This appeared late last week in the context of the new ADHA CEO being appointed.
Australian Digital Health Agency: so long, thanks for all the (brightly coloured) fish
September 10, 2020 Jeremy Knibbs
One suspects the new Australian Digital Health Agency CEO appointment puts a fairly substantive full stop on the exciting but eventual car crash experiment that was the ADHA and the opt-in My Health Record. What now?
Who ya gonna call when digital health is having the most important moment in its history?
When a pandemic has thrown the utility of digital in healthcare into the spotlight, and it’s proven its credentials; when the public is all ears and yearning for more as a result of the introduction of telehealth; when government agencies have thrown the rule book out, taken calculated risks and come up trumps using new digital strategies; when transformation in health has been bowled up, ready for a talented and experienced new digital health agency leader to hit it over the boundary?
An unusually senior career bureaucrat opting to take a few steps down the public service career ladder, whom no one has heard of … apparently.
The agency announced Amanda Cattermole this week as the permanent replacement for Tim Kelsey, a role temporarily filled by the very competent Bettina McMahon. Ms Cattermole is a lawyer with virtually no primary and tertiary healthcare exposure or networking in the sector, no track record engaging the public on complex, political and emotional issues, no formal background in technology, no track record of vision and leadership from the past (that anyone can glean), no real-world commercial experience, no public profile to speak of – and a recent history working in the department that brought us digital transformation in the form of “robodebt”.
As harsh as these initial observations may seem, there is one notable positive. Suddenly the relatively small (and, unless you’re in the sector, insignificant) government agency ADHA, with a staff of about 250 and budget of about $300 million, now has the former COO and interim CEO of the Department of Human Services, which has a staff of 35,000 and a budget of over $5 billion.
This still feels like an unusual pick.
When does the COO of a $5bn venture decide that a great career move would be to take on the head role in a troubled and controversial third-tier government agency with a budget of $300m? If you look at the Department of Health organisation chart, it’s a step down in reporting of about four levels. The CEO of the ADHA doesn’t even actually appear on the DoH organisation chart.
One industry blog has already unkindly suggested that the appointment represents a once high-flying DHS COO being sent to purgatory for the robodebt debacle.
It’s possible.
But whether this is in play or not is not all that relevant, really. Given that such a COO presumably has some serious talent to have gotten so high in such a large, complex and important other department at such a young age, surely this has a chance of being really good for digital health.
What is the Health Minister thinking here?
Is this a highly competent bureaucrat available because of a big departmental bungle, or does she see a career path in sorting out digital health? Or is she a safe and competent pair of hands that can drag the entire digital health thing, and its management, out of the spotlight and back into the depths of government containment where no light can reach?
No more brightly coloured fish flying past our screens featuring big digital transformational projects such as the My Health Record (MHR) or electronic scripts, which catch the public eye easily and are awesome when put on display, but which ultimately don’t make for good eating, and are sometimes poisonous?
No, the next person to run digital health federally is going to be a serious, hardened, oblique technocrat, who will take orders and not stupid risks, and will make sure that there is no more grief for any of her political masters.
Pages more here:
It all makes fun reading but has mostly to be speculation as neither Jeremy or I can divine what has gone on internally and what will follow until we see what exactly happens in the next two to three months.
FWIW I suspect we will see a very ‘steady’ as she goes with little change and a progressive wind down of Government involvement in digital health with the slack being taken up by the private sector.
What do you think the next few months hold?
I suspect we will all know by the New Year!
David.
19 comments:
There are a number of examples to indicate the direct ADHA is headed, most ‘digital’ Agency fads We’re quickly stamped out and taken over by the grey squad. This could be good news for some, perhaps a return to standards and compliance focus and away for embarrassing’agility’ by third rate players.
Good article, I disagree one the observation of Bettinas performance. Having worked under her and her acting COO they have been far from effective.
