Post on 30-Aug-2018
www.digitalhealth.gov.au
Adobe Summit: Government The My Health Record Digital Journey
Rachel de Sain
Executive General Manager, Innovation & Development Australian Digital Health Agency
www.digitalhealth.gov.au
About Us
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• Give consumers more control of their health and care when they wish it
• Connect and empower healthcare professionals • Promote Australia’s global leadership in digital health and innovation The Agency reports to its Board, appointed by the Minister.
The Agency is the system operator for the My Health Record, and a number of other clinical information systems and standards, and commenced operations on 1 July 2016.
The Agency is a Corporate Commonwealth Entity funded by all Australian Governments. It designs and operates national digital health services and set data standards that:
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“The digital health market will grow at over 25.9% compound annual growth rate to reach $379bn by 2024
Australia is well placed globally to take advantage of this growth as a test bed for health innovation and research
Hendersen et al. (2016)Global Market Insights, Inc 23 Nov 2016
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Figure 1: Accessing the internet, by age, 12 months to June (2011 and 2015)
Base: Australians aged 18 and over. Note: Relates to ever accessing the internet in the 12 months to June of each year. Source: Roy Morgan Single Source, June 2011 and 2015.
Older Australians are the highest increase in uptake, usage and engagement with both internet usage, mobile apps and online services.
Figure 2: Devices used most often to go online, six months to May (2014 and 2015)
Base: Australians (aged 18 and over, and 65 and over) who are internet users. Note: Relates to the most often used device to access the internet in the six months to May of each year. Source: ACMA-commissioned survey, May 2014 and 2015.
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Figure 3: Health and government information online, July 2014 to June 2015
Base: Australians (aged 18 and over, and 65 and over) who are internet users. Note: Relates to undertaking one or more internet activities online in the last four weeks (July 2014 to June 2015). Source: Roy Morgan Single Source, June 2015.
In Australia, 15 per cent of older internet users accessed government services, and health and medical information online. These proportions were closely aligned with the adult Australian online population as a whole.
A review of international data showed that the number of older online Australians who access health and government information is significantly lower than their UK and US counterparts.
In 2015, 30 per cent of older UK internet users looked up information and services on government or council websites, and 35 per cent accessed information on health-related issues.
The proportion of older users of government services online was even higher in the US, where 74 per cent of US internet users aged 65 and over had used a government website for transactions or information in 2010. In comparison, 2013 data on use of health information online indicated that only 30 per cent of US adults aged 65 and over had gone online for health information in the past year.
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National Digital Health Strategy
Australians value our high quality healthcare practitioners and workers, and generally experience affordable and accessible care
Over 65% of respondents say the Australian healthcare system is difficult to navigate. People want to know the cost, quality, and availability of services
Over 45% of respondents had difficulty accessing healthcare when they needed it. Top reasons given: - Cost, - Location, and - Couldn’t get an appointment
More than four times as many people want to access their personal health information on their smart phone than do currently
The top three activities people want to be able to do on their mobile device: 1. Manage their medications 2. Track their health 3. Request refill prescriptions
www.digitalhealth.gov.au
Delivery themes emerging from consultationForums
Interviews Submissions Surve
ys
History
Peer
-revie
wed
Rese
arch
Eviden
ce
Analysis & Review
User Needs
Themes
Consultation & Evidence
PRIORITY AREAS
We are undertaking broad scoping reviews of the international peer reviewed and grey literature, including publications from key digital health organisations, policy and media, as well as conducting targeted interviews with digital health thought leaders
• 3,193 attendees
• 1050 written and survey submission from general public, organisations, technology sector etc.
• 103 forums, meetings and workshops
• Interviewed thought leaders across different sectors
• Deep engagement with jurisdictions to understand their strategies and priorities
Evidence
Consultation overview
Support me in making the right healthcare choices, and provide me with options
Help all the people who care for me to understand me, and together, provide safe and personalised care
Create an environment where my healthcare providers and I can use and benefit from innovative technologies
Preserve my trust in the healthcare system and protect my rights
• Vision • Priority Areas • Initiatives
CONSOLIDATED THEMES1 2 3 4
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Support me in making the right healthcare choices, and provide me with options
Help all the people who care for me to understand me, and together, provide safe and personalised care
Create an environment where my healthcare providers and I can use and benefit from innovative technologies
Preserve my trust in the healthcare system and protect my rights
“[I want] better culturally diverse resources, health literacy and personalised support” – Healthcare Provider, Female, Qld •11.7% of people >15 years of age in in rural/remote experienced difficulty accessing a doctor
“It is vital that medical professionals have access to a holistic view of patient data to fully understand the client’s needs…” •91% of people living with dementia live in the community rely on an informal carer to support them with 22% relying solely on informal care
“Our smartphones and tablets need to be an extension of access to the healthcare system and customizable to our individual needs.” •7% make an appointment online to see a doctor or organise a hospital appointment •83% complete doctor or hospital registration details online before visit •70% order prescription drug refills using mobile apps on your phone.
