This paper is in the following e-collection/theme issue:

Viewpoints (45) mHealth in the Developing World/LMICs, Underserved Communities, and for Global Health (717) Equity and Digital Divide (370) Digital Health, Telehealth and e-Innovation in Clinical Settings (556) Health Services in Resource-Poor Settings and LMICs (541) Shared Electronic Health Records and Health Information Systems (93)

Published on in Vol 14 (2025)

Preprints (earlier versions) of this paper are available at https://preprints.jmir.org/preprint/67460, first published .
Digital Health for Australia: Bridging the Rural, Regional, and Remote Health Gap

Digital Health for Australia: Bridging the Rural, Regional, and Remote Health Gap

Digital Health for Australia: Bridging the Rural, Regional, and Remote Health Gap

Authors of this article:

Shakeel Mahmood1 Author Orcid Image ;   M Mamun Huda1 Author Orcid Image ;   Kedir Yimam Ahmed1 Author Orcid Image ;   Thapa Subash1 Author Orcid Image ;   Feleke Hailemichael Astawesegn1 Author Orcid Image ;   Anayochukwu Edward Anyasodor1 Author Orcid Image ;   Mohammad Ali Moni1 Author Orcid Image ;   Muhammad J A Shiddiky1 Author Orcid Image ;   Utpal K Mondal1 Author Orcid Image ;   Setognal Birara Aychiluhm1 Author Orcid Image ;   Santosh Giri1 Author Orcid Image ;   Allen Ross1 Author Orcid Image
Article Authors Cited by Tweetations Metrics

    Viewpoint

    Rural Health Research Institute, Charles Sturt University, Orange, Australia

    Corresponding Author:

    Shakeel Mahmood, PhD

    Rural Health Research Institute

    Charles Sturt University

    346 Leeds Parade

    Orange, 2800

    Australia

    Phone: 61 0416689348

    Email: shmahmood@csu.edu.au


    In rural Australia, recent trends reveal an exponential increase in the rates of physical inactivity, central obesity, metabolic syndrome, and cancer in the population. The limited rural health workforce, which is struggling to meet this growing burden, is boosted by digital technologies such as My Health Record, Cardihab, Healthdirect, and MindSpot, all of which offer opportunities for improved diagnostics, monitoring, and management of chronic diseases. However, implementing proven digital health technologies in rural communities has been challenging on numerous fronts. This perspective aims to (1) highlight the rural health gap and propose a way forward in implementing evidence-based digital health technologies in the rural, regional, and remote communities of Australia and (2) guide future rural health policy.

    Interact J Med Res 2025;14:e67460

    doi:10.2196/67460

    Keywords

    rural health inequities; digital health adoption; telehealth services; chronic disease management; socioeconomic disadvantage; health workforce; shortages digital literacy gaps; equitable access to care 


    Approximately 7 million Australians (28%) and 260,000 (32%) First Nations peoples live in rural, regional, and remote (RRR) areas [1,2] (Figure 1 [3]). These regions encompass more than 1700 small towns with populations under 10,000 people [2]. The leading causes of the rural burden of disease are central obesity, type 2 diabetes, coronary heart disease, suicide and self-harm, chronic obstructive pulmonary disease, and lung cancer [4]. Cardiovascular disease is a significant health problem in RRR regions in Australia, where prevalence rates are approximately 20% to 30% higher than in urban areas [4]. Other significant health challenges across RRR communities include chronic kidney disease and dementia and other mental health disorders [5]. As a result, individuals residing in RRR regions experience an age-adjusted mortality rate that is 2.3 times higher than that of those living in major cities [6]. This viewpoint aims to guide policymakers on how to leverage digital health, using global evidence and strategies, to reduce RRR region health inequities.

    Several social determinants of health contribute to health disparities in RRR areas, including chronic unemployment, lower educational attainment, historical social injustices, and limited access to fresh fruit and vegetables [7]. For instance, the year 12 completion rate is the lowest in very remote areas compared with that of major cities (55.5% vs 79.4%) [1,8]. Similarly, the median weekly income declines with remoteness, from AUD $1915.2 (the conversion rate at the time of the study was AUD $1=US $0.65) in major cities to AUD $1362.7 in very remote areas [1,8]. The availability of health care professionals also varies substantially, with very remote areas having approximately 205 full-time equivalent doctors per 100,000 people, compared with 427 full-time equivalent doctors per 100,000 in major cities (Table 1) [1,8]. Medicare data from 2022 to 2023 show that general practitioner (GP) visits were lowest in remote and very remote communities, while hospitalization rates (eg, for end-stage renal disease) were almost twice as high in very remote areas and 1.3 times higher in remote areas, with no improvement since 2013 to 2014 [9].

    ‎
    Figure 1. Australian map by remoteness. Adapted from [3].
    Table 1. Sociodemographic and health workforce profile of Australia by remoteness [1,8].
    VariablesMajor citiesInner regionalOuter regionalRemoteVery remote
    Population size (%)72188.11.20.8
    Year 12 completion (%)79.474.567.669.255.5
    Median weekly household income (AUD $)1915.21637.61391.01478.71362.7
    Health care workforce (medical practitioners), FTEa per 100,000427311285285205

    aFTE: full-time equivalent.


