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."

Thursday, June 07, 2018

This Has Me Rather Scratching My Head - I Wonder Where It Actually Fits?

This appeared last week.

Digital Baby Book Budget boost for parents

Investments in digital technologies and children’s health will have long term benefits for Australians.
29 May 2018
The 2018 Federal Budget, announced on 8 May, is notable for its emphasis on long--term investments in the health of Australians, particularly in children’s health and digital health technologies.

Better health from day one

New parents currently receive a hard copy “blue book” to record and track their children’s health and immunisation milestones, but this will be phased out in favour of a digital record next year. The Budget allocated $5 million to the development of a Digital Baby Book, which will let parents compile a complete medical history for their children from the very start of life, ensuring that their children need never be without the medical information they need to ensure optimal health.
$77.9 million has also been allocated to programs targeted at improving infant and maternal health, such as diet and exercise recommendations for expectant mothers, as well as free whooping cough vaccines. Together, these initiatives are expected to save money over the longer term by reducing reliance on the healthcare system in later life.

Digital health investments

$1.3 billion will be invested over 10 years in a new National Health and Medical Industry Growth Plan, which will cement Australia’s status as a global centre for medical research and innovation. This will include a $500 million investment in genomics research to develop the use of precision medicine.
Other investments include $92 million to the Digital Transformation Agency for the GovPass system, which enables unified digital identification across government services to improve access and reduce duplication. The Australian Health Institute of Health and Welfare received $30 million for technology upgrades and better data sharing capabilities.
Pharmacy gets a boost with $15.3 million allocated to introduce a national electronic prescribing system for the PBS, due to begin in October 2019. This measure will improve medicines safety and compliance, as well as overall efficiency.
Here is the link:
A bit of googling came up with this:

Digital tools set to improve child health

Home » News Hub » Digital tools set to improve child health
New South Wales and Victoria are leading a new national collaboration to leverage ehealth digital tools to capture child health and developmental information electronically, as part of a new child digital health record scheme.
Led by the National Collaborative for Child Health Informatics, the initiative is set to look at the potential of offering a digital health record for every child in Australia from conception through to adolescence. Both parents and healthcare professionals will be able to access the records.
Traditionally, child health and development data has been recorded in baby books ‘coloured’ for each jurisdiction. NSW, which piloted an electronic version of its Blue Book during in 2012, will lead the digital baby book project.
The digital rollout forms part of four initiatives that aim to build a ‘longitudinal’ child health record for all Australian children moving forward. The other three initiatives, set to launch in 2019, will involve moves to see how to upload school immunisation records digitally to the Australian Immunisation Register (AIR), led by the ACT in association with Tasmania; a new national Digital Pregnancy Health Record, led by Queensland in association with South Australia; and digitising child health checks so the information can be shared electronically, led by the NT with the help of Western Australia.
The National Collaborative Network for Child Health Informatics was formed last year by eHealth NSW in partnership with the Sydney Children's Hospitals Network with support from the Australian Digital Health Agency.
The aim of the Network is to bring together Australia's leading experts in children’s health to identify nationally focused, child-centred and clinician-friendly digital health projects to positively impact the health and social outcomes of Australia’s children and their families.
“This is a unique opportunity to make a real and lasting difference to the health and wellbeing of the children – and indeed the future – of Australia,” eHealth NSW’s Chief Executive, Dr Zoran Bolevich, said. “NSW Health has a significant program of work underway to enhance our health services through effective use of digital technologies.”
Here is the link:
So we seem to have had the technology for years!
In the Budget we have this:

Infant Health – Digital Baby Book

Page last updated: 08 May 2018
Infant Health – Digital Baby Book - PDF 117 KB

The Government will invest $77.9 million in infant and maternal health. The Government will develop a national Digital Baby Book for children as an update to the traditional state and territory hard copy paediatric baby books.

Why is this important?

Most Australian families have paper records of a child’s health, development and childhood vaccinations. However, for many people, paper records are inconvenient and are often lost or not brought to appointments, which can result in delayed and potentially substandard care.

The Government will develop a national digital platform to enable families to replace the hard copy books with a digital book, which will be easier to keep track of key health information when they need it.

Who will benefit?

The Digital Baby Book will give every newborn Australian the opportunity to maintain a lifelong digital health record. The ability to have access to the baby’s records anytime, anywhere and be able to build a complete medical history from birth is an important benefit to support families.

How much will this cost?

This measure will cost $5 million from 2018–19 to 2019–20.
Here is the link:
So it seems we are getting a baby myHR, in app form I imagine, for each nipper.
What is interesting it that it is by no means clear if this is the myHR or something else and how the two hang together.
$5M seems almost ‘chump change’ for the ADHA – I wonder is it them, or someone else, developing the project and where the data is held.
Maybe someone who  knows and can explain how it all hangs together as this seems like a very useful and worthwhile initiative?


Anonymous said...

This is nothing new, specifications and applications were created on the back of taxpayers donations five years ago. The ADHA must have lost a lot of corporate memory. Probably locked up in a filling cabinet next to the fax room.


Looking on the apps store ‘my child’s eHealth Record’ the app has not been cared for for many years, no updates. This is not a good look, the ADHA obviously cares little about servicing their products, seem more interested in marketing a dream based on a reality that does not exist.

Now we have to spend more on something that clearly no government is able to maintain or support.

Grahame Grieve said...

Well, what we had in the past was to throw an app out that piggy-backed on top of the PCEHR infrastructure to reproduce the existing paper book.

