The 2015 eHealth year in review: part one

It was a bright and shiny new minister who ushered in a bright and shiny new year for the eHealth and health IT industry in 2015, with the albatross around the neck of the previous minister that was the GP co-pay finally dislodged and the new one able to start afresh.

Sussan Ley then proceeded to spend the year on a magical mystery tour – better known in Canberra circles as “wide-ranging consultations with stakeholders” – racking up five or six wide-ranging reviews over the course of her travels. Whether any actual decisions are made or policies are developed based on the results of these reviews before the next election arrives is still to be seen, but health does look to be, yet again, a fertile ground for battling ideologies.

As most of the review work on eHealth policy had been set in train by Ms Ley’s unfortunate predecessor, it was mainly left to her to announce in the May budget a very large amount of money for the ongoing operation of the PCEHR and a change of name to the more palatable My Health Record. NEHTA is set to go but the PCEHR will stay for another round.

The year also got off to a quick start in the primary care sector with the summer release of MedicalDirector Clinical and PracSoft. Still the market leader in the GP sector, MedicalDirector added some new functionality this year such as its own online appointments booking module and a specialist referral service from Healthshare to its Sidebar. It also launched a cloud-based managed service in late January, with MD CEO Phil Offer predicting that most users would in time migrate to the cloud.

The very slow progress of the roll-out of the national Electronic Reporting and Recording of Controlled Drugs (ERRCD) system was a constant theme throughout the year, with yet more coroners calling on state governments to pull their fingers out and get the system going. In the meantime, electronic prescription exchange service MediSecure continued the roll-out of its Dr Shop service, announcing in January that it would be integrated into the next version of Best Practice.

Problems with the PCEHR emerged yet again early in January – surprising no one – with the long debate over how to get pathology reports uploaded still causing angst after several years of debate. The consumer view of the PCEHR got new spots for pathology reports and diagnostic imaging reports, but there was nothing to fill them as few if any pathology or DI providers were registered with the system and the design to upload them has yet to be agreed upon.

Our story on the practical issues facing pathology providers covered some of reasons behind the challenge, from the inability of GPs to order tests electronically to disagreements over who would fund the private pathology sector to change their systems to what to do with sensitive tests and results. The Northern Territory might have come up with a solution by the end of the year, but little if any progress beyond that was apparent.

Also in January, the Department of Human Services (DHS) belatedly added an option for two-factor authentication to the MyGov website, the portal through which consumers get access to their PCEHR and Medicare data. The whole system is still causing headaches with regular stories bemoaning its bugs, not just for eHealth but for Centrelink and most particularly the new online tax return functionality from the ATO. Bring back e-tax was the general consensus of opinion.

DHS didn’t fare much better later in the year when it launched the referral functionality in the My Aged Care website – those bugs are still being squashed in an industrial-sized laundry press. DHS’s access reform branch – then part of the Department of Social Services (DSS) following an unnecessary move after the 2013 election that was quickly reversed by new Prime Minister Malcolm Turnbull upon his ascension in September 2015 – gave a series of sector briefings about the new capabilities of My Aged Care (MAC) in March, promising to build a business-to-government between aged care service providers and the department which hospitals and other healthcare providers could also use.

The government thought it was catering for the peculiarities of GP and specialist referral practices when it decided to allow doctors to continue to use fax machines and the phone to make referrals to the new MAC call centre while everyone else had to do it online. Little did they expect the uproar when told later in the year that GPs wanted an electronic referral template integrated into their practice software and the ability to send the referral using a secure messaging service. My Aged Care wasn’t geared up for those capabilities at launch and isn’t ever likely to, with the government looking at some variation of a web form for hospitals and GP referrals instead.

Any news about SA Health and its struggles with its ambitious eHealth program, especially the fraught enterprise patient administration system (EPAS) roll-out, dragged in many eyeballs this year. The SA government got the fodder-for-tabloid-outrage ball rolling early on in the year with the release of its Delivering Transforming Health paper, which foreshadowed hospital closures, including some or all of the beloved Repat General. It is a brave – or foolhardy – politician who closes a hospital or reduces its scope, but the SA government ploughed on nonetheless. It perhaps made a clever decision in keeping IT out of its Transforming Healthcare plans, knowing full well that dramas with SA Health’s IT strategy might only just be starting.

Pulse+IT crowned last year as the year of Telstra Health for the massive interest shown in its every move and this year could have been the same, but one of its big rivals for reader interest was the move to fast-track the draft standard Fast Healthcare Interoperability Resources (FHIR) into use in the wild. Some of our best-read stories for the year looked at the challenges of healthcare interoperability and how FHIR might be one of the solutions, starting off with our report on a presentation FHIR developer Grahame Grieve gave on why eHealth interoperability is so hard in early February. In March, we looked at the first moves by vendors to actually use FHIR in their systems, including Cerner and Orion Health and even in primary care through Brett Esler’s Hiasobi independent middleware platform. (In April, Telstra Health would join the FHIRstorm and give Pulse+IT headline heaven – Telstra and FHIR together.)

Anything to do with Telstra was always of interest and this year some of its acquisitions began to return the favour. In February we reported that its investment in eHealth so far was over $100 million – it would be close to double that by now.

