The Digitalization of the Australian Healthcare system
This post summarizes the implementation of Electronic Medical Reports across Australia’s Healthcare system and the role played by the Australian Digital Health Agency.
The Australian Digital Health Agency (ADHA) is tasked by Australian Federal and State governments to lead the development and implementation of the National Digital Health Strategy. The Strategy focuses on four core themes; increasing access to useful medical information, creating a secure and trusted information network, supporting interoperability of data across the supply chain and fostering innovation .
Like many developed economies Australia is facing the challenge of reigning unsustainable growth in healthcare costs. In 2016 healthcare spending accounted for 9.6% of Australia’s GDP, having outgrown GDP by an average of 2-3 percentage points since 2000 . In response to growing cost pressures many organizations, both public and private, have leveraged digital innovations to reduce cost, save time and increase the quality of outcomes for patients.
The challenge which arises from increased digitalization of Australian Healthcare is one of co-ordination. If uncoordinated, such technology investments risk further dividing the industry and increasing transaction costs along the supply chain rather than reducing them. Failure to integrate data may further fragment the industry resulting in unnecessary duplication and errors. Furthermore, in an effort to extract competitive advantage, companies are incentivized to further silo their data, increasing switching costs for consumers and deepening silos between businesses .
Short term focus: Improving access to relevant patient data through My Health Records
In 2011-2012 the ADHA defined the technical vendor specifications for the Australian electronic medical record (EMR) system, My Health Records. This digital solution allows authorized healthcare providers to access patient information more effectively. 22% of Australians have a My Health Record .
Today the ADHA is responsible for ensuring every Australian has a My Health Record by the end of 2018. To do this the ADHA is actively educating patients and providers of the benefits and uses of EMRs. Furthermore, the ADHA established a Technical Working Group of industry stakeholders to develop a simplified and universal Secure Message Delivery (SMD) Program to enable organizations to securely share patient information. Coupled with standardize clinical terminology, these technologies improve data access and interoperability, providing authorized healthcare providers with the right information at the right time .
Providing secure access to patient data will enable more sophisticated healthcare data analytics. Technologies such as big data, artificial intelligence and machine learning will improve care coordination and reduce costs. Potential applications of these technologies include more personalized care, predictive diagnostics and improved chronic disease management .
Medium term focus: Laying the foundations for digital health innovation by 2022
To support sustained digital innovation the ADHA will roll out 6 “test bed” projects by 2022 which will be designed to rigorously test and validate the benefits of new digital technologies. These test beds are expected to focus on clinical priorities such as chronic diseases management, telehealth, aged care services, end of life care, childhood health and emergency care . Testing digital innovations in in a real-world environment will allow the ADHA to assess and refine each initiative before scaling nationally. This will support policy reform and validate alternative, sustainable and scalable models of care.
Further opportunities: The role of public-private partnerships in implementation
The greatest challenge facing the ADHA is that of implementation. The ADHA needs to work closely with the largest healthcare organizations to implement priority digital solutions. While it will be difficult to transition them across to digital, the early adoption by high volume hospitals for example, is critical to achieving scale and accelerating innovation. Third party vendors are less incentivized to build on top of the My Health Record system until sufficient scale is achieved.
Furthermore, many organizations have begun to independently invest in their own digital solutions. To minimize friction and increase participation, it is important that the ADHA works closely with these organizations. Cooperation will also facilitate learning and sharing of best practice from those organizations who have already invested in change. For example; Australia’s largest private hospital network, Ramsay Health Care, has deployed data standards for identifying, capturing and sharing information with suppliers, enabling them to save time and money through their procurement processes . Ramsay can play a critical role in informing industry standards as well as sharing best practice applications for delivering value.
Strong public-private partnerships will be critical. In 2016 the Parkville EMR project received $5M in funding from the state government to scope the needs of 3 major hospitals to introduce EMRs. A year later the project failed to secure funding for implementation and subsequently postponed indefinitely . Without funding support, large public hospital – the main providers of care to the majority of the population – will struggle to integrate digital solutions.
Questions for consideration
Is an EMR system a public good?
Should the public sector be leading digital innovation?
How can the ADHA mitigate implementation risk?
