It is vital that digital technologies are rigorously tested and their benefits proven in real-world environments (i.e. “test beds”), prior to being scaled up to the whole of the Australian health system. Establishing test beds based on clinical priorities will allow evaluation and refinement of new and improved models of care based on digital health foundations and investigations into how to deliver such innovations nationally.
Developing a test bed framework will ensure that, where digital health is shown to be beneficial in Australia’s health context, learning will support scaling up and rolling out to other communities and regions. This will also ensure that only proven interventions with measured benefits are translated into usage in the Australian health system.
The test bed framework will guide how governments, industry, universities and healthcare providers can work together to trial and evaluate the use of digital health technology in regions, with the aim of expanding proven digital health solutions for scaling up to benefit all Australians.
The test bed framework will create the supportive policy, regulatory and governance framework to enable these models of care to be scalable and sustainable. Test beds will generally be cross-jurisdictional (spanning two or more state or territory health departments) and their development will involve primary health networks as coordinators of care. State and territory health departments to be included will be chosen through a commissioning process led by the Australian Digital Health Agency.
" Health does not lack innovation, the issue always is in scalability, and execution in a fragmented system."
- HCF submission
The choice of test bed projects will not simply be about utilising the latest digital technologies and care models, it will also support the harmonising and scaling of existing best-practice-based evidence about what works, and what can be integrated into existing clinical workflows.
Australia has the potential to be recognised as a unique location to test and trial digital health solutions for subsequent implementation not only nationally, but also internationally. A mature test bed model will attract international interest, with economic benefits to the Australian community.
There is a significant amount of work being undertaken across Australia by state and territory health departments on enhanced models of care, such as renal services information management in the Northern Territory  and a genomic service in the ACT. Queensland is also investing in new models of care.,  Telehealth also features strongly in the future planning of all state and territory health departments; for example, the Burns Telehealth Service at Princess Margaret Hospital in Western Australia11 and the delivery of a telehealth network of 180 video-conferencing units across all acute care facilities in South Australia.
It is envisaged that approximately six test beds will be developed over the period of the National Digital Health Strategy, with each having a formal evaluation, examining the degree to which target benefits have been achieved and lessons learnt from implementation and roll-out.
The clinical priority areas for the test beds will likely be centred on the following health priority reform areas:
Better management of chronic disease (including Health Care Homes) – Consultation feedback showed that health consumers with chronic conditions often experience a lack of coordination of their care. Almost four million Australians (16% of the population) see more than three different health professionals for the same condition. Of those, one in eight (13%) reported that there were issues caused by a lack of communication between their health professionals.
Hospitalisations from chronic diseases are a substantial burden on our healthcare system, , but digital health solutions now exist which could support better management of chronic conditions through new models of care. This test bed will support investigation of how chronic disease management and care coordination can be digitally enabled and scaled up across Australia in ways that maximise improvements to health outcomes, preventing complications from chronic disease and reducing admissions to hospital.
Case study: Gold Coast Primary Health Network (PHN) integrated care model
Commencing in March 2015, 14 general practices across the Gold Coast established a Coordination Centre that offers proactive shared care of high-risk patients with chronic illness. The initiative covers a population of approximately 140 000 active patients as part of the Gold Coast integrated care model. This care model is designed to improve services for local patients with chronic and complex conditions in collaboration with general practitioners, and aims to reduce presentations to the local health service’s emergency department and decrease planned and unplanned hospital admission rates.
Development of a holistic assessment process and systematic register has commenced, focusing initially on diabetes, respiratory, cardiac and renal conditions as well as frailty, end of life and residential aged care residents. Evaluation data are being collected on all interactions, to capture staff and patient experiences and perspectives on the new model of care, including satisfaction indicators.
" Digital health initiatives, such as the My Health Record, which enable patients to access their own health information, have the potential to help them monitor and manage chronic and complex health problems."
- Cancer Council Australia submission
Embedding telehealth into clinical consultations – Timely access to healthcare services is important to ensure early diagnosis and early interventions, which are associated with better health outcomes for the recipients of these services.,  There are many reasons why barriers to timely access exist, such as demand exceeding the number of services provided or the lack of access to a healthcare service in a rural or remote area.
