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."

Tuesday, November 21, 2017

The ADHA Issues Its First Annual Report - Not Much That Is New I Have To Say.

This appeared last week:

Annual Report 2016-17: New momentum for digital health in Australia

Tuesday 14 November, 2017
The first Annual Report of the Australian Digital Health Agency has been tabled in Parliament – it highlights a new partnership between governments, clinical and consumer leaders, industry and the research community to put real momentum behind bringing the benefits of digital health services to all Australians.
Significant progress has been made in the last year, the report says: Australia has a new National Digital Health Strategy endorsed by all health ministers; My Health Record is on track for national expansion in 2018; and new initiatives to enable secure paperless communications between clinicians have been launched.
Agency Chair Jim Birch AM said that the Agency is tasked with improving health outcomes for all Australians through the use of digital health technologies.
“Technology is already transforming our ability to predict, diagnose, and treat disease. But there is much more we can do to realise its full potential for the health of every Australian: giving consumers more control of their health and care, connecting and empowering healthcare providers and promoting Australia’s global leadership in digital health and innovation,” Mr Birch said.
In its first year the Agency has built a new organisation, connected hospitals and health services to My Health Record, improved the user experience for the 5.3 million registered Australians, and grown the volume of clinical document sharing with 14 million prescription and dispense records now uploaded.
Agency CEO Tim Kelsey said: “The Agency is here to serve the patients and citizens of this country – and would like to thank all our partners in the community – leaders in patient and consumer services, in clinical practice, industry and research, as well as the governments of Australia - for their continuing commitment and collaboration to ensure that everybody has access to the benefits of digitally empowered health services.
“Digital information is the bedrock of high quality healthcare and our shared goal is to ensure that all Australians benefit from the increasing number of digital health services,” Mr Kelsey said.
Media contact
David Cooper, Senior Media Manager
Mobile: 0428 772 421 Email: media@digitalhealth.gov.au
About the Australian Digital Health Agency
The Agency is tasked with improving health outcomes for all Australians through the delivery of digital healthcare systems and the national digital health strategy for Australia. The Agency was established on 1 July 2016 by the Australian Government as a statutory authority in the form of a corporate Commonwealth entity, and reports to all Australian governments through the COAG Health Council.
Here is the link:
In the best NEHTA tradition there are a zillion happy smiling Digital Health Users and a lot of positive reporting.
Fun Facts:
1. As of 30 June, 2017 there were 247 employees (Temp and Permanent).
2. Agency Funding 2016-17. The Agency is jointly funded by the Commonwealth ($120.892 million) and the states and territories ($32.25 million) reflecting the commitment at all levels of government to the delivery of digital health reform. Note is seems the States are paying a lot less than they were under NEHTA! with the Commonwealth paying more.
3. Registrations:
 In 2016-17 the Agency, as System Operator, registered 1,120,817 people for a My Health Record. There were a total of 20,151 cancelled registrations during the year.
In 2016-17 the System Operator registered an additional 1,320 healthcare provider organisations. 89 registrations were cancelled or suspended.
A total of 664,278 people accessed their My Health Record via the consumer portal in 2016-17.
A total of 2,217 unique healthcare provider organisations, via their clinical information systems, viewed records in the My Health Record system during 2016-17.
A total of 4,538 unique healthcare provider organisations uploaded records to the My Health Record system during 2016-17.
A total of 218,776,890 documents were uploaded to the My Health Record system in 2016-17.
5. Breaches:
35 data breach notifications were reported to the Office of the Australian Information Commissioner as required under Section 75 of the My Health Records Act 2012 (concerning potential data security or integrity breaches). Twenty-nine of these were reported by the Chief Executive Medicare as a registered repository operator under Section 38 of the Act.
6. Complaints:
In 2016-17 a total of 64 complaints were made in relation to the My Health Record system and, as of as of 24 July 2017, one remained open.
7. I could not find a single issue that was seen as a problem and all seems to be going fine.
A small reward is offered for anyone who can find a self-critical comment in the report. Maybe next year?


Anonymous said...

and how much has been saved or costs avoided because of the myhr?

Oh,I forgot, that's not what it's for. It's for the government to hoover up as much personal data on its unsuspecting citizens and their doctors as it can. And it's not doing that very well either.

But it is putting a lot of personal data onto a system connected to the web, so that's a good thing, eh?

Andrew McIntyre said...

Had a meeting to review the interoperability of applications today and was quite depressing with a large number of serious errors on the books and all prevent safe interoperability and preclude free messaging system interoperability. I think we should connect the messaging system on Friday April 13 next year, for 1 day, so we have superstition to blame for the widespread mayhem that would occur.

All the PMS vendors are busy working on cloud based solutions and are snowed under with development jobs, including MyEHR work. There are a lot of demands on them and unless ADHA get serious about a plan for compliance extending over a few years I think Tim is going to be very disappointed at the number of fax machines in the rubbish bin.

MyEHR solves nothing and is pdf central which will end any possibility of meaningful decision support and our testing shows that the ability to on send pdf reports is a further interoperability nightmare and a storage, interoperability and bandwidth hog that will increase costs significantly. There are also lots of new players and without any compliance requirements and a push to get to market we are playing Russian Roulette with patient safety, dropping quality from a pretty low bar.

We desperately need some good governance that works behind the scenes to start insisting on quality in the interests of patient safety as the first priority and a path to decision support and free exchange of atomic data as its second priority, but I see no sign of that with less and less technical depth in 300 employees and no preservation of the experience "gained" since the days of health connect. They are looking for the "big win" but its not going to happen, even in their wildest dreams.

