This appeared last week:
Australian Digital Health Agency
Strategy and policy advice on standards governance principles
Opportunity ID 17252
Deadline for asking questions Thursday 11 November 2021 at 6pm (in Canberra)
Application closing date Monday 15 November 2021 at 6pm (in Canberra)
Published Wednesday 10 November 2021
Panel category Strategy and Policy
Overview
The Agency is seeking a suitably qualified vendor to undertake the development of a Digital Health Standards Governance – National Guiding Principles (the guiding principles) document and supporting resources. The guiding principles will be a nationally agreed document to guide software developers, standards development organisations and governments with an in interest in digital health standards on the best practice methods of developing and using Australian Digital Health Standards. The preferred vendor will deliver the work under the leadership of the Clinical and Digital Health Standards Governance Branch. The guiding principles will be evidenced-based, developed in close consultation with key stakeholders and endorsed by all parties before publication.
Estimated start date ASAP
Location of work Offsite
Working arrangements
Offsite, potential face to face meetings with stakeholders
Length of contract 5 months
Contract extensions Up to 2 months at the buyer's discretion
Evaluation criteria
Essential criteria
Weighting
Demonstrated capability to undertake this work - 50%
Qualification, Competence and Experience of proposed consultants - 50%
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Here is the link:
https://marketplace.service.gov.au/2/digital-marketplace/opportunities/17252
Talk about a blast from the past – as I read this I had an awful sense of having been here before.
I confirmed my impression with this extract of a CV from my consulting days!
Work I did in 2005 for the then NEHTA covered:
1 - Core contribution to the development of specifications for a Shared Electronic Health Record for Australia (2005)
2 - Major Contribution to the NEHTA project to develop a business case for the implementation of a National Clinical Terminology for Australia (2005)
3 - Major Contribution to the NEHTA project to develop a business case for the implementation of a National Patient Identifier for Australia (2005)
4 - Contribution to the NEHTA project to develop Health Information Technology Standards Priority and Framework for Australia (2005)
As I ‘vaguely’ recall the year before we also had catalogued and assessed available “Standards” in Australia. There is also a 2020 report on standards etc from David Rowlands (among others) still on the ADHA site.
See here:
https://www.digitalhealth.gov.au/about-us/policies-privacy-and-reporting/interoperability-reports
So having blown up all this Standard setting capability and structure by 2010-12 or so with the “Tiger Teams” etc. doing stuff for the PCEHR and so on we were left with most real experts walking away from Standards Australia amd NEHTA and working with HL7 etc. (note: this is a vast simplification of what happened but captures the outcome.)
Later on NEHTA was terminated and the ADHA took over. And now they are starting out again it would seem (again) and doing it all over! I wonder who at ADHA has the documents and reports from way back when and which of the staff are still there?
It is going to be interesting to see what interest the old ‘experts’ have in getting involved again after the way they were sidelined all those years ago!
Also you really do have to wonder just what the 160 or so staff at ADHA working on "Strategy" are actually doing if they are seeking outsiders to help!
Looking at the timeframes mentioned in he RFT it looks to me like this engagement is a 'done deal' for someone. I wonder who?
I never thought I would live long enough to see the cycle repeat so amazingly!
David.
24 comments:
The definition of insanity - doing the same thing over and over again and expecting different results.
You can always tell an agency out of its depth. They turn to consultants.
It's the Dead Sea Effect
http://brucefwebster.com/2008/04/11/the-wetware-crisis-the-dead-sea-effect/
Good talent evaporates leaving a salty, stagnant, lifeless mess.
"So having blown up all this Standard setting capability and structure by 2010-12" .....
"You really do have to wonder just what the 160 or so staff at ADHA working on "Strategy" are actually doing if they are seeking outsiders to help!"
I never cease to be amazed by this Circus-Merry-Go-Round.
It will be to push ADHA specifications as standards and simply mention HL7 and ISO to incorrectly add weight. The don’t understand the value of standards
If it is one of those fools from the “tiger Team” days it will be a non-starter again. The idea that a few selected experts behind closed doors can determine the standards and the content is highly questionable. It is clear the ADHA approach to standards is hat weds to be in place to enable clinical systems to be feeder systems to their health record thing.
Does anyone really care? Cannot see the major vendors paying much more than an API token gesture.
ADHA is simply an administrative brand of Services Australia.
In Australia, the e-health/digital health standards community does not operate through a sustainable business model and further guidance and investment is needed to ensure this is a workable foundation for Australia. Government investment in standards is common across many nations and forms the momentum and basis for greater recognition and adoption. Consistently advised and consistently ignored a starting point should seek to create a targeted but broad-based Standards Catalogue that documents the recommended standards from the Agency but more generally, captures and documents the use of digital health standards in Australia. This recognition of current standards use is the first necessary step in national recognition of standards, ensuring that standards are not regarded as a government dictated edict.
Partnering with the broader community - aim to establish an overarching, arms-length group to provide cross-standards leadership, resourcing, and investment to ensure optimal and sustainable development of digital health standards.
