Helen Almond, Carey Mather
Learning outcomes
On completion of this chapter, learners will have the capability to:
Key terms
digital health transformation
health and social care
information technology
person-centred
In pursuit of equitable, comprehensive and integrated health and social care models the Alma-Ata Declaration in 1978 encouraged a focus towards ‘... the progressive improvement of comprehensive healthcare for all, with priority given to those most in need’ (World Health Organization [WHO] 1978). Nearly 50 years later, countries are reaffirming their aspiration and collective imperative to strengthen health and social care as they reinterpret Alma-Ata goals in a modern context (Nunes 2022). This textbook focuses on opportunities presented by digital technologies in realising digital health as a transformative vision for health and social care for all.
When the Alma-Ata Declaration was signed, information and communication technologies were in their infancy. Adoption of technologies in health and social care was complicated, costly and limited. Smartphones, tablets and laptop computers, which are now commonplace, did not exist. However, by 1990 innovative technologies, most notably the internet, had begun to have a transformative impact. Technologies have demonstrated remarkable value for health and social care as they have advanced and become integrated in society. However, even in societies with higher human development, we have not been able to eradicate the complexities of social exclusion in the form of global access to technology. This is due to human factor association, demography and geography (Nunes 2022, Showell et al 2017).
In Australia and New Zealand, where workforces are required to use digital technologies, a profound impact on how health and social care services are delivered and how health systems are managed is being noted (Butler-Henderson et al 2020). Health and social care delivery and management includes providing technologies that allow people to manage their health more effectively, better ways of diagnosing disease, and monitoring the impact of policies on population health. Australian and New Zealand national digital health strategies reflect a strong commitment to using digital technologies to advance health transformation, support universal health coverage and shape the future of health and social care (Australian Digital Health Agency [ADHA] 2019, Manatū Hauora Ministry of Health 2022).
Digital strategies, policies, frameworks and service models are rapidly evolving and being established by health and social care organisations globally. However, there are still differences of opinion about how to best engage providers in the delivery of digital health and social care. Understanding technology is now commonplace in our personal lives, posing an incorrect assumption that learners know how to professionally engage with digital health and social care technologies. Before introducing the contents of this textbook, and how to effectively engage health and social care providers in using digital health and social care technologies, it is useful to reflect on the multifaceted reasons for using these technologies as present or future health and social care providers.
Digital health and social care provision offers the ability to reduce healthcare costs while also preventing and monitoring disease, health and wellbeing. Digital technologies can personalise healthcare provision for each health and social care user. Through regular monitoring and tracking of signs and symptoms, digital health and social care technologies assist individuals in self-management and advocacy of their health issues. Health and social care providers can retrieve and save data related to an individual’s health record using technology. Technology can also improve person-to-provider communication by supplying information in an understandable format that any health and social care user or provider may access and use. As a result, accurately curated digital health and social care technologies can reduce human errors, improve clinical outcomes, facilitate care coordination, accelerate practice efficiencies and track data over time.
A person-centred approach to healthcare requires digital transformation in health and social care. Transformation can help providers streamline health and social care service provision, gain a better understanding of each user’s health and wellbeing goals, increase trust and loyalty and provide a higher quality experience. In addition to overcoming healthcare management challenges, health and social care organisations can benefit from digital transformation in a range of ways. Telemedicine is regarded as a new method of routine health and social care delivery. Emerging telehealth technology may be particularly effective in facilitating recipient-of-care access to general practice services, particularly those services that do not need physical examinations; for people with chronic conditions, enabling timely and convenient access to repeat medications and allied health services are important elements of multidisciplinary care (Javanparast et al 2021). For example, health and social care providers can use telehealth to reach communities where access to health and social care providers are limited or specialist expertise is unavailable. Telehealth has the potential to improve healthcare collaboration by giving health and social care providers additional ways to collaborate, actively participate in person-centred care (PCC) and improve the care coordination continuum. Virtual consultations are convenient and have the potential for faster responses to progress health and social care provision. Furthermore, well-designed digital health information systems facilitate easier and more-efficient information flows, which are vital to the safety and quality of health and social care environments, while also benefiting healthcare users.
