These two articles appeared last week. First we have this:
Accenture gets another $11m for My Health Record enhancements
By Justin Hendry on Sep 27, 2021 6:51AM
Decade-long deal climbs higher.
Accenture has been handed $11 million to further enhance the My Health Record system, bringing its long-standing national infrastructure operator (NIO) deal to $641 million.
The Australian Digital Health Agency revealed the nine-month contract with the tech giant earlier this month amid its massive national infrastructure modernisation program.
The new deal comes just two months after the AHDA extended Accenture’s decade-long umbrella deal until at least July 2022 at a cost of $42.7 million.
Accenture has held the NIO contract for the design, build and integration of the My Health Record system since 2011, when it was known as the personally controlled electronic health record (PCEHR).
A spokesperson told iTnews the contract signed this month – as well as one signed in December 2020 for $15 million – as relating to “enhancements to the My Health Record system”.
“Amendment two [is] for work undertaken in the 2020-21 financial years and amendment four [is] for work in the 2021-22 financial year,” the ADHA said.
Further enhancements to the system come as Deloitte gets to work building the new health information gateway that will support the My Health Record.
The gateway, which will be used for exchanging and accessing health information, is considered the first stage of the ehealth record refresh, called the national infrastructure modernisation program.
More here:
https://www.itnews.com.au/news/accenture-gets-another-11m-for-my-health-record-enhancements-570292
Second we have this:
Accenture gets $11m boost for My Health Record ‘enhancements’
Denham Sadler
National Affairs Editor
In June 2012 Accenture was awarded a contract for “national infrastructure services” for the My Health Record system, with the tech firm operating an Oracle-based platform underpinning the digital health service.
Across a number of amendments this contract has now ballooned out to be worth just under $641 million, running until the end of June next year.
The first value increase was awarded in October 2019. In July last year, Accenture won a one-year extension of the contract worth $42.5 million, and a further $15 million to make a number of improvements to the system in the 2020-21 financial year.
The Australian Digital Health Agency (ADHA) awarded Accenture a further $11.5 million recently to make more “enhancements” to My Health Record this financial year, a spokesperson said.
“Separate amendments were made to distinguish enhancement work from the contract extension,” the spokesperson told InnovationAus.
The Agency did not comment on what these further “enhancements” will involve, or what Accenture delivered as part of the previous contract amendment for more work.
The ADHA is embarking on a significant update to Australia’s digital health ecosystem.
In July the agency awarded consulting giant Deloitte a near-$18 million contract to develop the “foundational capability” for this ecosystem, known as the Health Information Gateway. This will be a “secure and scalable platform for exchanging and accessing health information” and will eventually replace the system currently managed by Accenture.
Microsoft was also recently awarded a short closed tender worth more than $600,000 by the ADHA as part of its whole-of-government sourcing agreement.
The ADHA has also gone to the market for a contractor to develop a MHR app which will connect to the broader system through a new gateway, supporting two interaction models for consumer-focused apps.
More here:
https://www.innovationaus.com/accenture-gets-11m-boost-for-my-health-record-enhancements/
Reading closely we see there has been a range of little $M10-15 extras – adding up to a fair bit - just happening with Accenture while we see other extras of similar amounts to other contractors.
The major offender is this one with all the add-ons.
https://www.tenders.gov.au/Cn/Show/adf5f1db-6c83-440c-b390-dc8b2d706038
Contract Notice View - CN3612552
AusTender holds Contract and Standing Offer Notices for the 07/08 financial year forward. For information related to previous years, please refer to https://data.gov.au/dataset/historical-australian-government-contract-data.
Subcontractors: For Commonwealth contracts that started on or after 1 December 2008, agencies are required to provide the names of any associated subcontractors on request. Information on subcontractors can be sought directly from the relevant agency through the Agency Contact listed in each Contract Notice.
