12 April 2021
COVID induced digital progress in health being retarded by obsession with My Health Record
Steve Posnack describes himself as “the No 1 No 2 digital health policy development and implementation staffer in the US”.
His role, as the deputy national coordinator for Office of the National Coordinator for Health Information Technology (ONCHIT), in the US, reports directly to a serious political minder appointed by the ruling party of the day. The minder has a direct line to the US president.
Last week he officially got his new boss from the Democrats, and while Posnack is that sort of refreshing intelligence that can somehow keep you onside regardless of the politics in play, you get a distinct feeling of energy and optimism that is perhaps a little more than his everyday exuberance for his work (of which he always has a lot) and something to do with the Trump regime moving on (for now anyway).
Posnack’s job – how he’s managed it in the past 10 years, who he reports to – should inform how Australia might better go about converting some pretty robust thinking on digital health in this country into, first, meaningful policy and then successful implementation.
His equivalent in Australia might have been seen, until recently perhaps, as the CEO of our Australian Digital Health Agency (ADHA).
But there are some important differences. Posnack reports directly to a powerful political figure that can get things done when needed (as stated above his boss pretty much has the President’s ear) and who intimately understands the power of properly digitally transformed health. In contrast, the ADHA CEO reports to someone in the Department of Health (DoH) who reports to someone else, and then eventually to Dr Brendan Murphy (DoH secretary), who of course reports to the federal health minister.
A lot can and does get lost in translation in that chain of communication.
This goes a long way to understanding that while the US health system is largely an eclectic mess created by vested interests in private-, public-, federal- and state-based funding, with the resultant interoperability issues at a multiple greater than Australia, a lot more fundamental change is being executed in the US system than Australia in terms of digital health.
Yeah, the US government is orders of magnitude better than us in understanding and developing meaningful facilitation of fundamental technologies that are going to make our entire healthcare system a lot safer, less expensive to run and more efficient. That’s not what any minister is going to hear from senior health bureaucrats and certainly not from the leadership of ADHA.
The US doesn’t have a better health system, sure, but on any ranking of bang for buck in moving the dial on technology in health that works for patients and doctors, they are way ahead of us and gathering speed rapidly. We are stuck and starting to go backwards.
A key example of fundamental, meaningful and impactful change in the US is a piece of legislation introduced five years ago that demanded that healthcare providers, suppliers and tech vendors end ‘information blocking’ in the sector.
Information blocking is when healthcare vendors and service providers deliberately prevent healthcare data sharing in order to retain commercial advantage – literally, you can’t go across the street to another hospital because they’ll never be able to get your data and work out what’s going on. The blocking has been at the vendor level (if I’m Cerner, two systems in two hospitals across the street from each other is better than one in money terms every day) and because of the unique private insurance system in the US, which controls much health provision, at the provider level you want to do everything to prevent losing a customer (if you leave me, your data won’t come too, and that is going to cost you a fortune as a patient).
As well as Posnack getting a new boss, that legislation formally came into play yesterday in that yesterday was the deadline when every provider and vendor had to have their act together on having systems that were open enough to allow smooth transfer of their important patient data.
Posnack has been one of the major people overseeing the introduction of the legislation, and he may be the lead on investigating any complaints from interested parties (often patient advocate groups) who suspect blocking is still going on (which it will be in spades).
The change is important globally as the stance of the US government has deeply affected the major US-based EMR vendors – groups such as Cerner, EPIC and Allscript – all of whom operate globally and in some way or another in Australia, and all of whom have, as a result, put Fast Healthcare Interoperability Resources (FHIR) interfaces (an emerging and powerful web-based healthcare data sharing protocol) on their products and sometimes even spruik the idea of open APIs throughout the digital health ecosystem.
Past and present leaders of the ADHA might like to argue that Australia’s equivalent to the ONC’s success with anti-blocking legislation is the MyHealthRecord (MHR).
But there is virtually no comparison.
The MHR is an infrastructure project that was politically motivated as a show pony project by a health minister many years ago, is infrastructure built and run by the government, was never a future-proofed technology solution, and was out of date as a means of platforming better sharing of data in the system up to 10 years ago.
The MHR has absorbed vast sums of money (now more than $2 billion), achieved virtually nothing in terms of substantive advances in efficiency and patient safety, and faces an uncertain future as a centralised honeypot of disorganised patient data, the principles and structure of which now fly in the face of how distributed data technology, open APIs and effective secure sharing of healthcare data in the future should be facilitated.
