Survey shows laboratory information systems not likely to cope with change

A survey of Australian laboratory scientists carried out by information systems vendor InterSystems has found that the quest for cost savings and an increase in automation are driving change in the pathology sector, but for public laboratories at least, current laboratory information systems (LIS) are not up to the task of coping with these changes.

InterSystems, which markets a laboratory module as part of its TrakCare suite and is due to launch what it calls a laboratory business management system (LBMS) early next year, conducted one of its annual surveys of the sector at the Australasian Association of Clinical Biochemists (AACB) conference in Sydney in September.

InterSystems surveyed 60 people representing 29 public pathology labs, 18 private pathology labs and 13 related organisations including government. Over half (53 per cent) of those surveyed were biomedical or clinical scientists and 19 per cent were lab managers or heads of department.

The survey found that 75 per cent of respondents cited cost savings and efficiencies as drivers of change in their laboratories, with 63 per cent singling out automation. Other drivers were consolidation of labs or formation of laboratory networks, the introduction of electronic health or pathology patient records, and point of care testing (PoCT). Only one-third said patient-centred care was driving change.

There were differences in emphasis between public and private labs – for public laboratories, the biggest driver was cost savings and efficiencies (83 per cent), while private labs were more likely to cite competition with other laboratories and increased demand for genomic testing.

Public labs also cited consolidation of laboratories and the formation of laboratory networks.

The survey found that in Australia, only 29 per cent of public laboratories thought their current LIS was capable of supporting these changes, with 36 per cent saying they disagreed or strongly disagreed that their systems were up to the task. 36 per cent were neutral.

Private labs look to be in better shape, with 45 per cent saying their systems could support the changes and only 17 per cent thinking they couldn’t.

The two sectors were more in alignment when it came to what laboratory system capabilities were the most important to the success of the lab in the future, although the public sector cited the ability to integrate the pathology record with the organisation’s EHR and interoperability with other organisations much more highly than private.

Three quarters (75 per cent) of respondents cited ‘Complete visibility, control and accountability over the testing process’, and ‘Support for laboratory workflows occurring across a number of sites’ as important.

‘The ability to predict laboratory workloads and pinpoint bottlenecks’ was chosen by over 83 per cent of public laboratories and only 44 per cent of private.

Capabilities also rated as important were:

The public pathology sector in Australia uses a relatively small number of systems, including InterSystems’ TrakCare, which was recently installed at Macquarie University Hospital in Sydney and has a long-standing relationship with St John of God Pathology.

A new system from PJA Solutions is currently being implemented as part of an alliance between Royal Melbourne Hospital, The Austin and the Peter MacCallum Cancer Centre in Melbourne. PJA Solutions was bought by the publicly listed, Canberra-headquartered Citadel Group in June for $45 million.

SA Pathology is due to roll out a new system from Cerner to replace its Ultra system as soon as SA Health can get its enterprise patient administration system (EPAS) from Allscripts working. The Cerner product, called the enterprise pathology laboratory information system (EPLIS) by SA Health, is likely to run alongside Ultra until then.

Both Pathology Queensland (PJA’s Auslab) and PathWest (Ultra) are likely to issue tenders for new systems over the next few years.

The private sector uses a mixture of provider-owned or bespoke systems, including Sonic Healthcare’s Detente system and Healthscope and Primary Health Care both using a version of Ultra, which was originally developed in Australia by Triple G, was then sold to GE and is now owned by a Northern Irish company called Cirdan.

Orion Health wins Queensland integration contract with Rhapsody

Orion Health has won a tender to roll out its Rhapsody integration engine as a replacement for the legacy JCAPS-based middleware system used by Queensland Health.

The contract is the first step in an overhaul of Queensland’s interoperability requirements, part of the 20-year health ICT strategy outlined by Health Minister Cameron Dick in September.

The strategy has a number of key components, one of which is to deliver better systems integration and interoperability. Queensland Health estimates that $130m of the overall $1.26 billion strategy will be needed for information interoperability and eHealth foundations alone.