Using transformational digital health and social care technologies can enhance communication while allowing for better health and social care planning, delivery, documentation and evaluation of acquired data to promote evidence-based practice. Ultimately, technology advancements refocus health and social care provider attention towards providing high-quality care, as the priority for PCC.
Chapter 1 introduces Chapters 2 to 12 in the context of digital health and social care as a transformative interrelated method. The following outlines issues that should be considered for digital technologies to succeed as a transformative approach in health and social care contexts. Through the text, transformative digital health and social care themes are presented as four units:
Concepts in this book are supported by real-world examples, learning activities, reflection points and case studies. When engaging with and browsing chapters, learners are encouraged to first consider how healthcare providers are using digital health and social care technologies in their daily practice to improve safety, quality and value of health and social care today, and then consider how healthcare providers can better use digital health and social care technologies to transform safety, quality and value of health and social care in the future.
Understanding digital health and digital health ecosystems enables learners to gain an insight into the complexities of interrelationships of health and social care and digital technology. Understanding digital health within the Australasian context requires learners to comprehend a world view or lens that may differ from their own. Authors discuss potential enablers and barriers to a person-centred approach, including those related to surveillance and privacy, motivation or health behaviour. Further discussion includes educational theories that promote digital literacy and learning. Digital health is an evolving discipline, so understanding the foundational concepts outlined provides a background for learners to refer to when these topics are introduced in more detail in later chapters. While individual perspectives and organisational and national policies will continue to evolve to guide the access and use of digital technologies, the underlying principles of person-centred communication will remain central into the future.
Chapter 2 introduces the definition and concept of digital health and digital literacy and how the field is understood within the Australasian context. Examples of how digital health records, telehealth and digital devices are now being utilised within health and social care are described. A context to digital health and digital literacies is also provided, demonstrating the importance of digital literacy and how diverse levels impact on communication within and between users and healthcare delivery and how appropriate access and retrieval of information depends on a range of factors, including an example of cultural diversity and inclusion. Chapter 2 then examines digital health and social care strategies, providing an overview of the development of digital health ecosystems in Australia and New Zealand and tracing the evolution of electronic health records, electronic medical records, electronic medication management records, as well as how and why digital information has become embedded into health and social care services, supporting the discourse.
Integrating and personalising health is possible by embedding digital technology into health and social care. However, health and social care systems are complex and fragmented, and implementing authentic, integrated digital health and social care programs can be difficult. Theoretical frameworks are required to facilitate successful and efficient evidence-based ways to adopt digital health technologies in healthcare systems.
Chapter 3 looks at how digital health research is used in the context of health and social care environments. By aligning digital health research with the World Health Organization guidelines for digital health research (WHO 2019), learners are introduced to how research methodologies and methods are incorporated into digital health and social care environments using an approach consisting of individual, organisational and systems perspectives. Terminologies such as micro, meso and macro are also acceptable as a systems approach, and used in other chapters of this book. In both terminologies: individual/micro recognises cooperation between the health and social care user and professional; organisational/meso recognises cooperation between the health and social care professional and the organisation; and system/macro recognises governance which influences all aspects of cooperation.
Learners are introduced to the Context Optimisation Model for Person-centred Analysis and Systematic Solutions (hereafter known as COMPASS) as a digital health theoretical framework and implementation model (Mather & Almond 2022). There are two aims of the COMPASS theoretical framework and implementation model. The first aim is to provide learners with a visual and descriptive theoretical framework, giving digital health providers direction when planning digital health solutions as a component of digital health transformation in the context of health and social care environments. The second aim is to provide an implementation model that gives detailed direction and process on how to research in digital health transformation. A detailed explanation of implementation model components of the theoretical framework and how they can be used to guide digital health research in health and social care environments is also provided.
