This commentary appeared a day or so ago.
A certain digital behemoth is blocking innovation
Steve Posnack describes himself as “the No 1 No 2 digital health policy development and implementation staffer in the US”.
His role, as the deputy national coordinator for Office of the National Coordinator for Health Information Technology (ONCHIT), in the US, reports directly to a serious political minder appointed by the ruling party of the day.
Yesterday he officially got his new boss from the Democrats, and while Posnack is that sort of refreshing intelligence that can somehow keep you onside regardless of the politics in play, you get a distinct feeling of energy and optimism that is perhaps a little more than his everyday exuberance for his work (of which he always has a lot) and something to do with the Trump regime moving on (for now anyway).
Posnack’s job – how he’s managed it in the past 10 years, who he reports to – should inform how Australia might better go about converting some pretty robust thinking on digital health in this country into, first, meaningful policy and then successful implementation.
His equivalent in Australia might have been seen, until recently perhaps, as the CEO of our Australian Digital Health Agency (ADHA).
But there are some important differences. Posnack reports directly to a powerful political figure that can get things done when needed (this person pretty much has the President’s) and who intimately understands the power of properly digitally transformed health. In contrast, the ADHA CEO reports to someone in the Department of Health (DoH) who reports to someone else, and then eventually to Dr Brendan Murphy (DoH secretary), who of course reports to the federal health minister.
A lot can and does get lost in translation in that chain of communication.
This goes a long way to understanding that while the US health system is largely an eclectic mess created by vested interests in private-, public-, federal- and state-based funding, with the resultant interoperability issues at a multiple greater than Australia, a lot more fundamental change is being executed in the US system than Australia in terms of digital health.
Yeah, the US government is orders of magnitude better than us in understanding and developing meaningful facilitation of fundamental technologies that are going to make our entire healthcare system a lot safer, less expensive to run and more efficient. That’s not what any minister is going to hear from senior health bureaucrats and certainly not from the leadership of ADHA.
The US doesn’t have a better health system, sure, but on any ranking of bang for buck in moving the dial on technology in health that works for patients and doctors, they are way ahead of us and gathering speed rapidly. We are stuck and starting to go backwards.
A key example of fundamental, meaningful and impactful change in the US is a piece of legislation introduced five years ago that demanded that healthcare providers, suppliers and tech vendors end ‘information blocking’ in the sector.
Information blocking is when healthcare vendors and service providers deliberately prevent healthcare data sharing in order to retain commercial advantage – literally, you can’t go across the street to another hospital because they’ll never be able to get your data and work out what’s going on. The blocking has been at the vendor level (if I’m Cerner, two systems in two hospitals across the street from each other is better than one in money terms every day) and because of the unique private insurance system in the US, which controls much health provision, at the provider level you want to do everything to prevent losing a customer (if you leave me, your data won’t come too, and that is going to cost you a fortune as a patient).
As well as Posnack getting a new boss, that legislation formally came into play yesterday in that yesterday was the deadline when every provider and vendor had to have their act together on having systems that were open enough to allow smooth transfer of their important patient data.
Posnack has been one of the major people overseeing the introduction of the legislation, and he may be the lead on investigating any complaints from interested parties (often patient advocate groups) who suspect blocking is still going on (which it will be in spades).
The change is important globally as the stance of the US government has deeply affected the major US-based EMR vendors – groups such as Cerner, EPIC and Allscript – all of whom operate globally and in some way or another in Australia, and all of whom have, as a result, put Fast Healthcare Interoperability Resources (FHIR) interfaces (an emerging and powerful web-based healthcare data sharing protocol) on their products and sometimes even spruik the idea of open APIs throughout the digital health ecosystem.
Past and present leaders of the ADHA might like to argue that Australia’s equivalent to the ONC’s success with anti-blocking legislation is the MyHealthRecord (MHR).
But there is virtually no comparison.
The MHR is an infrastructure project that was politically motivated as a show pony project by a health minister many years ago, is infrastructure built and run by the government, was never a future-proofed technology solution, and was out of date as a means of platforming better sharing of data in the system up to 10 years ago.
The MHR has absorbed vast sums of money (now more than $2 billion), achieved virtually nothing in terms of substantive advances in efficiency and patient safety, and faces an uncertain future as a centralised honeypot of disorganised patient data, the principles and structure of which now fly in the face of how distributed data technology, open APIs and effective secure sharing of healthcare data in the future should be facilitated.
Already we see that mobile technology can more securely and effectively store and share a patient’s healthcare data, as they need it, and as they want it.
There are pages and pages more here:
https://medicalrepublic.com.au/a-certain-digital-behemoth-is-blocking-innovation/43256
It is not hard to make the need for major change pretty clear.
The present ADHA strategy argues that the #myHR is the central part of the forward direction for Digital Health in Australia.
This is clearly bunkum! If the #myHR were so wonderful we would not be seeing:
1. Weekly distorted press releases from the ADHA claiming all sorts of benefits that are not supported by any evidence.
2. Statistics outlining the size of the ageing document pile while providing no information of what might be considered ‘meaningful clinical use’ of the system and evidence of real clinical impact.
