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:
- A subset of the SNOMED clinical terminology specifically for health encounters in general practice was released, along with a map from the subset to ICPC-2
- MIMS launched a new version of its popular iMIMS app for iPhones, featuring a redeveloped user interface and faster downloads
- Healthdirect Australia launched a new app for iOS and Android devices that combines the health service finder functionality of the National Health Services Directory (NHSD) with a clinically validated symptom checker and trusted health information
- The implementation of Cerner’s electronic medications management (EMM) module at Concord Hospital in Sydney picked up the NSW Minister for Health’s top award for innovation, heralding the beginning of the statewide roll-out of EMM in 28 major hospitals over the next few years
- It was a big last quarter for Adelaide’s Alcidion Corporation, as it prepared for a reverse listing on the stock exchange and began compartmentalising its underlying Miya technology into product groups, including a mobile-based EMR application called Miya Mobile, its intelligent patient flow system Miya Bed Manager, and its emergency department order sets technology Miya Orders
- We’ll probably be hearing a lot more about Health& next year, but in the meantime it signed an agreement with US firm Validic to use its API capabilities to connect data from fitness and medical devices with the personal electronic health record platform Health& is building
- An extensive Cochrane review of structured telephone support and non-invasive telemonitoring of people with heart failure living at home has found that these interventions can reduce mortality and hospitalisations; and
- The University of Technology Sydney got ready for the first intake of students in its new Bachelor of Health Science degree, which includes what is thought to be Australia’s first major in digital health and analytics.
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:
- The 2015 eHealth year in review: part one
- The 2015 eHealth year in review: part two
- The 2015 eHealth year in review: part three
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.