Royal Perth begins uploading discharge summaries to PCEHR

Royal Perth Hospital’s Shenton Park campus has become the first WA hospital to begin uploading discharge summaries to the PCEHR, with the main Wellington Street campus set to come online in the next few months.

Royal Perth is using the Healthcare Information and PCEHR Services (HIPS) technology designed by SA Health and a vendor partner to link to the national system from its iCM clinical information system.

South Australia, Tasmania, the Northern Territory and Queensland are all using HIPS, while NSW, Victoria and the ACT are uploading directly from the various clinical information systems in use.

A Royal Perth spokesperson said discharge summaries are being completed using WA’s new Notifications and Clinical Summaries (NaCS) system, which is due to be rolled out as a state-wide solution to centrally host and share clinical documents like discharge summaries and outpatient letters.

NaCS is due to replace The Electronic Discharge Summary (TEDS) system still in use at the Wellington Street campus. TEDS is due to be progressively phased out at Royal Perth and the other health facilities currently using it in the south metropolitan area.

According to the hospital’s liaison GP, Jacquie Garton-Smith, Royal Perth was the first hospital in Australia to send electronic discharge summaries into GP practice software via secure messaging back in 2005. Dr Garton-Smith has been working with local GPs to prepare them for the change to the new system, which she said won’t be too different from current practice.

She also said Fiona Stanley Hospital, which will use iCM when it opens later this year, will be linked to the new NaCS central system.

For the PCEHR, discharge summaries must be packaged as clinical document architecture (CDA) files, but the hospital spokesperson said they will be sent to GP systems as PDFs for the time being, as not all recipient systems can accept discharge summaries in CDA format.

“Depending on the secure messaging provider, the opportunity exists to send the discharge summaries in both CDA and PDF format,” the spokesperson said. “This remains a future option dependent upon confirmation of its success.”

At Shenton Park, local copies of the discharge summaries are stored in the hospital’s Global Document Store and are viewable from iCM. The hospital is linking the patient’s Individual Healthcare Identifier (IHI) to its unique medical record number through WA’s Enterprise Master Patient Index.

Interactive dashboard to graph PCEHR indicators

The Improvement Foundation has developed a new interactive dashboard and a set of eHealth indicators for its qiConnect portal, which allows general practices to automatically upload data on certain clinical measurements for analysis and benchmarking.

qiConnect is used by participants in the Australian Primary Care Collaboratives (APCC), a program managed by the IF on behalf of the Department of Health. Practices use Pen Computer Systems’ clinical audit tool (Pen CAT) to extract data from their practice software on a range of clinical and non-clinical measures, including those for chronic heart disease, diabetes and COPD.

Data is lodged monthly and can be reviewed by practices to see the percentage of patients who meet certain criteria, such as diabetic patients with a HbA1c of less than seven. Practices can then focus on working more closely with that subset of diabetic patients, as well as benchmark themselves against other practices in the state.

The IF has now added eHealth indicators to the portal, including measures such as medication list currency and PCEHR-related indicators such as number of patients with an uploaded shared health summary (SHS), total number of SHSs uploaded, the age of those uploads and number of patients with a verified Individual Health Identifier (IHI).

Real-time feedback graphs can be used to identify areas where practices can make improvements and then track the results of their improvement efforts. It will also allow them to benchmark progress on a national level.

Improvement Foundation CEO Colin Frick said the new indicators will provide an additional insight to identify where improvements can be made and the results of those improvement initiatives.

APCC clinical chair Alison Edwards, a GP at the Broughton Clinic in South Australia’s Port Broughton, has been involved in the collaborative ‘waves’ for a number of years, including one that had a focus on heart disease and diabetes.

Dr Edwards said she uses the information to monitor how her practice measures up in terms of the percentages of patients achieving certain levels, but also to benchmark the practice against others. “We are very competitive, both with other practices and within the practice itself,” she said.

“As doctors, we’d like to think we’re doing a perfect job but then we pull the data out and see that we’ve only got 60 per cent of our patients with glycated haemoglobin in the right range. But it allows you to see that some are only just outside the range, or you’re tweaking things and it hasn’t quite had the chance to come back into the range.”