Up to $30m of that will be needed for information interoperability to support sharing of information between Hospital and Health Services (HHSs) and other healthcare providers.

Mr Dick said in September that the strategy also addresses legacy system risks, eventually leading to the replacement of the ancient HBCIS patient administration system and the statewide pathology system.

Queensland Health is currently working on refining and confirming its requirements for the new integration engine along with the solution design and implementation approach.

Queensland Health CTO Colin McCririck and chief architect Brendon Kirby will take a co-design approach to the project with Orion Health and Fujitsu, which is providing implementation and change management services.

It expects to complete the first phase by June next year and begin the replacement after that.


Orion Health senior vice president for the Asia Pacific, Darren Jones, said Orion was pleased to be working with Fujitsu to deliver the first stage of Queensland Health’s future interoperability platform.

“Together we have a shared vision for a fully integrated statewide health system and Orion Health is excited to have the opportunity to provide the foundation for this with our Rhapsody solution,” Mr Jones said in a statement.

Rhapsody is used in a number of global markets to help simplify healthcare interoperability. It is able to support numerous protocols, languages and messaging systems including HL7, JavaScript and modern web services, and was the first in the world to build support for HL7’s new FHIR standard.

It was recently chosen by the US Department of Defense to be the link its new EHR and civilian healthcare systems as part of the $US4.3bn Dim-sum project.

Standards Australia to write digital hospitals handbook

Standards Australia has launched a new project to develop what it says is the world’s first digital hospitals handbook, based on an original proposal from the Victorian Department of Health and Human Services.

The project aims to develop a set of principles and recommendations that inform the design and implementation of digital hospitals, both new and refurbished, including articulating exactly what a digital hospital is.

The project will be led by the Australian Health Ministers’ Advisory Council (AHMAC) and the National Health CIO Forum (NHCIOF) and will be managed by Standards Australia technical committee IT-039.

The idea is to broadly address how technology can be used to deliver more efficient hospital services.

According to Standards Australia, the handbook will ensure that “digital hospital principles are clearly aligned with the benefits of taking a digital hospital approach to the design, construction and commissioning of healthcare facilities through a benefits estimation/realisation framework”.

It will also ensure that the ICT systems architecture of healthcare facilities “enables innovative ways for providing healthcare services that support positive outcomes for stakeholders now and into the future”.

Standards Australia CEO Bronwyn Evans said the value of applying technology to the delivery of health services could not be underestimated.

Dr Evans also leads an industry growth centre for medical technologies and pharmaceuticals, based at the University of Sydney’s Institute of Biomedical Engineering and Technology, which aims to boost the competitiveness, productivity and innovative capacity of Australia within this sector.

“The work around digital hospitals will effectively align with the innovation emerging from the direction of this new industry policy,” Dr Evans said.

International health IT week in review: November 1

Pulse+IT’s weekly weekend round-up of international health IT and eHealth news:

Interview: Tim Kelsey
Digital Health News ~ Rebecca McBeth ~ 29/10/2015

Tim Kelsey believes that things are changing in health and social care, as the sectors face up to what may be their greatest ever financial challenge; and the huge reform agenda required to address it.


NHS 24: £117m IT crashes on go-live
Digital Health News ~ Thomas Meek ~ 29/10/2015

Use of a new, £117 million computer system at Scotland’s NHS 24 was abandoned on Wednesday evening after experiencing significant technical problems the day it went live.


Johns Hopkins, Microsoft tackle ICU errors
Health Data Management ~ Greg Slabodkin ~ 29/10/2015

Johns Hopkins University School of Medicine has joined forces with Microsoft to better connect medical devices in ICUs with the goal of significantly improving patient care and preventing complications.


Many EDs dissatisfied with enterprise EHR emergency modules
FierceHealthIT ~ Katie Dvorak ~ 29/10/2015

Visits to the emergency department are on the rise in the U.S., and a lack of usability and interoperability of ED Information Systems (EDIS) are only adding more complications, according to a new survey from Black Book.