(Word count: 793)
 Australian Digital Health Agency (2017). Safe, seamless and secure: evolving health and care to meet the needs of modern Australia. Australian Digital Health Agency. Available at: https://www.digitalhealth.gov.au/australias-national-digital-health-strategy#1-strat-priorities [Accessed 12 Nov. 2017]
 Stats.oecd.org. (2017). Health expenditure and financing. [online] Available at: http://stats.oecd.org/Index.aspx?DataSetCode=SHA [Accessed 12 Nov. 2017].
 Brailer, D. J. (2005). Interoperability: The key to the future health care system. Health Affairs, 24, W5-19-W5-21. Available at http://search.proquest.com.ezp-prod1.hul.harvard.edu/docview/204638804?accountid=11311 [Accessed 13 Nov. 2017]
 Australian Digital Health Agency. My Health Record Latest Statistics: Commonwealth of Australia; 2017 [Available from: https://myhealthrecord.gov.au/internet/mhr/publishing.nsf/Content/news-002]
 Pearl, R. (2017). How An Electronic Health Record Can Save Time, Money And Lives. Forbes. [online] Available at: https://www.forbes.com/sites/robertpearl/2016/12/01/how-an-electronic-health-record-can-save-time-money-and-lives/#14f1102a2347 [Accessed 13 Nov. 2017].
 World Economic Forum in collaboration with Accenture (2016). Digital Transformation of Industries: Healthcare. World Economic Forum White Paper. [online] World Economic Forum. Available at: http://reports.weforum.org/digital-transformation/wp-content/blogs.dir/94/mp/files/pages/files/wef-dti-healthcarewhitepaper-final-january-2016.pdf [Accessed 14 Nov. 2017].
 GS1 (2017). Stories of successful implementations of GS1 standards. GS1 Healthcare Reference Book 2016-2017. [online] GS1, pp.48-50. Available at: https://www.gs1.org/sites/default/files/docs/healthcare/gs1_rb2016_web.pdf [Accessed 12 Nov. 2017].
 McDonald, K. (2017). Back to the drawing board for Parkville precinct EMR. PulseIT Magazine [online] Available from: https://www.pulseitmagazine.com.au/news/australian-ehealth/3731-back-to-the-drawing-board-for-parkville-precinct-emr [Accessed 13 Nov. 2017].
Student comments on The Digitalization of the Australian Healthcare system
I think it’s fantastic that Australia has implemented a standard patient record as a starting point for centralizing patient health record information. My background is in EHR implementation and integration, so not surprisingly I have some thoughts on what Australia can do to avoid the siloed data issues that we currently face in the US. One of the biggest challenges that providers will face is in selecting an EHR. The biggest EHR vendors, such as Epic, Cerner, and AllScripts, pretty much all operate on outdated technology that is often highly customized for specific clients and therefore makes standardized integration between systems difficult.
It’s hard to develop a standardized data transfer methodology when every system has a different field that they’re trying to pull that information from, which is in turn stored in a different format and therefore requires customization in the receiving system to transform that data into a usable format for that system. I’m sure what I wrote sounds complicated and confusing, and that’s because it is. The ideal outcome would be for Australia to pick one cloud-based EHR that all providers are required to use, but that seems unlikely, and frankly there is no one EHR that currently exists that would meet the needs of all specialties. It is important to note that My Health Record, from what I can tell, is not an EHR (a system used by providers in their daily workflows to update patient information and record patient visit outcomes) but rather an online health database that both patients and providers can access and update.
The AHDA can mitigate implementation risk by working with providers within different specialties to make the fields within the EHRs as standardized as possible to normalize the data between these systems to the greatest extent possible. The AHDA could also make a rule that providers have to be able to transfer information from their EHR to the “My Health Record” database in a particular format that then updates that record with the most up-to-date information. If the “My Health Record” can act as a source of truth for patient information, then any updates could also be transmitted to other providers who have access to that patient’s record.
Thanks for this wonderful article, Mazen. Very informative.
It is heartening to know that the Australian government is making a concerted effort to digitize healthcare data. I will be curious to know how they handle patient data ownership as the implementation goes on. As Francie touched on it briefly, one of the main impediments in US right now is that the HCPs own this data, and this limits its interoperability.
Secondly, I feel that in such cases it helps to have a broad idea of what kind of applications they would like to support, and then build the data architecture around it. This reduces implementation risk, saves a lot of rework at a later stage, and creates incentives for hospitals to invest into applications rather than the data pool itself.