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Background: Health data sharing is important for monitoring diseases, policy and practice, and planning health services. If health data are used for secondary purposes, information needs to be provided to assist in reuse. Objectives: To review government health information asset websites to ascertain the extent of readily available, explanatory documentation for researcher sharing and reuse of these data. Method: Documentary analysis was undertaken on selected Victorian Government health information assets' websites in Australia. Data were obtained on nine information-categories: data custodian; data context; data dictionary; quality controls; data quality; limitations; access process; privacy/confidentiality/security and research requests/outputs. Information-categories were compared by dataset type (administrative or population-health) and by curating organisation (government or other agency). Descriptive statistics were used. Results: The majority of the 25 websites examined provided information on data custodian (96%) and data context (92%). Two-thirds reported access process (68%) and privacy/confidentiality/security information (64%). Compared with population-health websites, administrative dataset websites were more likely to provide access to a data dictionary (67% vs 50%) and information on quality controls (56% vs 44%), but less likely to provide information on the access process (56% vs 75%) and on research requests/outputs (0% vs 56%, p = 0.024). Compared with government-curated websites, other agency websites were more likely to provide information on research requests/outputs (80% vs 7%, p < 0.001). Conclusion: There is inconsistent explanatory documentation available for researchers for reuse of Victorian Government health datasets. Importantly, there is insufficient information on data quality or dataset limitations. Research-curated dataset websites are significantly more transparent in displaying research requests or outputs. [ABSTRACT FROM AUTHOR]

Background: This study explored the feasibility of integrating a clinical decision support tool into general practice clinical management software in Australia to prompt for alcohol screening among patients who are pregnant or planning a pregnancy. The study aimed to increase understanding of what is an appropriate and acceptable clinical decision support tool, the circumstances when a prompt to use such a screening tool should occur, and the barriers and enablers of successful implementation. Methods: This feasibility study employed a mixed methods approach and purposive sampling to identify key stakeholders to interview. Participants included vendors of clinical software used in Australian general practice, clinicians in general practice, and relevant others. Data from a literature review and 23 interviews were analysed leading to recommendations which were 'sense-tested' by an additional 22 stakeholders. Results: Although there are at least 18 clinical software packages used in Australian general practice, it is feasible to integrate an alcohol screening tool for pregnancy into software for the majority of general practices in Australia. The AUDIT-C alcohol screening tool for pregnancy was widely accepted as suitable for such a purpose. Clinicians suggested the greatest barriers to screening were lack of time within antenatal consultations and insufficient remuneration for longer consultations. Many clinicians saw opportunity for introducing a multifunctional antenatal tool that could incorporate screening and clinical decision support for alcohol, tobacco and other substance use, mental health, domestic and family violence and potentially other areas informing healthy pregnancy. It could also be used opportunistically for preconception screening and counselling. Deployment of the tool could be supported by an education campaign from professional associations. Conclusion: The integration of a tool for screening for alcohol use among women who are pregnant or planning pregnancy into general practice clinical software is feasible; however, a multifunctional antenatal screening tool, incorporating other psychosocial elements, was considered more useful than a stand-alone alcohol screening tool. Codesign is needed with vendors and end-users to develop an acceptable tool that can be widely implemented. Issues with GP renumeration need also to be addressed to encourage alcohol screening pre-pregnancy and in the early months of pregnancy. [ABSTRACT FROM AUTHOR]

