Australasian health IT week in review: December 5

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

$15 million donation may ‘change the way suicide prevention is handled in Australia’
ABC News ~ Sophie Scott ~ 03/12/2015

A private donor will give a massive $14.7 million to fund Australia’s first evidence-based suicide prevention programs, to be run by the Black Dog Institute.


Speculation Fremantle Hospital intensive care unit to be scaled back next year
ABC News ~ Andrew O’Connor ~ 03/12/2015

Intensive care services at Fremantle Hospital may be scaled back next year, with Fiona Stanley Hospital to take over management of the smaller facility from February.


Inter-island telehealth system takes specialist help to the Chathams
NZ Doctor ~ Bruce Lee ~ 03/12/2015

Telehealth video conferencing now available at Chatham Islands Health Centre means specialist help from Canterbury DHB is possible without patients needing to fly to Christchurch.


Medjacking risk: Warning hackers could target wireless medical devices
ABC News ~ Rebecca Turner ~ 03/12/2015

Life-saving wireless heart pacemakers could actually be ticking time bombs at risk of cyber attack, a Perth conference has been told.


Orion Health, Medtech and CSC build ‘collective data ecosystem’
CIO NZ ~ Staff writer ~ 02/12/2015

Health software providers Orion Health, Medtech and CSC have teamed together to deliver integrated precision medicine system for New Zealand.


Government policy, not consumer behaviour, is driving rising Medicare costs
The Conversation ~ Stephen Duckett ~ 02/12/2015

A report released last week by the Parliamentary Budget Office shows that government policy has driven a significant proportion of the growth in MBS costs.


Government communication on aged care reforms needs improvement: PC
Australian Ageing Agenda ~ Darragh O’Keefe ~ 02/12/2015

BPAC has received a three-year Ministry of Health contract worth $750,000 to distribute nationally an electronic decision support tool to improve detection and management of patients with chronic kidney disease.


New kidney disease support tool to go nationwide
NZ Doctor ~ Liane Topham-Kindley ~ 01/12/2015

BPAC has received a three-year Ministry of Health contract worth $750,000 to distribute nationally an electronic decision support tool to improve detection and management of patients with chronic kidney disease.


Medicare safety net on ice as negotiations break down
Medical Observer ~ Julie Lambert ~ 01/12/2015

Medicare safety net changes have been put on ice after the government broke off negotiations with cross-bench senators.


What will the NBN really cost?
The Conversation ~ Rod Tucker ~ 01/12/2015

Cost is a central issue in the ongoing debate about the best approach to building Australia’s National Broadband Network (NBN).


E-health provider blames SA govt for tough times
iTNews ~ Paris Cowan ~ 01/12/2015

Global Health is locked in a Federal Court fight with the state over its refusal to upgrade the CHIRON software used in 12 of South Australia’s 75 public hospitals.


Alcidion launches mobile app for consolidated view at the bedside

Adelaide-based health informatics firm Alcidion Corporation has launched a mobile EMR application called Miya Mobile, which promises to provide clinicians with a consolidated view of their patients’ data on the move and at the bedside.

Miya Mobile sits on top of the underlying Miya informatics platform, which is able to extract data from any clinical or administrative system in a hospital, including EMRs, patient administration systems and point-of-care devices. The disparate data sources are then consolidated according to the patients’ known clinical risk and the essential data presented to the clinician in one view on an iPad.

What it in effect does is provide a high quality electronic health record for the patient that is accessible from a mobile device. It also provides access to patient flow data, test results and electronic assessment forms so that clinicians can refer to and collect this information at the point of care.

The launch of Miya Mobile follows work done with Melbourne’s Western Health on patient flow and bed management, which has resulted in the Miya Bed Manager, as well as with the Northern Territory Department of Health on a mobile app for emergency department pathology order entry.

Alcidion executive vice president Nathan Buzza said powering the apps was the core Miya architecture, which is the engine room for what sits on top. Miya contains the various interfaces into clinical information systems from which data is extracted, primary through HL7 feeds, DICOM images or other imaging formats.

