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Australians making the shift to digital health services

The pandemic has undoubtedly helped accelerate the adoption of digital services as in-person interactions shifted to virtual. Arguably the more significant shift has been in people’s willingness to interact with organisations via self-service platforms. 

That shift in behaviour is a key aim of digital transformation programs in the public and private sectors to drive value at the back end. On the one hand, each interaction can help build a more detailed profile of the customer, which can be monetised. In the private sector that can mean new sales; in the public sector that can mean cost savings through better targeting of where, how and what services are delivered. 

Though for all the advances in data automation, Australians are wary of being targeted by robots, as the robodebt debacle demonstrated. Or they have been burned by other government data-collection programs, such as the COVIDSafe app, which didn’t deliver benefits.

On the other hand, streamlining the provision of services via self-service digital channels can help reduce administrative burdens and costs while improving access for customers.

While a stated aim of digital government in December 2018 (and reiterated in December 2021) was “Australians can access government services that are simple, clear and fast”, some citizens have been hesitant to engage with digital-first programs such as My Health Record because they were concerned about the collection and management of their personal information

Customers are more willing to engage with organisations via digital self-service platforms when the mutual benefits are clear, says Australian Digital Health Agency CEO Amanda Cattermole.

“We’ve seen people who had previously chosen not to have a record ask to have one during the pandemic,” says Cattermole. “They’ve said, ‘I didn’t want one of those before because I was nervous or I wasn’t sure about privacy, now I can see the benefit – how do I come back into the system?’ And so we’ve seen a sort of virtuous circle, if you like, of people sharing more information with My Health Record and more engagement on both sides.”

Improving user experience in digital health

According to the ADHA’s statistics, the number of records with data in them on My Health Record grew from 5.39 million in January 2019 to 22.31 million in December 2021, with more than 537 million documents uploaded. Monthly views of content on the platform were 476 per cent higher between July and December 2021 (6.08 million avg/month) compared with pre-pandemic views from March 2019 to February 2020 (1.06 million avg/month). 

“We want to make it as easy to access as possible for Australians to engage with their digital health information and cover as many Australians as possible,” she says. “And we do that with health providers, too. It’s as much about the back end and uplifting the digital capability of health providers so they can then provide extra support to patients.”

Improving the back end of digital health services across public and private sectors is a complex but crucial task, adds Cattermole, because providing that extra support to patients relies heavily on uploads of up-to-date and accurate health information.

“We do a lot of connectivity work across the health sector, linking lots of disparate systems that have grown over time,” she says. “GPs have particular clinical information systems, hospitals have multiple systems supported and provided by state governments, and there are myriad others used by pharmacies and specialists. We build pieces of infrastructure to link all those systems so health practitioners can get on with helping patients.”

Public hospitals, for example, benefit from access to documents uploaded by other providers so they can provide appropriate services. Views of the most commonly needed documents that shed light on a patient’s medical history and treatments have more than doubled since December 2020: medicines from 250,000 to 520,000 per month and diagnostic imaging from 70,000 to 190,000 per month.

Linking disparate systems to ‘one source of truth’

One of the ‘little pieces’ of infrastructure the ADHA set up during the pandemic is a platform that sits between the Australian Immunisation Register and more than 3000 providers of vaccines, including GPs, pharmacies and vaccine clinics managed by state governments.

“Our strong links to Services Australia and the clinical information systems used by GPs and others meant vaccine information could pass rapidly from the health professional giving the vaccine into the immunisation register,” says Cattermole. “It was about solving what’s needed on the front end to reduce admin and ensuring one source of truth on the back end.”

In August 2021, the ADHA provided access to COVID-19 digital certificates through My Health Record, and more than 2.3 million certificates were viewed in the following five months. In November 2021, the ADHA launched a one-stop COVID-19 dashboard that Australians access via their myGov login. In January 2022, the dashboard was accessed more than 1.14 million times.

Beyond the pandemic: meeting daily healthcare needs

The ADHA’s primary focus remains to simplify services that meet people’s day-to-day healthcare needs.

“I think the most visible piece we did in 2021 was our work on electronic prescribing,” says Cattermole. “It was already in the pipeline, but it was accelerated very early in the pandemic to ensure Australians in lockdowns could access prescriptions digitally. So we went from an almost standing start in March 2020 to eight weeks later the first electronic prescription was successfully transmitted from a doctor to a pharmacy.”

The ADHA collaborated with relevant peak bodies to smooth the introduction across Australia region by region, completing the national rollout by the end of 2021.

The Pharmacy Guild of Australia and the Pharmaceutical Society of Australia helped get pharmacists on board, while Primary Health Networks, Services Australia and the Medical Software Industry Association helped educate and engage GPs.

“Since we launched, more than 38 million scripts have been sent electronically and we couldn’t have pulled it off without those deep collaborations across industries and government,” she says. “It’s just become a routine way for people to manage prescriptions: Australians are now used to getting their doctors to send scripts to their mobile phones and then heading to the pharmacy or – certainly during lockdowns – arranging for the pharmacy to deliver their medications.”

Collaboration in digital health services

Along with governance input from its own board and subcommittees, which include executives with health and digital expertise, the ADHA engages a group of 50 ‘clinical reference leads’ from across the health sector. It also surveys consumers to give feedback on the user experience.

“We test in real-time to make sure any new services or changes to existing services work on the systems people use every day,” Cattermole says. “I feel that giving users a voice and influence in changes is one of the most exciting things about our digital engagement with the community. 

“We also have strong relationships with community organisations, such as the National Aboriginal Community Controlled Health Organisation and the Consumers Health Forum of Australia, and their reach really matters to promote digital health literacy and engagement. They know their communities so well and they know how to drive adoption of services in ways that really resonate.”

Similarly, active partnership and community engagement are among the ADHA’s top criteria for considering third-party providers. Cattermole notes broader government requirements such as information security, good organisational governance and technical capability should be givens:

“We expect them to be competent in all those areas, and security is paramount, but the game changer I think is the collaboration mindset of the third-party provider,” she says. “A genuine partnership includes structures for routinely escalating issues, fixing problems fast together and sharing lessons and ideas for improving people’s engagement with the services. The best partners come up with ideas for the greater good.”

How the pandemic has tested public sector collaboration

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