Incentives on offer for private hospitals to link to PCEHR

The National E-Health Transition Authority (NEHTA) will offer funding to private hospital groups to begin integrating their systems with the PCEHR.

NEHTA has announced it will shortly release an invitation to apply for its Private Hospital PCEHR Rapid Implementation Program (RIP) to offer funding to allow private hospitals to deploy PCEHR viewing and clinical document upload capability.

A NEHTA spokeswoman declined to reveal how much funding would be available, but said the invitation to apply would be released within the week.

NEHTA CEO Peter Fleming told the Rural Medicine Australia (RMA) conference in Sydney recently that the organisation was in discussions with the private hospital sector about the potential to use middleware developed by the South Australian Department of Health to link to the national system.

SA Health and a vendor partner designed the Healthcare Identifier and PCEHR Services (HIPS) software to allow its public hospitals to view a patient’s PCEHR and upload discharge summaries in advance of the roll-out of software that can directly link to the system.

HIPS was then licensed by NEHTA for use in other jurisdictions and a rapid implementation program for public hospitals undertaken.

In addition to uploading documents and viewing the PCEHR, HIPS is able to link hospital systems to the Healthcare Identifiers (HI) Service.

Pulse+IT also understands that the state and territories are planning to use its secure message delivery (SMD) capabilities to improve outbound and inbound document exchange between public hospitals and primary care, including electronic referrals and discharge summaries sent to GPs, to overcome the stalemate in interoperability between the secure messaging vendors.

HIPS is being used by public hospitals in South Australia, Tasmania, Western Australian and Victoria. Queensland is using HIPS to send discharge summaries but is also using its The Viewer technology to view records.

NSW has developed its own integration through its HealtheNet service within the Cerner clinical application, while Sydney’s St Vincent’s Hospital – the first in Australia to link to the PCEHR – can do it directly through its EHS clinical information system.

Mr Fleming said that every jurisdiction had committed to linking to the PCEHR in terms of discharge summaries and viewing the record, but was also working on medications data as well. This work is being led by Tasmania.

Mr Fleming said the technology would now be offered to the private sector. “The work we have done to integrate that we are now making available to the private hospitals, the HIPS system, and entering into some quite detailed discussions with them at the moment,” he said.

The difficulties in getting the private hospital sector involved in the PCEHR were laid out by Healthscope CIO Paul Williams at the Health Informatics Conference (HIC) in Melbourne in August.

Mr Williams told a Q&A session at HIC that convincing private hospital management to invest in public eHealth programs like the PCEHR was tough.

Healthscope, which runs 44 private hospitals and 69 pathology labs as well as 46 medical centres, announced in June 2013 that it would be offering the PCEHR through its general practices. Those practices use PCEHR-compliant software, and while its labs are not yet linked, they have been using integrated software and secure messaging systems for many years.

On the hospital side, however, Mr Williams said that his managing director was “unconverted” on the benefits of hooking up to the system and the lack of engagement from the sector as a whole was not necessarily due to scepticism but more to do with the fact that few were aware the system even existed.

“My MD is unconverted and it’s a tough gig,” Mr Williams said. “Even if you’ve got a will and a desire, trying to make a business case for a private entity that is publicly listed, that’s got to show a bottom line return for every dollar that you spend, becomes tough.”

Mr Williams said Healthscope was happy to link its medical centres because there was government funding for that process, but he doubted there would be “a big bang approach” to the PCEHR for its hospitals.

“There needs to be a realisation that today there’s not an obvious economic return,” he said. “We do things when we can obviously make a buck, save a buck, or there is significant patient quality issues.

“We’re very heavy on that within Healthscope. We believe if there’s a quality initiative [that] reduced risks, improves good outcomes, we get good outcomes for our patients – those are the three things that would obviously drive our organisation. Those are the things that would get the ear of the decision makers.”

Aged care record to go live with no link to the PCEHR

The central client record that is due to become available from next July as part of the roll-out of the Aged Care Gateway system will not be linked to the PCEHR, but there are plans to do so in future.

The aged care sector has become increasingly concerned that the Department of Social Services (DSS) is in effect creating two eHealth records by allowing the inclusion of healthcare information on the central client record alongside the separate roll-out of the PCEHR.