    Health care is increasingly being delivered in a technology-driven environment [10]. In Australia, digital health technologies are transforming health care delivery, with significant advancements in electronic medical records (EMRs), telehealth, and remote patient monitoring [11]. EMRs have been widely adopted within GP practices, hospitals, and other service providers, facilitating seamless transfer of patient records among health care providers. Studies indicate that EMR adoption rates in RRR areas often surpass those in urban settings. For example, a 2012 study found that 56% of RRR region practices had adopted EMRs compared with 49% in urban areas [12]. Similarly, another study reported that solo practices in RRR regions were more likely to adopt EMRs than their urban counterparts (41% vs 33%) [13]. My Health Record, a Medicare-funded national digital system, improves care continuity by providing comprehensive, accessible patient information across health care settings (Figure 2) [14].

    Telehealth services have also grown substantially, particularly with Healthdirect, a national service funded by federal, state, and territory governments [11]. Healthdirect operates as a “virtual front door,” triaging patients, providing self-care advice, and connecting them to necessary health services. Several regions, including Victoria’s Northern Health, have implemented “Virtual Emergency Departments” using telehealth to triage patients efficiently [15]. The use of telehealth has extended to innovative outpatient care models, such as the Royal Prince Alfred Hospital’s “Spirituals.” In the Aboriginal Community Controlled Health Organisation sector, telehealth supports culturally appropriate health care through methods like “Store-and-Forward.” Specialized imaging captures patient data and forwards them to specialists for diagnosis and treatment, supporting complex conditions like heart, eye, ear, and diabetes care [16].

    Remote care technologies such as remote patient monitoring and digital therapeutics help in effectively managing chronic conditions and reducing hospital admissions in RRR settings [11]. For example, Cardihab delivers personalized digital cardiac rehabilitation, enabling clinicians to monitor patient progress through an online portal [17]. Mental health digital therapeutics, provided by services like Mental Health Online, MindSpot, and THIS WAY UP offer stand-alone or blended care options [18]. Blended care enhances flexibility, supports RRR access, and integrates digital tools into traditional pathways for cardiac and mental health services [19]. Hospitals also leverage remote patient monitoring, with the Royal Prince Alfred Hospital’s “Virtual Hospital” providing 24/7 multidisciplinary care [20]. The Virtual Clinical Care program in South Australia is another example, aimed at reducing preventable hospital admissions through early intervention and continuous monitoring [21].

    Artificial intelligence (AI) integration in health care is still limited, mostly restricted to research settings rather than widespread clinical use [22]. The health sector is one of the least mature industries in terms of AI implementation both in Australia and internationally [23,24]. AI analyzes data to support decisions; telehealth delivers care remotely. Together, they enhance access, efficiency, and personalization [25].

    ‎
    Figure 2. Four available digital platforms in Australia: A) My Health Record securely stores key health information, accessible anytime by patients and healthcare providers, including during emergencies; B) healthdirct operates a ‘virtual front door’ service. It triages patients, provides advice on how they can manage their condition on their own (‘self-care’), and connects them to health services; C) Cardihab is a digital-based cardiac rehabilitation service for patients recovering from a cardiac event or procedure; D) MindSpot is free, confidential psychological assessments and treatments, and access to qualified therapists via online or telephone.

    In 2022, nearly half of RRR Australian regions experienced significant broadband or mobile internet connectivity gaps [6]. RRR Australians face ongoing challenges with internet connectivity, especially in terms of video connectivity, and limited digital literacy, despite the narrowing of the urban-rural digital access gap [26]. Implementing My Health Record, an electronic health record (EHR) system, has been challenging on many fronts (Table 2). Issues relate to usability, safety, and the burden it places on physicians [27]. Other challenges of EHR implementation include data entry issues, inadequate alerting systems, and problems with interoperability [27]. Other concerns include high implementation costs, EHR standardization issues, resistance to change, and initial system use reducing productivity [28]. One survey found that most people (71.2%) knew little about My Health Record, and 29.4% had opted out of the system [29]. My Health Record improved access to information, but health literacy gaps, language barriers, and medical jargon caused misinterpretation and sharing issues. Studies need to assess whether the My Health Record improved Australia’s health care as per the objectives of the 2012 Act [30].

    Table 2. Resources required for the 4 digital health platforms in Australia [17,31-33].
    Resources requiredMy Health Record (electronic health record)Healthdirect (telehealth)Cardihab (remote care)MindSpot (remote care)
    Internet✓✓✓✓
    Broadband connections✓✓✓✓
    Electricity✓✓✓✓
    Cellphone

    		Normal phone
    		✓
    		✓

    		Smart phone✓✓✓✓
    Computer or tablet✓✓✓✓
    Trained staff✓✓✓✓

    		IT staff✓✓✓✓

    		Health staff✓✓✓✓

    Healthdirect Australia offers nurse-led telephone triage, crucially supporting RRR areas facing GP shortages and limited health care access. The service helps patients determine the most appropriate level of care, reducing unnecessary emergency department visits [34]. Healthdirect specializes in providing virtual health information, advice, and referral. However, the implementation of such digital health services can be challenging. A key barrier to implementing is the complexity of navigating Australia’s health care system [35], where coordination between primary and specialist care is poor, especially affecting access in underserved and RRR communities, according to the Grattan Institute report [36]. This leads to missed follow-ups and fragmented care, especially for patients with chronic or complex conditions [36]. Failure to involve a patient’s GP in all aspects of patient care can disrupt continuity of care and compromise the provision of high-quality, cost-effective care [37], particularly in Australia, where the health care system heavily relies on GPs for primary care. A theoretically based implementation plan that can be reported transparently is another pressing requirement [38]. Furthermore, allocating resources to implement the intervention within routine care can also pose difficulties [38].

