Here is some coverage provided by the Consumer Health Forum.
Health debate highlights need for a transforming vision
2 May 2019 —
The National Press Club election health debate today provided a rare if welcome opportunity for the rival health policies to come under the sort of scrutiny we need to see more of, the CEO of the Consumers Health Forum, Leanne Wells, said.
“We congratulate the Health Minister, Greg Hunt, and Shadow Health Minister, Catherine King, for exposing themselves and their policies to questions on their health policies.
“This was a reasoned debate with only the odd heated exchange. However, the debate demonstrates that what we have is a patchwork of piecemeal proposals to fix various problems in the health system.
“What the Australian health system needs is a more holistic vision and coordinated health strategy that focuses on consumer needs.
“Both speakers put hospitals and medicine first. Neither spoke of the social determinants of health, such as housing, education and employment, which have such an impact on health.
“What we want to see is prevention and transformative primary care being central to the vision for better health in Australia.
“Each side is offering different initiatives, whether it be Labor’s bumper $7.5 billion boost to public hospitals, cancer care and pensioner dental treatment, or the Government’s plans to reform primary health care for the elderly by enabling easier communications with the doctor.
“Mr Hunt emphasised the individual benefits for patients able to access life-saving and highly expensive drugs through the Pharmaceutical Benefits Scheme, while Ms King said that on overall policy there was a stark choice between the two sides.
“Even before the debate yesterday, both sides of politics launched fresh initiatives. The Coalition announced earlier in the day a $308 million expansion in subsidies for medicines prescribed to patients with multiple conditions --- a pledge Labor said it would also meet.
“Labor also announced a $115 million preventive health plan, including a national obesity strategy which we welcome.
“The two parties’ views on a variety of issues ranging from mental health, to health insurance rebates to codeine regulation, highlight the diversity of costly and complex issues that bedevil health care.
“What Australian health consumers need now is a more joined up approach that gives much more emphasis to integrated care in the community,” Ms Wells said.
Here is the link:
Here is the coverage from AAP.
Election offers a 'stark choice' on health
Australia's healthcare system could be taken in two very different directions after the nation votes in this month's federal election, according to the two people vying to be its stewards.
Health Minister Greg Hunt and Labor health spokeswoman Catherine King have tried to distinguish their plans for keeping Australians well and looking after them when they are sick in a televised debate.
Ms King talked up Labor's proposal to spend $2.3 billion over four years to improve Medicare coverage of cancer services and an extra $2.8 billion on public hospitals.
"This election offers a stark choice, and nowhere is that choice more stark than when it comes to health policy," Ms King told the National Press Club in Canberra on Thursday.
"It's a choice between a Labor Party with an ambitious health agenda, and a Liberal Party with no agenda at all."
Mr Hunt challenged the sentiment that his party doesn't have a vision for improving health care, saying it is focused on four areas: primary health, hospitals, mental health and medical research.
The coalition's efforts to improve primary health have involved increasing funding for Medicare, diagnostic imaging, and subsidies for making medicines more affordable, he argued.
It has also been making doctors more accessible to older patients over the phone and computer.
Hospitals, mental health centres and medical research have also been getting more cash under the current government, he argued.
Mr Hunt noted that Labor stopped subsidising all new medicines through the Pharmaceutical Benefits Scheme when last in government in 2011, a claim the party denies.
"That's why you need a comprehensive, long-term national health plan and you need a strong economy to back it," Mr Hunt said.
The minister also accused Labor of offering far too little detail on its new cancer investment and not estimating its costings correctly.
"They haven't done the work," he said.
But Ms King said the coalition simply had no plan to match its efforts to grapple with out-of-pocket costs for cancer treatment.
Labor also pledged on Wednesday to spend $115.6 million on initiatives to prevent people from becoming unwell, including $39 million over three years to implement a national anti-obesity strategy.
The opposition said it would "consider" forcing food companies to change the recipes of their products to make them healthier.
But Ms King stressed Labor wouldn't necessarily make the change "straight away".
Here is the link:
The election campaign has been underway for a bit over three weeks and we have about two to go.
