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Transforming Australia’s Digital Health Infrastructure - Registration

Questions and Answers from the Information Session

The Australian Digital Health Agency invited stakeholders and potential partners to learn more about its transformative vision for national digital health infrastructure at an information session on Transforming Australia’s Digital Health Infrastructure on Monday 15 July 2024 at the Hellenic Club in Canberra. 

At the information session, attendees were invited to ask questions through Slido. This page contains published questions and answers which were not answered on the day. Where an answer is relevant to multiple questions, the answer spans those questions.

View the recording of the event here.

 QuestionAnswer
1How does the Agency's current architectural practice support the delivery of complex technology change across the ecosystem, and what governance is in place?The Agency’s architecture practice governance involves significant discovery, peer review and socialisation. This is currently being demonstrated through the development of the HIE Architecture and Roadmap document that is being developed in collaboration with the funding states and territories through the Jurisdictional Advisory Groups with the oversight of the Digital Health Oversight Committee.  The HIE Architecture and Roadmap is currently going through a broader socialisation phase where the Agency is facilitating sessions with peak organisations and industry.
2What is the scope for integration with other virtual care systems such as Healthdirect, jurisdictional providers, Head to Health etc?Specific integration with existing health and jurisdiction systems is being evaluated on a case-by-case basis as the HIE program progresses through socialisation of the HIE Architecture and Roadmap. Healthdirect has a significant role in the first priority for the HIE program and following the confirmation of funding for The Directory project within the HIE program, detailed workshops will be scheduled to progress the target architecture early in this financial year.
3Love the thought of all of this data being available, but is the consumer still going to be able to control who has access and how and why? The existing My Health Record legislative framework provides for registered healthcare providers to upload information to the system and allows the consumer to apply access controls to any item or all of the information. It is expected that similar controls will be replicated across future national digital health solutions.
4Seems to be a push for consumer choice, but what about continuity of care, clinician relationships and the power of having an existing relationship with GPThe approach is intended to support both, making information available to clinicians enables continuity of care and clinical decision making while also being led by Australian healthcare consumers themselves. 
5There’s a lot of focus on keeping consumers at the centre, which is great. How are you proposing to actually make this a reality? The Agency operates using a comprehensive Experience Design Framework that contains principles and tools (including co-design) that are used to ensure that the consumer is at the centre.
6What is the vision for digital health access for vulnerable groups (CALD, First Nations, rural & remote etc.)? Scope for working with DHA on this front?

The vision for digital health for these cohorts is to help to enable better access for vulnerable groups with better support to seek, navigate and obtain healthcare in a system that all can understand and understands them. Leveraging digital tools to identify products and services can help to improve access and in turn health outcomes and reduce disparities. Key aspects of this vision include universal access, cultural and linguistic sensitivities, empowerment through education, community collaboration, integrated care, telehealth expansion, data privacy and security, and equity in health outcomes. The Agency works with multiple partners on these aspects across the workplan and agenda.

 

 

7How does digital health access for vulnerable groups such as CALD, First Nations, rural & remote communities etc. fit into this digital health plan?
8With all the cyberattacks on the global healthcare industry lately, how with ADHA ensure Australia’s health infrastructure remains secure?The Agency has in place a range of proactive controls to ensure existing systems are designed and built to meet secure architectural standards, including multi-tiered layers of security. Each system maintains current certification to meet the ISM and PSPF requirements utilising regular independent audits and technical testing.

