Last week’s MHR senate inquiry spent a lot of time trying to understand what some of the numbers meant. There were so many numbers in such confusing context you got the feeling the ADHA apparatchiks weren’t even sure what some of them meant.
Here’s an interesting selection:
The amount of people who have actively opted out since opt out started in July. According to the Australian Digital Health Agency’s (AHDA) CEO Tim Kelsey this was a lot less than the ADHA expected. We can’t find anywhere the ADHA gave that prediction of opt out. 900,000 is over 3% of the possible population that could opt out but the indicator we all understood via the opt out trials was that the figure would be more like 1.8%. Given we aren’t at the end of the period of opt out yet, we think we could probably expect opt out to get to 5%. That’s actually probably fine for the ADHA as having 95% of people left in the program has to make it doable moving forward, where something over 10% might have started getting tricky. But we aren’t sure how they now say they expected more than the current level, which looks like it will settle well over two times the amount recorded in their trials. They should probably just say, “Hey, 5%-ish, bit more than our trials indicator sure, your honorable senators, but not too bad at all in the scheme of things…”.
This is the number of the public who have actively opted in to the MHR since opt out commenced in July. One cocky senator noted to the ADHA panel that this was five times less than the number that had opted out (which it is) and asked Kelsey: “Does that worry you?”. Kelsey, ever charming and calm, gave a similar reply to the opt out number saying that they had actually expected a lot less to opt in. You could see from the senator’s reaction he had no idea what Kelsey was getting at by saying it was actually a great number. It was counterintuitive to what you might expect. So far about 6.1 million of the public have opted in. But most of those opt ins are from the trials where people were not given a choice. Someone representing the ADHA on the same panel chimed into this argument saying that of the 6.1 million that are already opted in, most of them had done this actively – like the 181,000. They were trying to say that although the 181,000 number seems low, there are a lot out there who have actively opted in . But is that right? Prior to the opt out trials there were about 1m of the public who had opted in over the period where opt in wasn’t a forced measure. That took many years to build up. Most of the 6 million came from the opt out trials where the ADHA gave people a record without their permission essentially and effectively pumped the opt ins up considerably. Confused? So are we. We hate to think what the senators made of it. By a few hours in, and with numbers swirling around all over the place, without much context, you did get the impression they resigned themselves to not quite understanding what was actually going on.
This was a sleeper figure that one (pesky) senator required the ADHA’s COO , Bettina McMahon go digging for, as she couldn’t reel it off the top of her head impressively, like she and others could on GP registration and pharmacist registration. So what does 287 represent? The total number of specialist private practices which have registered for the MHR. To give some perspective on that there are nearly 7000 GP practices registered and 4000 pharmacist practices registered, which means that although most GPs and pharmacists still don’t actively engage with the MHR, at least they can access it, if and when they feel the need. All up some 14,000 HPI-O ready health organisations are MHR registered, which is a great number for the AHDA – they are achieving quite a lot despite much of the controversy. But with30,000 private practicing specialists and only 287 practices registered, probably representing only about 3% of all private specialists, there seems to be something of a huge hole in the ADHA’s integrated digital health community vision. We were so stunned by this small number that we did a bit more research and ended up writing a feature about it. Essentially, we can’t leave 30,000 specialists hanging outside the system and remaining unengaged in the MHR and the digital strategy as it unfolds this country. They are simply too large a group and too important in the scheme of things. But they are currently are. Dinosaurs trapped on a non digital island in time, that won’t be connecting to the rest of the heatlhcare system in the near future at all if we keep them on the outer like we currently are. See the next issue of The Medical Republic for this report.
This is how much the ADHA has paid one doctor in particular in the past few years for helping with the project. How many doctors are on their payroll overall? Nineteen apparently.
But we are assured the money they are all getting paid by the AHDA isn’t influencing them to spruik the project. They are all entirely independent, say the ADHA.
In answer to a query along these lines by the senators Kelsey replied:
“These are very senior clinical figures – for example, the president of the Pharmaceutical Society of Australia – and I can assure you … they retain full independence in relation to their opinions.We are just inviting them to be part of the co-design process which is vital to the long-term sustainability of technology in health care.”
That feels just a tad banking royal commission in its naivety. Once you pay someone anything the question of potential for conflict is settled. There is potential. Once you pay someone more than $1m? Hmmmm….
This is the year that the Accenture contract on the technology platform underpinning the whole MHR system is due for renewal. Mid 2020. Boring? A long way away so who is caring? Normally you might think so but a huge sleeper issue for the ADHA that is starting to emerge as a possible project breaker is how this technology is going to be renewed.
In a fascinating testimony to the senate from one of our most prolific and talented healthcare technology experts, Grahame Grieve, the founder of relatively new and breakthrough global healthcare standard FHIR, we were reminded that the ADHA had been promising to consult with the public on moving the MHR onto a platform that was significantly more fit for purpose for the future of health data integration and patient centric focus, but this process hadn’t even started.
His point is fairly simple. Although the MHR has come a long way and we have all learnt a lot, it, like most similar projects around the world, had to move to new technology that allowed the data on the MHR to be shared far more securely, fluidly and in a much more distributed manner – to patients in particular. He noted that Apple was moving fast and had adopted FHIR as its base standard for all healthcare app integration, and developments like this were a likely starting gun on getting patients seriously and significantly involved in their own healthcare decision making.
But Australia is stalling. And although 2020 seems like a long way off, its not if you want to move to technology like FHIR, because you do need the public and all the key stakeholders to understand the implications of such technology. You can’t do it without buy in, is what Grieve, who supports the MHR and the ADHA efforts, was trying to point out. And if we don’t start that process pretty much now, we are going to be stuck with Accenture just rolling through their same platform on a new contract that will doom us to another five years of falling behind the rest of the world.