RFI responses on the future of the national …...Source: Australian Digital Health Agency Request...

RFI responses on the future of the national infrastructuremanaged or operated by the Australian Digital Health Agency, including My Health Record

RFI responses to DH2298 - 2

Australian Digital Health Agency ABN 84 425 496 912 | Level 25, 175 Liverpool Street, Sydney, NSW 2000Telephone 1300 901 001 or email [email protected]

Acknowledgements This report was developed by Nous Group, acting on behalf of the Australian Digital Health Agency.

About Nous GroupNous Group is an independent consulting company, commissioned by the Australian Digital Health Agency to develop this report. Nous Group is an award-winning management consulting firm, that partners with leaders across the Australian healthcare system to shape world-class services, effective policy, and empowered communities.

Ref: CSR-1254Date: 1 July 2020

mailto:help%40digitalhealth.gov.au?subject=

mailto:www.digitalhealth.gov.au?subject=


Foreword

I want to acknowledge and thank all stakeholders who participated in the Agency’s Request For Information process to inform the future of the national infrastructure currently operated by the Australian Digital Health Agency.

The feedback received has been extremely valuable and provides great insight into the areas that should be considered as we move forward, particularly with respect to future design considerations, technology focus areas, priorities for the future, capabilities that might be required and considerations that influence further development. Reinforced by the feedback received, a focus on consumer use and uptake remains at the front of government and stakeholders’ minds when considering the national infrastructure.

We will continue to align our work to the National Digital Health Strategy and build on the success of the creation of My Health Records for more than 90% of Australians.

I look forward to working with all our stakeholders to deliver the digital health products and services this country needs, while promoting a culture of continuous improvement and innovation.

Ronan O'Connor National Health Chief Information Officer Infrastructure Operations


Executive summary 6

Purpose of this report 7

Overview of respondents 8

Focus area 1 | Future design considerations 13

Focus area 2 | Technology focus areas 17

Focus area 3 | Priorities for the future 20

Focus area 4 | Capabilities which might be required 23

Focus area 5 | Considerations that influence further development 26

Appendix A Respondent list 29

Table of contents


Flexible platform enablers e.g. open APIs, standards (i.e. FHIR), containerisation, web-based mobile and desktop applications, elastic cloud, XaaS

e.g. artificial intelligence (AI), data visualisation

e.g. digital identification including biometrics,cyber security, secure messaging, distributed ledger

Analysis technologies

Identity and security technologies

Technological trends to prepare for

THE AGENCY RELEASED ITS REQUESTFOR INFORMATION ON THE NATIONALINFRASTRUCTURE MODERNISATION

Respondents were asked for feedback across five focus areas:

Future design considerations

Technology focus areas

Priorities for the future

Capabilities which might be required

Considerations that influence further development

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RESPONDENTS SPOKE WITH THREE VOICES

RESPONSES EMPHASISED SEVEN COMMON CONCEPTS

A WIDE RANGE OF TECHNOLOGIES ARE ALSO DISCUSSED IN THE RESPONSES

36 RESPONSES TO THE RFI WERE RECEIVED

The common concepts and the percentage of responses discussing them are:

Respondentsby location

Respondents by industry

Stakeholdersshould be engagedon an ongoing basis

97%Appropriate securityis required to ensurerisks are well managed

86%An ongoing focus onconsumers will drivebetter health outcomes

83%

headquarteredin Australia

72% IT 28% NOT IT

NOTITIT

39%headquarteredoutside Australia

Peak bodyOther organisationsProfessional services

61%

Data analytics capab-ilties are required tounlock future value

75%

The national infrastructure should behighly interconnectedand operate as a singlecohesive ecosystem

83% Good governanceis required of thenational infrastruc-ture and the datacontained with it

89%The nationalinfrastructure shouldbe flexible in itsability to evolve andimprove over time

92%

Health advisoryservices

3Technologyadvisory services

12Technologyproviders

21

Large organisationsSME

8% 10%

20%

92% 70%

e.g. 5G networks, Internet of Things including wearables


Executive summary

The Australian Digital Health Agency (the Agency) engaged industry through a formal Request for Information (RFI). The RFI was issued on 26 September 2019 and closed on 3 December 2019. Nous Group (Nous) was engaged to synthesise the responses and identify common themes. Nous did not undertake any evaluation of the quality or accuracy of the responses in doing this work.

The Agency’s RFI elicited 36 responses from a diverse range of organisations in a variety of industries, which are categorised into five distinct demographic groups:

1. Large IT organisations

2. IT small to medium enterprises (SMEs)

3. Professional services

4. Peak bodies

5. Other organisations

The respondents discussed the focus areas presented by the RFI with three distinct voices:

1. Health advisory services which discuss how a future health system could improve healthcare and delivery.

2. Technology advisory services which discuss how technologies could be used to improve the health system and delivery of health outcomes.

