Just a reminder it is now over 11 months since the ADHA Board let the public know what it was doing - other than via their overly glossy (and badly formatted for printing) Annual Report that was released this week - because the LAW says they have to release an Annual Report each year! I am pretty sure we would not even see this piece of puffery otherwise!
From the Annual Report we discover that the Board Members are being paid nearly $100,000 a year to keep the ADHA's secrets!
Just so you know!
David.
It's a pity they can't keep patient data as secret as they can their own embarrassment.
ReplyDeleteNo doubt ALL WILL BE REVEALED at HIMSS Australia Digital Health Summit 2019 in Sydney 20/21 Nov 2019. How do I know?
ReplyDeleteIt says so in the blurb ....... HIMSS Australia Digital Health Summit 2019 (ADHS) will be centred around the theme of Interoperability and Connected Care, which is especially pertinent now that My Health Record has become a key pillar of Australia’s national digital health strategy.
The national interoperability roadmap will be announced at ADHS, and this will be the platform for delegates to explore and understand how the sharing of data across a common healthcare network can create better health outcomes, empower patients and drive even more innovation of digital health technologies.
HAVEN'T WE BEEN THERE BEFORE AND BEFORE AND BEFORE AND BEFORE ....... AD INFINITUM?
Yes we have but there is a difference. This time around everything will be different. This time the INTEROPERABILITY ROADMAP:
- will tell us all HOW,
- and we will all say WOW,
- that's what we've all been waiting for?! ?!
- and we will ask WHY,
- WHY did we wait?
- and a little voice will whisper,
- BECAUSE we are all so bloody stupid, gullible and naive.
HIMSS Australia Digital Health Summit Nov 20-21 2019 - SYDNEY
ReplyDeleteCan you believe this! What an incredible one-day wank. Look at the sponsors. It's a one day love in and a travel jaunt for speakers from USA and elsewhere probably with all travel expenses paid by the ADHA. Who would waste their time and money attending?
It's a form of Henny Penny effect. Many people are talking about it therefore it must be important - so more people talk about it.
ReplyDeleteAnother analogy is the South Sea Bubble. Eventually it gets burst when it doesn't deliver. Rather like the AI, Expert Systems, 5th generation fad of the mid 1980s
So who's roadmap will this be? Will it be COAG policy roadmap? Will if be a roadmap to resolve the funding model challenge? Will it simply be yet another attempt to prevent the Myhr is a centralised solution to solve what is in effect a distributed problem?
ReplyDeleteMaybe ADHA is getting a little stale but I have absolutely no interest I left in anything they put out. The world is moving at a different pace and in other directions.
Of course it may end up being the blueprint that brings equality to data ownership and usage, which in the case I will happily eat my hat.
If they look at interoperability as a technology problem it will fail miserably - it isn't a technology problem it is an information exchange problem
ReplyDeleteIf they do not analyse and address issues around data quality, consistency etc they will fail miserably.
If they do not analyse and address issues around workflow (in clinics, hospitals and specialists) they will fail miserably.
Considering they have no expertise or even interest in data quality or workflow my advice is - don't hold your breath, it's more of the same: lots of money spent for no healthcare outcomes.
re this week's poll that has the claim "The #myHealthRecord Is A Fundamental Feature Of Australia’s Health Infrastructure" is a bit like saying a map of Australia that shows the major highways is a fundamental feature of Australia's transport infrastructure.
ReplyDeleteBoth are stupid claims made by stupid people. Except that the second claim has never been made - nobody is that stupid. The ADHA is in a bubble of its own.
Recall NEHTA Interoperability framework 2007. Now the ADHA promote this new Interoperability stuff will be the next big thing. We've been there, done that and has been largely ignored the previous times. GP minimum data set (ask RACGP?) and suggested terminology/classification more than 15 years ago but never accepted (no enforcement of standards). NeHTA, ISO, ADHA, HL7 et.al. and yet it's still a current problem yet to be solved.
ReplyDeleteNEHTA-1146:2007 Interoperability Framework - Interoperability Framework v2.0 Dated 17-08-2007
The greatest problems with their new roadmaps and dreams are 1) we have long memories; and 2) we therefore know how reality is much harder than the PR fluff would have you believe.
FHIR has many benefits but it's only 1 piece in a larger system that requires people to find consensus and implement changes to work practices (and HL7 know that).
Areas of differences that limit/complicate interoperability:
- different terminologies used
- different meanings of the same term label by different people (and over time)
- different data models
- different data types and/or units for the same measure / test result
- different workflows that uses different data elements
- different data quality
- changes over time
- complexity of use cases and implementations
Origins of differences that limit/complicate interoperability:
- training
- experience
- new or changed knowledge
- personal preferences
- cultural
- languages spoken
- regional differences within the same language
- political (I like person A and not person B so I agree with A not B)
- software used
- commercial interest or IP related
- government regulation
- workplace or clinical association rules (eg. college of surgeons)
- complexity of >100 roles/specialties multiplied by the >20K conditions multiplied by the >20K tests/treatments/medications/management.
