Dr Steve Hodgkinson has a message for digital health innovators: the longer a project takes, the more likely it is to fail.
Dr Hodgkinson, the CIO at Victoria’s Department of Health and Human Services, has overseen the launch of around 30 new applications in the past 18 months, with products delivered in as little as six weeks, and none taking longer than six months.
The thinking behind a swift roll-out was that it gave stakeholders a sense of how the application would work and provided an opportunity for feedback early in the process.
Rather than taking 18 months or two years to develop the “perfect” system, the department used existing cloud platforms to get a working model up as soon as possible and then executed the design based on user feedback.
This transparency promoted organisational learning and made people feel energised and excited about the project, Dr Hodgkinson said.
“Just getting started is the thing,” he said, speaking at Microsoft’s “Creating a Digital Difference” event in Sydney this month.
The department launched a thunderstorm asthma early-warning system in October, in partnership with the Bureau of Meteorology, the University of Melbourne, and Deakin University. The computing work was done by Microsoft’s Azure platform.
The system gave three days’ warning of a likely event and sent notifications to the public through the Vic Emergency app.
The department also built the first version of a system for regulating medical cannabis growers in around six weeks using Salesforce’s platform.
Similarly, the department produced a cloud-based system for family-violence referrals within six months.
Prior to this system, over 70,000 police referrals were sent by fax each year, creating an inefficient and error-prone bottleneck.
“For 10 years there had been multiple attempts to modernise the system,” Dr Hodgkinson said.
The project never managed to get started because it proved too difficult to agree an approach, secure funding and get complex processes working across more than 50 different agencies, while maintaining the very stringent security requirements of Victoria Police.
“It was a revelation to everybody a project of that scale and complexity could be implemented so quickly with no fuss, no bother,” Dr Hodgkinson said.
Having existing partnering arrangements in place with cloud service providers allowed the department to bypass the slow process of going to market and commissioning a vendor to build a dedicated service from scratch, he said.
Instead, the department configured generic pre-existing application and cloud service platforms for the specific use cases.
This strategy, which Dr Hodgkinson named “Platform+Agile”, could be useful for the development of a range of digital health systems, he said. “But electronic health records it is a more complicated conversation,” he said.
Digital health often feels stuck in the mud, with systems unable to talk to each other and projects such as My Health Record eating into $2 billion without much to show for it.
Part of the problem was that government was trying to create “a single system to rule them all”, which was neither necessary nor practical in a fragmented sector like health, Dr Hodgkinson said.
A better solution would be for government to become an “intelligent consumer” of global digital services.
The market-leading cloud services vendors had already created many platforms and applications that could form the basis of an interoperable ecosystem that could be applied to health.
“We can make much better progress if we give up on the idea of building our own dedicated things and instead start to consume and build upon mature cloud service platforms that are available as shared services from the contestable market,” Dr Hodgkinson said.
“We start getting more interoperable because we are playing with the same toolsets.”
Platforms such as those built by Microsoft and Salesforce, “are the most secure forms of computing environment that exist without question”, he said.
These companies were hyper-exposed to security breaches and invested more in protection. They were also extensively audited and held to high compliance standards by government, he said.
Partnering with industry came with risks, but these could be mitigated by preserving a contestable market and hiring multiple service providers.
“We do not want to create a monopoly,” Dr Hodgkinson said.
“Some degree of contestability in arrangements is important to keep everyone honest and fair. Also, from a resilience point of view, nobody wants to be in a world of one ubiquitous platform.”