“Whilst it is not a trivial task to acquire the data, it is the collection of that data that is the magic of the platform,” Mr Buzza said. “It constructs an electronic health record internally within Miya, using quite a sophisticated platform to nominate which feeds are the most trustworthy.

“It has smarts and that’s why we call it an intelligent electronic health record. Another component is that it’s done in a temporal format. We never override any of the parameters but every time we get new information, we time and date stamp it and build up a historical record about the patient. It has the intelligence to assess trending in the patient’s measurements.”

Once that data is collected, it is then exposed to the clinician through through the various apps and clinical views, he said. One of those is the Miya ED product developed for the NT, which has an emphasis on collating urgent and critical lab results and exposing them to the clinician in real time.

The clinician can see all of their patients and if there is any abnormal result it is highlighted in red. They can also drill down into each result for more detailed information. For the NT, Alcidion has since expanded the functionality to allow the clinician to raise a new order from a number of order sets.

Diagnoses are associated with ICD-10 codes and there is clinical decision support in the background. Results are then pushed back to the initiating physician for a closed loop.

With Miya Mobile, Alcidion has taken some of the functions from the ED app and applied them to inpatients. However, he emphasised that it was the Miya engine that has the power.

“It’s not the app that has the smarts but the underlying platform – all the app does is expose it to you,” he said. “The Miya Mobile enables the clinician to carry an iPad with them and they can look at all of their patients on the mobile device.

“Because we’ve collated all of the information from the disparate clinical information systems, when they click on that patient, every single result for every single sub-system resides on that device. Another really nice thing is the speed of the interaction.”

The data is all cached locally on the device in case the clinician moves out of mobile coverage, which makes the system smooth and fast, he said.

The end result is that doctors are provided with what they need – a patient list on the left hand side, the essential data from other clinical systems collated and rated as green, orange or red, and the ability to click on that information to drill down further – all on their iPad.

Miya is also the basis for the cardiovascular system developed for Western Health in association with Fujifilm, and its intelligent patient flow system.

The company is currently in the process of executing a reverse takeover with a view to listing on the stock exchange by the end of the year.

PCEHR review duo set for new eHealth governance taskforce

UnitingCare Queensland executive director Richard Royle, former AMA president Steve Hambleton and rural GP Ewen McPhee are set to be announced as three members of a steering committee being set up to oversee the transition of eHealth operations from NEHTA and the Department of Health to a new Australian Commission for eHealth (ACeH).

The committee will also include at least one jurisdictional health department CIO and one director-general, understood to be the Northern Territory’s Stephen Moo and Queensland Health D-G Michael Walsh.

Mr Royle, who is also president of the Australian Private Hospitals Association, and Dr Hambleton, who is currently the chairman of NEHTA, worked on the review into the PCEHR ordered by former health minister Peter Dutton in November 2013.

In addition to recommending that the government continue funding and developing the PCEHR – albeit with major changes including making it an opt-out system – the reviewers recommended that NEHTA be dissolved and that a new agency be set up to take over operation of the PCEHR from the Department of Health.

The government has accepted the bulk of the review’s recommendations and will run trials next year on moving to an opt-out model. It has also introduced legislation to change the name of the system to My Health Record, another review recommendation.

However, despite promising to announce the trial sites last month, it still remains unclear where or how many sites have been selected. The government allocated $51 million in the May budget to running the trials.

Health Minister Sussan Ley also announced as part of the budget package that the new commission would be established from July 1, 2016, with NEHTA to be abolished by June 30 next year.

The implementation taskforce, originally slated to be convened in July, was also promised as part of the reforms.

The minister’s office refused to comment, while a health department spokesperson told Pulse+IT last week that the committee membership would be announced “shortly”.

SNOMED mapped to ICPC-2 for continuity of health data

A subset of the SNOMED clinical terminology specifically for health encounters in general practice has been released, along with a map from the subset to the International Classification of Primary Care, Version 2 (ICPC-2).

The International Health Terminology Standards Development Organisation (IHTSDO), which is responsible for SNOMED CT, and the World Organisation of Family Doctors (Wonca), which develops and maintains ICPC-2, have jointly developed the general practitioner/family physician (GP/FP) subset, which includes concepts that represent the terms commonly used by GPs to describe reasons for encounter or health issues (problems).