The Northern Territory Government and the Australian Digital Health Agency are already working together to improve telehealth service delivery in remote Australia. The National Telehealth Connection Service will help improve access to health services to those patients needing it most. The aims of the National Telehealth Connection Service are to improve access to health services, better manage costs and optimise resources, and establish a telehealth scheduling system.
The telehealth test bed will focus on ensuring telehealth models are harmonised across Australia by undertaking a review of existing telehealth use, and addressing regulatory, policy and other barriers that have arisen, to inform a business case for the embedding of telehealth into clinical consultations. The use of telehealth solutions in rural and remote and Aboriginal and Torres Strait Islander communities will be a focus., 
Case study: CSIRO - Telehealth home monitoring of chronic diseases for aged care
A trial of home monitoring via telehealth for patients with chronic diseases in an aged care setting was conducted by the CSIRO over a 20-month period. Concluding in December 2014, the results provided a series of insights showing numerous benefits, including a 46% reduction in Medicare Benefits Schedule (MBS) expenditure and a 25% reduction in Pharmaceutical Benefits Scheme (PBS) expenditure.
The trial also showed a 53% reduction in the rate of admissions to hospital. Among those patients who were admitted, there was also a 75% reduction in the rate of length of stay, with a greater than 40% reduction in mortality.
Users and clinicians alike were strongly supported the system, with over 83% user acceptance and use of telemonitoring technology, and over 89% of clinicians saying that they would recommend telemonitoring services to other patients.
Case study: Northern Territory telehealth project
The provision of telehealth services to deliver outpatient appointments was assessed at three Northern Territory sites between 2014 and 2015: Alice Springs, Katherine and Tennant Creek.
The evaluation demonstrated that increasing telehealth use in these locations (more than seven-fold in Tennant Creek, four-fold in Alice Springs and a doubling in Katherine) led to reductions in travel, with patients in Tennant Creek more likely to use telehealth than to travel. The “Did Not Attend” (DNA) rate for appointments lowered significantly. The estimated cost savings for the project for participants was in the order of $1.189 million.
Surveys indicated high levels of support for telehealth from participating patients and a strong desire to use telehealth in the future. Clinicians had similar attitudes in their endorsement of telehealth, reporting an improvement in continuity of care for their patients, and that they would be likely to use telehealth in the future and recommend it to their colleagues.
" There is a long history of (rural and remote people) embracing alternative models and using available technologies to provide those services lacking in their communities."
- Rural Doctors Association of Australia submission
" Several years ago my Melbourne-based endocrinologist offered me the option of Skype appointments. He now mails me his pathology test request form beforehand (a copy goes to my GP) and I upload my insulin pump data prior to the appointment. The appointment progresses exactly as if I attended his rooms. The Skype appointment means I don’t have to spend at least 7 hours travelling, starting at 6.30am and not arriving home till 11pm. Travelling to face-to-face appointments leaves me stressed and tired, adversely affecting my blood glucose levels for the day. The Skype appointment makes me feel much better, with normal blood glucose levels, because there is no stressful travel."
- Consumer, Regional NSW
- Improving quality of health services in residential aged care – When aged care residents are treated by aged care and healthcare professionals, there is often an “information gap”, with a lack of sharing of the older person’s information about health conditions and medicines between the two sectors. It has been demonstrated that digital health interventions for aged care residents can dramatically reduce the number of transfers into hospital. The aged care test bed will explore how digital health technologies can improve outcomes for Australians in residential aged care facilities.
- Respecting patients’ end of life care preferences – Very few Australians currently have their end of life care wishes documented.,  When coupled with the lack of capability to share patient information, treating clinicians in hospitals are often unaware of the wishes of patients during end of life care, regardless of whether advance care directives are in place., 
The end of life care test bed will explore how improved care coordination during end of life care can be embedded into existing clinical workflows, and rolled out across Australia in ways which offer greater opportunities for individuals to have their wishes respected at the end of their lives.
