Annual performance statements 2020–21
Statement of preparation by accountable authority
On behalf of the Board, I present the 2020–21 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
16 September 2021
Performance targets from the Portfolio Budget Statements 2020-21
This section reports on the Australian Digital Health Agency’s 2020–21 results against the performance measures and supporting annual targets published in the Minister for Health’s Portfolio Budget Statements 2020–21 (PBS) and in the Agency's Corporate Plan 2020–21. The measures have been developed to assess the Agency’s delivery of the seven strategic priority outcomes (strategic pillars) to be achieved by the Agency by June 2022, as outlined in Australia’s National Digital Health Strategy (2018-2022).
The Agency has been successful in progressing the objectives of the National Digital Health Strategy in 2020-21 and achieving the Agency’s purpose:
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.
In addition to these specific performance outcomes, the Agency has also successfully delivered a range of other initiatives outlined in the following national work program delivery.
A performance analysis is provided in the table below for each 2020/21 target, noting that all targets have been met or exceeded.
2020–21 target and source
Health information that is available whenever and wherever it is needed
My Health Record system operability, availability and usage is maintained or improved for the benefit of Australians and the Australian healthcare system.
1. Maintain My Health Record software, hardware and storage currency.
2. Maintain My Health Record system availability of at least 99%, excluding planned outages.
3. Maintain or increase the percentage of healthcare provider organisation registrations and usage of the My Health Record across clinical settings.
Source: PBS p186, CP p17
1. My Health Record software, hardware and storage currency was maintained, and a range of enhancements delivered to allow early visibility of COVID-19 pathology reports and to support implementation support for the COVID-19 vaccine rollout. These enhancements improved provider and consumer access to important vaccination and immunisation information. The enhancements include:
2. My Health Record system availability was maintained at 100%, exceeding the 99% target. This is an improvement on all previous years, including 2019-20, when My Health Record system availability was 99.96%.
3. The Agency maintained healthcare provider participation in the My Health Record system, and increased registration or use in the categories bolded below. Use is defined as an organisation uploading to, or viewing, at least one My Health Record at any time.
June 2020 comparison with June 2021
Registrations have remained consistent at 99%
Use has increased by 14% from 81% to 95%
Private Hospitals – Day
Registrations have increased by 6% from 16% to 22%
Use has increased by 1% from 5% to 6%
Private Hospitals – Inpatient
Registrations have increased by 1% from 68% to 69%
Use has decreased by 1% from 55% to *54%
* This does not represent a drop in real terms: some sites were re-classified during the year (from inpatient to day surgery) as part of ongoing data reconciliation processes.
Registrations have increased by 2% from 95% to 97%
Use has increased by 4% from 91% to 95%
Registrations have increased by 4% from 10% to 14%
Use has increased by 2% from 4% to 6%
Pathology labs – public
Registrations have increased by 4% from 95% to 99%
Use has remained consistent at 99%
Pathology labs - private
Registrations have increased by 4% from 77% to 81%
Use has remained consistent at 67%
Diagnostic Imaging sites – public
Registrations have remained consistent at 79%
Use has increased by 1% from 78% to 79%
Diagnostic Imaging sites – private
Registrations have increased by 4% from 70% to 74%
Use has increased by 3% from 23% to 26%
High public hospital registrations reflect both significant participation by larger facilities and digital enablement across small and remote sites. As we reach near full utilisation in the public hospital sector, expectations of further increases are low. The focus is to maintain active meaningful usage of the My Health Record system, as well as increase the diversity of document types uploaded by public hospitals.
Similarly, with larger private hospitals now registered, engagement strategies continue to support the considerable number of larger single facility operators and smaller private day surgeries to connect to the My Health Record system, as they invest in their digital capability and engage their vendors. The largest engagement was among private day surgeries, where an additional 6% of private day surgeries registered for the My Health Record system in 2020-21.
Although usage of the My Health Record system across private hospitals (both inpatient and day surgeries) was low compared with usage in public hospitals, it is not unexpected the natural increase in usage was impacted as the sector prioritised resources to support the response to COVID-19 and experienced a drop in non-urgent elective surgery.
In 2020-21, one public and five private pathology organisations began uploading diagnostic reports. More than 95% of public labs and 42% of private organisations (comprising 64% private pathology labs) are uploading reports. Work is ongoing to register more laboratories and increase use by labs.
Over 60 million pathology reports were uploaded – a 121% increase over the previous year. More than 80% of Australians are now able to access a pathology lab that can upload their reports with My Health Record.
