It seems the ADHA has noticed there might be some leverage, for it, in Aged Care.
ADHA outlines digital health in aged care plans
The Australian Digital Health Agency has developed a three-year program to drive the adoption and use of digital health in residential aged care homes in response to royal commission’s recommendations.
ADHA’s acting chief digital officer Rupert Lee provided an industry forum and update on the agency’s plans for the aged care sector arising from the Royal Commission into Aged Care Quality and Safety’s final report.
He said recommendation 68, which calls for a universal adoption of digital technologies and My Health Record, stood out most to the agency.
That recommendation includes that all providers of clinical or personal care must have a digital care management system with electronic medication management by July 2022.
“Consequently, the agency is initially focusing on residential aged care facilities,” Mr Lee told the ITAC April International Forum on Tuesday.
ADHA is focusing its activity on recommendation 68 as well as 109, which proposes the government invest in ICT architecture and in technology and infrastructure for aged care.
The program will drive the adoption and use of digital health in residential aged care homes to facilitate the sharing of healthcare information when it is needed most, Mr Lee said.
“The purpose of our aged care program is to implement system wide enhancements that will support critical moments in the health care journey of older Australians,” he said.
Three-phase program
The three-year program will focus on the development of specifications and conformance profiles for digital enablement in aged care, Mr Lee said.
The first phase includes My Health Record conformance, viewing capability and the ability to upload advanced care planning information, he said.
“[It includes] My Health Record system enhancements to enable My Health Record to support the transfer of information supporting transitions of care between residential aged care and other healthcare settings, as well as collaboration with the aged care access branch to explore the possibilities between two-way information sharing between My Health Record and My Aged Care,” Mr Lee said.
The second phase includes uploading aged care transfer data, secure messaging functionality and electronic prescribing capabilities.
He said the goal is to have 100 per cent integration and adoption of My Health Record among aged care providers by 30 June 2023.
The program’s third year will assess the next steps for the rest of the sector including home care, Mr Lee said.
He said it was more realistic to prioritise residential aged care given the pressures on the sector and the royal commissioners’ strong focus for significant reform in this part of the sector, he said.
However, the agency is assessing opportunities for home care and recognises that some in this cohort are tech-savvy and especially in virtual care, Mr Lee said.
ADHA eyes primary care, telehealth
The ADHA will also respond to recommendation 56, which proposes a new primary care model to improve access.
“It’s important that the agency also plays a key role in helping to define the role of digital technology and My Health Record in the new primary care model as it directly aligns with the agency’s strategic priority to digitally enable primary care,” Mr Lee said.
In response to recommendation 63, which calls for improved access to specialist telehealth services, he said the ADHA would provide education and solutions on telehealth and virtual care models.
The ITAC April International Forum took place on 27 April.
Here is the link:
There is a review of the recommendations here:
https://www.australianageingagenda.com.au/royal-commission/rc-calls-to-mandate-digital-care-systems/
The contents of recommendation 68 are:
Recommendation 68: Universal adoption by the aged care sector of digital technology and My Health Record
The Australian Government should require that, by 1 July 2022:
a. every approved provider of aged care delivering personal care or clinical care:
i. uses a digital care management system (including an electronic medication management system) meeting a standard set by the Australian Digital Health Agency and interoperable with My Health Record
ii. invites each person receiving aged care from the provider to consent to their care records being made accessible on My Health Record
iii. if the person consents, places that person’s care records (including, at a minimum, the categories of information required to be communicated upon a clinical handover) on My Health Record and keeps them up to date
b. the Australian Digital Health Agency immediately prioritises support for aged care providers to adopt My Health Record.