Really I am quite depressed about the chances of significant progress in the current environment. :-(

Anonymous said...

The Interoperability of applications? Did you make that up Andrew?

Grahame Grieve said...

Well, Andrew, let's say you were a program manager at the agency, and you had a bit of a budget, and a couple of years time frame to try and make some real difference to this thorny problem. What would you do? How much would you ask for?

Dr Ian Colclough said...

You are not alone Andrew but sadly the politics are such that whatever we might wish it is highly improbable that the leadership of ADHA and the Department will accept or understand that anything needs to change.

Andrew McIntyre said...

Hi Grahame,

its not really a question of money, well not really significant money in eHealth spending terms. Its a matter of insisting that all medical applications that receive data can reliably display and acknowledge it as per the standards. This needs a test/certification which need not be developed by government, we used to have AHML which would have been a good start and was only a few thousand $ to do. Once receiving certification was done you would apply the same process to senders with a stepped program that also looked at things like terminology and atomic data. Every new release would have to undergo testing and certification.

You would also ideally start a series of data modelling workshops with special interest groups to produce models similar to what has been done with histopathology of cancers so that there were defined clinical models and terminology for reports with atomic data. Clinically obvious targets are radiology and diagnostic procedures such as echos, endoscopy reports and eg sleep studies. This would involve workshops with craft groups and would cost some $ and take a few years to mature and employ some of the 300 ADHA staff to do something useful. Reports that had atomic data would attract higher compensation once they were certified compliant.

We also need to insist that every Heath provider has PKI certificates, and make it such that their billing ones were usable for clinical data and insist that they be used to secure clinical data for transmission and for authentication. Every new provider/practice would be issued with a certificate/location specific provider ID/practice ID as part of registration and would bring back individual keys. Key renewal would be automated using the still valid PKI key as authentication.

The Medicare provider numbers could be opened up for use by all and made searchable via apis.

What the messaging interoperability attempts have exposed is that this work is non trivial and would increase the cost of applications, and I guess you could try and compensate users by putting a # after item numbers if the report was sent electronically and in a compliant way and give them some sort of small $ value. This would encourage lots of electronic communication so is at risk of perverse outcomes, but could be monitored. It would however fund the increased cost of compliant applications.

If you applied the same rules for any patient directed results then you would allow patients to receive data in the same format (Not pdf) and let people develop patient orientated data stores that held atomic data. This would remove the central repository and open the door for patients to run decision support over their own data or share it if they chose to. The privacy risks would be their own, but you could use their tax department certificates to secure data and these could be obtained via ?LDAP.

We would just insist that all this applied to existing standards and restart the standards process in a way that people knew that any new standard would be subject to these rules so they may as well get involved to stop silly things getting up.

Can you please just get that implemented for me?, thanks

Anonymous said...

Re7:48 AM that sounds too complex for Tim and his management team to understand. The ADHA Board is beholden to the politicians and the Health Department and their imperatives are deliver things that work now and leave the hard stuff to later. Opt out is enticing because 20 million registrations for MyHR is an early deliverable equating to pats on backs for politicians.

Grahame Grieve said...

Sure, Andrew, I'll get that done today.

What your write up shows clearly is the complex dependencies any such endeavour must have -
which is why any sensible project manager runs away screaming from it.

It remains a wicked problem (to use language that was in vogue a decade ago). The governance challenge is to make short term projects useful towards sensible long term outcomes.

Anonymous said...

8:47 am. Perhaps a project manager might as the scope would be to fluid and a project is focused on outputs, on the other hand a program manager would not or at least should not, programs are designed to work with boundaries, be adaptive enough to stay aligned with changing strategic direction and capitalise on opportunities and are intended to orchestrate a dossier of projects and activities to deliver outcomes and move toward a goal.

So yes this may be a complex web of things but going in with a project mindset and framework without the program above it is not a good option. It is as limited and constraining as believing an API approach in isolation will save us all. I am also guessing with some experience the program and project managers are rarely allowed to direct, the same as other key disciplines, rather than listen to them they are forced to make the unworkable work and then laid to rest when it does not yield the fantasy required.

Although you could all just do what you are told and stop believing in alternatives.

My personal view is the secure messaging inability project is a placebo. The MyHR is the only true concern.

Anonymous said...

David said: "7. I could not find a single issue that was seen as a problem and all seems to be going fine."

Self flagellation is not in the ADHA Charter.

Andrew McIntyre said...

"The Interoperability of applications? Did you make that up Andrew?"

Not sure, its like the old sneaker net where you save a message from one application onto a usb and then walk over to another application and try and import it. You will find that you have trouble getting a message out of many and have trouble getting it into the recipient, at least in a way that displays correctly. Until this works flawlessly replacing the usb with a messaging system is just going to make the problems much bigger.

Enrico Coiera said...

For those interested in the interoperability of applications, have a look at SMART. https://smarthealthit.org/

And now that SMART is on FHIR, it is becoming a compelling candidate for the defacto standard for creating apps that interoperate, down to the semantic level.

Grahame Grieve said...

@Enrico - yes, that's pretty much what I proposed (http://www.healthintersections.com.au/?p=2720) - has caused a lot of discussion around the industry and government

Anonymous said...

Good god, why not just rename it to - fluffy stuff that won’t result in effort

Bernard Robertson-Dunn said...

re: http://www.healthintersections.com.au/?p=2720

Why does the (government owned) MyHR have to exist at all? What clinical benefits does it deliver?

Do these benefits outweigh the risk to privacy, perception (as a minimum - it might be fact) that myHR is a blatant data grab and high cost?