Review article
A meta-synthesis of competency standards suggest allied health are not preparing for a digital health future

https://doi.org/10.1016/j.ijmedinf.2020.104296Get rights and content

Abstract

Objective

This study reviewed the competency and threshold standards for allied health professionals to identify the inclusion of digital health competencies.

Materials and methods

A nine-stage, sequential meta-synthesis of professional standards was undertaken. Statements relevant to digital health were extracted, categorised by discipline, and coded to the level in the standards, skills or knowledge and level of learning.

Results

Eighteen standards were analysed. Of these, fourteen standards contained a total of thirty-five statements related to digital health in the themes of data governance and technologies, but not data translation. Only four disciplines included more than two statements related to digital health.

Discussion

The study highlighted four key gaps in the Standards. Statements in competency and threshold standards for allied health professionals lack reference to digital health, with predominantly information management statements. The statements are ambiguously worded, and could be interpreted to only refer to paper records management, and when there is a reference to digital health, it is more likely to be a skill as opposed to knowledge, typically at the indicator or cue level, and largely a lower level of learning (Bloom’s). The lack of digital health in standards may result in limited instruction in already full tertiary education curriculum.

Conclusion

Digital health represents a major gap in competency statements for all allied health disciplines, signifying the need for a national approach to developing quality and specific digital health competencies, to support allied health graduates being prepared to work in the digital health age.

Introduction

Significant changes have occurred in Australia to move toward national primary healthcare policy and the creation of multi-disciplinary community-based health services to take action on the social determinants of health [1]. These reforms began twenty years ago when it was first identified that healthcare systems would require profound changes to ensure care that is safe, effective, timely, efficient, and equitable [2]. The reforms drove changes in higher education and tertiary institutions started preparing health professionals to deliver safe client-centred care as members of interdisciplinary teams, with an emphasis on evidence-based practice and quality improvement approaches [3], including digital health. Australian health services remain too complex to navigate [5] and with widespread usage, digital health is expected to deliver significant healthcare system and population health benefits [5]. Advocacy for the need to prepare allied health professionals for digital health practice dates back to 2011 as part of the Australian Government Department of Health’s eHealth readiness of Australia’s allied health sector [6]. Since this time, there has been more targeted discussion and action on digital health [7]. Australia’s new National Digital Health Strategy [8] articulates the importance and contribution of digital health to health system change. Strategies 5 and 6 of the National Digital Health Strategy specifically relevant for allied health professionals, ‘digital-enabled models of care that improve accessibility, quality, safety and efficiency (fifth) and ‘a workforce confidently using digital health technologies to deliver health and care’(sixth). Advancement of the allied health workforce in the face of digital health is the key pillar of strategic priority that underpins this study [9]. These discussions and policy actions are largely buoyed by the rapid speed of global digitalisation, and the focus on the innovative uses of data and digital health systems for driving and enacting health system and service reform [4]. Situating these discussions within the context of preparing graduates for practising within this digitised future was the impetus for this study. The focus was to identify the level of digital health capabilities in allied health professional standards in Australia and consider whether they are sufficient for building capability in the development of digital health competencies.

Allied health is an umbrella term used to refer to a diverse range of health disciplines who are not nursing or medical practitioners. Allied health professionals have a diverse range of technical skills, discipline knowledge and professional practises. They comprise nationally registered professions (under the National Registration and Accreditation Scheme) as well as non-registered or self-regulated allied health professions [10]. All allied health professionals are autonomous members of the health care team who are responsible for providing safe, high-quality services to clients and their families across a diverse range of sectors, contexts and settings. Each allied health discipline has their own approach to credentialing, scope of practice, and capability frameworks that set out the competencies and practice threshold standards required for particular work functions, processes, roles and professional outcomes [10]. Herein referred to as the Standards, these frameworks serve a number of functions and used as the benchmarks for learning, assessment, and the formal recognition of achievement in entry-to-practice programs. Therefore, they play a critical role in establishing expectations in the design and implementation of education that focuses on the desired digital health performance characteristics of allied health professionals.