Kelsey: November start on DMI data
Digital Health News ~ Rebecca McBeth ~ 29/10/2015

NHS England’s director of patients and information Tim Kelsey has told Digital Health News the commissioning board will write to trusts in November to kick off the first baseline self-assessment for a new ‘digital maturity index’.


Caldicott: care.data hangs on engagement
Digital Health News ~ Thomas Meek ~ 28/10/2015

The UK government and the health service must engage with GPs and the public if the care.data programme is to go ahead, the NHS national data guardian has told MPs.


Safety still shaky at most hospitals, says Leapfrog
HealthcareITNews ~ Bernie Monegain ~ 28/10/2015

The number is startling for how large it is. It pops off the page: 440,000 people die each year from preventable errors in hospitals.


Congress takes DOD, VA to task for lack of interoperable EHRs
Health Data Management ~ Greg Slabodkin ~ 28/10/2015

Officials from the Departments of Defense and Veterans Affairs got an earful from members of Congress on Tuesday about continued lack of interoperability between DOD and VA electronic health record systems and failure to identify goals and metrics to clearly define achievement.


Congress to VA, DoD: Interoperability issues reflect poor management, not technology
FierceEMR ~ Dan Bowman ~ 28/10/2015

House lawmakers grilled Veterans Affairs and Defense Department officials at a hearing Tuesday about a continued lack of health data interoperability, calling the agencies’ progress inexcusable and demanding more accountability.


AHIMA, HIMSS, IHE lay out map to interoperability standards
Government Health IT ~ Jack McCarthy ~ 28/10/2015

Three healthcare industry groups have released a white paper with an eye toward promoting development of interoperability standards and improving health information practices (HIM).


Do patient portals exacerbate healthcare disparities?
HealthcareITNews ~ Mike Miliard ~ 27/10/2015

Portals and personal health records have been touted as ways to spur better patient engagement and set the stage for improved outcomes. But a new study shows they often aren’t used at all by the very people who may need them most.


NPfIT transitions ‘high risk’
Digital Health News ~ Rebecca McBeth ~ 26/10/2015

Four NHS hospital trusts that need to replace their nationally procured electronic patient record systems by the end of the month are deemed “high risk” by the board overseeing the programme.


Walgreens puts expansion of Theranos’ blood testing centers on hold
FierceHealthIT ~ Katie Dvorak ~ 26/10/2015

Theranos’ relationship with Walgreens may be fraying after the drugstore chain announced it will delay the opening of blood-testing centers until questions about the startup’s technology are answered.


VA, DoD officials to discuss EHR interoperability with lawmakers
FierceEMR ~ Dan Bowman ~ 26/10/2015

Veterans Affairs (VA) and Defense Department (DoD) technology officials are set to meet with members of Congress on Tuesday to discuss looming interoperability issues between the agencies’ electronic health record systems.


Open source e-prescribing in pipeline
Digital Health News ~ Rebecca McBeth ~ 26/10/2015

An electronic prescribing system open sourced for the NHS may be introduced at Taunton and Somerset NHS Foundation Trust.


Is healthcare IT ready for Baby Boomers coming of age?
HealthcareITNews ~ Bernie Monegain ~ 23/10/2015

People over the age of 60 are likely to be driving the healthcare market around the world in less than five years, according to global research firm Frost & Sullivan.


How we’re using FHIR to create EHR-agnostic applications
FierceHealthIT ~ Dan Bowman ~ 23/10/2015

When it comes to the widespread use of the Fast Healthcare Interoperability Resources (FHIR) standard, Geisinger Health System Chief Clinical Informatics Officer Alistair Erskine calls himself impatient but optimistic.


NBN satellite provides room to manoeuvre

The NBN company has successfully launched the first of its long-term satellites, which promises better broadband for regional and remote Australia and increased capacity to provide telehealth services.

NBN Co has made available a short video of the launch, which took place this morning at the Guiana Space Centre in South America.

Nicknamed Sky Muster, the satellite will take about two weeks to manoeuvre from its geostationary transfer orbit, where it will deploy solar panels to charge its onboard batteries, before a chemical thruster is fired to lift it into its final orbital position 36,000 km above Australia.