    Cardihab offers digital cardiac rehabilitation [38], improving access and participation in RRR areas, where travel distances historically limited program engagement. In North Queensland, inadequate discharge planning and referrals limit cardiac rehabilitation access for hospital-treated patients [39]. Cost-effectiveness shows savings via fewer rehospitalizations, but sustainability requires continuous Medicare funding and digital skills training for clinicians and patients [40,41]. Despite these benefits, integrating digital cardiac rehabilitation into routine health care remains challenging. Service underuse persists due to a combination of patient and provider factors. Barriers include high costs, staff resistance, training demands, usability issues, data privacy, technical limitations, migration difficulties, and interoperability challenges [38]. National data show that among the 49,900 eligible patients between 2013 and 2015, only 30% were referred to cardiac rehabilitation, and of those referred, fewer than one-third (28%) attended the program [42].

    MindSpot delivers online therapy to underserved RRR Australians [43], effectively reducing depression and anxiety symptoms comparable to face-to-face psychological care [44]. Despite these benefits, uptake remains disproportionately low; only 18.9% of registrants are from RRR areas, where approximately 29% of Australians live [45]. Barriers include persistent digital access issues, cultural acceptability concerns, and limited targeted promotion in Indigenous and farming communities [46]. Furthermore, evidence is lacking about the effectiveness of digitally delivered mental health care in real-world settings [45]. Challenges related to the collection of outcome data also persist [47], highlighting the complexities of implementing digital health services in RRR settings.


    Telehealth is also being leveraged beyond these 4 platforms. For example, the Royal Flying Doctor Service delivers telehealth consultations to remote patients for chronic disease management and mental health, reducing emergency retrievals [48]. The Northern Territory Health Department outlines a structured approach to early detection and management of type 2 diabetes in Aboriginal youth [49]. This includes referral pathways and screening protocols that align with telehealth-enabled services, such as diabetic obesity screening [49]. In addition, Healthy Rural Hearts telehealth in NSW delivers personalized nutrition therapy for cardiovascular disease risk, although its effectiveness and patient engagement are still under evaluation [50].

    A systematic review finds evidence of the promising potential of portable ultrasound in RRR Australia, enabling nurses to capture scans and receive automated reports for obstetric and cardiac diagnostics [51]. For example, studies in remote Indigenous communities have shown feasibility and improved diagnostic capacity when nurses use portable ultrasound devices under tele-supervision from specialists [51]. This approach reduces the need for patient travel, supports timely clinical decision-making, and strengthens local health care capacity in under resourced areas. AI-supported triage tools in Healthdirect call systems also show promise, as evaluated in a 2025 Macquarie University usability study of the Triage Platform [52]. The platform can aid in detecting high-acuity cases but is still in the pilot stages, needing further validation, especially in RRR areas [52].


    Australian residents who are registered with Medicare or an individual health care identifier can access My Health Record via their mobile app or via the official webpage [53,54]. Mental Health Online provides tailored cognitive behavioral therapy programs for anxiety, depression, posttraumatic stress disorder, and obsessive-compulsive disorder, guided by its Electronic Psychological Assessment Screening System [55]. My Health Record is particularly valuable for continuity of care when patients need to travel across large distances for specialist consultations. Rural GPs report improved care coordination, especially for patients with complex multimorbidities, where local facilities cannot provide specialist services [36]. Rural solo practices adopt centralized health records more than metropolitan groups owing to benefits in sparse referral networks [34]. However, full integration is limited because of persistent opt-out rates in remote areas, partly due to mistrust and low awareness [11]. Healthdirect offers 24/7 helplines and online resources, providing Australians with accessible, trusted, and quality health information and advice [54,56]. Cardihab has been used by Australian private health insurers, clinicians, and patients in Queensland, Victoria, and South Australia [57]. Cardihab, a class I medical device registered in Australia, is being implemented nationwide to support cardiac rehabilitation services [58]. In 2023, 27% of MindSpot users were from RRR areas [59]. Mindspot provides mental health services to underserved populations, including Indigenous Australians, those facing access barriers, and residents outside major cities [60]. THIS WAY UP offers evidence-based online mental health courses, supporting RRR region practitioners and providing culturally safe tools for Indigenous communities via the WellMob portal [61].


    In Canada, the Ontario Virtual Care Program, initiated in 2006 and supported by the Ontario Telemedicine Network, introduced virtual visits to assist patients in remote locations [62]. This initiative aimed to enhance access to care and improve continuity and coordination of services. The program has evolved to integrate virtual care services within the health system, benefiting underserved populations, including those in RRR communities [63]. Additionally, the Ontario Virtual Care Program enhances sustainability by enabling policymakers to iteratively adapt service delivery models to RRR realities [64].

