Annual work plan priorities from the Corporate Plan 2020–21
The targets in the 2020-21 PBS and corporate plan covering all the critical activities within our digital health remit give a broad perspective of the Agency’s performance, but do not complete the performance story. The Agency is one of only a handful of Commonwealth entities with a statutory obligation to produce an annual work plan.1 The effect is to put that work plan at the centre of any performance discussion.
The work plan was an attachment to the Corporate Plan 2020-21 and this section of the performance report covers implementation and achievements in its delivery.
Agency annual work plan
The diagram below presents the Agency’s annual work plan priorities for the 2020-21 financial year. It consists of a series of seven programs aligned with the seven strategic priority outcomes of the current National Digital Health Strategy.
In support of measuring the Agency’s performance in 2020-21, each program is assessed in terms of its purpose (overview and 2020-21 work plan focus) and the results produced, followed by a synoptic analysis of factors contributing to results.
This approach shows how each priority area of work within the Agency furthers the overall purpose of delivering the benefits of digitally enabled health and care.
My Health Record
The 2020-21 priority was threefold.
1. Create new connections
In 2020-21, registrations across all healthcare provider types increased as follows:
2. Improve the system
Consolidated immunisation view
Australian healthcare providers have an improved and consolidated view of their patients’ immunisation details through My Health Record thanks to a new consolidated view of immunisation details from the Australian Immunisation Register (AIR), and the individual’s record. This makes it easier for healthcare providers to view their patients’ immunisation information and enables consumers to access their immunisation history statement from My Health Record to show proof of vaccinations.
Improved usability for healthcare providers
The Agency worked with software developers, particularly those working with specialist clinical information systems, to incorporate My Health Record into standard screens and workflows for healthcare providers. The changes remove the need for a healthcare provider to search for My Health Record data in separate areas within their software, improving both the user experience and quality of data readily available to clinicians.
3. Accelerate use
A range of factors contributed to increased use of My Health Record in 2020-21, including:
- improved utility for both consumers and healthcare providers
- ongoing promotion through partnerships with the wider healthcare landscape and consumer groups
- a proactive public relations strategy, allowing timely responses to media and issues resulted in more than 7,000 media mentions
- an effective advertising and communications program that resulted in increases for healthcare providers and consumers in intention to use the system and positive sentiment towards it.
The following infographics provide a synopsis of key use metrics as at June 2021.
Analysis of factors contributing to results
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Increasing document volume in My Health Record
The number of documents in My Health Record increased by nearly 50% in 2020-21 and now totals almost three billion.
Clinical documents uploaded by healthcare providers presented the greatest change (+119%) driven by significant increases to pathology (+143%), diagnostic imaging (+92%), dispensing documents (+86%) and specialist letters (+141%) following the adoption of clinical software that supported new document types and increased participation of healthcare organisations contributing these documents to the system.
Similarly, new functionality paved the way for a more than 440% growth in the availability of a new clinical document called the Pharmacist Shared Medicines List (PSML) – a current, consolidated list of medicines that can be used to assist in the medication reconciliation process in a hospital or primary care setting. Increasing use of PSML in 2020–21 to create a more detailed source of medicines information (at a point in time) – in addition to existing prescribed and dispensed medicine data – is aimed at reducing medication errors, especially at transitions between episodes of care when the risk of error is increased.
These developments have been supported by the practice incentive requirements for general practice organisations and My Health Record engagement activities, including partnering with PHNs and clinical peak organisations.
The following table shows the number of documents uploaded to My Health Record (by category) during 2020-21 and change relative to 2019-20.