Industry representatives have told Pulse+IT that the sector was still in favour of the original plan to either link the record to the PCEHR to provide a comprehensive view of the older person’s needs or to use the PCEHR as the central client record with added functionality to include specific aged care social and living requirements.

What they don’t want, they say, is two separate records that do not interact with each other.

A DSS spokesperson confirmed that the central client record will not be linked to the PCEHR in 2015 but rejected claims there would be in effect two eHealth records.

“The central client record will be available from 1 July 2015 as part of the national rollout of the Gateway system,” the spokesperson said.

“The central client record will ensure that clients only need to tell their story once. It will hold information about clients’ care needs and any current services being received, as well as a history of screening and assessment events and past service delivery.”

While the client’s healthcare priorities and concerns may be included as part of the screening and assessment process, this does not mean that it was an eHealth record, the spokesperson said.

“Gateway assessment and service provision information in the central client record is specific to assessing the aged care needs of a client to help develop their support plan and access to aged care services.

“The central client record will record aged care client needs, as determined during the client screening and assessment process, but will not contain specific information relating to a client’s medical history.

“The central client record will not be linked to the PCEHR in 2015. This functionality is planned to be pursued as part of future enhancements to the Gateway system.”

The Aged Care Gateway was one of the centrepieces of the Labor government’s Living Longer Living Better aged care reform package – the majority of which has been supported and will be implemented by the Coalition government – and was originally recommended by the landmark Caring for Older Australians report by the Productivity Commission in 2011.

The Gateway aims to create an entry point for the aged care system and enable timely and reliable information to be accessed by older people, their families and carers.

A key element of the gateway is the My Aged Care website, which aims to provide consolidated information on ageing and aged care services. It currently provides a searchable database of residential aged care providers, their accommodation prices and services, as well as other community-based services such as Home and Community Care (HACC) and the Home Care Package Program.

It will eventually include quality indicators and a rating system for aged care services, and recently went live with home care and residential care fee calculators.

From next July, all new entrants into the aged care system will be assessed for their needs and a central client record initiated. The record, designed by DSS after what it calls “extensive collaboration” with the National Aged Care Alliance and the state and territory governments, will be accessible by the client and their authorised representatives, such as family and carers, as well as relevant assessors and service providers.

The DSS spokesperson said authorised representatives could also include GPs and other healthcare practitioners if so desired.

“The registration process will collect information relating to a client’s personal details,” the spokesperson said. “The screening and assessment process will involve collection of information in response to structured decision support questions to assist assessors to determine the type and level of aged care services required.

“Information collected during screening and assessment will include the client’s current level of support (formal and informal) and engagement, carer availability and sustainability, health concerns and priorities, functional status, psychosocial and psychological concerns, home and personal safety considerations, and decision-making capabilities.

“Screening and assessment will also identify any complexities a client may have that indicate a level of vulnerability.”

In the original plan, the idea was to link the central client record to the PCEHR to provide a comprehensive view of the client’s social and living needs as well as their healthcare information.

This is something the aged care sector would still like to see. Concerns were raised at a forum at the ITAC conference in Hobart earlier this year about the potential creation of two health-related records for each person.

At the forum, industry consultant Rod Young and health informatician George Margelis voiced strong disapproval of the perceived plan 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”.

Mr Young told Pulse+IT that he understood the central client record would stand quite separately from the PCEHR, or My Health Record as it is expected to become known.

“What we were arguing in that panel session was, does this make a great deal of sense?” Mr Young said. “Particularly if the government, which I believe they will, adopts one of the primary recommendations from the Royle review and that is that we move from opt-in to opt-out model in the future.

“Our view was, wouldn’t it not make more sense to actually start from the point of integrating the My Aged Care record and My Health Record into a common platform.

“That’s what we want them to do. My understanding at the moment is that there will be two quite separate standalone records and the two will not, for the foreseeable future, have any interoperability at all. That was our point in Hobart.

“As far as we are aware, and we are happy to be told we are wrong, but our understanding is at this stage there will be no interface between the two systems.”

The DSS spokesperson said the department currently plans to run a demonstration project of the central client record at a site in Victoria from the end of March 2015, until commencement of national rollout on July 1.

“The project will entail early rollout of Gateway functionality,” the spokesperson said.

CSC to complete ADF eHealth implementation by year’s end

CSC has rolled out an eHealth system for the Australian Defence Force (ADF) in three states and is due to complete the implementation for the other states by the end of the year.