    In Finland, the OuluHealth ecosystem in northern Finland brings together stakeholders from the health sector to facilitate cooperation and improve health and social care services. Collaboration in medicine, wireless technology, ecosystem enabling, and big data facilitates rapid responses to digital health challenges, effectively addressing societal needs [65]. Integrated digital health models with robust infrastructure can improve health care access and continuity in remote regions.

    The Framework for Digital Health Equity study [66] emphasizes that equitable digital health solutions must address barriers for marginalized, Indigenous, and older adults in rural US communities. Ensuring these groups have access to technology and the necessary digital skills will be crucial in reducing health care disparities and promoting digital health equity.


    The evaluation of digital health programs in RRR regions relied on a mixed methods design that incorporates the following:

    • Service use data (eg, Medicare claims or platform analytics) to quantify reach and uptake [67]
    • Health outcomes (eg, hospital admission rates or disease-specific metrics such as HbA1c also known as glycated hemoglobin levels for diabetes) [68,69]
    • Economic evaluations assessing cost-effectiveness considering patient travel, workforce efficiency, and avoided hospitalizations [40]
    • Qualitative feedback from patients, clinicians, and community leaders in RRR areas to assess cultural safety, usability [70], and trust

    Implementing digital health services in RRR areas is a complex task requiring careful planning and strategic investment (Figure 3 [15,53,57,71,72]) [26]. Rural communities’ needs must be assessed to identify current and future essential clinical services [41,73]. This will involve a cross-sectional survey, community consultation, and data analysis [41,73]. Analyzing ethical risks, privacy, security, consent, and regulations can enhance telehealth governance and strengthen digital health policy recommendations [11,74]. Furthermore, systematic data collection would enable benchmarking, monitoring, and ethical oversight, driving continuous improvement across digital health services [75]. Federal and state health authorities must prioritize RRR region–specific data and programs to address unique needs [2]. Once the needs and current capacity are identified, a plan to roll out digital services needs to be developed to complement the existing clinical practice. One such project was the implementation of electronic prescribing infrastructure in 2021, where 36% of GPs generated e-prescriptions, and 95% of the Pharmaceuticals Benefits Scheme pharmacies dispensed them [11]. RRR health service implementation is expensive because of the costs incurred through infrastructure, equipment, skilled workforce, tailored interventions, multilevel strategies, local leadership, and advocacy needs [76,77]. Socioeconomic, connectivity, literacy, and funding gaps worsen RRR region digital health disparities, necessitating inclusive, equity-focused strategies [78-80]. Government subsidies for devices and training programs for RRR health care workers can help reduce barriers and strengthen digital health adoption [81,82]. Government funding; partnerships (policymakers, health care providers, and technology developers) with the private sector; and innovative financing models should be explored to cover these costs [76]. Effective implementation of digital health in RRR areas requires long-term Medicare funding, strengthened public-private partnerships, and targeted workforce training. Equitable policies, reliable infrastructure, and practical integration of telehealth, EHRs, and remote monitoring are essential. Overcoming RRR region digital health barriers in Australia requires community engagement, device subsidies, digital literacy, and socioeconomic support for sustainable, accessible, and culturally appropriate care. Coordinated planning, cost management, and sustainable funding enhance efficiency, scalability, and long-term impact of digital health services in underserved RRR communities. Future research should co-design dietary interventions combining community-based support with digital approaches for greater effectiveness [50]. By aligning digital health initiatives with the realities of RRR region practice, Australia can move closer to bridging the health gap and ensuring equitable access to care for all communities.

    ‎
    Figure 3. The key implementation steps.

    Acknowledgments

    The authors sincerely thank the epidemiology team at the Rural Health Research Institute (RHRI), Charles Sturt University, which includes MMH, KYA, TS, AEA, MAM, MJAS, UKM, SBA, and SG, for their valuable insights and thoughtful suggestions.

    Authors' Contributions

    SM conceived the idea and conducted the literature review. SM extracted the data and wrote the first draft of the manuscript, which was critically revised by the Epi team and AR, focusing on improving cultural sensitivity, methodological appropriateness, respect for cultural values, and ensuring ethical considerations. All authors approved the final version of the manuscript.

    Conflicts of Interest

    None declared.

