Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"


H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Wednesday, June 20, 2018

Magical Thinking Is Given A Whole New Meaning By This Release And Report.

This was released a few days ago:

Digital health to transform Australia’s health system and save lives

Australia now has many of the building blocks in place to roll out a digitally enabled health system that could transform care services, an expert report has found.
The report, developed after an expert roundtable initiated by the Consumers Health Forum and The George Institute for Global Health, says “the time is now ripe” to support the expansion of digital health technology in vital areas including chronic care and residential aged care.
The report is based on discussions held by around 40 consumers, clinicians, academics, government and industry supported by the Australian Digital Health Agency.
Roundtable attendees considered four sectors --- chronic care, residential aged care, emergency care and end of life care --- in terms of what is wanted from digital health, the current state of digital health in that sector and how to meet goals for the future.
The report says major progress is being made with My Health Record, e-prescriptions, patient registries, shared care portals, state-based digital health strategies and linked hospital patient information systems.
“The time is now ripe to leverage this maturing digital health capacity in ways that are meaningful to both consumers and providers.  If done well, it has potential to be transformative for Australia’s health system bringing about rapid enhancements in quality, safety, accessibility and efficiency,” the CEO of the Consumers Health Forum, Leanne Wells, said.
“Digital disruption is not coming in health care – it is already here. For too long health has been lagging behind other sectors.
“For Australia to embrace digital health and benefit from its huge potential, we need national leadership. The COAG National Digital Health Strategy provides a foundation but what is needed is stronger, coordinated direction from the federal, state and territory governments.
“It would be good news for consumers to bring health into the 21st century but we need to be mindful that people have differing levels of health literacy and some will need support to embrace a digital health future or we risk inequities of access and knowledge.
“We need to invest in implementation and change management to avoid the risks and pitfalls that can accompany the roll-out of such powerful technology into a complex and sensitive area like health care,” Ms Wells said.
Professor David Peiris, Director of Health Systems Science at The George Institute, said emerging digital health strategies had the potential to transform Australia’s health system for both health care providers and consumers.
“Our report sets out clear recommendations on what is needed to enable people to be much more in control of their own health needs and to make informed choices about the care they choose – from urgent life-saving situations through to respecting their wishes at the end their life.
“We also want to ensure that every health professional in Australia can take full advantage of the digital health eco-system to improve people’s healthcare experience and provide care that can be co-ordinated across the system. Many Australians are tired of having to constantly repeat their story to multiple care providers and it’s vital that we tap into digital technology to ensure we deliver a more person-centred, safer and sustainable healthcare system.
“Australia has made a great start in its uptake of digital health technology and we have identified practical steps in several areas that could be rolled out rapidly. The challenge now is to ensure they are adopted.”
The recommendations identified by the roundtable included:
In chronic care: To trial virtual care teams to support patients with high care needs; and trial a “Patients Like Me” platform to enable patients with chronic and complex care needs to safely connect and share experiences with one another.
In residential aged care: Ensure that residents’ health and social services information is available in a single location, on a platform easily accessible by consumers and providers anywhere, anytime and on any device.  Collate and publicise data that allows patients, their carers and future consumers to compare residential care facilities based on health outcomes and patient experiences.
In emergency care: Develop digital health technologies that leverage My Health Record data to be rapidly accessible to paramedics and other emergency providers; develop a text/image message system to support improved communication between emergency care and other medical teams and assist with referrals to other health care providers for post-discharge care.
In end of life care: Develop and promote existing professional and consumer portals that provider information on care options, medical services and pathways for those nearing end of life; and engage in targeted social media campaigns to encourage consumers and medical professionals to normalise conversations about death.
Media Enquiries
Mark Metherell, Communications Director
Consumers Health Forum of Australia
P: +61 429 111 986 E: m.metherell@chf.org.au 
Julia Timms, Senior Media Advisor, Australia      
The George Institute for Global Health
P: +61 410 411 983 E: jtimms@georgeinstitute.org.au