Here's a clue as to what the ADHA might be going to do next:
"Summary of RFI responses on the future of the national infrastructure managed or operated by the Australian Digital Health Agency"
https://conversation.digitalhealth.gov.au/industry-briefing
specifically this report
"RFI responses on the future of the national infrastructure managed or operated by the Australian Digital Health Agency (PDF, 1,332 KB)"
https://conversation.digitalhealth.gov.au/sites/default/files/2020-07/Report%20on%20RFI%20responses%20to%20DH2298%20-%20July%202020.pdf
The buzzword of the future is "ecosystem"
This is from the report:
"Theme 2 | Building an ecosystem
This theme explores the way in which different elements of a future digital health infrastructure interact with each other. This includes consumers, federal and state government health agencies, and third-party health providers or technology developers. Factors presented include technologies, approaches, governance, system interoperability, technical standards and consistency of terminology. Responses to this theme emphasised:
* Enabling interoperability between internal My Health Record systems and other government systems (e.g. NDIS, myGov, digital identity) to provide coherent national infrastructure and a seamless digital experience for end users."
What an "ecosystem" is supposed to do is rather vague. The report seems to be all about Non-Functional Requirements rather than healthcare objectives, problems to be solved, the sorts of data that would be managed and/or communicated over this infrastructure.
It is quite possible that the ADHA will try and leverage off the current push by the government to share our data among agencies as outlined in this ABC report:
"Draft legislation proposed by Federal Government would allow your personal data to be shared between government agencies"
https://www.abc.net.au/news/2020-09-16/government-draft-law-share-personal-data-between-agencies/12666792
The most obvious "benefit" to the government could be to have the Disability Pension and/or the NDIS people access myhr, as implied by the Minister for Government Services Stuart Robert who is quoted as saying
"it will allow government agencies to streamline their services and cut down on duplication.
'If you apply for a Disability Support Pension, we will ask you a whole range of questions — some of them quite intrusive and difficult, for obvious reasons.'
'And then we'll do exactly the same thing if you are applying for NDIS and then we'll do the same thing when you apply for the age pension.' "
I have carefully read this document with considerable experience behind me. I must be living on another planet. I found it particularly unhelpful and uninformative. Nothing new of note, just a repetition and recycling of everything said repeatedly before for a decade or more. In short,the document is words, words, words and still more words with the end-result being that a few 'really good points' are buried in repetitive detritus. A classic "Consultant Document" of little use. If this is meant to point to the pathway ahead don't be upset when you eventually realise that the pathway has led you back in time.
"I have carefully read this document with considerable experience behind me."
Maybe you can help me. I went looking for a requirements statement - you know, a definition of what the thing will be required to do. I couldn't find anything. Did you?
@1:08 PM No, I didn't, but then I only read the Nous Group's Report analysing the responses received to the RFI. Reviewing who the 36 'organisations' were that responded I guess the Report will be perceived by politicians and bureaucrats as having a lot of credibility and of 'value' to charting a way forward. It's marvelous to see how big consulting firms and large technology vendors view the health market and manage to convince politicians and bureaucrats they know so much about digital health. I guess the Report will be used to support ADHA's triennial 'business case' for another $300 to $500 million! Pathetically sad really.
About the only thing that can be said about this government is that they are consistent. They are still pumping money into MyHR, ADHA and Covidsafe without getting anything for it
Another $2m spent on COVIDSafe app
https://www.innovationaus.com/another-2m-spent-on-covidsafe-app/
Bear in mind the Government pumps in the money based on the frank and fearless advice the politicians receive from their bureaucrats!
My Health Record isn't even on the radar. I went to a pharmacist today to fill a script. I mentioned to him that I had asked the GP next door about escripts and was told she wasn't doing them (as I handed over my paper prescription). He pointed to a sign that said he was escripts compliant.
@8:48 PM What is the benefit to the GP to do escripts? My GP rural Vic prints my prescription and gives it to me. If he didn't print it what would I do?
You simply need to go digital. All that rare earth mineral mining, plastic and other non biodegradable material that goes into computing along with its carbon footprint is far better for the health of people and our planet than a simple price of paper. And that is without the cost savings
Do you mean that I simply need to have a mobile phone?
