This appeared yesterday.
Doctors refuse to use the $1.5 billion My Health Record
Sue Dunlevy, National Health Reporter, News Corp Australia Network
January 10, 2020 8:00pm
Exclusive: It’s cost taxpayers $1.5 billion but the online My Health Record is at risk of becoming a white elephant, with barely more than one per cent of patients accessing it.
The record, which was created for any Australian who did not actively opt out last January, is also being ignored by doctors who don’t trust it to be up to date.
The Australian Digital Health Agency (ADHA) reports there are now 1.6 billion medical documents on the records including blood test and scan results and medical histories.
But around half the records are merely empty shells — only 12.5 million of the 22.6 million records have any documents in them, the ADHA has revealed.
To be useful to patients, the My Health Record needs a shared health summary uploaded by a GP which outlines a patients key health conditions but less than one in 10 records include such information.
In the past year, just 356,530 Australians — only 1.5 per cent of the population with a record after the opt out period ended — accessed it, the ADHA told a Senate estimates committee.
The record started as an opt in system in July 2012 and in the seven years since then only 2.21 million records, or eight per cent, have been accessed by consumers.
Fewer than eight per cent of specialists are registered to use the record and the government admitted to a Senate estimates committee it has no way of knowing whether GPs or hospital emergency departments are using it during patient consultations.
The government claimed the record would save $14.6 billion by cutting the number of duplicate tests being ordered if doctors could view previous results on the My Health Record.
This money can only be saved if GPs, specialists and hospitals use the record.
There are nearly 90 million GP consults per year but in the last nine months GPs have viewed documents on the My Health Record only 200,000 times a month.
Royal Australian College of General practitioners president Dr Harry Nespolon admits he is not using the My Health Record.
Lots more details here:
It's hard to believe that with this level of usage the Government will get its investment back on the myHR – let alone actually see the accrual of any significant benefit either clinical or financial.
As I have said many times, the sooner the ‘sunk cost fallacy’ is put to bed, the program cancelled and new investment made in programs that will attract clinical and patient adoption the better.
Most who read here know what is needed. We now need to work out how to make it happen!
David.
60 comments:
President of the RACGP "Dr Harry Nespolan admits he is not using the My Health Record."
I wonder how much Steve Hambleton uses it?
Ian, he claims he uses it all the time and makes sure all his patients are fully up to date. Of course he is just a part time GP with all his other digital health commitments so probably has lots of time to do the work!
David.
@2:30 PM That simply confirms how stupid he is.
With Bettina now taking up the senior leadership role at ADHA perhaps this champion of woman's rights can fix this little problem - https://journals.sagepub.com/doi/full/10.1177/2055207619847017
Happy New Year Everyone,
We know the system doesn't work. We told them it wouldn't work, it hasn't worked, we were right but we need to move on.
My favourite metaphor for the MHR is that of the Zeppelin Aircraft. Approximately 1,000 people crossed the Atlantic in a dirigible operated by Luftschifflau Zeppelin, before it was realised, via the explosion of Zeppelin's flagship the Hindenburg, that this was entirely unsuited to commercial air -travel and various interested parties then solved all of the problems needed to get fixed wing aircraft into commercial operation and while it has its faults no-one could really mount an argument that fixed wing has been the wrong mode of travel.
For approximately 20 years Luftschifflau Zeppelin was ahead of fixed wing aircraft in terms of visibility and tangible results. and while ignoring the risks that eventually settled the matter, Zeppelin continued to relentlessly plug 'Zeppelin airships as the prime mode of international travel.
Surprisingly Luftschifflau Zeppelin is still in business and has 7,800 employees, it seems to focus on tourist flights these days.
But while Zeppelin/dirigible was once touted as the pre-eminent mode of trans-Atlantic travel,it suddenly became chrystal clear that the strategy was entirely flawed.
I believe that the large nation scale shared record system has a similar bunch of flaws that mean it will never work in the manner envisaged by its proponents.
I keep returning to the concept of an opt on system for enrolled patients combined with a patient app or portal for everyone else, all underpinned by a strong standards regime.
Other ideas anyone?
Kind regards
Tom
My Health Record is more of a Titanic than a flagship.
Happy new year Tom
Clearly shared records have been the downfall of many international govt investments and I am sure will continue to be so. In support of Tom’s suggestion and if I interpret correctly. Effort should focus on getting meds exchange, diagnostics exchange, path exchange right and then use a virtual health record to link them together. I would like to see more clarity around data ownership and consent.
