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Healthcare systems and providers – with notable exceptions - have been notoriously slow to adopt new digital technologies and innovations and to push forward on the road to digital maturity. All that changed almost overnight with the global COVID-19 pandemic - resistance to online healthcare receded, attitudes shifted, regulations were temporarily relaxed and the result was years of digital transformation happened in a matter of weeks or days. The adoption of digital health services in Australia has been dramatically accelerated by the COVID-19 pandemic – and in ways that nobody could have imagined: the key question, as for countries around the world, is how to maintain the momentum, build future resilience and drive the opportunity for innovation in new digitally-enabled models of care. Titled Acceleration of Digital Health: An overview of Australia’s Digital Health landscape, this HIMSS eBook provides readers a broad overview of the country’s digital health developments and features highlights from the nine-episode HIMSS Australia Digital Dialogue Series. Episode summaries: Episode 1: Western Australia Episode 2: Queensland Episode 3: Victoria Episode 4: South Australia Episode 5: Northern Territory Episode 6: Australian Capital Territory Episode 7: New South Wales Episode 8: National Round Tables Part 1 Episode 9: National Round Tables Part 2 You can download the eBook here for insights on:  - How various States in Australia responded to the COVID-19 pandemic  - Case studies on how technology has transformed healthcare delivery in the country - Perspectives from healthcare leaders on Australia’s ongoing digital health journey - Lessons and challenges learnt from the pandemic to help health systems prepare for the future - Telemedicine’s rapid growth in Australia and its associated challenges

Positive findings from the two year study could be used to guide the implementation of nurse-led volunteer programs and pain assessment interventions across other Ramsay hospitals.

For digital health services to work well, building community confidence in its usage through extensive testing is essential.

In this eighth episode of HIMSS Australia Digital Dialogue Series hosted by Tim Kelsey Senior Vice President of HIMSS Analytics International and guest speakers-  Steve Hambleton (Deputy Chair of the Primary Healthcare Reform Steering Committee and Adjunct Professor), Martin Bowles AO PSM (National Chief Executive Officer, Cavalry Health Care), Dr Louise Schaper (Chief Executive, Australasian Institute of Digital Health) and Prof Mary Foley (Managing Director, Telstra Health) share more about the implications which COVID-19 has had on digital health as well as the obstacles encountered whilst implementing telehealth across Australia. DIGITAL CHALLENGES FACED BY AUSTRALIA DURING THIS PANDEMIC Healthcare in Australia, as compared to other industries has taken a much longer time to digitalize. Hambleton referred to this phenomenon as “clinical inertia” within Australia and added that, “we certainly get things set up things in a way which we like to practice and it is very difficult to move from there unless there is a burning platform.”   As such, there is a need to deduce what the various drivers are in order to remove this inertia. This includes funding which is currently lacking in the healthcare industry in Australia as well as the ease of access and usability of new technology. Healthcare providers often have to rely on software providers to make it seamless and ease their transition into telehealth.  In addition, in order to reap the best possible results from telehealth, there is a need for video conferencing between patients and healthcare providers. However, majority of such telehealth interactions are over the telephone and this results in connections between the parties which are not as rich a communication vehicle as compared to video. There is also a need to make such digital opportunities accessible and user-friendly for the elderly in Australia.  Hambleton said, “Australia has the second highest penetration of smartphones around the world and that we need to use those tools to connect with our patients.” With telehealth, it is now easier for patients to have a consultation with their healthcare professionals with e-prescribing services.  A token can be generated which patients transit to a pharmacist and subsequently, the medicine can be delivered straight to the patient’s home.  HOW AUSTRALIA CAN BETTER MANAGE THE EFFECTS OF THIS PANDEMIC “Manage the pandemic as a business continuity issue. Put clear leadership in place and make sure that we use the structures around that to manage the crisis,” Bowles added. Businesses who were unable to transform their operations or business models into a digital model inevitably suffered during this pandemic. “Telehealth will enable virtual care”, he explained as “we have to be strategic and use digital technologies to enable us to actually meet the needs of consumers and healthcare professionals within the country.” Dr Schaper elaborated that in Australia, they were able to achieve ten years’ worth of innovation within ten days as “We (they) were motivated by improved patient outcomes .and improved working conditions for clinicians”. She further commented that there should be a shift towards “not just models of care that are very different but also outcome- based workforce redesign” and making sure that the infrastructure as well as the training and specialist workforce are all in place in order to fully support this version of healthcare.  Agile teams were swiftly developed and worked together to develop new software in order to accommodate the swift technological changes in the healthcare landscape as well as provide digital services all around the country. “Major digital implementations were deferred because whole workforces, administrative and clinical in both public and private hospitals sectors had to completely remobilise and therefore the sort of engagement and change management and need for strong digital implementation of core systems was not in ideal circumstances,” Prof Foley said.  Quick fixes were quickly developed by the healthcare providers to mitigate these limitations and software developers worked tirelessly around the clock on shifts to accelerate and rethink design of healthcare technology around policies developed by the government.   