As best I can tell the ADHA and their CEO are in ‘witness protection’ and it seems just no one wants to talk about Digital Health from either side.
Labor Policy from their manifesto (The National Platform) is as follows (p137):
Investing in digital health
49. Information and communications technology play a crucial role in health care by improving coordination and reducing duplication to deliver better health outcomes.
50. To drive better use of information and communications technology in health, Labor will:
· Continue to build the digital health record system while ensuring appropriate privacy and security protocols protect consumers’ rights and their sensitive medical information;
· Educate all Australians on the benefits of an electronic health record that will improve the coordination of care, eliminate duplication, and reduce the likelihood of errors;
· Work with health care professionals to disseminate health and related education via technology and increase utilisation of digital health, including uploading of required data;
· Integrate digital health records with hospital, pathology, diagnostic imaging, aged care, medicine compliance and other clinical systems, and where appropriate, seek to deliver more health care solutions into people’s own homes;
· Work with States and Territories to introduce electronic health records and integrate them with national systems including the My Health Record;
· Prioritise interoperability so information can be shared across our health care system;
· Expand the rollout of TeleHealth services for specialist care where the efficacy is already proven; and
· Encourage processes to facilitate better information sharing between patients, health providers, hospitals, pharmacies and insurers.
----- End Extract.
Here is the link:
Given Ms King’s comments in the period around opt-out with condemnation and a call for various changes and investigations it is hard to know how much actually is current. I think the approach may just be a bit more sceptical.
As for the Coalition they have a health policy:
See here:
No mention of Digital Health I can find – send a link if you can locate any useful policy material.
I listened to the whole debate and Digital Health was totally AWOL!
We can only conclude that both sides are so embarrassed with what has / is going on they prefer it not to be even mentioned! Pity no-one wants for face up to the issues and fix them!
What do you think?
David.
ADHA and all it touches has become the Health Ministers MacBeth
ReplyDeleteThe Departments Agency is said to be cursed, so Ministers and Department Secretaries avoid saying its name when in the theatre of public scrutiny (the euphemism "The TK Play" is used instead). Ministers and their staff also avoid even quoting the lines from The NDHS and FFA before performances, particularly the Burn the faxes' incantations.
May 05, 2019 4:10 PM. Most amusing. Probably not to far from reality. The announcements by both political camps was the standard pattern. Lots of ribbon cutting, yellow hat wearing, and photo opportunities. Digital Health as seen in the past 9 years of PCEHR/MyHR is fait accompli.
ReplyDeleteIt’s all traditional building of hospitals, PBS and the new shiny toy - medical research/genomics. Which is not a bad thing, although I do wish the genomics and research folks the best of luck, they will need it. The bureaucrats and consultants are massing on the hills surrounding you.
Don't forget the ANAO. They will have been asking some probing questions that Health may well have had trouble answering. They and the politicians in both parties are not stupid, even if they are out of their depth when it comes to digital health.
ReplyDeleteQuestions like -
What is the value of myhr and where is the evidence?
What is the long term funding model?
Has proper process been followed? (which would have required answers to the questions above before the project got initial approval)
It could well be that the deafening silence on myhr is because they are all starting to get an idea of the conclusions the ANAO is likely to come to.
I suggest that the writing is on the wall, and it is not good reading for anyone.
Bernard, you have been around long enough to know what will happen. They will simple scrap off the frothing top layer, say the magic words and reset the clock. There are signs this is already happening.
ReplyDelete
ReplyDelete@9:33 AM, as you said Bernard,the politicians are not stupid even if they are out of their depth when it comes to digital health.
It is quite likely they have gone silent and are waiting on the ANAO's findings. I think both parties would embrace a circuit-breaker being provided by the ANAO. They may not welcome it, because it would be politically embarrassing as they have both been responsible for failing to ask the hard questions. Even so, political pragmatism is likely to prevail if the ANAO's findings are as you as suggest they might be.
This puts an onerous responsibility on the ANAO, which is fiercely independent and objective; as it should be. At this late stage in the My Health Record project there is nothing to gain by turning a blind eye as that will simply result in perpetuating the status quo to no avail.
