Practical patient apps

This article first appeared in the November 2014 issue of Pulse+IT Magazine.

Do a search on iTunes or Google Play and you’ll be inundated with apps for health, fitness and wellbeing, most aimed at ‘the worried well’ and many of dubious worth to say the least. For patients with a chronic illness, there are some apps of practical use that clinicians can use in concert with their patients. Here’s a selection of some of the more impressive patient-focused apps released in the last year.

Medical technology company iSonea released a smartphone app called AsthmaSense in September to help asthmatics manage their condition.

The app, available for iOS and Android devices, is aimed at helping asthmatics follow their asthma action plan, providing active reminders to take medications or lung function tests and allowing the user to keep a journal of symptoms and recordings of peak flow and wheeze rate.

It also allows users to receive alerts when their asthma is judged to be well controlled or poorly controlled – alerting them to a potential attack – to add emergency contact information and review up to two months of medication use. The app will also allow asthmatics to share their data with doctors or family members.

iSonea plans to release future versions of AsthmaSense to incorporate its WheezoMeter device, which uses the company’s acoustic respiratory monitoring (ARM) technology to measure wheezing. In future versions, the company plans to support other operating platforms and incorporate features such as a sensor that detects changes in environmental conditions such as air quality and weather.

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

Systems restored following Queensland Health outage

Queensland Health has announced that technical issues that caused a widespread outage of some clinical systems yesterday have been rectified.

The problems were first noticed at about 11am yesterday, forcing many hospitals to revert to paper-based contingency plans, Queensland Health said.

“All hospital and health services have experienced some level of interruption to services but all have developed contingency plans to ensure services to patients continue,” the organisation said yesterday.

“The issue is in the central data service centre and technical experts are working to rectify the problem.”

IT experts worked overnight to fix the problem, which occurred during a scheduled upgrade when a fault was identified.

“The attempt to fix the fault caused the system to fail. It could take up to 24 hours to rectify the problem. The most critical areas of the system will be restored first.”

This morning, Queensland Health issued a statement saying the problem had been fixed and the affected systems restored.

iTnews is reporting that the outage affected the encryption service Queensland Health uses for its discharge summaries and its statewide endoscopy system. However, the HBCIS patient administration system was not affected.

Integrated apps for medicines

This article first appeared in the November 2014 issue of Pulse+IT Magazine.

There are any number of apps available that consumers can use to keep track of their medications, but the real value in an app is the ability to order script repeats or set up a convenient time to pick up their medications. For that, the app needs to integrate easily with the pharmacy’s own systems, which is where specialist apps come into play.

The National Prescribing Service (NPS) first released its MedicineList app back in 2011, at the time featuring some nifty capabilities such as allowing users to take a photo of their medicine’s packaging, dispensing label as well as the medication itself.

The app also allowed users to enter details of the brand, its active ingredients and the strength and dosage. Similar apps had flooded overseas markets and they began to appear here too, but whether any of them were used regularly or not is a matter for conjecture.

For consumers, what would prove much more valuable was a way to use their app to communicate directly with their pharmacy, particularly the ability to request that repeat scripts be dispensed, and to set a time to physically come into the pharmacy to pick them up. For that to happen safely, and to ensure it was the right patient and the right time for a repeat, the app had to be able to communicate with the pharmacy’s dispensing system.

That began to happen in earnest with the release of Send a Script in mid-2013, although the GP2U telehealth service had begun working on a similar system earlier that year. Send a Script, designed by Wollongong pharmacist Fabian McCann, initially allowed consumers to take a photo of the script and SMS it to the pharmacist. At the pharmacy end, Mr McCann developed a web-based dashboard app that received the SMS, managed the dispensing process and then sent a notification back to the consumer when the script was ready to be collected.

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

AMA, Labor slam move to prepare for disputed GP co-pay

The Australian Medical Association (AMA) and the federal opposition have both criticised moves by the government to begin work on changing Medicare electronic claiming and practice management software to accommodate the proposed GP co-pay before the legislation has even been introduced to parliament.