In the seventh episode of HIMSS Australia Digital Dialogue Series hosted by Tim Kelsey Senior Vice President of HIMSS Analytics International and guest speakers- Dr Zoran Bolevich (Chief Executive of eHealth NSW), Emma Hossack (CEO of Medical Software Industry Association & Director of Australia Digital Health Agency), George Margelis ( Independent Chair of Aged Care Industry Information Technology Council), Kate Quirke (Chief Executive Officer and Managing Director , Alcidion) and David Williams (Country Manager of Ascom Australia) discussed New South Wales’ transformation of their healthcare landscape through their three pronged framework to embed, accelerate as well as innovate through insights derived from data driven approaches. SALIENT LESSONS GATHERED FROM THE COVID-19 PANDEMIC “We have seen a significant shift in societal expectations and consumer expectations as a result of this pandemic,” Dr Bolevich stated. Fortunately during this outbreak, there was an increased acceptance and adoption of telehealth services amongst consumers within the New South Wales as they realized that it was not only a necessity in such trying times but also a convenient way to access healthcare services. This further motivated clinicians and healthcare providers to utilize digital healthcare tools to provide their services via online means in numerous healthcare fields, ranging from pediatrics to rehabilitation and chronic disease management. The implementation of digital health in New South Wales was also a result of the collaborative effort between the healthcare facilities and the government as well as the various other industries. Hossack added, “We need to have everyone involved, not just the sick people. We also need the clinicians, the consumers and every part of the community involved in this.” The Australian government introduced a new project in New South Wales which centered around e-prescribing. This involved a joint partnership between the government and all of the dispensing software systems, prescribing software services as well as the digital health agencies.  HEALTHCARE ISSUES BROUGHT TO LIGHT AMIDST THIS CLIMATE “One thing COVID has done is highlight the challenges associated with delivering care to the aged community in Australia’’, Margelis pointed out. There is a lack of coordination and integration within the various facets of healthcare delivery within the country especially when it comes to the delivery of such services to the elderly. Access to the medical information of some of these elderly patients is sometimes close to impossible to retrieve as these medical records can date back to 80 years ago. As such, this serves as an impediment to the development of new drugs or vaccines that can be catered specifically to the elderly.  ENABLING THE DELIVERY OF DIGITAL HEALTHCARE SERVICES Alcidion brought forth their cutting-edge resources to help ensure the smooth monitoring and delivery of healthcare services to patients inflicted with COVID-19. Through the use of an arm-band and their mobile devices with the EMR application installed, healthcare professionals were able to provide healthcare support to patients situated in healthcare facilities as well as those held in isolation in their homes.  Quirke explained that they managed to do this through the “use of their mobile device to access the EMR data which was extremely positive of infection control as there were no shared keyboards and they could get the data on their phones.” She added that “the next thing we (they) did was to move to using the platform to create a dashboard to monitor COVID positive patients both within the hospital and at home.”  This live data of the patients was displayed alongside any pre-existing/chronic information about the patient to create a longitudinal record which was critical to enabling the delivery of comprehensive virtual care.  Williams further elucidated on the role which Ascom had played in enabling the digital transformation of healthcare in Australia: “Ascom plays a very important part in the enablement of elements of the digital transformation” through its “ability to deliver rapidly in the current COVID pandemic.” It provides a connectivity solution across the disparate landscape of structured, unstructured and formatted data through multiple different interfaces.  The data is then extrapolated and orchestrated into a meaningful and actionable fashion so that healthcare caregivers are enabled. Ascom strives to support healthcare facilities and provide them with the best mix of technology to enable them to provide the necessary healthcare responses at rapid speeds.   

