What Do You Think Of Australia’s 10 Year Digital Health Plan?

Somehow this was released while we were all busy with other things.

Australia's digital health pipeline in 10 years

The government is doubling down on modernising My Health Record and building a framework for national health information sharing.

By Adam Ang

January 12, 2024 03:26 AM

In the coming decade, Australia is expected to carry out several digital health initiatives that it outlined in its recently published blueprint. 

An accompanying Action Plan to the 2023-2033 Digital Health Blueprint explains each initiative and how target outcomes are going to be met in short, medium, and long-term horizons.

Many of those initiatives, such as electronic prescribing, the Health Delivery Modernisation Program, and several digital population health tools, are ongoing. Meanwhile, a couple of initiatives outlined are in the pipeline, including:

·         continued modernisation of My Health Record and making sharing of other key health information by default to My Health Record;

·         connecting Allied Health to My Health Record;

·         supporting preliminary work to develop a national legislative framework on health information sharing in states and territories;

·         establishing Genomics Australia, which will guide the responsible collection, storage, use and management of genomic data;

·         Dollars Going to Care, which will publish standardised and benchmarked financial information of residential aged care providers, promoting financial transparency and accountability;

·         Government Provider Management System, which will allow aged care providers to self-manage, view, and maintain their records with the government

WHY IT MATTERS

The modernisation of Australia's digital health record system is a major focus of the Department of Health and Aged Care in the coming years. It is working to fulfil some of the recommendations provided by the Strengthening Medicare Task Force last year, including overhauling the "clunky" My Health Record and establishing robust national governance and legislative frameworks to better connect health data across the health system.

"Planning for the modernisation of the My Health Record system to meet [national health information] sharing requirements for consumers and healthcare providers is underway, with future phases to be considered by [the] government," it said. 

Last year, the government also invested A$5.8 million ($3.8 million) to help allied health software vendors connect to My Health Record. Funding was also set aside for initial legislative policy and analysis work by states and territories to establish a national legislative framework for national health information sharing across settings and borders.

THE LARGER CONTEXT

Australia's Digital Health Blueprint envisions a "trusted, timely and accessible use of digital and data underpins a personalised and connected health and wellbeing experience for all Australians."

It has identified four key outcomes which revolve around digitally empowering consumers and the health workforce, safe data and information sharing, and building modern digital foundations of a standard-based health system. 

The blueprint was created to meet growing expectations and demand from consumers to have more control over their health through digital means. It consolidates the federal government's long-term investment in digital health, as well as complements the National Digital Health Strategy, which is currently being redefined.

More here:

https://www.healthcareitnews.com/news/anz/australias-digital-health-pipeline-10-years

Here is the reference:

https://www.health.gov.au/sites/default/files/2023-12/the-digital-health-blueprint-and-action-plan-2023-2033_0.pdf

Digitl Helth Blueprint 2023-2033

A more personlised and connected helth and wellbeing experience for all Australians

There is extensive commentary here:

How to make GP digital health gravy

By Jeremy Knibbs  - 12 January, 2024

A short critique of our Gravy Day digital health blueprint.

On 21 December last year DoHAC published what should rank as one of our most important health planning summary documents for decades: the Digital Health Blueprint

2023-2033. So I wrote a quick song …

Hello Dan, it’s Jeremy here, I hope you’re keeping well
It’s the 21st of December, and they’re ringing the Blueprint bell
If you turn out to be a saviour, we’ll be out of here by July (2033)
Hope to kiss patients on Christmas Day (2033), please don’t let them (continue to) cry…

GPs will be familiar with the song but probably not Dan(iel) McCabe, who is the main man inside the Department of Health and Aged Care running a pretty good new digital health agenda for the country, and one which will eventually impact GPs in a big way.

So what’s with the timing on something so important?

I was Christmas shopping at the time the plan came out, as I suspect were most other people who might have found it interesting.