Already we see that mobile technology can more securely and effectively store and share a patient’s healthcare data, as they need it, and as they want it.
Mobile phones can already talk to relevant databases that are distributed at the point a patient is interacting with in their health ecosystem.
Apple is hard at work ironing out the concept. Apple has declared that in 10 years’ time no one will remember the brand as being a mobile phone and computer company, and will instead remember it for health.
How?
They will be the central point of information exchange with a patient via their iPhone.
As a sidenote, Apple came to Australia as a perfect market where they could test such a system with its vast mobile footprint a few years back.
But they were scared off by the government and the ADHA, both of which were focusing their entire effort on a reboot of the MHR. Apple went to New Zealand instead.
The two concepts are not compatible, of course.
One is a centralised data base of everything controlled by the government, platformed on old technology that is not and can now ever be data sharing friendly in relative terms.
The other is a mobile phone in the hand of a patient that talks to everything relevant in the system that they are interacting with which gives patients complete control, security and, more importantly, functionality that meet the patient’s day to day actual needs.
Which one would you go for?
The problem is our leaders in the DoH, not knowing any better, decided to stick with pouring more money into the MHR.
The project gained momentum a few years back under a charismatic CEO from the UK, and as a political sell, it was pretty sexy at the time.
The Apple road (which will become the Apple Google road pretty soon) would have required the government to:
- Take a reasonably big PR hit on retiring the MHR after they had spent more than $1.2 billion on it without getting anywhere.
- Properly understand the ramifications of putting all your eggs in an MHR basket many years ago.
- Care.
The last two points go to the fact that, in the US, healthcare cost and safety is a giant problem compared to Australia. That’s the most likely explanation for their putting so much emphasis on and resources into getting it right.
In Australia, digital health isn’t on the political radar for anything other than doorstops.
And when digital health becomes an issue, it is parked because it can be. Witness how the government parked the ADHA last year, when the last CEO left. The government buried it where no one could really get to it anymore while they thought about what to do with it.
The ADHA, or something like it, is vital for Australia. But not how it’s being treated at the moment, which is like an accident you put in the corner and tell those now responsible, “not one bit of bad press more please or we will exit you as well!”.
The government does not understand.
You can see how they got here.
But COVID has changed the digital health transformation game, and the penalty for foregoing your country’s digital health future because you aren’t paying attention is too big to ignore now. It’s not just a political issue any more. It’s affecting everyone.
Everyone in Australia is going to suffer because of poor political management. It’s a time bomb for some political operative in the future, but for the public it’s a disaster starting to unfold now.
We maybe could have put up with it before COVID. But not now? We’ve jumped so far so quickly and seen the potential of a better connected system.
If we don’t act on what covid has led us too we are knowingly going to choose to let Australia become a Third World country in terms of digital health.
The MHR concept is almost wholly dead if you understand the evolving digital health ecosystem, which has lagged most other sector-based ecosystems because of the complexity and risk in health.
The best that can be done with it now is arrange it to supply data that is commercially difficult to collect and distribute to a patient distributed network system (web based) that the ADHA shifts its focus to facilitating.
There are other things to be salvaged. There are lots of assets built around the MHR and lots of IP and knowledge among staff that are not lost. A lot of the staff are great and committed. But they need leadership and direction.
One other important consideration here? Sometimes failing big time is the best thing to do in working out very complex problems. So long as you learn along the way. This was always an extraordinarily complex problem, so people shouldn’t be regretful that the MHR has failed.
They should just stand up and admit it so they can get on with implementing the learning.
Allied health, pharmacy, pathology and tertiary-care EMRs and information systems tend to see all of the most relevant data pass through their systems already, and this will be the data that is organised on a patient’s own phone and stored on the cloud, without any central infrastructure requirements from the government.
So why are we sticking stubbornly with the MHR by proposing a very expensive workaround to re-platform it to have good open APIs and FHIR integration?
Why are we going to spend upwards of $300 million with an Accenture or the like, again, putting a modern interoperability interface on a honey pot centralised database (pig’s ear) that:
- Is too far away from where important data exchange is taking place with patients (physically and technologically) and is as a result usually lacking vital data, or publishing data that is out of date (which can present safety issues).