The COMPASS theoretical framework and implementation model is comprised of a core, quadrants, two layers and three continuums. Each component is described and provides learners with information about requirements to consider when planning, developing, implementing or evaluating digital health solutions. How to use the COMPASS implementation model when considering planning or developing digital health research or solutions is established. Finally, a case study is included to demonstrate, engage and encourage learners how the COMPASS theoretical framework and implementation model can be used in practice.
For decades, the possible challenges and repercussions of the digital divide known as the gap between those who have access to digital health and social care technologies and those who do not, among users, as well as equity and literacy factors, have been considered. Recent health and social care advances have placed greater emphasis on this topic, highlighting challenges related to lack of access to digital health. Digital literacy and access to digital technologies as resources are now considered critical health and social care indicators. Through digital health and emerging virtual care models, these indicators must be addressed to ensure equitable health and wellness promotion and improved healthcare outcomes.
In today’s healthcare, PCC plays an important role as a health and social care quality indicator. The idea that users who use health and social care services need to be central within systems is a relatively new concept. Additionally, digital health and social care providers may only be indirectly involved with users, making it difficult to appreciate how work undertaken may include a person-centred approach. PCC must, however, be practised by all stakeholders in health and social care systems, so that PCC becomes a reality for all users of health and social care.
Chapter 4, together with Chapter 10, presents direction to assist digital health and social care providers in ensuring PCC practice and their work supports PCC across health and social care environments. The aim of Chapter 4 is to provide learners with an understanding of health and social care user involvement in the context of safe, ethical and effective digital health use, and investigate the health and social care user relationship with emerging trends of digital inclusion and digital health literacy.
Chapter 4 presents a description of PCC, why it has become so important in contemporary health and social care and how to enable and practise PCC. A background for considering the role of digital health and technology in PCC and the concept of frameworks to provide PCC are also introduced. The role of health and digital literacy is explored, offering key considerations for providing PCC at individual, operational and systems levels, and providing examples of the need for synergy to enable PCC to occur within healthcare environments. Finally, the concept of how PCC is practised in an increasingly digitally enabled health and social care environment is examined. How digital health and social care technology are empowering users from a range of perspectives in their own care is explored, including the concept of virtual care and PCC.
The modern health and social care system is a complex ecosystem. Systems are increasingly incorporating digital aspects using a wide spectrum of technologies. The development of information technology and high computer capacity has resulted in changes to health and social care that have been revolutionary in every aspect of healthcare.
Chapter 5 examines and discusses the national digital health strategies of Australia and New Zealand in relation to principal issues and assumptions that exist regarding digital adoption within health and social care. The chapter explains the importance of undertaking a design process that considers the users of the technology. It then considers and discusses the national digital health strategies of Australia and New Zealand in relation to assumptions that exist about digital adoption within health and social care.
Learners are encouraged to explore current digital health and social care practices and are introduced to barriers preventing implementation of digital health and technology systems. This understanding is gained through recognising the critical role that human-centred design plays in the development of digital health and technology and systems. Additionally, there is a discussion of strategies, principles and recommendations for the design of digital health and technology. Health and social care systems are complex, and data storage is fraught with ethical and legal concerns. Digital system usability by all health and social care stakeholders is critical. Identified issues must be investigated and addressed, as they may restrict potential benefits of implementing digital health and social care systems. National health strategies aim to improve health and social care while acting as catalysts for change.
Chapter 5 demonstrates that as digital innovation in health and social care progresses, it is increasingly necessary to examine a range of concerns, many of which are based on incorrect assumptions about how digital technology works and how individuals and organisations interact with digital interfaces. Chapter 9 explains this topic in greater detail. Users contribute to the utility of digital health and social care technology designs by ensuring co-design that results in a better understanding of how digital health and social care technologies will be perceived and used in the real world based on the capabilities of the user and colleagues. Co-design enables designed output to fit with intended aims while respecting user privacy and guaranteeing safe and effective health and social care delivery.
