The 2015 eHealth year in review: part two

As the industry awaited the government’s belated response to the Royle review 18 months after it had been delivered, and its subsequent decision on the future of the PCEHR, NEHTA and the new Primary Health Networks (PHNs), April dawned with some big news and some pointers to developing sagas that would keep us interested in the coming year.

One of the biggest announcements came on April 1, when the federal Department of Health announced it was dumping IBM as its prime ICT infrastructure and support services contractor after 15 years. Pulse+IT doesn’t usually cover non-clinical, back-office stories like this one, but the awarding of the five-year, $242 million contract to New Zealand-owned IT services provider Datacom came as a bit of an eyebrow-raiser.

Telstra Health got in early as well, announcing it had bought health insurer Medibank Private’s telehealth service, Anywhere Healthcare. When added to its own plans for consumer-to-GP telehealth through the ReadyCare service it announced last year, as well as work with the WA and NT governments on telehealth infrastructure, it became obvious that Telstra Health sees telehealth as a cornerstone of its business in the future.

Primary care software vendor Best Practice also made a surprise move, announcing it had bought New Zealand-based Houston Medical. While initially it looked as if BP was simply expanding into the medical specialist realm – Houston’s VIP is widely used by specialists such as ophthalmologists in both Australia and New Zealand, but it has a very small client base in general practice in New Zealand – later in the year it became increasingly obvious that BP had much bigger plans.

A new office in Hamilton has joined BP’s existing offices in Bundaberg and Brisbane, and the company is serious about raising its market share amongst Kiwi GPs, where Medtech has long dominated. Few would give the company a chance to make many inroads into what is in both countries a very conservative market, with GPs notoriously reluctant to budge from their chosen PMSs, if it weren’t for one thing. Heading BP’s assault on Medtech’s market share will be Frank Pyefinch, who has taken BP to close to a 40 per cent share of the Australian GP desktop market since selling out of his previous baby, long-term market leader MedicalDirector.

The extraordinarily fraught progress of SA Health’s Enterprise Patient Administration System (EPAS) hit the headlines again in early April, with an announcement by SA Health CEO David Swan that rather than implement the system at the existing Royal Adelaide Hospital (RAH), it would wait for the new one to open before going ahead. Later in the year, SA Health was given even more breathing space when it was announced that the new RAH itself would be delayed due to unforeseen problems with its construction.

EPAS proved to be a particularly popular topic this year. No one will go on the record, but quite a few people are scratching their heads as to the reasons why it is proving so difficult to get the system sorted in just a handful of hospitals in SA when it is based on Allscripts’ technology, which is widely used in the US and the UK. Much like Cerner’s headline-grabbing problems in NSW five or six years ago, it seems like big-bang US EMRs cannot be easily shoehorned into Australian hospitals.

Also in April we took a brief look at who was viewing the PCEHR (nobody much) before the people working for Medicare Locals were finally put out their torment when the successful bidders for the new Primary Health Networks (PHNs) were announced.

That announcement, made with much fanfare by the minister and a convenient leak of the story to a favoured newspaper before the losing bidders were informed they were out of a job, turned out to be a bit of a damp squib on closer inspection. While the 61 MLs were indeed much reduced as recommended by John Horvath in his review, 24 of the 28 PHNs announced on that day were what we called “rebadged Medicare Locals”.

The intense scrutiny that new public hospitals come under was highlighted when Lady Cilento Children’s Hospital looked likely to become Brisbane’s version of Fiona Stanley Hospital. The newly elected government ordered a review of the commissioning of the $1.5 billion hospital and yet again, ICT and medical records came in for criticism. The main thrust of the criticism about LCCH is that it opened too early, but Pulse+IT also heard a few, unverifiable rumours that there were some pretty odd things going on, including one that a load of industrial dishwashers were delivered and lined up in the kitchens, only for it to be discovered that they could not be hooked up to the taps because there weren’t any. Apparently, someone had forgotten to properly configure the plumbing.

Telstra Health and its wholly owned subsidiary HealthConnex made a big splash with the launch of the MyCareManager home telehealth platform. Featuring an array of technologies such as WebRTC-based video conferencing capability and Bluetooth-enabled telemonitoring, the real news was that this technology is one of the first, if not the first commercially available device, to use the FHIR standard to allow different vendors’ clinical information and client management systems to integrate with the device through an API.

Orion Health then came to the FHIR party with the announcement that version 6.1 of its Rhapsody integration engine would be FHIR-powered. Rhapsody 6.1 now includes support for the JSON data interchange format and the REST architecture approach, meaning organisations will be able to start implementing FHIR-based interfaces.

As eyes began to turn to Canberra to discover the fate of the PCEHR in the May budget, we spoke to South Australian GP Alison Edwards, an early adopter of the system, to see what the progress has been, how often she or her patients use it and for what purpose, and how it fits in with the workflow of a busy, two-doctor regional practice.

The Health Information Management Association of Australia (HIMAA) raised the alarm in April about a pending workforce crisis for health information managers (HIMs) and clinical coders. This would be raised again later in the year when HIMAA organised a summit with the Australasian College of Health Informatics (ACHI) and the Health Informatics Society of Australia (HISA) to develop a plan of action to confront the problem.

An exclusive report in a Fairfax Sunday newspaper in early May looked suspiciously like a leak to yet another favoured media outlet the week ahead of the May budget when it used the term ”rescue package” for the PCEHR. This term turned up in the Minister for Health’s subsequent press release but her office refused to answer any questions from Pulse+IT.

