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:
- mCareWatch launched a new 3G version of its SOS Mobile Watch and a new GPS SmartSole device that fits into a shoe so the wearer can be remotely monitored
- Tasmanian-based telehealth provider GP2U launched a new activity monitoring widget for its iPhone app, using the core motion framework that Apple has built in to the iPhone 5S and later models
- Clinic to Cloud (C2C), a cloud-hosted electronic medical records system aimed at new and existing specialist practices was officially launched after a couple of years of development, signalling the first fully cloud-hosted system for specialists on the market
- Melbourne-based Sonoa Health popped up here and there, sponsoring some conferences and making its name known around the traps, but it was tough to work out exactly what services or products it was touting. That became a bit clearer in the middle of the year when it began to publicly speak about its plans, which are quite revolutionary. After a name change to Health&, expect to see a lot more of this company in 2016
- Oncology systems vendor Charm Health signed a master agreement with private hospital provider Healthscope for the Charm oncology information management system
- Spok released version 4.1 of its Spok Mobile secure texting app, featuring a new mobile API that allows information contained in messages to be attached to the patient’s file
- The Improvement Foundation (IF) tore up its agreement with Pen Computing’s Clinical Audit Tool (CAT) and signed on with the developers of the Canning Tool instead
- Community care provider Integrated Living announced it was rolling out telehealth services to 13 different regions in four states following the success of its Staying Strong telehealth project
- Melbourne’s Royal Children’s Hospital (RCH) introduced a WebRTC platform based on Healthdirect Australia’s video call service for providing telehealth consultations with patients and remote clinicians.
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