Background: Research has highlighted a need to improve the quality of clinical documentation and data within aged care and disability services in Australia to support improved regulatory reporting and ensure quality and safety of services. However, the specific causes of data quality issues within aged care and disability services and solutions for optimisation are not well understood. Objectives: This study explored aged care and disability workforce (referred to as 'data-users') experiences and perceived root causes of clinical data quality issues at a large aged care and disability services provider in Western Australia, to inform optimisation solutions. Methods: A purposive sample of n = 135 aged care and disability staff (including community-based and residential-based) in clinical, care, administrative and/or management roles participated in semi-structured interviews and web-based surveys. Data were analysed using an inductive thematic analysis method, where themes and subthemes were derived. Results: Eight overarching causes of data and documentation quality issues were identified: (1) staff-related challenges, (2) education and training, (3) external barriers, (4) operational guidelines and procedures, (5) organisational practices and culture, (6) technological infrastructure, (7) systems design limitations, and (8) systems configuration-related challenges. Conclusion: The quality of clinical data and documentation within aged care and disability services is influenced by a complex interplay of internal and external factors. Coordinated and collaborative effort is required between service providers and the wider sector to identify behavioural and technical optimisation solutions to support safe and high-quality care and improved regulatory reporting. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to identify and evaluate tools and resources used to support the implementation of workplace healthy food and drink policies, primarily in Australia and New Zealand. Methods: A scoping grey literature review included searches of government agencies and non‐governmental organisations' websites in six English‐speaking countries, public health nutrition intervention databases and Google search engine queries. Paper‐based and digital tools were included if they were written in English, referred to within a policy or on a policy's website, and primarily targeting supply‐side stakeholders. Tools were evaluated on two domains: 'Features' (summarised descriptively) and 'Usability and Quality' (with inter‐rater reliability scores calculated using an intraclass correlation coefficient). Results: Twenty paper‐based tools were identified relating to Australian (n = 14) and New Zealand (n = 6) policies, and a further six digital tools were identified from Australia (n = 3) and Canada (n = 3). Target audiences included workplace managers, food providers and suppliers. The paper‐based tools focused on general implementation guidance. In contrast, digital tools tended to support specific elements of policy implementation. 'Usability and Quality' scores ranged from 2.9 to 4.5 (out of 5.0) for paper‐based tools, and 3.9 to 4.2 for digital tools, with a moderate agreement between reviewer scores (intraclass correlation coefficient 0.523, p = 0.010). Conclusions: A range of tools have been developed to support the implementation of workplace healthy food and drink policies. Understanding the strengths and limitations of current tools will assist in developing improved aids to support policy implementation. [ABSTRACT FROM AUTHOR]

Background: In Australia, national policy prioritises the integration of clinical genetic data with networked electronic medical records (EMRs) for enhanced coordination of care and clinical decision-making. Objective: To examine the needs, privacy expectations and concerns of patients, family members, patient advocates and clinicians in relation to the use of networked EMRs for clinical genetic information. Method: Purposive sampling was used to recruit 27 participants for a semi-structured qualitative interview, primarily over Zoom. The interviews were audio and video-recorded and externally transcribed. Interview transcripts were then coded and analysed in NVivo, using an inductive thematic approach. Results: Thematic analysis revealed diverse preferences regarding genetic information access and handling across participants, with five core themes being identified: degree of access and control; central role of genetic professionals as information gatekeepers; complexities of familial implications; external risks; and law, governance and policy; all strong themes that emerged across numerous participants. Conclusion: This project yielded unprecedented and significant insights into the views, needs and concerns of key stakeholders in Australia regarding the inclusion of health-related genetic test results in networked EMRs. Implications: These findings provide a critical reference point for much-needed law reform and policy-making around genetic test results in Australia. [ABSTRACT FROM AUTHOR]

Background: There is increasing global incidence of acute kidney injury (AKI) and significant short‐ and long‐term impacts on patients. Aims: To determine incidence and outcomes of community‐acquired AKI (CA‐AKI) and hospital‐acquired AKI (HA‐AKI) among inpatients in the Australian healthcare setting using modern health information systems. Methods: A retrospective cohort study of adult patients admitted to a quaternary hospital in Melbourne, Australia, between 1 January 2018 and 31 December 2019 utilising an electronic data warehouse. Participants included adult patients admitted for >24 h who had more than one serum creatinine level recorded during admission. Kidney transplant and maintenance dialysis patients were excluded. Main outcomes measured included AKI, as classified by the Kidney Disease Improving Global Outcomes (KDIGO) criteria, hospital length of stay and 30‐day mortality. Results: A total of 6477 AKI episodes was identified across 43 791 admissions. Of all AKI episodes, 77% (n = 5011), 15% (n = 947) and 8% (n = 519) were KDIGO stage 1, 2 and 3 respectively. HA‐AKI accounted for 55.9% episodes. Patients required intensive care unit admission in 22.7% (n = 1100) of CA‐AKI and 19.3% (n = 935) of HA‐AKI, compared with 7.5% (n = 2815) of patients with no AKI (P = 0.001). Patients with AKI were older with more co‐morbidities, particularly chronic kidney disease (CKD). Length of stay was longer in CA‐AKI (8.8 days) and HA‐AKI (11.8 days) compared with admissions without AKI (4.9 days; P < 0.001). Thirty‐day mortality was increased with CA‐AKI (10.2%) and HA‐AKI (12.8%) compared with no AKI (3.7%; P < 0.001). Conclusion: The incidence of AKI detected by the electronic data warehouse was higher than previously reported. Patients who experienced AKI had greater morbidity and mortality. CKD was an important risk factor for AKI in hospitalised patients. [ABSTRACT FROM AUTHOR]

