Wednesday, April 12, 2017

I Wonder Why The myHR Is Not Mentioned When Talking About Government IT And Its Problems?

This appeared last week:

Is government IT getting worse?

By Paris Cowan on Apr 6, 2017 2:00PM

Opposition says the public isn’t happy.

Labor’s digital transformation spokesman Ed Husic says public confidence in the government’s ability to deliver modern digital services has gone down the gurgler, hit by high-profile tech prangs like with the Census, ATO and Centrelink.
He told the AIIA's digital government summit yesterday that these sagas weren’t just teething pains.
“A whole row of front teeth have been knocked out after the government stumbled and tripped over its botched digital transformation efforts," Husic claimed.
“And the response to this has been some cosmetic surgery."
Husic’s office has dug through the AGIMO archives to unearth a 2011 government-run survey of user satisfaction with the Commonwealth’s digital efforts.
It found users rated their satisfaction high as 86 percent. The AIIA ran a similar survey with Galaxy this year which found only 19 percent considered digital services to be meeting their expectations.
Husic welcomed Coalition policies like the establishment of the Digital Transformation Agency, and insisted Labor would be bipartisan "where we can - certainly when it helps to create certainty for industry”.
But he also warned the opposition that the party “won’t be dragooned as cheerleaders when we see things going off the rails”.
IT mud-slinging is a tricky game in Australian politics, with unblemished records rare. Husic acknowledged that Labor had experienced “its fair share of IT problems in office too”.
Assistant Minister for Digital Transformation Angus Taylor told the same event that much of Canberra’s burden comes from years of IT underinvestment during the Labor years, which he said the Coalition plans to address by boosting the Commonwealth’s annual IT expenditure to $9.5 million a year.
Taylor insisted that “despite some real challenges" - like the Census bungle, ATO outages and Centrelink robo-debt controversy - "we are starting to see some projects really deliver”.
He pointed to airport Smartgates, Medicare’s work automating registration for newborns, and the DTA’s GovPass digital identity program as examples of successful IT initiatives.
More here:
This really is a simple question. It is really clear that the PCEHR was a failure and right now, without compulsion, so is the myHR.
That being the case, why are we not reviewing the myHR for value and effectiveness and for meeting its objectives.
Mr Husic, it is time to start asking!!
David.

16 comments:

Anonymous said...

Perhaps it is so down the pain ladder it does not even get a thought, that and the fact nobody uses it to have an opinion?

I wonder if because of this, when the opt-out happens and the envertable distasters propogate, then this sleeping giant will crush a few ministers and destroy a PM, and as fate often does, it will be just as the PM is turning a corner towards a period of good news.

But in a sharing and caring way it will still be there for the next Government to enjoy, only each time the problem gets bigger and the risk impact so so much more severe.

I hope I am wrong, I had thought we would see Timmy cooking out good money on thought bubble dribble and glad I have been wrong to date.

Bernard Robertson-Dunn said...

Maybe because as an IT system it sort of works. Or at least it hasn't caused any problems the general public is aware of.

It's a bit like the Yes Minister hospital with no patients - an IT system with no users.

Anonymous said...

I do not wish to deflect from the world class health system we all share here in Australia thanks to the many who dedicate themselves to this cause, both medical and none medical persons. I do feel as many on your blog also seem to share, that we need a radical rethink of the national digital health strategy, simply to enable us to improve our healthcare system and take advantages of new mainstream of near mainstream medical advancements and new opportunities technology and the standards they are based on offer us whilst ensuring quality and safety is at the forefront on thinking and design. I hear there is a rethink coming from the ADHA but to be honest it seems simply a rebranding of old thinking with some trending terminology rapped around it.

I am hoping the NDHS is both a policy and an actionable plan to deliver on a gaol using the resources we have available targeted at a more an inevitable culture of sharing within a trust based architecture. The Strategy Goal will need to take a balanced view of the community as a whole, that goal needs to be very relevant to the broader healthcare system and harmonise with the States and Territory recent published strategies.

I am neither a medical professional or an computer scientist, I am sick and have been for many years, I am also sick of watching as my healthcare team are overworked, underpaid, and seemly less and less appreciated by the Government and there information systems that are indifferent to the needs of me or my care team, and against some amazing devices used it my treatments look like they are designed using cave painting and rock hammers.

I used to work in large scale construction, if we ignore best practice and standards our civilisation would have collapsed many years ago. Can you please get you’re A into G and get experts in computer designs and the medical professions working together, not play them off against each other, and please, stop these patronising gimmick merchants that gets rolled out selling snake oil benefits.