Standards and agreed conformance points to support interoperability wishes at a technical and data layer is rarely a bad thing. In the past few years Vendor specific standards have started to dominate. These might need to be taken as the starting point. It is one thing to retrieve data via an app, it would seem beneficial to have data injected directly into clinical workflows in real-time. That would mean being conform any to large system architectures.
Even Tim Kelsey would to some extent agree that there is little understanding of what the strategic intent is of the MyHR in terms of clinical business models, consumer models, etc.
What is the value proposition of a shared health record? AFAIK, no proper analysis, including costs and risks, has ever been done. Without a justification, it's all pie in the sky.
There are numerous “value propositions” from numerous viewpoints. Are you after one to support your specific narrative?
I've never seen a value proposition for a summary record system like the My Health Record that included system wide costs and risks. Neither do I have a narrative, other than, without a value proposition it is impossible to justify anything.
There is a value proposition in sharing records, but on demand, with total privacy and security and in a manner that is lossless to data quality. Once you enforce high quality data, security and privacy you can build anything and transfer the data to whom ever needs it in a near real time manner. It does not matter is its a GP, a specialist, a pathologist or a patients personal record system, they need to share the same rules and process compliant standards compliant data in a reliable, tested way.
Poor security, questionable privacy and complete lack of interest in data quality and message standards/display compliance leads us to where we are today... out in the weeds, far off track and about to fall of any cliff we do not see coming. Welcome to the real world...
Andrew.
That's only part of a value proposition. What's the cost of enforcing high quality data, security and privacy in near real time?
The cost of High data quality, security and privacy is minuscule compared to what has been spent on our national eHealth programs and the cost of not doing it is enormous and includes serious medical misadventure, which I am sure has happened. The point is that without those things it just won't work and we should just all buy a fancy fax machine.
Personally the cost was about 10,000 hours of time and $2M of R&D, not billions like Healthconnect, NEHTA and ADHA.
Andrew, you are talking development costs. I'm talking about operational costs - costs borne by every GP, nurse and patient.
This has some of it discussed:
https://aushealthit.blogspot.com/2019/12/the-adha-is-pulling-large-and-costly.html
David.
January 15, 2020 8:33 AM Delete
People seem to be able to keep their billing PKI certificates up to date and manage to apply and receive a provider number whenever they move to a new location? We should have leveraged those things rather than create unworkable and unsupported systems. Once you have PKI, provider identification and software you are mostly there. Data compliance would be relatively cheap, if a little painful initially. Data quality/Terminology would take longer, but mostly to engage clinicians to create clinical models, like the RACP have done for some histology reports. However they can't be implemented because the work on data quality and compliance has not been done.
Like many things eHealth is a layered activity. You need basic compliance with standards and testing before you can build on top of it. Imagine trying to build a house where every brick was a different size and nothing fitted together out of the box. Complex things are build on lower layers that work.
Value Proposition:
YOu might not be searching under the correct terms. Back in the day what is now branded My Health Record, was referred to as IEHR. What you are in search of would be all prior to PCEHR branding. Also use earlier language - Value Proposition might be captured under Benefits, problems statements or service needs. Many of these documents where/are subject to gateway reviews so specific terminology is used.
Just a passing note: THe value proposition for the fax back in the day was never an arguement about stationary and stamp savings. It value proposition was far more visionary than that
As an example:
4.2 Key findings
Analysis of the direct costs and benefits of the Base Case and IEHR scenario based on the Deloitte Economics modelling suggests that the potential improvements in patient care that can be catalysed by the national IEHR system above Base Case expectations are of such magnitude that they demand action from all Australian governments.
By driving uptake of the national IEHR system by the primary care sector, Government is able to ‘unlock’ a stream of benefits to the acute care sector in both public and private settings that would not otherwise be realisable by these sectors.
The national IEHR system will deliver incremental benefits above the Base Case by:
• unlocking benefits of primary sector participation
• bringing forward investment and benefits in the public acute care sector
• catalysing investment and benefits in the private healthcare sector
• bringing forward the rollout of IEHR capability across the Australian population.
This Business Case has identified six priority health activities that can be supported by the national IEHR system: improved medication management, stronger consumer participation, enhanced coordination of care, better clinical assessment and treatment selection, improved continuity of care, and improved system monitoring services.