    1. Rural and remote health. Australian Institute of Health and Welfare. Apr 30, 2024. URL: https://www.aihw.gov.au/reports/rural-remote-australians/rural-and-remote-health [accessed 2024-06-24]
    2. Thapa S, Ahmed KY, Ross AG. Beyond statistics: health inequities in rural and remote communities of Australia. Lancet Public Health. Nov 2023;8(11):e834. [FREE Full text] [CrossRef] [Medline]
    3. Australian Statistical Geography Standard (ASGS): volume 5 - remoteness structure, july 2016. Goverment of Australia. URL: https://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/1270.0.55.005Main%20Features5July%202016 [accessed 2025-11-10]
    4. Ion D. Cardihab enables home-based, digital cardiac rehab for remote North Queensland patients. Cardihab. Mar 21, 2025. URL: https://cardihab.com/news/mater-private-hospital-townsville-program-success/ [accessed 2025-10-28]
    5. Australian burden of disease study 2022. Australian Institute of Health and Welfare. Dec 13, 2022. URL: https://www.aihw.gov.au/reports/burden-of-disease/australian-burden-of-disease-study-2022 [accessed 2024-06-06]
    6. Digital health. Australian Institute of Health and Welfare. Jul 02, 2024. URL: https://www.aihw.gov.au/reports/australias-health/digital-health [accessed 2025-10-28]
    7. Main contributors to the Indigenous life expectancy gap. Australian Institute of Health and Welfare. 2016. URL: https:/​/www.​aihw.gov.au/​getmedia/​5d39a104-a2d5-4ab5-900c-697ee0e5a1d8/​ah16-5-8-main-contributors-indigenous-life-expectancy-gap.​pdf.​aspx [accessed 2025-10-28]
    8. Health workforce. Australian Institute of Health and Welfare. Jul 02, 2024. URL: https://www.aihw.gov.au/reports/workforce/health-workforce [accessed 2025-10-28]
    9. Admitted patients. Australian Institute of Health and Welfare. URL: https://www.aihw.gov.au/hospitals/topics/admitted-patient-care [accessed 2025-10-28]
    10. Butzner M, Cuffee Y. Telehealth interventions and outcomes across rural communities in the United States: narrative review. J Med Internet Res. Aug 26, 2021;23(8):e29575. [FREE Full text] [CrossRef] [Medline]
    11. Leveraging digital technology in healthcare. Australian Government Productivity Commission. May 07, 2024. URL: https://www.pc.gov.au/inquiries-and-research/digital-healthcare/ [accessed 2025-10-28]
    12. Whitacre BE. Rural EMR adoption rates overtake those in urban areas. J Am Med Inform Assoc. Mar 2015;22(2):399-408. [FREE Full text] [CrossRef] [Medline]
    13. Murphy P, Burge F, Wong ST. Measurement and rural primary health care: a scoping review. Rural Remote Health. Aug 2019;19(3):4911. [FREE Full text] [CrossRef] [Medline]
    14. Nguyen KH, Wright C, Simpson D, Woods L, Comans T, Sullivan C. Economic evaluation and analyses of hospital-based electronic medical records (EMRs): a scoping review of international literature. NPJ Digit Med. Mar 08, 2022;5(1):29. [FREE Full text] [CrossRef] [Medline]
    15. Virtual service expanding to relieve hospital pressures. Premier of Victoria. Apr 20, 2022. URL: https://www.premier.vic.gov.au/virtual-service-expanding-relieve-hospital-pressures [accessed 2025-10-28]
    16. Australian-first virtual ED triage launches. Northern Health. Oct 08, 2020. URL: https://www.nh.org.au/australian-first-virtual-ed-triage-launches/ [accessed 2025-10-28]
    17. Improving outcomes for people with cardiovascular disease. Cardihab. 2025. URL: https://cardihab.com/ [accessed 2025-10-28]
    18. An overview of THIS WAY UP 2015 to 2025. Australian Government Productivity Commission. 2025. URL: https:/​/assets.​pc.gov.au/​391878/​sub036-mental-health-review-attachment.​pdf?VersionId=aW_vZfrkuuvukzQfXUOq9I5_Ny5tD4Tq [accessed 2025-10-28]
    19. Understanding blended care. Australian Government Department of Health, Disability and Ageing. 2022. URL: https://www.medicarementalhealth.gov.au/for-health-professionals/understanding-blended-care [accessed 2025-10-28]
    20. Australia's first virtual hospital. Sydney Local Health District. 2025. URL: https:/​/slhd.​health.nsw.gov.au/​sydney-virtual/​about/​history#sydney-local-health-district-virtual-hospital,-an-australian-first [accessed 2025-10-28]
    21. Virtual clinical care. South Australia Health. 2025. URL: https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet [accessed 2025-10-28]
    22. AI trends for healthcare. Commonwealth Scientific and Industrial Research Organisation. Mar 2024. URL: https://aehrc.csiro.au/wp-content/uploads/2024/03/AI-Trends-for-Healthcare.pdf [accessed 2025-10-28]
    23. Lehne M, Sass J, Essenwanger A, Schepers J, Thun S. Why digital medicine depends on interoperability. NPJ Digit Med. Aug 20, 2019;2:79. [FREE Full text] [CrossRef] [Medline]
    24. Maslej N, Fattorini L, Brynjolfsson E, Etchemendy J, Ligett K, Lyons T, et al. Artificial intelligence index report 2023. arXiv. Preprint posted online on October 05, 2023. 2025. [FREE Full text] [CrossRef]
