Meet HL7 AUSTRALIA’s Benefactors
Commonwealth Scientific and Industrial Research Organisation
Dr David Hansen
Dr David Hansen is CEO and Research Director of CSIRO’s Australian e-Health Research Centre. With over 150 scientists and engineers, AEHRC is CSIRO’s digital health research program and a joint venture between the CSIRO and Queensland Health. David is involved in leadership positions in many national research initiatives including the NHMRC Centre for Research Excellence in Digital Health and the Australian Alliance for Artificial Intelligence in Healthcare. David is on the board of the Australian institute of Digital Health and is a member of the Connected Care Council for the Australian Digital Health Agency. David is passionate about the role of information and communication technologies in health care and the role of digital health professionals in developing a safe, high quality efficient and sustainable healthcare system in Australia.
CSIRO at the forefront of health data interoperability: An interview with the e-Health Research Centre’s CEO
Australia’s national science agency, CSIRO, is at the forefront of addressing health data interoperability across the country. As CEO of CSIRO’s Australian e-Health Research Centre (AEHRC), Dr David Hansen leads 150 scientists and engineers focused on efforts to drive digitally enabled services to improve the safety, quality and efficiency of healthcare.
Integral to that objective is standardisation and David describes HL7’s Fast Healthcare Interoperability Resources (FHIR) standard as a boon to those efforts.
“About a quarter of our staff are focused on interoperability – so clinical terminologies such as SNOMED and data standards such as HL7 FHIR – our goal is to lower the barrier and increase the value of adopting standards across healthcare in the digital health world,” he said in a recent interview with HL7 Australia. “The standardisation that FHIR gives us for digital technology and healthcare is really important.”
HL7: Can you share with our members how your relationship with HL7 began and how it has evolved?
David: We had done a little bit with HL7 as a standard, but it wasn’t until Graham Grieve (FHIR Product Director at HL7 and Adjunct Science Fellow at CSIRO) started developing FHIR that we really began our collaboration with HL7 around the terminology standards within FHIR and in particular the terminology APIs. Graham was aware of our significant research and development around the use of standard terminology, such as SNOMED and LOINC, so we began discussing what sort of APIs FHIR should have when it comes to terminologies, which drove us to get involved with FHIR standards development.
With the implementation of the FHIR terminology APIs, we now have a world-leading FHIR terminology server, Ontoserver, which we continue to develop, license and provide. But FHIR is also a delivery mechanism for many of our other digital health tools, whether that’s decision support, or just SMART on FHIR apps. So we use the FHIR standard a lot across the rest of our research program from genomics and imaging through to virtual care and mobile health and data analytics.
HL7: Would you mind talking about some of the major projects that CSIRO is working on with HL7, and the key objectives around those?
David: The biggest one is the Sparked accelerator program, which is a collaboration between us, HL7 Australia, the Department of Health and Aged Care, and the Australian Digital Health Agency (ADHA). The objective is to set the foundations for digital health in Australia in terms of the FHIR.AU core data set for interoperability. That’s a two-year project by the end of which we anticipate having the appropriate standards and implementation guides approved through the FHIR process.
We’re really following on, and trying to mimic to some extent, the Argonaut project which ran in the United States to get an agreed standard that then was part of the health information technology provisions of the 21st Century Cures Act.
As part of the Sparked project we are supporting HL7 Australia to establish the HL7 FHIR management committee in Australia and a process for the national adoption of FHIR standards, supported through the FHIR community process.
HL7: When did the Sparked collaboration begin?
David: It was initially funded in this year’s (2023) budget announced in May and it kicked off on 1 July. We had our launch in mid-August. But it does build on work that we’ve been doing for three or four years, which started with the Primary Care Data Quality Foundations Programme and defining the foundation data standards in primary care funded by the Department of Health. For this we led a community process to build an implementation guide for the exchange of information between GPs. Then we continued that with some work around the SMART Health Check forms server and health checks for Aboriginal and Torres Strait Islander people.
