Quote Of The Year

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

Friday, December 29, 2017

It Looks Like The ePIP Program Has Created Quite A Few Unhappy Campers!

This appeared last week:

'We're becoming unviable,' says GP hit with $22k e-PIP repayment

20 December 2017
General practice has lost a total of almost $11 million in e-health cash incentives since new requirements were introduced in 2016, the Department of Health has revealed.
The Practice Incentive Program (PIP) payments were linked to uploading My Health Record shared health summaries for 0.5% of patients every quarter - starting from the quarter ending July 2016.
However, health department figures show that of the 5000 practices registered for the so-called e-PIP, about 1,440 were asked to repay the funds in April, after falling short of the My Health Record requirements. 
Although some practices appealed, about 1,170 had repaid an average of $9000 each by the end of November this year.
Melbourne GP Dr Igor Jakubowicz (pictured) told Australian Doctor his practice was asked to repay more than $22,000.
“We’re becoming unviable,” he said.
“Basically, the partner doctors have to bear it. Between this and the freeze we may just retire.”
The practice was one of about 400 that appealed against having to repay the incentives.
“It wasn’t for a lack of trying,” he said.
“Part of it was the IT provider and we couldn’t do much about that, even though it was an approved provider.”
According to the health department, the large number of appeals led to delays of several months, with practices waiting to hear if they would lose money or not.
After receiving an initial letter in April, Dr Jakubowicz waited more than six months before he was told practice’s appeal had been rejected.
Dr Jakubowicz said he had an interest in IT and wanted the My Health Record scheme to succeed but could not overcome the technical issues.
“There’s nine buttons to press and it can take two to three minutes to register patients, then sometimes it doesn’t go through.
Read all the successful and not successful appeal reasons in the rest of the article:
Love the comment about the nine buttons to press to register a patient.
It is amazing that 1/3 or so of GPs could not reach the required (very low) number of Shared Health Summary uploads.
Speaks volumes why we are being all forced to opt-out.
Looks like just more good money after bad is being spent and wasted to me.
David.

35 comments:

Bernard Robertson-Dunn said...

re: "It is amazing that 1/3 or so of GPs could not reach the required (very low) number of Shared Health Summary uploads."

Maybe this has something to do with it:

"To create a Shared Health Summary (SHS), the healthcare provider will need to obtain the patient’s agreement that:

The healthcare provider is to be the individual’s nominated healthcare provider
The healthcare provider is to create and upload the SHS for the patient

The document is a good idea for the healthcare provider to have a conversation with the patient about the type of information the provider will include in the SHS. There is no explicit requirement for the patient to review the SHS before it is uploaded to their My Health Record.

When creating the SHS, the nominated healthcare provider needs to ensure that all aspects of it have been completed and verify the accuracy of the information it contains. In assessing its content, the nominated healthcare provider should take into account other relevant information on the patient’s My Health Record.

It is important to note that consent given by the individual is subject to the parts of the Public Health Acts of New South Wales, Queensland and the Australian Capital Territory that prohibit the disclosure of certain sensitive information (such as in connection with AIDS or HIV) without the express consent of the individual."

https://myhealthrecord.gov.au/internet/mhr/publishing.nsf/Content/healthcare-providers-faqs?OpenDocument&cat=Using%20My%20Health%20Record

In other words, it is not a matter of simply pressing a button and the SHS is uploaded (although that is technically possible). GPs are probably very careful about liability and patient care. Therefore, uploading a SHS is time consuming and risky for a GP. Considering that there is little or no benefit to the GP (they've already got far more patient information than they can find in a myhr) all myhr is to them is a waste of face-to-face patient time.

Whatever problems myhr may or may not solve, it has created far more serious problems for a lot of people than it has solved or is ever capable of solving.

No amount of re-platforming or flash whiz bang FHIR can change that.

Grahame Grieve said...

> No amount of re-platforming or flash whiz bang FHIR can change that

I'm starting to feel like a broken record here, but I'll try again. The myHR is constrained by political, policy, financial, and technical constraints. Some of the technical constraints come from CDA/XDS directly, and these caused or contributed to outcomes that generate regular comments here.

Merely putting a FHIR interface on the existing system - something that has already been done, btw - will change nothing except making a few programmers who have yet to encounter the system a little happier.

Going back and reconsidering the design in the light of 10 years of experience with the outcomes, a revised political situation, leveraging the enhanced capabilities a true web stack offers (FHIR is part of that), and leveraging the kind of engagement process that FHIR has proven (not pioneered- no, we create as little as we can) - that's what can make a real difference here.