    25. Chatterjee J, Sujatha R. Transforming healthcare: the synergy of telemedicine, telehealth, artificial intelligence. In: Chatterjee JM, Sujatha R, Saxena SK, editors. Role of Artificial Intelligence, Telehealth, and Telemedicine in Medical Virology. Singapore, Singapore. Springer; Feb 01, 2025:1-29.
    26. Digital health and connectivity in rural Australia. National Rural Health Alliance. 2024. URL: https:/​/www.​ruralhealth.org.au/​publication/​fact-sheet/​digital-health-and-connectivity-in-rural-australia/​ [accessed 2025-10-28]
    27. Henry TA. 7 EHR usability, safety challenges—and how to overcome them. American Medical Association. Dec 11, 2023. URL: http:/​/ama-assn.​org/​practice-management/​digital-health/​7-ehr-usability-safety-challenges-and-how-overcome-them [accessed 2025-10-28]
    28. Lorenzi NM, Kouroubali A, Detmer DE, Bloomrosen M. How to successfully select and implement electronic health records (EHR) in small ambulatory practice settings. BMC Med Inform Decis Mak. Feb 23, 2009;9:15. [FREE Full text] [CrossRef] [Medline]
    29. Holt M, MacGibbon J, Smith AK, Broady TR, Davis MD, Newman CE. Knowledge of Australia's My Health Record and factors associated with opting out: results from a national survey of the Australian general population and communities affected by HIV and sexually transmissible infections. PLOS Digit Health. Mar 01, 2023;2(3):e0000200. [FREE Full text] [CrossRef] [Medline]
    30. de Mesquita RC, Edwards I. Systematic literature review of my health record system. Asia Pac J Health Manag. Mar 15, 2020;15(1):14-25. [FREE Full text] [CrossRef]
    31. Connecting Australia to a healthier future. DXC Technology. URL: https://dxc.com/au/en/insights/customer-stories/connecting-australia-to-a-healthier-future [accessed 2025-10-28]
    32. What is healthdirect video call? Healthdirect Australia. URL: https://help.vcc.healthdirect.org.au/about-healthdirect-video-call/whatishealthdirectvideocall [accessed 2025-10-28]
    33. Free, digital psychological care with MindSpot. MindSpot. URL: https://www.mindspot.org.au/ [accessed 2025-10-28]
    34. Bourke SL, Harper C, Johnson E, Green J, Anish L, Muduwa M, et al. Health care experiences in rural, remote, and metropolitan areas of Australia. Online J Rural Nurs Health Care. May 04, 2021;21(1):67-84. [FREE Full text] [CrossRef]
    35. McMahon B. Healthdirect – taking the difficulty out of navigating health services. Health Voices. 2022. URL: https:/​/healthvoices.​org.au/​issues/​may-2022/​healthdirect-taking-the-difficulty-out-of-navigating-health-services/​ [accessed 2025-10-28]
    36. Breadon P, Geraghty J, Jones D, Baldwin E. Special treatment: improving Australians’ access to specialist care. Grattan Institute. Jun 15, 2025. URL: https://grattan.edu.au/report/special-treatment-improving-australians-access-to-specialist-care/ [accessed 2025-10-28]
    37. Healthdirect Australia 2021-24 strategic plan. Royal Australian College of General Practitioners. May 28, 2021. URL: https:/​/www.​racgp.org.au/​FSDEDEV/​media/​documents/​RACGP/​Reports%20and%20submissions/​2021/​Healthdirect-2021-24-Strategic-Plan-consultation.​pdf [accessed 2025-10-28]
    38. Ross J, Stevenson F, Dack C, Pal K, May C, Michie S, et al. Developing an implementation strategy for a digital health intervention: an example in routine healthcare. BMC Health Serv Res. Oct 19, 2018;18(1):794. [FREE Full text] [CrossRef] [Medline]
    39. Field P, Franklin RC, Barker R, Ring I, Leggat PA. Cardiac rehabilitation in rural and remote areas of North Queensland: how well are we doing? Aust J Rural Health. Aug 2022;30(4):488-500. [FREE Full text] [CrossRef] [Medline]
    40. Gentili A, Failla G, Melnyk A, Puleo V, Tanna GL, Ricciardi W, et al. The cost-effectiveness of digital health interventions: a systematic review of the literature. Front Public Health. Aug 11, 2022;10:787135. [FREE Full text] [CrossRef] [Medline]
    41. Digital health blueprint. Department of Health and Aged Care, Commonwealth of Australia. URL: https:/​/www.​health.gov.au/​sites/​default/​files/​2024-01/​the-digital-health-blueprint-and-action-plan-2023-2033_0.​pdf [accessed 2025-10-28]
    42. Heart, stroke and vascular disease: Australian facts. Australian Institute of Health and Welfare. Oct 22, 2025. URL: https://www.aihw.gov.au/reports/heart-stroke-vascular-diseases/hsvd-facts/contents/about [accessed 2025-10-28]
    43. Mohr DC, Weingardt KR, Reddy M, Schueller SM. Three problems with current digital mental health research . . . and three things we can do about them. Psychiatr Serv. May 01, 2017;68(5):427-429. [FREE Full text] [CrossRef] [Medline]
    44. Titov N, Dear BF, Staples LG, Bennett-Levy J, Klein B, Rapee RM, et al. MindSpot clinic: an accessible, efficient, and effective online treatment service for anxiety and depression. Psychiatr Serv. Oct 2015;66(10):1043-1050. [CrossRef] [Medline]