HL7: How did the Sparked collaboration come about?
David: For a number of years we’ve been partnering with the Australian Digital Health Agency and HL7 Australia to run Connectathon events around the use of the FHIR terminology server which underpins Australia’s National Clinical Terminology Server. Because of that, the primary care branch of the agency wanted to know how to standardise the use of SNOMED, and our advice was – do it through a FHIR implementation guide and the exchange of information between GP practices. And that has now led to the Sparked programme.
HL7: Are there other priority projects with HL7 that you would like to highlight for our members?
David: One of our research engineers has been looking at how we leverage FHIR and terminology together around analytics, so we’ve built a FHIR analytic server called Pathling. There’s now a lot of focus internationally on analysis of FHIR data. A working group at the last HL7 international standards meeting was looking at FHIR and SQL and how we use it to hide a lot of complexity of FHIR under SQL. So, a lot of what we’ve been doing in Pathling is along those lines.
HL7: Why is the collaboration with HL7 a priority both for CSIRO as well as for the broader healthcare objectives?
David: One of the things we’re conscious of is that running a standards development organisation isn’t easy, both from a finance and broader support perspective. What we’re trying to do with the Sparked program is to not only build the implementation guides for the Australian core data sets but also to embed the FHIR community process into Australia’s digital health community. By doing that, when other organisations want to collate and share data – say in the genomics or infectious diseases fields –they’re not asking CSIRO but rather the wider FHIR community. So, the aim of the collaboration and our Sparked initiative is at the end of the two years to have established the processes and the support structures that we need for HL7 Australia to be offering those services generally to the digital health community. We would argue that, in so doing, we have established processes that can improve interoperability in Australia across the board, which we believe will lead to better health outcomes.
Department of Health Victoria
Mr. Board is Victoria’s Chief Digital Health Officer and heads the Digital Health Branch. The Branch conducts health sector planning and assurance. The Branch is developing unique identification and clinical information sharing for Victoria health services, and is connecting health services to the My Health Record system. The Branch also leads the Victorian health service cyber security program and ICT operational assurance programs.
Prior to coming to Victoria in 2018, Mr. Board headed the eHealth and Medication Safety program at the Australian Commission on Safety and Quality in Health Care. He is also an Adjunct Fellow at Macquarie University’s Institute of Health Innovation.
Building continuity of care and patient centricity: A conversation with Department of Health Victoria’s Chief Digital Health Officer
The digitisation and connection of care is a primary objective for the Digital Health Branch of Victoria’s Department of Health. For Neville Board, Chief Digital Health Officer, digitisation means care is safer, health information is more legible and care journeys can be connected.
In 2021, Victoria’s Department of Health issued its digital health roadmap to improve safety and efficiency of Victoria’s healthcare system. The Roadmap is premised on securely wrapping health information around the patient. This requires different applications to exchange information, and Victoria’s partnership with standards development organisation HL7 Australia Ltd plays a big part in realising this.
As Neville noted during a recent interview with HL7 Australia: “We require our health services to deploy systems in such a way that they are interoperable. It is the right thing to have Australia’s national standards organisation lead that work. Our Policy and Funding Guidelines direct health services to apply national standards for the secure exchange of health information, largely developed from HL7 Australia.”
HL7: Are interoperability and standards important for Department Health Victoria, and why?
Neville: Interoperable standards are about connecting the patient’s care journey, and that is fundamental to Victoria and probably to all state health systems. There are a couple of areas where it’s particularly important. One is where the patient moves around between different facilities, so clinicians need to see what medicines they are taking, discharge summaries, and previous lab and imaging tests. None of that will work without a common standard and the ability to be interoperable. That’s fundamental for continuity of care and for patient safety. What makes this more complex is that Victoria has quite a heterogeneous environment, with different lab systems, electronic medical record (EMR) systems and patient administration systems. That means common interoperability is even more important to provide a shared view through something like health information exchange.
