This appeared a few days ago.
Perspectives and considerations in digital health standards, and standards selection
You are invited to join a discussion about Australia’s digital health standards selection and the benefits of working towards a consistent, system-wide approach.
This webinar marks the start of targeted consultation sessions to continue through August.
As a highly informed stakeholder in the standards community, we would appreciate your participation in this early stage of consultation.
Specifically, webinar participants will talk about ways to develop a process of digital health standards selection for national use and adoption to form part of a broader strategic approach to standards and standards lifecycle management.
Who is involved?
The Australasian Institute of Digital Health (AIDH) is working with the Australian Digital
Health Agency (ADHA) to develop a process for digital health standards
selection for national use and adoption. This session will be followed up by
targeted industry and key stakeholder consultation sessions through August
coordinated by the AIDH.
Leading healthcare executive Dr Tim Smyth will facilitate the discussion with senior representatives from the standards community, the AIDH and the Agency.
We look forward to your attendance and participation.
Contributors will include:
· Dr Tim Smyth
· Bettina McMahon
· David Rowlands
· Grahame Grieve
· Michael Walsh
The time and date are as follows.
When
Tuesday 28 July 2020 (Next Tuesday)
1:00 – 2:00pm AEST
Where
Online via Zoom
Price
Free to attend
Here is the link to the event page:
https://digitalhealth.org.au/events/webinar-digital-health-standards/
There is really only one big question here. Just where have the ADHA been in this space for the last four years?
To the outside observer pretty much all the mechanisms that used to be in place for Digital Health Standards to be developed, selected and maintained have been allowed to wither and die as have the facilitated links and ongoing conversations between experts regarding these critical matters.
For my part I see what has happened as a major betrayal of the Digital Health community and developers by the ADHA who have essentially taken their joint eyes off the ball.
What do you think about the mess we are now in?
David.
30 comments:
The standards ADHA will try to push will be limited, out dated and irrelevant. At least a few will get a cheque or two out if this fruitless exercise. Standards thrives elsewhere with little necessity for that lot.
Seems a noble attempt. I am a bit confused though, none of these organisations is an SDO or even standards like organisations. Why would they seek to dictate the process? The process behind a standard is probably it's real value.
Now if the intent of the standards fellows is to merely secure government funding, then say so from the outset.
Perhaps it is a reflection of the poor performance of ADHA and AIDH that leaves me thinking this is all a bit of a performance with little substance.
Strange no major vendors are on the panel after all it is product that adopts standards in this context.
There will be a relationship to the recently published white paper from the Global Digital Health Partnership. Which ADHA provided plenty of input into to support more random things.
Although I share the sentiments of David and the other commentators. Let's reserve to harsh a judgement till we see what inspiring visionary leadership we get. I don't yet see it on the talking points but I will be interested in understanding how this all leads to interoperability in an open and free market where everyone is on a level playing filed.
.a standard alone won't solve the challenges or deliver the agreements need to coax systems into working together for some shared purpose and clinical outcome.
Indeed I will be interested in what they see as the ’standards’ there are literally hundreds of standards used in healthcare IT. If we come away with FHiR, CDA, and Snomed it will be a day wasted IMHO.
Interesting ADHA is only part of the baggage and are not leading this. If they are the certainly are not advertising the fact. Can't say either organisation seems grounded in the culture and intellect required for standards. As Karen Duffy says - if it just about government funding then say so that is a good move, just stay a safe distance from the actual doing.
"Can't say either organisation seems grounded in the culture and intellect required for standards"
Regarding AIDH - what more could you ask for? (Don't confuse AIDH with HISA...)
ADHA Strategy?
1. Appoint a new CEO
2. Hope for a miracle
3. Wonder why they failed, yet again.
If nothing else, the Health Department is consistent in its failure to understand what people will actually find useful.
Federal government's $2.5m out-of-pocket-costs website reaches 10,000 people
https://www.smh.com.au/politics/federal/federal-government-s-2-5m-out-of-pocket-costs-website-reaches-10-000-people-20200722-p55edf.html
By Dana McCauley
July 26, 2020
A medical costs comparison website set up with $2.5 million of federal government funding to tackle bill shock has been accessed by fewer than 10,000 people in six months as consumer advocates fear surgeons scrambling to make up for income lost in the pandemic will charge even higher gap fees.
The Medical Costs Finder website, which Federal Health Minister Greg Hunt announced last year as part of the Morrison government's plan to address "excessive" fees charged by specialist doctors had just 9861 unique visitors in the six months to June 17, official data shows.
Consumers Health Forum chief executive Leanne Wells said the website must be overhauled so that prices charged by individual doctors, which leave some patients owing thousands of dollars, would be "visible and comparable".
Ms Wells said out-of-pocket health costs would "hurt families more than ever as a result of the economic impacts of the pandemic" and called on surgeons to "take into account the financial stress on individuals and families" when setting their fees.
