The 2015 eHealth year in review: part four

The summer season for eHealth and health IT kicked off with a tip that the membership of a committee charged with paving the way for the creation of a new digital health agency was set to be announced. The establishment of an Australian Commission for eHealth (ACeH) was a recommendation by the Royle review into the PCEHR and the suggestion was supported warmly by the government.

A week later we received a list containing what turned out to be close to the full committee make-up from well-placed sources, and while the minister’s office stayed shtum, we published the names of five of them. Those tips turned out to be spot on and the government announced the full list for the grandly named Implementation Taskforce Steering Committee three days later.

Since then, silence. We hear that the committee members have been barred from speaking to the media and a distinct lack of returned phone calls bears this out.

Early in October there was good news for people living in rural and remote areas of the country when the NBN company announced it had successfully launched the first of its long-term satellites, which promise an increased capacity to provide telehealth services. While former communications minister Malcolm Turnbull once infamously claimed the satellites weren’t necessary as commercial operations could carry the load, he seemed to be mighty chuffed when Sky Muster rocketed upwards.

The peak bodies representing the health information sector – the Health Information Management Association of Australia (HIMAA), the Australasian College of Health Informatics (ACHI) and the Health Informatics Society of Australia (HISA) – got together to organise a summit on the looming shortages facing the health information workforce. HIMAA has been beating the drum on this for several years as the situation is becoming critical.

The summit, held in late October, heard that as many as one in three health facilities in Australia are facing vacancies they can’t fill for clinical coders, and one in five are facing the same challenge with health information managers (HIM).

October saw an increase in the already intense interest, particularly from the primary health networks (PHNs), about where the trial sites for the opt-out models for the PCEHR would be held. The government eventually released the selection criteria, and late that month the minister announced the two successful sites: Nepean Blue Mountains and north Queensland.

Confusingly, however, it was also revealed that the department was still open to ideas for innovative ways to boost participation in the PCEHR as part of the current opt-in model. While the current rate of opt-in participation is nowhere near the disaster some people make it out to be – it’s in line with local and international experience – the complete lack of basic marketing of the system over the last three and a half years has not helped.

The government’s legislation enabling the minister to run the trials and then move the system to an opt-out model, along with changing its name to My Health Record, authority to establish ACeH and other odds and sods, made its way through parliament reasonably quickly. While Labor supported the bill, it did recommend that the upper house have a think on the privacy aspects of an opt-out model.

Meanwhile, a parliamentary joint committee on human rights also questioned some of the privacy provisions, leading the privacy lobby to get its knickers in a knot and causing a bit of a flap in the media, but there was never any doubt the legislation would pass. For those who were around when the original legislation and concept of operations for the PCEHR was being developed in 2010, it was deja vu all over again.

A Senate committee duly held a quick-fire inquiry and recommended that the legislation be passed, which it duly was on November 12. We farewelled the Pecker, but My Health Record is still not gaining much love in the acronym stakes.

A bucketload of peak healthcare bodies got together in mid-October to demand action from the state and federal governments on doctor shopping and the glacial rate of movement towards implementing the Electronic Recording and Reporting of Controlled Drugs (ERRCD) system.

Comprising the Australian Medical Association, the Royal Australian College of General Practitioners, the Pharmacy Guild, the Medical Software Industry Association, the Royal Australasian College of Physicians, the Pharmaceutical Society, the Society of Hospital Pharmacists and the Consumers Health Forum, the organisations issued a strongly worded letter to assorted health ministers telling them that in the absence of action, “avoidable deaths involving prescription medicines continue to occur at an alarming rate”.

Information released under freedom of information showed that former health minister Peter Dutton had written strongly worded letters himself to two states in particular in 2014, urging them to get with the ERRCD program. This is an issue that is not going to go away, and we will continue to follow developments in the new year.

In good news for the newly renamed PCEHR, specialist letters are now being uploaded to the system. While neither NEHTA nor the Department of Health bothered to let anyone know, small numbers suddenly appeared on the department’s new My Health Record Statistics page on the ehealth.gov.au website, and when Pulse+IT asked politely what that was all about, we received an interesting answer.

St Vincent’s Hospital and its vendor partner Emerging Systems first developed the functionality, but according to NEHTA, the bulk of the numbers were coming from the Northern Territory. Specialist letters turned out to be just one of the clinical documents that are now flowing through to the national system as part of the NT’s M2N project, which in addition to NT Health, NEHTA and DoH, includes technology partners DWS, Chamonix and Ocean Informatics. Next thing you know, diagnostic imaging reports are popping up too.

Submissions to the feds on their proposals to tie “active and meaningful use” of the PCEHR to ePIP payments also started to flow, almost all of them resolutely opposed to the idea. The RACGP led the charge, making the very good point that the ePIP is a practice support payment, not one for individuals, and therefore should not be tied to an individual’s choice on whether or not to use the PCEHR by uploading shared health summaries to it.

The college also made the excellent point that GPs saw little or no value in the PCEHR as yet and that the system lacks basic utility. The AMA also rejected the PCEHR-ePIP link, although ACRRM hedged its bets.