..... at the pharmacy ... curses .. the battery is flat.
Even easier, just get glasses. They'll be more effective than MyHR and the Covidsafe app put together.
http://medicalrepublic.com.au/got-covid-shouldve-gone-to-specsavers/34501
Talking about eScripts, you know, that system that was supposed to be fast tracked for the end of May.
Seems ADHA is still co-designing it.
TMI? Privacy concerns over eScripts
18 September 2020
http://medicalrepublic.com.au/adha-pulls-brakes-on-escripts/32994
The RACGP has expressed concerns over the Active Script List, which could allow any participating pharmacy to see medications a patient may want to keep discreet.
The purpose of the ASL is for patients to be able to have their medicines dispensed at a pharmacy, without the need to present their paper or digital script.
The system will use the existing eScripts token model to enable consenting patients to have their digital scripts show up on a single list displaying all active scripts waiting to be dispensed.
But a recent meeting of the Australian Digital Health Agency (ADHA) and key stakeholders some including the RACGP, AMA, Pharmaceutical Society of Australia and the Pharmacy Guild of Australia has revealed some conflict about how the technology should populate patient medications.
To have an ASL created in the first place, patients would consent to have the live record created, likely through their community pharmacy.
But the difference in opinion comes down to whether, at the time an ASL is created, it should begin blank or populate the list with any historical eScripts or electronic transfer of prescriptions that have been generated.
Dr Rob Hosking, chair of the RACGP expert committee of practice technology and management, said the college had concerns about the risk of GPs inadvertently breaching their patient’s privacy if the latter model was adopted.
“Currently the patient has control over who views their token (script) as it resides on their phone or in their email,” he said.
But if a new ASL was to populate with all previous scripts that patient has received electronically up until that date, it had the potential to expose a patient list of all medications to any pharmacy participating in ePrescibing and electronic transfer of prescriptions, Dr Hosking said.
Dr Hosking said it would be akin to a patient leaving their paper scripts at the pharmacy, as some patients do now.
“However, currently the patient chooses which scripts to leave at which pharmacy,” he said.
“In some communities (particularly small ones) patients may not want some pharmacists knowing what scripts they are getting dispensed elsewhere.
“We would be very disappointed if the roll out of ePrescribing is impacted negatively by the implementation of the ASL if it has not been thoroughly assessed and understood by all involved.”
Andrew Matthews, ADHA director of the medicines safety program, said that no decisions had been made and that the co-design process was ongoing.
“Certainly from a convenience point of view the purpose of having an ASL is to make all active scripts available to be dispensed, but that’s something we are working through to figure out whether when you establish your ASL any available active script is able to be seen, or if only scripts generated after the time that you consent to an ASL will populate,” he said.
Mr Matthews said a key component of the technology would be to let the consumer pick and choose which medications they want to be seen on their ASL.
The GP software vendor Best Practice told The Medical Republic they also had concerns about the ability for patients to exclude certain medications from their ASL.
And the solution would see GPs being able to, upon patient request, block certain medications from appearing on their ASL.
“In consultation with other software providers, a method was agreed to identify scripts that the patient has requested not to be sent to the ASL and this software change will be incorporated in our Bp Premier Saffron release, due mid-October,” said company board director, Lorraine Pyefinch.
According to the ADHA website, ASL technology is set to be available by the end of the month, but The Medical Republic understands this release has been delayed for further refinement and testing.
David is there an issue with your web survey tool? Been getting a blank all day. Using iOS 14
It shows up with Safari and Chrome on iOS 13.7. I am holding off on 14 till 14.1 if I can!
Web view is needed.
David
Will just be a delay by the developers. I have a few issues with the my health record which I am guessing is the same root cause. My gov seems okay though. Maybe the enhanced privacy features are upsetting some software designs
"I have a few issues with the my health record which I am guessing is the same root cause."
You mean unreliable data and poor data protection? That's a pretty fundamental problem.
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