said...

David...
"ongoing commitment to co-production" - what exactly does this mean...are they setting up a softwarehouse/production group? This is industry's work not a governments. I cannot think of any government software that has been a success?
Co-design - YES that is a good idea
I hope one of your readers at HIC will tease out the meaning of this new expression which I don't believe I have seen before.
Keep up the good work

Anonymous said...

It possibly refers to this - https://www.digitalhealth.gov.au/implementation-resources/digital-health-developer-program

I am not sure what the constant delays are due to, perhaps some are finding it is more complicated than first thought, going on the latest product releases PDF specifications seem to remain the norm and I am not sure how this ties into HIE and FHIR communities especially FHIR which will be hard to trump and project argonaut seems to be going well for the global players. Maybe they are looking to relieve industry of the need to have their own IDE? I am sure Emma would support that.

It maybe that the are throwing lots of things out there hoping something will stick

Anonymous said...

With Accenture as the infrastructure provider and, presumably, the developer of the MyHR, would they not be responsible for managing and controlling the IDE? or Have I missed something?

Anonymous said...

Accenture, Oracle, Orion that is a good point where are they in all this? Maybe they will make MyHR open source, or maybe down the line to recoup costs there will be a licensing fee?

Anonymous said...

The vendor lock-in will be interesting if they try and replatform the document store, I cannot see that be easy or cheap, even the opt out cannot be cheap. Are there in the mantra of transparency is cost tables relating to licensing costs and expansion costs?

The Strategy is what it is, it is a milestone and that is all, not worth rolling out a parade for, the ADHA had done enough to tick the box, no more no less.

Anonymous said...

9.25 PM did they get a mention in the ADHA Strategy? If not, why not?

Anonymous said...

Why is there NO DATE on the document?

Why are NO AUTHORS names shown on the document?

Anonymous said...

Incompetence? Shame? Both?
It's almost as though someone who should know doesn't know how the public sector should work. I wonder who that might be?

Anonymous said...

Accenture, Oracle, Orion are not alone. No vendors got a mention. At this stage they are not eligible to ride on the ADHA magic carpet flying high through the fluffy white clouds above.

Anonymous said...

Why should any vendors be listed? I'm a little confused as to what people expected in this document. It is a strategy, a statement of intent and objective. It's not an implementation plan.

The strategy is solid, it focuses on all the areas that need work in a logical way. The biggest issue will be how they make said vendors get on board, which is a simple matter of mandating that all clinical systems must use their frameworks.

Anonymous said...

Why should any vendors be listed? Good question. Surely the strategy embraces those vendors(assuming they exist)which are involved in providing the infrastructure *as it is today) and involved in developing the MyHR (as it is today)else the strategy becomes something quite isolated from the real world by ignoring the existence of some essential ingredients upon which, in theory at least, the 'strategy' and 'strategic way for moving forward' is predicated. Is that too difficult to come to terms with?

Anonymous said...

3:22 PM yes a strategy requires an implementation plan, however 3:49 is also correct, the current state has a number of constraints which I assume would form a number of assumptions that underpins the objectives and any logic.

6:59 Asks a good question, for software developers, obtaining the source code for the major innovation constraint the strategy calls out (myHR) would be vital. There is no strategy around this

3:22 - which is a simple matter of mandating that all clinical systems must use their frameworks. what frameworks are these? The only mention of a framework is one related to a call for action, what does that translate to for clinical system design? ADHA has not developed any frameworks. At least it has not resulted the the ADHA making all standards and specifications interopable by 2018.

Anonymous said...

3:22 PM yes a strategy requires an implementation plan, however 3:49 is also correct, the current state has a number of constraints which I assume would form a number of assumptions that underpins the objectives and any logic.

6:59 Asks a good question, for software developers, obtaining the source code for the major innovation constraint the strategy calls out (myHR) would be vital. There is no strategy around this

3:22 - which is a simple matter of mandating that all clinical systems must use their frameworks. what frameworks are these? The only mention of a framework is one related to a call for action, what does that translate to for clinical system design? ADHA has not developed any frameworks. At least it has not resulted the the ADHA making all standards and specifications interopable by 2018.

Anonymous said...

Aug 6 6:25 That is easily solved. You simply get one of the big end of town consultancy to subcontract to some standards boffs who have a reputation in interoperability and the domain knowledge of health to develop the framework and outline the essential standards for interoperability, make sure they have a technology focus and to meet the new narrative probably represents patients views. Job done as the say. Few hundred thousand well spent.

Anonymous said...

ANON August 08, 2027 1:16 PM. Endorsement through association, the hidden part of the stakeholder engagement strategy, or should I say co-endorsement.

tygrus said...

You need to target the source of the data and inconsistencies then work along the chain.
GIGO = Garbage In = Garbage Out
AI and Free text is not the solution.
The greater the differences are in the databases and software the greater the difficulties to retrofit interoperability. Start small and expand it over time. There are people trying to standardise health data and communication but they lack the required support.
No work will be done for free so someone must pay. $1B spent on academics, research, education, SW companies and users could have created a far better health system where the pipe dreams would have some possibility. The greater the systems have in common should: make it easier for users; require less retraining; make data entry quicker; improve data reliability; make interoperability easier; improve data for better research; improve outcomes for patients.

Carrots and sticks are required to encourage collaboration and discourage non-compliance. Interoperability becomes a side-effect of implemented standards not a retrofit to the lowest common denominator.