Annual work plan priorities from the corporate plan 2016-17
- Secure messaging
- Medicines safety
- Pathology and diagnostic imaging
- My Health Record
- Core clinical
- Organisational excellence
- Privacy and Security
The following diagram shows the Agency’s work plan priorities for the 2016-17 financial year:
|AGENCY STRATEGIC PRIORITIES|
|MESSAGING||MEDICINES SAFETY||PATHOLOGY DIAGNOSTIC IMAGING||MY HEALTH RECORD||STRATEGY||CORE CLINICAL||ORGANISATIONAL EXCELLENCE|
Consistent with the Agency’s commitment to open dialogue with the health system, the priorities for 2016-17 were determined following consultation with a variety of healthcare providers, jurisdictional representatives, industry participants and consumer advocates.
Each work plan priority has a governance structure that puts system users – clinicians, consumers, jurisdictions – at the forefront as co‐producers. The clinical community, jurisdictions, vendors and consumer representatives have all indicated their willingness to participate in the governance of these programs, and the Jurisdictional Advisory Committee also advised that these activities would provide value to jurisdictions.
The Agency’s Pathology Program is co-chaired and co-sponsored by Dr Steve Hambleton (clinical representative), Matthew Ames (consumer representative) and Dr Anne Duggan (representing the Australian Commission for Safety and Quality in Health Care).
The Agency’s Diagnostic Imaging Program is co-chaired and co-sponsored by Dr Steve Hambleton (clinical representative), Associate Professor Nick Ferris, Matthew Ames (consumer representative) and Dr Robert Herkes (representing the Australian Commission for Safety and Quality in Health Care).
The Agency’s Medicines Safety Program is co-chaired and co-sponsored by Dr Steve Hambleton (clinical representative), Steve Renouf (consumer representative) and Neville Board (representing the Australian Commission for Safety and Quality in Health Care).
The Agency’s Secure Messaging Program is chaired by Dr Nathan Pinskier and co-sponsored by Dr Pinskier (clinical representative), Dr Zoran Bolevich (jurisdictional representative) and Fiona Panagoulias (community representative).
Purpose: Many patients’ and carers’ experience of modern day healthcare involves interacting with numerous different healthcare providers.9 10 The ability of healthcare providers to easily, reliably and securely exchange health information – both directly with one another and with their patients – is a key enabler of coordination of care and integration of care.11 12 13 14
It is also a key driver of health service efficiency15 16 17 18, as well as patient engagement and satisfaction.19 20 21 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 $2 billion over 4 years and more than $9 billion over 10 years.
Research shows that General Practitioners waste 10% of their time daily in searching for paper records.22
In Australia, there is established use of secure messaging using a range of different electronic communication methods; for example, diagnostic requesting and reporting, and sending discharge summaries from hospitals to general practice. 23 However, these different methods are generally not compatible – meaning that these proprietary secure messaging approaches do not work with each other.24 Despite significant effort, there is no nationally consistent, standards-based approach to secure messaging, which limits the ability of healthcare providers to communicate effectively.
The inability of healthcare providers to share health information easily and safely can lead to communication breakdowns, which contribute to poor health outcomes, duplication and inefficiency.25 26 27 As a result, patients often have disjointed healthcare experiences, and feel that they need to repeat information all too often.28
“[There is] no common standard for secure messaging between providers – we are like nineteenth 19th century colonies each with their own rail gauge.”
- Health Service IT manager
“One of the most pressing priorities is to improve interoperability, integration and secure messaging capability of the various systems (with appropriate privacy parameters) of public and private organisations to share data, which is critical for providing coordinated and connected patient care.”
- Queensland Government, eHealth Queensland submission
The secure messaging program focuses on improving the messaging and information exchange experience for healthcare providers by providing a reliable, easy-to-use service that will give them the ability and the confidence to stop using fax machines. The work program involves a number of streams, including:
- Working with industry to improve the experience of users sending secure messages;
- Improving national directory infrastructure and service levels to bring them in line with the level of service demanded by clinical users;
- Simplifying the experience for clinical practices to renew authentication certificates;
- Increasing the number of clinicians who send and receive electronic messages by developing a strategy to increase take‐up and address barriers to use; and
- Supporting a number of targeted implementations to validate the approach and scalability of secure messaging capabilities to support broader national adoption.
The outcome of this program will ultimately be the end of fax machine usage in practices, as confidence is built in the usability and reliability of secure messaging services.
1. Working with industry to improve the experience of users sending secure messages
The project has been underpinned by industry collaboration with a key focus on engagement with clinical system users, healthcare providers and vendors. Industry has been consulted throughout the project to identify key barriers and obstacles to adoption, an agreed approach and technical direction and ‘quick win’ projects, including specific sites and participating vendors.
Initial implementations have been tailored to specific use cases, in order to validate the chosen approach. The secure messaging program is split into three core streams of activity covering industry adoption and business models, technical and solution implementation; and future architecture and roadmap.
2. Improving national directory infrastructure and service levels to bring them in line with the level of service demanded by clinical users
The Secure Messaging Technical Working Group (TWG) was established in January 2017, to support the development of a national secure messaging capability that enables seamless and cost-effective electronic communication between healthcare provider organisations of all sizes and sectors across Australia. The group is achieving this by identifying, analysing and proposing resolutions to technical issues and barriers that restrict or inhibit a seamless national secure messaging capability.
One of the key priorities of the TWG is improving accessibility and usability of directory information from federated sources, underpinned by an appropriate architecture.
This industry-led working group is responsible for developing the Fast Healthcare Interoperability Resources (FHIR®) based Application Programming Interface (API) for healthcare provider directory access and search, and significant progress has been made towards this goal. Due to the complexity of this work, the number of industry participants and the collaboration with HL7 Australia, this component will continue into 2017-18.
3. Simplifying the experience for clinical practices to renew authentication certificates
The use of appropriate identifiers and certificates to support short-term projects and solutions, as well as longer-term national directives (such as Individual Healthcare Identifier, Healthcare Provider Identifier, and NASH) have been considered as part of the secure messaging program.
Guidelines for the use of commercial certificates and proprietary identifiers to industry were drafted in June 2017. Assessment and documentation of the current processes was undertaken and the independent risk assessment completed by a third party, who delivered their report and recommendations in June 2017. The use of commercial certificates as an interim approach will simplify the user experience of renewing certificates. The guidelines will continue to be enhanced and refreshed through 2017-18.
