The eHealth Readiness of Australia's Allied Health Sector - Final Report

8. Intervention strategies for advancing the eHealth agenda

Page last updated: 30 May 2011

Our anchor questions asked us to consider (1) how to minimise barriers to eHealth readiness and adoption, and (2) how to apply eHealth enablers to drive adoption and effective usage. Achieving eHealth adoption and usage for allied health practitioners requires a strategic approach to behaviour change that must be effective across a wide array of healthcare settings and care-provision processes. It must selectively employ any number of potential interventions, directed at specific practitioner groups, at single clusters or a combination of them, or across the whole health system.

It is not the purpose of this report to lay out such a strategy in its entirety. However, in this section we:

  • Summarise an effective overall approach for each cluster (defining the expected role of each cluster in adoption, the targeted timing of their adoption, approaches to influencing that cluster, and the expected impact of that cluster in mobilising others),
  • Introduce a range of 20 potential high-level interventions, working in three complementary directions, and their effectiveness for different clusters, and
  • Offer an illustrative example of how a strategy might be designed for driving the adoption of telehealth solutions in the management of chronic diseases.

Proposed high-level approach to each cluster

Clusters differ in their current or intended use of eHealth solutions, perceptions of eHealth benefits and risks, adoption barriers and influencing factors. The following approaches to clusters would reflect these differences to maximize intervention effectiveness.

Proactive pioneer

Practitioners in this most proactive cluster have invested personally in the early development or adoption of eHealth systems, often in relative isolation. Their enthusiasm and vision for technology adoption implies that their foremost need is for the coordination and channelling of their effort, so that a coherent system emerges. A consistent message from both government and peak bodies will reassure this cluster that their pioneering role is on track, valued and supported. They respond strongly to all avenues of support, requiring little external motivation. In any engagement strategy, proactive pioneers need to be engaged early to play a lead role in both establishing the early design and use of coordinated eHealth technologies, and influencing eHealth adoption by the more hesitant clusters. Peer recognition is a strong driver, so opportunities should be made available for them to act as role models and formal leaders. Further findings on proactive pioneers to guide an effective strategy include:
  • 52% of proactive pioneers use an EHR, with similar numbers acknowledging the benefits that shared patient records could bring (58% strongly agree they would like access to a shared patient record, 54% strongly agree eHealth would improve continuity of care),
  • many proactive pioneers are concerned about the limited interoperability of available systems (25% strongly agree that maintaining compatibility with existing systems is a barrier),
  • proactive pioneers make adoption decisions pragmatically: although they are technology enthusiasts (47% strongly agree they like to be an early adopter), they will defer a decision until a suitable solution becomes available and the business case and/or patient benefits are clear,
  • although proactive pioneers are at the forefront of eHealth adoption in the allied health sector, financial incentives may allow them greater exploration (69% strongly agree that financial incentives are a driver), and
  • proactive pioneers are looking to expand their practice capabilities and enhance their reach and care process (64% strongly agree the ability to collaborate with other practitioners is a benefit).

Embedded converts

While embedded converts demonstrate relatively high current use of eHealth technologies as well as desire for improvement, their motivation is driven by the perceived expectation of use as well as their experience as users. Uniquely, this cluster represents allied health practitioners whose income stems predominantly from public sources, indicating the decision to deploy eHealth solutions and their involvement with eHealth technologies has to a large extent been mandated by the public organisation in which they work, but has been a positive experience nonetheless. This will almost certainly remain an efficient approach for this cluster, as well as a means to disseminate adoption throughout the allied health sector for those practitioners that migrate to private-sector roles or a mix of public and private.

As embedded converts make up 20% of all allied health practitioners, perhaps the cluster’s most important role in an engagement strategy is as a critical mass: demonstrating the potential of adoption and its benefits at a large scale, and driving expectations of use for the more risk-averse clusters in the private sector. It is also relevant that embedded converts may not have commenced their eHealth use independently, but rather the initial uses were mandated by their organisations. They are therefore a potentially credible influence for more risk-averse groups, as they can more readily relate to the concerns or barriers that these clusters perceive.

Further findings on embedded converts to guide an effective strategy include:
  • 49% of embedded converts use an EHR, and 61% strongly agree they would like access to a shared patient record,
  • Embedded converts observe the benefits of eHealth solutions (51% strongly agree they will improve continuity of care) but work in a cost-conscious environment (28% strongly agree that affordability is a barrier) where a low-cost implementation option is required,
  • Embedded converts feel that computer use is expected (80% strongly agree, and 83% strongly agree most practitioners in their network use computers) but compatibility with current systems (23% strongly agree) remains their leading concern, and
  • Embedded converts consider the voice of other practitioners an important motivator (46% strongly agree that demand from other practitioners is a driver).

Risk-conscious

In the first of three more hesitant clusters, risk-conscious practitioners acknowledge the benefits of eHealth adoption, but hold overriding concerns about data security, patient privacy, system malfunction and compatibility. Strongly swayed by peer adoption and peer expectations, they may nonetheless be the most likely of the three hesitant clusters to be influenced to adopt. To do so, they will need reassurance on the capability and maturity of systems, so should be targeted only once the proactive pioneers and, especially, the embedded converts are well underway. Lead strategies will include exposure to practitioner case studies and the certification and peer-attested evidence of system security and stability.

Further findings on risk-conscious practitioners to guide an effective strategy include:
  • Risk-conscious practitioners do use EHRs (42%), and many recognise the potential for greater collaboration (22% strongly agree) and continuity of patient care (14% strongly agree),
  • 61% of risk-conscious practitioners strongly believe that computer use is expected of them, (61% strongly agree that use of computers is expected) but remain cautious on adoption. Providing a peer role-model gives the opportunity to address their specific concerns (22% strongly agree that demand from other practitioners is a driver),
  • Risk-conscious practitioners require assurance on the security of data within eHealth solutions, both patient and practitioner level (53% strongly agree they are concerned about privacy breaches). A robust architecture will limit the opportunity for data corruption, system-wide malfunction or inappropriate access. A defined legal framework will establish the operating rules for the handling and storage of data,
  • Risk-conscious practitioners doubt the capability of eHealth solutions to perform adequately (34% strongly agree concerns about system malfunction are a barrier) and value a robust, reliable system (29% strongly agree they prefer to wait until technology is established before adopting), and
  • Even where an eHealth solution works as intended, risk-conscious practitioners have concerns about the visibility of practitioner performance data (28% strongly agree this is a barrier for them).

