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Australia’s health industry has a long history of using innovative technologies to improve health care delivery. In 1929, the invention of an affordable pedal-powered radio gave people in isolated areas access to advice and emergency medical services. In many ways, this radio was a predecessor to the digital advancements that were to come, and which have since been used to create a more sustainable system and respond to system-wide challenges including increased cost and demand pressures, access barriers, greater demand for personalised care and an ageing population.
Digital health is an umbrella term referring to a range of technologies that can be used to treat patients and collect and share a person’s health information, including mobile health and applications, electronic health records, telehealth and telemedicine, wearable devices, robotics and artificial intelligence.
Examples may include: My Health Record, fitness trackers, smartwatches, sleep trackers, wellness applications, SMS reminders via mobile messaging, electronic discharge summaries, electronic prescribing, secure messaging, voice interfaces, medical drones, paperless hospitals, implanted microchips, robotic nurse assistants, and so forth.
This page explains how digital health is being widely used, and as set out in the National Digital Health Strategy. Available national data on the uptake of digital health in the delivery of health services is limited, but there are many examples of its use.
There were 14.7 million internet subscribers in Australia at the end of June 2018, and 3.8 million terabytes of data were downloaded in the 3 months before 30 June 2018 (ABS 2018). Almost 91% of Australians have a smartphone and there were about 27 million mobile handset subscribers at 30 June 2018 (ABS 2018; Deloitte 2019). Globally, 2.5 quintillion bytes of data are created each day, and over 90% of this data was generated in the last 2 years—this would fill 10 million Blu-ray discs, the height of which stacked would measure 4 times the height of the Eiffel Tower (Forbes 2018). The majority of Australians are digitally connected in some way.
Almost three-quarters (73%) of Australians have used the internet to research a health issue, including the majority of older Australians (69% of those aged 65 and over), and most Australians (77%) would like their doctor to suggest health information websites (ADHA 2017). However, only a small proportion (6%) of Australians find an online health source that they trust (ADHA 2017).
The application of digital technology in health may bring improvements in service quality, efficiency and equity (WHO WPRO 2018). This creates opportunities for a health system that has as its aim enabling individuals, families and communities to maintain and improve their health through timely access to quality services.
Good health outcomes are produced by providers and health care users and their families working together. Users, their families and communities must be informed and empowered so that they participate actively in their own health care and can also influence health system development. Using digital technology may help to:
For health service providers, digital technology enables the right information to be available in the right place at the right time, which helps with better communication and connection between health services. Using digital health technology may help improve:
For the overall health system, digital technology can improve the functioning and relationships between different parts of the health system environment. Using digital technology may help to:
Non-attendance at scheduled appointments is a barrier to health care users receiving timely health care. It is also a major source of lost resources and underuse of health service provider time. Studies, mostly focused on accessible patient populations, suggest that non-attendance is caused by negative health care user–health service provider relationships, patients’ perceived knowledge about the diseases and experience with treatment regimens, forgetfulness, administrative errors making and cancelling appointments, and lack of transport (Akter et al. 2014; Paterson et al. 2010; Wilkinson & Daly 2012). Other studies have also found that wider social issues, including low socioeconomic position and low health literacy, are perceived as important determinants of non-attendance for some groups (Collins et al. 2003).
Electronic reminders via mobile text messages are a non-intrusive way to address this issue, especially given there is widespread use and acceptance of mobile technologies across different socioeconomic and cultural groups (Kannisto et al. 2014). Examples include increasing patient adherence to medication regimes for patients with different chronic diseases by reminding them of when to take medicines (Kannisto et al. 2014; Spoelstra & Sansoucie 2015), improving attendance at scheduled appointments (Boksmati et al. 2016; Poorman et al. 2015; Stubbs et al. 2012), and through provision of educational and motivational health information. Two-way messaging often promotes successful outcomes by generating personalised communication between health care service providers and users, allowing consumers to confirm receipt of the message or indicate whether they have taken their medicine or are able to attend their upcoming appointment (ACSQHC 2018).
There is little published research on whether improved attendance at appointments translates into improved health outcomes (Gurol-Urganci et al. 2013). It is also unclear what the best timing, rate and degree of personalisation of mobile phone reminders are. More research about message content, timing and frequency may help to define how text messaging can increase positive outcomes, and inform successful implementation of messaging.