The Australian Association of Practice Management (AAPM) argued that with multiple high-level reviews and projects already taking place, the last thing general practice needed was another big thing to deal with. “The industry is already fatigued by constant changes,” AAPM CEO Gillian Leach said.

Health Minister Sussan Ley gave a speech high on techno-jargon but low on detail to the National Press Club in late October. Ms Ley said she wants My Aged Care to be more like Trip Advisor and that she wants to give consumers “open source” access to their health data as part of a “great digital health revolution”.

“[Malcolm Turnbull] has made it clear we want to deliver a 21st century government that embraces the digital economy and health is no different,” Ms Ley said. “We need to embrace digital health and innovation in the health sector if we are to deliver integrated care.”

In its annual report released in November, NEHTA said it plans to spend its last months in operation concentrating on getting the pathology and diagnostic imaging sectors connected to the PCEHR and ensuring its IP is handed over to the new digital health agency that is being set up to replace it. The annual report repeated previous statements that NEHTA had “laid the foundations for eHealth” in Australia. Whether what has been achieved was worth the almost $1 billion in state and federal funding NEHTA received over the last decade is the question.

One area where Telstra Health has flown a bit under the radar is its work with the NT government and the National Health CIO Forum on building the National Telehealth Connection Service (NTCS). This service will allow hospitals and external healthcare providers such as GPs to hook into health-grade telehealth networks through a common platform that also handles scheduling, referrals and clinical document exchange as well as a virtual meeting room for video conferencing.

Telstra is working on helping out the NT first to get a whole host of Aboriginal Medical Services hooked up to health-grade broadband and secure video connections solely for telehealth, but over the next few years expect to see it working in other states. Telstra Health’s chief health information officer David Doolan says the company will build a platform that will allow existing state-based telehealth networks – which are pretty good – to connect to external providers, with Telstra providing the meat in the sandwich.

Pulse+IT also predicts we’ll hear a lot more about this next year: eForms in general practice software systems. While it may sound like pretty basic technology it is in fact very hard to do, especially considering the volumes of different forms GPs have to deal with and how to get the data they contain to integrate directly into receiving systems. It is hard work but secure messaging vendor HealthLink seems to have cracked it in New Zealand, and it is now coming to Australia.

As MedicalDirector’s medical director Andrew Magennis told us, the new eForms functionality that will be part of the next big release could very well revolutionise the day-to-day work of a GP. From next year, they will begin to be able to select forms, pre-populated with demographic and clinical data for the individual patient from their own PMS, and shoot it off with just the click of a mouse. While MedicalDirector is the first to announce the technology in its systems, it will soon enough be available to everyone.

As the year came to a close, DoH secretary Martin Bowles took to the international stage, giving a speech in New York outlining Australia’s approach to eHealth. Echoing Sussan Ley’s NPC address, Mr Bowles sees a big role for mobility and a smaller role for government, with the department simply providing the platform to share health data and the private sector picking up the ball and running with it. Both the minister and the secretary have outlined their commitment to the My Health Record for the foreseeable future, so despite all the hand-wringing and the naysayers, it looks like they are ready and willing to get on with it.

Acute care

It’s a brave move to be sure to rip out clinical systems that have only been in place for a couple of years and install in their place a new system from a sole vendor, but that’s exactly what Macquarie University Hospital in Sydney did this year. It is still having to deal with paper, but it now has an end-to-end solution using InterSystems’ TrakCare. Digitising pre-admission, integrating medical devices and creating a patient portal are next on the list.

After threatening to become Queensland’s version of how not to do hospital IT – or at least, unlike Fiona Stanley Hospital and Royal Adelaide, able to keep it out of the papers – Brisbane’s Lady Cilento Children’s Hospital (LCCH) received a cash injection of $5.8 million to support the roll-out of the state ieMR. LCCH had major problems with its medical record when it opened last year, as half of its staff and patients had come from the Royal Children’s Hospital (RCH), where an electronic medical record was in use, and the other half from Mater Children’s Hospital (MCH), where one wasn’t. An independent review found that MCH staff were not given enough training, and upon opening, sick kids were presenting with no medical record in sight.

In a big year of news for paediatric hospitals, attendees at the HIMAA conference in Sydney in October got a glimpse of the extraordinarily detailed work going on behind the scenes as the Royal Children’s Hospital in Melbourne prepares to go live with the first implementation in Australia of an Epic EMR. The $48 million system will be switched on in full next April, qualifying immediately for HIMSS Stage 6, with only patient administration, radiology and pathology not planned to go live. RCH is using existing systems for the time being.

Rumour has it that people set to staff the new Perth Children’s Hospital also wanted an Epic EMR, and that Epic won the tender for the new hospital, but those plans are now on the backburner as WA Health tries to standardise statewide systems. PCH will instead get the BOSSnet DMR being used at Fiona Stanley Hospital as an interim measure. WA Health says the tender is still being evaluated, but so is the opening date of the hospital itself.

Handing down what everyone hopes is the last report into the bungles and breakdowns that have marked the short but chequered career of Fiona Stanley Hospital, a parliamentary committee ably headed by Liberal MP Graham Jacobs called on Health Minister Kim Hames to clarify exactly what is happening with the roll-out of health IT in the state’s hospitals. The committee also took a swipe at WA Health for its failure to provide relevant information to it on the performance of ICT at the hospital.

