Quote Of The Year

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

Sunday, November 25, 2018

The War has Been Won. The Important Thing Now Is To Win The Peace! It Won’t Be Easy!

On Friday, after the Wild Health Summit, I published a blog pointing out just how much the ground around the myHR and the ADHA had shifted, based on reporting around the summit.
This can be read here:
In summary what seemed be the consensus at was that the present plans and future direction of the current manifestation of the myHR had essentially become untenable and that the time had come for some reality to be injected into the situation.
The essential problem, right now, is that the ADHA is, deliberately or not, being an horrific drag on Digital Health innovation by driving this it’s the myHR way or the highway agenda in Australian Digital Health.
Bluntly this is arrogant and ignorant foolishness and needs to be called out for what it is.
A day or so one of the Australian fathers of digital health published an interesting blog which I am sure he won’t mind me quoting.

Courage

Posted on by Grahame Grieve
Yesterday, I spoke at the Wild Health Summit, along with John Halamka, Eyal Oren from Google, and other Australian Health IT leaders.
During my talk, and in regard to how to move forward in regard to Interoperability, healthcare it, the MyHR, and the continued use of faxing in Australian healthcare, I spoke about the need for us to have courage. Today, as a follow up, someone asked me:
“What kind of things should we do to have courage?”
Here’s my top 3 ways that we should act with courage in Australia.
1. Have the courage to speak the truth, and say unpopular things.
Note that this not excuse for being rude, or causing trouble. Nor is it ok to ‘speak the truth’ without first investing time to make sure it’s the truth.  But if it really is the truth, we should say so, even if it’s unpopuler. And there’s a strong view right now in Australia that people need to toe the party line. In regards to healthcare IT, that’s hurting us right now.
An obvious corollary to that is not to punish people for speaking the truth – even if you don’t agree it’s the truth. If they’ve made a good faith effort to find it, then open discussion can follow
2. Have the courage to recognise when you fail, and do something else
To many of us get ‘locked in’ to past choices – it’s a variant of the sunk cost fallacy. Particularly when it’s group activity. How does your department/company/professional society look at projects and decide they’ve turned into a death march? Is the bar to kill a project lower or higher than to create one? Do you have any evidence that you broke the sunk-cost pattern any time?
And don’t think that everything you do will succeed either. If you think it does, then either you’re not trying hard enough, or your analysis is not objective enough. 
3. Have the courage to change how you are accountable to other people
Providing healthcare is a team game, a rich complex eco-system with 1000s of specialties. The real challenge with healthcare interoperability is not getting computers to talk to each other, but getting people to change their behaviour when technology and IT means there’s better ways to do things – different kinds of accountabilities between the players in the team. 
Too often, change is too hard. Even something as simple as using faxes – a constant theme of the day yesterday. There’s no technological reason to use faxes; they’re risky, and costly, but we still are using then extensively – because of human factors. The reaction of our international guests to that discussion (and the MyHR) was revealing: astonishment at the discussion we were having.
Things aren’t going to change unless we have courage. But too many people who listened to me yesterday heard my call to courage as intended for someone else other than them. But you can’t change someone else, only yourself. You, reading this blog, ask yourself:
Do I have courage? Does it show? 
Here is the link:
Without putting anything in anyone’s mouth I see three messages here.
The first is that change is required and that we can’t just press on as we have been as the costs and pain are becoming too high.
The second, linked to the first,  is that it is vital to recognise that there comes a time when the commonly accepted paths and directions are no longer sustainable, difficult though that may be!
The third is that options, other than the holy writ of the ADHA, need to be developed, refined, supported and implemented.
The work needs to begin now to start to develop the frameworks, standards and so on to move from the difficult to use collection of CDA documents that are the myHR to other ways that the agreed use-cases surrounding the myHR may be developed. We have spent way too long travelling down a railway that has little chance of arriving somewhere useful – and it is only the Digital Health practitioners who can do the work to define what the clinicians and patients actually want and would value. We need a new overall model for how and what Digital Health can deliver and I am not sure I see the ADHA as the ones to deliver that!
The myHR is a dead end, we all know that, and what needs to happen is that we need to define what usefully comes next. What part the ADHA plays is up to it, but being a ‘dead hand’ stifling innovation needs to be at an end.
Maybe the MSIA meeting on Wednesday in Sydney might be a good place for some initial discussion and ideas to be raised. The blog is here to help distribute and workshop ideas if people want to use it.
David.

