Make It an Experience adobe.com/government @AdobeGov Adobe - - PowerPoint PPT Presentation

adobe.com/government @AdobeGov

The Business of Government: Make It an Experience

www.digitalhealth.gov.au

Adobe Summit: Government
 The My Health Record Digital Journey


Rachel de Sain


Executive General Manager, Innovation & Development 
 Australian Digital Health Agency

www.digitalhealth.gov.au

Hey, I’m Rachel

Χ ε λ λ ο G’day Hallo Kia ora

www.digitalhealth.gov.au

www.digitalhealth.gov.au

About Us

5

• Give consumers more control of their health and care when they wish it
• Connect and empower healthcare professionals
• Promote Australia’s global leadership in digital health and innovation

The Agency reports to its Board, appointed by the Minister. The Agency is the system operator for the My Health Record, and a number of other clinical information systems and standards, and commenced operations on 1 July 2016.

The Agency is a Corporate Commonwealth Entity funded by all Australian Governments. 
 It designs and operates national digital health services and set data standards that:

” “ ” “

The digital health market will grow at

• ver 25.9% compound

annual growth rate to reach $379bn by 2024 Australia is well placed globally to take advantage of this growth as a test bed for health innovation and research Hendersen et al. (2016) Global Market Insights, Inc 23 Nov 2016

www.digitalhealth.gov.au

www.digitalhealth.gov.au

Figure 1: Accessing the internet, by age, 12 months to June (2011 and 2015)

Base: Australians aged 18 and over. Note: Relates to ever accessing the internet in the 12 months to June of each year. Source: Roy Morgan Single Source, June 2011 and 2015.

Older Australians are the highest increase in uptake, usage and engagement with both internet usage, mobile apps and online services.

Figure 2: Devices used most often to go online, six months to May (2014 and 2015)

Base: Australians (aged 18 and over, and 65 and over) who are internet users. Note: Relates to the most often used device to access the internet in the six months to May of each year. Source: ACMA-commissioned survey, May 2014 and 2015.

www.digitalhealth.gov.au

Figure 3: Health and government information online, July 2014 to June 2015

Base: Australians (aged 18 and over, and 65 and over) who are internet users. Note: Relates to undertaking one or more internet activities online in the last four weeks (July 2014 to June 2015). Source: Roy Morgan Single Source, June 2015.

In Australia, 15 per cent of older internet users accessed government services, and health and medical information online. These proportions were closely aligned with the adult Australian

• nline population as a whole.

A review of international data showed that the number of older

• nline Australians who access health and government information is

significantly lower than their UK and US counterparts. In 2015, 30 per cent of older UK internet users looked up information and services on government or council websites, and 35 per cent accessed information on health-related issues. The proportion of older users of government services online was even higher in the US, where 74 per cent of US internet users aged 65 and over had used a government website for transactions or information in 2010. In comparison, 2013 data on use of health information online indicated that only 30 per cent of US adults aged 65 and over had gone online for health information in the past year.

www.digitalhealth.gov.au

National Digital Health Strategy

Australians value our high quality healthcare practitioners and workers, and generally experience affordable and accessible care

Over 65% of respondents say the Australian healthcare system is difficult to navigate. People want to know the cost, quality, and availability of services Over 45% of respondents had difficulty accessing healthcare when they needed it. Top reasons given:

• Cost,
• Location, and
• Couldn’t get an appointment

More than four times as many people want to access their personal health information on their smart phone than do currently The top three activities people want to be able to do on their mobile device:

• 1. Manage their medications
• 2. Track their health
• 3. Request refill prescriptions

www.digitalhealth.gov.au

www.digitalhealth.gov.au

Delivery themes emerging from consultation

Forums Interviews S u b m i s s i

• n

s S u r v e y s History Peer-reviewed 
 Research E v i d e n c e

Analysis & Review User Needs Themes Consultation & Evidence

PRIORITY 
 AREAS

We are undertaking broad scoping reviews of the international peer reviewed and grey literature, including publications from key digital health

• rganisations, policy and media, as well as conducting targeted interviews

with digital health thought leaders

• 3,193 attendees
• 1050 written and survey submission from general public, organisations,

technology sector etc.