There are disagreements on disease definitions, classifications, research, standard practices and many other things that make national and international work difficult to find consensus. Fixing interoperability requires people to be part of the solution not just technology. We didn't have interoperability of health information before computers and IT will not magically fix PEBKAC (problem exists between keyboard and chair). We keep chasing the end of the rainbow to find the mythical pot of gold. I'll believe it when I see it. And ADHA still can't show the promised $$$ savings or value of the $Billions spent. They must be very busy doing something because we're still waiting to see their meeting minutes appear out of the transparency black hole.
Sorry for the cynicism but I can't find the code for it. Fools follow the headlines and wisdom is rarely brief.
> FHIR has many benefits but it's only 1 piece in a larger system that requires
ReplyDelete> people to find consensus and implement changes to work practices (and HL7 know that).
yes. we frequently hammer on that in our presentations: FHIR is helpful but the fundamental problem is a not a technical problem.
> Areas of differences that limit/complicate interoperability:
your list was good one from an informatics PoV but I think you omitted the 2 biggest issues: (1) legacy data and legacy clinical practices, and (2) common anti-sharing practices at all levels enshrined by all sorts of unchangeable business arrangement and regulations (ok, sort of in your list...).
> We didn't have interoperability of health information before computers
Right. we didn't. And we couldn't. But now that we can, we have to do the heavy lifting to get to it. As you say, this is a people problem.
> I'll believe it when I see it
Right. in taking this problem on, the challenge for a government is that there can be *no quick win* (as in election cycle quick). It's just going to be noise and churn for a decade at least. Given that, how would you sell the value proposition there for political funding and backing?
I'm glad the agency is taking this on, and I remain hopeful that the course they are taking will lead to some genuine fundamental improvements. But there are plenty of challenges for the course.
"how would you sell the value proposition"?
ReplyDeleteGood question.
But first, what is the value proposition? Not hand waving pixie dust stuff but a hard nosed financial cost/benefit model.
And a few alternatives.
@8:16 PM all the above comments present different aspects of this hugely complex problem. Unfortunately, Grahame's concluding comment suggests a curious and strangely misguided belief that the agency offers some real hope for the future when he says ........ "I'm glad the agency is taking this on, and I remain hopeful that the course they are taking will lead to some genuine fundamental improvements".
ReplyDeleteSurely with all that has gone before there is not the slightest modicum of evidence to suggest that Grahame's hopes are anything other than resignation and wishful thinking by one who sounds as though he is bereft of any alternative to finding a better way forward than that presented by the ADHA!
His concluding statement leaves me gobsmacked in extremis.
Others may agree or not.
That 2.7 million souls who opted out of the first ball and chain of Australian healthcare may well about for 90% of active online participants that could have to nudge the usefulness of the system to somewhere close to it being viable. The interoperability roadmap will be a technology-driven one.Why? Well ADHA is simply a solution organisation, that solution being a technology one - MyHR.
ReplyDeleteAs for standards etc.. well we just need to roll over and let epic and the like dictate those standards, the large systems are in place, cost a fortune and own a monopoly share. They happily add a cheap post to MyHR functionality so the DoH will be happy.
The current senior mis-managers at ADHA will soon be hitting the 5 year mark, the CEO can only stay for five years so his little dream will fade along with him.
The states will continue doing their own thing much as they have the past 3 years.
As others have mentioned, ADHA no longer warrants or carries interest in their publications. They disappoint, suppress staff and alternative views including valid legal and privacy concerns. They even stick two-fingers up at government rules around transparency.
8:16, always the diplomatic one and I hope the roadmap has something in it for you. As hope seems to be the emergent theme below are some of the question of mine for the roadmap to address:
• A rising tide or enabling the innovators?
• Change is an emergent issue for all aspects of interoperability: Complex
• Change is created by change
• A static system is a fragile system
• Design should build in facility for evolution up front including co-existence of current and future solutions
• Learning system will change with emergent system behaviour
"8:16, always the diplomatic one and I hope the roadmap has something in it for you."
DeleteDiplomatic! ? ? conflicted, duplicitous, insincere. Such diplomatic utterances made repeatedly undermine other genuine efforts to effect meaningful change, instead all they serve to do is perpetuate the status quo reassuring the bureaucrats to do more of the same. It pains me to be so blunt but it has to be said and diplo.atic niceties have no place here.
@9:37. Interoperability is a form of diplomacy. It is built on layers of agreements and more importantly an agreed language where stakeholder can identify divergences. Each layer in turn has many viewpoints. Seperate of concerns is a necessary evil I am afraid. Mr Grieves has voiced his expert opinion but I guess is used to having to operate in environment across the globe where help constraints and dark constraints don’t make vanilla thinking a viable option.
