Tuesday, February 27, 2018

Its Been A Really Big Week For Bureaucratic Swanning And Preening - I Wonder What Will Actually Come Of It?

I first got wind of something happening in Digital Health when all these obscure Indian links began to appear.

India building digital health ecosystem: Nadda

Canberra (Australia), Feb 19 (IANS) Union Minister for Health and Family Welfare J.P. Nadda on Monday said India is committed to reforms in health services delivery using Information and Communication Technology (ICT).Addressing delegates from around a dozen countries at the Global Digital Health Partnership Summit, he said the ICT had great potential to improve delivery of healthcare services and "India will take advantage of it under the Digital India programme".
Adoption of digital technology for improvement of governance had always been central to the Indian government, he noted. According to him, the four major areas where India has implemented digital technology in healthcare are health services delivery, compliance of people towards health and care, engagement of citizens in partnering with the government for planning and management of health services delivery and improving governance.
Nadda stressed on the importance of building digital health ecosystem partnerships with private healthcare providers, academia, health IT practitioners, industry, patient groups and regulatory bodies.
Present at the summit were Australian Minister of Health Greg Hunt, Australian Digital Health Agency CEO Tim Kelsey and delegates from Canada, Hong Kong, Indonesia, Italy, New Zealand, Saudi Arabia, Singapore, South Korea, Sweden, the United Kingdom, the United States of America and the World Health Organisation.
More here:
From then it was on for one and all.
The main release seems to have been this one:

Media Release: New Global Digital Health Partnership

---- Picture omitted to spare the children -----
The Hon. Greg Hunt MP, Australian Minister for Health, the Hon. Shri Jagat Prakash Nadda, Minister for Health and Family Welfare, the Australian Digital Health Agency CEO Tim Kelsey with participants at the Global Digital Health Partnership (GDHP) Summit 2018
International participants from thirteen countries, Hong Kong SAR, and the World Health Organization (WHO) have kicked off a new global network to support best use of digital technology in modern healthcare.
The Hon. Greg Hunt MP, Australian Minister for Health, and the Hon. Shri Jagat Prakash Nadda, Minister for Health and Family Welfare, welcomed the participants to the inaugural Global Digital Health Partnership (GDHP) Summit held in Canberra today.
Minister Hunt said the partnership will create a common platform for international experts to share knowledge and experiences, to network, and to forecast emerging trends to support the digital health landscape.
“Digital Health is the penicillin of our time, with precision medicine and genomics offering opportunities to cure previously incurable diseases and deliver better life saving medicine”.
The Global Digital Health Partnership is an opportunity for deep, transformational engagement by governments, digital health agencies, and the WHO so they can learn, share policy and other evidence that supports them to deliver better digital health services.
Australian Digital Health Agency CEO Tim Kelsey said that the Agency is privileged to be hosting the inaugural event.
“Australia and its international partners can learn from each other and share information about what has worked in their health settings, and collaborate on initiatives together that will support digital health systems working more effectively in their countries”.
“The partnership will help deliver actionable policy and program outcomes to both domestic and international agendas,” Mr Kelsey said.
Over the coming year, the Global Digital Health Partnership will collaborate on the following topics:
  1. connected and interoperable health care;
  2. cyber security;
  3. policies that support digital health outcomes;
  4. clinician and consumer engagement; and
  5. evidence and evaluation of digital health.
“It is important that guidelines created by governments and other agencies are co-produced with the needs of innovators, industries, clinicians and the community. The GDHP activities should consider the needs and input of these sectors to improve the delivery of digital health service,” Mr Kelsey said.
ENDS
Media contact
David Cooper, Senior Media Manager
Mobile: 0428 772 421 Email: media@digitalhealth.gov.au
About the Global Digital Health Partnership
The Global Digital Health Partnership is an international collaboration between governments, government agencies, and multinational organisations responsible for policy, funding, and delivery of health services to their citizens. Following a number of bilateral and multilateral discussions, interest in the partnership has grown strongly.
Senior digital health officials from Austria, Australia, Canada, Hong Kong SAR, India, Indonesia, Italy, New Zealand, Saudi Arabia, Singapore, South Korea, Sweden, the United States, the United Kingdom, and the WHO attended the inaugural Global Digital Health Partnership Summit in Canberra, Australia. The participating countries are now engaging in an international dialogue to learn and share lessons on effective policy design and practical delivery implementation of digital health services. For further information on the Global Digital Health Partnership, email GDHP@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 is the system operator of the My Health Record, and provides leadership, coordination, and delivery of a collaborative and innovative approach to utilising technology to support and enhance a clinically safe and connected national health system. These improvements will give individuals more control of their health and their health information, and support healthcare professionals to provide informed healthcare through access to current clinical and treatment information.
www.digitalhealth.gov.au
The release is here:
Clearly the excitement must have been overwhelming with breathless quotes like “ Digital Health is the penicillin of our time” coming for a clearly excited Minister. I wonder who gave him that line:
However these objectives seem pretty sound:
“Over the coming year, the Global Digital Health Partnership will collaborate on the following topics:
  1. connected and interoperable health care;
  2. cyber security;
  3. policies that support digital health outcomes;
  4. clinician and consumer engagement; and
  5. evidence and evaluation of digital health.”
I they are actually followed up it would be a wondrous thing to behold!
Following on the Summit (on the 21st February) there was a 1 day symposium where a lot of the usual suspects talked:

