Australasian health IT week in review: November 28

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

Victorian govt boosts start-up sector with LaunchVic
Computerworld ~ Rohan Pearce ~ 27/11/2015

LaunchVic will be led by Dr Pradeep Philip, a former secretary of the Victorian Department of Health and Human Services


Deliberate agenda’ to denigrate GPs: Primary chief slams govt
Medical Observer ~ Julie Lambert ~ 27/11/2015

Primary Health Care’s new CEO has hit out at a “deliberate agenda” to blame GPs and exaggerate waste to justify reforms of the health system.


Qld Health signs Fujitsu, Orion Health in middleware overhaul
iTNews ~ Allie Coyne ~ 27/11/2015

Queensland Health has appointed Fujitsu to help introduce Orion Health integration software into its IT environment as the first step in a massive work program to incrementally replace its legacy systems.


Marie’s mission to highlight fatal flaws in medical devices
Sydney Morning Herald ~ Liam Tung ~ 27/11/2015

Marie Moe is a thirty-something Norwegian security researcher with a rare heart condition that would have killed her were it not for the computerised pacemaker wired to her heart.


Transition to Fiona Stanley Hospital put patients at risk, report finds
ABC News ~ Andrew O’Connor ~ 26/11/2015

A parliamentary inquiry into transition and operational problems at the new $2 billion Fiona Stanley Hospital has found patient safety was put at risk as patients and services were moved from other hospitals.


Mental health overhaul: Central hotline, online services to launch under new approach
ABC News ~ Dan Conifer and Sophie Scott ~ 26/11/2015

Online and telephone one-stop-shops will be established directing people to appropriate services, as the Government abandons the current “one-size-fits-all” approach.


Primary Health Care hits back at government rhetoric on waste
Sydney Morning Herald ~ Tim Binsted ~ 26/11/2015

Primary Health Care chief executive Peter Gregg has delivered a veiled warning to health minister Sussan Ley that she risks a bruising fight with Australia’s doctors if her government continues its “alarmist” rhetoric about waste in the healthcare system.


Government signals consumer reviews for My Aged Care
Australian Ageing Agenda ~ Linda Belardi ~ 26/11/2015

The Minister for Aged Care Sussan Ley has reaffirmed the government’s intention for the My Aged Care gateway to progressively resemble TripAdvisor, the popular travel review website that now hosts more than 250 million user reviews.


Quality improvement a central theme at industry’s technology awards
Australian Ageing Agenda ~ Natasha Egan ~ 25/11/2015

A medium-sized NSW home care provider that transformed compliance and quality through new software is among the winners of this year’s Information Technology in Aged Care awards, which also honoured two industry veterans for their contributions to IT uptake in the sector.


Patients struggle as GPs create more care plans than ever
Medical Observer ~ David Rowley ~ 25/11/2015

More than a quarter of GPs believe their patients have difficulties understanding their care plans, according to surveys of almost 400 practitioners.


Push for specialist fees database
Australian Doctor ~ Tessa Hoffman ~ 25/11/2015

Giving GPs access to a database of specialist fees is being pushed as a way to help patients avoid hefty out-of-pocket costs.


The problem with the government’s eHealth vision
Medical Observer ~ Nathan Pinskier ~ 24/11/2015

THE government is set to introduce changes to the Practice Incentives Program (PIP) eHealth Incentive to encourage ‘active and meaningful use’ of the myHealth Record (formerly PCEHR).


Leaked NBN budget blowout documents threaten to embarrass Malcolm Turnbull
Sydney Morning Herald ~ Matthew Knott ~ 24/11/2015

The Optus cable TV and broadband network bought by the National Broadband Network for $800 million is in such poor condition the NBN is considering replacing it entirely.


Integrate stroke risk app into PMS, says inventor
NZ Doctor ~ Keira Stephenson ~ 23/11/2015

An award-winning researcher wants health professionals to start using his stroke risk app as a prevention and education tool, integrated into their practice management systems, to reduce the country’s growing stroke burden.


Absence of surgical robot leaves new Royal Adelaide Hospital ‘dumbed down’, SA Opposition says
ABC News ~ Staff writer ~ 23/11/2015

The lack of surgical equipment to perform delicate keyhole surgery at the new Royal Adelaide Hospital has rendered it a “world-class building with second-class medical equipment”, the South Australian Opposition says.


Medical and social tech among winners at start-up pitch event
Australian Ageing Agenda ~ Natasha Egan ~ 20/11/2015

Radiotherapy treatments that aim to improve access and accuracy, and smartphone-based artificial intelligence software that narrates the physical world to the blind in real-time are among the innovations winning at this year’s Tech23 event.


Leveraging technology: a provider case study
Australian Ageing Agenda ~ Jackie Keast ~ 20/11/2015

BaptistCare’s technology strategy may be futuristic, but its premise involves going back to basics: how to best provide quality care.