The Agency conducts continuous monitoring, response and reporting of cyber threats, working closely with technology partners and key intelligence and security organisations such as the Australian Cyber Security Centre. This ensures early detection of potential threats and fast and deliberate response to contain and stop any potential attacks.
9Security of Health data is arguably one of the biggest key factors in Data sharing platforms. What processes are planned to ensure citizen data is protected?
10One HIE database is the Utopia we want. How will we ensure the security of the data. It will be a big target for Cyber criminals. if compromised, trust would be lost.
11What is ADHA’s assurance mechanism for the new architecture, microservices and interconnections to ensure they are secure and reliable.
12How will information disseminated from My Health Record via 3rd party apps be protected to ensure vendor-owners of the 3rd party apps cannot access that health data?Third party apps connecting to My Health Record are assessed for conformance with the My Health Records Act 2012 to ensure they have sufficient security controls in place in line with the risk they present.  These assessments potentially include examining governance and access controls and require several layers of testing and assurance before any new application connection can ever be established.
13How will the ADHA address the ever-growing concerns from the public regarding data privacy and security to ensure trust is front and centre.The Agency is supporting consumers and healthcare providers through the development of guidance on cyber security and privacy, which are available through online training, periodic webinars, guides and factsheets. More information for healthcare providers can be found  here and for consumers here.
14What role will the ADHA play with regards to the proposed Health ISAC (Information Sharing & Analysis Centre) The Agency is one of the contributing agencies along with Services Australia, and the Department of Health and Aged Care to support the creation of the Health ISAC. As part of its cyber strategy and roadmap, the Agency is also working towards strengthening current information sharing practices for sharing of cyber threat information with the healthcare community. This will support an uplift in cyber knowledge and awareness in the healthcare community by enabling knowledge sharing with trusted peak bodies and health organisations. 
15Why is so much money being spent on the state EMR systems when some sectors do not get funding or support, they require to digitise and contribute to a HIE.There are a number of answers or approaches that go to business expense and investment. The Department of Health and Aged Care and the Agency have been funded to drive these changes and work with the sector to implement them as efficiently and effectively as possible. Further there are industry offers available for certain elements where the changes go above and beyond normal requirements. There are also a number of other Government funding/grant programs available for businesses large and small to access to build capacity and capability.
16Keen to understand how ADHA might play a role re lack of digital or EMR in Private Hospitals given the challenges with private health funding vs public hospitals?  The Department of Health and Aged Care and the Agency have been funded to drive these changes and work with the sector to implement them as efficiently and effectively as possible. Further there are industry offers available for certain elements where the changes go above and beyond normal requirements. There are also a number of other Government funding/grant programs available for businesses large and small to access to build capacity and capability.
17Software vendors “Build once” but “there’s lots of work coming for you” is concerning.  Software vendors have very full roadmaps. How will this work be funded?
18Do you believe the agency is appropriately funded and supported to actually achieve the described initiatives?

As part of the 2023–24 Budget, the Government secured the Agency as an ongoing entity, invested in My Health Record operations and modernisation, and renewed the Intergovernmental Agreement (IGA) on National Digital Health

for 4 years to progress the secure, safe and efficient sharing of information across the health system. This investment reflects the growing number of digital health tools and services the Agency now supports and delivers. 

19What incentives and grants/funding are government looking at for users and vendors to modernize infrastructure and software to enable sharing.The Agency works collaboratively across the healthcare sector to support and improve access to health information.
20How will you encourage private health care providers to participate in the ADHA initiatives?
21How do you plan to encourage uptake of the my health app? Would there be incentives for medical professionals and for consumers?The my health app was developed in response to consumer demand and is designed as a means of supporting Australians to have their health information at their fingertips. 20% of consumers accessing My Health Record, now do so via the app and the plan is to continue to develop features and improve functionality in response to the feedback of Australian healthcare consumers.  This is the primary way in which uptake of the app will be encouraged.
22Given that ACT has such "amazing" and the most digital health system in Australia, how is it we have the worst public health KPIs in Australia. The Agency works closely with all jurisdictions in relation to digital health policy and programs to support and improve access to health information, through the Intergovernmental Agreement on National Digital Health 2023-2027. Matters relating to the performance of state and territory health systems are a matter for each state and territory.
23Huge sums of money are pumped into these digital health initiatives. Recent audits show minimal ROI from money spent into health. How are you measuring ROI? 

There are many ways return on investment can be calculated in the health sector including improvements in health outcomes, reductions in medication misadventures, improved sustainability of the system, through all of these including reduced administrative burden.  While we are not sure exactly what audits you are referring, there have been a number of publications including a recent Productivity Commission Report that outline the benefits associated with digital enablement. The challenge for all in the system is to capture and demonstrate these benefits in a coordinated way across the entire sector, including the benefits of interoperability.   

