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Can we avert the MHR train wreck? • The Medical RepublicThe Medical Republic

Can we avert the MHR train wreck? • The Medical RepublicThe Medical Republic

The plotline of Hollywood’s most up-to-date runaway train epic, Unstoppable, and the My Well being Report (MHR) are delightfully aligned in lot of the way.

Big freight train leaves station with a lot of good intention to ship the items. By some means the driver doesn’t fairly make it on board. Issues roll on based mostly on the train’s unique timetable and plans. A couple of people see the drawback and alert the related authorities in time to sluggish the train down, and even cease it. People are ignored by a system which is political and sophisticated. Train subsequently picks up a lot velocity and momentum it turns into just about unstoppable. 

The train is heading for an un-makeable bend in a serious metropolis, the place it is going to certainly derail, and plough right into a chemical plant killing hundreds.

However … there exist a couple of courageous souls  – a few of whom the authorities don’t like or belief for his or her outspoken methods – who’re going to attempt  to leap aboard, make their method to the lead engine and avert mass catastrophe. 

As they do that, a few of train employees, who at the moment are decreased to non-paying passengers trapped on a dying journey, take the probability to leap off and save their very own lives.  If solely Denzel Washington was into digital well being. 

Final month, in the new and brightly furnished workplaces of the Australian Digital Well being Company (ADHA), in Darlinghurst, Sydney, some very senior leaders of the MHR had taken a while out of their busy schedules to satisfy with a visiting abroad digital well being dignitary. 

Professor John Halamka, of Beth Deacons Israel Hospital in Boston in the US, and of Harvard Medical Faculty, was on a whistle-stop tour of Australia, and somebody had organized to hook Professor Halamka up with the powers that be in the ADHA. It was on all the quiet and never organised by the ADHA itself.

The objective of the assembly was for the ADHA to get direct enter from somebody who has expertise of digital well being rollouts throughout the world.  Professor Halamka labored intently with the Bush and Obama administrations in digital well being technique and implementation. He  is one in every of the most completed, properly travelled, and skilled digital well being technique specialists there’s. And he’s handled the odd digital well being runaway train himself.

To the ADHA’s credit score, the company had indicated from the outset it didn’t need Professor Halamka to sugar-coat any of his considering.

Which was simply as nicely, as a result of Professor Halamka isn’t the sugar-coating sort. 

He doesn’t must be. 

In the days main as much as his 48 hour Australian journey he had been:

• With Invoice Gates to stipulate methods to make a few billion dollars in Gates basis cash have speedy and significant influence on HIV charges in Africa by way of digital well being connectivity, and easy know-how implementation.

• In China to satisfy the senior management of the Chinese language authorities, together with a fast meet up with one Xi Jinping, to assist that nation formulate a radical and excessive impression plan to kick begin the largest digital well being connectivity venture in the world. The plan is to see China go from close to final in digital well being innovation and connectivity to a worldwide innovation chief inside a number of years. The plan consists of the aspiration to attach the whole Chinese language inhabitants and create the largest AI medical database in the world. In the event that they achieve the latter, China will probably be the innovation hub for digital healthcare globally. The Chinese language don’t do issues by halves.

• To Norway to advise the authorities on how you can roll out its plan to reframe the nationwide wealth from North Sea oil, which can run out in 20 years, to inexperienced know-how and well being innovation.

• Doing his day job, as an ER doctor and CIO for the New England district of the US, overseeing about $US6 billion in digital expenditure and taking the odd telehealth name from a distant US group the place somebody was poisoned by a uncommon fungus. (He’s the US professional on the matter and makes  himself out there for emergencies.)

Professor Halamka, who’s charming, well mannered and thought of, doesn’t need to time to mince his phrases.

Regardless of the brevity of his go to to Australia, he appears to know the fundamentals of our well being system. Nevertheless, he acknowledges that evaluating nations on digital well being progress is close to unattainable.

