Not to worry though. The digital health mandarin is confident it presents nothing but opportunity and as he told the DHF audience, we must embrace change.
Daniel McCabe, the first assistant secretary of the Department of Health, Disability and Ageing’s digital health division, admitted he was “gobsmacked” when he heard that disability services and the NDIS had been added to the health portfolio.
In a sweeping address at the Digital Health Festival in Melbourne, Mr McCabe made the admission but quickly qualified it.
“In the last 48 hours things have changed for us,” he said.
“My minister and my department now have responsibility for disability policy as well as the National Disability Insurance Scheme, and I think initially we were a little bit gobsmacked with that.
“But that presents an important opportunity for us.
“There are millions of Australians living with disability,” he said. According to the AIHW’s latest numbers that figure was 4.4 million in 2018.
“The work that we can do as a department to connect and support people with their information, to make sure that they get access to the care they need – that’s really important work.”
Change or die
Mr McCabe urged the sector to embrace change.
“We have many challenges to overcome … addressing those challenges will require change — changes to our funding models to support complex care; changes that look at how we support our health professionals to work to their top of scope of practice; changes that enable vital consumer health information to be in their hands, where and when they need it; and changes to the way in which we use and collect data to inform our health service planning,” he said.
“Digital health is critical to enabling these reforms, supporting multidisciplinary care teams to collaborate and communicate together to ensure that health information is collected seamlessly at the point of care, to help us establish new models of care, and to modernise referral pathways to ensure a patient’s health history and privacy.”
Citing both the Productivity Commission – which predicted a $5 billion saving as a result of full interoperability – and the 2023 midterm review of the National Health Reform Agreement, Mr McCabe told the DHF audience that digital health offered one of the most significant chances to realise productivity gains in the healthcare system.
“The review recommended that all nine governments commit to progressing digital health to improve health service integration, clinical decision-making and transitions of care across the system,” he said.
“The review also encouraged appropriate data collection, curation and analysis to make sure that we can support effective healthcare and enhancements for patient outcomes as well.”
The department also did a review of after-hours care.
“Some of the key things that came out of that included information flowing for patients, no matter where they present, improving data flows across services to improve continuity of care, and enhancing Healthdirect’s role to support continuity of care for consumers,” said Mr McCabe.
Continuity of government
As the Labor government comes into its second term, the digital division of the DoHDA was working hard to “reform and shape the future of data and digital in our healthcare system”.
“We’ve made significant progress, but as I mentioned, we still face challenges,” said Mr McCabe.
“Digital information and sharing is improving but is still inconsistent and sometimes burdensome.
“Only 18% to 24% of GPs and public hospitals share information together using digital systems, and today, still – we hate to hear this – 75% of all fax traffic in the world relates to healthcare.
“Forty percent of GP time can be attributed to administrative burden. Clinical systems, while doing an excellent job in their setting, are still largely siloed, and there are varying levels of digital maturity across all parts of our system.
“Many allied healthcare providers still don’t use clinical systems to manage their patient information, and some healthcare providers don’t have the capacity to learn how to use and integrate digital technologies.
“We need to do better in that space.
“Consumers continue to experience poor navigation and access to health services – 49% of discharged patients from hospital experience adverse events because of delays in sharing information relating to their discharge.
“And last year, 8.8% of Australians delayed seeing a GP due to cost.
“So we have a lot to do.”
Mr McCabe sang the praises of the Sharing by Default legislation which was passed in February, and which is not yet enacted but still having a positive effect on the system nonetheless.
“At the end of last year, half of all pathology reports created in Australia had been shared with My Health Record, and 40% of all diagnostic imaging reports are now being shared to My Health Record,” he said.
“This has grown even further in the last five months. Each week, pathology providers are now uploading up to three and a half million pathology reports to My Health Record, and consumer views of My Health Record have also increased, with pathology results reaching 1 million views for the first time in one week, back in February, and growing from there.
“In the first year of this legislation, we could save $11 million in reducing duplication of pathology and diagnostic tests.”
What’s next for sharing by default?
Mr McCabe said it was now time to develop the rules for pathology and imaging sharing by default.