Two trial sites for opt-out PCEHR, trip advisor for My Aged Care

Trials of opt-out models for the PCEHR will begin in Far North Queensland and the Nepean-Blue Mountains region of NSW in early 2016 as part of what the federal government says is an attempt to re-set the agenda when it comes to digital health and innovation.

Federal Health Minister Sussan Ley (pictured earlier this year) told the National Press Club today that the government had committed to continuing with the PCEHR – soon to be renamed the My Health Record (MyHR) – and to the My Aged Care website as part of its new policy of delivering a 21st century government that embraces the digital economy.

The two trials will involve around one million people, Ms Ley said. Federal health department officials told a Senate Estimates committee hearing in Canberra last week that it was also still open to innovative models for an opt-in system.

Legislation amending the PCEHR Act to change its name and give the minister authority to stage the trials passed the lower house with bi-partisan support recently.

Ms Ley told the press club that while the PCEHR was an important element in the government’s digital plans, the “great digital health revolution” literally lay in the palms of consumers.

“We now live in the age of smartphones, watches and wallets,” Ms Ley said. “So what if we as a government got out of the way and gave consumers full access to their own personalised health data and full control of how they choose to use it.

“What if you as a consumer were able to take your personal Medicare and PBS data to a healthcare service, to an app developer, to a dietitian, to a retailer and say how can you deliver the best health service for my individual needs.

“It is a revolutionary concept in health but it shouldn’t be given it’s already happening in industries like finance across the globe.”

She also said she wanted the My Aged Care gateway to be similarly opened up where it could become the Trip Advisor for the elderly.

Ms Ley appeared to concede that moving responsibility for aged care to the Department of Social Services when the Coalition was elected in 2013 had been a mistake. With former aged care minister Mitch Fifield being promoted recently, she saw the opportunity to “bring aged care home to Health”.

The health department is where she believed aged care belongs, Ms Ley said, “and where I believe we are best placed to implement the reforms that have been started.

“My priority in doing this is to ensure choice and flexibility for older people … Consumers need to be able to find the services that are going to deliver on what is important to them, which is why I want the My Aged Care gateway to be more like Trip Advisor.

“We all know the value of that when we are planning a holiday. A style of information will be progressively available on My Aged Care to help older people make even more life decisions.”

Asked how she intended to ensure that digital health platforms like My Health Record and My Aged Care would be taken up by general practitioners, when they had not so far, Ms Ley said demand would be led by consumers.

“It is vital that GPs, who are the centre of a patient’s care, take an interest and appropriately receive an incentive to sign somebody up for an eHealth record, and that will be part of what we trial and what we ultimately roll out,” she said.

“But I just want to contrast the patient who sits quietly in their doctors’ surgery today listening to everything … but not even asking questions … with the next generation of patients who are already starting to walk into surgeries across the country and saying ‘I want this’.”

Consumers will demand to have all of their health information and their medical records from their different providers in one place, she said.

“I think we are facing a bit of a lull where people might have to be pushed towards this, but I just don’t see for the next generation that there really are any issues at all. But … we do have to get the GPs onboard and we will.”

Digital aspirations

According to Ms Ley, hers is a government that continues to be focused on ensuring Australian patients get affordable access to high quality healthcare services.

“However, like any industry, this should not be the limit when it comes to health policy,” she said. “The prime minister has made it clear we want to deliver a 21st century government that embraces the digital economy and health is no different. We need to embrace digital health and innovation in the health sector if we are to deliver integrated care.

“In particular we must embrace the concept of personal choice, ways to empower patients to build a healthcare model that suits their individual needs.

“It is time we re-set the agenda when it comes to digital health and innovation and open our minds to the wider possibilities available. As consumers, digital health has obvious benefits when it comes to the storage of our personal medical information that will vastly improve the way that diseases and conditions are diagnosed and managed for Australian patients.

“This concept is also designed to support doctors and other health professionals with accessing information at their fingertips. It will help deliver better health outcomes for patients for the first time and cut down on unnecessary risks and inefficiencies in the system currently frustrating doctors.

“That’s why this government has committed to revamping [the PCEHR] into a model that is easy to use and understand for patients and health professionals. Admittedly we could have walked away and put it in the too-hard basket but as I said earlier we are committed to delivering 21st century government for Australian patients.”

She said one of the great criticisms of Labor’s opt-in model for the PCEHR – which the Coalition fully supported when it was in opposition – was that patients had to sign up to it. What she would now like to see is an all-inclusive system that gives those consumers who don’t want their medical history made available to them the option to opt out.

She said she also wanted to “open source” health data to allow consumers the choice of what they want to do with it.

“Why can’t we allow people to use their own personal health information in the same way they would access and customise a banking product?” she said. “Why can’t we allow people to create a health portfolio of products and services, customised to their own needs simply by providing their data?