Based on the change in investment and benefits in the IEHR Scenario compared with the Base Case Scenario, the direct impacts model has identified the following incremental benefits associated with these key priority health activity areas.
Reduced avoidable hospital admissions and GP visits due to more effective medication management
The national IEHR system will enable the uptake of more complete health summaries for all patients from 2012, with E-Prescription capabilities enabled from 2012 (as part of Release 1 of the national IEHR system) and additional Medication Management capabilities enabled from 2014 (as part of Release 3 of the national IEHR system). With more complete information at the time of prescribing, adverse drug events (ADEs) in both acute care settings and in the community can be more effectively controlled.
Therefore the proposed national IEHR system will directly reduce the risk of ADEs above Base Case expectations by supporting healthcare providers with access to up to date consumer information at the point of care, independent of location or time constraints, leading to a reduction in the number of prescribing errors. The direct impact modelling shows that:
• By 2015 alone, nearly 85,000 avoidable hospital admissions will have been prevented in the public sector. By 2025, more than 1.4 million hospitalisations will have been avoided. Figure 2 Incremental hospital admissions and GP visits avoided due to national IEHR system (above Base Case expectations).
• In the primary care sector, more than 103,000 avoidable GP visits will have been prevented by 2015, with this figure increasing to more than 3.2 million GP visits by 2025. Figure 2 Incremental hospital admissions and GP visits avoided due to national IEHR system (above Base Case expectations).
• By 2025, the incremental benefit of avoided GP visits and hospitalisations will have grown to more than $21 billion to Australian governments
....• In addition to benefits realised in public acute and primary care settings, aged care settings will also see an incremental improvement in care over the Base Case. Polypharmacy in aged care is a significant concern for the community. On average, Australians living in supported care take on average 6 different medications at one time, with 20 per cent on more than 10 medications at one time. The direct impact modelling estimates that the rollout of E-Prescribing systems to residential aged care as part of the staged rollout of the national IEHR system from 2014 would be expected to prevent nearly 70,000 ADEs among elderly Australians from 2010 to 2025, at an estimated value of $953 million to Australian governments over the same period.
• The national IEHR system would also catalyse investment by the private sector, which would enable more effective control of ADEs for the 44 per cent of Australians treated in private hospital settings. Based on direct impact modelling, more than 215,000 ADEs would be expected to be prevented in private care settings due to the introduction of the national IEHR system from 2012 to 2025, at a value of more than $2.6 billion to private care providers.
• In addition, households would be able to avoid private contributions to avoidable care, which would be available to spend on other, higher value uses. Savings to households would be expected to exceed $6.5 billion over the 2010-2015 period.
and so on.......
Stronger consumer participation in the management of chronic disease and enhanced coordination of care across care settings
Release 3 of the national IEHR system includes funding to support the uptake of electronic care plan information through the national IEHR system. This capability begins to come online from 2014.
In addition, Australians in rural and regional areas would benefit from the avoidance of travel associated with potentially preventable hospitalisations associated with chronic disease management. Benefits arise from the fact that the national IEHR system and associated care plans will be accessible in remote and rural regions. On average Australians in rural and regional Australia have been found to incur costs of $1,287 ($2010) associated with travel for hospital care.
The direct impact modelling shows that:
• The national IEHR system business case will enable more care plans to be written sooner, with an additional 15,000 expected to be written by 2015 alone, and a further 3.4 million to 2025.
• The incremental value of avoided hospitalisations, GP visits and reduced costs of care in the IEHR scenario compared with the Base Case is expected to be almost $290 million to Australian governments from 2010 to 2025, $140 million to Australian households (2010-2025), and $103 million to private care providers (2010-2025).
• In addition, by 2025, an additional 432,000 Australians in rural and regional locations would be expected to access care plans remotely, resulting in an avoided 124,000 hospital admissions by regional Australians with chronic disease, at an incremental savings to households of $180 million above Base Case expectations.
In addition to these above benefits, access to information by consumers through online Patient Portals would be expected to enable significant benefits from improved self management. The national IEHR system will provide a significant improvement in the volume, quality and granularity of health information available to consumers, supporting them in better managing their personal health. It will also support consumers in self monitoring and maintaining their personal health information. Active consumer management and engagement in their health conditions has been shown to have a significant positive impact on health outcomes. Studies have shown reduced use of hospital bed days, reduced numbers of emergency room visits and improved clinical condition for consumers that actively manage their own healthcare. Due to the challenges associated with credibly estimating these benefits, these have not been included in the direct impact model. Overall this suggests the benefits claimed in the Deloitte Economic Impact Assessment Report from more effective chronic disease management are likely to be conservative.