The development work was led by the University of Sydney’s Family Medicine Research Centre (FMRC), which is also responsible for the BEACH project, a national study of general practice activity in Australia. The centre has also developed the ICPC-2 PLUS coding system used by many popular GP clinical systems in Australia.

FMRC medical director Graeme Miller said the GP/FP subset and map would enhance the usefulness of SNOMED CT for GPs around the world.

“SNOMED CT is very complex, with about 300,000 concepts to choose from,” Associate Professor Miller said.

“The GP/FP subset reduces this complexity by directing GPs to content that’s relevant to their clinical practice. The map from the GP/FP subset to ICPC-2 allows data recorded using SNOMED CT to be extracted using the well-recognised ICPC-2 classification.”

Dr Miller said there was a complementary relationship between SNOMED CT and local clinical terminologies and classifications such as ICPC-2, which was designed for reporting data from general practice. When used together, these terminologies can enhance direct clinical care, clinical information sharing and for data analytics.

The subset released by the IHTSDO and Wonca was developed by identifying terms commonly used by GPs in five countries so it doesn’t contain all the content needed by Australian GPs, Dr Miller said.

“The next steps are to convert the subset to the Australian language version of SNOMED, called SNOMED CT-AU, and to extend the subset to include other concepts Australian GPs need to use as health issues or reasons for encounter,” he said.

“The terms currently used in GP electronic health records need to be mapped to the GP/FP subset, and then to ICPC-2 and ICD-10-AM, the classification used in the hospital system. This will promote continuity of health information throughout the health system.”

Australasian health week in review: September 5

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

NBN a $20bn growth kickstart
The Australian ~ Mitchell Bingemann ~ 04/09/2015

The National Broadband Network has become a default stimulus program amid the gloom infecting the broader economy, as the taxpayer-funded company prepares to spend more than $20 billion on the nation’s largest ever infrastructure project and hire 7000 new workers over the next five years.


Q&A: Professor Phelps defends ‘best specialist’ website
Australian Doctor ~ Tessa Hoffman ~ 04/09/2015

The Specialist Doctors website generated a storm of controversy when it was launched last month.


Qld government apologises for Health payroll disaster
iTNews ~ Paris Cowan ~ 04/09/2015

Queensland Health Minister Cameron Dick has publicly apologised for the disastrous replacement of the Health payroll system under the previous Labor government, declaring his intention to turn over a new leaf when it comes to the state’s electronic health systems.


Qld Health on the hunt for super-CIO
iTNews ~ Paris Cowan ~ 03/09/2015

Queensland is looking for an IT chief to lead its new consolidated electronic health division, after former chief health information officer Mal Thatcher completed his year on secondment.


My Aged Care site criticised for wasting GPs’ time
Medical Observer ~ Julie Lambert ~ 03/09/2015

THE new national gateway for aged-care referrals is acting as a choke point for GPs trying to arrange care for elderly patients, doctors say.


HealthPathways tool to help Auckland GPs plan patient care
NZ Doctor ~ Rachel Wattie ~ 02/09/2015

Auckland health alliances have joined an Australasian trend with the launch of a local version of the Canterbury HealthPathways.


How new technologies are shaking up health care
The Conversation ~ Tim Usherwood ~ 02/09/2015

New tests and drugs have impacted health care for many decades. But we’re now seeing the emergence of completely different kinds of technologies that will radically alter how health care is both accessed and delivered.


Human Services’ computers keep disabled out of work
The Canberra Times ~ Noel Towell ~ 01/09/2015

Disabled Australians are prevented from getting into the workforce because faulty government computers cannot process their health checks, according to the Australian Greens.


National cancer registry likely by 2017
Australian Doctor ~ Michael Woodhead ~ 01/09/2015

State-based Pap test registers will be abolished and replaced with a single National Cancer Screening Register that will also incorporate bowel cancer screening data, according to the Department of Health.


David Russell-Weisz on why he took job as director-general of WA’s Health Department
Perth Now ~ Kara Vickery ~ 31/08/2015

There is a reason this job comes with a salary of $642,900. Ask anybody in politics and they will tell you running the Health Department is the toughest gig in the business.