“Why can’t we allow someone’s doctor to use an app developed on the free market to monitor their patient’s blood pressure at home following an operation or keep a real-time count on their insulin levels?

“Why can’t we keep informed of our parents’ health and wellbeing via digital connections so they can remain in their own homes rather than prematurely entering residential aged care?

“The answer is we can and allowing consumers open source access to their health data is the way to do it.”

Buzzwords

Shadow health minister Catherine King said Ms Ley’s speech contained nothing new and that the government’s record on eHealth was “truly dismal”.

“In a speech littered with buzz words, but no vision, the Minister’s only announcements were yet another delay to the roll out of eHealth and yet another review to add to the tottering pile on her desk,” Ms King said in a statement.

“The Minister’s announcement of eHealth trial sites in early 2016 is confirmation that the two years of delays in advancing this crucial health initiative are now set to extend into another year.

“Until this point, this government has done nothing for two years in eHealth except commission a review, then cut $215 million from the program in this year’s Budget.

“After sitting on that review for 500 days, the minister finally announced the government’s response in May this year, and then waited another 5 months before today announcing a further delay into next year.”

Royal Children’s Hospital on track for an Epic go-live

Melbourne’s Royal Children’s Hospital has started the six-month countdown to go-live for its new $48 million electronic medical record, with plans on track to switch on all clinical functionality at the hospital on one day next April and go straight to HIMSS Stage 6, only the second hospital in the country to do so.

In what is the first implementation in Australia of an EMR from giant US vendor Epic, the keenly watched project will see the system go live with all clinical functionality fully implemented, including emergency, OR and anaesthesia, all specialist modules, full medications, orders and results, clinical documentation and scheduling.

The hospital’s current patient administration system and radiology and pathology systems will remain for the time being, but the hospital has purchased the full Epic enterprise suite and those functions will come online down the track.

Epic’s mobility solutions have also been purchased, with nurses able to take vitals and do documentation at the bedside through Epic’s Rover app, doctors provided with mobile access to patient charts, lists, scheduling and ePrescribing through the Android and iOS-enabled Haiku app, and iPad access to almost the full EMR for doctors through the Canto app.

The hospital will also have a portal to allow patients and families to enter information, see results and request appointments, and GPs and paediatricians will also be able to see their patient’s records and communicate with hospital clinicians through a secure web portal.

On April 29 next year, the hospital will go from a Stage 2.3 on the HIMSS electronic medical record adoption model (EMRAM) to a Stage 6, although the hospital has also bought the functionality to go to the highest level, Stage 7.

The implementation is big and bold and currently involves 70 full-time project staff – which will rise to 90 at the end of the month – but as project director Jackie McLeod says, it may take a village to raise a child, but it takes an army to implement an electronic medical record at a children’s hospital.

Ms McLeod told the Health Information Management Association of Australia’s (HIMAA) annual conference in Sydney yesterday that there is a huge organisational focus on the project but it was the first in which she was confident enough to allow a countdown clock to be set.

Having formerly overseen the implementation of iPM at Northern Health and the Cerner Millennium system at Austin Health, Ms McLeod has experience in implementing large IT systems in public hospitals, but the Children’s Hospital EMR project is one of the largest and closely watched the country has seen.

It is now at phase four of the 19 month-long project, with the system built and configured and testing starting last week. It is now getting to the pointy end of the project, but its planning seems to have been meticulous.

“In any of the other projects I’ve been involved in I would never have put up a go-live clock, but I feel absolutely confident with what we are doing and in the system we’ve got from Epic that we will go live and we will hit that date,” she said.

Eyes on the prize

Ms McLeod and her team are well aware that all eyes in the health IT industry in Australia are on them with the roll-out. The Royal Children’s is a landmark building for the city of Melbourne and the announcement of the winning tender for the EMR in April 2014 made a lot of headlines, including ranking as the most-read story on Pulse+IT for the whole year.

Ms McLeod told the conference that when the hospital opened in 2011 it was supposed to be fully digital but that didn’t happen and it still very much runs on a mixture of electronic and paper systems.

However, the move to a full EMR was not a question of if but when, she said. “We work in a beautiful hospital that was built to be a digital hospital and was opened as though it was going to be a digital hospital, but it’s not,” she said.

“We all understand where we need to be and it’s not here. But implementing an EMR is not about taking the paper and digitising it. That’s a scanned medical record and we did that in 2011. An EMR is so much more than that.

“Typically when we implement an EMR in this country we go module by module. We do a bit of something, we move from paper to an electronic system and we implement one module at a time.

“We’ve chosen not to do that because we don’t believe it is the safest way to implement. We also believe that you get much better benefits when you implement everything together, and you test and build everything together.”

The hospital will go live with full medications, results and orders, clinical documentation and scheduling, but unlike a lot of other EMR implementations, the specialist modules will also be switched on at the same time.

