Wednesday, June 06, 2018

These ADHA Test Beds Are Interesting But Sadly May Be Focused On The Narrow myHR Mindset.

A week or so ago an EOI appeared from the ADHA. (16 May, 2018

Media release - Digital test beds to drive change in healthcare

Health technology organisations, clinicians, patients and health service managers are driving innovation and developing creative solutions to improve how health services are delivered. These ideas often give life to the next solution, which can improve safety, drive health efficiency, and enable choice and control for patients.
The Australian Digital Health Agency is calling for proposals for innovative test beds that can be rigorously reviewed and then scaled nationally.
These pioneering initiatives will be co-produced by consumers, governments, healthcare providers, and entrepreneurs and will test evidence-based digital empowerment of key health priorities.
Agency CEO Tim Kelsey said digitally enabled models of care are an important priority in Australia's National Digital Health Strategy – Safe, Seamless, and Secure and the test beds demonstrate the Agency’s commitment to work collaboratively with stakeholders.
“Our global peers are increasingly recognising that Australia is in a unique position to test and trial digital health solutions that can be implemented in a diverse and sometimes fragmented system, and have the ability to scale nationally.
“During my time as CEO, I have witnessed some incredible innovations that involve consumers, providers, and healthcare organisations tackling critical priorities such as managing chronic disease in completely new ways. The Agency wants to support these types of initiatives, to assist in their evaluation, and to develop an evidence base of sustainable, scalable initiatives to support further investment,” said Mr Kelsey.
The Agency is seeking expressions of interest that build on areas of high level of digital maturity, with evidence of integrated governance arrangements between the participants. Test beds should involve new approaches to addressing a health challenge rather than pilots that have no plan or capacity to scale across a population.
“These projects will require exemplar regions and sectors with a strong existing capability to deliver outcomes. It is essential to demonstrate feasibility and efficacy for a potential test bed to proceed,” said Mr Kelsey.
MSIA President Emma Hossack has welcomed the Agency’s approach to market.
“Australia’s health software industry has remarkable capability. These test beds will give our members the ability to showcase this capacity in worthwhile settings. Prerequisites of maturity and scalability together with transparent evaluation mean these exemplars will have real value for Australian healthcare,” Ms Hossack said.
Patient and consumer advocate Harry Iles-Mann has had frequent contact with the health system over the past 20 years and welcomes improved digital services to better support patients.
“As more people like me suffer from serious complex chronic health issues, we are reliant on multiple care providers to support our own care management. It’s crucial that we find better ways to provide digitised, highly coordinated health and wellbeing services so that patients can be supported, empowered, and enabled in care and in life,” said Mr Iles-Mann.
Further information
Projects can run for up to four years depending on the test bed however, baseline measures will be required by October 2018, and interim results at 12-18 months. Up to $600,000 is available per test bed.
The Agency has also responded to industry calls to minimise the regulatory burden for respondents, and is requesting submissions of no more than 3-5 pages. The tender closes at 2pm on Wednesday 6 June 2018. Further information available on AusTender.
Here is the link:
On 22 May, the ADHA held an industry briefing and a number of questions were put on notice and the ADHA’s response was published on Wednesday. (30 May, 2018)
In their response the ADHA released details of the six evaluation projects already underway:
1.  Evaluating how GPs in primary care use My Health Record to improve their patients’ health through improved medicines management, sharing information, and reducing unnecessary duplication of diagnostic services, this is with the National Prescribing Service (NPS) MedicineWise and the University of Melbourne;
2.  Evaluating how GPs and hospitals use My Health Record to improve their patients’ health through improved medicines management, reducing unnecessary duplication of diagnostic services, and reducing hospital admissions and length of stay, this is with PenCS, Western Sydney PHN, the University of Western Sydney, and NSW Health;
3.  Educating GPs how to use My Health Record to improve their management of patients’ medicines (specifically deprescribing inappropriate medicines) and reduce unnecessary duplication of diagnostic services, this project is a specific multifaceted education intervention with MedCast and the University of Wollongong;
4.  Quarterly tracking of healthcare providers to investigate awareness, readiness, attitudes, and experience regarding the My Health Record system through to early 2019, this is with McNair YellowSquares and Rodika Research Services;
5.  Changing clinical behaviour in primary care using My Health Record to improve uploading and viewing of documents, sharing of useful and accurate information, and informed clinical decision making, this project involves the discipline of behavioural economics and is with the Behavioural Insights Team; and
6  Evaluating the performance of the My Health Record system by conducting data analytics on de-identified, administrative, non-clinical My Health Record data to investigate the impact on medicine management, ordering diagnostic services, adherence to evidence based care, patterns
of healthcare utilization, and associated costs.
----- End Extract.
It seems these projects are very limited and focused on showing some clinicians are getting some use out of the myHR. Now we know they exist it will be important to follow up and to understand just what they are finding over I imagine the next 6 months to one year. It will also be interesting to see just how rigorous the studies are in terms of real clinical impact of the myHR, evidence for which since 2012 has been pretty thin on the ground. This is a useful list of things that apparently the ADHA thinks will show positive benefits. Reducing various interventions on a pretty large – and safe - scale will be necessary to make the myHR offer any value for money given all the costs!
I would also hope the actual test-bed projects are projects both maybe to optimize, perfect and make clinically useful the myHR and I would also have thought there would have been some useful myHR free innovation projects that actually have a chance of real success and national adoption. Sadly I fear it’s the myHR or nothing or so it seems whereas I reckon the myHR is already obsolete and it would be better to plan for useful myHR free interventions.  We will know when the winners are announced!
Another $3.6M down the drain is likely if the totality focusses on the myHR? One also wonders just how far $600,000 can go in conducting a 1-2 year pilot of a major intervention?
David.

