The Federal Budget was released a little under a week ago.
Here is the link to all the paper work.
https://budget.gov.au/2020-21/content/documents.htm
Here is the major piece of detail.
|
HEALTH |
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|
Agency Resourcing - 2020-2021 |
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|
Estimated Actual - 2019-2020 |
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|
Departmental |
Administered |
|||||||||
|
Appropriation Bill No. 2 |
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|
Entity/Outcome/ |
Appropriation |
Appropriation |
External Revenue(a) |
Special |
Special |
Appropriation |
|
|
Special |
|
|
$'000 |
$'000 |
$'000 |
$'000 |
$'000 |
$'000 |
$'000 |
$'000 |
$'000 |
$'000 |
|
|
Australian Commission on Safety and Quality in Health Care* |
||||||||||
|
Outcome 1 |
- |
- |
28,056 |
- |
- |
- |
- |
- |
- |
28,056 |
|
- |
- |
28,098 |
- |
- |
- |
- |
- |
- |
28,098 |
|
|
Total |
- |
- |
28,056 |
- |
- |
- |
- |
- |
- |
28,056 |
|
- |
- |
28,098 |
- |
- |
- |
- |
- |
- |
28,098 |
|
|
Australian Digital Health Agency* |
||||||||||
|
Outcome 1 |
183,120 |
- |
32,250 |
- |
- |
- |
- |
- |
- |
215,370 |
|
178,613 |
- |
40,500 |
- |
- |
- |
- |
- |
- |
219,113 |
|
|
Equity Injections |
- |
15,458 |
- |
- |
- |
- |
- |
- |
- |
15,458 |
|
- |
20,400 |
- |
- |
- |
- |
- |
- |
- |
20,400 |
|
|
Total |
183,120 |
15,458 |
32,250 |
- |
- |
- |
- |
- |
- |
230,828 |
|
178,613 |
20,400 |
40,500 |
- |
- |
- |
- |
- |
- |
239,513 |
|
A few points seem to be rather interesting here:
First – as I read this the External Revenue (which would be the State ADHA contributions) seems to have dropped by $8.25 million. Hard to know but this might be NSW or Victoria or a couple of smaller States have baled out from contributing.
Second it does seem that the Agency Budget has dropped slightly and will probably be covered by retained reserves.
It is also worth noting that the permanent staff for the Agency seems to be 250 on average. (that begs the question as to what this small army is actually doing) but no further details are provided.
Additionally we have this interesting item to apparently protect the myHR.
“Securing Government Data
Payments ($m) 2020-21 2021-22 2022-23 2023-24
Department of Finance nfp nfp nfp nfp
Department of Home Affairs nfp nfp nfp nfp
Total — Payments nfp nfp nfp nfp
“The Government will provide funding to the Department of Home Affairs (Home Affairs) for data storage for Home Affairs, the Australian Securities and Investments Commission, the Australian Digital Health Agency and the Australian Communications and Media Authority.
The financial implications for this measure are not for publication (nfp) due to commercial-in-confidence sensitivities.”
It is hard to know just why the amounts being spent are a secret.
Additionally there is also this item:
Guaranteeing Medicare and access to medicines
The amount is $32.3m in 2020 -21 as a receipt – its not clear who is paying the ADHA to me. Suggestions welcome.
This is associated with a revenue amount of $215.4m.
I assume this is related to telehealth / e-prescribing activity. Anyone know?
There is also this note – suggesting that some ADHA things were decided after the July 2020 Fiscal Statement.
“$200.0 million in 2020-21 to continue the operation of the Australian Digital Health Agency to deliver the national digital health strategies including the My Health Record system.”
Lastly, if you were wondering here is what the Government thinks the ADHA is doing:
1. “To deliver national digital healthcare systems to enable and support improvement in health outcomes for Australians.”
That seems to be it and it is hard to know much more given we have a secretive Agency with pretty much no accountability and no minutes!
Comments encouraged!
David.
25 comments:
A little difficult to breakdown as ADHA again fails to meet its obligations - they have not published contracts for 2019-2020. Looking at previous years in Logan with budget cycles.
$40m to host MyHR
$20m to DHS for various services like HI and NaSH
$5-10m for property leases
$10m ICT and Cyber Security licenses (what costly mistakes they incurred with cloud and analytics use is unknown)
I always thoughts the Accenture payment in 2018 was a typo but maybe they got paid out for something, as there are no recurring Oracle licenses
So this leaves 125m which is pretty standard going a long way back.
