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Sunday, March 11, 2018

The ADHA Framework For Action In Implementing Their Strategy From 2017. How Does It Stack Up?

The ADHA released a draft document last week and requested input by April 6, 2018.
Here is the request for a contribution.

Have your say on the Framework for Action

Australia's National Digital Health Strategy - Safe, Seamless and Secure - outlines a vision for 2022 focused on an evidence base of benefits prioritising national-level digital health activity which will result in:
  • Hospital admissions avoided
  • Fewer adverse drug events
  • Reduced duplication of medical tests
  • Better coordination of care for people with chronic and complex conditions, and
  • Better informed treatment decisions.
Achievement of the outcomes in the Strategy will depend on continued co-production with patients, consumers and carers – and the governments, healthcare professionals, organisations and industry innovators who serve them. That’s why the Agency is working closely with organisations representing these groups on the development of the Framework for Action – the implementation plan for delivery of the outcomes of the Strategy’s seven key priority areas.
The Framework for Action will outline the key activities prioritised for delivery between 2018 and 2022 that are necessary to implementing Safe, Seamless and Secure and realising the benefits of digitally enabled health and care. It will be a living document that is regularly updated to reflect the continuing progress on the Strategy’s outcomes. The purpose of the Framework for Action will be to:
  • Articulate the activities required to deliver on the Strategy’s outcomes, and the roles participants in the digital health eco-system will need to play in order to deliver them;
  • Promote collaboration and information sharing and provide a holistic view of the various investments and projects underway; and
  • Be a guide for organisations that are recalibrating their strategies or forward work programs to align to national strategic priorities.
Download Framework for Action Draft Consultation document here, and you will be able to provide your feedback to the survey form until Friday 6 April 2018.
Here is the link:
The direct link to the 43 page PowerPoint presentation is here:
What to say?
Basically, overall, this is an overly ambitious, mostly evidence-free and assertion rich, unfunded, grossly under detailed, timeline lacking, fantasy.
There is only one measure – and that is that things will apparently happen by 2022. There are no costs, milestones, evidence to justify investment and so on.
Unless there are 20-30 (or more) pages of detail, evidence, timelines, objectives and priority, staffing, risk assessment and a cost benefit analysis provided under each initiative we are essentially no further ahead, and I can really offer little comment. It maybe that such detail exists, but I doubt it. Right now we have a simply fantastic (in the real sense) marketing document without enough detail to make any realistic assessment of what can be funded, delivered and made useful.
If it intended that the Framework is to be useful, then the detail is vital. The scope, range and ambition of this 4 year plan is so grand as to mean lots of choices, sequencing and priorities will need to be considered, and decisions taken as to what should actually happen and be resourced and funded.
Right now we have a grandiose wish-list which will only obtain a modicum of credibility when associated with the necessary detail.
Even development of this detail may take till 2022! To me it is imperative that the detailed plans be developed as it is only with those done and costed can we get a proper appreciation of what is needed, what benefits will flow and whether there is evidence to support conduct of the project(s). Maybe we could then avoid the problems associated with the politically rushed and ultimately poorly executed myHR.
David.

22 comments:

Anonymous said...

I think david if you strip away the buzzword BS what this is attempting is the costed plan to implement the strategy. If they complete by the end of the year that leaves four years. Government business cases would see another 18-24 months before projects would commence. What these would be and where they would take place seems well out of the ADHA jurisdiction.

Many of these items are underway in various forms in jurisdictions. Standards and conformance will be a challenge as the ADHA Aus a solution provider and to bias to be a SDO like entity.

Innovation hub sounds a joke

They have not demonstrated the discipline or breadth of knowledge for either.

I guess I am struggling with the why and who cares questions.

It is also evident the ADHA has far to many internal issues to attract and retain talented people.

Anonymous said...

After four years of review, the dismantling of NEHTA and the standards landscape, complete fragmentation of the community and a complete breakdown of any knowledge continuum all we end up with by those who poo-pooed NEHTA, is the blueprint NEHTA had. I note there is a nice little earner in digital education. Did the name behind the Royal review just startup a digital hospital professional education company?

Andrew McIntyre said...

IMHO its all about high quality inter-operable data and standardized models for that data with well defined terminology. Without that, messaging data that may or may not be displayed or handled accurately is a challenge.

It is happening with Pathology and radiology and some clinical data but the reliability and consistency of the data is average and this is mostly due to errors at both ends, and a lack of good clinical models with specified terminology. Its not that the standards don't support it.

