Australian Digital Health Agency Research Articles

Methodology for the Development of the Australian National Nursing and Midwifery Digital Health Capability Framework.

Internationally healthcare organisations and governments are grappling with the issue of upskilling healthcare workforces in relation to digital health. Significant research has been undertaken in relation to documenting essential digital health capability requirements for the workforce. In 2019 the Australian Digital Health Agency funded work by the Australasian Institute of Digital Health to develop a National Nursing and Midwifery Digital Health Capability Framework. This paper describes the methodological approach used in the development of the Framework.

Role of digital technology in delivering 'healthy futures' and 'healthy cities'.

Digital health technologies and services play a critical role in the delivery of safe and efficient healthcare and better health outcomes. Interoperability of these technologies and services, as well as digital inclusion for communities are important enablers of a modern, connected health system. The ongoing development of these factors is an aspiration of Australia's National Digital Health Strategy (NDHS). The Australian Digital Health Agency co-designed the NDHS with input from healthcare consumers and providers, digital health industry, academic and policy experts and organisations. Approved by all Australian governments in 2017, it provides a forward vision to 2022, with seven pillars that include: Access to health information through My Health record; Secure Messaging; Medicines Safety; Interoperability; Enhanced models of care; Workforce and Education and Driving Innovation. All of these pillars have interdependent features, and many play a role in enabling communities to live healthier and happier lives supported by better connected healthcare services as well as access to information in a timely and efficient manner at the point of care. A 'Communities of Excellence' programme has supported regional communities to connect health services to My Health Record, increase digital health tools use and provide digital health literacy support to consumers. The aims of this programme are to allow the benefits of improved interoperability and better connected care to flow to people and their clinicians, test innovation that could go on to be scaled nationally, and close the health inequity gap experienced by people in rural and remote communities.

Utilisation of the Australian government initiative MyHealth Record to support the clinical approach to factitious disorder

AbstractRecently, the Australian Digital Health Agency launched MyHealth Record to the public. As of July 2019, 90.1% of Australians hold records with this service, allowing 16 400 health organisations access to >28 million clinical documents. The streamlining of patient data was intended to facilitate sharing of information and improve communication between medical providers, while promoting efficiency in clinical practice. We have identified a hitherto unrecognised application of this infrastructure in the identification and management of factitious disorder, a rare yet highly diagnostically challenging condition involving intentional feigning of illness, which presents a significant resource burden to the Australian health system.

Nurses as Stakeholders in the Adoption of Mobile Technology in Australian Health Care Environments: Interview Study.

BackgroundThe 2017 Australian Digital Health Agency (ADHA) Strategy is based on the underlying assumption that digital technology in health care environments is ubiquitous. The ADHA Strategy views health professionals, especially nurses, as grappling with the complexity of installing and using digital technologies to facilitate personalized and sustainable person-centered care. Yet, ironically, the 2018 debate over how to enroll Australians into the national electronic health record system and its alteration from an opt-in to an opt-out model heightened public and professional concern over what constituted a “safe, seamless and secure” health information system. What can be termed a digital technology paradox has emerged where, although it is widely acknowledged that there are benefits from deploying and using digital technology in the workplace, the perception of risk renders it unavailable or inaccessible at point of care. The inability of nurses to legitimately access and use mobile technology is impeding the diffusion of digital technology in Australian health care environments and undermining the 2017 ADHA Strategy.ObjectiveThis study explored the nature and scope of usability of mobile technology at point of care, in order to understand how current governance structures impacted on access and use of digital technology from an organizational perspective.MethodsIndividual semistructured interviews were conducted with 6 representatives from professional nursing organizations. A total of 10 interview questions focused on factors that impacted the use of mobile technology for learning at point of care. Seven national organizations and 52 members from the Coalition of National Nursing and Midwifery Organisations were invited to participate. Interviews were recorded and transcribed verbatim. Data analysis was systematic and organized, consisting of trial coding; member checking was undertaken to ensure rigor. A codebook was developed to provide a framework for analysis to identify the themes latent in the transcribed data. Nurses as stakeholders emerged as a key theme.ResultsOut of 6 participants, 4 female (67%) and 2 male (33%) senior members of the nursing profession were interviewed. Each interview lasted between 17 and 54 minutes, which reflected the knowledge of participants regarding the topic of interest and their availability. Two subthemes, coded as ways of thinking and ways of acting, emerged from the open codes. Participants provided examples of the factors that impacted the capacity of nurses to adopt digital technology from an emic perspective. There were contributing factors that related to actions, including work-arounds, attentiveness, and experiences. Nurses also indicated that there were attitudes and influences that impacted thinking regarding access and use of mobile technology at point of care.ConclusionsNurses are inadequately prepared for the digital future that has now arrived in health care environments. Nurses do not perceive that they are leaders in decision making regarding digital technology adoption, nor are they able to facilitate digital literacy or model digital professionalism.

