11 December 2019

And then there were none: ADHA loses all three amigos

MyHealthRecord Policy Technology

Losing your long-term and effective chief operating officer might be regarded as misfortune. But losing your CEO, COO and chief of staff within a matter of weeks, with no visible lines of succession? Oscar Wilde wouldn’t be happy.

Mercurial CEO of the Australian Digital Health Agency (ADHA), Tim Kelsey, announced on Monday that he was leaving within a month, not long after we learned that the agency’s hard working and long serving COO, Bettina McMahon, was also leaving in January. Both moves are within spitting distance of the recent departure of the Agency’s chief of staff (and political wrangler), Mark Kinsela, to take up the role of CEO of the Pharmaceutical Society of Australia.

The media release announcing Kelsey’s departure was unexpected, short, and distinctly lacking in any of the normal niceties signalling the moving on of a three year CEO. It doesn’t read like the board of the ADHA are all that happy (see below).

But Kelsey followed up the curt agency release with a personal note of his own, letting us know he is staying in the sector, and taking up a senior role with the influential US based global digital health organisation, Healthcare Information and Management Systems Society (HIMSS). Kelsey once worked with HIMSS CEO Hal Wolf in the UK and his appointment is linked to big plans at HIMSS to roll out a version of the successful, and near ubiquitous, digital hospital ratings framework, but in the broader realm of nationwide health “interoperability”.

Kelsey told TMR the opportunity at HIMSS was hugely exciting and that “it was probably time for him to move on from the agency anyway”.

He said he was proud of what he’d achieved at the agency, and pleased to be taking a role within digital health where he can use all he’s been learning over the years and work with governments around the world on interoperability.

That will likely include one day, the Australian government and, presumably, his old agency, if it still exists. When pressed on how HIMSS might end up working closely with the Australian government on country-wide interoperability, he said it was too early to be commenting about HIMSS’ emerging global interoperability initiative and Australia.

HIMSS’ play to expand its services into the much broader and more complex world of interoperability is a logical move for a group with its global footprint, experience and aspirations as a sort of global governor organisation of digital health standards and implementation frameworks.

Until now the organisation has been heavily focussed around hospital digitisation and analytics, but it has naturally started moving outwards as the technology of interoperability is making this broader challenge more accessible.

The politics and commercial complexities of interoperability are logarithmically more complex, however, than developing digital hospital implementation frameworks and working closely with the big hospital EMR vendors. But that is HIMSS. Big aspirations and a driven leadership. More on that story in our next edition. It will be interesting to see how the Australian version of HIMSS, the Health Informatics Society of Australia (HISA) which is itself expanding through a likely merger with education group the Australian College for Health Informatics (ACHI) , slots into this paradigm.

What is going on at the ADHA isn’t that easy to get your head around as most of the key players are staying very tight lipped. But losing most of your senior management team in just a few weeks, with no clear lines of succession, or announced plans, suggests a few things.

Firstly, the reign of CEO Kelsey, so rigidly hubbed around the roll out and the success of the My Health Record (MHR) project, may have naturally run its path. All these senior managers may have been sensing that now was a good time to go.

The MHR is at least up and running and the Office of National Audit recently gave them a tick on how the agency implemented the project. This wasn’t a tick on whether the project was still a good idea or would work in the manner promised.But in the context of other major government infrastructure projects, such as the NBN, the builders of the MHR could rightly make some claim of proficiency.

If you wanted to have a long career in digital health, and were the risk-adverse type, now wouldn’t be a bad time to bow out.

While the MHR is up and running, there is no proof that it is or ever will work as it was original conceived and promised. It is still early days of its “opt out” life (where most of the population was given an MHR by virtue of them not really caring to opt out or not even knowing about it), so reporting on the effectiveness and ROI, if it existed, would still likely be inconclusive.

That there have been no meaningful attempts to measure engagement of the key stakeholders in the MHR – doctors and patients – yet, even though we are coming up to one year of opt out, is perhaps telling. Those managers who are now leaving could easily have been worried at what patterns they were seeing, if they had benchmarked themselves and made meaningful measures of engagement before they started.

There are a lot of reasons to believe the whole MHR concept is not workable anymore, and will be superseded by distributed web sharing technologies and the utility of mobile phones in the hands of patients.