A public education program must be rolled out to promote awareness, she said, as promised when the initial funding was announced last year.
"We urge the government to address out-of-pocket costs as a priority," she said.
In the two days after going live on December 30, the website had 3482 unique visitors. It was immediately criticised for lacking the details needed for patients to work out how much it would cost them to have surgery after taking into account Medicare and private health insurance.
Answers provided on notice to a Senate Estimates committee by the federal health department show that 3689 people visited the website in January, followed by just 1036 in February.
In March and April, when elective surgery was restricted to urgent cases for six weeks, this fell to 471 and 315 visitors, then 564 in May and 304 in June.
While $7.2 million in funding was announced for the website in the 2019-20 federal budget, just $2.5 million had been spent by June 30 this year.
Regarding AIDH - what more could you ask for? (Don't confuse AIDH with HISA...)
I guess we are about to find out Graham, will it be good wish? or just another members club in a bubble?
Well, I'm not sure; there's good intentions and possibilities there, but real progress in the hands of the community. I do think that this is the best shot we've seen so far, but it's not clear it will be enough. But the comments seem to think it's more than it is; it's just a small first step. But it is a step and right now, that's a big deal
More, though, I was commenting on the AIDH. If not the AIDH, then who has more of the culture and the intellect required? If AIDH doesn't have it, where else could it be?
Not an easy thing to take on, everyone what's the value of standards but not the cost. Graham is correct something needs to happen and the AIDH at least has some useful tools amongst its membership. Look forward to a roundtable to rival anything on the ABC.
You are all seem so lost, confused and flailing around in the desperate hope something better will emerge. You have been there before in one form or another on a number of occasions and each time you end up in the same confused muddle. You lack clarity of vision, direction and strategy. A decade wasted because you keep talking and thinking the same way and fail to learn that it has been getting you nowhere other than into a new tangle. Reality is painful.
The road to hell is paved with good intentions.
Digital Health is littered with potentials and possibilities. What's missing are outcomes that are self evident and highly desirable by the medical profession and patients.
Nobody had to sell the concept of a smartphone but most everyone wants one.
I have a genuine question i.e. I'm not trying to make a point.
re: "ways to develop a process of digital health standards selection for national use and adoption"
What are these standards and who are they designed to benefit?
I've been reading an article
America’s Looming Primary-Care Crisis
https://www.newyorker.com/science/medical-dispatch/americas-looming-primary-care-crisis
What caught my attention was this sentence:
"A modern medical practice needs physical space, an electronic records system, malpractice insurance, and back-office support to handle the byzantine medical coding on which reimbursement depends."
How much of the work on Digital Health standards are/will be driven by the USA's healthcare model which is driven (apart from hospital A&E and Medicaid) by fee-for-service reimbursements by insurance companies?
The acceptance and uptake of digital health solutions can in no conceivable way be compared with the iphone. It's a stupid analogy.
Standards cannot be selected by this group, they have been trying to do that for years and have failed miserably. I remember they selected HL7V2 in about 2003 but then did nothing to ensure compliance and NEHTA decided to invent their own formats and have wasted over $2 Billion on that quest for the Holy Grail and have just made things worse. ADHA is clueless on virtually every front, although spend a lot on public relations. HL7V3 is another example of starting again and wasting decades only to end in failure.
Surely ensuring compliance with whats in actual use is what governance is about. The lack of compliance is risking lives every day and limiting interoperability. Government have created an environment where vendors demand $$ to implement anything and the specifications get dumbed down and proliferate with poor quality bits and pieces of various whimsical NEHTA/ADHA windmill tilts and very little genuine compliance testing.
The policy of rigorous testing of whatever you are using avoids these problems and allows confidence in the safety of whatever people are using. It also makes interoperabilty much easier if there is an expectation that the receiver will handle a compliant message, and if they don't its their job to fix it. We are a long way from that currently and a drongo level decision to move to something new will only make things worse, and this is exactly what government "help" has done for 2 decades. They should not pay vendors for standards compliance, just insist that the testing is done. If medical information arrives or leaves your application it should be done reliably or not at all. The quality or receivers and senders needs to be addressed, what they are using now should be tested and its a little negligent that it is not and I can assure you its far from reliable currently. If the price of software rises, which it would, and the government is feeling generous (they should not be wasting money on ADHA currently) then they should give the $$ to users to pay for the increased cost, but only if they are using software that has had real ongoing compliance testing done on it.
This type of meeting is a complete waste of time.
> How much of the work on Digital Health standards are/will be driven by the USA's healthcare model which is driven (apart from hospital A&E and Medicaid) by fee-for-service reimbursements by insurance companies?
Not much, in fact. We are well aware of the screwed up ways the US healthcare system works. So are they, in fact. There's no proposal for us to take up the US standards in that area. In the area of core healthcare, though, things are very similar (though not the same) across all countries.