3. Technology providers which outline specifically how their products or services (or their partner organisations’) could be used in a future health system.

Nous identified themes discussed within each focus area specified in the RFI. This revealed seven common concepts that consistently emerged across these themes and focus areas:

1. The national infrastructure should be flexible in its ability to evolve and improve over time.

2. The national infrastructure should be highly interconnected and operate as a single cohesive ecosystem.

3. Stakeholders should be engaged on an ongoing basis.

4. Appropriate security is required to ensure risks are well managed.

5. Good governance is required of the national infrastructure and the data contained with it.

6. Data analytics capabilities are required to unlock future value.

7. An ongoing focus on consumers will drive better health outcomes.

A wide range of technologies are also discussed in the responses including:

• flexible platform enablers (e.g. open APIs, standards (such as FHIR), containerisation, web-based mobile and desktop applications, elastic cloud, XaaS)

• identity and security technologies (e.g. digital identification including biometrics, cyber security, secure messaging, distributed ledger)

• analysis technologies (e.g. artificial intelligence (AI), data visualisation)

• technological trends to prepare for (e.g. 5G networks, Internet of Things including wearables).


This report synthesises the views presented in responses to the Agency’s Request for Information

The Agency invited stakeholders to contribute to a conversation about National Infrastructure Modernisation (NIM) that will determine the future of the national digital health infrastructure currently operated by the Agency.

This was done through a formal RFI issued on 26 September 2019 and closed on 3 December 2019.

The RFI was structured around five focus areas the Agency was seeking stakeholder views on (Figure 2).

Nous was engaged to synthesise the responses to identify themes discussed across the responses. Nous did not undertake any evaluation of the quality or accuracy of the responses in doing this work. While each focus area relates to a question within the RFI, some responses did not follow this structure. Consequently, in some instances Nous interpreted which focus area parts of some responses relate to. This enabled Nous to identify common themes across all responses, not only those that fully followed the RFI structure.

To perform the synthesis, Nous followed a process of six steps (Figure 3).

Purpose of this report

1


Capabilities that might be required


Technology focus area

Considerations that influence further development

1 2 3 4 5

Allocated respondents to demographic groupings based on the type or organisationresponding.

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Allocated responses to “voices” based on the content of the response.

Reviewed responses to identify emerging themes within focus areas and key points within themes.

Tested the emerging themes with the Agency and members of the National Infrastructure Modernisation (NIM) Program Board.

Reviewed responses again to identify which discussed the agreed themes and key points specifically within each focus area and recorded this information as metadata in a register to facilitate analysis.

Analysed the metadata to provide insight into the themes discussed within focus areas and concepts discussed across focus areas.

Figure 2 | Five focus areas

Figure 3 | Synthesis process


The Agency’s RFI elicited 36 responses from a diverse range of organisations from different industries and of widely varying sizes. These organisations are categorised into five distinct demographic groups. Synthesis of the responses identified these groups spoke with three distinct voices in relation to common themes present across the responses.

The demographics of each of the respondents is broken down on the following two pages.

Figure 4 presents further details of the respondents to the RFI. Most IT organisation respondents were large organisations (92%). Businesses within the IT industry comprise 72% of all respondents and of those not IT organisations, most are professional services (70%).

Overview of respondents

Responses from a range of organisations spoke with three voices

Demographic group Definition

Number of respondents in this demographic

group

Large IT organisations

Large scale organisations which provide technology products or services that may be used in the national infrastructure.

24

IT SMEsSmall to medium enterprises (SMEs) which provide technology products or services that may be used in the national infrastructure.

2

Professional services

Organisations that provide advisory services. These services may be in relation to technology, business operations or healthcare.

6

Peak bodies Organisations that represent a set of health system stakeholders. 1

Other organisations All other respondents. 3

Table 1 | Respondent demographics

Most respondents to the RFI are large companies spanning industries from telecommunications, software, e-commerce, devices and professional services. Nous defined five demographic groups to categorise the respondents (Table 1).

Demographics of respondents


Figure 4 | Respondents by sector

4

92%

8%

72% | IT organisations

SME

Large organisation

28% | Not IT organisations

Professionalservices

Otherorganisation

Peak body

20%

10%

70%

Figure 5 presents a breakdown of the IT organisation respondents’ service offerings. Of the 26 IT organisations (of all sizes) responding, 15 (all large) offered multiple services. A further five offered security services, four application services, one infrastructure services and one integration services.

