Uber CRCs and digital health buzzword bingo

We were all set to have one of our regular bouts of whingeing about the My Health Record this morning when what should pop into our inbox but an embargoed press release from the impressively titled $200 million+ Digital Health CRC.

Apparently this organ is set to transform healthcare delivery, improve the health of hundreds of thousands and save the health system $1.8 billion. It will also develop new solutions and take them to the world through the efforts of a crowd called HMS, which appears to be involved in flogging products to reduce costs for health insurers in the US.

Quite why we are using Australian taxpayer funds for this we didn't know so we read on to find out, but we must say we found it hard going working out exactly how technology is involved in all this. What the new CRC looks like instead is a rehash of the CRC for Capital Markets with a bit of sexy tech thrown in. The two CRCs share headquarters, staff and supporters, including a surprising amount from the private health insurance sector.

We were interested to learn that one of the main shareholders of the Capital Markets CRC was the Australian Health Service Alliance, which represents the private health funds. It also happens to be a big supporter of this new CRC, as does IAG. And one of the solutions produced at the first CRC is called HIBIS, which helps insurers identify and manage claims leakage.

For the new CRC, some of the research themes are how to reduce fraud, abuse, waste and errors; how to increase the value derived from public and private health insurance; and how to get sick and injured people back to their regular daily activities faster. Hmm.

There are loads of universities involved in this new CRC and some local health districts and PHNs, so perhaps it's all hunky dory, but for all the talk about working with digital health industry partners, there were only five recognised clinical software developers listed, including Fred IT, GuildLink and Telstra Health, which are all part of the same family.

There is also no MSIA, no HISA, no ACHI, no HIMAA, no AAPM, no AeHRC and no RACGP, which is concerning.

We received an approach about this CRC last year with the offer of an op-ed from the CEO-designate but it wasn't very polished, used the dreaded U word (Uber) and we had a load of questions about it.

We wanted to know how it would work with organisations who have been doing digital health for decades, was it supported by the brand new multi-million dollar government agency set up to guide digital health, and what the relationship would be with the new CRE in Digital Healthcare, which had just that month been announced.

We heard nothing until this morning, but what we have heard still raises a lot of questions. We'd like to ask why “developing Australia's future digital health workforce” is a main theme of this new venture when that is what HISA, ACHI, ADHA and the CRE for Digital Healthcare are also working on.

We'd like to know why the new CRC is planning to fund a project to develop apps to remind patients to take their meds on time when there's loads on the market, including one called MedAdvisor that has been validated by the one million people who use it.

We'd like to know why medicines safety is a big theme when the Australian Digital Health Agency, the Australian Commission on Safety and Quality in Health Care and the universities already run programs on this.

We also want to know whether this endeavour is worth $55m in taxpayer funding and the $55m the universities have promised in kind, why there are only five medical software companies involved and why is it called the digital health CRC when it seems it has little to do with technology?

We'll see if we can find out next week. This week, on the other hand, was dominated by My Health Record news. We had a repeat of the wrong PBS data fiasco and we encourage you to check out the comments on our story, as they cover a lot of different viewpoints and all are extremely well informed.

We take Jon Carrano's point that no one would know about these errors without the My Health Record making them visible, but we remain firmly of the opinion that if you know there are lots of errors with this data – and this is billing and admin data, not clinical data – then why would you compromise the quality of the My Health Record by including it in the first place?

ADHA this week launched a guide to using the record for the pharmacy profession and we hope to see the amount of dispense records increase. The GPs are doing the hard yards at the moment, having uploaded 14 million prescription documents compared to the pharmacists' 3.8m. Once the latter figure begins to grow, perhaps ADHA will look again at removing superfluous and potentially dangerous data.

Our other big stories were on telehealth this week, with a very cool story on Microsoft's HoloLens being used for in-home care and the news that Waikato DHB had pulled the plug on HealthTap. After our ramble last week we wondered if it was something we said, but we are assured it was because the $14.7m trial had come to its end.

We asked in our poll last week whether high-profile failures such as this would slow the march of telehealth. Gosh, you're a pessimistic lot: 77.5 said yes, just 22.5 said no.

This week, our poll question is: Is the CRC a positive development for digital health?

To vote in our weekly polls, sign up for our weekend edition or leave your comments below.

Comments  

+3 # David Jonas 2018-04-14 10:46
This piece is manifestly inaccurate on almost all points including many of those contained in our very plain English media release. It does a huge disservice to the dozens of women and men who have been involved from across 80 health and technology and university organisations in building this initiative over 18 months. It indirectly denigrates the CRC Advisory Committee (see: www.industry.gov.au/Innovation-and-Science-Australia/about-us/Pages/Committees.aspx) who evaluated 12 bids and selected the Digital Health CRC as one of only 4 to be funded, and suggests that the Australian Digital Health Agency and Medical Technologies and Pharmaceutical Industry Growth Centre, both of which supported this initiative, don't know what they are doing. The saddest aspect of this lazy piece is the innate cynicism that is a feature of so many commentaries about Australian research and innovation. The CRC Program alone, as noted in our media release, has had great success over the years generating billions of dollars in export earnings. These include the creation and/or development and commercialisati on of the Cochlear hearing implants, key parts of the new Boeing 787 Dreamliner aeroplane wings, vision and oral health products, and the SMARTS financial surveillance software used across the world to detect illegal trading behaviours.
David Jonas - CEO-Designate Digital Health CRC
-3 # Glenn Rosendahl 2018-04-14 14:59
In this magazine, I may be ‘a voice, crying in the wilderness’. But my thesis is… That in the clinical care of our patients, it is critically important that we continue to use and foster the resource and capability of skilled, competent human thought - and acknowledge its primacy over ’silicon intelligence’.