Timely sharing of high-quality information at transitions in care is recognised as critical to continuity of care and promotion of patient safety. An example of a transition of care is between acute and primary care service providers at patient discharge from hospital. However, in health systems where primary and acute care is provided by separate services, the transmission of discharge summaries to primary care providers is often delayed. Also, the quality of information contained in conventional discharge summaries may be suboptimal. Information about pending test results, discharge planning and medication changes may be left out, which could jeopardise health outcomes (ACSQHC 2018; Kattel et al. 2020).
Electronic discharge summaries have been shown to help in the preparation and transmission of patient information to primary care service providers in a timely manner (Unnewehr et al. 2015). They are also more successful when automatically filled in with information from a hospital’s electronic health record, delivered via secure messaging, and use reminders for health service providers to complete the electronic discharge summaries (ACSQHC 2018).
At November 2018, more than 700 public hospitals and health services across Australia were connected to the My Health Record system and are able to upload care summaries for patients with a My Health Record (ADHA 2018).
Governments have a role in setting policy and other frameworks that help to facilitate and manage advances in digital health to the benefit of users, providers and the system. This includes establishing frameworks for information sharing and technology adoption.
The National Digital Health Strategy sets out 7 strategic priorities intended to support Australia’s vision for digital health:
Outlined below are examples of initiatives under the National Digital Health Strategy that can be used, directly or indirectly, to improve health information availability and utility in Australia.
One of the main initiatives to ensure key health information is available whenever and wherever it is needed is the My Health Record (MHR) system.
The MHR system began on 1 July 2012 and since then has grown to reach 90% of health system users through the implementation of opt-out arrangements in 2019. Over this time, MHR has grown in its capability, usability and integration with clinical information systems across the health sector. There are currently 22.68 million My Health Records, with more than 16,000 health care provider organisations registered to use it, and more than 1.7 billion documents (including clinical documents, prescription and dispensing documents, user documents and Medicare documents) stored in the MHR system at December 2019 (ADHA 2019).
As the system matures, an increasing amount of information will be available to guide health service planning, policy development and research to further improve Australia’s health system. De-identified data could be used to answer research and public health questions for which there are currently no data available. A data assessment is under way to analyse the strengths and limitations of using existing MHR data for research and public health purposes, and to quantify the impact of any identified data quality issues. A thorough understanding of the quality of MHR system data will inform whether de-identified data can be made available for research and public health purposes while upholding the strictest data quality and privacy standards.
While much is known about the health and welfare of children in Australia, there are notable gaps and limitations in national reporting of this topic. There are limited data on children’s interaction with community services, including maternal and child health services (AIHW 2019). Many children’s health-related records are captured in multiple paper or electronic systems. These systems vary between state and territory public hospitals and various primary health care settings in which child health services are delivered. Paper records are easily forgotten or misplaced, and information often needs to be entered separately into both paper and digital systems.
The National Children’s Digital Health Collaborative is one of the initiatives of Australia’s National Digital Health Strategy that is seeking to use digital technologies to help overcome these challenges. Development work is under way for a proof of concept for the Child Digital Health Record, which will capture information currently collected in a child’s hard-copy ‘baby book’, as well as a Digital Pregnancy Record. The Australian Digital Health Agency (the Agency) is developing a business case for transitioning the proof of concept into national infrastructure and linking it to My Health Record.
Data from digital technologies are only useful if they can be turned into meaningful information with due respect for privacy. This requires high-quality data and the use of data definitions and standards.
Metadata standards for health-related statistical reporting are stored in Australia’s online metadata repository, METeOR, hosted by the AIHW. Digital health standards are supported by the National Clinical Terminology Service, hosted by the Agency.
Under the National Digital Health Strategy, the Agency also works to ensure clinical information is better connected and seamlessly shared between patients and their health care providers. Development of a National Health Interoperability Roadmap is under way to address the challenges in the health sector that prevent information moving electronically among different health information systems and health care providers.
For more information on digital health, see:
ABS (Australian Bureau of Statistics) 2018. Internet activity, Australia, June 2018. Canberra: ABS.
ACSQHC (Australian Commission on Safety and Quality in Health Care) 2018. Impact of digital health on the safety and quality of health care. Australian Commission on Safety and Quality in Health Care. Viewed 4 November 2019.