“We will be doing specialist cancer modules, specialist OR and anaesthetic modules, and they all sit together on an integrated database – no logging in and out of systems, all connected, all on the one database,” she said.

“That was a very strategic decision by the Children’s Hospital because we were unable to see, in our travels throughout the world, a best of breed hospital deliver the benefits that an integrated solution brings.”

In addition to providing Epic’s suite of mobile apps to its clinicians – the Rover app for nurses allows them to do medication administration, see their patient lists and their tasks and take vitals, and is supplied on a Motorola device – the hospital has also completed its integration of medical devices such as ICU monitors and ventilators with the EMR.

“That is live today, ready and waiting,” Ms McLeod said. “No longer will our intensive care nurses, our PICU and NICU nurses, spend time documenting on big foldouts. All of that information will go directly into the EMR.”

The hospital is also integrating with OnBase by Hyland, an enterprise content management system often used with Epic to provide clinicians with access to patient information stored outside of the EMR and to scanned documents. Ms McLeod said the hospital was converting its 17 million scanned documents into Hyland, which will also contain scanned paper documents such as ambulance charts.

Ms McLeod said the hospital still won’t be paperless but that is not the aim of the project. However, she does believe the the implementation will reduce paper use by at least 80 per cent.

In addition to the full clinical suite and mobile apps, the hospital will also implement Epic’s research and analytics capabilities to allow researchers from the co-located Murdoch Children’s Research Institute (MCRI) with access to the system.

MCRI has funded a researcher’s position on the project implementation team, and in the future, subject recruitment and identification for studies can automatically be done through Epic. The system is also be capable of embedded analytics and data warehousing.

GP and patient portals

The hospital is also very keen on opening up Epic’s capabilities to external providers and to patients themselves through portals. RCH will provide an external link allowing authorised general practitioners and private paediatricians a web-based portal into the Epic system.

This will allow GPs and paediatricians to view the EMR of their patients but also some limited functionality such as sending eReferrals and communicating securely with the treating hospital clinicians. The portal has the capability to allow GPs to order radiology and pathology but this will not be turned on for the go-live.

The hospital is also very excited about implementing what it is calling the My RCH Portal, Ms McLeod said. Based on out-of-the-box functionality called My Chart, the portal will be available to patients through the web, as an app and even through the Apple Watch.

“It’s an application that allows families and the patients to view and update information related to their care at the Children’s Hospital. It is a tool for them to manage their own healthcare and is a new way for us to put patients at the centre of care. We always talk about being family-centric and [how families] really need access to information. We are really excited about this. It is a new way to communicate between our clinicians and our patients and families.”

Ms McLeod said the hospital believed opening up the EMR to patients and their families will make a big difference to the way RCH provides care. While the benefits of sharing information with patients is well known and evidence for good health outcomes is mounting, some clinicians still struggle with the concept.

This is despite things like the US Open Notes project proving immensely popular and beneficial for patients and for their doctors, it will still take a bit of change management for some doctors to accept, she said. She cited a 2013 Accenture study that showed that Australian doctors were among the most conservative in their views on patient access to their medical information.

Only 18 per cent of Australian doctors thought patients should have full access to their medical records and yet 83 per cent said they wanted their patients to be more engaged in their own healthcare. This is despite evidence now showing a direct link between engaging patients in their own healthcare through access to information and better health outcomes.

The hospital has surveyed its clinicians and has developed a policy on who can use the portal and what information they can access, Ms McLeod said. For children under 12, only their parents or carers will have access to the record, but for kids aged between 12 and 16, both can have access.

“Once the child reaches 16, they then can consent for their parent or they can cut their parent off, which is an interesting discussion,” she said.

Patients and carers will be able to add information such as their medications, allergies and clinical problems to their records, and the hospital will run a pilot project to see trial allowing them to request, confirm and cancel appointments.

Patients and carers will be able to read their ambulatory progress notes so when they attend an outpatients clinic, by default their note will be released to them unless the doctor ticks a ‘not to be released’ box. They will also be able to request repeat scripts, view their care plans and participate in surveys and research studies.

The hospital has also decided to allow them to view their tests results, which will be released after eight days. While Ms McLeod says this will probably eventually be reduced to three days, many clinicians are still nervous about allowing patients to see pathology data.

“Patients and carers love the idea, particularly parents as they think it will help them make better decisions about their child, but some doctors had some very strong reactions,” she said. “A few strongly opposed it while others had a positive response. One said, ‘that’s not good, I think that’s inappropriate’. ‘That’s not good, that’s inappropriate.’ They had to say it twice so we really got it.”

The final countdown

For the Royal Children’s Hospital, the Epic project is well named. Ms McLeod said it had been the subject of a massive organisational focus at the hospital and was the biggest thing happening at the present time. And there’s still 185 days to go-live.

The planning for the project has truly been epic, and the implementation team has now grown to 70, with more to come.

