13 years later, we’re still thinking about tomorrow

You know that saying about how the definition of insanity is doing the same thing over and over again and expecting a different result? It’s usually misattributed to Albert Einstein or George Bernard Shaw but there’s decent enough evidence that it was first muttered by a member of Al-Anon about a dodgy family member who liked too much of a tipple.

Pulse+IT was pondering this profundity this week when we heard word that the Australian Digital Health Agency was setting out once again on the quest to develop a national digital health strategy that would deliver the Australian health system into a glorious digital future. ADHA is required to develop a new strategy as the last one is due to run out next year, and it has now set upon the usual round of consultations with the usual suspects.

In its eternal wisdom, ADHA has chosen the catchphrase of “thinking about tomorrow” for the initial stages of its publicity campaign, setting up a survey to capture consumer and provider sentiment, complete with a natty little video featuring Fleetwood Mac’s earworm from 1977. In a press release announcing the survey, ADHA CEO Amanda Cattermole is quoted as saying the new strategy was part of a journey that began in 2017 with the first National Digital Health Strategy.

We remember a bit further back than that, to the distant past of 2008 and the landmark National eHealth Strategy, written by Deloitte after extensive consultations also with the usual suspects. We thought we’d refresh our memories about that strategy and see how much progress we have made, 13 years later.

It’s an interesting read. With the strategy’s emphasis on setting down the foundations of eHealth through information standards before that glorious future arises over a 10-year planning horizon, it actually makes the National eHealth Transition Authority’s (NeHTA) efforts look a little better in retrospect, though not by much. The Deloitte strategy emphasised things like an “incremental and distributed approach to development of national individual electronic health records (IEHRs)” and we all know what happened there.

It also talks about an electronic prescriptions service, which has been been a success story largely through the efforts of companies like Fred IT and its eRx prescription exchange. While we think Andrew Matthews and his team from ADHA have done a pretty good job recently on getting ePrescriptions and active script lists going, it was only the pandemic that forced the Department of Health and its insistence on paper to get out of the way and it is only now, 13 years later, that Deloitte’s idea of an electronic prescription ‘token’ given to consumers has come to fruition.

There is also a lot in the strategy about interoperability, secure messaging, telehealth and all the things we are still grappling with today. Then we read this: by 2018, “Over 90% of consumers, or their carers, have access to an individual electronic health record.” Success! This actually was achieved through the My Health Record expansion program, with 90 per cent of Australians now having a record. But then the strategy forecasts this: “over 50% actively access and use these records to manage their health and interact with the health system”. Not even the true believers would claim we are anywhere near this level of adoption or meaningful use.

We also had a bit of a giggle at the numbers Deloitte came up with for costs vs benefits of investing in the eHealth strategy: “The total indicative estimated cost of the implementation of the national E-Health Strategy is A$1.5 billion over five years or A$2.6 billion over ten years,” the wildly optimistic report says. And “the tangible benefits associated with implementation of the Australian E-Health Strategy are estimated to be in the order of A$5.7 billion in net present value terms over ten years.” We’re pretty sure this is unquantifiable.

So, to the 2018-2022 strategy, in which we were all allegedly heading towards a system that is “safe, seamless and secure”. Are we there yet? Probably not. That strategy proposed seven strategic priority outcomes to be achieved by 2022, so let’s take a look at how it has gone:

1. Health information that is available whenever and wherever it is needed: By the end of 2018, every Australian will have a My Health Record, unless they choose not to. By 2022 all healthcare providers will be able to contribute to and use health information in My Health Record on behalf of their patients.

Yes, every Australian who wants one has a My Health Record. Is it used much? Not really. Most providers can contribute to the record but do they use the information? Not really.

2. Health information that can be exchanged securely: Every healthcare provider will have the ability to communicate with other professionals and their patients via secure digital channels by 2022. Patients will also be able to communicate with their healthcare providers using these digital channels. This will end dependence on paper-based correspondence and the fax machine or post.

Progress made, but no.

3. High-quality data with a commonly understood meaning that can be used with confidence: By 2022, the first regions in Australia will showcase comprehensive interoperability across health service provision.

No.

4. Better availability and access to prescriptions and medicines information: By 2022, there will be digitally enabled paper-free options for all medication management in Australia. People will be able to request their medications online, and all prescribers and pharmacists will have access to electronic prescribing and dispensing, improving the safety of our systems.

Yes and no, but this has very much been driven by the pandemic more than any innovation by ADHA.

5. Digitally-enabled models of care that drive improved accessibility, quality, safety and efficiency: these models of care were the much heralded “testbeds”.