Dr Hames has come under increasing pressure over his handling of his portfolio and has announced he will retire at the next election. In the meantime, some good news is coming out of the $2 billion facility, including a smart way to boost the use of telehealth that is being adopted statewide.

Bucking the trend for hiccups in the west was St John of God Midland, which opened on time, on budget and with no worries. It is using Emerging Systems’ clinical information system EHS, which is likely to be rolled out at all St John of God hospitals over time.

Meanwhile, there’s Royal Adelaide

Primary care

Prescription exchange service eRx released its 2015 Pharmacy eHealth Survey report in October, which showed that “paper-optional prescriptions” were the next electronic step for the community pharmacy sector with 62 per cent of pharmacists believing they could help prevent fraud and misadventure. However, while the majority of pharmacies were capable of electronic transfer of prescriptions (ETP), their biggest concern was that many of their local GPs were not.

The Pharmacy Guild fought a rear-guard action against plans to reschedule painkillers and cold and flu remedies containing codeine to prescription-only status. Rather than take that step, which modelling it commissioned showed could cost the government $316 million a year, the Guild instead argued that a real-time monitoring and clinical decision support tool would be a better option to combat misuse. In fact, the Guild already had the very thing. After some fierce behind-the-scenes argy-bargy, a decision on the rescheduling was delayed for a year, and the Guild promised to get onto the system roll-out quick-smart.

The problem of wrong scripts populating the PBS data on the PCEHR popped up again in November. We were told by the Department of Health that complaints to the PCEHR helpline about this problem are very rare, but we would argue that it probably happens a hell of lot more than is reported considering the enormous volume of scripts written and dispensed every day.

As we have also argued, it is only when PBS data is viewable on an individual’s record that mistakes are uncovered. We, like our consumer, remain irritated that it is up to the individual to approach the suspected pharmacy to attempt to sort the problem out, and we, like our consumer, remain angry that it takes vague threats of bad news stories on Pulse+IT for the helpdesk to escalate this problem to someone who can fix it.

Aged care

Telstra Health invested further in the aged and community care sector when it picked up EOS Technologies, the IT arm of WA-headquartered district nursing organisation Silver Chain. EOS makes the ComCare community care management system used by Silver Chain nurses. The company will become part of Telstra Health’s wholly owned subsidiary HealthConnex, which also makes the community care software product TCM. Both TCM and ComCare can be integrated with Telstra’s MyCareManager home device through a FHIR interface and client data viewed through its portal. Telstra also owns the market-leading residential aged care software package iCareHealth.

Dominating the last quarter of the year in aged care IT was the ITAC conference on the Gold Coast. There seemed to be a general consensus that moving responsibility for aged care back to the Department of Health was no bad thing, but it was also obvious that industry players, particularly providers, were a bit tired and emotional after the multitude of changes that have been thrown at them since the last government’s Living Longer Living Better reforms. Everyone agrees that CDC is the right way to go, but they also agree that it is hard.

Problems with a backlog of referrals for aged care services caused by new functionality in the My Aged Care system, which went live on July 1, were canvassed by DSS’s Fiona Buffinton in a keynote address. She promised to do better, including ratcheting up plans to link My Aged Care with My Health Record.

Hills Health Solutions was on hand to launch its beautifully designed, silicon-based pendant for nurse call systems aimed at people with arthritis, Telstra Health announced it was working on an iOS version of its MyCareManager app, and Health Metrics announced it was integrating SimaVita’s ‘electronic underpants’ incontinence system with its eCase electronic care plan solution.

But the big winner was Webstercare, which took out the title of ICT company of the year for its RxMedChart, a computer-generated version of the National Residential Medication Chart (NRMC). This promises to massively improve medications management – prescribing, dispensing and administration – in residential aged care and for the first time will allow GPs to prescribe from the chart without having to write a separate script. More on that next year.

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

We hope you have enjoyed this series of eHealth year in reviews. If you missed out on any of the other instalments, you can catch up with:

Pulse+IT is taking a three-week break and will be back on deck on January 11. Have a lovely Christmas from Simon, Kate and Emily.

The hot top 20: most-read stories on Pulse+IT in 2015

The emergence of HL7’s FHIR standard proved a popular topic for Pulse+IT readers this year, joining perennial favourites such as the PCEHR, primary health networks/Medicare Locals and the Telstra Health juggernaut with several entries in the top 20 most-read stories.

Any news on three particular hospitals – Perth’s Fiona Stanley, St Stephen’s at Hervey Bay and the new and old Royal Adelaide – also drew in the eyeballs, for reasons both good and bad.

But it was an ambitious, long-term, well-written strategy from a state government, accompanied by a billion-dollar price tag, that scored top spot this year. eHealth Queensland has appointed a new CEO/CIO in Colin McCririck to oversee the work. Good luck to him.