 

The Agency has developed a number of reporting mechanisms that go to utility of the system, and these are published regularly and further they demonstrate significant growth, and we continue to work with both the Commonwealth Department of Health and Jurisdictions on how we can continue to improve this reporting. The Agency has a comprehensive framework to measure benefits realisation that will be utilised to measure the benefits realised from these future investments.

24What are your thoughts on how we ensure that the transformation is environmentally sustainable?It is a requirement under the Commonwealth Procurement Rules, that the evaluation consider the environmental sustainability of those goods and services. 
25Given that Health Record Privacy Acts exist at jurisdictional levels, what support will the Agency provide to assist with the sharing by default frameworkThe Department of Health and Aged Care is working with states and territories and key delivery partners in the Commonwealth to identify the current regulatory settings that support health information sharing and what will be needed to underpin real-time health information exchange in future.
26What is being done at the whole of government level to align State and Fed privacy regs or at least providing clear comply once comply everywhere guidance.
27Why will any state based or big private provider acquiring new tech have to follow your new set of standards in the near future if there is no law mandating use
28What legislative challenges do you see for the HIE and how are you planning to overcome them?
29Can you detail how the respective states will be involved in this process and how they will support this initiative.
30CDO mentions a drug company app may be a way that people engage with My Health Record. Isn't the pharmaceutical industry prohibited from access by legislation?The My Health Records Act 2012 currently prohibits access by employers and insurers.
31Considering AI and GenAI, is it likely that ADHA will be trialling capabilities like ambient listening and translation from other languages to useful English?AI presents opportunities to improve wellbeing, quality of life and grow our economy. The Agency is a part of a whole-of-government (including the Department of Health and Aged Care and the Department of Industry, Science and Resources) effort to ensure AI is used safely and responsibly in Australia and any future use cases will align with all relevant Government policy and guidelines, including data and privacy regulations. Each emerging use case will be carefully assessed for alignment with regulations and implications for Agency products, digital health and the healthcare economy. 
32Ms Cattermole mentioned that you will use   “existing consent” for the health information exchange, what is meant by this? The existing My Health Record legislative framework allows registered healthcare providers to upload information to a patient’s record and allows the consumer to apply access controls to any item or all of the information in My Health Record.
33You showed the HIE lighting up public and pop health. Will that be constrained by My Health Record consent models?
34Consumer trust is paramount. For seamless data flow and patient on-sharing what reforms to the Data Sharing Act are being considered?The Department of Health and Aged Care is working together with states and territories and key delivery partners in the Commonwealth to identify the current regulatory settings that support health information sharing and what will be needed to underpin real-time health information exchange in future.   The My Health Records Act 2012, the Healthcare Identifiers Act 2010 and the Privacy Act 1988 provide some of the key legislative underpinnings to current national digital health infrastructure. The Department of Health and Aged Care will lead a review of the current legislative framework to support digital health initiatives and consultation on any proposed reform will follow.
35While I accept the need for collaboration is important what decision-making process is setup to ensure that decisions are made rapidlyThe Agency has established robust project and program governance structures to support timely decision making which is supported by external engagement fora such as the Council for Connected Care, the Digital Health Oversight Committee and the Jurisdictional Advisory Committee.
36The vision shown today seems 10-20% tech and the rest are policy, adoption & cajoling.  How would you quantify the split?  What is the limiting factor in this?Policy and adoption are critical components of transforming Australia’s health system using digital enablement, and the full vision can be found in the National Digital Health Strategy 2023-2028 (the NDHS) and Delivery Roadmap. These documents provide high level guidance to all stakeholders involved in healthcare initiatives that require national leadership, coordination, and investment. The strategy aims to prioritise individuals at the centre of a modern and digitally empowered healthcare system, fostering their involvement in an interconnected and digitally enabled environment. The Change Enablers identified in the NDHS highlight policy and regulatory reform, a digitally ready and enabled health workforce, and informed consumers with strong digital literacy - all within a secure, fit-for-purpose and connected digital system. 
37What is the plan to democratise access to this deidentified data for commercial organisations to leverage data science and AI to create better patient care? This topic will be extensively workshopped with key stakeholders, and more broadly in the community prior to direction being provided. 
38Will AI have a role, not only to summarise information that is duplicated, but also identify errors and inconsistencies in data?The Agency is supporting the Department of Health and Aged Care and the Department of Industry, Science and Resources with the development of national regulatory frameworks for AI and is considering how AI might be leveraged to uplift digital health. Each emerging use case, including those that promote data accuracy and quality, will be carefully assessed for alignment with regulations and implications for Agency products, digital health and the healthcare economy. 