The leak was correct so it came as no surprise, despite the minister’s media shenanigans, when she revealed that $485 million would be allocated to “reboot” the PCEHR, that the National E-Health Transition Authority (NEHTA) would be “dissolved”, that a new agency would be created in its stead and that the PCEHR would be renamed the predictable but palatable “myHealth record”. The preferred spelling of the latter seemed to fluctuate for the rest of year but now seems to have settled on a grammatically correct My Health Record.

It was subsequently revealed in the actual budget papers that the money was to last four years – and was thus in line with expenditure on the system in previous years and was no “rescue package” – but also that the government had originally provisioned for $700m to prop up the system. As if by magic, the $115 million difference then became a saving, according to the Coalition, and a cut, according to Labor.

As the eHealth sector slowly digested this news, SA Health popped up again to divert attention. It made a decision to pull out of a secure messaging trial with NEHTA and despite statements from both, we still can’t quite work out exactly what this kerfuffle was all about. We heard rumours that NEHTA’s CEO Peter Fleming was on the next plane to Adelaide after the news broke but these can’t be confirmed. If anyone knows the real story, our anonymous tip section is here.

It then became apparent that a dispute was brewing between SA Health and vendor Global Health over the use of the legacy Chiron clinical software in rural hospitals. Chiron is older than some of the people now using it but SA Health has refused to upgrade to Global Health’s MasterCare system, as the EPAS system from Allscripts was supposed to be rolled out statewide. SA Health refused to budge so later in the year, Global Health took it to court.

WA Health, another that has seen its fair share of horror headlines for its health IT bungles, announced that it was ceasing its big bang approach to concentrate on getting some of the basics, like a statewide PAS system, bedded down. The state budget alluded to the WA Health ICT Strategy 2015-2018 that had been released on the quiet weeks earlier, which set out a decision-making framework for ICT across WA Health focusing on “incremental and affordable change” to bring current systems up to date and deliver on existing projects. In other words, the WA government is broke. WA’s flagship Fiona Stanley Hospital would continue to cause headaches for WA Health later in the year.

As promised at budget time, the Department of Health released a discussion paper on options to move to an opt-out system for the PCEHR in early June. This would eventually require changes to the PCEHR Act, which would dominate discussion for the rest of the year, and in the meantime, the feds promised to consult the states to set up some trial sites or “quarantine zones” for modelling an opt-out system. That too would take forever, but it was eventually decided to run two trials, one in NSW and one in north Queensland.

DoH special adviser Paul Madden told a Senate Estimates hearing that the trials would involve up to a million people and would kick off in July next year. Mr Madden also gave an extensive interview to Pulse+IT on what to expect in the coming year as uncertainty over the future of the PCEHR diminished. In what he called a “big, complicated gig”, Mr Madden has now become the lead spokesperson for developments with the system, which he is personally overseeing.

Acute care

NSW announced that it was close to completing the statewide roll-out of the HealtheNet system, which began life as one of the Wave 2 sites for the implementation of the PCEHR. It has now gathered steam and is available to almost all hospital-based clinicians as their view into a number of clinical repositories as well as the PCEHR, and is also being developed to bridge the divide between hospitals and GPs caused by a lack of interoperability between secure messaging services.

One of the conditions of the grant that UnitingCare Queensland received from the federal government in 2010 to build its fully integrated digital hospital at Hervey Bay was that the organisation would be open to talking about its experience and throughout 2015, that’s exactly what it did. Executive director Richard Royle of review fame did the rounds of the eHealth and digital hospital conference circuit, as did its chief medical information officer Monica Trujillo and some other staff, and what they had to say for themselves was pretty interesting. Mr Royle is particularly fond of the closed loop electronic medications management system he has installed, which won St Stephen’s HIMSS level 6 certification within weeks of its opening.

Many hospitals in Australia are now looking at how to use patient portals to better connect with patients both pre and post-admission. US vendor InterSystems is also exploring that market with the launch of a patient engagement platform called Personal Community, based on the HealthShare technology used by a number of state health departments. InterSystems also plans to add the platform as a module to its TrakCare clinical information system.

Primary care

Telemedicine pioneer Ash Collins, who also practises as a GP in the NSW country town of Temora, has long had ambitious plans for his business, TeleMedicine Australia, but none more so than for his new MyOnlineClinic platform. This app-based telehealth service was launched in April and promises to bring together a portable medical record, video access to a GP, and a suitcase full of vital signs monitoring equipment that is perfect for older and disabled people living at home as well as grey nomads and younger people living with chronic disease.

The Victorian government and Medibank Private got together for the CarePoint trial, a two-year integrated care program that uses the services of Precedence Health Care’s cdmNet for shared care planning. However, it wasn’t all good news for Precedence or a number of other organisations as the three-year, $33 million Diabetes Care Project (DCP) that used cdmNet as a shared care planning tool ended on a negative note. An independent evaluation found that while some clinical indicators improved in some patients, the funding model used for the project was not cost-effective and was unlikely to be able to be scaled up nationally.

The Victorian branch of the AMA hopped into the new state government as it approached its first budget, calling for $50m over three years to improve secure messaging between hospitals and general practice and to fast-track the roll-out of the Electronic Recording and Reporting of Controlled Drugs (ERRCD) system. It came away empty-handed, but pressure would keep building throughout the year on Victoria over its recalcitrance in getting the system up and running, as urged by the federal government and a growing number of coroners.

GP desktop software vendor MedicalDirector released the results of a survey of 423 of its customers that showed that 42 per cent still prefer to send medical records by post and fax rather than electronically. Rural and remote practices were the least frequent users of snail mail and the highest users of the PCEHR, but at only 16 per cent of rural practices using the system that was nothing to write home about.