This article explores staff work patterns in an Australian residential aged care facility and the implications for high‐quality care. Rarely available minute by minute, time and motion, and ethnographic data demonstrate that nurses and care staff engage in high degrees of multitasking and mental switching between residents. Mental switching occurs up to 18 times per hour (every 3 min); multitasking occurs on average for 37 min/h. Labor process theory is used to examine these outcomes and to explore the concepts of high demand and high commitment as core components of work intensification. These conditions of work result in high levels of cognitive burden and stress on staff in managing the multitasking and mental switching, exacerbated by lack of knowledge about residents associated with labor force casualization. These new interpretations of data in relation to mental and manual labor can contribute to understanding, and, therefore, problem solving, in the aged care sector. [ABSTRACT FROM AUTHOR]

Background: The present study aimed to investigate health service nutrition practices of sites providing care to patients undergoing surgery for upper gastrointestinal cancer within Australia, including the provision of perioperative nutrition support services and outpatient clinics, as well as the use of evidence‐based nutrition care pathways/protocols. Secondary aims were to investigate associations between the use of a nutrition care pathway/protocol and patient outcomes. Methods: Principal investigator dietitians for the sites (n = 27) participating in the NOURISH point prevalence study participated in a purpose‐built site‐specific survey regarding perioperative nutrition practices and protocols. Data from the 200 patients who participated in the study (including malnutrition prevalence, preoperative weight loss and receipt of dietetics intervention, intraoperative feeding tube insertions, provision of nutrition support day 1 post surgery, length of stay, and complications) were investigated using multivariate analysis to determine associations with the sites' use of a nutrition care pathway/protocol. Results: The majority of sites (>92%) reported having dietetics services available in chemotherapy/radiotherapy. Eighty‐five percent of sites reported having some form of outpatient clinic service; however, a routine service was only available at 26% of sites preoperatively and 37% postoperatively. Most preoperative services were embedded into surgical/oncology clinics (70%); however, this was reported for only 44% of postoperative clinics. Only 44% had a nutrition care pathway/protocol in place. The use of a nutrition care pathway/protocol was associated with lower rates of malnutrition, as well as higher rates of preoperative dietetics intervention, intraoperative feeding tube insertions, and European Society of Clinical Nutrition and Metabolism (ESPEN) guideline compliant care day 1 post surgery. Conclusions: The results of the present study demonstrate varied perioperative outpatient nutrition services in this high‐risk patient group. The use of nutrition care pathways and protocols was associated with improved patient outcomes. Key points: Perioperative nutrition support is strongly recommended for patients undergoing surgery for upper gastrointestinal cancer. However, the level of perioperative nutrition services in Australia including the use of outpatient clinics and nutrition care pathways is currently unknown. Data from the 27 hospitals, and the 200 patients who participated in the NOURISH point prevalence study was analysed to report on health service nutrition practices in UGI cancer resection, and associations with patient outcomes. Results demonstrated inconsistent nutrition support practices, with 44% of sites having an evidence‐based nutrition care pathway/protocol in place. The use of a nutrition care pathway/protocol was associated with lower rates of malnutrition, and higher rates of preoperative dietetics intervention, intraoperative feeding tube insertions and ESPEN guideline compliant nutrition care day one post surgery. [ABSTRACT FROM AUTHOR]

