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, July 25, 2018

I Think There Is A Deep Underlying Reason Why Opt-Out Might Find Itself Struggling.

I don’t often bring Paul Kelly – Editor-at-Large of The Australian – onto these pages but his effort on Saturday last week struck a chord with me.

Trump and Brexit: Existential crisis torments great democracies

  • The Australian
  • 12:00AM July 21, 2018

Paul Kelly

The West lives through an era where democracy is under serious threat from within given the two great democracies — Britain and the US — are sunk in existential trauma over separation from Europe and the Trump phenomenon respectively.
It is folly to think Australia is immune from the democratic malaise. Our problems and our symptoms are different, yet serious. But our mood of dispirited indifference is far distant from the existential crisis that torments the two nations Australia used as models when writing its constitution in the 1890s.
The two specific triggers for the British and US traumas are mismanagement of globalisation and immigration, areas where Australia has largely avoided the same mistakes. From the 1980s onwards Australia’s embrace of economic liberalism was tied to social-democratic distribution of the benefits. Our immigration policy has been tied to strong border protection and government control of entry in the national economic interest. Our results are not ideal — but far distant from the virulent political revolts that triggered Brexit and drove US President Donald Trump’s election.
The experiences of the Britain and US reveal two overarching messages — once your politics is derailed then your country can lose its direction and even its sense of destiny; and the deeper lesson is that the fusion of economic and cultural dislocation is the indispensable grassroots force that feeds into and then drives political derailment.
While Brexit and the Trumpian eruption are different events they mirror a common failure — the inability of the ruling elites in Britain and America in politics, finance and business to service the economic needs of the entire community, respond to legitimate public grievance and honour traditional as well as progressive cultural values.
The political revolutions in Britain and US will shift the anchor of these nations with unpredictable consequences.
---- Huge Amount Omitted
University of Sydney professor James Curran, a delegate to the Australia-UK Leadership Forum, tells Inquirer: “The key for Australia is to hold its nerve. Trump has no regard or respect for the post-Cold War liberal international order and sees it as a charity project that the US should no longer have to pay for.
“The dysfunction of the Oval Office is real and disturbing. The damage this president is doing to domestic US support for the system that has worked for us is potentially deep — but it is not terminal.
“Australia should eschew panic for patience and look to maximum co-operation with regional partners as a means of demonstrating its enduring commitment to the rules that have underpinned relative peace and prosperity over the past three decades.”
In this context Britain needs a Brexit that strengthens, not weakens, its global role — and that won’t be easy.
Martin Parkinson, head of the Prime Minister’s Department under Turnbull, said in London this week that current events mean “there is a renewed imperative for Australia and the United Kingdom to prioritise working together” bilaterally and globally.
The truth is that Australia is a stand-alone nation.
It will never be a state of the US; it will never join the EU; it will never belong to some regional group that shares sovereignty.
It can only seek to leverage its power, support a rules-based international system and deepen its ties with its neighbours. This is more essential than ever, given the rise of an assertive China.
Parkinson warns that the contemporary challenge is twofold — from huge shifts in geopolitics, and a growing malaise within democratic systems.
He argues liberal internationalism is now more threatened by developments “within the West itself” — witness the British and US traumas.
And Australia cannot escape.
“Despite our impressive economic performance the political discourse in Australia echoes that in North America and Europe,” Parkinson says.
“There’s an underlying anxiety in our populace about what the ­future will bring and a dissatisfaction with the results of our longstanding social compact.
“This shows up in the fragmentation of our politics, the embrace of the outsider and the rejection of ‘supposed expertise’.
“This cannot be divorced from the ongoing erosion of public trust in traditional institutions.”
Parkinson argues that mistrust is tied to worries about government competence.
While governments, in Australia and elsewhere, work hard at ­improved policy, “incremental improvement may not be enough.”
Herein lies a confronting choice for governments and political leaders: do they need to be bolder?
The proper response to the world of Trump and Brexit is a range of attitudes: patience yet boldness, keeping one’s nerve yet realising a crisis demands decisive action.
The omitted parts are here with the rest of the article:
The highlighted paragraphs get it nicely – we are in a period of eroding trust in government direction and competence and, in that environment a sneaky and trustless move – like the shift to myHR opt-out - was always going to struggle as we have now observed.
This move is a bad idea at the wrong time. A better idea would be to shut the thing down and use the funds freed up on more urgent and persuasive Digital Health initiatives.


John Scott said...

David, an excellent briefing drawing the two articles together.

The first part of a response is set by Parkinson's two principles: "patience yet boldness", "keeping one’s nerve yet realising a crisis demands decisive action."

My comments relate to your statement that "A better idea would be to shut the thing down and use the funds freed up on more urgent and persuasive Digital Health initiatives."

I agree with your proposition.

I don't imagine Treasury and Finance nor Health itself would mind saving the budget allocations destined for the MyHR. So, it is not a question of finding new money.

The question is how to move forward?

IMHO there are three surmountable challenges:
1. Finding the decision-maker who recognizes that the MyHR initiative is an idea whose time has passed and the growing crisis surrounding it demands decisive action;

2. Appreciating that a different and more compelling narrative and solution framework may and indeed does exist; and,

3 Finding the means to connect these two challenges in a manner that enables progress to be made.

'Patience yet boldness' lies at the heart of resolving the MyHR crisis.

