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Australia is making a significant push to move hospitals from unsecure communication methods like fax and email to encrypted, standards-based digital communication. Led by the Australian Digital Health Agency (ADHA), the National Digital Health Strategy 2023–2028 prioritises secure messaging to address security risks, reduce clinical errors, and prevent administrative waste.
The ADHA views secure messaging not just as a convenience, but as the backbone of a connected health system. Some reasons why they have made secure messaging a mandatory focus for hospitals include:
Eliminating “Clinical Blind Spots”
The primary clinical driver is interoperability. When a hospital uses secure messaging (instead of a fax or a letter), the data arrives as a “structured” file. The information automatically integrates into the GP’s local software, so a doctor can instantly see a patient’s discharge medications or pathology trends. This system closes the loop by providing delivery receipts to confirm the message was actually received.
Patient Safety and Privacy
Research in Australia consistently highlights that communication failure is a primary factor in preventable medical errors. One of the most significant Australian research initiatives led by Professor Diana Slade at the Australian National University (ANU) found that communication is a factor in nearly all avoidable incidents. It’s estimated that over 90 per cent of avoidable critical incidents in Australian hospitals have a communication failure component.
A foundational study by the Quality in Australian Health Care Study (QAHCS), is a benchmark for the ADHA’s safety strategies. It identified communication error as a lead factor in adverse events (incidents that result in harm). Specifically, it found that 10–15 per cent of hospital admissions were associated with an adverse event. The ADHA notes that “closing the loop” via secure messaging is the most effective way to mitigate the 70-80 per cent of these errors that occur during handovers. Digital messaging ensures the “source of truth” remains intact and isn’t lost in transcription.
Economic and Workflow Efficiency
The ADHA’s economic analysis estimated that widespread secure messaging could provide a gross economic benefit of $9 billion over 10 years. Hospital staff spend thousands of hours chasing lost faxes or clarifying illegible handwriting. Moving away from paper, printing, and physical postage saves hospitals millions in operational overhead.
A Paperless and Fax-Free Health System
The ADHA is currently implementing the National Secure Messaging Network (NSMN) to ensure that every hospital in Australia—regardless of whether they use private or public software—can communicate seamlessly with any GP or specialist in the country. This is part of the broader Share by Defaultstrategy, where a patient’s story follows them digitally, no matter where they are treated.
The ADHA is mandating specific digital behaviours through the National Digital Health Strategy 2023–2028 to phase out legacy systems. The Sharing by Default mandate has a March 2026 deadline and is the most significant milestone currently in play. Because these updates require a modern digital handshake, hospitals that previously relied on faxing must upgrade their integration middleware to meet the deadline.
One of the biggest drivers of faxing in hospitals was image-based prescribing (faxing a photo of a script to a pharmacy). This was an emergency COVID-era measure that the ADHA and the Department of Health has now permanently ended.
Hospitals must now use electronic prescriptions sent via secure clinical pathways. If a hospital hasn’t upgraded to these secure channels, it simply cannot legally send a digital prescription.
All state and territory governments have signed an Intergovernmental Agreement (IGA) stating that any new hospital software or clinical systems purchased must meet the ADHA’s Secure Messaging Industry Standards. This means that as hospitals refresh their IT contracts, they are legally unable to buy systems that don’t support secure messaging.
While not a hard legal deadline for all types of communication, 2028 is the target set in the National Digital Health Strategy Roadmap to achieve a “fully interoperable” health system. The ADHA is currently working with the Royal Australian College of General Practitioners (RACGP) to certify that every “GP-to-Hospital” referral pathway is secure, effectively making the fax machine a violation of best-practice clinical governance.
Upgrade Challenges
Upgrading to secure messaging is a massive undertaking for Australian hospitals. While the technology itself is ready, the “readying” process involves overcoming significant technical, human, and financial hurdles.
Currently, hospitals are facing these five primary challenges:
1. The Fragmentation Barrier (Interoperability)
The biggest technical challenge is that Australia’s secure messaging market is split across multiple providers, and in the past, they didn’t always talk to each other, making communication a struggle. Hospitals are currently having to invest in “federated” directories or middleware that can bridge these gaps, which is a complex and expensive IT task.
2. Integration with Legacy EMRs
Many hospitals use Electronic Medical Record (EMR) systems that are 10–15 years old. However, secure messaging is most effective when integrated into these systems, but that isn’t supported by older systems that often treat secure messages as attachments or emails that still require manual filing. Upgrading these EMRs to meet modern standards, such as HL7 FHIR (Health Level Seven Fast Healthcare Interoperability Resources), is a costly project that can take years to implement.
3. Clinical Workflow and Alert Fatigue
Moving from a fax machine to instant secure messaging changes how doctors work. Clinicians are already overwhelmed with data. Replacing one fax with dozens of instant notifications can lead to alert fatigue, in which important clinical information is missed amid too much noise.
There is resistance to secure messaging on mobile devices in some hospitals because it blurs the line between “on-duty” and “off-duty,” raising concerns about doctor burnout.
[Related White Paper: Should Your Hospital Invest in a Secure Messaging App?]
4. Bring Your Own Device (BYOD) Concerns
Many Australian doctors prefer using their own smartphones rather than carrying hospital-issued pagers. This poses security risks if a doctor uses their own phone; the hospital must ensure that sensitive patient data isn’t stored in the phone’s camera roll or in cloud backups.
5. High Implementation Costs for Regional Hospitals
While major metro hospitals in Sydney or Melbourne have large IT budgets, smaller regional and private facilities face a digital divide. Fees include software licensing, setup costs for NASH PKI certificates (digital “passports” for health data), and ongoing staff training.
Connectivity remains a challenge for some rural clinics that don’t have a stable, high-speed internet connection.
Help from Secure Messaging Vendors
Vendors don’t just provide software; they act as clinical consultants. Secure messaging vendors can provide the infrastructure and support services necessary to meet the ADHA requirements by bridging interoperability gaps and standardising data using HL7 FHIR. By providing middleware solutions, vendors provide a “translation” layer that takes raw data from a hospital’s old EMR and packages it into the FHIR-compliant format required by the ADHA. Vendors also ensure that all data is encrypted both at rest and in transit, guaranteeing that hospitals remain compliant with the Privacy Act 1988.
Vendor software provides hospitals with audit trails and delivery receipts. This enables hospital administrators to prove they are meeting the 2026 mandates by showing exactly what percentage of their correspondence is now digital.
Some vendors have decades of experience partnering with health organisations and can help hospitals redesign their communication workflows and establish automatic processes to save staff time and improve patient flows.
This year, Amtelco is celebrating 50 years in the communications industry and the 15th anniversary of its Amtelco Secure Messages app. The app was specifically designed for the healthcare industry to address the specific needs and challenges experienced by hospitals and clinics. If you have questions about secure messaging for your hospital, please don’t hesitate to contact Nick Evans at +61 2 5017 9925 or nevans@amtelco.com.
