There was optimism expressed in this recent article that we may see some relatively immediate progress with Digital Health Standardisation and Interoperability.
See here:
Government circles biggest change to digital health since MHR
ADHA Cloud COVID-19 Interoperability MHR
After years of talking about the idea, it looks like the federal government is giving serious consideration to establishing a proper strategic (standards based) framework to help align digital health stakeholders in moving more effectively and faster to an interoperable future.
Possibly the most controversial element of Australia’s digital health journey of the last decade or so, outside of the enormous centre of gravity to the whole system created by the My Health Record (MHR) project, has been the abandonment by government, and the subsequent breakdown of, a cohesive standards regime in which digital health tech vendors and providers could evolve their offerings and innovate.
Most people in digital health understand that without a workable standards framework, sharing data effectively in the massively and increasingly complex eco system that is healthcare interoperability is next to impossible.
Yet our local national digital health standards regime broke down seriously in 2011. Apart from the efforts of a few largely unpaid individuals, it has not been the focus of any serious efforts to fix until early last year, when then interim CEO of the Australian Digital Health Agency (ADHA) commissioned JP Consulting and long-time standards expert David Rowlands to report on how a new standards regime might be reintroduced into the country.
That report – A Health Interoperability Standards Development and Maintenance Model For Australia – landed in the hands of the ADHA some time before May last year and was reportedly seen in some respects as controversial because Rowlands had been forthright and blunt in laying out the problems of the past (he had apparently been pressured to change parts of the report but refused to do that for good reason).
It was released publicly in May, and, possibly amid the mayhem at the agency that would have been caused by COVID at the time, and the impending changeover of most of the senior leadership of the organisation, including the departure of interim CEO and long-time COO, Bettina McMahon, virtually nothing was heard of the report since then.
The 154 page report is thorough, accurate and precise in its recommendations, including a blunt but necessary history of where things went off the rails in the past.
It is possibly the most important document that exists in the hands of the government in terms of the future of workable digital health eco system in this country. It is HERE in case you haven’t read it yet.
You’d think being about standards and interoperability it might be a bit dry. But it’s a fascinating read: an honest and blunt history of the National E-Health Transition Authority (NEHTA), the Personally Controlled Electronic Health Record (PCEHR), the ADHA, where good intentions got derailed and how, why the problem of interoperability is so complex in healthcare compared to other industries, how all industry has required standards to proceed with innovation, what has been done in other countries, why Australia has stalled and fallen behind (despite laying claim to being a world leader in digital health), and most importantly, a roadmap to re-establish a workable and agile standards regime in Australia, amid all the difficulties that would face such a task.
It’s a document than anyone in a leadership position in a major healthcare provider or tech vendor should read if they are serious about moving to the future with their organisations.
The fundamental proposition of the document is that “Interoperability is impossible without standards”.
That Bettina McMahon and the ADHA management team at the time commissioned the report probably suggests that the ADHA was running out of ideas to progress big issues that it was trying to solve, such as secure messaging, and wanted to revisit the past to relook at the future.
There is a great deal more here:
https://wildhealth.net.au/government-circles-biggest-change-to-digital-health-since-mhr/
Here is the direct link to the review from David Rowlands from early 2020.
Jeremy’s article and the report that is discussed are both worth a careful read.
In my view the historical analysis of how NEHTA and ADHA managed to largely destroy the Standards Australia working groups on e-Health Standards is spot on and – along with a pretty much total focus on the PCEHR / myHR – finds us where we are with an essentially defunct national Standards Setting ecosystem. The gap, in most areas, between practitioners and vendors and the ADHA has seldom been wider IMVHO.
That conclusion leads to 2 questions.
1. Do we need the ecosystem repaired and re-invigorated to make real progress in most Digital Health domains? To me the answer here is a definite ‘yes’.
2. How likely is this to actually happen? On this my answer would be it is extremely unlikely in my life time without a large and consistent effort to really re-engage and expand our skill base of expertise and provide some real incentives to (re)-engage! It also requires a leadership that could overcome an understandable level of cynicism and scepticism and a totally revamped payment / funding methodology. It will take decades before we could again provide processes and projects that are so interesting and worthwhile that the expertise would be volunteered! Till then the nation will have to pay for their time and expertise!
My view is that the mad standards development frenzy driven by NEHTA and the PCEHR has resulted in such alienation and mistrust of ‘big government digital health’ that we will need decades to see proper remediation and restoration of trust.
What do others think about our current state and prospects into the future?
David.