Introduction: Internationally, the adoption of technology into residential aged care settings has been slow and fraught with multiple challenges for residents, staff and service providers. The aim of this study was to evaluate the acceptability, efficiency, and quality of health information system implementation into aged care. Methods: Three‐stage, mixed‐methods participatory action research, concurrent with the natural experiment of a co‐designed health information system implementation into a 169‐bed aged care home in Australia. Data were collected pre‐, during, and post implementation between 2019 and 2021. Qualitative data included focus groups, interviews, and observations. Quantitative data included work observations, pedometers, record audits, incident reports and staff and resident surveys. There were 162 participants composed of 65 aged care residents, 90 staff, and 7 managers/consultants. Results: Improved work efficiency included reduced staff time searching for information (6%); reduced nurse time on documentation (20.4% to 6.4%), and 25% less steps. Documentation improvement included resident assessments (68% to 96%); resident‐focused goals (56% to 88%) and evaluations (31% to 88%). The staff reported being better equipped to manage the 'delicacies of dignity'. Conclusion: Implementation of a health information system into a residential aged care facility was associated with improved resident‐focused care and staff efficiency. Clinical relevance: Technology can support nurses and care staff to spend more time with residents in residential aged care homes, improve the quality of resident care, and assist meeting regulatory reporting requirements. Flexible and tailored co‐design strategies can enhance both effectiveness and success of technology implementation into residential aged care. [ABSTRACT FROM AUTHOR]

Background: The implementation of emerging technologies has resulted in an increase of data breaches in healthcare organisations, especially during the COVID-19 pandemic. Health information and cybersecurity managers need to understand if, and to what extent, breach types and locations are associated with their organisation's business type., Objective: To investigate if breach type and breach location are associated with business type, and if so, investigate how these factors affect information systems and protected health information in for-profit versus non-profit organisations., Method: The quantitative study was performed using chi-square tests for association and post-hoc comparison of column proportions analysis on an archival data set of reported healthcare data breaches from 2020 to 2022. Data from the Department of Health and Human Services website was retrieved and each organisation classified as for-profit or non-profit., Results: For-profit organisations experienced a significantly higher number of breaches due to theft, and non-profit organisations experienced a significantly higher number of breaches due to unauthorised access. Furthermore, the number of breaches that occurred on laptops and paper/films was significantly higher in for-profit organisations., Conclusion: While the threat level of hacking techniques is the same in for-profit and non-profit organisations, certain breach types are more likely to occur within specific breach locations based on the organisation's business type. To protect the privacy and security of medical information, health information and cybersecurity managers need to align with industry-leading frameworks and controls to prevent specific breach types that occur in specific locations within their environments., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Researchers have examined sub-groups that may exist among young people transitioning from out-of-home care (OHC) using various theoretical models. However, this population group has not been examined for trajectories of homelessness risk. To examine whether different subtypes of homelessness risk exist among young people transitioning from care and whether these trajectories of homelessness are associated with mental health and substance use disorders. A retrospective population-based cohort study was conducted from a population of 1018 young people (aged 15–18 years) who transitioned from out-of-home in 2013 to 2014 in the state of Victoria, Australia, with follow-up to 2018. Latent Class Growth Analysis was conducted using linked data from homelessness data collections, child protection, mental health information systems, alcohol and drug use, and youth justice information systems. Three sub-groups of young people were identified. The 'moving on' group (88 %) had the lowest levels of homelessness, with the slope of this trajectory remaining almost stable. The ' survivors' (7 %) group started off with a high risk of homelessness, followed by a sharp decrease in homelessness risk over time. The ' complex' (5 %) group started off with a low risk of homelessness but faced sharp increases in the risk of homelessness over time. Our study demonstrates that subgroups of young people transitioning from care exist with distinct longitudinal trajectories of homelessness, and these classes are associated with different risk factors. Early intervention and different approaches to tackling homelessness should be considered for these three distinct groups before transitioning from care and during the first few years after leaving care. [ABSTRACT FROM AUTHOR]

The article focuses on the cybersecurity landscape in 2024. It highlighting the rising threat of cybercrime in Australia, particularly targeting small enterprises and the increasing sophistication of cyber attacks; supply chain attacks and social engineering campaigns; the surge in cybercrime reports; strategies for strengthening cybersecurity defenses for small to medium enterprises (SMEs); and the role of cyber insurance in mitigating the impact of cyber attacks.