The PCEHR roared back into contention with Telstra and FHIR as a topic of intense interest in late February, when the traditional pre-budget lobbying period begins in earnest. The Consumers Health Forum (CHF) urged the government to come up with a long-term commitment rather than a one-off annual grant to maintaining the PCEHR, as well as incentive payments for GPs through the ePIP to get them to use the system. As things turned out, the CHF was successful with its first wish but the second became a huge bone of contention later in the year.

It may not have been obvious to many in the wider eHealth industry but there has been a groundswell of unrest in the eHealth standards community in the last few years. Some standards experts cannot quite manage to hide their contempt for NEHTA’s attempts to develop technical specifications and standards over the years, and despite the federal Department of Health providing several years’ worth of specific funding for eHealth standards development through Standards Australia’s health informatics technical committee IT-014, it all came to a head last year when Standards Australia decided to drop IT-014’s special status and chuck it back into the mix with the rest. In February, HL7 Australia decided to remove its valuable property from the clutches of Standards Australia and manage it by itself.

Also in February, Greens health spokesman Richard Di Natale voiced what most in the industry were thinking when he showed his exasperation at the secrecy behind the government plans for the future of the PCEHR, a decision on which still seemed not to have been made despite the Royle review being handed to former health minister Peter Dutton in December 2013. “What was Mr Dutton doing for all of the time he was health minister?” Senator Di Natale asked. Quite.

March saw news of a pretty terrible blow-out in the budget for what was originally known as the Joint eHealth Data and Information System (JeHDI) system, the contract for which was won by CSC in 2010. It is based on the EMIS system used by about half of all UK GPs but also by the UK’s Ministry of Defence (MOD). According to a report by the Australian National Audit Office (ANAO), the final bill for the project is $133.3 million, a mind-blowing $110 million higher than originally planned in 2009. The ANAO was not backward in coming forward with its criticisms of the Department of Defence.

By far the most curious – or better yet, notorious – event was the famous “GP labelled a meat inspector by PCEHR” yarn in late March. While some readers took us to task for our childish headline, we couldn’t resist, despite the gravity of the situation. Poor old software vendor Zedmed was inundated with calls from a baying health media pack but eventually recovered, and the fault was also eventually fixed. And as Pulse+IT found out, it’s amazing what photos come up when you search for “doctor meat inspector”. The one that we found was sheer perfection.

Rounding out the quarter, Telstra Health made a significant move when it acquired outright the Dr Foster health analytics firm. It was Telstra’s moves to licence Dr Foster back in 2013 that first alerted the industry that Telstra was beginning to make a serious, long-term play in healthcare beyond buying up successful local software companies. At the end of the year, Telstra announced that one of the former journalists who set up Dr Foster, Tim Kelsey – who had since gone on to play a leading role in moves to digitise the NHS – would move to Australia to take up a senior role with the company. Mr Kelsey starts in January 2016.

Acute care

The Sydney Children’s Hospitals Network (SCHN) announced it was building a patient portal and increasing the use of Microsoft’s Lync – now known as Skype for Business – to better manage the unique needs of its patients and their families. One aim is to create a lifetime eRecord, particularly for its chronically ill patients, and to share information between its providers, from the Children’s Hospital at Westmead in western Sydney to the Sydney Children’s Hospital at Randwick in the east.

It was a huge year for New Zealand’s Orion Health following its listing on the Australian and New Zealand stock exchanges. In February, it announced it would use the roll-out of the unified patient information system known as SI PICS in the South Island as a reference site for its activities in the Australasian and south-east Asian markets for its Enterprise solution.

It was also a big year for US EMR giant Cerner, which would later in the year figure large in Queensland Health’s plans for the next 20 years of health IT investment. In February, eHealth NSW announced it had won a tender for a large part of the the state’s ambitious, $170 million electronic medications management (EMM) project. Cerner’s EMM system will be implemented at 28 major hospitals using its EMR, which includes the bulk of the state’s Local Hospital Networks (LHNs). There may be some scraps for another EMM vendor to service the Hunter New England LHN, which uses an Orion EMR, but Cerner has most of the meat.

An upstart in Irish firm Slainte Healthcare made some headway in 2015 with a happy customer in Calvary Health Care Bethlehem for its Vitro electronic patient chart. Vitro is also being used at Bendigo Health for its hybrid approach to implementing a digital medical record (DMR).

Primary care

A couple of wins flowed through to indigenous healthcare practice management software specialist Communicare this year, including a roll-out throughout the vast North West Hospital and Health Service in Queensland. The Telstra Health-owned firm would also later win a healthy contract for an Aboriginal health service in Cairns.

NEHTA released version three of its clinical usability program (CUP) for the PCEHR in general practice software in March, although few seemed to really notice, while Telstra Health took its first steps in developing a software solution for radiology practices by signing a letter of intent with Melbourne firm 3D Medical.

Bringing primary and acute care together to offer integrated care is the philosophy behind NSW Health’s four-year, $120 million Integrated Care in NSW strategy. Underpinning a demonstrator site for the strategy in western Sydney is the LinkedEHR developed by Ocean Informatics for the Western Sydney Medicare Local, now PHN (WentWest). This project is a long-term one that will see extra support offered for chronic care patients and the divide between primary and acute care bridged with the help of the web-based shared care planning tool.

