A very long time ago I was involved in a project to try and define what a decent GP system might be able to do and how it might be architected. This was in fact late last century!!!
This page contains a lot of interesting history and some ideas which still do not look that silly:
In the light of the various memos going around with the ADHA, the MSIA, the RACGP and so on it is worth just seeing for how long all this has been discussed etc.
Enjoy the browse. The last entry (a paper describing what went on in the project) is a good introduction and still looks pretty reasonable after all these years!
The press release from the ADHA that set off all the excitement off is here:
Media release: GPs and software vendors enter new dialog for better health systems
Created on Monday, 5 February 2018
In Australian general practice, clinical information systems (CISs) have become a vital tool in the delivery of safe and high-quality healthcare and good practice management.
The Royal Australian College of General Practitioners (RACGP) has announced a new project that will see the college working closely with GPs and software developers to ensure CISs are useable, secure, interoperable, and ultimately fit-for-purpose.
RACGP President Dr Bastian Seidel said the project is aimed at opening a dialogue between the medical community and software vendors.
“GPs and clinical software developers both share a vision for high-functioning and usable clinical software systems which will help general practices deliver efficient and high-quality care.
“This project, supported by the Australian Digital Health Agency, is aimed at opening a dialogue between the medical community and software vendors to determine and develop the minimum clinical software functionality requirements that meet current and future healthcare needs,” Dr Seidel said.
Agency CEO Tim Kelsey said Australia’s GPs have access to digital tools that can improve the safety and quality of health care for their patients. The key is in ensuring that GPs can get the most out of their clinical systems, and the systems themselves can evolve with clinical practice.
“The need for medical and industry collaboration in defined software standards was identified in Australia’s National Digital Health Strategy – Safe, Seamless, and Secure.
“This collaboration between the RACGP, GPs, and software vendors will help create a platform for innovation to meet increased expectations from healthcare providers, consumers, and funders to take advantage of technology to ultimately improve patient care.
“We have a vibrant software industry that is rising to the challenge to work with us, and this project led by the RACGP with support from the Agency has the potential to foster the development of digital apps and tools that support Australians and their health providers to improve health and wellbeing,” Mr Kelsey said.
Here is the link:
Very amusing commentary on the whole imbroglio from Jeremy Knibbs is also around:
7 February 2018
The ADHA/RACGP’s brain fart on clinical information systems
Posted byJeremy Knibbs
One poorly worded press release and years of building a trust relationship between the software industry and the ADHA and RACGP is headed for the rocks
Most media releases we get from the Australian Digital Health Agency (ADHA) are reasonably tame and sensible, usually announcing a new stage ticked off in the timeline of their ambitious and detailed National Digital Health Strategy. It is doing OK with it.
But when yesterday’s release came in simultaneously to several of our journos, there was a collective murmur of angst, followed by a heated argument between two over what was going on. What had the agency said?
Although you suspect it was not anyone’s intention, the release essentially announced that the RACGP had joined forces with the ADHA to help the clinical information software vendors (folks like Best Practice, MedicalDirector, MediRecords and MedTech), communicate much better with their clients. Apparently they need help.
The release reads:
The Royal Australian College of General Practitioners (RACGP) has announced a new project that will see the college working closely with GPs and software developers to ensure [Clinical Information Systems] CISs are useable, secure, interoperable, and ultimately fit-for-purpose.
RACGP President Dr Bastian Seidel said the project is aimed at opening a dialogue between the medical community and software vendors.
So the RACGP was going get the software vendors to “open a dialogue” with their clients of 30 years or more?
It got worse, again, probably unintentionally.
“This project, supported by the Australian Digital Health Agency, is aimed at opening a dialogue between the medical community and software vendors to determine and develop the minimum clinical software functionality requirements that meet current and future healthcare needs,” says RACGP president Bastian Seidel.
Thus reinforcing the first point about the vendors needing customer help, but then announcing the RACGP was going to add software architecture skills to its ever-expanding remit over the GP landscape.
The reaction from the vendors was predictable.
The erudite and politic Emma Hossack, the head of the Medical Software Industry Association, was unusually forthright.
