These 2 reports of a recent international discussion appeared last week:
First we had:
https://wildhealth.net.au/three-nations-one-digital-health-message/
22 April 2021
Three nations, one digital health message
ADHA Big Data Booking Engine Cloud COVID-19 DoH EHR/EMR Hospital Insights Interoperability NHS Technology
Felicity Nelson and Talia Meyerowitz-Katz
A curious thing happens when you put digital health experts from America, Scotland and Australia side-by-side on a webinar panel. While the accents change from speaker to speaker, the message remains constant.
The core lesson from the Wild Health webinar
(which you can watch on demand here)
was that everyone wins when we put aside differences and pitch in to build
sturdy, lasting, interoperable digital infrastructure – and we can win big in
the middle of a global pandemic.
But each country has its own unique challenges and there’s always more work to
be done.
The panel was chaired by Jeremy Knibbs, the publisher of Wild Health.
Representing Australia on the panel was
Grahame Grieve (Founder of FHIR, global interoperability consultant and
principal of Health Intersections) and Professor Dorota Gertig (Medical
Director, Population Health at Telstra Health and a public health physician).
Professor George Crooks OBE (Chief Executive of the Digital Health & Care
Innovation Centre) tuned in from Scotland.
And from the US, Wild Health invited Steven Posnack (Deputy National Coordinator for Health Information Technology) and Aashima Gupta (Director, Global Healthcare Strategy and Solutions, Google Cloud).
In Scotland, the pandemic generated “top-down permission” and the “bottom-up need” for change, leading to some truly impressive leaps in the use of ICT architecture and cloud-based digital technology in COVID contact tracing, said Professor Crooks.
Because the cloud infrastructure was already established, the government could quickly switch on a new application, allowing citizens to participate in the contact tracing process.
“The beauty is that it puts the citizens at the centre, they do their own contact tracing,” said Professor Crooks.
“And the average time from getting a positive notification to an individual starting self-contact tracing is 12 minutes,” he said. “And 55-60% of citizens actually actively participate within an hour and a half of that notification.”
In
the US, major legislation pushed through in 2010 meant that 90% of US hospitals
already had electronic medical records before the pandemic hit, said Mr
Posnack.
COVID accelerated the expansion of digital health. “How we work has changed,”
he said. “In the past year, I have set foot in the office once as a government
employee running a government agency.”
Some provisions have been made to expand telehealth but there’s been a
reluctance to establish payment methods, he said.
There is also more appetite for health information from patients now. “Everyone wants access to their test results,” he said. “Everyone wants access to their vaccination status.”
The US has the HIPAA law, which provides a right for citizens to gain access to their health information.
“My
optimistic hope is that this may help prompt people to seek greater access and
more engagement in their care overall from a digital health perspective,” he
said.
Unfortunately, Australia’s digital health infrastructure was “very solution
focused, very insular in in the way it’s conceived”, said Grahame Grieve
“Instead
of building an infrastructure that leads to new integrated market development,
it seems that we’ve headed towards an infrastructure that sucks everything into
what it is,” he said.
“It’s very frustrating to see how that approach isn’t developing into, what I
think we need, which is a resilient and adaptable architecture.”
Lots more here:
https://wildhealth.net.au/three-nations-one-digital-health-message/
and the next day:
Why the UK and US are now in front of us in digital health
ADHA Government Interoperability MHR
Last week’s Wild Health webinar on lessons from the US, the UK and Australia from COVID induced digital health innovation, sponsored by Telstra Health, revealed two countries now in front of us and moving much faster towards a more interoperable ecosystem as a result of COVID induced digital health innovation. What happened?
If you ask virtually any senior digital health staffer in any advanced country what was the greatest leap forward that COVID induced in their healthcare set up the inevitable answer is telehealth. In the UK, the US and Australia, telehealth made leaps of various sizes, often associated with governments accepting that they needed to establish pay signals the system for it to be used more effectively.
But while vastly applicable and useful in the crisis, in some ways the telehealth story belies what COVID really did in many countries, which was put their existing interoperability infrastructures to the ultimate test.
In last week’s Wild Health Webinar, digital health leaders from the US, the UK and Australia were asked what COVID induced innovations were significant and real, and what ones were more potentially illusionary. Which ones might slowly slide backwards despite the hype?
As expected, Telehealth was an initial winner nominated for each country. Notably in the UK, video telehealth took off, whereas in Australia video has not taken at all. It feels likely that video telehealth was able to take off because of existing or developing infrastructure in that country, especially around delivery of hospital outpatient services.
Three years ago the UK moved to put all of its health service providers and vendors a notice that the intention moving forward from that point was “cloud first”. The NHS put a lot of detail around what they were expecting. It wasn’t a new standard (the route taken by the US) but it might have been as good as. If as provider you were going to doddle and not upgrade towards new web sharing technologies you would be in trouble. As a vendor there was nothing to do but start developing systems which met the criteria.
