This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.
It is called the Draft National Healthcare Interoperability Plan – Oct 2021
It can be found here:
It is worth a read to see how little seems to have really changed and it really does not seem that anyone actually has a real plan to actually move forward. Lots of positive thoughts but no real funding and mechanisms for implementation I can see.
To me it is totally unclear just what is going to cause any of this to happen!
What do others think?
David.
Surely you have appreciated by now (after al these years) that if they have no plan they will get no funding. The purpose of these 'DRAFT' plans is to provide support for the next round of funding submissions. Surely you understand that!
ReplyDeleteI know this is a bit radical, but would it not have been useful to analyse what has happened over the past decade when it come to eHealth in Australia?
ReplyDeleteA good question to ask is - did the PCEHR get delivered as proposed? If not why not?
The PCEHR was supposed to reduce data fragmentation by creating a virtual health record by joining up existing health data repositories. A central database would be created to augment this virtual record.
Did it get built? No. Why not? Because they could not solve the interoperability problem.
In fact, they reference the original PCEHR, 1.35 architecture document (which is based upon the Concept of Operations) and the discussion assumes that what was implemented was in these documents.
In the section on "The Case for Reform", they explicitly state:
"It is generally acknowledged that there is a concerning lack of interoperability in Australia’s digital health system. However, national data is not collected on a consistent basis to measure the nature and extent of the problem or whether progress has been made to improve digital maturity."
So what has NEHTA/ADHA been doing for the last ten years? It would have been a good idea to "measure the nature and extent of the problem" before developing a strategy?
Is there any evidence that ADHA is doing anything different that will result in success this time round? No. Has there been any progress anywhere around the world to suggest that the problem of health data interoperability has been solved? No.
Is there any evidence that that the authors of this draft strategy have any idea what the underlying problems are? No, not in my opinion.
Hidden in a section on the My health Record system they reveal that a "new Diagnostic Report that will enable uploading of additional health information and support healthcare providers to easily discover clinically relevant content". No discussion of what this is, why it is needed, or, more importantly, who will produce this report and the cost of producing it - a common failing in the whole approach.
We have come a long way in the past decade. We now have ample evidence that the approach adopted when developing the PCEHR did not work in that there are no acknowledged benefits or valued outcomes.
Is that reflected in the strategy? No. Why not? That's an interesting question. The strategy walks a fine line between the original promises, which were not delivered, and the aims of the strategy, which the strategy is attempting to now deliver.
It is worth noting that at the State level a different approach is being taken. The State initiatives have thrown out any idea of their systems being "patient controlled". These systems are aimed at supporting clinical care, rather than some vague concept of patient centric health information.
Thank you for posting David, I started reading and half way through I came to the realisation - not worth the time or effort ADHA is long bereft of the depth and breath to lead a national effort let alone be capable of running a bath.
ReplyDeleteIt is just rinse and repeat- mask it by introducing a few bits and bobs from various taxonomy models
If the ADHA really wants to make a difference to the provision of healthcare in Australia maybe they should start by looking at what the healthcare experts say:
ReplyDeleteAustralia’s splintered healthcare system is plagued by inequity
By John Dwyer
Dec 8, 2021
https://johnmenadue.com/australias-splintered-healthcare-system-is-plagued-by-inequity/
If the ADHA cannot directly demonstrate how their initiatives will address the many problems identified in that analysis they should pack up their tent and go home.
At the moment they are confused in that they believe a splintered healthcare system can be fixed by "reducing data fragmentation"
The Commonwealth is a one trick pony when it comes to fixing major problems (e.g. healthcare and the climate)- just implement new technology. Unfortunately they do not understand either the problems, nor why their magic bullet is not the answer.
Meanwhile, yet another Department of Health project manager is pushing for medical systems to move to the cloud.
ReplyDeleteThe jig is up: it’s cloud or bust, government admits to vendors
https://medicalrepublic.com.au/the-jig-is-up-its-cloud-or-bust-govt-admits-to-vendors/58321
"McCabe made it clear that the government was moving its platforms to the cloud and that they wanted doctors using those platforms so existing software systems needed to be properly cloud enabled as this process unfolded."
Healthcare systems need to be resilient, something you don't get by building in critical point of failure.
Amazon cloud outage hits major websites and streaming apps
https://www.abc.net.au/news/2021-12-08/amazon-cloud-outage-hits-major-websites-streaming-apps/100682378
How can interoperability help to share information if only a fraction of the clinical activities are recorded using computer records? Interoperability as thought of by ADHA, is only a link in a much bigger chain.
ReplyDelete“Of the participant hospitals, 12.5% had full EMRs; most reported hybrid medical records including in hard copy (paper-based), digitised (scanned) and electronic media. The hospitals had electronic: Discharge Summaries (78%); Emergency Department EMR (61%); medical-surgical inpatient Progress Notes (52%); Medication Management (52%). Discussion: The diversity of medical record media suggests complexity for HIMs and challenges for HIM-Coders and Clinical Coders, and stakeholders, e.g. clinical staff; clinician-researchers.”
Robinson, Kerin. (2021). Implementation status of hospital EMRs: Findings from a survey of public hospitals in Victoria, Australia..