“Around 95% of GPs in Australia are clients of our members. If there was any possibility that the systems which they buy to help them with their practice were not secure, the Australian Commission for Safety and Quality in Healthcare would have been involved. That is not the case,” she told The Medical Republic.
Likewise, if clinical information systems were not already fit for purpose, seamless and secure, our members would have been alerted by their clients or the government. In other words, these systems – largely developed by GPs for GPs – have a market willing to pay for them because they work.”
And on the subject of developing minimum viable requirements, Hossack said:
“It is always concerning when you read about the government wanting to set prescriptive standards and interfere in a market when it is working so well. We hope that is not what is intended.
“Examples like the NBN, which our PM said some time ago may not have a business case, could be an example as 5G and other innovations leapfrog over government-built infrastructure. Innovation requires agility which for obvious reasons the government cannot, and should not have to, provide.
Likewise, competition and productivity can be severely hampered by government, as we saw with the live-meat trade fiasco. If the industry is to be more vibrant, then great care needs to be taken not to impede it with red tape which could have unintended consequences.”
Hossack, and the local software vendor community weren’t alone in being taken aback by the media release.
Some of the larger global system vendors contacted by TMR, but who were not prepared to go on the record, were not impressed either.
One vendor told TMR the ADHA did not engage a lot with the major global EMR companies anyway. She said this was already pointing to something being wrong if you considered the whole hospital clinical information environment was dominated by the global vendors.
“If you consider the importance of information being shared in ED, why don’t the ADHA have a more meaningful engagement with us?” she asked.
She said the release was a confirmation that the ADHA wasn’t able to comprehend the relationships between the vendor community and end users.
The ADHA was initially surprised to hear the software industry was unhappy.
Here is the link:
I have to say I am on the side of the software providers who would prefer to work with their clients to meet their needs directly rather than being mediated by the RACGP or the ADHA.
Comments welcome.
David.
19 comments:
After two years we have to residing the requirements? One wonders if this is because the ADHA in its haste removed all corporate knowledge it inherited and now no longer knows what those requirements were or where to find them? This looks and feels like what NEHTA was doing upto a point in time. What happened? The PCEHR/MyHR is what happened. We will see code4health being bantered around next.
An observation: Requirements describe a solution. In the case of health care, the problem is not readily apparent, partly because there are so many problems, you need to start off with a specific problem.
NEHTA never started off with any sort of problem, they just decided on a solution - a health record. That's the primary reason why the question "what is myhr for?" has no answer - it isn't solving any particular problem.
That's also the reason it will ultimately fail - it has no value, just costs, a major risk to privacy and an irritation to most GP's. For a GP the value is in their own clinical/medical record keeping system.
The government can pretend it is giving every one who wants one a "summary of their health" - they aren't, all they are doing is preregistering people - it will be the GP in the street (or surgery) who will decide the fate of this white elephant.
Considering there is nothing it a myhr for a GP, only cost and risk, it's pretty obvious which way this will probably go.
IMHO this means nothing. The ADHA is of little relevance outside the GovHR. Perhaps they could better spend their time and effort getting their own ‘solution’ safe, secure and usable before they go out providing advice to others.
I cannot help wondering if this is all starting to build up one might thorn for the Minister and Government just as election season approaches.
IMHO this mean nothing. Just more unsubstantiated opinion from MSIA. Quoting: "If there was any possibility that the systems which they buy to help them with their practice were not secure, the Australian Commission for Safety and Quality in Healthcare would have been involved. That is not the case,” she told The Medical Republic."
So then, let's see the results of the CSQ's independent analysis and review of GP systems - perhaps (for eg) wrt to clinical decision support performance. Security is NOT the issue. Methinks Ms Hossack is being disengenuous.
https://digital.nhs.uk/GP-Systems-of-Choice
Another attempt at treating software and cloud as commodities:
https://en.wikipedia.org/wiki/UK_Government_G-Cloud
The UK government has been at this for years
The GP Systems of Choice seem to have no relationship with the Digital Market place.
It would seem that suppliers need to join both.
https://health-intelligence.com/g-cloud-gpsoc/
Who knew IT was so complicated?
I must agree with Anonymous February 12, 2018 9:02 AM. The ADHA is adding value where? They have a perception they are in a dominant position to orchestrate the market but I do not believe they even have a minor role.
