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!

https://www.digitalhealth.gov.au/australias-national-digital-health-strategy

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.