As reported yesterday, the Department of Human Services (DHS) has notified medical software vendors that it is beginning work on developing a client adaptor that they will need to implement to accommodate the $7 co-payment, as well as a verification service to allow general practices and out-of-hospital pathology and diagnostic imaging providers to check if a patient has reached the proposed service cap of 10 visits or episodes.

While DHS says the implementation of the changes is subject to the passing of the necessary legislation, it has outlined a series of steps that will need to be taken by July next year, when the government proposes that the co-pay commences.

However, Pulse+IT has learned from several software vendors that they have no intention of beginning any integration work until the legislation is passed, which is looking unlikely.

There is also a great deal of confusion over how pathology practices will collect the fee given they often do not see the patient in person, and how GPs might collected the fee from patients in residential aged care. There are also concerns about how providers will handle cash transactions when many bulk-billing general practices no longer keep a till.

Chair of the AMA’s Council of General Practice Brian Morton said the AMA remains opposed to the government’s co-pay model due to its effect on the most vulnerable patients and described the proposed DHS work program as “a bit premature, given the way things are shaping up”.

Responding to rumours that the government could introduce the co-pay by regulating for it rather than legislating, Dr Morton said the co-pay would need legislation but it was possible the government could still move to reduce the Medicare rebate by $5 by regulation.

“This reflects the zealotry of a government to enact its ideology despite the deleterious effect on general practice and the harm to the health care of the vulnerable,” he said.

Shadow health minister Catherine King said the move “highlights the deceit and dishonesty at the heart of this arrogant and out of touch government”.

“They lied about the GP tax before the election, and now faced with the overwhelming rejection of the Australian people and the parliament, are trying to introduce the GP tax by stealth, just as they did this week with the fuel tax.

“This is a government that refuses to listen to all the evidence from health experts and professionals, and instead ploughs ahead with its bid to wreck Medicare in defiance of the parliament and the people.”

DHS did not respond to a number of questions about the plans, including how the proposed verification service for the service gap and the low gap incentive would work in practice.

It also did not respond to questions on whether software vendors would be remunerated for any integration work.

“A new version of the client adaptor will be made available in 2015 that will resolve a technical issue and is not specific to the introduction of the patient contribution measure,” a DHS spokesperson said.

“The implementation of all government measures, especially those involving ICT, require considerable forward planning. Even where legislation has not been passed, forward development work of this nature is standard procedure for the department.”

The spokesperson confirmed that funding to develop the new capability was allocated in the May budget as part of the measure that funded it to investigate a “commercially integrated payment system” for Medicare’s claiming and payment processes for the MBS and PBS.

An expression of interest (EOI) was published in August, with a two-week timeframe for submissions. DHS did not respond to questions on the status of this EOI.

The AMA’s Dr Morton said he was also concerned about an increase in red tape if general practices had to check on whether each patient had reached the service cap.

“The practical implications are worrying as the system will have to be live, real-time and the interactions at the reception desk (and during the consultation) will add time and complexity to every patient visit,” he said.

The AMA released modelling last week showing that the $2 “windfall” that Health Minister Peter Dutton said would go to GPs would be almost completely swallowed by extra administrative time and costs. It has proposed its own co-payment that would not include a reduction in the Medicare rebate.

“The AMA alternative model spares the vulnerable (concessions and under 16s) with virtually no change to the billing requirements for these groups who will continue to be bulkbilled,” Dr Morton said.

“Practices will be enabled to charge those able to pay but these on costs can be balanced by a fee that recognises the quality of GP care – put simply the ability to recoup these extra overheads.”

A spokesperson for Mr Dutton did not respond to questions and instead referred Pulse+IT to DHS.

Bubble and hype: the reality of health apps

This article first appeared in the November 2014 issue of Pulse+IT Magazine.

The saying that “there’s an app for that” has quickly become a cliché, but that doesn’t mean there is not a lot of truth behind it. As health apps and fitness devices proliferate, it is timely to take a considered view of their relative worth and remember that in healthcare, it is the person, not the device, that is the lifesaver.