This can be a abstract of what he’s reported to have informed the ADHA:

• Authorities shouldn’t do infrastructure tasks like the MHR in the method it’s trying. There isn’t a instance of it ever working. Governments aren’t geared as much as construct and run stuff, particularly big stuff similar to the MHR.

• The MHR, although a noble concept, isn’t an infrastructure challenge that anybody of their proper thoughts would do now given how quickly data-sharing know-how is evolving. It’s means too centralised. Its very premise is already critically outdated.

• The ADHA ought to cease instantly, take a look at all the great things it has executed and continues to be doing, and refocus its cash and energy the place it might have significant and near-term influence for Australians and the healthcare system. 

Professor John Halamka, above, says governments are merely not geared as much as construct and run big tasks akin to the MHR

Particularly the ADHA ought to:

• Get into the recreation of serving to convene the main in a position events, and assist set up requirements and coverage frameworks for a way innovators and business can function in order that they have certainty about what they’re investing in and align with authorities on objectives.

• Truly embrace the FHIR (Quick Healthcare Interoperability Assets) info sharing normal know-how,  and cease simply speaking about it being a good suggestion. He pointed to the incontrovertible fact that Google, Apple, the US, UK and a number of other European  governments usually are not more likely to be incorrect, and even when they’re, Australia would no less than be in good firm.

• Recognise that tasks like the MHR can suck the oxygen out of the capacity of nations to rework healthcare methods as a result of they turn out to be some default for well being technique, when in reality, they aren’t technique, they’re simply tasks.

• The ADHA ought to take a look at its present technique and get agile.

Particularly it ought to:

– Break the huge points into some small, however necessary and achievable, tasks.

– Create an enabling coverage setting and ensure it’s properly supported so it will possibly help and shield innovators and danger takers.

– Settle for that there isn’t any such factor as “zero risk”, so cease making an attempt to handle it

– Assist the greatest expertise experiment boldly and fail quick and don’t punish that failure, notably whether it is recognised early.


Apparently, and maybe surprisingly to some, nobody from the ADHA listening to Professor Halamka giving his considerably uncooked evaluation was in disagreement. Apparently the physique language was: ”Yep, we get all that”. 

The senior management of the ADHA are something however silly, and they’re dedicated to enhancing the lot of the healthcare system.

Tim Kelsey, the CEO of the AHDA wasn’t at that assembly. And he’s since stated that from what he has examine Professor Halamka’s feedback, the professor doesn’t perceive what is basically happening in Australia.

Which is unusual, as a result of Mr Kesley speaks very enthusiastically about doing almost every little thing Professor Halamka was suggesting.

Final week, he emphasised to a gathering of the Medical Software program Business of Australia (MSIA), that authorities’s most pressing future process was to co-ordinate the improvement of widespread requirements and coverage for business, and decide learn how to replatform the MHR on extra applicable know-how.

That’s probably the excellent news. Our native digital well being leaders seem to get it. The MHR in its present iteration is woefully outdated and must be replatformed.

 The ADHA ought to put much more effort into enabling doers by getting the nation’s act collectively on interoperability coverage and requirements. Why, then, if the senior management of the ADHA will get it, does it let the MHR train hold accumulating velocity, heading in the direction of that unmakeable bend?


Here’s a attainable rationalization:

• The MHR is a poster youngster authorities venture. Positive it’s had its points with value and failure however it’s daring, and it’s perceived to be getting issues completed. Forcing choose out, which in all probability wasn’t a nasty concept in sensible phrases, is an indication of simply how authorities can truly make the arduous selections and get issues finished.

• Healthcare in Australia is, in relative phrases to the remainder of the world, in fine condition. If  well being spending is simply at about 10% of GDP and the US is at 18%, and we’re getting on with issues like digital transformation, who’s going to upset that story? If it’s not broke, don’t repair it. Politically, the MHR is underneath management, even when, in actuality, it’s fairly a multitude.

• We’ve spent $2 billion up to now. We will’t have gotten that flawed. Butif it’s flawed, simply repair it please. It’s now too huge to fail. Therefore the runaway freight train analogy. How does it, on its potential present trajectory, actually cease? How do we get on with the stuff that the management of the ADHA says is necessary, however isn’t truly doing but?