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15

4 4

111

Multiple services

Application services

Security services

Infrastructure services

Integration services

SME Large Organisation

IT RESPONDENTS BY SERVICEFigure 5 | IT organisations by service offering

Figure 6 presents IT organisation respondents by their country of origin. Of the 26 IT organisations who responded, most (62%) are headquartered overseas, nine of which are headquartered in the USA.

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9

17

IT ORGANISATIONS BY COUNTRY

9 Headquartered in Australia

1 Application services

1 Integration services

4 Multiple services

3 Security services

17Headquartered overseas



12 Multiple services

1 Security services

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9

17

IT ORGANISATIONS BY COUNTRY

9 Headquartered in Australia



4 Multiple services

3 Security services

17Headquartered overseas



12 Multiple services

1 Security services

Figure 6 | IT organisations by country of origin


Voices of responsesThe demographic analysis of the business types of the respondents is not the most useful way to synthesise the themes presented in the responses overall. This led Nous to identify three voices used within the responses to enable better consideration of the discussed themes. These voices represent the content of the response, not the nature of the responding organisation.

The three voices identified are:

1. Health advisory services These respondents discuss how a future health system could improve healthcare and delivery. Their emphasis was on the end-user experience of consumers and healthcare providers.

2. Technology advisory services These respondents discuss how technologies could be used to improve the health system and delivery of health. Their emphasis was on the role and benefits of technology.

3. Technology providers These respondents outline specifically how their products or services (or their partner organisations’) can be used in the national infrastructure.

Figure 7 illustrates how demographic groups of respondents relate to voices in the responses. Of the large IT organisations that responded, approximately half used the voice of a technology advisor, with the other half that of a technology provider.

The professional services firms are approximately evenly split between voices of technology advisory services and health advisory services. The single peak body that responded had the voice of a health advisory service in its response.

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Large IT organisations

Technologyproviders

Technologyadvisoryservices

Healthadvisoryservices

Otherorganisations

Peak body

Professionalservices

IT SMEs

Source: Australian Digital Health Agency Request for Information on the Future of the National Infrastructure (RFI No. DH2298) Nous Group RFI response data

VOICEDEMOGRAPHIC

Figure 7 | Respondent demographics and voices


The voices discussed common concepts in all focus areasMost respondents discussed all five focus areas of the RFI, and all three voices are present in the discussions of each focus area (Figure 8).

Figure 8 | Responses discussed all five focus areas of the RFI

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Submissions broadly addressed all focus areas.

Source: Australian Digital Health Agency Request for Information on the Future of the National Infrastructure (RFI No. DH2298), Nous Group RFI Response data

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Considerations that influence development

Capabilities that might be required


Technology focus areas


Technology advisory services Technology provider Health advisory services

Nous identified themes discussed within each focus area and this revealed seven common concepts that consistently emerge across themes and focus areas:

1. The national infrastructure should be flexible in its ability to evolve and improve over time.

2. The national infrastructure should be highly interconnected and operate as a single cohesive ecosystem.

3. Stakeholders to be engaged on an ongoing basis.

4. Appropriate security to ensure risks are well managed.

5. Good governance of the national infrastructure and the data contained with it.

6. Data analytics capabilities.

7. An ongoing focus on consumer outcomes.

Figure 9 presents how these concepts relate to themes identified in each focus area.


Figure 9 | Key concepts that span multiple focus areas

A wide range of technologies are also discussed in the responses, including:

• Flexible platform enablers (e.g. open APIs, standards (such as FHIR), containerisation, web-based mobile and desktop applications, elastic cloud, XaaS)

• Identity and security technologies (e.g. digital identification including biometrics, cyber security, secure messaging, distributed ledger)

• Analysis technologies (e.g. AI, data visualisation)

• Technological trends to prepare for (e.g. 5G networks, Internet of Things including wearables).

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Key concepts relate to a need for:

The key concepts appear in:

Focus area 1 Focus area 2 Focus area 3 Focus area 4 Focus area 5

The national infrastructure to be flexible in its ability to evolve and improve over time

• Technology evolution process

• Robust and flexible technology

• Continuous improvement

• Agility and flexibility

The national infrastructure to be highly interconnected and operate as a single cohesive ecosystem

• Building an ecosystem

• Communication and connectivity; seamless information exchange

• Cohesive national infrastructure

• Interoperability

Stakeholders to be engaged on an ongoing basis

• Stakeholder engagement

• User uptake • Engagement• Building and

maintaining system credibility

Appropriate security to ensure risks are well managed

• Information access and security

• Information access and security

• Security

Good governance of the national infrastructure andthe data contained with it

• Governance• Data infrastructure

and governance

• Governance; system management

Data analyticscapabilities

• Providing data analysis and insights

• Data analysis • Data analytics

An ongoing focus onconsumer outcomes

• Consumer driven healthcare

• Improved tailored health care

• Benefits realisation


The first focus area that respondents were asked to discuss relates to the future design considerations for the NIM.