By the time the COVID pandemic hit, NHS cloud based solutions like Carenotes allowed staff to view and share patient medical records from a desktop or mobile device anywhere in the UK.
----- Lots omitted
The My Health Record, which should have been the centre piece of a crisis like COVID, if it was ever going to live up to the government’s promises, was almost entirely missing in action.
Unfortunately, Australia’s digital health infrastructure is “very solution focused, very insular in in the way it’s conceived”, Grahame Grieve, the founder of FHIR, told the Webinar.
“Instead
of building an infrastructure that leads to new integrated market development,
it seems that we’ve headed towards an infrastructure that sucks everything into
what it is,” he said.
“It’s very frustrating to see how that approach isn’t developing into, what I
think we need, which is a resilient and adaptable architecture.”
The best that we could manage in Australia was expediting a program for electronic script writing, a program that was initially going to take a year, and we managed to get up in a raw working form in about three months.
Ironically, this program, which is yet to be fully implemented, is a case of cloud based and distributed architecture in the system. But it has virtually nothing to do with our supposed backbone project of the My Health Record.
If you read between the lines on the Wild Health webinar, which looked at COVID induced digital health innovation between the UK, the US and Australia, the single biggest message that was apparent is that Australia is stuck in the past as far as digital health is concerned.
Such a view might come as a surprise to most of our politicians, who don’t really understand the basics, but, ironically, have been given the My Health Record to point to as just how great progress has been in Australia.
While there was much in place to facilitate much better interoperability in the US and the UK systems when COVID hit, there simply wasn’t in Australia.
If it was meant to be the My Health Record, then what COVID demonstrated probably for once and for all was that this project is an interoperability dead end for the country.
We need to back up, check out in more detail what other countries are doing with modern distributed and open systems, and rethink our approach.
Part of that approach should probably also take note of both the US and the UK, which as base did not try to dictate technology or systems but gave the market context and direction, in the case of the US via an enforced standard, and in the case of the UK, at least by notice to everyone in the system that they should be hubbing around cloud, and then setting up support services to help align providers and vendors.
Both the UK and the US in varying degrees announced and dictated the future for vendors and providers, via some sort of standard setting, and then made sure they gave everyone the time and the support to make the transition.
In some ways, our government’s persistence now with the My Health Record is laziness brought about by a feeling that things are OK. That we managed the pandemic better than anyone else, and our health system is largely better than anyone else’s.
Both things are true.
But it’s a stark reality that our digital health policy and infrastructure are backwards now and fast starting to hold back the potential of our whole healthcare system.
It’s patients that will bear the brunt of this lazy approach in the end.
It’s a climate change like problem for Australian policy makers.
It’s difficult to see today, and there is a lot of politics resisting changing our current settings.
But like climate change, a weak digital health infrastructure and leadership from government, is going to blow up in our faces sooner or later. Likely, in a big way.
You can watch the Wild Health Webinar on which the ideas in this article are based HERE.
Here is the link:
https://wildhealth.net.au/why-the-uk-and-us-are-now-in-front-of-us-in-digital-health/
Seems like a good idea to watch and see what you think! Fascinating stuff.
The key lessons I took from the discussion from an OZ perspective were:
1. The #myHR is a useless piece of dated infrastructure that needs to go.
2. OZ needs to re-awaken its e-Health Standards processes and start moving towards distributed data management and interoperability.
3, The Digital Health Industry sees the #myHR as irrelevant and is just ignoring it.
David.
22 comments:
The Federal Government, and ADHA specifically, live in their own opaque bubble.
They do not know enough to know they are wrong.
Sad but expensive and a road-block to true progress.
Amazing how no one from our national body was on the conversation. Grahame is certainly in it for the collective, but we seem to be missing something. I recall a previous US talk where a couple from ADHA spoke. One gentleman stood out and spoke well on interoperability and standards.
ADHA does not understand interoperability, where it should be seen and how investments might be prioritised. The point of interoperability is not to link the whole community together from the get-go, but to create an environment in which linking different systems together is simple,. The telephone network of the internet are good examples.
Grahame Grieve:
"Instead of building an infrastructure that leads to new integrated market development, it seems that we’ve headed towards an infrastructure that sucks everything into what it is," he said.
"It’s very frustrating to see how that approach isn’t developing into, what I think we need, which is a resilient and adaptable architecture."
IMHO, I think he's 100% correct.
The problem is that ADHA don't know the first thing about a "resilient and adaptable architecture". Their supposed goal of re-platforming - an ecosystem - is a poorly specified solution, not an architecture.
Their replatforming tender of November 2020 doesn't even mention non-functional requirements all all, never mind resilience and adaptability.
There's no way they are going to get something they haven't even asked for
Are you referring to this Sarah? - https://www.ghdonline.org/tech/discussion/project-spotlight-interoperability-in-australia-ma/index.html?ref=expertpanels
That was the last time I recall grown up discussions taking place. Some took exception or had axes to grind and gaged any further dialogue. Sure those who committed the bullying are now sitting in Chairs in rooms made of cotton wool and hypocrisy.