The two main patient-facing online appointment booking services battled each other for publicity this year, with upstart 1stAvailable announcing it would list on the stock exchange with hopes of raising $10 million. It didn’t quite meet that target but it did raise enough to buy two practice-facing rivals – DocAppointments and Clinic Connect – as well as the enterprise-level booking system GOBookings. Market leader HealthEngine added a number of new services throughout the year, including a practice recognition program to allow patients to provide positive feedback, and is itself pondering a listing.

Aged care

Changes to the My Aged Care system continued to gather steam, with the new regional assessment services (RAS) named in April. From July 1, all new referrals to federally funded aged care services will be sent electronically to a RAS, which will also be able to view the person’s central client record.

Aged care provider Feros Care got a lot of attention for its fabulous Wheel-I-Am telepresence robot, which is not only able to stream visits to the art gallery back to residents but also to help conduct video conferencing between residents and remote GPs.

Consumer-directed care continued to be a big news item in aged care for the year, with cloud-based vendor Leecare Solutions launching a new version of its P5 Finance product that includes capabilities to handle CDC reporting.

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

The third quarter of the year, which we’ll take a look at tomorrow, would be dominated by a cacophony of high-pitched squawking when the phrase “meaningful use of the PCEHR” was uttered in the same breath as the term “ePIP”. Elsewhere, WA Health and SA Health duked it out for the honour of having the worst run of bad headlines for health IT ever, as Queensland Health suddenly burst forth with a grand scheme of its own.

Missed the first instalment? Here it is: The 2015 eHealth year in review: part one

Alcidion gears up for IPO to fuel expansion plans

Adelaide-based health informatics firm Alcidion Corporation is looking to move from a project-oriented business to a product-oriented company based on its Miya informatics platform as it awaits the go-ahead of shareholders in reverse listing partner Naracoorte Resources next week.

Alcidion and Naracoorte signed an agreement in August in which the resources company proposed to acquire Alicidion before re-quoting on the stock exchange as the Alcidion Group, divesting itself of its minerals exploration interests and concentrating on the health IT business.

Shareholders are expected to give the go-ahead to the acquisition at a meeting on Monday, after which the company will then re-list on the ASX and seek to raise $2 million as part of an initial public offering (IPO).

According to the share prospectus, the new company will then transition Alcidion from its project-oriented origins into a product-oriented company, with the Miya Platform as the cornerstone product.

It will also seek to commercialise Alcidion’s clinical decision support and SmartForms platforms in the Australian and New Zealand markets and develop a sustainable and commercial model with a view to establishing a direct US presence in the medium to long term.

Alcidion currently has 10 customers and its technology is installed in 11 hospitals, but it sees the need for significant sales and marketing expenditure to get its name out into the market, having flown very much under the radar since its establishment in 2000.

It has worked with the Tasmanian Department of Health and Human Services for many years but it is the work it has done with Western Health in Victoria to develop its patient journey technology and the intelligent Cardiovascular Information System (iCVIS) – developed with and now being marketed by Fujifilm – that is best known for.

The Northern Territory Department of Health is now a major customer, recently signing a $1.75m contract to roll out Alicidion’s Miya Orders emergency department order sets technology to streamline pathology ordering in the ED. It also uses Alcidion’s patient journey technology.

According to the prospectus, Naracoorte has $3.65m in cash and Alcidion has $1.75m, which when combined with the expected $2m from the IPO makes $7.4m in funds available. It plans to spend $1m on R&D, $1.5m on US market expansion, $1m on sales and marketing and $1.75 on business development.

There are risks, the prospectus warns, particularly in terms of gaining market acceptance for its products. However, it has developed a strategy based around entry to the private hospital market by using a single installation in one hospital and rolling it out to ‘sister’ sites.

Alcidion has commenced an implementation study for such a private hospital chain with many hospitals in Australia and internationally, the prospectus says.

It also hopes to get repeat installations through state-based public hospital networks, a strategy it hopes to repeat in New Zealand.

It is also happy to continue working with OEM partners such as Fujifilm that can then use its huge reach to market the jointly developed products internationally.

While domestic growth is Alcidion’s short-term focus, it has also set its sights elsewhere. “The United States market is the primary target market for Alcidion and a concerted effort is planned to prepare the company for US market entry,” the prospectus says.

It lists its competitors in the patient flow management solutions, clinical decision support and SmartForms markets as Allscripts, Cerner, Core Medical Solutions, Epic, GE Healthcare, Health IQ, CSC, McKesson, Orion Health, Philips and Siemens.

International health IT week in review: November 15

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

NHS IT needs £8 billion – McKinsey
Digital Health News ~ Thomas Meek ~ 10/11/2015

The NHS needs to spend an additional £7.2 billion to £8.3 billion on digital technology over the next five years in order to achieve savings of between £8.3 billion and £13.7 billion, according to a report by management consultancy firm McKinsey.


22 point plan for NHS digital adoption
Digital Health News ~ Rebecca McBeth ~ 10/11/2015

A high-level report on NHS IT by management consultants McKinsey makes 22 recommendations to drive the adoption of technology and achieve the anticipated productivity gains; many of which have already become policy.


Docs are flocking to digital communications tools
mHealth News ~ Eric Wicklund ~ 12/11/2015

Clinical decision support vendors are among the front-runners in the move to mobility. The latest to jump is Medscape, which rolled out its Medscape Consult digital platform during this week’s mHealth Summit.


Boston Children’s Hospital discharge tool puts patient, parents in control
FierceHealthIT ~ Katie Dvorak ~ 12/11/2015

The tool sends families either a text message or email within in 24 hours of discharge that contains a link to a Web-based survey.