Chapter 5 offers learners an introduction to digital health and social care technology and systems. The chapter finishes with a discussion as to why it is critical to conduct design processes that address technology users before outlining methods that are available to providers; a case study is presented to highlight the importance of using a human-centred design approach in health and social care environments.
Interoperability refers to the capacity to transfer health data between digital systems while maintaining meaning within the context of a person’s health and wellness journey. PCC necessitates successful interoperability. It contributes to safety and quality, particularly during health and social care transitions, by facilitating a seamless user experience (UX) across the continuum of care. However, full interoperability is complex and difficult to achieve due to multiple levels of UX involved. Other challenges with interoperability include managing inconsistent information across multiple sources, such as validating electronic requests, overcoming organisational resistance of data sharing, privacy and security, and high costs associated with employing expertise to manage interoperability. Interoperability is critical to digital health strategies in Australia and New Zealand.
Chapter 6 provides learners with an overview of the two major approaches to interoperability, fundamental health interoperability standards and the necessity of health information exchange infrastructure. In regard to digital health ecosystems, the chapter covers two key concepts: interoperability and UX. The Healthcare Information and Management Systems Society (HIMSS) and The Open Group Architecture Framework (TOGAF) are used to explore different levels of interoperability.
Chapter 6 discusses the concept of UX, as well as typical design principles and frameworks, the benefits of increasing UX and its obstacles. The chapter suggests that strong UX increases the quality and availability of data in the context of digital health through technological adoption, acceptance and user satisfaction. While interoperability improves information transmission and availability, UX can promote digital health technology uptake and acceptability. Strong UX can aid clinicians and other stakeholders in finding and using data for clinical decision-making in a timely manner. Data and information quality become more crucial when interoperability allows data to be transferred between health and social care settings. However, inaccurate or partial data can be passed from one setting to the next, posing a major threat to safety and quality of care. Furthermore, adoption, acceptance or high level of satisfaction with the use of digital health technologies by healthcare providers does not guarantee adoption, acceptance or use by users. These elements determine whether digital health delivers on its promises of safety, high quality and efficiency. This chapter discusses key tenets and expectations for UX, ensuring user-centric digital health and social care experiences.
Through investigation of the three horizons of digital health transformation (creating digital foundations, revolutionising health and user care, and rethinking the future), and how to practically apply them in health and social care settings, Chapter 7 enables learners to engage with digital health as a transformative approach. Learners will gain understanding in the application of data and analytics principles in health and social care systems after gaining awareness of the application of key pillars to creating digital health foundations in health and social care systems.
Chapter 7 explores the layers of clinical informatics, demonstrating their intricacy. The purpose of clinical analytics is explained, as well as how this method is applied in decision-making processes. Learners will begin to comprehend the several types of descriptive analytics. The goals of predictive analytics, as well as the applications of traditional statistical inference and artificial intelligence (AI), are discussed. Real-world examples of clinical predictive models are provided to enable understanding of the benefits and risks associated with using clinical analytics.
The quadruple aim of healthcare (Bodenheimer & Sinsky 2014) is applied to clinical informatics suggesting improved population health, health and social care user experience, practitioner experience and care cost reduction. Three horizons—creating digital foundations, revolutionising health and user care, and rethinking the future—are also utilised to investigate clinical informatics. Each of the horizons is examined in detail, with particular attention paid to the individual, processes, information and technology. Health and social care providers are described in the section on Horizon 1 as examples of developing health discipline frameworks to construct digital foundations. The concept of digital governance is discussed, as well as categories of how decision-making takes place in health and social care settings. This challenging notion is contextualised with a real-world example of ‘Go-Live’ governance. Finally, the collection of standardised clinical terms to enable consistency of clinical data collection is introduced.
The section on Horizon 2 emphasises the importance of understanding the purpose and application of data, as well as why information must be consistent, accurate and timely for health and social care providers. This horizon is referred to as ‘transforming care using data and analytics’. The data cycle is explained to demonstrate context about why it is important to complete data entry, or ‘close the loop’, for the right person, at the right time and in the right place, and then turn it into meaningful information.