• 103 forums, meetings and workshops
• Interviewed thought leaders across different sectors
• Deep engagement with jurisdictions to understand their strategies and

priorities

Evidence Consultation overview

Support me in making the right healthcare choices, and provide me with options Help all the people who care for me to understand me, and together, provide safe and personalised care Create an environment where my healthcare providers and I can use and benefit from innovative technologies Preserve my trust in the healthcare system and protect my rights

• Vision
• Priority Areas
• Initiatives

CONSOLIDATED THEMES

1 2 3 4

www.digitalhealth.gov.au

Support me in making the right healthcare choices, and provide me with options Help all the people who care for me to understand me, and together, provide safe and personalised care Create an environment where my healthcare providers and I can use and benefit from innovative technologies Preserve my trust in the healthcare system and protect my rights

“[I want] better culturally diverse resources, health literacy and personalised support” – Healthcare Provider, Female, Qld

• 11.7% of people >15 years of age in in rural/remote experienced difficulty

accessing a doctor “It is vital that medical professionals have access to a holistic view of patient data to fully understand the client’s needs…”

• 91% of people living with dementia live in the community rely on an informal carer

to support them with 22% relying solely on informal care “Our smartphones and tablets need to be an extension of access to the healthcare system and customizable to our individual needs.”

• 7% make an appointment online to see a doctor or organise a hospital appointment
• 83% complete doctor or hospital registration details online before visit
• 70% order prescription drug refills using mobile apps on your phone.

"I need to be confident that my information is securely held and that it is not going to be accessed by unknown people.”

• In the UK, based on a cost to the NHS of £45 per GP visit, ensuring everyone

had the basic digital skills to access health information online would provide savings of around £120 million a year by 2025

Delivery themes emerging from consultation

www.digitalhealth.gov.au

www.digitalhealth.gov.au

www.digitalhealth.gov.au

My Health Record

An electronic summary of an individual’s health information that can be shared securely online between the individual and registered healthcare providers involved in their care to support improved decision making and continuity of care.

• There are 230,000 hospital admissions due to

medication adverse events per year, costing up to $1.2 billion annually. My Health Record will reduce this number.

• Empowering people with health care information to

support self-management could save $1,300 to $7,515 per patient per year.

• Sharing information electronically about tests could

reduce unnecessary duplication by approximately 18% and significantly lower hospital re-admission rates.

Key Facts

“ “

My Health Record is the future of medicine.

Dr Michael Gannon, President, Australian Medical Association

One of the recurring contributory factors identified during health-related coronial investigation and inquests is a failure in communication, particularly in documentation, discharge and handover…lapses in communication can have the potential for serious outcomes for patients. I cannot overstate the importance of effective communication in a health care setting.

Ms Ros Fogliani, State Coroner, Western Australia“

“

www.digitalhealth.gov.au

The My Health Record is a secure electronic summary of a patient’s health records. It provides an active online record from different sources that

• ver time will follow patients as

they move through Australia’s health system.

My Health Record

www.digitalhealth.gov.au

My Health Record Statistics

as at 14 May 2017

791,576 941,679 247,801 Age Range 45,517 29 Pathology Reports 35,984 47,269 State ACT TAS SA NT NSW VIC QLD WA % of population 23% 20% 18% 20% 21% 15% 27% 15% 7,514,243 2,175,813 84,237 36,213 13,237 1,014 1,257,804 463,977 285,726,713 197,422,047 Australian Organ Donor Register 2,109,855 Shared Health Summary Discharge Summary Event Summary Specialist Letter Demographic Breakdown

Approximately 20% of Australia's population is registered for a My Health Record

9,923 Healthcare providers registered

732

4,825,325 Consumers registered

1,237 134,701 484,870,541 1,313 166 Prescription Documents Advanced Care Directive Custodian Report Australian Immunisation Register Consumer Entered Health Summary Dispense Documents Consumer Entered Notes Advance Care Planning Document Pharmaceutical Benefits Report

*Organisation type based on Healthcare Provider Organisation (HPI-O) data, except for Hospital provider data which is based on jurisdictional reported facilities that are connected to the My Health Record system.