Specifically, respondents were asked:

Figure 10 | Six common themes identified in relation to future design considerations

A total of 35 respondents discussed this focus area. The review of these responses identified six themes:

• Information access and security • Building an ecosystem • Technology evolution process

Within these themes, technologies discussed by respondents include open APIs, distributed ledger, containerisation, web-based mobile and desktop applications, elastic cloud, and AI.

Figure 10 presents the number of responses that discussed each theme. All six themes were discussed in a significant number of responses. Four themes were discussed by over half the respondents: information access and security (discussed in 78% of total responses); building an ecosystem (75%); technology evolution process (67%); and stakeholder engagement (67%). The other themes discussed by respondents were providing data analysis and insights (47%) and governance (44%).

Further information about each theme is provided below.

Focus area 1 | Future design considerations

Please describe what you see are the design considerations for future updates and improvements of the national infrastructure that supports the digital health products and services delivered by the Agency. Please include how you consider catering for future expansion, scalability and emerging technology areas

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Governance

Provide data analysis and insights

Stakeholder engagement

Technology evolution process

Building an ecosystem

Information access and security


Focus Area 1 – Future design considerations


• Stakeholder engagement • Provide data analysis and insights• Governance.


This theme explores the way in which systems and processes are designed to ensure appropriate levels of information access and security. This encompasses systems that enable appropriate access, governance systems to oversee access rights, and the security and privacy procedures that mitigate risks of cyber-attack. Responses to this theme emphasised:

• Ensuring that consumers can easily provide and access their health data. Emphasis is given to the design of systems that enable appropriate access rather than of front-end user interfaces.

• Ensuring appropriate governance over who does and does not have access to consumers’ health data.

• Ensuring technological and physical security and privacy procedures appropriately mitigate risks of cyber-attack. This includes attacks on consumers (e.g. unauthorised data access) and attacks on systems (e.g. DNS attacks).

This theme explores the way in which different elements of a future digital health infrastructure interact with each other. This includes consumers, federal and state government health agencies, and third-party health providers or technology developers. Factors presented include technologies, approaches, governance, system interoperability, technical standards and consistency of terminology. Responses to this theme emphasised:

• Enabling interoperability between internal My Health Record systems and other government systems (e.g. NDIS, myGov, digital identity) to provide coherent national infrastructure and a seamless digital experience for end users.

• Facilitating the creation and adoption of common healthcare terminology by providers to enable seamless digital healthcare journeys and frictionless communications among providers and with consumers.

• Supporting a platform-based approach that enables different component systems of the infrastructure (both known and unknown) to easily connect and deliver aggregate value beyond their parts. This includes across the Australian Government, with other governments, and with non-government systems.

• Supporting interoperability by encouraging the adoption of common technical standards and templates, and specifications for integration, informed by the views of consumers, providers and technology vendors (e.g. FHIR, data definition specifications).

• Ensure that strong central governance is applied to ecosystem-wide system design and implementation decisions.

• Leveraging new and emerging technologies to support frictionless communications of information across an open architecture. Example technologies include open APIs, smart APIs, distributed ledger, containerisation, web-based mobile and desktop applications, and elastic cloud.

“…privacy is not just about security, but increasingly about health consumers knowing they have choice and control over who uses their health data and for what.”

– Deloitte Touche Tohmatsu

Theme 1 | Information access and security

Theme 2 | Building an ecosystem


This theme refers to the way in which infrastructure is designed and technology is managed to allow for future evolution. This encompasses the ability of the future infrastructure to adapt to new technologies at greater scale, manage data control over the data lifecycle, plan for changes in the health system and promote an innovation culture. Responses to this theme emphasised:

• Enabling seamless system transformation/technical change management, including future expansion and scalability to new technologies.

• Supporting enhanced data control for the full data storage lifecycle. This includes considerations of the quality of data stored, the data storage structure and the physical location in which data is stored.

• Planning for known future healthcare drivers with major impacts on data volumes, velocity and variety (e.g. consumer provided data, genomics).

• Promoting a culture of continuous improvement and innovation.

This theme represents the way in which stakeholders are engaged in the design and ongoing development of the future infrastructure to ensure active participation, equity of access and development of a future infrastructure that fulfils user needs. Responses to this theme emphasised:

• Ensuring equity of access to health information and digital health services regardless of social demographic, cultural background, location or age.

• Working closely with stakeholders to enable co-design processes that put patients at the centre of healthcare innovations. This includes ensuring human-centred design drives the development of systems, processes and end-user interfaces for consumers and providers.