Cost-conscious

As in the risk-conscious cluster, cost-conscious practitioners are relatively neutral to the benefits of eHealth adoption, but in this case their primary concern is in finding an affordable, appropriate solution. They require a well-established, straightforward solution appropriate to their practice that is low-cost to both implement and maintain. Potential strategies include the development and delivery of low-cost, robust systems meeting minimum capability requirements (potentially exploring ‘Cloud’-based access models to the solutions), ensuring that early releases of solutions deliver clear efficiency benefits to them and their practice, exposure to the business case experience of earlier adopters, peer recommendations and financial incentives. Again, the cost-conscious sector should be considered a follower target rather than an early adopter cluster, but should be engaged early to make sure both solution design and delivery models address their concerns.

Further findings on cost-conscious practitioners to guide an effective strategy include:
  • Cost-conscious practitioners appreciate the benefits of collaboration and continuity of care in the health ecosystem (36% agree), and they would like access to a shared patient record (39% strongly agree), but their concerns over-ride these perceived benefits,
  • Cost-conscious practitioners also perceive the practice benefits of eHealth adoption (30% strongly agree that eHealth would improve practice efficiency) and would appreciate the opportunity to upgrade (33% strongly agree they like to be an early adopter), but they desire affordable, mature technology (58% strongly agree that affordability is a barrier, 33% strongly agree they prefer to wait until technology is established),
  • Cost-conscious practitioners need simple solutions tailored to their needs (27% strongly agree they cannot find a solution that meets their needs, 22% strongly agree it takes too long to access and use eHealth technologies, 15% strongly agree that eHealth solutions are too difficult to select and implement), and
  • Although 50% of cost-conscious practitioners strongly agree that computer use is expected of them, they lag the leading adopters significantly. They would consider both demand from other practitioners and the advice of professional bodies as motivating drivers (33% strongly agree that demand from other practitioners is a driver, and 30% recognise their professional body).

Doubters

The doubters cluster is the most difficult of the three hesitant clusters to influence, as its practitioners harbour strong concerns about compatibility, connectivity, downtime and IT support as well as affordability. They do not accept that computer usage is expected to the same extent as other clusters, and are similarly little impressed by peer adoption. Despite a higher overall level of concern, the engagement strategies relevant to this cluster are similar to those above – well-developed and proven systems, exposure to the experience of early adopters and financial incentives. However, their lower overall readiness implies they are a later adoption target cluster, whose confidence and ability to adopt will take longer to develop.

Further findings on doubting practitioners to guide an effective strategy include:
  • Doubters understand that computer use is expected (39% strongly agree, though the lowest of all clusters), see collaboration and continuity of care as relevant benefits (34% strongly agree) and would like access to a shared patient record (31% strongly agree), but their many concerns override these attitudes. A peer role-model may address their specific concerns (32% strongly agree that demand from other practitioners is a driver),
  • Doubters need reassurance on both business case (48% strongly agree they cannot afford eHealth) and the technical side of adoption (62% strongly agree the need to connect to external systems is a barrier, 55% strongly agree the need to maintain compatibility with existing systems is a barrier, 50% strongly agree they are concerned about system malfunctions, 38% strongly agree inadequate access to IT support is a barrier),
  • Doubters find investing in eHealth solutions difficult and are reluctant to upgrade their systems voluntarily (16% strongly agree they can’t find a solution that meets their needs, 28% strongly agree eHealth systems are too difficult to select and implement). Accordingly, 38% strongly agree they prefer to wait until technology is established before adopting.

Firm non-adopters

The most resistant of all clusters are sceptical towards the potential benefits of eHealth solutions. Although they feel the use of eHealth solutions is expected, their strong concerns about all potential consequences of adoption have limited their uptake. Firm non-adopters are typically older, more experienced practitioners. For many, the concept of wholesale change to their working environment or care delivery process at a late stage of their career is unappealing, and they will remain unwilling to participate. Further, the transformation of the health system to delivery models including eHealth enablement is likely to take place during a period of time that will see a significant portion of this cluster retire.

Four strategies will be needed to influence those who remain in practice to adopt appropriate eHealth solutions. First, the widespread adoption and acceptance of solutions across the rest of the health system will allay non-adopter concerns over system maturity, suitability and risks, as well as driving an expectation of use. Secondly, financial incentives will motivate firm non-adopters, although their use must be carefully targeted. Thirdly, mobilising the influence and help of support staff in their practice, and identifying alternative, simpler ways for them to use the eHealth solutions, can help achieve the minimum expected level of use from this group. Finally, there will come a point at which requiring participation (e.g. via registration or reimbursement processes) becomes appropriate once adoption rates across the rest of the clusters are significant.

Further findings on firm non-adopters to guide an effective strategy include:
  • Only 18% of firm non-adopters use an EHR, and only 19% strongly agree they would like access to a shared patient record. They also have a low perception of computer use amongst other health professionals (only 42% strongly agree that computer use is expected, and 48% strongly agree most practitioners in their network use computers),
  • Firm non-adopters are the only cluster with a strong negative view of the benefits of eHealth (52% strongly disagree that eHealth will improve patient relationships, 48% strongly disagree that quality of care would be improved, 40% strongly disagree that eHealth will improve patient safety). Only collaboration with other practitioners (11% strongly agree) and continuity of patient care (7% strongly agree) register as perceived benefits,
  • The strongest suggested driver for firm non-adopters is financial incentives, which correlates with their overwhelming perception of system affordability as a barrier (78% strongly agree),
  • Firm non-adopters are reluctant to upgrade their systems voluntarily, and need to be convinced an adequate system exists (33% strongly agree they cannot find a system that meets their needs, 36% strongly agree available technology takes too long to access and use, 51% strongly agree they are concerned about system malfunctions, 53% strongly agree they have inadequate IT support),
  • Firm non-adopters will undoubtedly be the hardest cluster to motivate, but peers remain an influence (16% strongly agree practitioners are influential, while 23% strongly agree professional bodies are a driver).

EXHIBIT 33 – Overview of cluster engagement objectives


EXHIBIT 33 – Overview of cluster engagement objectivesD

High-level engagement strategies

Given the insights into infrastructural, aptitudinal and attitudinal readiness described above, it is clear that interventions that focus solely on, for example, educating and training the individual practitioner would be insufficient. They would fail to address some of the more fundamental barriers to adoption, such as real concerns about the suitability or limitation of the sets of eHealth solutions and how they are delivered, or the network- or environment-based constraints and influencers.