“It takes a village to raise a child … but it takes an army to implement an EMR,” she said. “We are building a whole EMR – every specialist system is being built all at the one time. I have 12 doctors, seven pharmacists, five health information managers (HIMs), nine nurses, technical folk … we are a big team but this is what it takes to build and implement an EMR.”

Fifty implementation staff have completed training in the US, including Ms McLeod. This involved her gaining certification in the emergency department module through nine days of face-to-face courses, sitting three exams and completing two assignments, one of which took 45 hours to do. Those certified in the OR and anaesthetic course had to complete an assignment of over 160 hours.

“One of the reasons we chose Epic is because they have a very strong implementation philosophy,” she said. “You might be a great HIM or a great nurse or a great doctor, but that doesn’t mean you are a great EMR implementer. It takes resilience, it takes quick thinking, it takes an ability to respond to pressure, and you’ve got to be able to listen to people and understand what workflows look like. All of that and you have to be able to configure software.”

Now the focus is turning to training the hospital’s 4500 staff. This will involve role-based training with a minimum period of training for any clinicians of about six to nine hours. And training is mandatory – no one will be allowed to provide clinical care if they have not been trained.

“It is not an iPad – you cannot learn it by just picking it up and having a go,” Ms McLeod said. “In fact, you would be unsafe.”

Her team has 30 super trainers but is trialling a new model in which medical staff train other doctors. 58 doctors have put their hands up to be EMR trainers, which Ms McLeod said showed that clinicians were fully engaged in the roll-out.

“They picked this system – we had 24 clinicians involved in the evaluation panel,” she said. “They picked this system and they were involved in configuring this system and now they want to take the lead in educating their colleagues.”

Training will begin in earnest seven weeks ahead of go-live, and more than 200 superusers will be on hand post go-live, as will 24/7 supernumerary support. The team has even set up two “command centres” – one with space for 60 staff and one to look after the superusers. The hospital will also reduce outpatient activity in the first weeks of go-live.

“We will have personalisation labs so clinicians will have their favourites set prior to go-live and our project team is employed right up until six months post go-live,” she said. “The first four to six weeks is stabilisation and everything just gets fixed, and then we’ll move into an optimisation phase after that. Ongoing, we think we will have something like 40 EFT to look after this system.”

Ms McLeod is under no illusion that her task is huge – it is a $48 million project and perhaps the largest IT project in Victoria at the moment – and that many staff are worries about what will face them on the day their pens and paper are taken away.

However, she believes it will be a success. “You have to be honest with your staff but you have to say we will do whatever it takes to help you with this. You have to plan beyond go-live because go-live is just the start.

“It is a sprint to get to the starting block but this EMR will be with us for 20 years – it’s like a child and we have to nurture it and nourish it and make sure we have the right supports in place so we can make the best of it.

TeleConsult looks to raise funds for pay-per-minute telehealth service

Start-up company TeleConsult, which launched at GP15 in Melbourne last week, is looking to raise $1 million to support the local and global expansion of its telehealth platform, which offers pay-per-minute telephone consultations between patients and their regular doctor, with video capability planned for the future.

Devised by Sydney-based consultant respiratory physician Jonathan Rutland, TeleConsult promises to finally provide a way that doctors can be paid for offering advice and follow-up care over the phone to their patients.

Dr Rutland said he had been thinking about the concept for many years, prompted in part by his own experiences as a patient. Like all other patients, Dr Rutland had to take an afternoon off work, drive across the city, pay for parking and then wait for hours when his specialist was running very late.

On one occasion he asked the receptionist if she could bill him and get the specialist to phone Dr Rutland later when he had the time.

“She said to me very archly, ‘Doctor, we don’t do that’,” Dr Rutland said. “And I thought, one day you will; I just don’t know when.”

While consultations will be privately billed, Dr Rutland believes there is a large market of people who would be willing to pay per minute for the convenience of talking to their doctor over the phone rather than taking time off work or to travel long distances to attend in person.

Matters that don’t need a face-to-face consultation, such as requesting a repeat prescription, discussing test results or reporting adverse reactions to a treatment would be suitable, although there is also the potential for a doctor to triage urgent consultations and smooth the way for patients to be admitted to emergency if needed.

Dr Rutland said he is aiming the service at both specialists and GPs to use with their regular patients, and has designed the service so doctors can retain control over when and to whom they are available.

Doctors can register for free to use the service, with TeleConsult taking a percentage of the fee for providing the platform. There is a minimum fee of $15 per call although doctors can set their own fee scale. Dr Rutland himself charges a $15.30 minimum fee and then $3 per minute.

“I suggest to the doctors, try and work out what your work is generating per hour, divide it by 60 and make that the per minute rate,” he said. “It seems pretty fair to me all round.”

Patients can search for their doctor and then register themselves, including an email address, phone number and credit card information. For privacy and security purposes all email addresses and phone numbers are validated.