• Supporting ongoing, iterative stakeholder engagement throughout the lifecycle of components of the national infrastructure.

• Building trust with and among stakeholders by ensuring transparency of decision-making and accountability for results.

• Ensuring the technology products that consumers and providers engage with deliver a meaningful digital experience focused on the needs of the end user.

Theme 3 | Technology evolution process

Theme 4 | Stakeholder engagement

"Sometimes the best solution… adopts tried, tested and simple fixes to meet the user needs.”

– PBT Group


This theme represents the way in which a future infrastructure can provide insights to consumers and practitioners beyond those contained in individual records or datasets. This encompasses the speed at which insights are provided, as well as the use of multiple data sources and information-centric models to enable insight generation. Responses to this theme emphasised:• Supporting real-time data capability to allow proactive health management by consumers and providers.• Aggregating and correlating multiple information sources to enable use of flexible data platforms and

machine learning.• Focusing on information-centric models to break the clinical ‘document paradigm’ and enable data analysis

tools that create value across information sources.

This theme explores the way in which the future infrastructure is developed and managed, and how decisions are made. Responses to this theme emphasised:• Enabling decision-making on how new and future models of care will be supported by the national

infrastructure to ensure healthcare innovations rapidly deliver widespread consumer outcomes.• Driving cost efficiencies using financial incentives and partnerships to reduce the total cost of ownership

to government of infrastructure assets.• Ensuring oversight and improvement of the service commissioning process through value-based

decision-making.

Theme 5 | Providing data analysis and insights

Theme 6 | Governance


The second focus area that respondents were asked to discuss relates to the technology focus areas for the NIM.


Figure 11 | Six common themes identified in relation to technology focus areas

A total of 35 respondents discussed this focus area. The review of these responses identified six themes:

Focus area 2 | Technology focus areas

Please outline the technology focus areas (including new or emerging technologies) that should be considered to keep pace with the latest developments (including standards).

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Consumer driven health care

Seamless information exchange

Information access and security

Communication and connectivity

Data analysis

Data infrastructure and governance


Focus Area 2 – Technology focus areas


• Information access and security• Seamless information exchange• Consumer driven healthcare.

Within these themes, technologies discussed by respondents include biometrics, digital identification technologies, identity proofing levels, cyber security technologies, secure/encrypted messaging, AI, cloud-based data analytics platforms, genomics, and 4G/5G networks.

Figure 11 presents the number of responses that discussed each theme. All six themes were discussed in a significant number of responses. Data infrastructure and governance featured most (discussed in 72% of total responses), followed by data analysis (69%), communication and connectivity (67%), and information access and security (64%). Seamless information exchange and consumer driven healthcare both featured in 56% of responses.


• Data infrastructure and governance• Data analysis• Communication and connectivity


This theme encapsulates the rules governing the way that data are managed and stored. This includes rules concerning who can access what data for what purposes and how the data may be distributed. Responses to this theme emphasised:• Using open standards (such as FHIR by HL7), specifications and templates to ensure interoperability across

systems to deliver seamless digital journeys. • Ensuring the processes and governance supporting the mobilisation of and access to data to enable innovation

and mitigate risk.

This theme explores the technologies to enable data manipulation, visualisation and automatic analysis (e.g. AI). This encompasses the use of emerging technology to support the development of tools for data analysis and using that analysis to provide meaningful insights to consumers and providers. Responses to this theme emphasised:• Using modern data analysis tools (such as AI and cloud-based data analytics platforms) to rapidly derive

valuable insights from new types of data accessible on the modernised infrastructure (such as personalised real-time insights from wearables data).

• Using the analysis of data made available through the national infrastructure to provide population health insights. For example, targeted population health insights through analysis of genomics data.

This theme highlights the way in which the different elements of the future infrastructure connect with each other, as well as with consumers and providers. Responses to this theme emphasised:• Achieving maximum connectivity by leveraging advancements in communication, security and information

exchange. This includes 4G/5G technologies and software-defined networking.• Realising benefits within and across areas of healthcare by enabling faster (or real-time) communications and

connections between consumers and providers and among providers. Examples include monitoring medicines, prescriptions, and sharing of clinical information.

• Enabling consumers’ equity of access by ensuring older and/or remote technologies can use the national infrastructure.

• Using modular and distributed systems to enable flexibility and connectivity.

Theme 1 | Data infrastructure and governance

Theme 2 | Data analysis

Theme 3 | Communication and connectivity

“In an age of data, suddenly, every health stakeholder is a data organisation”

– Tableau

“[5G] offers greater speed, lower latency and, importantly, the ability to connect massive numbers of sensors and smart devices within a network.”