23 comments:
As the old saying goes; The road to Hell is paved with good intentions.
Made even worse by promises, exaggeration and denial of reality.
Don't expect any changes real soon now.
We had an old employee come and make some standard recommendations; his suggestion was to have a few chosen experts decide the standards. It seems he was an architect behind the tiger teams for standards during pcehr and did not have a clue.
Secondly, the strategy is interesting, odd there was one commissioned; there is one just as useful sitting on the servers at ADHA, done in 2016/17. The approach seems similar, and the costing not too far apart. Sadly can not be shared, you are tracked at ADHA, and everything you access, print, email, or save is logged.
Some standards bodies do exactly do themselves any favours. The HL7 Aus website is a sad case of neglect, why would anyone invest. Whoever is running HL7 Aus should be freed up to spend time on whatever they are doing because the chair and board are not spending time on HL7 Aus.
We certainly allowed under ideals to trample eHealth Standards under Standards Australia. The wild health summit in 2019 shows the uphill challenge being faced.
The government has a role to play, it is under visuals and their reckless behaviours and obvious bullying tactics and inability to work with experts that created this mess - not government. In a way this was allowed to happen by those it hurt the most.
Agree with G. Carter; the HL7 Aus website is a sad but probably accurate reflection of its operations. Behind the broken shopfront there remains activity. As you point out - from an adopter or finder perspective - why would this be taken seriously.
I do have a question for @Gcarter - what were you trying to say - We certainly allowed under ideals to trample eHealth Standards under Standards Australia.
Perhaps just shut it down and point to HL7 international.
Sarah asked - We certainly allowed under ideals to trample eHealth Standards under Standards Australia.
Correction - We certainly allowed individuals to trample eHealth standards....
Not surprising those who participated in the trampling of standards and vicious attacks on some, later claim to be trying to fix it. Sounds like IT Hero or Munchausen at workbehaviour at play.
So an organisation funded by taxpayers to operate a system that adopts HL7 standards to underpins its products (products other must conform to) is neither a member of HL7 more provides annual funding to HL7 Australia?
Does not sound right to me, there should be a line item in ADHA budget to support a base operation at HL7 Aus ( with no decision making roles being ADHA) the line item should also allow ehealth standards published by standards Australia to be free.
They throw away more cash creating fluff stating why interoperability is needed but not a cent towards supporting standards development organisation who provide the means to solving a couple of layers.
There are new faces at ADHA at decision-making levels. Perhaps a change may come, we seem to have made it through the big push of the big mistake, and the cultural revolution of the previous two CEO’s. The current CEO and executive looks predictable.
Noting the problem might be hidden in “there are new faces at decision-making levels,” this happens all too frequently.
That Bettina McMahon and the ADHA management team at the time commissioned the report probably suggests that the ADHA was running out of ideas to progress big issues that it was trying to solve, such as secure messaging, and wanted to revisit the past to see if their was a better way to the future.
I get a sense this happened simply because it was on a list of things rather than for any meaningful purpose.
I also struggle to connect the “commissioning a report” with “doing something about it” if there was a dollar for every report commissioned, we could pay down the national debt tomorrow.
While agree that HL7 Australia has been less active than I would like the Orders and Observations workgroup has recreated the HL7V2 standards and balloted the first version and the next version is out for comment currently. Basically the same people that contributed to the previous Standards Australia standards have done this work.
https://confluence.hl7australia.com/display/OOADRM20181
I think it is a perception thing Andrew, if the HL7 website was a house it would have squatted by ice addicts. Sure there is some stuff going on, but who would know? As an example across the ditch it looks amd smells like an active community that cares.
From any investors stand point why would HL7 Aus be an attractor?
As someone once explained to me, the value in standards is not the published output necessarily but the process behind it. Take a look at the public facing shopfront of HL7 Aus - then ask yourself - would I buy medical supplies from a shop that was in such a state of disrepair?
As G,”. Carter asks - where is the Chair and Board in all this? They are letting the standards community and the nation down.
As someone once explained to me, the value in standards is not the published output necessarily but the process behind it. Take a look at the public facing shopfront of HL7 Aus - then ask yourself - would I buy medical supplies from a shop that was in such a state of disrepair?
As G. Carter asks - where is the Chair and Board in all this? They are letting the standards community and the nation down.