I have been around long enough to remember the Whole of Government IT outsourcing debacle. The ANAO review led to the Humphry review which was the end of the Finance Minister John Fahey.
ReplyDeleteIt's worth reading this:
https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/Publications_Archive/archive/itoutsourcing
especially the recommendations from both reviews.
BTW, John Fahey commissioned the review by Richard Humphry - they were friends up until the review was published. They had a blazing row and AFAIK did not speak again.
You may be correct in your predictions, I wouldn't lay money on it though.
Bernard, Ian,
ReplyDeleteI agree that we all, most particularly the politicians and Departments of Health, need a circuit breaker.
The ANAO Findings could be the circuit breaker we are looking for. However, I suggest the Findings are the Necessary bit. But, the Finding cannot address the Sufficient bit for us to move forward.
For that we need: A New Idea and a New Way Forward--that can become the new "Truth".
I have been involved in one of these exercises and this new solution will have to be able to achieve some necessary consensus, including Australian Health Ministers. But the new narrative will have to resonate with clinicians and healthcare Executives in a way that the present technology-dominant paradigm does not.
There is a rising chorus internationally for change. What I haven't heard locally is any signs of agreement that fundamental change is both necessary and desirable/urgent.
Perhaps after the election.
IMHO, the circuit breaker has two parts:
ReplyDelete1. Stop trying to use computers to automate existing manual processes used in the practice of health care (using computers for normal business functions is fine). For example, the manual effort doctors are having to put into collecting more and more data for little return is having bad consequences. At best Digital Health might deliver some small incremental benefits, at worst it will make things less effective and efficient.
2. Understand the fundamental problems experienced by clinicians and develop solutions that address them. This is what is needed to transform medicine.
IMHO, the ADHA does not understand the damage they are doing trying to accomplish #1. and does not have he capability, knowledge, skills and/or incentive to even attempt the understanding part #2. I can guarantee they have no capability to develop solutions that transform clinical medicine. Neither can they rely on their advisers or consultants.
History teaches us that true transformation of something like healthcare does not come from within but from without. Neither will it come from government or any top down initiative.
Here's a problem clinicians face - patients using complementary medicines that interact with prescription medicine.
ReplyDelete"Updated guide outlines risks of ‘natural’ interactions"
http://medicalrepublic.com.au/updated-guide-outlines-risks-natural-interactions/20740
Would someone care to explain how myhr and/or the RTPMS will help?
"Recent research by of the University of Technology in Sydney shows only that only one in three people taking complementary medicines tell their doctors about that use.
The reasons for patients not revealing use of complementary medicines included thinking their doctor will disapprove; the doctor not asking; or the patient believing the doctor won’t know enough about the therapy.
Patients’ perceptions of how doctors might respond to them using alternative therapies was an important factor in whether or not they would disclose that practice, the research found."
Why continue paying $M for an evidence based vacuum in an area of science?
ReplyDeleteTesting of the MyHR system focused on the technical implementation compared to the specified design (the design as specified at the time which has continued to be changed many times).
What has NOT been sufficiently tested is the BENEFITS & COSTS of the ACTUAL implementation (or variations) compared to the expected benefits & costs nor the status quo.
We have literature reviews of EMR's, decision support systems and data sharing which are far from the actual system implemented. A few example case studies but no quantitative study of the benefits & costs of having a full, half-filled or empty record (as many have today).
It would appear the claimed benefits can not be measured or fail to meet expectations. Apart from the cost of the contracts & funding ADHA, we have no idea of the real costs of such a system.
No idea of the real benefits versus the costs. No evidence equals a potential big waste of money for no net benefits.
Don't confuse benefits with value.
ReplyDeleteA benefit is a characteristic of a solution. The value of the solution comes from the problem it solves, relevant to the cost of the solution. If you don't have a particular problem, no solution will deliver value.
A claimed benefit of myhr is the availability of patient health data. Apart from the reality that there is not much data in a patient's myhr and very few patients have a myhr, who has the problem of data availability and are they prepared to pay the cost?