Clinical Document Uploads Prescription and Dispense Uploads Consumer Documents Medicare Documents General Practices Public Hospitals and Health Services % of total registrations 36% 25% 25% Medicare/DVA Benefits Report 14%

46% are male 54% are female

Aged 20 or less 254 Organisation Type* Count 6,060 Retail Pharmacies Aged Care Residential Services Other categories of healthcare providers including Allied Health Organisations with a cancelled registration 161 Private Hospitals and Clinics 9,690,056 eReferral Note Diagnostic Imaging Report Aged 65 or higher Aged 40-64 Aged 20-39

My Health Record Usage Provider Registrations Consumer Statistics

www.digitalhealth.gov.au

www.digitalhealth.gov.au

www.digitalhealth.gov.au

National( Consumer( Portal

71# 71#page pages 48# 48#he help# p#page pages

Mobile(App( Services

15# 15#APIs

B2B(Services(

(clinical(system(use)

15# 15#APIs 58# 58#softwar are#vendo ndors

National( Provider( Portal

21# 21#page pages 22# 22#he help# p#page pages

Administration( &( Support( Portals

48# 48#page pages

Participation( &( Authorisation( Services

7# 7#appl applicat ations 95# 95#aut auth. h.#po policies

Document( Index(&( Store( Services

3# 3#appl applicat ations

Clinical( View( Services

3# 3#appl applicat ations 9# 9#aggr aggregat gated# d# vi views

Audit(&( Notification( Services

6# 6#appl applicat ations ~5 ~597,000,000# audi audit#ent ntries

Reporting( &( Analytics( Services

4# 4#appl applicat ations

Security( Information( &(Event( Monitoring

2# 2#appl applicat ations

Service'Co*ordination'Layer

National' Document'Index,' Repository' &'Clinical' Data'Cache NPDR Medicare' Repository Future'Pathology' Repository

467,890,728)documents)indexed 10,576,269)document)stored 455,124,810) documents

Individuals(&( Representatives

4, 4,678, 678,367# 367#records

My(Health(Record(National(Infrastructure Infrastructure#Sizing

!24/7%Support !99.9%%availability% service% level%met%since%August%2016 !46%networking% appliances !55%physical%servers !>500%virtual% servers !7%superfast%data%appliances !11%environments !800%terabytes%of%allocated% storage

~2 ~250#tx txs pe per#day day ~1 ~170#tx txs pe per#mn mnth ~590,000 tx txs pe per#day day ~3 ~32,500#tx txs pe per#day day

Third(Party(Mobile(Apps( and(their(users

3# 3#in# n#pr produc duction

Healthcare(Providers

12, 12,878# 878#regi gistered# d#pr providers 9, 9,787# 787#regi gistered# d#organi ganisat ations ns

Foundation(Services

~4 ~450,000#transa sactions# s#per# day day

Healthcare% Identifiers NASH Clinical( Terminology

~1 ~1.3#million#linked#accounts ~5 ~5,100#logins# s#per#day

myGov

~6 ~650%verifications% s%per%day

Identity% Verification% /% Proof%of%Record% Ownership%Service

Call(Centre

622# 622#cal alls pe per#mont nth

Diagnostic' Imaging' Repository

41,108) documents

As%at%27th March

www.digitalhealth.gov.au

www.digitalhealth.gov.au

Interfaces of the My Health Record

Patient / Consumer Clinician

Consumer Portal Provider Portal

Clinical Information Systems Specifications / standards

API’s

3rd party mobile apps

2%

www.digitalhealth.gov.au

R6.1 June 2015 R7 April 2016

Mobile responsive user interface implemented

R7.1 June 2016

Example introduced icon use implemented in R6.1 and major improvements to user experience for Access Controls

