It doesn’t differ much from the draft plan but now there are 44 recommended actions, and one expert says, a vacuum of incentives for change.
The Australian Digital Health Agency has today released its National Healthcare Interoperability Plan with experts in the field saying it lacked incentives to drive change, leaving Australia lagging behind the world … again.
The Plan includes 10 principles, five priority areas and no less than 44 “implementation actions” to be addressed before “mature interoperability” can be achieved.
The goal, say the plan’s authors, is to “support safe, secure, efficient, quality care through a connected healthcare system that conveniently and seamlessly shares high-quality data with the right people at the right time”.
But the big problem, said digital health strategist Michelle O’Brien, was a lack of incentives to convince different health sectors to work together collaboratively.
“I can’t see anything in the report that will drive change,” Ms O’Brien, head of content and strategy at our sister publication Health Services Daily, told TMR.
“Where is the voice of the industry?”
The plan’s authors said it was “developed under the governance of a national steering committee”.
“It was informed by national consultations undertaken in 2019, and engagement with health departments and other key stakeholders in 2020 and 2021.
“The Agency will establish a stakeholder advisory group that reflects the diversity of stakeholders in the health system. Its roles and responsibilities will include providing advice on how the interoperability plan can best deliver benefits for interoperability in the health sector, and any stakeholder activities that may be interdependencies for the success of the plan.
“There will be opportunities for working groups of experts to be formed to address specific issues as they arise during the implementation of the plan.”
Ms O’Brien said the plan released today felt like the draft plan had been run through ChatGPT to update it.
“There is a lack of leadership here,” she said. “We can’t afford to have more stakeholder reviews and consultations.
“How long do we think the world is going to wait for us to catch up? This is the ship that is supposed to be guiding us to 2028, and for the most part the world is already at 2028.
“In the end the world will change us.”
Five priorities
Identity:
Australia already has a well-established health identifiers service which provides patients with an individual healthcare identifier (IHI), each provider with a healthcare provider identifier (HPI) and each provider organisation with a healthcare provider organisation identifier (HPI-O).
These identifiers allow for accurate identification and data-sharing, give control to individuals over access to their information, are handy for researchers, and help with auditing and traceability. They are currently used in the covid vaccine rollout, for accessing the My Health Record system, to deliver e-presciptions, and to improve funding models. The TGA is also looking into using them to track medical devices.
The National Healthcare Interoperability Plan lists 10 implementation actions needed in this priority area, with the three big-ticket items being:
- Jurisdictions adopt national healthcare identifiers in future digital health initiatives;
- Implement a roadmap of improvements to support wider use of healthcare identifiers; and,
- National Health Services Directory used as core national infrastructure.
Standards:
Australia currently has no centralised approach to using standards, which leads to a “proliferating number of standards, which inhibits information sharing and integration, and leads to a lack of interoperability”, say the plan’s authors.
Not all infrastructure is supported by conformance rules and assessments, either. “This leads to inconsistent implementations that can affect interoperability”, the plan says.
Fourteen implementation actions are recommended for this priority, with the three most important being:
- Strengthen the digital health standards environment with a standards catalogue, guiding principles and gap analysis;
- Develop and maintain strong partnerships with the standards community; and,
- Review current policy tools and assess what is required to accelerate interoperability.
Information sharing:
Information-sharing in the Australian healthcare system is notoriously poor. “This leads to repeated requests and procedures, and decisions made without access to all information,” says the plan.
The ADHA continues to highlight the My Health Record system as the answer to data-sharing into the future, saying:
“[The MHR system] represents a model that could enable future exchanges of information directly between organisations and through discoverability.”
It’s going to take 12 implementation actions to make it happen, however, with the ADHA particularly highlighting four key actions:
- Develop interoperability procurement guidelines for future clinical system procurements;
- Build an online toolkit to support interoperability projects;
- Promote the use of the API Gateway to support interoperable information exchange; and,
- Work with consumers to investigate options enabling individuals to grant consent to access their health information.
Innovation:
“Building a workforce that can confidently use digital health technologies to deliver healthcare is a strategic priority of the National Digital Health Strategy,” says the plan.
“The workforce required for standards development, system architecture and software development (APIs, HL7 FHIR®, and so on) needs to grow and have access to ongoing education and training. There is also a need for trained health managers and clinicians who can bridge the gaps between clinical care and digital technology.”
The Australasian Institute of Digital Health, in partnership with the ADHA, is developing a capability action plan to progress the National Digital Health Workforce and Education Roadmap, according to the plan’s authors.
“This includes developing a digital health capability framework and assessment framework for organisations to assess their workforce capability and readiness for change.”
Three implementation actions are listed in this priority area:
- Develop education content in partnership with users to increase awareness of interoperability;
- Run interoperability innovation challenges and connectathons; and,
- Implement the National Digital Health Workforce and Education Roadmap.
Benefits:
The plan outlines four broad benefits of a fully interoperable health system:
- Enhanced patient experience;
- Improved safety;
- Increased productivity and reduced costs; and,
- Improved data for health research and practice.
Three big actions are needed to make it happen:
- Undertake interoperability maturity surveys in hospital, pharmacy, GP, allied health, specialist and aged care settings;
- Produce an annual report on progress and key benefit metrics; and,
- Assess digital health maturity model options for use in Australia.
While 44 implementation actions suggest that there is a long way to go to achieve the goals of the plan, the authors also list achievements so far:
- The Healthcare Identifiers Service supports the unique and consistent identification of healthcare recipients, healthcare providers and healthcare provider organisations;
- The Australian Medicines Terminology (AMT) and the Australian extension of SNOMED CT (SNOMED CT-AU) provide standard vocabulary to record and exchange clinical information;
- The My Health Record system provides an online summary of an individual’s key health information;
- Electronic prescribing enables prescribers, individuals and pharmacists to use electronic prescriptions;
- The National Clinical Terminology Service (NCTS) contains localised HL7 FHIR® resources (Fast Healthcare Interoperability Resources) and SNOMED CT-AU (including the AMT), which is maintained and released monthly;
- The National Health Services Directory (NHSD) enables individuals and healthcare providers to access comprehensive, consolidated, accurate and up-to-date information;
- The National Authentication Service for Health (NASH) enables healthcare providers and supporting organisations to securely access, encrypt and share health information;
- Provider Digital Access (PRODA) allows individual healthcare providers and healthcare provider organisations to securely authenticate and access online provider services across all government sectors; and,
- The Metadata Online Registry (METEOR) is Australia’s repository for national metadata standards for health, housing and community services statistics and information.
For a full list, read the plan here.