Some doctors complain that they could do with better access to existing data, but how many and what's the real value to them of getting it?
Claiming benefits is easy. Proving the claims is much harder.
Establishing the value/cost relationship is even harder and AFAIK has never been done. The test bed projects won't because they are only looking for benefits, not value and/or costs.
The benefits of good data are around informed decision making and the lack of moments where you think, "If only I had known about X". The value of MyEHR is lacking because even when the data was there its in an opaque non atomic format where its like many current referrals, A long, long document with multiple results as text that requires scrolling up and down actually looking for stuff, rather than an index of results that can be viewed as a graph or table.
ReplyDeleteThe current MyEHR is a joke because there is no data in it. If they manage to get all the data in it it will be a joke because there is so much opaque data you will miss whats important. So its either an empty lever arch file (now) or 10 lever arched files stuff full of randomly filed photocopies (in the future).
Getting both benefit and value requires the easy movement of data in its original atomic format so that it can be easily managed, indexed and viewed in useful ways, like tables, graphs and used for decision support. So in the end we need easy, reliable, lossless, fast transfer of medical data between providers that respects the privacy of the patient. That is a world where you have high quality compliant formats, that have been tested for compliance, with atomic data and standard terminology. The applications have also been tested for reliable display and handling of compliant data. Its transmitted with trustworthy PKI infrastructure that uses digital signatures on an individual level so that access is regulated and audit-able.
Other that a PKI infrastructure, which was in place, but has been white anted, we don't need government to build large white elephants, just put a governance and compliance requirement framework in place.
You want government to put a governance and compliance framework in place!!!
ReplyDeleteThink about that.
Governance of the ADHA has been zilch. The Department and !the ADHA's ability to understand what is required to make governance meaningful and effective is zilch and it's futile to suggest they will be able to put anything in place now. As for compliance may I, with the utmost respect, suggest that as they have repeatedly demonstrated they don't understand the complexities involved in digital health it is impossible for them to grasp what is involved in introducing an effective compliance regimen.
Governance and compliance, dream on.
ReplyDeleteAndrew is correct. Governance and compliance and conformance is a must have, not a should have or could have. Anon is also correct. The ADHA has demonstrated time and time again that as an organisation it lacks structure, process and leadership (look them up on glassdoor). We have also witnessed a very real and dangerous lack of engineering discipline. We all read the report regarding a known issue where records were being rejected, even their simple publication processes seem lacking.
ReplyDeleteThe Department and ADHA will be reluctant to implement governance and compliance measures as this would be enforced on the MyEHR system. That is the hole that has been dug. They own and operate a system that competes in the market. We have seen they will use legislative instruments to maintain dominance (forcing subscription). I can see many reason for them to avoid mechanisms that might retract their license to operate.
They could I guess to make things fair, opt everyone in to pay a subscription to each secure messaging vendor equally.
Agree Berdard - do not confuse Benefits and Value
ReplyDeleteValue is the perceived benefits, usefulness, and importance of something. Inherent in this description is the understanding that value is subject to the perception of the stakeholders, whether they be the customer or consumer of a service, or part of the service providers organisation. Simply put value can be subjective.
Where we may be having some divergence is the positioning and thinking of the ADHA is still very much set in the age where organisations self-identifying as ‘service providers’ saw their role as delivering value to their customers in much the same way a package is delivered to a building by a delivery company. This might explain the opt-out rationale ‘you will have value whether you want it of not’ safe, secure and in secret.
The problem here is that this view treats the relationship between the service provider and the service consumer as mono-directional and distant. The provider (in this case the ADHA charity) and the consumer receives value, (in this case to broad and to ill-defined), the consumer plays no role in the creation of value for themselves. This is where the failures come in, the ADHA (albeit inherited from the DoH eHealth branch debacle in the PCEHR/MyHR, which they managed to use NEHTA as the whipping boy for). Anyway, there is a failure to take into consideration the extraordinarily complex and interdependent service relationships that exist, and some might highlight healthcare is a very complex service model in its own right.
