This release appeared on Friday last week.
Media release - Modernisation of national digital health capabilities to drive innovation
13 November, 2020: Following on from the Request for Information (RFI) inviting stakeholders to contribute to a conversation about the future of the national infrastructure in 2019, the Australian Digital Health Agency (Agency) has commenced a program of work to undertake activities to modernise the national digital health infrastructure to better connect Australia’s healthcare system and deliver significant improvements in the quality and efficiency of healthcare.
Agency CEO Amanda Cattermole said “2020 has demonstrated the tangible benefits of a better connected healthcare system.”
“In addition to the benefits from telehealth and electronic prescriptions, healthcare providers are in increasing numbers using My Health Record as a safe and secure way to upload and access documents to support patient care.”
“The modernisation of the national digital health infrastructure will provide the framework for future innovation.”
The National Infrastructure Modernisation (NIM) program has been developed with feedback from stakeholders to consider what a digital health ecosystem could be over a 10-year horizon. It supports Australia’s National Digital Health Strategy and the connections between state and territory government services.
The Program will deliver three key outcomes for Australian healthcare providers and patients:
- a secure and sustainable digital infrastructure with improved ability to innovate and expand future capabilities and services nationally;
- ensure that digital health needs for all users are further progressed through a modern, future-proofed seamless digital platform; and
- ensure that the benefits of digital health technologies and services supported by the national infrastructure are realised for consumers and clinicians, leading to improved health and wellbeing for all Australians.
Agency Chief Information Officer Kerri Burden said the tender announced today is focussed on replacing the current gateway services for the national infrastructure, including the My Health Record system.
“This is the first step in the procurement to increase the opportunity to deliver contemporary digital services and enhance connections across the digital landscape. The importance of a connected health care system has never been more evident than in 2020.”
“We look forward to working with all our stakeholders to deliver the digital health products and services Australia needs, while promoting a culture of continuous improvement and innovation,” Ms Burden said.
Here is the link:
There is press coverage here:
ADHA launches program to modernise national digital health capabilities
Following on from the Request for Information (RFI) inviting stakeholders to contribute to a conversation about the future of the national infrastructure in 2019, the Australian Digital Health Agency (Agency) has commenced a program of work to undertake activities to modernise the national digital health infrastructure to better connect Australia’s healthcare system and deliver significant improvements in the quality and efficiency of healthcare.
The CEO of the ADHA stated that 2020 has demonstrated the tangible benefits of a better-connected healthcare system. In addition to the benefits of telehealth and electronic prescriptions, healthcare providers are in increasing numbers using My Health Record as a safe and secure way to upload and access documents to support patient care. The modernisation of the national digital health infrastructure will provide the framework for future innovation.
The National Infrastructure Modernisation (NIM) program has been developed with feedback from stakeholders to consider what a digital health ecosystem could be over a 10-year horizon. It supports Australia’s National Digital Health Strategy and the connections between state and territory government services.
The Program will deliver three key outcomes for Australian healthcare providers and patients:
- a secure and sustainable digital infrastructure with improved ability to innovate and expand future capabilities and services nationally;
- ensure that digital health needs for all users are further progressed through a modern, future-proofed seamless digital platform; and
- ensure that the benefits of digital health technologies and services supported by the national infrastructure are realised for consumers and clinicians, leading to improved health and wellbeing for all Australians.
The Agency’s Chief Information Officer noted that the tender announced recently is focussed on replacing the current gateway services for the national infrastructure, including the My Health Record system. This is the first step in the procurement to increase the opportunity to deliver contemporary digital services and enhance connections across the digital landscape. The importance of a connected health care system has never been more evident than in 2020.
The government looks forward to working with all its stakeholders to deliver the digital health products and services Australia needs while promoting a culture of continuous improvement and innovation.
OpenGov Asia recently reported that following the recent release of the national digital health skills and training plan, Australia’s largest healthcare workforce of more than 400,000 nurses and midwives can now assess their digital health knowledge and skills against a new professional development framework.