National Infrastructure Services for the My Health Record System
Agency Details
Contact Name: Australian Digital Health Agency
Email Address: contracts@digitalhealth.gov.au
Office Postcode: 2606
CN ID: CN3612552
Agency: Australian Digital Health Agency
Publish Date: 22-Jul-2019
Category: Management information systems MIS
Contract Period: 27-Jun-2012 to 30-Jun-2022
Contract Value (AUD): $640,975,227.00
Original: $529,557,294.00
Description: National Infrastructure Services for the My Health Record System
Amendments:
- CN3612552-A4 - Variation to Contract value (15-Sep-2021)
- CN3612552-A3 - Variation to Contract term and value (9-Jul-2021)
- CN3612552-A2 - Variation to Contract value (8-Jul-2021)
- CN3612552-A1 - Value Increase and Extend (10-Oct-2019)
Procurement Method: Open tender
ATM ID: DH0070-DOVZ5
Agency Reference ID: 4500121282
Supplier Details
Name: ACCENTURE AUSTRALIA HOLDINGS PTY LTD
Note that the various amendments added about $110,000!
Then there is also this:
https://www.tenders.gov.au/Cn/Show/f0aa7b81-9eea-458a-8745-f2a3101358bb
Contract Notice View - CN3805871
AusTender holds Contract and Standing Offer Notices for the 07/08 financial year forward. For information related to previous years, please refer to https://data.gov.au/dataset/historical-australian-government-contract-data.
Subcontractors: For Commonwealth contracts that started on or after 1 December 2008, agencies are required to provide the names of any associated subcontractors on request. Information on subcontractors can be sought directly from the relevant agency through the Agency Contact listed in each Contract Notice.
Software Agency Details
Email Address: contracts@digitalhealth.gov.au
Office Postcode: 2606
CN ID: CN3805871
Agency: Australian Digital Health Agency
Publish Date: 18-Aug-2021
Category: Software
Contract Period: 30-Jun-2021 to 31-Aug-2021
Contract Value (AUD): $269,192.00
Description: Software
Procurement Method: Open tender
ATM ID: DH3519
SON ID: SON3413842
Agency Reference ID: DH3519
Supplier Details
Name: Accenture Australia Pty Ltd
Between these to very vaguely
specified contracts almost a $1billion has wandered out the door. Who knows
what we got for most of it? Looks like a very profitable 'gravy train' to me. I wonder what the margin is? Remember all this is meant to be spent by July 2022!
I reckon there should be much more public explanation of all this! What do others think?
David.
20 comments:
I think the Australian National Audit Office [ANAO] has been absolutely incompetent beyond belief and totally derelict in its duty in every way, nothing less.
It should be obvious what is going on, enough information about their intentions is freely available. Start with this:
Deloitte scores national health API gateway deal
Solution will replace My Health Record's existing Oracle gateway..
https://www.itnews.com.au/news/deloitte-scores-national-health-api-gateway-deal-566888
This gateway is supposed to allow any Health IT system to talk to any other Health IT system without going through MyHR.
To make this work, Accenture has to modify MyHR to use the new Deloitte gateway instead of the existing Oracle method.
This means that Accenture is not "enhancing" MyHR. All they are doing is replacing a bit of their code with Deloitte's code.
When all this is place, MyHR will be irrelevant (even more so than now, if that's possible)
ADHA's problem then will not be at the infrastructure level but at the data interchange level - systems will need to pass meaningful data between themselves.
This is probably two orders of magnitude harder than the MYHR central database of pdfs, even if they are conformant to a common data model.
When this new gateway is in place and tested, the world will have moved on even further - state systems will be doing everything the MyHR ever promised except feed data into the Federal governments dark databases which are shown on ADHA's architecture diagrams.
The MyHR will have delivered little benefit, certainly nothing worthy of the costs which will be approaching $3billion. The ADHA will then have the tasks of a) solving the data interchange problem at a content (not infrastructure) level and b) persuading all those health service providers to give their data away with no privacy safeguards.
Not many people realise that the existing "privacy safeguard" MyHR legislation does not apply to data that is available through other systems - i.e. everything in MyHR except that which has been directly input into it and which only applies to the MyHR.
As I asked of Sarah, "do you believe any of ADHA's claims?". They claim "enhance" but really mean re-implement some infrastructure.
That all adds up to the ADHA has been sold another pup absent, any obvious planning and understanding of the problem(s) they think need to be solved. The gravy train trundles on into the never never
The ADHA hasn't been sold anything, they are doing the selling, trying to justify their existence.
It's the exact opposite of Climate Change. Do nothing and achieve nothing.
ADHA is doing lots but also achieving nothing.
A common purpose - achieve nothing. Which comes from a total lack of inspiring leadership.
Is it health information or clinical data? Does it include medicines terminologies? If so which is the primary to be mandated? And who will be responsible for governance?
