Wednesday, August 21, 2019

Why Is There Such Total Conviction, From Many, That More And More Digital Health Is Good For You?

This appeared last week:
An interview with Angela Ryan, Chief Clinical Information Officer, Australian Digital Health Agency.

Creating better health for all Australians through digital health

August 15, 2019 08:27 PM
With more than a decade of experience as a registered nurse, Angela Ryan combines her clinical experience with her knowledge in health informatics towards the practical, meaningful and integrated use of digital health tools in Australia. In this interview with Healthcare IT News, she shares more on her role as the Chief Clinical Information Officer (CCIO), at the Australian Digital Health Agency (ADHA) and talks about why the My Health Record is a key pillar in Australia’s National Digital Health Strategy.
Could you tell us more about your role as CCIO of ADHA and your background in healthcare?
In my role as Chief Clinical Information Officer at the Australian Digital Health Agency, I work collaboratively across the health system to develop and maintain strong relationships with key stakeholders in the community to promote adoption and meaningful clinical use of digital health services and technologies, to deliver benefit to all Australians. A key priority is ensuring strong clinical engagement with the National Digital Health Strategy and associated programs and services – including the My Health Record system – and clinical input and assurance into the design, development and delivery of digital health systems. The role provides clinical leadership for the implementation, advancement and optimisation of digital systems nationally.

I’m a clinician with a background in health informatics, and decades of experience in hospitals and public sector organisations, with an emphasis on governance, design, development and deployment of digital health strategies and technologies. Before moving into digital health, I had more than 14 years’ experience as a registered nurse, including paediatric and adult intensive care. I am now able to apply my understanding of health systems and practice not just to optimise technology design and rollout, but to act as an effective agent of change, building engagement and momentum around transformational programs.
What are some of the latest projects/developments that you are currently working on at ADHA?
The Australian Digital Health Agency is setting out the pathway to achieve our goals in the National Digital Health Strategy, to support the premise that “A workforce confidently using digital health technologies to deliver health and care will be required to address the technology adoption challenge and calls for supporting the workforce to better adapt to, use and embrace the changes and opportunities created by digital health innovation.” A digitally enabled workforce for Australia will benefit consumers, healthcare professionals and the broader health system. In addition, future innovations and approaches to healthcare delivery, such as applied data analytics, and technologies such as machine learning, artificial intelligence (AI) and advanced robotics, will require a shift in the skills mix of the healthcare workforce in order to obtain the greatest benefit of these advances for healthcare consumers.
To support this, the Agency is undertaking a program to consult the health sector and other relevant stakeholders on strategies to address the enablement of the workforce and any perceived gaps. Our aim is to develop a holistic understanding of the potential skills and workforce shortages and develop strategies to address them. This will culminate in the development of a National Digital Health Workforce and Education Roadmap. The roadmap will be a focal point for a National Digital Health Workforce and Education Summit being planned for later in 2019. This event will bring together stakeholders from across the sector to consider the roadmap and agree the practical actions required to deliver the workforce Australia needs.
There is vastly more here:
Sadly, to me this title for the talk reveals the overreach. “She will also be giving a keynote titled “Digital Health, Better Health for All Australians” It seems somehow it is all upside and the issues of patient safety, clinician burnout, the digital divide and lack of hard evidence for positive clinical outcomes (most especially related to the My Health Record) somehow recede into the background. The link between more Digital Health initiatives and better health for Australians is yet to be genuinely proven as yet I believe.
Now I am not criticising Ms Ryan on this but pretty much all we see at going on HIMSS and HISA conferences where there seems to be so little self reflection and so many ‘gunna’ (going to do) papers.
All this enthusiasm may sell conference places but do we come away with a balanced view of the state of play and where the maximum effort needs to be applied? I fear not. All that success with secure messaging, interop. etc is hardly a wonderful and glorious success to date!
That the new Long Term National Health Strategy was mute on the topic of Digital Health speaks volumes about the real place Digital Health has earned to far in the minds of policy makers.
With that said, am I being too hard and should I really be drinking more of the Kool-aide?
Let me know!
David.

9 comments:

  1. Bernard Robertson-DunnAugust 21, 2019 5:43 PM

    David.

