Among all the excitement around Digital Investment in the Budget last week – with all that $500M on myGOV and the #myHealthRecord you may have missed some lesser but arguably more important stuff.
First we have this:
Budget 2021: Digital mental health services to see AU$110m injection
Australia's mental health system will receive a AU$2.3 billion investment package as part of this year's federal Budget, with a portion to go into expanding digital mental health services while another will go into extending financial support for telehealth services until the end of the year.
By Campbell Kwan | May 11, 2021 -- 11:28 GMT (21:28 AEST) | Topic: Digital Health and Wellness
The Australian government will provide AU$111.2 million over four years to expand and enhance the nation's digital mental health services to provide Australians with easier access to high quality digital mental health services.
The decision to allocate funds into expanding digital mental services was made to ensure Australians are able to quickly access appropriate care, Budget documents say. The funding is part of a larger AU$2.3 billion package dedicated specifically for expanding Australia's mental health and suicide prevention services.
"The AU$2.3 billion package in this Budget is a first step to responding to recommendations from the Productivity Commission and the National Suicide Prevention Adviser. With this commitment to Australians' mental health, the government is laying the foundations for systemic, whole-of-government reform to deliver preventative, compassionate, and effective care," the government said.
More here:
https://www.zdnet.com/article/budget-2021-digital-mental-health-services-to-see-au110m-injection/
Compared with the amount being invested in the #myHealthRecord (Approx $430M over 2 years) this seems like a bargain that might actually make a difference in a number of people’s lives!
I have to say it can actually be very hard to work out what dollars a going where from Government statements.
Here is a link to the Health Department Budget Summary that may help if you are curious!
Please enjoy the details of all of it – if not the smiling photo of the Minister!
David.
20 comments:
"digital assistance to make it easier to navigate the aged care system"
"The government did not provide details on how much would be spent on improving digital assistance, however."
"Money has also been allocated towards modernising diagnostic imaging, with AU$7.2 million to be spent on the development of an integrated electronic diagnostic imaging referral system."
Not a lot about improving healthcare, just improving access to whatever happens now.
The wrong answer to the wrong question.
.... "an integrated electronic diagnostic imaging referral system" !!!
Do they know what "Referral Systems" are operating today?
Is there none suitable / applicable to support diagnostic imaging referrals?
Why do they use the word "integrated" - what do they think they mean by this?
What will the $7.2 Million be spent on?
System design?, market research / focus groups?, Contracting consultants to prepare a 'development and implementation' plan?, or something else? Unfortunately, based on past performance $7.2M won't deliver much of anything.
What will the $7.2 Million be spent on?
1. Buy a strategy - $2.5M
2. Develop a business case - $4.5M
3. Webinars to explain the business cases recommends the market to agree on whatever and make sure it uploads to MyHR - $200k
It makes no sense to me! Imaging groups already upload results to the MyHR. Is the market bereft of any Imaging Referral Systems?
A patent goes to se a GP. The GP wants the patient to get an X-Ray (or whatever) and gives the patient a referral form.
The patient can take that referral to any path lab (that does imaging) and they will do it. and send the results to the GP. Some path labs allow the patient too see the results on the path lab's website.
A question:
How do you make the referral system digital, remembering that you can't stop using paper based referrals so you will now have two systems to maintain and keep compatible?
A second question:
what's the savings and benefits?
If you really want to have part of it digital, just give the patient a paper copy and email them a pdf copy of it. When the patient makes an appointment the path lab can ask for the pdf to be emailed to them.
Paper is often the best user interface.
Digital Health is in danger of making things worse, not better. The resistance to dumping fax shows how useful and reliable paper can be.
IMHO, a lot of the vendor push for Digital Health is computers for computer's sake.
And vendors have the ear of those pesky bureaucrats who are desperate to control costs but don't understand the consequences.
And here's a thought.
Way back in the dark ages, the USA military decided that the best defence to an attack of their communication systems was an active distributed network (i.e. the system would route around blockages and allow many to many connection to use the system.
The result of DARP's research was the TCP/IP and the internet.
Scroll down to today and we have reports of cyber attacks on major health systems. The more centralised the system the greater the risk.
We have built centralised systems on an infrastructure designed to be resilient by being distributed.
If we wanted to adopt the original architecture, every end point would need to be able to operate on a stand alone basis. There would be a layered approach to communications and network so that you get security in depth.
There are two ways to look at this.
1 It is cheaper to concentrate and centralise. But you don't get resilience and security.
2. If you want resilience and security you need to spend time and money to get it.
Who wins in the end? The vendors selling cheap solutions to cost cutting enterprises.
The system hasn't delivered any value we know of and it's cost a fortune.
Ironically, with myhr, the only winners are the vendors and the government agencies who drank the Kool-Aid. NEHTA expired and ADHA may well follow suit.
Well done the government.
The Government, the Health Department and the ADHA have been the major contributors to the increasing fragmentation of the health market over the last decade.
This "imaging referral project" is another example of their stupidity and ignorance about healthIT. As Dr Colclough said at 10:23 AM "It makes no sense .. ".
4:44 PM agree, also agree with G. Carter’s sarcasm
It really is quite bewildering. On the one hand the government proselityses how strongly supportive it seeks to be of small health technology companies and their health innovative, entrepreneurial, initiatives. Then, in the next breath it sets itself up to compete in the market and in doing so block progress and undermine such initiatives.