Aged care

It was an interesting year for Hills Health Solutions to say the least. The company that signalled in 2014 that it wanted to dominate healthcare delivery platforms in both the acute and aged care sectors got off to a great start to 2015 in March, holding a big tech expo in Sydney to showcase a number of new technologies it planned to introduce throughout the year. Hills then-CEO Ted Pretty was on hand to talk up the new range, but mid-year machinations would see Mr Pretty depart, and later in the year its head of health solutions, Peta Jurd, followed suit. Hills’ share price was not looking too healthy towards the end of the year, but the company soldiered on and was a noticeable presence at the ITAC conference on the Gold Coast in November.

By far the biggest topic in aged care this year was the ramifications of the move to consumer-directed care (CDC). For community and at-home aged care providers it has been a particularly difficult transition, and problems with IT systems haven’t helped. Aged, disability, mental health and carer support services provider Care Connect took an agile approach to not only reconfiguring its IT systems but its business as well.

Always at the forefront of technological innovation in aged care is Feros Care, which in February announced it was taking part in a federally funded trial to investigate whether paying GPs to conduct video consultations with residents could improve patient care. Lifesize’s ClearSea mobile application is being used as part of the trial.

Allied health and pharmacy

In January, allied health practice management software specialist coreplus announced a bit of a breakthrough, partnering with secure messaging vendors HealthLink and HealthConnex to create a secure message delivery (SMD) service built into the coreplus platform, meaning allied health practitioners can avoid having to install different vendors to receive eReferrals from GPs as coreplus is handling it all through a hub in the cloud.

The quarter also saw something rare in the launch of a new pharmacy dispensing system. Called Dispense Works and marketed by Queensland-headquartered point-of-sale technology specialist POS Works, the system features natively integrated Australian Medicines Terminology (AMT) and the ability to detect and warn of ‘triple whammy’ drug interactions.

Some of the more interesting software, apps and new players in the market that caught our eye in the first quarter included:

The second quarter of the year, which we’ll take a look at tomorrow, would be dominated by budget night, with the government committing enormous funds – and some political capital – to keeping the PCEHR going. NEHTA got its marching orders, and the industry was taken back to 2010 with a reheat of the opt-in or opt-out debate.

Fiona Stanley Hospital’s data-led telehealth method to go statewide

A new approach to telehealth using data analysis to identify patients who might be suitable for a remote consultation rather than a face-to-face visit at Perth’s Fiona Stanley Hospital (FSH) has been so successful it is now being rolled out statewide.

The new method involves delving into the data to find rural patients who have outpatient appointments in upcoming weeks, and actively engaging with their clinicians to determine if they are clinically appropriate for telehealth.

Since adopting the method, FSH has seen a 300 per cent increase in the number of telehealth consults conducted, from around 80 per month to over 250. It also estimates it has saved rural patients between $300,000 and $600,000 in travel costs – and 1.5 million kilometres in distances travelled – over the last six months.

The service has now achieved a did not attend (DNA) rate of 8.3 per cent, down from about 11 per cent a few months ago. The average DNA rate for normal outpatients clinics is 30 per cent.

Much of the credit for the achievement goes to Josh Sacks, who was appointed as FSH telehealth coordinator back in June. Mr Sacks has taken a data-driven approach to identifying patients who could be seen by telehealth rather than having to travel all the way into the hospital, and a mobile approach to ensuring telehealth fits in with normal clinical workflows.

Mr Sacks said FSH has been capable of providing telehealth since it opened last October, but the numbers using the technology were quite low and it was a struggle to get clinicians interested.

“We were going to a lot of multidisciplinary team meetings and doing a lot of presentations about the benefits of telehealth, but it was sort of going in one ear and out the other,” Mr Sacks said.

“I’m from a chartered accounting background so I started to play around a bit with the data and found out there was a way that you could extract data on suitable patients. There is a business intelligence team here and they helped me pull the data and since then the uptake of telehealth appointments has grown dramatically.”

Using the South Metropolitan Health Service (SMHS) data warehouse, a data extract is pulled from FSH’s webPAS patient administration system, collating rural patients who have upcoming outpatient appointments, Mr Sacks said.

The data is filtered by rural post code for patients who have follow-up appointments in the upcoming weeks. The process does not apply to new patients.

Requests are then sent to the treating clinician to determine if the patient is clinically appropriate for telehealth and if they require any investigations such as pathology, diagnostic imaging or require a nurse or doctor at the rural site.

Once approved by the clinician, the patient is booked in through the MMEx booking system. (This is soon to be replaced by Telstra Health’s iScheduler, which won a contract with the WA Country Health Service’s (WACHS) Statewide Telehealth Service (STS) for a statewide roll-out in March.)

A WACHS rural telehealth coordinator then receives the booking, liaises with the patient about appointment times and any investigations required, organises any clinical staff and books a telehealth room at the hospital closest to the patient’s home.

Equipment and network

The STS has an extensive network of video conferencing units in hospitals, community health centres and nursing posts across WA. Fiona Stanley itself uses a mixture of video conferencing equipment, including PC-based VC units, mobile units and fixed units.

“The PC-based VC units are workstations with a high definition webcam and supporting software,” Mr Sacks said. “PCs with this equipment require a dual screen to enable clinicians to maintain visual contact while the same time accessing patient notes or information on the other screen.”

There are also a number of mobile VC units, which have a single screen and are mounted to a mobile trolley that requires power and data at the point of use to operate. Outpatient clinics may share mobile units depending on patient volume.