No AHPRA checks performed on ‘best specialists’
Australian Doctor ~ Tessa Hoffman ~ 31/08/2015

The doctors behind a website claiming to list the country’s “best” specialists admit failing to obtain participating doctors’ permission and checking AHPRA to see if they faced sanctions before adding their profiles to the site.


Battle of the blowouts: how real can Labor make its Real NBN?
ZDNet ~ Chris Duckett ~ 31/08/2015

If Labor wants to bring more fibre to the premises into the NBN mix, then it must decide how much extra money it will allow NBN to spend.


HIC2015: PCEHR not perfect but in for the long haul – Ley

The national PCEHR – soon to be renamed the My Health Record – does not need to be perfect right now but it does need to become functional, practical and beneficial, according to federal Health Minister Sussan Ley.

Ms Ley told the Health Informatics Conference (HIC 2015) in Brisbane today that the PCEHR will not deliver its full benefits – including mooted savings of $2.5 billion per year within a decade – for some years even with better take-up by patients and clinicians, as envisioned under the proposed move to an opt-out system.

“We need to acknowledge that the benefits will flow sometime after we have broad use by patients and providers,” Ms Ley said.

“We need to be honest about the path ahead. My Health Record won’t deliver its full benefits for some years. It will take time, even with a better take-up rate by patients and clinicians, to build up the clinical data held in each person’s record.”

While the system has its problems and uptake has been poor due to a combination of complexity and poor communication, it does not need to be perfect right now, she said.

“In fact innovation and consumer choice will ensure that what we think consumers want now will be superseded very quickly, not to mention changes that will occur in clinical practice and service delivery over the next decade.

“What we need is for My Health Record to be functional, practical and beneficial. Let’s get some experience before we build longer term plans.”

Ms Ley said she believed it would be consumers who would drive the uptake of digital technologies and digital usage in in healthcare, and it was important for providers, developers and governments to recognise this.

“What government can do is empower and facilitate consumer-led change,” she said. “This needs to be seen as a consumer health system, and not just an IT system.

“Now is the time to make a determined and collective effort to make the digital world an accepted and widely used part of our health environment.”

The government plans to run trials starting in April next of opt-out models in four different sites, which Ms Ley said she hoped to announce shortly.

It also plans to take steps to raise awareness and provide access to education and training materials for doctors and other healthcare providers “so that they are able to reach a level where they can confidently use the system for their patients”, she said.

“We will also give them a bit of encouragement. The eligibility requirements for the Practice Incentives Program for GPs are being reviewed, and changes will require doctors to actually use the system to continue receiving the incentives, and not just have access to it.

“They may, for example, be required to upload shared health summaries for a proportion of their patients, and we will be consulting with peak bodies on these changes.”

In terms of the new Primary Health Networks (PHNs), Ms Ley said the government would not be prescriptive but would like to see real health benefits emerging from the use of eHealth, which is one of the six key planks of PHNs.

“[The PHNs’] framework of operations is that they need to report to government about how in their various areas of operation they are helping improve health outcomes,” she said.

“We have given them key tasks and eHealth is one of them. Ultimately though, what they will be doing is saying health has been improved in our population in this way by this much, and what government should be doing is not micromanaging a contract but giving them the resources and the ability to get on with it, and I’d like to see them being paid on that outcome.

“Yes, we’ve said use eHealth … it won’t be perfect but use what is there. Remember they are very well resourced – there is $900 million over three years for the networks across Australia – so we look forward to some good ideas from them.”

HIC2015: FHIR chief takes out inaugural Jon Hilton award

The brains behind the emerging Fast Healthcare Interoperability Resources (FHIR, pronounced “fire”) standard, Melbourne-based interoperability consultant and standards expert Grahame Grieve, was named as the winner of the inaugural Jon Hilton Award for Excellence in Primary Care Informatics at the Health Informatics Conference (HIC 2015) in Brisbane last night.

Mr Grieve began working on FHIR in 2012 with the aim of bringing modern internet technologies to existing standards such as HL7 to try to allow interoperability to happen more quickly and more easily. It is currently a draft standard but is increasingly being implemented by major vendors on a global scale.