Trevor3130 said...

The Minister needs only to wave a weekly "Life saved!" to keep it alive. His scouts are probably phoning hospital EDs every day.

Bernard Robertson-Dunn said...


That's a bit too logical and rational.

Politics and public opinion will decide this and it's not looking good for ADHA. I wonder how many currently working there are updating their seek.com profiles.

I heard an ABC talkback last night. All the callers were against myhr but for different reasons. The presenter repeated the observation that Greg Hunt doesn't know what he's talking about. The Minister's credibility is very low and still heading south. He's got Tim to thank for that.

There was widespread confusion and ignorant about what this thing is which is a consequence of the ADHA's failure to properly communicate the benefits of myhr. Considering there are very few benefits for most people it's not surprising, but they didn't even try.

Ironically Tim said that care.data failed because they didn't communicate the benefits sufficiently well. He's making the same mistake again and will get the same results - IMHO.

There is no way now that the government can rescue this, for two reasons:

1. the government owns the system and has given itself enormous powers over the information through Section 70. Furthermore, in the Secondary use framework it has exempted itself from the framework, also citing Section 70. The public don't like this

2. Whatever the government does to address the issues raised by Section 70, it will be argued that future governments will have the ability to change existing legislation and create new legislation. Therefore we are being asked to trust this and future governments not to misuse our health data. That's a big ask in the current climate.

We are less than two weeks into the opt-out process. I doubt that the government thinks it's going all that well. That's because it isn't.

Anonymous said...

The Minister needs only to wave a weekly "Life saved!" to keep it alive

There's probably a good reason why he hasn't done just that - it's never happened.

John Scott said...


My comments are both logical and rational.
However, that is not the critical element.

As you say, this is all about the politics and more specifically, the politics for both major parties. Each has contributed to this debacle in different ways over many years.

Equally, walking away would be 'good news' for a wide variety of stakeholders implicated in this debacle, especially in health.

The core issues now are:
1. Is there a new narrative and solution framework that the stakeholders can see could/will deliver apparent value?

When I and my colleagues tackled this challenge for the first time in Australia, our narrative was about 'moving information to care'. The sense of that message still rings true, albeit it is hidden in the so-called 'interoperability' challenge.
Placing doctors, nurses, and allied health at the centre and focusing on improved patient outcomes as well as improved safety, quality and efficiency rings far truer to health than digital innovation.

2. How should the Message be Managed in regard to the shift away from the MyHR?

Martin Parkinson's principle of 'patience and boldness' is the order of the day.

If this principle was accepted then the other issues, such as privacy, medico-legal liability, etc. can be addressed through organized purposeful collaboration where the principles of trust and virtuous cycle are foundations for the design, establishment and operation.

Bernard Robertson-Dunn said...


I agree, your comments are both logical and rational.

I also agree with your suggestion about 'moving information to care'

In fact I agree with everything you've said.

My interpretation is that you are recommending a distributed system with no government ownership at all.

Again, I totally agree.

So far we have gone down the same road as the UK complete with, in the latter stages, the same person at the helm. It is highly likely that we will end up with the same final result. Ditch the myhr and move to a GP centric system. which is what the UK did. They also lost the services of the Dear Leader. We can but hope.

That will leave getting the data to specialist and hospitals, something that the interoperability that was critical to myhr but not delivered becomes central to the way forward.

ADHA, a political, PR oriented government agency is not equipped to deliver this. So, the key question is: what is the best national organisation to drive this.

I don't know the answer to that.

John Scott said...

Bernard, the short answer to your question is that the national organization has to be created based on the principles of Trust and Virtuous Cycle. It has to be independent and has to have a compelling narrative, a comprehensive approach to the range of issues to be acknowledged and addressed as well as a business model. All of these are required in order to be fit-for-purpose.

I would equally suggest that the issue is not one of 'driving' rather it is one of 'enabling' because there is no shortage of knowledge nor good initiatives to support.

While it sounds like a tall order, the real challenge lies in the two challenges I mentioned in my earlier comments.

Dr Ian Colclough said...

John and Bernard I am in agreement with you both. Bernard's last comment concludes with:

1. "ADHA, a political, PR oriented government agency is not equipped to deliver this."

That has been abundantly clear to me and some other experts for a very long time. However, the Government and the Opposition refuse to accept that and I do not expect them to change their position; so one has to live with that reality.

2. "the key question is: what is the best national organisation to drive this." I would argue that a national organisation is not the way to make the progress you both envisage. National organisation, at this point in time, will prove to be an impediment to progress. I do not expect to find many prepared to embrace that view. Be that as it may, new ways of thinking will not thrive unless they do.

Anonymous said...

Bernard, John you might find this story of interest. - https://abcnews.go.com/Health/healthcare-patients-opinion/story?id=56793017

And perhaps this tells another side of the healthcare cube - https://www.9news.com.au/national/2018/07/26/18/47/queensland-new-digital-health-system-failures-putting-patients-lives-at-risk

Maybe the answer to patient care and the health of society resides in apes communicating not apps.