Quote Of The Year

Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Wednesday, October 10, 2018

The ADHA Just Continue To Be In Denial Regarding The Digital Divide.

This appeared last week:

Digitising social services could further exclude people already on the margins

04 Oct 2018
Siobhan O'Sullivan and Christopher Walker
People who are most dependent on social services are also the least able to easily transition into the digital age.
Digital or e-government has been prominent on Australia’s political agenda for at least a decade. It has led to improvements in e-services that allow you to pay rates online, submit a digital tax return, or claim rebates for medical bills.
But while e-services can make life more convenient for those who have access, there are signs that transacting with the state digitally is fast becoming mandatory. The My Health Record opt-out system, for example, assumes everyone will participate in this digital initiative unless they take deliberate action to do otherwise.
Our research suggests those who will not, or cannot, engage with the state online, may find themselves without basic government services – and even more alienated from government in the future.

People are being left behind

There are many reasons why citizens may not be able to engage digitally, including poverty, digital illiteracy and lack of digital infrastructure.
Research suggests that the so-called digital divide is shrinking in Australia, with 97% connectivity among households with children under 15 years.
But the same research shows that an inability to connect digitally is fast become a very serious force for compounding social exclusion. Those who are left behind, are being absolutely left behind – the gap is narrow but deep.
The Australian Digital Inclusion Index identifies those most likely to be digitally excluded as:
  • people on low incomes
  • people aged over 65
  • people with a disability
  • people with low levels of education
  • Aboriginal Australians
  • the unemployed
  • people living outside capital cities.

Face-to-face services are shrinking

E-government is supposed to be efficient, cost effective, and according to some scholars, enhance democracy by allowing for greater interaction between citizens and the state.
But e-government isn’t only about increasing the number of ways citizens may transact with government online. It’s also moving services online that have traditionally relied upon face-to-face, empathetic and therapeutic relationships. For example, services such as those offered by the employment services sector.
To better understand the likely impact of social service digitalisation, we looked at what it might mean for people living in remote Aboriginal communities in Western Australia and the Northern Territory.
We conducted interviews with federal public servants working as e-government specialists in a number of social services and Aboriginal services portfolios. We also interviewed federal service providers, NGOs, and a representative from a private telecommunications company.

Exclusion is structural

We found a great appetite for digital connectivity among the people we spoke to. Facebook, Instagram, online banking, and online buying and selling websites such as eBay are popular among the communities we engaged.
At the same time, we found the ability to speak to a front line public servant – either face-to-face or over the phone – is diminishing. This is creating a service gap with very real and adverse impacts on the lives of some citizens. One interviewee told us:
until a couple of years [ago], you used to get your fortnightly form mailed out to you […] and you took that down to Centrelink and lodge it on its due day. Now you’re expected to remember that you’ve got to go online every second Tuesday and self-report.
And the penalties for missed engagement can be significant:
a mainstream client would have received a text message telling them that you’ve missed an appointment, please contact your provider immediately. Because our clients don’t get those text messages they don’t find out their allowance has been suspended […] until their next payment day when it doesn’t come.
It’s the people most dependent on social services, who are least able to easily transition into the digital age. In some cases, they live in a part of Australia that simply does not have internet infrastructure, and perhaps will never get it. We were told:
there’s no NBN infrastructure, and it’s not going in. One day they’ll get the satellite connections, but at the moment no-one has internet in the homes.
In other cases, there is infrastructure but maintaining digital connectivity is a personal cost that exacerbates the divide. People living in remote parts of Australia do not have a choice of providers, and that is reflected in the costs of monthly plans.
Sometimes the citizen may have access and a working device, but colonial assumptions that permeate the e-government landscape act as a deterrent to engagement. For example, one interviewee told us that when it comes to setting security questions:
they’re questions like, what is the name of the street you grew up on, which is not applicable. A lot of communities have house numbers, not street names. It’ll ask you the name of your first pet. And again, Indigenous people don’t think of the animals around as pets in the same way that we do.