39Given the significant procurement effort outlined by the Agency, how will we ensure that outcomes for the sector are achieved with an impending election?The Agency's procurement planning is considering all time horizons, technical requirements and the need to deliver value for money from these procurements. 
40Will the ADHA require suppliers to disclose carbon emissions and setting targets for emission reductions?At this time, there is no requirement for suppliers to report on emissions, but we are committed to implementing any future change in Government policy. 
41What is the specific timing around each tender? The Agency has published a number of planned procurements on AusTender, including indicative timing. Creating a watchlist on AusTender to receive updates is a great way of staying informed.
42How are you going to ensure you improve upon your previous procurement processes? The Agency is confident it has in place sound governance and strong policies and processes that support compliance with the Commonwealth Procurement Rules and related policies and guidelines issued by the Department of Finance, building on past learnings and taking a continuous improvement approach to all elements of our operations. The Agency has released information about the procurements it currently has planned on the Department of Finance AusTender site. The Annual Procurement Plan may be updated from time to time and interested parties are encouraged to add this to their tenders.gov.au watchlist, so that updates are automatically received from AusTender
43What Australian Government procurement channels and supply panels will you be using for your tenders and will SMEs have access to these.The Agency intends to undertake competitive procurements using open approaches to market and other, existing government panels. We are fully committed to complying with the Commonwealth Procurement Rules, including recent changes to support increased sourcing from small to medium enterprise.
44Given the volume and scope of work, what processes will be in place to ensure it is distributed competitively on value and on merit, not just to the usual crowd.
45Will a new procurement panel be established?The Agency has no current intentions to establish its own panels and intends to undertake competitive procurements using open approaches to market and existing government panels.
46What procurement channels will the Agency be using for the plethora of smaller pieces of consultancy work under the $80k threshold of BuyICT Digital Marketplace The Agency uses a range of mechanisms for procurements under $80,000 including panels, in line with government procurement rules. 
47Where can we find details of the open tender for suppliers with experience?The Agency has published a number of planned procurements on AusTender, including indicative timing. Creating a watchlist on AusTender to receive updates is a great way of staying informed.
48Is the Annual Procurement Plan a complete list of all of the procurements that the Agency expects to take place in the next 12 months?The Annual Procurement Plan is a live document, and further planned procurements may be published as the Agency progresses these transformative activities.
49Does the Agency expect insourcing/outsourcing advisors (who also have capability to deliver below-the-line) to be precluded from future outsourced build work?The Agency is fully committed to complying with the Commonwealth Procurement Rules, including appropriately managing probity. This issue will be considered on a case-by-case basis. 
50Will there be an RFT for a national viewer? Can’t the architecture for the HIE accommodate a fetch when as needed?  Is in house or RFT process envisioned?A national diagnostic imaging viewer is on the roadmap for the HIE; however, further consultation, engagement and decisions are required in the future.
51When would we start the HIE program? Given its centrality to everything now why not within the year on procurement for first parts of project?The HIE program has already commenced, including funding for the first phase.
52How much of the core infrastructure will be built by software engineers directly working for the ADHA vs outsourcing to consulting service providers?The Agency has no set parameters on this and is currently considering its optimal operating model relating to aspects of design and delivery.
53Is the ADHA really committed to “being the glue” between systems OR are they looking to build their own clinical products?The Agency’s primary focus is on systems and services that connect the different elements of the health ecosystem together.
54The UK NHS have implemented a patient mobile app. with mixed success. Despite having a connected network not all data is flowing. Did you research the NHS?The Agency has engaged with both NHS England and NHS Wales and their experiences and insights have been incorporated into the workplan for the my health app.
55A microservices ecosystem is more redundant/flexible yet requires a much higher governance and sustainment overhead. How is the Agency planning to address this?The Agency will be publishing conformance profiles for the discrete APIs in addition to aggregated FHIR query APIs to ensure both granular and bundled resource requests are meeting the standards. Regarding consumer control and authorisation of access to more granular health information, this is a key feature of the design work that will inform future changes to the authentication, authorisation, and business logic strategic platform.
56I want to know the "pattern" you mentioned brought by digital health system emphasize on what aspects more.Unfortunately, without further detail from the requestor, we are unable to answer this question.
57Does the new standards catalogue include the capability to download the endorsed standards at no charge?The need for a digital health standards catalogue was identified during the process of creating the National Healthcare Interoperability Plan, which resulted in the inclusion of Action 2.5. The Digital Health Standards Catalogue provides a user-friendly access point to various digital health standards needed by the healthcare sector in Australia to help achieve more connected care. 