The discussion about Horizon 3 demonstrates digital-first care models to establish a learning health system, in which all data collected during episodes of care is used to improve the care of future users. Horizon 3 predicts greater digital disruption as sophisticated clinical analytics shift treatment away from ‘break–fix’ and towards a more-efficient ‘predict–prevent’ paradigm.
The rapid rise of digital diagnostic technology to support delivery of digital health and social care has been facilitated by technological advancements. Chapter 8 assists in navigating and deciphering the vast array of diagnostic technology available in digital health and social care. Interpreting diagnostic technology can be accomplished by presenting technology, clinical application and UX views in a holistic and practical debate relevant to all health and social care stakeholders.
Chapter 8 presents the context for diagnostic technology, exploring how a diagnosis is reached and how understanding this process is foundational to the effective design and implementation of digital diagnostic technology. The section on technological advancements facilitating digital diagnostics focuses on the role of digital technology for diagnostics, where the information is gathered, while the impact of digital technology on the diagnostic process is explored through three vital areas to understand how digital health and technology can underpin shifts away from traditional diagnostic practices. Evaluating digital technology and implementing any digital health and technology for diagnostic purposes requires robust evaluation processes; implementation of technology suggests the provision of diagnostically relevant information. Finally, the chapter looks at the future to demonstrate various ways in which digital health and technology can increase coverage and outreach with reduced cost and footprint of devices used. Each section includes instances of how digital technologies support and affect diagnostics in healthcare, such as the usage of wearables, which enables the aggregation of information into big data that may then be used to produce AI or machine learning. Sociotechnical issues and data integration into a single user profile are taken into account.
Our most precious asset is health data, which must be handled and supervised carefully. Many adjustments to present health data management techniques are required to capitalise on what the digital era has to offer and reap the many potential advantages. The importance of trust in digital health cannot be overstated.
Chapter 9, aptly titled Trust in Digital Health—Power of Data Myths, introduces the issue and defines data myths in digital settings using the COMPASS theoretical framework and implementation model. Common data misconceptions are discussed and debunked. One popular example is that currently utilised electronic health records hold comprehensive data sets that describe an individual’s whole health and wellness status; this myth is dispelled early in Chapter 9. Following on, trust in the context of values-based healthcare and personalised medicine is discussed, as is the significance of data being utilised in context; as stated in the introduction, health data is an asset that must be properly managed and controlled.
Data components include health data, information, knowledge and digital technology, which are collected and handled in a variety of ways. Data categories and how they affect information, knowledge and wisdom based on how ‘raw’ facts are acquired and analysed is explained. The data, information, knowledge and wisdom hierarchy is introduced, as well as its interaction with the data cycle; a clinical decision support system example is presented to explain this approach. The evolution of clinical registries is briefly tracked in the context of the goal of safety and quality of health and care users; factors that contribute to high-quality and secure data management procedures, such as data standards, value sets and governance, are offered. Chapter 9 finishes by emphasising that digital transformation demands strong leadership into a future that enables integrated vendor/technology-neutral cloud-based data platforms and multi-model data repositories that are accurately curated, fit-for-purpose, entered once and used in multiple ways.
In concert with Chapter 4, user participation in health and social care services and systems is the focus of Chapter 10. Attention to user participation is necessary because systems-level frameworks are required to facilitate participation in all aspects of the health and social care systems, including digital health.
User participation in the planning, design, delivery and evaluation of health and social care services is becoming widely recognised as a critical component of providing safe, quality and equitable care. Also, user involvement in design, development and deployment of digital health and social care technology is crucial. However, user participation can be difficult to achieve. Comparable to health and social care providers, users can participate in a variety of ways, with each strategy having advantages and disadvantages. User involvement has numerous advantages, and all stakeholders in health and social care sectors can assist in facilitating and promoting use.