250 staff is just the APS cap, add another 200-300 contractors and consultants.
This things to be delivered are certainly bold Minister, many should have started 3-4 years ago.
They say if you can’t get the little things right then you have zero chance of delivering the big things
The NSW impending tender for a Single Digital Patient Record (SDPR) is a clear rejection of the My Health Record (MHR).
The MHR offers absolutely no benefits to the NSW health system in the face of NSW plans for a Single Digital Patient Record. The ADHA know this, they can do nothing about it, other than keep spinning their wheels.
The only thing keeping the MHR going is face saving. As far as this government is concerned, the only thing worse than keeping it is getting rid of it. It's the equivalent of sports rorts - money spent defending their electoral position.
An interesting article (below) about health apps (which is really all that MyHr is)
In short, they don't get used very much. Not only that, but MyHR has a lot of competition - from apps that actually do things (at least they claim to do things) rather than just present fragments of a patient's health data - which a patient has to curate anyway.
MyHR may have been a good idea 10 years ago (which is questionable), but the idea was never properly implemented. Now it's just a tired old shadow surpassed by other, better ideas, which, guess what? are still not being widely adopted.
And even these newer apps are full of promise.
Here's the article.
Health apps: what are they good for?
http://medicalrepublic.com.au/health-apps-what-are-they-good-for/35462
"What is new, and interesting, is the rise of apps. Mobile phone applications have become one of the most talked-about medical interventions, partially because they are flashy and cool, but mostly because they hold such an enormous promise. You can make an app for a fraction of the cost of traditional medical care, and instantly reach millions of users, in theory.
And so, a huge number of apps have sprung up across the world to manage and treat chronic disease, because when we have new and flashy things we want to try them on every problem to see if they work.
But there’s an issue with apps. Anecdotally, people don’t use them for very long, which is a problem when we’re thinking of using them for diseases that last a lifetime. If people only use the app for, say, a month or two, then it’s not going to help very much with diabetes that may not ever go away."
Highlighting key words in your comment Bernard - "manage and treat", "chronic diseases", "that last a lifetime". This reinforces the need to focus on 'collaborative healthcare' first and foremost and that involves understanding workflows, communication between clinicians, and the utilisation of technology to enable and enhance clinical collaboration.
The old ‘Planet of the Apps’. Even my shoes have Bluetooth, as you point out Bernard the novelty soon wears out for the majority.
When a programme manager from ADHA blurbs on LinkedIn that this is the first time Interoperability has been mentioned in a budget and therefore change is in ever stable you know the bottom of the barrel has been reached.
Ian @10:28am
Exactly. The initiative should be driven by the meed to solve problems that are worth solving. This is a good start "enable and enhance clinical collaboration"
myhr starts off with the wrong question "how can we reduce data fragmentation and let the patient control that information?"
In other words, myhr is the wrong answer to the wrong question. Which explains why it has never delivered anything of value. It also explains why ADHA is desperatly looking for (ad failed to find) a problem it can claim to have solved.
Interoperability is a technical problem, not a clinical problem. And as long as it is even potentially controlled by the patient, myhr will fail.
Interoperability is a technical problem, not a clinical problem.
Cannot agree with that statement Bernard.
Clinical collaboration is the starting point and the end point.
Defining 'clinical collaboration'
defines the solution.
Interoperability is embedded in the solution. Interoperability is part clinical, part technical and part cultural.
Effective clinical collaboration will breakdown silos and make a major contribution to eliminating fragmentation.
-10:28 AM & 3:11 PM Two of the most sensible explanations I have heard; clear and simple. Does the ADHA understand this? If not, why not?
@ Bernard 10:49 AM " .... the need to solve problems that are worth solving .... "
So you don't think data fragmentation is a problem!!??
While eHealth needs to be aligned to clinical needs the major current issue is a technical problem! Some applications can't consume the messages they produce, display is unreliable and many message workflow issues are not implemented or do not work reliably.
If we had a firm tested expectation that applications must produce standards compliant HL7V2 (or whatever standards format they are producing) and reliably consume standards compliant messages it would go a long way to meeting clinical needs.