To start delivering content and enable greater engagement through demonstrating what the catalogue will be, the Agency has taken a phased approach to the delivery. This process aims to grow engagement across the wider user community as content and functionality becomes available.

Many of the standards listed in the catalogue are available to download at no charge and we are currently assessing the remaining standards with a view to determining if it is appropriate and viable for the Agency to meet the costs to download any of the remaining standards.
58Does Healthdirect fit into the health information exchange?A consolidated national healthcare provider directory will look to index a variety of other existing directories including the National Health Services Directory operated by Healthdirect Australia.
59Outstanding vision and great first steps. Are you expecting all EMRs to share patient data via the HIE and how are you planning to deal with conflicting info?Any system (including an EMR) sharing information via the HIE will need to use the appropriate National Health Identifiers to unambiguously identify Patients, Providers, and Organisations.  The existence of conflicting records will be resolved systematically where clinical governance has confirmed it safe to do so.  Where conflicts cannot safely be resolved by the systems (based on agreed rules) human intervention will be required to confirm the overriding record and publish this for other HIE users.
60Regarding interoperability how will we achieve this when 60% of information is on paper? The Agency is working with healthcare providers to increase digital readiness ahead of the proposed mandate to upload health information to My Health Record. Pathology and Diagnostic Imaging reports are the first focus.
61Is there an update on the Security Conformance Profile? And what is the agency’s expected outcome of this?The Agency is aware of the cyber security risks posed to software systems used by healthcare organisations accessing the My Health Record system. An updated security conformance profile, intended to be published by Q4, 2024, aims to strengthen the cyber security posture of all systems connecting to national infrastructure. 
62What about the perennial tree problem of lack of interoperability between SMD providers? Is the intention that the HIE removes the requirement for SMD?The IGA currently funds a range of activities, including work on the future Health Information Exchange, as well as supporting interoperable secure messaging. The Agency has worked over a number of years to support the National Secure Messaging Network to develop technical standards for secure messaging interoperability, a conformance assessment scheme and an operating Deed to support these arrangements between vendors. 
63Your talked about data at call through the HIE, how do you stop this data being duplicated and we end up like the USA…The HIE patterns that enable data to be retained in their source location is the first step in avoiding duplication.  Holding data only centrally where appropriate also reduces risk of duplication.  In cases where data must be cached in locations to ensure availability, ensuring linage back to the source record as part of the discovery process will be key, working with the most up to date information available.
64You’ve mentioned a lot of use cases via ‘national infrastructure’. Is your view to remove point to point communication all together?Applying the centralised authentication and authorisation model will ensure all health information flowing across the health system can be consistently secured and audited. This also ensures that consumers are not excluded from opportunities to view and drive their own patient journey.
65Has there been any consideration of SDOH in this roadmap to achieve better health and wellbeing in community?The Agency’s role in stewarding the standards that underpin digital health provides the mandate to ensure all health information elements needed (including social determinants of health) to enable improved health outcomes.   Health information sharing through the HIE is not limited to interventional care provided in care settings, it will enable holistic information sharing that supports wellness models.
66Augmented clinical decision support seem far away given discussion today. Are there plans for an innovation and early adoption cadence? How we connect to this?The HIE microservices approach will complement information available in clinical systems with information available across the ecosystem. Clinical decision support (CDS) opportunities expand with increased availability of granular information.  HIE will support and enable CDS innovation in clinical and information systems.
67Why does MyHR need to save data in a FHIR format? I can understand the use of FHIR to send/receive info - but prevents sharing of social determinants The Agency is actively engaged with the community on the ongoing evolution of FHIR through Sparked. In the days following the Information Session, Sparked held a roundtable in Darwin which specifically looked at social determinants of health and other key data elements.
68Can a document replay be mandatory for Software Developers to develop for My Health Record, so end users have the ability to uploaded those documents when advised to do so.The Agency will use conformance templates that align with the applicable policy and legislation to ensure mandatory requirements are met.   Document replay is likely to be a key feature of future conformance templates.
69Is there a risk that The Directory will largely duplicate the National Health Services Directory? Why would Government continue to fund both?A consolidated national healthcare provider directory will look to index a variety of other existing directories, as opposed to replicating them. 

