HealthEngine and 1stAvailable go to market as booking numbers grow

Rival online appointment booking services HealthEngine and 1stAvailable have both gone to the market recently to raise capital for their growing businesses, with both reporting revenue growth and hailing million-booking milestones in what is still an immature sector.

HealthEngine, which says it is Australia’s largest health marketplace, last week celebrated its two millionth booking with a new round of capital raising focused on further growth and expansion.

HealthEngine, which first began in 2006 as an online directory for GPs looking for specialists, branched out into online appointment bookings for GPs in 2012 and received a huge boost through a $10.4 million investment from Telstra and Seven West Media in May 2013.

A new, high profile investor in the last round is Greg Roebuck, founder and CEO of carsales.com.au, for an undisclosed sum. “HealthEngine has demonstrated itself as the clear market leader in the provision of online health services and are best positioned to capitalise on further growth in the industry,” Mr Roebuck said in a statement. “I see a number of similarities with Carsales at the same stage in its growth.”

HealthEngine CEO Marcus Tan said more than seven million people were visiting the website and using the mobile app annually to find and book health appointments online. The company says it has close to 10,000 practitioners across Australia now using the service, representing more than 200 per cent increase in revenue and a 400 per cent increase in health bookings.

HealthEngine has also added online check-in functionality for patients through its mobile app, which Dr Tan said had also seen growth of over 300 per cent in the last 12 months.

“Mobile app check-ins will be offered free to participating HealthEngine practices, allowing patients who book via the app an easier check-in experience,” he said.

1stAvailable, meanwhile, has also gone to market and raised $1.2 million a private placement last month with up to $600,000 to be raised in a share purchase plan closing in December.

1stAvailable raised $5.3m as part of its successful listing on the stock exchange back in June. That money was used in part to acquire competitor GP online booking systems Clinic Connect and DocAppointments, along with GObookings, which has been active in government and corporate online bookings for 15-odd years.

The purchase and merger with GObookings and the two smaller systems has allowed 1stAvailable to now be able to boast three million bookings in total, the vast majority from GObookings.

According to a presentation at 1stAvailable’s annual general meeting held last week, its financial year 2015 revenues tripled to $300,000 for an overall loss of $3.3m. It had total cash at the end of the period of $3.4m.

The company is continuing its strategy of integrating with practice management systems, which is up to 22 in number now, almost half of them GP systems, but it has set its sights on the corporate and government markets as its strongest position.

The company says it will continue to market its corporate and government solution into other markets, but that there is a significant market opportunity in the private practice segment as well. Figures cited by 1stAvailable show that only three per cent of healthcare professionals are currently using online booking systems.

In August, the company appointed a new chief financial officer in Graham Mason, and has also consolidated its offices down to one combined office in Sydney.

In what has been a big year for online appointment systems, practice-focused vendor Appointuit was acquired by Jayex in September and Melbourne start-up HotDoc, which counts Healthscope and Sonic’s medical centres as customers, raised $2.2m from venture capital fund AirTree Ventures in August.

HotDoc also rolled out a smart recalls system with practice management system Zedmed, which is also integrated with Best Practice and MedicalDirector, and Zedmed and MD launched their own integrated online booking services.

eForms and insights set to revolutionise MedicalDirector

Clinical and practice management software vendor MedicalDirector is in the final stages of beta testing for its next big release, which will introduce to Australian general practice new functionality that is set to fully digitise and potentially even revolutionise how GPs communicate with governments and the wider health system.

Also due to be offered by the other major GP desktop vendors besides MedicalDirector, the new HealthLink Forms functionality has been developed and rolled out in New Zealand by secure messaging specialist HealthLink.

It is a standards-based application for pre-populating electronic forms – including medical certificates, referrals and almost anything else that requires a clinician to fill out a form on behalf of a patient – and submitting them securely with the press of a button, all within the GP’s or specialist’s desktop software.

MedicalDirector’s next version, due in early January, will also feature a new standalone practice analytics tool called MedicalDirector Insights that can extract clinical and demographic data to help identify, manage and report on different patient cohorts.

Functioning much like the Pen CAT tool or the Canning Tool but built by MedicalDirector’s own software development staff, MedicalDirector Insights will allow practices to conduct population health surveys and export de-identified data to Primary Health Networks as well as for the practice’s own requirements. Where practices are required to report various data to government funders, MedicalDirector Insights has this functionality built-in as well.

The next version of MedicalDirector Clinical will also feature an integration with RealTime Health, which provides a library of unscripted, real-life patient stories through hundreds of video clips that GPs can recommend to their patients much as they can currently print out or email information through the Healthshare Factsheets function in the MD Sidebar.

It will also feature a revamped recalls service that will make it faster to contact patients in urgent need and most importantly close the loop so practices can see which patients haven’t been in contact. MedicalDirector chief medical officer Andrew Magennis said users who have seen this feature say they will be very grateful for the hours this can save and the reduced risk of patients missing the follow-up.

And the company plans to release a new smartphone app for patients through which they can make appointments with their regular GP, and which MedicalDirector plans to cumulatively add new functions to over time until it becomes to all intents and purposes a patient portal.

News on the next version of the market-leading GP software, which launched a cloud version earlier this year, follows the launch last week of a whitepaper on the increase in chronic conditions seen by Australian general practice and how technology can help overcome some of the challenges.

Data from MD’s General Practice Research Network (GPRN) shows there is a growing burden on primary care to manage complex, ongoing conditions. The results show that almost one in three patients now present with chronic conditions, compared with about one in four in 2010, and almost a quarter of all patient visits are for chronic conditions.

