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Sunday, September 08, 2019

Here We See Just More Vague Flim-Flam From The ADHA On The Future Of The #MyHealthRecord.

This appeared last week.

Changes likely for GP-generated summaries in My Health Record

Shared health summaries are set for a shake-up after the head of the Australian Digital Health Agency flagged the need for a broad modernisation of the technology underpinning My Health Record.
02 Sep 2019
Speaking at the RACGP’s eHealth forum last week, Tim Kelsey said there is an opportunity to ‘modernise My Health Record’s infrastructure’.
Mr Kelsey was speaking in response to a question from prominent RACGP digital health advocate Dr Nathan Pinskier, who had asked whether it was now time to reassess the ‘value proposition’ of shared health summaries.
‘We designed shared health summaries around 10 years ago. My feeling is we need to go back and have a look at why we’re asking GPs to upload shared health summaries, how it fits into their workflow, what the value proposition is, and whether there’s a better way of doing it,’ Dr Pinskier said at the forum.
‘Now’s a great time to revisit this. Do we need shared health summaries, or is there a better way of extracting data, as in other parts of the world?’
Mr Kelsey said he ‘completely agreed,’ pointing to the Australian Digital Health Head Agency’s (ADHA’s) push this year to move forward on interoperability more broadly in digital health.
‘What we haven’t worked out yet is the governmental appetite for interoperability, [but] I believe it will be very positive. That will give us the mandate to have that much broader conversation … [o]ver how we design My Health Record to be fit for the future,’ Mr Kelsey said.
‘While [it was built with] good intentions, we’re still operating a system that was designed a decade ago for a very different world.’
The My Health Record program began in 2012 under a different name, the Personally Controlled Electronic Health Record.
Speaking after the event, Dr Pinskier told newsGP shared health summaries in their current form are not delivering for GPs.
He said Mr Kelsey holds a similar view.
‘If you ask 100 GPs about electronic prescriptions, almost all would say it’s wonderful – because it happens in the background, as a by-product of our work. If you did the same for shared health summaries, you’d get a handful,’ Dr Pinskier said.
‘We don’t want to make more work for GPs; we want to consolidate existing workflows.
‘GPs don’t see them as part of their routine workflow. They don’t derive an immediate benefit. It creates additional work and sends information to a government repository for a future use for an unknown provider in unknown circumstances.
‘It’s got a really unclear clinical use case.’
Dr Pinskier said a revised health summary useful to GPs could borrow from models in other countries where data is directly extracted from existing clinical software.
In this model, only important information that had changed between two points in time would be uploaded, meaning My Health Record would act as a living document rather than generating new documents with much repeated information after every consultation.
‘If you made it semi-automated, where new medications or allergies were automatically identified and pushed up to the national record, it would take away complexity and angst,’ Dr Pinskier said.
Lots more here:
This article deserves close reading to see just how the ADHA has wandered off the reservation.
First it seems there is agreement that the uploading of Shared Health Summaries – which are meant to be the fundamental clinical core of the record – is both clumsy, workflow destructive, and not fit for purpose and not the quick easy to find current summary of where the patient is at! After 10 years they notice!
Secondly it is clear that the whole thing is based on technology and standards that are past their use-by date!
Third the ADHA is not even certain whether its current push for interoperability even has Government support!
It really is hard to envisage a more complete omni-shambles! We have a $2Billion white elephant that no one is using and which we now know even the RACGP has deep doubts about!


Anonymous said...

It (ADHA) is a failed experiment. The cost of this failure and specifically the clear evidence early on that iADHA was poorly thought out, poorly overseen, poorly implemented and woefully executed is beyond measure.

Tim and co resemble moths under a street lamp. No one there is equipped to go anywhere near interoperability. Maybe it is not interoperability the government has lost its appetite for Mr Kelsey!!

Bernard Robertson-Dunn said...

"Dr Nathan Pinskier, who had asked whether it was now time to reassess the ‘value proposition’ of shared health summaries."

Dr Pinskier asked about the value proposition of shared health summaries. Mr Kelsey responded by talking about interoperability and extracting data.

If Dr Pinskier's question doesn't get a good answer that everyone agrees with, no amount of technology will deliver anything of value.

Anonymous said...

For some years Dr Pinskier has been busy on behalf of the ADHA advocating use of the MHR and the great benefits it offers. Now, suddenly, in a gob-smacking act of sheer duplicity he does an about face. This political chicanery is par for the course for all these so called 'experts'. Pinskier and the RACGP should hang their heads in shame.

Anonymous said...

Sinking Ships?

Anonymous said...

It bears repeating one more time - unless the Australian National Audit Office recommend terminating the MHR project we will witness another $2 billion or more being wasted over the next decade.

Anonymous said...

Tim has a value proposition for My Health Record. Gather as much data about Australians as possible and he will look good in the eyes of his employers - the government. It has nothing to do with patient health and everything to do with him.

Anonymous said...

...... "everything to do with him".

If that is true, and all the evidence indicates that it is so, then the entire premise upon which the PCEHR and the My Health Record were established is no longer valid and funding no longer justified.

Anonymous said...

@10:19AM You are correct, absolutely. Even so, only one thing will change - the spin and puffery by Racgp and ADHA to secure more funding to do what they have always done!

Anonymous said...

- to do what they have always done. I presume you mean ingratiate themselves to the ADHA and the department for fear of political reprisals if they don't, and in doing so demonstrate their ignorance, naievty and incompetence about digital health.

Anonymous said...

The more things change the more they stay the same.