This initiative has a direct relationship to the issue of a sustainable model for digital health standards in Australia. By consolidating the standards efforts and having government support greater certainty of support and longer term efforts, standards will achieve greater impact and deliver better value, especially if aligned to national objectives and strategies.
This model of investment has worked for Canada where a similar spread of investments were brought together under a collaborative model. A successful standards community is an effective litmus test for a productive
digital health community.
Or we could just forget the whole standards thing
1. Vendors will pay no attention.
2. ADHA does not understand.
3. ADHA does not know what problem(s) it is trying to solve.
4. Market forces will prevail.
5. The whale will keep thrashing around in the ocean, flipping and flopping, from issue to issue as it attempts to give itself relevance, viz:
(a) interoperability
(b) standards
(c) RTPM
(d) Health Exchange
(e) Return to (a) ad infinitum
@November 18, 2021 8:37 AM
And they don't and never will understand the dynamics of health data. They have this simplistic view that it is somehow the same as commercial, financial and/or banking transactions.
Not that many other people do either.
Even with such relatively simple things as discharge summaries there are few if any standards at the clinical level, never mind technical interopoerability
Danger in discharge summaries: Abbreviations create confusion for both author and recipient
https://pubmed.ncbi.nlm.nih.gov/34636114/
(an Australian Study)
IV, DVT, CVA, GA, PRN, IM, BP, BD, CPR, CXR, ECG, SR, GFR, EMG, FSH, GI, ENT, ICU, IVP, MI, PRN, PR, HR, MVA, MS, RBC, SIDS, STD, UTI, URTI, SOB, WBC, MRSA, ... we have been using these for many decades. New ones have emerged like ADHD, ECHO, ECMO, .....
They will always be part of health care communications. You simply have to know them. You cannot and should not expect them to be written out in longhand. Know them, get used to them and use them correctly is simply good practice.
@10:36 AM "And they don't and never will understand the dynamics of health data."
True. The same holds true to some degree for the vendors too in that they tend to develop s/w applications on the fly and fix the problems as they go along when the customer complains or when a 'breakdown' / 'problem' with the system becomes apparent. In other words they start out developing an application never quite understanding the "dynamics of health data" either and with the attitude "no problem, we'll sort that out as we go along".
That's life today in ICT; nothing is perfect.
@November 18, 2021 11:46 AM "They will always be part of health care communications. You simply have to know them."
Did you even read the results summary section?
"Results: 99% (794) discharge summaries included abbreviations. 1612 different abbreviations were used on 16 327 occasions. The median number of abbreviations per discharge summary was 17 (range 0-86).
254 GPs and 62 junior doctors responded to a survey which found that no abbreviation was interpreted the same by all respondents.
GPs and junior doctors were unable to offer any interpretation in 17.9% and 15.2% of cases respectively.
GPs offered a greater range of interpretations than junior doctors, with a median of 9 and 3 different interpretations per abbreviation respectively.
94% (239) of GPs felt that the use of abbreviations in discharge summaries had the potential to impact patient care.
152 (60%) GPs felt that time spent clarifying abbreviations in discharge summaries could be excessive."
How do you propose to make sure that doctors "... use them correctly"?
Yes, I read the summary and noted the results. The perfect world does not exist and you cannot expect, nor will you ever get, clinicians to cease using abbreviations and revert to longhand; regardless of whether they handwrite or type.
It's a combination of education in medical school, culture change and reinforcement / oversight of record writing by hospital staff; nurses, residents and specialists.
To begin the process the medical colleges should agree on a 'basic' set of abbreviations, distribute them on 'card' and 'electronically, make them readily accessible on the hospital computer and insist / enforce their 'usage' as a policy and standard in the hospital.
It's not a perfect world. Improve on the above by all means. Tha tr's a start (I hope).
It's all to do with Professional Standards and courtesy.
The best way is to:
1) reduce reliance on free text;
2) use more structured data entry which give context & post coordination;
3) keywords, abbreviations & acronyms connected with terminologies & other attributes for filtering. Start typing in 1st textbox, 2nd is the dropdown list of related terms (filtered using the value of the 1st). The HCP selects what they mean to say so others don't have to guess. The SW context & user can filter the lists & keep them short eg. a GP would have a different list than an Optometrist & different to a heart surgeon. But the terms are coded with a reference terminology codes shared with all & the version/release for interoperability. The codes also have a classification hierarchy to aid aggregation & research.
Talk to GPs who use ICPC-2 PLUS.
"Why code, why classify?"
The list of tests ordered in the EHR limits that dropdown list to just tests, path just has path..
Training needs to start as Uni students.
@6:01 PM Dropdown lists; free text versus structured data; tailored lists specific to both the 'user's specialty' and the 'user's preference (different radiologists have different preferences for their style of reporting)'.
Conceptually this 'approach' is all well and good in the most simplistic of terms but the further one reaches and the deeper one digs the more complex and confusing such concepts and solutions become; notwithstanding the questionable viability of any underlying business model to support such an approach, the time constraints imposed on clinicians and others, and above all the relatively crudely developed unproven solutions currently available to test and prove any practicable approach to addressing these issues.