Document category/name | At 30 June 2020 | At 30 June 2021 | Growth |
Clinical documents | 75,000,000 | 153,000,000 | 104% |
Shared Health Summary | 4,700,000 | 6,600,000 | 40% |
Discharge Summary | 7,400,000 | 11,400,000 | 54% |
Event Summary | 1,800,000 | 2,500,000 | 39% |
Specialist Letter | 260,000 | 603,000 | 132% |
eReferral Note | 290 | 406 | 40% |
Pathology Report | 52,800,000 | 117,000,000 | 122% |
Diagnostic Imaging Report | 8,200,000 | 15,000,000 | 83% |
Pharmacist Shared Medicines List | 11,000 | 60,000 | 445% |
Prescription and Dispense Record | 143,000,000 | 255,000,000 | 78% |
Prescription | 61,000,000 | 106,000,000 | 74% |
Dispense | 82,000,000 | 149,000,000 | 82% |
Consumer documents | 296,000 | 348,000 | 18% |
Consumer Entered Health Summary | 201,000 | 240,000 | 19% |
Consumer Entered Notes | 60,000 | 66,000 | 10% |
Advance Care Directive Custodian Report | 28,000 | 32,000 | 14% |
Advance Care Planning Document | 6,900 | 9,200 | 33% |
Goals of Care | 240 | 1,050 | 338% |
Medicare documents | 1,870,000,000 | 2,560,000,000 | 37% |
Australian Immunisation Register | 14,800,000 | 16,500,000 | 11% |
Australian Organ Donor Register | 1,500,000 | 2,000,000 | 33% |
Medicare/DVA Benefits Report | 1,090,000,000 | 1,500,000,000 | 38% |
Pharmaceutical Benefits Report | 768,000,000 | 1,040,000,000 | 35% |
Child My Health Record documents | 18,800 | 19,900 | 6% |
Personal Health Observation | 8,500 | 9,000 | 6% |
Personal Health Achievement | 1,400 | 1,500 | 7% |
Child Parent Questionnaire | 8,900 | 9,400 | 6% |
Total active documents in My Health Record | 2,010,300,000 | 2,970,000,000 | 48% |
Secure messaging
The need for healthcare providers to connect to each other safely and securely is greater than ever.
Secure messaging is a foundational capability to enable interoperability and safe, seamless, secure, and confidential information sharing across all healthcare providers.
The priority in 2020–21 was twofold.
1. Provider Connect Australia
- The business case to mobilise a nationally scaled Provider Connect Australia service (formerly Service Registration Assistant or SRA) solution was approved by the Agency Board in February 2021. The Agency established a project team to deliver this initiative, progressed the requirements and design of the solution, and started development in June 2021.
2. Industry participation and adoption
- 86% of participants in the secure messaging industry offer delivered enhanced secure messaging capability into their production systems, despite the impact of COVID-19 on their resources.
- A successful pilot ‘go-live’ of the South Australia (SA) Health state-wide interoperable secure messaging project, with the start of outbound discharge summaries from SA Health hospitals to general practices across the state.
- Successful completion, publication and promotion of the Safety and Quality Benefits of Secure messaging research report by the Australian Commission on Safety and Quality in Health Care.
Analysis of factors contributing to results
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Interoperability and data quality
Today, most healthcare providers securely store patient information in computer-based clinical information systems.
Better connected healthcare is about supporting the exchange of high-quality data between healthcare providers and the systems they use.
By bringing patient information from multiple, trusted sources together, healthcare providers and patients will have greater visibility of accurate information that leads to better decisions, and in turn, better outcomes.
Interoperability lays the foundations for better connected health services by defining system and product standards to maintain and enhance Australia’s reputation for world-class healthcare.
In 2020–21, the Agency continued to take significant foundational steps in making interoperability a reality. Noteworthy achievements included:
- National Health Chief Information Officers’ Roundtable agreed to the governance and timetable for the Interoperability Implementation Plan.
- The Interoperability Plan was drafted and reviewed by Steering Committee members ahead of consultation and approval in 2021-22.
Work commenced on several actions to support interoperability including a cost–benefit assessment for the wider use of healthcare provider identifiers, a survey to understand what types and information sources clinicians would like to discover digitally, and a review of current approaches to support patients identifying care network members.