Hospital EHR adoption up, but problems persist
FierceEMR ~ Marla Durben Hirsch ~ 12/11/2015

More hospitals than ever have implemented electronic health records, but challenges and the adoption gap have not dissipated, according to newresearch published in Health Affairs.


E-discharge: unmonitored target defended
Digital Health News ~ Rebecca McBeth ~ 12/11/2015

The October target for all providers to send discharge letters electronically is not being monitored nationally, but has focused attention on the need to make the process paperless, supporters have argued.


E-discharge: Nottinghamshire junks faxes
Digital Health News ~ Rebecca McBeth ~ 12/11/2015

Nottinghamshire GPs have used the October e-discharge target to stop receiving faxes altogether, forcing providers to adopt electronic processes.


Q&A: Epic president Carl Dvorak
HealthcareITNews ~ Skip Snow ~ 11/11/2015

Healthcare IT News had an opportunity to speak with Dvorak about Epic’s approach to population health. Here’s what he had to say.


FCC selects frequency coordinator for medical body area networks
Health Data Management ~ Greg Slabodkin ~ 11/11/2015

The Federal Communications Commission has selected the Enterprise Wireless Alliance to serve as frequency coordinator for Medical Body Area Networks (MBAN) to ensure interference-free sharing of spectrum between wireless patient monitoring devices in hospitals and aeronautical testing systems that might be operating outside.


FDA warns of cyber threats to networked medical devices
Health Data Management ~ Greg Slabodkin ~ 11/11/2015

The U.S. Food and Drug Administration is concerned that networked medical devices may provide potential cybersecurity vulnerabilities allowing hackers access to hospital networks and putting protected health information and patient safety at risk.


Why interoperability efforts are heating up
Health Data Management ~ Fred Bazzoli ~ 11/11/2015

In recent weeks, participation in interoperability initiatives has been growing from different constituencies within the healthcare industry. Most striking has been an influx of interest from groups that have not been at the table before.


Walgreens pushes outward with major telehealth expansion
HealthcareITNews ~ Jessica Davis ~ 10/11/2015

The largest U.S. drugstore chain and telehealth provider MDLive are expanding their virtual care collaboration to 20 more states, bringing the total to 25.


Unnecessary opioid alerts ‘overwhelm’ emergency department
FierceEMR ~ Marla Durben Hirsch ~ 10/11/2015

An electronic health record’s clinical decision support (CDS) tool in a hospital’s emergency department issued so many unnecessary and clinically inconsequential alerts relating to opioids that providers found them “overwhelming” and contributing to alert fatigue.


Apple ResearchKit: ‘a huge step forward’
mHealth News ~ Eric Wicklund ~ 10/11/2015

ResearchKit is making the clinical trial process a whole lot easier – and that’s the first step toward achieving better clinical outcomes.


Lack of adherence sinks UCLA remote monitoring study
FierceHealthIT ~ Susan D Hall ~ 10/11/2015

Telemonitoring failed to improve readmission rates for heart failure patients inresearch from the University of California-Los Angeles.


Feds to conduct audit of hospital networked medical devices
Health Data Management ~ Greg Slabodkin ~ 09/11/2015

The Department of Health and Human Services Office of the Inspector General will conduct an audit looking at whether the security of networked medical devices at U.S. hospitals is sufficient to effectively safeguard electronic protected health information (ePHI) and ensure patient safety


New standards coming to aid medical device, 3D printer interoperability
Health Data Management ~ Joseph Goedert ~ 09/11/2015

Two new standards being created by standards development organization IEEE are designed to foster plug-and-play interoperability of medical devices and 3-D printers.


Inadequate device cleaning tops alarm fatigue on ECRI health hazards list
FierceHealthIT ~ Katie Dvorak ~ 09/11/2015

ECRI Institute released its annual list of top hazardous technologies that pose a danger to patients, hospitals and health systems.


Has gamification gone over a cliff?
mHealth News ~ Eric Wicklund ~ 08/11/2015

The idea of creating games for healthcare has fallen so far off the radar, it’s not even being tracked by Gartner any more.


Congress between a rock and a hard place when it comes to enforcing VA-DoD interoperability
FierceHealthIT ~ Dan Bowman ~ 05/11/2015

After nearly two decades of failed efforts to play nicely together, and billions of dollars spent, perhaps it’s time to punish noncompliance of federal requests.


AMA rejects link between PCEHR meaningful use and ePIP

The Australian Medical Association (AMA) has rejected the government’s attempt to link eligibility for the eHealth Practice Incentives Program (ePIP) payment to meaningful use of the PCEHR.

Echoing similar arguments made by the Royal Australian College of General Practitioners (RACGP) in its submission on the Department of Health’s ePIP discussion paper, the AMA said in its submission that the ePIP was a practice-level payment, not one made to individual practitioners, and that a better way to encourage GPs to participate in the system is to remunerate them through an MBS item or a Service Incentive Payment (SIP).

However, before any of those measures were contemplated, the fundamental issues with the design of the PCEHR must be fully addressed, according to the submission.

“The AMA has long argued for appropriate financial support to encourage GPs to take up the electronic health record,” it says. “However, we do not agree that the PIP e-Health incentive is fit for this purpose.

“Contrary to the government’s policy intent, it will not encourage GPs to make active and meaningful use of the My Health Record (MyHR). There are fundamental issues with the design of the MyHR that are yet to be fully addressed as well as more relevant funding avenues that could be utilised to much better effect.”

The AMA listed among the numerous problems with the PCEHR the fact that patients can remove information from view, which the organisation claims makes it potentially of no clinical value.

Radiology and pathology reports are still not able to be uploaded, and most consumers don’t yet have a PCEHR and are unlikely to under opt-in arrangements.