The new Defence eHealth Information System – first announced in 2011 and known then as the Joint eHealth Data and Information (JeHDI) project – is live in Queensland, the Northern Territory and Western Australia, with South Australia currently underway and the other states to follow.

The system, which was contracted for $56 million, is based on commercial off the shelf technology provided by UK firm EMIS, a primary care software specialist that has over 50 per cent of the UK general practice market.

EMIS last year acquired Ascribe, the UK’s market leader in acute care electronic patient care and patient administration systems.

For the ADF contract, CSC provided systems integration, solution development, project management, organisational change management, user training and ongoing system hosting and system support.

Other partners include defence sector management and engineering services firm Kellogg, Brown and Root along with consulting firm PwC.

The new system will provide health professionals throughout the ADF’s Joint Health Command with access to aggregated health information at the point of care and at all levels of management.

Each ADF member will have a comprehensive eHealth record from enlistment through to retirement as well as health management information focused on improving healthcare outcomes, CSC said.

“CSC in partnership with the Department of Defence is successfully delivering one of the most complex business transformation programs undertaken by the ADF,” CSC Australia managing director Seelan Nayagam said.

“CSC has been a trusted partner for the ADF for 42 years, and this implementation cements our position as one of the leading systems integrators in both health and defence in Australia.”

The interoperable system will allow health information to be shared with the Department of Veterans’ Affairs as well as civilian health providers.

Fire and air: joint project promises better collaboration

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

While the eHealth sector in Australia is currently consumed with speculation about the next steps for the PCEHR, there is some very exciting work being done on a new, clinically driven collaboration that has flown under the radar. The collaboration between FHIR and openEHR may prove a valuable step for healthcare software vendors and information managers in how healthcare information is represented.

In early July, a group of four informaticians, representing the FHIR (pronounced “fire”) project, openEHR (“open air”) community and the HL7 patient care working group, gathered virtually to develop a common information model for adverse reactions, allergies and intolerances, based on input from a diverse international group of clinicians and other domain experts.

The editorial group includes Heather Leslie, clinical program lead at the openEHR Foundation and modelling lead at Ocean Informatics; Grahame Grieve, primary author of the FHIR specifications and consultant at Health Intersections; Ian McNicoll, board member at the openEHR Foundation and consultant at FreshEHR in the UK; and Russ Leftwich, immunologist and co-chair of the HL7 patient care working group.

This team is using the international openEHR Clinical Knowledge Manager (CKM) as the tool to coordinate the online, crowd-sourced collaboration from international domain experts. The aim is to develop a common model for allergy/intolerance, which is a record of an ongoing propensity to react to a substance.

From this, both openEHR and HL7 will derive openEHR and FHIR-specific archetypes/resources, which will be published on CKM and through the FHIR specification for implementation in both communities.

The plan is that this will forge a meaningful working relationship which will foster a more collaborative approach in the future.

Bridget Kirkham is the CEO of the Medical Software Industry Association (MSIA).

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

Telstra highlights eHealth as an emerging opportunity

Telstra has signalled plans to continue to invest in software solutions and platforms as part of a focus on emerging opportunities such as its new Telstra Health division.

Releasing its annual report last week, Telstra revealed that it had paid $44 million for the 100 per cent shareholding it took in DCA eHealth Solutions last September.

DCA’s eHealth assets, now rebranded as Health Connex, include the Argus secure messaging service, Communicare clinical software and the TCM aged and community care package, as well as a support contract for the National Health Services Directory (NHSD).

It also paid $27 million for is 50 per cent share of the Fred IT Group, which includes Fred dispensing software and eRx Script Exchange.

While it did not release any revenue figures for these companies, it has placed a goodwill value on Fred of $21m and $16m for Health Connex.

Telstra Health also took out licensing agreements for products such as iScheduler, InstantPHR and Dr Foster Intelligence’s Quality Investigator and Global Comparators products.

It also recently bought the Medinexus radiology and pathology secure messaging solution, although the price has not yet been disclosed.

Last year, it made its first strategic investments in HealthEngine with a 25 per cent share and a 32 per cent share of IP Health, now rebranded as Verdi. It has since invested further in HealthEngine and controls one-third of the company’s shares. These investments combined were valued at less than $8m last year.