We at TMR had largely stopped all our news services to go on break. We do still break big news over Christmas if it’s big enough, but even though this is a very important document, there wasn’t exactly any breaking news in it.

I did eventually read the blueprint and its associated action plan over my break. When East of Eden starting to get really slow (after the 350-page mark if you haven’t read it yet), I’d stop every now and then and read a bit of the blueprint, until eventually I’d read it all.

Maybe this explains the timing.

People need to be relaxed and have nothing much else to do to get through an important summary document like this, thus allowing them to savour the ideas a bit longer and ponder what might really come of it.

That’d be my get best attempt at a “get out line” if Mark Butler sent a WTF email though to my boss on the timing of the plan’s release – which if he didn’t, he probably should have.

If you haven’t read it yet, and everyone – including GPs – should at least try, here’s a tip: skip the blueprint and read the action plan first.

The blueprint is the sort of political PR aspirational puffery that might turn away the most hardened digital health nerd from persisting even with the far more important action plan.

For those non hardened nerds who want to save even more time and not even give the action plan a decent go (I’m going to assume a lot of GPs might be in this category), here it is in shorthand (note, my interpreted words not the blueprint’s):

By 2033 we want:

• Patients and healthcare providers to be able to share meaningful and important health data in real time anywhere, anyhow
• We want to empower both providers and patients to make much better health decisions in real time using this meaningful information
• We want to make the system transformationally (not a real word, but it fits) more efficient, not just for cost but convenience, for providers and patients

We’re going to do that by:

• Improving the relevance and functionality of the My Health Record significantly
• Getting technology vendors and providers to play ball by quickly agreeing to sets of standards which would enable modern web-based sharing technology to be implemented nationwide and create the ability for meaningful real-time data sharing
• Aligning the states, the federal government and emerging private providers on healthcare data sharing standards, data privacy and sharing legislation and technology so it all works for providers and patients

Of course this is a somewhat kindly (and horrifically simplified) summary (and you probably can’t see the word GP in there, but you’re there big time, believe me).

The first thing I’d say is that to at least have a government with these collective goals and some plan to achieve them – no matter how insanely wicked many of us know the detail under it actually is – is probably a very important starting point for transforming health in Australia, and a not a point we’ve been at, probably since someone pretty clever thought of Medicare (Medibank back then) in the early 70s, and how that might help things along much better for quite a few years.

On the other hand, given just how wickedly complex the issues are, you soon realise that what detail there is is not the detail required to inspire a lot of confidence that this plan is achievable, even given its 10-year horizon.

The action plan does list quite a few actual projects, either in play already, or in planning (way too many in planning), and most of them do go to the overall goals above, some even with just a whisper of co-ordination, which is another glass-half-full observation of the document.

They include (with some short observations in brackets):

• modernising the My Health Record (“modernising” says it all given we’ve spent over $2 billion and 10 years on it for no net meaningful result so far)
• enhancing digital medication management (expand a pretty good start on e-scripts across hospitals, aged care and so on)
• creating national standards to support real-time data sharing (doable big goal with a lot of power to change things quickly; question is, when?)
• create e-requesting for pathology and imaging in the mould of the national e-scripts service (big issues here emerging with software vendor resistance, especially GP software vendors – more below)
• create a national Health Information Exchange capability (sounds good but no one is sure how it could happen, given how eclectic our state-federal system is; and if it could do what is being suggested it might, why would you need the My Health Record?)
• equip the health workforce digitally (whatever that means, and, the key issue here, what workforce? We need digital faster precisely because we know we are never going to have the workforce we’re predicted to need)
• fix mental health with lots of cool new digital apps (I’ll expand below)
• get genomics fixed in Australia and integrate that infrastructure to the whole plan (noble goal and a smart thing to do, but probably completely unrealistic given the major basic interoperability issues to overcome first and the government funding paradigm)
• fix aged care with all of the above (it’s getting silly now, the plan is far too sprawling, but you can’t not mention aged care in a digital health blueprint)
• and a throwaway par about AI and health (I guess there had to be one as this is a digital plan and AI is going to help at some point if we get it right).