Bernard Robertson-Dunn said...

Let's join a few dots.

There's Dr Pinskier's question: is it "now time to reassess the ‘value proposition’ of shared health summaries."

And Tim's recent comments about "how we design My Health Record to be fit for the future"

And today this:

"Time may be nigh for some medical software vendors"

In which the main message is summarised as:

"Systems that are not interoperable are not safe, so we wouldn’t purchase them anymore. It is quite simple. Procurement is one significant lever we have to meet our objectives.”

Although not a direct statement on how the software vendors should be doing business, or planning, this was writing on the wall for some medical software vendors.

The big end of town, the big state government hospital budgets and their leaders, are now demanding a future that is open and interoperable in every possible respect. The whole system, hospital and primary, via government agencies like the Australian Digital Health Agency (ADHA) is moving to being interconnected, as it should be."

Moving to being interconnected?

The one thing we know about myhr is that it is not interconnected - far from it. It is a manual system with human readable data being manually uploaded and read. Even pathology tests and discharge summaries are effectively manual, although the uploads may have a small degree of automation.

The conclusion I draw from all this is that the only way for myhr to survive, according to the Wild Health message is for myhr to be totally redesigned.

That would suit Tim as he has a ready get-out "Yes we know myhr needs to be improved, we will treat what has been delivered so far as an experiment from which we will learn a lot. The next version will be oh so much better. It will include all sorts of automatic data extraction capabilities - just like care.data. Oh sorry, I shouldn't have said that!!"

Which brings up back to Dr Pinskier's question about value proposition.

IMHO, the value proposition for a government owned, secondary heath record should be about more than Shared Health Summaries. It should include all the data in a shared health record - is it the right sort of data organised in the right way? how does it fits into clinical workflow? what does it add to interconnected clinical systems?

You know all the things that were not dealt with ten years ago.

Once you have a value proposition, then yuo can estimate the cost of development and implementation and decide if the value is worth the cost.

The one thing we can be absolutely certain of is that myhr in its current from is as dead as a very dead dodo.

The danger for Tim is that the myhr experiment will prove to the hard headed economists in Treasury and Finance that the Federal government just shouldn't get involved in such things - even if it does result in the prospect of lots of lovely data just ripe for exploiting.

Anonymous said...

Systems that are not interoperable are not safe, ??really why is that

so we wouldn’t purchase them anymore. And how will that happen. The current COO of ADHA trashed and burned the national CCA Program. How are procurement officers supposed to ensure conformant software meets agreed compliance's so that that disparate system can interoperate if required?

Wonder if they have thought through the risk this interconnected universe they dream of holds?

By the way their tee connected world is happening because ADHA and Canberra have been asleep at the wheel

Anonymous said...

David nails it - omni-shambles - perfect.

"It really is hard to envisage a more complete omni-shambles! We have a $2Billion white elephant that no one is using and which we now know even the RACGP has deep doubts about!

Anonymous said...

So DOROTHY DIX is alive and well.

Dr Pinskier asked whether it is time to reassess the value proposition on shared health summaries.

Dr Pinskier advises / consults to ADHA.

ADHA needs a platform to begin changing the conversation.

As in Parliament Question Time, so too at the RACGP eHealth Forum.

Dr Nathan Pinskier obligingly asked ‘THE QUESTION’ to which Tim Kelsey ‘OBLIGINGLY RESPONDED’ and, halleluiah, the door was opened for all to climb on board the new ‘here we go again train to never-never land.

Anonymous said...

It's called vested interest. Some parts of the health care industry don't want to improve the delivery of healthcare. ADHA is one of them. If they did, they could immediately save the government large amounts of money by disbanding.

Anonymous said...

Which would be quicker and cheaper? ADHA's consortium of dozens of organisations trying to implement secure messaging or just plain old digital fax?

The Future of Fax in Healthcare Is Paperless

I guess it depends on what your goal is. If it's ADHA, it's more work. If it's more effective health communications, maybe not.

I wonder what @T.38 has to say about this.

Anonymous said...

@2:28 PM Bernard referenced The Medical Republic article "Time may be nigh for some medical software vendors" http://medicalrepublic.com.au/time-may-nigh-medical-software-vendors/22584

Dr Zoran Bolevich, head of eHealth NSW said: “In NSW, we are starting to achieve a more commissioning approach to our procurement,” he said. “We are thinking about what outcomes we want to achieve and starting to purchase technology that can achieve those outcomes. “This approach creates space for the industry to actually innovate."

It leaves me flabbergasted to read that "... in NSW we are thinking about what outcomes we want to achieve .... "

Sooooooooooooo . .. what were they thinking about for the last decade?

Long Live T.38 said...

There are standards, innovation and interoperability challenges to be worked through, over in the other universe there are a Axes

eFax is a good example of innovation. Simple and eloquent, cheap and easy to use. Powered by standards

Can’t stop the signal Kids

Anonymous said...

Haha T.38, yes the answer for ADHA is not how to integrate or even interoperate with other technologies. It is merely to take an axe to the market and remove any need for them to integrate with others.

As for NSW, I am guessing their time on the ADHA board is due to end and the grown passed to another jurisdiction. The NSW approach is a valid one. It is a localised approach to local (closed)interoperability. Will it work at a national level? Time will tell

Dr Ian Colclough said...

@11:57AM Success has more to do with laser-like strategic thinking. "ADHA's consortium of dozens of organisations trying to implement secure messaging" is quite the opposite, more like a blunt sledge-hammer if there is such a thing.