I sense that there was some awareness or recognition that value is co-created through active collaboration between the actors that are part of the relevant service relationships and that providers (DoH) should no longer attempt to work in isolation to define what will be of value to their customers and users, but actively seek to establish mutually beneficial, interactive relationships with their consumers, empowering them.
I highlight the DoH and how they destroyed NEHTA and managed rather well to tag the legacy on that organisation. For the record, the DoH forced the PCEHR/MyHR onto the community rather than NEHTA which is a common misconception, it consumed NEHTA and destroyed anything that organisation was working toward and nothing is perfect.
The model NEHTA was operating complimented a modern approach to value as in their specifications and frameworks largely where intended to provide a set of common agreements that enabled technical interoperability to be achieved but allowed for vendors to develop there solutions in a wide variety of customisations.
This was clearly intentional, and I am sure had a worthy justification. The problem we face now is that the data/information that the government thinks it is collecting might meet the AI/Machine Learning – Lots of data requirement, however I struggle to see how the data collected will be of much use for clinical focus AI/ML, just what input value will the MyEHR have and just what will machines learn?
Anon May 07, 2019 2:03 PM
ReplyDelete"Simply put value can be subjective."
IMHO, value can only be subjective.
When the system was opt-in a person could make a value judgement. If they saw value, they could opt-in. They may be wrong, but it was their choice.
Now it is opt-out, nobody makes a value judgement. From the person's perspective it is value free.
If you agree with my contention that the value of a solution lies in the problem it solves, very few, if any, people get value because they do not have a health record problem.
On the other hand, the government has lots of problems, not the least being accused of wasting money. That is the problem they are trying to solve, by spending more money and digging themselves a bigger hole.
The one thing they cannot do is to get GPs to use the system and keep patient data up-to-date and accurate. Apart from GPs seeing little value in myhr (it doesn't solve a problem they have), the reality is that a large proportion of people do not see a GP regularly enough to keep it current.
Last year fewer than about 15% of registered people had a SHS uploaded. As soon as the system was changed to opt-out that figure fell to fewer than 5%.
That's probably one reason why ADHA is so shy about the statistics. myhr is even more empty than it was and there is little likelihood of it filling up with useful data.
If there had been a sudden uplift in upload rate, the ADHA and the government would be shouting it from the hustings. As it is: silence. A silence that speaks volumes.
Bernard, the lack of statistical data is a issue. There are some out there that have been using this data to map long-term utilisation patterns. I have made a number of queries through the website contact us form. To date I have not received a response. When I say no response I have not even received an auto-response to acknowledge my submission. All very odd IMHO.
ReplyDeleteAnon is correct - Value is only created by the consumer of the service.
You can’t get the statistics because the data feed is broken. The data is corrupt somewhere as it leaves the MHR environment and the BI environment where it is compiled. Someone didn’t bother designing the process and left out basic data quality stamps.
ReplyDeleteAny other organisation and I would question the claim made by 7:16 PM. Unfortunately the ADHA track record suggests a high probability there analytics services is broken. Hopefully normal service will resume shortly.
ReplyDeleteThe last weekly statistics were dated 13 January. The myhr statistics dashboard issued after the opt-out process was completed is obviously hand crafted (everything is round numbers)
ReplyDeleteOver 4 months and they can't fix a data feed problem.
And they want us to believe that they have properly implemented the far more complex record delete function?
No wonder the FOI for details on how it was supposed to work was knocked back.
Isn't interoperability, at the technical level, a data feed problem? One that is far more complex than a point to point, internal data feed.
Bernard Robertson-Dunn said at May 07, 2019 3:32 PM:
ReplyDelete"The one thing they cannot do is to get GPs to use the system and keep patient data up-to-date and accurate. Apart from GPs seeing little value in myhr (it doesn't solve a problem they have), the reality is that a large proportion of people do not see a GP regularly enough to keep it current."
I beg to differ. The 87% of Australians who attend general practice every year make an average of seven visits, with people under 60 years making an average of four visits and those over 60 years making an average of eight visits.
This means that on average each person is attending a GP more often than once every two months. If GPs had a reason to do so, they could update the average person's My Health Record more often than once every two months.