I love my mobile phone and take it everywhere with me. I love it so much I have a spare one in case something happens to it so I can switch my SIM card and be back online in seconds. I don’t consider myself a Luddite, and judging by the number of gadgets in my home office my wife thinks I am trying to maintain the mobile electronics industry all by myself.

I have an iPad, an Android tablet and a Windows Surface tablet, just in case one of them wins the tablet wars, as well as a notebook and two desktop computers, one a Mac and one a PC. However, I have become pretty good at recognising hype, probably because I have been burned by it so many time before.

Hype is not necessarily a bad thing. It usually correlates with passion, innovation, opportunities to make a profit and much more. However, I get a little upset about it in healthcare, because with the hype comes people who dream of their illness being cured, their suffering being lessened, their children being healthy. Those are noble goals we all should aim for, and it is heart wrenching when you see them taken away from people by hype.

mHealth is currently full of a lot of hype. That’s not to say that there are not some good mHealth things out there. There are, and I use some of them every day. But when people become so enmeshed in the hype that they have to verbally attack anyone who questions its value, I smell the bad side of hype, and I get worried.

I do believe that mHealth can play an important role in healthcare, but only when it learns to interact with the whole system. It needs to integrate not only with the technology used, but the workflow and the culture.

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

Innovative technologies for improving healthcare at HITWA

The organisers of the Health Information and Technology WA (HITWA) conference being held in Perth in November have put out a call for submissions from researchers and students interested in showcasing their projects during the event.

HITWA 2014, jointly organised by the WA branches of the Health Informatics Society of Australia (HISA) and the Health Information Management Association of Australia (HIMAA), will stage a workshop highlighting health IT research in WA, involving a series of three-minute presentations.

The research must relate to the conference themes and have been conducted in 2013-2014. The student projects must have been conducted by a student at a WA university.

Keynote speakers include burns surgeon Fiona Wood, who will discuss IT as a core member of the healthcare multidisciplinary team; Fiona Stanley Hospital director of nursing and midwifery Taylor Carter, who will discuss how informatics links to nursing staff; Princess Margaret Hospital senior pharmacist Lea Dias, who will discuss informatics and medication management; and head of Edith Cowan University’s School of Medical Sciences, Moira Sim, on whether we are HIT-ready for baby boomers in aged care.

The afternoon session will hear lessons on IT integration from other industries, feature speakers such as Bankwest CIO Andy Weir and Coles general manager for financial services Richard Wormald.

Joshua Boys, director of document and record management and business intelligence firm Ignia will discuss modernising the traditional business intelligence environment.

HITWA 2014 will be held at the Perth Convention and Exhibition Centre on Friday, November 7. Registrations are available online.

Short window for expressions of interest in Medicare outsourcing

The federal government has allocated two weeks for the private sector to submit an expression of interest to provide a claims and payment solution for Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) transactions.

Fairfax newspapers revealed last week that the government was going ahead with its plan to explore a “commercially integrated health payment system”, as briefly outlined in the May budget. Half a million dollars was allocated to the Department of Health (DoH) to develop a proposal in conjunction with the Department of Human Services (DHS) to market test the delivery of a new system.

The budget papers state that expressions of interest “will be sought from commercial providers to gauge interest in the proposal and to identify potential alternative approaches to the delivery of health payments”.

DoH currently contracts DHS to handle MBS and PBS claims and payments on its behalf, with hundreds of millions of transactions being processed each year.

DHS has had an automatic payment system for bulk-billed transactions for almost a decade and is increasingly encouraging online transactions, both from healthcare providers and patients.

Between 2007 and 2009, the government provided financial incentives to GPs, specialists, pathologists and medical software vendors to transition to online services under the Transitional Support Package (TSP). Online services now account for the vast bulk of transactions handled by DHS.

It runs the Medicare Easyclaim system for bulk-billed general practice consultations, which allows practices to swipe the patient’s Medicare card through an EFTPOS terminal to have the rebate paid to the practice on the patient’s behalf.

