Introduction by Croakey: To achieve the benefits of a “truly integrated digital health system”, healthcare professionals need to be sufficiently trained in new digital health technologies, and internet connectivity across rural and remote Australia must be increased.
This is according to Adjunct Professor Richard Royle, Chair of the CSIRO’s Australian e-Health Research Centre and co-author of a new book, Connected Care: Digital Health in Australia.
In the article below, he calls on healthcare professionals, policymakers and advocates to become more engaged with championing the opportunities of digital health.
Meanwhile, the Australasian Institute of Digital Health has called for a bipartisan policy approach to digital health, which it says will significantly help overcome the intermittent funding cycles and federal-state divides that hinder health reform in Australia.
The Institute – an amalgamation of health informatics and digital health organisations Health Informatics Society of Australia and the Australasian College of Health Informatics since 2020 – wants the next Federal Government to commit ongoing funding for key Australian Digital Health Agency initiatives, particularly the health information exchange.
The next Government must also “commit to enacting robust and workable legislative frameworks for the safe, efficient, transparent, equitable and ethical use of AI and digital health technologies”, says the Institute in a recent statement.
Royle’s article is based on extensive research in digital health for Connected Care: Digital Health in Australia, the latest book in Monash University Publishing’s In The National Interest series, which he co-authored with Dr David Hansen, CEO of the Australian e-Health Research Centre.
Richard Royle writes:
Australia has already invested heavily in digital health, but for consumers, there is not a lot to show for it… yet. The good news is that this is changing – and fast.
The “My Health” app, along with apps like Medicare, are starting to enable consumers to access their own health data – a vital step to increasing consumer agency in their own healthcare.
The potential for improved health outcomes, seamless data sharing among healthcare providers, and the promotion of clinician-led health initiatives is substantial, but only if both the Australian public and medical professionals actively engage with the opportunities that digital healthcare presents.
The Government’s ongoing investment in My Health Record and the digitisation of general practitioners’ practices are steps in the right direction, but they are not enough on their own.
There is an urgent need for a unified digital health system in our country and, to achieve this, we need active engagement from all healthcare professionals.
The ‘Sparked’ program – led by CSIRO’s Australian eHealth Research Centre – is laying the groundwork for digital health interoperability, but it will take industry-wide collaboration to make a truly connected health system a reality.
Now is the time for healthcare professionals, policymakers and advocates to get engaged in the world of digital health, advocate for integration in the workplace and champion patients on the benefits of a truly integrated digital health system.
Long journey
Digital health in Australia has had a long and at times tortuous journey, with early moves commencing in the 1990’s with the implementation of comparatively basic electronic health records.
Since those early digital years, we have seen rapid growth, not only in comprehensive electronic medical records, but also in emerging areas such as artificial intelligence and genomics.
But it is still a very fragmented system, with information silos frustrating the clinician and consumer alike.
The good news is that we are now starting to see the engagement of the broader health industry (including acute care, primary care, aged care, diagnostic providers and health technology companies) working with governments to develop standards for health-related software that will allow for genuine interoperability.
This has been the case for many years in industries such as banking and travel, where the consumer is very used to being able to undertake transactions and view data across those industries. This has been due to agreed industry standards and a commitment within those industries to using those standards.
Patients who use the healthcare system frequently report the frustration of having to repeat information about themselves at every touchpoint in their journey.
Similarly, it is frustrating for the health practitioner not to be able to clearly see what tests, medications or previous treatment regimens have been given to the patient sitting in front of them.
This is not only potentially clinically dangerous but also expensive for the healthcare system in general, because of delayed treatment and repeated tests.
In tandem with strong leadership from state, territory and federal governments and agencies, the Commonwealth Government recently funded several new digital health initiatives, including significant investment in the underlying infrastructure, technology and standards to achieve a connected health system.
Australia already has a number of sound platforms for digital health – we have the most computerised general practitioner workforce in the world (95%), a nation-wide My Health Record system that is increasingly being populated through a combination of policy initiatives and clinician and consumer interest, and an increasing number of acute hospitals with a solid electronic health system in place.
Combined with this, digital innovations in areas such as large language models, artificial intelligence and genomic medicine (to name but a few) are rapidly gaining clinician engagement and consumer interest.
Our ability to manage large volumes of digital data through increased computing power will further lead to increased take up of these new innovations.
If we look into the future of digital health, we can see a world where health data – with the patient’s approval – is fully available to the healthcare team, and that data can be shared with other specialists as required to support health needs as they arise.
Health data won’t be just blood tests and other information that can be discussed with a GP. It will include the data captured on personal devices such as fitness and heart rate data, as well as artificial intelligence that is able to identify clinical findings more accurately than clinicians do.
The data might also include DNA sequence, initially identified to pinpoint the best possible drug to prescribe, but which can also be used to identify risk factors for future health conditions.
Active engagement
For this to be achieved, several actions need to be successfully undertaken, including the work that is now occurring in developing interoperability standards, training clinicians in the use of these new technologies, and further increasing the rollout of internet connectivity across rural and remote Australia.
But critically, it will also need to ensure that clinicians are comfortable using these new digital technologies and have confidence in the benefits that they will bring both for their patients and for their own practice.
