learning experiences

WEEK 10
Your learning experiences in this module will be guided by the following learning outcomes:
1. Discuss the strategic framework developed by the Australian Government to embed
digital health into the healthcare system.
2. Identify the key legislation that governs the use of digital technology in healthcare
3. Articulate the ethical principles that underpin safe provision of care using digital
technologies
4. Discuss the alignment of the Registered Nurse Standards of Practice to digital
healthcare
5. Articulate the connection between the Australian Strategic priorities and the nursing
workforce
6. Discuss the actions taken by government, industry and healthcare providers to advance
digital health
Australia’s National Digital Health Strategy is built upon the need to create healthcare that is
safe, achieves improved coordination of care, and better-informed treatment decisions. The
Australian Digital Health Strategy draws from Australian’s calling for control and transparency in
their healthcare. The Australian population seek healthcare that is mobile and digital for all
individuals, not just those skilled in new technology use (Australian Digital Health Agency, 2018
a).
Healthcare professionals seek a secure digital service that provides instant access to patients’
information. This will be used in emergency situations, to support earlier diagnosis, to achieve
better management of disease and to develop new medicines and treatments. Technology is
sought to decrease the administration burden and allow more time to be spent with patients
(Australian Digital Health Agency, 2018a).
Healthcare service providers are currently undertaking steps to address the needs of healthcare
professionals and the consumers of the healthcare they offer. Each state is supporting the roll
out of electronic health medical records initiatives. This coupled with local innovations, to bring
data together and change decision making processes, has led to a need for a national set of
priorities. The national priorities of digital health guide the diverse healthcare sector to a betterconnected digital service (Australian Digital Health Agency, 2018)a.
The Australian Digital health Agency (2018a) promotes the use of digital health to save lives,
improve health and wellbeing and to support the health system to be sustainable and provide
safe, high quality effective healthcare. The National Digital Health Strategy aims to benefit
Australians by:
· Reducing errors in medication and adverse medication related events, improve vaccination
rates, better coordinate care and create better informed treatment decisions.
· Sustaining a more efficient healthcare system, with less time searching for patient data and
results, reducing avoidable hospital admissions and minimising the duplication of tests and
investigation.
· Improving the availability of healthcare and the patient experience by creating personcentred care and minimising admissions to hospital.
· Providing greater access to healthcare for those people living in rural and remote Australia.

· Protecting the national digital health infrastructure and ensuring a secure storage of person
health information for Australians.
(Australian Digital Health Agency, 2018a).
The Australian Digital Health Strategy proposes seven strategic priority outcomes by 2022
1. Health information that is available whenever and wherever it is needed
2. Health information that can be exchanged securely
3. High-quality data with commonly understood meaning that can be used with confidence
4. Better availability and access to prescriptions and medicine information
5. Digitally enabled models of care that drive improved accessibility, quality, safety and
efficiency.
6. A workforce confidentially using digital health technologies to deliver health and care.
7. A thriving digital health industry delivering world-class innovation.
Please watch this short video that provides an overview of the Australian National Digital Health
Strategy.
AuDigital Health (2018, July 3) Launch of the National Digital Health Strategy and Framework for
Action 3 July 2018 [Video] YouTube
Australia’s National Digital Health Strategy for Nurses
Widespread national implementation of digital health records and a broader use of telehealth
allows strategic priorities
one and two to be achieved. The sharing of data with confidence,
priority
three, requires that healthcare professionals understand digital health the impact it can
have upon consumers of healthcare. Through comprehensive sharing of information and
utilisation of
My Health Record a more cohesive provision of care can be achieved. The use of
digital prescriptions and records within
My Health Record also creates better availability to
medication information, priority
four. Using medication knowledge from My Health Record allows
nurses and other healthcare workers to seek clarifications regarding allergies and medications
prior to administering treatment.
Please read about strategic priority number
five, pages 38-43 of the National Digital Health
Strategy (ADHA, 2017), that addresses models of care to improve accessibility, quality, safety
and efficiency. You will see a focus upon chronic health, which is a key area that requires
support and attention in Australia.
As nurses regulated by the Nursing and Midwifery Board of Australia you are required to adhere
to standards of practice and clinical expectations for the provision of safe person-centred care.
Integral to achieving this is a strong understanding of digital health, the role it plays in health care
and adapt with the future of a rapidly advancing digital healthcare sector. How will you as a
registered nurse ensure you are able to provide digitally safe care to those in your care? Please