1. The Queensland government stepped boldly into the future with its 20-year, $1.26 billion health ICT strategy

2. After buying up big, Telstra Health began to show its strategic hand

3. There were few new faces when the successful bidders for the PHNs were announced

4. Telstra’s investment in eHealth topped $100 million in February, but is about double that by now

5. Telstra Health’s subsidiary HealthConnex was behind the launch of this FHIR-powered telehealth solution

6. The federal government came through with some big bucks to “reboot” the PCEHR

7. FHIR-starter Grahame Grieve explained why eHealth interoperability is so hard

8. Fiona Stanley Hospital has an enduring IT headache

9. Telstra launches its ‘doc around the clock’ telehealth service

10. General, specialist and allied health practices were warned about opening Windows

11. The cuzzy bros announce plans to build a a national EHR

12. The future of NEHTA and the PCEHR hung in the balance

13. The company formerly known as Sonoa Health explained its plans for world domination

14. NSW goes all out for Cerner for EMR and EMM

15. All eyes on Royal Adelaide Hospital and the ongoing EPAS saga

16. General practice was up in arms over plans to tie ePIP payments to the PCEHR

17. St Stephen’s Hospital has integrated medical devices with its EMR

18. The $33 million Diabetes Care Project came to an unfortunate end

19. Large and small vendors are increasingly keen on playing with FHIR

20. DoH special adviser Paul Madden has a big, complicated gig.

Anything you’d like us to cover in more depth next year? Let us know.

Opt-in My Health Record still on the cards as PHNs invited to apply

Primary Health Networks (PHNs) have been invited to propose solutions for ways to boost participation in the My Health Record (MyHR) system under voluntary or opt-in arrangements, as the two PHNs selected to help run opt-out trials begin planning their establishment.

Northern Queensland PHN (NQPHN) – which encompasses a huge area stretching from Mackay up to Cape York and the Torres Strait – and Nepean Blue Mountains PHN – which includes the Blue Mountains, Hawkesbury, Lithgow and Penrith regions of NSW – were chosen last month by Minister for Health Sussan Ley to help run the opt-out trials.

A Department of Health spokesperson said individuals within the PHN boundaries will have a My Health Record (MyHR), formerly known as a PCEHR, created for them unless they wish to opt-out.

“Those not wishing to take advantage of the benefits of having a record, will have the opportunity to opt-out of the trial prior to the records being created,” the spokesperson said.

DoH first assistant secretary for eHealth Bettina Konti told a Senate Estimates hearing last month that the government is still open to proposals on how to improve participation and meaningful use of the system within the current opt-in or voluntary arrangements.

However, Ms Ley strongly supports the opt-out model, telling the Health Informatics Conference (HIC) in August that it was necessary for the system to achieve critical mass.

The DoH spokesperson said the department wrote to the PHNs not involved in the opt-out trials yesterday to invite proposals for opt-in solutions. Funding for any trials that eventuate will come from the $51 million allocated for trials in the 2015-16 federal budget.

Legislation allowing the minister to create rules for opt-out trials passed last week.

The department expects the Northern Queensland site will have about 695,000 participants and Nepean Blue Mountains about 355,000.

NQPHN chairman Trent Twomey said the PHN’s membership, location and regional demographics made it an ideal trial site.

“We are the fourth-largest PHN in terms of geographical size, and the rural and remote nature of our region reinforces the need for a functional electronic health system,” Mr Twomey said in a statement.

“It’s a huge opportunity to tangibly and meaningfully improve the connectedness of care for our community, especially in improving health outcomes for Aboriginal and Torres Strait Islander peoples.”

While the PHNs form the physical boundaries of the trial sites, state health departments will also have an active role in co-designing and conducting the trials, the DoH spokesperson said. “Health has already commenced initial planning discussions with the PHNs.”

Northern Queensland fulfils many of the selection criteria for the opt-out trials sites, including a large indigenous population, rural and remote locations and strong ties with local hospital networks.

NQPHN is a member-based alliance involving the Torres and Cape Hospital and Health Service (HHS), Cairns and Hinterland HHS, Mackay HHS and Townsville HHS as well as the Australian College of Rural and Remote Medicine (ACRRM) and the Pharmacy Guild.

It has offices in Mackay, Townsville, Cairns and Thursday Island.

Nepean Blue Mountains PHN is run by the former Medicare Local and aligns strongly with the Nepean Blue Mountains LHD. It worked with the neighbouring Western Sydney ML – now the Western Sydney PHN but better known as WentWest – on the Greater Western Sydney Wave 2 site for the implementation of the PCEHR.

Much of the work done during the Wave 2 program was incorporated into the NSW HealtheNet project, which has been rolled out across the state.

The DoH spokesperson said the department was currently in the process of appointing an independent evaluator for the trial sites.

“The independent evaluator will work with the department to develop an evaluation framework which will be announced once finalised. Evaluation methods of each site will be determined by the independent evaluator.”

The trials will commence in July 2016 and continue through until the end of October.

Home telemonitoring of heart failure an effective intervention: Cochrane

A Cochrane review has found that structured telephone support and non-invasive telemonitoring of people with heart failure living at home can reduce mortality and hospitalisations, can improve quality of life and is well accepted by patients.