There is now a growing band of digitally engaged health practitioners who are driving the adoption of these new technologies through the workforce.
History in Australia has shown that unless practising clinicians are actively engaged in digital health and can understand the potential benefits (and risks) that come from using these new technologies, then any attempts at adoption will fail.
Consumers are becoming increasingly digitally savvy, and there will be an increasing expectation amongst consumers for their health data to be available for them and their treating clinicians to access.
The uptake across Australia of fitness trackers and smart wearables shows that we increasingly have a population who want greater access to their own health information.
So the future of digital health in Australia looks bright. Governments are increasingly aware of the benefits that digital health investments can make not only to health outcomes but also to minimising the rising costs of healthcare.
The breaking down of the current information silos through interoperability standards will be a game changer and governments will need to continue to invest in digital health to maximise the benefits for all Australians.
Streamlining practice
One of the questions that we are often asked is about how we work to try and ensure people aren’t left behind in this move to digital health – those who can’t or won’t engage with digital technology?
The individual consumer has always had the choice to engage in the digital health journey. When the predecessor to the My Health Record was introduced to the Australian community in 2011 – the Personally Controlled Electronic Health Record or PCEHR – it was an opt-in model.
Consumers had to personally select that they wished to have their information stored on their personal record. This turned out to be a major problem with the uptake of the PCEHR, as was identified in the review of the PCEHR and the national digital health investments undertaken in 2013 (the Royle review).
In essence, very few Australians bothered to go through the process of opting in as they saw little benefit in engaging in what was a small and little used document.
With the support of the Consumers Health Forum, as well as agreement with the Office of the Australian Information Commissioner, the PCEHR was replaced with the My Health Record in 2016 and became an opt-out model, to gain momentum in the coverage of the nation’s population.
As part of that change – which resulted in just under four percent of the population opting out – each Australian would be messaged or emailed to notify them when their My Health Record had been accessed, thereby allaying fears of inappropriate access to personal health information.
Health practitioners are increasingly using digital health technologies as those technologies begin to become more mainstream and demonstrate clinical benefits.
A good example of a significant uptake in the digital health space has been the use of electronic prescriptions. Ironically, it was the COVID pandemic that turbocharged the uptake of electronic prescriptions (the technology had been developed for some time).
People who use this service generally find it to be far easier than having to deal with paper prescriptions – and the pharmacists much prefer them as there is no need to decipher illegible doctors handwriting.
Similarly, radiologists have been using AI for some time, particularly in areas such as mammography, and it has been shown to have benefits as a second reader to maximise the identification of emerging tumours.
As these types of digital initiatives gain further traction, the various health practitioners will increasingly use them as they have potential to not only help their patients but also streamline their business practice.
History tells us that most people will listen closely to what their doctor tells them – they are a trusted professional in the Australian society. So as doctors start to talk increasingly positively about digital health technology, both in record keeping and in clinical usage, so their patients will start to take more notice.
This will not stop people from not wanting to engage digitally, but the tide will change, albeit gradually, as digital becomes more mainstream and is positively recognised by the health practitioners.
Further improvements in the My Health Record, including the development of the My Health record ‘app’ to allow greater ease of access for consumers, will also be actively promoted by the government of the day to gain greater traction. This will further raise the profile.
Co-design
Another area of positive focus to gain further traction in the uptake of digital health is in co-design.
A 2024 MJA article titled ‘Towards a Best Practice Framework for eHealth with Aboriginal and Torres Strait Islander Peoples‘ identified a foundational need for co-design with Aboriginal and Torres Strait Islander people in developing e-health interventions.
There have been several studies on the use of digital technologies with Indigenous people and, in addition to co-design, co-governance and partnership with an Indigenous Health organisation was a vital part in the successful implementation of digitally enabled interventions.
The Smarter Safer Homes initiative has been taken up by several retirement village operators who ensure adequate Wi-Fi and internet coverage in the homes they construct and manage. Remote access monitoring is a rapidly growing area of sub-specialisation in healthcare, and whilst it has limitations dependent on internet coverage, it is used in many rural and regional towns in Australia.
Consumers are increasingly engaging in their own healthcare, albeit at the margins at present. The rapid uptake of wearables with clinical applications has been strong in Australia, demonstrating that there is an underlying desire by many to have some direct knowledge of aspects of their health and fitness.
The major premise behind the support for the national My Health Record is that it gives every Australian the opportunity to be more informed about their own health. The next few years will see a significant uptick in the volume of data being uploaded to the My Health Record, and this will drive increased usage by clinicians and therefore by consumers.
About the author
Adjunct Professor Richard Royle oversaw a landmark national review in 2013 that led to the establishment of the Australian Digital Health Agency and the My Health Record. He has chaired the CSIRO’s Australian e-Health Research Centre (AEHRC) since 2017 and continues to be closely involved in digital health innovation.
He has been the CEO of a number of public and private hospitals over the last forty years, and spearheaded the development of Australia’s first fully integrated digital hospital in Hervey Bay, Queensland—St Stephens Hospital opened in 2014 and has since won a number of international awards for its comprehensive digital implementation.
See Croakey’s archive of articles on digital technology