Telstra Health falls under the Telstra Retail business, headed up by Gordon Ballantyne, which includes its core domestic activities in the fixed and mobile phone and broadband markets for consumers and businesses, pay TV and the NBN.

In its annual report, the telco says the Telstra Health business “continued to work towards its objective of establishing a connected health IT ecosystem capable of creating transformative change in the healthcare sector”.

“Growth to date has been through strategic acquisition and investments, partnership and commercial relationships.

“These investments enable us to play a role in eHealth solutions via means such as connectivity of health services, electronic health records and electronic prescriptions.”

While not part of health business, Telstra is also investing in unified communications and video conferencing solutions. It bought unified communications integrator NSC Group last year for $45 million and recently increased its investment in video streaming and analytics firm Ooyala to 98 per cent as part of its new Global Applications and Platforms (GAP) group.

These investments are dwarfed by the money it is putting into its own mobile and WiFi infrastructure, including $1.1 billion in its 4G mobile network, which Telstra says now reaches 87 per cent of the Australian population. 3G is available to 99.3 per cent of the population.

It is also building Australia’s largest national public Wi-Fi access network, in a $100 million project to deliver 13 million Wi-Fi hotspots around the world over the next five years.

Telstra Health representatives told the Information Technology in Aged Care conference last month that it planned to soon release details of a platform it hopes will bring together the data held in GP, aged care and pharmacy systems.

Pathology sector decides against authority to post for PCEHR

Industry groups involved in devising a method to upload pathology reports to the PCEHR have decided against the authority to post (ATP) method, instead agreeing on a seven-day waiting period before reports are directly uploaded by the pathology provider.

Both the pathology and the diagnostic imaging sectors have been debating the best method to include reports on the PCEHR, which the Department of Health (DoH) wants to commence in December.

The favoured method appeared to be ATP, in which the referring doctor would send an authorisation message to the diagnostic provider to upload the report once it has been reviewed.

However, at a second pathology consultation workshop held in Melbourne on August 8, participants agreed that there should be a seven-day period in which the referring doctor can view the results – sent by normal secure messaging – before the actual report is made available to the patient on the PCEHR.

The workshop agreed that this design would support the appropriate communication of results to the patient by their GP. It would also mean that the majority of results can be authorised to be uploaded automatically at the time of referral.

Metadata from the report will be available immediately to the patient but not the report itself. The report will be uploaded as a PDF.

In a summary of the solution design presented at the pathology meeting and issued by the DoH, a series of principles were agreed to, including that the design should be evidence based and result in no increased clinical risk to patients.

It was agreed that the pathology provider will upload the reports, not the GP, and that the design would include a process for making inaccurate reports inaccessible to the users of the system.

Updated versions of the report will be able to be uploaded, and the PCEHR will maintain a history of pathology reports. “There is clinical benefit in preliminary, final and corrected reports being available to the PCEHR,” the summary says.

It also says that wherever possible, the model for incorporating pathology and diagnostic imaging reports into the PCEHR should be consistent. This may reflect the views of the diagnostic imaging sector, which in a meeting last month concluded that an automatic upload from the radiology practice was preferable to ATP.

In terms of technical design, the meeting agreed that the design should use existing infrastructure wherever possible and avoid redefining existing HL7 v2 messages.

The reports will be uploaded as PDFs until standardised terminology is finalised and agreed to, meaning atomic data will then be available through the PCEHR.

Individual and healthcare provider identifiers (IHI, HPI-I and HPI-O) will be used, meaning IHIs will need to be included on both electronic and written requests. Pathology providers will all need to be registered to use the HI Service, with the potential that middleware be used to interact with the service.

More work will also need to be done to map the metadata provided with the PDF to the existing HL7 v2 (AS 4700) standard to support the implementation of the design in software systems. The metadata is necessary to support the searching, viewing, provenance, updating and auditing of the reports.

Another meeting is scheduled for this Friday, August 22.

At the Health Informatics Conference (HIC) in Melbourne last week, PCEHR review panel chairman Richard Royle said the panel had agreed in its report that the PCEHR could not move to an opt-out model until one of three essential clinical modules was up and running – pathology, radiology or medications.

GP co-pay: where is the data?