Andrew:
> Government have created an environment where vendors demand $$ to implement anything
And here's you demanding that the government require conformance...
"And here's you demanding that the government require conformance..."
yes, its called governance, in the interests of patient safety, something that government can do? Do you have a problem with that?
Well said Andrew, without agreed conformance to standards enforced through independent testing then it is all a bit of a waste of time. In attempts to ’nudge’ things along and roll over every time a vendor's demands for leniency is meet and conformance relaxed we get further from the primary goals. It also makes a mockery of public funds that are being thrown away.
By being half-arsed a situation has been created where it is going to be very difficult to reign everyone back in line with conformance profiles. Shame those who drove the decline in standards, conformance and compliance are no longer around to admit their errors - oh wait they are!!
Well said once again Andrew. And well said Anon @6.0 PM. I've said it previously and its worth repeating one more time - close down ADHA, close down My Health Record. Find another way independent of Government and bureaucratic meddling.
> its called governance, in the interests of patient safety, something that government can do?
What the government should do is govern. That might involve that. What I'm interested in is how you inconsistently combine the idea that the government should solve our problems while saying that the government shouldn't have to sole our problems.
What I want to know is, why don't the customers just ask for standards conformance, and the vendors just do it? and if they won't, what magic wand can the government wield over industry to make it happen?
> Find another way independent of Government and bureaucratic meddling
Which pretty much never happens because people are looking to the government to fund this. Since that means meddling, the correct question is, how do we govern this process correctly? I'm hoping that David Rowland's analysis and proposals are published soon, so that we can move the discussion along
@9:14 AM You can hold that position ad infinitum and not progress. Close them down, disrupt and destabilise, new doors will open and new horizons will appear. Bite the bullet, be not afraid.
When you buy a phone or car or electrical appliance you expect it to comply with standards and be safe and if it proves not to be it needs to be recalled. I am not asking for government to fund anything, in fact I would prefer they did not. Someone in government needs to insist on standards compliance. They should stay out of standards creation and selection and implementation of anything, if possible. PKI is a possible exception, but the quality of that has also been poor.
Its not inconsistent at all, its the role of government to govern and its been a very consistent message from me. Somehow government insists on standards compliance for many things, but not eHealth where patient safety is at stake. Voluntary compliance does not work, experience has taught be that. Does anyone know how standards compliance works for other areas?
@10 AM Andrew McIntyre gets it, others simply don't want to - "I am not asking for government to fund anything, in fact I would prefer they did not. Someone in government needs to insist on standards compliance."
What did those people who attended the webinar think of what they heard and saw?
For me two key themes were first, just how much work we have to recover back to where we were before NEHTA blew up the Standards Australia e-Health standardisation effort with destruction of the morale of so many of the contributors, before we can move forward.
Related and second was the damage to the trust of the Digital Health community in NEHTA / ADHA which is still in need of repair.
What did you take away?
David.
Another big bang system coming for the ACT. EPIC wins $150 million ACT Health contract. Little hospital big money. Joins RCH, RMH, PeterMac, RWH in the Melb precinct. EPIC rides high.
AFAIK, EPIC is an Electronic Medical Record system designed to meet the needs of advanced medical care in hospitals.
A Medical Record is different from a Health Record and different from a Personal Health Record.
The ACT is creating a Digital Health Record
https://www.health.act.gov.au/digital/dhr
which will be all things to all people.
By using a single system it gives the impression that the problem of interoperability has been avoided. Technically this may be valid, unfortunately interoperability is really a problem of exchange of information, not data, between users with different needs.
WCGW?
@8:58 AM Stand aside AllScripts and Cerner, EPIC is on the march. Stand aside My Health Record we give patients access to their record held on EPIC. Goliath has arrived and Samson is nowhere to be seen. A new double-decade of big American hospital systems has commenced.
EPIC and other big American hospital software vendors may sell an EHR. During the sale cycle discussions they interchange EHR, PHR, EMR, PMR, all in the same breath. The target customer comes to believe that the EHR and EMR and PHR are all covered, integrated and available through the EPIC system.
Yes, there will be problems but the way they solve that is to charge a few more million dollars to fix the problem leading to budget overruns, but no problem, that is normal and par for the course.
So, the answer to your WCGR question is ..... NothingCGW ... because we always fix anything that does .... for more money.
It's standard sales policy.
All very fascinating bit returning to the point of the posting. For those who could not attend AIDH has released the webinar and made available various reports via that other did-organisation.
I was less the overwhelmed with the professionalism and presentation skills, some snippets of interest. betting a is someone who wants to be somewhere else, Graham, I am now convinced owns that Victorian call centre that call but then is silent. A note to one analyst that still photo you use is rubbish, change it.
There also seemed to be a decade of interoperability and standards thinking that was treated like Trump treated John Lewis’s passing.
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