UX improvement

www.digitalhealth.gov.au

www.digitalhealth.gov.au

Flexible & 
 Responsive Personal and 
 Context Enhanced UX Atomic design

AEM has a powerful responsive capability, which means that we can think Mobile First. This is a major difference from the current Orion Implementation and is guiding our design work. As we saw in the POC, the personalisation possibilities via AEM are impressive. In the POC, we showcased personalised messaging and content based on location, condition, context. We are looking at the mobile and tablet experience, we are identifying some areas in the current experience that don’t directly translate. We are documenting these and how they are informing our design. A modular approach allows us to take a holistic view and also think about the overall MyHealth experience, rather than a page-based approach. We are aiming for a consistent and enjoyable experience, agnostic of channel.

AEM & Experience Design Considerations

www.digitalhealth.gov.au

By starting with the mobile we are designing a lean experience that can then be Progressive Enhanced as appropriate on other channels – making the experience more robust, rather than watering it down Know who we are engaging with and understand what they need to do, when and why. Always considering how the Beside Manner can guide us in displaying the relevant information as needed. We can often decide to serve up content in different ways. Mobile first, in fact forces us to do this in a way – by virtue of the fact that the screen size automatically focuses. Leading us to consider leaner IA, content hierarchy etc. Holistic View + Modular Atomic Design + Contextual Page Guidance = Future Scalability. We’re creating an experience not pages.

Evolving to the unconstrained UX

Mobile First Optimising Content & Context Relevant to Needs Atomic Modular design

www.digitalhealth.gov.au

Medicines Pathology Diagnostic1Imaging Usability1improvements Operational1requirements

Single'view'of'medicines,' allergies,'adverse'reactions Enhanced'search'and'filter' in'Pathology'Report'View Upload'and'view'of' diagnostic'imaging'reports Improved'consumer'access Keeping'systems'up'to'date' and'secure GO GOALS Support1clinicians1with1their1 medicines1reconciliation Improve1searchabilityof1pathology1 results1in1provider1portal1and1local1CIS More1complete1and1timely1access1to1a1 patient’s1diagnostic1imaging1results Improve1success1rates1for1individuals1 accessing1My1Health1Record1the1first1 time

Release 8

www.digitalhealth.gov.au

Better research capability

A/B testing Capability to design and execute online tests, create audience segments, and target content and online experiences that will enable us to: Learn more about what individuals and clinicians are searching for, where they land on websites and where they end up, and use this information to determine what is or isn’t working on webpages and take steps to improve user experiences See what type of headline attracts people to stay on the Consumer Portal for longer, and find hidden patterns and behaviours of use of My Health Record that guide how to encourage individuals to actively manage their care Trial different content in the Portals that are shown to a particular audience, or group, based on criteria such as, prototypes of options to personalise first access to a My Health Record so people stay online longer, complete their personal details and record their preferences and status, and upload any advance care planning documents comparison of user preferences for different prototypes of Access Dashboard, to address the complex language and diversity of individuals’ health conditions testing a new shared care workflow with one jurisdiction Determine how to create a mobile experience for individuals and clinicians that is smart-device friendly to support people who now access the services they need almost exclusively using mobile devices

www.digitalhealth.gov.au

Adoption(of(the(Digital(Transformation(Agency’s(Digital(Service(Standard

Co Collaboration

• co;design
• validation(of(concepts(and(designs
• core(design(teams
• co;production

Us User;ce centred ap approac ach(

• user(research
• insights(from(evaluations(and(national(strategy(consultations
• user(experience((UX)(improvements

St Strong(governance(and(oversight

• assurance:(clinical(safety,(security,(operations
• release(management

Principles for enhancing My Health Record

www.digitalhealth.gov.au

Input

• Help%desk
• Feedback
• Forums
• Usage%statistics
• Policy%directive
• Communication
• Adoption
• Training
• Support
• Simulators

Co-design Process

www.digitalhealth.gov.au

27

www.digitalhealth.gov.au

How is My Health Record changing healthcare today? 1/2

It made me safe when I left hospital
 


“It was my son’s birthday and I visited him in Sydney to

• celebrate. We checked into the hotel and three hours

later I was in the back of the ambulance on the way to

• hospital. They found I had a thing called pancreatitis.