Analysis of factors contributing to results
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Jurisdictional engagement on the development of the draft National Health Interoperability Plan via the National Interoperability Steering Committee. | The impact of COVID-19 related priorities delayed the establishment of formal governance arrangements and the timeframe for finalisation of the Interoperability plan. |
Medicines safety
In November 2019, federal, state and territory health ministers declared medicines safety the 10th National Health Priority Area for Australia. This recognises the urgent need to ensure medicines improve the health of Australians and not put them at risk of harm.
Some 250,000 Australians are hospitalised each year and another 400,000 present to emergency departments as a result of medication errors, inappropriate use, misadventure and interactions. The annual cost of medication-related problems in Australia is nearly $1.4 billion.2
The Agency’s Medicines Safety Program uses digital interventions that enhance access to information about medicines, allergies and adverse reactions, and support safe and efficient medicines use and reduce adverse events. Further, in response to the COVID-19 pandemic, the Medicines Safety Program accelerated the implementation of electronic prescribing for Australia.
The priority for 2020–21 was threefold.
1. Electronic prescribing
- The significant acceleration and rollout of electronic prescribing was made possible by an outstanding collaboration between state and territory jurisdictions, the Commonwealth, clinical peak bodies, clinical software developers and the Agency. It set in place a new standard for working together to deliver digitally enabled healthcare reforms for the future. The Agency and Department of Health were recognised for their collaboration with industry through the electronic prescribing project, by winning an Australian Government Digital Award in the category of excellence in government-industry partnership.
- Electronic prescribing is providing a safer, faster and more efficient supply of prescriptions to Australians – in person via their doctor or via a telehealth consultation – sent straight to their mobile phone or by email. Combined with new virtual models of care such as telehealth, electronic prescriptions improve accessibility of healthcare. The viability of telehealth consulting has been constrained previously by the limitations of a paper prescription as the only legal form by which medicines could be supplied. But now, even beyond COVID-19, it will be a great advantage for Australians living in rural, regional and remote areas to have a telehealth consult with a doctor (e.g. a specialist) in a metropolitan city and receive their prescription electronically.
- Three electronic prescribing industry offers were managed by the Agency. Their purpose was to incentivise delivery to market of prescribing software, dispensing software and mobile applications that allow healthcare professionals and consumers to use electronic prescriptions. These industry offers have significantly accelerated the availability of electronic prescriptions to Australians.
- Contracts executed under the industry offers are enabling a variety of software products to deliver features to market across prescribing systems for GPs and specialists, dispensing systems for community and hospital pharmacies, electronic medication charts in hospitals, residential aged care facilities, mobile applications and mobile intermediaries. These enhanced products have seen clinical benefits enabled for healthcare professionals providing services to patients in acute and primary settings, and also to patients who choose to use mobile applications and emerging innovative solutions which leverage the Active Script List (ASL) to better manage their electronic prescription tokens.
- In February 2021, the ASL service went live via a test phase in a small number of community pharmacies. ASL is an electronic prescription token management solution. ASL is now scaling nationally through pharmacy dispense products with products listed on the Agency’s electronic prescribing conformance register. As well as consumer medication management apps, ASL provides enhanced convenience and functionality for Australians using electronic prescriptions. At 30 June 2021, 12,702 patients had established their own ASL.
- On 16 April 2021, Electronic Prescribing Conformance Profile v3.0 (CPv3.0) was published by the Agency. CPv3.0 identifies conformance requirements for software to achieve ‘full’ electronic prescribing functionality as per the original solution architecture. This includes chart-based prescribing capability for aged care and hospital electronic prescribing and enhanced consumer options for the ASL through medication management apps. Software will transition to CPv3.0 conformance by end of April 2022. As part of the stakeholder consultation in developing CPv3.0, 600 items of feedback were addressed by the Agency’s Conformance and Assurance Unit.
2. Remote Area Aboriginal Health Services (RAAHS) S100 PBS medicines viewing project
Under the S100 PBS RAAHS Program, clients of approved Aboriginal Health Services are able to receive medicines at the point of consultation without the need for a normal PBS prescription and without charge. Often these medicines are not supplied as a prescribe or dispense activity using My Health Record conformant software and therefore medicines information is not being uploaded into My Health Record. The project improves the inter-provider visibility of medicines provided under the S100 RAAHS provisions using the My Health Record system as a vehicle. The project will also improve the IHI (Individual Healthcare Identifier) matching rates for Aboriginal and Torres Strait Islander people. The (RAAHS) S100 PBS Medicines Viewing project continues into 2021-22.