4. Increasing the number of clinicians who send and receive electronic messages by developing a strategy to increase take-up and address barriers to use
A sustainable commercial model is required to support the continued adoption of secure messaging across the health sector. Secure messaging requires the involvement of different vendor and user participants, and so needs to be supported in a consistent and manageable way to ensure ongoing adoption and use.
The consideration of sustainable economic and commercial models will continue into 2017-18.
5. Supporting a number of targeted implementations to validate the approach and scalability of secure messaging capabilities to support broader national adoption
In February 2017 the Agency released a request for tender, seeking partners from industry to establish and implement secure messaging capabilities as ‘proof of concept’ projects addressing specific use cases. The goal of these projects is to improve ‘point-to-point’ messaging between healthcare providers and the clinical information systems in use across Australia by bringing together the various components of the Agency's secure messaging program into end-to-end implemented projects.
The preferred vendors for the implementation projects have been identified, informed and the projects established.
These implementation projects have been established to validate the solution approach, improve interoperability between vendors, and drive scalability to support a broader national deployment. The initial implementation projects will be underpinned by use cases that cover discharge summaries from hospital to general practitioners (GPs) or other providers, referrals from GPs to specialists or allied health professionals, and reports or referrals from allied health to GPs, specialists or other providers. These ‘proof of concept’ projects will continue into 2017-18.
“When patients move between care settings, the absence of complete and up-to-date medication data can contribute to instances of care becoming high risk, resulting in medication misadventures and unnecessary hospital re-admissions.”
- Pharmacy Guild of Australia submission
Purpose: In any two-week period around 7 in 10 Australians and around 9 in 10 older Australians will have taken at least one medicine.29 Those medicines keep Australians out of hospitals, prevent disease and play a pivotal role in ensuring a productive and healthy community.
However, with the growth in use of medicines comes an increase in the risk of adverse drug events. Medication-related hospital admissions have been estimated to comprise 2% to 3% of all Australian hospital admissions, with an estimated annual cost of $1.2 billion.30 These problems are particularly acute in the elderly and those with chronic disease. Great care needs to be taken to ensure that the right drug is given to the right patient, at the right time, in the right dose and form, through the right channel.
In addition, those prescribing, dispensing and administering medicines need to be aware of an accurate picture of other medicines currently being taken by a patient, and any allergies that they might have.
The medicines safety program aims to increase medicines awareness, reduce hospital admissions due to adverse drug events, reduce harm due to medicines misadventure, and improve quality of life through the safe and effective use of medicines.
Although work will be a multi‐year national program, important progress was made during the 2016-17 financial year, including:
- Providing better medicines information for healthcare providers through the My Health Record by improving the quality, timeliness and access to the medicines information in the various documents in the My Health Record, and making this more readily available to patients, carers and healthcare providers;
- Co‐producing a robust, integrated and safe ‘medicines at your fingertips’ national program, utilising the community conversation about the National Digital Health Strategy; and
- Accepting that while healthcare provider systems are primarily geared to meet the needs of the individual clinician or practice, those systems can have broader benefits for patients if the information could be more easily be shared and used.
The medicines safety program of work has been run in partnership with the Australian Commission on Safety and Quality in Health Care (ACSQHC), supporting national objectives to improve medicines safety, and avoid preventable hospital admissions that occur due to adverse drug events.
1. Design better medicines information for healthcare providers through My Health Record
An extensive co-design process was undertaken to develop a new approach to displaying medicines information in the My Health Record system. The design for the new Medicines View has been improved through user feedback received from a range of healthcare providers, e.g. general practitioners, hospital specialists, community and hospital pharmacists, peak health care industry and professional bodies, including the ACSQHC. The new Medicines View, made available in the My Health Record system in June 2017, will form a platform for future enhancements to the display of medicines information.
2. Coproducing a robust integrated and safe national program
The Agency established the Medicines Safety Program Governance Framework with the steering group as its key stakeholder, representing more than 20 peak industry bodies and professional organisations.
Progress by the steering group so far includes:
- Conducting and validating an environmental scan of all the current and planned digital activities that support access to safer medicines, and identifying opportunities for improved coordination, collaboration, and investment;
- Identfying new priority projects or activities, through consultation with the healthcare sector, which should be delivered directly by the Agency or through partnerships with other organisations. This will include the investigation of any short-term opportunities for improvement identified through the National Digital Health Strategy consultation, which will be included in the Agency’s work plan; and
- Developing an evidence-based, sector-wide digital Medicines Safety Program roadmap, including a benefits realisation plan to monitor progress of both adoption and outcomes.
3. Increase use of electronic prescriptions, electronic medications management and terminology
Clinical terminologies are critical to the quality of shared data, and support the standardisation of medicines information by facilitating medicines information sharing between local and national systems; supporting greater data accuracy during transfer of care using medicines information in electronic discharge summaries, shared health summaries, and referral records; and enhancing the medicine information exchange capabilities of the existing electronic medication management systems (hospitals).
Good progress has been made in 2016-17 with regard to increased use of clinical terminologies, with SNOMED CT-AU and the AMT having been implemented and deployed in a variety of sites and clinical applications, including public and private hospitals within Victoria, Northern Territory (NT), New South Wales (NSW), Queensland, Tasmania and Western Australia (WA).
In recognition of this work, the Agency won a Queensland iAward in collaboration with the AEHRC and the CSIRO for providing “state-of-the-art terminology services that promote adoption of national clinical terminologies in electronic health and medical records in Australia”.31
Harry Iles Mann, Sydney NSW
Case study – Harry Iles Mann, Sydney NSW
Harry Iles-Mann is 22 years old, currently studying at Macquarie University in Sydney. At 3 years old, he was diagnosed with Inflammatory Bowel Disease (Ulcerative Colitis) and Liver Disease (Primary Schlerosing Cholangitis) and in 2013, he was diagnosed with severe depression and anxiety.
He has spent essentially his whole life interacting with various facets of the healthcare system, and found to his disappointment and frustration that clinicians were sometimes unwilling to share information with each other, let alone with him directly, which impacted on the quality of his care, his health and ultimately his wellbeing.
As a result, he has developed an interest in how clinical information and access to that information can be used to make the system more user friendly and patient-centric. He sees the My Health Record as a valuable tool for managing his health information, and in the process taking control of his healthcare.