Non bulk-billing practices can also use Easyclaim to have the Medicare rebate paid into the patient’s bank account, and patients themselves can make online claims through Medicare Online – now linked to MyGov, which also handles Centrelink and child support payments as well as acting as a gateway to the PCEHR – or through an express app, which allows patients to take a photo of the receipt and send it to Medicare.

PBS claims at the pharmacy work similarly, with Online Claiming for PBS allowing pharmacies to submit PBS claims automatically. That system has been in use since 2004. Both Easyclaim and PBS Online are integrated into general practice and pharmacy software.

DHS also runs ECLIPSE, which is used for hospital inpatient Medicare and PBS claims and is linked to all of the private health insurers.

In a statement, Health Minister Peter Dutton said the current IT systems that manage the claims and payments processes “are dated and in need of a substantial upgrade”.

He did not specify what those IT systems were, but said the government it was “good process to review and test existing and alternative systems”.

Mr Dutton hinted that he might have a preferred solution in mind when he addressed the HIMSS conference in Sydney a week after the budget was released.

“I’d like to draw people’s attention to … the government’s desire to go to market and call for expressions of interest about the the way in which the payments model works, the transfer system in particular, between government and general practice across the country,” he told the conference.

“It’s an area we want to see streamlined and to provide greater support outside of the current regime that will deliver a cutting-edge technology and efficiency gain that we think we can deliver fairly promptly to general practice.”

The EOI, which does not include face-to-face services provided by Medicare, will close on August 22.

Opening medical records for patients: a limited literature review

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

Personal health records (PHRs) are the next big thing after electronic health records (EHRs), enabled by the uptake of electronic clinical notes and additional functionality. As part of the Australasian College of Health Informatics’ (ACHI) new biannual evidence review, we assessed 10 research articles on patient accessible records published in 2013 to see if a picture is emerging on the design and use of PHRs.

PHRs have begun to feature in health IT policy, such as the development of the PCEHR in Australia, and a New Zealand policy specifying that everyone will have access to the basics of their health information. What does this mean and how can we leverage PHRs to improve health outcomes? Is it safe for patients to use the functions, and what are some of the barriers to engaging in healthcare via PHRs? What is the potential for PHRs to improve access to care and how will services change?

We have conducted a literature review of 10 articles about patient accessible records – a broader term to identify papers about PHRs, and the ‘state of accessibility’ – to assess the current state of play with PHR adoption. The articles were chosen from a broader group of articles suggested by ACHI members as being of particular importance or interest, as part of its newly instituted biannual evidence review.

The objective of this process was not to produce a systematic review of the literature, but rather a contemporaneous snapshot of evidence around an issue – in this case the issue of patient accessible records – put forward by the members of a key relevant national professional body.

The first step of our literature review was to invite ACHI Fellows to recommend articles for review for the year of 2013 on the topic of PHRs. There were 13 recommendations, and the authors also searched Medline, Google Scholar, PsychInfo and CINAHL databases to add to articles from the ACHI constituency to ensure good coverage on the topic. Articles were included if they presented research findings about patient accessible records (which were often PHRs) and/or patient portals. In total there were 33 articles, of which 10 were selected for more detailed analysis. Table 1 lists the selected articles.

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

Waitemata DHB signs with Orion for Long White Health Cloud

Orion Health has signed a three-year agreement with Waitemata District Health Board (DHB) to co-develop eHealth initiatives at North Shore Hospital’s special care baby unit and haematology ward.

The agreement will use Orion’s new national innovation platform, which it has dubbed the Long White Health Cloud (LWHC), to improve existing and develop new technologies based on the input of clinicians.

Orion Health’s NZ country manager Jerome Faury said the LWHC is a software-as-a-service (SaaS) model that supports the company’s latest products with continuous delivery architecture. Orion has been developing the platform over the past 12 months with HP and Gen-I.

This particular agreement is between WDHB and Orion Health directly, but there is the potential for collaboration and engagement with other entities, Mr Faury said.

