1. Introduction

As more health data is being generated, by individuals and organisations, information enabled care (IEC) provides a collective term for the evidenced-based actions and behaviours required by healthcare providers when encountering and using health and social care technologies. For example, telecare, health, and medicine, assistive technologies, mobile health, and wearables. The National Nursing and Midwifery Digital Health Capability Framework (NNMDHCF) ^[1] categorises IEC as data sharing, information creation and use, and extending practice . The domain sub-headings - data sharing, information creation and use, and extending practice provide the opportunity for greater definition context and clarity as demonstrated in the figure below^[1].

Date sharing discusses the ability to share the same data resource across multiple applications or users. The sharing of data and needs developed critical thinking skills to integrate, evaluate and communicate the benefits and drawbacks of openly providing data ^[2] .

Information creation first requires understanding the reason and process of creation (why, what, where, when, and how?) as well as the final product. The capability to critically evaluate the usefulness of the information is part of the process of creation ^[3].

Use and extending practice is reliant on the ability to search, find and disseminate information online. By building on foundational health and social care competencies and capabilities, and linkage to the domains of Digital Professionalism, Leadership and Advocacy, and Data Information and Quality ^[1], extends practice and deepens knowledge. Demonstrating innovation in how to apply these concepts to planning and implementation in practice provides focus on extending healthcare practice whilst using health data and technologies, ultimately assisting in building digital healthcare capability and developing personal strategies ^[4] .

2. Development of Information Enabled Care Internationally

Some of the earliest collections of healthcare records describing recipients of care ailments, questions, and management date from 1596 to 1634 ^[5] . In the 1920s healthcare, medical practitioners specifically, decided the best way to advance diagnoses and treatment was to document their management, sharing their information with interested others. In 1928 the American College of Surgeons established the American Health Information Management Association, and between 1920 and 1960 medical records and complete record-keeping became standardised – as paper records ^[6]. During the 1960s, computers offered the opportunity to record and store medical records. However, due to high costs, data entry errors, poor initial physicians’ acceptance, and lack of any real incentive , failed to add value to recipients at the point of care. Once it became sophisticated enough to manage data and provide information, digital health and technologies (or health informatics as it was known) developed as a specialty. In 1965 the digital health evolution and the requirement for standardisation of medical records encouraged the development of systemised nomenclature of medicine (SNOMED), the original terminology being systemised nomenclature of pathology (SNOP). Through numerous iterations, this coding system is now commonly referred to as SNOMED CT (clinical terminology) ^[7].

In the 1970s, the advancement of computers and software design across health and social care was prolific. Yet, functionality remained siloed and department/speciality specific. Independent sub-systems within systems persisted until the integration of systems or problem-orientated medical information systems were implemented in 1971 ^[8][9]. In the 1980s, the use of personal computers, health and social care related software programs became widespread. Again, hospitals and communities still could not access or share information outside of their siloes and disparate systems evolved ^[10]. During the 1990s the United States of America (USA) introduced the master patient index (MPI) . Healthcare professionals now had the potential to access health information across the continuum of care.

In the 2000’s the importance of integrated electronic health records (EHR) was realised, enabling healthcare providers in their decision making and care provision, reducing duplication of effort and medication errors ^[11]. The functionality of electronic medical records (EMR) improved and, in the USA, by 2015 - 96% of hospitals ^[12] and 87% of medical practices were engaging with an EMR or electronic health record (EHR) ^[13]. In 2010, quality, safety, accessibility, and improved healthcare outcomes, in preference to a cost-based model of care, were alleged to drive the growth in the need for data to inform knowledge ^[14] . Taken from a keynote speech delivered by Jean-Claude Healy at the Medical Informatics Europe conference 2005 “medicine will change in the next twenty years more than it has changed in the last two hundred years!” and e-health will bring an important contribution to this change ^[15]. Clinicians accept and understand the importance and need for complete health records (data) to inform decision making processes and enhancement of care. However, there remains a gap between the reliable aggregation of data, towards information and knowledge, across health and social care systems that can now be augmented. This can be achieved by ensuring IEC is supported by appropriate capability and evaluation frameworks, which evaluate and optimise technology use by explicating the relationships between users, tasks, technology, and the environment in which they operate ^[16].

3. Development of Information Enabled Care across Australia

In the 1990s, Australia recognised Digital Health, as a potential opportunity to overcome the ‘tyranny of distance’ for healthcare consumers and professionals alike ^[17]. Across Australia, to ensure IEC or evidenced-based actions and behaviours, individual or organisational capability assessments are championed as effective in the generation of national and local digital roadmaps ^[18]. Utilising digital health technologies is using data safely to work for healthcare consumers and the professionals who care for them. Capability assessments can assist the individual and organisations in understanding their state of readiness to participate with digital healthcare and technologies ^[19] . Readiness can be achieved by assessing individual understanding of their current digital health knowledge and skills and provide a pathway to further their professional development; organisational capability and information systems compatibility to safely and effectively communicate within and across organisations ^[20]. Through the development of evidence-based actions and behaviours, and by responding to findings of capability frameworks, such as the NNMDHCF ^[1], Australian health and social care systems will be better equipped to provide a human-centred service to meet local needs within a national framework.

4. Formation of Information Enabled Care

IEC requires recognition of the knowledge and skills required to deliver health and social care. Advocating for IEC to augment appropriate actions and behaviours is required by health and social care professionals. In summary, IEC requires health and social care professionals to develop capabilities to:

• understand how health information technology systems are used in practice, and the factors that influence adoption, and the impact of digital health systems on practice;
• identify organisational influences that lead to improved quality and safety outcomes following implementation of digital health systems;
• determine how health and social care user-reported data can be captured and used to support clinical decision making, which is aligned with individual preferences; and
• use IEC as digital interventions that will facilitate equitable engagement of individuals in their health and social care planning within hospital, community, and long-term care settings. Thus, maximising self-management, wellness, and independence at home ^[21]

5. Transitioning

Successful transition to IEC should be regarded as a complex and incremental process. As with all health and social care delivery, the development of capability in digital health technologies, evidence-based actions, and behaviours takes time and effort. There is a necessity to assist health and social care professionals achieve IEC. This change requires

• a continuation toward shared decision making, between health and social care providers users;
• improved access to and use of information and computing technologies that allow for increased synchronous and asynchronous communication, resulting in increased communication between health and social care providers and recipients of care;
• greater emphasis placed on IEC methods for digital communication between health and social care users, providers, and organisations;
• understanding and developing evidence-based behaviours and information resources that encourage a collaborative approach toward digital information exchange, necessary to allow for individuals, families, significant others, advocates, or other stakeholders to participate more fully in information seeking whilst enabling care coordination; and
• accepting IEC as integral to reducing disparities in accessing and using health information through digital technologies and online resources ^[22].

6. Conclusion

Digital health technologies provide a foundation for informing the quality and safety of health and social care whilst having the potential for increasing value. Decisions made to improve recipient care must be accompanied by well-researched return on investment strategies. A thorough understanding of IEC, which engages all stakeholders in access to evidence-based health information is essential, particularly for healthcare organisations, provider groups, or other public health agencies that market materials or resources for public health, health promotion, and maintenance of well-being.