The Agency’s 2016-17 work program includes a number of initiatives designed to improve user experience in medicines, pathology and diagnostic imaging. Early adopters like Harry Iles- Mann will immediately appreciate these benefits, as will many others soon after.
4. Increase the volume of ‘dispense’ data sent to the My Health Record system from community pharmacies
The Agency launched the Community Pharmacy Dispensing Software Providers Partnership offer, to enable all pharmacists in Australia to utilise national digital health services, and to ensure that healthcare providers and consumers have access to important medicines information.
The offer invited software developers to apply for funding to build capability to support direct upload of AMT-coded Clinical Document Architecture (CDA) dispense records; to support viewing of the My Health Record; and to support their users to connect and begin using the My Health Record. The offer supports the execution of required technical development to connect all community pharmacy dispensing software providers to the My Health Record system.
The Agency also entered into an agreement with the Pharmacy Guild of Australia, aimed at driving adoption and use of the My Health Record system by community pharmacies (supported by education and training) and maximising medicines safety benefits.
Pathology and diagnostic imaging
Purpose: Having pathology and diagnostic imaging results available in a single location and accessible by all healthcare providers will enhance clinical management and care by reducing wasted clinical time locating results, and avoiding unnecessary repeat tests.32 33
This work program includes a number of streams:
- Addressing the interests and concerns of private pathology laboratories to gain their support in making results available through the My Health Record;
- Co-design final end-to-end design and adoption requirements for private pathology;
- Upload pathology and diagnostic imaging reports to the My Health Record from public hospitals; and
- Upload pathology and diagnostic imaging reports to the My Health Record from private providers.
Results: These projects were developed to connect data feeds from public and private pathology and diagnostic imaging providers to the My Health Record system. Design and development of the required My Health Record capabilities has been completed and the system is now accepting data from pathology laboratories and radiology practices.
1. Addressing the interests and concerns of the private pathology industry
Engagement with private pathology laboratories is ongoing, both directly and through representation on the Pathology Program Steering Group.
In April 2017, the Agency announced that it had reached its first agreement with Australia’s largest provider of diagnostic services, Sonic Healthcare, to share pathology reports with the My Health Record. Under the agreement, Sonic Healthcare will progress the upload of pathology reports to the My Health Record in North Queensland, Nepean in New South Wales and Tasmania, commencing in the second half of 2017.
A significant number of private pathology laboratories have also expressed interest in connecting with the My Health Record by submitting expressions of interest to participate via the diagnostic software industry partnership offer released in June 2017.
2. Co-design final end-to-end design and adoption requirements for private pathology
The Agency has convened a Technical Working Group with sector representatives and is working with the largest private pathology providers on the approach to participation and upload, to inform the early deployments by private laboratories.
3. Upload pathology and diagnostic imaging reports to My Health Record from public hospitals
At the end of the reporting year, 77,893 pathology reports had been uploaded to the My Health Record from 12 laboratories, and 52,859 diagnostic imaging reports had been uploaded to the My Health Record from five public hospitals.
The Agency has agreements with five jurisdictions to progress upload of pathology and diagnostic imaging reports to the My Health Record. The Northern Territory Health Department has completed its implementation and is uploading both pathology and diagnostic imaging reports. NSW Health commenced upload of pathology reports from the South Eastern Sydney and Illawarra Shoalhaven Local Health Districts in April 2017 and will be adding more laboratories over the next year. Pathology and diagnostic imaging reports from other NSW Local Districts will be rolling out in 2017-18, as will those of other state jurisdictions.
4. Upload pathology and diagnostic imaging reports to My Health Record from private providers
Upload of pathology and diagnostic imaging reports by the private sector was not commenced by June 2017. At 30 June 2017, Australia’s largest pathology provider, Sonic Healthcare was connected to the My Health Record test system ahead of planned upload of pathology and diagnostic imaging reports later in 2017. The Agency released a diagnostic software industry offer on 2 June 2017 to organisations that develop or maintain software systems for private sector pathology laboratories and diagnostic imaging providers.
The Agency is offering sector-wide funding to enable pathology laboratories and diagnostic imaging practices to access upgraded software to enable their participation in the My Health Record. By 30 June 2017 there had been strong interest from the market and contracts with industry will be offered from July 2017.
My Health Record
Purpose: The objective of the My Health Record program is to identify important opportunities that support the realisation of the full potential of the My Health Record. This will allow clinicians to experience benefits from the system in their day-to-day work, and consumers to experience improvements in the quality and convenience of healthcare services through better sharing of information supporting their care.
The program will work collaboratively with users to co-produce improvements to the My Health Record that have a significant impact upon patient care.
This program will improve the value of the My Health Record for a range of users, including those in hospital emergency departments who are a key group that could benefit from better information about a patient’s current medications and medical history at the point of care.
Results: The latest version of the My Health Record (Release 8) delivers user interface improvements and improves support for pathology and diagnostic imaging information. Over 140 clinicians and 220 consumers contributed to the development of this release.
A key factor in the continued growth and adoption of the My Health Record is the connection of more hospitals, and the national transition to an ‘opt-out’ approach. Trial data suggests that approximately 2% of users are likely to opt out; applying this figure to the current population suggests that the consumer base will grow from 5 million Australians (as at 12 July 2017) to approximately 24 million. As a result, Australia will have the highest participation rate in a national health record system in the world by the end of 2018.
“My Health Record is the future of medicine.”
- Dr Michael Gannon, President, Australian Medical Association
Case study – Increasing document volume in the My Health Record system
The number of documents uploaded to the My Health Record has increased substantially during the past financial year.
The number of Shared Health Summaries uploaded to the My Health Record increased fourfold, supported by the new practice incentive requirements for general practices and the My Health Record participation trials.