ADHA (Australian Digital Health Agency) 2017. Australia’s National Digital Health Strategy: safe, seamless and secure. Sydney: ADHA. Viewed 4 November 2019.
ADHA 2018. Public hospitals and health services connected to the My Health Record system. Sydney. ADHA. Viewed 17 February 2019.
ADHA 2019. My Health Record statistics. Sydney: ADHA. Viewed 4 November 2019.
AIHW (Australian Institute of Health and Welfare) 2019. Australia’s children—in brief. Canberra: AIHW. Viewed 14 February 2020.
Akter S, Doran F, Avila C, Nancarrow S 2014. A qualitative study of staff perspectives of patient non-attendance in a regional primary healthcare setting. AMJ (Australasian Medical Journal) 2014, 7, 5, 218–226.
Boksmati N, Butler-Henderson K, Anderson K & Sahama T 2016. The effectiveness of SMS reminders on appointment attendance: a meta-analysis. Journal of Medical Systems 2016; 40 (4):90.
Collins J, Santamaria N & Clayton L 2003. Why outpatients fail to attend their scheduled appointments: a prospective comparison of differences between attenders and non attenders. Australian Health Revue 2003; 26 (1):52–63.
Deloitte 2019. Australia reaches peak smartphone. Mobile Consumer Survey 2019. Viewed 15 November 2019.
Forbes 2018. How much data do we create every day? The mind-blowing stats everyone should read. Viewed 4 November 2019.
Gurol-Urganci I, de Jongh T, Vodopivec-Jamsek V, Atun R & Car J 2013. Mobile phone messaging reminders for attendance at healthcare appointments. Cochrane Database of Systematic Reviews 2013; 12.
Hambleton S & Aloizos J 2019. Australia's digital health journey. MJA (The Medical Journal of Australia) 2019; 210 (6).
Kannisto KA, Koivunen MH & Valimaki MA 2014. Use of mobile phone text message reminders in health care services: a narrative literature review. Journal of Medical Internet Research 2014; 16 (10).
Kattel S, Manning DM, Erwin PJ, Wood H, Kashiwagi DT & Murad MH 2020. Information transfer at hospital discharge: a systematic review. Journal of Patient Safety 2020; 16(1).
National Children’s Digital Health Collaborative 2019. About the Collaborative. Sydney: National Children’s Digital Health Collaborative. Viewed 4 November 2019.
Paterson BL, Charlton P & Richard S 2010. Non-attendance in chronic disease clinics: a matter of non-compliance? Journal of Nursing and Healthcare of Chronic Illness 2010; 2 (1):63–74.
Perillo A. Connecting users to their digital health: Perspectives on users opportunities in the digital healthcare revolution: Telstra Health. Viewed 4 November 2019.
Poorman E, Gazmararian J, Parker RM, Yang B & Elon L 2015. Use of text messaging for maternal and infant health: a systematic review of the literature. Maternal and Child Health Journal 2015; 19 (5):969–89.
Ramaswami P 2015. A remedy for your health-related questions: health info in the knowledge graph. Google. Viewed 4 November 2019.
Research Australia 2016. Australia Speaks! Research Australia Opinion Polling 2017 Sydney. Viewed 4 November 2019.
Spoelstra SL & Sansoucie H 2015. Putting evidence into practice: evidence-based interventions for oral agents for cancer. Clinical Journal of Oncology Nursing 2015; 19 (3):60–72.
Stubbs ND, Sanders S, Jones DB, Geraci SA, Stephenson PL 2012. Methods to reduce outpatient non-attendance. American Journal of the Medical Sciences 2012; 344 (3): 211–9.
Unnewehr M, Schaaf B, Marev R, Fitch J, Friederichs H 2015. Optimizing the quality of hospital discharge summaries: a systematic review and practical tools. Postgraduate Medicine 2015 Aug; 127 (6): 630–9.
WHO (World Health Organization) 2018. Regional action agenda on harnessing e-health for improved health service delivery in the Western Pacific. WHO. Viewed 4 November 2019.
Wilkinson J & Daly M 2012. Reasons for non-attendance: audit findings from a nurse-led clinic. The Journal of Primary Health Care 2012 Mar; 4 (1): 39–44.
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