Healthcare: follow the work around the patient

A referral arrives by fax. A discharge leaves actions in free text. A cancer meeting needs results from six screens. Each piece of work moves around the patient through many systems, and people carry it by hand. Agents can prepare, chase and track this work. Clinicians keep every clinical decision. The frame is the guide's own: layers you own, a lifecycle you run, and capabilities you add.

The estate

The estate below is a typical public hospital network. It has one tertiary hospital, two district hospitals and one rural hospital (typical, unsourced). In Australia this is a local health district or a hospital and health service. A state body such as eHealth NSW or eHealth Queensland runs the statewide systems. In New Zealand it is a district of Health New Zealand (Te Whatu Ora). Metro South Health in Brisbane has five hospitals and over 10,000 staff (Heidi Health, 31 August 2026 [vendor]).

The table names the systems on each floor. Generic names come first. Vendors are in brackets where they help recognition.

Three layers are new ground for agents. The intelligence and learning layer (R06) holds rules and a few vendor models. Few services check a model's performance after go-live (typical, unsourced). The agent platform layer (R07) is mostly absent. No Australian or New Zealand public health service was found running its own agent runtime. None had an agent registry or an identity per agent. The agent data engineering layer (R14) reads fax for indexing, not for workflow fields. It lacks extraction that keeps the page and position of each field. It also lacks indexes that respect who may see what.

The EMR and the PAS are packaged systems of record. The general pattern for agents around them is on agents and packaged applications.

The use cases on this estate

Four worked examples sit on this estate. Each uses one agent on fixed steps. Model calls only read documents and draft text. Fixed rules, not the model, decide order, limits and status.

The rules that bind the work

Clinical decisions stay with clinicians. The Australian Commission on Safety and Quality in Health Care published its AI Clinical Use Guide in August 2025. Clinicians stay accountable for AI output that enters the record. The Commission's ambient scribe scenario adds a warning. A tool that suggests a diagnosis or treatment may need listing with the Therapeutic Goods Administration (TGA). So no agent on these pages sets urgency, reads a result, or recommends treatment.

The rule for decisions about people. A named person decides any significant decision about a person, and health is one of them. Here that covers clinical triage, declining a referral, booking out of order, and sending a patient back to the GP. The rule sits beside the deterministic zones.

Consent and privacy. The Privacy Act 1988 and state health records laws apply in Australia. The Health Information Privacy Code 2020 applies in New Zealand. Contact preferences and consent are recorded, and an agent checks them before any message. Two sets of data sovereignty principles also shape what data may be used. They are Te Mana Raraunga for Maori data, and Maiam nayri Wingara for Aboriginal and Torres Strait Islander data.

My Health Record. Since 1 July 2026, pathology and imaging reports go to My Health Record by default. They must be uploaded within 24 hours of release. The rule covers written reports, not the images (Australian Digital Health Agency, accessed 15 October 2026). An agent may use these documents only where the service's access policy and the patient's own controls allow.

Patient identifiers. In Australia, the Individual Healthcare Identifier (IHI) comes from the Healthcare Identifiers Service. The service is called with the organisation's NASH certificate. Check its rules before a vendor hosts an agent that looks up identifiers. In New Zealand, the National Health Index (NHI) has a live FHIR interface (Health New Zealand, accessed 15 October 2026).

Accreditation. Australian hospitals are assessed against the eight National Safety and Quality Health Service (NSQHS) Standards. Since 1 July 2023, assessments come at short notice, with at least 24 hours' warning (the Commission). A service can exclude up to 20 business days per cycle, according to a search summary of the Commission's page. A secondary summary says hospitals are reaccredited at least every three years. In New Zealand, services are audited against Nga Paerewa, NZS 8134:2021.

What runs in Australia and New Zealand today

Results are as reported by the party named. None is independently audited.

• Ambient scribes are live. Health New Zealand bought 1,000 Heidi scribe licences for every public emergency department (HINZ, 26 November 2025 [vendor]). It added 100 for mental health crisis teams. The minister later put use at about 1,250 staff, so the reports conflict. Metro South Health announced Heidi across five hospitals on 31 August 2026. In its trial, 92 percent of clinicians reported less admin time (Heidi Health [vendor]).
• Referral triage is at validation. At Logan, a model called ReferralAI suggests an urgency category for ENT referrals. Clinicians decide. A national study of AI-assisted colonoscopy triage invited sites in July 2026. A pelvic pain triage pilot runs at the Austin in Melbourne (undated).
• Public symptom triage is live. Healthdirect's virtual triage handled about 1.55 million encounters from April 2023 to March 2025 (Medical Republic, 2025).
• Vendor agents are arriving in primary care first. Heidi II launched on 28 September 2026. Its agents prepare charts and draft referrals, follow-ups and recalls. A clinician reviews before anything is sent. No Australian public hospital site was found (Medical Republic, 30 September 2026 [vendor]).
• One statewide EMR is coming. NSW is moving every district to one Epic record. The first go-live was in March 2026 (NSW Health, 27 March 2026). All districts are due by the end of 2028. It is not an agent. It brings a platform with vendor agents into Australian public health.
• Nothing found on follow-up or accreditation. No Australian or New Zealand public health service was found using an agent to check that follow-up was done. None was found collecting accreditation evidence with an agent.
• Not confirmed here. Epic's agents are not confirmed in Australia. Microsoft Dragon Copilot is not offered in Australia or New Zealand. Oracle's clinical agent has no Australian listing. All three were checked on 15 October 2026.

Evidence and limits

The estate is a composite. No Australian or New Zealand health service publishes its full system estate. The table is industry knowledge, not a survey.

Most deployment figures come from vendors or their releases. Four sources refused the fetch during research, so their status lines come from search summaries. Scribe numbers for New Zealand conflict between sources.

The four agent designs are proposals. Two of them have no published precedent in Australia or New Zealand: checking follow-up completion and collecting accreditation evidence.

Three accreditation facts were not verified. They are the current NSQHS version, its number of actions, and the period to fix a Not Met action. The Commission's site timed out during research. Check them before relying on them.

Next step

Start with referral to appointment, the fullest worked example. The healthcare blueprint sets out the four agents as one design.