The following table shows the number of documents uploaded to the My Health Record (by category) during the 2016-17 reporting period.
|Document Category||At 26 June 2016||At 25 June 2017||Percentage growth|
|Shared Health Summary||144,605||839,530||617%|
|Diagnostic Imaging Report||15,686||52,347||333%|
|Prescription and Dispense Documents||3,995,189||10,689,086||267%|
|Consumer Entered Health Summary||59,247||86,637||146%|
|Consumer Entered Notes||28,005||37,289||133%|
|Advance Care Directive Custodian Report||10,060||13,625||135%|
|Advance Care Planning Document||191||1,124||588%|
|Australian Immunisation Register||709,675||1,389,099||195%|
|Australian Organ Donor Register||351,895||481,272||136%|
|Medicare/DVA Benefits Report||179,231,336||299,939,038||167%|
|Pharmaceutical Benefits Report||118,594,291||207,083,264||174%|
|Child My Health Record (CeHR) Documents||12,875||14,772||115%|
|Personal Health Observation||5,902||6,915||117%|
|Personal Health Achievement||847||982||115%|
|Child Parent Questionnaire||6,036||6,875||113%|
|Total Active Documents in My Health Record||303,668,325||522,109.265||171%|
1. Working with the software industry to improve user experience and connect GP, pharmacy and aged care providers
This project was designed to increase the volume of content being uploaded to the My Health Record, by working with software developers and vendors of clinical information systems to improve the user experience and connect GP, pharmacy, and aged care providers to the My Health Record.
Projects were completed with seven vendors to enhance software to interact with the My Health Record.
2. Connecting hospitals to the My Health Record
A large number of public and private hospitals in NSW, Queensland, Victoria and WA were connected to the My Health Record system during the 2016-17 financial year. Details of the participation of public and private institutions are provided below.
Public hospitals and health services
Connection of public health services to the My Health Record system has made significant progress during the past financial year. In 2016-17, an additional 231 public hospitals and health services were connected to the My Health Record, increasing the proportion of healthcare services connected from 52% in July 2016 to 67% in June 2017.
A range of connectivity projects were undertaken in 2016-17, delivering state-wide coverage of the My Health Record in WA health services, while Victoria is commissioning state-wide My Health Record infrastructure that will allow district health services to quickly connect to the My Health Record. The following services are already connected in Victoria: Austin Health, Eastern Health, Peninsular Health, Royal Children’s Hospital, and Monash Health.
In Australia, there are a total of 1,129 public hospitals and health services, with 760 (67%) of these connected to the My Health Record, as of June 2017. 748 of these can view the My Health Record, and 549 are able to upload.
Private hospitals and health services
In 2016-17, an additional 95 private hospitals and health services connected to the My Health Record, increasing the proportion from 38% in July 2016 to 79% in June 2017.
Private hospitals connected include Ramsay Healthcare Group – all 77 hospitals (and mobile app for staff), Mater Central Queensland and Cura Day Clinics in nine sites.
In Australia, there are a total of 204 candidate private hospitals and clinics, with 161 (79%) of these connected to the My Health Record, as of June 2017. 161 of these can view the My Health Record, and 154 are able to upload.
Dr Liz Jackson, Cairns QLD
Case study – Dr Liz Jackson, Cairns QLD
The Agency’s 2016-17 work program includes a number of initiatives designed to improve medicines safety and improve medicines information for healthcare providers. These benefits are already being experienced by Dr Liz Jackson and her patients in Cairns, North Queensland.
Dr Liz is an Obstetrician Gynaecologist practicing in one of the areas where the opt-out trials took place recently. As a result, individuals in that region had the opportunity to have a My Health Record automatically created for them – and roughly 98% took up the offer.
“It's been the game changer for me in this region because everyone is in it,” says Liz.
“When a patient calls the hospital, the midwife looks at their most recent updated pregnancy information on the My Health Record and we can plan what health services they require when they are coming in to have their baby. If it’s a potential emergency, we can plan theatre and staffing. With the paper pregnancy handheld record, we would not see that information until the patient walks in the door.”
One of Liz’s patients had the most complex pregnancy that she had dealt with for some years. The patient’s GP was using the My Health Record and they both were able to share information that the patient could see – using Shared Health Summaries and Discharge Summaries from Cairns hospital. Together they kept the patient at home, rather in hospital and had multidisciplinary input using the My Health Record as the mode through which information was communicated.
“You would not operate not knowing how your medical systems work – a computer is now a tool in medicine,” says Liz.
My Health Record is now the main tool that Liz uses for managing pregnancy records between her rooms, the hospital and the patient’s GP; she has not used paper-based pregnancy records for over a year. At her urging, all her patients now use the ‘Healthi’ smartphone app, which makes possible new levels of convenience and control in managing their health information.
3. An innovative mobile interface to the My Health Record
This project created a developer interface which enables mobile apps to connect to patient information stored in the My Health Record, with informed patient consent. Mobile apps that implement this interface thus allow consumers to interact with their My Health Record using smartphones or other portable devices. Four mobile apps achieved production access to the My Health Record by 30 June 2017.
4. Release 8 of My Health Record – improved user experience, implementing outcomes from medicines and pathology and diagnostic imaging streams
The Medicines Information view, introduced in Release 8, enables users to quickly sort and display medicines information held in a patient’s My Health Record documents by date or in alphabetical order. The medicines information is gathered from:
- The patient’s most recent (and up to two years’) prescription and dispense records and other Pharmaceutical Benefits Scheme claims information;
- The patient’s most recent Shared Health Summary and Discharge Summary;
- Recent Event summaries, Specialist Letters and e-Referral Notes uploaded to the patient’s record since their latest Shared Health Summary, and
- The patient’s Personal Health Summary that may include any Allergies or Adverse Reactions and other key information.
Early reviews suggest that this new feature is a welcome development.
Release 8 also improved access to relevant pathology and diagnostic imaging information by providing a new search function and an enhanced user interface. New user interface features in the pathology and diagnostic imaging views include column sorting, reordering and renaming, and group by filters.
“I just found this new document on a patient’s My Health Record called Medicines View. A single document with everything I need about a patient’s medications, easy to read, easy to download and incredibly useful. Absolutely brilliant – too good to be true but it is! Along with pathology and radiology this will be a game changer.”
- Dr Daniel Byrne, RACGP Chair SA & NT and GP in suburban Adelaide
Sandra Motteram, Bunbury WA
Case study – Sandra Motteram, Bunbury WA
By Chloerissa Eadie
“Phone access makes health care easier”, Bunbury Herald, 3 January 2017
BECAUSE Bunbury woman Sandra Motteram could access her daughter Eli's health records on a phone, the four -year-old went through with a scheduled vaccination instead of having to make another appointment.
