Australia's inside-out digital health strategy

If patients are to be 'put at the centre of their healthcare', they need to be put at the centre of their health data.

The thing to remember about strategy documents is that they're merely aspirational. They set out a proposed pathway to achieving a set of defined goals, but they're no guarantee that those goals will even be achieved.

Australia's digital health strategy, released on Monday, is no exception.

As the old BBC TV series Yes Minister taught us, when it comes to writing government reports, "the tricky bit should be disposed of in the title". This strategy [PDF] does exactly that: Safe, seamless, and secure.

That dealt with, let's look at some of the details that worry me.

"An economic analysis, undertaken as part of the development of this strategy, has estimated that the gross economic benefit of secure messaging could be around AU$2 billion over four years and more than AU$9 billion over 10 years," says the strategy.

That's the gross benefit, but what about the net economic benefit? Setting up the digital health record system during its trial phase had its budget topped up by a few hundred million a couple of times, putting it well into the billion-dollar project category.

As a submission from health insurer HCF put it: "Health does not lack innovation, the issue always is in scalability, and execution in a fragmented system."

This integrated national system will have to link up statewide systems, and as the strategy notes, there's "no overarching standard in place to govern the sharing of data". The potential for massive cost blowouts is obvious.

"There have been widespread calls from peak professional bodies and health services for immediate action to create a standardised, universally accepted, secure messaging capability," the strategy says.

So why implement secure messaging as part of a massive, complex data interoperability project, where delays in other parts of the project could well delay this "immediate action"?

You could just set up encrypted email as a separate project. Or use WhatsApp?

The strategy does list some "critical success factors", but there's no discussion of risk mitigation strategies, except to note that the risks exist.

The top critical success factor is "trust and security assurance", of course. And here we hit what I think is the big problem.

If patients are to be "put at the centre of their healthcare", and their biggest worry is that their confidential health data might be breached, then surely this whole strategy is inside out.

Surely you don't mitigate the data breach risks by pouring all that data into a massive, complex system that can be accessed by tens of thousands of people.

If patients are meant to be at the centre of their healthcare, then maybe they should be carrying the data. After all, medical practitioners only need that data if the patient is right there in front of them.

Give every Australian resident a USB stick to carry around their neck on a string, like soldiers wear dog tags recording their blood type. Or maybe a wristband with some Bluetooth cleverness.

I'm guessing that won't happen, because that way we can't include all that delicious data in a big data champagne cocktail to hand to Big Pharma or whomever.

Ah yes, here we are, in goal seven: "A thriving digital health industry delivering world-class innovation". That doesn't sound very patient-at-the-centre to me.

There are so many ways for this or any other digital health strategy to fail. But don't worry. The strategy recognises that another critical success factor will be "effective governance and leadership".

"Strong national leadership will be critical to the success of this strategy. No single organisation can achieve the desired outcomes from digital health alone. A coordinated approach will support governments and industry to deliver on the objectives," it says.

With the Australian government's well-known track record with this sort of big IT project, we can obviously rest assured that everything will run smoothly as expected.

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