What I have indicated is that there is an opportunity to discuss what next for the MyHR. Many commenters (brave anonymous ones) have assumed that because it is 'next step for the MyHR' then some combination of it's existing design and architecture is somehow involiate - but I think that's wrong. The MyHR as a political brand will be maintained, but the architecture / design etc (and the engagement process) have to change if the outcomes are going to change. IMHO, but it's a fairly widely held view.

And it must change if the Digital Health Strategy has any meaning. Things like:

* "My Health Record will be an unprecedented platform for innovation in the provision of digital apps and tools that will support Australians and their health providers to improve health and wellbeing"

* "Every healthcare provider will have the ability to communicate with other professionals and their patients via secure digital channels"

People might argue with these goals, but if they're going to happen, then big changes are required.



Anonymous said...

(brave anonymous ones) well you get sacked for having an opinion.

Bernard Robertson-Dunn said...

Grahame,
I agree with all you said except for "The MyHR as a political brand will be maintained"

IMHO, like care.data it will probably die a political death. There is no valid reason for the government to have so much personal, medical data, to analyse, link and search to its heart's content.

Grahame Grieve said...

Anonymous: "(brave anonymous ones) well you get sacked for having an opinion." - yes I've heard that view, and had lots of comments privately about things for this reason. I don't think that it's true (easy for me to say). I'd like to see this claim go away - it's very counter productive

Bernard: you are assuming that MyHr has a certain set of characteristics. Why? It may be that MyHR does die a political death... but I think that would mean that we would say good bye to an infrastructure for health data sharing at a national level. IMO, That would cost us all more money, not less, and set general progress back a few years. I'd rather see rational progress

Dr David More MB PhD FACHI said...

Grahame said:

"That would cost us all more money, not less, and set general progress back a few years. I'd rather see rational progress."

Rational progress requires a realistic assessment of what has / is working and a hard nosed look at all national e-health initiatives for value, safely, utility, practicality etc. not some fluffy marketing document that is claimed to be a national Digital Health Strategy. Until that happens we are all just waving our arms uselessly in the air.

You, of all people, know how hard this is and how much hard work lies ahead - even if we see some much better quality leadership and thinking from the ADHA.

David.

Dr Ian Colclough said...

Grahame, you have combined two elements to present your argument; 1. the MyHR should be preserved. 2. the national infrastructure is dependent on the MyHR for its existence!

With respect may I suggest you dissect your argument into its two component parts. This leads one to ask: Given that it is generally acknowledged that the MyHR is a failed project what are the arguments for preserving the national infrastructure in the absence of the MyHR?

Grahame Grieve said...

depends on what you think the national infrastructure is. Here's a candidate list:

- health identifiers + service
- national provider directory
- national certificate arrangements
- secure content transfer exchange arrangements
- terminology services
- national patient managed health storage
- NIO
- national agreements about content models
- national agreements about clinical process flows
- political/governance framework for collaboration
- standards that support and encode those arrangements
- community that fosters the growth of those things

Some of those things are provided under the MyHR umbrella, variably well. All of them need significant work (either starting, or further work) to turn what is loosely called 'the MyHR' into a platform for solving problems.

I don't think that this list is all to remarkable. The issue at hand is whether we should start with what we have, or destroy it and start again. That's a political/values judgement, so people might disagree, but given that political will is still determined to see MyHR succeed, I'm going to build towards those things as long as there's forwards progress.

Bernard Robertson-Dunn said...

The single characteristic that is (IMHO) wrong with myhr is that the government gets to see and keep the data.

Sharing medical data among health professionals is defensible. Sharing it with the government is not.

Remove the central database and keep those infrastructure components that support interoperability.

Dr David More MB PhD FACHI said...

Grahame,

Only the top 5 of your list are real and I agree should be refined and improved - but they a valuable and useful separate from the myHR.

To me the rest is a great wish list - but again would be useful quite separate from the myHR.

I am struggling to see the link between a set of good ideas and a very bad one (the myHR). Surely we should keep the good and turf the bad - and key to this is a political fact based argument identifying why the myHR is such a bad idea and all the rest is a much better idea!

David.

Grahame Grieve said...

Bernard, you should dig into the story of conformant repositories and the PCEHR.

David - some of the others are just as real

Dr David More MB PhD FACHI said...

"David - some of the others are just as real "

Other than the NIO - whatever that is - I am curious to know what is really real - if you take my drift. The rest seem rather vague, airy fairly and hardly well known (by me as least).

David.

Bernard Robertson-Dunn said...

re "Bernard, you should dig into the story of conformant repositories and the PCEHR."

I have done. I've also read what Tim Kelsey has said.