Ms Motteram visited the Bunbury Community Health Centre to find that the computer system was down, which meant medical staff could not access Eliza's health records requiring the pair to come back at a later date. However, because Ms Motteram was registered for My Health Record she pulled up her daughter's records on her phone, allowing her to receive the vaccination on the spot.
"It was really convenient at that time and everyone pretty much has a phone on them these days," she said.
Community health nurse manager Marie O'Donoghue said it was "a particular glitch" which prevented the centre from accessing the records.
"It saved a lot of time, because children are often apprehensive when they come in for an immunisation at that age and Sandra had prepared her well, so it was important that we followed through on that." she said.
Digital Health Agency chief executive officer Tim Kelsey said it was a good example of how the experience of health care was improved with vital information accessible on a mobile device. "If you have your mobile phone with your information on it and you had an emergency, the treating clinician and the paramedic could know what your allergies were and medications" you had," he said.
"There are lots of reasons why we need to encourage people to participate in the My Health Record because it is better for them."
In the South West, 57 organisations have registered for My Health Record and about 1400 Shared Health Summaries have been uploaded this year. To register, speak to your GP at your next appointment or visit www.myhealthrecord.gov.au.
5. Return to Government on My Health Record consumer participation options
This program was aimed at implementing a national opt-out arrangement for the My Health Record. An opt-out rate of 2% is expected based on the outcome of trials undertaken in Northern Queensland and the Nepean Blue Mountains Primary Health Networks in 2016. Extending this figure to the entire population suggests that 98% of the population could have a My Health Record by the end of 2018.
To deliver on national opt-out arrangements, there are a range of systems and services (NASH, HI and the Contact Centre) currently provided by the Department of Human Services which need to be enhanced and scaled up to support the ongoing operation of the My Health Record system when it supports all Australians. These systems and services will be transitioned to the Agency as part of the program.
Achievements to the end of the reporting period include:
- Supported the Department of Health in preparing submission to government on expanding My Health Record consumer participation
- Mobilisation of the program team and establishment of program governance arrangements after decision made by federal government;
- Engagement of Primary Health Networks as key delivery partners;
- Agreement of the National Infrastructure Operator sourcing strategy;
- Delivery of clinical improvements, including enhancements to the Medicines Information view, pathology and diagnostic imaging; and
- Completion of exploratory research to inform the communications strategy and activities required to achieve the required level of consumer awareness.
My Health Record system reporting obligations
The My Health Record system operates under the My Health Records Act 2012. The Act establishes the role and functions of the Agency as System Operator; a registration framework for individuals, and entities such as healthcare provider organisations, to participate in the system; and a privacy framework (aligned with the Privacy Act 1988) specifying which entities can access and use information in the system, and the penalties that can be imposed on improper use of this information.
The Agency takes the security of patient’s health and other personal information very seriously. Many of the protections provided by the My Health Records Act 2012 are about ensuring that Australians have strong protection of their digital records. These protections are underpinned by rigorous reporting obligations.
Section 107 of the Act requires the Agency to include statistics in its Annual Report on My Health Record system registration, usage, security, and complaints, and the outcomes of those complaints in terms of investigations, enforceable undertakings or court proceedings seeking injunctive relief. These statistics are outlined in the following table:
|My Health Record system reporting obligations|
Registrations, cancellations, suspensions of registrations
In 2016-17 the Agency, as System Operator, registered 1,120,817 people for a My Health Record. There were a total of 20,151 cancelled registrations during the year.
In 2016-17 the System Operator registered an additional 1,320 healthcare provider organisations. 89 registrations were cancelled or suspended.
Use of the My Health Record system by healthcare providers and healthcare recipients
A total of 664,278 people accessed their My Health Record via the consumer portal in 2016-17.
A total of 2,217 unique healthcare provider organisations, via their clinical information systems, viewed records in the My Health Record system during 2016-17.
A total of 4,538 unique healthcare provider organisations uploaded records to the My Health Record system during 2016-17.
A total of 218,776,890 documents were uploaded to the My Health Record system in 2016-17.
Occurrences compromising the integrity or security of the My Health Record system
35 data breach notifications were reported to the OAIC as required under Section 75 of the My Health Records Act 2012 (concerning potential data security or integrity breaches). Twenty-nine of these were reported by the Chief Executive Medicare as a registered repository operator under Section 38 of the Act.
The remaining six incidents were reported by the My Health Record System Operator. These included:
There have been no purposeful or malicious attacks compromising the integrity or security of the My Health Record system.
Complaints received, investigations undertaken, enforceable undertakings accepted, injunctions granted
In 2016-17 a total of 62 complaints were made in relation to the My Health Record system and, as of as of 24 July 2017, one remained open.
Complaints are initially registered and actioned by DHS customer service officers. If the matter is complex or relates to a potential privacy or clinical safety issue, the complaint is referred to Agency staff for resolution.
No enforceable undertakings were accepted by the System Operator and no proceedings were initiated by the System Operator in relation to enforceable undertakings or injunctions.
National Digital Health Strategy
Purpose: During the 2016-17 financial year, the Agency developed the National Digital Health Strategy, outlining the seven strategic priorities for digital health in Australia. The Strategy will guide a coordinated approach to the delivery of digital health in Australia through 2022.
Results: In developing the National Digital Health Strategy, the Australian Digital Health Agency led the extensive ‘Your health. Your say’ consultation process to ensure that the Strategy was informed by Australian consumers, carers, healthcare providers, community groups, professional bodies and many other key health stakeholders. 3000 people attended over 100 forums, workshops, webcasts and town hall meetings held across Australia.34
- 94% of people want to use digital technology to access general health information.
- 93% of healthcare professionals want to use digital technologies to share health records with patients.
Source: 'Your Health. Your Say.' survey, Australian Digital Health Agency, Nov 2016 - Jan 2017
Four key themes emerged from the consultation process, forming the foundation of the National Digital Health Strategy:
- Support me in making the right healthcare choices, and provide me with options;
- Help all the people who care for me to understand me, and together, provide safe and personalised care;
- Create an environment where my healthcare providers and I can use and benefit from innovative technologies; and
- Preserve my trust in the healthcare system and protect my rights.
The consultation has:
- Enabled the Agency to build an understanding of what a broad and diverse set of Australian communities want and expect from a modern healthcare system;
- Generated a positive and constructive discussion about how data and technology can be used to create healthier lives, including resetting the relationship between the Agency and key stakeholder groups; and
- Established a new, collaborative way of working in partnership with stakeholders and end users that can be sustained across Agency programs.