The fixed VC units are equipped with a single 55-inch screen and multi-input VC capability. These units allow for consultation with multidisciplinary teams or multiple sites within a single consultation. They also have the capacity to project images from a PC to the receiving VC site via the VC equipment.

These dedicated telehealth rooms have a PC for accessing patient notes and other ICT applications and are bookable through the hospital’s Helpdesk function.

However, the most popular are the mobile units, which are wheeled into the doctor’s rooms during normal outpatient clinic times. Mr Sacks said the use of mobile units meant there was a seamless mix of face-to-face appointments and telehealth appointments during each outpatient clinic.

“When a face-to-face patient comes out, we’ll wheel the mobile unit in,” he said. “We’ve got the patient ready, the doctor logs onto [the patient’s file in FSH’s BOSSnet digital medical record], speaks to the patient and away you go.

“When we turn up to the room, we plug in a unit, the patient is ready and waiting, we turn on the machine and we can sit in there if they want and control the zoom or to help if there’s any technical problems. We’ve only had two instances of insufficient audio visual quality. It is very rare.”

The telehealth support officer will have done most of the organisation beforehand by liaising with the regional coordinator and ensuring that any pathology or imaging is available. Mr Sacks said he owes a lot of the success to his team who he said do an amazing job, and to FSH, which is fully committed and supportive of telehealth and the team.

“We are running it like a business; I am always looking at ways to make the process more efficient,” Mr Sacks said. “We provide the best customer service and we don’t leave anything to chance. We understand doctors are extremely busy and going above and beyond what they need to do, our aim is to make the telehealth experience as seamless as possible for all.”

As FSH runs the state burns service, burns is the most commonly provided clinic, followed by gastroenterology and respiratory medicine. Mr Sacks said orthopaedics and infectious diseases were also becoming more popular. There are now 41 specialties using telehealth, with nine designated telehealth clinics.

The increase in numbers – from six consults provided in October 2014 to 254 in October 2015 – has caught the eye of the telehealth team at WACHS and Mr Sacks recently conducted a workshop on how it is done at FSH.

“Some of the other services are now starting to utilise our processes and their numbers are growing too,” he said.

The roll-out of iScheduler looks likely to remove one step from the process – bookings currently have to be made in webPAS, MMEx and Outlook – and Mr Sacks is now looking at how to further expand the service, perhaps one day for residential aged care facilities.

Australasian health IT week in review: November 14

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

Is Apple’s iPad Pro a PC and laptop killer?
Sydney Morning Herald ~ Tim Biggs ~ 13/11/2015

Almost comically large and coming at a time when iPads are far from de rigueur for everyday life, the iPad Pro has prompted much head-scratching and scepticism since its announcement in September.


Australians are tech pessimists
The Australian ~ Jennifer Foreshew ~ 13/11/2015

Australian technologists are among the least positive globally when it comes to seeing improvement in the country’s innovation position, a study finds.


Senate passes eHealth legislation
Computerworld ~ Rohan Pearce ~ 13/11/2015

The Senate yesterday passed without amendment the government’s legislation to revamp the national eHealth record system.


Australia to bring citizens’ health records online
iTNews ~ Allie Coyne ~ 12/11/2015

The Australian government has been given the go-ahead to create a digital health record for every Australian by default pending the success of trials of the model, after the bill for opt-out records passed the parliament today.


Big data can improve health but first we need to build the foundations
The Conversation ~ Julian Elliott ~ 11/11/2015

“What if we, as government, got out of the way and gave consumers full access to their own personalised health data and full control over how they choose to use it?” Health Minister Sussan Ley asked in her recent speech to the National Press Club.


e-health prescription blunder
Pharmacy News ~ Meg Pigram ~ 11/11/2015

Six scripts over six months have been incorrectly been uploaded to a patient’s PCEHR record.


Inquiry backs legislation for ‘opt-out’ eHealth record
Computerworld ~ Rohan Pearce ~ 10/11/2015

A parliamentary inquiry has endorsed a government bill that will enable the national eHealth system to potentially be shifted to an ‘opt-out’ model.


Smartphone AF screening makes sense: cardiologist
Australian Doctor ~ Alice Klein ~ 10/11/2015

Hundreds of strokes and premature deaths will be prevented every year if screening for atrial fibrillation in over-65s is incorporated into primary care, says a leading cardiologist.


Guild’s real-time monitoring system could help solve OTC codeine debate

The Pharmacy Guild is set to demonstrate a prototype real-time monitoring and clinical decision support tool it has developed to combat the misuse of combination analgesics containing codeine as it goes on the offensive against proposals to reschedule codeine products as prescription only.

Calling the proposed scheduling changes “a blunt instrument”, Guild executive director David Quilty said they would be ineffective at addressing concerns about abuse and could have unintended adverse consequences such as encouraging more consumption of higher strength doses in larger packs.

Instead, the Guild is recommending the government look at implementing a mandatory real-time monitoring system in community pharmacy to help identify at-risk consumers.

The Guild’s technology arm, GuildLink, has developed a prototype of such a system which Mr Quilty said will be demonstrated to politicians and bureaucrats in the lead up to the final decision on rescheduling being made on November 19.