More here:
https://opengovasia.com/adha-launches-program-to-modernise-national-digital-health-capabilities/
If you register you can access the Tender Documents that are mentioned in the release:
Provision of Health API Gateway Services
ATM ID: RFT DH2843
Agency: Australian Digital Health Agency
Category: 43200000 - Components for information technology or broadcasting or telecommunications
Close Date & Time: 22-Dec-2020 2:00 pm (ACT Local Time)
Publish Date: 13-Nov-2020
Location: ACT, NSW, VIC, SA, WA, QLD, NT, TAS
ATM Type: Request for Tender
Here is the link:
https://www.tenders.gov.au/Atm/Show/e42a8b1a-e8bb-4b68-af20-6313c396cefe
The documents are not an easy read but page 5 of the 22 page document on the planned future state a decade out it totally dominated by the #myHR and a range of other Government Registers (immunization, cancer etc.).
It is fair to say that you need to spend time with this picture / diagram of the ecosystem to begin to come to grips with just how the #myHR is planned to dominate all forms of Digital Health in Australia.
The ambition is stunning, the cost will be humongous and proof of any clinical value or benefit is still very vague. The questions raised are truly legion!
The architecture and information
flows all seem to fall out of a clear blue sky! In this document it is explained
that they will be details filled in later…. Fat chance!
To me – given this tender is a major underpinning of what is planed the lack of a high level architectural option analysis tells you all that is needed. This is an attempt to retrospectively and wrongly embed a failed idea into our digital health future permanently. Astonishing over-reach I reckon without a great deal more evidence and explanation! One is forced to describe the whole thing as based on Trumpian Alternative Facts!!!
Of course the chance of the ADHA being able to get something like this actually done has to be zero!
I see this as utter nonsense and pure hubris unsuited for the real Australia Digital Health World, but oh so well suited to the big consulting houses. What do others think?
Comments welcome indeed!
David.
Two things jump out-
ReplyDelete1. The Chief Digital Officer is out of his depth, this has been a common theme since his odd appointment
2. It does seem the current role advertised has been filled internally - the acting CIO is clearly not ‘acting’
Oh well I doubt it really matters, the states and their vendors play a different game so without them nothing much will come of this bollocks.
Read two things:
ReplyDelete1. The ADHA needs a new camel
https://medicalrepublic.com.au/the-adha-needs-a-new-camel/37113
2. The rft (or David's extracts)
Does the second answer the criticisms in the first?
If you think so, maybe you should seek help.
The ADHA is living in a bubble all of its own creation. Will they succeed? Probably no more than the My Health Record has succeeded - i.e. not at all.
A camel? Or a dead deformed hoarse?
ReplyDeleteIt's a con trick perpetrated by technologists who think they are building an edifice that the world will worship at the feet of but which will be totally ignored by those who are trying to improve the delivery of healthcare, a subject the tricksters know nothing about. It's called hubris.
ReplyDeleteIts just crazy, it seems we have learnt nothing from 20 years of very expensive failures. The governments attitude should be: Go off and innovate but we will be insisting that whatever you do has adequate security, respects privacy and is compliant and fully tested against any standards you choose to use. Providing terminology and universal PKI would be useful extras, as would access to things like provider numbers, but where is the evidence that government can innovate or even implement reliable systems?? They are best ignored, but insist on getting in the way of real progress.
ReplyDeleteAn advocate of the adoption of safe and well-engineered information technologies as trusted tools within medicine will not only improve healthcare but also drive economic growth. Because real economic growth depends on real innovation, and technology will play a key role in enabling those innovations to become a reality. Without innovation, efforts at digital health transformation are likely to lead to uninspiring attempts to keep doing the same things but with new technology, which might cut some operational costs, but is neither innovative nor transformational. This is why innovation capability is such a key component of “effective” digital transformation regardless of the sector. The delusion of Digital health transformation (even when using modernisation) is the tendency to label any project or programme involving digital health technology as “Digital Health Transformation”. As ADHA and others consistently demonstrate – they are often initiatives that will neither disrupt markets nor protect against disruption and often lull stakeholders and the public into a false sense of security when the community for which are intended benefactors are led to believe they are transforming their lives through digital health advancements. This is common when so-called digital health modernisation happens without taking innovation seriously. The word ‘Innovation’ conjures up different definitions for different people. While ADHA and its cousin organisations proudly announce how innovative they are, many are yet to do any genuinely innovative. While most people do at least agree that it’s good to be an innovator, how ADHA and its cousin organisations translate those good intentions into action vary dramatically and more often than not end disappointingly.
ReplyDeleteI am sure the ADJA latest attempt delivers a warm and fuzzy feeling and ticks the boxes for the ATs version of strategy pitching. As Andrew states this misses reality and belongs in a galaxy a far far away.