The whitepaper also shows that there has been a massive increase in the use of GP management plans, but that GPs are unsure of whether they are very effective. More than a quarter of clinicians surveyed said a key hurdle in managing chronic conditions was a lack of engagement with patients and patients not understanding their care plan. For MedicalDirector, this is where it thinks it can play a part.

Dr Magennis said that in addition to the existing Healthshare Factsheets on the MD Sidebar, the RealTime Health integration will assist GPs with patient education and engagement.

RealTime Health has created a library of videos for about 100 conditions, which pretty much covers everything you are likely to see in general practice, and most are delivered in an upbeat yet informative way.

“They’ve managed to marry it together so they have unscripted answers from real people with real conditions, presented in a way that is actually really helpful,” Dr Magennis said.

“We already have the HealthShare Factsheets, so if you put in MedicalDirector Clinical the reason for an encounter, as soon as you type that in and press enter, the Sidebar gets fed that and the Factsheet app goes trundling off to their central repository and in less than a second it shows you that there’s seven fact sheets about this or three about that.

“GPs can then print that off or email it to the patient with just one click. RealTime Health will work in a similar way.”

MD’s new smartphone app is also designed for patient engagement. Earlier this year, MedicalDirector launched its own online appointments bookings system that Dr Magennis said had gone exceptionally well, with statistics showing large numbers of patients making bookings after hours.

Unlike online appointment search sites like HealthEngine or 1stAvailable, the MedicalDirector system is practice specific. The company is now planning to extend that functionality to a mobile app, which will also have new functionality added over time until it becomes, for want of a better word, a patient “portal”, Dr Magennis said.

“This is an app that would go out to support the practice and maintain continuity of care,” he said. “In time we see it becoming the natural entry point for a patient to get in touch with the practice or receive information.”

While online access to the patient’s medical record is not on the cards at this time, MedicalDirector is taking a serious look at the ability to provide access to a patient summary through the app, including medications, vaccinations, allergies and significant diagnoses – in essence, what the PCEHR/My Health Record should be providing but hasn’t yet managed.

Electronic forms

While the app and RealTime Health are interesting new functions for MedicalDirector, it is the HealthLink Forms and MedicalDirector Insights capabilities that are sure to be of huge interest to clinicians.

While HealthLink has not spoken much publicly about eForms in Australia, the capability is up and running and being used from within GP practice management systems in New Zealand. In Australia, rumours are growing about just how revolutionary it could prove to be to the day-to-day workload of not just general practitioners but specialists too.

HealthLink is partnering with all of the major names in medical software in Australia and will over time continue to add more forms, which in MedicalDirector’s case will be housed under a new HealthLink Forms tab in the product’s menu bar. HealthLink will also provide a generic template service to healthcare and service providers so new forms can be created and added to the forms library quickly and cheaply.

As the technology is standards-based, each time a change is made to a form it can be rolled out to all software packages at once rather than having to be altered for each system, which is usually done by the software vendor. In this case, HealthLink will manage that responsibility.

As Dr Magennis says, there are hundreds if not thousands of forms out there for multiple purposes, from Medicare to the DVA, medical certificates for Centrelink, insurance companies and employers, referrals to social services like Meals on Wheels, admission forms to hospitals and order forms for pathology.

All of these are available electronically in one form or another, but most still need to be printed out and faxed, posted or given to the patient, and most require the doctor to copy and paste information or type in information again.

What HealthLink Forms promises is the capability to have pre-populated web forms and web applications that can be initiated by the doctor or their staff, filled out quickly and then sent electronically through in-built secure messaging.

The forms will contain the details for the end receiver so practices don’t even need a directory. At the other end, the data is extracted in a form suitable to the end receiver and integrated straight into their systems in a manner they choose.

“It is the pre-populated bit that is going to be an absolute game-changer for everyone,” Dr Magennis said. “It is standards based, which means anyone can implement it and as far as I know, the HealthLink people are effectively handling the release of the forms that are available. Anyone can then go and fairly easily select whatever the form is.

“As I understand it, HealthLink have encouraged all of the clinical systems of note to install the Forms functionality and now the next trick is to get it into hospitals for incoming and outgoing forms, and the government departments. That appears to have been solved to a fairly large degree in NZ and based on that there is similar interest from the government departments in Australia.

“It is a bit of a coup and it is going to meet an absolute need. It’s not just GPs – specialists have to fill out lots of forms too. The potential is profound.”

MedicalDirector also plans to release the Insights tool next month as a standalone product aimed at population health. Designed to fill the niche created by the Pen and Canning tools but built by MD so as to be able to explore all of the software’s “nooks and crannies”, as Dr Magennis describes it, the company has had the tool on its work plan for some time.

“We’ve had it on our work plan to provide that sort of insight into practice goings-on in terms of reporting anything and everything that can be reported,” he said. “We got some business analysts to ring around and find out what was needed in terms of clinical reporting for local, state and federal government programs and made sure that our reporting tool could actually spit all of that out.

“It will be linked into MD Clinical but it’s a free-standing piece of software that is going into the MD Clinical and PracSoft back-end as it will use both. For example, it can look for assessment item numbers that can only be reused after a set period of time and can then tell you this person is eligible to be assessed again. It is using the accounting and front-desk data, appointment data, item number data plus clinical stuff and then lets you find people who should be having assessments.

“All of the data can then be exported fully de-identified so the Primary Health Networks can then say to their cohort of general practices we want to do this because we are being paid by the government to do a population health program. So MedicalDirector Insights can export that data and the Primary Health Networks can collate that data and present insights.

“It is insights into a particular doctor’s patients, or a particular practice or a particular cohort of people or a particular area. Some of that data is already in MedicalDirector Clinical through its search function but this just adds that extra dimension.”