"When asked to clarify, Mr. Kelsey said that My Health Record takes copies of records from other systems, EMR systems included, from hospitals, from GP software systems, from pathology and radiology systems. It takes those copies (not original documents) and makes them easily visible to clinicians, keeping in account reports such as pathology and digital imaging display only the report itself, not the visual image."

http://opengovasia.com/articles/how-the-australian-digital-health-agency-is-helping-create-a-seamlessly-connected-digital-healthcare-system-for-australia\

AFAIK Australia is the only country in the world to have created a system that sucks up medical data into a secondary system owned and run by the government.

http://international.commonwealthfund.org/features/ehrs/

Canada has a similar federal/state structure - they aren't doing it.

If the Australian approach is so good, why isn't everybody else at least trying to replicate it? They aren't, they are going for interoperability and networking of point-of-care clinical systems. Probably because it makes a lot more sense and is cheaper.

Dr Ian Colclough said...

Grahame, your first five points are commendable. BUT, national managed health storage, and national agreements about clinical process flows and content models, is indicative of a technologists view of a centralists perfect world.


Pragmatism leads one to shy away from unrealistic wish lists in support of a commercially viable market driven approach nurtured, supported and encouraged by government, but not directed, managed or controlled by government

Dissect the National Digital Health Strategy into its component parts and all one comes up with is unsubstantiated wish lists of little insight and no real substance which David so aptly describes as "a waving of arms uselessly in the air".

I understand your comments are based on your belief in what the FHIR can do. I have no problem with that. By all means give it a go it will open new horizons I'm sure. But please step back and look objectively at what has transpired with these government initiatives over the last decade and take care not to be dragged down by the politics of ineptitude. with

Anonymous said...

I find this statement amazing "All of them need significant work (either starting, or further work) to turn what is loosely called 'the MyHR' into a platform for solving problems."

It's been on-line, gathering data since 2012. And it still needs to be turned into "a platform for solving problems"

WTF is really going on?

Dr Ian Colclough said...

@1:53 PM You ask - "What is really going on"?

A failure of Government and a failure of governance.

Anonymous said...

So we have ended up with "a fluffy marketing document" and not an ".. unprecedented platform for innovation .." as the ADHA would have us believe. (6:17 PM).

Bernard Robertson-Dunn said...

"A failure of Government..." Government hypocrisy?

Watch this and ask yourself, "is government really interested in the health of Australians?"

@1:17 "Government really should not be trying dictate to people how to live their lies." George Christensen MP (National Party) representing people in the Dawson electorate in North Queensland.

But they must have a useless My Health Record, which will have no impact on their health whatsoever.

Does myhr record your sugar intake so you can make informed choices? Of course not.

Whatever is going on, it isn't about health.

Bernard Robertson-Dunn said...


an "unprecedented platform for innovation .."

What's wrong with that?

Definition: Unprecedented, adjective.

"without previous instance; never before known or experienced; unexampled or unparalleled: "

Just because it's unique doesn't make it useful or even of benefit.

Donald J Trump, a POTUS with no experience of government or public service is unprecedented.

In fact, you might say that the similarities are uncanny.

Grahame Grieve said...

> It's been on-line, gathering data since 2012. And it still needs to be
> turned into "a platform for solving problems" What is really going on?

I think it's pretty simple - the first round of development didn't quite meet the original goals, and the lack of consensus around the system - specifically, whether to consolidate or redesign - has prevented the government doing anything to address the actual concerns, so we end up in a situation where we have a half-done system that was baked in a hurry, but at the political level it's being treated as ready for prime-time. We're stuck.

> national managed health storage, and national agreements about clinical process flows
> and content models, is indicative of a technologists view of a centralists perfect world.

It depends on how these things unfold.

> Pragmatism leads one to shy away from unrealistic wish lists in support of a
> commercially viable market driven approach nurtured, supported and encouraged
> by government, but not directed, managed or controlled by government

This I agree with completely. In as much as we have the government providing a solution, not a platform for solutions, we'll not get anywhere. My interest is seeing us have a platform on which people can risk build working solutions (innovation), and we can find out what works. It was my post proposing opening up the contact points for that purpose that opened this discussion.

Dr Ian Colclough said...

Lack of consensus led to a half-done system that was baked in a hurry.

Exactly.
1. Lack of consensus arises from too many cooks spoiling the broth.

2. A half-done system arises from inadequate governance, failure to properly analyse, understand and define the problem, too much money being made available, deficient project management, an unrealistic sense of urgency, and an all encompassing project scope so vast as to be totally unrealistic.

Anonymous said...

Grahame sad "This I agree with completely".

I find that particularly reassuring and I'm sure many other competent health informatitians do also.

"We'll not get anywhere as long as we have the government providing a solution, not a platform for a solution."