Drawing on the experience of the pharmaceutical industry and its approach to major product launches in the healthcare system, we believe that an effective approach to eHealth adoption by allied health practitioners and across the health system needs to simultaneously consider interventions along three complementary axes:
  1. Shaping the product
    Interventions that modify the capability of potential eHealth solutions, their delivery or the way their potential is communicated, to address priority barriers for the clusters, real or perceived
  2. Shaping the demand
    Interventions that focus on creating a more active and ready demand for the eHealth solutions, addressing primarily the attitude and aptitude readiness gaps, e.g. by creating more compelling and tailored benefits and value proposition cases
  3. Shaping the ecosystem
    Interventions that focus on putting in place the most effective enablers and influencers of adoption, within and across clusters

Accordingly, we have developed a ‘toolkit’ of potential high-level intervention levers, structured along these three interconnected intervention axes:

A. Shaping the Product

The insights from the research into the eHealth readiness of allied health practitioners clearly identified that a number of barriers to adoption of eHealth stem from real or perceived concerns about the eHealth solutions or ‘product’ itself, such as the security, privacy, suitability, interoperability, usability, reliability or cost (of installation and operation) of the solutions.
Therefore an effective adoption strategy needs to consider explicit interventions focused on shaping the ‘product’ itself, and not be limited to engaging or shaping the demand.

The objective of these interventions is to effectively lower the product-related barriers (real or perceived), and enable an appropriate degree of tailoring of the product or its delivery to the differentiated needs identified through the clustering analysis.

1. Ensure access to or provide fundamental infrastructure

Rationale
Coordinated system-wide adoption of eHealth is predicated on the availability of three fundamental infrastructure building blocks:
  • Hardware, e.g. desktop, laptop or tablet computers, smart-phones, teleconferencing and video-conferencing facilities, and data-warehouses
  • Communications, e.g. landline and mobile telephone networks, wired and wireless internet networks, adequate bandwidth and reliability
  • Technical equipment, e.g. specialised diagnostic, imaging or pathology equipment

While hardware and communications infrastructure are universally available, practitioners without adequate infrastructure cannot adopt eHealth solutions regardless of their desire. Several interviewees have expressed their frustration over the lack of reliable telecommunications in remote areas. The least-equipped practitioners are those that practice occasionally, but are not based, in a rural or remote area.

Intervention
For these practitioners, an appropriate intervention would be to provide or support the acquisition of infrastructure enabling their participation. For example, subsidising laptops for Aboriginal and Torres Strait Islander health workers on outreach programs, providing video-conference facilities at community health centres or helping dentists upgrade to electronic rather than film-based imaging equipment.

Main clusters influenced: Embedded converts, cost-conscious, doubters, firm non-adopters

2. Establish, enforce and communicate compliance with clear interoperability standards

Rationale
While allied health practitioners have widely differing needs for both data access and interface design, their integration into coordinated health-system wide initiatives relies on a minimum level of interoperability. Not even proactive pioneers will push to adopt systems without that interoperability, while embedded converts have seen first-hand the advantages of reliable interoperability in their public hospital work settings.

Establishing and enforcing clear standards for that interoperability will also reduce development risk for vendors developing new platforms.

Intervention
Ensure clear standards are set and adopted which cover compatibility, interoperability and security for eHealth integration between platforms and systems. Establish appropriate mechanisms to accelerate vendor compliance of vendors with the requisite standards (e.g. accreditation, transparency on compliance, incentives, making conformance testing easier and cheaper, or providing platform architectures containing standards-compliant services or component libraries – see no. 3 below), taking care not to create an excessive certification and administration burden which would risk slowing down innovation and competition within the solutions market.

Main clusters influenced: All

3. Provide ‘backbone’ framework establishing legal, data ownership, data storage and security standards and rules

Rationale
One of the barriers to development and adoption of suitable eHealth solutions is uncertainty for practitioners, patients and vendors on the legal framework, data ownership and governance frameworks, and clarity on technical standards addressing security, interoperability and other essential system elements.

Intervention
Engage professional and patient bodies and jurisdictions to establish a clear legal, technical and ethical framework for the implementation of eHealth solutions.

An example would be to thoroughly define how data within broader health system is accessible, and to whom (e.g. ensure practitioner-level data is only visible to an appropriate audience and not the patient body, ensure health system level data maintains anonymity).

Main clusters influenced: Proactive pioneer, risk-conscious, doubters, firm non-adopters

4. Establish shared solution architecture platforms to ensure more efficient development and delivery of standards-compliant solutions

Rationale
The research has provided evidence of a fragmented landscape for vendor solutions, insufficient coverage of allied health specialities functionality and usability requirements by these solutions, and a concern for interoperability and standards compliance.

There is a risk, therefore, that the efforts required of these solution vendors to extend and upgrade their solutions to make them standards compliant and continuously invest to maintain this compliance would lead to delays in availability of suitable solutions, confusion for allied health practitioners, and costs that would reduce the attractiveness of the market for vendors and/or the financial affordability of solutions for allied health practitioners.

Intervention
One innovative approach, leveraging emerging trends in Cloud computing, and especially ‘Platform-as-a-Service’ (PaaS) approaches, would be for a centrally coordinated effort to establish and maintain a shared platform architecture This would include shared standards-compliant services, components libraries and a development and compliance-testing environment. This architecture would reduce the burden of compliance for individual efforts and reduce duplication of efforts, accelerate dissemination of innovations, and create greater assurance of consistent standards compliance across solutions. This is an emerging concept, but one that is championed by global software industry leaders, and is particularly pertinent to the healthcare system, given the level of fragmentation of solutions and the critical importance of interoperability.

Another opportunity to pool resources and assets via a PaaS approach is data storage and ownership, as this is of particular relevance to allied health infrastructure development. By its nature, the majority of allied health services occur outside the hospital system in small practices or community health centres. While allied health practitioners are willing to engage in system-wide eHealth initiatives, the scale of investment required for wholesale secure data warehousing requires it to be established peripherally.

Main clusters influenced: Proactive pioneers, doubters

5. Create the conditions which engage vendors in developing eHealth solutions aligned to practice and cluster type to address usability and functional requirements concerns

Rationale
The fragmented allied health vendor and system landscape illustrates the limited availability of software solutions finding broad adoption in meeting the needs of allied health practitioners. Generic solutions often fail to address specific requirements of allied health specialties.

Intervention
Engage early adopters, especially in the proactive pioneer cluster, and professional bodies, in an effort to define and communicate to the vendor community their requirements in terms of either ability to customise certain elements of functionality or solution delivery, or in terms of specific functionality required to support their processes. This would help clarify and prioritise needs and required changes for the vendor community.