Dr Magennis said the new versions of MedicalDirector Clinical and PracSoft are in the final stages of beta testing and will be ready to be shipped soon. The product has also been demonstrated in the wild at the recent GPCE in Melbourne, where he said doctors were very enthused. “We were a bit chuffed as well,” he said.

After a few years in which MedicalDirector, like its competitors, was distracted somewhat by the demands and wishes of NEHTA and the government, Dr Magennis said the company has now resumed its customer focus and the new version will prove a game-changer.

“MedicalDirector has been reborn,” he said.

Royal Adelaide delay may prove blessing in disguise for pharmacy, pathology

The extra time afforded by the recently announced delay in opening the new Royal Adelaide Hospital (new RAH) may prove a godsend for the roll-out of the planned closed loop medications management system, but may also see the new enterprise pathology system implemented at another hospital first.

A report by the South Australian Auditor-General Andrew Richardson tabled this week has highlighted the complexity of the state’s eHealth program, with the difficulties being faced by the troubled Enterprise Patient Administration System (EPAS) and the move from the current building rescheduled to November 2016 having flow-on effects on both the new Enterprise Pathology Laboratory Information System (EPLIS) and plans for a closed loop medications management system.

In the case of pharmacy, this may prove a blessing in disguise, potentially allowing time for an electronic prescribing interface between EPAS and the i.Pharmacy dispensing system to be ready by the time the hospital opens.

However, it might not be enough to overcome the challenges facing the EPLIS roll-out, with the possibility that it will still not be fully operational by the time the hospital opens and the likelihood that it will be rolled out to one of the other hospitals on the schedule first.

According the report, the plan for pharmacy services at the new RAH is based on the principles of closed loop medications management and will be progressively rolled out over 18 months following initial operation.

The existing i.Pharmacy system from CSC is being transitioned across to the new RAH, where it will be integrated with a Rowa automated pharmacy distribution system (APDS) from CareFusion and in-pharmacy robotics, and 81 automated dispensing cabinets (ADCs) linked to CareFusion’s Pyxis software.

It will also be linked to the Oracle Corporate System for pharmacy patient billing and procurement and supply chain management. The use of APDS was expected to result in a reduction in stock waste of between four and 10 per cent, with savings of up to $71 million over the 15-year life of the APDS asset.

The new RAH will have two pharmacies – one for inpatients on level 1 and one for outpatients on level 3 – and the overall solution will have a patient queuing and wait management system to handle pharmacy outpatient management.

However, one of the big challenges was always going to be ePrescribing, which is meant to be done through EPAS. The auditor-general has found that a decision on whether EPAS electronic prescribing functionality would be ready for initial operations at the new hospital was still pending as late as April this year.

“Certain constraints of EPAS current system functionality have presented challenges to pharmacy electronic prescribing,” the auditor-general writes. “These include barcode scanning functionality for consistent identification and administration of medication to patients, and the complexity and effort required to configure matching patient medication profiles across systems.

“SA Health originally advised that there would not be an electronic prescribing interface from EPAS to i.Pharmacy for initial operation of the new RAH. As such, prescription orders appearing in EPAS will require printing and a manual check if the medication is available in the ward ADC.

“At the time of this report, SA Health had not indicated whether the new RAH delay will allow this functionality to now be available at initial operation.”

The auditor-general also found that while EPAS is essential to the pharmacy plan, the EPAS program and the pharmacy program only commenced formal meetings in May 2015, although SA Health insists there has been ongoing dialogue. The auditor recommended that the project should continue frequent communications with other relevant programs, including EPAS.

He also recommended that SA Health reassess whether the new RAH delay provides sufficient time to provide electronic medications management functionality at the hospital’s initial operation.

The auditor criticised the ambitious time frames in the original project plan, but said the announcement of the delay should reduce the implementation risks. However, contingency plans will still be needed.

Pharmacy billing will also have to have a contingency plan as Sunrise Financial Manager, the EPAS financial module, does not currently have the functionality to process pharmacy patient billing. Billing is also causing problems for the EPLIS roll-out, although on a larger scale.

Pathology

The auditor-general has taken a detailed look at the status of the $30 million EPLIS project and noted a number of risks, both to the new RAH and to public and private pathology services.

With the new RAH, the auditor found that pathology program delays have occurred, staff will be unfamiliar with EPLIS and its associated workflows when the hospital opens, procurement of some laboratory instruments is yet to be finalised and there are major integration challenges to be faced. He also found deficiencies in system contingency plans.

Concerning the wider pathology program, he has warned that the budget and its contingency for EPLIS may be insufficient, there are ongoing resource challenges, and there are major challenges with pathology results reporting, which is contingent on EPAS.

SA Pathology’s current system, Ultra, is reaching the end of its life and is increasingly prone to failure, the auditor reports. The system used at the current RAH can’t receive inbound orders from OACIS or external medical practitioner software, and even the two versions of Ultra in use by SA Pathology are not compatible with each other.

Ultra will be replaced by a pathology system from Cerner’s Millennium suite following a decision made in November 2013. Deployment of EPLIS is planned for a number of sites within SA Pathology, including eight metropolitan hospitals, 11 regional laboratories and 65 collection centres, 38 in metropolitan areas and 27 regional.

The original plan was to implement EPLIS at the new RAH and Frome Road Laboratories by April 2016. This would then be followed by the Women’s and Children’s and The Queen Elizabeth in July 2016, Flinders Medical Centre, the Repat General and Noarlunga in August 2016, and Lyell McEwin and Modbury in October. Ultra will continue to be operated alongside EPLIS until May 2017.

However, the new RAH delay will upset these plans, and the auditor reports that the program had yet to determine the implications to the overall EPLIS rollout plan and the associated costs. There are now tentative moves to roll out EPLIS at another site before the new RAH. This may cause changes to the budget as well, although these appear to be minimal.

