For a recent interview, we caught up with Peter O’Halloran, Chief Digital Officer at the Australian Digital Health Agency (the Agency), to learn more about current projects and priorities, what’s in the pipeline for digital and data across the next five years, progress toward Australia’s National Digital Health Strategy, and more.
Peter offered a brief introduction to his role and some of the recent projects he’s overseen with the Agency, saying “I’ve been at the Agency for about two years now, but have worked in healthcare IT for more than twenty years”. Referring to what he calls a “digital health revolution” in Australia at the moment, he told us that the Agency has a plethora of ongoing projects across the health and care space, adding “I’ve seen more activity in the last two years than I did in the preceding twenty years”.
Specific projects under way at the Agency include “rearchitecting Australia’s entire digital health ecosystem”, modernising the My Health Records platform, and introducing a full national Health Information Exchange (HIE) which he estimates will take place over a period of five years. “We’re doing all of the design work for that now, and we start the first bit of coding in January,” he said.
Another area of focus is healthcare interoperability, according to Peter, “so that involves a lot of work with national identifiers for healthcare providers, consumers and organisations, as well as with standards and clinical terminology – we have a FHIR accelerator, and although FHIR was invented in Australia we’ve done very little with it until now; now we’re trying to leapfrog everybody else!”
Finally, Peter shared that the Agency is working on offering consumers choice, with the my health app that he describes as a “digital front door for all things healthcare in Australia”, and planning for a go-live this month for “the next big step”, which is e-prescribing. “That’s probably a decade’s worth of work we’re trying to get done in the next two or three years,” he added, “but the time has come, and we can’t wait any longer.”
There’s work at the Federal level to bring in new legislation, Peter added, “which is set to mandate that pathology and diagnostic imaging test results must be shared with consumers through their My Health Record – with some exceptions based on consumer preference, clinical concerns, safety concerns, or technical issues – and there’ll be big financial penalties for diagnostic providers who don’t do that.”
Collecting and utilising health data
Peter shared with us some details around how the Agency currently collects and utilises data, pointing to the fact that most of the data currently collected is for primary use, through pathology providers, diagnostic imaging providers, hospitals, specialists and GPs sharing data with the national system. “That’s something we’ve been doing for well over ten years in Australia,” he said.
Another important thing to consider for data is that “around 90 percent of Australians have a My Health Record”. A lot of the last ten years has been looking at how to ensure that includes “the right information”, according to Peter, “that can be surfaced at the right time, when that clinical care is being provided, to assist the clinician in providing exceptional care”.
As a consumer, patients have the option to control who has visibility of information contained within their My Health Record, and can create an alert directly to their phone to let them know every time someone looks at their record, Peter said. “I could also go into my record and control which parts of my record are visible,” he continued, “so we have a really good mechanism in place for that, and the true power of that is in our strong consumer control legislation.”
Updates to the My Health Record and my health app functionality
When it comes to recent developments on My Health Record and my health app functionality, Peter talked about current modernisation efforts, including efforts in the last three months to introduce new functionality to enable aged support plans for those in residential aged care. “Those can now be shared with their clinicians and representatives through My Health Record,” he said.
Peter’s team has also been looking at how paramedics “could better use the My Health Record”, he went on, “and whether we need to design something specific just for them”. Additional functionality has just gone live to enable patient data to be sent along with them in the ambulance for the paramedics when a patient is moved from aged care to acute hospital care, in the form of an Aged Care Transfer Summary, he said.
“The my health app is even more exciting,” Peter noted, “and we’ve got upcoming work around medicines, emergency contacts – looking at our roadmap we’ve got about four years’ worth of work to do in the next twelve months!” Now is also the time, he said, to look at the functionality that consumers are wanting which isn’t available yet, “and we’re enjoying feedback which tells us how this additional functionality we’re putting in is making the lives of those using it much easier”.