The new directory will consolidate information sources from a variety of other directories and present it to health services and providers in a consolidated view.
70What advantages will the provider ‘directory data’ give over & above other existing sources such as Healthdirect’s National Health Services Directory? 
71Is there any roadmap for international data to be brought into the national systems- cross border patient records that comply with FHIR?The Department of Health and Aged Care is leading the discovery work on the International Patient Summary.
72How does ADHA intend to provide patient summaries for any clinician or practitioner? Needing to read a patients history would appear to lengthen appointmentsProviding patient information in more granular/atomic detail enables the relevant data elements in patient summaries to be displayed in context with other patient information.  This is a shift away from the document-based paradigm.  It should be noted that clinicians will need to be able to easily confirm the sources of specific data elements to appropriately inform care and interventions.
73To help IT suppliers position themselves to supply services to the Digital Health POW, what IT/health standards/ technologies will be vital apart from HL7 FHIRThe specific nomenclature and terminology sets to be applied in the FHIR delivery structure will be vital. The Digital Health Standards Catalogue can be referenced for details around the applicable standards and will be updated as more specific guidance becomes available.
74How will you ensue that the consolidated provider directory information is kept up to date?This would involve a variety of approaches to support providers to keep information up to date, such as promoting and leveraging the existing Provider Connect Australia service where details can be updated once and then distributed to various directories.
75What IT Products and Technologies have the ADHA already selected as being foundational to the realisation of it vision moving forward.The Agency is taking an agnostic approach with regards to bespoke versus off the shelf solutions in progressing its transformative activities. The Agency is also working closely with the Digital Transformation Agency to ensure proposals are aligned strategically with the Australian Government’s digital and ICT objectives.
76Can you please elaborate the Authentication and authorisation framework - does that leverage the MyGov for consumers, NASH for providers? Information about the HIE authentication framework will be provided following the HIE Architecture and Roadmap socialisation phase.
77What does the onboarding look like to this new ecosystem? E.g. for someone who previously opted out of My Health Record. Does the system enable retrospective data ID?In the case of a consumer who has previously opted out of My Health Record choosing to register for My Health Record within the HIE enabled future state, the discovered information exchange pattern could identify information specifically linked to the consumer’s IHI if it exists in care settings and other sources. 
78Does HIE exchange patterns rely on HI framework for identity, or will it be supplemented by the federated identities used by other systems connects to HIEThe expected model is that the HIE patterns will use the centralised identity for authentication, with source systems connected to the HIE supporting both local and national authentication.  For providers this is where the link to the directory for proof of identity is important.  Variations on this expectation will be explored through consultation.
79Data sovereignty concerns across all repositories. What are your considerations, concerns and how will you be addressing this?The My Health Records Act 2012 currently requires all repository operators to store information on shore and to have central management and control in Australia.
80How does the agency ensure alignment with technology and architecture to drive clinical transformation? The national infrastructure components should be designed and built to specifications that will be subject to national digital health governance structures. Systems and information sources outside the national infrastructure will be subject to conformance profiles to ensure architecture and technology alignment that is in lock step with the applicable policies and legislation.
81Future AI initiatives require implementation of this strategy now against all data repositories. How are you assessing what AI outcomes are needed?The Department of Industry, Science and Resources is leading the whole of government review of legislation and regulatory frameworks to inform the safe use of AI. The Department of Health and Aged Care is reviewing legislation to clarify and strengthen existing regulation for artificial intelligence (AI) in Australia’s healthcare system. 
82What is the agency’s timeline for implementing the FHIR repo given the current complex legacy system? As per the Agency's Annual Procurement Plan published on AusTender, there is a planned procurement for the FHIR repository for early 2024-25.
83Can you touch on the transition plan from the current repository to a FHIR repository? 