Objectives: This project aimed to determine where health technology can support best-practice perioperative care for patients waiting for surgery., Methods: An exploratory codesign process used personas and journey mapping in three interprofessional workshops to identify key challenges in perioperative care across four health districts in Sydney, Australia. Through participatory methodology, the research inquiry directly involved perioperative clinicians. In three facilitated workshops, clinician and patient participants codesigned potential digital interventions to support perioperative pathways. Workshop output was coded and thematically analysed, using design principles., Results: Codesign workshops, involving 51 participants, were conducted October to November 2022. Participants designed seven patient personas, with consumer representatives confirming acceptability and diversity. Interprofessional team members and consumers mapped key clinical moments, feelings and barriers for each persona during a hypothetical perioperative journey. Six key themes were identified: 'preventative care', 'personalised care', 'integrated communication', 'shared decision-making', 'care transitions' and 'partnership'. Twenty potential solutions were proposed, with top priorities a digital dashboard and virtual care coordination., Discussion: Our findings emphasise the importance of interprofessional collaboration, patient and family engagement and supporting health technology infrastructure. Through user-based codesign, participants identified potential opportunities where health technology could improve system efficiencies and enhance care quality for patients waiting for surgical procedures. The codesign approach embedded users in the development of locally-driven, contextually oriented policies to address current perioperative service challenges, such as prolonged waiting times and care fragmentation., Conclusion: Health technology innovation provides opportunities to improve perioperative care and integrate clinical information. Future research will prototype priority solutions for further implementation and evaluation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Clinical documentation improvement (CDI) is a recent initiative gaining increased momentum in Australia. The benefits surrounding its success internationally include improved quality and patient safety outcomes and increased reimbursement. The premise of CDI is simple: engage clinicians to improve the clinical documentation in the medical record in "real time" so that it is fit for reporting, analysis and reimbursement. Every country has differing healthcare systems and this article has focused on validating the relevancy of CDI for the Australian healthcare environment. [ABSTRACT FROM AUTHOR]

Background: Research has associated some chronic conditions with self-harm and suicide. Quantifying such a relationship in mortality data relies on accurate death records and adequate techniques for identifying these conditions. Objective: This study aimed to quantify the impact of identification methods for co-morbid conditions on suicides in individuals aged 30 years and older in Australia and examined differences by gender. Method: A retrospective examination of mortality records in the National Coronial Information System (NCIS) was conducted. Two different methods for identifying co-morbidities were compared: International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) coded data, which are provided to the NCIS by the Australian Bureau of Statistics, and free-text searches of Medical Cause of Death fields. Descriptive statistics and χ2 tests were used to compare the methods for identifying co-morbidities and look at differences by gender. Results: Results showed inconsistencies between ICD-10 coded and coronial reports in the identification of suicide and chronic conditions, particularly by type (physical or mental). There were also significant differences in the proportion of co-morbid conditions by gender. Conclusion: While ICD-10 coded mortality data more comprehensively identified co-morbidities, discrepancies in the identification of suicide and co-morbid conditions in both systems require further investigation to determine their nature (linkage errors, human subjectivity) and address them. Furthermore, due to the prescriptive coding procedures, the extent to which medico-legal databases may be used to explore potential and previously unrecognised associations between chronic conditions and self-harm deaths remains limited. [ABSTRACT FROM AUTHOR]

Background: Information management systems and processes have an impact on quality and safety of care in any setting and particularly in the complex care setting of aged care. Few studies have comprehensively examined information management in the Australian aged care setting. Objective: To (i) critically analyse and synthesize evidence related to information management in aged care, (ii) identify aged care data collection frameworks and (iii) identify factors impacting information management. Methods: An integrative review of Australian literature published between March 2008 and August 2014 and data collection frameworks concerning information management in aged care were carried out. Results: There is limited research investigating the information-rich setting of aged care in Australia. Electronic systems featured strongly in the review. Existing research focuses on residential settings with community aged care largely absent. Information systems and processes in the setting of aged care in Australia are underdeveloped and poorly integrated. Conclusions: Data quality and access are more problematic within community aged care than residential care settings. The results of this review represent an argument for a national approach to information management in aged care to address multiple stakeholder information needs and more effectively support client care. [ABSTRACT FROM AUTHOR]