The evidence cited for all this was Page 323 – Volume 3 of the Final Rreport:
Found here:
https://agedcare.royalcommission.gov.au/publications/final-report-volume-3a
“Aged care providers should be using digital care management systems. Professor Johanna Westbrook, Director of the Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, gave evidence that the aged care sector currently relies heavily on faxing, scanning, emailing and, in some instances, mailing information between external care providers and service providers. She said that this ‘increases the risk of error’ and ‘is resource intensive and inefficient’.198
Electronic medication management systems are particularly important in aged care given the high use of medicines by people receiving aged care. We are encouraged that the Australian Government is trialling an Electronic National Residential Medication Chart in a number of residential aged care facilities.199
My Health Record is an Australian Government online summary of a person’s key health information. It is progressively being adopted across the health care system. The Australian Digital Health Agency has stated, however, that ‘while a number of aged care clinical information systems are conformant and can connect to My Health Record, it is not extensively used across the aged care sector’.200 In October 2019, only 247 out of a possible 1800 aged care residential and home care providers (14%) were registered for My Health Record.201 The Australian Digital Health Agency stated that aged care is ‘a key priority area for future focus’.202
Universal adoption by approved providers of My Health Record should be an immediate focus. Given the high frailty and acuity of older people receiving aged care and their increased need for health care, it is appropriate to expect that all approved providers should be using My Health Record by no later than 1 July 2022. This will ensure that multiple health care and aged care providers can access one central source of health information about people receiving aged care. Any improved information sharing will depend on the person receiving aged care having a My Health Record and giving prior consent to their health records being accessed, used and shared in this way.
System interoperability will support communication and information sharing between the aged care sector and the health care sector.203 For instance, system interoperability between the clinical systems of general practice and approved providers would ‘improve communication and minimise any errors in treatment, particularly when a GP [general practitioner] is required to respond to a clinical situation’.204
Interoperability should be pursued in the short term through My Health Record. The adoption of My Health Record, and systems interoperable with it, will assist with information sharing between care providers and others and hence assist with improved and safe care. Data interoperability, whereby data is captured according to a common set of definitions, is also worthwhile pursuing.
The Australian Government has agreed that all residential aged care services should move to digital electronic care records.205 The Government has further supported the use of electronic discharge summaries through My Health Record.206 The Government also supports changes to encourage the use of My Health Record by aged care providers.207 The Government has, however, submitted that ‘My Health Record has been designed as a fundamentally voluntary system’ and that ‘the My Health Record system is voluntary for providers as well as health care recipients’.208 We accept that a person receiving health care is entitled not to participate in the My Health Record system, but observe that the Australian Digital Health Agency has said that over 90% of Australians have a record.209 We also do not consider that the participation of aged care providers should be voluntary.
Paper-based systems are outdated, inefficient, and can lead to errors during the transfer of residents between residential aged care and hospital settings. Transition to a digital care management system interoperable with My Health Record will result in a safer, more efficient and more comprehensive transfer of critical information relating to a person’s relevant care and medical history. Such a transition
Here is the evidence cited
“198 Exhibit 6-23, Darwin and Cairns Hearing, Supplementary Statement of Johanna Westbrook, WIT.0196.0002.0001 at 0006 [34].
199 Submissions of the Commonwealth of Australia, Canberra Hearing, RCD.0012.0058.0001 at 0029 [99d].
200 Australian Digital Health Agency, Public submission, AWF.500.00298.0002 at 0010.
201 Exhibit 14-31, Canberra Hearing, Statement of Glenys Ann Beauchamp, WIT.0573.0002.0001 at 0065 [269].
202 Australian Digital Health Agency, Public submission, AWF.500.00298.0002 at 0010.
203 Exhibit 14-31, Canberra Hearing, Statement of Glenys Beauchamp, WIT.0573.0002.0001 at 0064 [263].
204 Exhibit 14-9, Canberra Hearing, Supplementary statement of Anthony Bartone, WIT.1301.0001.0001 at 0002 [11].
205 Transcript, Canberra Hearing, Glenys Beauchamp, 12 December 2019 at T7584.5–13
206 Submissions of the Commonwealth of Australia, Canberra Hearing, RCD.0012.0058.0001 at 0027 [92]; 0033 [109]–[111].
207 Submissions of the Commonwealth of Australia, Response to Counsel Assisting’s final submissions, RCD.0013.0014.0037.
208 Submissions of the Commonwealth of Australia, Response to Counsel Assisting’s final submissions, RCD.0013.0014.0037.209 Australian Digital Health Agency, Public submission, AWF.500.00298.0002 at 0009.”