Implementing clinical decision support with wrong or non existent codes is less than 100% reliable but can be done even now, but not with MyEHR pdfs. Despite being made aware of these limitations the ADHA is not engaged in coming up with any credible plans to fix them. The pathologists managed to get ePathology going in the 1990s and are miles ahead but none of the national eHealth bodies have ever really helped to try and get proper standards compliance going for pathology. Even codes for common things like Liver Function Tests are not done correctly by some pathology labs, but the consequences for not doing that are not there. Radiology is an atomic data and code free zone, even though they use the same HL7V2 format as pathology. We need clinical models for radiology procedures and code sets and nothing has been done in the clinical space, although HL7 Australia is trying in the referral and Virtual Medical Record areas. See Australian Diagnostics and Referral Messaging

The pathologists are trying to standardize codes but it has not been championed by the ADHA or NEHTA etc and there is no compliance checks. If Air bags cost 24 lives worldwide I would hazard a guess that errors in the pathology/PMS space, due to lack of standards compliance at both ends would have resulted in an order on magnitude more deaths in the medical space. Can we recall the ADHA and have it fixed please?

If we had good quality data with reliable rendering by endpoints and some modelling of clinical concepts we could a lot more of the decision support front. We do need ADHA to actually understand this and they as a whole they do not, although some individuals within it may (If they are still there) If you enable high quality compliant data and receiving systems then messaging becomes a service rather than an interface engine and many people would leverage that data for innovative things. The role of government is compliance with standards and they are and have been failing miserably in that role. Every endpoint should be able to produce and consume standards compliant messages and clinical models should be developed around what things are being transmitted in all domains, radiology and clinical models are way behind, but could be developed and sent within the existing HL7V2 messages with proper terminology. This sort of development is completely lacking and I have given up on the ADHA ever getting it. This report is a variation on the same theme we have seen since HealthConnect and if this is what $2Billion buys there is not enough money in the world for government to actually achieve the sort of outcomes they keep promising.

Anonymous said...

This does appear to imply a significant and disruptive level of change. It would be a struggle for a single organisation let alone at a national level. As Andrew points out without agreements and adoption of appropriate models there is little chance a balanced and holistic change could take root.

Power point is not a good format to start with, I don’t find the work easy to digest or follow.

Bernard Robertson-Dunn said...

Further to my rants there being nothing on funding or mention of patient centric care, that document is sadly lacking in real actions. There's lots of words but nothing about real actions, as opposed to more objectives.

This document says it is a "Framework for Action – Implementing the National Digital Health Strategy".

If ADHA thinks that is an implementation plan, they have some serious problems.

Look at 3.1.1 National Interoperability Strategy
Co-produce and publish a National Interoperability Strategy

"To address the risk of uncoordinated investment in technology that does not meet a common set of standards that will exacerbate siloing in the health system, Australian governments, industry and the health sector will co-produce a National Interoperability Strategy (NIS) which will include agreed vision and blueprint for interoperability in Australia,agreed base level requirements for using digital technology when providing care in Australia with governments and colleges, agreed set of national interoperability specifications and standards, accreditation regimes, and procurement requirements."

That is not much of an implementation plan. It certainly won't deliver real interoperability - probably the single most important thing they could be doing to help the states and real health care institutions do a better job.

The PCeHR was supposed to be built on an interoperability infrastructure. It went live in 2012 without it. Ten years later, in 2022, ADHA aims to have delivered an interoperability strategy.

Not are they doing something with no perceived value - myhr - they are not doing something that would deliver value.

Someone needs to have a quiet word with senior management and explain to them they are losing whatever little credibility they may have ever had.

Anonymous said...

Regarding Interoperability:

Had we not already paid for a strategic Interoperability Framework? That was suppose to have been delivered last year? Where is that and how much did that cost?

Surely everything that is done is done for interoperability reasons? Why do we now need a seperate strategy? Sticking something like a consumer as the lead actor will result in very little difference.

The real challenge would appear to be semantic and policy layers, the semantics will be a challenge to resolve is a few years.

I must agree with Bernard, the document, sorry slide deck, seem devoid of any real understanding. It will become one of those referenced things to support business cases that have not been thought through properly

Anonymous said...

The ADHA, which employs around 250 people, is totally out of control. Greg Hunt, are you incapable of doing anything about this?

Anonymous said...

Plus the 100-150 contractors and consultants.

Anonymous said...

The framework for action implementation plan is the plan you have when you don't want a plan that can be measured and assessed. As someone pointed out, there is no money to do any of the things in the plan. That's because it's all talk and no action. It allows you to pretend you are doing things until 2022 by which time certain people can have moved on. In Australia Digital Health is a con job. The Department of Health and the Health Minister have no idea what is really going on - they are being taken for a ride.

Anonymous said...

I would like to see how this lays down the mechanisms to advance and shape healthcare for the next twenty years. I get a sense this will simply be a directory of projects based on current investments. How is policy setting the enablement of all this? And as others rightfully ask where are the funding models for sustainability?

As a consumer how does all this positively impact my bottom line? All I care about is getting healthcare at an affortable rate and that those providing care are paid and treated well.

Anonymous said...

