Systems integration, secure messaging, interoperability standards, Smart Referral platforms, Provider Directories, Identity management solutions, Electronic Medical Record (EMR) systems – “buzz words” for some, but these cannot be viewed as isolated IT concepts used for administrative convenience. They are foundational pieces that support most health information exchange use cases that drive a better service experience for all. In today’s health system they are working seamlessly together, but maybe just not for every single use case.

When successfully delivered at scale, they combine to meet the expectations of the modern-day patient and clinician, without interrupting the operation (and workflow) of the health system:

• information flows seamlessly within, and between, healthcare settings;
• patients do not have to retell their story at every point of care;
• clinicians can make decisions with better context and with minimal data entry;
• health organisations can reduce waste created by duplication, delay and manual rework;
• and the information (and its data components) can be further shared and utilised beyond the initial exchange.

FAMILY JOURNEY

Seventeen years ago, my family’s health journey was impacted because of poor information exchange and the duplication of medical records within the hospital system. How did this happen? Why were our referral and registration details manually received and entered separately, forms misplaced, names misspelt, mistyped, etc.? Why were we delivered appointment scheduling complications at the hospital and then confusion with follow-up community management? Why did this event steer us out of the public health system that we had invested in, to be managed in the private health system?

The significance of this event drove me to confront the problem head-on, as Australians have more complex names, medical histories and backgrounds than me.

Having previously worked at SAI Global/Standards Australia, I learnt about the importance of why Australian Standards exist, how they are reviewed, why they evolve, and how they are successfully applied across different industries (eg building and construction, IT, business management, mining and manufacturing). Australian Standards, when referenced in legislation, play a critical role in ensuring a quality assurance uplift when it comes to the trade and function of an industry. Within Health Information Exchange, the Health Level 7 (HL7) standards play a critical role in securing the delivery of information across different software systems and settings. But in healthcare, superseding existing standards is no mean feat.

For example, plumbing, wiring and building codes update regularly (every seven years or so), but the plumbing in your home doesn’t get updated at this rate.

So how do existing standards and systems integration that already work effectively in today’s connected healthcare system get updated and implemented across the healthcare landscape, and who funds this ongoing body of work?

In 2026, healthcare organisations are not mandated to use a software platform or system that supports an approved/compliant secure messaging interface that meets the Australian Standards. Why? The AS4700.2 ORU and AS4700.6 REF standards have been in operation since 2004 and 2005 respectively – they are effective standards and are now over 20 years old.

SYMPTOM – NOT DISEASE

The persistence of fax, post, unsecured email and phone-based chasing in healthcare is not simply a technology failure. It reflects some of the deeper problems that have faced healthcare over many years: information exchange has too often been treated as a local workflow issue rather than a national capability and obsession. As a result, clinical information still moves through fragile channels that aren’t electronically capable, are slow, incomplete, difficult to audit and prone to error – so why not just send a fax?

The recent My Health Record Share by Default reforms do help in reducing the reliance on the fax machine to communicate information within healthcare, but it’s currently only a send-to-a-separate-record-summary process, and not fully enabled using new standards. More investment is required to enable the appropriate use, authentication and access to information when it is needed – like for the Shared Care Plan. It’s not a foolproof solution on its own, as patient information (particularly urgent info which may contain medical opinions) still needs to be shared reliably, and via direct means, with other providers.

TRUST FOUNDATION

Healthcare information is among the most sensitive data a person has. Any system that stores it or moves it around the health system at scale must be built on a framework of privacy, authentication, encryption, auditability and organisational control. Convenience cannot come at the expense of trust. Investments into the framework must be ongoing.

Secure messaging interfaces built to Australian Standards and housed within EMR systems are providing the crucial trust chain for supporting the encrypted transmission of patient information. Defined (authenticated) sender and receiver endpoint identities, tracking dashboards and auditing tools are all supported within the software itself. The safeguards matter not only for operational compliance, but for confidence and convenience in today’s healthcare system. Secure Messaging does this very well, reliably and consistently for both general practices (which communicate with up to 80 different organisations a week) and the larger-scale diagnostic and hospital providers that can communicate with thousands.

eREFERRAL EVOLUTION 

Referrals sit at the heart of the care continuum and are acknowledged as one of the most difficult-to-master processes in the health system. They are the handover between primary care, specialists, hospitals, diagnostic providers, community services, allied health and other government and non-government agencies. When referrals are incomplete, manually delivered or poorly structured, the consequences ripple across the wider health and care system: critical data is missing, appointments are delayed, referrals are rejected, clinicians seek additional clarification, data is manually entered, errors are invited into the process and patients are simply left waiting for their required service.