84Amazing presentations, the blue book was mentioned, however anything new for the pregnancy relevant antenatal card.... becoming digital based? Under the Intergovernmental Agreement on National Digital Health, the focus of the Agency is to enable interoperability and connected data across Australia's health care settings. Priority projects funded through the IGA, such as the Health Information Exchange, are critical for building the infrastructure that is necessary for national solutions, including those digital health solutions supporting pregnancy, birth and early childhood. There are some activities with a specific focus on child digital health set out in the Strategy Delivery roadmap, which underpins the National Digital Health Strategy 2023-28 (initiatives 1.1.04 and 2.2.13 in particular). States and territories also continue to play a key role in the collection of important child health information, including through their ongoing work with 'baby books'. 
85Can you provide an example of the directed information exchange? I'm trying to understand who directs who & how you might ensure that direction is actioned? An example of directed information exchange is a pathology result being sent to the requesting provider.  In this case the ordering clinician does not require the patient's approval to receive the result.  The directed information exchange model should only be used in cases where consumer mediation is explicitly not required.
86Will the HIE write data back to other systems, e.g. between GP and EMR systems or between EMR systems? The HIE facilitates the exchange of information, with an ability to hold information either temporarily or persistently within national infrastructure repositories (as required and subject to applicable policy and legislation).  Practice management systems (PMSs) for GPs and electronic medical records (EMRs) in hospitals and other care settings can view in context the discovered information and where appropriate use this information to update the local records.
87When implementing new tech, is it right to assume preference is on existing solutions with minimal customisations, or is there an appetite for purpose built?The Agency is taking an agnostic approach to bespoke versus off the shelf solutions in progressing its transformative activities.
88Can the Agency realistically deliver better digital services while building technology capabilities from the ground up?The Agency will continue to define its optimal operating model across design and delivery capabilities including consideration for what’s procured and what is delivered inhouse as is currently the case for products and services such as My Health Record, EP and PCA etc. This will include further strengthening of the inhouse system integration capability and consideration of other inhouse capabilities over time. The optimal operating model will be focused on achieving the best outcomes for the health sector. 
89Are the consent patterns described dynamic? And is it the agency’s intention to define these in-line with patient outcome products? Will consent be a product? The existing My Health Record consent model provides the legislative framework for registered healthcare providers to upload information to the system and enables the consumer to apply access controls to any item or all the information in their My Health Record.
90Where do you see the existing secure messaging eco system sitting within the HIE? Will they be redundant? The National Secure Messaging Network (NSMN) project has delivered on its commitment to a set of standards that can be implemented, proposed deliverables on the National Health Information Exchange (HIE) Roadmap represent the next evolution of information sharing capabilities that can be supported with modernised infrastructure.

The project will close as plans for future infrastructure and progression of secure directed information sharing are progressed through the HIE program of work. Knowledge, artefacts, and lessons learnt from the NSMN journey will be used to inform and support the HIE.
91How can the Agency ensure that current legacy technology does not limit its capability to evolve?The modernisation of My Health Record and the HIE are being structured to gradually reduce the dependence on legacy methods of information sharing and storage. The Agency is working with the Australian FHIR Coordination Committee (AFCC) to progress implementation guides that enable transformation between legacy and new to enable more time for the transition to be implemented without hindering innovation.
92What is the timeline for the development and launch of the my health app?The my health app was launched in February 2023. More information can be found here
93What are the main critical path work that you need to execute in order to hit your ambitious timelines?The Agency has put in place strong governance and project management approaches to support this program of work, including detailed critical path and interdependency mapping and management.  At a broad level this can be seen in the Agency's Workplan which is updated and published annually and includes all activities that will be supported by the published annual procurement plan.  These activities are also updated annually in the Corporate Plan and reported on in the Annual Plan.