Consumers Health Forum of Australia
The Consumers Health Forum of Australia (CHF) is the national peak body representing the interests of Australian healthcare consumers. CHF works to achieve safe, quality, timely healthcare for all Australians, supported by accessible health information and systems. CHF is committed to being an active advocate in the ongoing development of Australian health policy and practice.
Facebook at CHFofAustralia  Twitter @CHFofAustralia  Web chf.org.au
The George Institute for Global Health
The George Institute for Global Health conducts clinical, population and health system research aimed at changing health practice and policy worldwide. Established in Australia and affiliated with UNSW Sydney, it also has offices in China, India and the UK, and is affiliated with the University of Oxford. 
Here is the link:
First it needs to be said that all this is just totally well intentioned and of value, but when you read the report you are left with the sensation of simply floating in a cloud if impracticality and fantasy.
Early on you read the following:
“The report says major progress is being made with My Health Record, e-prescriptions, patient registries, shared care portals, state-based digital health strategies and linked hospital patient information systems.”
Somehow this is all true but also fails to recognise that we are still on the beginning of these paths and by no means at the end. To reach full implementation of solutions to all these core problems, with the best will in the world, is 5 years off at least I believe!
No one I know is casting about for things to do saying we have got all the basics done and it is time to start working on new things!
Additionally the four proposals seem to me to lack clear cut sponsors and plans beyond the woolliest of motherhood statements.
This report is another poorly formatted .pdf document that needs to stay on the shelf until we have got the basics well and truly bedded down. Sorting out the data quality and usability in the myHR, if we are to have one, is way more important and necessary.  Testbeds that fully fix the basics are much more important than this list!
Heavens I am a depressive Grinch! But I believe I am also reasonable, realistic and practical.
Opposing views welcome!


Anonymous said...

No opposing view David, just a plea, can they all just stop the utopia sales and marketing pitches please. Apart from that fact they are not top sales and marketing people, it’s all rather tiresome.

Anonymous said...

cargo cult thinking by people who have no understanding of the real problems or why their solutions are so totally wrong.

Anonymous said...

The report does go into 'what we have' under each section of recommendations to point out limits and restrictions - and it deals in general explicitly at what might be possible in the future. I think your criticisms are a bit more based in reflex than actually reading the (agree poorly formatted) pdf...

Dr David G More MB PhD said...

"I think your criticisms are a bit more based in reflex than actually reading the (agree poorly formatted) pdf... "

Nope, my point is that these are peripheral issues to be addressed after the more core issues are addressed and right now we are no where near that.

Look at the claim recently that Secure Messaging is all done - but actually talking about futures over the next few years - think for example how many specialists don't use clinical systems - they will be using faxes for years yet!


Anonymous said...

"Nope, my point is that these are peripheral issues to be addressed after the more core issues are addressed and right now we are no where near that."

Of course you're right but I don't think the report really disagrees with you - some of the more marketing speak does yes, but that's not really the grist of it. There is value in discussing how a system could/should work and what it could/should enable before the system is capable of doing it.

It also highlights areas other than technical that need work - one of the major recommendations is: "Principle 2: Develop a strategy to enhance digital
health literacy for the Australian community, its care providers and health administrators." You need both health and digital literacy for digital health, and that is at best around 60% of the population - this is harder to fix than convincing specialists computers aren't the devil.

I think too you would have some really interesting thoughts on the NASSS framework from Trisha Greenhalgh et al (linked below) that principle 3 references; "Principle 3: Systematically appraise and reduce complexity where possible when designing test
beds, embracing the need for flexible and iterative improvements over time.". Embracing flexible and iterative improvements would require fundamental changes to the way Govt procures, manages, measures, and delivers projects - again, much bigger than just digital health but required for digital health to be effective, so also partially the responsibility of the good people that come here to connect and keep across things to be part of changing.

We can focus on how media and comms teams oversell and oversimplify things (yes a problem, but a bit of a Canute and the sea problem), or instead engage with the actual policy work. This is especially important from a social perspective, rather than just a technical one.

Reference - 'Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies.' https://www.ncbi.nlm.nih.gov/pubmed/29092808

Bernard Robertson-Dunn said...

Observations and lessons from history;

If you are going to use computers to help automate processes to deliver an outcome, there are two options:

Automate existing processes or implement new processes.

The first is fraught with potential problems. What tends to happen is that things that used to go wrong but were picked up by people using common sense, go wrong faster and go wrong with major negative consequences. The second involves transforming existing practices and procedures and the systems need to accommodate all possible exceptions.

The big lesson from history with regard to transformation is that the people who understand and are familiar with the old ways are not able to come up with radically new ways of doing what they are already doing.

Looking at the people who are promoting Digital Health, there are three groups. There are the medical specialists, people who understand current medical practices. The George Institute is full of this type of people. There are technology specialists who are familiar with current technology solutions. This group includes vendors and consultants. And there are consumers and their advocates, - people who see the poor outcomes and symptoms of the current environment.

All these people are familiar with current solutions, and that’s the difficulty.

The big give-away in the article David has referenced is this statement: “For too long health has been lagging behind other sectors”.

