This appeared on Sunday
How did the Covidsafe app go from being vital to almost irrelevant?
The PM told Australians in April the contact tracing app was key to getting back to normal but just one person has been identified using its data
Sun 24 May 2020 06.00 AEST Last modified on Sun 24 May 2020 06.01 AEST
It was sold as the key to unlocking restrictions – like sunscreen to protect Australians from Covid-19 – but as the country begins to open up, the role of the Covidsafe app in the recovery seems to have dropped to marginal at best.
“This is an important protection for a Covid-safe Australia,” the prime minister, Scott Morrison, said in late April. “I would liken it to the fact that if you want to go outside when the sun is shining, you have got to put sunscreen on.”
“This is the same thing … If you want to return to a more liberated economy and society, it is important that we get increased numbers of downloads when it comes to the Covidsafe app … This is the ticket to ensuring that we can have eased restrictions.”
The health minister, Greg Hunt, tweeted that it was the key to being allowed to go back to watching football.
Yet nearly a month since launch, the contact tracing app has barely been used – just one person has been reported to have been identified using data from it.
And the language from public officials has been toned down. No longer is it the key to freedoms, but an add-on to existing contact tracing methods, to work in concert with social distancing rules and continued testing to keep a lid on outbreaks.
So how did it go from being the key to allowing Australians to get back to the footy to being barely relevant?
The big sell
The Covidsafe app keeps a record of everyone a user has been in contact with in the past 21 days, using bluetooth technology. In truth it has never been more than an addition to manual contact tracing methods, designed to catch infections from random contacts, such as people on the bus or in a queue.
But the government has been selling it as much more than that.
It set a target of 40% of the Australian population using the app for it to be effective. While close to six million Australians now have the app, the number of new downloads has declined in the past few weeks.
Here is the link:
This is a really sobering example of how Digital Health can be overhyped and can under deliver. Seemed like a good idea at the time I guess.
What do you think?
David.
8 comments:
hi David. I think that there's a very definite capacity for digital solutions to over-hype and under deliver. We've seen this again and again. In fact, it leads to the opposite problem: to expect digital solutions to not deliver fundamental change. Yet our lives are completely transformed by digital solutions (acutely, right now, but also totally anyway).
If anyone has a magic wand to predict which digital solutions will work and which won't, I haven't seen them applying it successfully and repeatedly. The only indicator I've seen which is reliable is around network effects. Once they get going, then you can see how things are going to play out.
In this particular case... There's no con here. There's so much uncertainty, risk, pressure around the pandemic ... the government had to do something like this. They picked the best basis to do this going forward as far as I can tell - the Singapore app. They made the best fist of it that they could. They put as much data protections as they could around it (given the known chronic problems around data privacy in Australia). It's not obvious to me that there could be better decision making on this given when the real decision would have been made (mostly back in early-mid March).
But it was delivered (even though at warp speed) after the heat had gone out of the pandemic here in Australia. Given that, it was never going to get network effects, which are obviously critical for this app (that's something for us to celebrate!). So given that (a) case counts are low and (b) app install penetration is low, then (c) it's predictable that it wouldn't be very useful. But it was useful in 1 case - that's pretty good, actually.
If the virus hadn't magically gone away here in Australia (and it's far from satisfactorily explained why that happened, for me), and we were instead looking at the situation in US in our immediate future, the network effects around the app would probably be very different, and we would be very happy to have it.
So mainly we should just be really happy that it doesn't actually matter that much. (and fingers crossed etc that we don't turn out to need it)
"If anyone has a magic wand to predict which digital solutions will work and which won't, I haven't seen them applying it successfully and repeatedly."
Have a look at Estonia.
Estonia Already Lives Online—Why Can’t the United States?
https://www.theatlantic.com/international/archive/2020/05/estonia-america-congress-online-pandemic/612034/
We have built a digital society and we can show you how
https://e-estonia.com/
Healthcare
https://e-estonia.com/solutions/healthcare/e-health-record/
Estonia’s healthcare system has been revolutionized by innovative e-solutions. Patients and doctors, not to mention hospitals and the government, benefit from the convenient access and savings that e-services have delivered.
Enter e-Estonia: digital health
https://e-estonia.com/enter-e-estonia-digital-health/
Since 2007, health records have been digitalised in Estonia and are available to both the patient and health care professionals. This includes doctors, nurses, and paramedics.
It can be done. It has been done. Why can't the USA, UK and Australia do something similar?
IMHO, because we don't trust our governments. For two reasons. the first is a general lack of trust the second is that we don't trust them to deliver.
hi Bernard. Estonia are certainly the class of the world. I pretty much wrote this with Estonia in mind: http://www.healthintersections.com.au/?p=2711
Also, while I think that there's no magic wand to decide which technological solution will work, there's no need for any magic wand to decide what kind of governance will or won't work for making best use of the technologies that do work.
Thanks Grahame.
Your first and following paragraphs say it all:
"One of the under-appreciated factors that affects how successful you’ll be at ‘interoperability’ (for all the various things that it might mean) is your underlying culture of working with other people – your and their underlying expectations about whether and when you’ll compromise with other people in order to pursue a shared goal."