Media Release: International Digital Health Symposium brings leaders together

Digital health leaders from around the globe have met at the inaugural International Digital Health Symposium in Sydney to learn from different global approaches to digital innovation that are inclusive, evidence-based, and support sustainable, high quality health and care.
The leaders discussed the global advancement of digital health policy, how digital health can support clinical quality and safety, challenges in healthcare interoperability, data sharing for health systems improvement, and building the evidence base for digital health benefits. The management of global public health priorities, new approaches to disease prevention, and maximising the benefits of precision medicine were also discussed.
Australian Digital Health Agency CEO Tim Kelsey said that Australia and its international partners can learn from each other and share information about what has worked in their health settings to support best use of digital technology in modern healthcare.
“We are privileged to learn from our Australian and international visitors leaders in digital health innovation. The symposium is an opportunity for collaboration in the ever-evolving sphere of digital health and will help us to solve our own challenges and contribute to the advancement of health and care for the world’s citizens,” Mr Kelsey said.
The symposium was hosted by the Agency, The George Institute for Global Health, and UNSW Sydney and attracted leaders from thirteen countries together with colleagues from Hong Kong SAR, the World Health Organization (WHO), industry, universities, clinical medicine, and civil society.
Lots more here:
I look forward to refined and constructive leadership following all this - but I have to say it is hard to believe anything will change for the better. The ADHA’s furious pushing of the myHR hardly gave me confidence neither did the ongoing lack of serious program evaluation. Maybe at Senate Estimates in the coming week some facts will emerge?
We have all seen this before and the outcome has always been the same - once the canapes have been consumed back we go to the state prior - waiting for some real progress that makes a clinical difference to emerge.
Maybe this time - what do you think?
David.

30 comments:

  1. Not a thing about improved health outcomes.

    Not a thing about achieving Patient Centered/Centric health care - the holy grail of improved clinical medicine.

    Tim Kelsey was quoted in that notorious Forbes article:

    "The people working in this area of digital health are doing the most important work of our generation,” Kelsey says. “I believe healthcare can be transformed through technology, and I am incredibly excited and privileged to be involved."

    https://www.forbes.com/sites/oracle/2018/01/17/australias-electronic-health-record-program-already-showing-benefits/#c2aade778adb

    He is quite correct in one respect "...healthcare can be transformed through technology", the problem is to transform it and improve it.

    So far all MyHR has achieved is an increase in the cost of health care by at least $1.7billion. Not a bad transformation.

    All Digital Health is doing is to automate the status quo but at a greater cost.

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  2. I think they will form an annual jet setter committee sponsored by the big four consultancy houses propping them up. It is good for them to meet and share ideas. The ADHA CEO does look a little out of place though. He is the one in the blue suit for those not familiar with him.

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  3. Just an observation:

    J.P. Nadda (The Indian Health Minister) and Greg Hunt are both Lawyers. Tim Kelsey is a historian/journalist.