-----

As a coda I have to say if I was the ADHA I would be hoping someone would come up with a plan and a migration path the render the myHR into something people would be keen to have, would maintain and would be heavily used by clinicians. Dream on David.

D.
 

36 comments:

Anonymous said...

Let’s check in a year, I wonder if these are to small and to long to hold the attention of political buffs. I sadly do not get a sense anyone can focus beyond a 90 day plan these days.

I am interested to see how they attempt to scale, all nice a cozy at a tea party level but involve more and more actors you get more and more divergences.

The other question is, what happens if the test beds provide evidence the ADHA does not like?

Anonymous said...

Those aren't test beds, they are benefits measurement things already underway.

Anonymous said...

those six evaluation projects are squarely aimed at providers, not patients. Totally supports the hypothesis that My health Record is all about monitoring the health care industry and that it's just the start.

Let's see if they move from paying GPs via ePIP to nudging them to compelling them to upload data.

I wonder if the RACGP is starting to feel a little nervous.

The Medical Republic is running a survey of GPs who don't have a My Health Record. Will they opt-out? The results will be interesting.

Anonymous said...

"The other question is, what happens if the test beds provide evidence the ADHA does not like? "

Same as always - gets ignored. When you're dealing with spin, confirmation bias doesn't exist.

And if one thing is true, this government is spinning for all it's worth. That's why they employed Timmie, not for his health or IT expertise.

tygrus said...

The projects seem biased and unscientific. They all ask how xyz use the My Health Record to IMPROVE abc outcomes with no mention of studying the negatives. The proper way is to ask the positives and negatives effects of using the My Health Record. The second problem is these studies should have been done years ago and the results used to justify expansions like automatic signup (the requirement for opt-out).

Anonymous said...

The only platform this BS is built on is an ever growing bed of lies

https://www.itnews.com.au/news/my-health-record-data-could-be-uploaded-without-consent-492029

How many other ‘omissions’ are there? Is this blantent attempts at misleading the public, peak bodies and others or is it a simple case of the ADHA has no idea how the MHR works?

Anonymous said...

6:39 AM. Thanks for drawing attention to this.

The only platform this BS is built on is an ever growing bed of lies

I guess that falls under the ‘test bed’ project. As for ADOHA, looking at their response they are lacking any depth of understanding, I am sure in their little minds this is a storm in a teapot.

It does appear they are being less than open with the truth, innocently or not it is yet another sign ( no board papers for 6 months is another) those running ADHA cannot be trusted. What are they hiding and why

Anonymous said...

The job of the ADHA is to sell the myhr. Like most IT salesmen, they don't know much about the product, just the supposed benefits. If you go to buy a car, does the salesperson tell you about the bad stuff, about the competition? Do they exaggerate the features?

Can you find anything on the myhr website about costs, risks, competition, who would be wise to consider opting out and why?