My observation is that the factors affect more than interoperability. It goes to pretty much all attempts to invoke significant change through the use of advances in science and engineering.
I think the central problem is one of control. When it comes to the change that Estonia has put in place they have been in total control. This is partly because of their size (about 1.3 million) and lack of diversity in government. They are a unitary state - a single entity in which the central government is ultimately supreme.
In comparison, the Australian Federal government has very little control, although it tries to exercise what little control (usually financial) it does have.
This lack of control means that the Estonian approach - decide what they want and implement it - will not work in Australia.
The Australian Federal government can either carry on pretending it will or realise it won't and develop an alternative approach. Unfortunately the Federal government has dug itself a big hole by divesting itself of the expertise that might be able to help them do just that. When I came to Australia in the early 1970s there were many more scientists and engineers in the public sector - I was one of them. There are now very few soentists and engineers left, those who are in very specialist positions (e.g. TGA, Health, Industry) We don't even have a minister for science.
The great outsourcing push of the 1990s hollowed out the Information System capability from most departments.
We are now left with a public sector devoid of skills and expertise to solve today's highly technical problems.
The Digital Transformation Agency is currently trying to create "Digital Professionals" in the public sector. I went to a DTA workshop in February (run by external consultants, of course) where they were trying to define the phrase.
Now DTA is attacking the problem from an HR perspective. They are using the Skills Framework for the Information Age (SFIA).
The SFIA Framework is a model of professional skills on one axis and seven Levels of Responsibility on the other.
SFIA is a common reference model. It is a resource for people who manage resources for ICT, Software Engineering and Digital Transformation and is independent of technology, method or approach.
There's more at
https://en.wikipedia.org/wiki/Skills_Framework_for_the_Information_Age
including this nugget
"SFIA alone does not deliver any business benefits, however, it does create a foundation to leverage and create additional value to the organization."
How this is going to change anything is beyond me.
Getting back to control, the great outsourcing disaster was implemented by central agencies (Finance mostly) using procurement as the big stick. Under the constitution, it's the only power they have over ministers of state.
By destroying the capability, skills and corporate knowledge in individual departments, the central agencies now have no tools they can use to co-ordinate initiatives on a whole of government or (in the case of healthcare) whole of industry basis.
IMHO, the failure of health IT initiatives has nothing to do with NEHTA/ADHA/Dep Health, it has everything to do with the culture and structure of the public sector.
In case it is not obvious, my broader perspective is in total agreement with your observation re interoperability.
I agree about professional technical capacity. But there's more to it than that.
One feature of the department since I've been in this space is the continual rotation of senior public servants through healthcare. They're only just learnt the actual issues and boom! - they've moved on. I'm told that the point of this is to prevent regulatory capture but I think that the downside is strong - there's no capacity to think big and understand when projects are off the rails for strategic technical reasons.
As a Australian friend of mine who works for the world bank told me: Australia is both lucky to have and cursed with a stable government that rides on the glories of past hard work
Many occupying decision-making and appointed leadership roles are disciples of system thinking, complexity cannot be imagined resulting in never understanding the ‘why’. If you don’t understand the why then you should not replicate the what. An ordered system is one with a very high level of constraint. The constraints are so high that all behaviour is predictable. This lends itself well in some circumstances but perhaps is what prevents eHealth and to some extent healthcare in general from moving forward in Australia, it needs to be viewed as a complex adaptive system which has enabling constraints not governing constraints.
I'm told that the point of this is to prevent regulatory capture - this is an emerging pattern across private and public sector. Kick the can down the road so it is someone else’s problem. I fear we are running out of road.
Re Grahame's "One feature of the department since I've been in this space is the continual rotation of senior public servants through healthcare."
Definitely. And it's even worse in Defence. I did some IT strategy consulting for the RAAF. The guy heading the section was a pilot - Hercules and 707s. He used to fly the VIP fleet - Prime Ministers and such.
re T.38 "Many occupying decision-making and appointed leadership roles are disciples of system thinking"
IMHO, systems thinking is the toy version of systems or control engineering. Systems thinking uses soft, descriptive concepts. Systems engineering is a hard engineering discipline involving significant amounts of higher mathematics.
It's like trying to understand physics without knowing mathematics. You can get an idea but to do it properly you need the mathematics. Same with engineering.
If you look at a site like this
https://medium.com/disruptive-design/tools-for-systems-thinkers-the-6-fundamental-concepts-of-systems-thinking-379cdac3dc6a
there is nothing wrong, but it's not enough.
When I did my Masters in Control Engineering the entry criterion was mathematics. There were two entry paths - a BEng in Electronics (me) or a BSc in Mathematics.
Grahame highlights one of the major (only one of the major) obstacles to development of a hugely complex project like the “National My Health Record System”.
So, project stability, corporate memory, strategic direction, consistent competent leadership federally and across jurisdictions, all fall victim to the “continual rotation of senior public servants through healthcare. They've only just learnt the actual issues and boom! - they've moved on.” Compounded further by the human inability to keep such a complex project on an even keel when so many of the problems it is ‘intended’ to address are not well-defined and not well-understood at every level. A fast track to failure for many and riches for a few!
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