    Can I suggest that people who actually know something about clinical medicine and/or how to solve problems using technology (as opposed to just throwing technology at them) would do a much better job implementing Digital Health?

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    Replies
    1. Suggest it by all means Bernard but the politicians and bureaucrats won't take any notice. There are many reasons for this not the least of which is they firmly believe clinicians are too difficult to deal with and they are somewhat intimidated by them. Also clinicians have a tendency to say things that are confronting and challenging and that is not what the bureaucrats and politicians want to hear. Although they don't know much about the health system they think they do and they know they know how to fix it. As for leadership capabilities and IT management experience, they don't have that either. So the only conclusion one can arrive at is to focus on addressing this hugely complex and wicked set of problems quite differently.

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    2. I often refer to ProMedicus as an exemplar of how to ..... led by a GP who hailed from Moonee Ponds in 1984 and his then patient, a programmer. Today, with an $800 million market cap, a rapidly expanding customer base in the world's toughest healthIT market, the USA, I often wonder what must they be thinking when they ponder the shenanigans of the ADHA.


      I feel privileged to have been in a position in 1984 to have been able to support them to climb the early rungs on the ladder to realise their vision.

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  4. I noticed some activity posted for #2018IDHS and #GDHP2018 and wondered at the time whether all those people, including Ministers, had any idea of how to measure the effects of electronic intrusions on interactions between medicos and their patients. I mean, particularly, keyboard entry of notes in the composition of narrative. So, do any schools in the health fields assess their students for typing skills?

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  5. Bernard Robertson-DunnFebruary 28, 2018 7:25 AM

    You mean this sort of thing?

    EHR Use, Administrative Burden Accelerating Physician Burnout

    https://ehrintelligence.com/news/ehr-use-administrative-burden-accelerating-physician-burnout

    “Burnout is associated with lower patient satisfaction and care quality, higher medical error rates and malpractice risk, higher physician and staff turnover, physician substance abuse/addiction, and physician suicide,”

    “The causes are numerous, and in many cases physicians point to the increasing demands of electronic medical records, quality metrics, administrative tasks such as prior authorization, and value-based payment requirements, which take time away from direct clinical care,”

    And our government wants GPs etc to use two systems - their own and MyHR.

    Yes, we are world leaders in Digital Health. But not in a good way. We are also world leaders in gambling - another government led initiative.

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  6. Accenture and Oracle tie all these players together. Just an observation. Shame Ireland, Canada, Germany, France , Brazil, Thailand, China etc were not able to make it.

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  7. You can add Accenture and Oracle to the list of people who know little about the problem they think they are solving.

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  8. Is ADHA working on this problem?

    One third of Australians don't know difference between ovarian and cervical cancers

    https://www.smh.com.au/healthcare/one-third-of-australians-don-t-know-difference-between-ovarian-and-cervical-cancers-20180227-p4z1xz.html

    "Earlier this month, federal Health Minister Greg Hunt announced the government would provide $3 million to support the TRACEBACK project, which hopes to identify and then offer testing to women at risk of having the BRCA 1 and 2 genes."

    At $3m per project, $1.7b could have been better used on over 500 similar sized initiatives, At $30m/project that would have been 50 initiatives.

    Many such projects almost certainly would have saved lives. How many lives has myhr saved?

    Someone should hold their head in shame.

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  9. and then there's this, also in today's paper.

    Home doctor services to close in wake of Turnbull government cuts.
    https://www.smh.com.au/politics/federal/home-doctor-services-to-close-in-wake-of-turnbull-government-cuts-20180227-p4z1w5.html

    "After-hours home doctor services have begun shutting down as a result of recent Turnbull government cuts to Medicare rebates, sparking fears of further pressure on hospital emergency departments.

    The National Home Doctor Service - the country's largest provider of home visits - has begun sending letters to patients in NSW, Queensland, Tasmania and Western Australia to tell them of imminent closures.

    "As you can imagine, it is already difficult to get doctors to work in the after-hours period - especially given most of them choose to work during the day rather than drive long distances at night and often in inclement weather at personal risk," says one of the letters, obtained by Fairfax Media.