There will be some parts of the MHR project we can use ongoing, and there would be, if the management is right, lots of important learnings to take from the project. But you wouldn’t want to be around when it became obvious that doubling down on the MHR a few years back, when it already looked a shaky proposition, was going to lead to another $ 1 billion down the drain, and an awful lot of delay and distraction on more important facilitation projects.

There is more to it than all this though. The departure of COO McMahon wasn’t and still isn’t easy to comprehend. McMahon says that after 10 years she just needs a break and isn’t going to a new job.

But if Kelsey was going, McMahon was the person you needed to stick around. She was over most of the key projects, had a good relationship with industry and reputation, and was a hard worker. She loved what she did too from what you could gather. McMahon leaving still doesn’t make sense.

Which brings us to succession and the future of the ADHA.

Plenty of people are suggesting the agency may now be rolled back into the Department of Health now the MHR is in play and there are no major issues that are obvious to the public.

This would not be a good thing. Digital health still needs people to run cover on it in Australia, especially on facilitating the vendor side, and burying it inside our biggest and most complex federal department can’t help that. And if you look at the US model, where the equivalent agency to the ADHA, the Office of the National Co-ordinator for Health Information, is achieving a lot of progress in what many would say is a far bigger, more complex and politically volatile environment, the argument for retention of a separate body such as the ADHA is very strong.

Much like the new CEO coming in on the back of a company that is quivering with doubt about its future and its past performance, changes will have to be made quickly at the ADHA to give the new leadership credibility. In fact, the appetite across the sector for change is such that if nothing changes, the new leaders are likely to lose credibility quickly.

The biggest job will be to very determine where the MHR should actually sit in the agency’s priorities and objectives moving forward. If, as many people think, the MHR is not the hub of digital health, but a wrong turn (albeit with some good learning and useful parts), then the new boss will need to be able to communicate that quickly and reset everyone’s expectations in a politically sensitive way.

It’s not like the public knows or cares about the MHR like they do the NBN. When the NBN doesn’t work you can’t watch Netflix. If the MHR quietly fades to a back stage role, filling in holes where commercial vendors can’t meet the needs on certain data feeds and the like of a patient’s shared health record, who will actually notice other than a few long term sceptics? Politically, it is all achievable and if the new leader knows they have remit to change, they should.

So rather than being careless in letting the top brass leave all together at a critical time, some on the ADHA board (or a few them) may be a lot more on top of things than the optics suggest.

With Kelsey and his major commanders gone, and no obvious internal successors to carry on the mantle of the MHR crusade, maybe, just maybe, the ADHA can shift its agenda to focus on what many think are more effective strategies to facilitate interoperability and digital innovation. Maybe, we can let our obsession with the MHR go.

Kelsey, the agency, and the My Health Record, had any number of critics. But it is worth remembering that from the time he took the job a few years ago, after a major failure by the previous incarnation of the agency – NEHTA – everyone involved had large targets on their backs. They had to get runs on the board quickly to restore confidence.

Kelsey decided that doubling down on the MHR was the way to do that. Or, he may have even been told that was the job by his employer, Paul Madden, then of the Department of Health. Madden perhaps wanted his legacy to be a successful MHR. Either way, Kelsey, who had run a similar project in the UK (now defunct) bought into it in a big way.

Would it have been braver to step back and review and restart everything rather than continuing to push the MHR?

Kelsey’s jump to HIMSS is as well timed as he could make it.

Even taking into account that we haven’t yet got the data to say the MHR is a dud (we may never have such data), there is plenty of evidence to say the project is, at best, very troubled. A fresh look at where and how we spend our money in facilitating digital health in this country is direly needed. The spill at the top of the ADHA presents us with an ideal opportunity to have a go at that.

That task falls in the first instance to the chair of the ADHA, Dr Elizabeth Deveny.

By all accounts Dr Deveny is considered and very smart, which is just as well because the next 6-12 months of hiring, review, planning and policy setting, or resetting, at the ADHA, are going to be the most important months in the history of digital health in Australia.

She has the remit to step back and question a lot before the ADHA moves on. Hopefully, she and her new leaders will take that opportunity.

Read the ADHA media release here