For example, in developing patient records, needs identified could include a greater ability to capture diagrams for physiotherapists, focus on entry of large free text fields for occupational therapists and psychologists with facility to automatically upload key words and data.

For practitioners who have not yet adopted appropriate eHealth solutions, developing a robust, simple to use system incorporating the minimum functionality required to play their role in eHealth will spearhead adoption. Introducing practitioners to a straightforward, low-cost system also provides an avenue to enhance capabilities over time.

Main clusters influenced: Proactive pioneers, cost-conscious

6. Establish support mechanisms to prevent or mitigate downtime risk and other non-functional performance issues

Rationale
An important barrier to adoption identified in the research is the perception of risks to clinical practice in the event of downtime, or loss of efficiency if system performance does not meet practice requirements.

The research also identifies that although most healthcare practitioners believe they have and implement IT security and disaster recovery policies, in fact they lack understanding of what constitutes appropriate IT security and disaster recovery, and lack access to proper IT support, especially in private practices.

Intervention
Given the small scale of most practices and fragmentation of vendors supporting them, an intervention could be to establish shared services for eHealth solutions deployment, maintenance and support. These could be provided on a territorial basis (e.g. by a jurisdiction, a Medicare Local, an LHN), or by pairing larger institutions (e.g. a hospital or large practice network) with smaller practices.

Main clusters influenced: Risk-conscious, cost-conscious, doubters, firm non-adopters

7. Assist EHR early adopters transitioning to structured record-keeping

Rationale
Many allied health practitioners have embedded some form of EHR use into their practices, yet the information content, semantics and structure are incompatible externally. In order to harness the energy of these practitioners in continuing to drive uptake and adoption, their transition to interoperable records should be accommodated. The personal investment of these practitioners implies a level of ownership of their solution – as such their efforts should be redirected rather than abandoned and replaced.

Intervention
Engage with early adopters, their vendors and professional bodies to determine an appropriate migration path for users who have already started using eHealth solutions which are not compliant with new or upcoming standards. Consider where appropriate providing incentives for these early users to migrate to the standards-compliant solutions to establish an early expert user base and reference points..

Main clusters influenced: Proactive pioneers

8. Provide a ‘practice upgrade and change management’ service

Rationale
The survey highlighted widespread concern about system malfunction and downtime, as well as many practitioners using a combination of both paper and computerised records. These barriers reflect a level of discomfort amongst practitioners, not simply in the deployment of a technology solution, but also in implementing a change to the way care is delivered. Migrating to electronic patient records, for example, has the potential to fundamentally affect practitioner care delivery processes, administrative management requirements and patient-practitioner relationships. A significant level of both familiarisation and trust are required to make this transition, particularly for those not versed in the technology, for whom the support of an expert change management service would smooth the process.

Intervention
Develop a program to establish an existing practice with the fundamental suite of tools and new processes required for their engagement in eHealth, with a minimum of both disruption and personal involvement by practitioners and support staff. Aim to maintain current practice functionality, with the opportunity to further enhance system capability if required. Provide training and support to cover the transition to familiarity and capability.

Manage around firm non-adopter cluster by developing (and supporting) a generic toolkit for practice managers on ‘how to computerise you practice’ to enable adoption to occur “behind the scenes.”

Training will be most effective if it is delivered by respected peers. As early pioneers, they are especially eager to share their experiences with EHR technology and will be able to communicate benefits to their peers.

Main clusters influenced: Risk-conscious, cost-conscious, doubters, firm non-adopters

B. Shaping the Demand

The research into eHealth readiness clearly identifies wide variations in intended usage of eHealth solutions, as well as in the underlying attitudinal causes for these variations. The clusters identified have markedly different perceptions of the benefits, costs and risks of eHealth.

Therefore, a concerted effort must shape the demand for eHealth solutions and the related changes in the healthcare delivery models that they enable. This effort must be grounded in the understanding of the current perception and needs profiles identified in the research, by speciality and by cluster.

Some examples of demand-shaping interventions are outlined below, focused on defining, proving and communicating tailored value propositions and stimulating awareness and early adoption.

9. Define tailored value propositions by profession and/or cluster

Rationale
The wide variation in practice setting and care process across allied health implies that different practitioners will have very different potential utilisation of eHealth. The research clearly established different profiles of current and intended usage, as well as perception of benefits, between specialities and clusters. Therefore value propositions for eHealth solutions cannot be generically defined across the whole allied health sector, or even by speciality within the allied health sector.

Intervention
Work with early adopter leaders and professional bodies to identify relevant usage segments within and across professions, and define value propositions for specific eHealth solutions that are tailored to their needs and perceptions.

Define corresponding early implementation initiatives that will establish robust evidence of these value propositions, and identify and mobilise the most appropriate channels to communicate these value propositions, or interventions which will help target clusters or professions experience these value propositions

To generate momentum, focus initially on universal business drivers - integration of financial systems and reimbursement, reduction of operating costs and administrative efficiency, as well as on clusters or professions with the most visible early benefits potential.

Main clusters influenced: Embedded converts, risk-conscious, cost-conscious, doubters

10. Empower “super-users” and professional bodies to define, establish and promote benefits

Rationale
Both professional body and peer influences are seen as motivating drivers of technology adoption across all clusters (67% of embedded converts, and 23% of firm non-adopters, strongly agree their professional body is a driver: 46% and 16% respectively strongly agree peers are a driver). Further, the more hesitant clusters perceive significantly lower benefits to eHealth adoption than the proactive pioneer and embedded convert practitioners (14% of risk-conscious practitioners strongly agree continuity of care is a benefit, compared to 54% of proactive pioneers, and 51% of embedded converts). Utilising ‘super-users’ and professional bodies to emphasise the benefits they’ve uncovered will be a driver of perception and adoption.

Intervention
Cultivate and support a pool of skilled users who can both provide a tangible showcase of successful adoption and help develop training programs that will resonate with their peers. In addition to supporting more hesitant practitioners, this role provides an avenue for recognition amongst proactive pioneers, for whom this visibility is a strong driver.

Main clusters influenced: Risk-conscious, cost-conscious, doubters, firm non-adopters

11. Develop an evaluation framework to track and report on business-, patient- and efficiency-related benefits

Rationale
At early stages of an adoption curve, unconvinced practitioners can legitimately suggest there is limited data supporting an adoption decision that will potentially alter their care process and customer experience significantly. As weight of evidence builds, persuading these practitioners becomes a more straightforward task.