NBN’s satellite program director Matt Dawson said once Sky Muster is in its orbital position above Australia, it will need to undergo several months’ tests to make sure it is functioning correctly.

“We will then need to integrate the satellite with the ground stations and commission the 101 spot beams,” he said.

He described a spot beam as a focused satellite signal that is specially concentrated in power so that it covers a specific geographic area on earth.

The second long-term satellites is due to launch next year and together, they will provide broadband access to around 400,000 Australian homes and businesses.

NBN CEO Bill Morrow said the satellite will provide access to fast broadband for the parts of Australia that need it most.

“With the launch of Sky Muster, we’re one step closer to changing the digital face of our nation,” Mr Morrow said.

“The ability to video-conference friends and family, study courses online and visit doctors from your lounge room will all be possible in areas which have traditionally struggled to access basic internet services like online banking and shopping.

“Many homes and businesses in regional and rural Australia still rely on dial-up level speeds and have little or no access to a commercial broadband service – this satellite will help to close the divide and ensure no one gets left behind.”

The satellites are designed to deliver download speeds of up to 25Mbps and 5Mbps upload, although real speeds will depend on the individual retail service providers.

The potential for improved telehealth services to remote areas is one of the main selling points of the satellite.

Earlier this year, NBN’s executive general manager of new developments, wireless and satellite Gavin Williams said it could help businesses to operate more efficiently by using new cloud-based software and also helping them to find new global markets for their products or services.

“It could also be by allowing more efficient delivery of education services to remote students or facilitating the delivery of specialist healthcare services to areas with few medical facilities – or it may even be in ways we don’t even know of yet,” he said.

eHealth reform and chronic conditions in rural and remote Australia

A full-day session on how eHealth and telehealth can affect the management of chronic and complex conditions in rural and remote Australia will be held at the Rural Medicine Australia conference in Adelaide later this month.

The session will be facilitated by former Australian College of Rural and Remote Medicine (ACRRM) president Richard Murray, and will include a number of panel discussions on eHealth and primary care reform along with demonstrations of eHealth tools and capabilities.

ACRRM president Lucie Walters and Rural Doctors Association of Australia president Dennis Pashen will provide a rural doctors’ perspective on new policy and reforms relevant to chronic disease management in rural practice.

This will be followed by a facilitated panel session on the key issues affecting rural and remote practice from the national reform agenda, including eHealth reform – particularly around the PCEHR/My Health Record and telehealth – primary care reform, the MBS review and incentives payments, and the frameworks for chronic conditions such as diabetes and asthma.

Panel members include NEHTA chair Steve Hambleton, Department of Health special adviser on eHealth Paul Madden, rural doctors John Hall and Ewen McPhee, deputy secretary in charge of the DoH’s indigenous, rural and population health divisions Wendy Southern, and DoH’s first assistant secretary for primary care, Mark Booth.

The roles of Primary Health Networks (PHNs) and Local Health Networks (LHNs) in supporting clinicians to improve health outcomes for chronic and complex conditions will also be discussed.

Former ACRRM president Jeff Ayton will facilitate an afternoon session demonstrating eHealth tools and capabilities, including clinical improvements to the PCEHR, innovations in telehealth, new point-of-care testing devices, and care planning and PCEHR integration.

The eHealth session will take place on the third and final day of RMA15, which is this year being held at the Adelaide Convention Centre from October 22 to 25. Registrations are now open.

Easy on the eye version of iMIMS promises faster downloads

MIMS has launched a new version of its popular iMIMS app for iPhones, featuring a redeveloped user interface and faster downloads.

iMIMS was first launched in March 2011 specifically for users who needed a mobile, locally installed way to access MIMS medicines information.

It is optimised for iPhones but the latest version is also optimised for presentation on iPad and iPad mini screens, which MIMS says will save time from pointless scrolling down.

“The aim of the redevelopment was to make it even faster and more intuitive to use,” a MIMS spokesperson said. “To achieve this everything from the initial download to monthly updates to the user interface have been redesigned.