Industry collaboration and procurement
“We’ve got a whole range of procurements happening at the moment,” Peter said, “and they’re looking at how we take everything we’ve got and modernise it”. Talking specifically about a recent Request for Information (RFI) put out for application support and maintenance, he told us that that was part of finding out from the software industry and vendors “what the newest and greatest ways of doing things are, because ultimately, we’re not the source of innovation, we’re learning from our colleagues across the sector”.
In parallel with that is the Agency’s work on consumer engagement, Peter told us, “because everything in the my health app is actually co-designed with consumers, patients, and carers. What we’re hearing from them about what they’d like to see from digital healthcare infrastructure is they tell their story once, to one clinician, after which everyone else just knows it and has all the information, so healthcare isn’t one of those things that takes time away from them enjoying their lives.”
This engagement has led to procurement processes to see how the Agency can do that, Peter continued, “to bring all of that information together, allow data to be retrieved on demand, and build newer, better ways for our clinicians to view that information – it might be using AI to allow them to talk to the system and have it pull out the data they’re looking for – we want them to be able to just dive in and pull out the bits that they want. We’re hearing from that RFI now just how technically we can do that.”
On whether he feels there is enough space for industry collaboration in Australia, Peter mentioned a recent briefing the Agency held for the healthcare and IT sector, in which it presented its vision for the future, took on board feedback, and “answered hundreds of questions”. A consultation document has also recently gone out with “about 140 pages of architectural genius, if I believe my staff”, he said, “talking about the architecture for the health information exchange”.
All of this work has been directed at “getting the best out of industry”, Peter told us, “and we also hear regularly from clinicians and consumers on what matters to them – now we’ve got those ideas it’s about how we make it easier for industry to work with us, including publishing an annual procurement plan which lets vendors know what we’re looking to buy at various times across the year.
“We’re also doing other things to try and encourage that digital healthcare ecosystem in Australia, embracing global standards, and remaining ruthlessly focused on ensuring absolutely minimal local customisation to allow companies developing in the Australian market to sell their products globally. We’re trying to reduce the time it takes vendors to connect to our national infrastructure and to My Health Record, down to one month,” Peter highlighted, “and we’ve already shaved nearly six months off that time.”
Embracing industry in the health sector in Australia is integral, Peter said, “as there are so many problems to solve, and I don’t have enough smart people to do it – I need all the help I can get”.
Progress toward Australia’s National Digital Health strategy
Directing his attention to the nation’s progress toward its National Digital Health Strategy, Peter hailed some of the “great progress” to have happened over the last decade or so, saying, “we have things like digital radiology, digital pathology, an active EPR market, and some really strong legislation around data sharing – I think all of those things, plus our central My Health Records system have set us up well, but they’re only the foundational building blocks.”
Implementation of the National Healthcare Interoperability Plan will take place over the next two or three years to “start to join all of that together”, Peter shared, “and then when we start working on technology modernisation and moving to FHIR, upgrading all of our systems; that’s when I think Australia will excel, because at the moment we have lots of islands of digital excellence, but they don’t operate as one system yet.”
Joining all of those pockets of care together will be key, Peter went on, “whether that be disability care, care for veterans, or just day-to-day visits to a pharmacist, GP, or hospital – that’s really what Australia is focusing on now”. Within ten years, he said, “I hope Australia will be a nirvana for health tech globally. We’re embracing international standards; we have an aggressive plan to modernise; and we’re really looking to develop what we’re doing, working with industry and building on what we know about what consumers, patients, and clinicians want.”
What that looks like in practice is “not talking about health tech, but just having that be a natural part of conversations about health”, Peter said. “So we won’t be talking about e-prescriptions or how one system talks to another; we’ll be talking about what clinicians are doing with data and how they’re treating consumers differently because they have access to all of these systems and services to facilitate that.”
One of the major challenges in reaching that point will be the “vast distances” the Australian health system is required to cover, according to Peter, “because we have long distances from one part of the country to another, and it’s how we promote access to services, and how we use digital technology to reduce that distance and achieve health equity. It’s also how we use things like digital twins to allow clinicians to provide that next level of care, that precision medicine, but at a population level.”
