Digital health

WEEK 5
Digital health aims to advance the quality, safety, and efficiency of health care through the design
of technologies and systems that support the practitioner- patient interface across the range of
health care services and encounters. Electronic health records, telehealth and M-health are
examples. In Australia, the Australian Digital Health Agency (ADHA), through its National Digital
Health Strategy, has identified priority areas and guidelines to support adoption of digital health.
This is important to ensure the rapid growth in digital health is underscored by relevant
governance and regulatory standards. Registered nurses must understand the background and
practice implications of digital health in order to meet their registration requirements, and to know
how to engage in safe, effective professional person- centred care.
Digital health falls under government legislation at both federal and local government levels. An
understanding of this legislation allows nurses to understand the scope and boundaries when
accessing and using digital technology. To support the integration of digital technology within
nursing, key nursing bodies including the Australian College of Nursing have worked with the
ADHA to develop the Nursing and Midwifery Digital Framework, which aligns to the Registered
Nurse Standards for Practice. These standards include ethical practice and address the ethical
principles of autonomy, beneficence, non-maleficence and justice which are core to the
registered nurse code of ethics. An understanding and appreciation of how to align ethical
person-centred care with the use of technology and data is essential to promote safe care. You
will explore these topics in detail in later modules.
Learning Outcomes:
At the completion of this Module , it is expected that students will be able to
1. Describe digital health and its relationship to nursing care;
2. Outline the World Health Organisation’s approach to digital health.
3. Discuss the actions taken by government, industry and healthcare providers to advance
digital health
Introduction
2. Global perspectives on digital health
Digital health is defined by the Australian Digital Health Agency (2021) as the use
of the best available technology in the provision of health care. It is anticipated that the
implementation of improved technology into a healthcare system for providers and
consumers, will create better health outcomes. Digital health offers consumers (patients
and clients) greater control and better access to key health information. The Australian
Digital Health Agency was formed to advance and create a connected healthcare
system, using technology, to achieve safer and better-quality healthcare. Digital health is
a part of modern healthcare, aiming to create access for all (Australian Digital Health
Agency, 2021).
Digital health is an advancing area. In 2020 the COVID-19 pandemic forced digital
healthcare to the forefront of healthcare in all areas of practice from rural and remote
community practice, aged care, primary health care, to acute care. Nurses working in
these areas were provided greater access to digital health services and technology with
the aim to provide advanced, effective and efficient person-centred care despite the
challenges of access that were brought about by the pandemic. Many of the adjustments
made have continued as refined approaches to digital health have created efficiencies
without compromise to effectiveness. Telehealth is an example of a digital health
innovation that is likely to be retained.
As individuals we engage in technology on a frequent basis. The ability to engage with
technology is of course limited by capabilities, both of the individual and of the

technological infrastructure. For example, telehealth requires connectivity, and digital
health literacy on the part of the patient. Health professionals need to know how to
operate telehealth equipment and to use it effectively to undertake patient assessment.
You may be asking why a unit on Digital Health. Digital health education for healthcare
professionals is a key priority area of the Australian Digital Health Agency. Please watch
the video below to learn why study of digital health is relevant to your nursing practice.
AuDigital Health (
Sep 15, 2020) Australian Digital Health Agency: Digital Health
Workforce and Education Roadmap. You Tube video
https://www.youtube.com/watch?v=fVcUrDNt36o&feature=youtu.be
In the following article, Barbosa, Abbott and Sasso (2021) briefly discuss, through a Guest
Editorial, nursing in a digital era. This short reading presents an informative introduction to the
field
Barbosa, Abbott, P., & Dal Sasso, G. T. M. (2021). Nursing in the Digital Health Era. Journal of
Nursing Scholarship, 53(1), 5–6. https://doi.org/10.1111/jnu.12620
Global perspectives on digital health
In 2005, the World Health Organisation identified and promoted a need for governments to
create a strategic plan to advance eHealth services using developing technology. The use of
eHealth was seen as a means to create equitable, affordable and universal access to
healthcare. In 2013 the World Health Assembly adopted the resolution for eHealth
standardisation and interoperability, urging its members to explore and develop policies and
legislation for eHealth (World Health Organisation, 2020).