There's an old joke - what's the difference between a computer salesman and a used car salesman? The used car salesman knows they are lying.

It is quite possible that Tim really believes in what he is selling. Unfortunately he doesn't seem to be much good at learning lessons. He failed in the UK, he will probably fail in Australia for exactly the same reasons.

Dr Ian Colclough said...

I disagree. The ADHAS' job is to establish an environment in which digital health can thrive.

Anonymous said...

As long as they equate myhr with digital health they will fail. myhr is nothing more than a dumb document management system.

Anonymous said...

I don’t necessarily disagree with your proposed purpose Dr Ian, that said ADHASHTAG is in no more of position to facilitate an environment for health to thrive than its competitors like Cerner or Orion or the other proprietary big system vendors. The Department can though through Policy. ADHA has two roles, TheirHR and marketing.

The sooner we return to standards and publishing the quicker DoH can set policy to support industry and the healthcare community thrive.

If we really want true digital, it is not the fax protocols that need to be removed, it is perhaps the printer

Dr Ian Colclough said...

.... and that they do not have the skills and experience needed to do that is not necessarily their fault - that is the government's fault. It's not a difficult task if you know what needs to done and how to do it! .... it's inordinately difficult.

Anonymous said...

I believe the ADHA has a lot to answer for regarding a pack of skills and experience. They cleaned out that capability and we lost a lot of experience and skills, many lost forever.

Dr Ian Colclough said...

Correction ..... I meant to say "It's not a difficult task if you know what needs to done and how to do it! .... on the other hand it is inordinately difficult for government's and their bureaucracies which are lacking in skills, and which have little experience and understanding of the breadth, depth and complexities of the many domains that comprise the health industry.

Anonymous said...

If we really want true digital, it is not the fax protocols that need to be removed, it is perhaps the printer

That is actually a very valid observation. I have often wondered what all this noise about fax machines was. I guess when you hang on a phrase like bonfire of the faxes for so long you end up sounding out of touch, unable to resonate with those you are talking at.

Dr Ian Colclough said...

June 08, 2018 4:31 PM I disagree. The skills still exist but they are no longer in the ADHA. They are where they should be, outside of the ADHA working in industry, not wasting their time beating their heads up against a brick wall discombobulated in a confused, leaderless, bureaucracy.

Anonymous said...

You are quite correct Dr Ian, I was looking at it from a hope we had a national capability that could work with local and regional efforts to bind them at a holistic national level ensuring agreements could be clued together. That is another five years away

Anonymous said...

Passed one with one comment. Should we not be providing equal and funded airtime for other views?

http://annystudio.com/misc/opt-out-of-my-health-record/

Dr Ian Colclough said...

With respect I suggest you bury 'hope' and replace it with some hard nosed pragmatism, defining the problems, drilling down to the very essence of the root of each problem, thinking through analytically and critically until the brain hurts and repeat the process moving forward iterating progress step by step. Hope - is a waste of time and resources and will achieve nothing. ADHA has been founded on 'hope'!

Dr Ian Colclough said...

@8:41 AM ... and one must add acutely disciplined formalised thinking practised by engineers. Heresy you might suggest; I think not.

Dr Ian Colclough said...

... and the other critical element is uncomplicated, accountable, responsible, informed, effective, Governance which has never existed since NEHTA was established and subsequently ADHA.

Anonymous said...

But only if done well. And the amount of complexity behind that simple phrase -- 'if done well' -- is enormous and largely unrecognised and ignored.

Eric Browne said...

There is a glaring error in the "alternative view" article http://annystudio.com/misc/opt-out-of-my-health-record/
posted by anonymous at June 09, 2018 8:30 AM

The statement "My Health Record will not make patient access to diagnostic test results any easier" is manifestly wrong. Doctors don't have any control over diagnostic results being posted to the My Health Record system. The diagnostic organisations that opt in to the program already are, or will be posting results directly to the My Health Record system. The results are then held by the system for seven days before patients are allowed to view them.

I agree with many of the other sentiments about doctors wanting to control information flow to the patient, or doctors wanting to ensure a follow up appointment for financial gain. I also think many doctors are simply unaware, or indifferent to the wishes of patients to obtain their results. There are probably also many patients that don't wish to have access to their results.

Many labs will not copy results to patients by mail, even when requested to do so by the ordering doctor.

