An Australian National Health Infostructure Dr Branko Cesnik MBBS, MD, FACHI (standing in for David Rowlands)

- 1 - Australian Health Information Council BACKGROUND In July 2003 Australian Health Ministers agreed for the Australian Health Information Council (AHIC) and the National Health Information Group (NHIG) to jointly develop the national strategic plan for health IM&ICT, that builds on Health Online: A Health Information Action Plan for Australia, September In July 2003 Australian Health Ministers agreed for the Australian Health Information Council (AHIC) and the National Health Information Group (NHIG) to jointly develop the national strategic plan for health IM&ICT, that builds on Health Online: A Health Information Action Plan for Australia, September The national health IM&ICT strategic plan will: identify national strategic reform issues set long term reform directions advise on how IM&ICT effort can be harnessed to address current and emerging needs in health care delivery, management and planning recommend national guiding principles for investment in and use of IM&ICT. The national health IM&ICT strategic plan will: identify national strategic reform issues set long term reform directions advise on how IM&ICT effort can be harnessed to address current and emerging needs in health care delivery, management and planning recommend national guiding principles for investment in and use of IM&ICT.

- 2 - Australian Health Information Council DRIVERS  Quality and Safety imperative  ‘Cost’ of burden of disease  A focus on ‘wellness’ and not ‘illness’ – prevention is key imperative link health promotion risk factors SCENARIOS  External threat e.g. biosecurity  Intergenerational issues Population growth and age distribution Size of the workforce Health as % of GDP THE OPERATING ENVIRONMENT FOR THE NEXT 5 – 15 YEARS IM&ICT IMPLICATIONS Broadband system that supports all Standards-based IM&ICT IMPLICATIONS Broadband system that supports all Standards-based

- 3 - Australian Health Information Council Drivers And Assumptions  Cost of health/burden of disease  Federated system and dysfunctions  Demands for wellness - reach larger population  Pressures for safety and quality  Consumer and community will expect to be more actively involved  Workforce will be under pressure to work differently – evidence based medicine  Assume Australians want national health care system Implications for Health IM&ICT  Need to create and nurture a sense of urgency for health IM&ICT reform  Need to advocate the future of health IM&ICT (the ‘story’ of the future)  Need to ensure an effective governance model, e.g. the ‘entity’  Need to design an effective electronically enabled health system  Need to build-in capacity for change  Need for cost effectiveness in health THE OPERATING ENVIRONMENT

- 4 - Australian Health Information Council Strengths in health IM&ICT  Health community’s readiness for change  Timing for progressing the IM&ICT agenda is right  Increase in existing IT skills and the capacity/ingenuity to use the technology  Recognition for the need for national collaboration Weaknesses  Lack of dedicated resources  Lack of a co-ordinated national approach  No clear ‘leadership’ / ‘champions’ and a lack of understanding at senior levels of decision makers about the need for health IM&ICT  Lack of building blocks necessary for an electronically enabled health care system - the ten national health IM&ICT priorities  Variability across jurisdictions STRATEGIC ANALYSIS Opportunities in health IM&ICT to seize  Successful completion of key short term IM&ICT projects  Advocate and nurture a sense of urgency for health IM&ICT reform  Use smart people/technologies  Health reform has public support - bipartisan support for electronic health record Threats to the health IM&ICT  Few incentives including financial  Failure to focus on real needs/health outcomes  Failure to comprehend and communicate the complexity of health IM&ICT  Failure to recognize cultural/attitudinal barriers especially at clinicians level  Failure to deliver successful projects

- 5 - Australian Health Information Council GOALS FOR THE NEXT THREE YEARS  Develop a 15 year strategy that includes strong change management  Set directions that are realistic, achievable, articulated and communicated to its stakeholders  Establish the robust national building blocks of an electronically enabled health care system that ensures congruence as the IM&ICT systems are developed and implemented VISION FOR THE NEXT THREE YEARS  Concerted national effort, properly resourced and clearly understood, to progress the health IM&ICT agenda with a focus on improving health outcomes across the continuum of care  Health IM&ICT as an enabling factor to the work of clinicians – recognising the shifting focus in health care to greater self-care by health consumers

- 6 - Australian Health Information Council Key Factors of Success  Develop a coordinated national approach Fund partnerships- Understand the need Establish the proposed Entity- Interoperability Clear and shared vision  Design and implement projects/initiatives Improve safety and quality of care Harness efficiencies  Build infrastructure and capacity Technical- Human skills Cultural/attitudinal change- Research  Ensure effective incentives and investment  Advocate and communicate the need for health IM&ICT reform Craft the ‘compelling story’- Champions/leaders KEY FACTORS OF SUCCESS FOR HEALTH IM&ICT