So some very general evidence on some rather old fashioned communication tech and a lot of assertions, with no evidence, that the #myHealthRecord would be wonderful and needs to be adopted in 18 months having languished, almost unused, for almost a decade.
Talk about the ADHA seeing a main chance to try and show value in a non-automated sector when the more digitally enabled sectors have “walked on by”!
Worse we see the ADHA plan is in the “The first phase includes My Health Record conformance, viewing capability and the ability to upload advanced care planning information”.
The second phase is “to have 100 per cent integration and adoption of My Health Record among aged care providers by 30 June 2023.”
The third phase seems not to have been worked out yet!
Words fail me that the ADHA would have such a plan, and apparently think it is even ½ reasonable or urgent given all the other sad and really urgent problems we see in aged care.
They are really on some sad and distant island unrelated to the real world!
I
note they offer not a single cent to help and fail to realise how many internal
systems would be far more useful for Aged Care if tech it must be. I see the
self-interested hand of the ADHA offering a plan for its survival and not a
plan to improve Aged Care. Typical I guess! The RC was badly advised in Digital Health seeing it as a solution to many problems without testing the evidence!
David.
25 comments:
The aged care sector will undergo significant change, what seems to be missing is an appreciation of the impact of what the ADHA proposes will have on other more pressing changes.
That said statements like - uses a digital care management system (including an electronic medication management system) meeting a standard set by the Australian Digital Health Agency and interoperable with My Health Record
Make me laugh. A standard set by ADHA. I guess that would be set by a select group of self appointed expects behind closed doors. What happened to engagement, dialogue, apathy, design thinking, delivering experiences? Seems they have all the assumptions worked out. All that is needed is insert the word FHIR somewhere and it is good to go.
The only saving grace is that as with everything ADHA, nothing will come of it.
Not sure claiming uploading unstructured data in a PDF format should be claimed as interoperability. As for medication management, the ADHA dropped the ball on terminology and their specifications and conformance profile still look hand crafted and out of sync. I am sure when it come down to it ADHA will roll over and relax their ‘standard’ because the big vendors are happy to bulk export PDF summaries in the form and frequency dictated by the vendors.
ADoHA through the MyHR is now a competitor in the market and is not taken seriously due to it product, it cannot operate as a serious regulator or setter of standards because it is wedded to a solution. A solution that has no value, delivers nothing to consumers or practitioners leaving the government desperate and running around begging for scraps and generally getting in the way. It has an array of former employees and one-man band consultancies providing useless advice for fees and holding everything back.
Cannot see what else the ADHA could do. This seems a standard out of the box set of things to do. Ironically it looks like a watered down and disconnected set of output NEHTA would have done. Just missing some important bits that might assist in connecting the dots. So much for a better brighter community driven future.
The GM behind the MyHR opt out transferred to aged care a year or two ago so I am guessing this has been in the works for a longtime.
There is light at the end of the tunnel, there is also a rumbling sound coming from the tunnel.
Your remarks sum it up quite well David. The opening remarks by the ADHA spokeswoman leaves me puzzled
“ enable My Health Record to support the transfer of information supporting transitions of care between residential aged care and other healthcare settings, as well as collaboration with the aged care access branch to explore the possibilities between two-way information sharing between My Health Record and My Aged Care,”
Why would you use the GovHR system to broker information exchange? Seems a process step for process step sake? If Aged care is so technologically barren then surely this is a chance to implement all that innovation we have heard so much about and not use tech from a bygone age.
re: The Australian Government should require that, by 1 July 2022:
a. every approved provider of aged care delivering personal care or clinical care:
iii. if the person consents, places that person’s care records (including, at a minimum, the categories of information required to be communicated upon a clinical handover) on My Health Record and keeps them up to date
What does this mean, especially the "keeps them up to date" bit?
AFAIK, the only relevant document that could be uploaded is a discharge summary, assuming they were being discharged, as opposed to getting care from another provider. A Shared Health Summary isn't appropriate, that's supposed to be kept up to date by their GP.
Looks to me as thought the Royal Commission has fallen for the three card trick the government plays by inferring that My Health Record is a complete medical record, which it isn't.
