The majority of Australians are digitally connected, and make everyday use of digital services across a range of industries including travel, banking, education and government services. The amount of data being downloaded from the internet has doubled in the last two years. Almost 80% of Australians have a smartphone, which (as of 2015) they collectively glance at 440 million times a day.
Figure 1- Key statistics about digital connectivity in Australia
In terms of digital technology and health, most (77%) Australians would like their doctor to suggest health information websites and 73% have already used the internet to research a health issue. However, only a small proportion of the population (6%) manage to find an online health source that they trust. Of all Australian Google searches, one in 20 are health related. Interestingly, the majority of older Australians (69% of those aged 65 and over) have used the internet to look up health information. Taken together, this data demonstrates that most Australians are using digital technology as part of their daily life.
National achievements in digital health
Australia has made steady inroads in implementing digital health solutions. My Health Record has continued to grow in its capability, usability and integration with clinical information systems across the health sector. Almost five million Australians now have a record (20% of the population) and, with opt-out participation arrangements due to be implemented from 2018, an estimated 98% of the population will then have a My Health Record. In 2018, Australia will have the highest participation rate in a national health record system in the world. For the first time, members of healthcare teams will have ready access to key health information for their patients.
Consumers are already accessing their health information from My Health Record through mobile apps. A number of app developers are providing innovative mobile digital health solutions that address the challenges faced by health consumers and healthcare providers. The imminent rapid growth in the number of users of My Health Record will provide an opportunity to transform healthcare, allowing better integration of health information, better quality healthcare and financial savings to the health system.
My Health Record is being leveraged to support trials of new models of care for people living with chronic conditions. For these people, our health system can seem disjointed and hard to navigate. Different health professionals and services work in isolation from each other, care is often uncoordinated, and patients can find it difficult to get to different services and appointments. The Australian Government’s Health Care Homes trial will involve patients with chronic and complex conditions being supported by a care team which can be more innovative in the way it provides coordinated care.
Many other initiatives complementing the My Health Record have recently been launched or are under development. Another national digital service, My Aged Care, provides an online portal for consumers and carers to access information on aged care and to find information on aged care services. In addition, the Australian Government is finalising the development of a mental health portal which will provide support in finding and access to quality endorsed mental health apps and mental health services. The Australian Government is also building a National Cancer Screening Register that will create a single view for Australians participating in cervical and bowel cancer screening. It will integrate with GP clinical information systems and assist GPs to identify a patient’s screening eligibility and history to support real-time clinical decision making. Health professionals, including pathology providers, will have improved access to their patients’ information.
Over time, digital health can support policy changes and may be the key to commissioning good public health policy. Digital health can improve access to healthcare through telehealth and online consultations and can support health reforms such as Health Care Homes, mental health and integration of care.
Recognising that healthcare information is some of the most private information, and that digital health innovation is reliant on secure digital operations, the Australian Digital Health Agency has established the Digital Health Cyber Security Centre. Its primary purpose is to protect the national digital health systems and personal health information of Australians from the cyber threat, and to raise the security posture of the Australian health sector. The Centre partners with national and international cyber security organisations, across government and the private sector, to improve knowledge of the cyber threat and leverage shared expertise and material across organisations. It will support the security of Australian healthcare information by sharing best practice guides and mitigation strategies to improve information security and risk management right across the Australian health system.
State and territory achievements in digital health
State and territory health departments have begun to see significant improvements to health outcomes through their investments in digital health. In Queensland, all public hospitals and health services are now connected to the My Health Record system. Queensland is the first of the states and territories to do this.
The widespread implementation of electronic medical records throughout the public hospital system, secure messaging , , discharge summary capabilities and eReferral and booking capabilities ,  are all being implemented within states and territories. The Victorian eReferral Program, for example, has enabled secure messaging and exchange of clinical information, timelines and roles and responsibilities among health professionals. This initiative has been implemented in four Victorian health services to develop a foundation eReferral technical architecture for sector-wide use.