As adoption levels increase, the ability to quantify benefits will become increasingly critical to convince the practitioners who are less likely to reap immediate or direct rewards

Intervention
Define a clear and quantified articulation of direct and indirect benefits made possible by the deployment and use of the eHealth solutions, covering quality, access and cost benefits, to the patients, practices and the health system.

Determine the metrics and the context, scale and duration of deployment required to prove these benefits to different stakeholder groups, and engage the relevant stakeholders (e.g. professional bodies) early in the definition of benefits, metrics and proof points.

Anticipate how this evidence will be communicated to stakeholders (e.g. via professional bodies, academic publications, events, CPD training, etc.)

Main clusters influenced: Risk-conscious, cost-conscious, doubters, firm non-adopters

12. Build the expectation that practitioners “should” use eHealth solutions, at practitioner and patient level

Rationale
A strong correlation is observed between use of computers, and practitioner perceptions that computer use is expected of them, or that the majority of their peers are using computers. Although not necessarily a causative effect, the level of suggested peer and peak body influence by practitioners suggests that developing the expectation of use will drive adoption. The influence of patient expectations is less prominent, although ‘mobile’ patients shifting between practitioners also serve to reinforce practitioner perceptions about their peer’s use of technology.

Intervention
Build and maintain system-wide awareness of the level of use of eHealth solutions within the healthcare system. Keep the ongoing development of eHealth top-of-mind for allied health practitioners by coordinating campaigns highlighting the progress of general practitioners, medical specialists, community health centres, vendors and insurers. Educate patients about the benefits to ongoing maintenance of their health through improved access to healthcare. Practitioner attitude, motivation, perception of barriers and perception of benefits all correlate with perceived expectation of use.

Main clusters influenced: Cost-conscious, doubters, firm non-adopters

13. Reduce the perception of risks in the change to an eHealth solution via peer testimonials and professional bodies communications

Rationale
Conflicting perceptions of risk emerge between practitioners who have and have not adopted eHealth solutions. Those who rely on traditional record-keeping and communications stress that their records are locked away safely at night, reliably available when required and only available to those who genuinely require access. Those who have adopted eHealth solutions respond that electronically stored records can be backed up, can be adequately secured and provide significant patient benefits including safety, engagement in managing their own health and continuity of care. This is essentially a difference in perception, with a level of education required to circumvent the “all change is dangerous” attitude, and emphasise the collaboration and efficiency benefits for providers.

Intervention
Identify the main perceptions of risks that are likely to delay adoption by the risk-conscious and firm non-adopter clusters especially, determine the evidence that is required to allay these concerns, and scope and run demonstrations and early implementations that generate this evidence.

Determine robust mitigation approaches to the main risks perceived, and ensure these are communicated to these clusters via stakeholders they trust (e.g. peers)

Main clusters influenced: Risk-conscious, doubters, firm non-adopters

14. Provide financial assistance at key milestones

Rationale
Financial incentives are suggested as a top-two motivator by all clusters. However, while there is undoubtedly a place for financial incentives in the adoption of potentially costly or disruptive technology, they can also prove a blunt instrument unless properly targeted. For example, providing allied health practitioners with a grant to purchase EHR solutions is inefficient if the available systems are unable to communicate. Hence incentives should generally not be ‘cash handouts’ to individual practitioners, but rather productivity initiatives such as establishing profession-based network support or tax deductions for specific eHealth professional training.

Intervention
Financial interventions should be used to supplement a case for adoption where the benefits to the practitioner are insufficient, but the benefits to the overall health system justify the investment. For example, community health centres might be provided with video-conferencing facilities to promote the integration of multi-disciplinary care teams.

Main clusters influenced: Cost-conscious, doubters, firm non-adopters

C. Shaping the Ecosystem

Introducing changes, such as eHealth solutions, which affect the care delivery model across the healthcare system, requires coordinated approaches to adoption across the system. The eHealth readiness research has confirmed the importance of the overall health ecosystem as a strong factor influencing individual adoption by Allied Health Practitioners.

Therefore an effective eHealth adoption strategy also needs to include specific interventions which create the conditions in the ecosystem which influence and support adoption, within and across clusters. Critically, coordinated action within an ecosystem must be guided top-down – governments must establish the regulatory and incentive environment before vendors and professional bodies can take the right initiatives along with individual practitioners.

15. Establish a clear and aligned aspiration and timeline for eHealth adoption, to facilitate decisions and commitments by practitioners and solution vendors

Rationale
A clear system-wide directive for the introduction and adoption of eHealth technologies is required to guide stakeholders whose investment relies on the actions of adjacent stakeholders.

The leading examples are eHealth system vendors and the subset of proactive pioneers who have undertaken to develop their own systems. Establishing development priorities significantly mitigates development risk. For practitioners, an adoption timeline sets expectations of use, allows forward planning and coordinates migration to eHealth solutions system-wide.

Intervention
Establish and publish clear standards early, as well a realistic but clear timeline of expected adoption by the majority or all stakeholders, including any reinforcing mechanisms which will kick in at defined times in the future (e.g. penalties for non-compliance, conditional accreditation, etc)

Main clusters influenced: Proactive pioneers, cost-conscious, doubters

16. Coordinate critical mass of adoption within defined health networks

Rationale
Widespread adoption hinges on the ability for practitioners to connect and share information with a large number of other care providers. Ensuring that these other providers (e.g. GPs, specialists and pharmacists) are simultaneously integrating with the systems will help encourage, and in some instances force, practitioners to come on board. The strong network effect achieved by widespread adoption calls for a coordinated push system-wide, such that all stakeholders in the ecosystem join simultaneously. (40% of firm non-adopters strongly agree there are not enough people using eHealth technologies.)

Intervention
Building on the analysis of benefits for defined clusters or specialties, identify use cases involving multiple healthcare professional categories, which have a strong potential to generate visible benefits early, and will stimulate adoption from stakeholders who are critical for the realisation of many other attractive use cases. An example regularly mentioned by practitioners was the need for an accessible complete record of patient medications, particularly for elderly patients.

Main clusters influenced: Risk-conscious, cost-conscious, doubters, firm non-adopters

17. Create transparency on adoption plans and trends

Rationale
The eHealth readiness research has identified perceptions of adoption by other practitioners in a network of care as strong influencer.

Further, the full range and scale of benefits from eHealth solutions will only become possible once there is sufficient penetration amongst all participants in a given healthcare delivery system or network.

