Funding for interoperability and the inclusion of the ADHA in the next agreement are two recommendations of the mid-term review.
The current National Health Reform Agreement “lacks adequate funding mechanisms to enable and incentivise digital care services” and the Australian Digital Health Agency must be explicitly referenced in any new agreement.
That’s according to the federal’ government’s Mid-Term Review of the National Health Reform Agreement Addendum 2020-2025.
“There is broad agreement on the value of having ready access to comprehensive patient health information at the point of care, with digital health viewed as integral to delivering patient centred care,” wrote the authors of the review, led by Rosemary Huxtable AO PSM.
“The health system is experiencing increasing expectations from patients and providers, with Australians displaying a higher desire to utilise digital health tools to access their personal health information.
“However, the current ability to draw together a ‘single view’ of a patient and their experience is hampered by the lack of system interoperability across the health system, and there is little within the NHRA to incentivise the health sector to commit to supporting digital health solutions.”
The ADHA had a clear role to play and “a clear purpose” said the review, but there was “a need for their role and focus to be reinforced in a future Agreement”, with the following priorities:
- Commitment to putting patients at the centre of healthcare, empowered with timely, accurate and comprehensive information necessary to participate in their own healthcare.
- Recognition of the role of digital health solutions in supporting patient-centred care and advancing the objectives of the NHRA – improving health outcomes, access and innovation.
- Acknowledgement and support for the National Digital Health Strategy and the IGA on National Digital Health, where they advance the objectives and outcomes of the NHRA.
- Commitment to strengthen public hospital support of Commonwealth and cross-jurisdictional digital health initiatives, including the use of My Health Record and Healthcare Identifiers.
- Commitment to implementing the Interoperability Plan to achieve a more interoperable Australian health system and support implementation of digitally enabled models of care.
“Incorporating ADHA into the NHRA could leverage its partnerships with jurisdictions to support the digital solutions that will help the Addendum achieve its objectives,” said the authors.
The current funding model of the NHRA did not adequately capture the costs of digital health technologies, Ms Huxtable and colleagues wrote.
“Healthcare data remains siloed, largely driven by the lack of connected digital infrastructure, with data processing in rural and remote services often highly manual and paper based,” they wrote.
“This is limiting the ability to view and track the full patient journey across the system, and between services, due to a lack of interoperability, the absence of cohesive standards for electronic health records, and low public trust in data collection and sharing.
“The inability to access and use accurate and timely data to inform clinical decisions impacts on outcomes and causes inefficiencies.”
While the government had been producing strategies, roadmaps and plans such as the National Digital Health Strategy, the Intergovernmental Agreement on National Digital Health, and the National Healthcare Interoperability Plan, none of the objectives or priorities of those documents were embedded in the NHRA.
“[This impedes] the development of incentives for the health sector to commit to supporting digital health solutions within hospitals and at transition points,” wrote the authors.
“The NHRA does not include information about digital health literacy which is a determinant of health and required for communities, patients and clinicians to understand why and how care can be digitally enhanced.”
As part of Recommendation 6 of the review, the authors said that while the architecture of the national bodies relevant to the NHRA should be retained, dedicated bodies such as the Australian Digital Health Agency, “should be referenced in the Agreement, with relevant purpose, strategies and outcomes incorporated”.
More specifically, Recommendation 40 of the review said the next NHRA should include “an explicit commitment to progress digital health as a key enabler to improving the health system, as an additional Schedule”.
That Schedule should reflect:
- Support and incentivisation for a digitally enabled healthcare system, including integrated funding for evolving models of care.
- The role of the ADHA in progressing digital health.
- The IGA on National Digital Health 2023-27 and Connecting Australian Healthcare – National Healthcare Interoperability Plan 2023-28.
- Agreed priorities, roles and responsibilities, and actions to progress digital health, data sharing and data linkage as a foundation to advance effective co-commissioning and optimal models of care.
“A future Agreement should incentivise the adoption of digital health solutions in supporting patient-centred care,” wrote Ms Huxtable and co-authors.
“It should also encourage appropriate data collection, curation and analysis of health data assets to make the health system more efficient and enhance equity and patient outcomes.”