Image taken from World Health Organisation (2021) Global Strategy on Digital Health 2020-
2025, p. 30 https://www.who.int/docs/defaultsource/documents/gs4dhdaa2a9f352b0445bafbc79ca79 9dce4d.pdf?sfvrsn=f112ede5_68
The above image provides an overview of the World Health Organisation’s action plan that
aims to advance digital health technologies that support the achievement of health priorities,
and particularly in relation to universal health coverage (WHO, 2021, p. 30). strategy and
intended outcomes and achievements. As you move through the content of this unit and
consider Australia’s use of eHealth / digital health the global origins will become familiar.
The World Health Organisation’s
Global Strategy on Digital Health provides a brief overview
of their vision and plan for digital health. Digital health in Australia is underscored by the
WHO plan. It is relevant to your professional knowledge to be able to understand the wider
context of digital health practice in nursing.
Download the pdf document from the hyperlink above.
1. Read the four strategic objectives from page 19. You don’t need to memorise the
details but be sure you have a general understanding of the meaning and scope of each
objective.
2. Refer to the glossary from page 39. This is an excellent resource that you can use
when defining key terns in your assessments, and checking your understanding of the
language used in this field.
Australia’s use of digital health is advancing in order to meet the needs of the population. To
understand how eHealth has evolved in Australia requires taking the time to look back at
historical milestones. You will be able to see the relationship to the broader context of digital
health as proposed by the WHO in the resource above.

Eslami Andargoli, Amirhossein. (2021). e-Health in Australia: A synthesis of thirty years of
e-Health initiatives. Telematics and Informatics, 56, 101478.
https://doi.org/10.1016/j.tele.2020.101478
2. Global perspectives on digital health
Conclusion
What is health informatics?
Historically, data about patient health was primarily obtained from physical
examination/observation and patient history. Care based on this level of interpretation was often a
reflection of the knowledge, experience and subjective preferences of the clinician. Over time,
technical developments have enabled clinicians to draw from more objective or quantifiable
information about patients via through diagnostic imaging tools, laboratory procedures, and
various mobile devices. The development of electronic health records has provided a means for
such information to be collated, and for professionals to be able to use data to advance patient care
and diagnosis in a way that was not possible previously (Kim & Groeneveld, 2017). These
advances are representative of the field of health informatics.
Defining health informatics is not a particularly simple task. The number of different definitions
reflects the evolutionary nature of the discipline as well as the subjective views and particular
interests of the authors.
Health informatics has been defined as:
o “an evolving scientific discipline that deals with the collection storage, retrieval,
communication and optimal use of health- related data, information and knowledge. The
discipline utilizes the methods and technologies of the information sciences for the
purposes of problem solving, decision making and assuring highest quality health care in
all basic and applied areas of biomedical sciences (Graham, 1994, p.1).
o “the science and practice around information in health that leads to informed and assisted
healthcare”. The term ‘informed’ references
the right information about the subject
(consumer, patient or population) together with relevant health knowledge available at
the
appropriate time and in a format that enables it to be used. ‘Assisted’ healthcare
is used to explain that the use of health informatics ensures that the job of health workers
is made safer and easier and that consumers are supported in their decisions and actions
(Health Informatics Society of Australia, 2020).
o “the acquiring, storing, retrieving, and using of healthcare information to foster better
collaboration among a patient’s various healthcare providers” (Quintana & Saron, 2017 p.
2).
While an older definition, Graham’s emphasis on the evolutionary nature of health care resonates
well with the fast paced technological advancements that are so familiar in contemporary
healthcare contexts. The definition offered by the Health Informatics Society of Australia (2020)
also adds value to our understanding as it emphasises
relevance, timeliness and
communicability. Quintana and Saron’s (2017, p. 2) emphasis on collaborative decision making
gives presence to an essential principle in contemporary healthcare delivery: that of inter
professional team work and decision making.