Background: A lack of standard terminology or means to identify and define models of maternity care in Australia has prevented accurate evaluations of outcomes for mothers and babies in different models of maternity care. Objective: As part of the Commonwealth-funded National Maternity Data Development Project, a classification system was developed utilising a data set specification that defines characteristics of models of maternity care. Method: The Maternity Care Classification System or MaCCS was developed using a participatory action research design that built upon the published and grey literature. Results: The study identified the characteristics that differentiate models of care and classifies models into eleven different Major Model Categories. Conclusion: The MaCCS will enable individual health services, local health districts (networks), jurisdictional and national health authorities to make better informed decisions for planning, policy development and delivery of maternity services in Australia. [ABSTRACT FROM AUTHOR]

Background: Efficient information systems support the provision of multi-disciplinary aged care and a variety of organisational purposes, including quality, funding, communication and continuity of care. Agreed minimum data sets enable accurate communication across multiple care settings. However, in aged care multiple and poorly integrated data collection frameworks are commonly used for client assessment, government reporting and funding purposes. Objective: To determine key information needs in aged care settings to improve information quality, information transfer, safety, quality and continuity of care to meet the complex needs of aged care clients. Method: Modified Delphi methods involving five stages were employed by one aged care provider in Victoria, Australia, to establish stakeholder consensus for a derived minimum data set and address barriers to data quality. Results: Eleven different aged care programs were identified; with five related data dictionaries, three minimum data sets, five program standards or quality frameworks. The remaining data collection frameworks related to diseases classification, funding, service activity reporting, and statistical standards and classifications. A total of 170 different data items collected across seven internal information systems were consolidated to a derived set of 60 core data items and aligned with nationally consistent data collection frameworks. Barriers to data quality related to inconsistencies in data items, staff knowledge, workflow, system access and configuration. Conclusion: The development an internal aged care minimum data set highlighted the critical role of primary data quality in the upstream and downstream use of client information; and presents a platform to build national consistency across the sector. [ABSTRACT FROM AUTHOR]

Australia is stepping up to the new e-health environment. With this comes new legislation and new demands on information security. The expanded functionality of e-health and the increased legislative requirements, coupled with new uses of technology, means that enhancement of existing security practice will be necessary. This paper analyses the new operating environment for Australian healthcare and the legislation governing it, and highlights the changes that are required to meet this new context. Individuals are now more responsible for security and organisations should be prompted to review their security measures in light of the new demands of legislative compliance. [ABSTRACT FROM AUTHOR]

