Opinion: Can the Digital Health Strategy achieve its insubstantial goals?

For a long time I have been concerned that the Australian Digital Health Agency (previously NEHTA) has been attempting to develop various solutions to a number of complex digital health problems which it does not seem to really understand, and as a consequence it is promoting an assortment of unsubstantiated ideas deficient in clarity, prudence and substance.

I read the recently released Digital Health Strategy and at the end of the 63 pages I asked myself: so what? What did I learn and expect to learn? How clear was I about where we were heading? About how and when we were going to get there? And would it make a difference?

I wanted to see a clear five-year roadmap and a concise realistic vision statement underpinned by a pragmatic strategy and achievable goals. I was disappointed and troubled this was not evident to me.

I know we have spent over $1.5 billion so far on an eHealth record system that was supposed to save money and bring benefits to patients. In five years, how many times has the MyHR been used? How much has it saved for patients, health providers or the government? Where are the statistics that show it has value? There is nothing in the strategy that answers these questions.

After pondering these questions I looked for an executive summary to seek some clarity rather than ferreting thorough the 63 pages all over again. Unfortunately there was no executive summary, so what is this strategy going to deliver?

Isn’t this a high risk strategy? Have the risks been identified? What are they? How will they be mitigated and managed? I assumed that somewhere in the document would be an ROI chart showing the economic benefits that will be realised over time, plotted against the cumulative investments already made and which we are being asked to continue making to bring this strategy to life. But first I’d like to see some concise evidence that demonstrates what it has delivered of significance so far.

This hugely fragmented health market is comprised of a disparate range of stakeholders, technology and application needs and cultures. I hoped they would be referred to somewhere in the document, together with a map that would provide an overview of the market segments this strategy is focusing on and the key applications or solutions that will be delivered into each segment or overlapping segment.

I’m also troubled by the significant doubt expressed by many experts that the system has no obvious clinical use and the cost and burden to the patient and their GP of keeping data accurate and up to date in a summary system like the MyHR is quite impractical.

Why is this not identified as an issue in regards to basic functionality and patient safety, and why is there no discussion of how this inherent weakness in the system design will be overcome to satisfy health providers that the data held in the MyHR is reliable and can be trusted?

All these issues lead me to ask what are the hard questions and answers that this strategy is predicated upon? Have they been asked? Can I find them in the strategy document? Does this strategy give me confidence that the money that has been and will be spent is a sound investment?

There is not a single reference to published papers that discuss the difficulties and risks of eHealth. How can this be a balanced and realistic strategy without a recognition that eHealth is a major challenge, not fully met anywhere in the world?

Has there been any genuinely concerted effort to fully think through a government-owned and run national health record system that has no obvious clinical use, but which presents a high risk to patient safety and privacy? My concern is that if that hasn’t been done, the consequences could become extremely problematic for health ministers, doctors and their patients, as we move from opt-in to opt-out. This is when the system’s underlying deficiencies will be highlighted.

In the absence of such fundamental information, can we justify continuing with this strategy? I believe that NEHTA lost its way and the project went off the rails after $1.5 billion had been spent with nothing much to show for it. That raises the question whether the health minister should have sent the strategy document back to the drawing board to satisfy these concerns.

Dr Ian Colclough has over 40 years' experience in health informatics in a career spanning medical practice, public hospital administration, sales, marketing and business development in the corporate health and ICT sectors in Australia, South Africa and the UK.

Tags: Australian Digital Health Agency, national digital health strategy


# Darryl Carr 2017-09-20 17:12
Ian, you make some very valid points in your article. Many of the omissions you speak of would have made this a substantially more complete strategy document (although I should point out that there is indeed an Executive Summary starting on page 5). With some of the things you mention, here would have been a better (or more easily identified) roadmap for all participants to follow. My question to you would be "If not this (My Health Record) then what (and who, how long, how much and all of those related questions)?". I feel the strategy's core Principles were good, and their CSF's are worthwhile pursuits. I would argue that the implementation is the key, along with ability to integrate what is effectively a public service, with a commercial environment that is adjacent to, but not aligned with, the ADHA objectives. That appears to be a difficult environment to navigate, with criticisms (justified or not) plentiful, regardless of the path taken. I look forward to hearing your thoughts.
+1 # WA Primary Health Alliance staff member 2017-09-21 12:18
Part of the reason for being high level I believe is that there are a number of factors in play that require cross departmental change and not necessarily all the responsibility of the Agency. They do touch on this indirectly throughout the strategy, to achieve what people want requires massive industry change, not just technical solutions (ie MBS claiming and telehealth for instance)
+2 # Ian Colclough 2017-09-21 21:49
Thank you for your feedback Darryl. I did note the ‘Executive Summary’ heading but what followed was far from illuminating. It was basically an aspirational piece which was more like a ‘Promotional Marketing Flyer’. As an ‘Executive Summary’ it was so generic and open-ended, lacking in substance, pragmatism and detail, as to be of little use. No competent manager or politician would commit to spending hundreds of millions of dollars without a lot more clarity and specifics on the project scope and deliverables to underpin their decision.

Your question “If not this (My Health Record) then what?” That should be the essence of the ADHA’s raison d’etre. That must be the starting point for the project. Unfortunately that question and numerous related questions have never been asked, analysed and thought through in any breadth or depth. Nor has an analysis of ‘nominated’ stakeholder needs, relationships and levels of importance within the stakeholder hierarchy relative to one another. Instead a few claims, devoid of any consideration of how and where the pieces ‘fit’ together, have been bandied around to secure funding for what seemed at the time, to many MyHR advocates, as being a ‘nice idea’ and ‘a good thing to do. At the heart of all this lies the questions ‘for whose benefit’ is this to be done, why and how?

I place a very high priority on the importance of implementation and deployment – get that wrong and everything else will be for naught. Regardless of the importance of implementation I say again and will continue doing so, the fundamental questions which form the basis of the entire project have never been asked and therefore have never been answered. That is the starting point and no matter how hard the ADHA and others try to avoid that inconvenient truth if the starting point is wrong, or has never been delineated, there is no foundation upon which to build a meaningful and worthwhile project.

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