Computers, internet and the marvel of modern communications, even for someone at my age is common place and quite the norm, it is no longer some fringe technology anymore. I see things that in ten years will have fixed me, if only we could get you all working together and create systems that enable information to be captured to enable people to use in various ways and study illnesses and come up with new remedies.

When I was working, we never let the real-estate agent design the architecture, and the bricklayers stayed well clear of the wiring, we did though come together to deliver, and to very precise specifications and industry standards.

Please get this right for my grandkids sake, who by the way get a great laugh out of observing these Government systems in action.

john scott said...

David,

I suggest that your comment "why are we not reviewing the myHR for value and effectiveness and for meeting its objectives" does not provide a way forward. I suggest it will lead simply to more politics, at the very least, because both the Coalition and Labour have been invested in the MyHR evolution.

Rather, I suggest that Anonymous 11:12 has provided an opening for a new and different narrative. A narrative that people and organizations could embrace.

Anonymous 11:12, has implicitly asked 'what does a solution architecture look like' and as a corollary, 'how do we organize all the relevant contributions in the right way'?

Drawing from the comments, I suggest we need to focus on the healthcare team, lighten their load and enable them to be more 'productive' (in terms of safety, quality and efficiency) in supporting the patient journey.

From this I suggest we can derive the following.

The first order issue comprises agreement of a reform narrative along the lines suggested with a solution framework demonstrating where and broadly how contributions can be made. This would be wrapped up in a purposeful organized collaboration. This collaboration would span the length and breadth of our health system and connect with the digital. It would be predicated on the principles of: Independence, Trust, Competence and Capability.

The second order issue is how do we convert opportunities for improved care delivery, where the care delivery embraces the reality of digital pathways. This is the domain where we address the normative aspects of healthcare, separate from and taking cognizance of the contributions that digital technology can make.
What we are looking to identify here are opportunities which if developed and implemented locally have the potential to spread more broadly. These opportunities will inevitably narrow the focus of our attention on the clinical and other reforms necessary to support their development and in the process help to establish the new norms for healthcare in the digital landscape.

The third order issue concerns the actual connection to the digital infrastructure. The patient journey in our health system invariably means crossing both healthcare and technology boundaries. The focus on the patient journey brings to the forefront the challenges for the software industry of clinical models and semantics.
Further, based on real-world experience, we will also need new instruments of productivity to enable and support these boundary crossings as living and breathing service delivery.

The fourth order issue is the technological infrastructure. Once we begin to focus on enabling and supporting information flows crossing the various boundaries of healthcare, the benefit of and need for new infrastructure will become more apparent and the case for such infrastructure investments better connected with healthcare returns.

Sometimes we need to hear the voice of the unrepresented and Anonymous 11:12 reflects this voice.

Trevor3130 said...

That automated system for enrolling newborns in Medicare looks interesting. Possibly, starting off a clean slate with a completely new person is an attractive pilot study.
Except ... that "new" person has been imaged a few times already. Some will be "known" (genetically) from before conception, and some will have been tested by invasive in utero methods.
I wonder if Medicare/Health has plans to transfer such data from the mother (or elsewhere) to the newborns?

Anonymous said...

The average public 'punter' is aware and has possibly been affected by the Census, ATO and Centrelink debacles. But most people you would stop in the street and ask about the PCEHR/MyHR would not know what you were talking about. To the majority it is a big secret. Those in medically affiliated professions may be aware, but even then, not keen. I know my medical clinic won't be touching it, no Government bullying, um, incentive, withstanding.

Anonymous said...

10:55 am, I agree not many would, I also question if many understand that the rules around you information and its privacy and use can change without notice or debate. The opt out is a good example, did a million people ask?

Things are already starting to change - https://consultations.health.gov.au/genomics/national-health-genomics-policy-framework/supporting_documents/National%20Health%20Genomics%20Policy%20Framework%20Consultation%20Draft%20D161310112.DOCX

I cannot help wondering if the genomics community know what they are getting themselves in for? Government will grant you money just at what price?

Bernard Robertson-Dunn said...

Re the average punter.

In the assessment of the opt-out trials I wonder how many "(wo)men in the street" they asked if they knew they had been given a MyHR.

IMHO, anything less than 80% means the whole thing was a failure.

So far the Federal government's health records initiative has been ideologically/evidence-free/politically driven.

All the assessment is likely to do is confirm that belief.