The new award was named after the late Jon Hilton, a long-time member of the Health Informatics Society of Australia (HISA) who was a strong advocate for better communications between GPs, allied health practitioners and hospitals.

The winners of the annual Don Walker Awards for the best submitted industry/clinical case studies at HIC were:

The winner of the Joan Edgecumbe scholarship for continuing professional education was Natalie Page of Macquarie University.

The media award was won by Jenny Brockie of SBS.

HISA also announced the make-up of its new board at the awards night. It is:

The Branko Cesnik Awards for best academic/scientific papers will be announced at the conclusion of HIC 2015.

IT at the centre of action plan for Medicines New Zealand

The NZ Ministry of Health has released a five-year action plan to implement the Medicines New Zealand strategy, focusing on seven “impact areas” that includes the My List of Medicines initiative to provide a single, accurate, shared and complete list of a consumer’s medicines.

The Implementing Medicines New Zealand 2015-2020 (pdf) plan follows a previous plan that saw the establishment of the New Zealand Formulary and changes to prescribing rules.

The new plan will include an enhanced role for pharmacists and may lead to certain prescribing rights that are also shared by nurse practitioners and midwives.

In his forward, associate minister for health Peter Dunne said he believed an enhanced role for pharmacists would help the movement towards more integrated consumer-centred care.

“Pharmacists are in a position that makes them accessible to people seeking health care or advice,” Mr Dunne wrote. “They can work collaboratively with other health professionals to ensure the right people receive the right services at the right time.

“Making changes to the interaction a person has with a pharmacist could therefore have a large impact on the health outcomes of New Zealanders, as well as on their consumer experience.”

The action plan is aimed at bringing about the changes required to deliver on the overall strategy, which has three core outcomes: medicines are safe, of high quality and effective; New Zealanders have access to the medicines they need, regardless of their individual ability to pay; and that choices about medicines and the ways the system delivers them result in optimal outcomes.

The seven impact areas are:

The first impact area seeks to ensure that every contact with a patient or consumer is optimised so that health information is shared, understood and the value of care provided is maximised. The plan’s objective in this impact area is to ensure that medicines adherence, lifestyle management and symptom management are better supported through improved communication between all health professionals and consumers.

It also wants to see an increased use of monitoring, screening and brief interventions to improve the quality of care, particularly for at-risk or vulnerable groups.

Health IT is assisting in this area through the implementation of the New Zealand ePrescription Service (NZePS) in general practice management systems as well as its current secondary care initiatives such as as electronic prescribing and administration (ePA) and electronic medicine reconciliation (eMR).

Over the next five years, the MOH promises to work with the sector to make best use of new IT infrastructure, the plan states.

“My List of Medicines will provide a single, accurate, shared and complete list of a consumer’s medicines, including pharmacist-only medicines, plus diagnoses, adverse reactions and allergies.

“All health organisations can support medicines adherence further by exploring options for improved online communications, and by ensuring the provision of appropriate written information and multimedia applications to support face-to-face communication.

“Pharmacists can increase the use of evidence-based screening and interventions with an additional focus on self-care, medicines adherence and lifestyle modification.”

To enable shared care through an integrated healthcare team, an initial focus will be the development of an IT infrastructure that enables current and accurate information to be shared across providers and settings.

This will see each person who interacts with the health system have electronic access to their health information through shared care plans, patient portals and electronic prescribing.

The MOH promises to work with DHBs to implement electronic medication reconciliation within their hospitals, and will use it at admission, transfer and discharge.

It will also work with professional pharmacy organisations to explore and develop models for pharmacist prescribing.

To empower individuals to manage their own medicines and health, emphasis will be place on improving health literacy so they can make informed decisions. The provision of patient portals to provide health information will be emphasised.

To ensure optimal medicines use in older people and those with long-term conditions, the National Health IT Board will continue with the national roll-out of regional clinical workstations to enable clinicians to access clinical information about health consumers.

A national My List of Medicines will be established to provide a single list of medicines for every consumer, and primary and aged care providers will work to ensure medicine reconciliation happens consistently at transitions and involves the patient as well as make better use of electronic prescribing and scheduling and put in systems to enable appropriate de-prescribing.