Engagement is focused on private diagnostic imaging organisations to support their registration. One public and eight private diagnostic imaging services started uploading diagnostic reports. Seventy-nine percent (79%) of public diagnostic imaging service locations are uploading reports. Seventeen percent (17%) of private diagnostic imaging organisations (comprising 26% practice locations) are uploading reports. More than six million diagnostic imaging reports were uploaded – an 82% increase over the previous year.
All major community pharmacy software products are My Health Record conformant, enabling access to almost all pharmacists across Australia. Registration rates are at 99% but usage rates are slightly lower, at 95%, highlighting the ongoing need for continued education and engagement with the community pharmacy sector to translate registrations into use.
There were two major contributing factors to this result:
In 2020-21, most pharmacies who initially registered approximately two years ago reached their two-year expiry of NASH certificates. This generated a large volume of work not only to renew these certificates but also to register to these pharmacies for Provider Digital Access (PRODA – an online identify verification and authentication system) as their initial registration occurred prior to PRODA Healthcare Provider Identifier for Organisations (HPI-O) registration. The rollout of electronic prescribing resulted in an increased number of HPI-O registrations and certificate renewals, which in turn had a positive effect on registration.
Health information that can be exchanged securely
All supported patient data is exchanged securely between healthcare providers.
1. Enhance secure messaging software capability across the health landscape.
2. Develop the business case for the Service Registration Assistant (now renamed Provider Connect Australia) *
Source: PBS p186, CP p17
* a national capability that will streamline the process for healthcare providers to register and maintain details about their healthcare service and practitioners with any external service providers and government programs with whom they have a relationship.
1. Secure messaging software capability
The now completed Secure Messaging Industry Offer (SMIO) included 56 vendor products participating to enhance their software products to include capabilities such as standardised payloads, the Fast Healthcare Interoperability Resource (FHIR), Application Programming Interface (API), federated lookup capability and standardised acknowledgements to drive adoption and use of secure messaging in the sector.
Of the 56 vendor products, 48 (86%) complied with the SMIO requirements and have released their enhanced products, extending the adoption of secure messaging capabilities across users of electronic medical records and clinical information system software.
2. Provider Connect Australia
The business case for a nationally scaled Provider Connect Australia (formerly Service Registration Assistant) was approved by the Agency Board in February 2021. This project achieved meaningful progress towards realising a federated provider directory capability, thus providing the technical platform for improved continuity of care through increased information exchange across care settings.
Accurate and reliable information about healthcare services is a necessary foundation to support a digitally connected healthcare system. The Provider Connect Australia service will enable healthcare organisations to maintain and publish an authoritative record of their healthcare services and practitioner details to their business partners. This will not only improve the efficiency of healthcare organisations (reducing their administrative burden) but also dramatically uplift the completeness, timeliness, accuracy and availability of healthcare service information and healthcare identifiers across the health ecosystem.
Ultimately, Provider Connect Australia will reduce the IT burden on health services by being the single source of truth for up-to-date, consistent information about providers and health services. In turn, this will significantly reduce provider red tape and enable messages to pass easily and securely between them.
High quality data with a commonly understood meaning that can be used with confidence
Progress towards delivering high-quality healthcare data, with a commonly understood meaning, that can be used with confidence to exchange clinical information between healthcare providers, and the systems they use, to improve the quality of patient care.
Develop a National Health Interoperability Implementation Plan for consultation and approval by all jurisdictions.
Source: PBS p187, CP p18
Following agreement of the National Health Interoperability Principles by all Australian health departments, the National Health Interoperability Steering Committee was established in October 2020 to support the development of the Interoperability Plan.
The plan was developed and informed by analysis related to healthcare identifiers, standards, information sharing, maturity measurement and innovations enabled through interoperability. The Jurisdictional Advisory Committee has endorsed the stakeholder consultation and approval stages to take place over 2021-22.
Better availability and access to prescriptions and medicines information
Better availability and access to prescriptions and medicines information for Australians.
1. 500,000 PBS prescriptions are prescribed as electronic prescriptions.
2. 30 healthcare software systems are conformant for electronic prescribing and exchanging e-scripts.
Source: CP p18
1. Electronic prescribing
The implementation of electronic prescribing is a joint initiative of the Department of Health and the Agency. As part of the Australian Government’s COVID-19 National Health Plan, accelerated implementation of electronic prescribing was announced on 11 March 2020 and the first electronic prescription in primary care issued on 6 May 2020. The Agency delivered well beyond target owing to the higher priority given to this initiative as part of the COVID-19 response.
In 2020-21, 11,055,641 electronic prescriptions, including both original prescriptions and pharmacy repeat prescriptions were issued. More than 21,000 prescribers have issued them and at least 98% of all Pharmaceutical Benefits Scheme (PBS) approved community pharmacies are dispensing electronic prescriptions.