Applications should also produce these messages as a standard feature and not demand payment or a kick back to do so. Pathology Labs/Radiology systems should be required to accept order messages that meet standards without demanding custom formats and vertical integration for $$
We need to support not just pdf documents in messages, but the full range of atomic data in the Australian standard, including medication lists.
Until this is done the system will not work and patient safety will remain at risk, as it currently is. I see critical errors in patient data every day, but luckily can drop down to the raw HL7 or use alternate display formats to work out what they are trying to say, but this is not something that many can do! Many labs send wrongly formatted data because it is the only thing that works in popular GP applications (eg Use ST (String) rather than a SN (structured numeric))
I am horrified at what errors must be occurring because of poor implementations and messages, but it seems the powers that be just don't care?
Vendors will say doing a proper implementation will be expensive and take time! Well doing medical training is expensive and takes time but we try and insist people are competent before they are let loose on the public. In eHealth there is NO test, just say you "support" HL7 and you are done. Its not safe currently.
Healthcare service providers claim they need better access to existing data, but I've never seen anyone put a value on solving the "problem" of data fragmentation.
Data fragmentation isn't a problem. It may cause problems, but what exactly are those problems?
The value of solving those problems need to exceed the cost and, according to Andrew, that's going to be expensive.
It's far simpler, and maybe even cheaper to just get tests done again. And the argument that there is such a thing a duplicate tests is questionable. A repeat test is not necessarily a duplicate test - people change and so do their condition
There may be information when comparing the two, especially when the second test is most likely done by a different lab. This mean you get a confirmation (or not) which has value in reducing testing errors.
You won't know until you've done the second test and performed a comparison, by which time its too late - the money has been spent.
Hi Bernard, Access to existing data in referral mode is essential, as patient probably referred because of test results! Some tests involve radiation etc and do not want to repeat them. Getting that data moving reliably in atomic form is the aim. A pdf/text version of reports is not good enough. Currently results from GPs transferred in text form which is difficult to read, highlighting is lost and I usually request results from the Lab so can have the atomic data to allow decision suport etc. Being able to reliably transfer results is essential.
Thanks Andrew.
What you have provided is the start of an analysis of the current environment along with some value statements.
I say a start, because more analysis needs to be performed.
E.g. what is "existing data"?
The easy answer is everything because the healthcare provider does not know what(s)he needs to know. but the easy answer comes at a cost. Is the value worth the cost?
A harder answer is "relevant data". Which raises the question - how do you identify and acquire relevant data?
Another answer is "current data" i.e. data that is acquired at the time and place of care. This is probably the most valuable - it tells you the current state of the patient and, if done comprehensively, contains evidence of all the patient's history. It could also tell you how a patient would respond to potential treatment. This is something of an engineering approach, but, hey, it's not as though engineers haven't worked out ways to maintain and fix highly complex systems. Maybe they could teach clinicians a bit about the subject.
It may be the most valuable data, which suggests that testing a patient is likely to deliver the best outcomes. The downside is that its the hardest to acquire.
We need to accept reality and managing current health records is essential, but only if managed properly, effectively and efficiently, while also attacking the high value problem of testing.
The billion dollar questions are:
1 does myhr currently manage data properly, effectively and efficiently?;
2 if it doesn't, what's the plan to rectify the deficiency?;
3 who is driving the research into testing?; and
4 how will the initiatives/approaches be integrated and/or co-exist.
If the ADHA had a strategy for answering those questions (and the questions they imply/raise), I'd be on board like a shot.
Hints, the ADHA know the answer to Q1 and the National Infrastructure Modernisation project is all about data acquisition, not management, so it is not the answer to Q2.
"A harder answer is "relevant data""
Not really in referral context, the sender selects relevant data that they want the recipient to have without sending 200 INR tests from 2 years ago, unless that is relevant. Important thing is that the data quality is not trashed, and in many application, including MyHR it is trashed to a human only readable format. This is why when getting a referral we request the data directly from the labs, so is easier to view and do CDS on.
The valuable data outside test results is the Patient summary and there is a Virtual Medical Record in current Australian standard, but not implemented by GP systems and would need to upgrade there hl7 processing to do it well.
