On 15 July 2024, the Australian Digital Health Agency (ADHA) brought interested parties together in Canberra to outline plans for a National Health Information Exchange (HIE).

With an encompassing vision that infuses and embraces technology, the Commonwealth’s investment in an HIE could improve health outcomes, reduce costs and grow Australia’s economy.

An HIE is a collection of services, technologies and interfaces that allow health information to move securely between providers and patients, organisations and jurisdictions, and a set of capabilities that support a nationally consistent ability to exchange data wherever it resides.

States and territories already use HIEs to connect IT systems, but the planned national HIE will create a national provider directory to connect patients, GPs, hospitals and other providers, facilitating patient engagement and clinical decisions by making more information available at the point of care.

We believe the HIE should also help to address the rising cost burden of healthcare and its negative consequences by reducing demand, improving efficiency, and helping to grow Australia’s economy.

The HIE could play a major role in reducing demand

Demand for healthcare is increasing, driven by an ageing population and chronic health disease burden. In NSW, the future health strategy predicted a doubling of demand between 2022 and 2032.

Australia does not have the budget to keep building new hospitals nor hire the people to staff them, so reducing demand is critical to maintain the high quality of care and outcomes that Australians expect.

Australia has the advantage of learning how other countries’ entities have handled rising demand. Fueled by value-based funding mechanisms, integrated health systems such as Kaiser Permanente use predictive analytics across linked datasets to predict deterioration and trigger early intervention.

This enables wellness, prevention and proactive care models that reduce expensive hospital admissions. In Australia, initiatives such as Lumos in NSW link GP data with hospital data to identify opportunities for improving patient outcomes and experiences across the patient journey.

The same data can empower patients to take greater responsibility for their own care, enable better outcomes and reduce demand through emerging technologies such as AI that nudges patients to take medications or adopt preventative behaviours.

A national HIE creates an unprecedented opportunity to generate real-world evidence to drive clinical care. With access to data, clinicians and hospital administrators can evaluate different interventions for current patients based on the results of those treatments on similar patients.

The HIE could be a changemaker in driving healthcare efficiency

In 2022 the Annual Healthcare Professionals Survey identified that 84 per cent of respondents experienced stress and pressure in the workplace, and Health Workforce Australia estimates there will be a shortage of over 100,000 nurses by 2025, whilst close to 11,000 additional GPs will be needed by 2032.

In a post-Covid economy, training and hiring more staff is restrained, so improving efficiency is a critical tool to allow more patients to flow through existing services.

Efficiency improvements can be made by reducing administrative tasks and enabling data driven innovation. Health services have started to implement platforms to drive innovation, use ambient AI to automate clinical documentation, and implement virtual care models.

However, innovation that supports integrated care, precision medicine using genomics data and health services research will require data across the continuum of care. The HIE could provide the source of such data and accelerate improvements in efficiency, without compromising care delivery, quality and safety.

The HIE could boost Australia’s economy

The Australian government has a strategy to promote small to medium sized companies (SMEs) and create a Future made in Australia, and boost the economy. Yet healthcare start-ups find themselves unable to connect with traditional health systems. 60 per cent of start-ups fail in Australia, and that number is higher in healthcare.Whilst health systems are incentivised to procure SMEs, the sector is reticent to use them due to perceptions of risk.

Tech innovations in other industries utilise application programming interfaces (APIs) that make data available to be used by apps in consumer-friendly and innovative ways. Whilst the new HIE will expose FHIR-based APIs through the Sparked on FHIR program, a holistic ecosystem design enabling entrepreneurs to engage directly with HIE data for 25 million people is needed. This would enable start-ups to connect and develop useful services to Australians, potentially exporting these technology-enabled solutions across the world.

A world-class HIE with diverse data sources could be a world-first, and springboard new ventures that would take the world by storm.

What is needed to make this happen?

To maximise the value of the HIE to Australian healthcare, we need to:

• Set up a multidisciplinary taskforce to consider the full potential of an HIE and to map out an evolutionary journey covering people, process and technology.
• Revisit the authorising and legislative environment for privacy and use of data in healthcare and standardise this across the nation: the privacy measures need to facilitate sharing without compromising the confidence that consumers place in their providers and ensure that particularly sensitive information is additionally protected.
• Secure as much data as possible to minimise bias, designing in data validation, ensuring patients understand the implications of ‘opting out’ and ensuring that data is captured consistently across all care settings.
• Establish permanent data and clinical governance processes and oversight at a national level to build trust in data and ensure that safety concerns are addressed before, during and after implementation.
• Enable access to data for real-world evidence and translational research and establish a national library of tested analytics and AI algorithms that can be accessed by all health systems and built on to avoid reinventing the wheel.
• Design the HIE, API landscape and related data infrastructure to be safely and securely accessible to entrepreneurs in a consistent way. For example, in addition to controlling access through compliance and contracting, a database of representative anonymised data could be used for commercial enterprises to trial new applications safely.
• Encourage the establishment of local provider networks that can utilise image, reports and atomic data via the HIE across care settings to develop and measure innovative care models that improve outcomes in their community, then facilitate learnings that can be shared with similar communities around Australia.

About the authors

Dr Robin Mann, BEng MBBCh FAIDH trained as an engineer before qualifying in medicine in the UK in 1998. He is currently Fujitsu’s lead for health care consulting in ANZ.

Associate Professor Bhavesh Patel, MBChB FRACS FACS CHIA works as a senior paediatric surgeon in Queensland. He is involved in state and national systems change as the Queensland clinical lead for surgical quality improvement at Clinical Excellence Queensland and digital health roles within Queensland Health.

Dr Tal Rapke is an entrepreneur, physician and bio-pharma expert. His most recent venture as CEO and sole founder, ScalaMed, saw him create a smart prescription tech platform which he launched in the US.

Dr Honor Magon, MBBS, MS, is an Australian physician currently working in San Francisco as a medical director at Atropos Health. She was the first clinical informatics resident at Metro South Health, and was awarded a Fulbright Scholarship to study a Master of Science in Clinical Informatics Management at Stanford University.

Disclaimer: The views expressed in this article are solely personal to the authors, and do not in any way represent those of the companies affiliated with the authors, nor a relationship between companies affiliated with the authors.