read strategic priority six and seven pages 44-51 of the National Digital Health Strategy, to gain
an understanding of the future direction and expectations upon you.
Digital health has a bright future, and the reality is that current healthcare is in a state of digital
infancy. COVID-19 has led to a rapid implementation of telehealth and other digital forms of
communication that have now become the dominant tools for communication in healthcare and in
areas of everyday life. This can only lead to better health care provision to Australians and to a
more holistic and socially acceptable delivery of person-centred care.
The role of healthcare workers and providers is to provide support and to encourage consumers
to utilise digital products and solutions that will promote better health and wellbeing. In doing this
it is expected that healthcare professionals will support the options of digital technology and the
consumer in accessing these systems. Healthcare consumers are expected to engage with
digital products and online communities that lead to better health and wellbeing. If not confident
in digital technology all Australian’s are expected to seek support and contribute via community
avenues (Australian Digital Health Agency, 2018a).
Please read pages 79-82 of the Australian Digital Health Agency (2018a).
Framework for action
available to you at https://www.digitalhealth.gov.au/sites/default/files/2020-
11/Framework_for_Action.pdf
Nurses and midwives are the largest healthcare professional group in Australia. The National
Nursing and Midwifery Digital Health Capability Framework supports nurses to develop effective
skills in digital health, and the accompanied knowledge and behaviours that are expected of the
profession. The framework allows current nurses to evaluate their level of digital health capability
and to identify areas for professional development.
The digital framework addresses five (5) key digital health domains:
1. Digital Professionalism: the standard required to be maintained in a digital environment
2. Leadership and Advocacy: Digital health leadership and advocacy are supported by clear
policies.
3. Data and Information Quality: the data entered must be quality data.
4. Information-enabled care: care provided must be supported by rigorous data analysis with
critical appraisal.
5. Technology: needs to be understood and used appropriately.
Australian Digital Health Agency (2020) National Nursing and Midwifery Digital Health Capability Framework, p. 10
The framework outlines three (3) levels of capability and encourages all nurses to aspire to reach
the highest level of capability in their role and practice setting. The three capability levels are:

1. Formative level: for nurses beginning to use and understand digital health and the
implications for practice.
2. Intermediate level: for nurse’s who are developed increased knowledge, confidence and
skills with extended capability in the use of digital healthcare in their practice.
3. Proficient level: this level relates to nurses who are in leadership and who champion digital
health within both practice and the broader nursing profession.
It is expected that nursing students’ performance will fall between level one (1) and (2). (Fedele,
2020)
Australian Digital Health Agency (2020)
National_Nursing_and_Midwifery_Digital_Health_Capability_Framework_publication.pdf
Download the document and read about the five (5) domains and the requirements of each
domain. As a student nurse and a future registered nurse this knowledge is important as you will
continue to engage with digital technology and must be aware of the governing
requirements. You are not expected to memorise these details but be aware of the broader
principles and intentions and add this document to your professional library for later use.
Self-Assessment and Reflection Activity
With reference to the above resource, pages 22 – 33 conduct a self-analysis of your digital health
skills. Some of you may have experience working in healthcare and others’ experiences may be
limited to clinical placements. At this stage you are only expected to be formative at best. For
some areas you may feel that you need to undertake considerable work. Your analysis will
support your future learning in this area.
As a final activity, examine this model that summarises key dimensions of the framework. It
encompasses many facets of nursing and digital health and I am sure you will be able to identify
evidence form your placements of these domains in practice.

