Quote Of The Year

Quotes Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"


H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Sunday, September 10, 2017

A Former Liberal Health Minister Points Out Just How Badly We Have Done With E-Health Over 20 Years.

This appeared late last week:

Philips’ Barrow: funding ‘debacle’ hurts e-health innovation

Former health minister Michael Wooldridge says health IT is a “disgrace”.
  • The Australian
  • 12:00AM September 7, 2017

Sarah-Jane Tasker

Australians want their health information shared among care providers but government funding mechanisms are being blamed for holding back innovation to make that happen.
Kevin Barrow, the Australia and New Zealand head for Philips, said patients were frustrated by the inability of the health system to share what seemed to be fundamentally basic and useful information.
Michael Wooldridge, who was health minister in the Howard government, argued at a recent industry event that in 2000 Australia led the world in health IT but today it was a “disgrace”.
“We don’t still have a functioning e-health and hundreds of millions of dollars have been put into that debacle,” he said.
Mr Barrow said one of the problems for e-health was the funding mechanism, adding it was challenged by the fee-for-service model.
“Things like the My Health record is rapidly starting to be more of a real time repository of information but it is not a way of easily sharing clinical information,” he said.
“It’s starting to change but the proliferation of technology is one thing ... but how do you build a care system around that, which actually uses that technology appropriately?”
More here:
While it is hard not to feel that Dr. Wooldridge is not looking backward through rose tinted glasses it is true that we have been at this as a nation for close to two decades and somehow the progress has been less than hoped. Political recognition of the failure of the  myHR is welcome however!
On the positive we do now have General Practice and the Public Hospital Sector pretty well automated with the private sector moving along close behind. Where we seem to have trouble is with interoperability and national infrastructure as well is the implementation of co-ordinated national initiatives – especially in the public sector.
We have also had some missteps with various entities such as NEHTA, some underutilised infrastructure and ill-fitting Standards etc. and I won’t even comment on the myHR debacle as I see it.
To me we need a better thought out approach and I have to say the new ADHA Strategy really does not cut it for me.
Where do you see Australian Digital Health as being positioned and what changes in direction would you like to see if any?


Anonymous said...

You might find this an interesting perspective as well - https://www.cnbc.com/2017/09/06/digital-health-is-dead-says-this-health-tech-investor-rob-coppedge.html

Anonymous said...

I do agree that funding is still a challenge, the Government with the best intentions throws cash at various initiatives but seems unable to build a business model that is sustainable once funding is removed. Where the issue is, probably resides somewhere between vested interests profiting from large Government incentives and short term Government thinking focusing on politics rather than policy.

Nehta had its faults but the common thread has been the PCEHR/MyHR, collectively this initiative has stopped progress, victims include, NASH, HI, P2P, Standards (development and adoption) advancements in the clinical payloads, and an even greater cost has been the depletion of highly skilled subject and domain experts to work at a national level.

John Scott said...

Anonymous, 8:30PM has pointed us to a valuable article from the CEO Rob Coppedge of Echo Health Ventures in Seattle.

The following comments stood out for me:
1. The digital health party is over and those of us focused on long-term systemic transformation should be happy to put this hype cycle behind us;

AGREED, particularly in respect of the MyHR;

2. Digital health has brought two important developments to the industry: a pervasive optimism that health care services problems could be solved with better technology and a keen proficiency at venture capital raising;

The Innovation agenda with its technology focus is no substitute for the need to address the more fundamental questions of:
a. How productivity works in knowledge-based service industries like health care;
b. How we achieve quality of collaboration in the sector; and
c. How we address the Normative aspects of health care, particularly when working with new technology.

Productivity concepts and measurement tools developed for manufacturing do not work with service industries. In effect, productivity has left production behind.
Service industries are about mutuality NOT about the maximization of scarce resources.
The new productivity equation has to address both quantitative and qualitative metrics such as safety, quality and efficiency in health care.

Addressing the interoperability challenge in Health IT is predicated on addressing dot points a, b, and c. Something which is achievable today.

As far as the investment question is concerned, in Australia this can be addressed by understanding the solution to the productivity challenge.

Dr Ian Colclough said...

@10:17 AM Rob Coppedge provides a terrific insight into the healthIT space. Basically the problem in Australia has been that for far too long there has been too much hype, too much money, too little planning and too many bureaucrats which has got us to where we are today.

This is reflected in spades in the AFR article on Telstra Health

It's a great pity Shane Solomon was so seduced by his experience in Hong Kong that he believed that with Telstra behind him he could replicate the HK approach thereby solving most of Australia's eHealth issues in one fell swoop!

Telstra gave Shane too much money to play with. That, when combined with too little experience in the healthICT space, masses of hubris, huge egos and an overriding drive to be the dominant player in healthIT in Australia led Telstra Health into a muddled mess that its 1,000 employees will find nigh impossible to turnaround. Pragmatically, from a shareholder perspective, there is probably only one sensible way forward for Telstra - exit health and write off the losses as a bad dream.

Cynthia Whelan got it pretty right when she said "Solomon's decision to leave was good for him and good for the company." I do not expect to see Telstra pushing hard into the health sector this time next year.

Bernard Robertson-Dunn said...

The sooner people realise that the problem of improved health care is in the medical space, not the technology space, the better.

IMHO, those who start with the technology (i.e. in the solution space) are doomed to failure. What look like similar solutions in other areas, e.g. manufacturing, construction, communications, finance, etc, end up being totally ineffective once you look closely at the problems.

You have to understand both sets of problems to identify the differences. Technologists don't understand medicine and medical people don't understand these other areas.

Bureaucrats understand neither, at the depth required.

John Scott said...

The elephant in the room is the Innovation Agenda where innovation is represented as technological innovation.

We have to purposefully expand our concept of Innovation beyond the technological and include innovation in the social and economic dimensions.

Importantly, we need innovation to speak to Networks rather than Organizations if we are to properly address Services because services are based on Mutuality.

We also need to move away from the straight-jacket of the 'Market' and 'government as the problem' rather than part of the solution.

No small agenda BUT importantly the conversation is finally beginning to turn in this direction as exemplified by Ian and Bernard's comments.

Dr Ian Colclough said...

In the 1970’s with a medical degree and clinical training behind me I entered the computer industry in the UK. That was when I came to appreciate the enormity of the communication barrier between clinicians and IT professionals. Although not quite so great today the problem (barriers to progress) still exists as Bernard so aptly describes.

Extensive technology and clinical experience however is not sufficient, they need to be underpinned and complemented by pragmatic management and business development skills, as well as clinical and political acumen, and a deep understanding of what is required to support truly innovative approaches in a fast moving entrepreneurial environment.

Combine the attitudes and beliefs expounded by Bernard and John under some enlightened leadership and we might just begin to see some light at the end of the tunnel and a far smarter way of spending the taxpayers digital health dollars.