Background: Systematic collection and analysis of global hemodialysis patient data may help to improve patient outcomes. Methods: The MONitoring Dialysis Outcomes (MONDO) initiative comprises data from eight dialysis providers worldwide. Data are combined into one repository. Extensive procedures are employed to merge data across countries and providers. Results: The MONDO database comprises longitudinal data of currently 128,000 hemodialysis patients from 26 countries on five continents. Here we report data from 62,345 incident hemodialysis patients. We found lower catheter rates in South-East Asia and Australia, lower hemoglobin levels in South-East Asia, and a higher prevalence of diabetes in North America. Longitudinal analyses suggest that there is a decline in interdialytic weight gain and serum phosphorus and an increasing neutrophil-to-lymphocyte ratio before death in all regions studied. Conclusions: While organizationally lean and low-cost, MONDO is the largest global dialysis database initiative to date, with a particular focus on high longitudinal data density and geographical diversity. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: The use of government health data for secondary purposes, such as monitoring the quality of hospital services, researching the health needs of populations, and testing how well new treatments work, is increasing. This increase in the secondary uses of health data has led to increased interest in what the public thinks about data sharing, in particular, the possibilities of sharing with the private sector for research and development. Although international evidence demonstrates broad public support for the secondary use of health data, this support does not extend to sharing health data with the private sector. If governments intend to share health data with the private sector, knowing what the public thinks will be important. This paper reports a national survey to explore public attitudes in Australia toward sharing health data with private companies for research on and development of therapeutic drugs and medical devices.Objective: This study aims to explore public attitudes in Australia toward sharing government health data with the private sector.Methods: A web-based survey tool was developed to assess attitudes about sharing government health data with the private sector. A market research company was employed to administer the web-based survey in June 2019.Results: The survey was completed by 2537 individuals residing in Australia. Between 51.8% and 57.98% of all participants were willing to share their data, with slightly fewer in favor of sharing to improve health services (51.99%) and a slightly higher proportion in favor of sharing for research and development (57.98%). There was a preference for opt-in consent (53.44%) and broad support for placing conditions on sharing health information with private companies (62% to 91.99%). Wide variability was also observed in participants' views about the extent to which the private sector could be trusted and how well they would behave if entrusted with people's health information. In their qualitative responses, the participants noted concerns about private sector corporate interests, corruption, and profit making and expressed doubt about the Australian government's capacity to manage data sharing safely. The percentages presented are adjusted against the Australian population.Conclusions: This nationally representative survey provides preliminary evidence that Australians are uncertain about sharing their health data with the private sector. Although just over half of all the respondents supported sharing health data with the private sector, there was also strong support for strict conditions on sharing data and for opt-in consent and significant concerns about how well the private sector would manage government health data. Addressing public concern about sharing government health data with the private sector will require more and better engagement to build community understanding about how agencies can collect, share, protect, and use their personal data. [ABSTRACT FROM AUTHOR]

Electronic health records and the Internet will continue to transform how information is accessed and shared. Users of health data such as health professionals, governments, policymakers, researchers and patients themselves need to be able to access the right information at the right time and be confident in the quality of that information, whether personal, aggregated or knowledge based. It is essential to evaluate information systems and applications that claim to improve information quality and access in order to provide evidence that they support healthcare delivery and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Digital health is widely believed to have vast potential in improving patient care. MyHealthRecord (MyHR) is a digital health information system which enables Australian citizens to access their health information centrally, making it available anywhere, at anytime. The aim of this study is to explore the adoption of MyHR in general practices in Victoria and understand its impacts. A qualitative case study research method was used to underpin this investigation. Ten general practices were engaged where MyHR was implemented/used. Detailed interviews with MyHR implementers were held and GPs were engaged in short interviews. Twenty observations were made during GP/patient consultations for health summary uploads. Findings indicate that the practice incentive payment (PIP) funding policy change encouraged the use of MyHR, but the adoption was limited to satisfy funding criteria. Change management was often extemporised. Health summary upload was a quick and easy process but was influenced by clinical system data quality and GP familiarity with the system. Community awareness and GP interest in MyHR was lacking. The conclusion is that MyHR was not well integrated in general practices nor the community. As a result, an improved engagement approach between healthcare organisations, the MyHR system operator and Australians is required.

Background: The Council of Australian Governments has focused the attention of health service managers and state health departments on a list of hospital-acquired complications (HACs) proposed as the basis of funding adjustments for poor quality of hospital inpatient care. These were devised for the Australian Commission on Safety and Quality in Health Care as a subset of their earlier classification of hospital-acquired complications (CHADx) and designed to be used by health services to monitor safety performance for their admitted patients., Objective: To improve uptake of both classification systems by clarifying their purposes and by reconciling the ICD-10-AM code sets used in HACs and the Victorian revisions to the CHADx system (CHADx+)., Method: Frequency analysis of individual clinical codes with condition onset flag (COF 1) included in both classification systems using the Victorian Admitted Episodes Dataset for 2014/2015 ( n = 2,623,275 separations). Narrative description of the resulting differences in definition of "adverse events" embodied in the two systems., Results: As expected, a high proportion of ICD-10-AM codes used in the HACs also appear in CHADx+, and given the wider scope of CHADx+, it uses a higher proportion of all COF 1 diagnoses than HACs (82% vs. 10%). This leads to differing estimates of rates of adverse events: 2.12% of cases for HACs and 11.13% for CHADx+. Most CHADx classes (70%) are not covered by the HAC system; discrepancies result from the exclusion from HACs of several major CHADx+ groups and from a narrower definition of detailed HAC classes compared with CHADx+. Case exclusion criteria in HACs (primarily mental health admissions) resulted in a very small proportion of discrepancies (0.13%) between systems., Discussion: Issues of purpose and focus of these two Australian systems, HACs for clinical governance and CHADx+ for local quality improvement, explain many of the differences between them, and their approach to preventability, and risk stratification., Conclusion: A clearer delineation between these two systems using routinely coded hospital data will assist funders, clinicians, quality improvement professionals and health information managers to understand discrepancies in case identification between them and support their different information needs.