And finally, participation trends within a specialty or a cluster can also encourage and sustain the development and support of vendor solutions specifically addressing their needs

Intervention
Create a simple tool allowing (or requiring) participants to specify their intentions in terms of timing and extent of eHealth solution adoption, and transparently make the information available to the relevant communities, and alert these communities of opportunities presented by the rate or extent of penetration achieved.

Main clusters influenced: Pressured adopters, risk-conscious, cost-conscious

18. Embed eHealth training into professional education programs, and anticipate implications of eHealth-enabled models of care in workforce planning and education and development

Rationale
University education and continuing professional development are cornerstones of allied health practice, and both play a lead role in shaping the expectations of the community of practitioners, as well as the dissemination of new skills into the workforce.

Intervention
Engage with early adopters, professional bodies and other relevant organisations (e.g. Health Workforce Australia), to determine how the eHealth solutions affect healthcare professional roles and skills.

Determine implications for both initial training and CPD, and how to embed eHealth training into relevant programs.

Main clusters influenced: Pressured adopters, risk-conscious

19. Enlist the full support, engagement and influence of professional bodies and patient representation groups

Rationale
The eHealth readiness research has suggested that allied health practitioners are relatively interested in eHealth uses which involve sharing records with patients, and are sensitive to patient-related benefits (i.e. patient satisfaction, patient relationships and patient engagement). To a large extent this reflects the educational role played by allied health practitioners, and their requirement for influencing long-term patient behaviour. In addition, the influence of professional bodies, peers and to a lesser extent, patient groups emerged as strong levers to drive eHealth adoption.

Further, one of the main barriers identified in the survey was perception of risk (to the patient quality and the practice efficiency, as a result of concerns over privacy, data security or system malfunction or downtime).

Therefore, interventions that engage the patient and professional representation bodies in designing and communicating effective implementation of eHealth solutions which mitigate the perceived risks and deliver safety and experience improvements for patients are likely to be effective.

Reciprocally, given allied health practitioner’s overall interest in patient engagement and benefits, they and their professional bodies can be an effective influence on patient’s consent to and engagement with eHealth solutions.

Intervention
Utilise professional and patient representation bodies as key influencers by liaising early to ensure that they provide best-practice adoption and use guidelines for their members, and communicate effectively on benefits mitigations of risk and liability. Additionally, collaborate with the peak bodies to confirm the most influential benefits for their members and ensure that their communications align with these benefits.

There is a wide range of possible specific interventions involving these bodies, ranging from formal communications to inclusion of eHealth readiness training in elective or mandatory (mandatory) CPD through peak body or registration requirements, via inclusion of eHealth promotion in events hosted by these organisations, or active involvement of these organisations in early implementations.

Main clusters influenced: Proactive pioneers, risk-conscious

20. Require mandatory participation via regulation or other mechanisms

Rationale
Eventually only a subset of difficult to influence practitioners will remain and therefore requirements may be the only way to convince them to make the change.

Also, setting realistic but firm ‘deadlines’ by which participation will become mandatory can accelerate commitment and investment decisions by individuals and practices, and can also strengthen solution vendors participations and investments, as t provides a greater certainty of the emergence of a sustainable market.

Intervention
There are a number of potential levers, including enforcing compliance through registration or CPD requirements,7 making access to MBS dependent on using mandatory eHealth solutions or components such as secure messaging use, or adjusting insurance premiums.

Main clusters influenced: Cost-conscious, doubters, firm non-adopters

Engagement interventions mapping

Three broad strategic families emerge above, with applicability by cluster as indicated below:

TABLE 4: Product-shaping levers by cluster


Shape the product Proactive pioneer Embedded converts Risk-conscious Cost-conscious Doubters Firm non-adopters
  1. Ensure access to or provide fundamental infrastructure
L
M
L
M
H
M
  1. Establish, enforce and communicate compliance with clear interoperability standards
H
M
L
L
H
L
  1. Provide ‘backbone’ framework establishing legal, data ownership and storage, and security standards and rules
H
L
M
L
H
M
  1. Establish shared solution architecture platforms to ensure more efficient development and delivery of standards-compliant solutions
H
H
L
M
H
M
  1. Create the conditions which engage vendors in developing eHealth solutions aligned to practice and cluster type to address usability and functional requirements concerns
H
L
L
H
M
M
  1. Establish support mechanisms to prevent or mitigate downtime risk and other non-functional performance issues
L
L
H
H
H
M
  1. Assist EHR early adopters transitioning to structured record-keeping
H
M
L
L
L
L
  1. Provide a ‘practice upgrade and change management’ service
L
M
H
H
H
M

TABLE 5: Demand-shaping levers by cluster


Shape the demand Proactive pioneer Embedded converts Risk-conscious Cost-conscious Doubters Firm non-adopters
  1. Define tailored value propositions by profession and/or cluster
L
M
L
L
L
M
  1. Empower “super-users” and professional bodies to define, establish and promote benefits
H
M
H
M
H
M
  1. Develop an evaluation framework to track and report on business-, patient- and efficiency-related benefits
L
L
M
M
H
M
  1. Build usage expectation at practitioner and patient level
L
L
M
H
M
M
  1. Reduce the perception of risks in the change to an eHealth solution via peer testimonials and professional bodies communications
L
L
H
L
M
M
  1. Provide financial assistance at key milestones
L
M
L
H
H
M

TABLE 6: Ecosystem-shaping levers by cluster


Shape the ecosystem Proactive pioneer Embedded converts Risk-conscious Cost-conscious Doubters Firm non-adopters
    1. Establish clear and aligned eHealth adoption aspiration and timeline to facilitate decisions and commitments by practitioners and solution vendors
H
M
L
M
M
L
    1. Coordinate critical mass of adoption within defined health networks
M
L
H
M
H
M
    1. Create transparency on adoption plans and trends
L
M
H
M
M
L
    1. Embed eHealth training into professional education programs, and anticipate implications of eHealth-enabled models of care in workforce planning and education and development
L
H
M
M
M
L
    1. Enlist the full support, engagement and influence of professional bodies and patient representation groups
H
M
H
M
M
L
    1. Require mandatory participation via regulation or other mechanisms
L
L
M
L
M
H

Developing coordinated adoption strategy from the interventions toolkit

To demonstrate the development of a targeted adoption strategy from the toolkit of intervention levers described above, we consider their application to a scenario where the Government wishes to drive the adoption of telehealth services across the allied health community to supplement the provision of ongoing care for patients with chronic conditions.