The patient then clicks a ‘talk now’ button, which brings up a dialogue box so they can quickly type in the nature of the call.

The patient is then shown the per-minute fee and minimum fee, and the call is then sent to the doctor. If they are busy, they can ignore the call and it will inform the patient that the doctor is not available. If they accept it, the doctor is informed of the nature of the call as the text is converted to voice.

Once the consultation is finished, the patient’s credit card is debited and an invoice is emailed to them, although it also has the capability for the doctor to waive the fee. The company expects to add Paypal functionality and a credit top-up facility in future.

All consultations are recorded, to which both doctor and patient have access. Each registered patient and doctor will have a dashboard, accessible through the website or an app, through which they can go back to replay a consultation if necessary.

“So for example, if you explained to Mrs Smith what dose you wanted her to take but she doesn’t remember it, then she can go back and listen to it as often as she wants,” he said. “This is also of course good from the medico-legal point. It is actually a documentation of what you’ve done.”

Doctors can also elect to have the recordings transcribed and then downloaded into their medical software, or a link to the recording added to the patient’s record. The TeleConsult server is hosted by Amazon Web Services (AWS) and the data remains in Australia.

“The other thing that we will be putting in place shortly is the option for the doctor to dictate something,” he said. “I personally do all of my letters by dictation and transcription on an iPhone, so soon you will be able to dictate a brief message to your secretary to organise a chest X-ray and a follow-up appointment, for example.

“It might be a note for your medical software, it might be a GP referral to the specialist, or the specialist letter to the GP. Then you will have a choice of having it emailed to you. You can get your secretary or whatever transcription service you use to type it – and later we will actually have a transcription service that will do it for you – so very rapidly you will get a typed version of what you said.”

The company also plans to add more choices for the doctor if they can’t attend to the call immediately, including a “call me back” function so the patient can ask the doctor to call between certain hours, and also a “schedule a call” function for non-urgent or routine matters.

For repeat scripts, the idea will be that the doctor writes the script as usual and then faxes it to the patient’s pharmacy of choice, to be followed by the original script in the post. The company is also exploring the options available to have medications delivered directly to the patient.

Dr Rutland said there was a growing number of competitors out there but what set TeleConsult apart was its simplicity. The idea is to make everything as easy as possible for both patient and doctor, but also to finally solve the problem of doctors not being paid for their valuable time when consultations were done over the phone.

There are also big plans for expansion, which is why the company is currently looking for investors. TeleConsult’s co-founder, David Whitfield, is based in Singapore and the company plans to launch there as well later this year.

A potential partnership with a major player in the health IT sector is on the cards, with details also to be released later this year. In the meantime, Dr Rutland believes the service would be perfect for practices providing after-hours care.

HealthEngine partners with Software of Excellence for dental practice marketing

Dental practice management software vendor Software of Excellence has partnered with online appointment booking and health directory service Health Engine.

The partnership will enable Software of Excellence users to access HealthEngine’s integrated online marketing solutions through their existing software.

Software of Excellence was founded in New Zealand in 1988 and now has offices in the UK and the Netherlands as well as Australia and New Zealand. It is part of the Henry Schein group, a wholesaler of dental consumables, equipment and digital technology.

HealthEngine currently has more than 1800 dentists on its online health directory and is looking to expand its reach in the dental sector. It has 5600 general practitioners on the books for its online marketing solutions.

The company, part-owned by Telstra Health and Seven West Media, has moved beyond its beginnings as a directory of specialists for GPs and an online appointment bookings service for patients into offering online marketing solutions for general and allied health practices.

This includes offering directory listings, search engine marketing, patient marketing and staff recruitment. HealthEngine CEO Marcus Tan said Neilsen figures showed that HealthEngine was now Australia’s largest consumer health site.

Software of Excellence general manager Jonathan Engle said partnering with HealthEngine meant dentists now have additional tools available to them when it comes to finding new patients.

Sonic and Pascoe take a stake in GP2U as it looks to expand

Sonic Clinical Services, the primary care division of diagnostics giant Sonic Healthcare, has come on board as one of two new investors in Tasmanian-based GP2U as the telehealth firm completes a series B capital raise to fund its expansion plans.

Sonic Clinical Services owns and runs the Independent Practitioner Network (IPN) of general practices as well as a number of skin clinics. Its group executive, Scott Beattie, is set to join the GP2U board, along with the second investor, medical entrepreneur Andrew Pascoe.

Dr Pascoe co-founded Medical One, which runs nine medical centres in Melbourne and one in Adelaide, along with medical software firm Zedmed.

“Given the pace of change occurring with mobile and data technology, video consultations are likely to play a part in healthcare in the future, and we believe GP2U is well placed to work with the industry to offer quality solutions,” Dr Pascoe said.