The auditor found that there have already been program delays with EPLIS, including a time when the program was put on hold. And while the delay in opening the new RAH will provide additional time for the program to complete all required activities, he warns that further program delays may still lead to compromises in the scope and quality of delivery.

“This has the potential to result in a sub-optimal solution on initial operation at the new RAH and/or delayed patient pathology services being offered,” he writes.

Like EPAS, he warns that the switch to EPLIS will cause problems for users as workflow practices will be different. In the case of SA Pathology, the software is not being adapted to workflows but the other way around.

There are also major integration challenges to be faced. For EPLIS to work as expected, it will have to interface with EPAS for test ordering and results viewing, the Enterprise Master Patient Index for patient identifiers, the PowerHealth Billing & Revenue Collection (PBRC) system for pathology billing functionality, the Oracle Corporate System and medical device integration. Much of this will be done through SA Health’s Health Integration Broker.

And despite the new RAH opening being delayed, thus providing the program with additional time, the auditor says there are still a number of integration challenges with other systems that need to be addressed prior to any testing at the new RAH.

One of the big problems the auditor-general has uncovered is that the essential integration with EPAS for ordering and reporting has still not been finalised.

“For electronic ordering functionality to be operational, development work is required within both EPAS and EPLIS to match the SA Pathology order and results catalogue,” he writes.

“Although the program originally scheduled EPAS integration testing to be completed in May 2015, at the time of our review Cerner was still developing the SA Pathology order and results catalogue in EPLIS. This catalogue is now expected to be finalised by mid-October 2015.

“On completion, the order and results catalogue will be provided to the EPAS Program for integration into the pathology order and results interface. Until completion, the EPAS Program’s associated development costs and timelines for completion remain outstanding.”

He reports that SA Health is currently working on a contingency option should electronic pathology ordering not be available at the new RAH, including performing manual workarounds using paper forms.

There was also a delay with the billing system – SA Pathology does private pathology work as well as public – and procurement of laboratory instruments and robotic tracks has yet to be finalised.

Budget bottom line

In terms of budget blow-outs, the auditor-general warns that the problems with the EPAS roll-out may affect the EPLIS bottom line.

“The new RAH laboratory was designed on the assumption that electronic pathology ordering would be received through EPAS,” he writes. “At the time of our review, SA Health was working on identifying the extent of work and cost of this solution. In addition, the source of funding to deliver this functionality is yet to be determined.

“Should this functionality not be delivered in time for initial operation at the new RAH, a suitable contingency is required.”

More money will need to be found to archive legacy data from Ultra, which could cost up to $3.6 million, and up to $5 million extra may need to be found for a secondary data centre solution for disaster recovery. The original plan only accounted for a single data centre solutions.

“Given the project time frames and the minimal contingency funds remaining for the remainder of the project, there is a high risk that SA Health will not have sufficient approved funding to support the implementation of the new EPLIS and its ongoing operations,” he warns.

And finally, there are problems with the legacy Electronic Data Interchange (EDI) solution, which is used to send pathology results and reports from Ultra to GP and specialist desktop software. It is also used to send reports Flinders Private Hospital and some other external requestors, and acts as a gateway service to send medical imaging reports to GPs from the existing RAH, the Women’s and Children’s Hospital, The Queen Elizabeth Hospital and the Lyell McEwin Hospital.

Private practitioners will need to continue to use EDI as EPLIS does not have the functionality to directly interface with private medical practice software through its external interface engine, the auditor reports.

A replacement solution is being sourced but in the meantime, EDI will be retained. “From an SA Pathology business perspective, we were advised a long-term interface solution is imperative to provide private clinicians not only with the ability to view pathology results, but to also order pathology results electronically. At the time of our review, we were advised that a solution has yet to be determined.”

In conclusion, the auditor-general found that the EPLIS program has experienced a number of interruptions and changes that can be attributed to delays in governance approvals, inadequate early program planning and portions of time when the program was put on hold.

And despite modifying the implementation approach and the announcement of the new RAH opening delay, there is still a risk that EPLIS will not initially be fully operational as per the program’s implementation schedule, he found.

“In terms of the new RAH, the program schedule is dependent on other SA Health programs and vendor requirements. There is also significant change facing new RAH pathology staff in transitioning to the new hospital environment.

“Given these challenges, significant focus will be required on the business change management strategy and tasks to ensure a fully functional implementation is finalised in a timely manner. These tasks include interface integration of key components, close monitoring of the status of pathology hardware procurements, proactive monitoring of resourcing as the program progresses and thorough contingency planning.

“There is minimal contingency funding available for the remainder of the program and recently a number of additional activities have been identified. These activities are required to produce the planned EPLIS functionality, support ongoing operations and ensure benefits are realised through a successful transition.

“We consider that the program may require additional funding to complete all program necessities, with expected benefits potentially delayed.”

Announcement on steering committee for ACeH ‘imminent’

The membership of a taskforce that will lead the transition of the operation and control of eHealth to a new independent commission will be announced ‘imminently’, Pulse+IT understands.

The implementation taskforce was promised by Health Minister Sussan Ley in the May budget, with a Department of Health (DoH) discussion paper stating that it would be established in July.

Pulse+IT understands from two sources that the names of the members of the taskforce are set to be announced imminently, with the committee having met on the quiet last week. It was expected that the names would be announced last Friday.

A DoH spokesperson would only say the members’ names were due to be announced ‘shortly’.

“An Implementation Taskforce Steering Committee is being established to lead, oversee and establish the structure, governance and operations of the Australian Commission for eHealth,” the spokesperson said.