24 comments:

Anonymous said...

Where to start? How about a survey of local clinical software suppliers currently providing systems to NZ medical practitioners together with their patient portals, and an assessment of what could be easily introduced here.

Then swallow our pride and go ask the Kiwis how they've done it so easily and cost effectively.

I realise this doesn't achieve the grand aim of creating a centralised database for the government but, hey, it does provide all the actual clinical benefits we want for patients and doctors.... and that's what we set out to achieve in the first place, yes?

The MSIA should be ashamed of itself for doing such a poor job of communicating and promoting local capabilities.

We're not even on the same playing field as the Kiwis in e-health - let alone the rugby or the cricket!

https://www.health.govt.nz/our-work/ehealth/other-ehealth-initiatives/patient-portals

Anonymous said...

This is the one I'm most familiar with, as it is used by family members living in average Auckland, Wellington and Christchurch suburbs...

https://www.managemyhealth.co.nz/m/Main/Individual

It works really well, and it operates on a "needs" basis.... if you're young, fit and well, you really don't need an e-health record.

But if you're a mum with bubs and children, have a chronic disease or are facing surgery, this is a Godsend.

Please stop the MyHR bullshit! We could have achieved the same thing here years ago, and at far less cost to the public purse.

Anonymous said...

Go tell Tim the Anointed. He won't listen of course, we're all stupid and/or evil.

Anonymous said...

Go tell the Health Ministers how many billions Tim, his mates and their predecessors have wasted on this pile of **. I'm sure they'll be delighted to discover the scale of the calamity!

Anonymous said...

As much as point 1 is a great idea, the reality for some is not as simple. To speak up on anything or propose alternative views, express the potential downstream costs of orders is one that is career ending I am afraid. Oh the ADHA has posters in values and leadership days ( very expensive ones) and little cultural change people with motivation poster and what not. The reality is that from the top to middle management it is simply paid lip service to and once the surveys and motivation gurus have left the room, so to does the vail of falseness leave and it all, “not interested Tim wants it done, I am not interested in the details make it work. Soon followed by “why is it not being delivered?, why can’t you get things right? This team is hopeless”, and the always present lack of approvals to proceed with agreed contracts and payments for contracts.

So nice ideas but unlikely to change the current ADHA.

Bernard Robertson-Dunn said...

1. Have the courage to speak the truth, and say unpopular things.

Some of us, with David in the lead, have been speaking the truth for many many years.

What is missing from this is the need for people to listen to, and learn from the truth.

It is obvious that the government and now CEO of ADHA keep making the same mistakes over and over again. They are just not listening to the truth.

There's an old management consulting mantra: If you can't change the people, change the people.

The opportunity will come next year.

Tom Bowden said...

I do agree with some comments made by the anonymous bloggers above, NZ has done some good things in eHealth - however it is far from perfect.

One good thing is indeed the concept of a Patient Portal, I just wish we could lift the uptake, still we are working on that, some practices have a significant proportion of their patients using them.

In the above commentary I think you are being a bit hard on MSIA - I think we are starting to do a really good job (declaration of interest, I am Vice President)- We are operating in an environment in which the big decisions have been made, the MHR architecture is set in stone and for the foreseeable future we have to work within or alongside the current MHR framework.

Yes the Patient Portal is a wonderful concept and when implemented well really helpful to patient care.

Dr David G More MB PhD said...

"We are operating in an environment in which the big decisions have been made, the MHR architecture is set in stone and for the foreseeable future we have to work within or alongside the current MHR framework."

Tom I totally disagree, the game has changed and pressing on with the myHR is becoming more and more stupid and ridiculous. As they say "What do you do when the evidence changes?" I say we change and if you do not you doom yourself.

It is that simple IMVHO.

David

Anonymous said...