The great tragedy of all this is
that because the government really doesn't understand what it is doing it continues doing the same thing over and over again, further weakening the local healthIT industry and embedding the cancer of fragmentation of our healthIT infrastructure, services and solutions, deeper and wider; all the while doing so in the misguided belief they are 'helping' to integrate the national health service delivery model. Ignorance is bliss.
That's correct Ian, They are a distraction, but not a real threat as the chances of ADHA actually implementing anything are a million:1 - but people wait for something to be delivered from on high, and wait, and wait...
@7:55 PM With the utmost respect I have to disagree with Andrew in so far as - yes, they are a distraction but much more importantly they are a "real threat" and the reason they are a threat is because they undermine local industry developers by hindering their ability to grow and expand in Australia.
In short ADHA achieves this by setting itself up to COMPETE, DICTATE and INTERFERE, instead of fostering development and growth of local industry. The one local company that is a standout exception which has been able to quarantine itself from government interference enabling it to become hugely successful on a global scale is ASX-PME (Market Cap >$4 billion, six $20M-$30M sales in the US in the last 12 months). PME has achieved its phenomenal success by never having anything to do with government. The proof is in the pudding.
"... instead of fostering development and growth of local industry"
You mean like this?
Millions in Australian taxpayers’ dollars invested in struggling NZ exoskeleton company
https://www.smh.com.au/national/millions-in-australian-taxpayers-dollars-invested-in-struggling-nz-exoskeleton-company-20210507-p57pv2.html
An Australian government fund meant to support local biomedical development invested millions in a struggling New Zealand-founded exoskeleton company that has almost no staff in Australia.
Rex Bionics, which manufactures $150,000-plus exoskeletons for wheelchair users, employs only one person in Australia, and is running no local clinical trials. Research, development and manufacturing all remain based in New Zealand.
Bear in mind that the States could quite easily withdraw their combined 50% of the ADHA funding. They could certainly put that money to far better use.
@7:55PM .... "people waiting and waiting" for something to happen from on high is just another way of ensuring no change will occur. If people want things to change they need to proactive and do something to bring about change.
We have HL7V2 standards capable of doing orders and some systems produce them, but the quality is poor and often they demand payment to produce them. In fact everything seems to result in demands for payment, which is one of the barriers to interoperability. Given the lack of quality its not worth it in any case. There is a radiology project to come up with order codes, hopefully they will choose SNOMED-CT, but that is not certain.
This issue of patients being able to go anywhere to have order filled is soluble in a secure manner, but radiologists want direct transmission as well and now one system demanded 10K to allow a GP to put their name on the order??
I have to opinion that systems should produce compliant messages as an expectation of functionality but this opinion may be in the minority and demands for payment are common.
Again, in the end the free, open availability of standards compliant messages (Which is V2 currently) is the base level of function we need to get things moving, but the ADHA will probably go for something new like FHIR which is not supported by radiology systems, whereas v2 is supported, but they need the messages to be compliant to do it safely.
Again, it is useless messaging something that doesn't work, first get the message quality up to scratch and then you can be innovative with how it gets there and what else you do with it. If you get it there and it doesn't work people rapidly lose faith. Its like trying to write software with a compiler that keeps making errors, you are continually hacking the system to try and make it function and are scared to make changes because the subsystem is unreliable. The subsystem of interoperability is compliant messages, both being produced correctly, and being consumed correctly.
I wish ADHA understood this, I guess no one, with any technical ability, lasts, so we have eHealth by generic management, nice pdfs and PR campaigns, but its all mock up, a $2.5 Billion mock up that is paper thin. Don't try and do anything with it or you will break through the shell and find there is nothing inside.
After thinking long and hard about an Electronic Imaging Referral System, my colleagues and I have been unable to come up with any compelling benefits to justify such a system.
We would be very interested to see what others can come up with. Two lists of 5-7 points, first list the pros and second list the cons would be illuminating.
Here are a few Pros,
1. Accurate transfer of demographics, copy doctors, allergies, patient history etc
2. Ability of radiologist to arrange investigation more quickly, contact patient
3. Eliminate lost referrals, need to take paper around, record on eg phone
4. Transmit placer order number so can know when test done/not done as can mark request as complete
5. Avoid need for patient to fax/email request to radiologist so they know what to do when arranging investigations
6. There are potential efficiency gains wrt re-keying information on referral and requester knowing if test has been done (assuming everyone uses it)
Cons
Requires quality implementations to get advantages and this costs $
re "Requires quality implementations to get advantages and this costs $"
Sort of. How about:
Requires quality implementations to get advantages and this costs lots and lots of $.
And that's only the implementation.
so you have to include:
Requires constant maintenance, and this costs lots and lots of $ and never stops.
Remember the problem when (it would seem) that prescription software that needed a patch to be compatible with Windows 10?
Once you have a large scale production system it sucks up a lot of resources. It's like buying a horse, or a yacht. It's not an asset it's a money pit.
You could offset those cost through lower cost to information requests, physical storage of paper records and a few others I am sure.
Don’t have any nautical comparisons other than perhaps procurement often resembles a Preussen when a Felucca was all that was needed
Considering the number of orders the unit cost is not going to be high, if its not run by government that is!
Your argument seems to be that paper orders are better, I think there are good reasons to get electronic orders going. People scoff at $72M, I suspect that would pay for it for about 20 years if it was done efficiently. I am not sure the ADHA is that vehicle based on track record.
Its not that hard, constructing a valid compliant message should be very easy, but there is a technical debt which also effects results/reports/letters etc being sent reliably. Until that technical debt is paid off nothing will work reliably.
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