Can you share with our members a little background on the Digital Health Branch of the Department of Health Victoria and how it is helping to drive health standards and interoperability?
The Digital Health Branch operates the state-wide cybersecurity program; we invest in health service ICT resilience and assure major projects across the sector. Apart from data security, it’s important that systems are down as little as possible for safety reasons. We conduct the investment planning for the digitisation of care, and we manage state-level projects such as the statewide mental health and wellbeing record, the information sharing elements of Victoria’s Pathology Reform, and a broader health information sharing agenda.
In addition, we have quite a strong focus on rural and regional health services in Victoria. These operate as shared service Alliances. So, we do a lot of coordination to support that.
Victoria’s digital health roadmap obviously sets out to make care safer and more connected; it also underpins virtual care models as we shift to higher rates of home-based care and specialist rural outreach. You cannot do that safely without secure, connected digital systems underneath. Another priority area in our Roadmap is to give patients access to their own information. Again, you cannot give citizens access through a front door without coordinated digitisation of care processes and health services.
What do you believe are the barriers that make it hard to achieve state-wide healthcare interoperability?
The first is obviously cost. While interoperability will save the healthcare system money in the long run, the transition to applying standards does require investment.
The second barrier is about the technical nature of conversations, with terms such as interoperability and standards adoption. Senior decision-makers can lose interest with these types of dense and jargon-laden language. It would be much better to focus the message on safety, continuity of care and patient-centricity. The more we talk about FHIR, HL7, mapping methodologies and SNOMED, the less likely it is that the messages of improved patient and clinician experience, safety and access will get through. That is a problem because you do need that investment.
Another complexity is how much you mandate, and how much you encourage and support. We were fortunate in Victoria to get support for updating hospital messaging systems across the state, swapping out JCAPS with Rhapsody, which was quite a large investment. It might sound dull, but it has absolutely transformed the sector’s ability to be interoperable. Those foundational investments can be hard to get money for; they’re not as exciting as cutting a ribbon.
With those barriers in mind, how do we get to that next important step of building a connected healthcare system that does deliver continuity of care?
First we need to shift the narrative to connected care, enabling people to access their information and safe virtual care, and away from interoperability, FHIR and HL7 technology. The second thing is to national support and willingness to achieve conformance across participating systems. Having both investment and oversight is far more effective than just hoping people will conform.
Achieving conformance across larger, more complex EMR, lab systems and radiology is a hard journey, and we’re still at the start of that. One thing you can do is make that a requirement of your next tender and your next procurement. We do that in Victoria and have just completed procurement for health information exchange.
The other important element is the ‘clinician experience’, or ‘user interface’. If using an application is hard for clinical people, the change to legible, secure systems with decision support won’t happen. Think about how easy or hard it is for hospitals or general practitioners to ensure their treatment record can be made available to other providers on that patient’s journey. So, we need to ask how easy or hard it is for clinicians to take those steps needed to make generate and transfer that information, making it accessible and sharable along that patient’s journey.
We obviously need groups like HL7 to be working on the technical side of things, and a skilled workforce to, for example, to review a conformance checklist so you’re not missing anything. From our point of view, as with any large project, rollout takes time, but as we get more and more sites involved, the time to implement gets shorter and easier as we learn more.
If there is one takeaway or call to action from this interview you would like to give to the broader healthcare community, what would it be?
The patient journey has to be connected to improve the citizen experience, to make care safer and to enable more use of virtual care.
Australia Digital Health Agency
Amanda Cattermole PSM
“Ms Amanda Cattermole PSM is the Chief Executive Officer of the Australian Digital Health Agency, a role she commenced in September 2020. The Agency is auspiced by all the governments of Australia to lead digital health strategy for Australians and to drive digital innovation. It also builds national health infrastructure and delivers national digital health products and services to support Australia’s progress towards a safer and more efficient health system.