The tool allows her practice to analyse the data further and make an assessment on patients who may not have had their bloods done recently. Some may have ceased to be active patients or have entered residential aged care, but some may also be reluctant to accept their diagnosis, she said.

“That then highlights to us that the next time they’re in, maybe we can capture them,” she said.

The APCC is now up to wave 10, which for the first time involves a chronic kidney disease focus. Dr Edwards’ clinic is looking at its data on a population-wide level to target patients of a certain age with conditions like diabetes and hypertension to ensure they have had blood and urine tests recently.

“It has been great to be able to pull that data out and look at that list and say, potentially there’s 900 of our 2500 patients who should be checked and we’ve only checked about 100 of them. We now can look at that from month to month and see that we’ve managed to catch this many more.”

Dr Edwards has been doing her own data collection on patients who are involved in the PCEHR, keeping a database of how many patients have expressed an interest in the system, how many have registered and which ones have had an SHS uploaded. This will now all be able to be automated through the dashboard.

Her practice was an early adopter of the PCEHR, as it has a higher than average population of older people, including a good proportion of grey nomads for whom the concept of a portable medical record is attractive and which is her target audience for the PCEHR.

She does admit that it has been slow progress and she doesn’t review the records that often, and only one discharge summary has been uploaded for one of her patients.

While she said she is “confident that it’s not a perfect system”, she has talked her patients through their privacy concerns and most are keen.

“I know quite a lot of doctors who have held back, just with concerns about privacy, but my approach is if we don’t play with it and try and get it better, then it’s not ever going to happen. It’s more than 51 per cent good, so we’ve jumped in and gone with it.”

One of her cancer patients is waiting for the day in which she will be able to log on to her PCEHR to look at changes in her blood tests, while a new patient who recently moved to SA from the Northern Territory had set up records for her children, and Dr Edwards was able to use the PCEHR to check their immunisation status.

“It does work in certain circumstances and I’m sure in time, it will eventually work,” she said. “We have to start somewhere and honestly I think it will be the patients that drive it. I have not yet had any of my grey nomads come back to me and say [they had urged another doctor to use it]. I’m waiting for that moment.”

Challenging apps for HISA Apps Challenge

A medicines dose calculation app, a digital version of a junior doctor’s rounds sheet and an appointment booking and remote consultation system are three of 16 app concepts entered in the Health Informatics Society of Australia’s Apps Challenge, voting for which closes today.

The Apps Challenge is in four categories this year, including aged care, medication management, the quantified self and clinician productivity, with the winners to be announced at the Health Informatics Conference in Melbourne on August 13.

Several of the apps are already available for use, including DoseMe, a dose-individualisation tool developed for the cloud-based DoseMe software that recently won its creators a Queensland iAward for best start-up company.

The software helps to determine the optimal dose of a medicine based upon a patient’s individual ability to absorb, process and clear the medicine. It can be used on smart devices as well as through a web app, and can integrate into patient management software.

14-year-old Dhruv Verma’s app for the aged care category allows family members to monitor the movements of family members in the home. Using real-time location system (RTLS) tags, the app is designed to display exactly where the person is at that point in time.

Called PROTEGO, or PROactive Technology for Elderly on the GO, the concept is different from other apps that use GPS, which are unable to pinpoint exact locations. It is designed to be easy to use, featuring animations and bright colours, and will be suitable for phones, tablets and desktops.

Two clinical productivity apps aimed at junior doctors have been entered by Rob Pearlman, including Rounds, which includes a patient tracker and task list with colour-coded job tasks for team-based care in the hospital setting.

He has also entered the AfterHours task manager for overtime shifts, which is already available on the iTunes store and is being used by RMOs in several Sydney Hospitals. It aims to solve the problem of keeping track of patients and jobs on overtime shifts, and to ease clinical handover.

The instadok app is designed to be used by both doctors and patients to set and manage appointments, do video consultations and order prescriptions. Established by Rajanaidu Ganesha, instadok has signed an agreement with prescription exchange service MediSecure to have prescriptions sent to the patient’s home or nominated pharmacy.