The MOH plans to develop a single competency framework for prescribers to enable the sixth impact area and will also lead work to promote the adoption of standards for clinical documentation, linked to medication charting standards, within shared electronic health records by the different healthcare professions.

Removing barriers to access will see an increased use of technologies such as telehealth and video conferencing to improve access to pharmacists in remote locations and after hours in rural areas.

Eligibility information for the Prescription Subsidy Card will be shared with prescribers as well as pharmacies via the New Zealand ePrescription Service.

Implementing Medicines New Zealand is available from the MOH website.

Orion Health continues SE Asia push with Vietnam contracts

Orion Health has signed two new contracts to supply software solutions to public and private hospitals in Vietnam, adding to its existing footprint in the Philippines and Thailand.

Orion Health will roll out its Enterprise software solution to Vinmec International Hospital, a private healthcare provider headquartered in Hanoi that services a large number of medical tourists. Vinmec plans to implement a single, integrated, multi-site interface that will enable a single view of the patient record across all of its sites.

These include Vinmec Hanoi, Vinmec Phu Quoc, Vinmec Central Park and in two clinics: Vinmec Royal City and Vinmec Saigon. The initial deployment will then be followed by a further six sites as part of the group’s bid for accreditation by the patient safety and quality accreditation organisation the Joint Commission International (JCI).

Orion Health has also signed a strategic partnership with VIT Corporation to improve hospital efficiency in several Vietnamese provinces. The pilot delivery of eHealth solutions to hospitals in the public sector will begin in Khanh Hoa province, and Orion said it expects to expand across Vietnam in the coming years.

Orion Health’s senior vice president for the Asia Pacific, Darren Jones, said the agreement was pivotal for Orion Health to enjoy long-term success in Vietnam. “We see huge potential for our integrated hospital solutions throughout Vietnam and we will be actively pursuing a number of new opportunities throughout FY16,” Mr Jones said.

“This partnership with VIT Corporation will help us to strengthen our market presence and provide us with a number of additional relationships and opportunities that would have taken us years to generate on our own.”

Orion Health recently completed a fast-track roll-out of its Enterprise and Consult technologies to two hospitals in The Medical City (TMC) hospital group in the Philippines.

It also provides the hospital information system for the 580-bed, JCI-accredited Bumrungrad International Hospital in Thailand.

Elsevier buys Arezzo clinical decision support tool

Medical and scientific publishing firm Elsevier has bought InferMed, the UK-based company that produces the Arezzo clinical decision support system widely used by GPs in New Zealand.

Arezzo technology supports clinicians in choosing the most appropriate treatment path for each patient by matching the appropriate evidence-based guidelines with patient information and evaluating best-practice options in the light of current patient and disease information.

InferMed clinical decision support systems are installed in several regional and national health systems that provide patient-facing self-care advice, such as the NHS’s symptom checker, as well as supporting nurse triage telephone services including those provided by Medibank Health Solutions.

In New Zealand, InferMed has worked with the Best Practice Advocacy Centre (BPAC) to roll out Arezzo as a web-based system that is designed specifically to support general practice in the management of a patient’s health through screening, risk assessment, management and referral.

Arezzo is integrated into the main practice management systems (PMSs) and BPAC estimates it is used by 90 per cent of Kiwi GPs. In the UK, it is integrated into EMIS, the market leading PMS.

The president of Elsevier Clinical Solutions, Jay Katzen, said the acquisition would bolster the company’s set of point-of-care solutions. “InferMed will enhance our point-of-care decision support suite and provide additional capabilities to deliver better information where and when clinicians and patients have the need,” Mr Katzen said.

“In addition to integrating InferMed’s technology into Elsevier’s decision support suite, we are excited to support the great work InferMed does with its existing clients.”

Elsevier Clinical Solutions’ suite includes embedded workflow and decision support, clinical reference and patient engagement, including ClinicalKey.

InferMed is headquartered in London and has employees in New Zealand, Australia and France. The acquisition is effective immediately and financial terms of the transaction were disclosed.