While a leading GP says it remains more profitable to stay siloed, the ADHA says we are well on the way with existing rules coming into force and imminent systems migrations.
A lack of enforcement is the number one barrier to achieving health information interoperability in this country, according to an AMA report released today.
But the Australian Digital Health Agency says we are getting there sooner rather than later.
“Australian governments have committed to digital interoperability, but we haven’t moved to implementing it by establishing the legal frameworks, rules and regulations needed,” said AMA vice-president Associate Professor Julian Rait.
“Without this step, having systems that talk to each other, benefiting patients and doctors alike, will remain a pipe dream.”
Professor Rait said that most healthcare data was stored in isolated, incompatible databases that use proprietary software.
“While Australia has voluntary codes in the digital health sector, we need to have mandated standards to realise the potential of digital systems being able to connect and share data,” he said.
“Having clear standards will create a level playing field for all relevant stakeholders and a fair marketplace for everyone.
“This is the main barrier to having systems in Australia that connect to each other. We need a set of agreed upon national standards that everyone signs up to, including the states and territories.
“Without this we are likely to still be working in ways that lead to poorer outcomes for patients.”
Only one in 10 specialists used My Health Record and just one in five diagnostic imaging reports were uploaded because of “inefficiencies and incompatibilities” between My Health Record and health IT software used in various practices, the AMA said in its report.
In some cases, notes were being printed out in one hospital department, physically carried to another, and typed into their system, the report said.
This kind of thing led to delays in patient diagnosis and care, errors, time wasted, and data lost, leading to subsequent unnecessary duplication of tests, the AMA said. And the “greatest hindrance” to fixing it was that companies were not forced to adhere to health IT standards, they said.
The government needed to set regulations for health data interoperability, including standards, privacy protections, security measures and data sharing protocols, and then it needed to make them compulsory for healthcare providers, electronic health record vendors, health IT software providers and other relevant entities, said the AMA.
“Furthermore, legislation should prescribe penalties for non-compliance with published interoperability standards. Such legislation should also contain clauses outlining the procedures to be implemented when circumstances change — for instance, when health systems and software require updates or modifications to adapt to the evolving landscape — and software providers fail to comply,” the report said.
Those penalties would include “significant monetary penalties, loss or restriction of software licence, and the removal from government contracts”, similar to those in the US’ 21st Century Cures Act and the EU Data Act.
The government could also offer financial incentives, grants or tax benefits to healthcare organisations, like hospitals and GPs, who adopt interoperable systems, the AMA suggested.
After all, the government had already invested hundreds of millions of dollars in digital health, the AMA pointed out.
“Establishing policy tools, which take the long-term view of data interoperability in the Australian healthcare sector, will save endless frustration and wasted efforts over time,” the report said.
The frustration felt by clinicians was reiterated by Dr Max Mollenkopf, a GP and practice owner in Newcastle, NSW, who told TMRthat he agreed with the AMA.
“An industry-led solution is clearly inadequate, as there has been a real lack of progress,” he said.
Dr Mollenkopf said industry players were not moving towards interoperability because keeping their data siloes was still the most profitable thing to do. He said a “much more aggressive approach” from government was needed.
“I read and see all these gushing articles and LinkedIn posts about how they do all these kind of showcases to government where they link a patient journey and share all this data. But in my day-to-day PMS solutions, I see none of that being delivered,” he said.
“It is a commercial choice to remain that way. They would like users and data to be locked into their systems. The large vendors and commercial providers have benefited greatly from data siloing.”
Clinicians wanted to share data, but it was difficult to do, he said. While files could be transferred to other settings that used the same software, they couldn’t do it when they used different software.
And MyHealthRecord had “such a clunky format” that it was difficult for clinicians to navigate, he said – something federal health minister Mark Butler acknowledged back in 2024 when he described it as “little more than a shoebox of PDFs – the kind of shoebox every accountant has nightmares about”.
The 21st Century Cures Act in the US had led to much greater progress in interoperability than we have seen here, Dr Mollenkopf said.
“An industry-led, collaborative approach hasn’t really led to much on the ground. Ultimately, a stick-based approach is going to be the only way that we are likely to see real and meaningful change for clinicians and consumers,” he said.
The Australian Digital Health Agency leads the government’s health data interoperability push, is in charge of My Health Record, the digitalisation of the health system and supports the implementation of health interoperability standards (FHIR) for industry and government entities through programs like the SPARKED FHIR Accelerator.
Its chief digital officer, Peter O’Halloran, said the agency welcomed the AMA’s report. He also told TMRthat changes lie in the immediate future as rules came into force and systems were migrated.
“We are really at a tipping point right now,” he told TMR.
“Legislation has come in, which is mandating sharing information. Likewise, the SPARKED Accelerator has been running for two years, which is not a long time.”
He said the agency was “well across” the laws passed in the US and Europe.
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“Their legislation does permit penalties, particularly if we talk about 21st Century Cures Act. The question would then be, how many times have they actually applied a penalty?” said Mr O’Halloran.
“The approach we have in Australia, which the government has made abundantly clear and the legislation was passed with bipartisan support to say, is healthcare consumers have a right to get access to their information through My Health Record that they can then choose to share with their clinicians.
“There is a tie directly to the payment of Medicare benefits at that point in time. And I would suggest that having it tied at the front is probably far more effective than waiting for something to fail and then have a penalty afterwards,” he said.
The legislation is the Health Legislation Amendment (Modernising My Health Record—Sharing by Default) Act 2025.
New rules starting from 1 July this year – (My Health Record (Share by Default) Rules 2025) specify that diagnostic imaging services and pathology services must upload information to My Health Record, and only when that’s done will Medicare benefits be paid.
This legislation is “a game changer”, said Mr O’Halloran.
“It changes the whole paradigm to ensure that consumers have control and access their own health information. And the power of that legislative change cannot be understated,” he said.
Key is that the agency was now working with consumers, clinicians, health services and software vendors through programs like Sparked on the specifics of the digital health standards and their application, said Mr O’Halloran.
“We have projects actively underway inside the digital health agency to actually migrate My Health Record system to being on FHIR.
“We’re going out for public consultation later this year on our new conformance profiles that actually then codifies those into: here are the steps, and here are things you must conform with to get connected or remain connected to national infrastructure such as My Health Record, electronic prescribing, national medicines record and the like.
“So those parts really are key and are changing what occurs today … to what will be in place in a year or two’s time, [which] will be quite different.
“As we move the Australian healthcare system and My Health Record specifically onto FHIR, the agency is updating all of our conformance profiles to incorporate compliance to those relevant digital health standards,” he explained.
“So some of the work that’s being done in Sparked today will actually be incorporated in the conformance profiles which software vendors who are connecting to national infrastructure must comply with,” he said.
“Software vendors can choose to be conformant, to connect to national infrastructure or not. If they choose not to, that is fine, and that’s their choice, and they may not need to be. The challenge is the way it will work for their customers,” he said.
Clinicians and health services who were required to upload health information into My Health Record would need software that enabled them to do it, whether it was their existing vendor or someone else.
“It’s at a point where, really, healthcare consumers will now get access to their information much more routinely, which I think is exciting for everyone,” he said.
Read the full AMA report here.