“The pace of innovation with COVID-19 has been extraordinary but the challenge is to maintain that pace and benefits from it,” said Peter O’Halloran.

“We’ve got people onboard now, what we need to do is to keep them there,” said A/Prof Didier Palmer.

In episode four of the HIMSS Australia Digital Dialogue Series hosted by Tim Kelsey, Senior Vice President, HIMSS Analytics International, the panel of four guest speakers reflected on some of the current developments in digital health in South Australia and shared their thoughts on some of the most important priorities in digital health. CURRENT DEVELOPMENTS IN DIGITAL HEALTH IN SA “It has been a difficult journey in pushing digital health and recent happenings (during the COVID-19 pandemic) has exposed issues, such as telehealth that wasn’t set up for the patient, and we found out that within SA Health that the main COVID-19 hospital was not able to put discharge summaries out to GPs electronically from the EDs,” explained Dr Chris Moy, GP, Vice President of the Australian Medical Association & President AMA South Australia. Despite some of the exposure of gaps, Dr Moy said that the flip side was the ‘can do’ attitude that emerged which has been really positive. There has been progress in areas like electronic prescribing and connecting electronically to get a discharge summary from hospital EDs to the GP immediately. “The next step is really to leverage on all that and the ‘can do’ attitude is really something we need to harness.”  Prof Libby Roughead, Director, Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, leads the Veterans' Medicines Advice and Therapeutics Education Services (MATES) program, a data-driven program to improve the health of Australian veterans. She and her team uses algorithms through routinely collected healthcare data and they provide patient-specific information from that data to providers but they also provide tailored, targeted education to both providers and veterans. During the lockdown in March, Prof Roughead and her team summarized the evidence of who is at most risk coming out of China, Italy and Spain where the epicenters were at that time, developed algorithms, ran them through the data and identified 80,000 veterans who are at risk of poor outcomes if they were to contact COVID-19 due to co-morbidities in addition to their age. “We knew we needed to get information out to doctors quickly, it was the same week the government had announced telehealth for all. We had been a predominantly paper-based service but we have been developing in-house software so we could securely to the general practitioner clinic desk tops, at the right practice with the right patient, and integrated into the clinical record,” she said. The software was cautiously trialed and a thousand messages were sent. During that period, the evidence and policy announcements were changing daily – the only way to be agile and flexible was to do it through digital delivery. 55,000 messages were sent out across the country to 11,000 doctors, alerting them to the patients who were at risk and what were the risk factors that they had. 70,000 messages were delivered to veterans, alerting them that telehealth and medicine delivery services were available. Philip Robinson, Executive Director Corporate Services and the Executive Lead, Women’s and Children’s Hospital, Adelaide mentioned two key issues needed to be addressed immediately from the state of emergency that was declared back in March 2020. Firstly, how can the workforce be digitally enabled (which had been primarily working in an office environment), so that they can work from home? In addition, how to reduce patient admission and people coming into hospital? For the issue of enabling the healthcare workforce to work from home, VPN access was quickly reconfigured for a large cohort of computers and a help desk was set up to assist the digital help desk which was getting overwhelmed. To reduce the numbers of patients coming into hospitals, a video conferencing system was set up with key principles – for instance, video calls had to be an adjunct to current service models and it had to be patient and clinically-focused with proper clinical documentation.  Commvault’s Australian Alliance Lead Paul Lancaster observed that in the healthcare sector, platforms are constantly changing with an emphasis on mobility and the ability to access applications. He also sees that there is a greater understanding of data sets in the sector – where Commvault adds value is in the connection of these data sets with large and growing health data emerging from consumer health devices and health applications. This provides opportunities to use predictive tools to identify and mitigate risks. PRIORITIES IN DIGITAL HEALTH Lancaster said that interoperability standards around data need to be set and that the data is already there, it just needs to be managed properly and utilized for better health outcomes. Prof Roughead wishes for a national data set to be created and started to be used. For Robinson, there needs to be a proper financing model that supports digital technologies such as telehealth, otherwise it will be difficult to maintain the different ways of working. “Standards, aiming for interoperability with backing at the political level and from the national/state level, which has an emphasis on procurement – all these will start to bring things together,” concluded Dr Moy. 