You may have recognised that some of really cool things in here that we’ve done already (electronic scripts for instance) are not the product of superior goals and planning from the past, but accidents of a pandemic that forced us all to drop our weird bureaucratic and protectionist behaviours for a couple of years.

But everything in this list (bar perhaps the My Health Record) all go to a set of collective aspirations and goals which are mostly sensible.

You may also have again noted that there is still not a lot about general practice. But keep reading. If the government does what it can do now fast, general practice is going to see a lot of change in how it interacts with the rest of the healthcare system and its patients within a couple of years.

Back to my awkward reinterpretation of the first verse of a Paul Kelly classic for a sec.

Can we afford to wait 10 years to achieve some of the key goals in this plan?

It’s a question I think everyone in charge should be pondering a lot harder following the release of this blueprint.

We know the time frame is not the government giving themselves tons of wiggle room to protect themselves. If you include some of the big throwaways in the blueprint at the end – “we’re gonna fix aged care and mental health with this here plan” – 100 years might be a better time frame.

Even if we look at the basic obstacles this plan faces in just getting data sharing, standardisation and technology alignment going, 10 years is pretty optimistic.

Ten years can also easily be argued a wise time frame if we are to avoid large scale and very expensive screw-ups given the complexities, politics and interdependencies associated with healthcare provision. Mind you, if anyone ever wants to get honest about the ROI of more than $2 billion for the My Health Record, it’s pretty hard to see how anyone today could engineer an ongoing mistake that big again.

So, it’s sensible to plan this long, right?

I don’t think so.

Here’s why:

• Some parts of our system are going to crash almost certainly soon without bolder faster action. The most immediately identifiable collapse is within most aspects of our health workforce. All areas of workforce are vita and stressed but if our general practice network collapses our system will collapse entirely and the time frame for fixing that will be a lot longer than 10 years.
• Ten years is good and bad for healthcare planning. The bad side is that a lot of organisations and people can keep doing average and even bad things, often driven by natural commercial pressures, without being outed in such a long-term plan. Such constant long-term resistance can be very destructive in the end. Being bolder makes everyone clearer about what is going on and provides very little room for bad actors to hide.
• We’ve wasted maybe 20 years in Australia trying to get our act together in digital health and we find ourselves a very long way behind. We should learn from our many and large mistakes, trust our new plan and instincts, and not be afraid to be a little bold. We owe it to Australian health consumers and providers.

I think most people looking at where we are might recognise a climate change-type problem in our healthcare system.

Nearly everyone’s livelihoods and security – perhaps except GPs who are getting slaughtered anyway, so haven’t got a lot to lose through change – are tied in some way or another to the system not changing, or at the least not changing fast.

Vastly more follows here

https://www.medicalrepublic.com.au/how-to-make-gp-digital-health-gravy/104186

Having gone this far I am sure most readers need a summary in a line of two!

Basically the Government wants to run the decrepit, dysfunctional My Health Record for more years forward that I expect to be on this earth and still hope that it will be suddenly found useful and worthwhile.

In the meantime, as far as I can tell, the rest of Australia is getting on with their life and the usage of the myHR is as low as ever.

Have a look here to see just what little change there is in record use over 18 months or so. The thing just sits there with data going in and no apparent impact or use.

https://www.digitalhealth.gov.au/initiatives-and-programs/my-health-record/statistics

The key to all this is the lack of clinical impact and the total lack of any attempt to measure impact.

As we go into 2024 and beyond the myHR becomes less relevant and hopefully other Digital Health initiatives will be better supported and encouraged.

For the sake of the Almighty can’t we kill off the myHR and spend the funds on the other much more useful Digital Health initiatives like referrals and prescribing! That would be a Blueprint we could all agree on!

David.