Guild president George Tambassis said in a statement that the system will be a clinical decision support tool and not a law enforcement mechanism such as the Project STOP system, which is designed to prevent pseudoephedrine shopping.

“Real-time monitoring in community pharmacy could be implemented in a very short timeframe, and would be more effective and economical in assisting to identify at-risk consumers, facilitating access to education materials, and supporting appropriate referral when required,” Mr Tambassis said.

A Guild spokesman told Pulse+IT that the GuildLink system would be a pharmacist-only medicine decision support system and not a ‘codeine policing’ tool.

The idea is to gather data and report on pharmacy clinical management of combination analgesics containing codeine. Through the system, pharmacists will be able to review any other recent purchases to assist in making a clinical assessment on how best to manage the patient.

Unless the patient consents to their details being recorded, the pharmacist will not supply the codeine product. Instead, they can offer the patient a different over-the-counter product or refer them to a GP if that is more appropriate.

A consumer survey conducted by the Guild in April found that the overwhelming majority of consumers – 95 per cent of the 506 surveyed – would be willing to have their details recorded when purchasing OTC codeine products so they could continue to be purchased without a prescription.

The system would also allow other pharmacists to see the patient’s history and previous use. Patients in turn wouldn’t need to repeat the same details to different pharmacists.

The Guild says that recording of codeine sales will need to be supported by nationally consistent provisions in state and territory legislation, which will in turn ensure that patients receive a consistent and professional approach from pharmacies nationally.

“The system will have the capacity for pharmacists to record clinical notes and provide guidance regarding suitable referral pathways to help patients better manage their pain,” Mr Quilty said.

“This is not about operating a ‘codeine watch’ program, but identifying patients at risk of dependence and better tailoring treatment options.”

The Guild is calling for the final decision on rescheduling to be deferred for 12 months to allow time for the monitoring system to be implemented nationally, and it also wants warning labels advising consumers of the potential for dependence from prolonged use of codeine products to be mandatory.

“It is a matter of public health that these products remain available in Schedule 3 to treat mild to moderate pain when it occurs,” Mr Quilty said.

“Existing scheduling of these products allows timely access to important analgesic medicines in a pharmacy environment where an appropriate level of supervision exists.”

Tunstall releases tracking app for mobile nurse safety

Tunstall Healthcare has developed a new smartphone app linked to a 24-hour monitoring system that is designed to provide security to lone workers such as community nurses.

Tunstall CIO Geoff Feakes said the myCareTrack app is a mobile safety solution tailored for people who work alone or in potentially hazardous environments.

“Some roles – such as community nursing – require a person to travel and work in isolation on a regular basis, which can pose a safety risk to them and extra worry for their employers,” Mr Feakes said.

“We designed the myCareTrack app specifically for these isolated workers and developed a concept that would improve staff safety, with processes that have minimal impact on their work day.”

The myCareTrack app has check-in, check-out capability, activity reporting, and SOS and GPS functionality monitored by Tunstall’s 24-hour response centre, which will allow workers to notify Tunstall of their movements and distress situations.

“The app utilises individual lone worker ID access, so users can check in and inform us of their intended schedule for the day,” Mr Feakes said.

“Once checked in, our PNC call management platform makes automatic check-up calls, which aim to identify any remote worker who may be in need of assistance.

“If the check-up calls go unanswered, an emergency call will be automatically escalated to a Tunstall care consultant, who will commence the worker’s individual alarm response procedure.”

He said that in the event of an emergency, myCareTrack also has a built-in SOS button that can be activated by the worker, sending an alert and GPS location to the Tunstall monitoring centre.

“We already have the infrastructure to support this type of service,” he said. “Our monitoring centres operate 24 hours, seven days a week and our staff are experienced in managing emergency calls and locating clients through GPS mapping.

“Those working in isolation can feel reassured that, should an accident or emergency arise, an alarm will be raised and help will be alerted.”

The app is currently only available for Android devices, but a Tunstall spokesperson said the company was working towards completing an iOS version of the app for Apple devices, which will be available before the end of the year.

RACGP wants ePIP meaningful use targets dumped

The Royal Australian College of General Practitioners (RACGP) is urging the federal government to dump proposed changes to the eHealth Practice Incentives Program (ePIP) that would see the quarterly payments tied to ‘active and meaningful use’ of the PCEHR.

The Department of Health released a discussion paper on the proposed changes last month, suggesting that four of the five criteria for the ePIP remain the same but that the fifth – showing readiness to use the PCEHR – should be changed to demonstrating actual meaningful use of the system.

The government has proposed that ‘active and meaningful’ use be defined as the contribution of shared health summaries to the PCEHR and also suggests targets, such as a set amount of SHSs uploaded per quarter or a percentage of the standardised whole patient equivalent (SWPE).

It then suggests that uploading other clinical information and actually viewing records be considered for inclusion as ‘meaningful use’ in the second year of the scheme.

The RACGP today hit out at the proposals, saying it strongly opposes changes that would see payments linked to meeting targets for uploading shared health summaries.

In its submission to the discussion paper, the college says increased uptake of the PCEHR – to be renamed the My Health Record upon the passage of legislation – will only be achieved by fixing the usability issues that have dogged the system rather than using the carrot and stick of financial incentives.

RACGP president Frank Jones said in a statement that the proposed changes to the ePIP aimed at encouraging GP participation were “futile”.