GP2U has also appointed Sam Holt, former director of Medibank Health Solutions’ Anywhere Healthcare telehealth division, as CEO to help lead the telehealth provider from a start-up to a more mature company. Anywhere Healthcare was bought by Telstra Health earlier this year.

Mr Beattie said Sonic Clinical Services was very impressed with the GP2U platform, and as a result has taken an investment in the company.

“We will certainly be looking to use the GP2U platform where it makes sense in our businesses, including for example our occupational health and travel health business, as well as potentially offering a convenient way for our GPs to provide services to their patients,” he said.

GP2U founder James Freeman has run the business from his medical practice in Tasmania for the last four years. It provides Medicare-funded telehealth services between GPs and specialists as well as privately billed direct-to-GP services.

Dr Freeman has built a strong technology platform that includes WebRTC-based video consultations, a smartphone app and an image capture and secure store and forward system, all delivered in the cloud.

He has also devised a method that allows for prescribing, ordering and delivering medications electronically and offers the service in association with Terry White Chemists, Priceline and Amcal.

GP2U has provided over 50,000 telehealth appointments, with psychiatry, general practice, endocrinology and dermatology the most common.

Australasian health week in review: August 29

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

The NBN satellite Malcolm Turnbull never wanted prepares for liftoff
Sydney Morning Herald ~ Hannah Francis ~ 28/08/2015

In 32 days and counting, Australia is set to blast a satellite weighing as much as an elephant one-tenth of the way to the moon.


Primary embraces ‘medical home’ model
Australian Doctor ~ Paul Smith ~ 28/08/2015

Corporate giant Primary Health Care says it is embracing the “medical home” concept and is now pitching the idea to federal politicians.


NICTA no more as CSIRO takes over
iTNews ~ Allie Coyne ~ 28/08/2015

Australia’s peak science and research bodies NICTA and the CSIRO will officially merge when the former becomes part of CSIRO’s digital productivity group, under a new business to be known as Data61.


Prescription drug dilemma
Pharmacy News ~ Meg Pigram ~ 28/08/2015

The abuse and misuse of prescription medication has been labelled a “national emergency” by the AMA, with professional groups calling for a concerted nation-wide campaign to confront the issue.


What human emotions do we really want of artificial intelligence
The Conversation ~ David Lovell ~ 27/08/2015

Forget the Turing and Lovelace tests on artificial intelligence: I want to see a robot pass the Frampton Test.


The baby and the bathwater: let’s keep the NDIS but slow down its roll-out
The Conversation ~ David Gilchrist ~ 27/08/2015

Former Treasury secretary Martin Parkinson has expressed doubts about the financial viability of the National Disability Scheme (NDIS), which is being trialled in various locations around Australia.


Dip a cautious toe in the patient portal waters says early adopter GP
NZ Doctor ~ Keira Stephenson ~ 27/08/2015

Harry Pert was recently called on to give a patient portal presentation at a Lakes DHB meeting, due to his status as an “early adopter”.


The NBN blowout and the blame game
The Australian ~ Mark Gregory ~ 26/08/2015

The $15 billion cost blowout and further rollout delays highlighted this week by NBN Co are an exercise in allowing the Coalition to get the bad news out of the way and hope for better news before the 2016 federal election.


Balancing the health budget: chronic disease investment pays big dividends
The Conversation ~ Maureen Rimmer ~ 26/08/2015

Australians may be living longer but lifestyle-related chronic diseases are now the leading cause of illness, death and disability. Nearly 40% of Australians aged 45 and over have two or more chronic diseases


NBN ups its cost blowout by $15b since last estimate in December 2013
Australian Financial Review ~ Tony Boyd ~ 24/08/2015

The harsh and costly reality of building the world’s first government-owned national broadband network hit with a $15 billion thud on Monday. 


NBN Co dumps FTTP plan for another half a million premises
Delimiter ~ Renai LeMay ~ 24/08/2015

The National Broadband Network Company this afternoon revealed up to 550,000 less Australian premises would receive the full Fibre to the Premises rollout than had been previously been planned under the Coalition’s Multi-Technology Mix.


Turnbull defends NBN cost blowout
iTNews ~ Andrew Sadauskas ~ 24/08/2015

Communications Minister Malcolm Turnbull has said a government-owned startup was the wrong model for the NBN after its latest corporate plan showed the network will exhaust government equity funding by 2017.


NBN 2.0 costs more than expected
Computerworld ~ Rohan Pearce ~ 24/08/2015

The ‘multi-technology mix’ network could cost as much as $56 billion, though the new corporate plan’s base case is $49 billion.


Cost blowout to push NBN past $41bn budget
iTNews ~ Andrew Sadauskas and Allie Coyne ~ 24/08/2015

NBN’s construction costs will blow out past the $41 billion price tag previously forecast for the infrastructure project, the company revealed today.


International health IT week in review: August 30

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

Epic grabs VA software contract
HealthcareITNews ~ Tom Sullivan ~ 27/08/2015

Whereas Epic late last month lost out on the Defense Department’s massive modernization contract, the EHR maker is part of a team that won a smaller but notable bid this week.


