Here are the results of the poll.
What Do You Think Is The Most Important Digital Health Initiative For The Next 2-3 Years?
E-Prescribing 16% (12)
Telehealth 30% (23)
The My Health Record 3% (2)
State Based Health Information Exchange 23% (18)
None Of The Above 25% (19)
I Have No Idea 4% (3)
Total votes: 77
Telehealth and State Based Info Exchange along with e-prescribing were seen as important and the #myHR not at all with very little support! Can people please comment re: what the ‘none of the above’ initiatives were?
Any insights on the poll welcome as a comment, as usual.
A very reasonable number of votes, given the time of year.
It must also have been a bit hard with 3/77 readers were not sure how to respond.
Again, many, many thanks to all those who voted!
David.
15 comments:
David, I was one of the few who said 'none of the above'.
The reasons for my vote largely relate to the failure to address the human-sphere level issues, such as Medico-legal, privacy, security, etc. in a coherent manner. Add to this the issues surrounding making any new initiative sustainable through modified funding flows; these are before we get to the technology issues.
The ability to gain traction within an enterprise is one thing; it is entirely a different proposition when you cross organizational, professional, jurisdictional and other boundaries.
Add to this is the potential to expose highly sensitive personal information which reminds those of us old enough to remember HIV/Aids and CJD of the public attention and reaction to missteps, etc.
So, for me, the major challenge ahead is to address the void in how we move forward through qualitatively improving information flows such that public trust is maintained in our health and care systems.
Throughout the world enormous (huge, vast) amounts of money have been invested in attempting to build these ‘exchanges’ but as far as I can tell they have all failed to achieve their far-reaching aspirational claims and promises. I might be wrong, but I think not.
That being so, why are you and others suggesting that ‘a health information exchange’ will solve the problems of Digital Health?
It sounds like you see it as a technical solution to an ill-defined problem.
Where in the world have Health Information Exchanges been shown to be widely effective on anything other than a relatively basic simplistic exchange of very limited amounts of health data?
John said "So, for me, the major challenge ahead is to address the void in how we move forward through qualitatively improving information flows".
I think it fair to say that is a given, certainly at the highest level and, in principle, widely accepted by all; health professionals, ICT practitioners and technology advocates, politicians and bureaucrats.
That's the easy bit, but so what. Words are cheap. There are vast numbers of organisations and people all working with various good and noble intentions and in their differing ways trying to do just what John says. The philosophical thinking he describes is nothing new; but where does it lead, if anywhere? Does it provide any solid substance and foundation upon which to build or is just quicksand?
Are all these organisations and people getting anywhere? Are they making progress? Or are they just keeping themselves 'gainfully' employed chasing 'their' individual rainbows? Is it a case of two steps forward, one step backward? Is it more a case of 'they can't see the wood for the trees?' Are they making money from their efforts?
Digital health has a long way to go in Australia, at both ends.
(1) See https://www.nytimes.com/2021/01/01/world/middleeast/israel-coronavirus-vaccines.html
Israel’s heavily digitized, community-based health system — all citizens, by law, must register with one of the country’s four H.M.O.s — and its centralized government have proved adept at orchestrating a national inoculation campaign, according to Israeli health experts.
That success has much to do with Israel's biometric ID cards, I guess. The turnaround times at our vaccination points will be lengthened because each subject will have to go over their bona fides for manual entry into the database.
(2) Much to improve with delivery of telehealth consultations. I've had to "attend" a few, the last one was with a registrar, new to me, whose name I couldn't catch in the introduction. The one before that had a lot of important stuff to get across to me, I thought I was taking to someone new but it was my usual physician. I'm yearning for telehealth consultations over video link, high quality so nothing is lost.
Digital health does little, if anything to improve medical care, in the sense that more people are made healthier. Digital health is about the business of health, not health care. The only reason governments are interested is to try and contain costs. There's also the opportunity to spy on people just in case they are doing things they shouldn't be doing, something governments are always in favour of.
???!!! "yearning for telehealth consultations over video link, high quality so nothing is lost".
???!!! .. . what? ... so nothing is lost" !!!