THE GAMUT OF ‘PRIMARY CARE’
The ‘general practitioner’ – using the generic meaning of the descriptor - will be a doctor who can, with skill and efficiency, integrate patient care…

• across both the medical specialties and the allied health disciplines,
• informing specialists and allied health of the patient’s concerns, and interpreting specialist and allied health perceptions back to the patient.
• with a specific task of ensuring that all involved specialties have an integrated, generalist overview of the patient.
• along the span of patient life and of clinical event duration - in continuing, (never ending) real time attention – to all ages from conception to palliative care
• across all organ systems, in an integrated manner,
• across the disease gamut from the viral to epidemiologic and population medicine
• from specific physical and/or biochemical pathology to psychological disorder
• from the incidental and irrelevant to the catastrophic.
• In the hospital, in aged care and in the community
• Providing both pharmacologic and surgical competencies
• by assessing, encouraging and motivating patients
• by cooperating with, coordinating and supervising the effective, purposeful, valuable actions of a clinical team.
• by using the gamut of available clinical tools, from the historical (e.g. the stethoscope, the telephone) to what is contemporaneous , advanced and innovative (including digital, artificial intelligence technology) facilitate the above goals.
• by personal initiative, and/or in collaboration with others with relevant capabilities, develop ideas, concepts and technologies that will advance the above stated goals of clinical care.

In doing this, we must respect and utilise the unique gifts that arise in the human brain. Human thought. It remains a different, and intrinsically a superior ‘thought process’ to the competence of the silicon chip. A difference true in its global generality, and a specific difference in the intellectual (and physical) processes of clinical care. I observe that of the 14 dot points above, only the last two specifically relate to ‘artificial intelligence’. The first 12 matters have been in place, as of the nature of primary care, from the first half of the last century - and from that time have been matters of human intelligence.

Computers are sophisticated wheelbarrows. Yes, once wheelbarrows were invented, people could (and still do) carry a greater load of volume and weight in a wheelbarrow than they could (and can) in their arms. Now we are using silicon wheelbarrows to carry information and ideas in greater volume, faster, and (to a degree) in a more convoluted manner than we experience with our brains. The amount of information that the FACEBOOK ‘cloud’ now contains has been completely beyond our imagination - until now. We now have been told. In general terms, now our brains (if we think) can comprehended it. Of greater significance, Zuckerberg has now stated that he did not think sufficiently intelligently - and ethically - about how his silicon chip wheelbarrow could be misused. It has never been suggested (by him, or anyone else) that the FACEBOOK computer, in its ‘cloud’, is capable and competent to do this thinking. He concedes it is human thought that is necessary to modify and control his silicon intelligence. That inability become very evident in the series of questions and answers that have come out of his recent interrogations. A circumstance well understood by any intelligent, informed human being. Silicon chip computers do not understand these issues, nor share these concerns.

Zukerberg has stated it will take his company many months, using a substantial cohort of staff, to analyse the ability and action of third party apps to utilise Facebook data for inappropriate purposes. Facebook has one of the largest ‘computing clouds’ in current existence. He explicitly acknowledges that this computing capability is completely inadequate for the task If his ‘computer’ had been competent for this task - particularly with the claimed lightning speed of silicon intelligence - he would have had all the answers well before he testified to the Senate Committee.

It is critically important that we continue to acknowledge, foster and utilise the primacy of skilled, competent human thought - over ’silicon intelligence’ - in the clinical care of our patients. And it is also critical that we have the resource of time - and therefore of funds - to do a proper job. Ever since the conclusion of the ‘Relative Value Study’ (it must be almost two decades ago) the Federal government, in its Medicare embodiment, has quietly - but obdurately - declined to critically examine and assess its funding model for general practice. The purchasing power of the GP MBS items have continued to diminish. Expenses have continued to increase. Inexorable increases in the cost of living, in ‘average weekly earnings’ have been blithely ignored. In computing terms, the analogy is simple. Of necessity, over time, new computing units, new programs, more data have needed to be added to the system. but the total power supply has been fixed. ‘That is all you can have’. In human terms, we have had less and less time to do a unit of human clinical work. And that is not the way our brains work.

I suggest computers cannot solve this problem. Under the same circumstances, they would have failed a long time ago. And they cannot do the human kind of cerebral work. ‘Thinking’.

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