"It's a nice idea if you get sick or you get hit by a car or something like that, that the data will be available, that you don't stand the chance of getting something that gives you an allergy, that you get the proper medication, they know your blood type, they know your medical history, all this kind of stuff," he said during an interview on the ABC Radio National Breakfast program on Wednesday.
"But the way that it has been presented to people as sort of like, poof, we've got this record and we didn't tell you anything about it. After years of working on it and spending $2 billion and in the light of a whole series of tech wrecks, it doesn't inspire a whole lot of confidence."
Shetler (below, right) said the UK Government had built something similar in the past, known as care.data, which had failed. "In the UK they did something similar. They did care.data and some of the people involved with this were also involved with that," he said. "I didn't actually work on care.data. That's something which happened well before I was in government.
Pressed about whether MHR was beginning to look like a possible tech wreck, he said it was too early to say.
Shetler was appointed chief executive of what was then known as the Digital Transformation Office in July 2015 by current Prime Minister Malcolm Turnbull.
According to his own website, he held that role, and later was Australia's chief digital officer until November 2016, delivering six exemplar services: a digital marketplace, a government cloud platform, a services dashboard, an alpha of a whole-of-government website – GOV.AU – and an alpha government identity platform.
When iTWire recently interviewed Rupert Taylor-Price, the chief executive of Vault Systems, the company that is building the Govpass ID system, he credited Shetler with having provided him with ideas about how to go about building the system.
Shetler indicated that the statistics around MHR seemed to be somewhat exaggerated. "I think when we are looking at the numbers we are talking about, usage, we have to be careful what we are talking about. That's six million people who have kind of signed up for it. That does not mean they are actually using it. When I was first briefed on this about three years ago, i was told that about 10% of the population had signed up and about 10% of that 10% were actually using it. So the actual take-up of the service is about 1%."
He said this meant that "the doctors you are actually seeing are not on it. So there's two sets of people who have to be on it: you have to have the patients on it, but you've also got to have the medical practitioners on it. And a large number, perhaps most of the medical practitioners, also don't use it, because they say that their own systems do everything that they need."
But he did not agree with interviewer Hamish McDonald that it was misinformation. "I would say that they are not necessarily active users. Let's put it that way. It's kind of like if you signed up for Myspace and you haven't used it. You're still a Myspace user but you are not actually not on it. And probably haven't been on it for the last seven or eight years."
Shetler was asked whether it was right for the government to be paying doctors and medical practices to sign people up for MHR. He replied: "I'm not saying that it is right. I think if when this was built people had actually looked at what are people looking for, what are the actual user needs we are meeting with this, then perhaps people would have been more willing to both sign up and to use it.
"I think that one of the issues that you have right now is that you spent $2 billion over a decade developing a piece of software without a clearly defined set of needs that it meets, either for the practitioner or for the patient, and as a result you've got to now make it mandatory."
He said ultimately people would do what they needed to do to get the thing they opted for. "Again, I think if there was something that met people's actual needs, and people felt that, then they would be more than willing to sign up for it and they'd be pressuring their practitioners to use it. That's not what we are seeing. In some cases, yes, you do give subsidies to things to bootstrap themselves upright and, in theory, this is a really good idea. It's a nice idea to have this kind of data available. (But) people say, well I don't know what it's really for, what do I get out of it, and they don't sign up for it."
Asked again if the MHR project was on a trajectory that could lead to a tech wreck, Shetler said: "There is some potential there, if people don't sign up for it. Look, in the very first couple of days you had 20,000 people opt out. They had to opt out under very difficult circumstances - after waiting for an hour or an hour and a half on the phone to do that.
"If you were launching a new product and you had 20,000 people willing to wait for an hour and a half on the phone, to be put on hold, and to go through a very obscure process and they signed up, you'd say 'wow that's a pretty amazing demand for that product, it's a pretty successful product'. Now reverse that."
He said the security settings for the MHR system were problematic. "It was initially designed as an opt-in system. and those kind of security settings make sense for an opt-in system because you know what the system is going to be used for, or you know why you are going to be in it. You've chosen to do it and therefore you want to make this data available.
"When it becomes an opt-out system, you find out all your data is on there and, oh by the way, it's all being shared. I think that's one of the flaws. The rollout of this thing has been significantly flawed. It's got a lot of similarities to what has happened in the UK: the security model, which is basically unsuited for the particular user case being adopted here, and the way they are signing people up, it seems to be symptomatic of the way government handles IT in these big projects."
Shetler said he understood why many Australians felt uncomfortable about the MHR system. "If i was Australian, I probably wouldn't sign up," he said. "Simple reason: the security model I think is actually quite strange. Also, the fact that your data can be accessed for reasons of public revenue, you know, things which have nothing to do with your health.
"Again that might have made sense in some peculiar kind of way or maybe people didn't scream about it at the time, when it was an opt-in system because you opt in knowing that's the case. But it's not opt in, it's opt out and it's kind of hard to opt out. And all of a sudden you find these weird loopholes for how data can be shared."
Asked about who should bear the blame for the faults he saw in the system, Shetler responded: "I think that has to go back to the Digital Health Agency. I think they clearly have seen what's worked and what's not in other countries and they didn't learn from history.
"You don't sort of spring something on people and tell them, 'we're going to be doing this' with no preparation, with no clear understanding of what the benefits are, without having designed it around user needs, and then with a weird security model."
Photo: courtesy paulshetler.com