– Deloitte Touche Tomatsu


This theme refers to the way in which systems and processes are designed to ensure appropriate levels of information access and security. This encompasses systems that enable appropriate access, governance to oversee access rights, and the security and privacy procedures that mitigate risks of cyber-attack. Responses to this theme emphasised:• Identification technologies that enable access to information. This includes, for example, digital identity

technologies and biometrics.• Technologies that manage levels of access to information (such as identity proofing levels and staff access

based on roles). Technologies and operations that mitigate cyber-threats (such as security operations, threat intelligence).

• Designing security to be embedded into the infrastructure’s technology and operations from the ground up rather than adding security measures to system features.

• Ensuring adequate privacy and confidentiality processes are in place to protect sensitive identifying and/or health information.

Theme 4 | Information access and security

This theme represents the way in which the new infrastructure can support consumers to receive healthcare outside of a traditional healthcare setting. This includes supporting in-home healthcare, virtual care, and the generation of consumer-driven data. Responses to this theme emphasised:• Using virtual care to enable healthcare to come to consumers. Examples of virtual care include telehealth

and augmented reality (AR).• Supporting the rapid uptake of technologies that enable the generation of consumer-driven data, such as

wearables and mobile applications. • Using enhanced data and connectivity to support in-home healthcare.

Theme 6 | Consumer-driven healthcare

This theme captures the enabling of future infrastructure to support consumers and providers to engage with digital health at multiple key points across their journey. Responses to this theme emphasised:• Enabling infrastructure to support healthcare providers to communicate with other providers and consumers. • Ensuring the infrastructure allows government to communicate effectively with consumers and providers.• The use of secure messaging to enable communication among providers and between consumers and providers.

Theme 5 | Seamless information exchange

“…consumer adoption of and engagement with health IT is improved when people can take some action and actively engage in their care and leads to creation of real demand for enhanced models of care.”

– Orion Health


The third focus area that respondents were asked to discuss relates to future priorities for the NIM.


Figure 12 | Five common themes identified in relation to priorities for the future

A total of 34 respondents discussed this focus area. The review of these responses identified five themes:

Focus area 3 | Priorities for the future

Please outline your view of priorities for the future of the Agency’s digital products and systems (including technologies) and how you consider the Agency could drive efficiencies in the total cost of ownership).

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Security

User uptake

Continuous improvement

Improved, tailored health care

Robust and flexible technology


Focus Area 3 – Priorities for the future


Within these themes, technologies discussed by respondents include open APIs, FHIR, and cyber security technologies.

Figure 12 presents the number of responses that discussed each theme. All five themes featured in a significant number of responses. Robust and flexible technology was the most prominent theme (discussed in 75% of total responses), followed by improved, tailored healthcare (64%), continuous improvement (64%), user uptake (56%), and security (39%).


• Robust and flexible technology• Improved, tailored healthcare• Continuous improvement• User uptake• Security.


This theme encompasses the way in which the future infrastructure can be designed and managed to adapt to technological, health system and societal changes. This includes considerations of interoperability and technology lifecycles. Responses to this theme emphasised:• Developing the future infrastructure to support a high level of technology integration and interoperability.

Examples include standards such as FHIR, open APIs, models of infrastructure delivery, and a continuous integration environment.

• Creating frameworks to enable effective decision-making on technology lifecycles. This includes, for example, the sunsetting of old technologies, and the transition to new technologies.

This theme represents the way in which the future infrastructure can enable improved and tailored healthcare experiences. This includes using diverse data for a more holistic approach to healthcare, the development of bespoke products, and the enablement of consumer-led healthcare. Responses to this theme emphasised:• Enabling support for consumers’ overall wellbeing by drawing together diverse data sources to create

meaningful digital experiences that provide holistic insights to consumers and providers.• Development and uptake of bespoke products/applications that seamlessly leverage the national infrastructure

to provide tailored digital experiences to consumers and providers. This includes, for example, paperless prescriptions/e-prescribing applications, integration and smart utilisation of medications data across patient care settings, innovation to allow digital product trials, testing and rapid rollout.

• Enabling consumer-led healthcare that allows the consumer to fully participate in decisions surrounding their clinical care.

• Providing user consent and control mechanisms to allow consumers to access systems and their data.

This theme included key points about ensuring the national infrastructure is proactively and continuously improved by identifying new opportunities and leveraging examples of best practice elsewhere. Responses to this theme emphasised:• Continuously identifying opportunities for cost efficiencies and investment priorities. This includes identifying

and employing the right mix of internal and external capabilities.• Leveraging international learnings and models for future development.

Theme 1 | Robust and flexible technology

Theme 2 | Improved, tailored healthcare

Theme 3 | Continuous improvement

"The future national infrastructure must provide continuity and a smooth path for expanding the platform without disrupting its existing functionality."

