1267 What impact do ACP legislative frameworks have on digital health system reforms in Australia?

<h3>Background</h3> Digital health systems are a key enabler of access to advance care planning (ACP) documents at the point of care. This impacts on ACP documents being used as intended, to ensure that a person’s wishes and preferences inform decisions about their health care if they are unable to make or communicate decisions for themselves. The current digital health infrastructure in Australia has significant limitations in providing access to ACP documents, including a lack of standardised approach, and lack of connectivity between systems in different settings and locations. Efforts to improve the utility of digital health systems for ACP documents are impacted not only by technological challenges but also by existing ACP legislative frameworks, which differ across the states and territories. <h3>Aim</h3> This paper explores current ACP legislative frameworks and their impact on development and enhancement of digital health systems for ACP documents. <h3>Methods</h3> A document analysis was used to review legislation governing ACP document creation and substitute decision-maker appointments across Australia. The content, scope, and formal process requirements were compared. The impacts of these frameworks for development of digital systems for ACP were identified, including in relation to: data and system standards, interoperability of systems, and digitisation of information. <h3>Results</h3> Findings highlight the complexity of ACP legislative requirements, and significant disparities between jurisdictions, including in relation to: witnessing and documentation requirements, scope, and enacting documents. Storage repositories (digital or otherwise), and access arrangements also differ markedly between jurisdictions. Legislative requirements such as wet-ink signatures limit the ability to digitise ACP forms. Other impacts include barriers to the development of digital information system standards for ACP information, and to development of interoperability to share information between systems. <h3>Conclusions and Implications</h3> This analysis highlights multiple systemic limitations impacting ACP document utility across diverse clinical contexts. Improving national digital health infrastructure to better enable utilisation of ACP documents will require addressing not only technological and resourcing challenges but also addressing the legislative issues identified in this analysis. Highlighting these complexities and their impacts can also provide impetus for legislative reform to simplify and harmonise requirements for ACP documents. <h3>Unique Contributions</h3> This work explains how digital health reform agenda, including intended health systems improvements, are made more complicated by the complex ACP legislative landscape. This analysis assists in identifying the systemic barriers that need to be addressed to realise improvements in digital health systems for ACP documents.