Q&A-Med is an app that produces auto-generated questions that patients can use to prompt them to ask doctors and pharmacists about the medicines they are taking, including over-the-counter medicines and supplements, as well as store details of all medications and any allergies.

It also has an audio recording function that lets the patient record the practitioner’s answers so it can be played back later, as well as a reminder function to order more repeats.

HISA members can view all entries and vote for their favourite on the HISA website.

PCEHR registrations hit 1.5 million mark

The latest figures from the Department of Health show that consumer registrations for the PCEHR have reached 1,514,805, exceeding the department’s target for the system by a number of months.

After a slow start in which the forecast of 500,000 registrations for the first year of operation was missed by several weeks, patient sign-ups for the second year have now exceeded the 1.5 million mark estimated by the department in the 2012-2013 budget papers.

Based on international experience, it hopes to have a further 700,000 registrations by July 2015, which it seems more than likely to reach on current figures but which are dependent on the new government’s plans for the system.

According to internal DoH documents seen by Pulse+IT, the vast majority of these registrations were facilitated by Aspen Medical, which was hired last year to assist consumers to register in general practices and in public hospitals.

The figures show that Aspen, whose contract finished at the end of last year, registered over 730,000 people. More than 260,000 have registered online, and another 200,000 through the Department of Human Services’ administration portal.

Assisted registration through Medicare Locals and the assisted registration tool, which has been used to sign patients up by healthcare providers, total over 176,000. Registrations for newborns through Medicare’s FA101 forms are also included.

While consumer registrations are continuing, figures for uploading clinical documents appear to be well behind.

Electronic discharge summaries have overtaken the number of shared health summaries on the system by 20,000 to 16,000. More than 200 public hospitals are now connected and are predominantly using it to load discharge summaries.

A Pulse+IT source who did not wish to be named said the small number of shared health summaries – the primary clinical document – was a major concern and showed that clinicians in the primary care sector had “disengaged” with the system over perceptions that it had little clinical value and uncertainty over its future remained.

More than 700 event summaries have been loaded, as well as four specialist letters and three eReferral notes.

Consumers have entered many of their own notes, including over 33,000 health summaries, 11,000 consumer notes and almost 5000 advance care directive custodian reports. The Child eHealth Record (CeHR) – which parents, GPs and community nurses can access – has over 4000 documents, but none have been entered by clinicians.

The National Prescription and Dispense Repository holds almost 95,000 records, over 90 per cent of them dispense documents.

Actual viewing of documents seems to be improving with 484 unique providers and 8328 unique consumers accessing the system in the week of February 26 to March 4.

The documents show that as of March 4, the PCEHR has been used by healthcare providers to view 11,858 clinical documents.

Improvements and complaints

NEHTA has also released details of improvements to the system interfaces following sustained criticism of its lack of usability from clinicians.

According to NEHTA’s website, it worked with peak bodies to produce guidance material for software vendors on improvements that could be made under its clinical usability program (CUP).

NEHTA said the focus of the first release of the guidance material was specific to improving the usability of the shared health summary and viewing and downloading documents from the PCEHR.

The improvements will be made through each vendor’s new releases and are all due to be implemented before June.

NEHTA has recommended that certain columns and headings be displayed in clinical documents to allow clinicians more clarity when selecting clinical documents from the PCEHR list view.

It also recommended that administrative data, which is the first thing seen when opening a record, be hidden from the clinician’s view and clinical data shown first.

When creating a shared health summary and filling out the medical history section, NEHTA has recommended that medical history be no longer separated into sub-groupings, but displayed as one list in chronological order.

A final recommendation is that improvements be made to assist clinicians when checking if a PCEHR exists for the patient. Rather than the clinician having to check themselves, the software will instead search and validate both the Healthcare Identifier and PCEHR status in the background when the patient’s record is opened.

According to NEHTA, when a PCEHR is found, a record status indicator will turn green and be displayed to the clinician. “An entry point to PCEHR functionality will be displayed prominently on the patient chart,” the organisation said.