Amanda has previously held senior roles in the Commonwealth Departments of Treasury, Prime Minister and Cabinet and Families, Housing, Community Services and Indigenous Affairs, Services Australia, the Victorian Department of Health and Human Services and the Western Australian Department of Indigenous Affairs. In her earlier career Amanda worked as a lawyer in Victoria, the Northern Territory and Western Australia.”
The role and purpose of the Australian Digital Health Agency (ADHA) is to bring together different parts of Australia’s complex and asymmetrical healthcare ecosystem to support digital innovation and achieve a “modern, accessible healthcare system”.
To advance these goals, in August 2022, ADHA signed a memorandum of understanding with standards development organisation HL7 Australia Ltd to support the development of robust, easy to adopt and properly managed digital health standards.
As ADHA CEO Amanda Cattermole stated when the MoU was signed: “The objective is to create a new era of digital health in Australia with strong governance. This means open and collaborative processes for the agreement, development, testing, publishing and maintenance of digital health standards.”
HL7 Australia recently spoke with Amanda about ADHA’s role and purpose, why the collaboration with HL7 and other organisations and agencies is important, the challenges facing Australia’s healthcare system and what is being done by ADHA and others to mitigate these.
HL7: Can you share with our readers a little background on the ADHA, its setup and broader role in helping to achieve health standards and interoperability in Australia.
Amanda: First it’s important to understand that the agency was established by the states and territories and the Commonwealth and is funded by all of them. In establishing ADHA, there was broad recognition that the objective of interoperability and a connected healthcare system could never happen without buy-in from all stakeholders. We were set up to help with that buy-in as a coordinator in the development and stewardship of digital health standards in Australia.
Can you describe some of the ways in which you drive that coordination?
At a high level, we set the parameters for what an interoperable healthcare future looks like through our National Healthcare Interoperability Plan. This sets the expectations, the domains in which we need to work, and the way in which we think we should go about this in the one- to-five-year horizon. We also
engage with the standards community to support and enable standards development to flourish in Australia. That includes, importantly, our relationship with HL7.
Let’s go into a bit more detail on the interoperability plan, including HL7’s role in the broader goals.
Over the past couple of years, my team led a very broad-ranging consultation on what is needed to deliver health interoperability in Australia, which culminated in this plan. It has strong support from across the sectors. The plan articulates a nationally agreed objective to get to this new level of digital
maturity and bring us to a much more fully connected healthcare system. It defines the domains that need to be tackled to get there and sets out actions under each of those domains. One of the domains that is most important in the work we’re doing with our colleagues at HL7 is that there needs to be a live,
innovative, mature national digital health standards program.
The recently signed MoU serves to support the plan by helping to develop digital health standards. This is something we’re deeply committed to supporting and stewarding, along with our work with other partners, including CSIRO, who we’re collaborating with on clinical data and digital standards and
These objectives have support from our jurisdictional colleagues, including in industry. It’s something the Australian public expects and demands so that their information moves seamlessly across the healthcare system and ensures clinicians have it in front of them during any interaction with the consumer.
It won’t be easy, but these MoUs with partners like HL7 and CSIRO help to ensure broad agreement to get us to that next point.
What do you believe are the barriers that have made it hard to achieve
interoperability before now?
There are many challenges to standardisation but none are insurmountable as long as all the different parts of the system are working together and moving in the same direction. One challenge is just the sheer complexity of health itself. You only have to think about a system that is funded both federally and at the state level, privately and publicly, and is supported through the acute system, the primary care system and a network of specialists and allied health providers. On top of that any one hospital has a huge number of digital systems that come together, both administratively and clinically. And that is
extrapolated across multiple different hospitals.
To address this challenge, you have to be able to map a lot of interconnected parts in order to progress to a system that can meaningfully share information, support data analysis, protect data in whatever part of the system it’s in, and enable that to be brought to bear for the benefit of both clinicians and, really
critically, Australian healthcare consumers.