“It will bring together clinicians, public and private healthcare service providers, consumers, health informatics and analytics specialists, technology innovators and people experienced in delivery of digital health services to design and guide the transition to the arrangements.

“The membership of the Steering Committee will be announced shortly.”

The move to a new agency to oversee all national eHealth systems was a recommendation of the Royle review into the PCEHR in 2013. It recommended that ACeH be set up to not only oversee the governance of eHealth in Australia but to take over operational control of the PCEHR from the Department of Health.

It also recommended that NEHTA be abolished, which the government has agreed to.

Ms Ley introduced legislation into parliament on September 18 that will abolish two advisory committees overseeing the governance and operation of the PCEHR. The legislation also renames the system as My Health Record.

According to the DoH discussion paper, ACeH will be established as a new corporate Commonwealth entity through rules made under the Public Governance, Performance and Accountability Act 2013 (PGPA Act) and the PGPA Rules, with a proposed commencement date of July 2016.

Aged care to revert to Health after two years with DSS

The federal government will bring responsibility for aged care back to the health portfolio two years after it was moved to the Department of Social Services.

Health Minister Sussan Ley was today sworn in as minister for aged care and said in a statement that newly appointed assistant minister for health, WA MP Ken Wyatt, would have a specific focus on aged care.

Fairfax Media is reporting that public servants working on aged care issues will now move from the Department of Social Services back to the Department of Health.

Aged care was cut from the then Department of Health and Ageing when the Coalition government was elected in 2013. The previous government had a dedicated minister for ageing as part of the portfolio.

Ms Ley said she had “proactively put [her] hand up to bring responsibility for aged care back to health and give it a seat at the cabinet table”.

“Aged care is more than just residential aged care homes or facilities – after all only one in 11 Australians aged over 70 actually receive permanent residential care,” she said.

“Studies have shown people are most comfortable when they can spend as long as possible in their own homes and communities … I believe that we can support older Australians – and indeed their carers – better. A key factor in this support is how our aged care services integrate and complement our health services.

“Bringing the aged care portfolio to sit alongside the Ministries of Health and Sport will complement our integrated health system. We know aged care plays an important role in the overall health system and this move will benefit all Australians, particularly those over the age of 65.”

In a joint statement, shadow minister for health Catherine King and shadow minister for ageing Shayne Neumann said the backflip vindicated a two-year campaign by Labor to get the government to take the portfolio seriously.

“After two years of neglect by the Liberals, responsibility for ageing will now be returned to the health portfolio after what has been an unnecessary, expensive and disruptive move by the Liberal government,” they said.

“Former Prime Minister Tony Abbott refused to appoint a stand-alone Minister for Ageing, tacking responsibility for this vital sector on to the social services portfolio. So did new Prime Minister Malcolm Turnbull.

“Now, two years after an expensive and disruptive move into the Department of Social Services, the Liberals are set to spend millions more returning ageing to the Department of Health.”

They also drew attention to a claim last week by new Minister for Social Services, Christian Porter, that he had been given responsibility for aged care.

The DSS aged care division is currently rolling out massive changes to aged care policy as part of the Labor government’s Living Longer Living Better policy, which has been adopted by the Coalition.

Community and home aged care provision has been shaken up with a number of assistance packages brought together under the new Commonwealth Home Support Program (CHSP). DSS has also been rolling out the My Aged Care Gateway project, which provides a central point of contact for all people receiving federally funded aged care services and their carers.

This includes the establishment of a My Aged Care contact centre and the development of a central client record and electronic referrals for aged care assessments, which has been criticised recently by both GPs and the aged care sector for slowing up the referral process.

In its most recent newsletter to the aged care industry, issued this week, DSS said it acknowledged that the contact centre and referral process “has not operated at acceptable levels of performance in the early weeks of transition”.

“The Department has sought to be highly responsive to these issues,” it said. “The IT system is now largely stable and additional contact centre staff have been recruited and trained. Call volumes and inbound referrals are reaching acceptable standards and a focus on the quality of a client’s end-to-end journey is now the key focus.”

Leading Age Services Australia (LASA) CEO Patrick Reid welcomed the elevation of aged care to cabinet, but warned that the sector must not be viewed purely through the prism of medical care.

“Age services is the biggest growth industry in Australia, and its impact on our health system cannot be ignored if we are to keep up with the increasing demand for these services,” Mr Reid said.

“Hospital costs are the highest for people aged over 75 years, but many hospital beds are taken up by people who do not need acute medical care but services which could and should be provided in their homes or care facilities.

“A cabinet minister responsible for Australia’s ageing portfolio can ensure that providers, residents, their families and those who receive care in the home get the best possible outcome for their health, wellbeing and quality of life.”

Mr Reid said the biggest question on everyone’s mind now would be how the move will affect My Aged Care and the other reforms underway.

“LASA seeks a commitment from Minister Ley that government processes will not derail or stymie the reform process, nor provide an excuse to avoid the issues emerging from these changes,” he said.

Vensa Health to digitise communications with TXT2Remind v4

Vensa Health is gearing up for the launch of version 4.0 of its TXT2Remind practice-patient messaging system, which has five new features that the Auckland-based company hopes will automate most if not all routine communication to patients.

The company is also planning to use some of the funding it received through a Callaghan Innovation growth grant to begin building new technology for the nascent “health care home” or “medical home” concept that four of the largest PHOs have recently submitted to the Ministry of Health.

The new release of TXT2Remind will be available from September 10, with 100 sites having pre-ordered. Vensa Health CEO Ahmad Jubbawey said the company was scaling up its network in anticipation of those 100 sites going live and an expectation that most of the other general practices in the country will come on board in the next 12 months.