For all the MHR faults and horrendous cost on the negative side of the ledger, potential widespread patient access to diagnostic test results sits on the positive side - providing it actually happens, and happens safely and reliably.

Dr David G More MB PhD said...

Eric said:

"Doctors don't have any control over diagnostic results being posted to the My Health Record system."

I believe the path and image request forms have a tick box, which if ticked, will stop result upload, to avoid HIV tests and the like floating about. A good thing I believe....

It is my view all uploads should be curated and approved (agreed) but I guess I am just old fashioned,

David.

Andrew McIntyre said...

The request forms are to have a box to indicate NOT to upload to MyEHR and that box must be unchecked by default, so permission is on the order.

Anonymous said...

Without context or cushion, do online medical results make sense?

https://www.fiercehealthcare.com/tech/without-context-or-cushion-do-online-medical-results-make-sense

Dr Ian Colclough said...

Andrew, I am not sure I understand what you are saying. I thought it went like this:

1. The request form contains a 'box'.
2. The box is prefilled with an 'X' when the request form is printed.
3. What does the label against the box say? eg. Does it say send report to My Health Record? .... !!!

If 1,2,3 are correct how does one 'uncheck' the box to ensure the report is not sent to MyEHR?

In the event I have opted out and am not registered for a MyHR will the report still be sent to the ADHA if the request form is so marked?

Apologies if I have this 'wrong' but I think it important we get a precise clarification of what .. box, label, check, uncheck, is carefully clarified. Can you help please. Thanks. Ian

Anonymous said...

? @2:47PM are you saying the request form will have a box and instruction saying do not send report to MyHR and that unless the box has been filled in the report will be sent to MyHR even if I don't have one because I have opted out?

Who completes the box? Is it the doctor or the patient? Does anyone ask the patient what they want? Do I detect a malodorous smell of trickery and deceipt?

Anonymous said...

There is also the little matter of providers being able to trigger the record activation by uploading to a patients govhr

Anonymous said...

@ June 10 1:15PM. Perhaps more concerning is no matter who provides commentary on the Governemnt health record database, there are inaccuracies and little consistency in understanding. This is the cases across the board, be it the ADHA, reporters, industry experts, analysts etc...

It would in the surface appear that no one really understands this system, how it is suppose to behave is the broader system-of-systems. Should we really be turning this on?

Eric Browne said...

Thanks David and Andrew for the clarification.
I can not find any description of the process on the My Health Record system help site. The only reference I can find is:
"You can ask your healthcare provider not to upload a Pathology Report or, once a Pathology Report has been uploaded to your My Health Record, you can choose to remove it."
Presumably, under standing consent, the default is for all pathology results to be uploaded by the pathology provider unless instructed via the order form for the results not to be sent to the MHR.
It sounds like the checkbox is a convenience for the doctor to convey the fact that the results for all the tests on the order are to be suppressed from being uploaded, and also a convenience for the lab because the instruction will be conveyed in a clear and consistent manner.
The request forms are usually completed by the ordering doctor, but potentially, if the patient is given the form to take to a collection centre, then the patient might be able to check the box herself.
I also assume that it will take some time, perhaps years(?) for these new forms to percolate throughout the system.

Andrew McIntyre said...

The box appears to be there now, from what I have seen. I am not sure what happens if it is not checked and you have opted out? Systems can check if the patient has a MyEHR record before they upload.

Anonymous said...

from https://www.myhealthrecord.gov.au/for-healthcare-professionals/pathology-reports

checking the Do not send reports to My Health Record check box in your practice management software, or

checking the Do not send reports to My Health Record check box on the paper referral form, or

writing Do not send reports to My Health Record on the request form.

Anonymous said...

If the boxes are already there and systems can query the HR system, then I would siggest the answers might be in the conformance profiles and/ specifications.

I understand these are now available through the developer.digitalhealth site.

Anonymous said...

writing Do not send reports to My Health Record on the request form.

That is great I did not know the MyHR could read hand writing? Do we scan it first or just fax it

Bernard Robertson-Dunn said...

Nudge theory says - make the default what you want the system to do. Apathy and ignorance will do the rest.

This is the result of DoH and ADHA getting up close and personal with Behavioural Economics. It's been going on since at least 2016 if you know where to look for it and without any fanfare or publicity.