– Siemens Healthcare


This theme delves into the ways in which consumers and providers can be empowered and encouraged to engage with new digital health solutions, and how an environment can be created to enable this. Responses to this theme emphasised:• Engaging with providers to facilitate their uptake of new digital health solutions.• Engaging with consumers to facilitate their uptake of new digital health solutions.• Creation of an environment that places consumer and clinician experiences at the heart of all digital products

and services.

This theme encapsulates the way in which systems and processes are designed to ensure appropriate levels of security. This encompasses the technologies that enable monitoring and response to threats, risk management processes and the balance between robust security and access to enable innovation. Responses to this theme emphasised:• Risk monitoring and risk management to prepare for and respond to security concerns.• The use of technologies to enable real-time monitoring and response to cyber-attacks including data breaches

and other security threats.• Balancing the need for robust security with the need to enable an innovative developer environment to rapidly

realise consumer outcomes.

Theme 4 | User uptake

Theme 5 | Security


The fourth focus area that respondents were asked to discuss relates to the capabilities that might be required for the NIM.


Figure 13 | Five common themes identified in relation to capabilities that might be required


Focus area 4 | Capabilities that might be required

What capabilities do you think might be required for the future success of the national infrastructure?

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Benefits realisation

Cohesive national infrastructure

Agility and flexibility

Engagement

Future workforce capability


Focus Area 4 – Capabilities that might be required


Within these themes, technologies discussed by respondents include mobile application, web-based applications, Internet of Things, and AI.

Figure 13 presents the number of responses that discussed each theme. All five themes were discussed in a significant number of responses. Future workforce capability and engagement were the most commonly discussed themes (featuring in 64% of total responses), followed by agility and flexibility (61%), cohesive national infrastructure (58%), and benefits realisation (56%).


• Future workforce capability• Engagement• Agility and flexibility• Cohesive national infrastructure• Benefits realisation.


This theme encapsulates the role of the Agency in the development of capability across the infrastructure workforce and other key stakeholders in the health system. Responses to this theme emphasised:

• Supporting digital health education and training.

• Ensuring the Agency workforce is capable and equipped to adapt to changes in technology and community expectations.

• Outsourcing capabilities and partnering with the right technology or healthcare partners (e.g. clinical and market engagement).

• Engaging health sector expertise to coordinate with technology experts to optimise clinical and operational effectiveness.

Theme 1 | Future workforce capability

This theme references the ability of the healthcare infrastructure to adapt to technological and societal changes. Responses to this theme emphasised:

• Ensuring the systems in the future architecture are sufficiently adaptable to new technologies and able to be developed in a controlled and trustworthy way.

• Ensuring the national digital delivery model is flexible and able to respond and align to changing needs and expectations of stakeholders.

Theme 3 | Agility and flexibility

This theme covers the way the Agency will engage with consumers and providers at an individual and population level in both the development and operation of the national infrastructure. This includes developing strategies designed to generate user buy-in. Responses to this theme emphasised:

• Build and maintain trust in government use of data.

• Community education for digital health to drive uptake and benefits realisation.

• Using multiple channels to engage consumers (e.g. apps, devices, and websites) to encourage maximum use of the new infrastructure.

• Using multiple channels to engage providers (e.g. web-based applications) to encourage maximum use of the new infrastructure.

Theme 2 | Engagement

"the Australian public and clinicians accept[ing] that… actions are taken in good faith, are acceptable to them, individually and en masse, and represent a net benefit to them… constitutes [the Agency’s] social licence [to act]."

– Infosys


This theme refers to the ability of the future infrastructure to work seamlessly with technology across Australia. This includes connecting to complementary state and federal infrastructure. Responses to this theme emphasised:

• Distributed technology model that allows connectedness and information exchange.

• Maintaining cohesive information exchange across the national infrastructure as new and emerging technologies are onboarded (e.g. Internet of Things, AI).

• Ensuring that consumers, providers and technology vendors have enough access to the infrastructure to enable meaningful digital experiences.

• Ensuring coherence between all Commonwealth systems, and between Commonwealth and state systems, to move towards an integrated single consumer digital record nationally.

This theme encompasses the ability of the future infrastructure to support the development of meaningful insights for consumers, providers and public policy. Responses to this theme emphasised:

• Using incentives derived from economics (including behavioural economics) to incentivise maximum participation from consumers, providers and vendors.

• Emerging data tools to enable the distribution of ready-made insights to consumers and providers.

• Using analytics from both digital experience data and public health outcomes data to encourage maximum participation from consumers and providers.

• Supporting secondary use of data for research and development to drive improved health outcomes.