Technologists and health workers have been saying this for decades. What they don’t understand is that health care is a radically different problem from any other industry or sector. Neither do they understand why this is true and why totally different solutions are needed.

What should be done is to better understand the problems associated with achieving better health care, more effectively and efficiently.

It may actually not be possible to do this is any top-down way, in which case the best strategy is to provide an environment of innovation, growth and minimum government/regulatory constraints.

The revolutions of the past have all worked this way, apart from one. The space race was a massive effort with enormous benefits; but the problem was exceptionally simple – how to get men to the moon and back. Health care is not only a harder problem, it is probably the hardest problem facing societies today.

IMHO, the things people are trying to do with Digital Health are only making the problem much worse.

Dr David G More MB PhD said...

"There is value in discussing how a system could/should work and what it could/should enable before the system is capable of doing it."

Indeed there might be if all the solutions were not predicated on use of the myHR as the enabler. If you take a clean sheet of paper the myHR would not get a mention IMVHO!

No one asks just what is the ideal approach rather than how can we press the myHR into service!

This is a classic "if you want to get there I would not start from here" problem!


Anonymous said...

The MyHR will simply fade away no matter how they try and force it on people. Why, because like secure messaging it is a based on technology from the 80’s. The world of technology will and is surpassing it. It is not built on convenience, human behaviour is drawn to convenience.

Bernard Robertson-Dunn said...

myhr will fade away because it is critically dependent on health providers, specifically GPs, and using it is not in their best interests.

No amount of Behavioural Economics will work if the aim is to nudge GPs into doing something that has an enormous downside for them - which myhr does, in spades. Apart from costing GPs time and effort to manage, putting data into myhr will give the government a flawed insight into a GP's practices and behaviours which can be misused against them.

Most Australians are apathetic about their health and know next to nothing about health records. GP's, on the other hand, care deeply about both their survival as medical practitioners and their patients' health.

The government cannot afford to keep paying e-PIP and it is reported that:

"GPs could be forced to upload more shared health summaries to qualify for the Practice Incentives Program eHealth Incentive when My Health Record becomes opt-out in December.

Dr Steve Hambleton, a Brisbane GP and adviser at the Australian Digital Health Agency, says he expects the Department of Health to "lift the bar" for the so-called e-PIP."


Anonymous said...

I don't think it will "fade away". There is so much political capital invested they will change the story, pour in another $400+ million, find some ribbons to cut and pats on the back all round

Anonymous said...

The My Health Record or whatever name it goes under after conscription has ended is pretty much the modern version of the miasma theory.

Miasma theory held that disease was spread by bad smell and as such had utility while being wrong. It got people to clear up decomposing mounds of food and such like. Florence Nightingale was a proponent of the theory and it didn’t really die out until the turn of the last Century. The bad smell was actually an indicator of something wrong, but it was not a vector for disease; nor would using a mask or hiding the smell with a posy prevent infection. The belief did drive various movements for sanitary improvements and so on so its partial utility needs to be acknowledged, as for many false beliefs!

So the PCEHR/MyHR/GovHR has been useful, although wrong, has had some utility in improving electronic information and technology. It has perhaps moved healthcare along the cultural acceptance of digital technology as a useful tool. It is I propose, a modern day miasma where people assemble the usual and common platitudes under its banner, while ignoring the multiple small actions, or inactions that contradict the claim. It is an example of the confusion of symptoms with causes and such confusions are all to common and widespread, distilled by the ADHA and a small group of stakeholders, and vomited forth as a condensed soup of well intended but ultimately doomed wonderful statements about promoting and valuing the role of clinicians and consumer/patients and professional organisations, while in practice nothing changes except for small pockets where emergent properties take root, temporarily of course, as the big wonderful creativity and innovation crushing mob come crashing down with their armies of culture change priests and motivational posters chanting ‘we are here to help’ and suck the life out of all that surrounds.

Anonymous said...

The only thing myhr proves is that governments are very bad at true innovation. In fact, they should not involve themselves in radical commercial/business risk taking.

Anonymous said...

June 22 8:32 PM, one wonder why the use these examples as reasoning behind digital health. https://www.digitalhealth.gov.au/news-and-events/news/media-release-industry-collaborates-to-end-the-era-of-the-fax-machine

We all know that the MyHR posts to the wrong record at times, surely a similar event could happen when rely and presuming if it has been posted to the MyHR then is has been received by the correct recipient.

As for secure messaging I am not sure what they have progressed for the better, looks like we have created a closed market place riddled with any old certificates. I can’t see the incumbents being to open to new players entering the market

Anonymous said...

Sensationalism, tacky, insensitive, - take your pick.