Annual performance statements 2019–20
Statement of preparation by accountable authority
On behalf of the Board, I present the 2019–20 annual performance statements of the Australian Digital Health Agency, as required under paragraph 39(1)(a) of the PGPA Act. In my opinion, these annual performance statements are based on properly maintained records, accurately reflect the performance of the Agency, and comply with subsection 39(2) of the PGPA Act.
Dr Elizabeth Deveny
6 October 2020
Performance measures and annual targets
The table below provides information on the Australian Digital Health Agency’s 2019–20 performance against the individual planned performance measures published in the Agency's Portfolio Budget Statements 2019–20 and the Agency's Corporate Plan 2019–20. References to each of these planning documents are included for each performance measure.
Overall, the Agency has been successful in progressing the objectives of the National Digital Health Strategy 1 and achieving the Agency’s purpose, which is:
“Better health for all Australians enabled by seamless, safe, secure digital health services and technologies that provide a range of innovative, easy to use tools for both patients and providers.”2
Detailed analysis of factors affecting performance are provided in the table for each performance measure. Where annual targets have been met, this generally reflects strong availability of delivery systems like the My Health Record system, successful roll out and completion of enhancements, and effective collaboration and cooperation with key stakeholder groups. Where targets have been partially met, this reflects some slower than expected take up of some products and services, and longer than expected negotiations with some service providers.
The COVID-19 pandemic has also affected full achievement of some targets. In responding to the pandemic, health service providers and vendors reduced engagement and re-prioritised resources. However, while some performance targets have been affected, the pandemic has also highlighted the critical role of digital health technologies in connecting people to healthcare providers and services.
2019–20 target and source
Health information that is available whenever and wherever it is needed
Enhance the My Health Record system to maintain availability (excluding planned outages), improve participation, usage, content and engagement with the service.
Continue to operate a reliable and secure My Health Record system, maintaining system availability at 99%. Enhancements will be delivered over multiple releases, which will improve the end user experience, medicines view, and design of access controls.
Source: PBS p180, CP p17
Maintained My Health Record system availability at 99.96%. In 2018–19 the target was also met with My Health Record system availability at 99.65%.
Enhancements were delivered over two major releases, which improved the end user experience, medicines view and accessibility utility. Notable enhancements included:
In 2018–19 the target for major system upgrades was also met focusing on initiatives to support the creation of a My Health Record for the majority of Australians and to deliver legislative changes to strengthen safety and privacy protections in the system.
Increase My Health Record system adoption by public and private hospitals.
Connect an additional 20 public hospitals and health services and 15 private hospitals to the My Health Record.
Source: PBS p181, CP p18
Target partially met
A total of 25 additional public hospitals and health services and 12 private hospitals were connected.
Engagement with private hospitals continued throughout 2019–20, with a focus on day hospital groups and the considerable number of single facility operators, all at different stages of My Health Record adoption. The shortfall in private hospital connections (12 rather than the projected 15) can be attributed to the fall in engagement opportunities and resource capacity as the hospitals prioritised a response to the COVID-19 pandemic.
In 2018–19 the target for increased adoption was met with an additional 32 public hospitals and health services and 18 private hospitals connected.
Establish foundation sources of pathology and diagnostic imaging reports in the My Health Record with key implementation partners from public hospital networks and the private sector.
All states and territories, and more than 80% of private pathology labs and 20% of private diagnostic imaging practices connected and sharing reports with the My Health Record.
Source: CP p18
Target partially met
All states and territories are now connected and sharing reports with My Health Record from inpatient settings, with more than 95% of public labs connected. Nationally, 67% of private pathology labs (not 80% as targeted) were connected to the My Health Record.
23% of private diagnostic imaging practices connected and shared reports with the My Health Record – exceeding the 2019–20 target of 20%.
Extensive engagement with private sector pathology and diagnostic imaging providers continued throughout 2019–20, supporting providers with their connection and software upgrade challenges. Negotiations with several larger organisations regarding their willingness to participate were ongoing, which accounted for the shortfall in private pathology participation for the year.
In 2018–19 the target was partially met. All states and territories were connected and nationally 41% of private pathology labs and 20% of private diagnostic imaging practices were connected
Health information that can be exchanged securely
Establish a trustworthy, seamless process for a message to flow securely from one provider to another and over time to consumers.
Co-produce a conformance, compliance and accreditation framework and process, building on existing schemes.
Source: PBS p181, CP p18
Target partially met
While an industry wide framework was not co-produced in 2019–20, the Agency Secure Messaging program continued to work with industry, government and clinical peak stakeholders to design and implement a range of interoperable solutions that support widespread improvements for clinical communications.
The keystone Provider Addressing Service – Service Registration Assistant proof-of-concept trial in Northern New South Wales was completed and evaluated. This project has achieved meaningful progress towards delivering a national federated provider directory service, thus providing the technical platform for improved continuity of care through increased information exchange across care settings. The business case for the go-to-market for a national solution has commenced. Delivering a nationally scalable Service Registration Assistant will be a focus area for the Secure Messaging program in 2020–21.
In March 2019, the Agency launched an industry engagement and enablement strategy to the software community to implement agreed standards that support widescale consistent approaches to secure messaging. There are 55 vendor products participating in the secure messaging industry offer to become compliant in secure messaging payloads and standards. Initially this capability was expected to be in production software by mid-May 2020. However, due to the impact of COVID-19 on participating vendor resources, where they were required to prioritise electronic prescription and telehealth capability, the Agency has extended the end date of the offer to the majority of vendors until October 2020.