Problem: Despite acknowledged benefits, the impact of advance care planning on usual care is inconsistent., Design: Quality improvement study., Setting: A Western Australian regional hospital., Key Measures for Improvement: This project aimed to create a system for storing, accessing and incorporating advance care planning documents in clinical care., Strategies for Change: Interventions over 18 months addressed four areas: medical records processes for receiving and processing advance care planning documents; information technology solutions for electronic storage and alerts; clerical staff duties in regards advance care planning documents; and clinician education., Effects of Change: There was a 12-fold increase in advance care planning documents stored electronically and 100% of audited notes had correct filing of advance care planning documents with an alert in place at follow-up audit. Clinician recognition of the presence of an advance care planning document improved. Detailed examples of interventions are described., Lessons Learnt: Repeated exposure to different forms of advance care planning education, in conjunction with simple but effective system changes can make a difference in changing established hospital practice. Final impact of these changes on end-of-life care requires further audit., (© 2019 National Rural Health Alliance Ltd.)

Background Diagnostic testing provides integral information for the prevention, diagnosis, treatment and management of disease. Inadequate test result reporting and follow-up is a major risk to patient safety. Factors contributing to failure to follow-up test results include unclear delineation of responsibility about who is meant to act on a test result; poor coordination across different levels of care; and the absence of integrated health information systems for the efficient information communication. Methods A 2016 Australian Stakeholder Forum brought together over 30 representatives from 14 different consumer, clinical and management stakeholder organisations to discuss safe and effective test result communication, management and follow-up. Thematic analysis was conducted drawing on multimodal data collected in the form of observational fieldnotes and document artefacts produced by participants. Results The forum identified major challenges which pose immediate risks to patient safety. Participants recommended priorities for addressing issues relating to: (i) the governance of test result management processes; (ii) integration of health care processes through the utilisation of effective digital health solutions; and (iii) involving patients as key partners in the decision-making and care process. Conclusions Stakeholder groups diverged slightly in their priorities. Consumers highlighted the lack of patient involvement in the test result management process but were less concerned about standardisation of reports and critical result thresholds than pathologists. The forum foregrounded the need for a systems approach, capable of identifying and addressing interconnections and multiple factors that contribute to poor test result follow-up, with a strong emphasis on enhancing the contribution of patients.

Objective: Human 'functioning' is about how people live on a day-to-day basis. This paper sets out the case for adopting a common language about functioning that would improve population health information and information sharing across health and community service systems., Approach: Modern health systems recognise the importance of human functioning in addition to diagnosis and disease prevention. 'Functioning' is important in the context of chronic disease, mental health, healthy ageing, and the right of people with disabilities and their carers to participate in society. We outline major directions in the health system and their relationship to the concept of functioning., Conclusions and Implications: The concept of functioning has not been used explicitly and consistently in Australian health and human service systems, which nevertheless deal with the 20% of the population who experience difficulties in functioning. The International Classification of Functioning, Disability and Health (ICF) is the international standard for definition, classification, information and measurement of functioning. While it has been partially implemented in Australia, it should be used more broadly, across health and community services, as the basis for information on functioning. This is an intended parallel to the use of the ICD as the standard classification and code list for disease monitoring and related health information systems. Monitoring health status and planning interventions and resources require information about people's functioning in their daily lives as well as their diseases. Such information should be based on the international standards developed for this purpose., (© 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia.)