Digital innovation in healthcare has been talked about as a laggard, but more recently – accelerated in part by COVID-19 – it has started to surge ahead. In addition, we’ve seen a new national conversation about digital enablement in health. Australians have moved to a point where they expect something quite different from their healthcare system. They expect connectivity, they expect continuity of care, they expect their information to move with them and to be available to those providing their healthcare.
How do we get to that next step, building connected, patient-centred healthcare system?
It’s not easy, but we’ve got a lot of things in our favour. One is that there is so much momentum now in the same direction, accelerated by the events of the past few years. We’ve also got good building blocks, including a personally controlled electronic health record, an individual health identifier service that
enables us to know who each person is in the system and, above all, consumer engagement. By working with HL7 and other partners, we’re in a position to grow that development and be the enabler for this transformation.
HL7 is an absolute cornerstone in making this happen and our partnership is critical to driving the change we’re talking about. Our deepening collaboration with HL7 combined with our role as steward will not only help that standards development but will support the broader healthcare community to engage with those changes. We need our health community to be digitally literate if we’re going to enable information to move around the healthcare system in the way that is needed to support better healthcare outcomes.
If there is one takeaway or call to action from this interview you would like to give to the broader healthcare community, what would it be?
We have long spoken about the world we want, but we all had far too many deeply held views and positions for us to get there. We now have the ingredients to move forward. So, my key takeaway would be to ask every stakeholder, partner – anyone who is part of the broader healthcare system – to dig deep and work together to support and participate in these transformational changes and help ensure great healthcare for all Australians well into the future.
New South Wales Health
Dr Zoran Bolevich
Dr Zoran Bolevich is the Chief Executive of eHealth NSW and the Chief Information Officer (CIO) for NSW Health. He represents NSW Health on the Board of the Australian Digital Health Agency and the NSW Government’s ICT Leadership Group and is a board member of the Australian Institute of Health and Welfare.
Zoran is well-recognised in the healthcare sector and ICT industry for driving innovation and influencing rapid change across NSW Health. In 2019 he was ranked fifth by the CIO Australia CIO50 as one of Australia’s top 50 technology and digital chiefs.
Driving the vision for standards-based interoperability: An interview with the Chief Executive of eHealth NSW
As a specialist agency within NSW Health, eHealth NSW is responsible for bringing to life the vision of a digitally enabled healthcare system. Integral to that objective, says Zoran Bolevich, Chief Executive of eHealth NSW, is to have a sustainable health system that delivers patient-centred outcomes that encourage empowerment and wellbeing for patients.
“To enable that vision to happen, we recognise the importance of information and data, and clinical information in particular, being accessible at all points of care and increasingly also by patients and families themselves. Standards-based interoperability is key to making that happen,” Zoran said in a recent interview with HL7 Australia.
“However, we must also always remind ourselves that there is a lot at stake in healthcare, because we’re dealing with human lives. We have to be safety minded. Interoperability is an incredible enabler, but we also need to make sure that we do it in a way that is proven, with good risk management practices in place,” Zoran added.
HL7: Can you share with our members some background on eHealth NSW and its role in implementing and supporting digital capabilities across the state?
Zoran: We work with our partners across the public health system in New South Wales to strengthen the state’s digital infrastructure and enable NSW Health to adopt digital technologies in a meaningful and effective way in order to achieve the best health outcomes and deliver the best tools for clinicians and patients.
We have both strategic responsibility, in terms of developing and coordinating digital health strategy, as well as responsibility for implementing programs across the state. In fact, we run quite large implementation programs across the state, coordinating with the many hospitals adopting platforms. Once the platform is in active use, we are responsible for supporting its ongoing performance, functionality and security, in conjunction with our ICT industry partners and suppliers. We do all that in collaboration with our local health districts and other agencies.