Oliver, Thanks for the comments.
ReplyDeleteI have been looking for detailed data on patient visits. What I'd like to see is not the averages but the distribution.
e.g. is a graph of patient visits per person per year to see a single GP a Gaussian distribution or or a power law?
Depending on the data, my observation (admittedly something of a guess at the moment) could well be valid.
Proper analysis of such data could be very useful.
There will be a certain number of people who rarely see a GP - so have little opportunity and/or need for a myhr.
There will be another cohort who have high needs but who only see one or a small number of health care providers - so a myhr is not suitable (a lack of detail)
There will be another cohort in aged care facilities who probably won't become grey nomads and who see the same GP every time.
There will be another group who go to the most convenient health care facility GP or hospital and so there is no one GP who is in a position to create and/or maintain a myhr
The interesting number is the Goldilocks group who don't see a GP too little or too much, who see a single GP/Medical Centre and who have an interest in maintaining a health record and who believe the government can do a better job than they can.
@9:24 AM Oliver, the various scenarios that Bernard has provided reflect the real world. I hope you will agree that the MyHR has not been designed to accommodate these multiple scenarios in a way that would render it acceptable to the majority of GPs notwithstanding the intense superficial marketing rhetoric and unsubstantiated claims to which we have all been exposed over the last few years.
ReplyDeleteThe interesting number is the Goldilocks group
ReplyDeleteI would make an assumption that a large majority of the 2.5 million that opted out would represent this goldilocks group. Tim and his merry band have all but lost a large cohort (and probably the most important) of stakeholders that would have been the influences of adoption and delivered rich datasets.
10:21 AM is spot-on the mark. "the MyHR has not been designed to accommodate these multiple scenarios". No-one in authority seems to understand this simple fact.
ReplyDeleteExcept this is no longer about GP’s in as far as delivering them value. They still have a role as data clerks. The whole thing has swung across to pharmacies. The pharmacy guild seems to have the government under its spell and wields far to much influence IMHO.
ReplyDeleteMay 08, 2019 1:29 PM. You might find this article interesting. https://johnmenadue.com/richard-day-pharmacy-guild-out-muscles-government-again/
ReplyDeleteRegarding the collapse of backend reporting capabilities at ADHA
ReplyDeleteThis simple FOI was refused on 3 May 2029
please provide the names of organisations with cancelled registration with My Health Record. There were 426 organisations. This statistic was last updated on 27 November 2018 on ADHA site.
Can I also have the up to date list of organisations that have cancelled their registration with MHR as well please?
https://www.righttoknow.org.au/request/healthcare_provider_organisation#incoming-14715
May 08, 2019 1:38 PM, thanks for posting. Interesting article and certainly raises a few questions about this guild. They certainly need taking down a peg or two and the ADHA does seem to be far to cosy with this mob.
ReplyDeleteT.38May 07, 2019 3:43 PM
ReplyDeleteADOHA seem to have released new made up stats, well updated the ppt slide.
I have two copies of the dashboard downloaded 22-Feb-2019 and 7-April-2019 (the April one was downloaded today 10 May.
ReplyDeleteThere is no date on the webpage, and neither document is dated which makes them rather useless.
The February one has numbers like
SHS 2.415,994
April has
SHS 2.5Million.
At the bottom of the April one it says:
"All document counts are rounded to two significant figures; therefore, some totals may not correspond with the sum of the separate counts."
The section on document uploads is and always has been labelled "My Health Record Usage".
However the April version now says Clinical Documents (but used to say Clinical Document Uploads) and Prescription and Dispense Documents (but used to say (Prescription and Dispense Uploads)
It almost seems that they don't want people to realise that these numbers refer to the total number of documents uploaded since day 1. i.e it includes deleted records, records of people now deceased and documents subsequently replaced (which is he only way to update a document)
I think the most appropriate word is obfuscate:
to confuse, bewilder, or stupefy.
to make obscure or unclear: to obfuscate a problem with extraneous information.
to darken.
Nice work ADHA. How is such information of any use? It is simple transactional data what is the issue?
ReplyDelete