Vensa Health boasts over 650 general practice customers, or 65 per cent of the market. Many PHOs or DHBs buy the service on behalf of their practices as one way in which to achieve Integrated Performance and Incentive Framework (IPIF) targets for smoking cessation, immunisation, cervical screening and heart and diabetes checks, but also to improve communications between practices and patients.

The five key new features are a campaign manager, patient initiated text, updated appointments confirmation, PMS auto update, and improved recalls.

“The new features are designed to essentially digitise all practice communications,” Mr Jubbawey said. “We’ve introduced five key features and the theme of it is automation and digitisation.

“We’ve got practices around the country now that have gone entirely digital and we want to move the whole industry forward. TXT2Remind 4.0, at its core, is designed to take away all of that administration work.”

Vensa Health says the new campaign manager automates the health target process, such as updating smoking status and read-code classifications. The new patient-initiated text feature enables patients to text-in requests for repeat scripts and appointments, which traditionally account for 80 per cent of all incoming phone calls into the practice.

The updated appointments confirmation feature will also enable patients to confirm or decline their appointment via text, and this will automatically be updated and colour-coded in the practice appointment book.

The PMS auto update feature will automatically file messages against the patient outbox or inbox to allow practices to keep a record of all sent and received communications, and the improved recalls feature now supports bulk recalls for all screenings and vaccination groups.

While some practices would baulk at allowing patients to text in requests for an appointment or script refill, Mr Jubbawey said only patients that have had previous communications from the practice would be allowed to use the patient-initiated text feature, and even then it was up to the practice.

“If the practice wants to enable it all they have to do is essentially tell patients to save the number on their phone and to text in rather than call,” he said. “Those texts can be redirected to any person inside the practice team based on the configurations that they set out.”

The bulk recalls feature will enable practices to send out recalls to target groups just with one click and to remove or at least decrease the most annoying jobs for practice nurses or reception staff.

Patients opt in to receive messages through a consent process that Mr Jubbawey estimates about 70 per cent of practices use.

“The patient consent process is a mass broadcast to the whole population and by doing that we know who doesn’t want it or who is no longer valid as a patient or who has a mobile number that has changed,” he said. “We provide the practices with all of the templates and we have been careful about disclosing too much information in the messages.”

He said the improved recall feature would help automate the process of achieving IPIF targets. These include getting patients in for more heart and diabetes checks, which has a national target of 90 per cent of the relevant enrolled population; better help for smokers to quit (national target of 90 per cent); increased immunisation for eight-month-olds (95 per cent) and two-year-olds (95 per cent); and cervical screening (80 per cent).

“With our campaign manager, you can run a smoking campaign for all of your current smokers, if they’re interested in receiving brief advice,” Mr Jubbawey said. “If they are, those responses come back and they automatically update the PMS. For those that decline or for those who are no longer a smoker, this will help those practices achieve those targets a lot sooner.

“The smoking campaign needs to be done every year and is the one that causes PHOs a lot of stress. This is just taking that stress away from the practice.”

Vensa Health will be concentrating for the next year on supporting v4.0 and signing up PHOs and practices not using the system, but it will also be working on some new technology that it has in the pipeline.

The company recently received a growth grant from Callaghan Innovation that will be used to support its R&D activities for the next three years, which will focus on the new health care home model of care that is increasingly favoured by PHOs.

Earlier this year, four of the largest PHOs – ProCare, Midlands, Compass and Pegasus – put forward a business model to the Ministry of Health to introduce the health care home model to New Zealand on a national basis.

Based on the medical home concept developed in Seattle and widely used in Washington state and Idaho, the health care home aims to use technology to improve primary health care provision, including web access to patients’ medical records, using secure messaging between patients and practitioners and providing online prescription refills.

While the patient portal program backed by the National Health IT Board provides this sort of technology, the health care home model is about a lot more, and Vensa Health hopes to play a part, Mr Jubbawey said.

“That model essentially changes the way primary care offers services,” he said. “It’s more nurse-centric, more pharmacy-centric, more care management-centric and less transactional.

“With this whole paradigm movement, we want to lead this movement from the front when it comes to digital communications with patients and how those teams are going to be communicating with their population.”

While what Vensa Health is planning will overlap somewhat with the patient portal idea, that is not what his team plans to build, he said.

“We are out to build essentially a marketplace platform for people and their health providers to receive health care in a whole new way. That’s the future of healthcare and it’s where we making rapid investments. We think that by 2016, there will be something that Vensa will go to market with.”

CAReHR adapted for children in out-of-home care

The Clinical Audit Research electronic Health Record (CAReHR) developed by Melbourne firm Arcitecta for Melbourne’s refugee health network has been adapted for use to securely share health information about children and adolescents in out-of-home care.

Victoria currently has more than 6400 children and young people living in out-of-home care such as foster care or kinship care. Under the Pathways to Good Health project, overseen by the Department of Health and Human Services, children entering out-of-home for the first time are given a medical assessment by a paediatrician and other members of a multi-disciplinary allied health team.

Doctors, mental health clinicians and speech pathologists can use CAReHR to create health assessments and treatment plans for children that can be accessed across a number of sites and as the child moves through different parts of the health and social care system.

Predominantly focused around north-west Melbourne, the project involves health services such as Dianella Community Health, Travancore, the Royal Children’s Hospital and Djerriwarrh Health Services, which operates the Bacchus Marsh & Melton Regional Hospital along with a number of community clinics and aged care services.

Clinicians can use CAReHR to generate health management plans and health summaries that can be sent to the child’s carer and general practitioner, and to identify health trends and health interventions needed for children sharing common conditions from de-identified clinical information.

Djerriwarrh Health Services acting CEO David Grace said the child’s GP is kept in the loop but on many occasions children entering out-of-home care don’t have a regular GP and there is little information on them.