In the third episode of the HIMSS Australia Digital Dialogue Series, hosted by Tim Kelsey, Senior Vice President, HIMSS Analytics International, guest speakers Neville Board, Chief Digital Health Officer at Victoria’s Department of Health and Human Services, Dr Nathan Pinskier, Member of The Royal Australian College of General Practitioners (RACGP) Expert Committee ehealth, Advisor ADHA Secure Messaging, Renza Scibilia, Manager - Type 1 Diabetes and Consumer Voice, Diabetes Australia and Peter J.K. Weston, APAC Leader, Healthcare Solutions, Hyland Healthcare, Australia discussed COVID-19’s impact on digital health developments in Victoria, and what needs to be done to maintain the momentum from the ‘gains’ made from the pandemic. COVID-19'S IMPACT ON DIGITAL HEALTH DEVELOPMENTS IN VICTORIA Board laid out the context with regards to digital health priorities in Victoria – over 50% of beds in public hospitals are already supported by EMRs and there are multiple EMRs since health services do their own procurement within the given assurance framework.  Some of risks associated with work processes often have to do with paper and digital applications have brought in to reduce this along the continuum of care. “For primary care, we have been given a strong boost by My Health Record with a high uptake of 90% by GPs and community pharmacies. For patients in the public health setting, knowing what medicines they are on is useful, time saving and reduces risk,” said Board. In terms of the digital context, Victoria is in the process of rolling out unique patient identification across health services. Looking forward, digital health support will also be created for touch points in mental health and aged care. “We’ve spent a decade developing national strategy, and in January and February, along comes COVID, and within a matter of a few weeks, we’ve seen healthcare organizations around the country having to fundamentally change the way they do business,” said Dr Pinskier. He added that in General Practice, specialist practice and paramedic practice, there are waiting rooms that are empty as people as afraid of visiting clinics and sitting in carparks. Telehealth, which has seen a struggle in uptake in over a decade, suddenly became mainstream in a matter of weeks.  “We’ve got telehealth and we still have to provide people with a whole lot of information and documentation, and we have not developed a model by which to do that. For instance, how do you hand over a prescription across a digital screen? It’s really hard to do. We are able to work with the federal department at state levels to implement image-based prescriptions as an interim, until we move to the new world of digital prescribing.”  Other challenges include handing a sick note digitally, and My Health Record was not designed to deal with PDFs. He said that a rethink is required to think about what needs to be achieved in a digital world and how to best support telehealth, which is likely to be stay as a dominant model of care.  Scibilia observed that what has been happening with the diabetes community is applicable to other chronic health conditions and other health service users – a lot of processes were paper-based, forms need to be double signed, and all of these processes have to be streamlined due to the pandemic.  “There was a real surprise in the community that these things happened so quickly, especially considering it’s what advocates have been asking for for so long – things such as easily accessible telehealth consultation,” she said. Commenting on what Dr Pinksier said earlier, Weston said that the technologies already exist to enable organizations to be able to have content delivered to them, whether it is on a mobile phone, tablet or computer. He hopes that medical image and content can be enabled on My Health Record. “In the medium and long term, I am really excited in terms of delivering smarter solutions that enable access by anyone, anywhere securely and leveraging that on My Health Record”. MAINTAINING MOMENTUM FROM THE 'GAINS' MADE FROM THE PANDEMIC While telehealth adoption has increased rapidly in the Victorian public health setting in response to the pandemic, Board said that two broad areas of concern: which care models are amendable to video conferencing and which patient/client cohort are comfortable with video conferencing?  “We have to look very carefully at each use case such as chronic disease and mental health, to see what other tools need to be in place for that care cohort to be looked after. I think we have to look at mixed models and not make everything digital,” Board said. “Nothing beats a face-to-face consultation and we still recognize it as the gold standard,” Dr Pinkier said. What he observed with the rapid roll-out of telehealth is that 90% of the consultation funded under the MDS are telephone consultations and only about 10% are video. The reason for that is that is easy to pick up a phone compared to setting up a video call.  If opportunistic providers go into telehealth unfettered for all kinds of basic things and start undermining the fabric of tradition practice, it can lead to the decline of general practice and fragmentation of care.  “The telehealth model we have implemented is a rushed one and it needs a comprehensive review. We also need to have conversation once and for all about mandated (software) standards, and what we would like to see is a standardized approach to how software is funded and implemented, concluded Dr Pinkier.   

“COVID-19 has taught us that digital health is the way that we will underpin new models of care, and that our staff and consumers are desperately keen to embrace digital,” said Dr Clair Sullivan.