The Business of Government: Make It an Experience · 2018-08-19 · • Promote Australia’s...

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The Business of Government: Make It an Experience

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


Hey, I’m Rachel

Χ ε λ λ ο G’day

HalloKia ora


About Us

5

• 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:

”

“

”

“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


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.


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.


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


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


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

www.digitalhealth.gov.auwww.digitalhealth.gov.au


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

““

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“

“


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


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



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



Interfaces of the My Health Record

Patient / Consumer

Clinician

Consumer Portal

Provider Portal

Clinical Information Systems

Specifications / standards

API’s3rd party mobile apps

2%


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



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


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


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


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


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


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/

“ “ “


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.

““ “


The future…..


Thank you

Email [email protected]

Website www.digitalhealth.gov.au

Twitter https://twitter.com/AuDigitalHealth

mailto:[email protected]

http://www.digitalhealth.gov.au/

https://twitter.com/AuDigitalHealth

adobe.com/government @AdobeGov

The Business of Government: Make It an Experience

The Business of Government: Make It an Experience · 2018-08-19 · • Promote Australia’s...

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