    45. Battersby MW, Baigent MF, Redpath P. MindSpot: a valuable service that raises questions. Lancet Digit Health. Nov 2020;2(11):e562-e563. [FREE Full text] [CrossRef] [Medline]
    46. Meurk C, Leung J, Hall W, Head BW, Whiteford H. Establishing and governing e-mental health care in Australia: a systematic review of challenges and a call for policy-focussed research. J Med Internet Res. Jan 13, 2016;18(1):e10. [FREE Full text] [CrossRef] [Medline]
    47. Prescott MR, Sagui-Henson SJ, Welcome Chamberlain CE, Castro Sweet CC, Altman M. Real world effectiveness of digital mental health services during the COVID-19 pandemic. PLoS One. Aug 18, 2022;17(8):e0272162. [FREE Full text] [CrossRef] [Medline]
    48. Rural areas desperate for more local mental health services. University of Western Australia. URL: https:/​/www.​uwa.edu.au/​news/​article/​2019/​august/​rural-areas-desperate-for-more-local-mental-health-services [accessed 2025-10-28]
    49. Type 2 diabetes in young Aboriginal people clinical. Northern Territory Health. URL: https:/​/health.​nt.gov.au/​media/​pdf/​chronic-conditions/​type-2-diabetes-in-young-aboriginal-people-clinical-policy.​pdf [accessed 2025-10-28]
    50. Needham C, Partridge SR, Alston L, Rawstorn JC, Livingstone KM. Co-designing interventions to improve diets in rural communities. Proc Nutr Soc. Feb 06, 2025:1-7. [CrossRef] [Medline]
    51. Shaddock L, Smith T. Potential for use of portable ultrasound devices in rural and remote settings in Australia and other developed countries: a systematic review. J Multidiscip Healthc. Mar 29, 2022;15:605-625. [FREE Full text] [CrossRef] [Medline]
    52. Blakely B, Magrabi MF. Healthdirect Triage Platform usability follow up study: second usability study report. Macquarie University. 2025. URL: https:/​/researchers.​mq.edu.au/​en/​publications/​healthdirect-triage-platform-usability-follow-up-study -second-usa/​ [accessed 2025-10-28]
    53. About my health record. Healthdirect Australia. 2024. URL: https://www.healthdirect.gov.au/my-health-record [accessed 2025-10-28]
    54. Action plan for the digital health blueprint 2023-2033. Australian Government Department of Health and Aged Care. 2023. URL: https:/​/www.​health.gov.au/​sites/​default/​files/​2023-12/​the_action_plan_for_the_digital_health_blueprint_2023-2033.​pdf [accessed 2025-10-28]
    55. Independent evaluation of supported digital mental health services – phase 2 final report. Australian Government Department of Health, Disability, and Aging. 2022. URL: https:/​/www.​health.gov.au/​resources/​publications/​independent-evaluation-of-su pported-digital-mental-health-services-phase-2-final-report?language=en [accessed 2025-10-28]
    56. Get health information and advice. Healthdirect Australia. URL: https://www.healthdirect.gov.au/ [accessed 2025-10-28]
    57. About us. Cardihab. 2024. URL: https://cardihab.com/who-we-are/ [accessed 2025-10-28]
    58. Our evidence. Cardihab. URL: https://cardihab.com/our-evidence/ [accessed 2025-10-28]
    59. Meeting Australians where they are. MindSpot. URL: https://www.mindspot.org.au/rural-mental-health/ [accessed 2025-10-28]
    60. MindSpot clinic. Healthdirect Australia. URL: https://www.healthdirect.gov.au/partners/mindspot-clinic [accessed 2025-10-28]
    61. eMHPrac: supporting national implementation of digital mental health in Australia. eMental Health International Collaborative. May 20, 2025. URL: https:/​/emhicglobal.​com/​case-studies/​emhprac-supporting-national-implementation-of -digital-mental-health-in-australia/​ [accessed 2025-10-28]
    62. OMA’s virtual care working group FAQ. The Ontario Medical Association. 2023. URL: https:/​/www.​oma.org/​siteassets/​oma/​media/​pagetree/​pps/​running/​operations/​virtual-care/​vc-working-group-faq.​pdf [accessed 2025-10-28]
    63. Virtual care policy framework. Government of Canada. Jul 07, 2021. URL: https:/​/www.​canada.ca/​en/​health-canada/​corporate/​transparency/​health-agreements/​bilateral-agreement-pan-canadian-virtual-care-priorities-covid-19/​policy-framework.​html [accessed 2025-10-28]
    64. Ontario's virtual care streamlined action plan. Government of Canada. 2022. URL: https:/​/www.​canada.ca/​en/​health-canada/​corporate/​transparency/​health-agreements/​bilateral-agreement-pan-canadian-virtual-care-priorities-covid-19/​action-plan-ontario.​html [accessed 2025-10-28]
    65. OuluHealth facilitates close cooperation that drives innovation, boosts the healthtech business and supports the implementation of better healthcare services. OULUHEALTH. URL: https://ouluhealth.fi/about/stakeholders/ [accessed 2025-11-10]
    66. Richardson S, Lawrence K, Schoenthaler AM, Mann D. A framework for digital health equity. NPJ Digit Med. Aug 18, 2022;5(1):119. [FREE Full text] [CrossRef] [Medline]