- A big chunk of patients aren’t engaged in using and never will be – they have either opted out already, they aren’t engaged and never were because they were forced to join with ‘Opt out’ or because usability through their mobile or apps is hopeless, or they do engage and set the system up in a way that is confusing for medical professionals, lacking vital data, and can also compromise the system and safety.
- Takes a huge chunk of vital health professional time and DoH money (ePIP incentives) to keep updated (an opportunity cost no one puts in any of the MHR efficiency analyses). No one wants to update it, so it has become ‘garbage in, garbage out’ in some cases (not all, but some). This just creates more issues of safety and utility.
- Remains a honeypot with multiple points of access by both approved healthcare professionals and people who aren’t approved to use it but do for practical purposes (it’s a lot of data entry which doctors and pharmacists don’t need or want), like pharmacy assistants, making it riper for large-scale hacks into the future. Remember, it’s not if you will get hacked, it’s when, and how badly. It’s been hacked a few times already. It will be hacked in a big way eventually.
- Because of its centralised mass information nature, in no way synergises to modern cloud distributed technologies that are rapidly evolving around it, nor the increasingly demanding needs of clients in a world where networked chronic care, allied health and primary care need to start supplanting the giant shiny hospital model of healthcare. In simple terms the ADHA is building old technology that doesn’t belong in the modern world and as a result they have to waste inordinate amounts of money making bridges between the two technologies – hence the new re-platforming contract.
So are we are literally about to spend hundreds of millions building a technology bridge to a digital health desert island and no one cares in government?
Not quite.
It’s not that no one cares.
It’s that no one is getting what is going on. No one is paying attention. Probably no one in office now will be in office when the impact is really obvious, which makes this easier for politicians and some public servants to let things slide.
In the US, they have a genuine burning platform.
In Australia our health system is OK so the Australian political cycle lets the busy politicians and bureaucrats kick the problem down the road with with relative ease.
It’s a slow boiling frog problem for Australian health.
One of the greatest myths in digital health in Australia is that we have one of the most advanced digital health environments in the world. It’s not. It’s actually stuck in the past now.
Another part-myth that becomes a trap for people thinking things out is that the US healthcare system is a complete mess so why would we ever want to look at what they are doing.
The US healthcare system is a huge mess. But the US government, on a like-for-like basis, is facilitating digital health change for the future at a rate that is incomparably better than Australia.
Yes, DoH, you’re pretty hopeless when we stack you up against the US, if you analyse what is going on properly in digital health policy and facilitation here versus there.
Part of why the US is so far ahead from a government perspective is ‘burning platform’ induced as suggested above.
The US system is worse than a mess.
This is why US governments, Democratic or Republican, are partisan about facilitating the efficiencies of open data sharing in healthcare, because the system is such a mess that if they don’t provide optimal regulatory and other support to change the system soon, they won’t even be able afford the mess they have now.
You have to have a pretty bad system for Republicans and Democrats to be in more or less violent agreement over what needs to be done.
The US government’s introduction of ‘anti information blocking’ legislation for both providers and vendors is probably the greatest single change to how healthcare will be delivered in the US, more than Obamacare now that it got ravaged by partisan politics in the last US political cycle.
When the government introduced anti- blocking it understood the change would be very painful, but they nurtured and facilitated service providers and vendors over a five-year period.
They also communicated really well.
It’s something the Australian government needs to think more carefully about. Forcing some logical policy change but making sure they protect our local software industry assets through the almost certain distress and pain of moving to a much more appropriate infrastructure.
The change in the US reverberated though the whole US healthcare system and eventually the world.
The legislation has facilitated a network of localised Healthcare Information Exchanges (HIE) in the US that oversee data sharing within defined regions to vastly increase their efficiency of data movement between institutions and which has gone directly to efficiency and safety.
There is a long way to go, but it’s a move that is catalysing innovation and open data sharing, not retarding it. In some well-resourced HMOs, the interoperability achieved, along with efficiency savings and even patient care and service, is completely unrecognisable to Australia for how good it is. But that’s only provided to a select, richer demographic in the US, unfortunately.
Without the US ONC forcing the issue for vendors and providers, the change that is starting to occur in the US would never have happened – at least in the next decade or so. Market forces sometimes need a little directional coercion from the government. That’s what government does, isn’t it? Make sure market forces don’t actually drive your citizens to poverty and poorer living standards.
In Australia, the government has its head in the sand on the issue of facilitating meaningful change in our digital health infrastructure.