Theme 4 | Cohesive national infrastructure

Theme 5 | Benefits realisation


The fifth focus area that respondents were asked to discuss relates to the capabilities that might be required for the NIM.


Figure 14 | Five common themes identified relating to considerations influencing further development


Focus area 5 | Considerations that influence further development

What factors do you think should be considered for inclusion in the future development of the national infrastructure?

16

5

6

7

5

5

7

9

9

12

14

1

1

2

2

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0 4 8 12 16 20 24 28 32 36

Governance

Data analytics

Systems Management

Interoperability

Building and maintaining system credibility


Focus Area 5 – Considerations that influence development


Within these themes, technologies discussed by respondents include wearable technology (wearables), genomics, bio authentication, AI, and cloud-based analytics and data visualisation.

Figure 14 presents the number of responses that discussed each theme. All five themes were discussed in a significant number of responses. Building and maintaining system credibility was the most commonly discussed theme (featuring in 58% of total responses), followed by interoperability (53%), systems management (50%), data analytics (44%), and governance (36%).


• Building and maintaining system credibility• Interoperability• Systems management• Data analytics• Governance.


This theme encompasses the way the future infrastructure ensures system credibility with its stakeholders by responding to demands and delivering outcomes for consumers and government. Responses to this theme emphasised:

• Focusing on maximising the usability and responsiveness of the infrastructure for consumers and providers. This includes maximising usability by lowering the barrier for those new to the technology, and responding rapidly to new technologies, issues, or changes in the healthcare landscape.

• Building trust by consistently delivering outcomes and providing value to consumers and providers while effectively managing risk. For example, this includes the technology ‘doing what it says it does’ and improving the value of a service for consumers.

• Building trust by effectively managing information and data security. This may include through continuous assessment and improvement.

Theme 1 | Building and maintaining system credibility

This theme encapsulates the setting of technology and data standards to enable seamless interaction and information exchange across systems. Responses to this theme emphasised:

• Standardising information to enable interoperability, including the use of international standards that allow interoperability with overseas platforms.

• Continually expanding the scope of interoperability to cater to new and emerging types of data and access methods. For example, this may include genomics data, data created by wearables, or the use of bio-authentication to access information.

• Ensuring the national infrastructure remains independent of specific technology choices that will change over time. For example, by designing the system with a decoupled architecture built on open standards.

Theme 2 | Interoperability

This theme references the way infrastructure will be managed into the future. Responses to this theme emphasised:

• Leveraging existing infrastructure across the health system and whole of government. This includes current Agency infrastructure as well as other existing governmental or health system infrastructure (for example, infrastructure at the Department of Social Services, or in hospital systems).

• Supporting improved processes for onboarding new infrastructure through forward planning and strategic decision-making.

• Supporting increased uptake of the national infrastructure by consumers and providers. This includes the scalability of the platform to support increases in both the generation of data from consumers (e.g. through wearables), and increased demand for access to and insights from this data.

Theme 3 | Systems management

"The first step in driving efficiencies in the total cost of ownership is to get more benefits out of the existing system.”

– Atostek and Nortal


This theme refers to the way data analytics will evolve over time and how analysis can be used to provide insights. Responses to this theme emphasised:

• The provision of data and data analytics in real-time to consumers and providers. This may include through real-time reports and dashboards.

• Increasing the value of data through analysis and tools. For example, this may include the use of AI and cloud-based analytics and visualisation platforms.

This theme covers the way legislation, policy and governance may change or can be used to set change across the system. Responses to this theme emphasised:

• Understanding and awareness of the way legislative and policy changes may impact on the national infrastructure and its governance.

• Ensuring internal governance structures are appropriately designed and coordinated with oversight that allows for adaptation as the legislative, policy or healthcare environment changes take place.

• Designing governance approaches that enable consistent and cohesive operations across different elements of the health system.

Theme 4 | Data analytics

Theme 5 | Governance

"Changes to harmonise state legislation will ensure system requirements can be determined and implemented at a national level.”

– RACGP


Appendix A Respondent list

Accenture KPMG

Amazon Web Services Microsoft

ASG Group NTT Australia

Australia Post Oracle Corporation

Australian Survey Research Group Orion Health

Atostek and Nortal Palo Alto Networks

Cerner Corporation PBT Group Australia

Datacom Systems ACT PwC

Deloitte Royal Australian College of General Practitioners

Doll Martin Associates Rubicon Red

DXC Connect Salesforce

DXC Technology Siemens

Ernst & Young Tableau

Fred IT Group Tata Consultancy Services

Ingenuous Telstra Health

Infosys Limited The HCI Group

Integrating Healthcare Enterprise ThinkPlace Australia

InterSystems Toukanlabs

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