“Until these problems have been rectified MyHR is neither a meaningful or functional tool, and it is unreasonable to expect GPs to actively use it,” the AMA says.

“If the MyHR is easy for practitioners to utilise, the information it contains is reliable, the system and record transparently interoperable, and practitioners can quickly and clearly recognise how it will enhance patient care then they will readily engage with it.

“However, we know that the MyHR is none of these things and using the PIP incentive to try and mandate use of the MyHR will not solve this.”

The organisation recommended that the ePIP instead be focused on supporting other eHealth technologies, and that any changes to the eligibility criteria for the ePIP be put off until after the outcomes of trials of opt-out methods of enrolment are known.

The other four ePIP criteria should remain the same, although more support is needed to encourage allied health, specialists and hospitals to use secure messaging, the AMA said.

From best of breed to unified system at Macquarie University Hospital

Sydney’s Macquarie University Hospital (MUH) has taken the unusual step of removing a number of best-of-breed clinical software systems after less than five years in operation and installing in their place a unified system based on InterSystems’ TrakCare healthcare information solution.

First developed in Australia, TrakCare is built on InterSystems’ HealthShare health informatics platform and provides a common user interface for a number of its core systems, including patient record, patient administration, order entry, medications and progress notes, as well as its add-on modules, which include laboratory, pharmacy, emergency department and radiology.

Having opened its doors just five years ago, it could be seen as an unusual step to go through the pain of taking out functional systems and getting staff used to new ones, but according to MUH’s director of IT Eliza Kenny, the hospital decided to take the leap for a number of reasons, not the least of which was improved patient safety, reduced cost and the ease of having to deal with just one system and one vendor.

While the hospital’s early spruikers claimed that when it opened in 2010 it would be the country’s first fully digital hospital, this was always a long shot. Ms Kenny told the Health Informatics Conference in Brisbane recently that the hospital still has to deal with paper, particularly that coming in from and going out to local GPs and the general practice clinic that has recently opened on the university campus, as well as for particular forms such as the theatre count sheet.

However, what was formerly set aside as space for a medical records department is now inhabited by the IT team, with clinical coding a three-desk operation now located far from the underground bunker of old.

And while there is still quite a lot of scanning going on, those scans are immediately attached to the medical record and are viewable by authorised users on any computer anywhere in the world.

TrakCare has been live at MUH for about five months, replacing the ePAS patient administration system from CSC, the MedChart medications management system, also from CSC, along with its Viaduct integration platform. The MetaVision ICU system and Houston Medical’s software for ophthalmology have also gone.

While not disparaging the worth of those systems, the best-of-breed model did mean that there were real inefficiencies to be faced, not the least with medications, Ms Kenny said.

“We’ve got over 80 applications in the hospital, which all had different contact points,” she said. “The six core clinical systems that we were using did have points of interaction, but not much.

“The outpatient system was completely isolated from anywhere else. In ophthalmology, they would have had to print off some documents, walk 15m across a connecting pathway and hand that to the office where you put it back into the system again.

“If [the patient] went to ICU, we’ve had to stop drugs and reorder them in the ICU system and cease them again on moving out of the ICU, then re-chart them for ward-based prescribing.

“Now we have TrakCare, which does this completely end to end. The efficiencies are in decreased risk of errors in transcribing, the practicalities of not having to maintain and support six disparate systems, and just having our technicians focus on one.”

The 144-bed MUH is still the only private hospital in Australia located on a university campus, and is fully owned by Macquarie University. Operated as a not-for-profit, it offers a range of surgical and acute medical services, in particular orthopaedics, neurosurgery and cardiovascular surgery, as well as a day of surgery unit, endoscopy unit and cardiac cath lab.

It prides itself on its cutting edge technology – MUH owns Australia’s first gamma knife for stereotactic radiosurgery and the latest da Vinci SI system for minimally invasive surgery – and it also has a Stryker surgical system that it hopes to integrate with TrakCare for recording of medical images.

Ms Kenny, who worked as a nurse at the commissioning and opening of MUH in 2010 before moving into project management and then heading up the IT department from 2014, said the hospital is also expanding into primary care and is hoping to open more outpatients clinics as well, adding to the on-site GP clinic, an ophthalmology centre and a cardiology clinic.

The hospital has a deep relationship with the university’s faculty of medicine and health sciences as part of Macquarie’s Health Sciences Centre. And in November last year, the well-known Australian Institute of Health Innovation (AIHI) – which features leading researchers in health informatics such as Johanna Westbrook, Enrico Coiera, Jeffrey Braithwaite and Andrew Georgiou – jumped ship from the University of NSW to take up residence at Macquarie University.

“Everyone’s got loads of data which we are now struggling to know what to do with, so we are relying on our colleagues at AIHI to help us utilise our large repository of data to research key issues and to achieve improved patient outcomes,” Ms Kenny said.

Why go digital

For any hospital, the obvious reasons for going fully digital are patient safety and reduced costs, but for Ms Kenny and her team, high on the list were also clinician satisfaction and future proofing the hospital.

“You have to invest to find [those benefits], you need to spend money to save money, and we are now starting to get some of the efficiencies that we hoped for,” she said.

“A digital hospital is all-encompassing – it’s more than just an electronic medical record. You’ve got risk management systems, you’ve got wireless networks so you can have wireless integration of systems and wireless monitoring.

“Our rostering and attendance is all electronic. We can now extract that data out to get an understanding of what the cost per patient day is and through that data, to find out exactly what the cost of surgery is.