The Department of Health has also taken note of consumer complaints about the system. Departmental documents show that of the 200-odd complaints made since December 4 last year, over 70 relate to access issues, registration difficulty or unique email requirements for the MyGov website, which consumers must use to register online.

Dissatisfaction with the design or operation of the PCEHR totalled 22 complaints between December 4 and March 5, while 15 were recorded for the assisted registration process.

Only one complaint was made on the grounds of privacy with the PCEHR operation, nine privacy or consent concerns were made about the assisted registration process, and three were concerns over personal information through the DHS registration process. Only one of those complaints remains unresolved.

My Film Bag goes live with patient films online

Melbourne-based radiology specialist Zed Technologies has gone live in its first practice with its new My Film Bag app, which allows patients to view their radiology images online.

Rolled out a fortnight ago by Melbourne’s Imaging @ Olympic Park, the app is also due to go live at Port Macquarie X-ray in NSW next week as a way to test it with patients who have to travel out of the area to see specialists.

My Film Bag is available as both a web app and as a mobile app for iOS and Android devices, and has been developed by Zed Technologies’ Ross Wright and Ronald Li as a way to allow patients to view their own images and to share them with doctors without having to cart around films or CDs.

Mr Wright said Imaging @ Olympic Park and Port Macquarie X-ray are paying for the app on behalf of their patients. “Their reasoning behind it is that it’s a value-added service but there’s also a small saving on film,” he said. “It was something that they thought some of their patients would appreciate, being mobile and reasonably tech savvy patients.”

In addition to allowing patients easy access to their scans while travelling and the ability to share them with multiple healthcare providers, another obvious market to explore is new parents to allow them to store and view ultrasound images. However, the company plans to initially market the app to radiology providers before individual patients.

The app is the first consumer venture for the start-up company, which has also developed a DICOM viewer in use in hospitals as well as a mobile app that can be used with Medinexus to allow GPs and specialists to view DICOM images from within their desktop software or mobile device.

Mr Wright and Mr Li are currently spending time at the muru-D start-up accelerator in Sydney, which has been sponsored by Telstra to encourage innovation in the start-up scene.

Mr Wright said the duo was using the opportunity to continue to develop its market, scale its product and talk to investors.

instadok to launch mobile consultation platform

Melbourne-based company instadok is preparing to launch an early prototype of its new telehealth platform, collaborating with appointment booking service HealthEngine and prescription exchange service MediSecure to provide a completely mobile video consultation service.

instadok is targeting the nascent paid remote GP consultation market, planning to recruit 20 general practices in Melbourne to test its minimum viable product (MVP) before launching a beta version in a few months.

The alpha release of instadok’s platform is designed for Apple mobile devices and will include a pre-configured iPad for doctors and an iPhone app for patients through which they can manage appointments, attend the video consultation with the doctor, have prescriptions sent to their home or nominated pharmacy and pay using a credit card.

instadok managing director Ganesha Rajanaidu said the platform was aimed at closing the loop in the primary care market by giving patients in metropolitan areas access to remote GP consultations and fulfil prescriptions.

The plan is to add an electronic health record feature that allows the patient to view previous consultations. For doctors, the plan is for the video consultations to be automatically transcribed from voice to text and attached to the GP’s patient record. As part of the beta phase, instadok will look to integrate GP practice management software solutions with instadok’s electronic health record and prescription management system.

Mr Rajanaidu said the company had begun working on the technology in the middle of last year and is finalising the basic platform design, including user experience testing. The MVP will be launched in about two or three months, and is expected to move into beta development within three months of the alpha launch.

He said the idea was to bring together services that have emerged over the last few years in the primary care sector, such as HealthEngine for online booking and MediSecure for electronic prescriptions, into a new vehicle for GPs to service both existing and new patients.

“There are electronic appointment and prescription fulfilment companies, but in the middle of that is the remote consultation piece, which we think is underserved,” Mr Rajanaidu said. “There are similar services; however their focus has been on remote areas, [the geographical classifications] RA2 and RA3, and not specifically focused on servicing metropolitan areas.