3. Continued failure by clinicians to use the system other than at a rate that will attract the generous ePIP payments.
4. Surveys showing patients use doctors and nurses to guide their clinical course and interventions and a pretty much total avoidance of the #myHR by the vast majority of the general public!
The system is costing millions per year to operate and there are plans to spend vastly more on upgrading a system which – even following an upgrade – will not be useful to doctors or patients in any meaningful way.
What is needed is a totally new
strategy that does not have an elderly clunky idea at its centre and which
supports the actual information needs of patients and clinicians as well as diversion of the funding presently wasted on
the #myHR to initiatives which will really help and make a difference inside and outside the public sector! Modern standards-based approaches with API's etc are a given were appropriate.
It really is that simple. I really hope that ADHA might actually be up to the challenge but I suspect we are sadly going to see more ‘waste and mismanagement’ into the future.
What do you think? It is pretty clear from the very long article cited above that its author is pretty deeply frustrated just as I am as are many who read here!
David.
11 comments:
TL;DR
"The MHR is an infrastructure project that was politically motivated as a show pony project by a health minister many years ago, is infrastructure built and run by the government, was never a future-proofed technology solution, and was out of date as a means of platforming better sharing of data in the system up to 10 years ago."
says it all.
Then rubs salt into the wound
"The MHR has absorbed vast sums of money (now more than $2 billion), achieved virtually nothing in terms of substantive advances in efficiency and patient safety, and faces an uncertain future as a centralised honeypot of disorganised patient data, the principles and structure of which now fly in the face of how distributed data technology, open APIs and effective secure sharing of healthcare data in the future should be facilitated."
The real question is "why is the Federal Government doing any of this Digital Health stuff?"
In which other industry does it run an equivalent "National Strategy"? Does it tell universities how to teach? Does it tell the states how to run their legal systems?
There's a difference between regulating/setting standards and actively participating in the market place.
Given the conservative preference for small government there's something driving the LNLP that they are not telling us about. They've even conned the Labor party.
Something smells and it's not the roses.
"why is the Federal Government doing any of this Digital Health stuff?"
maybe because they can divert attention away from those things for which they are responsible but are failing to deliver on: Aged Care, NDIS, COVID-19 Vaccination
Disability sector labels wait for COVID-19 vaccines 'shameful'
https://www.abc.net.au/news/2021-04-12/disability-providers-wait-covid-19-vaccine/100061966
As Australia enters its eighth week of the COVID-19 vaccine rollout, thousands of the nation's most vulnerable are still waiting for their first dose.
We need to get back to grassroots. Listen to health staff, collect their experiences and ideas and build better services. For to long the My Health Record has drowned out the rest of digital health.
That is very Noble G Carter, interested how that funding would be administered, by whom, and with what return? The My Health Record is a symptom of a larger sickness. I can find no entity coordinated enough to achieve the goal of national coordination. Certainly not ADHA, AIDH, CRC or any other the other spin-offs. They are all self serving and focused on bits.
That is a hard set of questions Sarah Conner. It would appear on the surface to be simple enough. The track record to date would indicate that it is all to easy to make a complete hash of things, leaving a bigger and more unmanageable mess than was started with.
Certainly worth debate
Given the track record of all the National eHealth agencies I think the best policy is the minimal one, but the one thing that has not been done! The Health Department should verbally encourage eHealth, but simply say "Go forth and code, but peoples lives are at stake so we insist any transaction between providers is standards compliant and tested". Standards are something developed by knowledgeable users, after much debate, not handed down from the ivory tower cast in stone.
Its not a mystery, the foundation of interoperability is compliant data and compliant data handling, and data quality will only improve when that compliance is expected, in fact demanded. This is the one thing, the foundation stone of eHealth, that has been totally ignored. My Health Record is a distraction that appears to be generated by the PR department. What they should be saying is "We made sure everyone's software complied with standards and look what people built on top of that", but it appears that doesn't satisfy the content for the glossy brochure espousing achievements?
Maybe remove AIDH from the mix, that is a members club and is focused on building membership and providing pathways, has a roll as a pay-to-participate fiefdom but is not a body that can act of behalf of major funders and policy setters. AIDH still has some maturing to do in one of two state branches, one particularly looks more like a collection on sole-trader consultants rather than a health informatics leadership group.
A not so shuttle rebuttal of the stubborn belief held by far to many ( either misguided or self serving). The big question is - did they design in an off switch?
A good read, nicely written
Can’t argue with Andrew’s comments. Sound decision support requires solid and meaningful information, that information is only as good as the data feeding it. My Health Record is ROT - redundant, obsolete, trivial. Get clinical communication working well and you can overlay any number of consumer health record solutions, consent tools to share data and so on.
Another perspective might be - Microsoft just paid $25 Billion to acquire a component of its health portfolio. Not sure our Government quite has the budget to compete, by continuing to compete it is robbing Australians of real digital tools.
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