“We’ve got business intelligence, fridge monitoring, the Aeroscout asset tracking system. We have wheelchairs that are no longer stuck in corridors or hiding in the back-office because you don’t want people to take them. You can see where they are and use them as they are needed, rather than having to store excess stock and equipment.”

While Ms Kenny said it was exciting times and the hospital was moving ahead in leaps and bounds, that doesn’t mean it is not an extraordinary challenging process and one that is difficult to get right.

MUH is certainly not there yet, she said. “We’ve got a ‘paper lite’ scanning solution, so we’re not paperless and we won’t be paperless until everybody else is paperless. We are part of a community and we’ve got GP practices that send in paperwork that gets scanned in.

“There are still some paper forms which we need to use because that is more efficient than technology at this point. The theatre count sheet is one example. How to get a count sheet to really work electronically and facilitate the same workflow has been a challenge to date, so we are still using a paper form.

“However, we are doing an end-to-end journey from outpatients. If the patient comes to ophthalmology, they can have their outpatient treatment done there, they have full access to their record. They can have their operation done and their booking done.

“It would be unusual but they could go to ICU for a period and transition back to the ward, discharge and back to outpatient management, all through the one medical record, which is fantastic.

“To have just the one system to be able to manage is really great. We had one of our bookings team saying that using just the one system meant they were saving about half an hour off their processes for booking in some of the patients.”

Technology roadmap

While one medical record is a massive boost for efficiency in the hospital, Ms Kenny said going digital was an ongoing journey. The hospital has definite plans for using its repository of data to do research and to get the health outcomes it is after.

There is more integration that needs to be done, including with medical devices and the Stryker theatre system.

Pre-admission is still very much paper-based with patient details and referrals still scanned in, although the hospital is currently working on a patient portal that will allow some of these data entry processes to be handled by the patient themselves.

Ms Kenny said she hoped to have the patient portal online at the end of this year or early next year, and her team is also working on the hospital’s cloud capability. At present, it has one on-site data centre and one off-site but hopes to have some cloud functionality shortly.

Getting the right mix of mobile devices is also a challenge. MUH has invested in 20 Surface Pros for clinical staff and plenty of desktop systems, and while there are computers on wheels Ms Kenny said they tended to be too cumbersome and take up too much room.

Integrating the GP clinic’s clinical system with TrakCare is on the cards, although making communication with local GPs paperless is limited by their use of different clinical systems and secure messaging services, so referrals in and discharge summaries out will be paper-based for the foreseeable future.

Challenges

To have the patient travel through one system is a great step forward, but it has also come with some unexpected challenges, Ms Kenny said.

“The fully integrated nature of our new system has meant that there has been a necessity to understand the multiple, very complex work flows in the organisation. Our staff have had to working closely together, recognising that each step of the patient journey is now integrated and the work done by people in one area potentially affects the workflow both up and down stream.”

While the previous set-up was digital with an electronic record already in place, thus overcoming in part the great leap necessary from paper to electronic, some staff had become attached to the previous systems and had combined them into their workflows.

“We have a service helpdesk that is [open 6am to 6pm] but it was 24 hours when we first went live,” she said. “That is fundamental to make a project of this size work. It needs to be there for ad hoc requests, such as when theatre starts at six o’clock and the surgeon has forgotten their password.

“To get the clinicians involved is essential. I think we get fooled into thinking that this is all IT but it is a clinical project and they need to be driven and run by the clinical experts.

“Training is difficult, particularly for practitioners who are time poor and in our environment some of them only work once a month in the hospital. So to have them be able to come and work efficiently with the system and be familiar with it obviously needs training and exposure to the system. To be able to manage that, in a way that suits the accredited practitioners, is challenging.”

Password ageing is also a challenge, particularly for accredited practitioners, and communication is essential, she said.

“You think you are doing enough and sharing the message, but it’s more around ‘what’s my problem and how are you answering my problem’. It becomes very individualistic and rightly so – it’s a massive change and people have to deal with a lot of change in a short period of time.

“To be able to be responsive to everyone’s needs has proved challenging. You may have to have 10 times more than what you think is necessary, because it’s never enough.

“I’ve had the pleasure of going through this sort of thing twice now in five years. This time it has been in a very different role than when I first joined the organisation, but I’d like to wait another five years before doing it again.”

RACGP not happy with lack of representation on ACeH committee

The Royal Australian College of General Practitioners (RACGP) says it is disappointed that there is no direct college representative on the steering committee overseeing the implementation of the new Australian Commission for eHealth (ACeH).

While there are three doctors on the committee – former AMA president and current NEHTA chair Steve Hambleton, Queensland GP Ewen McPhee and Melbourne’s Chris Pearce – they have been appointed as individuals rather than on behalf of the college.

“As the peak representative body for 31,500 GPs and with a history of being at the forefront of innovation, standards and education in the health sector, to be excluded from this taskforce is regrettable and reflects a non-collaborative approach,” RACGP president Frank R Jones said.

“I do acknowledge there are clinician representatives on the committee, however they have been appointed in a personal professional capacity and not as a representative voice of the RACGP.

“The failure to formally engage with key stakeholder organisations regarding the future of eHealth and its modus operandi in Australia is of concern yet again.”

The college has taken an increasingly firm stand on the role of GPs in eHealth decision-making, this week issuing a strongly worded response to the Department of Health’s discussion paper on proposed changes to the eHealth Practice Incentives Program (ePIP) payment.

Dr Jones said that the college supports the concept of a national shared electronic health record system and welcomed the government’s commitment in the 2015-16 budget to strengthen the national eHealth system.

However, Dr Jones said there are still significant problems with the design and functionality of the PCEHR, soon to be renamed the My Health Record (MyHR).