The secure messaging industry offer included development of conformance and compliance requirements relevant to the scope of the offer. This will inform the design and planning of a wider conformance and compliance scheme in 2021.
High quality data with a commonly understood meaning that can be used with confidence
Strengthen and improve the tools for digital interoperability in the Australia health sector.
Base-level requirements for using interoperable digital technology in the provision of care in Australia agreed with governments, peak clinical bodies and other key stakeholders.
Source: PBS p182, CP p20
Target partially met
All Australian governments have agreed to the National Health Interoperability Principles that outline high-level requirements for progressing interoperable digital technology in the provision of healthcare in Australia. The principles were developed following consultation with peak clinical bodies, software industry, consumer representative organisations and other key stakeholders.
These principles cover the building blocks required to deliver interoperability through:
A series of ‘communities of interest’ were established, which helped identify use cases that will build on the principles and requirements for delivering interoperability in the healthcare system.
These use cases cover common challenges experienced in healthcare settings, such as radiology, pathology, medicines safety, connectivity between primary and secondary care and self-care enablers.
The Interoperability Roadmap was not approved by AHMAC in 2019–20. Due to the impact of COVID-19 on timeframes and additional time required for consultation with jurisdictions, the base-level requirements could not be fully delivered in 2019–20 and will continue to be developed and co-designed over the next 12 months following AHMAC approval of the interoperability principles in December 2019.
The target for 2018–19 was met, which related to commencement of the co-design process with stakeholders resulting in development of a draft national health interoperability roadmap.
Better availability and access to prescriptions and medicines information
Improve the accuracy, timeliness, visibility and accessibility of medicines information in the My Health Record system.
83% of community pharmacies connected and uploading dispensed prescription records to the My Health Record
Source: CP p20
Target partially met
At 30 June 2020, 97% of community pharmacies were registered for My Health Record and 78% were uploading dispensed prescription records.
While all major community pharmacist software products are My Health Record conformant – enabling access to almost all pharmacists across Australia – the upload rates are slightly lower than target (78% rather than 83%) with ongoing need for continued education and engagement with the community pharmacy sector to translate registrations into use.
In 2018–19 the target was partially met with 66% of community pharmacies connected and uploading to the My Health Record system.
Digitally- enabled models of care that improve accessibility, quality, safety and efficiency
Trial new models of health care to test their effectiveness in real-world environments to accelerate national uptake of initiatives with greatest benefit.
Deliver initiatives to test evidence-based digital empowerment of key health priorities.
Source: CP p20
Children’s Health Collaborative: NSW Health has been providing overall leadership and program management of the National Digital Children’s Health Collaborative. That collaborative co-designed, implemented and evaluated proofs-of-concept for the Child Digital Health Record (0–4 years) and a Digital Pregnancy Health Record, and collated information requirements for designing a Child Digital Health Record (5–14 years). An evaluation report has been completed by the Agency for future consideration as part of the National Infrastructure.
Goals of Care: Western Australia Department of Health was commissioned to lead a National Goals of Care Collaborative. The Collaborative delivered the My Health Record Advance Care Planning National Guidelines which provides guidance for health care professionals on how My Health Record can be used to support the advance care planning process with consumers. The Agency implemented additional functionality as part of My Health Record Release 11 that enables healthcare providers to upload advance care planning information on behalf of consumers. Release 11 also introduced the goals of care clinical document.
In 2018–19 this target was met, with 15 initiatives to test evidence-based digital empowerment of key health priorities including for hospital admissions, cardiology care and aged care integration.
A workforce confidently using digital health technologies to deliver health and care
Support healthcare professionals to trust in, and capitalise on, the benefits of digital technologies.
Support governments and educational institutions to develop curricula to build digital workforce capability.
Source: CP p21
The Agency has continued its partnership with the Australasian Institute of Digital Health (AIDH) – the merger of the Australasian College of Health Informatics and the Health Informatics Society of Australia – and Macquarie University to sponsor PhD candidates with an industry placement, as a pathway to AIDH Fellowship in the Fellowship by Training Program. It is the first program of its kind in Australasia and prepares individuals for leadership roles in the health informatics workforce and addresses demands for experienced and qualified health informatics specialists from various disciplines.
In addition, the Agency is working closely with the AIDH to grow the CXIO Network. This network brings together health informatics professionals working in leadership roles (e.g. chief clinical, nursing, medical and pharmacy information officers) to provide supporting workforce and educational materials and resources as well as a peer support network for new and existing CXIOs.
The Agency has continued its partnership with the Australian Commission on Safety and Quality in Health Care to develop an optimised model for use of the My Health Record in emergency departments. The My Health Record in Emergency Departments Project is establishing a framework for optimised use of the My Health Record system by clinicians in hospital emergency departments. The project will determine what factors contribute to use of the My Health Record system in the emergency department setting and how to incorporate the system into clinical workflows. There have been four pilot sites across Australia where quantitative and qualitative data has been collected and is now being analysed to inform the model. The project is near completion with a report being delivered in 2020.
In 2018–19 this target was also met through supporting industry placements for research students, building health informatics networks and support continuing professional development for a range of clinical peak organisations.
A thriving digital health industry delivering world-class innovation
Drive innovation by working with industry, healthcare consumers and the research sector to expand existing digital tools and create new ones that meet the changing needs of patients and providers.
Improve the Developer Partner Program to reduce barriers to innovation and aid integration with the My Health Record system and other digital services.
Source: CP p21
During 2019–20, the Driving Innovation program delivered the following items: