Holiday reading: Mobile Health

Pulse+IT is taking a break from daily news reporting for the festive season but will return on Monday, January 5.

If you are after some holiday reading, you may like to review our 2014 Mobile Health magazine online below. This and other editions of Pulse+IT are available via the ‘Magazines’ menu at the top of this site, and also via the Issuu app for iOS and Android devices.

Telstra to launch direct-to-GP, 24-hour telehealth service

Telstra Health has announced a joint venture with Swiss company Medgate to establish a new telehealth service called Telstra ReadyCare in which patients can consult directly with GPs over the phone or by video conference 24 hours a day.

Telstra also announced it was partnering with the Northern Territory government to build a National Telehealth Connection Service, including scheduling capabilities, that will initially provide telemedicine services to deliver health services to people in remote communities with the potential in future to be offered nationwide.

The new ReadyCare service could work with other services such as the nurse-led hotlines provided by Healthdirect Australia, which is funded by the state governments. Healthdirect has been investigating adding video conferencing to its service portfolio, including the potential to use WebRTC. There is also the potential in the future for GP to patient services to be MBS-funded.

Telstra Health managing director Shane Solomon said that while there were a number of options for funding the service, including offering it through private companies for employee healthcare, partnering with health insurers and offering it eventually to GPs in private practice, the full details had not yet been worked out.

Telstra’s group executive for retail, Gordon Ballantyne, said ReadyCare would involve employing GPs to do the consultations. One major point of difference is that ReadyCare will be able to offer online diagnostic services, electronic prescriptions and specialist referrals as well as advice.

Medgate has been providing telemedicine services in Switzerland for 13 years, with a central Medgate Telemedicine Service providing telephone and video consultations for minor ailments. It has developed an app that allows patients to take a photo of skin conditions, for example, and send them to a Medgate doctor, and it also allows patients to order medications.

It also has a partner network that allows patients to access high-definition video consultations with a Medgate doctor in their local pharmacy. Services are paid for by health insurance.

While it is still early stages yet, Mr Solomon said he envisaged Telstra ReadyCare would become a national service that would complement the services GPs deliver. As with medical deputising services, notifications of any consultations done with a ReadyCare doctor will be communicated to the patient’s regular GP.

He also said the service could be offered to GPs to use as their telehealth platform in their own practice. The platform includes telemedicine-specific call management, forecasting and demand management, productivity, patient management software, protocols and performance management.

For the National Telehealth Connection Service, Telstra has been working with the Northern Territory Department of Health, which was chosen by the National Health CIO Forum to lead the development of the service.

It will involve coordinating clinical-grade video conferencing and scheduling services with metropolitan specialists initially for Aboriginal health and people living in remote communities. Building on the NT’s existing infrastructure, the service is already operating in community health centres in Tennant Creek and Santa Teresa, an Arrernte indigenous community near Alice Springs.

The plan is to eventually offer it for specialist consultations to rural areas on a nationwide scale.

Telstra Health also announced that the in-home monitoring platform it has been building with RDNS in Victoria has been chosen by Silver Chain, Western Australia’s visiting nursing service, for its hospital in the home and specialist nursing care services.

Mr Ballantyne said it would involve hospital medical staff having access to a secure portal to keep track of the services provided by Silver Chain and remotely monitor changes in the patient’s condition.

At the launch of the three new services in Sydney today, Telstra revealed that it had invested $100 million in its health division over the last year. This includes acquisitions and partnerships such as those with Fred IT, HealthConnex, HealthEngine and Verdi.

It has also invested in the UK’s Dr Foster as part of its health analytics and big data division, which prominent neurosurgeon Adrian Nowitzke is heading up.

Mr Solomon said Telstra’s move into the healthcare sector was about using technology and connectivity to tackle mainstream health system issues, predominantly at the chronic illness rather than acute end of the sector.

“We are determined not just to buy products and flog them,” he said.

Hossack heads MSIA as it enters 20th year

Extensia CEO Emma Hossack has been elected as the new president of the Medical Software Industry Association (MSIA) as it gets set to celebrate its 20th year in 2015.

At the MSIA’s annual forum and general meeting last week, a new board was elected to see the organisation through the next two years, with a focus on strengthening the MSIA as a respected and representative voice for the industry and organising a celebration of its 20th anniversary.

Ms Hossack, who takes over from immediate past president Jenny O’Neill, said the MSIA had attracted a number of new members to the board who will complement the more experienced members.

“This reflects the growing stature of the MSIA as a trusted voice for the healthcare software industry,” she said.

The MSIA’s part-time staff of Vince McCauley, Marg Prichard and John Green, along with CEO Bridget Kirkham, were recognised by the membership for their dedication and hard work with a loud round of applause, she said.

Guest speakers at the forum included Navy Design, Opaque Media, CSIRO, NICTA and Simulation Australia.

The Andrew Magennis Award for outstanding service to the industry was presented to Richard Hutchinson from Emerging Systems.

The new board is:

Ms Hossack said the aims of the MSIA included keeping a strong focus on member benefits, strengthening the MSIA as a respected and representative voice for our industry, increasing member engagement in working groups and stakeholder groups, providing greater transparency of the MSIA projects and outcomes to members, and improving the financial position of the association for the future.

UTS hosts social robotics conference as Woz joins faculty

A special session on social robots for therapeutic purposes will be held at next week’s International Conference on Social Robotics (ICSR 2014), being hosted by the University of Technology, Sydney (UTS) from Monday.

The University of Auckland’s Robotics Research Group, led by Bruce MacDonald, will present results from randomised cross-over trial it has conducted using robots in older people’s homes to improve medication adherence and quality of life, as well as the development of brain training games for a healthcare service robot for older people.

UTS itself has a robotics faculty that includes leading researchers in mechatronics and robotics for health applications, robots at home, and autonomous wheelchairs and assistive technologies, including Gamini Dissanayake, Hung Nguyen and Mary-Anne Williams. Professor Dissanayake will present at ICSR 2014 on a novel, collaboratively designed robot to assist carers.

Other presentations will look at the effect of a social humanoid robot as a therapy assistant in cancer treatment for children, and examining social cognitive mechanisms of individuals with autism observing robot and human faces.

University of Birmingham bioethicists Simon Jenkins and Heather Draper will discuss robots and the division of healthcare responsibilities in the homes of older people.

The conference is being held at the Powerhouse Museum in Ultimo from October 27 to 29.

UTS has also announced that Apple co-founder Steve Wozniak has joined the university as an adjunct professor.

Mr Wozniak is working with staff and students in the Magic Lab at UTS’s School of Software and Centre for Quantum Computation and Intelligent Systems, led by Professor Williams.

“Woz loves the energy, the vibe and the robots in the Magic Lab,” she said.

According to Professor Williams, Wozniak is the “coolest person in the universe” and provides an exceptional inspiration for UTS students.

“He beams in on our telepresence device to chat with students, share his latest ideas and entertain with jokes and the occasional prank,” she said.

“Woz constantly highlights the new possibilities for technology to change the world and enjoys sharing his insights and experiences. The students have been totally wowed by the attention he has given them – one claiming he had changed her life in less than 60 seconds.”

Woz is expected to arrive for his second visit to the UTS city campus in December, she said.

Opinion: It’s time to get involved in eHealth

This story first appeared in the August 2014 issue of Pulse+IT Magazine.

Former AMA president Steve Hambleton was appointed chairman of the National E-Health Transition Authority (NEHTA) in June, and was a member of the three-person panel that conducted a review of the PCEHR for the federal government late last year. The review’s report, released in May, recommended a number of changes to the national eHealth system, including the dissolution of NEHTA.

What is eHealth? It is probably one of the sector’s most discussed and yet misunderstood terms. This is disappointing because few developments over the coming years will have as much impact on how patient care is delivered.

I believe an effective eHealth system is essential for Australia. A huge amount of investment has gone into IT in this country, and I think there is a real opportunity to make sure we leverage off the investment we’ve made so far and get outcomes that are meaningful.

NEHTA has delivered the solid foundational products that we need including individual healthcare identifiers, medicines and disease terminology, secure messaging, and the infrastructure. This has, in effect, created the national eHealth rail gauge (and some of the rolling stock) for securely transporting and sharing clinical information.

Much of the planning and development conducted by NEHTA since 2005 has now been delivered. However, it’s too simple to define the promise of eHealth by the complex technologies that will enable and support connected care. This is ultimately not about technology; it’s about people. People like you and me, people that share the eHealth goal of safer, quality healthcare for all Australians.

I strongly believe we are on the verge of something that will be fantastic for our health system and will deliver some of the long-term structural savings that we really need. NEHTA’s outputs and standard setting over the past nine years have set Australia up for the 21st century. Widespread adoption and utilisation of those standards and protocols will allow us to communicate better and gain efficiencies across the sector.

This is a watershed moment for our health system where the points of care can finally be connected, and deliver safer, better quality care with fewer errors, and ultimately, fewer lives lost.

I was fortunate enough to be part of the government’s review panel, chaired by Richard Royle, into the implementation and uptake of Australia’s PCEHR system. When the review was released in May, it contained 38 recommendations to address shortcomings of the system and make it more effective for doctors and patients.

Overall, we found strong support for continuing to develop and implement a consistent and effective shared electronic health record for all Australians. The government is currently in consultation with key stakeholders to understand the issues and consider the implications of the recommendations. It is important to note that the feedback I am getting from government is also positive and shares my view that eHealth has a strong future.

To read the full story, click here for the August 2014 issue of Pulse+IT Magazine.

Opinion: Cloud is more secure than traditional networks

Australian companies are keen to embrace new technologies and despite ill-informed perceptions of cloud security limitations, adoption of cloud solutions continues unabated.

In fact, as indicated in a recent Forbes article, Oracle Australia and New Zealand managing director Tim Ebbeck believes that advances in the cloud are driven by companies’ belief that the cloud aids success in a global marketplace.

However, some are reluctant to place data in the cloud, believing that the resulting lack of admin control, which can vary from provider to provider, can result in security lapses.

This is not the case. The benefits in efficiency can outweigh any disadvantages, allowing on-site IT staff to concentrate on internal tasks. OS updates, a significant drain on IT resources, are automatically handled by remote staff, for example.

Selecting a third party cloud provider may seem a daunting task but a little research can yield positive results.

Companies in the public and private sectors in Australia must adhere to legislative requirements, especially in the area of data privacy, with the main consideration being the Privacy Act 1988. In March 2014, 13 new Australia Privacy Principles (APPs) were introduced, two of which directly relate to the cloud.

APP8 regulates the transfer or disclosure of personal information outside Australia’s borders and APP11.1, which requires that companies take “take reasonable steps to protect the personal information it holds from misuse, interference and loss and from unauthorised access, modification or disclosure”.

Providers of cloud services also use encryption to secure data and many are industry certified. For example, ISO certifications holders have passed an independent audit by experts in accounting, auditing and data security, with all policies and procedures tested and evaluated.

Clearly, there are other considerations when dealing with medical records, with data loss and recovery options absolute minimum requirements. Again, top tier data centres meet requirements, with multiple back-ups and disaster recovery solutions in place to prevent loss of information.

In addition, the physical security practices of the data centre are audited, to ensure on-site staff cannot access privileged information and that intruders cannot use low-tech hacking techniques to acquire data.

User permission management ensures that only authorised staff can access medical data, with software and hardware encryption at all stages of the process. In addition, secure file and folder controls prevent successful hacking attempts.

Once all of these conditions are met, under conditions that exceed those required for on-premise networks, cloud security concerns are eliminated. However, it is recommended that service-level agreements (SLAs) are analysed carefully to ensure adequate disaster recovery solutions are included, with some charging extra for off-site tape back-up, for example.

Cost is not the most important consideration when selecting a cloud provider. Instead consider the importance of securing medical data and choose a solution that exceeds those requirements, allowing a certain level of future proofing as technology advances to improve process efficiency.

Cloud considerations

There are specific factors to consider when deciding which cloud provider you wish to use. The first and most important factor is to ensure that the data centre used is located in Australia and has passed through all the relevant audits, as well as having met all the required standards.

A data breach represents a disaster for any business and likewise for any cloud technology vendor. A good start in assessing what security strategies the vendors offer is to ask how they keep your data separate from other companies’ data. Ask whether your company will share the same virtual server or application server with others, and finally, ask how the vendor can ensure that people without the right credentials aren’t able to access your data.

The second factor to consider would be the type of cloud service being offered by the provider. Not all cloud computing solutions are the same and they differ from one vendor to another. Some providers may offer a remote desktop-like solution (log into a virtual desktop) from a single data centre whilst other providers with more capabilities will be able to offer a complete cloud platform with redundant data centres, faster platforms and so on. We always recommend that you try the platform before committing to using it.

Another factor to consider would be to establish whether your local technology infrastructure could support a cloud-based environment. Whilst a cloud platform is hosted within high-end data centres, there are certain requirements that must be met so you can have the best possible user experience.

Some of those requirements include the Internet speed available to the business and whether it’s enough to handle the number of cloud users within your organisation.

Not requiring super computers or a server is a great benefit of using a cloud-based platform, yet a requirement that tends to be forgotten is the local hardware that is currently used. There needs to be an assessment by the vendor to confirm that the router, network cables, printers, scanners and end user devices are all sufficient to deliver the best cloud user experience.

There is no doubt that the cloud revolution is well on its way in Australia and we have some of the best security laws, technologies and resources in the world. We see new emerging niches with cloud-only IT vendors or cloud-based health businesses venturing all around Australia.

This only brings opportunity and competition to a very exciting marketplace. As we are aware, an increase in competition will bring quality in service with it.

Rob Khamas is an eHealth solutions strategist with REND Tech Associates.

Fear and loathing in the early days of patient portals

Not-for-profit health IT organisation Patients First has released a review of the New Zealand patient portal market, finding that while the technology is now readily available and is beginning to be adopted, there are many barriers to be overcome, including what a consumer representative characterised as “fear and loathing” from healthcare practitioners.

The review, the first in a series of four planned briefing papers, does not use the scoring system used in Patients First’s previous review of practice management systems (PMSs) as portals are still considered a nascent technology.

Instead, it provides an overview of what functions are currently available, what patients themselves want from portals and raises some questions about portals that the review panel says need to be addressed “in order to reach the tipping point which will move us from ‘why?’ to ‘why not?’”

The review provides a definition of what a patient portal is, differentiating the concept from current shared care portals that patients do not have access to such as Canterbury’s eSCRV, the Northern Region Shared Care project and the Northland DHB Care Insight project.

It compares the functions available in the three products on the market – Medtech’s ManageMyHealth, MyPractice’s Health365 and Intrahealth’s Accession – and also compares New Zealand’s “organic”, demand-driven and market-led approach to a national roll-out with the centralised, fully funded models that have been tried, and some would say failed, in the UK and Australia.

The panel finds that the organic approach, with demand led by patients and uptake in general practice encouraged by the National Health IT Board’s ambassadors program, should work if there is “demonstrable benefit that is cost neutral or cost saving”.

While the review finds that there are not necessarily any architectural barriers to wider use, it does recommend that standards be introduced to untether patient portals from the vendor-specific PMS and allow data from other sources to be able to feed into existing products.

According to figures provided by the vendors, as of June this year, ManageMyHealth has been implemented in 235 general practices and Health365 eight. Accession is not yet being used in New Zealand, although Intrahealth says it is being used in its main market in Canada. (The other PMS vendor, Houston Medical, is currently working with Medtech to integrate ManageMyHealth into Houston’s VIP.net.)

Patients First CEO Jayden MacRae said that although the technical capability to offer portals is now there, less than 25 per cent of general practices in New Zealand are using them regularly.

“Most patients will see the benefits of these systems when they can book appointments, review test results, order repeat prescriptions and send short electronic messages to their general practice online,” Mr MacRae said. “Giving patients access to their own information is the first step towards a more interactive electronic experience.

“There are still many areas of uncertainty around how electronic interactions will integrate in current work flows in practices and this is one of the prime reasons uptake has been modest.”

What the review predominantly looks at is the questions that need to be asked at this early stage of the roll-out. These include whether patients should have full access to their EMR, and if so, what issues does that give rise to for clinicians. “Should consumer-generated data be added to portals, and if so, would it be useful?”

It also asks questions about the commercial viability of patient portals, raising the issue of payment models and whether consumers should contribute to the cost, as well as questions on whether patient portals increase or decrease clinician workload.

While the review forecasts that it is likely that within five to 10 years a significant proportion of the population, patients and clinicians alike, will be using portals in everyday practice, it also looks at the perceived barriers to adoption in general practice.

These include concerns over the additional workload of “email” consults, the uncertain financial effects of different ways of consulting – for example, through secure messaging rather than face to face – and a lack of general interest from the GP community and from patients.

These barriers are also covered in an appendix by Jo Fitzpatrick, a consumer representative from the National Health IT Board’s consumer panel.

“Patient portals have the potential to change the face of primary care and health care in general,” Ms Fitzpatrick writes. “While the possibilities are exciting, the reality is more sobering.

“It is easy to leap ahead to a dizzying array of possibilities and potentialities but these are accompanied by an equally dizzying array of challenges and barriers. It is important to tread carefully and walk before we run. The path forward is one of small steps …”

Ms Fitzpatrick urges that the value to the patient of better communication with healthcare providers not be forgotten in the discussion on barriers to implementation, and that while cost is one of those barriers, she warns that there is “no consumer enthusiasm or expectation” that these costs will be borne by patients.

However, the biggest barrier to the use of portals, she says, is “the fear, and sometimes loathing, from anxious health practitioners who imagine a future fraught with the multiple challenges of change”.

“While this fear is not unfounded, it is one we can discuss and resolve together. We need to start the journey towards patient portals, one small step at a time, always ensuring that we are all comfortable with the incremental changes involved.”

The review is available online at the Patients First website (pdf). The next three briefing papers will cover cloud and hosted PMSs, PMS prescribing modules and practice support.

ITAC: ThoughtWare takes out top prize, Margelis enters the hall

Software development and compliance management specialist ThoughtWare, which makes the i.on my care risk, governance and compliance system for aged and community care, was named the ICT Company of the Year at the 2014 ITAC Awards in Hobart.

It is the fourth ITAC win for ThoughtWare, with previous awards including a win last year for an implementation project with Sydney’s St Luke’s Care and one for McKenzie Aged Care in 2012.

Industry stalwart George Margelis, who attended the inaugural ITAC conference in 2007, which as he described it involved “50 people wondering how to capture people’s names on a database”, was inducted into the ITAC Hall of Fame for his outstanding contribution to ICT learning and adoption in the aged care industry.

The award for the best implementation of the year for facilities with a total income of under $5m owned by the one organisation went to the NSW Northern Rivers Social Development Council.

Best Implementation of the Year for facilities from $5m to $30m went to Moyne Health Service.

The Best Implementation of the Year over $30m was taken out by Silver Chain, incorporating RDNS SA.

The award for the Best Implementation of the Year for Infrastructure went to Regis Aged Care.

ITAC: aged care concerned over “policy silliness” of client record

The aged care industry needs to step up its lobbying efforts over the direction of the central client record being planned as part of the Aged Care Gateway, with industry representatives voicing concern that it will duplicate the PCEHR and providers will be saddled with two aged care health records for each client.

At an industry forum held at the ITAC conference in Hobart on Tuesday, panelists including former Aged Care Association Australia (ACAA) CEO Rod Young, the University of Western Sydney’s George Margelis and aged care provider Feros Care’s manager of allied health and wellbeing, Kate Swanton, voiced their opposition to what they see as a doubling up of effort.

However, all three were strongly in favour of a move to an opt-out model for the PCEHR, with a consensus view that the former Labor government should have chosen that model when it legislated for the system in 2011.

On the PCEHR, Associate Professor Swanton said she thought it was a good idea and was improving all the time. Feros Care has rolled the system out in association with its software vendor, TCM, first to the company’s community care clients and then into residential care, but A/Prof Swanton said the organisation would be “gung ho” in its support for the system if it moved to opt-out.

Mr Young criticised the tediousness of the registration process required, but said he entirely supported the view that an eHealth record was necessary, particularly for older people. However, he said the system should always have been opt-out if the benefits were to be realised.

Dr Margelis said it was to Australia’s credit that we were the first to try an eHealth record on a national scale, but criticised the rushed implementation and the lack of clinical input into its design and use. He said one of mistakes the previous government made was that “they were too nice about it”.

“They sort of said, ‘you can have one if you want, you can use it if you want’. The reality is that to get the value out of it you really need critical mass.”

He said the system needed to go beyond a repository of data to become a tool used for clinical care, but there were some unreasonable expectations from many who thought it would be all things to all people. “Where we are up to now is we have a lot of people on board, but not a lot of data on board.”

While there seemed to be a consensus that opt-out was the preferred model – one audience member said it was a small minority of privacy advocates and civil libertarians who had spooked the government into changing to opt-in at the last moment – the most immediate concern was over the planned central client record for all older people accessing aged care services through the Aged Care Gateway.

Originally designed to be a record of personal and social data on older people as they began to use aged care services, the plan was to link it to the PCEHR as the recognised health record. However, it appears that the closer the central client record comes to final design, the more it is resembling an eHealth record.

Mr Young voiced strong disapproval of what he said was the potential creation of two health-related records for each older person and urged the industry to step up lobbying efforts with the government to change direction.

“They are proceeding with an aged care health record, that is what they are proposing, and if we are to change this we need to run a campaign,” Mr Young said. “This is policy silliness.”

Dr Margelis agreed, saying “it is not a time to be polite: it is time to shout on the street and say this is ridiculous”.

Panel moderator and conference organiser, Aged and Community Services Australia’s (ACSA) national corporate relations manager Judy Martin, said the peak organisations had already begun lobbying the government about their concerns, with plans to ramp this up as the final design got closer.

“It is going to be a nightmare administratively and time-wise, but it is also the explanation to your clients [about another record],” Ms Martin said. “There will be a myriad of confusion and all of us as an industry are trying to alleviate a lot of that confusion.”

Dr Margelis said it was technically possible to link the central client record to the PCEHR, but that all health IT roll-outs had shown that “a single source of truth for all data is critical”.

ITAC: hands-free nursing through voice-activated documentation

Aged care software vendor HealthMetrics has released a voice-activated, hands-free communication system that allows nurses to document care processes at the bedside by speaking into a lightweight headset, with the notes then integrated into HealthMetrics’ eCase clinical software.

Based on the AccuNurse technology from US company Vocollect Healthcare Solutions, now owned by Honeywell, the voice recognition technology allows for a two-way dialogue between the nurse and the system, with the nurse able to ask questions and call for assistance as well as receive prompts on care processes.

While the underlying voice recognition technology is based on an algorithm originally developed by Nuance Communications, makers of DragonDictate software, AccuNurse is not a dictation system.

Rather, it acts as a “clinician in the ear”, allowing the nurse to ask questions and receive a response in real-time. It also has the ability to block out ambient noise and only recognise the user’s voice commands.

HealthMetrics has rebadged the technology for the Australian aged care market as eCase Hands-Free. HealthMetrics CEO Steven Strange said four of his aged care clients had committed to trialling the system later this year, and there are also plans to launch a similar system aimed at acute care nurses.

Mr Strange said one of the main benefits of the technology is that it allows nurses to complete their documentation at the bedside, without having to enter data into a computer or a paper chart.

“They are also able to page other staff if they need assistance, without having to leave the patient’s bedside,” Mr Strange said.

Demonstrating the system at the ITAC conference in Hobart today, voice recognition technology specialist Rizan Mawzoon said the system used two microphones, one that recognises the nurse’s voice after some basic training and one to sense ambient noise.

“It can then cancel out all of that other noise, which is important in aged care where there are other patients and staff,” Mr Mawzoon said. “It also senses the vibration of your voice, so even if you have a blocked nose it can recognise your voice.”

AccuNurse can also be told to go to sleep when not needed. When it is woken up, it asks the user to repeat a couple of words to re-establish voice recognition.

In addition to common documentation and taking notes, the system can be used for handover. Rather than a face-to-face handover to the next shift, the incoming nurse can listen to a recorded message from the previous shift as they walk to the ward or room. Nurses can also call up all of the resident or patient’s details and be prompted to fulfil certain tasks.

The headset leads to a lightweight receiver that can be attached to a belt, and which communicates with a server by WiFi. Messages are sent to and from the clinical record using the HL7 standard.

Mr Strange said older nurses or those unfamiliar with technology found the system easy to use, as the spoken word is far simpler than writing notes into a computer. It also means that the documentation is completed for each patient in real time, rather than all at once at the end of a shift.