After four days in hospital, I talked them into letting me

• ut as long as I went to see my doctor for important

follow up work as soon as I got home. When I got to my doctor I realised the hospital hadn’t given me any information about the treatment I needed. Luckily my doctor checked My Health Record and within a minute was able to find details of what needed to be done to look after me.”

http://ncphn.org.au/benefits-of-my-health-record/

It helps me improve medication safety for my patients


“When a patient is admitted, I become like a detective, as I need to ask lots of questions to establish what medications people are on and how that will work with their diagnosis. By having access to the My Health Record system, I get to see a summary of a patient’s medical history, including their medications. I receive the information instantly. It is very powerful.”

http://www.primaryhealth.com.au/a-hospital-pharmacist-shares-how- he-benefits-from-my-health-record/

It made it easier for me obtain my medicines


A My Health Record meant Shaij Ataij in rural NSW could get a repeat prescription made up at her pharmacy without having to make a special appointment with her GP . She said: “I called my GP to get a new script for my usual medicine. It was something I didn’t need to see the doctor about. But the receptionist told me that I would need to tell her the details of the medication before she could provide me with the prescription. I wasn’t sure of the name and dose of my medication, so I got onto my computer and found my medication information on My Health Record. I was then able to call back the GP and they faxed a script to my pharmacy for me to pick up.”

http://ncphn.org.au/benefits-of-my-health-record/

“ “ “

www.digitalhealth.gov.au

How is My Health Record changing healthcare today? 2/2

It helps me care for my patient safely at home

Kevin is a 48 yo man with multiple chronic conditions including diabetes, renal failure and hypertension. He was admitted to hospital after a serious cardiac event. His GP visited Kevin at home shortly after he left hospital and had not yet received the discharge summary in his practice, but by viewing the summary in My Health Record was able to see that five of Kevin’s medications had

• changed. His G was able to provide immediate follow up care to

Kevin regarding the medication changes. “I was able to prepare and print the prescriptions for the new medicines and use the discharge summary as a checklist when I visited Kevin and reviewed the

• medication. Without this information I would not have been able to

provide the follow up care I needed to.” He was then able to upload a new Shared Health Summary for Kevin, ensuring the new medication regimen was available in his My Health Record to other care providers.

My Health Record enhances patient self-management and reduces time communicating with care professionals

Ray and Lorraine Gardner are ‘grey nomads’ who frequently travel

• Australia. They both suffer from chronic conditions including

diabetes, melanoma, a back fusion, and a penicillin allergy. Their local GP in Windsor, Dr Michael Crampton , has been contributing their health information to My Health Record to assist other GPs and health care professionals in other states who often become involved in their care. This reduces the time they need to spend with other clinicians, who have immediate access to see their medications and important health summary information including tests and reports. This enhances Ray and Lorraine’s ability to self-manage their conditions and enjoy their travels with the confidence that they have access to their own health information, and can share this with providers when they choose.

My Health Record guides community care for families

Tresillian is a community health care service that supports and educates families in the community with newborn children, to help manage early parenting issues. A clinician at Tresillian in the Nepean Blue Mountains region found the clinical information for a mother attending the service invaluable in providing past history and discharge summaries, and reported that this information changed the course of clinical treatment for the family. The service are now avid users of My Health Record, and have fed back to their Primary Health Network that My Health Record gives them a more complete picture

• f the patient and information they need.

“ “ “

www.digitalhealth.gov.au

www.digitalhealth.gov.au

www.digitalhealth.gov.au

The future…..

www.digitalhealth.gov.au

www.digitalhealth.gov.au

Thank you

Email help@digitalhealth.gov.au
 Website www.digitalhealth.gov.au 
 Twitter https://twitter.com/AuDigitalHealth 
 


adobe.com/government @AdobeGov

The Business of Government: Make It an Experience