The following video explains briefly the concept of health informatics.
Mason College of Health and Human Services (18 May 2019) What is health informatics?
[YouTube Video]
https://www.youtube.com/watch?v=qphAzLkYfyI
Note that health informatics is applied in health care at varying levels- from simple data bases of
patient information to more sophisticated systems that are capable of analysis as explained in the
video.
Big Data
You will also hear the term ‘big data’ in relation to health informatics. The following video
differentiates these two concepts. The role of big data becomes more apparent in the readings that
follow.
Vinay Shanthagiri (26 October 2014) Big data in health informatics [YouTube video]
https://www.youtube.com/watch?v=4W6zGmH_pOw
The following reading presents an excellent illustration of the relationship between individual and
‘big’ data. As you read this paper, I suggest you focus on the sources of data, how it has been
extracted and used in answering the researchers’ question. If you find the methodology difficult to

understand, skip to the interpretation. It is however recommended that you view and seek to
understand the graphs that are central to the arguments presented.
Falster, M. O., Jorm, L. R., & Leyland, A. H. (2016). Visualising linked health data to explore
health events around preventable hospitalisations in NSW Australia. BMJ Open, 6(9), e012031.
doi:10.1136/bmjopen-2016-012031
Based on your reflections on this content area, you are encouraged to clarify your definitions of
digital health, and of health informatics, in your own words.
Health informatics is not without its challenges. In an area of rapid growth, the experts in the field
are learning at a similar rate to the clinicians using the software to enter data. This creates a risk
that healthcare will not be able to effectively access the data and this will in turn lead to delays in
treatment. Without access to the data the provision of high-quality healthcare is impeded, and
potentially important information remains unknown and waiting to be discovered. Health
informatics is moving from the development of software to record and track healthcare to
accessing this data (Fridsma, 2016). The area of health informatics is now central to the provision
of person-centred care and creates an opportunity to meet the national standards of healthcare
provision that require safe and efficient care with robust systems. The National Safety and Quality
Healthcare Service (NSQHS) standard of Clinical Governance and the Aged Care Quality
Standard of Organisational Governance both require organisations invest in health informatic
systems.
3. Health informatics and big data
References
In this module you have explored the concept of digital health and by now you should have
knowledge of key definitions associated with this field of practice. You should also understand
why nurses need to know about digital health. In the next module we will explore some of the
common digital health applications
AuDigital Health (Sep 15, 2020) Australian Digital Health Agency: Digital Health
Workforce and Education Roadmap. You Tube video

Barbosa, Abbott, P., & Dal Sasso, G. T. M. (2021). Nursing in the
Digital Health Era. Journal of Nursing Scholarship, 53(1), 5–6.
https://doi.org/10.1111/jnu.12620
Eslami Andargoli, Amirhossein. (2021). e-Health in Australia: A synthesis of thirty
years of e-Health initiatives. Telematics and Informatics, 56, 101478.
https://doi.org/10.1016/j.tele.2020.101478
Evans, R. S. (2016). Electronic health records: then, now and in the future. Yearbook
of Medical Informatics, (Suppl 1) S48-S61, doi: 10.15265/IYS-2016-s006
Falster, M. O., Jorm, L. R., & Leyland, A. H. (2016). Visualising linked health data to
explore health events around preventable hospitalisations in NSW Australia. BMJ
Open, 6(9), e012031. doi:10.1136/bmjopen-2016-012031

World Health Organisation (2021) Global Strategy on Digital Health 2020-2025, p.
30 https://www.who.int/docs/defaultsource/documents/gs4dhdaa2a9f352b0445bafbc79ca79
9dce4d.pdf?sfvrsn=f112ede5_68