This appeared a few days ago.
My Health Record’s ‘dumb numbers’ versus ‘meaningful use’
The Department of Health finally wants to see some evidence of the usefulness of the MHR.
If you trawl the health portfolio budget statement from March, on page 183 you will see a table that suggests the government is starting to lose patience, and perhaps even faith, in the whole idea of My Health Record (MHR).
The table says that as a part of measuring the performance of the Australian Digital Health Agency (ADHA) into 2023, it is going to require that the agency “Establish an approach and trial baseline for measuring meaningful use via a ‘meaningful use index’ for My Health Record”.
What the government wants is for the ADHA to start properly measuring just how useful this $2.6 billion project is today, and moving forward.
Finally, someone wants some proof that the MHR is doing, or even starting to do, what we’ve all been promised it would do.
It should be shocking to us all that we’ve spent this much money and time and we haven’t actually been measuring usefulness for the entire life of the MHR project.
But MHR has never been in the public eye enough for anyone to seriously question how the project has been managed over time and whether, in relative terms, it was returning on its investment over the years. It’s always been political, used as a show project when needed for a bit of sparkle in health policy by the pollies and then sent to the reserves bench – more or less out of sight – when things got embarrassing, as they did after Opt-Out.
No one has really cared enough about it politically or publicly to stand up and say: “Enough willing that this thing will work one day, let’s put in place some proper audit and measurement of this project.”
Note: The Australian Office of National Audit has audited the ADHA and how it has implemented the MHR, but its remit was not how much the MHR is used or how much value it brought to the system. That might be about to change.
We should have cared more than we have because the idea of sharing healthcare data seamlessly and securely across our healthcare system, and giving patients access to their data in a meaningful way, is possibly the most important idea for the future of our healthcare system since the thought bubble that resulted in Medicare.
What may have got in the way of altering our attitude to MHR in the past couple of years was covid, and a changing of the guard at the ADHA at the end of 2019 – the entire senior management team left in the space of a few months, something that should have prompted a little more inquiry.
Not withstanding, some in government have quietly been trying for a reckoning of the ADHA and the performance of MHR for some time now.
Check out these dazzling numbers (which have no baseline or reference points), everyone!
We’ve written a few stories in the past about the array of big numbers the ADHA publishes regularly, but these are meaningless because they never have a baseline or reference point and there is no attempt at all to frame them in some sort of return on investment to the public context.
It’s a long list of usually big, but meaningless, non-referenced “dumb numbers”. Without the context of a baseline, any of these numbers could mean anything.
There are pages and pages more here:
https://wildhealth.net.au/my-health-records-dumb-numbers-and-meaningful-use/
You can read similar sentiments from a few years ago from me here:
https://aushealthit.blogspot.com/2019/12/let-us-not-get-misty-eyed-about-tim.html
The astonishing thing is that the 2.5Billion dollars has flowed from the Government into the program and there is still no evidence is available to date identifying any real value being delivered either clinically or financially.
This, to me, is a much larger scandal than all the ‘sports rorts’ and
‘car park pork-barreling’ we have seen from the Federal Government in the last
9 years! It is really amazing that such
huge money sink was not watched more closely. The ADHA has a lot of culpability for this debacle I would suggest. I can remember making most of these points personally to Tim Kelsey in around 2016!
One has to wonder what an integrity commission might find if the program was investigated.
It seems that the #myHealthRecord was yet another one of the ideas that was answers to the data sharing issue what was ‘Simple, Clear and Wrong’ as per my blog header!!!!
David.
33 comments:
Agree David with your comments and the Wild Health article. I am a little more than pessimistic that anything will come of this other than more money down the drain. The ADHA will come up with measures consistent with the government guidelines - designed to tick boxes. The whole system is built on lies and a culture of success through attrition. Stay long enough and you slowly move up the pile. They adopt flashing terms drawn for the outside world and methodologies they know very little about. This works well as they build up “experts” and “leaders in their fields” not on merit, not on breadth and depth just based on time served and without external forces polluting the belief structure.