It’s not getting better

Our research suggests that while digital services have great potential, that potential is yet to improve the life chances of the most vulnerable members of our community. And things appear to be getting worse. While the government is focused on e-services as an alternative way to engage citizens, the reduction of much more costly face to face services is problematic.
Our research also suggests the government is not investing the time, money and effort needed to make sure all Australian citizens are successfully transitioning to the digital world. There is a widening gap, which the not-for-profit sector is graciously filling in many communities, But our concern is while e-government may bring advantages for some, it will further marginalise those who are already seriously disadvantaged.
Supporting an individual’s transition to active digital engagement is just as important as the ongoing development of digital services. As digitalisation progresses it must bring all citizens along with it.
Siobhan O'Sullivan, Senior Lecturer in Social Policy, UNSW and Christopher Walker, Head of School, Social Sciences, UNSW
This article is republished from The Conversation under a Creative Commons license. Read the original article.
Here is the link:
To me the key sentence is this one:
“But the same research shows that an inability to connect digitally is fast become a very serious force for compounding social exclusion. Those who are left behind, are being absolutely left behind – the gap is narrow but deep.”
Interestingly the article does not seem to specifically call out the mentally ill.
The ADHA produced a document for the Senate Inquiry.
Brief: Reaching People with Mental Health Conditions, from Australian Digital Health Agency, received 25 September 2018.
Here is the link:
Basically it is just a seven page list of all the groups of people who have been engaged / met with but somehow really feels like box-ticking rather than actual engagement with individuals.
Has anyone seen a document from the ADHA outlining its strategy for addressing the Digital Divide in the opt-out period and beyond. I have not and given it may involve a good 20% of the population it is pretty late.
David.

5 comments:

Anonymous said...

"Has anyone seen a document from the ADHA outlining its strategy for addressing the Digital Divide in the opt-out period and beyond" - well, what might it say?

Anonymous said...

That would be the core of any interoperability strategy surely? How to deal with systems (human and computer) that are quite different and largely independent of each other. Required to work together for a shared purpose, but may also be part of multiple communities of purpose. Ensure those communities are resilient as actors come and go.

Anonymous said...

Or you could always just axe the fax, strap a sinker to the printer, or bren the pen. It would be far better to cut the bull and cheap slogans and allow for some actual debate and learnings to take place.

The ADHA has shown it has not been able to listen to understand and facilitate conversations where the community feels heard and can see their issues being addressed to some level of joint agreement or appreciate where a divergence accours.

Bernard Robertson-Dunn said...

The big problem that has faced the PCEHR/myhr from the start is that no work has been done (or at least has not been published in any of the design documents) about how the system is supposed to fit into the the larger health care system.

The assumption seems to have been that the better mousetrap that is a computerised record keeping system will magically deliver wondrous benefits to doctors and patients and that people will embrace it with open arms.

The problem that is the digital divide is just one of many that have never been considered, let alone been addressed.

The one step that is missing from the project plan supposed to deliver improved health care is the last one - "then a miracle happens".

The ADHA and the government can do all they like to register as many people as they can get away with, the fact remains, there is minimal benefit from a computerised record keeping systems that increases costs and inefficiencies into the health care process.

Not only that, but efforts to increase the functionality and content will only make it worse.

This whole "improvement" in health care record keeping is a reminder of other ill fated attempts to legislate without regard to reality. An example is the Indiana Pi Bill of 1897 where the legislature tried to solve the problem of how to square the circle - something mathematicians claimed was impossible. The "solution" implied various definitions of pi as 3.2, or 3.23 or maybe 4.

https://en.wikipedia.org/wiki/Indiana_Pi_Bill

Fortunately the bill was never passed, unlike here in Australia where governments of different persuasions have been trying to square a different circle oblivious to the futility of the exercise.

Bernard Robertson-Dunn said...

The Department of Health seems to recognise that some communities have trouble dealing with the complexities of the health care system

This is from a recent tender announcement

"The Government is calling for tenders for trials of a new aged care navigator network, including information hubs, community hubs and one-on-one support from specialist workers, to streamline and simplify aged care service access.

“These trials will aim to assist senior Australians and their families to get the best outcomes from the aged care system,” said Minister for Senior Australians and Aged Care, Ken Wyatt AM."

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2018-wyatt138.htm

The question I've got is this "If this group have trouble with health care, why is the government forcing those who want to utilise health care homes to have a personally controlled My Health Record?"

http://www.health.gov.au/internet/main/publishing.nsf/Content/health-care-homes-cp/$File/Health%20Care%20Homes%20first%20consult%20and%20enrolment%20checklist%20for%20clinicians.pdf

Calling it "personally controlled" or "My health Record" for these people is a sham.

The government's desperate attempts to use myhr for everything and everybody means it will be of no use to anyone.