The National Digital Health Strategy [8] reports that the majority of Australians are digitally connected, evidenced through several national and regional digital health innovations, such as the My Health Record, Digital Health Cyber Security Centre, and telehealth. There has been significant state and territory investment in digital health leading to electronic health records, secure messaging, discharge summary, and e-referral capabilities Healthcare consumers indicate they not only want to be able to access digital health services, but expect healthcare providers to make greater use of digital health tools and services in their work. Increased use of digital health will lead to greater interoperability through programs of work to update clinical information systems, data governance and management, and the better utilisation of clinical data. If this can be achieved, Australia will move closer to the evolution of a safe, seamless and secure health system that can meet the needs of modern Australia. For this to occur, the health care workforce must develop and maintain digital health capabilities, as visioned in the Australian Digital Health Agency’s strategic priorities “A workforce confidentially using digital health technologies to deliver health and care” [8]

Digital health competency standards to date can be grouped as either: 1) Digital health for all health professionals, such as Australasian Health informatics Education Council [11] or the framework proposed by Brunner et al; [12] 2) Digital health for medical practitioners, such as the CanMEDS [13] or Academy of Medical Royal Colleges (AMRC) [14]; 3) Digital health for nurses, such as TIGER [15]; or 4) Digital health specialists, such as International Medical Informatics Association (IMIA) [16], International Federation of Health Information Management Associations (IFHIMA) [17], Certified Health Informatician Australasian (CHIA) [18], Health Information Management Association of Australia (HIMAA) [19], Digital Health Canada [20], American Medical Informatics Association (AMIA) [21] and American Health Information Management Association (AHIMA) [22], and others. Whilst most digital health specialist competency statements are relatively current, the majority of competency statements for health professionals or specific clinical areas are not. As such, there is a lack of contemporary evidence that professional bodies can draw on when updating their own competency standards.

Many health professional graduates are not adequately trained in digital health, in part due to the lack of digital health competencies within professional standards [23]. Recently, Edirippulige et al. [24] presented evidence from interviews with medical practitioners, and concluded that without the inclusion of digital health competencies in professional standards, it is unlikely that curriculum will change. With many Australian health professional standards approaching or undergoing review, incorporation of digital health competencies is essential. For example, the new Australian Registered Nurse standards for practice [25] includes several references to digital health competencies. However, the lack of a specific digital health competency framework for allied health professionals means there is no best practice starting point. Further, it is not known how digital health is already incorporated in existing professional standards for allied health professions. To this end, we reviewed Standards for allied health professionals in Australia to identify strengths and areas for improvements where competency and threshold standards could better support educational processes and preparation of digital health work ready allied health graduates.

Section snippets

Materials and methods

The study used a sequential meta-synthesis approach, with the results from each step informing the design of the subsequent steps.

Results

Overall, references to digital health was limited across the eighteen allied health Standards. There were 111 statements that could be clearly identified as relating to information management/technology, of which only 35 were specifically related to digital health. These statements were classified by discipline and statement type (Table 3). No statements could be identified in the Clinical Psychology standards, and no digital health statements could be identified within the Exercise Physiology,

Discussion

This meta-synthesis and analysis of the allied health competency standards to identify the inclusion of digital health competencies demonstrates a distinct lack of digital health capabilities in current professional standards. The study highlighted four key gaps in the Standards denoted by: 1) lacking reference to digital health; 2) predominantly relating to information management; 3) ambiguously worded; and 4) addressing low level requirements (not higher level learning).

The first gap

Conclusion

This study demonstrated there is a lack of competency and threshold standards for Australian allied health professionals in relation to digital health. Further, there is limited consistency across the allied health disciplines, statements were ambiguous, they largely related to information management as opposed to technology or systems, and are typically low levels of learning behaviour and importance. Without quality, clear and specific digital health standards, it is unlikely that current

Funding and ethics

This study was an unfunded project that did not require ethical approval as data was not collected from humans, only from historical documents.

Summary Table

What was already known on the topic

  • Health professional graduates are not adequately trained in digital health, in part due to the lack of digital health competencies within professional standards.

  • Whilst allied health professionals today need to be digitally capable, there is no existing digital health competency framework for allied health.

CRediT authorship contribution statement

K. Butler-Henderson: Conceptualization, Data curation, Formal analysis, Methodology, Project administration, Software, Writing - original draft, Writing - review & editing. L. Dalton: Conceptualization, Data curation, Formal analysis, Methodology, Software, Validation, Writing - original draft, Writing - review & editing. Y. Probst: Data curation, Formal analysis, Writing - review & editing. K. Maunder: Data curation, Formal analysis, Writing - review & editing. M. Merolli: Data curation,

Declaration of Competing Interest

The authors report no declarations of interest.

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