This is not intended to promote telehealth as a national priority; instead, it is meant to illustrate the end-to-end adoption strategy development process that could follow from the eHealth readiness research. Telehealth was selected as an example of eHealth that is generating considerable interest globally, but for which neither the use-case nor business-case is yet well-established. The research supporting this report has showed telehealth is already being adopted by allied health practitioners across Australia. Today, patient-facing use of telehealth is low, as are practitioner expectations of patient-facing use – however the potential of telehealth solutions to significantly improve healthcare outcomes for many Australians is widely recognised.

Our approach follows the process outlined below:

1. Describe the objectives

For any given eHealth adoption program, first clarify the objectives and aspiration in detail, along with metrics for measuring success. Understand and describe both the starting position and the intended end-state. Describe the program and its objectives in the context of the overall evolution of healthcare delivery, not as an isolated deployment of eHealth solutions.

2. Develop and prioritise use- and business cases

Describe the use-cases envisaged in achieving the program objectives. Prioritise these both on their impact – e.g. for patients, healthcare professionals and the healthcare system – and their reach – e.g. how many patients or clinicians will be touched by the use-case.

3. Identify the critical participants and their role in the use-case

Within each use-case, identify the critical participants, the roles they play in enacting the scenario and the interactions required both horizontally, e.g. between healthcare practitioners or between systems – and vertically, e.g. from patients to healthcare providers

4. Highlight participant clusters and their role in adoption

Identify the composition of participant groups by cluster. Clarify for each cluster their role in adoption, the timing of that role, and their relative influence and importance to overall adoption success.

5. Prioritise clusters and their intervention levers

Consider the intervention strategies appropriate to targeting each cluster, along with their relative merit for the intended objective, optimum sequence and timing.

6. Integrate intervention levers to develop a coordinated strategy

Combine and refine the potential interventions to develop a coordinated strategic plan, ensuring they are consistent with the objective, appropriately sequenced (both between clusters and between strategies) and can translate into a clear plan of action on the ground.

7. Measure performance and refine the approach

Establish a regular rhythm of performance measurement and review along the stated metrics. Consider progress on both how well you are doing at getting traction on adoption and use case enablement, but also whether you are achieving the targeted engagement role for each cluster and shifting core eHealth readiness attributes for these clusters (e.g. infrastructure, aptitude, and attitude). Refine the engagement approach as required.

Case study: Incorporating telehealth in the management of patients with chronic conditions

1. Describe the objectives

For the purposes of this hypothetical case study, we envisage an articulated goal of improving outcomes in the management of patients with chronic conditions through the adoption of telehealth solutions. The objective is to provide more regular touch-points with practitioners, such that improved patient monitoring and motivation, for patients that require it, is achieved in a manner convenient to both patient and practitioner, particularly in rural and remote scenarios, but also for elderly, juvenile and time-pressed patients.

The start-point is the current management scenario:
  • Access to Medicare rebates for dietetic services is achieved when a patient with a chronic or terminal medical condition and complex care needs is managed by their GP under a GP Management Plan (MBS item 721) and Team Care Arrangements (MBS item 723) and referred for dietetic services under Medicare.
  • Allied health practitioners are currently unable to claim Medicare Rebates for telemedicine consultations and no health professionals are able to claim Medicare Rebates for services where a patient is not present either by videoconference or in person MBS does include case-conferencing items, although these are little used..

The criteria for measurement of success include patient mortality and life-expectancy, quality of life factors, progression and adherence to care plan objectives, progress on known risk-factors such as blood glucose levels, and number of patient contacts per year.

2. Develop and prioritise use- and business cases

Potential general use-cases for telehealth amongst allied health practitioners might include:
  • A physiotherapist treating a chronic musculoskeletal condition utilises regular video-conferencing to monitor progress through live gait analysis
  • An Aboriginal and Torres Strait Islander Health Worker supplements face-to-face contact with telephone monitoring to encourage patient self-management
  • A psychologist provides web-based treatment programs allowing patients to self-manage their progression
  • An occupational therapist seeking to develop a specialisation in the management of chronic conditions undertakes continuing professional development through a series of webinars
  • An optometrist who believes a patient’s deterioration warrants specialist attention collaborates directly with a specialist by sharing images for diagnosis
  • A coordinated care plan is developed allowing a dietitian and an exercise physiologist to manage a patient suffering Type II diabetes in a rural community (further detailed below)

One of the most difficult aspects of working with patients with chronic health problems as a result of long-term behavioural and social patterns is motivation and compliance. We will therefore consider the final case as the highest priority, and continue with this focus.

3. Identify the critical participants and their roles

The potential of telehealth as an effective delivery channel for healthcare education, collaboration, consultation and monitoring depends crucially on the care process involved. The healthcare provision process of allied health practitioners can be divided into three broad categories (below), although the diverse roles played by allied health practitioners imply significant overlap.
Care process groupCharacterisation
Counselling-based therapiesThese practitioners are heavily reliant on the practitioner-patient relationship as a basis for patient education in the management of their own healthcare. While a level of face-to-face contact is broadly considered beneficial in establishing trust, ongoing consultation is not generally reliant on direct practitioner-patient contact. Patient history is a critical enabler of health management.

This group includes:
Aboriginal and Torres Strait Islander Health Workers, Dietitians, Psychologists, Social Workers, and Speech Pathologists.
Physical therapiesFor these practitioners the physical presence of a patient is almost universally required. The core diagnostic and therapeutic processes involve direct interaction between patient and practitioner. Care is typically on a case-by-case basis.

This group includes:
Chiropractors, Exercise physiologists, Occupational therapists, Osteopaths and Physiotherapists.
Specialist technical therapiesThese practitioners rely on a range of specialist equipment to accommodate patient diagnosis and therapy. Patient relationships vary from single-visit to intermittent repeat visits over many years.

