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Australia's National Digital Health Strategy

Prepared for ANZ by Barbara Carney, Carney Advisory

November 2017

On 4 August 2017, all Australian Health Ministers – Commonwealth, State and Territory – approved a five-year digital health strategy for Australia. Entitled Safe, seamless and secure; evolving health and care to meet the needs of modern Australia, the strategy document sets out the key outcomes that the strategy aims to achieve over the years to 2022.

These key outcomes are:

  • An electronic health record for every Australian by 31 January 2019, except for those who choose not to have one (currently 5 million people have a My Health Record);
  • Secure electronic communication amongst all health care providers;
  • Interoperability (i.e. uniform data exchange and transfer) and standardisation of clinical data;
  • Real time data exchange;
  • A fully digitalised prescribing and dispensing system for medications;
  • The use of digital technology to improve both patient access and safety and quality of services;
  • Upskilling of clinical and administrative staff; and
  • A suite of nationally accredited health apps.

The strategy was developed by the Australian Digital Health Agency (ADHA). Set up with the agreement of all Health Minsters and headquartered in Sydney, the ADHA is responsible for the delivery of the strategy. ADHA consulted widely on the strategy with medical and allied health professionals, patient groups and carers.

The Digital Health Cyber Security Centre has also been established to support secure operation of national health systems, and protection for personal health information that is stored and transacted through the ADHA.

Despite these negative factors, there has been significant investment in information systems, technology and data analytics by State governments, private hospitals, medical practices, and aged care and community care providers over the past twenty or so years.

With the rise of digital technology and applications, the market for innovative health products has developed rapidly. However, many of these applications are not compatible with larger health information systems. The current landscape looks like Australia’s former railway system, with a different gauge in use in different States.


Key drivers of the move to a national digital health system

Australia’s health system is highly fragmented. Its funding and governance models are complex. Consistent and timely communication between primary care providers, hospitals, diagnostic services and allied health providers is often very difficult, or does not occur. Patients with complex or chronic conditions and their families often find it very confusing to navigate the system.

The national strategy is aimed at overcoming this lack of co-ordination and preventing further fragmentation. Its key drivers can be summarised as:

  • Cost – the Commonwealth Government’s spending per person on health is projected to rise from $2,800 per person in real terms in 2014-15 to around $3,400 per person in 2024-25 under current policy settings; some projections see State Governments, that fund the majority share of public hospitals, using up to 50% of their budgets on health by around 2030 (Source: Department of the Treasury, Intergenerational Report 2015, published March 2015);
  • Efficiency – the health system currently uses a vast quantity of resources creating and re-creating patient records in different sectors and these records are often incomplete; and
  • Safety and Quality (and cost) – for example, a 2016 study approved by the Australian Commission on Safety and Quality in Healthcare found that between 2 and 3% of all hospital admissions were medication related, and an error rate of around 9% of medication administrations in hospital. At discharge, errors in medication documentation in discharge summaries may occur at a rate of up to two errors per patient. The estimated annual cost of medication errors — many of which happen because all of a patient’s medications are not known, so adverse reactions occur — is $1.2 billion (Source: Roughead, EE et al., Journal of Evidenced Based Health, 4, 2016).

The strategy document does not refer to the cost of implementation. Governments have spent, and will spend, significant funds on digital health. Private providers, particularly doctors and hospitals, have unanswered questions about whether any incentives or support will be provided during the move to interoperability of the system.

The other stand out issues are continuing concerns about both the privacy and accuracy of the health record. Many consumers are not convinced that their information will be safe, reinforced when Medicare card numbers appeared for sale on the so-called “dark web” in July of this year.

Clinicians have expressed disquiet at the fact that, because patients can alter their own health record data, information may become incomplete or inaccurate. As patients do not use agreed terminology or language, a further risk of inconsistency arises.

Overall, the response from peak provider and consumer groups to the National Digital Health Strategy has been positive, with a distinct tone that Australia needs to get on with the digital health agenda without further delay.

Key implementation issues

The most important of these is the current lack of an overarching standard to govern the exchange and sharing of data.The strategy document states that there will be a public consultation on base-level requirements for using digital technology, to determine an agreed roadmap for implementing interoperability by the end of 2018. However, it will not be until 2022 that interoperability will be rolled out in the first regions of Australia (not yet defined).This timeframe means that providers and services face a period of uncertainty in making IT investment decisions.

This information has been prepared for ANZ Health by an independent consultant. Any opinions expressed therein are those of the author, not ANZ Health.

The information in this article is provided for information purposes only, it is general in nature, does not take into account the objectives, financial situation or needs of any person and is subject to the ANZ General Disclaimer which is available on the ANZ website.

Item No. 95396 11.2017 W584971

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