SMD: scrap it and start again?

A couple of very interesting blogs caught our eye this week, both written by experts in their field that raise new possibilities and go against the orthodoxy. One of those was an op-ed by epidemiologist Raina MacIntyre in the Age and Sydney Morning Herald that poured a lot of cold water on the hysterical reaction to news that contact tracers by and large use whiteboards, pen and paper in what is still very much a manual process.

Victoria is belatedly investing in a common IT solution that is sure to assist this process somewhat but it's not going to solve all problems. People will still need to be interviewed and maps of their movements still need to be made, unless we go down the track of more authoritarian regimes and mandate that the population wears a trackable device. Considering the squawks of horror from the privacy lobby that met the announcement of the nondescript COVIDSafe app, we can't see this happening.

The other was a very interesting blog by Grahame Grieve, creator of the FHIR standard and all-round interoperability guru. He drew attention to some mutterings around the traps about the continued lack of progress with secure messaging, which has been going on for a decade now but has increased in volume during the pandemic as concerns over security and privacy gave way to the need for convenience and social distancing. Image based prescribing, where a faxed copy or photo of a script is sent directly to the pharmacy, has been highly successful and has instigated a conversation on whether the strictures against email for healthcare messaging need to be so rigid.

The pandemic has meant the focus on secure messaging, a big part of the Australian Digital Health Agency's work program over the last few years and one of the first targets for the national digital health strategy, has dropped off of late and as Mr Grieve writes, the program “appears to have run out of steam without delivering on its original intent”. Technical interoperability has been largely achieved in theory but not in practice, he says. So, is there an alternative? He thinks so, and has proposed a new approach with a new architecture, based on current web standards and using NASH certificates.

As he has argued in the past, secure messaging systems are built on older, pre-cloud technology, and like the architecture of the My Health Record, if you were developing a secure message delivery system now you certainly wouldn't do it the same way. He lays out the bones of an alternative that he suggests could achieve maturity and scale. Let us know what you think.

In other news, the 30th of September is approaching and with it the potential expiry of the temporary COVID-19 telehealth MBS item numbers. We fully expect these to be extended, probably for six months, but it would be nice if Health Minister Greg Hunt would get a move on and announce it.

It is something that the newly elected RACGP president Karen Price is promising to move on quickly once her official term begins in November. Most GPs have become big fans of telehealth during the pandemic but many are not so keen on the requirement that they bulk bill. There is also some question over its constitutionality. Dr Price says decoupling telehealth from compulsory bulk billing will be one of her first cabs off the rank.

She is also adamant that GPs take back control of PIP QI data from the primary health networks. This is an issue that has been bubbling away under the surface and looks set to continue to be a headache for the Department of Health. We'll see if the college is successful in any of these endeavours, which it hasn't in the past. Considering 30,000 doctors were eligible to vote in the presidential election and only 4050 did, it seems the college's membership doesn't think it is worth engaging with much either.

Telehealth was again the subject of our poll from last week, when we asked: Should telehealth rebates be adjusted to promote video conferencing over telephone calls? A big majority agreed: 72 per cent said yes, 28 per cent said no.

This week, we ask:

Should ADHA scrap its secure message delivery project and let the industry start again?

Vote here and feel free to leave your comments below.


+3 # Malcolm Thatcher 2020-09-12 10:36
For a short period as co-sponsor of SMD (while Qld Health CIO) I held an unpopular view that the Commonwealth should provide a web services based national brokerage service for secure messaging. Here ADHA would establish the messaging standards and provide a store and forward service that could interoperate with a set of compliant web services which didn’t have to be acquired from commercial providers; Perhaps this gives a clue as to why the proposed solution was unpopular;
Prof. Mal Thatcher
+2 # Guest 2020-09-12 13:23
Keep it simple. Make it free . Too many organisations and services clipping the ticket in general practice affecting its viability.
0 # Global Health 2020-09-15 09:52
Well, it's not our first rodeo, let's be honest here.
There's two way out, Fold, cut our losses and learn or keep building on it...
it'll either come together like Voltron or it'll be our Frankenstein (look at the NBN). As a pleb, an old pleb, I saw it burn it down and start again. You look at the star technologies out there today, they've gone through the same pain.

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