The first part of this article, outlining the many problems with My Health Record, appeared on Friday.
The Australian Digital Health Authority (ADHA) has a tender out to re-platform the My Health Record (MHR) program. The project is the government’s answer to a lot of the criticisms laid out in Friday’s instalment. The revised platform will provide some snazzy technology bridges for data sharing with the big central database, including open APIs and cleaner integration with Fast Interoperability Healthcare Resources (FIHR).
But it’s still a big old database of disorganised information in the far corner of a government server room which a patient and a tech vendor have to access back and forth for any data to flow.
Why put a giant old database in the middle of the process? Why not just help patients by facilitating distributed technology to talk to a patient’s mobile phone when needed?
Past the embarrassment of having to mothball a $2 billion white elephant, the bureaucrats in charge would be giving up a lot of control if they let the market work as it should. They wouldn’t be running a giant and important data project, and they wouldn’t have oversight of all that important data. They would lose a lot of perceived power in guiding digital health.
A common refrain from Australians in digital health is that we are ahead of the pack globally. We like to point to the US and say, “we don’t want that mess”. Which is ironic because, while the US healthcare system is a huge mess, the US government and its approach to digital health is a shining light to other governments around the world.
In Australia we have a pretty good healthcare system. We aren’t looking over a precipice like they are in the US.
But that doesn’t mean we shouldn’t be looking their way for guidance on the future.
The US government has taken a very different approach to Australia. They don’t build or run infrastructure for digital health, like we have attempted to in Australia with MHR. They have stepped back, taken some very deep breaths, and put in place policy and legislation to systemically guide the landscape of data sharing. And they aren’t building anything or controlling anything. They are helping their vendors and healthcare providers to do it, which suits how web sharing and cloud technology works.
Legislation to prevent information blocking, announced five years ago, has changed the US digital health system dramatically. And, because so many US health tech vendors operate globally (Cerner, Allscript, EPIC, etc.) it is starting to change the world. Most now have FIHR interfaces to all their products, so some form of efficient sharing is feasible.
Information blocking is when healthcare vendors and service providers deliberately prevent data sharing in order to maintain commercial advantage — literally, you can’t go across the street to another hospital because they’ll never be able to get your data and work out what’s going on.
The blocking has been at the vendor level. Because of the unique private insurance system in the US, which controls much health provision, at the provider level you want to do everything to prevent losing a customer (if you leave me, your data won’t come too, and that is going to cost you a fortune as a patient).
The anti-blocking legislation just recently came into formal effect. The US government gave vendors and providers five years to get ready. That is how far behind Australia is in serious digital health reform.
Five years were needed in order to nurse vendors and healthcare providers through a very difficult period of their existence. Going from the old world of server-bound locked data and information sinks, to open-sharing web-based technology that would meaningfully engage patients in the picture.
In Australia there has been some information blocking by vendors and healthcare providers. Vendors of GP patient management systems made it hard for the GP to take their data and move to another vendor. Private health insurers still try to make it a little hard for customers to move — and the easiest way to do that is have great data on your customer that your competitors can’t get.
But blocking in Australia has mostly been as a result of legacy server-bound systems not really talking to each other. It hasn’t been deliberate and targeted like in the US, where distorted funding signals forced it down a harsher path.
Blocking in Australia is in effect all done by the government now — via MHR, which is a system that is old and doesn’t share data well. Even when it’s upgraded, it will be a system that isn’t needed to share data, but may still be forced upon us all.
In Australia MHR is our Ever Given, stuck across the canal by which we are supposed to get the future of digital health. Except now, by persisting with MHR and deciding to spend up to $300 million on a big consultant such as Accenture (it had the original MHR contract for build and maintenance) to re-platform it on FIHR, the government is actually going to scuttle the MHR in the middle of the canal.
That’s going to doom significant health innovation in the country for years to come, if it happens.
Blaming our high-level health bureaucrats and politicians for where we find ourselves is simplistic.
Ain’t broke, don;’t fix
The Australian healthcare system is still among the best in the world. It’s an “if it ain’t broke, don’t fix it”, scenario for most politicians — particularly in the febrile health policy environment which COVID has created.
Somehow we have to lead the bureaucrats in the Department of Health (DoH) and the politicians to understand. They aren’t that bad a bunch. The management of COVID has been mostly spectacular to witness. In order to get things done they broke a lot of their own rules and pulled off some short-term technology miracles.
There is also a lot of latent potential and talent in our health bureaucracy.
A good starting point for Canberra would be to look at how the US Office of National Co-ordination for Healthcare IT has been set up, and has managed the facilitation of digital health in that country.
For one thing, the person in charge of this unit, Steve Posnack, reports directly to a very senior politician who reports directly to the US President. His boss’s job is to understand the potential of digital health for transformation of the country’s healthcare system.
Here, by contrast, the CEO of the ADHA reports to someone in the DoH, who reports to someone, who eventually reports to the secretary of the DoH, Dr Brendan Murphy, who then reports to the Health Minister, Greg Hunt, who theoretically can talk to the Prime Minister.
You can lose a lot of important communication points in a chain like that. It might sum up just how seriously we take digital health in Australia.
In Australia we are being blinded to the power of digital health transformation by history and complacency. Remember, healthcare is our highest government spend and the one most under pressure to blow out over time. Anything that can help us make changes in this sector is something we should have up in lights — not stuck three tiers down in the Department of Health with a safe pair of hands keeping it from changing anything.
We need a functional ADHA in this country.
The other lesson to be learnt from the US is to facilitate digital health — don’t try to build and run it. In that facilitation, make sure you nurse your local software industry through the mammoth change that is moving from a server-bound world to a cloud-bound world.
The other big issue stopping Australia moving forward in digital health is that most of our medical software industry is surviving on maintaining older server-bound technology. The transition to cloud can be disruptive, and the challenges unpredictable.
As a result many of these old vendors are content, for now, for digital health in Australia to move slowly. They don’t mind a big tanker sunk in the middle of the canal, as it’s giving them time to think how they make it to the other side.
One of the big issues here is that disruptors have access to venture capital and a lot of support in terms of advisors and the like. It’s difficult for incumbent vendors to get into this space. They can’t afford to lose money chasing a new business model that may not even exist for them.
Digital natives might think “well, that’s life in the digital transformation game,” but the government needs to think hard about letting a generation of committed companies with a mass of important IP go by the wayside.
The Australian government needs to think carefully about protecting at least some of its older medical software vendor community. It should assist vendors and the healthcare system into the digital future, as the US government has done with its software vendor community.
But before any of this can happen, the powers that be in Canberra need someone to wake them up. They are placing the future of healthcare in this country in danger by letting digital health ride along as a third-tier government issue, nursing a sick old white elephant in the form of MHR further into the future.
COVID-19 has sparked a revolution around the world in digital health. Prior to COVID, it might have been acceptable to put up with the situation whereby digital health is misunderstood in the halls of Canberra a bit longer.
But not now.
Now the government must wake up and fix a very big problem it has, or almost certainly we will be looking back and counting the lives lost in our antiquated and disconnected healthcare system, by not acting earlier.
Jeremy Knibbs is the Publisher of Media Health Group, The Medical Republic and a non executive director of cloud based patient management system company, MediRecords.