11:54 AM, you miss the point. The value is being able to view it in your digital watch, if you can afford one that is

Bernard Robertson-Dunn said...

It's a classic example of cargo cult thinking. Other industries have used IT, health care should use IT. IT is good, more IT is better.

The only thing missing from that so called implementation plan is the project manager's get out of jail free card - TMH.

Then a Miracle Happens.

If it were a private company wasting their time and money, that would be the free market at work. That it is the government and they are wasting our money is an outrage.

Anonymous said...

I guess we can but waiting to be engaged and see how this evolves. I am assuming this will not be developed of the back of a survey with very leading questions again?

The States and Territories will happily support this, after all they will not be bound by it so why be seen to be less than supportive.

Anonymous said...

1.1.2 Future use of the My Health Record
Making the My Health Record an unprecedented platform for innovation.

That says it all, sadly

Anonymous said...


Making the My Health Record an unprecedented platform for innovation.

Father, forgive them; for they know not what they do.
King James Bible

tygrus said...

"...evidence base of benefits prioritising national-level digital health activity which will result in: Hospital admissions avoided; Fewer adverse drug events; Reduced duplication of medical tests; Better coordination of care for people with chronic and complex conditions; and Better informed treatment decisions."

1) Are they doing data collection to measure the expected results, either a subsample or industry wide ?

2) What methods will be followed to evaluate these expected results?

3) Can we put a $$$ figure attached to these savings?

4) Does the cost to benefit analysis better than that of other spending options?

Anonymous said...

What does not seem clear in this slide deck is the actual role of the ADHA. Once the GovHR is optout and they have a few months doing the rounds with the framework, then what? I have seen nothing come out of ADHA that is much more than the left overs from NEHTA. Are they able to actually do anything once they have all these requirements and agreements?

Anonymous said...

The role of ADHA is to support travel and events. The CEO communications and entourage must be easily 50 people. I cannot wait for the release of the yearly expenditures. I believe the CEO was famous for spending tax dollars on hotels

Anonymous said...

NHS chief who blew £46K on expenses: Man in charge of plan to centralise patient records had highest expenses bill of top NHS officials
http://www.dailymail.co.uk/news/article-2626783/NHS-chief-blew-46K-expenses-Man-charge-plan-centralise-patient-records-highest-expenses-bill-NHS-officials.html

The official, who is in charge of the troubled programme to centralise GP records, claimed more than £46,000 during 2013/14, on top of his £180,000 salary.
Related Articles

Mr Kelsey’s claims include 130 nights in hotels, costing up to £370 a night, as well as a £20 daily meals allowance, and 39 train journeys from NHS England’s offices to his home in Somerset.

The organisation on Tuesday said that when Mr Kelsey was recruited to the post, special terms were agreed to pay for him to live in a hotel four days a week, and claim for a weekly train home to Taunton.

https://www.telegraph.co.uk/news/nhs/10828627/NHS-expenses-health-service-chiefs-received-free-travel-and-hotel-stays.html

Anonymous said...

https://www.opendemocracy.net/ournhs/tamasin-cave/whos-really-benefiting-from-visions-of-‘digital-nhs’-of-caredata-kelsey-and-tele

A UK friend pointed me to this. He also remarked about a number of inderviduals and organisations that link into this and the ADHA but that is not for me to point out, I am sure it is all simply good business. And as open and honest as a banker

A month later, NHS England announced the nine ‘consortia’ of approved ‘commissioning services’ suppliers - who will from now on determine how and where a huge chunk of the NHS’s budget will be spent.

Dr Foster is a supplier to a third of these consortia.

A month later, Telstra bought Kelsey’s old firm Dr Foster outright for a reported £20-25m.

Telstra, through its acquisition of Dr Foster, had just entered the NHS market.

A few weeks later, Kelsey jetted off to Australia to discuss all things digital with leading Australian investors Mooroolbark Group, private hospital group UnitingCare Health, and his old employer, McKinsey. He also took part in a Health Roundtable of (mystery) attendees to discuss data and technology policy; attended Australia 3.0, which appears to be about ‘driving the innovation agenda’ to help Australia’s business compete; as well as ‘Code for Australia’.

It is not clear who has benefited more from these and other meetings: the NHS, Telstra, or Kelsey.

In May he was back down under discussing digital innovation with, you guessed it, Telstra.

And now, with the summer behind us, he is leaving the NHS to become Telstra’s commercial director.

Anonymous said...

All very interesting and the sometimes questionable financial gains and conflicts are well known and nothing can be done.

Perhaps the role of the ADHA is simply to act as a National PMO and communications/newsfeed aganecy. They could just operate a national dashboard like the Health IT does in the USA. Then projects can be viewed transparently across the nation

Anonymous said...

@1:39 PM that sounds like a very reasonable approach and probably the safest bet to date.