Moving the needle on interoperability with the Digital Health Blueprint

The Australian Government’s Digital Health Blueprint represents a crucial step forward in driving a more connected healthcare system. The release of the blueprint follows the Strengthening Medicare Taskforce Report, which emphasised the importance of digital and data solutions and modernising healthcare systems in terms of healthcare stewardship.

“In the 2023-24 Budget, the Government invested about $1.1 billion in a range of modernisation programs, including modernising My Health Record and a FHIR accelerator program, Sparked,” Simon Cleverley, Assistant Secretary at Australian Government Department of Health and Aged Care (DoHAC), told HL7 Australia. “The investment and the roadmap that sits alongside the blueprint demonstrate the ongoing commitment to driving the transformation of how we deliver healthcare in Australia.”

One of the critical building blocks to that transformation, Simon noted, will be a digital health strategy that is enabled through a true partnership approach.  

The question is, what will it take to achieve that transformation across all healthcare systems Australia-wide? Simon sat down with HL7 Australia to share his vision and perspective.

HL7 Australia: As you have noted, partnership is integral to achieving an integrated digital healthcare future. With that in mind, can you talk about the consortium striving to develop national data models and interactions using Sparked and the FHIR Accelerator?

Simon: I think it’s caught  many people across the health sector by surprise that governments across Australia have translated their deepening understanding of the benefits of a community approach, and been agile enough to move so quickly to leverage this approach to achieve those lofty goals through digital enablement. That’s come from lessons learned about how we all need to do business together to help people stay well for longer and to help those who are sick get the right, targeted treatment plan.

This consortium enables us to leverage the best knowledge, stakeholders and policy development expertise into a format that enables anyone to contribute to the way data is shared within the healthcare system. And it’s not just getting noticed in Australia. We are getting a lot of people coming from international governments and bodies who are interested in the pathway and partnership approach we have taken and are asking us for advice on how they can do similar sorts of things in their country. It’s really that partnership approach that has been the key to the success we have had.

HL7 Australia: As the blueprint makes clear a key pillar of connected digital healthcare is My Health Record. What is envisioned with the modernisation of the platform through data standards, such as FHIR?

Simon: My Health Record has been on a really interesting journey from its establishment in the early 2010s, which has enabled real-time sharing of information to benefit the consumer, no matter where they are. It provides that authorising environment for healthcare professionals that allows them to access information about their patients, again, no matter where they are. But we do need to keep moving forward to provide a seamless access point for consumers to get information about their health and well-being journey. And the modernisation agenda, including FHIR programs, are really going to be the catalyst for that transformation.

It’s not just about My Health Record; it’s about all the clinical systems out there as well. One of the powerful things that has been enabled through the FHIR program and the journey we have embarked on with CSIRO, the Australian Digital Health Agency and HL7 Australia, is that we can drive that transformation in order to achieve the panacea of an interoperable future. Rather than throwing out what we have, we can make sure that what we have can be improved upon. And, certainly, the government’s commitment to move to sharing pathology and diagnostic imaging reports by default, which we’re planning to have in legislation presented to the Australian Parliament this year, demonstrates that core objective.

HL7 Australia: Can we pivot to talk a bit about the DoHAC funding for the creation of the Australian FHIR Management Framework (AFMF) including the Australian FHIR Community Process (AFCP), and the establishment of the Australian FHIR Coordination Committee (AFCC).

Simon: The Sparked program was launched on 23^rd August 2023, and now just seven months down the track we’re already seeing significant progress. That’s down to a strong partnership. What’s really crucial about the AFCC is ensuring we have scrutiny and appropriate open and broad views brought into the standards development process.

One of the things that I’m really focused on is having the appropriate governance to ensure that we can scale not only the standards at the core level but also springboard that to incorporate all the important use cases that drive that connected care agenda. From the AFCC’s perspective, it’s going to be really important that we do have that national viewpoint to assess where we are, where we are going and whether we have the right checks and balances in place. In my role as department representative on the AFCC I feel I’m learning a lot as opposed to contributing a lot. There’s a wealth of expertise to tap into, but we must also make sure we’re succession planning, not just around the AFCC itself, but around the standards community and around the industry and community more broadly to ensure we have the workforce of tomorrow to support all the use case work that’s going to have to happen once it’s developed.

HL7 Australia: HL7 Australia’s response to DoHAC’s Health Identifiers Framework consultation included the suggestion that the ageing B2B technical interface to the HI Service should be replaced with an API based on contemporary interoperability standards like HL7 FHIR and SNOMED CT. Is this under consideration once we have published a foundation standard like AU Core?

Simon: The Healthcare Identifiers Act is likely one of the single most important bits of legislation we have in this country that’s going to help us achieve full interoperability for our health system. However, the act is 14 years old now, and it’s not lost on us that it was written before a lot of the current capabilities we have existed. It was before we had things like the modernisation in the aged care space or connecting disability services in healthcare. It wasn’t fit for purpose to enable access for some of our most important administrative systems like Medicare and how we can pass Healthcare Identifiers through  administrative systems to support patients end to end.

Therefore, the government does have some really important work underway to support the modernisation of the policy and the legislative framework that supports Healthcare Identifiers.

Our big focus at the moment is making sure that we do get a bit more dynamism built into the Healthcare Identifiers Act whilst maintaining vital protections for consumers. We will provide advice to government in consultation with states and territories to make sure that we get a fit for purpose, more robust policy framework that allows us to achieve that objective. And, the feedback from HL7 Australia in that context is definitely a consideration that we’re looking at.