Not a great deal has been achieved there that we are aware of.

6. A workforce confidently using digital health technologies to deliver health and care.

No. This was always best left to the professional colleges, software vendors and trainers, and the Australasian Institute of Digital Health anyway.

7. A thriving digital health industry delivering world-class innovation: this envisaged an ecosystem of accredited health apps, including the ability for consumers to access their health information from My Health Record through mobile apps.

ADHA really dropped the ball here. While there are two apps available that give people direct access to their record on MyGov, mobile use has been a debacle that the agency is only getting around to fixing now.

So, 15 years after the Deloitte strategy and four after the ADHA one, where are we at? And what should the next one look like? Let us know your thoughts below.

That brings us to this week’s poll:

Would you give ADHA a pass or fail on the 2018 national digital health strategy?

Vote here or leave your comments below.

Last week, we asked: Does the Australian Digital Health Agency need a clean sweep? 75 per cent said yes, and 25 per cent said no. We asked why you thought so, and you can read the comments here.

Comments  

0 # Kate McDonald 2021-09-03 12:55
We asked readers what they thought ADHA should focus on in its new strategy. These are some of the responses:

Interoperabilit y to connect up our fragmented digital health systems

Quality improvement of healthcare and research using routinely collected data

Good health care is about good relationships. Digital health requires duplication , endless discussions on consent and a huge time impost to Doctors. It is grossly underfunded from a Doctors input time. Patients do not have high levels of trust in government, other health carers or the ability for that information in the cloud to be hacked and used inappropriately .

Becoming independent of DoH

Read, learn, what has already been achieved elsewhere -locally and internationally -and listen to end users.

The Basics, not unobtainable and very-far-out bells and whistles.

ADHA has delivered no value at all. The problems seen in the ACT where there have been mismatches of end of quratantine COVID19 test results and ACT health patient records shows that not even the IHI (arguably the only good thing ever delivered by NEHTA) has been pretty much ignored.

secure and open data transfer between everyone

Take advantage of the pandemic making digital health a house hold conversation.

Interoperabilit y

Consumer/patien t empowerment

Real initiatives run through the healthcare sector, not spin doctors telling how good they are.

Enabling business models for digital innovations.

This requires a much deeper initiative, lumping documents into a repository with a bit of context and searching is more like SharePoint not a true digital health record

My health record - get consumers and professionals to use it. It’s the baseline. Anything like apps and other technologies linking will come later

Doing the best they can with the budget they receive

I suggest a focus on the real world, rather than the theoretical one. 20+ years on the vendor side and the ADHA policies (much like the My Health Record) are an afterthought AT BEST for clients and suppliers alike. It's my view that this is because nobody on either side of the buyer/seller equation sees real value in what they put forward.
Setting standards and expectations of digital health workforce qualifications and experience, encouraging health professionals to enter digital health workforce, government funding for digital health allied health roles in public health, Allowing health services to easily access other health services EMR notes or a public health app showing important medical and Allied info from different systems with improved interoperabilit y standards, improved usability and integration of my health record

Interoperabilit y - the real solution to information sharing for health consumers

Although I have worked in digital health since the 1990's my greatest frustration is as a consumer of the My Health Record. The contribution by health providers across the ecosystem is so incredibly patchy and at times completely absent. I say this as a patient who attended an emergency department in the public system and had investigations and surgery in the private system in the last 6 months. Apart from pathology, immunisations and e-health prescriptions there is no information about the current health problems and procedures I have experienced. This is a fail on the part of GP practice, public emergency department, specialist private rooms and the private hospital in which I had surgery - pretty much across my entire patient journey. The last event summary and shared health summary was 2 years ago. My husband accessed his My HR for the first time recently to get his Covid vaccination certificate. He experienced considerable frustration even being able login (very convoluted) and then navigating around MyHR required considerable assistance from me who is an experience user. And despite him having a medical history including anti-coagulant therapy that is important for others to know there was absolutely nothing recorded from his GP practice which he attends regularly. So what is the ADHA doing to ensure that clinicians across Australia are routinely forwarding patient information to MyHR??? With such abysmal patchiness in what is recorded it is of little use if it needs to be accessed by clinicians to make decisions about patient care. Immediate and urgent attention to this is needed if MyHR can ever be relied apon. Otherwise it is a very expensive white elephant.

National consent processes. Consent to contact, consent to use health data for purposes other than delivery of their direct healthcare..... . with this information available on my gov.

Fundamental standards for identification and communication

innovation - better care, better tools, better (ethical) use of data

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