If this is done right it will provide a useful development for other to emulate in actual clinical settings.
@G. Cater "Is it health information or clinical data?"
Nobody knows. When I commented on the Concept of Operations document way back in 2011, I pointed out that they (NEHTA) had not defined or analysed "health information".
They went ahead anyway and tried to build a system that "reduced data fragmentation" but failed because they didn't understand how data from disparate sources should be merged meaningfully. That's the real interoperability problem; it's a data content problem not a system interface problem.
AFAIK, neither NEHTA or ADHA have made any attempt to understand the information they are supposed to be managing. From what I have seen of MyHR they treat health data in the same way as businesses treat financial transaction data.
Once a transaction occurs it becomes a fact which does not change (apart from errors and exceptions). Health data is very different. There are some facts (a hip replacement, a vaccination, a heart attack etc) but in general it is often uncertain, incomplete, inconsistent, irrelevant or just plain wrong.
The result is that their approach is to gather as much data as possible and leave it up to future health service providers to wade through it - which they often don't.
What they do is order new tests to make sure that they have current, relevant data. Which then gets added to the health record and probably ignored after a very short period of time.
re "And who will be responsible for governance?" Nobody, because governance of health data is an impossible task because you don't know which data will be useful and/or what the data will be used for.
If you want to understand the real problems of healthcare you need to understand how decisions are made (and/or how they should be made) in an environment of uncertainty. Governments don't like uncertainty. They either don't make a decision because they can't work out what the "right" decisions is, or they make a decision about something that is constantly changing.
> "failed because they didn't understand how data from disparate sources should be merged meaningfully"
Sadly, the problem is deeper than "didn't understand" - there were good people in the organizationswho totally did understand the problem, including in leadership. But that's not enough. You have to empowered to fix the hard problems, and overcome organizational inertia.
With respect Grahame, I don't think anyone properly understands the problem, even clinicians.
I have read a lot of the literature on clinical decision making and current approaches are nearly all are based upon risk. That's because every human being is unique and therefore there will always be a degree (greater or lesser) of uncertainty in diagnosis and treatment response/effectiveness.
Any data on a patient has uncertainty in its meaning. When it comes from different sources, probably at different times, in different contexts, the uncertainty may increase or it may decrease.
The classic approach of a differential diagnosis compares a patient with "normal" or "average" or "healthy". The trouble is that there is no such thing as "normal", it's a statistical measure. A particular patient's "normal" may be quite different from the statistical "normal", especially if the statistically "normal" is based upon male data and the patient is female.
There are cases when women are left out of trials because their menstrual cycles interfere with the data.
There will always be problems with health data.
One of the things that I think HL7 V3 had correct was that every "fact" about a patient is an observation which means you can have conflicting "facts" and know when and by whom the data appeared in a patients record, observations are non always correct.
Dealing with uncertainty and errors is a critical part of dealing reliably with heath observations when doing decision support.
Want interoperability? Give us a reason
The Medical Republic
6 October 2021
https://medicalrepublic.com.au/want-interoperability-give-us-a-reason/55056
By Holly Payne
Championing the cause of interoperability standards may be noble, but medical software industry experts predict that Australia won’t see much success until both vendors and system users can agree on clear incentives.
Speaking at a Wild Health webinar on the relationship between standards and the future success – or failure – of interoperability in Australian digital health, Medical Software Industry Association CEO Emma Hossack said that it was a lack of interest, not ability, which was holding the industry back.
……
Moderated by Wild Health/TMR publisher Jeremy Knibbs, other panel members included:
• Department of Health first assistant secretary of benefits & integrity Daniel McCabe,
Daniel McCabe used to be a project manager at the Department of Defence. The whole My Health Record debacle was driven by another Department of Health project manager.
What is it with the Department of Health thinking that all you need to make a complex information system happen is a project manager? What do technology project managers know about health information, health care and health systems users?
Maybe the MSIA needs new leadership. Obviously old Cossack does not deem Aussie software good enough for the international markets. Standards play a big roll in developing product that can be used with little or no customisation for a particular region or country.
Old thinking that will see MSIA become irrelevant beyound some annual Christmas gathering
Further to my rant about health data
https://aushealthit.blogspot.com/2021/10/it-really-looks-like-myhealthrecord-is.html?showComment=1633308195942#c42910941923453630
Your paper has left something out: Women
https://medicalrepublic.com.au/your-paper-has-left-something-out-women/55100
Women and girls account for 50% of the population, yet most health and physiology research is conducted in males.