How little has been achieved at such a high cost. This is a snapshot from 7 or so years ago.

https://www.aph.gov.au/Parliamentary_Business/Bills_Legislation/bd/bd1112a/12bd100

Tom Bowden said...


David, if you reread my email you will notice that I said nothing in favour of pressing ahead with the MHR. For the record I am fully in favour of a more thoughtful approach, rather like the one we have in NZ - which as you are aware I have now been very much involved in creating for nearly 25 years.

What I did say is that for the foreseeable future that the MHR is where government investment is going and that love it or hate it, that is the current reality. For that to change we need to argue for an entirely different approach.

I do think that we should question the present strategy. To me it is very clear that it is not working at all well. I do think however that we need to focus on force of argument and be respectful in the way in which we deal with people whose views we disagree with.

In my view good arguments are often disregarded when they become part of a mudslinging contest.

That said, please keep up the good work of questioning eHealth policy. Currently the results speak for themselves - they are dismal in the extreme.

Kind regards,

Tom


Anonymous said...

Funnily enough, last week I saw my GP about a "positive" finding from a routine cancer screening test. Had an appointment on Tuesday afternoon, during which she located a specialist clinic and sent an electronic referral with all my details.

On Thursday morning, I received a call from a clinic practice nurse, who double-checked my medications, allergies, general history, against the information contained in the referral. All correct and complete.

And an appointment was booked for within three weeks - I was amazed at such excellent, seamless service.

Now, I have opted out of MyHR, and I understand my GP is not using it.

So, this miracle of coordinated care occurred solely via the GP's clinical practice software... Why do we need the MyHR?

Dr Ian Colclough said...

Based on Tom's lengthy practical experience his comments seem quite genuine. This raises in my mind the question why David totally disagrees with Tom, as David too has considerable experience.

Is Tom conflicted? or has he simply taken the pragmatic view that if you can't change the way they are thinking then get into bed with them and try to change their thinking from the inside by accepting "that the MHR architecture is set in stone and for the foreseeable future we have to work within or alongside the current MHR framework."

Is David too inflexible in his thinking to bend to that view or so determined to see the MyR project terminated that any compromise would weaken that resolve or challenge that objective?

Or perhaps it is just simply a matter of hugely complex politics operating in the extraordinarily complex health environment across a multitude of health domains which no bureaucrat or politician can ever hope to fully grasp or understand; such that the powerful reign supreme and always will until they come crashing down, only then to be replaced by others who find it all too difficult to do other than accept the status quo.

Does this reflect the cleverness of the MyHR imbroglio which the seasoned bureaucratic intelligentsia have built at the urging and behest of the powerful, yet ill informed, peak political bodies (AMA, RACGP, PGA, etc), which have the ability to intimidate the bureaucracy and bend them to do their bidding when they want.

So much to think about with the most important part being - notwithstanding the foregoing - what strategy is required to circumvent these issues which form formidable and almost insurmountable obstacles to achieving meaningful progress on the pathway to a secure, trusted, functional and useful, shared, interoperable, electronic health record?

Anonymous said...

David I am not sure anything has been won. If you look at the Cancer screenings registery project:
When the Department of Health assistant secretary Matthew Boyley tells Senator Murray Watts it would not be in the government's interest or the public's interest to terminate the contract with Telstra because terminating the program would demand a new procurement process, delaying the project even further.

All that might reignite the debate will be that the ADHA continue to make reassuring noises but, with access to the system open to thousands of healthcare practices, it seems inevitable an unscrupulous individual will go on a fishing expedition and lay bare the records of at least one high profile patient in 2019.

You can also wind the clock back 7 or so years and see how much has changed - https://www.aph.gov.au/Parliamentary_Business/Bills_Legislation/bd/bd1112a/12bd100

Dr David G More MB PhD said...

Tom,

I still disagree.

Just as Grahame Grieve argues for courage I am arguing for a cessation of obvious stupidity. A blog a week ago provides my reasoning.

https://aushealthit.blogspot.com/2018/11/we-are-really-at-end-of-road-with.html

I believe we are far beyond being submissive and patient with the degree of waste and mismanagement we are witnessing.

Your mileage may vary!

Cheers,

David

Grahame Grieve said...