HL7: Can you describe eHealth NSW’s relationship with HL7 Australia and what in particular is important to the agency?
Zoran: NSW Health has a long and proud history of being a user and beneficiary of the original HL7 standard, and we have adopted it in many applications across our health systems. Our technical information systems talk to one another exchanging HL7 messages. Our diagnostic systems talk to our EMR using HL7 and our EMR is able to communicate with other systems using HL7 messages. That includes a platform we developed to enable us to connect better with community health and primary care clinicians, which lets us share summary information with clinicians across the state.
It’s also important that standards are governed, and that Australia is connected to the international standards community because, despite some differences, there are many process similarities to other health systems.
We are working with HL7 Australia to adopt those standards here, including some of the newer standards like FHIR.
HL7: What do you believe are the barriers that make it hard to achieve interoperability?
Zoran: While we have made good progress over the past 20 years, there’s still a lot of work to do. One of the biggest challenges is the sheer complexity of healthcare systems, processes, different stakeholders and funding arrangements that we are dealing with. When adopting new technologies from different vendors, it often means dealing with different approaches and methodologies.
Standards are the best way to support this complex environment and move towards interoperability.
Having clinical information systems seamlessly exchange clinical information in a way that is efficient, safe, and also semantically true to the original meaning, is a significant technical problem but it is also a clinical and human problem.
For instance, in areas where there is handover of care, we need to understand how clinicians share and exchange information with one another in order to determine the best technology to support that handover.
To better understand the underlying clinical needs, we start with people and clinical process. What are the problems that need to be solved? By engaging with clinicians, we get an understanding of the typical pieces of information that need to be available at different points in the care process. That allows us to start thinking about how technology can enable this to happen, which systems need to talk to one another, and how we can best move that information around.
Not all technology platforms or vendors are equally mature in their adoption of standards. That means we often end up with quite time-consuming, bespoke projects to overcome these interoperability issues. We are making progress, but interoperability remains very hard.
HL7: How do we get to that next step of overcoming these issues to build a connected healthcare system?
Zoran: Engagement with the right stakeholders is an important first step. If we are working to resolve an interoperability issue inside our hospital systems, we will convene design working groups, where we engage clinicians to co-design solutions that account for their processes and key safety issues.
In addition, while we are guided by HL7 and by what our vendors have in their toolkits, over the years we’ve gained greater clarity about the key standards that we believe need to be adopted. We’ve built an enterprise architecture function within eHealth NSW as a custodian of those standards and have branded that function as an interoperability office. That function’s role is to work with our colleagues across the health system to create a catalogue of standards that we will be adhering to when implementing new digital capabilities in NSW Health.
Once we are clear on that, we can start working with our vendor community to give them clarity about the interoperability framework, the set of standards, and the patterns we expect them to work with and comply to when we are procuring new systems. Those standards are often connected with the HL7 agenda because we don’t want to be in the business of inventing standards; we want to be in the business of understanding them and being part of the development process in partnership with HL7.
HL7: What takeaways or calls to action from this interview you would like to give to the broader healthcare community?
Zoran: The first is that the healthcare industry needs to make a collective commitment to a modern, standards-based, API-enabled technology of the future. That will be key to securing a seamless flow of information. Everyone has a responsibility to bring interoperability to life because it’s a safety issue, it’s a quality-of-care issue, and it’s a patient-centred care issue.
The other call to action is to do with the workforce. The digitalisation of healthcare is progressing at pace, but we’re often challenged by a lack of resources and access to a workforce with the right types of skills to bring their digitally enabled healthcare future to life. How do we train the next generation of health IT professionals? Are they conversant with the standards? Do they understand the importance of interoperability? Are we equipping them with the right skills to be effective in these projects? Have we got enough people able to participate in that API-enabled future industry? I think the answer probably at the moment is that we don’t, which means that we have to redouble our efforts in the areas of workforce development, training and education.
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