As a clinician (Renal Physician) the Health Secretary will be well aware that the My Health Record is a complete failure. Whether he has the mettle to do the right thing and put a stop to this psychophantic profligacy will be the measure of his tenure in leading the Department.
"Psychophantic profligacy"! Even David couldn't have said it better!
Just how would you go about ‘turning it off’. If it is as integrated as claimed is the government obliged to fund decommissioning of feeder system interfaces and processes designed to vomit data into the clutches of the ADHA and it’s PHN churches?
The simple answer would be hit the off switch but not sure it is that simple? Still that same thinking brought us the two billion dollar waste of space so maybe I am over thinking it.
You are overthinking. If you stop thinking you will feel much better.
April 27, 2022 6:30 AM - Agree mothballing the System would not be as simple as turning it off. An exit strategy would need to be in place and agreements across a broad set of stakeholders. Some would want funding - probably take a cybersecurity risk approach to achieve funding agreement.
Government is a stakeholder so an agreement on how data can be gathered to support population health decisions and other policy driven funding etc..
Definitely not something you would have ADHA do, perhaps this is part of the shift to Services Australia
@11.13 AM Wrong. The system offers no benefits and as such it is useless, a waste of money and a drain on resources. Decommissioning it is a stepwise process and can be done without too much inconvenience to anyone, provided you know what you're doing. First step, Human Services discontinues sending MBS, PBS, Immunization info to My Health Record. Second step .... , there, there, that didn't hurt did it?
Second step, Health Department instructs all PHNs to remove all reference to the My Health Record from their websites. That didn't hurt either, did it?
Third step, Health Department advises all pathology providers and all pathology software vendors that as from a 'certain date - one month ahead' the My Health Record will no longer accept pathology reports. Mmmm, not too much pain or confusion there either. My goodness, we are making progress. It won't be long before we will be able to turn off the system completely. Hopefully, you're feeling better now.
Fourth step, all records which have not been accessed in the last 12 months will be flagged and any subsequent access denied. A new benchmark measure of activity usage will be established, published and used to justify closing down the system in toto.
Personnel (consultants and employees) with no work to do will be terminated in the most expedient and cost-effective way possible. How do you feel now? Better or worse? As I am no longer holding a hose I am going on a holiday. Lucky Me.
That sounds like a very sensible plan for winding down the MHR. It shouldn't be too disruptive, certainly nothing that couldn't be managed fairly easily. It would probably take around 6 months and save annually $450 million.
Anon you are a worry, that sort of train wreck thinking got us here. Do you have a certificate from the Scaled Agile Framework people?
Dear Sarah, thank you for your comment which explains why you perceive a train wreck and so resistant to change and alternate thinking. I have a certificate in commonsense and realistic pragmatism from the University of Experience and Business Management.
I propose going to the data centre and shutting down the system tonight. Users would just think its playing up as usual and you could do a press release in the morning?
Sarah, I would like to think that after a period of quiet reflection you agree with Andrew. Both he and I (8:21 PM) can assure you there will be no train wreck and nobody will get hurt.
Great article. Slowly Australia is realising the mistakes it should have learned from Care.Data and other failed attempts to centralise through massive data collection hubs. Those stats paint a hard to ignore picture. Interesting to see the linage of the lie and how some profit by maintaining the faith.
Really is a bit cult-like.
Hopefully this marks a turning point.
@7:22 PM "Hopefully this marks a turning point" ...... ??? a turning point to where? Do you mean 'turning' the entire system off and permanently closing it down?
9:28AM - be happy it stops sucking all the oxygen from the room and allows other more important things to flourish. I see benefit in MyHR it centralises and contains some really annoying people who could do real damage if they escaped the pen.
Interested in what you see are the important things to tackle once the MyHR is repurposed? There needs to be a - “what next” story
The ADHA only sucks the oxygen from a small room it locked itself in. The rest of the world has moved on.