"I need to be confident that my information is securely held and that it is not going to be accessed by unknown people.” •In the UK, based on a cost to the NHS of £45 per GP visit, ensuring everyone had the basic digital skills to access health information online would provide savings of around £120 million a year by 2025
Delivery themes emerging from consultation
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My Health Record
An electronic summary of an individual’s health information that can be shared securely online between the individual and registered healthcare providers involved in their care to support improved decision making and continuity of care. • There are 230,000 hospital admissions due to
medication adverse events per year, costing up to $1.2 billion annually. My Health Record will reduce this number.
• Empowering people with health care information to support self-management could save $1,300 to $7,515 per patient per year.
• Sharing information electronically about tests could reduce unnecessary duplication by approximately 18% and significantly lower hospital re-admission rates.
Key Facts
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My Health Record is the future of medicine.
Dr Michael Gannon, President, Australian Medical Association
One of the recurring contributory factors identified during health-related coronial investigation and inquests is a failure in communication, particularly in documentation, discharge and handover…lapses in communication can have the potential for serious outcomes for patients. I cannot overstate the importance of effective communication in a health care setting.
Ms Ros Fogliani, State Coroner, Western Australia“
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The My Health Record is a secure electronic summary of a patient’s health records.
It provides an active online record from different sources that over time will follow patients as they move through Australia’s health system.
My Health Record
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My Health Record Statistics as at 14 May 2017
791,576941,679247,801
Age Range 45,51729
Pathology Reports 35,98447,269
State ACT TAS SA NT NSW VIC QLD WA% of population 23% 20% 18% 20% 21% 15% 27% 15%
7,514,2432,175,813
84,23736,21313,237
1,014
1,257,804463,977
285,726,713197,422,047
Australian Organ Donor Register
2,109,855
Shared Health SummaryDischarge SummaryEvent SummarySpecialist Letter
Demographic Breakdown
Approximately 20% of Australia's population is registered for a My Health Record
9,923 Healthcare providers registered
732
4,825,325 Consumers registered
1,237
134,701
484,870,5411,313
166
Prescription Documents
Advanced Care Directive Custodian Report
Australian Immunisation Register
Consumer Entered Health Summary
Dispense Documents
Consumer Entered Notes
Advance Care Planning Document
Pharmaceutical Benefits Report*Organisation type based on Healthcare Provider Organisation (HPI-O) data, except for Hospital provider data which is based on jurisdictional reported facilities that are connected to the My Health Record system.
Clinical Document Uploads
Prescription and Dispense Uploads
Consumer Documents
Medicare Documents
General PracticesPublic Hospitals and Health Services
% of total registrations
36% 25% 25%
Medicare/DVA Benefits Report
14%
46% are male54% are femaleAged 20 or less
254
Organisation Type* Count6,060
Retail PharmaciesAged Care Residential ServicesOther categories of healthcare providers including Allied HealthOrganisations with a cancelled registration
161Private Hospitals and Clinics
9,690,056
eReferral Note
Diagnostic Imaging Report
Aged 65 or higherAged 40-64Aged 20-39
My
Heal
th R
ecor
d U
sage
Prov
ider
Reg
istra
tions
Co
nsum
er S
tatis
tics
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National(Consumer( Portal
71#pages48#help#pages
Mobile(App(Services
15#APIs
B2B(Services((clinical(system(use)
15#APIs58#software#vendors
National(Provider( Portal
21#pages22#help#pages
Administration( &(Support( Portals
48#pages
Participation(&(
Authorisation(Services7#applications
95#auth.#policies
Document(Index(&(Store(
Services3#applications
Clinical( View(Services
3#applications9#aggregated#
views
Audit(&(Notification(Services
6#applications~597,000,000#audit#entries
Reporting( &(Analytics(Services
4#applications
Security(Information(&(Event(
Monitoring2#applications
Service'Co*ordination'Layer
National' Document'Index,'Repository' &'Clinical' Data'Cache
NPDR Medicare'Repository
Future'Pathology' Repository
467,890,728)documents)indexed10,576,269)document)stored
455,124,810)documents
Individuals(&(Representatives4,678,367#records
My(Health(Record(National(Infrastructure
Infrastructure#Sizing
!24/7%Support!99.9%%availability% service%level%met%since%August%2016!46%networking% appliances!55%physical%servers!>500%virtual% servers!7%superfast%data%appliances!11%environments!800%terabytes%of%allocated%storage
~250#txsper#day
~170#txsper#mnth
~590,000txs per#day
~32,500#txsper#day
Third(Party(Mobile(Apps(and(their(users3#in#production
Healthcare(Providers12,878#registered#providers
9,787#registered#organisations
Foundation(Services
~450,000#transactions#per#day
Healthcare% Identifiers
NASH
Clinical( Terminology
~1.3#million#linked#accounts~5,100#logins#per#day
myGov
~650%verifications%per%dayIdentity% Verification% /%
Proof%of%Record%Ownership%Service
Call(Centre
622#callsper#month
Diagnostic'Imaging'Repository41,108)
documents
As%at%27thMarch