“We take a user-oriented approach, focusing on the user experience and from this perspective, we believe that there is an opportunity to improve. From a user experience point of view, the idea is to use mobile devices to make the bookings, perform the remote consultation as well as get your prescriptions fulfilled, within the same workflow so to speak.”

As the alpha version of the platform is designed for Apple devices, the choice of video conferencing technology is restricted. Mr Rajanaidu said his team had considered WebRTC, but it is yet to be supported by Apple in native iOS.

As instadok wants to integrate an electronic health record and provide patients with access to their previous consultations, the company is considering the use of Adobe’s media streaming technology. Mr Rajanaidu said this technology allows consultations to be archived automatically and accessed as required.

“Because WebRTC is a peer-to-peer communication protocol, it makes storing consultations challenging,” he said. “Right now we are considering the use of Adobe’s Media Server and the technical detail will be finalised in the next three or four weeks.”

The ability to fulfil prescriptions is an essential part of the new platform, so instadok has teamed up with MediSecure to manage this process.

“We generate prescriptions on the platform which is automatically forwarded to Medisecure for fulfilment. There are two approaches that a patient can select. The first is to get the prescription delivered to their home, which MediSecure does, and the second is to nominate a pharmacy for pick up.

“If the pharmacy is already part of MediSecure’s network the prescriptions are pushed electronically. However, if the nominated pharmacy is not part of the network, a fax is used to fulfil prescriptions. From a patient’s perspective, prescription fulfilment is a seamless process. All they consider is whether they want to pick it up or have it delivered.”

In its alpha launch phase, Mr Rajanaidu said instadok is planning to recruit 20 practices in Melbourne that are already using HealthEngine for their bookings, and will provide a pre-configured iPad free of charge. The only requirement will be that practitioners commit to doing a minimum number of consultations a month using the platform in exchange for a free lease of the iPad and access to the platform.

“As part of the registration process we will provide them with marketing material targeting patients to make them aware that the practice is part of the instadok platform and they can use it for remote consultations,” he said.

In its planning stages, instadok conducted market research to investigate the value proposition of remote consultation services, and found that what doctors valued most was a new channel to connect with their existing patients.

“Mobility actually came out second. We had about five different propositions and they just had to rank them based on what they valued the most, and mobility and access to a larger pool of patients actually came up second and third. It was connecting with existing patients that is most valued.”

As it will be a paid service, billing will be relatively easy through credit card. It is actually pricing – how much doctors and instadok can charge – that is the biggest challenge, Mr Rajanaidu said.

“What we learn from the MVP will be important for addressing this question. I think that we must take a leadership position in terms of pricing. Where we’re coming from with this is that the platform has a low barrier to entry and does not include the normal brick and mortar overheads. And with limited overheads, we should be priced competitively for all stakeholders on the platform.

“Our focus is as about improving customer service. It is a service that will work out of the box with little to no set-up costs or time investment, however we will come back and re-evaluate our approach based on the feedback and learning from the launch of the MVP.”

AIHW launches OzWelfare app to partner OzHealth

The Australian Institute of Health and Welfare (AIHW) has released an OzWelfare app for iPad and iPhone providing key facts and figures from the 2013 Australia’s welfare report.

Like the OzHealth app launched last year, the data is a condensed version of the AIHW’s 13th biennial health report and is a comprehensive source of national statistics on the health of all Australians.

It includes a fact sheet exploring different topics, a detailed glossary and an interactive quiz to allow users to test their knowledge. The quiz involves 10 multiple choice questions drawn from a bank of questions based on the statistics and information contained within the app. Each question contains a hint option which takes users to where the information is listed in the app.

It also has a user favourites page to enable easy access to topics of interest.

It is a partner app to the OzHealth version, which contains statistics and fast facts on Australia’s population, life expectancy, births, deaths, international comparisons, population groups, diseases, injury, illicit drug use, tobacco, alcohol consumption, health promotion, organ donation, dietary recommendations, health and medical research, spending on medicines and health, and lifestyle factors that affect health.

The OzHealth app is due for a data update later this year.

Both apps are free and are available from the App Store. They have been optimised for the iPad and iPhone.