This week’s press release from the ADHA on secure messaging announced in carefully phrased and at times not easy to decipher wording that at a time somewhere in the future, standards for secure messaging, which are yet to be developed, will be mandatory in the procurement of ‘applicable systems’.
In the context of all of the events of last year at the ADHA, including much up front attempted work on sorting secure messaging, and of course, ‘opt out’ the announcement felt slightly odd.
But careful wording or not, and the fact that there was no date on when in the future this might happen, the release is a pretty important stake in the ground for the ADHA.
The real deal in digital health has always been making systems ‘interoperable’ in the most effective way – mapping in technical, commercial and even social needs and complexities. Not a centralised national health record as many politicians and some of the public have been led to believe. Most people in the ADHA are aware of how off track the MHR has taken them from this obvious and essential goal.
That’ real deal’ was dealt a near death blow after the 2016 Health Minister, Peter Dutton, flipped the political hype switch on the mess that was the My Health Record back then, organised an expert committee (who weren’t experts) to come up with recommendations (Royale Report ) the first of which was to double down on the failing MHR by going to ‘opt out’ and the second, was to solve secure messaging even sooner if possible. For an organisation whose primary role is interoperability, these two first goals became quickly politicised and the rest is now history. We spent another $500m or so, off track.
We employed a charismatic champion to proceed on these two priorities, with experience in the first from the UK (although that same project in the UK eventually failed and got closed down). This CEO dutifully executed the first priority (opt out), we got a few political sugar hits, and we got mostly nowhere on the second one, because solving secure messaging isn’t possible without a proper framework of ‘interoperability’ into which to fit your solutions. Then this CEO left. He may have been sick of chasing the first priority when it was getting very little if no traction.
A practical, smart, long term manager at the ADHA who has come to understand most of the awkward dynamics in all the above, and who accidentally became the CEO of the ADHA late last year, albeit interim CEO, seems to have, in a subtle and politically savvy manner, reset the course of the ADHA in one hard to interpret and seemingly harmless press release.
The statement quietly resets an interoperability framework firmly at the centre of the near term agenda and long term plans of the ADHA. Notably the ADHA had started this framework last year. But it got a little stuck in goings on towards the end of the year. The interim CEO may have had some help here from a relatively new and potentially more pragmatic ADHA board.
The press release is inoffensive and practical. Far into the future, when an interoperability framework is understood and established, there is virtually no chance that secure messaging standards won’t be mandatory and very little chance that today that this announcement will be State governments already put interoperability at the front of their procurement. So by announcing this seemingly harmless future change, you put a stake in the ground that is at once too far in the future for anyone to really be upset, but which might in one interpretation significantly reset the path of your organisation – even the short term path. That path is concentrate first and foremost on a practical, flexible and long term interoperability framework. Then fit the rest into it.
It might be masterful on the part of the ADHA board and its interim CEO.
But as usual, there’s a lot of hard work and detail to come. For one thing the state governments are going to need to align on the interoperability framework some time in the future, something made fairly difficult by large and long term contracts with big global vendors that most state governments are messily mid stream on. The press release wording makes that clear if you read it about five times.
Those global vendors would love to never align, and ideally keep their systems closed, where valuable patient data remains locked away with them and their contracts.
But that’s not going to be possible now the US government and other major governments around the world (not ours yet) have told them in no uncertain terms that if they don’t open up their systems for new technologies that allow ‘interoperability’ they will eventually not get any business from government. The big vendors are starting to shift to this tune overseas.
You might look at yesterday’s press release a disguised and mild version of what the US government started with the major global EMR vendors about 6 years ago with some more stark directives around open access to data.
It’s Australia’s little stake in the ground that says the future will be open all, so let’s all start working on the framework, not the politically expedient possible parts – like the MHR.
Locally, vendors need time to adapt. And it looks like this statement is acknowledging that they will get that time. Local vendors are very small in scale and not able to rapidly change underlying technology to meet the desires of government or the open systems flexibility of new technologies like FHIR.
So there is a long way to go. As usual. Anyone in the digital health community could be forgiven for thinking, “oh no, are we starting yet again?…Will this ever end?”
The answers to those questions are yes and no, and probably not.
For all that the obsession with the MHR and secure messaging has again wasted a lot of time and resources, unquestionably the ADHA is learning, and so is the digital health community. Everyone knows it’s going to take time and patience. Everyone excepts the politicians need to be kept clear of any mess in the process. But on that front digital health is becoming increasingly bi partisan anyway.
Most of the digital health community in Australia gets most of the issues and understands the complexities, including the requirement for vendors to move to open systems architectures and protocols over time. The vendors just need someone to help them do it in a way that they survive the process. It’s seems likely that some or even many won’t though. That tends to be the typical dynamic in digital transformation.