Now what we have as a considered plan to work with the stake holder community to develop technical and policy standards and operational infrastructure to support an eco-system for solving this problem. The technical standards part is being run through a new Child Health working group at HL7 Australia. this is a very different kind of thing than what's gone before. As far as i call tell, having read the project documentation, it's the kind of thing that people here have been asking for.

In terms of relationship with the MyHR: that's not known yet because requirements analysis and community building is coming before operational solutions. Also, the discussion about replatforming the MyHR hasn't happened yet, and will have a lot to do with this once thing get to that point.

Anonymous said...

I hope this next attempt considers:
- the role of these records. They are a screening tool to identify children that may not meet expected threasholds and if that is the case, the child falls into a regular care stream which ideally would include the standrd set of records being added to My Health Record.
- as it is a consumer owned record, it is usually neglected once the child has proven to develop within expected limits. If you are unlucky enough to be a second, third, fourth child, the paper record is mostly forgotten once you arrive home from birth.
- the choice of going with an electronic book is dependant upon your GPs adoption of My Health Record and that choice needs to be made soon after birth.
So the utility is demonstrably low and the electronic adoption is compromised by the healthcare providers use of digital health.
It would be far better to concentrate on getting near real time registration to Medicare and My Health Record of the child at birth, collect the important birth information and have that information sent to My Health Record and then let normal care processes document the childs health status. The gimmick of adding your child's heigjt at mother's group wears off quickly.

Bernard Robertson-Dunn said...

What we have is a government that has positioned the myhr and its infrastructure at the centre of the health care universe.

IMHO, this is totally misguided - the centre of the health care universe should be the patient. The centre of a patient's health care universe is their interaction with the health care system which is primarily, and over the longer term, the GP.

Patient centric health care does not mean focus on a patient's health record. A health record is a support capability, not an end in itself.

The problems that need to be addressed if a patient centric health care system is to be created have little or nothing to do with record keeping.

Digital Health, although still a rather a vague term, will play a large part in changing health care systems. This government equates Digital Health with health records. The international community doesn't agree with this.

The World Health Organisation held its Seventy-first World Health Assembly in Geneva on 25 May


Digital Health is mentioned as an enabling technology.

Search for health records in their agenda and program of work and will find nothing. Zilch, Zero. The WHO has moved on from the promises (largely unfulfilled) of the sparkling lights of health records.

Technology and automation that improve the practice and delivery of medicine will deliver improvements in health care. Document management as applied to health records is the wet dream of politicians, bureaucrats and managers.

Yes, administrative record keeping is important but so are many other things. What is most important is better health and health care.

Messing around with technology and accumulating large amounts of administrative and financial health care data thinking they are more important than health care outcomes gives the impression of action, but is actually a distraction and has the potential to disrupt real progress and delay advances towards a patient centric health care system.

Bernard Robertson-Dunn said...

Further to my observation that the WHO isn't prioritising health records, here's some details on an International Interoperability Healthcare Conference, 11th July @ 12:00 - 12th July in the UK.


The programme is here:

Oh look, not a mention of health records.

Interoperability and data sharing does not require health records, especially ones readable/controllable by patients and especially not ones owned and run by governments. Both of these distort and impede good health care data sharing.

It all depends on why you want to get at the data. Patients, health providers and government all have different requirements and interests. Guess whose interests myhr best serves?

Anonymous said...

@ Grahame Grieve June 07, 2018 7:25 AM "Now what we have is a considered plan to work with the stake holder community to develop technical and policy standards and operational infrastructure to support an eco-system for solving this problem."

How enlightening.
What exactly is this "considered plan" Grahame?
Should we know about this?
How and where does it fit into the overall scheme of things?
Is it part of a an overarching systems architecture?

I think Bernard Robertson-Dunne in his comments subsequent to your makes some particularly pertinent observations. I wonder what he would say about this "considered plan to work with" to which you refer!

And BTW who exactly from the stakeholder community are enrolled and funded to "develop the technical and policy standards and operational infrastructure" to which you refer and dare I ask - What are the timelines and deliverables?

Anonymous said...

@11:23 AM all good questions. Grahame's comment indicates that "technical, policy and operational infrastructure" have yet to be developed. I assume they have yet to be defined and documented!

What does all this really mean Grahame?

Does it mean all the energy, work, effort and documentation over the last decade have all been wasted?

Does it mean we have to start from first base again?

Does it mean a whole lot of stakeholders are now going to sit around the table and agree on what is needed? .... just like they have been doing for the last decade?

Grahame, is there a strategy anywhere? Surely it's not the rubbish produced by the ADHA last year! What is the strategy Grahame? Do I detect underlying your comment that the 'Stakeholder Community' with all its conflicts and vested interests will lead itself, resolve its differences and conflicts and magically come up with some 'sort' of solution that all will happily embrace?

Who will lead this? Who will fund it? How much money is required? Is there a budget? Where is it?

Anonymous said...

There is only one stakeholder and that is the federal government and its single minded desire for more and more data. There are no answers because the government has never asked them and never will. It knows what the answer is and it will keep at it until they are voted out.

Anonymous said...

You can’t vote those who pull the strings out. They will however continue to buy opinions they seek for endorsement. Which is not intended as a swipe at those who have HIT best interests at heart.

Anonymous said...

@2:45 PM "There is only one stakeholder and that is the federal government and its single minded desire for more and more data."

The root of all the problems. What say you Grahame?

Anonymous said...

Grahame Grieve June 07, 2018 7:25 AM "Now what we have is a considered plan to work with the stake holder community to develop technical and policy standards and operational infrastructure to support an eco-system for solving this problem."

Haven't we been there before, more than once? The same old same old will only give a repeat of the past all over again. Surely you don't want that - do you?