3. Medicines safety data analytics scoping and feasibility project
Completed in 2020-21, this study demonstrated that an internationally developed framework for assessing clinical data quality can be applied successfully to the assessment of My Health Record data. The quality of data applicable to medicines safety has been assessed to a level of detail that has enabled specific recommendations for improving medicines safety to be made. The proof-of-concept data analytics application trialled during the project demonstrated that it is possible to develop software applications using the structured clinical data in the My Health Record system to assist clinicians with patient care.
Analysis of factors contributing to results
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Enhanced models of care
The Enhanced Models of Care Program’s focus is on enabling digitally enhanced models of care across identified priority health reform areas. In 2020–21, the program focus was on four areas.
1. Digital reform driven by COVID-19
- The Clinician Vaccine Integrated Platform (CVIP) was developed to provide clinics without existing compatible software with a technology solution to enable upload of COVID-19 vaccine administration details to the Australian Immunisation Register (AIR) and thereby meet mandatory reporting requirements.
Note: As at 29 August 2021, the number of vaccines administered was 1,193,277
- My Health Record system changes to increase the immunisation views for consumers and healthcare providers through:
- Allowing COVID-19 pathology reports to be available to consumers 24 hours after they are uploaded by the pathology service (previously seven days).
- Simplifying access controls and improving access to immunisation information (including COVID-19 vaccination records) via a new consolidated immunisation view:
- This view includes information contained within the AIR as well as My Health Record information such as pathology reports and immunisation records.
- This view is accessible to consumers and health providers through My Health Record portals, conformant clinical information systems and conformant consumer mobile applications (Healthi and HealthNow).
2. Goals of care and advance care planning
- The National Goals of Care Collaborative endorsed the National Guideline for advance care planning and My Health Record.
- The National Guideline for advance care planning and My Health Record was launched in partnership with Advance Care Planning Australia with support from clinical and consumer peak bodies.
- WA Health completed a rollout of the upload of Goals of Care documents to My Health Record to 24 sites across the state.
3. Children’s digital health
The Agency delivered the business case for the National Pregnancy and Children’s Digital Health Record and managed the contract for the National Children’s Digital Health Collaborative, which delivered:
- national harmonisation of the state and territory baby books
- national harmonisation of state and territory antenatal records
- development of 51% of the digital clinical information for the Harmonised Baby Book
- digitisation within a test environment of antenatal visit health interactions
- 130 children and 96 mothers registered (March 2021) for the child record (0-4) proof of concept.
4. Test beds
In June 2021, the Agency closed out the last of the test bed program initiatives established in 2018 with demonstrated use cases for progressing thinking on digital interventions and the role they can play in improving delivery of healthcare. The results achieved included:
- identifying key impact and evaluation findings
- identifying recommendations for future digital health R&D projects
- identifying barriers and facilitators to inform future digital health R&D projects
- identifying the opportunity for an innovative research hub and the subsequent establishment of the Digital Health Experience Centre at the Agency
- Informing priority digital health initiatives including:
- Australian Primary Care reform
- Digital Health Specialist Toolkit
- COVID-19 response
- Commonwealth Digital Health Blueprint.
Analysis of factors contributing to results
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Workforce and education
Confident and efficient use of health technologies by all workers in the Australian health sector is critical for a skilled, digitally capable workforce. In 2020–21, the program focus was threefold.
1. Upgrade of online training environments
The Agency’s Adoption and Clinical Education team produced and delivered eLearning modules, webinars, podcasts, train the trainer sessions, virtual classrooms and pre-recorded videos reaching more than 50,500 healthcare professionals and consumers. Learning focused on My Health Record, electronic prescribing, secure messaging, COVID-19 vaccinations, cybersecurity, and telehealth.