The review, led by Sally Inglis, an associate professor at the Centre for Cardiovascular and Chronic Care at the University of Technology Sydney (UTS), looked at 41 studies of either structured telephone support or non-invasive home telemonitoring for people with heart failure, of which 17 were new and 24 had been included in the previous Cochrane review.

Two of the studies trialled both interventions so there were 43 comparisons in total. All randomised control trials (RCT), they involved 9332 patients for structured telephone support and 3860 for telemonitoring.

The results were good, with non-invasive telemonitoring reducing mortality by 20 per cent and heart failure-related hospitalisations by 29 per cent relative to usual care. Structured telephone support reduce all-cause mortality by 13 per cent and heart failure-related admissions by 15 per cent.

Neither intervention demonstrated effectiveness in reducing the risk of all-cause hospitalisations but there were good figures from the small number that measured quality of life and length of stay. There were variable numbers on cost effectiveness.

Adherence was rated between 55 per cent and 98.5 per cent, and participant acceptance of the intervention was reported in the range of 76 per cent to 97 per cent for studies that evaluated this outcome.

The reviewers said it was important to do the review – which followed one done in 2010 – because new trials of remote monitoring interventions have been continually commissioned and published.

“Results from earlier systematic reviews and meta-analyses … supported the beneficial effect of non-invasive home telemonitoring or structured telephone support” for heart failure-related programs, they write.

“However several large trials of remote monitoring interventions have since been published, and some have shown a lack of clinical benefit.”

Projects such as the UK’s huge Whole System Demonstrator project also showed a lack of cost-effectiveness on certain measures, although there were some good clinical outcomes.

It was also important to do the review in the context of limited health funding and a rapidly expanding population of older people, they write.

“Multidisciplinary specialist heart failure clinics are available only to a minority of people and do not have the capacity for frequent patient review. Patients may be unwilling or unable to make frequent clinic attendance due to cost, difficulty with transport or disability and frailty.

“Structured telephone support and telemonitoring can provide specialised heart failure care to a large number of people with limited access to healthcare services.”

They conclude that the review demonstrates that supporting people with heart failure at home using IT can reduce rates of death and hospital admissions from heart failure. It can also improve people’s quality of life and knowledge about heart failure and self care.

“Most patients, even those who are elderly, learn to use the technology easily and are satisfied with these interventions,” they write.

The technology used in the trials ranged from simple telephone calls to video conferencing to interactive voice response (IVR) and computer-assisted telephone interviewing (CATI), as well as more complex clinical telemonitoring involving automatic transmission of physiological data from measuring devices to a central server.

Australasian health IT week in review: October 17

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

NBN roll-out timetable detailing ‘ambitious’ three-year plan released
ABC News ~ Francis Keany ~ 16/10/2015

A new timetable for the National Broadband Network (NBN) is ambitious but achievable, the Federal Government says.


Royal Adelaide Hospital opening: FOI documents cast doubts on new date
ABC News ~ Angelique Donnellan ~ 16/10/2015

Fresh doubts have been cast on the completion date of the new Royal Adelaide Hospital by the South Australian Opposition.


NBN reveals HFC rollout areas
iTNews ~ Allie Coyne ~ 16/10/2015

NBN has provided a detailed breakdown of which areas will get which of the network’s multi-technology mix products over the next three years in a new construction plan.


Ministry launches five-year diabetes plan
NZ Doctor ~ Keira Stephenson ~ 16/10/2015

A five-year plan which puts patients at the centre of diabetes prevention and management was launched by the Ministry of Health at the Ko Awatea Centre in Manukau this morning


Former e-Health chief dismisses privacy concerns
Medical Observer ~ David Rowley ~ 16/10/2015

THERE is no foundation to concerns that automatically signing up patients to the personally controlled e-health records scheme risks breaching human rights laws, says former eHealth policy chief and ex-AMA president Dr Mukesh Haikerwal.


Free Priceline health checks
Pharmacy Daily ~ Mal Smith ~ 15/10/2015

Priceline Pharmacy is spending over $1 million to roll out sixty new “digital health kiosks” into its network. Effective from today Priceline is also offering free 15-minute in-store Women’s Health Checks


Privatisation at Fiona Stanley Hospital ‘working well’, WA Health Minster assures committee
ABC News ~ Andrew O’Connor ~ 15/10/2015

The privatisation of non-medical services at Perth’s Fiona Stanley Hospital is working well, a Parliamentary committee investigating serious problems at the hospital has been told.


Christchurch’s broadband fibre rollout has hit halfway
stuff.co.nz ~ Tim Fulton ~ 14/10/2015

Christchurch’s east is catching up to the rest of the city in ultra fast broadband as the regional rollout hits halfway.


Is medicine really having an Uber moment?
Australian Doctor ~ Chris Pearce ~ 14/10/2015

There has been a lot of interest in telehealth recently. In July, Telstra launched its ReadyCare scheme, which allows patients to have “treatment from a GP wherever you are and when you need it”.


Kim Hames: ‘I could have done things better at Fiona Stanley Hospital’
Perth Now ~ AAP ~ 14/10/2015

West Australian Health Minister Kim Hames has conceded he would have done certain things differently at the new Fiona Stanley Hospital.