This group includes:
Audiologists, Dentists, Optometrists, Podiatrists, Radiographers and Sonographers

At a high level, the potential of various applications of telehealth is related to the therapy process:
Care process group CPD Collaboration with other practitioners Patient consultation Patient monitoring
Counselling-based therapies
H
H
M
H
Physical therapies
M
M
L
M
Specialist technical therapies
L
M
L
L

In this use-case, the critical health system participants are the patient’s GP, dietitian and exercise physiologist, whose roles are:
  • General Practitioner is responsible for implementation and rhythm of review of the patient care plan, including medication requirements and practitioner roles. While they would potentially see a patient face-to-face initially, ongoing patient review could be held remotely via telephone, tele-conference or video-conference. The GP would also collaborate with dietitian and exercise physiologist to develop a care plan, monitor progress and consider refinements.
  • The dietitian and exercise physiologist work together to educate the patient on appropriate lifestyle change, instil a coordinated management plan and monitor patient compliance and progress in line with that plan. For both professions, developing a close patient relationship is a key success factor to motivation, so regular communication is critical. Ongoing monitoring and support can be provided remotely through telephone, tele-conference or video-conference facilities. Patient monitoring will include tracking weight, waist circumference, blood glucose, blood pressure and cholesterol – the patient can be empowered to undertake these measurements themselves, and enter the results into an online journal, keeping both dietitian and exercise physiologist informed of progress. Nutrition and exercise analysis can be linked to this data so that kilojoule intake and exercise output can be monitored in conjunction.

4. Highlight participant clusters and their role in adoption

Dietitians are overwhelmingly embedded converts (57%), while exercise physiologists have relatively even representation between proactive pioneer (25%), embedded converts (25%) and doubters (23%).

The small percentage of proactive pioneer dietitians (7%) suggests early adoption may not be spontaneous, but once underway would embed rapidly amongst embedded converts. Just 14% of dietitians are firm non-adopters, yet this use-case does not require all practitioners to adopt, so their involvement is not required. Due to their potential for negative influence amongst the profession, the approach towards them should be ‘containment’ rather than active involvement.

The large proportion of proactive pioneer exercise physiologists will drive rapid adoption of the use-case scenario, provided the infrastructure is in place - both communications and specialist applications. However the significant body of doubter exercise physiologists implies an infrastructure gap that needs to be addressed. Again, the use-case does not require all practitioners to be involved, so the smaller risk-conscious, cost-conscious and firm non-adopter clusters do not need to be actively targeted initially.

5. Prioritise clusters and their intervention levers

For dietitians, the clear priority is embedded converts, while both proactive pioneer and doubters deserve attention for exercise physiologists. Intervention levers appropriate to incorporating telehealth into their management of chronic conditions include:
  • Provide fundamental infrastructure – effective use of telehealth in developing the trust required to motivate and educate a patient requires high-quality voice and video communications. Access to this infrastructure will be particularly difficult for rural and remote patients.
  • Utilise “super-users” to promote benefits – proactive pioneers will explore greater utilisation of telehealth technologies if firstly, they observe respected leading practitioners taking steps in that direction, and secondly, there is an opportunity to be recognised as a leader in the field. Identification and cultivation of proactive pioneers should occur as early as possible, concurrent with infrastructure development, to both harness their enthusiasm, and promote and capture innovations in the care delivery process.
  • Build usage expectation at practitioner and patient level – although embedded converts consistently agree that the use of technology is expected of them, they are likely to be unaware of potentially new care delivery paths. It is important that embedded converts are presented a consensus adoption pathway, developed from the experience of the proactive pioneers, that establishes a clear set of steps and tools required to quickly adopt telehealth solutions, as well as expected practitioner and patient outcomes in doing so.
  • Provide peer-based support for practitioners undergoing the transition – embedded converts consider peers a strong motivator, and will generally adopt eHealth solutions where the experience has been beneficial in comparison to the cost, both financial and in terms of practice efficiency. It is critical that practitioner support is fully available, and potentially proactive, in the early stages of embedded convert adoption – their positive experience of the process will drive ‘critical mass’ of adoption.

6. Integrate intervention levers to develop a coordinated strategy

The four key intervention levers uncovered can be combined to form a cohesive strategy, deployed over time:
  • Underlying infrastructure is developed where required, region-by-region on a staged basis. Infrastructure is a basic ‘hygiene’ requirement for telehealth, with a regular connection between practitioner and patient required. Staged development allows pioneers to move quickly, disseminating learnings from their experience as further practitioners adopt. Practitioners may require video- or teleconference facilities, and integrated patient progress tracking as part of patient records. Patients without sufficient facilities may be able to access video- or teleconference facilities at local community centres, or alternatively rely on equipped community nursing or outreach staff. Regional prioritisation should consider both patient body and availability of suitable pioneers to lead adoption.
  • Utilise the proactive pioneers to promote the concept of telehealth as a management tool for assisting patients with chronic conditions. For example, a seminar coordinated by the DAA could describe in detail the implementation process, timeline and outcomes of an initial trial by a small group of dietitians. Where infrastructure is in place, adoption of telehealth to monitor chronic patients has typically meant evolution of the patient care process – for example greater patient autonomy and self-management, a change in the role of community nurses or outreach staff, and greater collaboration between general practitioner, dietitian and exercise physiologist. Educating practitioners on the benefits these changes can bring, both to their own practice and their patients’ outcomes, is a key attitude driver.
  • As practitioner familiarity with telehealth-supported care delivery grows, work with peak bodies, GPs and patient support groups to develop an expectation of use for telehealth solutions within a standard management plan. Best-practice patient management is built around patient outcomes – as a body of evidence develops supporting the most valuable use-cases for telehealth adoption, ensure this knowledge is passed to the wider health community. The integration of telehealth is then seen as a progressive step for patient management and an indicator of leading care provision. Establishing a forum between interested dietitians could ‘keep the conversation going’ as adoption is undertaken, while regularly reporting progress to the full membership both maintains eHealth adoption as front-of-mind, and provides an opportunity for recognition of practitioners’ achievements.
  • Assist practitioners that adopt telehealth solutions by ensuring they have a support network of professional colleagues undergoing the same transition process. Building on the experience of early adopters, the DAA could establish a knowledge-base of best-practice guidelines for both infrastructure questions and care delivery techniques, perhaps as an extension of the telehealth forum suggested above.

7. Measure performance and refine the approach

Maintaining strategic direction in a complex environment requires regular monitoring and review. During the initial phase this may be a simple measure of infrastructure reach (e.g. accessible population) and practitioner awareness (e.g. percentage of practitioners who comprehend how patients with chronic illnesses might be better managed through incorporating telehealth initiatives). As expectations within the patient and practitioner population develop and adoption commences, establishing a rhythm of assessment of the target success criteria - mortality and life-expectancy, quality of life factors, progression and adherence to care plan objectives, and number of patient contacts per year – allows objective measurement of strategy effectiveness and refinement of interventions where required.


7. For the 14 health professions regulated under the Health Practitioner Regulation National Law Act 2009, the power to change registration standards, codes and guidelines resides with the National Boards.


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