• The ADHA and the MHR successfully report back to the secretary of the division of well being, who successfully studies to the well being minister. Even when Greg Hunt himself was in the assembly with Professor Halamka and obtained the logic, who of their proper thoughts can be admitting that the MHR goes the incorrect approach with about six months to go till our subsequent election? Well being points virtually misplaced the final election. An enormous admission like “the MHR is wrong and we need to reset” just isn’t politically palatable presently. 

• The secretary for the division of well being, Glenys Beauchamp, unsurprisingly, in all probability will get all this. The train goes to go off the rails indirectly now. All of them realise this. However virtually, at the least for now, there’s nothing in any respect they will do about it, with out risking extra injury to their reputations and careers. Higher to let the entire factor drift alongside to what appears inevitable, a change of presidency. Everybody can wait somewhat longer.

• A change of presidency is the probably and affordable launch valve. At that time everybody who is available in new can blame everybody who’s going out. Glenys Beauchamp can probably get away with: “I told them to stop but they wouldn’t.” Careers are rescuable. Even a few of the senior leaders of the ADHA are more likely to maintain their jobs. It’s about timing and notion.


If this all appears a bit miserable, it truly isn’t in any respect. We should not have lengthy to attend. And if Professor Halamka is true, and the ADHA do get it, will probably be making some plans behind the scenes to vary issues when it will probably.

Why else must be we be feeling OK about this weird state of affairs?

Properly, the know-how is shifting to allow the sufferers, with or with out the help of presidency. Google, and most notably Apple have dedicated to FHIR, and to well being. And why wouldn’t they? Well being is the largest single value merchandise of any authorities. And it’s an enormous human difficulty. Each international platforms can do good with their know-how and make loads of cash.

Grahame Grieve, the creator of the FHIR normal and a technical marketing consultant to MHR, has a really primary piece of commonsense recommendation about the MHR and the place we are at. 

Mr Grieve says:

• There are not any complicated IT tasks that ever work first time since you merely don’t know what you don’t know. That was NEHTA and the PCEHR (the previous identify for the MHR).

• Second time spherical you’re studying. However actually, you solely then begin to get a very good sense of what your actual issues are and tips on how to deal with them. Which may clarify the elevated dedication to the MHR by the authorities two years in the past. We’re doing OK. The rules are good. We simply want extra hearth energy.

• Third time spherical is if you most frequently truly begin to apply your learnings and get traction. 

If you consider Mr Grieve’s logic, we aren’t fairly at third time round but. We’re coming as much as it probably when the authorities modifications and it turns into acceptable to assign blame, hearth a couple of individuals, cease issues that everybody is aware of at the moment are ridiculous, and go once more.

Mr Grieve has been very courageous in his time. And although he’s a troublesome character he’s weak like all of us. He get’s very affected by the harsh criticism that has been levelled at him over the years. 

Professor Halamka factors out to me that Australia has quite a bit going for it. “Mostly you see governments shooting the messenger in these circumstances, and I’ve been pleasantly surprised that the ADHA and others haven’t shot Grahame, who has so much to offer,” he says.

 I identified that Mr Grieve was shot by earlier digital well being apparatchiks in a reasonably brutal method a number of years again. However he simply acquired up, wiped away the blood, and stored going, in the US although principally.  

At present, he’s lauded globally for his work on FHIR, and in a lot greater and extra refined digital well being markets than Australia, and by main international well being distributors.  

It might be fairly embarrassing for Australia to shoot him once more when he’s main the world in fixing digital well being points.

Professor Halamka, ever constructive, laughed. “Oh, Grahame never pointed that out.”

Over the years Mr Grieve’s learnt plenty of political smarts. He is aware of that, in the finish, authorities and the ADHA, will type a crucial a part of altering our digital well being ecosystem for the higher. He sees each the good and the dangerous in the ADHA and the MHR, as a result of there’s each good and dangerous there.

And he’s decided to make it principally good.

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