E-health: psychosocial challenges for South Australian rural mental health consumers

Rates of mental health issues are increasing, coupled with insufficient resources to provide appropriate support. This is a particular challenge for rural areas in Australia that face significant social inequities including a scarcity of health resources. E-health initiatives are often proposed to maximise the number of rural mental health consumers able to receive support. The Australian Government has prioritised e-health within the remit of the Australian Digital Health Agency and the National Digital Health Strategy. However, despite increasing interest in e-health in policy and practice settings, uptake has been underwhelming. This study investigated the factors affecting the likely engagement with the internet, both for general and e-health purposes, within the context of South Australian rural mental health consumers. The focus was on psychosocial predictors, which embraced intrinsic (motivation), as well as extrinsic factors concerning equity, such as income, occupation, education and geographic location. Participants in this quantitative study included 208 mental health consumers in rural South Australia who had recently accessed a local health network mental health service. Data were sourced from the service's clinical management database and a questionnaire constructed for the study. The questionnaire included measures of personal characteristics, motives, equity and internet use. Motives and equity-related variables were directly linked to general internet use, which subsequently affected the likelihood of using the internet for health purposes. Intrinsic rather than extrinsic factors were the most significant drivers of internet use; that is, higher levels of general internet use were associated with being younger, having stronger motivation, greater trust, higher education, being employed, having a higher income and having home internet access. For health internet use, the identified significant associations were more modest and included only being younger, having stronger motivation, and greater trust. The model indicated that there were no direct predictors of internet use for health beyond use of the internet for general purposes. However, key study variables provided significant indirect paths to health internet use. General internet use was strongly influenced by motivation, and age and equity to a lesser extent. Motivation was influenced by trust, and age and equity, with trust also influenced by age and equity. This quantitative investigation sought to describe the barriers to and enablers of internet use generally, based on the assumption that before people will use the internet for health, they need to be prepared to use it for general purposes. The model proposed in the current research offers an indication of some of the factors that may influence rural mental health consumers' use of the internet for both general and health purposes. To appropriately design future e-health initiatives, the initial focus must be on consumers' individual capacity and willingness to use the internet generally. Policymakers and service providers are acutely interested in leveraging internet use to facilitate positive health outcomes. Understanding the factors that affect rural mental health consumers' use of the internet in general is beneficial in informing the efficient allocation of resources and the appropriate design of e-health initiatives to produce innovative solutions.

Digital health benefits evaluation frameworks: building the evidence to support Australia's National Digital Health Strategy.

Digital health benefits evaluation frameworks: building the evidence to support Australia's National Digital Health Strategy.

My Health Record implementation in private specialist practice.

My Health Record implementation in private specialist practice.

Sharing information safely and securely: the foundation of a modern health care system.

Sharing information safely and securely: the foundation of a modern health care system.