“Increasing the speed of the initial download and monthly updates means that users can be on their way sooner with the comfort of knowing they have the latest information accessible at their fingertips.

“The new user interface is bolder, featuring more colours that makes it easier for the eye to identify where to go next.”

The upgrade is available at no additional cost to individual and corporate subscribers and can be accessed as an update from iTunes.

From this month onwards, users will need to upgrade to be able to continue receiving their monthly updates.

InterSystems goes beyond the 3Rs with next-gen lab solution

InterSystems is set to launch a next-generation laboratory business management system (LBMS) early next year that promises to take laboratory information management beyond simply addressing the 3Rs to being able to analyse information at each stage, no matter where the data is captured.

Called InterSystems TrakCare Laboratory Enterprise, the development of the new system was announced today, with a preview of its capabilities to be shown at the Australasian Association of Clinical Biochemists (AACB) conference in Sydney later this month. It is set for a commercial launch early in 2016.

InterSystems’ head of solutions for the laboratory market, Martin Wilkinson, said the difference between contemporary laboratory information management systems (LIMS) and next-gen LBMS was the depth that the latter could explore.

“Standard management is about plan, do and review as a cycle of activity, and laboratory information management systems tend to concentrate on the doing,” Mr Wilkinson said. “In pathology terms we refer to that as the 3Rs: request the pathology test, results of pathology tests, and reports of pathology tests. That’s the doing and that’s the main core business of the pathology environment.

“What we are doing with an LBMS is expanding on the 3Rs. Every lab system on the planet has to do the 3Rs well, but we are building a capability to go into much more depth on what is happening under the covers of a pathology service.”

Mr Wilkinson said laboratory services were changing massively as more and more point-of-care testing is carried out, personalised devices begin to come to the fore and the massive datasets that genomic testing is set to unleash. TrakCare Laboratory Enterprise will be set up to handle these developments, as well as to allow a much greater level of granularity on the steps that labs take to get from request to report, he said.

“They can then analyse things like turnaround times at every stage of the process involved in that report. They can understand where they are taking too long, set targets for themselves, measuring their performance against those targets in real time as well as some alerting that they are breaching those targets.

“The laboratory is no longer constrained within the walls of the lab – laboratory testing is done all over the place these days and that even extends past the point of care to personalised devices. We are trying to build a greater level of accuracy and quality into pathology through integration of point of care results.”

While point-of-care testing is increasingly prevalent, many of these devices are still not integrated into the patient’s result history or the electronic health record. InterSystems is working on the concept of a contiguous pathology patient record that is integrated within the electronic health record and includes all test data, including point-of-care test results.

“When a clinician in a laboratory approves a test result, they look back at previous results but of course if point of care testing is not integrated into that result history for the patient in the pathology record, then they are only looking at half the picture,” he said. “Results from point-of-care devices and beyond that personalised devices are not universally adopted as part of the clinical record, but I’m sure there will be in the future.

“The system is built with that in mind, and more importantly as we go into the world of personalised medicine, then InterSystems has the technology to handle massive datasets. Genomic testing is a massive dataset, and we can incorporate genomic testing into the solution over time.”

TrakCare Laboratory Enterprise has been developed here in Australia but is built on InterSystems’ HealthShare platform, so it will be Integrating the Healthcare Enterprise (IHE) compatible.

Mr Wilkinson said an LBMS will enable laboratories to work differently. Not only will they communicate lab results electronically, but they will also identify their derivation, including workflows, equipment and personnel involved, regardless of where they are located.

InterSystems describes other features of an LBMS as:

The new system will be previewed at the AACB 53rd Annual Scientific Conference at Sydney Olympic Park from September 15 to 17.

Alcidion sets out to streamline ED pathology ordering with Miya Orders

Adelaide-based Alcidion Corporation is set to roll out its new Miya Orders emergency department order sets technology at Royal Darwin Hospital and Alice Springs Hospital before the end of the year.

Alcidion announced last month that it had won a $1.75 million contract with the Northern Territory Department of Health to deliver best practice ED order sets. The idea is to streamline pathology ordering and reduce over-ordering, and at the same time provide clinical decision support at the point of care.

