Creating better health for all Australians through digital health

With more than a decade of experience as a registered nurse, Angela Ryan combines her clinical experience with her knowledge in health informatics towards the practical, meaningful and integrated use of digital health tools in Australia. In this interview with Healthcare IT News, she shares more on her role as the Chief Clinical Information Officer (CCIO), at the Australian Digital Health Agency (ADHA) and talks about why the My Health Record is a key pillar in Australia’s National Digital Health Strategy.

Could you tell us more about your role as CCIO of ADHA and your background in healthcare?

In my role as Chief Clinical Information Officer at the Australian Digital Health Agency, I work collaboratively across the health system to develop and maintain strong relationships with key stakeholders in the community to promote adoption and meaningful clinical use of digital health services and technologies, to deliver benefit to all Australians. A key priority is ensuring strong clinical engagement with the National Digital Health Strategy and associated programs and services – including the My Health Record system – and clinical input and assurance into the design, development and delivery of digital health systems. The role provides clinical leadership for the implementation, advancement and optimisation of digital systems nationally.

I’m a clinician with a background in health informatics, and decades of experience in hospitals and public sector organisations, with an emphasis on governance, design, development and deployment of digital health strategies and technologies. Before moving into digital health, I had more than 14 years’ experience as a registered nurse, including paediatric and adult intensive care. I am now able to apply my understanding of health systems and practice not just to optimise technology design and rollout, but to act as an effective agent of change, building engagement and momentum around transformational programs.

What are some of the latest projects/developments that you are currently working on at ADHA?

The Australian Digital Health Agency is setting out the pathway to achieve our goals in the National Digital Health Strategy, to support the premise that “A workforce confidently using digital health technologies to deliver health and care will be required to address the technology adoption challenge and calls for supporting the workforce to better adapt to, use and embrace the changes and opportunities created by digital health innovation.” A digitally enabled workforce for Australia will benefit consumers, healthcare professionals and the broader health system. In addition, future innovations and approaches to healthcare delivery, such as applied data analytics, and technologies such as machine learning, artificial intelligence (AI) and advanced robotics, will require a shift in the skills mix of the healthcare workforce in order to obtain the greatest benefit of these advances for healthcare consumers.

To support this, the Agency is undertaking a program to consult the health sector and other relevant stakeholders on strategies to address the enablement of the workforce and any perceived gaps. Our aim is to develop a holistic understanding of the potential skills and workforce shortages and develop strategies to address them. This will culminate in the development of a National Digital Health Workforce and Education Roadmap. The roadmap will be a focal point for a National Digital Health Workforce and Education Summit being planned for later in 2019. This event will bring together stakeholders from across the sector to consider the roadmap and agree the practical actions required to deliver the workforce Australia needs.

From your experience both as nurse and in healthcare informatics, what do you feel are the greatest challenges in the journey towards achieving better health outcomes through digital health?

Striving to deliver real-time improvements in clinician workflow is the holy grail for me, but I know that we aren’t there yet. That said, l also know that many of my colleagues are deeply invested in this as an outcome, and recognise that to truly deliver on improvements in patient outcomes, we need to improve the way digital tools and technologies work inside healthcare environments. It might keep me awake at night, but I do believe we’ll see real change in the not-so-distant future.

In 2017, you were awarded a Churchill Fellowship to study methods to prevent patient harm through national digital health safety governance. Could you share with us some of your key insights/findings from the study, especially through your visits to the UK, USA and Canada?

My Fellowship trip was life-changing and I met so many people who gave their time, their insights and knowledge so generously – Australia can undoubtedly benefit from this wealth of experience. 

I developed a set of recommendations that drew on the overall findings and principles articulated within my Churchill report. I also drew on the premise of the ‘Health Information Technology (HIT) Safety Center’ model developed in the USA. I did this in part as it is the only fully elaborated model supported by an extensive evidence base, the structure of which is informed by learnings beyond the USA borders. The Center was originally recommended by the Institute of Medicine (IOM) Report ‘Health IT and Patient Safety: Building Safer Systems for Better Care’, published in 2012, with a subsequent commitment by the Obama administration to establish the roadmap to develop the Center. 

It was further endorsed through the USA Food and Drug Administration Safety and Innovation Act (FDASIA) of 2015. While the Center has not been implemented as it was originally envisioned, many of its proposed members are active in the ‘Partnership for Health IT Safety’, a multi-stakeholder collaborative of more than 50 organisations that come together to analyse safety events and hazards, identify, and share solutions and safe practices, and inform policymakers and the broader healthcare community about priorities for health IT safety.

I contend that Australia should assemble a taskforce of experts from across the health sector, to include clinicians, consumers, government, researchers, policy makers and industry to develop the vision, mission, outcomes and roadmap for better coordinated digital health patient safety in Australia. The taskforce’s expressed purpose is to ensure digital health is safer for patients and will build upon the significant progress already made in Australia, and internationally. More information can be obtained here. 

You will be speaking about how the implementation of Australia’s National Digital Health Strategy is improving patient health outcomes through integration of digital health services at the upcoming HIMSS AsiaPac19 conference in Bangkok. Could you tell us more about the key pillars of the Strategy?

The key pillars of the Digital Health Strategy include the expansion of My Health Record, supporting secure messaging between clinical software and the development of an interoperable health system. 

More than 90 per cent of Australians now have a My Health Record, 23 million clinical documents and 56 million medication prescription and dispense records have been uploaded, and close to 16,200 healthcare professional organisations are connected (as of 30 June 2019). As part of the expansion of My Health Record, the Agency is working with healthcare providers across the country to connect healthcare professionals to the My Health Record system and improve the information available to consumers who have a My Health Record. As more providers are connected and more information is uploaded, My Health Record will become increasingly useful in ensuring key health information can be viewed securely whenever and wherever it is needed. 

The work we are undertaking to support secure messaging will give clinicians the ability to communicate with other professionals and their patients through secure digital channels and end dependence on paper-based correspondence and the fax machine. New industry standards to share correspondence digitally have been agreed and these are now being implemented.

Through the development of an interoperable health system, we are working to set standards that will allow clinical data to be shared seamlessly and securely, in real time, by care professionals, patients, and citizens, with common understanding and meaning whether they are in or outside hospital. For example, this will give all clinicians and pharmacists access to electronic prescribing and dispensing of medicines, reducing the risk of medication errors for their patients. The Agency is leading a national consultation which will recommend the appropriate data and digital standards for connected healthcare by the end of 2019.

Angela Ryan is a panelist at the opening keynote plenary happening on October 7 at the upcoming HIMSS AsiaPac19 Conference. She will also be giving a keynote titled “Digital Health, Better Health for All Australians” on October 8 during the conference. Early bird rates for conference registration are still ongoing and more details can be found here. 

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