Misaligned and superficial’: RACGP slams eHealth PIP proposals
Medical Observer ~ David Rowley ~ 14/10/2015

The RACGP has issued a stinging rebuke of the government’s proposals to link PIP eHealth payments to the uploading of Shared Health Summaries (SHS), calling them “misaligned”, “ill-timed” and “superficial”.


Royal Adelaide Hospital delays and modifications settlement to cost taxpayers $69m
ABC News ~ Nick Harmsen ~ 13/10/2015

South Australian taxpayers will pay $69 million to private consortium SA Health Partnerships (SAHP) to settle claims for delays, modifications and unexpected remediation work at the new Royal Adelaide Hospital (RAH).


Smartwatch monitors elderly, helps keep them safe
The Australian ~ Jennifer Foreshew ~ 13/10/2015

Sydney start-up Edisse is set to press go on a soft launch of its “intelligent’’ wearable that remotely monitors the elderly at home or in aged-care facilities.


Peaks angry aged care misses out on eHealth support
Australian Ageing Agenda ~ Natasha Egan ~ 12/10/2015

Aged care providers will not be offered any financial support by government to participate in the forthcoming trials of an opt-out eHealth system, Technology Review can confirm.


Ex-CIOs appointed to Australian e-health records committee
iTNews ~ Staff writer ~ 09/10/2015

Former health CIOs Paul Madden and Michael Walsh will join fellow electronic health experts on the 11- person steering committee charged with guiding the revised implementation of personal electronic health records in Australia.


DSS gears up for data exchange amid criticism of My Aged Care

The Department of Social Services (DSS) held webinars this week for aged care service providers and their IT vendors as it nears the roll-out of its DSS Data Exchange web portal for service activity reporting for the Commonwealth Home Support Program (CHSP).

The DSS Data Exchange (DEX) will replace all existing service activity reports including Home and Community Care (HACC) minimum data sets for the CHSP from November 1 and promises to be a streamlined way for aged care service providers to upload mandatory data.

DEX will allow for six-monthly automatic uploads or manual bulk uploads in XML format, but also offers small aged care service providers a free online client management system.

The roll-out comes amid complaints by the aged care industry over slow response times and a backlog in processing referrals to home care providers and Aged Care Assessment Teams (ACATs) since the go-live of the My Aged Care referral system in July.

DSS acknowledged there were problems with the expanded My Aged Care in a communique to the aged care sector following a workshop on August 13.

Problems with call centre software and the screening process were found to be contributing to the backlog in referrals, causing data entry errors and referrals to be issued inappropriately. DSS has also had to add extra staff, bringing to 250 the number employed at the call centre.

Doctors have also complained about the web-based system, with the Royal Australian College of General Practitioners (RACGP) writing to DSS last month to complain that it is not integrated into GP software or workflows and does not allow for the use of secure messaging services for eReferrals.

There is also concern in the aged care industry that while most providers have gone through the process of applying for access to the system, many have not yet set up the ability to receive referrals electronically.

DSS figures show that there are more than 2000 aged care organisations identified in My Aged Care. According to the figures, detailed in Aged and Community Services Australia’s (ACSA) national report this week, of those organisation, over 90 per cent have registered their organisational administrator, who is authorised to make changes to the organisation’s details in the system.

But while 72 per cent have “activated” at least one outlet, only 37 per cent have assigned a team leader to at least one outlet. A team leader must be assigned in order to receive and process referrals sent from My Aged Care.

Statistics provided to the My Aged Care Transition Working Group, which was set up by the federal government to prioritise and resolve issues relating to the new system, show that the My Aged Care call centre was receiving on average 16,000 calls per week, thousands more than expected.

The figures, detailed in aged care peak organisation Leading Age Services Australia’s (LASA) most recent national bulletin, also show that between July 1 and August 30, more than 29,000 clients have been registered in the new system, with over 23,000 referrals for home support assessment and 6500 referrals for the more comprehensive assessments conducted by ACATs. The system is currently processing over 10,000 service referrals per week.

The My Aged Care referral system has been built to allow carers, assessors and home and residential care service providers to receive, view, accept and track referrals electronically. When a referral for a person new to the federally funded aged care system is made or for a change in needs that requires a new assessment, a central client record is being created to capture essential information about the person, which can then be shared.

An initial screening process is conducted by the My Aged Care call centre, after which a referral notice is sent to an independent Regional Assessment Service (RAS) or ACAT by email. The email does not contain personal details, but instead alerts assessors that there is a new referral, which can be accessed through a web portal.

However, while this process has been designed to allow transparency for the aged and community care sector, carers and the client, it has raised the ire of some GPs, who say it has not been designed with their workflows in mind.

RACGP president Frank Jones wrote a letter (PDF) to DSS last month to detail several problems with the system from a GP perspective. The college wants DSS to allow referrals to be sent using SMD-compliant secure messaging services such as HealthLink and Argus.

The RACGP also complained that the My Aged Care referral template requires doctors to duplicate information already entered into their clinical systems and does not even allow a cut and paste option. Nor is the web portal integrated into each practice management software solution, as most GPs prefer.