Looking ahead: Health tech in Australia over the next five years
Peter told us that his team are currently doing the design work for incorporating data from wearable devices like Fitbits and Apple Watches into the My Health Record system. “Moving to FHIR will help us immensely with that,” he considered, “and we expect to have a FHIR-based database in place probably within 12 months.” That work will mean that consumers will be able to share data from their wearable devices with clinicians, “and they can also store it, because they might want to use it themselves in a few years’ time to interrogate”, he said.
The Agency will be working to move “all of Australian healthcare” over to FHIR in the next five years, Peter shared, “so we’re looking at the substantial uplift of primary care systems across the sector, and they’re being rearchitected at the moment by the commercial suppliers – we’re also expecting those who provide the systems for acute hospital trusts or the equivalent to look at how we implement FHIR from day one.”
A project Peter voiced his particular excitement for is the native integration of clinical terminology. “That means things like SNOMED CT and Australian medicines terminology being embedded natively into all of our systems, so we can put the “plumbing” in place technically to enable the data flow from Point A to Point B. Having the data used and described in the same way, using the same clinical terminology which is globally interoperable, means clinicians are comparing apples with apples.”
The Agency is also active on an international basis, Peter said, “and I spend about half of my time working with development organisations globally and with other nations. At the moment we’re looking at how to implement International Patient Summary, so if someone travels from Australia overseas they can have their clinical records available through the app on their phone. If they need to share key data they can generate an International Patient Summary from their phone to be sucked in to the system of the location or clinician that’s treating them.”
The Agency is also involved in work on the European Health Data Space, “and with America as they go into their next phase of the Trusted Exchange Framework and Common Agreement (TEFCA) – so there’s a huge amount happening in the standards space!”
On interoperability, Peter highlighted challenges around implementing the National Healthcare Interoperability Plan for Australia, “a five-year vision with 44 actions addressing the steps we need to take – everything from changing legislation to terminology, identifiers, and even things like consumer engagement to ensure there’s actually a social license to share the data”. Today, however, “nothing is interoperable in many respects”, he said, “and we rely on HL7 version 2 messages that were cutting edge 30 years ago – the majority of information at the moment moves around by fax”.
There are also challenges around primary care IT systems, Peter shared, “which probably aren’t as advanced as they are in the UK”, talking about the difficulties which arise “even in transferring data from one GP practice to another”. With all of the work going in at the moment around healthcare identifiers and standards, however, “we expect in the next two years to be in a place where all of our systems will actually be interoperable”, he noted.
The limiting factor for many countries is national infrastructure, Peter observed, “and the hospitals themselves, rather than some of those new companies who are innovating and wanting to share this data more readily. One of the other things we’re working on is how to build a digital twin for every Australian – when looking into new and innovative treatments we can’t afford to do the traditional “try it and see how it works”; we’re looking at how to collect that data and make it comparable to get those digital twins in place for clinicians to run those scenarios and see what would happen with different treatment options.”
Bringing all of this together over the next five years would hopefully mean “better care, better access, and better outcomes for patients”, Peter concluded, “and we can maybe move to address some of our workforce challenges alongside that with technology like ambient scribes, because we’re already seeing AI technologies being used in administrative processes. As a healthcare consumer, I’m a lot more comfortable that my GP appointment might be prioritised using something like that in the background than deciding what treatment I get.”
Whilst this rapid pace of innovation is likely to lead to “some need for catch up” from a legislative standpoint, what the Agency is looking at is “how we can ensure some of those basic guardrails are there, so whilst we don’t have detailed legislation for some of these things yet, we have those broad parameters that everything fits into, that can still make it safe.” The exciting part, he went on, “is whether the government can keep up now the horse has already bolted to some extent”.
We’d like to thank Peter for taking the time to share these insights with us.