2. National Nursing and Midwifery Digital Health Capability Framework
After its publication in 2020, the National Nursing and Midwifery Digital Health Capability Framework received international interest and recognition for its content and approach. Most notably, it has been used as the basis to inform the development of the All-Ireland National Nursing and Midwifery Digital Health Capability Framework. The All-Ireland framework is a joint initiative between Health Service Executive (HSE) Ireland Office of Nursing and Midwifery and Northern Ireland Practice and Education for Nursing and Midwifery, due for release in 2021.
A corollary of the nursing and midwifery framework project was the Agency’s development of a self-assessment tool to help nurses and midwives identify gaps in their development measured against the five domains outlined in the framework and to guide them to resources available to remediate these gaps.
3. Consumer digital literacy
The Agency engaged Good Things Foundation and the Australian Library and Information Association (ALIA) to raise awareness and educate consumers on digital health literacy and My Health Records functionality, benefits and how to best use it.
Good Things Foundation engaged 67 network partners to deliver the Health My Way program to their communities, with 164 digital health mentors trained nationally. A digital health mentor online resource and a digital health literacy handbook for consumers were developed through the program.
ALIA, working with public libraries, health libraries in all jurisdictions and Queensland Indigenous Knowledge Centres, delivered training to library staff on digital health literacy, including My Health Record, to become a trusted source of information and support for consumers. A total of 2,858 public library staff completed the online training program. Today, more than half of Australia’s public libraries have trained staff to support consumers raising awareness and understanding of My Health Record.
Libraries also act as information points by displaying posters and brochures and session information on in-library screens and websites supporting My Health Record.
Analysis of factors contributing to results
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Innovation
Australians are choosing to use digital apps, tools and services as their preferred means to manage their personal and professional lives, and increasingly, they expect digital apps and services to support their health and care needs too.
Healthcare professionals want innovative tools that are not only safe and secure but also integrate with their workflow and improve efficiency. The innovation program is focused on supporting initiatives to enable industry and entrepreneurs to expand existing services and create new services that meet the changing needs of both patients and providers. The goal is for government to be a platform for industry and innovators to foster an agile and self-improving health system that is sustainable.
In addition to the innovation program outlined in the annual performance statements, in 2020-21 the program focus included these initiatives.
1. Clinician Vaccine Integrated Platform
The Agency developed an integrated platform – the Clinician Vaccine Integrated Platform (CVIP) – so vaccine providers who did not have conformant or integrated software could upload COVID-19 vaccination details to the Australian Immunisation Register (AIR) and meet their reporting obligations.
Free to use and available online through a web browser or downloaded as an app, by July 2021, more than 1700 providers using CVIP had lodged more than 550,000 vaccination encounters with AIR.
2. Innovation Challenge
In 2020, and against the backdrop of COVID-19, the Agency hosted its first Innovation Challenge. It was a an opportunity for Australian industry and academia to share ideas to solve key healthcare challenges and put forward digital tools to help improve the quality of healthcare services for Australians. Nearly 400 applications were received with the winners:
- CareMonitor
- Fred IT
- Allergy pal
- Disease Tracker
- Oculo
The winning entrants enabled delivery of care in new ways to improve health outcomes, strengthen responses to health emergencies and accelerate digital health into the future.
3. Experience Centre
Supporting the acceleration of innovation in digital health – particularly opportunities and behaviours arising from the COVID-19 pandemic – the Agency established an Experience Centre in 2021. This is a physical space in the Sydney office and a virtual space to facilitate ideation, participatory design, user testing and validation of the benefits that could be realised through adoption of new digital solutions in partnership with users and via simulated settings. Scheduled for launch in 2021-22, the centre will be used to identify validated solutions and applications prior to scaling, supported by data modelling and aligned to demonstrated benefits realisation. The Agency plans to partner with stakeholders sector-wide to collaborate and innovate.
Analysis of factors contributing to results
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Visit
https://www.transparency.gov.au/annual-reports/australian-digital-health-agency/reporting-year/2020-21-10