AHMAC endorsed the National Digital Health Strategy at the 2 June 2017 meeting, as well as the Agency’s Forward Work Plan 2018-22 and supporting budget, which are aligned to the Strategy.
In addition, AHMAC agreed to recommend submission of the National Digital Health Strategy and Australian Digital Health Agency forward work plan for approval by the COAG Health Council (CHC) at its first meeting in the next reporting period (4 August 2017). The Strategy was subsequently approved by the CHC at this meeting.
The National Digital Health Strategy defines strategic priority outcomes to be achieved by 2022. The seven priority areas were derived from the consultation process and associated research.
They articulate a set of shared outcomes for all stakeholders that complement existing investments in digital health initiatives and will enable health innovation and improved health and care experiences to be delivered. This will result in measurable benefit for patients, carers, healthcare providers and the broader health system. The following shows the vision, key themes and strategic priorities.Vision
Better health for all Australians enabled by seamless, safe, secure, digital health services and technologies that provide a range of innovative, easy to use tools for both patients and providers.Key Themes
Key Themes Strategic priorities
- Health information that is available whenver and wherever it is needed
- Health information that can be exchanged securely
- High-quality data with a commonly understood meaning that can be used with confidence
- Better availability and access to prescriptions and medicines information
- Digitally-enabled models of care that improve, accessibility, quality, safety and efficiency.
- A workforce confidently using digital health technologies to deliver health and care
- A thriving digital health industry delivering world class innovation
By 2022, the National Digital Health Strategy will deliver the essential, foundational elements of health information that can be safely accessed and easily utilised and shared. Innovators, entrepreneurs and developers will be able to use these foundational elements to develop tools that patients and health professionals can use every day to measurably improve healthcare and health outcomes.
My Health Record today and future
1. National Collaborative Network for Child Health Informatics
Purpose: This program of work is targeted with establishing a National Collaborative Network for Child Health Informatics that will bring together centres of excellence in children’s health innovation across the country. The network will create a forum in which to leverage the work in NSW and collaborate with groups across the country who are pursuing similar goals.
The network will also provide a link into the technology industry, the research community and health policy departments. This initiative aims to accelerate improvements to the practice of children’s health by supporting collaboration across organisational and jurisdictional boundaries.
Results: In 2017, the Agency partnered with eHealth NSW and the Sydney Children’s Hospitals Network to establish the National Collaborative Network for Child Health Informatics (the Network). The Network’s objective is to identify and scope 4–5 strategic national projects and initiatives, aimed at achieving positive health and wellbeing outcomes for Australian children and young people, made possible through patient-centred and clinician-friendly digital systems and capabilities.35
The Network has brought together stakeholders from all levels of government, consumers, clinicians, peak bodies, non-government organisations, researchers and ICT industry partners to identify and scope a number of potential initiatives for investment that will have a positive impact on the health and social outcomes and experiences of children and their families, through leveraging existing national digital technologies and platforms.
Through a number of collaborative workshops held in June, themed around the key priorities of the National Strategic Framework for Child and Youth Health (Healthy, Safe and Thriving), and utilising the feedback received through the Australian Digital Health Agency Strategy consultation process, the Network identified 41 potential digital health initiatives to support children’s health and wellbeing.
In the next reporting period, the Network’s Expert Reference Group, totalling 60 members of the Network split across three workstreams of Community and Clinical, ICT and Digital and Research, will meet to validate and prioritise these initiatives based on whether they will positively impact the health and social outcomes of children, whilst being safe, efficient, feasible and affordable.
2. Health Care homes strategy
Purpose: This program of work will provide Agency support for the Health Care Homes trials run by the Department of Health. The trials aim to reduce the barriers patients face across fragmented health services, with the aim of keeping them well, at home and out of hospital through the ongoing co‐ordination, management and support of a patient’s care. This work priority will identify opportunities for data and technology to support the trials to achieve the desired healthcare outcomes for the people involved.
Results: The Agency has identified a range of resources and support tools available to support the successful rollout of the Health Care Home trial. This support includes:
- Training resources to support the in-scope PHNs;
- Training packages for hospitals located near Health Care Homes practices;
- Collaboration with the Department of Health on clear communication resources, with the Agency’s focusing on ensuring that Health Care Homes patients;
- can access and use the information available in their My Health Record; and
- Identification of other program areas where work can be aligned to enhance the implementation of the Health Care Homes trial, including within the Pathology, Diagnostic Imaging and Telehealth programs.
The Agency has conducted an analysis to identify and assess a range of options for supporting the visibility of shared care plans that are generated for Health Care Homes patients. The Agency is working with the Department of Health on evaluation of the trial.
3. Embedding telehealth in clinical consultations
Purpose: Telehealth presents a huge opportunity to help prevent disease and provide more convenient and accessible healthcare services. It offers solutions to some significant challenges facing the healthcare system today, such as finding better ways to provide care to elderly Australians in an ageing population, helping people with chronic diseases to more effectively manage their conditions, and providing more accessible care to many Australians living in regional and remote locations who today need to travel significant distances to access healthcare.
Discussions with remote healthcare providers have uncovered significant usability problems with existing video‐conferencing technology and workflows that create a burden for providers and consumers currently using telehealth services, and a barrier to broader take up across the country. This program of work will focus on improving the experience of telehealth for users of those services, and extending the reach of these technologies into new geographies and health settings.
Results: The Agency commissioned NT Health to lead development of a national steering group tasked with completing this baseline of telehealth status and developing a roadmap and work plan to embed telehealth into clinical practice and as a core part of the National Digital Health Strategy. This work is delivering the following key outputs in 2017-18:
- Defining the scope of telehealth to best align to the national digital health agenda;
- Establishing a baseline of telehealth status and known issues; and
- Delivering a national engagement plan and set of initiatives to embed telehealth into clinical consultations.
The program of work is part of a longer term strategy to deliver telehealth to benefit all Australians.
Hermannsburg (Ntaria) Community Health Centre, NT
Case study – Northern Territory telehealth project
The provision of telehealth services to deliver outpatient appointments was assessed at three Northern Territory sites between 2014 and 2015: Alice Springs, Katherine and Tennant Creek.