“The proposed changes to the PIP eHealth Incentive are misaligned, ill-timed, superficial, will not support meaningful use, and – as a result – will not improve patient care and safety,” Dr Jones said.

One of the main sticking points for GPs is that the ePIP is a practice-level payment, not one paid to individual practitioners. The current ePIP provides financial incentives to practices to invest in new technologies such as secure messaging services, electronic transfer of prescriptions (ETP) systems and PCEHR-enabled software as well as the use of the Healthcare Identifiers Service and software that has a recognised clinical coding system.

However, the government’s proposal would see meaningful use measured on individual practitioners’ participation, which the RACGP says is “misaligned”.

“Meaningful use is not just uploading information to My Health Record, and nor is uploading information an acceptable starting point for meaningful use,” Dr Jones said. “Meaningful use relates to safety, quality, communication and healthcare outcomes – not merely numbers.”

He said that when the usability issues of the system have been addressed, a better approach to increasing practitioner uptake would be to introduce additional MBS rebates or a Service Incentive Payment (SIP).

The college is also understood to be angry that while three individual GPs have been appointed to the steering committee overseeing the implementation of the new Australian Commission for eHealth (ACeH), which will replace NEHTA and take over as the system operator of the PCEHR, none are there specifically as an RACGP representative.

It has also taken the unusual step for the college of voicing its “extreme” disappointment at the consultation process for the discussion paper. Three webinars were organised in a hurry by the department but they were not widely publicised, and the RACGP says in its submission that the feedback process was inadequate and lacked transparency.

“There was little meaningful audience participation, due to the use of a closed online question platform controlled by the department,” the college says in its submission.

“Attending GPs have advised that they were not able to view questions asked by other participants to provide constructive feedback or comment during the discussion, and a number of GPs have advised us many questions raised were not satisfactorily addressed.”

From the submission

The college argues that in its view, based on feedback from the GP community, the lack of adoption of the PCEHR by practitioners is not due to incentives or support payments but to basic lack of utility and usability.

It recommends that the criteria for requirements one to four of the ePIP be retained but has also called for a broader strategy to improve cross sector use of secure messaging using the SMD standard.

The college says GPs have expressed serious concerns about the proposal that uploading shared health summaries be the sole measure of meaningful use, and has rejected the use of targets outright.

“[The] RACGP cannot support the proposed mandatory requirements for the uploading of a specified quota of clinical documents to My Health Record,” it says.

“Meaningful use is not just uploading information to My Health Record, and nor is uploading information an acceptable starting point for meaningful use. Meaningful use relates to safety, quality, communication and healthcare outcomes – not merely numbers.

“Based on GP member input, the RACGP will not support mandatory requirements for the uploading of a specified quota of clinical documents to My Health Record. The RACGP does not support the setting of targets for the uploading of SHS.

“Increasing the number of SHS held in My Health Record does not create meaningful use or result in better patient outcomes. General practices need to be supported to curate and prepare their current clinical information system records to ensure SHS are accurate, up to date and useful.”

It also does not accept the proposal that in the second and third years of the incentive scheme, that uploading other documents and viewing them be included as part of ‘meaningful use’.

“In order to increase system uptake, GPs need to be provided with a clear My Health Record value proposition and a well defined use case in terms of deliverables, including clinical benefits and costs,” it says.

“Until such time where the uploaded SHS are demonstrated to be accurate and reliable, the RACGP cannot agree to the inclusion of any other document types and viewing of records in future years of the PIP eHealth Incentive.

“Once the identified issues with My Health Record have been addressed and resolved, the RACGP believes that any requirements regarding the uploading of patient information to My Health Record would be best supported by a practitioner SIP or an MBS rebate.”

Bad apps and where to find them

Victorian health promotion agency VicHealth has developed a guide to health and wellbeing apps using an Australian-first rating system that shows many are ineffective and poorly designed.

Launching the Healthy Living Apps Guide today, Victorian Health Minister Jill Hennessy said apps can be a great way to help in achieving a healthier lifestyle, but some are not as useful as they claim.

Of the more than 200 apps evaluated, only five apps achieved a rating of three or more out of five. Apps reviewed include popular ones such as Nike+ Running, Fitbit, My Diet Diary Calorie Counter and the Quit Now: My QuitBuddy smoking cessation app.

The apps were reviewed and rated using the mobile app rating scale (MARS) developed by Queensland University of Technology and the Young and Well Cooperative Research Centre, along with the CALO-RE taxonomy developed by University College, London.

The apps were all described as those that can help the user achieve a healthier lifestyle by eating more healthily, being more physically active, quitting smoking, drinking less alcohol and improving mental wellbeing.

Each app was rated according to its functionality but also its ability to affect user behaviour. VicHealth says that while many apps rated well in terms of functionality, they did not achieve a high rating on their potential to help users change behaviour.

More clinically focused apps that target specific populations such as people with diabetes or psychological disorders were excluded, as were any apps that has a low rating on Google Play or the App Store.

Those that rated highly were a personalised fitness program called Freeletics, My Quit Buddy, a meditation app called Get Some Headspace, a hydration tracker called Water Balance and a sleep, weight and activity tracker called UP – Tracker Required, which can share data with Apple Health.

The worst app of the 200 reviewed was Smoke Free – Finally Non Smoking, which achieved just half a star.

