17 November 2023
Is there a case for delaying ‘sharing-by-default’ for software vendors?
We aren’t even at first base of the government’s plans to transition healthcare interoperability and the MSIA thinks we should stop and wait a bit longer.
On first read, the Medical Software Industry of Australia’s (MSIA) calls for a delay on the government’s first major deadline in healthcare interoperability seem sensible.
The Department of Health and Aged Care (DoHAC) is aiming to ramp up interoperability next year by forcing all pathology and imaging reports to be uploaded into the My Health Record (MHR) and having no delay between upload and patient or provider access by Christmas.
Now, the MSIA is arguing that one year is way too short a time frame to ask its group of 165 mainly software vendors to align all the necessary elements – pesky software things like stakeholder consultation, co-design, actual design, coding, testing, standards alignment and, of course, all the money.
For a lot of vendors very little of this work will end up contributing to new revenue in the future, so there is understandable reluctance to go fast.
But although the MSIA submission to DoHAC is eloquently argued (the MSIA has a knack for this), there is very little in the way of objective evidence for the arguments being made. And by the time you get to the end of the paper, the flood of reasons given for slowing down starts to make you ask “doth the MSIA protest too much?”
Here are the major reasons given for delaying the 24 December deadline and, in brackets, a couple of possible ideas on how they might be dealt with:
- Detailed industry consultation is needed (maybe too late for that).
- Timeframes are needed for backwards compatibility of services (not if you don’t have any need for backwards capability).
- Everyone needs timeframes for sunsetting of versions (24 December seems as good a date as any).
- The need for transparency on testing availability (is there though?).
- The need for case-by-case consideration of specific environments (maybe, but mostly, it’s one big environment).
- The need to harmonise digital health strategies and standards first to avoid inconsistency (not sure this job needs that – other interoperability initiatives in the future likely will).
- The need to co-design the architecture for IHE and MHR (no need, the requirement is just getting data into the MHR not talk to the world – that should be a requirement but it’s not).
- The need to set a date for sunsetting CDA architecture (24 December again, I guess).
- Work out privacy issues (which ones? – it’s going into the MHR, so it becomes the government’s problem in this circumstance).
- Educate consumers on “sharing by default” (why? The information is going into the MHR only at this point of time and the public have been educated about that to death).
Apologies for the long list – but it’s meant to illustrate that when you break down all the arguments the MSIA is putting for delay, most of them either aren’t in play (yet at least) or they come down to a question of how long you want to give the vendors to update their systems to do what the government is, apparently, demanding.
How long they give should be dictated largely by the capability of the parties you are asking to change their ways.
One problem with the MSIA submission is that it is projecting that this first deadline problem is a problem for everyone. But it’s not. In fact, if you discount the very small providers to the pathology and imaging sector, 95% of what is being asked is being asked of either only three giant private pathology providers – Sonic, Healius and ACL – or hospital-based government pathology operations.
Sonic, Healius and ACL are easily big enough to do what is being asked of them and within the timeframe they are being asked. It’s just a question of will they do it, because the reason they haven’t so far is that doing it hasn’t been much in their commercial interest in the long term. It’s much easier to give both providers and patients access to pathology results and it starts to break apart some of the distribution lock these big pathology labs have on their channel to customers.
The question of whether they will do it or not is not entirely relevant to what we are arguing about here – do vendors need more time on that first deadline?
Either the government will put a big enough stick or carrot in place for them to do it – the stick can probably only realistically be “do it, or we won’t pay you anymore” – or not.
The thing is these big three can do it – they have the money, the expertise and organisational nous – so at least as far as most of private pathology is concerned it can be done.
What is left is a relatively small group of smaller regional private pathology and imaging providers, and public pathology.
The MSIA has some ground to stand on as far as the smaller regional providers are concerned. They will almost certainly be in trouble dealing with the cost and complexity of compliance within one year.
Although these small regional providers make up a tiny proportion of pathology volume the government would look pretty bad if they just ignored them.
It will make for some ugly “mum and dad businesses heartlessly destroyed” stories – something the government should try to avoid, as such stories could easily derail the narrative of the greater good they are trying to achieve.
So for reasons of tactics more than anything, the government should look to cover some of these smaller independent groups and try to ignore any bleating by the majors if they say they need to treat everyone equally.
As far as the public pathology labs are concerned, the MSIA is trying to make an argument that they will struggle as well, but for most of the big labs in the larger hospitals, this is hard to imagine.
The MSIA maintains that key software providers like Oracle (which owns the major hospital EMR provider Cerner) will need time to be able to adjust.
If it is the case that these are the systems that need to load pathology results to the MHR, then you could easily put any of the big global hospital EMR vendors into the same bucket as the big pathology providers – they can do it if they are motivated enough to do it.
How do you motivate the states as opposed to private pathology providers? Same way possibly. You threaten not to pay them, although how that works politically between the states and the federal government is another interesting article.
The overall point here is that most of private and public pathology providers are capable of meeting the 24 December deadline. It’s just a question of how they are incentivised or motivated to do it.
Which brings us back to the eloquent efforts to delay the very first deadline in a grand plan to upturn decades of legacy technology and upgrade rapidly and uniformly to allow providers to seamlessly share important data in real time with each other and patients.
Why object at the outset in this first requirement to push the country’s healthcare interoperability envelope? Everyone the government is asking to get their act together (bar those small regional pathology and imaging set ups) on uploading all their information to the MHR is almost certainly capable of meeting the deadline they’ve been given, if they want to.
A hint to the answer might be that, of the 165 software vendors that the MSIA represents, only a very small proportion are even affected by this first deadline – ACL, Sonic and maybe eight to 10 smaller regional pathology and imaging vendors.
But the remaining 150 or so are (rightly) sitting nervously in the wings waiting to see how serious the government really is about changing things.
If the government does manage to swing our top three private pathology providers into line, everyone will know it is serious.
Which is why this first deadline is so important. The government needs to largely hit that deadline so everyone else realises that “things are going to change around here”.
Of those other 150 providers, nearly all of them are running archaic tech that won’t survive the transformation the federal government has in mind.
The real MSIA battle hasn’t even really started.
This first deadline and step up is both easy and hard. Easy in that the parties being asked to upgrade have the capability to do it. Hard in that they are all powerful politically so it will be a test of the current government’s political resolve.
But if the government does complete this first phase, then all those vendors running technology that won’t cut the mustard in a new world of seamless data sharing will be in the firing line.
They’re on notice now already.
The question is, do they all sit and wait to see if the government will fail. It’s not like it’s got a great track record with getting technology stuff done – see MHR for the poster child of what not to do.
Or do these other software start working now in earnest on their plans to transition?
It’s not going to be easy. Some have business models – secure messaging is perhaps the most obvious example – that don’t even exist in a new world of web-based platforms and data sharing.