    "This Medicare cut has made recruitment and retention of doctors close to impossible. We apologise for the inconvenience that this may cause and we take the opportunity to thank you for your support."

    The first closures will occur in Perth, Hobart, Albury and Townsville in the coming weeks but more are expected.

    Health Minister Greg Hunt announced the rebate cuts - due to come into affect on Thursday - as part of the government's mid-year budget update in the week before Christmas. Until now the rebate for so-called "medical deputising doctors" undertaking home visits has been $129.80 but that will be reduced to $100."

    They'll save about $30 per visit. One $3m project would fund 100,000 visits.

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  10. Ian,
    Agree.
    The key to myhr is the users - people who get a benefit from the system. GPs get ePIP, but very little else. I don't know of anyone else who gets (or will, or could get) any benefit.

    The obvious conclusion is that it won't get used and that there is nothing the politicians and bureaucrats can do about it.

    re "So the only conclusion one can arrive at is to focus on addressing this hugely complex and wicked set of problems quite differently." which is exactly what Digital Health doesn't do.

    What Digital Health does do is try to automate existing practices, sets them in stone and make genuine progress that much harder.

    IMHO, the greatest danger of Digital Health is the one thing its proponents are desperately trying to do - get more data. Clinicians are in danger of drowning in the data they are having to spend more and more time entering into health record systems.

    There's more to clinical medicine than data - it's using the data effectively that counts.

    Does the Global Digital Health Partnership have that as a topic for the coming year? Oh dear. No.

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  11. From Fairness in Precision Medicine (pdf) at APO.

    Several of our respondents voiced the concern that there could be unintended consequences or biased analyses if precision medicine researchers fail to adequately recognize that much of EHR data is billing data, not clinical data.

    Also at APO Trusted Digital Identity Framework by DTA is not a place to look for anything more than, as it says, an Overview, and one bare mention of Health.

    --
    Will Health get a mention at The 4th Australian Government Data Summit (Mar 6-8)?

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  12. Health Minister Greg Hunt said:

    "Digital Health is the penicillin of our time, with precision medicine and genomics offering opportunities to cure previously incurable diseases and deliver better life saving medicine"

    "Fairness in Precision Medicine" says

    "Many participants also asserted that electronic health record (EHR) data, despite its potential for enriching precision medicine research, could prove to be a problematic kind of data to collect and analyze. They pointed out the complexity and variation of EHR data, the mismatch between its intended purpose and the goals of precision medicine, and the challenges of identifying missing data. Jake Marcus, a software engineer who uses health data to build predictive models, argued that electronic health record data is complex and hard to interpret."

    Or, to put it bluntly, MyHR isn't even an electronic health record and is even less use than a useless thing.

    Furthermore and IMHO, precision medicine is still part of Digital Health's automation of existing clinical medicine. "Fairness in Precision Medicine" does not contain a single reference to patient centric health care.

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  13. Something is going on at ADHA. I just heard on the wire a rather key Executive has decided to move on. This will I assume be the start of a number of exits. How history repeats.

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  14. "Something is going on at ADHA." Whatever it is it isn't their weekly statistics.

    After four releases in January (7/14/21/28) they could only manage once in February - 11th.

    One does wonder why.

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  15. Yes there are many aboundining ship. It is not looking gooo internally for the opt out. The Minister should be worried.

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    1. Why should the Minister be worried? He didn't set the ADHA up. He didn't appoint the ADHA Board. He simply inherited the mess. The same cannot be said of the Department. They set it up. They allocated the funds. Paul Madden drafted the initial 'strategy' then oversaw the appointment of the Board, the Chair, the CEO and then stepped back to leave it to them to accept the consequences. The Department will not get involved. The Minister won't get involved other than to tell the Chair to shut it down. Chopping the ADHA's budget is a simple matter and can be done quite quickly. The more the budget is cut, the faster people will leave, the sooner it will collapse. The only unknown is when will the CEO jump ship and whether his General Managers beat him to it. The process can be accelerated quite easily by the States withdrawing their financial support.

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  16. Health Minister Greg Hunt said:

    "Digital Health is the penicillin of our time

    That is a pretty bold claim from someone who would be aware of the transformation penicillin made to healthcare. Information technology is having a big impact but not through old technologies that the MyHR is built on.