Anonymous said...

April 16 8:21am. You might find this interesting. http://www.theaustralian.com.au/opinion/whole-genome-sequencing-is-medicines-snowy-scheme/news-story/b826676c1d7e1b3c31221ced480039e5

I cannot help wondering if the ADOHA interpretation is more towards, another PDF of context free stuff but looks good in slides?


Quote from article 'Our researchers are leaders in biomedical and clinical sciences. We have one of the first clinical genomics enterprises in the world and strengths in key enabling technologies such as data mining and software engineering. There’s an opportunity to integrate genomic data with the MyHealth records system that is overseen by the Australian Digital Health Agency and to implement novel technical solutions for interrogating data while maintaining privacy.'

Dr David More MB PhD FACHI said...

Have a read here for some context - great talk as well.

https://aushealthit.blogspot.com.au/2017/04/i-wonder-why-myhr-is-not-mentioned-when.html

David.

tygrus said...

I'm in the Opt-out trial area. I decided to check what was in my record about 3 months after they said they were going to add me..... Empty.

Check a week later ... Medicare added MBS and PBS records. I've visited GP (several times), specialists, had xray and CT scan (recent months) and then an overnight in a Private hospital ... no summaries or results listed in record, just the claim data.

And the claim data lists an item that was incorrectly claimed (Dr notified soon after and he said he sent a form to Medicare to correct) which still hasn't been fixed in the records in Medicare or MyHR. I could add a few details of medication and allergies but could not list current diseases and conditions.
When visiting specialists or being admitted to hospital guess what ? Answer all these questions of medical history and current status which >90% could not be answered using MyHR even if they accessed it.

Return on investment so far for my record = $0. I wish they could have spent $2B on better care for others or my $85 share towards preventing the 5 misdiagnoses I've had so far in my life (and I'm still counting).

Dr David More MB PhD FACHI said...

Hi Trgrus,

Do you reckon having a look at the record triggered the content addition?

Also does your GP use e-prescribing so that gets added or not?

Last - did you ask for the data to be added?

David.

Bernard Robertson-Dunn said...

Can I suggest that how the system is supposed to work is a bit of a mystery?

The Con-Op has disappeared; new legislation that defines how it is supposed to work has been passed but is not reflected in the government's website; even if it were it would appear to not work in any consistent way.

The only real conclusion is that it is not reliable or trustworthy, which we knew from day 1. They are characteristics built in and which cannot be corrected because of the basic design.

The sooner the government starts to promote MyHR and make it opt-out the better. Its faults will become more obvious to a wider audience and the claims will be exposed for what they are, unjustified hyperbole. Especially when linked to the census and Centrelink's robo-debt.

GPs and specialist are not stupid, they care about their patients and don't like wasting time and money on unnecessary and risky government initiatives. IMHO, it is most unlikely that as a group they will go along with the government and its harebrained schemes. It will fail because it is not used, a fact the government eventually will have to admit.

tygrus said...

I was just highlighting the limitations of the system have not changed since the introduction of opt-out.
1) It seemed my record wasn't created until I accessed it.
2) It still requires patients/GP's to be proactive about having data/documents uploaded to the system eg. GP not asked to upload summary; GP not using e-prescribing.
3) Patient engagement and education still required (anyway: I don't want to demand my GP miss his lunch or be late for dinner because I asked him to update MyHR).
4) We are still waiting for hospitals and other services to connect and upload event and results (a problem of either capability or incentive).
5) The system appears unable to satisfy a use case which is often promoted ie. a hospital admission.

There are many problems outside of the MyHR scope. For example: The private hospital had eAdmissions but was still using paper records and filling data in triplicate by hand. And please don't get me started on my numerous misdiagnoses that have nothing to do with drug reactions.

Dr David More MB PhD FACHI said...

Tygrus,

Don't forget prescription data and discharge summaries seem to be automatically uploaded - as per the recent Hsmbleton blog.

The bottom line to me is that we need an update CONOPS so we know how the System is working.

David.

Anonymous said...

Updated Conops, looking at the pattern of redundancies and hires at the ADHA I am less than confident the ADOHA is capable of creating one with any sense of ownership or adherence to a Conops. The ADOHA looks very managerial top heavy, one has to wonder if this is simply a lack of competency in the senior leadership to be able to create a culture and organisation that attracts and empowers highly skilled inderviduals that cohesively collaborate in an adaptive and inclusive manner. There is a need for management and corporate services, but to much of a good thing is never a good thing.