“In the past we have been doing assessments without any additional information, and this is what this system helps with in particular,” Mr Grace said. “If there has been other healthcare assessments done in the past then this will allow us to have access to that information and it allows others that require access to that information in the future.”

In addition to medical assessments, it can store assessments from audiologists, speech therapists and mental health workers.

The system is based on Arcitecta’s Mediaflux technology, a data management platform that is able to manage any type of structured or unstructured data through the capture and storage of metadata fragments, stored as encoded XML.

Mr Grace said one of the key benefits of using CAReHR is that it provides a consistent database of health information and management plans for children in out-of-home-care.

“These children have undergone a comprehensive multidisciplinary assessment using a consistent approach, with the resultant information entered into CAReHR,” he said.

“The areas of assessment include physical health, development, speech and language development, communication, and mental health and wellbeing. This information identifies areas that require further assessment or intervention, and/or treatment.

“Previously unrecognised areas of concern are often identified and able to be addressed at the time of assessment, expediting early referral to appropriate services.”

For the refugee health network, CAReHR is used to share and store information but also for research purposes on emerging infectious disease trends. Arcitecta chief technology officer Jason Lohrey said CAReHR can be easily configured by the clinicians and hospital administrators who use it and it can be adapted to any patient group or clinical service.

“This is a key point of innovation with CAReHR and one that arises from our collaboration with the clinicians involved in its design and those seeking a better way to manage patients with multiple health conditions,” Mr Lohrey said.

Emerging Systems to integrate Charm into EHS

Sydney-based clinical information system vendor Emerging Systems has signed a memorandum of understanding to form a strategic alliance with Brisbane-based oncology software specialist Charm Health which will see Charm integrated into Emerging Systems’ EHS acute care system.

Emerging Systems was bought by Telstra Health in December last year and is best known for its long-term client St Vincent’s Hospital in Sydney, where EHS is known as De Lacy.

St Vincent’s was the first hospital and EHS the first clinical information system to connect to the PCEHR.

According to Telstra Health, the integration of the Charm system into the Emerging platform will enable hospitals to provide a more comprehensive medical record for cancer patients, including populating e-discharge summaries for GPs and uploading into the PCEHR.

Emerging Systems’ managing director Russel Duncan said the formation of this partnership would help build on the ambition for a connected healthcare system to deliver better results for patients.

“Telstra Health has built its strategy on connecting and integrating the various components of the health system,” Mr Duncan said in a statement.

“This partnership is another example of bringing that strategy to life, making it easier for hospitals by removing the worry about needing to tailor solutions to ensure interoperability, while also allowing better information sharing across the continuum of care, including hospital, primary and ambulatory care settings.”

Charm Health’s flagship product has multi-site functionality that can manage the clinical and administrative coordination of a patient’s cancer care. The specialist software has about 45 deployments to Australian public and private cancer care providers.

Charm recently signed a master licensing agreement with private hospital operator Healthscope to allow any Healthscope hospital offering oncology services to licence the product and take advantage of a new rapid deployment methodology it has developed.

Charm Health CEO Gary Lakin said the arrangement with Emerging Systems would make Australian-based health IT solutions more appealing in a market that still has a tendency to be drawn to international solutions requiring significant changes to fit Australian conditions.

“We’re a proud Australian company with an intimate understanding of Australian health requirements,” Mr Lakin said. “Working with Telstra Health provides a chance to build on this and offer a better solution for Australian cancer patients and hospitals.”

In addition to St Vincent’s Hospital in Sydney, EHS is being rolled out to the other St Vincent’s Health Australia public and private hospitals and is also being implemented by St John of God Health Care.

It is set to go live when the new St John of God Midland Public opens in Perth later this year. The hospital is replacing the Swan District Hospital and is due to open in November.

PCEHR consultation report released, Deloitte refresh delayed

The Department of Health has publicly released a report compiled by Deloitte Australia summarising the outcomes of a series of public consultations held last year about the recommendations of the Royle review into the PCEHR.

Deloitte and the department held 37 consultation workshops around the country between July and September 2014, along with an online survey. The workshops were aimed at gauging the opinions of consumers, healthcare providers, software vendors and other stakeholders about the recommendations of the Royle review, completed in December 2013 and released publicly in May 2014.

The results were used to inform the federal government’s plans for the PCEHR, including whether to retain the system, whether to move to an opt-out model, how to increase participation in the system by both consumers and providers and any new functionality that would be considered useful.

While the consultation report was made available (PDF) this month, Deloitte long-awaited refresh of the 2008 national eHealth strategy has not. A draft of the refresh was provided to the PCEHR review panel, but according to a spokeswoman for the department, the full strategy is still being developed.

“The eHealth strategy is a national strategy and is the result of collaboration between the commonwealth and state and territory jurisdictions,” the spokeswoman said.

“Work is currently underway with states and territories to finalise the national eHealth strategy which will include updates to reflect the recent federal budget announcements in relation to eHealth.

“The eHealth strategy will then require consideration and approval by the commonwealth and state and territory health ministers before being published, potentially later this year.”

In this year’s federal budget, the government tipped in an extra $485 million to keep the system going for the foreseeable future, but said it planned to change the name to My Health Record, set up a new Australian Commission for eHealth to replace NEHTA, and most importantly to change from an opt-in to an opt-out system, which will require a number of legislative changes.

The department recently released a discussion paper on those changes, with submissions closing last week.

To date, submissions made publicly available include those from the Royal Australian College of General Practitioners, the Australian Primary Health Care Nurses Association, the Royal Australian and New Zealand College of Psychiatrists, and the Australian Privacy Foundation.

Consultation report findings

Deloitte’s public consultation paper states that the “overwhelming conclusion” from the workshops was that a significant majority of those consulted supported the concept of the PCEHR and wanted to see much more widespread use.