Better clinical assessment and treatment selection
It has been estimated that approximately nine per cent of all pathology and imaging tests ordered are either redundant or duplicates of previously performed tests. The introduction of E-Diagnostics solutions and more comprehensive patient summaries has been shown to prevent the performance of 69 per cent of such unnecessary tests. While in the Base Case these redundant tests would be expected to be controlled more effectively in the acute care sector, in the IEHR Scenario these benefits would extend to primary care settings as well. Based on current rates of test ordering per GP visit as reported in the AIHW’s annual BEACH report, in 2010 more than 12 million imaging tests will be ordered by GPs and more than 55 million pathology tests, of which approximately one million and five million, respectively are likely to be redundant. The direct impact modelling shows that by extending patient summaries and E-Diagnostics into the primary care sector:
Last one David dont want to clutter your blog
• The implementation of the national IEHR system could be expected to reduce the incidence of duplicate test ordering; nationally this would reduce unnecessary expenditure on tests ordered by GPs in the order of $1.6 billion from 2010 to 2025.
• The implementation of the EHR and E-Diagnostics in the private sector would also help to control unnecessary ordering in private acute care settings, at a value of $79 million to the private sector from 2010 to 2025.
Improved continuity of care
Reducing the time consumers and healthcare providers spend booking appointments, ordering treatments and repeating and sharing information across the health sector will significant improve the effectiveness of healthcare delivery. By providing more complete information compared with the Base Case, the national IEHR system would enable more efficient care delivery by healthcare professionals. GPs, for example, would benefit from reduced time spent clarifying prescriptions with pharmacists and referrals with specialists, as well as reduced time to develop medical histories with patients.
The direct impact modelling shows that over the 2012-2025 period the national IEHR system would be expected to deliver efficiency gains valued at $9 billion to GPs. In the public sector, the direct impact modelling indicates that less time to develop medical histories would be valued by Australian governments at $226 million over the 2010-2025 period, while in the private sector profit would increase by $112 million from 2010 to 2025.
Improved system monitoring and health systems intelligence
By enabling information on healthcare delivery and management across the full care continuum when and where it is needed, a consumer’s IEHR will provide critical information to support healthcare providers in determining the most appropriate treatment plans. This information, when de-identified, can also support healthcare managers in expanding knowledge about diseases and the effectiveness of treatment regimes. Specifically, the national IEHR system will over time assist with clinical data to support health monitoring, improving the quality and safety of care through research. The national IEHR system will also provide a rich source of de-identified information for service planning and resource allocation purposes. These benefits were not quantified as part of this analysis as there is a high level of uncertainty regarding the incremental benefit that would be realised through aggregated data collection and it is therefore difficult to credibly estimate these benefits.
Hi t.38,
Do you have a copy of the report you could send me - I will pass it on to whoever requests a copy...
Cheers and thanks.
David.
"what is now branded My Health Record, was referred to as IEHR"
myhr is nothing like what IEHR (or the PCEHR) was intended to be. The difference is not branding but base functionality. As the ADHA tells us, a patient's myhr will start off empty and cannot contain historical data.
The PCEHR (and I assume the IEHR) was supposed to join up existing data repositories which would automatically provide access to historical data at low cost.
Now SHS are created via manual effort by GPs thus increasing the cost and delivering less value. Test results without context are meaningless.
Any value proposition or cost/benefit analysis developed for anything but the current implementation is totally useless and misleading.
Milton Friedman has a quote that nails it:
“One of the great mistakes is to judge policies and programs by their intentions rather than their results.”
Building those types of systems depends on having data available that is compliant and its vital that the original data format is not lost or can be recreated on demand. In reality that meant getting everyone producing compliant HL7V2 data, creating medication messages etc
The Australian standards covered most of what was required, although none were as tested as the orders and observation standards and contained significant flaws that needed to be ironed out by real implementations.