- 7 - Australian Health Information Council  Develop a coordinated national approach  Design and implement projects/initiatives  Build infrastructure and capacity BROAD STRATEGIES FOR HEALTH IM&ICT (I) Strategies Determine what ‘delivery system’ is needed in future. Identify where and how to do things differently (key concepts, opportunities) - innovation, collaboration e.g. childhood vaccination - consumer focused/medicines Ensure ‘national priorities’ in place Develop initiatives for short term impact (prerequisites) e.g. Discharge event summaries, eSignatures TechnicalUndertake national stocktake of current infrastructure and capacity of systems, link funding to interoperability HumanEducation Strategy for IM&ICT at range of levels - Senior managers, clinicians, community, IT industry ResearchSecure IT research investment and research vehicle ChangeCommunicate the need for change to key audiences (decision- makers/Clinicians) GovernanceEstablish entity with sufficient funding for effective governance

- 8 - Australian Health Information Council Historic Fragmentation of (often) Voluntary Activity  Multiple Committees  Standards  EHR developments  Guideline Producers / Disseminators  Quality and Safety  Prescribing  Multiple Departments  Commonwealth  States and Territory  Local Government  Professional Bodies  Colleges  Academia  Multiple Trials  Communications  Incentive Programs

- 9 - Australian Health Information Council TIMEFRAME AND KEY MILESTONES 9/716/723/730/76/813/820/827/83/910/924/922/1019/1110/1217/12 Week Ending NHIG & AHIC members confirmed for the Strategic Plan Editorial Advisory Panel (EDP) AHIC National Strategy Workshop NHIG Meeting AHMAC Meeting AHMC Meeting AHIC Meeting NHIG Meeting Public release of the National Strategy at the National Health Information Summit 6-7 December 2004 Period for intensive development of the strategic plan: -Directions from the EDP -AHIC-NHIG Secretariat drafting team -Approximately six weeks AHIC to endorse the final draft of the strategic plan NHIG to endorse the final strategy and provide to AHMAC (21/10) and AHMC (19/11)

Australian Health Information Council Two Major Groups created to Govern Rationalisation Australian Health Information Council - AHIC Australian Health Information Council - AHIC Experts Conceptual Direction Task Specific Activities National Health Information Group - NHIG National Health Information Group - NHIG Bring together fragmented committees Operationalise AHIC direction Draw together Cross Jurisdictional efforts -States / Territory -Researchers -Financials (Health Insurance Commission)

Australian Health Information Council National Priorities Areas = eHealth Building Blocks Supply Chain Procurement Standards Secure Messaging & Information Transfer Technical Integration Standards Clinical Data Standards Consent Models Directories for unique ID of patients, providers and products Identification Standards Hospitals and Other Providers Clinicians Consumers and the Longituidinal Health Record Researchers

Australian Health Information Council Governance Arrangements for National eHealth Authority AHMC NEHTA Advisory Committee NHIG AHIC AHMAC AHMAC IM&ICT Working Group NEHTA CEO AHMAC IM&ICT Working Group Clinical Data Standards ID Standards Directories Patient Provider Product National Consent Models Technical Integration Standards Secure Messaging & Info Transfer Core Transition Team -Work Program Manager -Technical Expert -Finance Officer -Business Analyst -Administrative Support Reporting Consultation / Advice

Australian Health Information Council The Key Activities for a ‘New’ Agency (early hits) Clinical Data Standards Event Summaries / Records Clinical Coding Areas Base Level Clinical Terminologies Identification Standards Provider (with delegated ‘authority’) Products (Medicines, Consumables, Equipment) Patient (Tasmanian Smartcard trial) Directories Patient – National Health Identifier Solution end 2004) Providers – Business case development in Technical and operational specs) Product – National Formulary

Australian Health Information Council The Key Activities for a ‘New’ Agency (early hits) Supply Chain Procurement Consent Models in place Technical Integration Standards Priorities for development (eg recent HL7 acceptance Nationally) Actually Develop priority Standards (IT14) Consistent Implementation Documentation Secure Messaging and Information Transfer

Australian Health Information Council Specific Australian Infostructure Activities Implementation of the National Broadband Strategy. Specific targets for Healthcare (GP, State based) Benefits realisation via Demand Aggregation (critical at Community Level) Optimise Financials, Investigative communications Cross sectorial Integration (Discharge, Referral etc) Develop a planned approach to Workforce Capacity Development Training / Education Competency Standards Facilitate fragmented and poorly resourced programs Advancing work to date regarding Electronic Decision Support Order Entry benefits Guideline Creation, Representation and Delivery Evaluation models to demonstrate perceived benefits

Australian Health Information Council NEHTA Contact Details David Scott Elise National Health Information Summit, Melbourne, Victoria, December 6,7