ReplyDeleteIt this framework sets down the language for all stakeholders to be heard and understood then that would be fantastic. Early NEHTA efforts did this reasonably well as stick to what a framework purpose is. Even the Australian Standard on Interoperability helps guide the necessary dialogue. Interoperability is closer to a means-to-an-end not the end itself.
> conflicted, duplicitous, insincere
ReplyDeleteIt's always fun and helpful to be called that by anonymous participants.
It's interesting that when I said I remain hopeful, that I also recognise that there are also plenty of challenges, but no one has picked up on that.
Bernard:
> what is the value proposition?
For interoperability generally? (that's how I'm going to answer this question)
That's a challenging question. In principle, the value proposition should be established scientifically, but no one has yet convinced any substantial segment of a healthcare system to spend a billion dollars in a controlled experiment on this. So we have to fall back to less scientific methods. There's not enough rigorous analysis of the economics here, partly because there's such unclear and indirect outcomes from interoperability investment. Real outcomes are diffuse and cultural.
I've found that the best way to assess value is by listening the force of the anger from participants retrospectively when interoperability stops working for some reason. If they shrug, then it didn't bring value. If they freak out over safety and/or efficiency - then there's value there.
By that criteria, btw, I think that the value of the MyHR is political - I've always thought that. It seems to me that the problem right now is a determination on the part of DoH to prove that it has clinical value. I haven't seen any evidence that people would be very upset if the MyHR went away - but it's an experiment that hasn't happened yet. Nor do I think that MyHR has made the case. Not that my opinion matters, of course.
I do wish that we'd do more investment in economics. I've only run into 1 person in the whole world who identified themselves as an economist working on healthcare interoperability.
> one who sounds as though he is bereft of any alternative to finding a better way forward than that presented by the ADHA
umm, no? I think that my track record in public says something else. And expressing guarded hope in a plan is hardly being bereft of other plans.
Btw, it is certainly true that if the interoperability plan was going to be all about the MyHR, it wouldn't be a step forward. But I don't think it's going to be.
Grahame,
ReplyDeleteThank you for your response, I agree with your comments about interoperability generally and MyHR - its value is political.
Your comment "It seems to me that the problem right now is a determination on the part of DoH to prove that it has clinical value" is interesting - MyHR was never meant to be of much clinical value. Trying to make it so now is a very difficult job.
re: "Not that my opinion matters, of course."
It does. "The only thing necessary for the triumph of evil is that good men do nothing."
If you were to ask someone waiting for an aged care package if they thought that spending $2billion on the MyHR was good or evil - I bet I know what they would probably say.
mmmmm " expressing guarded hope" sounds very diplomatic only saying what 'they' want to hear not what the should be hearing.
ReplyDeleteYou are probably right in thinking that the interoperability plan will be about much more than just the MyHR. Looking forward to seeing how many experts like yourself give it resounding accolades.
If the MyHR is political and ADHA is the MyHR then you will excuse my scepticism that anything forthcoming from ADHA will simply be design to protect that political tool and dampen down any potential rival means for exchanging information. I am sure they might mention this to appease parts of the community but I doubt it will be policy and therefore not implemented. You reap what you sow
ReplyDeleteI will keep an open mind and reserve my judgement until the iinteroperability plan. is available and Grahame has made his views / comments known, diplomatically or otherwise.
ReplyDeleteThe fundamental challenge for a functioning health information system is not the technology, but rather, the people – the human interoperability layer. Coordination needs to make way for collaborations. All is founded on a bedrock of trust.
ReplyDeleteIt would appear there is more than a little mistrust between the community and ADHA. This mistrust is not without justification. Often leaders can influence through the smallest of actions.
So I wonder, even if the Intraoperability map solves climate change and delivers real difference it will simply further divide the community and erode trust, pitting players against each other rather than bringing them together.
As a tax paying citizen with a family. When will all these frameworks and standards talk reducing waiting times, improve healthcare workers conditions and number, reduce my health insurance costs and ensure in my evening years I will be taken care of and know the myself or my wife or friends will not be used and abused in homes?
ReplyDeleteAll that I get from your efforts to date is a pelican view ( no matter where I look there is an enormous bill in front of me)
@ 6:42 PM sobering thoughts indeed. It is hard to see after all these years how digital health (admin) has actually helped reduce the pressures put on our health system. You are right to demand answers, perhaps other more seasoned could provide some answers?
ReplyDeleteGiven that all available evidence supports the conclusion the $2 billion ADHA/MyHR system is a failed IT project there is no value in providing answers to those questions.
ReplyDeleteSome might say it is a co-design or clinical lead failed project.
ReplyDeleteSome are getting tired of “user” blame when they take the lead of technical choices and then blame those they ignore when it goes in the southerly direction they were warned about.