Hard to argue with your points John. ATS - assume you refer to the applicant tracking system? If so, I wonder if such a version is used for this sort of thing. Would explain why BS gets through everytime.
ReplyDelete(Part 2 of 2)
ReplyDeleteThe myhr is aimed at, and implemented for, Australians who wish to create and manage their own health data. If the consumer (I hate that term) does not wish to engage with the system then the only data in their myhr will be PBS/MBS (which the government holds anyway) and sporadic test data with no context.
The myhr is totally unsuitable as the core of any health data system.
If you look at the way the ecosystem is presented, it appears that myhr is central to the system. It hangs off the hub and appears to be the major focus. However, some critical functionality resides outside myhr - Authentication, Identification, Authorisation and Directory Services.
However, if the myhr were removed, what would be left? A highly connected system of data exchanges that feeds government.
If you compare the current state diagram with that of the future state, the goal is to externalise all the non-database components (which is based upon the flawed model, mentioned above). That way, the myhr can be retired (or parked) leaving in place a mechanism to get at patient data for use in the Research and Public Heath segment.
It is worth noting that nowhere in the Modernisation Overview document is the subject of government agencies sharing data. This is in spite of the aim of the ABS, through the MADIP program to link data and well as DTA/PM&C's objectives of maximising the use of public data (which includes health data)
There are two possibilities - either health is forging head on its own desperate to deliver something based upon a failed initiative, or they are working with other agencies to deliver an infrastructure that sucks in health data under the cloak of "helping patients better manage their health"
This is all speculation on my part, but a ten year program that does nothing to improve the functionality of myhr but which does allow government better access to detailed patient data must have something behind it. It could simply be ADHA justifying its existence, or it could be part of the current government’s fascination with, and addiction to, leveraging data. It is one thing to better use data that is legitimately gathered as part of its normal business processes. It’s another to go out of its way to harvest personal data to which it has no right or consent to gather and/or utilise.
(Part 1 of 2)
ReplyDeleteThe ten year modernisation program is an expansion of the infrastructure (they now call it an ecosystem) that supports the myhr app. It is not a transformation, neither does a summary health record system constitute a transformation
Figure 2: "National Digital health Ecosystem Future State Concept" of Attachment B to Part 1 (RFT): National Digital Health Ecosystem Future State Concept is a technologist's wet dream.
It is mishmash of a wide range of "things" (including a little picture of two suburban houses labelled Community, complete with swimming pools, not connected to anything and next to "social Determinants").
Cutting through the crap, there are two major components. The myhr and a hub which is the front end through which all data flows into and out of myhr.
The hub is also a means by which a set of data exchanges can access data which is then fed into the Health Analytical Store, which is described in the figure as:
"The Health Analytical Data Store provides a single place for analytical and big data analysis of Australian health information. The Data store supports the use of the data for research, policy development and predictive health. Health Data will be de-identified however restricted secure access will be available in certain cases."
It feeds the Research and Public Heath segment - government.
It is worth looking at Attachment A to Part 1 (RFT): Modernisation Overview, which includes this:
"The National Digital Health Strategy describes how the My Health Record System is positioned to be a key component of Australia’s national digital health infrastructure. It provides a safe and secure way of sharing health information that can connect key parts of the health system, such as general practices, pharmacies, private and public hospitals, specialists and allied health professionals. With the foundations established and operational, the opportunity now exists to enhance healthcare provider participation and clinical utility and deliver key benefits for the healthcare system."
There is a cognitive dissonance in this whole strategy and the RFT.
(Part 2 follows)
Great summary Bernard.
ReplyDeleteCognitive dissonance ......... refers to a situation involving conflicting attitudes, beliefs or behaviors. This produces a feeling of mental discomfort leading to an alteration in one of the attitudes, beliefs or behaviors to reduce the discomfort and restore balance.
One or more of the large consulting firms have clearly had a significant influence on the ADHAs thinking around - "Where do we go now?"
Reading the documents and key (buzz) words my money is PWC. Always was a favourite of BM, famously wasted 7 million of PMO consults and delivered nothing.
ReplyDeleteDoes anyone know or recall when ADHA moved its Head Office from 56 Pitt Street Sydney to 175 Liverpool Street Sydney?
ReplyDelete26 Oct 2018 Kate MacDonald reported in PulseIT that "ADHA is moving its Sydney headquarters from the stunning end of Pitt St to the relative doldrums of Liverpool St".