The Australian Medical Association (AMA) and the Australian Healthcare and Hospitals Association (AHHA) have both hit out at the lack of evidence or data modelling underpinning the federal government’s plans to introduce a $7 co-pay for GP consultations and pathology and diagnostic imaging tests.

In a strongly worded opinion piece in Fairfax newspapers today, AMA president Brian Owler criticised the measures as bad health policy and said healthcare was too important to become “an ideological toy”.

Dr Owler also criticised the lack of evidence for the co-pay policy, arguing that the cost would deter vulnerable patients from visiting their doctors and that available figures show the health budget is not out of control.

“The recent COAG Reform Council report showed that, among the more disadvantaged in society, 12 per cent of people defer or do not see their GP due to cost,” he wrote. “It will significantly increase with a co-payment.

“The health budget is not out of control. As a proportion of GDP, Australia’s healthcare spending has remained constant.

“Modern medicine is evidence-based. We are trained not to accept blind assertions or opinion, or indeed ideology, in determining the best treatment without the supporting evidence.

“The AMA is supportive of some co-payments, but not the one proposed by the government.”

The AHHA has also criticised the lack of modelling undertaken by the government in developing the policy as well as its claims that states were overstating hospital activity.

In a statement, the AHHA quoted Health Minister Peter Dutton’s remarks to the National Press Club last month in which he claimed that modelling showed there would be an increase in the number of GP presentations over the course of the next couple of years, necessitating the introduction of a co-payment as a price signal even though it would only reduce GP visits by less than one per cent.

“There will be, on the modelling that we’ve done so far, an estimate around one per cent of people who won’t present to general practice, and we say that in year two that drops off to about half a per cent,” Mr Dutton said.

However, a freedom of information (FOI) request by The Australian newspaper’s health editor Sean Parnell for any documents showing the modelling done by the Commission of Audit regarding co-payments for medical services and the PBS – Mr Dutton has been using the commission’s recommendation of a $15 co-pay to bolster his argument for a lesser co-pay – was rejected by the Department of Health as it could find no such document.

The department told The Australian that “an extensive search and consultation with the relevant policy areas revealed that there are no documents (summary or otherwise) held by the Department arising from all modelling conducted under the current government regarding co-payments for medical services, as recommended by the Commission of Audit and detailed in the Budget, and increased co-payments under the Pharmaceutical Benefits Scheme.”

The AHHA itself has requested information from the Department of Human Services through FOI on the number of people who were bulk billed in 2012-13 to attempt to find out the difference between that number and the proportion of services that are bulk billed.

That FOI request was also rejected “on the grounds that the information did not exist and that to produce it would require the development of a computer program”, the AHHA said.

The AHHA said that given that this policy measure was a fundamental change to bulk billing practices, “it is extraordinary that data required to understand the number of people who will be affected by the policy has not been developed, and that the limited bulk billing data that is available has not been used to model impacts”.

AHHA CEO Alison Verhoeven also pointed out that health department officials had told Senate Estimates hearings a fortnight ago that the department had not undertaken any modelling on the effect of the co-payment on public hospital emergency departments.

“[The Health] Minister has stated that Department of Health modelling suggests that the co-payment will stop only 1% of people going to the doctor in the first year of operation,” Ms Verhoeven said.

“Given that there is no data currently available on the number of people that are bulk billed, we would be very interested to learn how this estimate was developed.

“The co-payment policy is rapidly becoming an evidence-free zone, with the Commission of Audit claims about GP attendance rates being disproved, no apparent efforts made to model the potential impact, and no baseline data available to evaluate its effect over time.”

She also took issue with Mr Dutton’s statement defending funding cuts to hospitals for achieving the National Elective Surgery Target and the National Emergency Access Target because the government “did not support incentive payments as states had been overstating hospital activity”.

“Given the rigour applied to the analysis of hospital activity data by the Independent Hospital Pricing Authority, the Australian Institute of Health and Welfare and the National Health Funding Body, this will come as a surprise to the states and territories and we would welcome the opportunity to examine the evidence that the minister has available to him,” Ms Verhoeven said.

In his opinion piece, the AMA’s Dr Owler also criticised the effect the co-pay would have on pathology and diagnostic imaging practices. He said it would be logistically impossible for many pathology labs to collect the co-pay as many didn’t actually see the patient in person.