DSS representatives told an aged care sector briefing in March that while it planned to build a business-to-government (B2G) gateway to the referral system in future, for the time being it would allow referrals from healthcare providers to be made by existing methods such as fax or phone. GPs can continue to directly refer elderly patients to ACATs in emergencies.

DSS also plans to build an interface with hospitals so discharge nurses can more easily ensure older people have adequate care before being discharged from hospital.

In the meantime, DSS told Medical Observer that it was planning to introduce a webform specifically for GPs next year.

The new DSS Data Exchange portal has been live since last year but from November 1 will start to apply to the CHSP, which brings together the former HACC program, the Assistance with Care and Housing for the Aged program, the National Respite for Carers program and the Day Therapy Centres program. From 2017, it will also include the home care packages program, which involves seniors living at home but with more complex needs such as home nursing care.

DSS says DEX will enable fewer, more targeted data items to be reported but provide greater access to client outcome data. Aged care service providers receiving grants from DSS will need to upload a set of mandatory priority requirements twice a year, but the system also allows for a voluntary extended data set that providers can choose to participate in, which DSS calls the partnership approach.

By providing more data to the system, providers will receive in exchange access to a number of self-service reports to help inform service delivery. Lead trainer for DEX Marita Baier-Gorman told a webinar last month that this data would be de-identified using a statistical linkage key (SLK).

Ms Baier-Gorman said DEX will replace all existing service reports for CHSP, including the HACC minimum data set.

The DSS data exchange will allow providers to submit data in three different ways, she said. One is a system-to-system transfer using existing client management systems, which will require modifications to be made by vendors.

There is also a bulk-upload capability to allow providers to manually upload the data in XML format. Technical specifications for both of these options are being prepared for vendors.

The third option is aimed at smaller providers who don’t have their own client management systems. DSS is providing a free CMS through its web portal to allow providers to manage their clients’ information.

As with the My Aged Care provider portal, users need to apply for an AUSkey from the Australian Business Register to access the DEX. An AUSkey is a secure login that identifies and authorises businesses in their transactions with the government.

HSAGlobal wound up after sale of assets to Whanau Tahi

Auckland-based HSAGlobal has gone into liquidation owing $4 million following the sale of its Connected Care Management Solution (CCMS) to Whanau Tahi, the wholly owned IT arm of social and healthcare service provider Waipareira Trust.

Many former HSAGlobal staff, including founder and managing director Matt Hector-Taylor, have moved over to Whanau Tahi since the sale, although the company’s UK operations have been put on ice.

Insolvency practitioners PPB Advisory were appointed to begin winding up the company late last month. The liquidator’s documents show that while there is about $400,000 in cash on the books, there is also a long list of creditors, including the company’s major shareholders.

Whanau Tahi CEO Steve Keung told Pulse+IT last month that the purchase of CCMS would enable the organisation to expand into the secondary care sector and close the loop when added to the Whanau Tahi Navigator, which is integrated into primary care practice management systems.

Whanau Tahi has promised to continue to support the successful roll-outs of CCMS, including Auckland’s shared care plan program, Counties-Manukau District Health Board’s (DHB) at-risk individuals program, Canterbury DHB’s collaborative care program and the South Eastern Sydney Medicare Local (SESML) Access to Allied Psychological Services (ATAPS) and Partners in Recovery mental health programs.

Xplore Technologies releases lightweight tablet for healthcare

US-based Xplore Technologies, which in April acquired the Motion Computing line of products widely used in healthcare, has released what it says is the most progressive rugged tablet available, the XSLATE B10.

Weighing just over one kilogram, the Xslate B10 is a compact tablet featuring long battery life with a 20-hour hot swappable second battery option.

With a set of eight ports, four sealed from behind, the XSLATE B10 comes standard with an Intel CoreTM i5 CPU that is upgradeable to i7 vPro CPU to provide top speeds to process data.

It also a fingerprint reader for added security and convenience, 10-finger capacitive touch input with glove and wet modes, a Wacom pen digitiser and active pen and an optional integrated barcode scanner.

It weighs 1.09kg and has a 10.1” rugged backlit display. Optional accessories include a second hot swappable battery to extend system run-time to 20 hours, office or vehicle docking stations and simultaneous battery charging options.

Motion Computing in Australia and New Zealand officially rebranded as Xplore Technologies last month following the amalgamation of the two companies. Motion’s country manager, Brett Gross, is now director of sales ANZ for Xplore Technologies and the product line is known as Motion by Xplore.

The full portfolio of Xplore and Motion by Xplore tablet computers are now available through distributors such as Dicker Data.

Primary looks to MedicalDirector to create new revenue streams

Listed healthcare provider Primary Health Care is looking to increase its portfolio of multi-disciplinary medical centres in Australia as well as use the strategic position of its wholly owned health IT subsidiary MedicalDirector to develop new income streams.

Announcing its annual results last week, Primary’s new managing director Peter Gregg also outlined the findings of its strategic review, which was aimed at identifying the key drivers of future performance.