State and territory health departments are also facilitating and capitalising on interoperability through programs of work to update clinical information systems, , [13-15] and data governance and management, , and through better utilisation of clinical data., ,  For example, NSW has established a targeted activity and reporting system called “STARS” that makes health data more readily available to health services and professionals. NSW Health reports that STARS has been successfully used to identify clinical variation and emergency department utilisation, as well as to measure and compare quality and safety indicators and examine workforce utilisation.
In addition, medicines management – including medicines safety, real-time prescription monitoring and a single enterprise-wide drug catalogue – has been identified as a key priority area for investment by the states and territories. Western Australia and Tasmania have made significant progress in this area. Tasmania has real-time reporting and recording of controlled drugs and the Fiona Stanley Hospital in Western Australia has instituted the Automated Pharmacy initiative which is promoting safe, quality and cost-effective evidence-based use of medicines.
State and territory health departments are also leading the way in making better use of technology to address long-standing issues that have faced patients. The Northern Territory, for example, has focused on the needs of its remote population through provision of telehealth services. This digital health solution has increased attendance at appointments and has seen a greater uptake of the technology by doctors. The “Did Not Attend” rate for appointments has lowered significantly and there have been concomitant savings in the dramatic lowering of accommodation and travelling expenses because patients are able to remain in their community for treatment. In South Australia, all acute care facilities have been connected using telehealth, to foster collegiate decision making for patients with complex health problems and encourage knowledge sharing.
Recognising the health and economic potential of personalised medicine, the ACT has established a genomic service for researching, developing and delivering new and innovative techniques to improve care for patients.
The National Digital Health Strategy recognises the investment in these areas and considers how this digital system should interoperate, and how best to share from lessons learnt, to provide a more seamless service experience for healthcare providers and for consumers.
Non-government and local digital health achievements
The non-government sector has established a track record for local innovations in digital health, and is reaching into people’s homes and communities to provide care for patients close to their homes. A mobile health pilot program in Canberra for type 2 diabetes helped motivate patients to record their health metrics using mobile devices, and found significant increases in patients’ confidence in managing their chronic illness. Similarly, a CSIRO trial screened more than 1200 people in their communities for diseases such as diabetic retinopathy. Images were digitised to be reviewed by ophthalmologists in Brisbane and Perth, providing specialist services to those who would not otherwise have access to them.
In the acute sector, St Vincent’s Health Australia (private and public) now operates an electronic clinical information system that spans from pre-admission to post-discharge, including pathology and radiology, results viewing, multi-disciplinary progress notes and specialist referrals, and recording admission and discharge medications. Outpatient services have been a focus of innovation, with the CSIRO’s Care Assessment Platform smartphone app alleviating the need for patients to travel to outpatient clinics for rehabilitation appointments by bringing the rehabilitation program to the patients’ homes. Patients record their clinical data such as blood pressure and physical activity, with cardiac patients using the smartphone app far more likely to participate in the rehabilitation program. The smartphone app program demonstrated the same, if not better, health outcomes compared to the traditional rehabilitation program.
Digital health can also be used to make back-end systems more efficient, providing significant financial savings. Ramsay Health Care has deployed a full suite of data standards for identifying, capturing and sharing information to support interactions with its suppliers, including GS1 Electronic Data Interchange (EDI) standards. As a result, Ramsay has increased both the speed and efficiency of its purchasing processes, strengthened the efficient operation of its hospitals and helped ensure the continuous delivery of quality healthcare.
The private health sector has made significant investments in digital foundations over the past decade to improve operating efficiency and service delivery. There is an opportunity to create a more seamless service experience for consumers and those providing care to them, as they move across public, private and community health settings. By agreeing national priorities for digital innovation in healthcare, we can signal to all participants – public and private health providers, industry, and professional groups – where future investment could align to create synergies and maximise return on investment.
The strategy recognises that along with investment from the states and territories, private sector organisations will be key players in the delivery of innovative products, services and programs that improve health and care experiences and address Australia’s greatest health challenges.