The MHR has a mini-me that seems to offer a much more realistic path to sharing health information by default in real time.
At yesterday’s information day for the Australian Digital Health Agency it became clear that the national Health Information Exchange (HIE) is the major program and infrastructure lever the agency intends to use to achieve its stated objectives to transform information sharing across Australia’s healthcare system.
The session was a revelation on a lot of fronts.
The Agency has done a lot of research and thinking, and it is ready to start moving more aggressively on its many plans with the spearhead of everything being a national HIE, a timetable for which still isn’t exactly clear, but which the Agency has already started quietly to work on via a national health directory.
If you go onto the Agency’s website you will see a lot of plans – a national digital health strategy, a roadmap for that strategy, an interoperability plan, a procurement plan, an aged care plan and a few more. If you read all of those plans you will see literally hundreds of initiatives to achieve lots of stated goals with rough timelines against most of them. Even with some headlined goals it’s difficult to see if there is a unifying plan underneath it all.
Although the agency isn’t going to publicly admit it, the national HIE is a lot of that unifying plan.
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A lot of what they are doing today, including working with CSIRO to develop standards and to some extent coding protocols everyone can use, and with DOHAC, to push vendors and providers to upgrade to the right sharing technology needed by mandating legislation on the standards, is gearing the system for an HIE.
Yesterday, the Agency’s chief digital officer Peter O’Halloran started on some of the gory detail of how the ADHA intends to pull off its many grand goals and visions, and at the centre of it all is the HIE.
Mr O’Halloran wouldn’t say it was the new centrepiece however. He said every initiative was important and needed to be done and the national HIE was fundamental to all of the Agency’s plans. (We’ve also published ADHA CEO Amanda Cattermole’s speech from yesterday HERE).
And what of the My Health Record? That old thing, that’s cost us a cool $2 billion and hasn’t worked so far and doesn’t look like it can. Well, it’s still there.
Mr O’Halloran described it as a “monolithic tech stack” in his session, which sits neatly next to another definition recently of it being a centralised disorganised stack of inaccessible PDFs.
Mr O’Halloran answered someone’s direct question in a very politic manner about what the overlap between the My Health Record and the HIE programs would be, one being a giant centralised repository of hard-to-get-at and not real-time information, and one facilitating sharing of data to all points of the system seamlessly in near real-time to both providers and patients. In other words, two giant infrastructure projects almost diametrically opposed in how they work.
Mr O’Halloran said that the My Health Record still had a big role to play moving forward but that of course an HIE would be able to fill in a lot of the structural weaknesses that a centralised database like the MHR will always have.
He said that both projects would be synergistic: that the MHR could serve as a core data record, which wasn’t live updated and never had everything, and the HIE would “add colour” and “life” for when immediate data was required from any point of the system for a certain protocol.
When pushed to say which protocol might be the most important over time, a distributed discovery system like an HIE (which is now working pretty well in other countries like the US and Canada) or the centralised send-it-all-to-the-middle type system, Mr O’Halloran said, “time will tell”.
Which is again a way of leaving the MHR intact politically.
Of course, some parts of the MHR project are going to be seminal if the national HIE gets up and running. If this largely sorry project achieved one thing that turned out to be game-changing in the end, the national legislative framework for consent it forced into the system is it.
To do a national HIE you can’t move an inch without a decent consent framework, and with the MHR, we already have it.
We also have a lot of other starting elements in the system, some of which can be traced to the MHR. A national health identifier program is vital to this all working, and although it’s still young, it’s the basis of getting an HIE to work properly.
While we don’t see anything on the procurement schedule of the Agency for an HIE yet, a key component of the HIE – a national provider directory of substance – has already been funded, and work on it has started.
You can’t do an HIE without a decent workable and maintainable directory, so the Agency could easily argue it has started on the HIE project in earnest. And maybe it has.
But the real core of the project will come when the Agency starts to specify or tender for someone to develop the discovery element of the HIE – the part that goes out to the system and finds the right data in real time and gets it back to where it’s needed accurately.
That is going to really be the nuts and bolts of the HIE project, or, the “love child project”, as I think it should be named.
Before we all get carried away about our new love child though, one other fundamental problem the agency is facing as a precursor to the birth of its new progeny is that nearly 90% of our installed technology base of providers is operating largely on old server-bound systems that aren’t able to talk to an HIE at all.
There is of course some movement around this problem because all our software vendors – big global EMR hospital groups, and local patient management system groups – realise they can’t keep sitting on this old technology, or in the case of our hospitals systems, installing technology that doesn’t talk via the web when they could switch that technology on.
The Agency needs DoHAC to move on this problem with legislation for standards quickly.
Ever polite, happy and optimistic, Mr O’Halloran couched the problem for our vendors in the nicest possible way by saying that the call for them all to significantly re-architect their systems, was all upside for them.
“Fundamentally, for software vendors, it’s a really simple concept. We want you to build it once, and build to one set of requirements, not 57, “ he said.
He then said that because the CSIRO and Sparked were developing a standards set that was well harmonised with international standards, it would open up the possibility of local vendors work being available for export in some circumstances.
But he also said it would mean that well harmonised international standards would make it easier for international vendors to work in Australia, which didn’t sound that great for the local vendor community.
Again on a happy note:
“There’ll be a lot of re-architecting involved. But let’s be honest, watching how many of you are already involved with the Sparked FHIR accelerator, you’re already doing that now.”
It’s true that a lot of vendors are getting deeply involved with Sparked but it’s also true that the journey to the other side of them re-architecting their systems is expensive and perilous. This is even if some of them short-circuit the process by introducing “converter”-type FHIR middleware like the Halo Connect project which intends to wrap around some of our major landlocked GP systems and make the information we are talking about being accessible in real time the new national HIE, even though the old tech remains largely in place.
Even then, seamless sharing for a lot of our vendors is antithetic to their current business models.
Some GP systems gate access to data and make it a big part of their revenue mix.
How are they really going to respond to all this change?
And it’s not just vendors like this which might want to slow this process down, even subconsciously.
If the Agency succeeds in its plans for pathology information-sharing the big pathology vendors will lose up to 25% of their revenue.
I’m not sure the boss of Sonic Healthcare is going to let that happen overnight if he can slow it all down and give himself time to regear his business to the new paradigm the Agency is pushing here.
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And then of course, there are the pharmacists and the most powerful political lobbying group in the country outside the mining sector, the Pharmacy Guild.
Somewhere in today’s session someone pointed out that by combining a working national HIE with our already well-established e-prescribing infrastructure (and a good delivery service — Amazon perhaps), there is no reason for bricks and mortar pharmacies to exist anymore.
Remember how big newsagents were once? Without the need to get your script filled at a shop, what’s the unique proposition of a pharmacy against Woolies and Coles?
It gives you some idea of just what sort of political mayhem the Agency is inviting in its plan (it’s a good plan of course).
There is certainly a lot of change coming if the Agency can truly get this HIE thing done and do what Amanda Cattermole says they want to do in her opening remarks, the system might actually move to some sort of transformed state.