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  17. Dr Ian ColcloughMarch 01, 2018 8:10 AM

    I think the ADHA's many huge issues are far too complex and messy for any Health Minister to know what to do. He is beholden to follow his Department's advice!

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  18. It is easier to start a project/initiative than stop it. However what will stop it is political risk. This government has a one seat majority. Just wait until things start hitting the fan, especially via social media. And if you think that won't happen, you are sadly mistaken. Plans are being made, alliances formed etc. A lot of very smart and tech savvy people are very suspicious of this government and its blind grab for personal data. If the minister is smart he will be taking advice from people without vested interests (i.e. not ADHA, not DOH) and making plans to quietly dampen down MyHR and finally "re-align" the objectives of ADHA and turn it into a policy only agency.

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  19. @8:10AM the sooner someone with some common sense either in the health department or the Minister's office asks people like you and others on this blog for some help and how to make the pain go away the better for it we all will be IMHO.

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  20. Why would anyone carry on working at ADHA? If they are not aware of this blog and the other sources of concern about the whole myhr initiative, then they should be - otherwise they are derelict in their duty to themselves to keep informed of the business in which they are working and will get what they deserve.

    If they are aware, then the sensible thing to do is to get out on their own terms, and not wait for things to go pear shaped and become associated with a disastrous failure.

    When a future employer asks - why did you stay with ADHA for so long? their answer could reduce their chances of getting another job, either in the public service or in health care.

    Look at the wall and read the writing.

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  21. The only unknown is when will the CEO jump ship and whether his General Managers beat him to it

    The problem is all the wrong ones are jumping ship. There is a core group of friends whose appointments have been made by friends and populate positions they are not qualified to hold and bully those around who are not friends. The sooner they get rid of that element the better. Sadly that will never happen and the money will continue to be poorer into stupid cultural initiatives and other operational projects that never get finished or done fully enough to be of any value.

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  22. @ February 28, 2018 10:19 PM

    If you could allow a few more weeks, an employee left and we don’t know the password for the analytics spreadsheet that we create the bar charts with. Once we achieve a password reset we will co-design a new colour scheme for the graphs and look forward to working with anyone that is not a GP or a data analytics expert on this project

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  23. The problem is all the wrong ones are jumping ship.

    That's fine. They will be the ones who get the blame and the association with failure. Tim can head off back to the UK where he will probably have a problem getting a job.

    ADHA and what it is trying to do is unsustainable. The states do health care, not the Federal government. If ADHA has no workers but only managers, then it will be crippled. The sooner that happens the better. Tim will have to go crawling to the Secretary of Health to explain why all this is happening. At least she is a public servant, even if totally ignorant of health matters. Staff turnover is a critical indicator of the performance of an agency. I'm sure Bettina can help the minister read the tea leaves.

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  24. There is nothing that can be done. Most are focused on the MyHR and see not what goes on, some live under a protective blanket untouchable. I recently left and can only express there sadly has been a real downward spiral of late.

    In parting I would like to thank you David for your blog, it has been a great source of amusement, information and insight. I am leaving health for greener pastures.

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  25. Oh look stats.... Published 2 March.

    Eyeballing the registration and SHS graphs, they are both trending down. You would expect the SHS to rise as more people registered and then updated their SHS.

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  26. @6:21 PM Pity you can't attend this Murray PHN sponsored gathering in Albury on 15 March.

    "Health professionals and health consumers in North East Victoria are invited to meet with Tim Kelsey, the CEO of the Australian Digital Health Agency and Clinical Professor Meredith Makeham, Chief Medical Adviser. They are visiting the Albury region on Thursday 15 March to discuss digital health, including the My Health Record.
    For more information or to RSVP contact Robyn Lowe, Communications Program Manager e: Robyn.Lowe@digitalhealth.gov.au

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  27. @ 3:54 PM. You have me at a disadvantage. What does the Murray PHN have in relation to 6:21? Do Ageny staff go to all Tim and Merideth gatherings? Or is it the only opportunity existing and/or past employees get to actually see their CEO. I am sure I am missing something here could you elaborate?

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