Deck chairs are being shuffled again. https://www.digitalhealth.gov.au/about-us/executive-team-and-board-members
Wonder what the Taskforce is all about? And Mrs Lee is now acting chief digital officer?
So now MyHR is handling clinical handover?? Not sure I want to grow old anymore.
Bernard you now have a face and a name to attach to those Project Managers you have such faith in. Mr Lee has been at the forefront of some of the best - wave 1, self declaration of conformance, my health record ... now aged care
12:21PM - Wonder what the Taskforce is all about
Not sure, it could be aged care, or a recurrence of the global digital health partnership, whatever it is I am sure the mode-of-transport will be a bandwagon. Very odd it is a full time gig for a senior executive in the APS. The new COO is interesting. Don’t expect anything to change with the MyHR or the eHealth landscape in Australia. Nothing personal but that resume does not indicate disruption.
I do hope that the DOH and ADHA are not reflective of the Governments appreciation of what is needed and what the recommendations are saying in the Royal Commissions report. If this is the response perhaps Scotty from Marketing should rebrand these the Megan Markle Commission Report.
Wonder what the Taskforce is all about - when you have a team member you can’t shake - put them on a taskforce.
Its tragic really, we just keep going backwards. PDF is prettier PIT, and PIT was at least machine readable text and tiny in size. The marketing people like logos and fonts and I guess can include clinical images in pdf, but in reality to be pushing a printing format after 20 years of national ehealth authorities is quite laughable, but when its health laughable rapidly turns tragic.
That backward momentum is surely only going to accelerate. The emerging lineup at ADHA speaks bureaucracy and compliance. Not seeing any drive to improve or change the status quo. There would need to be an appreciation of what could be or how health might benefit from digital tools.
Is a new entity being formed to support standards development? Profile standards to publish community designed specifications, architectures, implementation guides, frameworks and software and conformance tools?
Anon @ 6:40 AM. Two aspects at work here
1. The ADHA seem to believe they set the standards, what the believe is a standard is probably not what you are thinking
2. So long as uploads to MyHR flow ADHA will not care.
The sooner ADHA is treated as a government funded competitor to private sector clinical software vendors the better. Then the can be regulated and held to account like everyone else.
DYK that the ACT has created MyDHR?
The only thing is does at the moment is allow you to book appointments at the two ACT clinics (not GPs). It had terrible trouble yesterday because of poor UX design.
Why they have created something with such a similar name to MyHR, I don't know.
They tell you about the MyDHR here:
https://www.health.act.gov.au/digital/dhr
"The Digital Health Record is an exciting initiative that will support health services in Canberra into the future. The Digital Health Record will transform the way health care is provided in ACT public health services.
The Digital Health Record will record all interactions between a person and ACT public health services. This will include Canberra’s major hospitals, community health centres and Walk-in Centres.
Each person will have a Digital Health Record that can be accessed by a person’s health care team at any service location. This will allow staff to have faster access to information which will improve care and reduce errors. Staff will have more time to focus on the person requiring care, rather than searching for key health information stored in different places.
People will be able to access their own Digital Health Record through a secure website or a mobile app. This will allow them to access and update their information from home and manage future appointments. They may also be able to access patient education materials tailored to their record. In the future we expect that people may be able to talk to their care team through video or phone appointments if they are unable to attend a service in person.
The full Digital Health Record system is expected to be available in 2022/23. This page will be updated with further information as the Digital Health Record project progresses."
And the FAQ answers the question:
"How is this Digital Health Record different to the My Health Record?
The Digital Health Record is a more detailed record than the My Health Record, which only holds a summary of key health information.
For example, the Digital Health Record will include data on observations performed by clinicians, details about who administered a medication and at what time, as well as information from devices such as heart rate monitors.
It will include information on what bed a person is assigned and operating theatre bookings including surgery staffing information.
Both the Digital Health Record and the My Health Record are useful and complementary. Relevant data from the Digital Health Record will be automatically uploaded to the My Health Record for people that have not opted out, as it is now from our current systems."
The big question seems to be "Why will anyone want or need a MyHR?"
One answer is that it will not contain much (any?) information from GPs and/or specialists not in the public system.
So, even if you decide to try and utilise both systems, you still won't have a complete picture of your health status.