VicHealth also released a survey undertaken on its behalf by an independent agency that found that two in five Australians think health and wellbeing apps are trustworthy sources of information about being healthy. Women are more likely than men to trust these apps (44 per cent vs 36 per cent).

VicHealth CEO Jerril Rechter said apps can be effective in helping people adopt healthier lifestyles, but those who trust them for information about being healthy should use them with caution.

“We rated the apps on how user-friendly they are and how effective they’re likely to be in helping someone adopt a healthier lifestyle,” Ms Rechter said. “We rated them out of five and the best rating achieved was three out of five.

“Besides giving people the information they need to make better decisions for their own health, we’re encouraging app developers to improve their products. We’ve also produced a set of new guidelines to assist app developers design more effective products, which is a win-win for everyone.”

The guide is available on the VicHealth website.

Slow but steady progress in uptake of patient portals

Over 180 general practices are now offering patient portals in what has been slow but steady growth in the uptake of the technology.

The National Health IT Board had hoped that all New Zealanders would have access to a patient portal by the end of last year, but as of this month, 181 practices are now offering a portal, up from 132 in April.

Health Minister Jonathan Coleman said 75,000 patients are now using a portal, up from 40,000 in April, with the number expected to exceed 100,000 by the end of the year.

Last month, not-for-profit health IT organisation Patients First released financial modelling it commissioned from consulting firm Sapere Research Group on behalf of the National Health IT Board looking at how the introduction of patient portals would affect general practice costs and revenues.

Patients First and Sapere have also developed an interactive tool that allows practices to add their patient population data to help model what effect a portal would have on their particular practice.

Patients First CEO Jayden MacRae said the modelling and the tool were part of a package of resources developed to help overcome practices’ uncertainty about patient portals.

“Like any initiative, it can take a while to permeate but I think it’s building up a head of steam,” Mr MacRae said. “Patient portals are quite new and there are quite a few things that are unknown about them.

”Before we embarked on [the financial modelling], we knew that clinically it was a good thing to have patient portals, [but] what we were a little bit less certain about was what impact it was going to have on general practice time and their bottom line. We had no idea of the order of magnitude about that.”

The modelling includes four different scenarios, including a baseline level, different levels of substitution in GP workload between online clinical queries and in-person consults, different volumes of online clinical queries per patient, and different cost-recovery fees charged by practices to subscribed patients.

“There’s different levels of information,” Mr MacRae said. “General practice is quite diverse and everyone is at a different stage of thinking, and the interactive tool is the most detailed output of that.

“It means practices can put in their whole patient population profile and have it match their practice quite explicitly, but we also realised that that is not going to be for every practice. Some practices are not at that stage. So along with the reports that Sapere have done, they’ve worked with the Ministry to develop some short single-page case studies, just to get practices thinking.”

The modelling includes the potential effects of introducing an annual subscription fee or a fee-per-service charged to patients. While there are no firm figures on how many practices have instituted a fee, Mr MacRae said the modelling was based on real-world experience.

Overall, the Sapere research found that patient portals have the potential to provide a net gain to general practice by releasing staff resources for more productive use.

Clinical queries resulting from a patient portal do not swamp GP time. The modelling shows that while some additional GP time may be needed to deal with clinical queries coming through a portal, the size of this is not large.

It also found that substitution of online clinical queries for some face to face consultations with co-payments can still result in a net gain in resource to a general practice.

“Copayment options for portal use, such as subscription models or fee for service payments for clinical queries, can result in significant new revenue for a practice, but have to be traded off against potential adverse effects on patient use of the portal, and consequently loss of some of the advantages of having it in the first place,” it found.

The New Zealand government has allocated $3 million to the patient portal initiative, including $500,000 for an awareness campaign with the remaining funding to be spent on tools and support for general practices signing up to use patient portals.

Decision support tool for minor stroke diagnosis rolled out

An electronic clinical decision support tool aimed at helping GPs to diagnose minor stroke has been funded by the NZ government for a free roll-out nationwide and is available through common practice management systems (PMSs).

The tool, developed by neurologist Anna Ranta in association with the MidCentral Stroke Service and Best Practice Advocacy Centre (BPAC), is aimed at helping to mitigate the problem of delayed referral to specialists of patients who have experienced transient ischaemic attack (TIA) or minor stroke.

The tool has been trialled in 56 general practices across the country, where it has shown improved outcomes for patients and reduced treatment costs.

Dr Ranta said the tool helps GPs to accurately diagnose TIAs, promoting treatment initiation at first point of contact rather than awaiting specialist review, and prompts GPs to manage TIA and stroke patients comprehensively and in accordance with New Zealand guidelines.

“In a nutshell, it uses a logic algorithm to assess likelihood of TIA/stroke diagnosis, seven-day stroke risk and then recommends evidence-based treatment options,” she said.

As part of the FASTEST trial, Dr Ranta and her team analysed general practice records and found that on average, GPs will be confronted four to five times a year with a patient with a presumed TIA/minor stroke.

However, diagnostic accuracy of TIA/minor stroke is only 50 to 80 per cent, the research found, so the actual rate of recognised presentations may be as few as two to three patients per year.

To help GPs better diagnose and manage TIAs, BPAC is hosting the tool as a module on its website, which is accessible to GPs through the BPAC button in the navigation bar of their PMS.