Easier and nimbler for Grahame to change his mind. As someone I worked with at ADHA use to say - you can paint government research and put a strip down it but it will never be a speedboat.
Right. that's very true. I can change my mind tomorrow, and I occasionally do when presented with new evidence or cogent argument. Government projects can't. When you're steering a very large container ship, it's a very good idea to think far ahead and think very hard hard about the relationship between today's decisions and where you'll be positioned on the hosizon.
I first mediated for the presentation of my current point of view ("a resilient and adaptable architecture" instead of a "centralised restrictive arhitecture") to DoHA leadership in 2016, and it was presented by someone far superior in both position and reputation than me. So here we are today, still continuing to sail in the same direction, in spite of the fact that we're already crashed in the channel, blocking everything else
If you've decided to steer "a very large container ship", you've already made a number of decisions you can't reverse and have to live with. It makes things worse if some of those decisions get overturned and make the ship even bigger and less maneuverable.
Considering many decisions were made well before the system went live in 2012, for DoHA to be thinking about "a resilient and adaptable architecture" in 2016 is a bit late.
The trouble with "someone far superior in both position and reputation" but less competent where it counts is all you get is hubris and self interest.
2016 - probably with hindsight not the best year for change discussions of that nature Grahame. Most were convinced NEHTA was the problem (confused NEHTA with the cancerous growth that was PCEHR). They believed the quickest path to success was left, then left, then another left until you reach the intersection and take another left. I believe the roadmap is at the second corner.
If aged care gets sucked into the MyHR void then I guess it will be 15 years of left turns. Many might try and have voice heard and alternatives pitched. Unless they can dangle future partner positions or other lucrative consulting/chair gigs —- well we all know that outcome
What is needed is an independent review to determine if the MYHR and the current so called "National Digital Health Strategy" is effective and useful.
Just don't expect this government to do such a thing, not given their track record for such things:
Josh Frydenberg secretly deletes ASIC corruption findings
https://independentaustralia.net/politics/politics-display/josh-frydenberg-secretly-deletes-asic-corruption-findings,15034
The recently published Fourth Australian Atlas of Healthcare Variation raises equity and quality questions clearly demonstrates what really needs to happen. And no ADHA, AIDH, CRC it does not need more half arsed ideas from you that never disrupt or make a positive difference.
There are far more important and critical problems in health and aged care to be addressed than "digital health"
Digital health is like giving a badly maintained FJ Holden a spray paint. It might look good, but won't do anything for the performance of the car.
I believe there is a significant role information technologies can play in healthcare. The issue is things have gone a bit of the rails, those entrusted to steer have in fact shat their pants and are woddaling about hoping no one notices, rather than cleaning themselves up and moving on.
@5:35 PM a bit!!!! Methinks you guild the lilly too too much.
ADHA is off with the fairies again.
ADHA outlines digital health in aged care plans
https://www.australianageingagenda.com.au/technology/adha-outlines-digital-health-in-aged-care-plans/
ADHA doesn't seem to realise that My Health Record is a user driven system. The chances of people in aged care having the capability, never mind access to the technology, to manage the (very little useful) data in their My Health Record is something approaching zero.
And another thing, they are all about uploading stuff. Still very little about meaningful use of the sparse data in the thing.
What that person is saying is that the ADHA in blindly imposing MyHR is simply steamrolling any hope to improve new ways of working, better funding and care. Why? Simply because they are setting ridged process from the outset. Typical nonsensical rubbish from a bully that is reliant on the MyHR for relevance and power.
Using secure messaging as a smokescreen is callous and misleading.
April 30, 2021 5:35 PM - ever considered a career with ADHA in communications and engagements?
Agree Paul, the ADHA will smoother all before it as has been the track record to date. The past year has had a visible effect on some. Good to see even without Bettina, some are still being encouraged. Change Is never fast.
ADHA in blindly imposing MyHR is simply steamrolling....
Not wrong; this is also about scoping up as much budget allocation as they can. This process started before the commission sat down. You can see the slices of pie in the report's recommendations.
The sad fact is that there are several organisations diseupting the old ways of aged care. As pointed out, ADHA and DoH will suck the oxygen up and starve these organisations into submission. I really cannot see how GovHR system will fit in a modern digital ecosystem of IoT and robotics.
Sarah Conner April 30, 2021, 9:18 AM
The underlying issue is not an institution like ADHA, AIDH or CRC. This is that there is an underbelly of rotten people with enormous bias and egos. They present hypocrisy at every corner – as an example, the AIDH recent Strategy purports to have engaged its member and looks to activate them – they chose not to engage a senior Fellow of AIDH. This is surely the result of petty-minded individuals who position themselves on committees for the sole purpose of exercising bias (bullying perhaps) and excluding voices from the conversation.
Hardly the foundation to start solving the challenges of mental health and aged care. I would like to think the leadership of these organisations would address this if they themselves are not part of the committee.
Well said Anon 12:52 PM
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