What we didn't need was a new set of specifications put together by people with no experience and that is what we ended up with. eg NEHTAs prescription messages were a joke so in the end they settled on pdf with minimal atomic data and the prescription info in MyHR is probably the least reliable source of information (single CDA document per script!), so we are still asking people to know exactly what they are on, which isn't a totally bad thing. Pathology has been turned into a pdf so no decision support or cumulative results are possible...
Its such as mess that my fear is that they will try and save face by continuing it and we are doomed to another 10 years in the wilderness.
Andrew's comments are completely right. Until we have the data quality sorted, no health professional worth his/her salt will rely upon any external facing system. If we have quality data then we can do all sorts of things with it, including improving continuity of care, sharing records and useful analysis of all kinds.
In chasing the holy grail of shared records and ignoring doing the basic things right, we have indeed become lost and are denying our health system the productivity tools it should have to improve delivery of care.
In terms of fixing this problem, improved standardisation, building on infrastructure and processes that work (instead of adding difficult to use new ones) must be a key priority.
As must be an overhaul of the existing monolithic 'one size fits all' shared record strategy that has cost the system so dearly.
You will need some sort of interoperability data savvy god. That will require lots of prays and himms
"You will need some sort of interoperability data savvy god"
I suspect what we actually need is for the government to stop spending huge amounts of taxpayer $ and try a bit of actual governance, which is actually pretty cheap. You can't convince people to fix errors unless they have a requirement to do so, believe me I have tried.
If messages are non compliant and you can't output a message on one system on to a usb and then load it and have it displayed correctly on another system how do you expect widespread messaging to function? It just propagates error which increases risk. The errors are on both message creation and message handling and display. Would you like your critical results to be evaluated and decisions made based on unreliable software? The quality is getting worse rather than better, with labs losing people with skills and a culture of disinterest in quality, "just ship it"
“ lots of prays and himms”
Suspect the use of HIMMS rather the hymns might be a sarcastic use. With Tim Kelsey off to HIMMS some might ask - just what could possibly go wrong for the government?
Your fears are well-founded Andrew.
I continue to advocate that real and meaningful progress will not be achieved in the absence of:- appropriate funding, a realistic achievable strategy, an R&D organisational structure, and pragmatic informed leadership.
Well Tim Kelsey departure has ended as a non-event.
it ends with a whimper not a bang. Un-noticed and unloved.
@5:28 PM Andrew said " Its such as mess that my fear is that they will try and save face by continuing it and we are doomed to another 10 years in the wilderness."
Glenys Beauchamp, Health Department Secretary, is the only person with the power to terminate it. She can cut the Department's 50% funding and inform the states that the Department believes they should terminate their funding too.
Perhaps an alternative option might be for her to meet with Andrew, Ian, Tom, and Bernard to help her understand why continuing it is not the right thing to do.
Wonder what turning off the federal system would cost? Nothing is as simple as flicking an off switch ( well saying just switch it off is easy). Anyone decommissioned a system with similar information store and retrieve characteristics in a similar setting?
Glenys Beauchamp may have the power and control of the purse strings but she doesn't have the leadership skills which requires courage to do anything other than turn a blind eye and dump all the responsibility on the ADHA Board and its incompetent Executive.
Well they have reshuffled the deck chairs and remove Timmy boat from their website. A successful publication must be cause for celebration at ADHA these days.
The celebration should be a short one. They also posted job vacancies. As an example the interoperability Director is a confused pitch, the online version does not match the PD. I cannot work out what they want. No wonder the keep seeking this role. Sooner she is gone and the Digital dodo the better
Love the new Executive Team lineup. Very reflective of the new peaking order and who is next to drop out the bottom of the table. I am sure the Anglo Saxon males on top is just a coincidence?
Only one person in the executive team has any formal qualifications in medicine.
WCGW?
And none in informatics = BUA
January 21, 2020 9:48 AM - BUA???? or do you mean business as usual BAU?
ADHA "Media release - Secure messaging standards to be mandatory".
https://www.digitalhealth.gov.au/news-and-events/news/media-release-secure-messaging-standards-to-be-mandatory
Bettina McMahon, Emma Hossack and Nathan Pinskier have all commented. But what exactly each of them has said eludes me.
BIG QUESTIONS.
WHAT EXACTLY ARE THE SECURE MESSAGING STANDARDS THAT WILL NOW BE MANDATORY?
WHERE CAN WE FIND THE SPECIFICATIONS?
Quote: MY HEALTH RECORD IS ABSOLUTELY SHINING.