There was also a great deal of support for the recommendations of the review panel, including support by consumers for a move to an opt-out model and for the access and privacy controls already existing in the system, even if few of them planned to use them.

And while clinicians also overwhelmingly said opt-out would remove some of their concerns over the efficacy of the system, they said a move to an opt-out model by itself would not deliver meaningful use.

Instead, clinicians were convinced that any benefits from the PCEHR would arise from a “virtuous circle” of contribution by other clinicians.

“Meaningful use will only come through the utility of the record and everybody in the continuum of care contributing in a virtuous circle to the record,” the report states.

“Concerns were regularly expressed amongst providers, that moving to an opt-out model will result in the majority of consumers having a record but will not in itself drive meaningful use by providers or consumers.

“Meaningful use will only be driven by the record delivering value to providers and consumers. Providers will receive value from the record if it contains useful content that assists in the delivery of care and when the record is easy to access and use.

“GPs, in particular, feel that they are the primary contributors to the record to date and that they derive limited benefit from this contribution. Other clinician groups (in particular allied health) have limited capacity to contribute but would like to do so.”

The highest priority for both providers and consumers was getting the content right, and this meant the inclusion of accurate and up-to-date alerts, allergies and medications. The report states that while there is a number of medications information sources in the PCEHR, including PBS data, event summaries, and prescription and dispense data, this is very difficult to reconcile into one list of current medications.

Clinicians also had concerns about the utility of the system, which the report says were primarily driven by the poor integration that software vendors had implemented.

“This has resulted in very little automation of the accessing of PCEHR information and poor alignment to clinical workflows resulting in impacts on provider time and making it difficult for providers to find information and to upload information,” the report states.

“While some software providers have since improved their software, these initial versions have left a poor impression with many providers resulting in them being reluctant to continue to try to use the PCEHR.

“It will be critical to address these issues of record utility prior to a move to an opt-out model to remove the barriers to provider participation. If the system remains difficult to use when and if an opt-out model is introduced, providers will remain reluctant to use the record and consumers will not realise the benefit of having a PCEHR.”

Software vendors for their part wanted an end to the stop-start process for implementations and specifications, sufficient lead time to test standards compliance, and a robust, transparent black-box testing process.

They also felt their expertise in the development of standards and specifications had been ignored.

What they wanted to see was a clearly defined roadmap of the planned PCEHR development over the next three to five years describing when new functionality will be implemented in the PCEHR, when new standards are available or standards will be changed and when standards compliance will be required “with sufficient lead time for development and testing”.

“Vendors are willing to innovate around the PCEHR and implement new functionality to use the data in the record, but ultimately this will be driven by the demands of their users,” the report states.

“In the absence of this they appear to have little incentive to undertake the cost of functional development. To enable innovation, vendors will need easy access to increasingly atomic data from the PCEHR through infrastructure that supports traditional and mobile device access and will also need to understand a more clearly defined (and adhered to) roadmap for the planned development of the PCEHR.”

Summary of findings

CSIRO connects Remote-I to satellite broadband

The CSIRO has been successful in a project testing whether it can use its Remote-I tele-ophthalmology service over satellite broadband, screening over 1000 patients in remote areas for conditions such as diabetic retinopathy and glaucoma.

It has also licensed the technology to US firm TeleMedC, which plans to integrate it into its EyeScan diagnostic solution, which is currently being used by NASA at the International Space Station for the assessment of intracranial pressure in astronauts.

The award-winning Remote-I, which has been developed over the years by a team from CSIRO’s Australian E-Health Research Centre (AEHRC) led by Yogi Kanagasingam, has been used since 2011 to deliver early screening to patients living and working in remote areas of Western Australia such as mines and indigenous communities.

It uses a mixture of advanced imaging, video conferencing and store-and-forward technologies to connect metropolitan-based eye specialists with nurses and Aboriginal health workers in the field, but there were some doubts that it could be successfully used considering the latency issues facing satellite broadband.

In 2013, the CSIRO was awarded $2 million under the NBN-enabled telehealth pilots program to screen patients in Western Australia, Queensland and the Torres Strait and also to do a technical assessment to determine the efficacy of satellite broadband in delivering telehealth.

During the project, 68 patients were identified as at high risk of going blind, including those with macular oedema.

Remote-I captures high-resolution images of a patient’s retina with a low-cost retinal camera, taken by a local health worker. The images are then uploaded to the cloud, where metropolitan-based specialists can view them on a tablet or desktop computer.

Consultant ophthalmologist for the project, Mei-Ling Tay-Kearney, said that once the image was uploaded, specialists were able to access it anywhere at any time.

“It takes me about five minutes to read the images, create the report, and then send it back to the health worker,” Dr Tay-Kearney said.

Professor Kanagasingam said that after the successful trial with WA and Queensland, his team was looking to see how it could work with governments and health care providers to roll the technology out to other states and territories.

The team has licensed it to TeleMedC, which focuses on ophthalmic medical imaging devices and smart diagnostic software for screening and management of chronic diseases and eye conditions.

TeleMedC plans to take the technology to the US and world markets, TeleMedC CEO Para Segaram said.

“We’ve had a great experience working with the team at CSIRO, and licensing Remote-I has helped us make basic eye screening more efficient and affordable so we can reach as many people as possible,” Mr Segaram said.

Professor Kanagasingam and his team have also won an NHMRC development grant to create an algorithm that can automatically identify all the pathologies related to diabetic retinopathy. Trials of this technology will be undertaken to see how it supports current and new referral pathways for patients.

NBN Co plans to launch the first of two long-term satellites this year, which will provide broadband to over 200,000 homes and businesses in remote areas of the country.