    I agree totally with "The link between more Digital Health initiatives and better health for Australians is yet to be genuinely proven as yet I believe", although I would change "more" to "any"

    It's been said before on your blog, but it's worth saying again, Digital Health is a cargo cult. The logic is that other industries have used IT to bring about major change and benefits, Digital Health is IT, therefore we will get major change and benefits.

    For those who do not watch such things, this week's Last Week Tonight with John Oliver featured sex and race bias in medicine. It is rampant and damaging.

    A recent BBC world service broadcast had a program about a book "Invisible Women: Data Bias in a World Designed for Men" by Caroline Criado-Pérez


    What does the National Digital Health Strategy say about bias in medicine - Nothing.

    What does McKinsey's Healthcare’s digital future say about bias in medicine - Nothing.
    (https://healthcare.mckinsey.com/healthcare%E2%80%99s-digital-future)

    What did John Oliver have to say about Digital Health and/or IT - Nothing.

    What does Caroline Criado-Pérez say about Digital Health and/or IT - Nothing.


    In the real world of medicine and health care, Digital Heath and Health IT are often seen as a source of frustration and broken promises.

    Tweets by @EPICEMRparody poke serious fun at a particular EMR vendor. It has 18.6k followers and its bio says: "My goal is to create confusion for doctors. I will not rest until doctors do nothing but click buttons. Eye contact is evil. (Parody)"

    More often than not Digital Health is not the solution to a serious problem being experienced by clinical medical, it is a big problem of its own.

    This government has spent over $2 billion that has advanced healthcare not one iota, but is reducing the effeciency and effectiveness of GPs

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  2. Dr Ian ColcloughAugust 21, 2019 8:45 PM

    David, you asked .... "With that said, am I being too hard .....".

    The answer is a categorical 'No'.

    After spending over $2 billion of taxpayers funds, with nothing of any real practical benefit to healthcare providers and their patients to show for that expenditure, those in authority have an absolute responsibility to ask some really hard questions - Why is it so?, What have we been doing wrong?, Why are so many healthIT consultants, Peak Bodies and vendors telling us to keep going, to keep funding the project?, Why are so many experts, including your blog and its readers, saying quite the opposite? And the Health Minister, Health Department Secretary and Treasury and Finance should also be asking of themselves in these turbulent economic times "Why have we suddenly stopped promoting and talking about My Health Record?, "Are we embarrassed by it?", "Is it because if we say nothing it will just quietly go away?

    As I said, the answer to your question above is a categorical NO.

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  3. What is the evidence that it is being used? What are the Access Statistics? Why aren't they available?

    Access Statistics - How many Medical Practitioner accesses are made each day? How many are made by other Health Providers? How many are made by consumers?

    Access activity is what is relevant, not the number of registrations or the number of documents which have been loaded into the system.

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  4. They are a State Secret because they are lousy. If the Access Statistics were good there would be endless press releases about the fact don't you reckon!

    David.

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  5. There is no reasonable excuse. The Audit Office has to be asking for this information. The Auditor doesn't audit secrets does he?

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  6. Bernard Robertson-DunnAugust 22, 2019 12:06 PM

    Access statistics are meaningless.

    What is the value of the data - i.e. how much has been actively used, what are the outcomes that are directly attributable to having access to that data and was it only available through myhr?

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  7. Small steps Bernard, small steps. Let’s see what roles are accessing the MyHR for what “type” of document. Then if the data points to possible good use then prosecute a case to revel more detail. Nudge em gently.

    I do agree with David, the silence on this is deafening and just a tad suspicious. The sort of gift hoarse a newly appointed opposition Jack Russell Terrier would want to sink his teeth into.

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  8. @12:06 PM I disagree. Access Statistics are the first step. They give a baseline from which to dive deeper into the value of the data and the outcomes. You need to step into the sludge rather than trying to jump from a great height, lest your parachute fails to open and you go SPLAT..

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  9. It’s all exploitation and no exploration. Those who where able to do the exploration and sow the seeds for the next step where pushed out or made to shut up. Now they have nothing let to exploit and nothing new to explore they roll out things like SMD like it’s innovative. The ADHA has managed to roll the nation back 15 years where level 1 CDA is king. At an organisational level FHIR is happening to everyone else.

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