Australian Digital Health Agency (2020) National Nursing and Midwifery Digital Health Capability
Framework Framework domains and subdomains
https://www.digitalhealth.gov.au/sites/default/files/2020-
11/National_Nursing_and_Midwifery_Digital_Health_Capability_Framework_publication.pdf
cute and aged care is governed by national standards for service providers. All registered nurses
are required to understand these standards and to practice accordingly. Acute care is governed
by the National Safety and Quality Health Service (NSQHS) standards. Aged care is governed by
Aged Care Quality and Safety Commission. Within the respective standards resides the
management and use of digital health.
Clinical governance within organisations aims to ensure that systems are in place to maintain
and improve the reliability, safety and quality of health care. This is the overarching standard in
acute care and recognises the importance of leadership, governance, patient safety systems,
performance and the environment to the delivery of high-quality care.
Digital health is an aspect of patient safety and quality systems, which requires monitoring of
performance, investigation of incidences and conducting audits to ensure compliance with
expectations. As registered nurses you will engage with systems that record health care provided
and incidents that trigger reviews of processes and with healthcare as organisations work toward
adhering to national standards. All acute care health services are required to have a digital health
system that can connect / access My Health Record.
Aged Care Quality and Safety Commission
Standard Eight (8) of the Aged Care Quality Standards, requires that organisations have
governance to monitor information management and care provided along with programs that
create effective risk management of both systems and practices. This aged care standard
requires that all members of the workforce are provided with the appropriate level of access to
information that can assist them in their roles and that there are continuous improvement
systems in place. Digital health offers avenues in which this can be achieved.
Legal Aspects of Digital Health
Digital health records do not simply provide a site for healthcare providers to record care related
information. The information uploaded at a local level can be communicated through summaries
and through sharing of files to the
My Health Record digital program. All information loaded into
electronic healthcare systems creates an ability to easily generate data. Healthcare providers
can retrieve information to run reports and identify information about age ranges of presenting
individuals, the conditions that are most common, and through to much more complex analysis.
This information then allows healthcare providers to make resourcing and care planning
decisions. State and national governments are also able to access this information in a process
often referred to as
Data Mining. This data can be used to assist in the distribution of financial
support, and to monitor the performance of public hospitals, that are both federally and
state/territory funded.
The depth of information and the need to protect the privacy and confidentiality of Australian’s
requires that legislation be constructed in a manner that it can be used and adapted with the
advances in digital health technology. Digital health in Australia is Governed by Federal
Legislation. Each state and territory has legislation that reflect their independent needs and
requirements around the use of health information and the data that digital health generates.
There is no expectation that you have a broad understanding of the law and be able to explain it.
However, as a Registered Nurse you are required to have an understanding of the key laws that
are involved around digital health and their intended scope and protections.
Please take some time to read through the Legislation and Governance that relates to
My Health
Record
. In this section you will see links to the legislation (you are not expected to read these),
but you are expected to understand what the legislation briefly addresses (this is provided at the
page below).
Australian Digital Health Agency (n.d.) Legislation and governance
Secondary Data Legislation
As discussed above digital health records create an abundance of information which can be
utilised in other ways. This data is called
secondary data. Electronic health records support the
use of health information to provide clinical care and outcomes. This information can be used as
secondary data to evaluate the services provided and health outcomes. Through use of
secondary data hospitals or healthcare service providers with higher-than-normal poor outcomes
can be flagged and investigations can occur. This information can also be used to guide service
planning, policy development and guide research (Australian Government, 2018).
Within Medical Health Record legislation, that determines System Operators use of data, is the
ability to prepare and provide de-identified data for the purposes of research and public health
(Australian Government, 2018). This data became essential in the management of care during
the COVID-19 pandemic in 2020 in Victoria during the peak of their outbreak. Each hospital was
required to report on a daily basis the number of patients that were Positive to COVID-19 and
Suspected COVID-19, along with the number of non-COVID-19 inpatients. The daily data
allowed services to be supported with relevant PPE, movement of patients across health
services. State government was also able to report figures to the public creating transparency for
public health reasons.
4. Legal aspects of digital health
6. Registered nurse standards and codes of practice in digital health
Ethical Aspects of Digital Health
Ethics is founded on the principles of right and wrong, drawing from moral theory to
provide a framework for ethical decision making based upon a tetrad of principles. Most of
you will have studied ethics in your undergraduate degrees and you will be familiar with
Beauchamp and Childress (2009) ‘principle based ethics’: a model of ethical reasoning
commonly taught to health professionals, and used as a framework for ethical decision
making in health care. As a reminder, the four principles are:
· Autonomy- people should be able to make their own choices and decisions. (Autonomy
has implications for consent);
· Beneficence- care and the actions of health professionals should seek to create benefit;

· Non maleficence- the actions of health workers should avoid harming others;
· Justice-resources should be allocated fairly.
(Kerridge, et. al, 2013, p. 124)
The principles of autonomy, beneficence, non-maleficence and justice are all essential
elements that require consideration and application (Finn, 2018) in digital health.
· The principle of autonomy centres on the right of the individual to make decisions
about their own lives and informed consent. A means for achieving autonomy is consent.
Consent should not be considered as endless, where it can be obtained once and is not
required again. Consent is something that registered nurses deal with on a daily, hourly and
even minute by minute basis. Key to consent is the depth of information that is supplied and
the associated understanding of the patient / participant.
· The ethical principle of beneficence centres on wellness of patients / participants. The
goal of digital health is to not change the life of participants but where appropriate use the
technology to facilitate timely and informed care.
· Non-maleficence is core to ethical principles and focuses upon the minimisation of
harm. Harm while able to be minimised can never completely be avoided.
· The ethical principle of justice considers power relationships. This includes those from
vulnerable populations which have a right to be protected and not disempowered or
exploited.
(Finn,2018)
Reflection Activity:
Reflect for a moment on what you know to date about digital health. Considering the use of
digital health as a means to minimise harm and to facilitate better patient outcomes, how
will you as the nurse ensure that you achieve the above ethical principles with your
patients?
Ethics in Digital Health Care
The use of digital technology to record information, formulate a diagnosis and provide
person-centred care is rapidly increasing. The human aspect of healthcare must remain
using the core concepts of person-centred communication and assessment. Human values
should remain central and govern practice, research and the management of health
information. Digital health brings the same challenges and issues around appropriate and
inappropriate behaviour and the need to define what is right and wrong. Students and
practitioners of health have an obligation to explore the moral underpinnings and ethical
challenges related to their practice. The ethical matters of digital health are relatively new
and therefore an evolving area (Goodman & Miller, 2006).
Informatics is now a source of many ethical debates in healthcare, and in the general public
with an increasing awareness and concern around how personal information is saved and
used. While confidentiality and privacy are key areas, the field is rich with other ethical
issues including the appropriate selection and use of informatic tools in clinical settings.