ReplyDeletehttps://www.pulseitmagazine.com.au/blog/4643-a-tale-of-two-comments
Late 2017 I recall
ReplyDelete2017 they moved Brisbane offices, from dreary downtown to high rise river views. They also moved the Canberra offices. The GM for these changes proved to be lacking listening and leadership qualities.
ReplyDeleteDavid, I am wondering who authored the API Gateway document! Part 2 for example seems to me to be well beyond the skill sets, technical, experience, and know-how of the ADHA!
ReplyDelete8:38 AM. Why do you say that?
ReplyDeleteI have no idea who wrote the document but it does not seem all that well done and a simple reader like myself has no clue as to what it means after trying quite hard to follow it. An idiot's guide would help me for one!
ReplyDeleteDavid.
The most obvious author of the document is Accenture. Maybe with some help from the FHIR people.
ReplyDeleteThey also seem to be trying to fix some of the authentication and authorisation problems of myhr.
There's an interesting clause in 2.3.4 of "Schedule 2A to Part 2 (RFT) – Health API Gateway Solution Requirements"
The Solution must support the orchestration of API requests, according to defined business rules, prior to calling the ultimate endpoint(s) for all API requests. Such orchestration includes:
...
• linking services (e.g. healthcare identifiers to social welfare identifiers); and
...
Anybody care to guess what this might mean?
"Who wrote the document" is an excellent question. I agree with Bernard - probably Accenture.
ReplyDeletePart 2 consistently refers to "THE SOLUTION". I get the distinct impression it is an all-encompassing generic template used by a global consulting firm and tailored in a few scattered places throughout with some specific references to the clients 'situation'. In effect it is the result of an extensive consulting / sales and marketing process as part of the typical modus operandi of global consulting firms to cuddle-up to the client in order to build trust and confidence over the lengthy 'sales cycle' in the lead-up to a tender being called.
It is not unreasonable to expect that if the document had been developed 'recently' (say over the last 12+ months) the ADHAs Head Office address would be shown as Liverpool Street. Given that ADHA relocated from Pitt Street at least 2 or more years ago it is reasonable to conclude that Part 2 documents (a la the large consulting firm) were initially 'compiled' 2 years ago. I am sure you will find that within the next 24 hours all references to the Pitt Street address will disappear!
The documents are inconsistent.
ReplyDeleteAttachment A to Part 1 (RFT): Modernisation Overview
and
Attachment B to Part 1 (RFT): National Digital Health Ecosystem Future State Concept
show Liverpool Street
Schedule 2A to Part 2 (RFT) – Health API Gateway Solution Requirements
shows Pitt Street
It will be difficult to change the documents that have already been downloaded. They will probably need to issue a formal clarification.
One might argue that they defined the solution first and then worked on the overview/concept/strategy etc later.
... of course they did BUT did they know what the problem was that they were trying to solve?
ReplyDeleteThey have never precisely delineated the problem that needed to be solved. Don't expect them to change their ways now; they won't.
ReplyDeleteThe reason is because they are driven by a belief in the power of technology that it can solve any problem.
That belief is driven by the sales and marketing personnel intent on selling their technology products.
So the way it all unravels is - "Yes, the technology sounds fantastic, let's buy that to solve some of our problems, then we will work out what problems we might be able to solve with our new technology".
.... and the winner is the technology vendors and their sales and marketing people.
ReplyDeleteand, of course, the consultants who are aligned (often behind the scenes) with the technology vendors. Surprise, surprise.
DeleteAt our sales strategy and tactics meetings we often talk about how to light the fire(s) then drop the fire blanket over the target customer from on high, and how to spread it far and wide to smother smaller competitors and deprive them of oxygen.
ReplyDeleteThe unstated problem they are trying to solve is "how can we stay employed?"
ReplyDeleteWhat did people think of the presentations of Greg Hunt and Amanda Cattermole at the MSIA summit today?
ReplyDeleteThey both seemed to say that the pandemic had highlighted to government that health tech has been embraced by clinicians and patients, and has provided efficiencies, and as such will be an important part of healthcare in future.
There was lots of talk about the benefits of telehealth, escripts, real time monitoring, interoperabiitiy, etc, and apparently there will be loads of collaboration and "listening" to industry in future, but nothing meaningful about investment.
Oddly, My Health Record was described many times as the "foundation" of the federal government's digital health infrastructure.