It is doing the opposite of the US. It is steadfastly sticking by an outdated strategy and agenda for the ADHA and its obsession with the MHR.
It is happy to unwittingly sink a giant tanker in the middle of the canal that is the route to a productive digital health future for the country.
Grahame Grieve, the founder of FHIR and an international consultant on interoperability technology, recently told TMR that, given the current context of digital health technology, re-platforming the MHR without first stepping back and reviewing all the massive changes in distributed web technology, and the nature of the evolving networked ecosystem in health, was like getting an expensive high-end architect to design a great-looking new house for you to live in, without ever giving consideration to the foundation on which you are going to build the house on.
“It doesn’t matter how great your house looks or feels, if you build it on sand and that isn’t taken into account in what you are designing, you are asking for a lot of trouble,” he said.
The MHR and through it the ADHA are a giant problem for Australian digital health now. Not a solution, which they should be.
By persisting with the MHR as the central tenet of our digital health infrastructure and by spending over $250 million each year on the ADHA to largely keep this facade going, (and another $300 million over the years that re-platforming will take for the MHR), Australia is not only stalling its potential in digital health, it is actively starting to send it backwards.
We are sinking more and more money into a project that not only is no longer fit for purpose. It wasn’t five years ago in fact when it was first rebooted by a new ADHA CEO flown in from the UK and Telstra to save the day. Today it works to significantly retard the proper advancement of modern and efficient digital health technologies by attempting to keep everything tied in the Australian digital health ecosystem back to the old way of the MHR.
The MHR is the Ever Given in the Suez Canal but the government is now choosing to scuttle it while it lays stranded across canal.
No innovation ships can get through to the right infrastructure required for fast moving digital health in Australia.
In order to go around it, the new open systems web based vendor community is going to have to get out and dig a new channel around the sunken tanker. The bizarreness of such a solution would be equivalent to the engineers in Egypt arriving at that solution for the Ever Given.
Digital health was never a huge priority for the federal government and it never really understood it properly. It started as a labor Health Minister brain fart and became a sparkling trinket to get brownie points at election time with lots of promises of a modern healthcare system for many pollies following on. It sounded great, looked great on paper at the time, and then when sold by a pretty good sales person in the ex CEO of the ADHA a few years ago, it seemed just great.
But it never was.
The problem we have is that we aren’t going to really see that impact for five years or so when we look back and realise we did the wrong thing and have to start it all over again. But in that time the loss to our system and to utility and safety among patients and doctors will have created a lot of loss…loss of life at the end of the day, and quality of life.
When controversy started to impact the MHR project, the sparkle left, and the federal government changed the entire management of the ADHA within the space of months, and sent the organisation underground.
Try talking to the ADHA today if you want to ask them real and hard questions.
We’ve put in 9 formal requests and each time we are told rubbish excuses for not being able to ask the senior management any questions that both the vendor community and the public should have answered. They don’t want to answer. They can’t answer. Answering them like they used too answer such questions – “ oh this is going great, look at all these meaningless and unmeasured stats “ just isn’t believed any more by virtually everyone.
Everyone around the MHR smells a rat, if they don’t already know it’s a long dead dead rat.
But naivety at the top, and probably to some extent wilful short term political expediency is holding us back.
There is so much politics left in the idea and fascade of the MHR you can imagine that a lot of the new innovative vendors might come under fire from snipers on the Ever Given as they attempt to build a channel around it.
There is another big problem for Australia and digital health other than this MHR obsession: the economics of smaller local Australian technology vendors economically being able to manage the transformation from where they are now to cloud and open web.
It’s a problem that is central to Australia realising it’s potential but one which will never be sorted if the ADHA and MHR obsession isn’t fixed first. Both problems need to be sorted to get clear air on good digital health in the country.
The stakes are higher than they’ve ever been now because COVID-19 seems to have made federal government smugger than ever about their role in digital health.
They try not to mention the war much (the MHR), but they are proud to spruik their effective and pragmatic response to the COVID pandemic. As they should be. They did respond fast, and effectively. They shelved bureaucratic protocols, rules and regulations, and literally gave an order to staff down the line to the coal face doers of “just get shit done quicky, and effectively, your ass is covered”.
It was amazing to witness in one respect. And revealing. Given the right motivation, nearly all our governments are not actually bureaucratic, incompetent and a danger to the public. Given the right motivation, they did get important shit done, quickly. Lives were saved. A lot of lives. Well done.
