Interoperability or integration – that is the question

Health was in the hot seat at the first National Cabinet meeting to be chaired by new prime minister Anthony Albanese this month. 

The big headline from the meeting of the cabinet – made up of the prime minister and state and territory premiers and chief ministers – was the federal government’s decision to extend extra health funding to hospitals until 30 December. 

The Commonwealth introduced the emergency funding, which is a 50/50 split between the states and territories and the government, in response to the covid pandemic. 

The program was due to finish in September and the three-month extension will cost the federal government an additional $760 million. 

NSW premier Dominic Perrottet had been hoping for a 12-month extension of the funding arrangement but told a post National Cabinet meeting press conference that it was a “great start”. 

“This is something we have been discussing at National Cabinet for some time so to have the first meeting today, and for this matter to be resolved in some degree to be extended to December, I think is incredibly welcome and was supported by every state premier and chief minister,” he said. 

While there is no doubt this was a big deal for the states and territories, it was another announcement about health reform that has the potential to be even more significant in the long-term for Australia’s healthcare system.  

But it also has digital health experts on the edge of their seats hoping the governments can wrap their collective head around what is needed from the get-go for any reform to have a chance of success. And that is interoperability. Not integration. 

Mr Albanese said the First Secretaries Group, chaired by Professor Glyn Davis, had been tasked with developing improvements to the way the health system operates and reporting back to the National Cabinet. 

“What that’s about isn’t necessarily additional dollars,” he said.  

“What it’s about is a recognition that our hospital system at the moment has people who should be looked after by their local GP, but GPs are just unavailable.  

“The lack of nurses and health professionals in the aged care system means that many people who should be either looked after at home or looked after as aged care residents end up in the hospital system as well, putting further pressure on the system.” 

Mr Perrottet welcomed the announcement, saying it was “incredibly pleasing” to see a “real focus of working with the states and territories in relation to substantive health reform going forward.” 

“This is something that has been in the too-hard basket for too long,” he said. 

“That is reassuring in the sense that there are quick areas where we can provide further support for our health systems right across the country. 

“They are all going through a challenging time, not just through covid but obviously the impacts of that going forward and the lack of integration between the GP network and primary care and the public health system is a challenge that every jurisdiction is facing.  

“And working closely with the Commonwealth Government, I think there is great opportunity for substantive reform in that space. As the prime minister has said this is not about money, it’s about working together on substantial reform and I thought today’s National Cabinet was refreshingly collaborative.” 

Digital health and interoperability expert Michelle O’Brien said the prospect of significant health reform, while much needed and welcomed, was destined to fail unless governments addressed our disconnected siloed technology infrastructure. 

The issue will not be solved by integration; Australia urgently needs a roadmap to interoperability, she said. 

“We need to focus on aligning our health reform agenda with the digital health infrastructure, which hasn’t been done so far, because our digital health agency sits in one building and the health reformers sit in another building, despite our digital infrastructure effectively being the tracks our health system runs on,” she said. 

She said that most GPs continued to use technology from the 1990s, which was originally introduced via a Commonwealth initiative to incentivise GPs to use electronic health records. Now, the Public Health Network’s commissioning strategies continue to incentivise the use of server-based PMS technology, and there is no incentive to move to more interoperability-friendly cloud technology. 

Meanwhile state departments have moved to cloud technology in response to the pandemic, rapidly scaling up virtual EDs and hospital in the home capability, but the lack of interoperability between cloud and server technology meant that hospitals and primary care cannot work together in real time to manage patients. 

“To achieve interoperability, we need to all be speaking in the same language,” Ms O’Brien said. 

“When Mr Perrottet says we need to integrate with primary care, what he’s really saying is we need to be able to communicate with primary care in real time to better manage patients so they don’t end up in an ambulance or and ED if they could be better managed by their GP. 

“Integration with primary care won’t achieve this outcome, interoperability will.”?? 

The topic of digital health reform and strategy will be the main focus of Wild Health’s next summit. Wild Health Summits: No greater time to align our digital health strategy with our health reform agenda will take place in Melbourne and online on Tuesday October 18. The agenda and registration details are here.