In the end, as long as an HIE is ‘easy, safe and useful’ its success shouldn’t rely on needing to upskill clinicians and other healthcare workers, says the boss of the AIDH.
Australia’s healthcare workforce’s digital maturity is “inadequate” and “uneven”, with primary care clinicians filling the tail-end of the Bell curve, but that should not stop the successful rollout of a national healthcare information exchange.
Anja Nikolic, the CEO of the Australian Institute of Digital Health, was speaking at TMR’s webinar on the future of the HIE yesterday.
When asked if the healthcare workforce was ready to embrace and optimise an HIE, Ms Nikolic said it was textured problem.
“If I look at the overall digital capability of the health care workforce in Australia, it’s inadequate at the moment,” she said.
“The more nuanced answer to that question is that it is actually really uneven.
“We have really deep expertise in tertiary care, digital health capability, health informatics capability. It can be quite broad and deep, but the bell curve of adoption and the bell curve of capability is really broad and drawn out.
“There are lots of clinicians that are at that tail end or well below average, or well below where we want them to be in terms of digital capability. We don’t talk enough about digital capability in primary care and aged care.”
Nevertheless, she said the success of the HIE should not depend on a “rapid uplift in capability”.
“It should not depend on a major change of process within a clinic or within a clinician’s daily life, and its success really will hinge on the acceptance by technologists, vendors, lawmakers, on a few gospel truths,” said Ms Nikolic.
“Unless it’s easy, unless it’s safe, and unless it’s useful, it’s simply not going to get the traction that we’re looking for.”
Unpacking that further, Ms Nikolic said clinicians wanted to know if the data would be secure and subject to good governance, if the records would be complete and tell them everything they needed to know, and if it would be user-friendly.
“Is it going to be intuitive? Is it going to slot into the current workflows that I have, or will I have to engineer a whole new process? Will I have to take time out of my busy day to accommodate this new thing?
“If the answer is yes, you will, and yes, you’ll have to invest significant amounts of time in your own education and in reconfiguring your workflows, then I think we’re really doing it the wrong way,” she said.
Ms Nikolic also underscored the possible role of the Australian Health Practitioner Regulation Agency in improving digital capability in the health workforce.
“There is an agency we don’t talk about often enough in that context, and it’s AHPRA and its role in formalising the need for capability in digital health across all of the different health boards in more substantive ways than exist at the moment,” she said.
A national healthcare information exchange will bridge gaps in real-time data access and record sharing that were beyond the capacity of My Health Record to fill, according to DoHAC’s first assistant secretary Daniel McCabe.
Mr McCabe said the ability to access data at its original location through the HIE, as opposed to moving it to a single, centralised source as done with the MHR platform, meant the exchange would have the capacity to facilitate interoperable data sharing in ways that were not possible with MHR.
“We’re not proposing to build a monolithic solution, [and] the HIE is not simply going to be a technology solution. It is a set of capabilities that will evolve over time,” Mr McCabe said.
“My Health Record was only ever designed to hold key summary information, and we’re working with government to look at mandating the sharing of those pieces of information.
“But when we start to look at the gaps in our health system, this is where we are starting to talk about the notion of a health information exchange.
“We’re looking at [identifying] what are the services that we need put in place to deal with [these] gaps, whether that be a central index where all health providers’ health information is accessible, the ability to enable better exchange of data in real time or near real time between providers and consumers, no matter where the data is captured, and providing much richer access to data than is ever going to be practical in My Health Record because the data will be accessed where it’s created.”
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According to Paul Wilder, executive director of CommonWell Health Alliance (US), establishing a “hybrid model” with a centralised source (MHR) working in concert with an infrastructure facilitating real-time access to data in its original location would put Australia ahead of the United States.
“We’ve actually gone a bit backwards on that [in the US],” Mr Wilder said.
“I’ll be curious to see if [Australia] leapfrog a bit and start out hybrid.”
Mr Wilder also highlighted the advantages of facilitating record location-based access from a cybersecurity perspective given the vulnerabilities posed by storing healthcare data in one, consolidated source.
“[Not] having the data all in one central point also creates trust, and there’s no country or healthcare system out there right now that isn’t aware of the problems of too much data available at one point for any sort of cybersecurity event,” he said.