Tell me again what the PCeHR was supposed to do? Oh, I remember. It was supposed to reduce data fragmentation.
When was it designed? If I remember correctly it was about 2010. Eleven years ago.
You can always tell a Digital Health bureaucrat. You can't tell them much.
@9:23 PM Yes Andrew it truly is tragic. In truth it's far far more than that. The ADHA website section "About us" leaves me flabbergasted, indeed speechless. Such a wasted opportunity. That there are a 'few credible people' on the Board or the Advisory Committees who should and could speak up about this 'travesty' and haven't says so much about how easy it is to seduce and corrupt those 'few people' who, in themselves, know how useless the ADHA is and how very wrong is the overarching political oversight that perpetuates the preservation of this massive $2.5 billion incompetence and fraud being thrust upon every Australian taxpayer.
And yet another app to download, manage and forget. You have to wonder that the focus should be on solving clinical communications (or interoperability) and then overlay a framework that would allow consumer apps to securely access relevant data and render it however it chooses. As a consumer I can have 1 app that the app developers can compete to win me over through delivering a great experience.
Ah, yes of course - "It was supposed to reduce data fragmentation.". !!!
Speaking out doesn't help. Telling it like it is doesn't help. Criticising the 'established' ways doesn't help. Suggesting new ways of thinking about the issues and new ways to approach the problem doesn't help. What does?
The problem is they are "Not even trying" to fix the problems!
see https://corruption-of-science.blogspot.com/
It used to be called "Computer Science" and we need a healthy dose of it to actually address problems but its all bureaucracy and smoke and mirrors and no real computer science. Its about extracting government funds and distributing them the multinational friends without a care in the world about the actual problem, they are "Not even trying" to solve the problem, and are not actually capable of doing it if they actually wanted to try.
You have to ignore ADHA to the maximal possible extent, but they try and make that difficult via propaganda. The realization that they are "Not even Trying" is helpful in thinking about it however.
Quite, Andrew, this is evident in the belief that the MyHR is nothing more than a controversial policy. The policy is not the problem; it is that the implementation delivers no experience, and humans gravitate to experiences and these form patterns of behaviour.
The aged care sector is about to be flooded with large internationals chasing those billions the government is spending. There is already postering; what should have citizens worried is who they are and why they are investing and what access to the health sector might deliver them, and their agenda. For the government and its controversial policy, it may find it is unable to keep pace or integrate with the new technology stacks to be deployed.
The government or more specifically the Depersonalisation of Health will have no trouble integrating, they accept PDF, that is such a low bar output.
It is the MSIA that is probably at most risk of exclusion.
@11:42 AM With respect, the MSIA has been their own worst enemy. The MSIA has gratuitously participated with the ADHAs direction, proposals and marketing propaganda, and in so doing remained silent, thereby signaling its acceptance and support for the entire mess.
Reinforcing this is the presence of its most senior representative on the Board. The MSIA and its members should stop deluding themselves. Get off the Board, face the facts this project is of no benefit to the Australian citizenry and have the courage to say so, openly and publicly. The sooner it is dismantled the better it will be for the MSIA and its members.
AnonymousMay 05, 2021 1:03 PM - no argument from me. I am simply predicting that the influx will push our software vendors to one side.
Also a correction - should have been department of health - guess my iPad was wanting to put out its thoughts.
@9:22AM I agree Andrew. They don't want to know about 'problems'. Today's managers all too often say "Don't tell me what the problem is just fix it". That way they don't have to worry about it, or try to understand it, or even have to fix it.
As you said "The problem is they are "Not even trying" to fix the problems!"
Therefore, the way forward is disconnect the My Health Record, dismantle the ADHA and terminate its 300+ employees, and let free market forces prevail.
..... and I should also have added @1:23 PM that, as the last 5 to 10 years have repeatedly shown they don't understand the problem(s) there is virtually no hope, after all this time, that they ever will understand the problem(s), hence thy cannot even try to fix the problems which is why the only reasonable conclusion one can come to is as I concluded "disconnect the My Health Record, dismantle the ADHA and terminate its 300+ employees, and let free market forces prevail."
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