It was meant to be another dispatch designed to promote the Australian Digital Health Agency’s collaborative style. But when it dropped a media release last week announcing a new project with the RACGP and the healthcare software industry, the furious fall-out caught the agency by surprise and still shows little sign of abating.

The ADHA-backed project, according to the announcement, was aimed at opening a dialogue between the medical community and software vendors to ensure GP clinical information systems were ultimately fit-for-purpose.

“The Royal Australian College of General Practitioners (RACGP) has announced a new project that will see the college working closely with GPs and software developers to ensure CISs are useable, secure, interoperable, and ultimately fit-for-purpose,” the ADHA’s media release said.

RACGP President Dr Bastian Seidel, who was quoted in the communique, said the project would lead to the development of minimum clinical software functionality requirements.

“This project, supported by the Australian Digital Health Agency, is aimed at opening a dialogue between the medical community and software vendors to determine and develop the minimum clinical software functionality requirements that meet current and future healthcare needs,” Seidel said.

The statement was met with outrage from the Medical Software Industry Association, which represents vendors. In a guest editorial in Healthcare IT News Australia, MSIA President and CEO of health record technology provider Extensia Emma Hossack writes that digital health in Australia is at a fork in the road.

“[T]he equilibrium between government and the health software industry is fragile,” she says.

Hossack claims the government is involving itself in an industry it has little expertise in and blasts the government’s roll-out of My Health Record.

“Despite being poised to learn from the failures of other OECD countries in this area, Australia fell into the trap of funding a misunderstood project without a clear business case. There was little consultation with the Australian health software industry, no recourse to the National e-Health Strategy or [National Health and Hospitals Reform Commission] report,” Hossack writes.

“The project appears to have been done on a hunch by people who then awarded the contract to a multinational company.”

 

Hossack says that rather than directing the industry via media release to take part in this latest project, the government should learn and heed the advice of experts in its efforts to build a major digital health infrastructure project.

 

“If Australia learns from its recent mistakes and international experience, we can cooperate to forge ahead and break open the system with federated networks, which enable individuals to get the right information at the right time in the way they want it – underpinned by a strong national foundation including the MHR.

“Alternatively, Australia can ignore all the evidence and re-platform the MHR at huge public cost, with more false expectations that it will be all things to everyone.”

The ADHA’s Bettina McMahon, chief operating officer for government and industry collaboration, strategy and delivery, told HITNA she had shared some “robust” discussions with Hossack in the last few days and hit the phones to appease offended vendors. But she insisted those she contacted were unconcerned.

“Everyone I spoke to except Emma actually said, ‘No, we haven’t got an issue with this’.”

McMahon said while initially concerned that the agency had alienated most of the software industry, she believes the damage was contained.

“They’ve all said the MSIA is entitled to put forward its views. So that’s a legitimate view that they’ve put forward but it hasn’t been widely shared with those vendors that I’ve spoken to. Although I do see that Emma has said she’s spoken to other people who say that they’re offended and I don’t dispute that. So there’s obviously some people who would prefer that it had been worded in a different way and we’ve taken that on board.”

But McMahon expressed surprise that the ADHA had copped the flak when the contentious quotes were contributed by the RACGP.

“If you take a look at the agency’s statements, there’s nothing in the comments from the agency that were in any way critical of the industry,” she said.

The RACGP’s comments were also in keeping with its long-held view that software needs to improve, according to McMahon.

“The RACGP, as the users of these systems, have called out that for a number of years their members have said they expect software to continue to improve. So I was also surprised that the agency had so much criticism given that all the quotes from us were actually quite complimentary about the work that vendors are doing.”

The RACGP has 35,000 members who generally use GP clinical software within their practice, according to a video statement by Dr Nathan Pinskier, Chair of the RACGP Expert Committee for eHealth and Practice Services.

“We’ve had feedback from those members over many years advising us that they have some concerns and issues [with] the way in which software operates,” Pinskier said.

“This is not about any individual product; it’s more about the ecosystem in which the software operates. There’s varied ability between the various software programs around common core functionality.”

Pinskier said the collaborative process was an attempt to improve the way software operates both at a local level and when it interoperates with other systems and databases.

“This is not about trying to drive a top-down process. It is not about trying to stifle innovation. It’s about working collaboratively with our colleagues, with the software industry and with other key stakeholders.”  

Matt Bardsley, CEO of GP software provider MedicalDirector, said he wasn’t concerned about the wording of the ADHA’s announcement and views the project as a chance to unify standards around issues such as data security.

“Our industry really needs to have a focus on this in terms of making sure that we create systems and frameworks that enable the industry, and the doctors, patients, the government, to work in a way that safety drives innovation in healthcare. Many other industries have the systems in place and ours is just catching up,” Bardsley said.

Although MedicalDirector is in “constant conversation” with its customers to ensure product standards, this new process could raise the bar industry-wide and reassure clinicians and patients.

In a recent interoperability survey of 320 healthcare professionals, the company found that 76 per cent of respondents nominated the security of storing and sharing patient data as their greatest concern.

“Working with the industry [and] working with those peak bodies to define what those standards are should allow doctors and patients alike to feel safe in knowing that their information is being stored and managed in an appropriate way, and that should do nothing else but drive innovation in the industry,” Bardsley said.

For the blindsided ADHA, which still has some relationship building to do, the new project is part of a long-term effort to create a dialogue on improvements to medical software that will harness the full benefits of technology for healthcare and healthcare providers. It’s a “co-production,” McMahon said.

“These are issues that will be discussed over many months and probably even years about how we actually bring together clinicians and the industry to improve healthcare and to improve technology. I imagine these sorts of releases and projects will continue for some time to come so we will need to sort out a way that nobody is surprised when we announce the work that we are doing.”

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