“In diagnostic imaging, the issues are even more significant,” he said. “The loss of the 10 per cent bulk billing incentive, as well as the $5 rebate cut, means that radiologists face much greater losses.

“The patient will have to pay the whole amount for the test and claim the rebate afterwards. Diagnostic imaging practices providing excellent services in disadvantaged areas will become unviable.”

The Australian Diagnostic Imaging Association (ADIA) said that in its view, the government has been too aggressive on patient rebates for diagnostic imaging.

“Many people will simply be unable to afford it under the measures announced in this budget – especially if they have to pay the full cost up front – and many conditions will therefore go undiagnosed,” it said.

The RACGP also opposes the co-pay in its current model, with president Liz Marles saying the college had not been consulted on its introduction and that she did not believe the government had any understanding of the practical implications for general practice in administering the fee.

“They have talked about an additional $2 to GPs, where there is a $5 cut in the rebate but a $7 co-pay and they say you’ll be $2 ahead,” Dr Marles said.

“In fact, the bulk billing practices will have to install a billing system or to collect cash and also to train their staff, and there is more staff time involved [in collecting it]. There’s an estimate that’s about $2.54, so you are behind from the outset, and that’s not even taking into consideration any patients for whom you may wish to waive the fee.”

The Rural Doctors Association of Australia (RDAA) is particularly concerned about the lack of clarity on how doctors are supposed to collect the payment from people in aged care facilities or palliative care patients.

RDAA president Ian Kamerman said the co-pay model would hit rural patients hard and cause significant problems to country medical practices and their communities.

Dr Kamerman said many other questions about the co-payment remain unanswered. “For example, what will happen with an elderly patient who is in a nursing home and incapable of managing their finances?” he said.

“Or the dying patient in the final weeks of palliative care, who is seen by the doctor at home? Is the GP really expected to collect seven dollars from these patients before providing treatment?

“The federal government has made it clear that one of the aims of the co-payment is to curb demand for services. However, over-servicing of aged care and palliative care patient populations is very rare.”

eHealth at the centre of NSW state health plan

The NSW government has released its full state health plan covering the next six years, focused around three directions to be implemented through four strategies, including eHealth.

The three directions are keeping people healthy (preventative health), providing world-class clinical care (acute care) and delivering integrated care.

These will be implemented through workforce measures, supporting research and innovation, designing and building infrastructure and enabling eHealth.

The eHealth strategy has been set out in the government’s Blueprint for eHealth in NSW, released in December last year, which aims to use technology for clinical care, business services, infrastructure and community outreach.

It has led to the establishment of a new, dedicated agency called eHealth NSW along with a refreshed eHealth vision for the state.

Health Minister Jillian Skinner has been spruiking her plans for integrated care (PDF), which she said would create a connected health system so patients get the care they need where and when they need it.

Integrated care will be joined to plans for preventative health and acute care through the four strategies.

In preventative health, the government has set targets to reduce rates of smoking, overweight and obesity, risky levels of drinking and reducing the gap in indigenous and non-indigenous infant mortality.

It will use measures such as improved consumer access to and understanding of health information to achieve these targets.

For acute care, it will invest in tools such as a patient flow portal to help clinicians and managers better coordinate patient flows through EDs and hospitals, as well as the development and roll-out of tools such as the new activity-based management (ABM) portal, developed in association with Qliktech.

For integrated care, the plan highlights major investments in eHealth, including programs such as HealtheNet, which aims to link medical records within the NSW public health system as well as to the national PCEHR.

The Central Coast, Western NSW and Western Sydney Local Health Districts will act as integrated care ‘demonstrator sites’ to develop and test system-wide approaches to integrated care, with funding contingent on delivery of results.

It also plans to support data linkages between state and federally funded services to help patients and clinicians have the information they need when and where they need it to make the best decisions in a timely way.

This also includes building and expanding investment in eHealth solutions such as telehealth and HealtheNet to support communication and connectivity across healthcare providers and treatment settings.

In community care, it plans to promote local health pathways that standardise and simplify referral and links for GPs, hospitals and community health providers.

The integrated care strategy will be funded through a $120 million investment over four years.

In terms of enabling eHealth, the plan says that 142 hospitals – or 80 per cent of the state’ bed base – now use an eMR enabling clinicians to order tests, schedule surgery and prepare discharge summaries electronically.

The majority of hospitals are also using picture archiving communication (PACS) and radiology information systems (RIS), with many clinicians able to access the enterprise imaging repository built as part of HealtheNet.

HealtheNet also links the electronic medical records used by public hospital and community services with the PCEHR.

According to the latest information from NEHTA, hospitals that can access the PCEHR and upload discharge summaries include eight hospitals in the Illawarra Shoalhaven LHD, four in Nepean Blue Mountains, nine in South-Eastern Sydney – including the majors such as Prince of Wales, Royal Hospital for Women, St George, St Vincent’s and Calvary.

Five hospitals in the Western Sydney LHD, including Westmead and Blacktown, are able to access the PCEHR, as are the two children’s hospitals that make up the special Sydney Children’s local health network.

NSW Health says all hospitals also have access to the patient flow portal, which is used to manage an estimated 3250 patient transfers per month. The state’s CBORD food services IT system is also being upgraded.

Future plans include the implementation of the Community Health and Outpatient Care (CHOC) system to integrate clinical and electronic record systems, phase two of the Cerner EMR roll-out, implementation of electronic medication management and the new MetaVision intensive care clinical information system from iMDsoft.

A rural eHealth strategy has also been developed that includes major upgrades to internet and telecommunications, and a full rural health plan is also soon to be released.

Major infrastructure over the next five years includes upgrades to Wagga Wagga Hospital, Blacktown/Mt Druitt, Lismore and Kempsey as well as the new hospital being built at Frenchs Forest on Sydney’s northern beaches.

PCEHR review recommends opt-out model, NEHTA dissolved

The federal government has released
the Royle review into the PCEHR, which recommends the name of the system be changed, that NEHTA be dissolved and the system move to an opt-out model, and that improvements be made to clinical usability.

Health Minister Peter Dutton told the HIMSS conference in Sydney today that the government’s response to the review’s recommendations was still several months away, but that he strongly agreed with the recommendation that the system be opt-out for consumers, rather than the current opt-in model.

The review, conducted by Uniting Care Queensland executive director Richard Royle, AMA president Steve Hambleton and Australia Post CIO Andrew Walduck, found that there was “overwhelming support” for continuing the path of implementing an electronic health record for all Australians.

However, it made 38 recommendations on how to improve the system, the most controversial being a recommendation to transition to an opt-out model from January 1, 2015.

The panel also recommends changing the name of the system to the My Health Record (MyHR), and that the National E-Health Transition Authority (NEHTA) be dissolved and replaced by an Australian Commission for Electronic Health (ACeH), to report directly to the Standing Council on Health (SCoH).

Pulse+IT understands that part of the $140m allocated in last week’s budget towards the system will be used to fund the Commonwealth’s obligation towards NEHTA until a decision is made on its future. NEHTA is co-funded by COAG and would need its agreement for the organisation to be disbanded.

To get clinicians using the system, the panel recommends that in addition to usability issues, the government “incent” GPs by changing the eHealth practice incentive payment (ePIP) to link ongoing ePIP funding to actual usage of the MyHR.

It also wants the government to alter the MBS item numbers next year for health assessments, mental health care plans, medication management reviews and chronic disease planning items to require a copy of the information to be uploaded to the MyHR.

Operation of the system should be moved from the Department of Health to the Department of Human Services (DHS), under contract from ACeH, the panel recommends. It also wants to see an expansion of the National Prescription and Dispense Repository (NPDR), which Mr Dutton praised as a worthwhile endeavour in his speech.

The review panel also wants to establish a number of advisory committees to the proposed ACeH, including a clinical and technical committee, a jurisdictional committee, a consumer advisory committee and a privacy and security committee.

Technical changes to make the system more attractive to consumers include a single sign-on capability and a notification system that tells the consumer by SMS when their MyHR is opened or used.

From January 1 next year, the panel wants the system to include a minimum composite of records that would include demographics, current medications and adverse events, discharge summaries and clinical measurements. This, in addition to an opt-out model, would dramatically improve the value proposition for clinicians, the panel said.

It recommended that work proceed on implementing diagnostic imaging and pathology into the system, and also to implement a standardised secure messaging platform. It also wants the secure messaging strategy to include secure communication between the medical industry and consumers themselves.

The National Authentication Service for Health (NASH) should also be reviewed, with a view to aligning the platform with the recommendations for digital identity as part of the government’s eGovernment policy.

In terms of submissions to the review panel, the reviewers say that the main concerns were the usability of the system, the lack of education and training modules or an effective test environment for software developers and integrators, and that the governance processes around the PCEHR did not adequately represent the industry and were overly bureaucratic in nature.

To overcome the common complaint about the system from clinicians that personal control means the full record is not available, the panel recommends that a flag be set to indicate that a document has been hidden, which is only visible to the practitioner who authored or uploaded the document.

“The panel noted that no medical records are complete (in either paper or electronic form) and that there are some people who legitimately do not want to share everything,” the report says. “The panel disagrees with the advice from many of the submissions that a flag should be able to be seen by all those who view the record as in the panel’s opinion it would be likely to result in emotional “blackmail” by providers attempting to seek disclosure of the hidden information.”

However, if the flag was visible to the practitioner who authored the document, this would allow a discussion to be had about it, or that an alternative, “clinically appropriate but different” document be put in its place.

Black Dog tracks mental health through the emohose

Researchers from the Black Dog Institute and the CSIRO have developed a tool for measuring and monitoring emotional states using real-time data from Twitter, which they hope to use to better understand regional fluctuations in mental health.

The We Feel tool allows researchers to create a visual representation of emotional content and compare it across space and time. The researchers say that the power of Twitter is its immediacy, allowing them to track changes in emotional states in real-time rather than months or years after the event.

They have also released a REST-ful API to allow other researchers and developers to access the raw data behind We Feel. The data is shared under a CSIRO data license so developers can use it royalty-free for non-commercial purposes.

Black Dog Institute director Helen Christensen said that being able to identify and analyse this kind of data in real time was of enormous benefit to both research and public health.

“Currently, mental health researchers and associated public health programs use population data that can be over five years old,” Professor Christensen said.

“Should the real-time data gained using this incredible tool prove accurate, we will have the unique opportunity to monitor the emotional state of people across different geographical areas and ultimately predict when and where potentially life-saving services are required.”

The project is being supported by Amazon Web Services’ Kinesis platform to deal with the huge data volumes of Twitter, and by Gnip, a commercial reseller of Twitter data that can provide access to every publicly available tweet dating back to Twitter’s launch on March 21, 2006.

The researchers are using Twitter data rather than other social media platforms such as Facebook as Twitter is a public platform and Facebook users commonly apply privacy settings. The developers says that the tool has been specifically designed to only look at the big picture and not to identify individuals.

The researchers say that of the hundreds of millions of tweets posted each day, a large part concern their emotional state.

“We Feel is about tapping that signal to better understand the prevalence and drivers of emotions,” they say. “We hope it can uncover, for example, where people are most at risk of depression and how the mood and emotions of an area/region fluctuate over time.

“It could also help understand questions such as how strongly our emotions depend on social, economic and environmental factors such as the weather, time of day, day of the week, news of a major disaster or a downturn in the economy.”

Tracking down exactly where these tweets are emanating from is tricky as many people don’t specify where they are tweeting from or use mock locations such as the moon, so the researchers are tracking the tweets by time zone. This works well for Australia, which is the focus of their research.

Professor Christensen said that as an example, her team analysed the emotions of Australians before and after the budget announcement last Tuesday.

“As Minister Hockey rose to speak, there was a sharp spike in fearful tweets,” she said. “As he finished, there was a surge of angry tweets, significantly larger than seen the night before. We also picked up increases in sadness and a distinct reduction in joy.”

The tool gathers its tweets from three “hoses” or sources. Twitter’s public API is known as the gardenhose, and Gnip calls its Twitter stream capability the “firehose”, so the researchers have taken up this terminology to develop an “emohose”.

A random sample of one per cent of the tweets is taken from the gardenhose, 10 per cent is from Gnip’s firehose, renamed the “decahose”, with the main source the “emohose”, which will monitor a large sample of emotional vocabulary derived from Parrott’s tree-structured list of emotions.

The researchers say gardenhose delivers about 900,000 English tweets a day, of which about 250,000 contain emotion terms, and the decahose delivers 10 times that amount. “The emohose delivers about 27 million English tweets a day, all of which contain emotion terms,” they say. That averages out to 19,000 tweets per minute.

Along with the visual explorer, We Feel provides a table builder and a REST API that researchers and developers can access.