‘I’d like to think you could trust the government, but I don’t really think we can’: Australian women’s attitudes to and experiences of My Health Record

The Australian government’s Australian Digital Health Agency is working towards its goal of enrolling every Australian in My Health Record, its national electronic health record system. This article reports findings from a qualitative project involving interviews and focus groups with Australian women about their use of digital health across the range of technologies available to them, including their attitudes to and experiences of My Health Record. A feminist new materialism perspective informed the project, working to surface the affordances, affective forces and relational connections that contributed to the opening up or closing off potential agential capacities when people come together with digitised systems such as My Health Record. These findings demonstrate that people’s personal experiences and feelings, the actions of others such as the agencies responsible for system implementation and function, their healthcare providers and broader social, cultural, technological and political factors are important in shaping their knowledge, interest in and acceptance of an electronic health record system. Even among this group of participants, who were experienced and active in finding and engaging with health information online, uncertainty and a lack of awareness of and interest in My Health Record were evident among many. Affordances such as technical difficulties were major barriers to enrolling and using the system successfully. No participants had yet found any benefit or use for it. Affective forces such as lack of trust and faith in the Australian government’s general technological expertise and concerns about data privacy and security were also key in many participants’ accounts.

Developing a Third-Party Analytics Application Using Australia's National Personal Health Records System: Case Study.

BackgroundMy Health Record (MyHR) is Australia’s national electronic health record (EHR) system. Poor usability and functionality have resulted in low utility, affecting enrollment and participation rates by both patients and clinicians alike. Similar to apps on mobile phone app stores, innovative third-party applications of MyHR platform data can enhance the usefulness of the platform, but there is a paucity of research into the processes involved in developing third-party applications that integrate and use data from EHR systems.ObjectiveThe research describes the challenges involved in pioneering the development of a patient and clinician Web-based software application for MyHR and insights resulting from this experience.MethodsThis research uses a case study approach, investigating the development and implementation of Actionable Intime Insights (AI2), a third-party application for MyHR, which translates Medicare claims records stored in MyHR into a clinically meaningful timeline visualization of health data for both patients and clinicians. This case study identifies the challenges encountered by the Personal Health Informatics team from Flinders University in the MyHR third-party application development environment.ResultsThe study presents a nuanced understanding of different data types and quality of data in MyHR and the complexities associated with developing secondary-use applications. Regulatory requirements associated with utilization of MyHR data, restrictions on visualizations of data, and processes of testing third-party applications were encountered during the development of the application.ConclusionsThis study identified several processes, technical and regulatory barriers which, if addressed, can make MyHR a thriving ecosystem of health applications. It clearly identifies opportunities and considerations for the Australian Digital Health Agency and other national bodies wishing to encourage the development of new and innovative use cases for national EHRs.

Demographic characteristics of Australian health consumers who were early registrants for opt-in personally controlled electronic health records.

Differential uptake of, or access to, personal electronic health records (PEHRs) has the potential to impact on health disparities among certain social groups. In 2012, the Australian Government introduced the Personally Controlled Electronic Health Record (PCEHR), an opt-in system operated by the then National E-Health Transition Authority (NEHTA). In July 2016, the My Health Record (MyHR), an opt-out model, operated by the Australian Digital Health Agency replaced the PCEHR, providing additional support for consumers. This research was carried out between 2012 and 2015, covering the opt-in PCEHR phase. The aim of the study was to explore demographic characteristics of Australian health consumers who were first to register for a PEHR, and to identify the age and gender populations less likely to register for a PEHR in the opt-in format. The study aimed to provide early data on registrants and potential methods to encourage individuals to register for a PEHR. A cross-sectional study investigated differences in registrations for PEHRs from 2012 to 2015 by age and sex. Results revealed that males were less likely to register than females, and adolescents of both sexes were the least likely to register when compared with any other age group. Similarly, middle-aged males had among the lowest reported registrations, as did older females. While e-health has the potential to improve health outcomes and PEHRs the potential to empower consumers to better manage their health and improve their access health services, evidence from this study suggested that some population groups that experience health inequalities (e.g. older people) were underrepresented among registrants for PEHRs. As income, ethnicity and education are major drivers for health disparities in Australia, future research should focus on uptake and use of PEHRs (now the MyHR) from the perspective of these variables.