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www.digitalhealth.gov.au
Interfaces of the My Health Record
Patient / Consumer
Clinician
Consumer Portal
Provider Portal
Clinical Information Systems
Specifications / standards
API’s3rd party mobile apps
2%
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R6.1 June 2015 R7 April 2016
Mobile responsive user interface implemented
R7.1 June 2016
Example introduced icon use implemented in R6.1 and major improvements to user
experience for Access Controls
UX improvement
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Flexible & Responsive
Personal and Context
Enhanced UX
Atomic design
AEM has a powerful responsive capability, which means that we
can think Mobile First. This is a major difference from the current Orion Implementation and is guiding our design work.
As we saw in the POC, the personalisation possibilities via AEM are impressive. In the POC, we showcased personalised messaging and content based on location, condition, context.
We are looking at the mobile and tablet experience, we are identifying some areas in the current experience that don’t directly translate. We are documenting these and how they are informing our design.
A modular approach allows us to take a holistic view and also think about the overall MyHealth experience, rather than a page-based approach. We are aiming for a consistent and enjoyable experience, agnostic of channel.
AEM & Experience Design Considerations
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By starting with the mobile we are designing a lean experience that can then be Progressive Enhanced as appropriate on other channels – making the experience more robust, rather than watering it down
Know who we are engaging with and understand what they need to do, when and why. Always considering how the Beside Manner can guide us in displaying the relevant information as needed.
We can often decide to serve up content in different ways. Mobile first, in fact forces us to do this in a way – by virtue of the fact that the screen size automatically focuses. Leading us to consider leaner IA, content hierarchy etc.
Holistic View + Modular Atomic Design + Contextual Page Guidance = Future Scalability. We’re creating an experience not pages.
Evolving to the unconstrained UX
Mobile First
Optimising Content & Context
Relevant to Needs
Atomic Modular design
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Medicines
Pathology
Diagnostic1Imaging
Usability1improvements
Operational1requirements
Single'view'of'medicines,'allergies,'adverse'reactions
Enhanced'search'and'filter'in'Pathology'Report'View
Upload'and'view'of'diagnostic'imaging'reports
Improved'consumer'access
Keeping'systems'up'to'date'and'secure
GOALSSupport1clinicians1with1their1medicines1reconciliation
Improve1searchability of1pathology1results1in1provider1portal1and1local1CIS
More1complete1and1timely1access1to1a1patient’s1diagnostic1imaging1results
Improve1success1rates1for1individuals1accessing1My1Health1Record1the1first1time
Release 8
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Better research capabilityA/B testingCapability to design and execute online tests, create audience segments, and target content and online experiences that will enable us to:
Learn more about what individuals and clinicians are searching for, where they land on websites and where they end up, and use this information to determine what is or isn’t working on webpages and take steps to improve user experiencesSee what type of headline attracts people to stay on the Consumer Portal for longer, and find hidden patterns and behaviours of use of My Health Record that guide how to encourage individuals to actively manage their careTrial different content in the Portals that are shown to a particular audience, or group, based on criteria such as,
prototypes of options to personalise first access to a My Health Record so people stay online longer, complete their personal details and record their preferences and status, and upload any advance care planning documents
comparison of user preferences for different prototypes of Access Dashboard, to address the complex language and diversity of individuals’ health conditions
testing a new shared care workflow with one jurisdictionDetermine how to create a mobile experience for individuals and clinicians that is smart-device friendly to support people who now access the services they need almost exclusively using mobile devices
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Adoption(of(the(Digital(Transformation(Agency’s(Digital(Service(Standard
Collaboration• co;design• validation(of(concepts(and(designs• core(design(teams• co;production
User;centred approach(• user(research• insights(from(evaluations(and(national(strategy(consultations• user(experience((UX)(improvements
Strong(governance(and(oversight• assurance:(clinical(safety,(security,(operations• release(management
Principles for enhancing My Health Record
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Input
• Help%desk• Feedback
• Forums
• Usage%statistics• Policy%directive
• Communication• Adoption
• Training
• Support• Simulators
Co-design Process
www.digitalhealth.gov.au27 www.digitalhealth.gov.au
How is My Health Record changing healthcare today? 1/2
It made me safe when I left hospital
“It was my son’s birthday and I visited him in Sydney to
celebrate. We checked into the hotel and three hours
later I was in the back of the ambulance on the way to
hospital. They found I had a thing called pancreatitis.