The evaluation demonstrated that increasing telehealth use in these locations (more than seven-fold in Tennant Creek, four-fold in Alice Springs and a doubling in Katherine) led to reductions in travel, with patients in Tennant Creek more likely to use telehealth than to travel. The ‘Did Not Attend’ (DNA) rate for appointments lowered significantly. The estimated cost savings for the project for participants was on the order of $1.189 million.
Surveys indicated high levels of support for telehealth from participating patients and a strong desire to use telehealth in the future. Clinicians had similar attitudes in their endorsement of telehealth, reporting an improvement in continuity of care for their patients, and that they would be likely to use telehealth in the future and recommend it to their colleagues.
The Agency’s 2016-17 work program includes an initiative to embed telehealth in clinical consultations, so many more people will soon experience these benefits first hand, with ongoing cost savings scaling with implementation.
Purpose: The Agency has an opportunity to deliver meaningful improvement to Australia’s health system – to patients, carers and healthcare providers, translating digital health technologies into improved health outcomes. By building on established national digital health foundations, significant progress is possible in a short timeframe.
Driving improved health outcomes through the use of digital health technologies requires an engaged staff and an organisation committed to excellence in delivery. The Organisational Excellence program of work will seek to instil an organisational culture of passion and commitment to improved healthcare through the use of digital health. The program will embed into Agency operations the principles of accountability, meaningful engagement and collaboration, and a focus on benefits realisation, as well as providing assurance to funders that funds are being applied to the right priorities and used prudently.
1. Committing to the prudent use of resources
The creation of the Agency represents a new chapter in the growth of digital health development, with a renewed focus on pursuing initiatives that have immediate, tangible benefits for the health sector and the community. The Agency’s challenge is to deliver these benefits at the greatest efficiency.
The first step in responding to this challenge is to build disciplined and robust organisational processes and infrastructure that support its business functions and aspire to the highest standards of governance. Discharging the Agency’s obligations under various regulatory frameworks that apply to Commonwealth corporate entities is a priority.
Significant activity has been directed at compliance with the Public Governance, Performance and Accountability Act 2013 (PGPA Act) and associated instruments and policies. These set the standard for the use and management of public resources, with a particular emphasis on planning, performance and reporting. This activity has led to the introduction of a number of compliance initiatives, including: a risk management framework, fraud control arrangements, a business continuity plan, the appointment of an independent Audit and Risk Committee, an Internal Audit Charter, Accountable Authority instructions; and financial delegations.
Efforts are also focused on meeting Commonwealth financial reporting obligations under the PGPA Act and adapting the Agency’s financial systems to adhere to the public sector governance structure. Important work has also begun on implementing a Budgetary Control Framework that will allow greater clarity surrounding business decisions, drive efficiency in developing budget positions and forecasts, improve capability to deal with externally imposed savings measures (such as efficiency dividends) and strengthen protocols in dealing with the Agency’s key governmental stakeholders.
2. Optimising opportunities as the national digital health agency
As part of improving the performance of the Agency, the Board approved the development and implementation of two key frameworks: the Agency Wide Quality Framework and the Agency Clinical Governance Framework. These frameworks are designed to drive quality improvements and safeguard high standards of patient care.
The frameworks were completed on schedule by the end of the 2016-17 reporting period, and implementation will commence in 2017-18.
Agency Wide Quality Framework
The Agency Wide Quality Framework describes how quality is embedded in all aspects of the Agency’s work, and ultimately how the delivery of the National Digital Health Strategy will be supported. It provides a foundation of specific quality principles and elements for the Agency to implement appropriate measures and initiatives, in alignment with the framework. It also offers transparency to external stakeholders, acting to instil confidence in the quality of internal Agency processes and the products and services delivered.
Clinical Governance Framework
The Australian Commission on Safety and Quality in Health Care (ACSQHC) defines clinical governance as:
“A system through which organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care. This is achieved by creating an environment in which there is transparent responsibility and accountability for maintaining standards and by allowing excellence in clinical care to flourish.”
This definition is used by the Agency as the foundation for its Clinical Governance Framework, recognising that the Agency’s products and services can directly impact the delivery of care by healthcare providers.
The Agency’s Clinical Governance Framework has ten Agency-tailored guiding principles, each focused on the digital health consumer experience:
- Alignment with the Agency’s strategic priorities;
- Culture of safety and quality improvement;
- Effective leadership and accountability;
- Transparent external assurance;
- Integrated and responsive risk and incident management;
- Governance embedded into core business processes;
- Evidence-based models of care;
- Supporting high quality data security and privacy;
- Frameworks, policies and processes are fit for purpose and are built to last; and
- Co-production with consumers and clinicians.
Note: Items 3 and 4 in this stream are treated separately for a more cohesive narrative. See Privacy and Security below.
5. Making the organisation hum
The Agency is founded with a clear sense of purpose: the potential for digital health technology to transform healthcare delivery. The Agency recognises that a strong network of staff who share this sense of purpose will better position us for success. The Agency needs staff to be highly capable, committed and sufficiently agile to meet the Agency’s evolving commitments to government and the community. Consequently, the Agency is striving to create a workplace that offers staff challenging and meaningful work. The goal is to create a vibrant and nurturing work environment that promotes professional and personal development.
The Agency’s focus on building organisational capability extends to fostering a culture of cohesion and collegiality, to ensure that the Agency’s values – working together, respect and trust, transparency, leading through learning and customer focus – guide decision making and make the Agency a great place to work. One initiative, Grand Rounds: Lunch and Learn, introduced primarily as a learning opportunity, has also strengthened group cohesion. Grand Rounds, which has a storied tradition in medicine, has promoted a sense of camaraderie across the Agency as networks of like-minded individuals with shared interests listen to leaders and innovators give their insights on emerging technologies in digital health.
6. Exemplifying openness and transparency
The Agency recognises that instilling and promoting transparency matters both for its culture and for its accountability to the outside world. Parliament and the public, just like shareholders in a listed company, have a right to know what the Agency has achieved with the funds provided. The Agency discloses intended and actual performance in a number of external reports, and also in internal reports made publicly available.
The Agency’s work plan priorities for each financial year and related measures of success are disclosed in its corporate plan, published on the website by 31 August every year (other than the Agency’s inaugural year). The Agency acquits actual performance against those work plan forecasts in Part 2 of this report.