“This will include extensive consultation with everyone to make sure that we’ve got the right settings in place,” he said.
“As we do that, we’re also working with the medical software industry to make sure that this approach to sharing by default can be reflected in clinical systems as they modernise their platforms to capture and share data seamlessly.
“And we’re starting to contemplate further advice around other opportunities for sharing by default. Some of the things we want to look at include sharing by default for all medication events and potentially working with our stakeholders around care plans and health assistance as well, moving to share by default in due course.”
1800 Medicare
The recent announcement to extend Healthdirect Australia’s services to include an after-hours GP service also drew the first assistant secretary’s attention.
“1800 Medicare will form the basis of a single front door for health information and services and virtual care that complements face-to-face interaction as well as referrals to urgent care clinics or back to a GP,” Mr McCabe said.
“We are working with Healthdirect to also build on the work that NSW has been doing to establish a single front door for healthcare, working with all states and territories to better connect Australians with primary care services.
“It’s an exciting opportunity which I’m really looking forward to.
“We’re continuing to build digital pathways to improve the consumer experience as they navigate and manage their prescriptions, diagnostics, pathology, tests and referrals. This includes making it easier for Australians to find a provider or service to meet their expectations on cost, location and other preferences.
“Critical to this is the expansion of our work on the National Prescription delivery service that currently delivers 95% of all prescriptions.
“This work in the medicine space is critical for access to medicines and also for improving clinical safety.”
E-referrals
The department will be looking to consider the new referral pathways.
“This work will ensure relevant health information supporting the referral is available to those that need it,” said Mr McCabe.
“It will also support notifications of key information in real-time to consumers and members of the multidisciplinary care team.
“We’re doing this and building on some work around the notion of a patient summary, which brings together health information from multiple sources, which is central to the way in which we provide digital, connected care.
Related
“A dynamic patient summary means that health information regarding patients, problems, allergies, medications, procedures and immunisations will be available to their consumer and their care team in real time.
“To support referral processes as these digital pathways are established, we will also look to provide consumers with more transparency on the cost.”
Health Connect Australia
All nine state, federal and territory governments have committed to support the design and support of Health Connect Australia, which will deliver National Health Information Exchange capabilities supporting access to and the sharing of the patient’s health information as they transition between care centres.
“For example, when a patient moves from their GP into a hospital, or from one hospital across the border to another, HCA will enable much sharing of information once it is established,” said Mr McCabe.
“To be able to view and reuse an X-ray or CT scan, for example, no matter where it was created or stored, is one of our objectives.
“Reducing the risks to consumers of unnecessary radiation by not duplicating these tests, building on My Health Record will help connect and reduce the risk to consumers.
“We’ll look to make healthcare much more fast and efficient, stitching together all our clinical systems so that consumers don’t need to repeat their medical issues and so the health professionals have access to the right information to make performance decisions.”
The first part of project is to establish a national provider of directory capability that will capture all 1.5 million healthcare professionals, building on the National Healthcare Identifier service providers.
“It will provide a rich set of services that connect to existing systems such as hospital EMRs,” said Mr McCabe.
“It will allow healthcare providers and healthcare organisations to find and communicate with any healthcare provider across the health system.
“We’ll also enhance the national health services directory by supporting the updates to healthcare providers and the services they provide.
“Health Connect Australia will be a significant step forward in Australia’s digital health journey.”
Primary care
Mr McCabe hinted at work the department is doing with the Australian Institute of Health and Welfare to develop a national primary care dataset that will be used to support primary care service delivery planning at local, state and national levels.
“[This will] support general practice and primary care practices in creating feedback loops so they can deliver value-based quality care and provide insights on patient needs and outcomes, to inform the design of multidisciplinary care pathways,” he said.
Mr McCabe concluded by saying that “we have made significant strides” along the digital health transformation.
“It means having data and information available to the right person at the right time,” he said.
“Multidisciplinary care teams will have instant access to patient information comprehensively, as well as consumers maintaining full control over their own health information.
“Different healthcare settings will be able to communicate seamlessly with each other, and this will reduce the burden on our health system and provide data driven insights to improve health outcomes.
“Ultimately, we are aiming to achieve a secure, learning health system for all Australians.”