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Tuesday, March 06, 2018

WA Health Is Being Lined Up To Give Digital Health Another Serious Attempt!

This article appeared last week:

WA Health in dire need of better IT investment: review

By Allie Coyne on Feb 27, 2018 5:00PM

Progress towards digital health system "critical".

Technology projects in the Western Australian health system have swallowed up large amounts of money for little benefit, creating a "culture of distrust" in the management of IT, a report into the state's health system has found.
The 'sustainable health review' interim report [pdf] painted a bleak picture of the state of IT within WA's health network.
The report - which was commissioned by the state government last June - found a track record of IT projects that had spent lots of money "in areas that have not necessarily supported the system or improved health outcomes more generally".
WA's health IT investments have shown an "inability" to deliver what has been required, the report found.
It specifically noted the state's disastrous centralised computing contract with Fujitsu, which in 2016 was revealed to have been mismanaged to the point of an $81.4 million cost blowout.
The state government admitted to "systemic" issues plaguing the health department following the revelations and pledged to proactively address IT failings.
The report also cited the bungled IT fit-out of the Fiona Stanley Hospital throughout 2015, which forced back the opening of the facility.
Instances of innovation and technology success were occurring at the local level, the report found, but "do not seem to spread effectively across the system".
"ICT investments across the WA health system have been beset with challenges and issues that have had a significant impact on delivery and created a culture of distrust in the management of ICT," the report states.
"The need to improve ICT systems across the WA health system is clear; the challenge is to mobilise and manage the upfront investment in ICT in such a way that it does not compromise the provision of other initiatives.
"Robust planning that supports greater use of technology and more contemporary approaches to health care and patient-staff engagement is required."
The review panel found an "overwhelming" need for better access to patient records through electronic health records and "more effective" data sharing.
WA Health was well-positioned to introduce a statewide electronic medical record given it already has a unique patient identifier system in place, the review panel said.
More here:
There is also coverage of the interim report here:

WA Health’s “poor” IT delivery has created “culture of distrust,” report finds

Lynne Minion | 28 Feb 2018
The creation of a statewide digital health strategy, improved data sharing and closer ties to My Health Record are among the recommendations of a scathing report into Western Australia’s health system that criticised budget blowouts and bungled implementations in the state’s transformation to digital health.
Past ICT delivery has been “poor”, according to the Sustainable Health Review interim report to the WA government, creating a “culture of distrust” in the management of projects.
“ICT investments across the WA health system have been beset with challenges and issues that have had a significant impact on delivery and created a culture of distrust in the management of ICT,” the report found.
The review helmed by Robyn Kruk, which was announced by the State Government in June 2017, delivered its preliminary recommendations following consultations with consumers, clinicians and staff in the WA health system, healthcare providers, non-government organisations and industry.
It found the government needs to address some “inconvenient truths” and introduce robust planning for ICT projects in response to the disastrous 2016 contract with Fujitsu that lead to an $81.4 million cost blowout, and delayed opening of the Fiona Stanley Hospital as a result of the troubled IT systems and infrastructure implementation in 2015.
“The WA health system’s track record in the delivery of information and communication technology has led to large amounts of money spent in areas that has not necessarily supported the system or improved health outcomes more generally,” the review found.
“The need to improve ICT systems across the WA health system is clear; the challenge is to mobilise and manage the upfront investment in ICT in such a way that it does not compromise the provision of other initiatives.
“Robust planning that supports greater use of technology and more contemporary approaches to health care and patient-staff engagement is required. Progress towards a digital health system – including an electronic health record – is critical, with more effective data sharing helping staff, consumers, carers, researchers and the community to make informed healthcare decisions.”
Lots more is found here:
The direct link to the Interim Report is found here:
It needs to be noted that the report covers much more that Health IT and that really only section 8.
Here is the relevant section:

Direction 8:   Greater use of technology, data and innovation to support consumers, and clinicians, and drive change

Both locally and globally, technology has been a driving force in health care delivery and reforms, and new horizons in digital technology are becoming the reality (60).
Across all sectors the Panel engaged with, it was agreed that enhancing the access to data and use of ICT was a major area for further improvement.

Digital strategy.

Consumers want to use technology to help navigate the complexity of the system and manage their care better themselves. This involves advances in biomedical devices, with virtual care options, such as telehealth, that could provide ‘truly patient-centred care by bringing the care to the patient, including at home and to their mobile device, at more accessible times and locations.’
There are further opportunities enabled by data and digitalisation that have been put to us, such as Enhanced Medical Mixed Reality Technology (which combines real-life, projected holograms and video conferencing) which Silver Chain reports it is exploring (61). Other opportunities include spatially enabled health, predictive algorithms for early prediction of disease, detection and monitoring of illness, robotics, collaboration of real time data and enhancing individual data analytics with systemwide data (60).
The Panel has heard that past investments in ICT have not delivered the benefits expected and the money spent has not been allocated under an integrated statewide plan. Further work is needed to develop a well-considered and orderly transition to a digital future in the WA health system. This work will involve exploring how digitisation can empower consumers, support clinicians and integrate services (with particular focus on regional and remote areas), with a focus on prioritising and optimising investment for digitisation

Electronic Health Records.