This reinforces Ian's profound view that "government should not be involved in directing, managing or controlling".

The government should get out of the way, the ADHA Executive should be dismissed, the ADHA should be cut back to bare bones and the ADHA Board should be dissolved.

Anonymous said...

@9:31 AM That will never happen because the bureaucracy and the government (and its predecessor the Opposition) have too much political capital tied up in the MyHR. Also the prevailing culture in the Department and the ADHA would never entertain seeking to engage with commentators who contribute to this blog and its all too big and difficult for the Health Minister and other politicians to comprehend.

Bernard Robertson-Dunn said...

re "the ADHA should be cut back to bare bones"

Have a look at this:

How big tech is getting involved in your health care
http://www.bendbulletin.com/health/5872878-153/how-big-tech-is-getting-involved-in-your

Does ADHA's definition of "Digital Health" include this sort of technology? Is ADHA working in this space? Is this sort of high tech included in the ADHA strategy? Can MyHR cope with this sort of innovation?

AFAIK, the answer to all of these questions is an emphatic No!

IMHO, the ADHA should be abolished altogether, along with the myhr. The delivery of health care should be left to the medical profession and the states. The federal government can do nothing other than slow things down by creating impediments and distractions.

Anonymous said...

5:38PM December 30 said 'we're stuck" .... I can think of a better word which sounds like -uck.

Trevor3130 said...

Re Bernard's "The delivery of health care should be left to the medical profession and the states" at 10:24 am.
Maybe, but the increasing involvement of "hi-tech" in personal health care is pushing the envelope is widely different directions.
The example spoken of by Dave Snowden in the video clip at HINZ is one where the consumer seeking to get on top of T2D engages with providers through the medium of intensively writing into personal electronic diaries and coordinating with calendars.
Another example was given by an acquaintance who had minimally-invasive robotically controlled surgery, the culmination of months of tests, MRIs, biopsies, etc. In this case he may as well have been mute, simply assenting and turning up at appointed times and places.
Snowden can count results of his personal investment by kgs shed and fingerpricks. The second, even though a highly credentialed person, will not be able to tot up the actual costs of his episode because they are concealed by layers of obfuscation. Moreover, the outcome (survival beyond ten years or so) cannot be known at this stage. A behavioural economist would not know where to start if it was desired to implement cost controls by getting users properly informed.

Anonymous said...

the ADHA should be cut back to bare bones"

Barebones of what? I fear like a lot of Government they have stripped the wrong aspects and now are no longer smart customers, the recent news around how much is being outsourced to big end consultancies is a good indication that they are stripping the wrong skills. How much money has been invested it outputs they lay around collecting dust because the initiator of consultancies has no idea what to do with the deliverable.

The CEO and executive team would do well to do a stock take and look at what waste has been created at great cost. I think you would find a good starting point for lean management.

Bernard Robertson-Dunn said...

Trevor "Maybe"?

Are you suggesting that what I was saying is wrong? If you had said "Yes" not "Maybe" I would have agreed with you 100%. You've just given examples of why ADHA is in the wrong place doing the wrong thing.

Anonymous said...

@11:46 get real, what planet are you on? The "CEO and executive team" lie at the heart of the problem.

Anonymous said...

The "CEO and executive team" lie at the heart of the problem.

When the CEO of a high tech agency is a historian/journalist, then I suspect it's the CEO that's the problem. If he had had any idea of the nature of the problem he was asked to take on then he wouldn't have taken it on.

It also means he doesn't understand the questions about ADHA/myHR that are being asked, never mind the answers.

Anonymous said...

@2;15 PM The CEO appointed his Executive Team. So it is not just the CEO who is the problem. Even so, he and they have been appointed to do the Department's bidding under the Direction of the ADHA Board, all of whom were brought in to play to implement Paul Madden's 'draft' Digital Health Strategy; perhaps you have forgotten what his 'draft' said.

Anonymous said...

If the CEO didn't understand the stupidity and futility of Paul Madden's 'draft' Digital Health Strategy, then he deserves all the insults he gets. There's a good chance he won't find work in digital health again, not after two miserable failures.

Dr David More MB PhD FACHI said...

For those who have forgotten here is a link to all that from mid-2016.

https://aushealthit.blogspot.com.au/2016/04/submission-sent-yesterday-to-department.html

David.

Anonymous said...

and for those who may not know or remember:

https://medconfidential.org/2016/caldicott-review-1-the-good/

https://link.springer.com/content/pdf/10.1007%2Fs12553-017-0179-1.pdf

Anonymous said...

@3:43 PM thanks that has left me extremely concerned. The opening paragraph surely raises a few questions in itself.