Primary had healthy revenues of $1.6 billion in the 2015 financial year, up 6.2 per cent on last year, with earnings before interest and tax (EBIT) of $248.1 million and reported net profit after tax (NPAT) of $136.5m, up 19.1 per cent on last year.

Mr Gregg said the financial results reflected reasonable revenue growth in the company’s core business in what he described as a “challenging transition year”. Primary’s founder and long-time MD Edmund Bateman announced his retirement last November, with Mr Gregg taking over in March.

The company also had intense negotiations with the Australian Taxation Office over the tax treatment of general practice acquisitions, and it sold its shares in ophthalmic day surgery group Vision Eye Institute for $38m, money it used to pay down debt. It also bought private health insurer Transport Health.

Primary’s portfolio of 54 large-scale medical centres brought in $327.9m in revenue for earnings before tax and interest of $103.9m. Its pathology business raised $937.8m in revenue for an EBIT of $129m and its imaging business brought in $339m for EBIT of $34.3m.

Its MedicalDirector business, renamed during the year from Health Communication Network (HCN), had revenues of $38.2m, up 2.4 per cent from last year, with an EBIT of $13.9m, up from $11.4m last year (21.9 per cent).

In addition to launching its own online appointments booking system this year, MedicalDirector also launched a cloud-hosted offering called MedicalDirector Online which CEO Phil Offer expects to gradually become the dominant hosting method in the future.

The company also added several new widgets to its MD Sidebar, including a specialist referral directory called Healthshare Referrals, signed a partnership with patient flow technology vendor Jayex for its self check-in kiosk, and signed an agreement with care pathway developer Map of Medicine to act as the Australian distribution arm.

While Primary is looking to expand the number of medical centres it owns – eyeing off five large-scale centres and one super-centre over the next 18 months – it is also looking to expand its large-scale imaging clinics.

It highlights Melbourne’s Bridge Road Imaging Centre, near Epworth Hospital in Richmond, as a new model for further expansion.

Primary says Bridge Road “represents one of the country’s largest dedicated imaging facilities with state-of-the-art equipment and a team of high quality experts, capable of providing patients and their specialists with the best diagnostic data available”. In pathology, it is investigating offshore markets to expand.

With MedicalDirector, it plans to invest for growth by continuing new product development such as online appointments as well as develop new income streams through eHealth and consumer connectivity, the company said.

“More than 60 million patient consultations are transacted through Primary’s Medical Director clinical software each year,” it said.

“There is a significant opportunity to leverage this footprint and offer new services and products around e-health, data analytics and consumer connectivity which will greatly increase potential income streams.

“The company is currently evaluating strategic partners and assessing the appropriate corporate structure for Medical Director.”

Mr Gregg told the Australian Financial Review that Primary had held talks with “strategic partners from around the globe” about selling off MedicalDirector, understood to have included Telstra.

It has been rumoured in the industry for some years that Primary would like to offload the profitable technology arm, but that its asking price of well over $100m is too steep.

Sky Muster NBN satellite to launch in October

The first of the new long-term satellites that will bring high-speed broadband to remote parts of Australia will launch into orbit on October 1, although actual services will not be available until early next year.

Nicknamed Sky Muster, the first of NBN Co’s next-generation ka-band satellites will launch from French Guiana and will provide internet to more than 200,000 homes and businesses.

The second satellite will be launched later next year to ensure there is sufficient capacity to meet the needs of users in regional and remote areas.

Federal communications minister Malcolm Turnbull, who notoriously criticised the purchase of the two satellites when in opposition, claiming there was enough capacity on private satellites already in orbit, said the launch of Sky Muster would be “a game changer for those living in the bush and will help bridge the digital divide currently experienced by many”.

The announcement comes after a positive report from Ovum Research last month found that the fixed wireless network that will service rural and regional parts of Australia and will eventually cover approximately 600,000 premises will be able to support more symmetric applications such as video conferencing and cloud services.

The satellites will be able to deliver peak download speeds of up to 25 megabits per second.

NBN Co’s space systems managing architect, Julia Dickinson, said it will take several months after the launch before customers will be able to hook up.

“[O]nce we launch the satellites we need to test out the satellites themselves and then we have to test out the ground systems and the IT systems for the end to end service,” Ms Dickinson said.

“So several months after the launch and then all of the remote communities will have access to the service but we’ll just have to roll out the ground system at each person’s house.”

Once the satellite is launched into orbit, it will take several manoeuvres over a couple of weeks to ensure it is its final location, she said.

“Then we spend a couple of months testing out the satellite; it’s a very complex piece of equipment. So we have to test it out from end-to-end to make sure everything is going to work the way it did on the ground. The launch environment is pretty stressful for a satellite.”

NBN Co has built 10 new ground stations in parallel with the satellite, including at Wolumla, Bourke and Broken Hill in NSW, Ceduna in South Australia, Geeveston in Tasmania, Roma in Queensland and Kalgoorlie (pictured), Geraldton, Carnarvon and Wagerup in Western Australia.

“[W]hen the satellite is in orbit we have to test the whole thing, end to end, from our retail service providers all the way down to the individual equipment at people’s houses – the small antennas on their roof,” Ms Dickinson said.