This is especially true for fundamental research (which builds knowledge but doesn’t have an application yet) and pre-clinical (animal) research. These types of research often only focus on male humans, animals and even cells.
In our discipline of exercise physiology, 6% of research studies include female-only participant groups.
So why do so many scientists seem oblivious to the existence of half of the world’s population?
...
So what does the Department of Health - the body responsible for health policy in Australia have to say about Evidence Based Medicine (which is what the story above is all about)?
A search of health.gov.au gives one hit
Evidence-based medicine and POCT
Page last updated: 14 May 2013
https://www1.health.gov.au/internet/publications/publishing.nsf/Content/qupp-review~qupp-evidence-based-medicine-poct
(They don't define POCT, but it stand for Point of Care Testing)
How many times do they refer to the topic of women, as identified in the story above? Zero. When was the page last updated? May 2013
How about the Department of Health gets on with doing the job it is paid to do (regulate and actually improve healthcare in Australia by developing policies) instead of messing about with Digital Health and other technologies in which it has no expertise and/or capability.
The MSIA should be focussed on strengthening the local industry. Ms Hossack was always going to be beholden to the big powerful vendors as their subscriptions go towards paying her salary.
You appear to have misunderstood Ms Hossack's comments, G. Carter. She is not saying she is anti-standards.
There is certainly a lack in interest in standards compliance in Australia and terrible compliance with message generation and consumption of standards based messages. It is a combination of lack of will and I suspect a lot of poor coding under the hood, so ability does come into it.
This is a huge safety risk, but as no one does forensic analysis when things go wrong its not being discovered, but it would be happening for sure.
Insisting on standards compliance is what we do for other products in Australia, from cars, to phones to the windows in your house. It seems that standards compliance for messages is something that is beyond the comprehension of our regulators, that is "Techo stuff" perhaps?
We have a culture of pay the software vendor and they will do it, (but probably not maintain it) and that is a big part of the issue. Insisting on standards compliance is pretty cheap for government and is actually "governance" something they seem incapable of doing. It would not stifle innovation at all, but might attract some interest in the standards meetings when they knew they had to actually comply. You can innovate by building on high quality data, but we are stuck in a glorified fax world, sort of PIT with fonts and pictures ie pdf reports.
The approach of insisting on standards compliance (not standards creation, the government is hopeless at that) is the correct approach, and has the ability to eliminate a lot of safety issues, which if they bothered to look, they would find. Ignorance is bliss I guess.
Excellent comment, Andrew. Very interesting indeed. What can be done?
"What can be done?"
We need competent regulators with small budgets, with a mission to ensure safety for the public. That's pretty scarce quality these days, so not sure anything useful will happen.
Of course actually specifying that your software is safe would increase the price of software so any spending could try and compensate users for the increased cost, but should not go to vendors, that model has failed. Safety should be the top priority, go forth and innovate, as long as you are sending and can reliably receive compliant messages. The question of increased software cost can be hammered out between users and funders.
I dislike calls for more $$, the priority is safe software and strict standards compliance both with sending and receiving data is the way to achieve that in the interoperability setting. If we have that we can then focus on data quality, currently good data quality just causes issues at the receiving end, so we default to pdfs or text, but even that is unreliable!
Slightly off topic, but you could map back to standards as an assurance/insurance policy
A debate starting to get traction - Is a Hospital to Blame if a Patient Dies During a Ransomware Attack?
Help I am about to commit suicide: Why because I am trying to link my Vax Certificate to my Victorian Check-in app. (a) Why cannot all the Australian governments have one single QR check in app(obviously streamed only to the relevant health department ? (b) Why can't the Vax Certificate be automatically sent to the person's QR code check in app? Why do "they" have to make it so hard. What do these governments' discuss at their frequent meetings (other than who has got the most incompetent IT section. PS I have a hard copy of my Vax Cert which I have to take every where like a whore displaying her/his wares. I have MyGov and it is linked to Various entities including Medicare and works fine ON MY PC.
Call yourself a country or call yourself ego bursts from the colonial era .
Ronald Stewart.
If you are really suffering distress please call Lifeline on 131114
David.
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