Naive? Note the old French proverb ... "The written word stays, while the spoken word flies away."
Now, what were you saying about Telehealth?
Anon, Jan 03: 11:01AM,
I agree with the thrust of your argument.
A Health Information Exchange will not solve the problems of digital health; it can be a component of an overarching solution framework.
I agree further that starting from the technology is the wrong approach.
Anon January 3, 1:12P)M
My first response is that we remain captured by the Record/Archive model focusing on collecting health information from an increasing array of sources.
The proposed Victorian CIS is a case in point although both the ACT and NSW Health appear to be proceeding along the same pathway.
If we adopt the lens of human communications the first question we can ask is how well these initiatives inform, guide, enable and support qualitatively improved information flows at the point of care?
The next question would be: to what extent do the clinicians themselves have real control over the nature of the information flows they receive and the ability to adapt/re-design these information flows to make them more meaningful in regard to subsequent action?
Further, can the clinicians design and implement new information flows; information flows not previously recognized by the vendor/solution provider? Friction can arise because the vendor/solution provider has a larger audience to service and the priorities may be in conflict.
In point of fact, the idea that clinicians themselves would articulate the specifications for these information flows is not part of the architecture of the Record/Archive model.
The above challenges point to the need for a solution framework that purposefully separates the human sphere from the technology sphere and enables the clinicians to work on qualitatively improving the flows of information to support action. The solution framework would use the community to 'pull' the enabling digital infostructure and infrastructure forward.
A recent publication by the WHO and ITU sheds light on some of the ways different health systems have addressed these issues. Here is the site: https://www.who.int/docs/default-source/digital-health-documents/digital-health-platform-handbook.pdf?sfvrsn=e76a2470_2
This Report has a Record/Archive model at its heart but it does flesh out a range of important issues for each health system to consider as it develops it 'way forward'.
The Canadian Health Infoway is featured as a case study (page 164). The 'lessons learned' section on page 170 is informative.
Greater emphasis will be placed on aged care and wellness. With Aged care a major shift in the way care is delivered with a shift away from traditional care home models. As with home care more generally this will see IoT as the digital tools and real time or close to driving decision support. The current methods used for prescribing and telemedicine will get flipped through the changing home care models.
Large hospital system will remain, there will be a surge in new entrants that will force change amounts the current incumbent vendors. My HR will not be able to keep pace.
@ long live t.38 - “the My HR will not be able to keep pace”
My Health Record worked best as an incubator of ideas, a place to pilot, test and learn -- and a way to share best practices across our states, territories and private healthcare organisations. These learnings have been invaluable. We must now take these learnings forward and boldly seek to:
Reimagine — using the national treasure that is our digital health strategy
Reorganise — build a cohesive and inclusive digital healthcare community based on education and resources
Rebuild — replay form the national infrastructure to establishing a modern digital infrastructure placing federal departments at the helm of healthcare delivery, freeing states to focus on dealing with payroll systems and unions.
Refocus — develop a relentless customer focus culture without lessening the need to support a large bureaucracy and population control monitoring.
Reinvent — continuously review the need to reshape business models and funding models, carefully ensuring any such recommendations are lost in the bureaucracy thus preventing a change from the status quo and comfort zone.
Happy 2021 all
@ 8:47 AM. Is that sarcasm woven into what could be straight out of the little red book of digital health sales? Well played Anon happy 2021
@ 8:47 AM Rebuild — replay form the national infrastructure to establishing a modern digital infrastructure placing federal departments at the helm of healthcare delivery
If you believe that, you'll believe anything.
I noticed recently that Minister Hunt had signed a contract with Accenture to develop a tracking system for recording everyone vaccinated against Covid-19.
My question is - Does the National Immunisation Register have any part to play in keeping track of my Covid-19 Vaccination information or is it another white elephant?
I'm not optimistic about the responses this question might generate!
I would have thought Accenture would develop the logistics and tracking aspect of the 'system' and interface that with the National Immunisation Register to update a persons Immunisation Record to which doctors and their patients can then refer.
Ask Brendan Murphy, he will know, failing that try Minister Hunt.
Sounds like Yes Minister.
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