An initial focus of the partnership will be on making the two wards paperless by using a range of electronic systems to replace traditional paper-based processes, including Orion’s Rhapsody integration engine, clinical data repository and portal along with clinical documentation and healthcare pathways.

Mr Faury said the full LWHC platform includes Orion’s Smarter Hospital and Intelligent Integration products, which also include patient engagement systems, direct secure messaging, clinical portals, mobile technologies, medicines management and clinical information system, as well as its big data platform and electronic referrals.

“The fundamental principle of the engagement is for end users to collaborate and provide feedback directly to Orion Health product and development teams,” Mr Faury said.

“We want to continuously improve our products, as we ramp up R&D in NZ to deliver more value to clinicians, system and consumers, faster, with measurable outcomes. Having the person with the problem or feedback working directly with the people who can potentially provide the solution is critical in effective design-led innovation.”

Under the agreement, Orion Health will provide the latest versions of its software systems for the two wards as well as implementation and support. The project will be reviewed after 12 months to evaluate the processes and further developments.

Waitemata DHB CEO Dale Bramley said the agreement would position the DHB as a national leader in technology adoption.

“The technologies developed under this agreement will be the product of real-world testing and refinement based on the input of people at the frontline of healthcare,” Dr Bramley said.

“Our patients and their whanau will benefit from the new models of care that flow as a result, such as the potential for mobile devices to be used for reviewing results, entering notes and coordinating care at the bedside.”

He said the partnership would enable improvements to existing products and the development of new products that could be made available to other DHBs.

Orion Heath CEO Ian McCrae said the company had other innovation partnerships which were extremely productive in generating new products and better health delivery and care.

“Health professionals have a lot of excellent product ideas and this gives them an outlet where that creativity can be realised as products,” he said.

Mr Faury said he could not discuss the financial aspects of the agreement, but that the focus was not on profits. “Terms are very favourable to the DHB, albeit commercially sensitive,” he said.

Shared health information platform for Kiwi kids

New Zealand’s Midlands Health Network will pilot a new National Child Health Information Programme (NCHIP) in Waikato from August, consisting of a shared health information platform that will give each health provider involved in a child’s care a view of the their milestone achievements.

The Pinnacle-owned Midlands Health Network has partnered with the NZ Ministry of Health, the National Health IT Board and four district health boards along with software vendor Orion Health and the Best Practice Advocacy Centre (BPAC) to develop the platform, with hopes that it will roll out nationally following the year-long pilot.

It consists of a telephone-based child health coordination service located in Hamilton and the information platform, which has been built by Orion with input from BPAC. Every child aged from birth to six years will be enrolled in the program, as they are in the national immunisation register, although an opt-out option is available.

The NCHIP will provide a shared view of the child’s health milestones, including immunisations, well child checks, hearing and vision checks, and B4school checks. Doctors will be able to log on to the system through their patient management software or a password-protected website.

Parents are also expected to be given access to the shared view through Midlands Health Network’s ItsMyHealth website, which uses Medtech’s ManageMyHealth patient portal.

Health Minister Tony Ryall said healthcare providers will also be able to see which other providers are delivering health services to a particular child.

“If they’re unable to contact or find a child who is due for a health check, they can phone or send a secure message to a coordination service that will be able to launch a wider search for that child,” Mr Ryall said.

He said the program is expected to result in more Waikato children being enrolled with GPs, well child-tamariki ora providers and oral health services, more children having their immunisations and health checks in a timely manner.

“It should also help to locate vulnerable children who might otherwise have dropped off the radar,” he said.

From birth, each child will be given a nominated well child/tamariki ora provider and a GP, and enrolled on both the national immunisation register and the national child health information platform.

The program will work alongside the primary care providers to locate any child ‘lost’ to the health system, the organisation says.

The pilot program will run in the Waikato region from August 2014 to March 2015, when an evaluation will identify areas for improvement ahead of a planned roll out to the Lakes, Tairawhiti and Taranaki DHBs, and then nationally.