In short an acceptable solution is still many years away dependent on the success of a huge amount of Research and Development still in its infancy.
@6:01pm You make it all sound so seductively simple.
"1) reduce free text + 2) use more structured data entry + 3) keywords, abbreviations & acronyms connected with terminologies & other attributes for filtering. Start typing in ...... "
Bingo, easy peazy. Give me the system now, please. Where can I get one? Who has developed it? How much does it cost? Oh nirvana has arrived at last. Is it quick, is it comprehensive, does it really work, is it prone to errors?
AnonymousNovember 18, 2021 6:49 AM
That is very well put. Very well put.
Is the ADHA attempting to position itself as an SDO?
6:49 AM. Find your position very interesting and probably a good avenue to peruse. Sadly “ establish an overarching, arms-length group to provide cross-standards leadership, resourcing, and investment to ensure optimal and sustainable development of digital health standards.” As practical as. That might sound ADHA does not share power. Nice but probably beyound the current meddlers ability to grasp
The level of ability is so low that their posturing would almost be amusing until you realize that the same department is supposedly in control of the actual health care systems future! I wonder if other areas of essential services are any better? The idea that health can be run without experienced clinical input and IT without computer science input seems to have become firmly embedded in the public service and the wheels are falling off everywhere.
If the same level of ability pervades things like electricity and the food supply its time to start studying the prepper literature!
Is this the same health department that helped stuff up aged care in St Basil's?
Coronial inquest begins into COVID-19 deaths at St Basil's aged care home
https://www.sbs.com.au/news/coronial-inquest-into-deaths-at-st-basil-s-aged-care-home-hears-how-doctors-warnings-were-ignored/fe44cdc3-9d97-45c4-85d7-055eb1e39c4a
The inquiry into the deaths at St Basil's Home for the Aged in Fawkner during the state's second outbreak in 2020 opened on Monday with the names of each of those who died read out in court.
In an opening statement counsel assisting Peter Rozen QC said staff at the home were deemed "close contacts" and furloughed on July 22, with the Commonwealth taking over the home despite multiple warnings from doctors that regular staff should not be replaced.
He said one doctor involved in the response, Dr Rabin Sinnappu, warned that furloughing St Basil's staff would result in disaster, while another doctor described it as a "shocking" idea.
Mr Rozen said a lack of care for residents had become apparent by the end of the first day of the takeover, after the federal health department could not find enough new staff.
"There were far too few of these workers at St Basil's for them to have provided care at the level the residents deserved and the law required," he said.
The court heard that by July 23, pathology staff visiting to test residents found the conditions "shocking to say the least".
The major vendors of hospital software are now so well entrenched in Australia's public hospitals that they virtually cannot be displaced. Consequently the only 'standards'they will acknowledge and adhere to are those that prevail in their major markets overseas: viz. the USA.
So basically they won't change to comply with whatever 'standards' Australia tries to develop and enforce where it applies to hospital software.
That leaves the 'standards push' in Australia stranded out on the proverbial rock like a Shag, pushing standards at the Primary Care, Community Health and Aged Care sectors; to what avail?
So, while the Commonwealth Health Department plays with its toys in its lonely sandpit, the real worlds of vendors, private/specialist healthcare, the states, CSIRO etc all go their own merry way?
Strollout, that word of the year, could well have applied to NEHTA/ADHA/DoH way back in 2012. The Feds can celebrate 10 years of inaction next year. What a great chance for a retrospective showing just how much progress has been made and how much they have saved the health budget and improved so many lives.
The irony is that, considering it's the Department of Health, it's all rather sickening.
@9:28AM Absolutely correct in every respect. When Australia is only 2% of the global market, it is, and always has been, folly to think our Government, our hospitals, our local IT industry, can impose and enforce locally developed (immature, evolving) on overseas vendors arriving on our shores in their longboats. It has always been so.
Yes, they will accede to requests to modify, Australianise, their systems functionality all through the sales cycle, but when it comes to the crunch post sales as deployment gets underway all those 'glib' assurances are thrown to the wind.
It started in the late 1980's with the arrival of Cerner, followed by EPIC and others since. By doing so Australia surrendered its opportunity to build a strong homegrown health (hospital) software industry. It is now too late to redress that position.
The Government and its bureaucrats do not understand, and do not want to know or accept, that this is the case, rather they want to play in this space in the misguided belief they can do better and show the world how clever they are.
The jury is still out on FHIR but its best hope for longevity is entrenchment in the American and European markets.
As for the Primary Care space perhaps Telstra and Government will combine their resources to prove up their rhetoric and show what can be done! Considerable skill, knowledge, and competence are needed underpinned by deep pockets and unswerving commitment to the end goal. Do they have what it takes? They think they do; but probably not unless they can come up with a better strategy and approach than hithertofore. Time will tell.
I think you might. E looking at standards development and the participation in those developments through the wrong window.
I also like the statement further up the trail.
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