Case Study - End of life care
A South Australian survey by Foreman et al. found that the majority of people with a terminal illness over the age of 15 would prefer to die at home. While there is limited published evidence evaluating eHealth interventions in palliative care in the Australian setting, there are international models of digitally enabled end of life care which appear to show remarkable success in enabling patients to die at home, and feel supported through their end of life care pathway.
Improving child health – Accessing and sharing information about their children's health is important for all parents. In 2017, the Australian Digital Health Agency partnered with eHealth NSW and the Sydney Children's Hospitals Network to establish the National Collaborative Network for Child Health Informatics (the Network). The Network is bringing together Australia's leading experts in children's health to identify national digital health projects that will have a positive impact on the health and social outcomes and experiences of children and their families.
This test bed will utilise the expertise of the Network to support child health in the most effective ways. One of the likely areas of effort is to address the fact that parents are often required to remember and repeat information about their child's health, including vaccinations. It has been demonstrated that access to an electronic health record for children improves vaccination rates, and that consumers would like better access to their children’s health records even when they move across state borders.,  Such access will also offer better support for children undergoing regular health treatments.
The children’s health test bed will examine how every child in Australia can have access to a comprehensive digital health record, readily accessible by parents and healthcare providers, to track key childhood healthcare interventions (e.g. immunisations) and ensure that healthcare providers are able to offer safe, high-quality care. A number of sectors will need to collaborate to investigate how to harmonise state and territory systems into a national child health record that can be easily adopted.
- Improving emergency care – The My Health Record system can potentially support healthcare providers in emergency department settings by providing efficient access to a patient’s medical history., [142 This test bed will examine how healthcare information can be shared across healthcare practitioners in real time, to better support management of healthcare emergencies, and will be undertaken in partnership with the Australian Commission for Safety and Quality in Health Care.
Case study - Collection of genomics data in the UK
The UK has established a national architecture to enable consistent collection of genomics data, and matching of this information with longitudinal healthcare and mortality data within cancer registries, hospitals and primary care clinics. This is enabling a myriad of clinical and industry research projects and collaborations, with over 39 research themes being worked on, from lung cancer to population genomics.
" Enabling Australia-wide access to high-quality genome sequencing is a foundational requirement for enabling precision medicine... Development and co-development (with our partners) of new capabilities that allow health consumers and payers to experience the benefits of precision medicine, including (but not limited to) more accurate (safe) and cost effective diagnosis and treatment (right therapeutic, right time, right place)."
- Garvan Institute of Medical Research submission
Advance Care Planning
The Australian Government and the states and territories recognise that promoting the autonomy and dignity of an individual is an important part of providing high-quality, patient-centred care. Advance care planning enables individuals to make plans for their future care, and encourages them to reflect on how they want to be cared for if they reach a point where they cannot communicate decisions about medical care for themselves.
The national objectives for advance care directives (ACDs) include ensuring that clinical care and treatment plans written by healthcare providers are consistent with a patient’s expressed values and preferred outcomes of care as recorded in their ACD, and that they be readily recognised and acted upon with confidence by health and aged care providers.
The National Digital Health Strategy contributes to these objectives by prioritising the end of life care test bed. The test bed will explore how the My Health Record system can improve consumers’ ability to seamlessly upload advance care planning documents, and help facilitate national harmonisation of formats and terminology. The Agency will collaborate with experts on how ACDs can be better incorporated into the My Health Record, to ensure that they become more accessible to treating health professionals, and encourage greater numbers of Australians to take control of their future life and care choices.
How will Australia benefit?
- Chronic disease management (Health Care Homes) will deliver reduced MBS, PBS and hospital expenditure due to reduced complications and hospital admissions.
- Telehealth will lead to a reduction in hospitalisations, reduced patient transport costs, and shorter waiting lists.
- Residential aged care will have fewer adverse drug events.
- End of life care will lead to reduced avoidable hospitalisations and shorter stays in hospitals.
- Child health records will lead to improved vaccination rates.
- Emergency care will provide improved quality and handover.
Framework for Action - How Australia will deliver the benefits of digitally enabled health and care
Digital Health Test Beds program - Improving patient healthcare through digital trials
Critical Success Factors of Australia's National Digital Health Strategy