@6:40 AM "repurposing" is a NO NO. It equates to kicking the can down the road and perpetuating more of the same. How stupid.
Always give a wounded bull an open gate to leave the field through.
Mr Knibbs has published a fine piece. I think the catch here is that the ADHA will be the ones to come up with the measures. It really is hard to quantify any benefit.
Am no legislative expert but there is legislation specific to My Health Record/PCEHR and more than a few referencing or referenced. Probably have to start there? Might be a good way to develop a standard for reverse engineering placebo interoperability. Have to agree with Sarah Conner simply cutting the electricity flow to a database is simple but does not address the many layers that went into its (HR) creation.
@12:50 PM What exactly do you want to address that is so pivotal and important?
2:56 not sure I understand the question
2:56 Oh. Then switch it off and let the 'many layers' wither.
Switch what off exactly and what are the consequences for everything else that gets left on?
@10:26 AM Switch off the My Health Record (ie.shut down the system)just like Andrew @10:40 PM proposed.
My Health Record is a brand - are you only shutting that down?
April 30, 2022, 1205 PM - what do you do for those using the system? They have a stake in any shutdown. Don't they?
@ 1:34 PM ... Return to 11:32 AM April 27 and start from there.
1:58 PM based on that refer back to Sarah Conner's first comment.
There is a need to dissolve the system surrounding the My Health Record. To do so safely and without making the same mistakes of treating people and their rights as collateral, just needs a little more thought IMHO.
The government can shut down whatever it wants:
Greg Hunt’s final act against universal healthcare
https://www.thesaturdaypaper.com.au/news/politics/2022/04/30/greg-hunts-final-act-against-universal-healthcare/165124080013802#mtr
Low down in the latest budget was a decision that will fundamentally change the availability of low-cost, safe healthcare. In a single line item, the Morrison government defunded Australia’s national prescribing service, NPS MedicineWise (NPS).
The move came without announcement. There was no warning or consultation with the organisation – or with any other medical bodies. It was a fait accompli.
From the first of January next year, NPS will lose stewardship of the code that ensures prescribers, pharmacists and patients are well informed about medications and use them properly – the quality use of medicines (QUM) strategy.
Two weeks after this announcement, on the day Scott Morrison called the election, the Department of Health quietly announced that it had invited Dr Peter Boxall to chair a review into the health technology assessment (HTA) processes. Boxall is a former senior public servant renowned in policy and medical circles for his attempts to abolish the Pharmaceutical Benefits Scheme (PBS)during the Howard and Abbott governments.
“I think the sector is going to lose a really valuable resource, primarily hitting primary and aged care.”
An HTA decides what medications and therapies are subsidised by the PBS. The review is the result of a formal agreement between the government and Medicines Australia, the peak body representing the research-based medicines industry, which agreed to give up about $2 billion in statutory price cuts over five years in return for an audit of how Australia applies the HTA.
Taken together, these decisions may do more damage to our universal healthcare system than any changes to bulk-billing.
Both major doctors’ groups – the Australian Medical Association and the Royal Australian College of General Practitioners – say the NPS decision was “a complete surprise”. They have expressed disappointment and concern about the potential discontinuation of a “reliable, independent, evidence-based resource for doctors, clinicians, and patients”.
“We weren’t consulted,” says NPS chief executive Katherine Burchfield. “We found out on budget night with everyone else. The department indicated it was a decision of government.”
The work of the NPS, which is an independent organisation previously funded by the Department of Health, will now be subsumed by the Australian Commission on Safety and Quality in Health Care (ACSQHC). While she respects the “really great work” of the ACSQHC, Burchfield says the commission is not structured to deliver the same kind of independent, evidence-based support that NPS MedicineWise has provided for decades to frontline health professionals and consumers, actively working to improve decisions about use of medicines, and ultimately better health and economic outcomes for Australians.
“It’s not something I believe the commission can replicate,” she says. “I think the sector is going to lose a really valuable resource, primarily hitting primary and aged care.”
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