2. Conformant software
The availability of electronic prescriptions was made possible by the development and release to market of software conformant to the electronic prescribing conformance profiles published by the Agency. As of 30 June, 57 electronic prescribing product versions across 38 software products were conformant for electronic prescribing and listed on the Agency’s electronic prescribing conformance register.
Digitally- enabled models of care that improve accessibility, quality, safety and efficiency
Models of care are enhanced through digital health, improving accessibility, quality, safety and efficiency for the benefit of consumers and the health system
1. Increase the usage of electronic prescriptions and telehealth within the Communities of Excellence as demonstrated by case studies.
2. Increase the usage of Advance Care Planning documents in the My Health Record system by 50% compared with 2019-20.
Source: CP p18
1. Electronic prescribing and telehealth were introduced in Communities of Excellence in June 2020.
Across the three Communities of Excellence – Emerald (Qld), Hedland (WA), and East Arnhem (NT) – the uptake of electronic prescriptions during 2020-21 was as follows:
Electronic prescriptions were embraced by the local community, as confirmed by these comments:
“While having a conversation to some friends in one of the metros in CQ, it took me a while to catch up with the blank look on their faces about what I had started to get very used to doing in our techno hub of Emerald.
“I thought everybody was using e-scripts, I know I didn't need to be asked twice by my doctor. I mean how simple is this: get an electronic script sent by your doctor to your phone, repeat is sent back to your phone, you save the number in your contacts as prescriptions. That is where your next 3 or 4 repeats, and all future scripts come to.
“No paper, no need to worry about forgetting your script. The pharmacies in Emerald love it, so good for business, good for environment and more importantly, good for my health."
Former Central Highlands Mayor Paul Bell AM (Emerald Qld)
Use of telehealth services across the three Communities of Excellence:
Telehealth uptake was strong in hospitals, general practices, Aboriginal Community Controlled Health Organisations and pharmacies but not in private specialist or allied health practices.
Telehealth was embraced by the local community, as confirmed by these comments:
“Many family conferences coordinated by the health workers with our Sydney-based doctor, who is well known and loved through his time spent in Laynha homelands, have provided valuable stories about complex health management.
Three-way conversations with specialist health teams in Darwin enable healthcare planning to happen in real time. The technology is well received by people in community.”
2. Advance care planning
Nationally, the views of advance care planning documents in My Health Record increased by 83% when compared with 2019_20 as a direct result of the addition of the new goals of care document type. Uploads of all types of advanced care planning documents increased by nearly 20%. This was supported by the launch of the National Guidelines for Advance Care Planning and My Health Record, as well as the clinical and consumer campaigns led by the Agency.
A workforce confidently using digital health technologies to deliver health and care
Healthcare professionals are using digital health technologies more confidently to improve the quality and safety of patient care
Increase the confidence of nurses, midwives, cardiologists and surgeons in using digital health technologies.
Source: CP p19
In 2020-21 the Agency continued and completed major projects designed to enhance digital health capability within the health workforce to increase health practitioner confidence using these technologies.
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.
Progress three innovation initiatives as demonstrated by case studies.
Source: CP p19
The Agency aims to increase adoption of My Health Record by connecting the platform to mobile applications that support the delivery of health using mobile devices (known as mHealth). This innovation involves the implementation of a streamlined and digitised onboarding process for mobile app developers applying through the Agency Developer Centre to connect with My Health Record. The Agency Developer Centre enhancements went live in July 2021.
National Infrastructure Modernisation (NIM)
The Agency successfully completed requirements, high-level design and procurement activities for the Health API Gateway – the first major deliverable under the NIM program. A contract will be awarded at the start 2021-22 to establish this modernised API Gateway platform based on contemporary technologies and standards, which will become the single point of access into the My Health Record system and other digital health products and services over time.
The NIM program also progressed design and scoping for subsequent phases of modernisation with a plan to develop a more modular contemporary national infrastructure over time. Scoping for the next phase of work is also complete and will progress to market in 2021-22.
National Authentication Service for Health (NASH) improvements
Enhancements to the national infrastructure were completed that allow NASH certificates to be used to access the Healthcare Identifiers Service. The Agency completed consultation and planning to support the transition from existing NASH certificates to a more secure form of NASH certificates (SHA-2 certificate) consistent with the Digital Transformation Agency’s Gatekeeper Public Key Infrastructure Framework. That framework governs the way the Australian Government uses digital keys and certificates to assure the identity of subscribers to authentication services.
NASH improvements is a two-year program of work extending through 2021-22 expected to deliver: