The Request For Information On The Future Support Of National Digital Health Infrastructure Is Just Amazing!

Reading the RFI document I found this list of key technological themes very interesting.
Here is the link:
https://www.tenders.gov.au/Atm/Show/c120551a-5788-49ac-bae4-7ef26e867c07

Part E: Key Themes

Since its formation the Agency has been undertaking or has participated in a range of consultations and market research which have included consideration of future technologies and capabilities. A number of themes have emerged that may impact the technology and capabilities within the national infrastructure.

This document provides a high level overview of these key themes. It is not exhaustive and is provided as lists (in no particular order) that Participants could consider as part of responding to this RFI. The list is not intended to be a definitive list; the Agency intends to consider all themes for the future, including those identified through the RFI process.

This document does include all of the areas that have emerged through the national conversation about interoperability. Information about this conversation can be found here: https://www.digitalhealth.gov.au/about-the-agency/digital-health-space/interoperability-better- connections-for-better-care.

Global Themes

Identified global themes from a technology perspective include:

·         Block chain and Healthcare - Investment towards block chain technology to underpin the future of EHR systems to drive the future of Healthcare record keeping.

·         Technology Investment - Greater focus in technological investment to reduce costs, improve access and care. E.g. redefined care delivery in hospitals through AI and talent development, as well as reshaping healthcare treatment.

·         Increased Healthcare Demand and Spending - Increased demand and spending are forecasted for the next decade. Need to focus on a EHR system that seeks an efficient and cost focused system.

·         Person centred Healthcare - Heavy focus and demand on individualised healthcare, which challenges the efficiency, demand, and innovation across electronic healthcare. This is seen through customer apps, patient portals etc. to work alongside healthcare

·         Industry wide issues - Escalating cost, inconsistent quality, and lack of access to timely care. Progression of modern web service standard approaches such as the Fast Healthcare Interoperability Resources standard

·         Data processing - Efficiencies in data processing have been realised from constant development in computing allowing a reduction in data traffic.

·         Privacy and Security - Greater focus on privacy and security from consumers for all personal data.

·         Information On Demand - Consumers are demanding access to healthcare information on demand. This is leading to more IT and digital focused environments.

·         Internet of Medical Things (IoMT) - This connected infrastructure of medical devices and software applications could have implications on timely, quality care & information sharing.

·         Technology and Innovation in Treatment - Innovation and technology in treatment development emphasises the need for accurate, accessible, and complete EHR for all patients.

·         Demand for Infrastructure - ICT infrastructure and its scalability are trend areas that are increasingly important.

Future concepts

Feedback suggests that there is a need for an enhanced user centric environment that is a responsive and seamless system based upon end to end User experience. Opportunities for innovation and interoperability need to be considered.

Themes raised include:

·         Open architecture by establishing a system with open software defined architecture that provides the flexibility and scalability required to respond effectively to increases in the usage and storage needs.

·         Interoperability through integrated standards based platforms which support interoperability and the sharing of data for primary and secondary use.

·         Breaking the clinical ‘document paradigm’ with a greater emphasis on capturing structured data, better managing unstructured data through defined classification standards and applying analytics to better understand social health.

·         Digitally Enabled solutions through exploitation of digital services delivery forms such as Bots, Artificial Intelligence & Machine Learning, Big Data, Internet of Things, Blockchain and Mobile Applications to facilitate access, data collection, management and utilisation of data.

·         Collaboration through enabling multiple stakeholders to work together in a coordinated approach to optimise clinical and operational effectiveness.

·         Engaged Talent through building an internal innovation capability to enable the development, testing and implementation of applications in response to User needs

·         Placing the consumer, whether patient or provider, at the centre of all design to achieve personalisation and adoption.

·         Ease of use equals trust in software and the related systems.

·         Consumer Benefit - access to your data in dynamic and insightful ways.

·         Accessibility - Interfaces optimised to provide access for all consumers including those with special needs and language barriers.

·         Multi-Channel – the ability to engage across multiple channels, which are likely to change over time (e.g. an API-led, multi-vendor ecosystem).

·         Buy-in - trust in the system, the security and management of data is critical to use

·         Consumer Visibility - making health data discoverable and enabling users to create content

·         Secure & Private through employing technology to maintain data privacy and security (cybersecurity), are foundational to the system. This technology would secure and support the system by proactively identifying and responding to potential threat. Security and privacy also includes:

·         Transparency and confidence in the security of the system being critical to maintaining consumer trust and engagement.

·         Any system must be ‘secure by design’, i.e. from the beginning the system and software is designed to be secure.

·         Security and Privacy must be supported by standards and policy to drive transparency, visibility and accountability.

·         User control to address consent and access issues.

Potential Technology Trends

Potential next generation technology considerations could include:

·         Blockchain use has been raised as a key next-generation technology

·         Robotics & Artificial Intelligence have been raised as next-generation trends

·         Big Data & Analytics through the use of high performance analytic systems capable of collecting, organising and analysing large sets of data (structured & unstructured) from multiple sources to discover patterns and trends to improve social health and shift to a ‘push/pull’ ecosystem

·         Internet of Things (IoT) by exploiting the network of intelligent physical devices that enable the exchange of data

·         Cloud computing through use of open architecture technology models and computing to support system interoperability, scalability, analytics & innovation

·         Mobility and Portability through applications deployable on different device types, for consumer usage and management of their Health Data.

·         APIs - Developing smart API’s and an API strategy are integral to evolution of access and information (specifically data access policies).

The general questions asked of responders were basically as follows.

1: Please describe what you see are the design considerations for future updates and improvements of the national infrastructure that supports the digital health products and services delivered by the Agency. Please include how you consider catering for future expansion, scalability and emerging technology areas.

2: Please outline the technology focus areas (including new or emerging technologies) that should be considered to keep pace with the latest developments (including standards).

3: Please outline your view of priorities for the future of the Agency’s digital products and systems (including technologies) and how you consider the Agency could drive efficiencies in the total cost of ownership):

4: What capabilities do you think might be required for the future success of the national infrastructure?

5: What factors do you think should be considered for inclusion in the future development of the national infrastructure?

----- End extracts.

Essentially what we have here is a totally incoherent and nonsensical farce. Absent any context as to what is expected of the so called “National Infrastructure” people are asked to comment on a large range of technologies and where they think they might fit in the future - unspecified.

Other than the tech wish / fantasy list, the rest of the document is a set of puff pieces on how wonderfully the ADHA is doing – with very little evidence – and the usual Government guff of how to respond and how they virtually own any ideas you offer!

There is nothing I could see on what the project objectives were, what sort of technological future might be preferred, how it was to all hang together, what sort of Budget was envisaged, what usage was expected, what use cases were seen as relevant and so on.

Were I responding to this I would want a detailed analysis of technology status at present, what were seen as the issues and limitations etc., and real usage stats on what was being used and so on to provide a base from which to build some sort of realistic technology future. It is also not made clear whether evolution or replacement is sought as far as I can see. If a new bespoke system is needed to replace the old one that will be both slow and expensive and to just evolve probably won't fix much!

Overall, I really suspect that this document might just be a con. The ADHA has a tech path it wants to follow and is seeking to have the industry agree – and in due course will tell us all what is planned. If this were not the case the ADHA would have opened the kimono properly, identified all the issues it was facing and be asking for providers to suggest coherent ways forward.

Remember this is all meant to be up and operational by, at worst, the end of 2020 when the Accenture contract ends. Fat chance!

David.