The Billion $ questions:
--1 does myhr currently manage data properly, effectively and efficiently?;
No it loses the atomic data and does not filter who sees what
--2 if it doesn't, what's the plan to rectify the deficiency?;
I have not seen anything coherent from ADHA ever so don't expect it
--3 who is driving the research into testing?; and
Not sure what you mean by "research" The testing is of myHR access and not what travels around currently and handling of that data. There is some pdf only testing of HL7V2, but inadequate. Testing the ability to reliably receive compliant data is the top priority as no one will create it until they know it will work, in meantime its a case of we are to scared to change it (to correct errors) because its being displayed ok in the major GP systems.
--4 how will the initiatives/approaches be integrated and/or co-exist.
If you could get original data format from MyHR might be of some use, but pdf only currently.
Differing schools of thought in these last few comments. One school is coming from a specialist clinician, well-versed in the development and practical application of information technology in the real-time healthcare environment, and deeply experienced in the health systems shortcomings. The other school emanates from an engineering discipline, well-versed in the application of academic research thinking to defining and solving complex problems and in the development and architecture of large-scale information technology systems.
While both schools have much to offer it is unlikely they will ever meet. The need to compromise is difficult to accept from the purists perspective whilst the imprecise world of medicine is full of compromises.
It leads one to question why spend energy and resources on national solutions blanketing the whole health system. Why not focus on some less ambitious solutions which encompass more well-defined areas of health, made up of specific cohorts of patients exhibiting complex chronic disease management needs using technology and standards in existence today to build some working models to prove what can be achieved.
Andrew: re -- 3 who is driving the research into testing?;
I was referring to testing the patient. In the world of biomedical engineering there is a lot of work going regarding non-invasive methods for acquiring medical data at the point of care. Similarly there are new ways to build devices that both measure the patient and apply appropriate treatment, either via drugs or electrical stimulation. The artificial pancreas is one example.
Hi Bernard,
Testing at POC still requires reporting and the ability on send those results to others, which means the ability to structure data and put it in messages. We have things like capsule endoscopy and ECAL metabolic testing that I have developed imports for so we can have atomic data to use within the practice and on send. POC testing increases the needs of everyone to be able to create good models of their data, which can be transmitted in a lossless manner. This is the role for clinical modelling/archetypes but to make use of this you build on top of the hl7v2 model and you need solid reliable handling of that to build on top of it!
Potentially POC testing is a problem if the quality of the testing and the quality of the data representation is sub optimal. While pathology labs have gone backward wrt message quality in the last 10 years, they are still streets ahead wrt atomic data and clinical quality control. The data representation is still suboptimal because of a lack of governance, but its useable in a pragmatic sense...
Hi, Andrew,
The conclusion I have come to is that applying computers to healthcare is far more than automating existing practices. True transformation will only occur when new ways to solve old problems are developed.
Most Digital Health I see is little more than using technology to do what has always been dome without improving how its done and sometimes making things worse.
@10:37 PM Sounds like reforming (transforming) the health system through the development of new models of health service delivery underpinned by digital technology.
There are the novel solutions like predicting outbreaks from google searches but the web has exploded because the underlying technology of browsers in terms of html, javascript and TLS etc have become mostly reliable and this allows things to work pretty reliably. Healthcare needs reliable infrastructure to enable innovations. We seem to obsess about quality in other areas of healthcare, but IT gets a free pass and we remain in the swamp, with our heads barely above water.
My day job involves evaluating investigations, doing investigations and communicating opinion to other doctors so I guess making that efficient is my focus. It is vastly more efficient than when I started, but is held back by endpoints that are unreliable and can't accept compliant data and are stuck with very simplistic and unreliable systems. Things like images and digital signatures, which have been possible for > a decade still don't work reliably and I am not getting referrals with basic things like coded medication lists.
I agree there is lots of innovation needed, but we need the reliable platforms to build it on. The standards exist, but we are stuck in the equivalent web world as Internet explorer V0.9
@11:00 PM that's a good way of putting it, the key phrase being "underpinned by digital technology" not "driven by digital technology"
If working at the ADHA has expose nothing else it has been this relentless culture war that has been the constant pain which get refreshed regularly. Whoever is in charge determines some future utopia where all sit in circles in perfect harmony praising flaws and describing how the previous interaction was wrong and did great harm. We are expected by those remaining of the former acting CEO to keep the cultural change going that started in late 2019 and accelerated through 2020. Which means make those bullies look good in front of the new CEO who will undoubtedly impose some new cultural revolution.
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