We know a lot of organisations, including at the Commonwealth level, are looking at FHIR readiness within their organisations. We do want APIs to support the way that we deliver modern healthcare services across Australia into the future. But there’s no timeline at this stage because modernising Medicare and all the different systems has to be phased carefully.

HL7 Australia: As you mentioned, the states and territories are playing an important role in all of this. With that in mind, what is your call to action for your peers not only at states and territories, but also other Commonwealth agencies and even other parts of DoHAC with regards to involvement with Sparked and FHIR?

Simon: I feel there’s a groundswell now, and certainly within the events that I’m participating in around the FHIR accelerator, I’m seeing that enthusiasm to be part of these sorts of programs from states and across all parts of our delivery systems. I’m also seeing the calibre of people it’s drawing in.

The partnership, and the model that wraps around FHIR standards, including the role of HL7 Australia, demonstrates there’s really a sense that if you’re not there, you’re missing out on the opportunity to contribute to the future of modern healthcare delivery in Australia. That’s happening now, and we see that with the chief policy and information technology leads from states and territories turning up and participating and presenting in the forums being held; we see that through significant clinical involvement from right across the sector and from industry.

Over the next five years, we will see a significant increase in digital capabilities, but how we connect and use our national infrastructure — such as MyMedicare, the modernisation of My Health Record, and our Healthcare Identifiers Framework – is going to need to be phased carefully in concert with the modernisation agendas happening across states and territories and in the private sector.

Probably my call to action is, if you’re not in it you won’t be able to shape it. Having said that, I would say we have significant buy-in from states and territories in a range of activities, including Healthcare Identifiers, including the My Health Record system, including the work to overcome information sharing barriers in legislation between states and territories, and the work that is happening with building and designing new EMRs for hospital systems that allows GPs to have access.

Ground zero, though, is making sure that we have nationally consistent and agreed standards for moving that information around the system, which can then be supported by those legislative and policy frameworks. This is the time to shape how those standards will operate into the future. As we have seen in the Strengthening Medicare Taskforce report and from what has been said by Minister Mark Butler, we are going to need to get to a point in the next few years where we mandate these standards, not only to benefit information sharing, but also to address security and privacy concerns.

HL7 Australia: Has your role been difficult in terms of getting momentum around these initiatives and gaining the necessary commitment to and enthusiasm for these programs?

Simon: What’s really difficult about digital and data technology capabilities, services and skills is people think you have to be a technical person to contribute to the conversation. And what has been shown through this work program is that that’s not the case. We need the clinicians, the consumers and those from all walks of the policy development lifecycle to play their role in making sure these systems support the clinical workflows and are simple for consumers to use. Certainly, there is a role for people that can actually translate the policy objectives into systems that allow us to move information around the healthcare environment. But it’s really about ensuring we have buy-in from all parts of the marketplace.

What is really difficult is ensuring we have a very clear understanding of the problems we are trying to solve, and what role digital and data systems can play in overcoming these problems. Those challenges include an inability for consumers to have a connected story across their health journey; lack of clinical insights at the point of care for clinicians wanting to provide more tailored, high-quality care; and inability to have real-time sharing of health information to support public health and planning at scale across our federated country. Having a strong community that is truly representative of the problems we are trying to solve will make it much clearer to governments around Australia as to why they are investing in foundational digital health capabilities and services.

We need plans to ensure we are clear about prioritising the delivery of these national capabilities. That’s why something like the Blueprint is so important. However, we also need a clear set of objectives and we recognise the need for a standards development roadmap. We will consult on the development of this roadmap throughout 2024, and seek to publish this in 2025 to help provide clear line of sight to all stakeholders about what we need to put in place to support Australia’s digital health transformation journey, and when.

We have to maintain and strengthen our partnership and the conversations we’re having with decision-makers. It’s really that ongoing collaboration and sharing what this means, and making sure that we’ve got the right people in front of those conversations at the right time. I do think we have the right ingredients and I’m positive that over the next 18 months of this Accelerator program we will be able to go back to the Commonwealth Government, state governments, and other investors with the direction that we are going to take as a country, which will allow all stakeholders to invest with confidence.

HL7 Australia: Is there a message for those stakeholders who are more reluctant to commit to standards?

Simon: I recognise, and our partners recognise, that we are stronger together. But, at the same time, we need to give visibility for the future of where we’re going and how we incentivise people to invest in moving a FHIR standard along as a baseline for how we move information around the system in Australia. We want to build and strengthen the community so everybody feels that they have a seat at the table and can contribute to the evolution of data and terminology standards in Australia.

I recognise that there is huge demand on organisations to do the things they are asked to do to comply with our changing regulatory frameworks, and to evolve their systems to improve user experience for their clients. We need to make it easy for people who are time poor to have the opportunity to become involved. I think the Sparked program strikes a good balance and offers opportunities to be involved. There have probably been some false starts in Australia when it comes to how we achieve a more connected health system but I would say to those who are still not sure if this is genuine to look at the signals. These include a national health interoperability plan that is being implemented with national oversight, Australia’s first FHIR accelerator program, and a Commonwealth Government leading and stewarding implementation of these initiatives backed by significant funding over the next two years. We must address challenges such as limited workforce capacity, a system that is dealing with more chronic disease, and a system that does not enable health information to move around in a systemic way. We must all commit to standardising our healthcare system.

For now, we are focused on making sure that we can get people together to create that dynamic partnership so that we can then make some decisions as a community about how we implement those standards.

The good news is we’re seeing more stakeholders who understand the role FHIR has within our ecosystem.

We know there’s a lot of work to be done but I think HL7 Australia is strong and I’m looking forward to continuing to work with HL7 Australia and all the other partners to drive the value proposition and achieve those national healthcare interoperability objectives.