“These require meaningful engagement between the federal government and general practice if it is to be a success and to drive adoption amongst GPs, who will be the main users of the system,” Dr Jones said.

“The RACGP sees the role of the ACeH as providing streamlined governance and accountability for all eHealth product design and release.

“The new commission must have appropriate governance and key health sector stakeholder representation, including the RACGP.”

The college’s new expert committee on eHealth and practice systems (REC-eHPS) is holding an eHealth forum at the end of the month to explore eHealth developments.

No decision on trial sites or enabling legislation for opt-out PCEHR

The federal government is now making available recent statistics on the uptake and use of the PCEHR on its eHealth website but has still not released promised legislation enabling an opt-out version of the system and there is still no decision on the location or make-up of the $51 million trial sites of opt-out models.

There is also no word as yet on the make-up of an implementation taskforce that is expected to oversee the transition of responsibilities for eHealth from the National E-Health Transition Authority (NEHTA) to a proposed new Australian Commission for eHealth (ACeH).

Recent stats added to the ehealth.gov.au website show that uploads of electronic hospital discharge summaries to the PCEHR have surged since the start of the year but that uploads of the most crucial clinical document – the shared health summary – are still vanishingly small.

The statistics show that 2,373,110 people had registered for a PCEHR as of August 28, or about 10 per cent of the population. The ACT has the highest percentage of consumer registrations on 17 per cent of its population and WA the lowest.

The total consumer figure is an increase of about 300,000 in the last nine months. There are now 55,052 shared health summaries in the system, up from about 38,200 in December 2014, and 192,602 discharge summaries, up from 85,960. Specialist letters have also begun to gather steam, with 3261 now uploaded.

The federal government ended a lot of uncertainty over the future of the system in the May federal budget with an allocation of $485 million over three years, including $51 million to run trial sites for its preferred opt-out model.

However, legislation to make necessary amendments to the PCEHR and the Healthcare Identifiers (HI) Service acts to enable opt-out trials to begin has still not been introduced to Parliament. A discussion paper on the proposed changes was opened for public comment in June and legislation was expected in August.

In addition to enabling changes to the individual participation arrangements, the amendments are also required to make a number of fundamental changes to the system as recommended by the 2013 Royle review.

This includes changing the name to the My Health Record, enabling the creation of the ACeH and the dissolution of NEHTA, and significant changes to the onerous participation agreements originally required of general and specialist medical practices and other healthcare provider organisations.

A spokesperson for the department told Pulse+IT in July that arrangements for an implementation taskforce to oversee the transition from NEHTA to the new eHealth Commission were being finalised and were expected to be established in August. However, no official announcement on this taskforce have been made.

The government had also promised to release the names of the chosen sites for trialling different opt-out models of the PCEHR this month. The trials are supposed to begin next April and received $51 million for their operation in the 2015-2016 federal budget.

However, despite inviting the states and territories to nominate potential trial sites at the COAG Health Ministers’ meeting in Darwin on August 7 and an expectation that the chosen sites – expected to be between two and five – would be announced by the Health Minister this month, the DoH spokesperson said there was no word as yet on whether a decision had been made.

The department also moved to quash rumours that the introduction of the new Windows 10 operating system would strike a “mortal blow” to the PCEHR due to incompatibility issues and the potential that some security certificates would no longer be valid.

Clinical software vendors have been testing their products for compatibility with Windows 10 since its release in July. While there have been few problems, many are recommending caution before practices install the new OS.

“The PCEHR provider and consumer portals are testing positively with the new Windows 10 operating system, and the National Authentication Service for Health (NASH) certificates will work with Windows 10,” the DoH spokesperson said.

“It is acknowledged that clinicians mainly access PCEHR functions and information through their clinical information systems.

“The department will work with software vendors to ensure the PCEHR functions continue to operate effectively as they and the users of their systems upgrade to Windows 10.”

The $485 million announced in May brought total direct spending on the PCEHR since it was first announced in 2010 to just over $1.2 billion. NEHTA has also received funding of almost $1 billion since it was established in 2005.

ACHI lends its weight to health information workforce summit

The Australasian College of Health Informatics (ACHI) will take part in the health information workforce summit being organised by the Health Information Management Association of Australia (HIMAA) in Sydney next month.

The summit aims to address the health information workforce shortage and configuration challenges highlighted by the 2013 Health Workforce Australia (HWA) health information workforce report, which is currently under review by the Australian health ministers’ health workforce principal committee.

HIMAA hopes that the summit will result in an action plan to address workforce shortages in the health information management and health informatics workforces.

ACHI president Klaus Veil said the college believed that a joint approach between the professions will be an effective one to address the current workforce shortage issues.

Mr Veil said it was hoped there would be recognition of the “urgent need” to expand and train the eHealth workforce in light of the government’s recommitment to the national PCEHR.

HIMAA president Sallyanne Wissmann said the HWA report provided a landmark opportunity to address current workforce challenges and plan for the future of the health information workforce to meet current and emerging national health reforms and initiatives.

“It establishes clearly in its early sections just how important key occupations in the health information management profession are in the management of health information within the healthcare system,” Ms Wissmann said.

“A joint approach by the health information management and health informatics professions can only strengthen our suit with government and industry.

“The third peak body in our combined field, the Health Informatics Society of Australia, will also be attending the summit, and we hope to be able to expand on their involvement shortly.”

The Health Information Workforce Summit will be held at the Dockside Cockle Bay Plenary Room at Sydney’s Darling Harbour on Friday, October 30.

Ocean rises to target PHNs and integrated care market

Sydney-based health informatics firm Ocean Informatics is set to use the success of the LinkedEHR platform it has built in association with Western Sydney Primary Health Network (WentWest) to offer its services and technology to more PHNs following a recent injection of funds from a private investor.