From there they can select the TIA/stroke tool from a menu, which then displays a single page of tick boxes to complete covering relevant aspects of presenting illness history and a brief focused physical examination.

Relevant past medical history is automatically populated by extracting data directly from the PMS.

The background tool takes between two to five minutes to complete, and based on the information provided, the software confirms or rejects TIA/stroke as the likely diagnosis.

If TIA or stroke is confirmed, a triage recommendation is generated based on the validated ABCD2 risk score.

Dr Ranta, who developed the technology while working as a consultant neurologist at Palmerston North Hospital and associate dean of undergraduate medical education at the University of Otago, Wellington, has now moved to the Capital & Coast District Health Board (DHB).

International health IT week in review: August 16

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

Use of OpenNotes increases safety, patient engagement
FierceHealthIT ~ Susan D. Hall ~ 13/08/2015

Through five years of experience with OpenNotes, which allows patients access to the doctor’s notes in their record, researchers say using the tool can increase safety, care quality and patient engagement, according to a study in The Joint Commission Journal on Quality and Patient Safety.


50 percent of digital health startups will fail within 20 months
FierceHealthIT ~ Katie Dvorak ~ 13/08/2015

As more startups enter digital healthcare, more are likely to quickly fail, but that gives larger companies the ability to “mine” them for new innovations, according to a report from Accenture.


DH refuses to release IT savings report
Digital Health News ~ Thomas Meek ~ 13/08/2015

The Department of Health has turned down a Freedom of Information request from Digital Health News to see a report that purportedly shows how technology can save the NHS billions of pounds each year.


Karen DeSalvo: In hindsight, we needed common interoperability standards
FierceHealthIT ~ Dan Bowman ~ 13/08/2015

A common set of standards for the exchange of electronic health information likely could have improved the current state of interoperability in the industry, National Coordinator for Health IT Karen DeSalvo said.


Doctors like EHRs even less than they did five years ago
HealthcareITNews ~ Jack McCarthy ~ 13/08/2015

Software should enhance efficiency and productivity right? Not so fast.


SCR ‘at tipping point’ with clinicians
Digital Health News ~ Thomas Meek ~ 12/08/2015

The Summary Care Record is approaching 50,000 views per week, according to figures released by the Health and Social Care Information Centre.


Real-life ‘tricorder’ brings a touch of Star Trek to medicine
Computerworld ~ Martyn Williams ~ 12/08/2015

It’s hard not to think about “Star Trek” when you see Scanadu’s Scout health sensor.


Microsoft posts Windows 10 for medical devices
HealthcareITNews ~ Tom Sullivan ~ 12/08/2015

When Microsoft made Windows 10 widely available at July’s end, the company foretold subsequent versions for both mobile and Internet of Things, or IoT, devices.


Public backs but doesn’t use digi health
Digital Health News ~ Lyn Whitfield ~ 11/08/2015

Just 4% realised that they could already access their health records online, and more than a third (40%) did not know that they could book hospital or GP appointments online.


NorthShore uses EHR data to create Alzheimer’s risk score
FierceHealthIT ~ Katie Dvorak ~ 11/08/2015

Researchers at NorthShore University HealthSystem in Chicago are using data collected in electronic health records to create a risk prediction model for Alzheimer’s disease.


AMA: Doc satisfaction with EHRs declining
FierceEMR ~ Marla Durben Hirsch ~ 10/08/2015

A greater percentage of doctors are unhappy with their electronic health records than five years ago, according to a survey from the American Medical Association (AMA) and AmericanEHR Partners, a free online resource for the medical community created by the American College of Physicians (ACP) and Cientes Technologies.


Sheffield steels itself for EDM project
Digital Health News ~ Thomas Meek ~ 10/08/2015

Sheffield Teaching Hospitals NHS Foundation Trust has picked Restore’s CCube as its electronic document management system as part of its transformation into a digital hospital.


Wales pilots GP2GP service
Digital Health News ~ Thomas Meek ~ 10/08/2015

Wales has started piloting a GP2GP service to digitally transfer a patient’s record from one medical practice to another.


AAFP tells family docs to consider HealthFusion EHR
Health Data Management ~ Joseph Goedert ~ 10/08/2015

The American Academy of Family Physicians has partnered with software vendor HealthFusion to offer its 120,900 members a cloud-hosted, single platform electronic health record system that includes practice management and patient portal software, as well as claims clearinghouse services.


ICD-10 hops Congressional hurdle
HealthcareITNews ~ Tom Sullivan ~ 10/08/2015

Health IT professionals and policy wonks sleeping with one eye open while watching Capitol Hill for clues about ICD-10’s fate can rest easy – at least for now.


AHA calls FCC wireless spectrum rule dangerous, agency disagrees
Health Data Management ~ Joseph Goedert ~ 10/08/2015

In early 1998, Dallas television station WFAA was one of the first to switch from analog to digital broadcasts. What happened at nearby Baylor University Medical Center started a debate over use of wireless spectrum near hospitals that continues today.


Telemedicine effective in care for children with special healthcare needs
FierceHealthIT ~ Katie Dvorak ~ 10/08/2015

Telemedicine is a valuable tool for treating children with special healthcare needs (CSHCN) as well children in regular childcare and school (CRS), according to research published in the August edition of Telemedicine and e-Health.