    67. Statistical information and data. Services Australia. URL: https://www.servicesaustralia.gov.au/statistical-information-and -data?context=22 [accessed 2025-10-28]
    68. Vayalil MP. 6 key metrics for HCPs in value-based care. blueBriX. Jan 08, 2025. URL: https://bluebrix.health/blogs/6-key-metrics-for-hcps-in-value-based-care [accessed 2025-10-28]
    69. Ravi S, Meyerowitz-Katz G, Yung C, Ayre J, McCaffery K, Maberly G, et al. Effect of virtual care in type 2 diabetes management - a systematic umbrella review of systematic reviews and meta-analysis. BMC Health Serv Res. Mar 06, 2025;25(1):348. [FREE Full text] [CrossRef] [Medline]
    70. Clough B, Fraser J, Flemington T, Power T. Implementation and evaluation of cultural safety initiatives in Australian hospital settings: a scoping review. J Transcult Nurs. May 2025;36(3):279-289. [FREE Full text] [CrossRef] [Medline]
    71. Your my health record. Australian Government. 2024. URL: https:/​/my.​gov.au/​en/​services/​health-and-disability/​seeking-medical-help/​accessing-your-medical-information/​your-my-health-record [accessed 2025-10-28]
    72. About MindSpot. MindSpot. 2025. URL: https://www.mindspot.org.au/about-mindspot/ [accessed 2025-10-28]
    73. Rural community engagement resource guide. Rural Health Value. 2023. URL: https:/​/ruralhealthvalue.​public-health.uiowa.edu/​files/​RHV_Community%20Engagement%20Resource%20Guide.​pdf [accessed 2025-10-28]
    74. Osman S, Churruca K, Ellis LA, Braithwaite J. Beyond the planned and expected: the unintended consequences of telehealth in rural and remote Australia through a complexity lens. Med J Aust. Jun 03, 2024;220(10):496-498. [FREE Full text] [CrossRef] [Medline]
    75. Hamilton S, Mills B, McRae S, Thompson S. Evidence to service gap: cardiac rehabilitation and secondary prevention in rural and remote Western Australia. BMC Health Serv Res. Jan 30, 2018;18(1):64. [FREE Full text] [CrossRef] [Medline]
    76. Rural health in Australia SNAPSHOT 2023. National Rural Health Alliance. 2023. URL: https:/​/www.​ruralhealth.org.au/​wp-content/​uploads/​2024/​04/​NRHA_rural_health_in_Australia_snapshot_2023.​pdf [accessed 2025-10-28]
    77. Krahe MA, Baker S, Woods L, Larkins SL. Factors that influence digital health implementation in rural, regional, and remote Australia: an overview of reviews and recommended strategies. Aust J Rural Health. Apr 2025;33(2):e70045. [CrossRef] [Medline]
    78. Digital exclusion in Australia. Australian Government Department of Infrastructure, Transport, Regional Development, Communications, Sport and the Arts. Aug 2025. URL: https:/​/www.​infrastructure.gov.au/​sites/​default/​files/​documents/​digital-exclusion-in-australia-report.​pdf [accessed 2025-10-28]
    79. Digital health literacy key to overcoming barriers for health workers, WHO study says. World Health Organization. Sep 18, 2023. URL: https:/​/www.​who.int/​europe/​news/​item/​18-09-2023-digital-health-literacy-key-to-overcoming-barriers-for -health-workers--who-study-says [accessed 2025-10-28]
    80. Closing the gap in a generation: health equity through action on the social determinants of health. World Health Organization. Aug 27, 2008. URL: https://iris.who.int/server/api/core/bitstreams/cb08095c-55c8-484e-bff6-0e9c78fd38dd/content [accessed 2025-10-28]
    81. Home Care Packages: access to $2,500 for urgent goods, equipment, and assistive technology. Australian Government Department of Health, Disability and Ageing. URL: https:/​/www.​health.gov.au/​resources/​publications/​home-care-packages -access-to-2500-for-urgent-goods-equipment-and-assistive-technology?language=en [accessed 2025-10-28]
    82. Specialist training program. Australian Government Department of Health, Disability and Ageing. URL: https://www.health.gov.au/our-work/specialist-training-program [accessed 2025-10-28]

    ‎
    EHR: electronic health record
    EMR: electronic medical record
    GP: general practitioner
    RRR: rural, regional, and remote

    Edited by N Cahill; submitted 11.Oct.2024; peer-reviewed by M Adamakis, E Popa, A Hasnain; comments to author 09.Apr.2025; revised version received 29.Aug.2025; accepted 11.Sep.2025; published 02.Dec.2025.

    Copyright

    ©Shakeel Mahmood, M Mamun Huda, Kedir Yimam Ahmed, Thapa Subash, Feleke Hailemichael Astawesegn, Anayochukwu Edward Anyasodor, Mohammad Ali Moni, Muhammad J A Shiddiky, Utpal K Mondal, Setognal Birara Aychiluhm, Santosh Giri, Allen Ross. Originally published in the Interactive Journal of Medical Research (https://www.i-jmr.org/), 02.Dec.2025.

    This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Interactive Journal of Medical Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.i-jmr.org/, as well as this copyright and license information must be included.