David, I'm with Tom on this one - It's up to the minister and his advisors to decide about changing course on government policy. For the rest of us, it's a reality that we live with, and make our decisions accordingly. Tom is also speaking publicly, which I advocated.

Dr David G More MB PhD said...

Grahame,

Well to just be silent in the face of a manifest failure is just wrong to me. They need to be called out and forced to justify going forward in the face of such obvious concern...and not behave like some all-knowing sphinx - which they are surely not.

The values/failings you walk past are those you accept is my view here.

As Tom remarks the outcomes right now are 'dismal'

David.

Anonymous said...

Every few years we witness a repeat of these circumlocutory discussions, best described as insane stupidity, where no-one seems capable of learning from things past.

Industry commentators go round and round in circles, MSIA announces a re-energized engagement with the Department and the vendor community, vendors beat the drum making lots of noise about new collaborative ventures, ADHA and the Department call for a new round of old tenders and RFI's and EOI's, and more consultation sessions pop-up with walls covered in butchers paper, and so it goes - same old, same old. No new thinking, no new approaches, no new people - same bureaucrats, same leadership.

Occasionally a few voices make themselves heard above the incessant mumbling of the masses jostling for a position round the table. This is usually followed by lots of energy and a raft of meetings as new committees of experts are formed to sort the problems and appease the disillusioned complainants. And it all starts over once more.

Anonymous said...

Things are becoming either desperate or farcical, or both

Shared Health Summary Upload Incentive Program for General Practice

https://www.nbmphn.com.au/Nurse/MHRincentive

Use My Health Record and WIN!

Following on from the trial of My Health Record in our region in 2016, by the end of 2018 every person in Australia will have a My Health Record unless they choose not to.

In preparation for the expansion of My Health Record, we are encouraging Registered Nurses to upload a patient's Shared Health Summary (SHS) to My Health Record after a GP consultation, particularly for those people with multiple medications and chronic diseases.

A Shared Health Summary is critical to patient continuity of care and is now being accessed by other healthcare providers such as allied health, pharmacists and hospital clinicians.

Every time you upload a Shared Health Summary, you are on your way to winning a prize.

But you’ll need to be quick – there are a limited number of prizes. Targets must be commenced and completed in the same calendar month.

What can you win?

The program has three levels of incentives:

etc etc

Anonymous said...

@5:38 PM. Surely that is a joke of some sort? A patients healthcare and medical records are not there to be used in some cheap lottery. Are health professionals held in such poor regard they believe that can be treated like this. This is in Wentworth as well? Is this what Dr Kerry Phelps MP going to allow?

Bernard Robertson-Dunn said...

It's a different Wentworth - it's Nepean/Blue Mountains.

Dr Phelps' Wentworth is the eastern suburbs of Sydney.

It's worth noting that at the bottom of the tally sheet, in very small type it says:

"This service is supported by funding from the Australian Government under the PHN Program."

Anonymous said...

Cheap lottery is right! Outrageous.... look at the "prizes"...

What can you win?
The program has three levels of incentives:

Level

Qualifying Uploads

Awards

Number of prizes per month

Level 1 20 A pack of six Syringe Pens plus either Fibreglass Measuring Tape or Prestige Cardiometer 90 awards
Level 2 90 Omron Non- Contact Thermometer 15 awards
Level 3 120 Paid registration to Mental Health First Aid online course 5 awards

Even the "targets" are low-rent... 120 uploads per month for a chance at one of FIVE Mental Health First Aid online courses!!!!

Anonymous said...

You are correct Bernard, My apologies to the folks in western Sydney. So this is funded by the Government using tax payer money. You would think if the Myhr was such an awesome product and service the blue mountains PHN would not need to stoop to such degrading behaviour. Where they not a poster child for the optout trials?

Anonymous said...

Can only imagine the offsite brainstorming workshops followed by deep dives that gave birth to this one.

Out of interest anyone know the optout figures?

Anonymous said...

With an appreciation of the position Tom and Grahame are situated and indeed make invaluable contributions, I also have to lean towards David’s opinion. Everyone has been far to tolerance and politel with the PCEHR, MyHR and the ADHA.