Miya Orders is built on Alcidion’s Miya health informatics platform and is a further extension of the company’s technology. Miya is also the basis of the intelligent patient journey system (iPJS) that has been rolled out at Victoria’s Western Health and in the NT.

It also forms the basis of the award-winning intelligent Cardiovascular Information System (iCVIS) developed in association with FujiFilm for Western Health.

Miya Orders promises to streamline emergency department workflow by providing guidance to doctors on the most clinically appropriate pathology tests to order for a patient, depending on the patient’s clinical presentation.

The technology can guide nurses in selecting common tests that can be ordered before the patient is seen by a doctor, and it also allows staff to see the status of orders and identify workflow problems that may affect the timely delivery of lab results and overall patient flow.

“For the most common clinical conditions, the system provides for junior doctors, and in some cases, nursing staff, to order tests for a patient as at the same level of expertise as a senior consultant with many many years of clinical experience,” Alcidion CEO Ray Blight (pictured) said.

The technology will ask junior doctors to justify ordering unusual tests and promises to reduce variations in diagnosis and to reduce costs due to uncontrolled ordering of expensive tests.

Alcidion says Miya Orders presents the market with a differentiated approach to introducing computerised physician order entry (CPOE) to a hospital in that rather than starting with the traditional medication order entry, it covers pathology and radiology ordering.

The company says this approach can allow a hospital to start implementing CPOE at lower risk and lower cost.

Alcidion also announced last month that it planned to list on the Australian Securities Exchange (ASX) in November pending a successful reverse takeover by minerals exploration firm Naracoota Resources, which would value the company at $12 million.

Australasian health week in review: August 1

Pulse+IT’s weekly round-up of Australian and New Zealand health, IT and eHealth news:

How to install Windows 10
Sydney Morning Herald ~ Hayley Tsukayama ~ 31/07/2015

Microsoft rolled out Windows 10 on Wednesday, making the new operating system available to the vast majority of the PC and Windows tablet universe.


Open source leader ‘livid’ at TPPA software patent capitulation
ZDNet ~ Rob O’Neil ~ 30/07/2015

Negotiations for the Trans Pacific Partnership Agreement appear likely to undo New Zealand’s ban on software patents.


SA govt taken to court over expired software licenses
iTNews ~ Paris Cowan ~ 29/07/2015

South Australian health minister Jack Snelling is refusing to buckle under legal pressure to move off an out-of-licence patient system used in the state’s regional hospitals.


A deadly dose of doctor shopping
Pharmacy News ~ Meg Pigram ~ 29/07/2015

The need to speed up the introduction of real-time monitoring of prescription drugs has been highlighted by a recent coronial inquest, the Pharmacy Guild believes.


Call to end ‘snail mail’ between doctors
Medical Observer ~ Julie Lambert ~ 28/07/2015

RACGP president Dr Frank Jones has endorsed calls for an update of medical communications after a missing hospital letter was blamed for contributing to the warfarin-related death of an elderly Adelaide woman.


Microsoft hopes computer users show Windows 10 some love
Sydney Morning Herald ~ Paresh Dave ~ 28/07/2015

Know someone required to use Microsoft Windows at work but who uses a Mac at home? Probably so.


Leaked report pushes for patient portal success
NZ Doctor ~ Reynald Castaneda ~ 28/07/2015

A leaked sector review document is pushing for the mainstream success of patient portals and eHealth records.


Home-sleep study firm denies misdiagnosis claims
Australian Doctor ~ Tessa Hoffman ~ 27/07/2015

Claims that scores of patients are being misdiagnosed with obstructive sleep apnoea (OSA) by companies selling CPAP machines have been strongly refuted by a major player in the industry.


Shake up of primary care funding signalled in leaked documents
NZ Doctor ~ Liane Topham-Kindley ~ 27/07/2015

A shake-up of primary care funding, including possibly an end to the Very Low Cost Access funding formula, is among proposals in a leaked sector review document.