Many patients’ and carers’ experience of modern day healthcare involves interacting with numerous different healthcare providers.,  The ability of healthcare providers to easily, reliably and securely exchange health information – both directly with one another and with their patients – is a key enabler of coordination of care and integration of care.[39-42] It is also a key driver of health service efficiency, [43-46], as well as patient engagement and satisfaction.[47-49] An economic analysis, undertaken as part of the development of this strategy, has estimated that the gross economic benefit of secure messaging could be around $2 billion over 4 years and more than $9 billion over 10 years.
In Australia, there is established use of secure messaging using a range of different electronic communication methods; for example, diagnostic requesting and reporting, and sending discharge summaries from hospitals to general practice. However, these different methods are generally not compatible – meaning that these proprietary secure messaging approaches do not work with each other. Despite significant effort, there is no nationally consistent, standards-based approach to secure messaging, which limits the ability of healthcare providers to communicate effectively.
The inability of healthcare providers to share health information easily and safely can lead to communication breakdowns, which contribute to poor health outcomes, duplication and inefficiency., [51-53] As a result, patients often have disjointed healthcare experiences, and feel that they need to repeat information all too often.
Enabling secure messaging was identified as a high priority for action throughout the “Your health. Your say” consultation. Communication issues were frequently raised by healthcare providers, who reported being unable to effectively and securely communicate with each other across organisational boundaries. Instead, they continue to use less secure methods such as fax, instant messaging apps and email to communicate and exchange information with their colleagues.
" Today, most providers that a rural generalist wants to communicate with do not have a secure messaging service."
- Australian College of Rural & Remote Medicine submission
" [There is] no common standard for secure messaging between providers – we are like 19th century colonies each with their own rail gauge."
- Health service IT manager
There have been widespread calls from peak professional bodies and health services for immediate action to create a standardised, universally accepted, secure messaging capability.
" Secure messaging, supported by fully functional provider registries, should be readily available to all doctors."
- Australian Medical Association submission
" One of the most pressing priorities is to improve interoperability, integration and secure messaging capability of the various systems (with appropriate privacy parameters) of public and private organisations to share data, which is critical for providing coordinated and connected patient care."
- Queensland Government, eHealth Queensland submission
" One of the key factors in enabling professionals to effectively connect, communicate and coordinate with the right people will be establishing interoperability of secure messaging."
- Australian Association of Practice Management submission
A key challenge to achieving a national, standardised approach to secure messaging is the existence of multiple health service directories and the lack of confidence in completeness and currency of data in these directories and addressing services. Other challenges that need to be addressed are:
- Sectors with low levels of participation – particularly allied health and specialists.
- Establishing confidence in the reliability of secure messaging through appropriate use of notifications to confirm documents are sent and received at the correct destination.
- Lingering challenges in the use of existing national foundations highlighted throughout the consultation, including registration, renewal of PKI certificates, identifier match rates and poor usability.
- Lack of a standardised approach to secure messaging hampering implementation of eReferral capability.
- Empowering healthcare providers to securely communicate directly with patients within an appropriate clinical policy framework.
International and local evidence supports a nationally led, standards-based approach to secure messaging. Countries including the UK , , USA, New Zealand , Canada , and Denmark  are investing in national foundations and standards to enable secure messaging and other usage patterns50, and realising the benefits of improved coordination of care, efficiency gains, increased patient engagement, and better health outcomes. 
" National leadership is required to set out the parameters for secure communication (e.g. Secure Message Delivery). The current 'hands-off' approach is not working, as the software vendors are unwilling to invest in product development in absence of set criteria. While software vendors have attempted to develop their own proprietary 'interoperable' SMD with other providers, the development of such interoperable platforms is patchy as each vendor is rightly protective of intellectual property rights for their own products and systems. Health professionals and consumers will not be able to benefit from the national eHealth record system unless this fundamental issue is resolved as a matter of urgency."
- The Australian Psychological Society submission
National foundations established to enable secure messaging will leverage collaborative work already underway by industry consortiums, and complement investments being made by states and territories in secure messaging, , discharge summary capabilities11 and eReferral and booking capabilities.,  National foundations will also be able to be utilised for a range of potential future uses, including enabling new models of care, more easily sharing different types of information, and making it easier to introduce vendor solutions (such as secure instant messaging) into health services. Consumer needs for transparency, convenience and informed choice will also be addressed.
Case study - Western Victoria Primary Health Network (PHN) secure messaging
Western Victoria Primary Health Network reports that in the Barwon region, clinicians sending secure messages via systems like ReferralNet and Argus are securely sending an average of 16 000 messages per month, saving time, money and effort. The number of messages sent each month continues to grow as clinicians incorporate this function into their daily work routine.
" E-mental health offers one of the greatest invest-to-save opportunities for government and the community in mental health. E-mental health is clinically effective and huge cost savings can be gained by integrating it into a fully functional mental health system of stepped care."
- National Mental Health Commission submission
Online mental health services – either as an alternative, or as an adjunct, to face-to-face mental healthcare – have in recent years become popular and effective services for the treatment of disorders such as anxiety and depression.. The Australian Government’s Fifth National Mental Health Plan, which is currently under development, recognises the maturation of data sharing and information and communications technology platforms such as My Health Record, and the potential that these digital services may have over the life of the plan to further support tailored individual care for people with severe and complex mental illness. 
The National Digital Health Strategy will contribute to maximising opportunities to prevent and reduce the impact of mental health issues and mental illness by prioritising secure messaging, which will support general practitioner and psychologist interactions. Increasing access to mobile health apps and online content will support healthcare consumers with tools to help manage their own health, and also give confidence to healthcare practitioners that they are recommending safe and evidence-based digital tools to their patients.
How will Australia benefit?
- There will be more appropriate servicing and better coordination of care.
- There will be improved healthcare availability and patient experience through online consultations.
- There will be reductions in administration and processing time.
- There will be savings from reduced costs.
Framework for Action - How Australia will deliver the benefits of digitally enabled health and care
Critical Success Factors of Australia's National Digital Health Strategy