As a test, if the closed tomorrow would the software industry descend into anarchy? Would healthcare collapse? As a patient would I be at risk?
If the ADHA was to close tomorrow:
Would the software industry descend into anarchy - no
Would healthcare collapse - no
As a patient would you be at risk - no
Would the goals and benefits of eHealth still be obtainable - Yes
https://doctorsbag.net/2018/02/04/is-the-medical-software-industry-holding-us-back/
Sadly this list rather ignores there is much more than practice systems needed to deliver much of the desired functionality.
My view is that the ADHA should do more of this stuff and less of the myHR!
David.
I love the fax mention. People do realise that you can send and receive faxes without actually using a piece of paper or having a fax machine. That said the NBN is going to cause a lot of hassle as setting up the right compression and bias rate is not a simple task.
"Sadly this list rather ignores there is much more than practice systems needed to deliver much of the desired functionality."
How true. I'm sure he's a very good doctor and he has plenty of good ides about what a system should be capable of doing. There was another great list of things in Medical Observer by Dr Oliver Frank. There are plenty of other doctors who too can and do contribute many great ideas.
BUT that is not good enough.
The discipline of defining what's needed and how it all fits together is far removed from a doctor's medical training and the production of 'wish lists' of good things to have.
This reminds me of the ADHA's (and before them NEHTA and the DOHA) community consultation sessions - lots of people in a room, plenty of butcher's paper, make some lists - there you go, good job. Discipline? No way. Disorganisation, confusion and chaos? That's more like it.
I see this morning the ADHA fight s back, pointing the finger at the RACGP and singling out the MSIA Chair. The arrogance is disturbing to say the least. This organisation (ADHA) has all the hallmarks of a desperate and destructive entity he’ll bent on control and manipulation. Attempts to discredit well respected indirviduals in their persuit. I now have little doubt regarding the reports of certain general managers and their savage bullying of staff if they demonstrate this will members of the community.
The Government needs to step in this reflects badly on the Commonwealth
"I see this morning the ADHA fights back" - perhaps you'd like to add some credibility to your obscure claim by sharing where you saw it and provide the link. Thanks
It might be this:
Backlash continues to reverberate following ADHA announcement
Lynne Minion
Health Care IT
13 Feb 2018
http://www.healthcareit.com.au/article/backlash-continues-reverberate-following-adha-announcement
It is nothing unexpected and a distraction from the main show which is the Optout. Perhaps this is just a simple case of definitions being different. I am interested in where interoperability will be measured and what the consequences of interoperability might be.
Hpw much money is attached to this project for the RACGP?
Or is it "something easy to do" by way of fulfilling their compact with the Gov?
This new initiative aims “to ensure CISs are useable, secure, interoperable, and ultimately fit-for-purpose.”
A good place to start is with the My Health Record CIS itself.
Useability?: let’s hope that the move to opt out, planned for this year, doesn’t just result in a larger volume of records that are not useable, especially by GPs.
Interoperability?: Can we safely assume that the MyHealth Record CIS can interoperate seamlessly with other CIS systems at the semantic level and can use and process the recommended national terminology standards that enable semantic interoperability, like SNOMED and AMT. Especially as many of the CIS vendors are incorporating these into their products.
Fit for purpose?: Perhaps it is time to stop and take a look at what is on those naughty persistent faxes, and consider making that content part of the My Health Record CIS. If those GPs keep persisting with the fax machines then there must be something very useable and fit for purpose there. Let’s make life easier for them. Maybe then we won’t even have to pay them to use the My Health Record system?
Fit for purpose?: Perhaps it is time to stop and take a look at what is on those naughty persistent faxes, and consider making that content part of the My Health Record CIS. If those GPs keep persisting with the fax machines then there must be something very useable and fit for purpose there. Let’s make life easier for them. Maybe then we won’t even have to pay them to use the My Health Record system?
That’s has to be the innovative suggestion I seen in the past two years and well worth a priority suggestion. Most CIS will have a fax capability built in and the GHR loves a PDF. Could we pay vendors to set up a GHR copy to feature?
Or we could just turn the GHR off and move on like the rest of the world.
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