The company is also rolling out what it says is the largest implemented infection control system in Australia with its Multiprac Infection Control solution, which has recently gone live at Mater Health Services in Queensland and the five public hospitals in the Northern Territory. It is now live in 72 hospitals.

Ocean Informatics CEO Hugh Leslie said the investment has allowed the company to boost its staffing levels by 40 per cent and to provide 24-hour, seven-day support to better service the increased growth it has experienced over the last few years, as well as with plans to open a new office in Darwin at the end of the year.

“One of the issues that we’ve had recently is that we’ve had more work than we have been able to cope with to some degree,” Dr Leslie said. “This investment has really enabled us to spread our wings a bit and get some room to manoeuvre and it is making a big difference.

“One of our big clients is NT Health and this will allow us to have a local presence.”

Ocean’s clinical data repository (CDR) platform has been used by NT Health for many years and forms the core of the territory’s shared electronic health record, known as the MyEHR, which has now been connected to the national PCEHR. The NT is also looking to do a refresh of its primary and acute care clinical information systems, which Dr Leslie said Ocean hoped to work on.

The link between primary and acute care is also something the company is targeting with its Multiprac suite of clinical solutions. Ocean’s technology, including Multiprac CP Care Planning and its CDR, forms the basis of the LinkedEHR system implemented by WentWest in late 2013.

LinkedEHR is the core IT infrastructure enabling the Western Sydney demonstrator model for NSW Health’s four-year, $120 million Integrated Care in NSW strategy. This is trialling a new model of care for patients with chronic illnesses involving GPs, hospital-based rapid access clinics and nurse-led care facilitation, powered by LinkedEHR as the shared care planning system.

Dr Leslie said the increase in resources would allow Ocean to work more closely with other PHNs, not just on care planning but the whole gamut of integrated care.

“Integrated care – that transition of patients between primary care and acute care – is something that we don’t do well here in Australia,” he said. “Actually I don’t think it is done that well anywhere in the world, but is something that our platform and software can help with.

“I think the LinkedEHR project and integrated care work that we are doing with NSW Health is really interesting and we have a number of PHNs interested in talking to us about that.”

Dr Leslie said integrated care was more than just about care planning. “One of the things that we can do is help to integrate all of a PHN’s systems. Like many organisations they have a whole lot of disparate systems and they need to try and bring them together. Care planning is just now part of integrated care.”

The new investment has also allowed Ocean Informatics to appoint a new chief operating officer in Richard Satur, who will be managing Ocean’s increased delivery, development and support requirements as well as the company’s plans to move its solutions to Microsoft’s Azure cloud platform.

The company has also recently completed the roll-out of a new Staff Health module for infection and exposure reporting that can be a standalone module or work in conjunction with Multiprac Infection Control.

A new version of Multiprac IC – nicknamed Beluga 1.1 – is due to be released next month and in keeping with the marine theme and faster releases, this will be followed in six months by Cuttlefish 2.0.

Ocean’s national engagement manager, Joe Griffiths, said Ocean had recently gone live with Multiprac IC at Mater Health Services Queensland’s seven public and private hospitals and at NT Health.

Mr Griffiths said that when added to the 57 Queensland Health facilities it is already installed in as well as St Vincent’s Holy Spirit Northside, St Andrews Toowoomba and Ramsay Greenslopes and Hollywood, Multiprac IC is the largest implemented infection control system in Australia.

The Staff Health module has been implemented organisationally wide at Ramsay Health Care and is due to be implemented in NT and St Vincent’s Holy Spirit Northside, he said.

Dr Leslie said new staff have been added to Ocean’s integration team and the company was also boosting its capabilities in product development, new enhancements and new products in the Multiprac suite. Support will be available 24/7 through a new helpdesk service.

Australasian health week in review: August 15

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

NBN’s new satellites ready for takeoff
The Australian ~ David Swan ~ 14/08/2015

The company building the national broadband network has announced its two new satellites will launch into orbit this October, described by communications minister Malcolm Turnbull as a “game changer”.


Doctor’s smart solution to medic alarms
New Zealand Herald ~ Brendan Manning ~ 13/08/2015

Q Watch aims to beat conventional devices with greater distance, voice control and storage of medical records.


Australia’s DTO hires UK govt’s digital ‘boy wonder’
iTNews ~ Paris Cowan ~ 12/08/2015

Australia’s Digital Transformation Office has continued its head-hunting spree through the ranks of the UK government, luring high-profile ‘boy wonder civil servant’ Jordan Hatch from the Government Digital Service.


They’re in denial’: MyGov users vent anger
Canberra Times ~ Noel Towell ~ 11/08/2015

The Commonwealth government is “in denial” over the performance of its online service portals, with MyGov coming in for savage criticisms from frustrated users of the system.


Telstra threat MyRepublic details Australia launch and slams NBN
Sydney Morning Herald ~ David Ramli ~ 11/08/2015

The Singaporean company named as one of Telstra’s biggest worries by its outgoing chief executive David Thodey has labelled parts of the $41 billion national broadband network as “shit” as it prepares to launch services in Australia.


GPs are throwing aside their doubts and opening up to patient portals
stuff.co.nz ~ Tom Pullar-Strecker ~ 10/08/2015

GPs appear to be warming to patient portals that let them communicate with patients over the internet.


200 staff await delayed decision on NICTA and CSIRO merger
Canberra Times ~ Henry Belot ~ 07/08/2015

The job prospects of up to 200 employees remain uncertain as a merger of the nation’s peak science and IT bodies continues to be negotiated.