COVID gave governments cover to go crazy, and for some of its very talented staff to do what they are apparently actually capable of doing. Money was no object, and so long as safety was reasonably in check, neither were all sorts of previous rules and fears around data sharing and data privacy.
Perhaps the most important example of system transformation that the federal government let loose was telehealth.
Without COVID it’s hard to imagine if telehealth ever would have been tested in Australia.
Now it’s been tested, the government has seen it isn’t the monster they thought it would be in terms of cost blow out and rorting.
It’s not perfect (yet) but the amount of efficiency it has introduced into the system in time saving for patients and doctors, and in quick information turnaround, is already transformational.
And although it is costing a bit more so far (not blowing out notably), the government will be able to tinker and get on top of that.
And if you actually started properly costing in the efficiency, customer utility and safety it has brought about, it is clear telehealth is a massive winner for the country’s healthcare system into the future.
So the government is (sort of) rightly pretty smug about themselves and digital health at the moment.
Which is unfortunate, because no one is stepping back and recognising that they about to sink the giant tanker (the MHR via the ADHA) in the innovation and efficiency canal of digital health in Australia.
No one in the DoH gets it.
Or if they do, they aren’t able to get to the Health Minister, Greg Hunt, who does listen when someone gets to him, and is probably in part why the federal government didn’t stuff COVID management up.
A big problem is that digital health simply doesn’t have the profile it does in places like the US, Denmark or Israel.
In all of these countries, the digital health personnel have a direct line to senior political leadership. Someone in each country has recognised that the potential of good digital health facilitation is game changing politically, and of course, socially, which is what they should be most concerned about.
That hasn’t occurred in Australia.
It’s probably not the fault of the senior leadership of the DoH or the government.
As stated above our health system is pretty good in comparison to most around the world in terms of fairness and cost of delivery. We spend less on it per capita than most advanced countries around the world in a fairer way.
A big downside of this situation is digital healthcare has a great PR image but is not the front and centre issue in healthcare it should be in Canberra. Yes, people will say it is. After Telehealth which was forced upon them they will also point to all the good work on the MHR and how much they’ve spent. And there is your proof they don’t understand enough about what is going on globally compared to Australia.
That, and the government got their fingers burnt badly when they played with the idea that the MHR would be a great promotional project to sell to voters. Digital health is complex and can easily kick you in the face as a politician so best to keep up the image of being committed without actually understanding what is going on.
There’s some important nuance to this issue because ironically, the digital health vendor sector has never had more power in Canberra, as a result of a charismatic and smart CEO of the Medical Software industry Association of Australia (MSIA). Emma Hossack can get the ear of the health Minister when she needs to and she has. When the government’s planned centralised booking system for COVID vacination was descending rapidly into a debacle she got all the major vendors and the DoH talking to sort it out as best they could with what little time they had left.
To a large degree Hossack has put digital health on the map in Canberra. Until now it has been nearly a cottage industry in Australia. We have lots of very clever local software vendors, but none of them are big and even together they couldn’t get the ear much of Canberra by themselves. Hossack has changed that.
But there’s a problem.
Hossack represents mostly small to medium Australian digital health vendors, and nearly all of them are purveyors of old technology. Technology which is largely server bound, isn’t open and which is very hard to connect and share healthcare data on
Hossack has to juggle the very difficult position these vendors find themselves in with a need to move Australian digital health properly into the future – the future being open systems, open APIs, FHIR and smooth, effective data sharing between all points on a complex system and a patient.
As the technology of most of the MSIA members is increasingly legacy technology, these vendors are often faced with an almost impossible financial dilemma: how do they take their systems to the cloud and meet the future with doctors, administrators and patients?
All these vendors are very creative , innovative and passionate about better healthcare for patients and doctors. But most are stuck with the innovators dilemma – jumping from one market model and technology model to the next without destroying their long held businesses.
The problem is a WICKED one for many vendors. Many simply won’t make it through to the other side. They won’t have the capital, or worse, open systems architecture and web sharing technology will allow smart new disruptors to ruin their old business models, so they won’t simply be able to rearchitect for the web. The new business models will undoubtably be better for the patient and the system, and they will unfairly compete with the old vendors because they will have venture capital backing them so they can run at massive losses. The old vendors can’t run at a loss. And they can’t get access to that capital to do what the new entries are doing, usually.