Message from Agency CEO, Tim Kelsey
20 December 2019: CEO reflections on the milestones that the Australian Digital Health Agency has helped to bring into realisation.
"At the moment, My Health Record is absolutely shining. The doctors are loving it, the nurses are loving it. The traditional relationships between GPs and patients don’t really exist at the moment, so everyone is trying to help each other, and My Health Record is able to provide a consistent medication profile."
notice the shift from claiming that my health record will be a boon in time of emergency (now shown to be an empty promise) to "a consistent medication profile"
AFAIK, my health record will only include prescription medication on the PBS list, so it is unlikely to be complete, never mind consistent. What will also not include is why the medication has been prescribed and when the person has taken what medication and how much.
The one thing that has been consistent in the past are empty promises.
"Quote: MY HEALTH RECORD IS ABSOLUTELY SHINING."
Can someone send me the full text of this e-mail for posting? Source not disclosed!
David.
I think the MyHR is somewhere between The Shining and Misery, it is certainly bone chilling and worthy of a Stephen King title.
The Kelsey self congratulating article can be found here: https://www.digitalhealth.gov.au/about-the-agency/digital-health-space/message-from-agency-ceo-tim-kelsey
published a month ago. He/they kept very quiet about it. Tim's last tweet was 10 December - no mention of his self glorification then or now. None from @AuDigitalHealth either.
You get the impression that they are trying to keep things low key.
It certainly has the look and feel of a hasty exit from someone who has rubbed a few important people up the wrong way. Can't be good for HIMMS.
I think when the current Exec. at ADHA notice what Tim said they will see merit in deleting the 'offending' paragraph near the end of 'his' blog as it can only continue to undermine the ADHA.
@4:35 PM true. But it's rather more subtly sinister than "undermining the ADHA", it's a straight-out thumb up your nostrils or wherever else he might choose to stick it. Wait till he gets out and about over the next 12 months, promoting HIMMS to all our politicians and in the process quietly undermining the ADHA as an organisation that has lost its way since his departure. He will sell the HIMMS story and convince the powers that be to divert scarce funds towards HIMMS which will be used to show ADHA how to 'fix' the problems.
Hello Minister, Prime Minister,
It's good so meet with you again. I'm now working with HIMMS and I'm here to discuss with you how we at HIMMS can help your Government advance Digital Health in Australia.
Minister, this is who we are: https://www.himss.org/who-we-are
and this is what we do: https://www.himss.org/what-we-do/solutions
By this time next week it will be ” Hello Minister, Prime Minister,
It's good so meet with you again” a sorry Tim who? I can take a message and leave it with the minister office and they may cont you. Cold by he will be shunned for a while and might make it back in through a second their consultancy.
Would that be the same Minister and same department he made a mockery of recently?
Guess everyone can put their pencils down now. ADHA has the standards and the sets of layered agreements necessary to coax systems and models into working together.
Seems Timmy was busy being a tabloid columnist late last year with a raft of things published on 20 December. https://www.digitalhealth.gov.au/about-the-agency/digital-health-space
Something has been going on. Anyone know any facts?
The fact is that Timmy was, is, and will always be first and foremost, a journalist. His only skill is spin. Judging by the behaviour of this government, he fitted right in.
Remember this?
Anonymous said...
No doubt ALL WILL BE REVEALED at HIMSS Australia Digital Health Summit 2019 in Sydney 20/21 Nov 2019. How do I know?
It 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.
November 09, 2019 4:01 PM
@11.22 AM Spot on. And don't forget this:
Anonymous said... Now is probably the best time for Tim to jump ship. Things can only get worse for him, they certainly won't get any better. There's only so long you can hide from the promises you've made. November 25, 2019 2:58 PM
The Lancet ran an article recently on the bush fires in Australia
Bushfires expose weaknesses in Australia's health system
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30096-9/fulltext
"While Australia has one of the world's most robust health-care systems, the crisis has not only left doctors unprepared to deal with the health impacts of climate change, but it has also revealed that the health system was not fully equipped to handle the massive humanitarian impact such a crisis would have on communities."
Not a mention of myhr or how it has helped doctors and/or patients. Or that it has cost as much as the $2b the government has put up so far to address at least some of the problems.
The system has been running for coming up for 8 years and as implemented is totally useless.
Maybe one day it will be seen for what it really is - a white elephant.
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