After four days in hospital, I talked them into letting me
out as long as I went to see my doctor for important
follow up work as soon as I got home. When I got to my
doctor I realised the hospital hadn’t given me any
information about the treatment I needed. Luckily my
doctor checked My Health Record and within a minute
was able to find details of what needed to be done to
look after me.”
http://ncphn.org.au/benefits-of-my-health-record/
It helps me improve medication safety for my patients
“When a patient is admitted, I become like a detective,
as I need to ask lots of questions to establish what
medications people are on and how that will work with
their diagnosis. By having access to the My Health
Record system, I get to see a summary of a patient’s
medical history, including their medications. I receive the
information instantly. It is very powerful.”
http://www.primaryhealth.com.au/a-hospital-pharmacist-shares-how-he-benefits-from-my-health-record/
It made it easier for me obtain my medicines
A My Health Record meant Shaij Ataij in rural NSW could
get a repeat prescription made up at her pharmacy
without having to make a special appointment with her
GP. She said: “I called my GP to get a new script for my
usual medicine. It was something I didn’t need to see the
doctor about. But the receptionist told me that I would
need to tell her the details of the medication before she
could provide me with the prescription. I wasn’t sure of
the name and dose of my medication, so I got onto my
computer and found my medication information on My
Health Record. I was then able to call back the GP and
they faxed a script to my pharmacy for me to pick up.”
http://ncphn.org.au/benefits-of-my-health-record/
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How is My Health Record changing healthcare today? 2/2
It helps me care for my patient safely at home Kevin is a 48 yo man with multiple chronic conditions including diabetes, renal failure and hypertension. He was admitted to
hospital after a serious cardiac event. His GP visited Kevin at home
shortly after he left hospital and had not yet received the discharge
summary in his practice, but by viewing the summary in My Health
Record was able to see that five of Kevin’s medications had changed. His G was able to provide immediate follow up care to
Kevin regarding the medication changes. “I was able to prepare and
print the prescriptions for the new medicines and use the discharge
summary as a checklist when I visited Kevin and reviewed the
medication. Without this information I would not have been able to provide the follow up care I needed to.” He was then able to
upload a new Shared Health Summary for Kevin, ensuring the new
medication regimen was available in his My Health Record to other
care providers.
My Health Record enhances patient self-management and reduces time communicating with care professionals Ray and Lorraine Gardner are ‘grey nomads’ who frequently travel
Australia. They both suffer from chronic conditions including
diabetes, melanoma, a back fusion, and a penicillin allergy. Their local GP in Windsor, Dr Michael Crampton , has been contributing
their health information to My Health Record to assist other GPs and
health care professionals in other states who often become involved
in their care. This reduces the time they need to spend with other
clinicians, who have immediate access to see their medications and important health summary information including tests and reports.
This enhances Ray and Lorraine’s ability to self-manage their
conditions and enjoy their travels with the confidence that they have
access to their own health information, and can share this with
providers when they choose.
My Health Record guides community care for families Tresillian is a community health care service that supports and
educates families in the community with newborn children, to help
manage early parenting issues. A clinician at Tresillian in the Nepean Blue Mountains region found the clinical information for a mother
attending the service invaluable in providing past history and
discharge summaries, and reported that this information changed the
course of clinical treatment for the family. The service are now avid
users of My Health Record, and have fed back to their Primary Health Network that My Health Record gives them a more complete picture
of the patient and information they need.
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Thank you
Email help@digitalhealth.gov.au
Website www.digitalhealth.gov.au
Twitter https://twitter.com/AuDigitalHealth