Amanda Cattermole said in a nutshell:
The controversy of the past in terms of the laying down of the foundations, such as My Health Record, has passed.
The use of MHR has become more embedded in clinical workflows.
Medicines and diagnostics information are the most viewed information sources.
There was/has been increased use of My Health Record during the bushfires and the pandemic.
Uptake and uploading of MHR has grown in public hospitals, general practice, pharmacy and diagnostic services.
And Amanda said that in discussions with jurisdictions and other stakeholders since she took on the role six weeks ago, “Nobody says throw out My Health Record but they do ask what’s next?” She said its value as a foundational platform will be built upon.
Interested in your thoughts.
I think those words might come back to giant them. Spikes in online content can be attributed to the pandemic, people have been on the web far more and away from the office. I think it is to early to be making such claims, as life returns to normal, old patterns of behaviour will return. Resulting in things more interesting to do.
ReplyDeleteMust be deaf in one ear if all she hears is no one saying turn it off. Following the party line I guess
"What did people think of the presentations of Greg Hunt and Amanda Cattermole at the MSIA summit today?"
ReplyDeleteThey are being fed misinformation about My Health Record which they repeat parrot-like.
Those who have been following the thing for the past ten years know that:
It is totally unsuitable for clinical settings because a) it contains no history or context, b) it requires the active engagement of patients, some of whom will delete data or prevent it getting into the system and c) rather than decrease fragmentation, it increases it. The information in My Health Record on medications comes from multiple sources and is often inconsistent, it's certainly unreliable.
No matter how hard they try and polish it, it will always be what it is - a pile of steaming brown stuff.
Well those who thought the My Health Record would be pushed to one side to wither away from neglect will be sorely disappointed. Nothing has or will change for the better, the status quo will remain, many more hundreds of millions of dollars will be spent in the forlorn hope that some good may come from it one day. Another decade of wasted opportunity lies ahead and no-one can do anything about it.
ReplyDelete@4;38PM Those who thought that are naive, gullible, wishful thinkers.
ReplyDeleteSome on this blog are really smart and highly experienced digital health practitioners, but they lack the strategic thinking wherewithal needed to overcome the barriers that have been put in front of them by the bureaucratic shenanigans of the last decade.
It may just be a useful distraction for some, the Feds are to busy playing with their own toys to have time to do much else.
ReplyDeleteThee reason why MyHR still exists is because the government wants o use it as a mechanism for acquiring and linking data with other data sets. It's a means to an end, not an end in itself.
ReplyDelete@10:24 AM Please explain what government hopes to achieve by doing so.
ReplyDeleteWhat benefits does it envisage will flow?
@9:28
ReplyDeletehttps://www.abs.gov.au/websitedbs/D3310114.nsf/home/Statistical+Data+Integration+-+MADIP+Research+Projects
https://pmc.gov.au/public-data
@9:46 AM I'm none the wiser about what the benefits are. Your links point to a lot of projects and a lot of words; so what. Are you impressed? Do you know what the aim is? Do you know what the benefits are? Oh, and what is the cost? Who is lapping up this rubbish?
ReplyDelete@5:11 PM That's the problem. The government is not being open about what it will do with all the data it is going to link.
ReplyDeleteThey have never said why the ADHD NIM RFT specifies the requirement to link healthcare identifiers to social welfare identifiers.
@7:35 PM Well, let's pretend you are the government. Why do you think you want to link healthcare identifiers to social welfare identifiers?
ReplyDeleteWell I spent the morning pretending to be the government. All I have now is a headache from shouting and muttering irrelevances across the table to myself. It left me with a large debt.
ReplyDeleteAs for the MyHR and it ongoing saga. I wonder if those in ADHA and the department have become wedded to a technology solution and lost sight of the policy aim. The requirement is still valid. However they have implemented a constraint which itself has manifested a web of dark constraints. Change will not be easy but there are signs wealth is being created through alternatives and only revenue streams will change the status quo. IMHO
Whatever the intend to do with all this data I hope they do not start handing it over to the university’s
That is a fair set of observations Paula. Don’t often hea r the term’dark constraints’ fits well in the murky world of healthcare financial mismanagement.
ReplyDeleteI see you have witnessed the frivolous way universities allow data to be picked up and shared with little care of understanding :)
Possibly a plank in the deep state machinery, they can check if you have had the experimental covid vaccine and check on your health if you are claiming benefits. Possibly the only thing its really useful for?
ReplyDelete