It's certainly easy to be frustrated about the lack of energy on the part of HL7 Australia, and I share the frustration. However, since I declined to be on the board, I'm not in a position to carp. However: HL7 Australia is a volunteer organization; it succeeds or fails in concert with the community it represents, the set of people who need to achieve something, and believe that HL7 Australia is a vehicle through which to achieve that something. It seems to me that the malaise of HL7 Australia is a natural response to the wider issues around digital health standards in Australia, and a group of people I respect greatly have given their heart and soul to try and turn it into something successful, but they are collectively mostly finding that other activities are more rewarding, and the arc of HL7 Australia is a long slow decline from what it was.
I believe that we need a functioning digital health standards process and eco-system in Australia. In fact, it's embarrassing that we don't have one in 2021, and the age of covid. I can point fingers in all directions, and many parties share in the guilt. But until the commonwealth government believes that an external standards process brings value long term *and it is able to act in any rational long term manner*, we will be where we are. The state of governance in Australia is parlous at this time; we are mostly resting on past achievements and thinking that she'll be right mate. And indeed, it will be right until it suddenly is very not right. But voters vote for what they vote for....
If anyone at HL7 Aus is reading this blog - take down your website, stick up a what we are page with links off to the confluence pages. It really is not helping anyone having that confused outdated mess float around as the face of HL7 Aus.
Hear what you say Grahame, but G. Carter and John are correct in their observation.
But voters vote for what they vote for....
Where were you going with that Grahame?
Voters do not vote for department and agency heads, and clearly when people voted to opt out, department and agency heads decided to correct their error and press gang them into a system that devalues the rest of the national infrastructure.
I do not believe our elected officials are to blame for this mess.
"I do not believe our elected officials are to blame for this mess."
With respect, I beg to differ.
Our elected officials are responsible for hollowing out the public sector of knowledge and expertise. John Howard was not the first and won't be the last, but he was responsible for politicising the senior ranks of the public service and he and John Fahey tried to outsource as much of the government's IT as possible.
It is no coincidence that the Department of Health IT was outsourced and now can't even spell IT.
I worked on IBM's bid for the Health Cluster and was also chief architect in the outsourced team that took over their systems and IT staff. I saw Health's Information Systems' capabilities wither and die.
Health was never much good at understanding the industry they are supposed to support and regulate, after the outsourcing debacle they were even worse.
It is far easier and quicker to break a thing than to build something at least as good in its place.
It also requires more competence than was needed to break it. There is no evidence of more competence.
At this level all the problems of Australia's health systems are those of governance and funding. Fixing a problem like health will take more money not less. At the moment most of the money seems to be going on survival - the government's survival.
and this is no coincidence either. Same governments, same outcome - a failure to deliver:
‘Basket case’: Key Defence assets out of action for more than half of each year
https://www.smh.com.au/politics/federal/basket-case-key-defence-assets-out-of-action-for-more-than-half-of-each-year-20210531-p57wjx.html
But I would agree with the sentiment; you get the government you deserve. There's too much "she'll be right, mate".
Have a look at the real meaning of "The lucky Country", the title of a 1964 book by Donald Horne.
https://en.wikipedia.org/wiki/The_Lucky_Country
"Horne's intent in writing the book was to portray Australia's climb to power and wealth based almost entirely on luck rather than the strength of its political or economic system, which Horne believed was "second rate". In addition to political and economic weaknesses, he also lamented on the lack of innovation and ambition ..."
> Voters do not vote for department and agency heads
No, they vote for politicians, and let themselves be distracted by peripheral arguments and tribal signalling, and don't vote for actual good governance. So: no surprise, we don't get much of it. Could be worse, of course. Bernard has identified different aspects of it than what I care about, but the underlying themes are the same.
578'000 MHR views out of 7M admissions in public Hospitals per year, about 8% of admissions. But there were also over 8M Emergency department presentations which some would have become admissions while others didn't. I'm guessing around 50 to 75% may overlap with an admission or later outpatient visit (I don't have a source, so I could be way off).
The point is, over 90% of patients presenting/admitted don't have any health professional bother with the MHR belonging to them. And we don't have much to indicate whether the few even got much value from looking.
Sorry, I posted that to the wrong thread.
You do get to vote (if you bothered renewing your membership) the chair and board of HL7 Aus. All that fanfare of restructuring and registering the organisation elsewhere seemed to have come to nothing. Was everyone distracted by peripheral arguments and tribal signalling?
I did no renew my subscription several years back as I disapproved. Not one of my favoured choices but one made in protest
And that concludes this years mentioning of standards - next
The good thing about standards is that there are so many of them. Just pick one you like. Or you can wait until the next one comes along. Even the Internet is not immune. Quic is about to replace TCP
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