The economic benefits of health information exchange interoperability for Australia (Dr Peter Sprivulis – Australian Health Review 2007) are articulated and understood as productivity benefits:

• When information flows automatically and accurately between systems, administrative burden falls.
• When referrals are complete the first time, triage improves.
• When discharge information reaches general practice promptly, continuity of care improves.
• When clinicians can see relevant history, results, medicines and allergies that are relevant to the patient while assessing the symptoms they are dealing with, or the outcomes they are tracking, they can act with greater confidence.

At scale, these gains compound.

A single electronic referral saves minutes; millions of secure exchanges save workforce time, reduce duplication, improve data quality and information integrity, and lower avoidable risk.

Smart eReferrals have already rolled out across most Australian private specialists, public hospitals and health services, and they are much more than just a digital form or PDF. They support systems integration at the referrer and receiver end to ensure information integrity and data pre-population capabilities align with the Australian Standards. Creation must include, wherever possible, the pre-population of referrer details and all relevant patient demographics – including medications, medical, social and family history – with an ability to attach relevant clinical and supporting documentation (tests/investigations, reports, etc). Where possible, they can also draw from the receiver’s clinical systems, or third-party directories, to help guide the referrer toward declaring the most pertinent information required by the receiving service as part of the transfer in care. And when received, they must reduce burden, not add another separate portal, password or parallel process into the business of healthcare.

The lesson from two decades of successful eReferral implementation is clear: adoption follows workflow. If an eReferral requires clinicians to leave their normal clinical software workflow, duplicate data entry, or navigate static templates or portals disconnected from the patient record, uptake will stall. If it is embedded, intuitive, secure, smart and clinically useful, it will become the default.

ROLE OF FHIR

Evolving standards, such as FHIR, introduce an enhanced model for interoperability. Rather than simply enabling the exchange of documents or messages, FHIR supports more modular, API-driven interaction between systems. Information can be accessed, updated and reused within clinical workflows, not just transmitted between them (what secure messaging is more widely known for).

The opportunity therefore must not be to simply replace secure messaging, but to extend it. Secure Messaging remains a proven and trusted backbone for most healthcare use cases where information gets shared across multiple health system providers without requiring a human or manual manipulation of the information. However, when combined with FHIR-enabled interfaces, directory services and structured data models, it can support richer, end-to-end workflows including referral triage automation, virtual consults, status updates and shared care coordination.

There are so many more roles FHIR is yet to fill in our digitally connected health system of the future. However, without ongoing public and private investment into FHIR standards development, and without the appropriate policies and reforms in place, there isn’t a successful implementation path to ensure the correct application and maintenance of the FHIR standards. We can’t leave the future of health information exchange in limbo.

The next wave of FHIR standards adoption and its expected efficiency gains will have many twists and turns. The path to achieving adoption of the standards appears to be ever-expanding, as new locally and nationally endorsed Implementation Guides (IGs), and an abundance of new technology and AI solutions, enter the market. The main challenge for government and industry here is to ensure alignment: align standards, incentives, workflows, vendors and clinical need. If we can get that alignment right, existing health system infrastructure can be enhanced and utilised as the connective tissue to providing the best service for patients.

FHIR is not a security standard, as no single standard will meet every need. So for most organisations a service “bridge” will be essential to ensuring FHIR improves interoperability by effectively integrating the transaction-oriented standards (HL7v2, HL7 CDA, X12, SCRIPT, etc.) with the interaction-orientated FHIR standard. The path forward is not to keep building isolated digital products and hope they connect later. It is to make standards-based information exchange a core requirement of our health system’s design. This requires know-how, leadership experience, coordination and collaboration.

Future funding models must reward proven adoption, not just procurement. Procurement should require systems interoperability and backwards compatibility, not merely digitisation. Vendors should compete on usability, reliability and value-added capability while conforming to the shared standards. Health services should continue to design and enhance referral and information sharing pathways with clinicians, not just for them. And governments should treat provider directories, identity services, messaging standards and security frameworks as national infrastructure worthy of continual investment.

NEXT STEPS

The future of healthcare will not be defined only by breakthrough therapies, new facilities or headline digital software programs. It will also be defined by whether the right information can move securely and intelligently through the health system at the moment it is needed for patient care. This considerable task requires unwavering commitment, collaboration and trust from the various government agencies and industry partners that work to support the patient’s journey through the electronic medical record ecosystems of healthcare.

Digitising health information is not a new concept.

So then, how do we economically fund the wiring enhancements needed to support the future healthcare system? How can we deliver the best possible service experience for patients in the future without breaking the budget, or the software vendor roadmaps that support required local initiatives? These are leadership questions we need answers on.

Disclaimer: HealthLink and Pulse+IT are both part of Lanas.