Digital transformation of health and social care has created new avenues for connection as well as new questions that user perspectives may be able to solve. User technology has created development of ecosystems of health apps and services external to traditional health and social care systems. Over the last two decades, there has been a growing emphasis on participatory design (often called co-design) as an attempt to actively involve all stakeholders in the design and development of digital and social care health technology. This is particularly noticeable among health and social care providers. Incorporation of users of health and social care as partners in digital health requires a consistent and timely approach of all stakeholders to involvement.
Chapter 10 considers user participation in health and social care. To allow participation in all aspects of the health and social care systems, including digital health, an emphasis on system-level frameworks is critical. Chapter 10 asks three crucial questions: Why is it important for users in health and social care to be involved in the planning, design, delivery and evaluation of services? What exactly do we mean when we refer to the user as a health and social care ‘customer’? What exactly does participation involve? Final reflection ideas based on the chapter contents may be used as collaborative initiatives.
It is critical to plan for digitally empowered workforces. The WHO (2021) recognises the need to lead digital health on a global scale, with a priority on PCC and literacy techniques. Financial issues must be acknowledged and explored, since investment in digital educational preparation and training adds layers of complexity to the health and social care workforces. New models of care have evolved from a combination of market forces, with biomedical and technological innovations enabling stakeholders to provide and to consume health and social care beyond the jurisdiction of specific national governments.
Chapter 11 explores these concepts within the rapidly evolving context created by the COVID-19 pandemic, which has accelerated the use of digital technology at all levels of health and social care delivery. Digital health ecosystems is introduced as a concept that is constantly evolving, expanding and being shaped by internal and external forces that are interconnected.
The importance of digital competence in the digital transformation of health and social care workforces for individuals, organisations and systems is highlighted in Chapter 11. The chapter directs learners towards crucial ideas such as who the stakeholders are in developing new digital transformation models in the Australasian health and social care contexts. Three lenses are used to explain how digitally enabled workforces can shape health and social care in the future: how countries can plan to develop and grow a digitally capable health workforce, with examples of current national initiatives; education, training and professional development requirements to support workforce development and management; and career planning and support for digitally skilled roles.
Chapter 11 examines key policy documents that have guided the digitalisation of Australasian workforces. It also looks at the education, certification and continuing professional development that has evolved to upskill and regulate practice within the healthcare workforce, including the development of competency standards, and the credentialling and specialisation of healthcare providers, leading to the recognition and acknowledgment of digital health specialists. The role, function and employment of digital health specialists is described in relation to career planning in Canada and the United Kingdom, and finally how these contexts can be levered within Australian and New Zealand health and social care systems.
Globalisation of digital health has occurred at varying rates and levels of implementation depending on a range of factors including governance, context and content. The WHO has urged countries to hasten digitisation as it is now considered vital for health and social care service delivery (WHO 2021). While it is important to implement digital health into health systems, there also needs to be evaluation of existing efforts to minimise risk of failure or missed opportunities to integrate digital health and technology in innovative ways into health and social care environments.
Chapter 12 examines digital health transformation using a contextualist approach of content and context process framework exploring programs in Australian, New Zealand, Denmark, the United Kingdom and the United States. This chapter provides an overview of the digital health programs of these countries with an emphasis on the content and process of each. Electronic health records are used to exemplify issues revealed during implementation and evaluation, and comparisons regarding these issues are offered. Lessons learned from evaluation of each program is discussed within a context sensitive lens. The chapter concludes with an overview of results and the implications of findings for future digital health and social care initiatives.
Technology is rapidly becoming established in health and social care settings. From person-centred treatments to financial implications, digital health innovation is altering all aspects of health and social care. In an era of exponential change, learners and providers in the health and social care capacities must stay contemporary and evidence-based in their work. The strategies are addressed in policies and procedures, but little is written about how to put digital health innovation into action. With the assistance of this guide to the concepts and principles of digital health and technology, present and future health and social care providers will be able to translate digital health and technology evidence into daily practice. The goal of this text is to enable learners to comprehend digital health and understand the capacity of technology to transform health and social care environments to improve health outcomes.