Questions surround who should use the tools, the role of evaluation, the obligation of the
developers and implementors of systems and the use of computers to track clinical
outcomes that is then used for future practice decision making (Goodman & Miller,
2006). Supporting the use of health informatics is a Code of Ethics, which guides the
implementation of electronic health records, health informatic programs and health
informatic research and decision making.
Read the following article that cautions the use of digital technology could result in the loss
of the individual and person.
Milton, Constance L. (2015). Ethics and the Digital Age of Discovery. Nursing Science
Quarterly, 28(4), 272–273. https://doi.org/10.1177/0894318415599225
The next reading explores the digital landscape in the United States and while their
healthcare system is funded differently, they practice westernised medicine and thus the
commonality to Australia exists. Please read the article by Lee (2017) that explores the
ethics and subsequent use of health record data.
Lee, Lisa M. (2017). Ethics and subsequent use of electronic health record data. Journal of
Biomedical Informatics, 71, 143–146. https://doi.org/10.1016/j.jbi.2017.05.022
5. Ethical aspects of digital health
Conclusion
Registered Nurse Code of Ethics and Standards for Practice
In Australia the Registered Nurse standards of practice are governed by the Nursing and
Midwifery Board of Australia. Registered Nurses in Australia are required to practice as per
the 2016 Registered Nurse Standards for Practice (Nursing and Midwifery Board of
Australia, 2016). To achieve safe and effective person-centred care the registered nurse is
required to use evidence and therapeutic and professional relationships with individuals,
their families and groups. Nurses are required to work with individuals with a range of
altered health including physical and mental illness (Nursing and Midwifery Board of
Australia, 2016).
The Standards are included below to refresh your memory.
The above image was taken from Page 3 of the Nursing and Midwifery Council of Australia
(2016)
Registered nurses standards for practice
https://www.nursingmidwiferyboard.gov.au/documents/default.aspx?record=WD16%2f19
524&dbid=AP&chksum=R5Pkrn8yVpb9bJvtpTRe8w%3d%3d

Code of Ethics for Nurses
Registered nurses in Australia are required to practice in accordance with the International
Council of Nurses Code of Ethics for Nurses. Inherent in nursing is respect for human rights.
This includes cultural rights, the right to life, the right to choose, to right to dignity and the
right to be treatment with respect. The International Council of Nurses Code of Ethics has
Four (4) elements that guide the standards of ethical conduct.
1. Nurses and People
2. Nurses and Practice
3. Nurses and the Profession
4. Nurses and co-workers
Please read the International Council of Nurses (2012) Code of Ethics and pay particular
attention to p.p-6-9. As you read through these sections consider which of these relate to
digital health.
https://www.icn.ch/sites/default/files/inlinefiles/2012_ICN_Codeofethicsfornurses_%20eng.pdf
in this module you have encountered a range of regulatory, professional and practice
standards in relation to digital health. It is important that you are aware of these standards,
their purpose and relevance to your work. There is no need to memorise these documents
but I suggest you add them to your professional library for future reference. It is also
important that you acknowledge that digital health is very much integrated with nursing
practice, that is, it is not a separate function but is an area of practice that is present across
the range of nursing practice areas.
REFERENCES
Australian Digital Health Agency (2020)
National_Nursing_and_Midwifery_Digital_Health_Capability_Framework_publication.pdf
Australian Digital Health Agency (2020) National Nursing and Midwifery Digital Health
Capability Framework Framework domains and subdomain

Milton, Constance L. (2015). Ethics and the Digital Age of Discovery. Nursing Science
Quarterly, 28(4), 272–273. https://doi.org/10.1177/0894318415599225
Lee, Lisa M. (2017). Ethics and subsequent use of electronic health record data. Journal of
Biomedical Informatics, 71,
143–146. https://doi.org/10.1016/j.jbi.2017.05.022