Old vendors will need to reinvent themselves in a new business model, in a new ecosystem. The strike rate of success in such a disrupted and transforming world is very low.
But one of the issues with the situation is that consciously or unconsciously, many of these older vendors are throwing the biggest anchors they can find out the back of their older digital health tug boats. They won’t mind if the government scuttles the tanker in the middle of the canal. It will give them a lot more time to keep making money on their old systems and try to figure their futures out. But it will severely disadvantage the system and patients for a long time unecessarily as well.
That they are meant to all be pulling up anchor and sailing down that canal for the greater good, or at least sailing around the sunken HMAS HMR, isn’t being recognised by anyone at the moment in Canberra .
So both a group of the long term vendors, and the government are acting to retard the system and hold back innovation and transformation in digital health in Australia at a time that it is most damaging – a time where COVID has presented opportunities for improvement in health via technology to beyond the horizon.
Needless to say it is a very difficult situation for all involved.
It’s hard to blame any of the parties as you can see how they are where they are why they are making the decisions they are.
Hossack, who is talented and a thinker, is a possible solution.
But she has another big problem. She sits on the board of the ADHA, the government unit which most people see as the main obstacle now to a fast evolving and innovative digital health ecosystem in Australia. A the very least if the ADHA didn’t’ exist and the MHR just evaporated, that might be better for the system given what the ADHA is doing now.
The ones who are prepared to sink the MHR tanker in the middle of the digital health innovation canal in order that the government does not have to admit it is time move on and use all the latent knowledge and talent that exists in the ADHA in a different way, aren’t going to help the local vendor community. And the new pure play could vendors aren’t going to help. They are next Gen businesses who would love to take the old vendor’s market as they move onwards.
So who helps the old vendors? Without question the IP, passion for health and commitment in this group can’t be lost in this unfolding dilemma as it might end up being worse without them, they can bring so much in experience and IP to the table.
It’s difficult to see anything short term that will change all these settings.
The ADHA is setting the explosive charges on the tanker as I write. The re-platforming contract process for the MHR probably has too much momentum to stop.
The ADHA is now run by a long term public servant, ex of the Department of Human Services (and of Robodebt, although that might be an unfair tag for this person as we are told she is highly competent)
It doesn’t feel likely that the ADHA CEO is either in a position to, or will find the will to upset her masters in the DoH and the health ministry. She probably couldn’t help even if she’d made the same assessment we have here. She’s a captive of the Canberra system.
The MSIA, which does have the ear of the DoH, is smart, and could have some impact but it is conflicted, because most of their members would end up being threatened by the government speeding up the path to an open data open systems future.
But the MSIA is probably our only hope at this point of time.
Unless the MSIA can somehow convince the government to support the digital health sector through a transformational and business model change they will keep throwing anchors out and trying to hold progress back (again consciously or not). If the government doesn’t help, the damage to the local medical software sector would be too great.
Emma Hossack keeps her cards very close to her chest when discussing her role on the ADHA board, which could be sign for her detractors that she quite simply is gagged by the role and thus conflicted. But knowing Hossack the tactic of being on the ADHA board is a very subtle one for which she is prepared to cop some of flack. That is quite simply that if she is on the inside of the government agency that can most influence the future of digital health, it is far better than being on the outside of it.
Hossack is the only individual at this point of time that has the ear of all the parties and can bring the government to bear on the problem of the MHR, the need to get out of the project and concentrate the ADHA in new direction which facilitates, doesn’t operate, a new open digital ecosystem, and bring the older vendors to the table to get them give, in return for reasonable government support.
It’s degree of difficulty job from this point of over 9.
But while the solution isn’t entirely clear in how you manage this balance the issues are actually fairly clear. And one thing we can’t afford is to continue treating the ADHA like a third tear government agency, which is only to be used as a political trinket when required.
We don’t have much time.
The ADHA is broken. The MHR is finished.
The ADHA can be fixed, and while you’d have to doubt all those older vendors will make it through to the other side, you’d have to believe that the smart ones will with a bit of government help, and that will be better for the whole system too.
If you want to listen to Grahame Grieve, Steve Posnack, Simon Eccles from the NHS UK, and Aashima Gupta head of Google Cloud Global, and Dorota Gertig from Telstra discuss this issue on panel at an upcoming free webinar, CLICK HERE TO REGISTER.
