Fixing the Digital Health Record’s unreliable data has been a focus of the ACT Government since the system’s rollout in 2022. Photo: Region.
Services for people with dementia can’t be effectively monitored to make sure they’re meeting the needs of the community because of “reporting constraints” in the Digital Health Record.
The ACT Auditor-General identified the issue as part of the office’s audit report into specialist assessment services for dementia and cognitive decline.
It examined the General Geriatric Clinic (GGC), Memory Assessment Service (MAS) and the Rapid Assessment of the Deteriorating Aged at Risk (RADAR) service.
Before DHR commenced, Canberra Health Services (CHS) used the ACT Patient Administration System to manage central patient information, giving outpatient services access to data and reporting capabilities for services such as referral data, workload, client hours and hospital readmission data. This could then be used to indicate service performance.
But reporting constraints, primarily due to “inconsistencies” in how services could record information in DHR, meant trends, issues, discrepancies, gaps and the cause of variances weren’t routinely identified and reported on.
“This means that the GGC, MAS and RADAR services are unable to monitor performance data relating to referral rates, wait times or staff workload and are unable to effectively monitor and report on performance to assess whether services are meeting the needs of the community or identify mitigation strategies to rectify performance issues,” the report stated.
DHR allows users to enter clinical information on an as-requested basis with no mandatory fields.
The report found this presented a challenge for nursing, specialist and allied health staff as accessing client information could require them to “navigate a multitude of fields”.
RADAR staff had been asking for 18 months for DHR’s reporting functionality to be improved, but “this had not been forthcoming”.
“The former ACT Health Directorate paused the development of tailored reports for outpatient services to focus on the implementation of a Data Remediation and Reporting Program that was established in August 2023,” the report noted.
It found CHS has a “poor understanding” of the timeliness of its assessment and diagnosis services and has been unable to report on wait times between referral and initial appointments due to DHR limitations.
The report noted that CHS used to collect data on the timeliness of assessments and diagnoses, including wait time data, but this was no longer possible.
“CHS advised that, since the implementation of the DHR, the accuracy of data is unverifiable and therefore unreliable,” it stated.
“Not having accurate data on the timelines of the delivery of services, including wait times, has implications for service planning and service delivery.
“The GGC, MAS and RADAR service are unable to effectively monitor performance data relating to referral rates and sources, wait times or staff workload and are unable to effectively monitor and report on performance.”
Wait times between initial and feedback appointments with the services are benchmarked at within four weeks, but the audit could not determine the wait time due to unreliable DHR data.
Issues with DHR data have been long documented, with Health Minister Rachel Stephen-Smith stating in 2023 that the entire project team, and herself, had been aware there would be issues with data reporting before the DHR went live.
Her office was contacted for comment on this story, but did not respond before deadline.
The Auditor-General also concluded that the planning for delivery of services from the GGC, MAS and RADAR service could be improved and that CHS has a “limited understanding” of referral patterns to the services, and doesn’t actively monitor or report on referral sources.
The GGC and MAS do not have models of care (the RADAR service does), and outpatient referral acceptance guidelines haven’t been created for any of the three services. None of the services accept self-referrals, even though this would “align with a person-centred approach”.
Several issues were identified that could impact how quickly a person could receive advice or treatment, which could help them delay or avoid developing dementia.
These included that some clinicians were receiving incomplete referrals and client questionnaires, key information could be omitted from external referrals (such as family history and investigatory results), a lack of referral prioritisation guidelines for GGC and MAS, and record-keeping inconsistencies.
In the report, CHS noted the audit had compared its practices against 2021 guidelines developed by the Australian Dementia Network, which the service didn’t follow.
“While these guidelines are respected and provide an aspirational model for multidisciplinary clinics, they have not been adopted or implemented by CHS and do not reflect the design or intent of the current operating model of the three services,” it stated.
“CHS is committed to considering the recommendations from the audit.”
According to the Australian Institute of Health and Welfare, as of 2025, an estimated 6100 people were living with a form of dementia in the ACT, including about 430 people living with younger-onset dementia.