The Panel has heard overwhelmingly of a need for access to patient medical records (including diagnostic test results) to patients and across all services and sectors via digital platforms.
The Australian Digital Health Agency is responsible for implementing the My Health Record system across the nation. My Health Record is a secure online summary of a patient’s health information that enables patients to control what goes into it and which health care providers have access to the information.
The Commonwealth Government announced in the 2017 Budget a commitment of $374.2 million over two years to the My Health Record to continue to expand the system (62).
The WA health system will be progressing connection to the My Health Record system through its various ICT applications. My Health Record is now accessible at all hospital sites across metropolitan and country regions.
Collectively, this represents 113 sites across metropolitan and country hospitals and a number of remote communities (63).
From the perspective of staff and the wider health sector, the use of electronic health records, accessible to health professionals in both the public and private sector, has been identified by many submissions as a logical step to reducing costs and improving efficiency by reducing duplication and unnecessary investigations (particularly pathology and radiological investigations). The WA health system is well advanced compared to other jurisdictions with a unique patient identifier system in place. This should facilitate the implementation of a statewide electronic health record system. The Panel supports the progression and implementation of a statewide electronic medical record. This may initially be developed in partnership by the Department of Health with one or two Health Service Providers, subject to robust business cases and available funding. Two-way data sharing between the WA health system and private providers should consider pathology results, patient discharge information and medical imaging as initial priorities and link directly to work with the expansion of My Health Record. This will assist with maximising clinician engagement, and would put the health system in good stead for the full roll out of electronic health records across WA. This area will be explored further in our Final Report including timelines.
The Panel has heard that when staff have difficulty accessing data, their ability to plan and improve services is limited, including the development of data analytics, and their ability to communicate with consumers.
The Panel has heard that when staff have difficulty accessing data, their ability to plan and improve services is limited, including the development of data analytics, and their ability to communicate with consumers.
‘There are various systems currently used to manage individual health records. These systems typically have limited interaction with each other. This results in various components of patient health records being held and stored in multiple, stand- alone systems with no single system, nor the patient having holistic access to their health information.’
The Panel supports data being ‘linked by default’ internally and externally within the wider health care landscape. WA is a pioneer in data linkage, with ‘one of the most comprehensive data linkage systems in the world’ (64).
It will be critical that data protection is well managed to ensure these systems consider privacy and confidentiality. The Service Priority Review also recommends the strengthening of data sharing. The development of legislation and processes to facilitate data sharing while protecting sensitive personal information is a key precursor to open data sharing.
The Panel also notes the Bureau of Health Information in NSW as an exemplar in the space of independent data analytics and performance reporting of the public health care system.

Recommendation for Immediate Action.

Develop and implement innovative approaches to sharing of patient-level data across public/private providers, including a pilot to demonstrate necessary policy and technology approaches, commencing with pathology results, patient discharge information and medical imaging as an initial priority linked directly to work with the expansion of My Health Record.

Areas for Further Work.

Develop a Digital Strategy for the WA health system that identifies priorities to support consumers, clinicians and the system management.
Explore options for progression and implementation of a statewide electronic medical record. This should be initially developed in partnership by the Department of Health with one or two Health Service Providers, subject to a robust business case and available funding.
Support and enact the Department of Health- related actions from the Data Linkage Review.
Partner closely with the Australian Digital Health Agency to support the expansion of the My Health Record program in WA by raising awareness among clinicians and increasing availability of patient information (including pathology, medical imaging results and discharge information) to My Health Record.
----- End Extract.
All this seems pretty reasonable and development of a State Digital Health Strategy is obviously vital. I really wonder with a State-Wide EHR why much attention at all to the myHR. Most value for WA patients will surely come from WA state systems.
I look forward to the outcome of the Digital Health Strategic Planning and hope, in the meantime, some concerted steps are taken to enhance the managerial and technical competence of WA Health. This seems to me to be a step that needs much more emphasis.
What do you think?
David.

1 comment:

Anonymous said...

The review helmed by Robyn Kruk. The Robyn Kruk behind the formation of ADHA. Hopefully WA fares better. All we got was a disorganised badly structured thing that is still ineffective and inefficient. God help the Minister if something goes wrong, it will expose how broken the ADHA is.