The Agency also makes internal board papers available on its website.36 These describe progress against the work plan and other commitments, and reflect the candour and accountability expected from the CEO, management and Agency board. They report on progress, as well as systemic, process and cultural factors that may be hampering progress.
The Agency also welcomes open dialogue and transparency for the other benefits they bring: sharing insights with stakeholders and authentic engagement will drive improvements in Australia’s digital health capabilities. The value of collaboration, listening and learning from a diverse stakeholder community was most evident in the development of the National Digital Health Strategy, and the strategy reflected the spirit of partnership across the stakeholder spectrum.
Privacy and security
Note: These two topics represent items 3 and 4 respectively within the Organisational Excellence stream.
Purpose: To earn and maintain the community’s trust as a reliable operator of national data systems, the Agency is focusing on ensuring its privacy compliance obligations are met and that privacy governance accountabilities and processes have been documented. Protecting the privacy and confidentiality of every citizen’s personal information is considered a critical success factor in managing national data systems.
Results: The Agency has established a Privacy team to embed privacy within the functions and culture of the Agency. The functions of the Privacy team include corporate privacy, assurance, engagement and advice.
While there is strong support for the value of the My Health Record system and the potential benefits to the Australian community, there is general community concern about the security of data and the extent to which individual privacy is appropriately protected. Maintaining community trust in the privacy and security of the My Health Record system is imperative to the success of the program. Therefore, the Privacy team will take a proactive, privacy design approach to managing the development and operation of the My Health Record system.
The Agency has reviewed the its operations as a Commonwealth government agency and as the System Operator of the My Health Records system as well as compliance with the Privacy Act 1988 and privacy-related provisions of the My Health Records Act 2012 and Healthcare Identifiers Act 2010. Resulting actions have seen the Privacy team deliver a privacy vision for the Agency, a privacy governance frameworksetting out roles and accountabilities, development of key processes (which are now being operationalised) and planning of a 2017-18 training and awareness program.
Purpose: The Digital Health Cyber Security Centre (Digital Health CSC) was established to support secure operation of national digital health systems, and protection for Australian personal health information that is stored and transacted through the Australian Digital Health Agency. The Digital Health CSC will also raise security awareness and maturity across the Australian digital healthcare ecosystem.
Following the themes ‘Partner. Secure. Inform. Respond.’ The Digital Health CSC provides a range of cyber security capabilities to support national digital health operations across Australia. This enables ongoing monitoring and assessment of evolving cyber threats, and facilitates continuous improvement to the approach to cyber security.
With the aim of maximising available resources and reducing duplication of effort, the Digital Health CSC has established, and is continuing to grow, partnerships with a range of national and international cyber security organisations across government and the private sector. These partnerships facilitate ongoing improvements to the Agency’s knowledge of evolving cyber threats, and provide opportunities to leverage shared expertise and materials across organisations. Information gained through these partnerships is used to support the development of guidance materials and threat intelligence information for the digital health sector.
In addition to ongoing security operations activities, the Digital Health CSC has worked to implement and enhance tools which support real time monitoring of the My Health Record system, provide improved alert capabilities and facilitate ongoing security management for the Agency. A continuous improvement program has been established to deliver enhancements to these tools over time.
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10 Royal Australian College of Practitioners. RACGP position statement: The use of secure electronic communication within the health care system. Sydney: Royal Australian College of Practitioners; 2016.
11 Georgiou A, Marks A, Braithwaite J, Westbrook JI. Gaps, disconnections, and discontinuities--the role of information exchange in the delivery of quality long-term care. The Gerontologist. 2013;53(5):770-9.
12 Banfield M, Gardner K, McRae I, Gillespie J, Wells R, Yen L. Unlocking information for coordination of care in Australia: a qualitative study of information continuity in four primary health care models. BMC Family Practice. 2013;14(34):1-11.
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18 HealthLink. Case Study General Practice: Henderson Medical Centre - Enhancing delivery of medical services. Auckland; 2004.
19 Goldzweig CL, Tow gh AA, Paige NM, Orshansky G, Haggstrom DA, Beroes JM, et al. Systematic Review: Secure Messaging Between Providers and Patients, and Patients’ Access to Their Own Medical Record: Evidence on Health Outcomes, Satisfaction, E ciency and Attitudes [Internet]. Washington D.C.: Department of Veterans A airs (US); 2012.
20 Baer D. Patient-Physician E-Mail Communication: The Kaiser Permanente Experience. J Oncol Pract. 2011;7(4):230-3.
21 Jenssen BP, Mitra N, Shah A, Wan F, Grande D. Using Digital Technology to Engage and Communicate with Patients: A Survey of Patient Attitudes. J Gen Intern Med. 2016;31(1):85-92.
22 Smith PC, Araya-Guerra R, Bublitz C, Parnes B, Dickinson LM, Van Vorst R, et al. Missing clinical information during primary care visits. Jama. 2005;293(5):565-71.
23 Deloitte. Secure Messaging Market Analysis. Sydney; 2014.
24 See note 22.
25 Georgiou A, Marks A, Braithwaite J, Westbrook JI. Gaps, disconnections, and discontinuities--the role of information exchange in the delivery of quality long-term care. The Gerontologist. 2013;53(5):770-9.
26 Australian Bureau of Statistics Patient Experiences in Australia: Summary of Findings, 2015-16. 4839.0 Canberra: Australian Bureau of Statistics; 2016
27 Health Care Complaints Commission. Case Studies, Volume 1. Sydney: Health Care Complaints Commission; 2003.
28 Australian Digital Health Agency. Secure Messaging Problem Statement. Sydney: Australian Digital Health Agency; 2016.
29 Australian Council for Safety and Quality in Health Care. Second National Report on Patient Safety – Improving Medication Safety. July 2002
30 Australian Council for Safety and Quality in Health Care. Literature Review: Medication Safety in Australia. Aug 2013.
32 Westbrook JI, Georgiou A, Dimos A, Germanos T. Computerised pathology test order entry reduces laboratory turnaround times and influences tests ordered by hospital clinicians: a controlled before and after study. Journal of Clinical Pathology. 2006;59(5):533-6.
33 Georgiou A, Prgomet M, Lymer S, Hordern A, Ridley L, Westbrook J. The impact of a health IT changeover on Medical Imaging Department work processes and turnaround times. A mixed method study. Applied Clinical Informatics. 2015;6(3):443-53.
34 See note 1