…I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I—
I took the one less travelled by,
And that has made all the difference.
— Robert Frost
Rarely has there been a better reason for optimism in our field of digital health. We have a solid, sophisticated health industry sector, the start of professional courses to assist individuals with health literacy and, significantly, I believe with Greg Hunt we have a Health Minister who properly understands digital health, together with a commitment to realising the value of data.
So where are we now? Why don’t we lead the world in digital health the way we have in med tech? What can we do to capitalise on this perfect opportunity?
Health is byzantine in its complexity: payment policies don’t match desired outcomes, the open data policies promoted by the Productivity Commission’s recent report have yet to become reality and the equilibrium between government and the health software industry is fragile, as recent media suggests.
Health knowledge, care and processes are highly dynamic. By the time a system is installed it may be superseded.
Australia had the excellent 2008 Deloitte National e-Health Strategy that recommended a middle market approach with a federated ecosystem to ensure our nation was future-proofed against a monolithic, government-implemented, one-size-fits-all system.
It is widely acknowledged that all countries can benefit from a national database of basic conformant data sets to assist with health planning, bio-surveillance and to provide individuals with some of their health information. That is what the Deloitte Strategy recommended and this in turn was endorsed by the National Health and Hospitals Reform Commission Report 2009, which had bipartisan support.
On the other hand, the failure of governments that attempt to do it all and be all things to all people is well documented. So which "fork in the road" did Australia take?
A good digital health economy “… should not require government involvement with designing, buying or operating IT systems.” The reason the NHHRC said this is because innovation and productivity are the life blood of industry. The constraints that are necessary for government, militate against the kind of agility which enables software that meets the market.
The role of the government is to provide key infrastructure like identifier and authentication services, indeed the MHR could be considered part of this. But hold on, what did Minister Roxon mean in 2010 when she said: “I can confirm that the government is not going to build a massive data repository. We don’t believe it would deliver any additional benefits to clinicians or patients – and it creates unnecessary risks”?
This is the nub of the problem. Too many people in the public service have not had the expertise, as the government’s Response to the ICT Procurement Strategy confirms.
The minister responsible for this massive digital health project in 2010, obviously did not understand what was happening when she had it built and clearly did not envision the infinite value of data for all Australians in research and Big Data.
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 NHHRC Report.
The project appears to have been done on a hunch by people who then awarded the contract to a multinational company. This exercise, as Graham Grieve – the father of FHIR – has said, sucked "all the oxygen” out of the Australian health software industry.
We are at a fork in the road. There is an increased awareness and understanding of what has happened and how it can be improved. 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.
It’s an exciting time to be in the health technology sector. I am optimistic that Australia will take the less travelled path – and that indeed will make all the difference.
Emma Hossack is the President of the Medical Software Industry Association and CEO of Extensia.