IT belongs to Glasgow
Digital Health News ~ Thomas Meek ~ 27/08/2015

When NHS Greater Glasgow and Clyde decided to close down several of the city’s ageing hospitals to create a new ‘super hospital’ on the old site of the Southern General, it wanted to create a modern facility that was truly fit for the 21st century.


CVS Health partners with American Well, Doctor on Demand, Teladoc
FierceHealthIT ~ Katie Dvorak ~ 26/08/2015

CVS and three top telemedicine companies are working together to look at how to improve patient care.


New hospital pioneers intelligent workflow using connected systems
Canadian Healthcare Technology ~ Rosie Lombardi ~ 26/08/2015

The newly constructed Oakville hospital, one of a trio of sites managed by Halton Health Services (HHS) in Ontario, was designed with a mega-network – a central brain – that interconnects all systems: clinical, environmental, security, communications, and more.


EHR ‘triggers’ effective in reducing time to diagnostic evaluation of cancer
Health Data Management ~ Greg Slabodkin ~ 26/08/2015

Researchers at Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center have developed electronic health record-based trigger algorithms that identify patients at risk for delays in diagnostic evaluation of colon and prostate cancer.


City workers view images from EPR
Digital Health News ~ Rebecca McBeth ~ 26/08/2015

City Hospitals Sunderland NHS Foundation Trust staff will be able to see imaging data from within their electronic patient record using Agfa HealthCare’s enterprise imaging platform.


Mackenzie Health launches second phase of Innovation Unit
Canadian Healthcare Technology ~ Jerry Zeidenberg ~ 26/08/2015

Mackenzie Health has announced the second phase of its Innovation Unit, a living laboratory with 34-beds that is about to implement and test smart messaging and clinical alerting, in conjunction with partners BlackBerry, Cisco and Thoughtwire.


More than $31B in MU incentive payments made to providers
FierceEMR ~ Marla Durben Hirsch ~ 25/08/2015

A whopping $31.3 billion in incentive payments have been made to providers pursuant to the Meaningful Use program, according to the Centers for Medicare & Medicaid’s latest report, which includes data through July 2015.


18 health technologies poised for big growth
HealthcareITNews ~ Mike Miliard ~ 25/08/2015

By now, everyone’s got an EMR … but many species of health IT are still surprisingly underused in the U.S. hospital market.


Cheshire runs large telehealth pilot
Digital Health News ~ Thomas Meek ~ 25/08/2015

Cheshire has launched a one-year project to use telehealth to support patients with long-term conditions.


New wave of Android Wear watches aims to make up for lost time
CNet ~ Shara Tibken & Roger Cheng ~ 25/08/2015

Asus, Huawei, LG and Motorola will use the IFA trade show in Berlin next week to show off their newest wearable devices.


Precision medicine initiative needs help with data sharing barriers
Health Data Management ~ Greg Slabodkin ~ 25/08/2015

The White House is looking for input from the healthcare industry to identify new information technology activities that can help make President Obama’s $215 million Precision Medicine Initiative a reality.


More providers join CommonWell
HealthcareITNews ~ Erin McCann ~ 24/08/2015

Five more Cerner clients have agreed to tap CommonWell Health Alliance’s interoperability services, the trade association announced.


Industry eyes calendar as ICD-10 countdown begins
HealthcareITNews ~ John Andrews ~ 24/08/2015

Less than six weeks from an oft-delayed deadline, health systems, hospitals, practices and payers finally seem (mostly, hopefully) to be ready.


CVS pilot shows big patient satisfaction with telehealth
Health Data Management ~ Joseph Goedert ~ 24/08/2015

A large pilot program that drugstore chain CVS Health conducted found satisfaction rates topping 90 percent when patients at MinuteClinics opted for a telehealth session if the nurse practitioner or physician assistant was busy.


Emis helps send emergency patients home
Digital Health News ~ Rebecca McBeth ~ 24/08/2015

An urgent care centre at the Royal Free Hospital’s A&E department is using Emis Web to do rapid assessments on patients, enabling it to send home more than 26,000 a year.


Putting mHealth to work in medication management
mHealth News ~ Eric Wicklund ~ 21/08/2015

mHealth experts have often wondered what would compel providers to take an interest in consumer-facing apps.


Chronic disease, elderly patients to fuel growth of home health technologies market
FierceHealthIT ~ Dan Bowman ~ 21/08/2015

Increased use of remote medical consultations to improve healthcare for chronic disease and elderly patients, particularly as cost models shift in the industry, will fuel steady growth of the global home health technologies market.


Medical device integration and the paperless hospital

St Stephen’s Hospital in Queensland’s Hervey Bay is currently running a benefits realisation study in association with PwC as well as some studies on nursing workflows to accurately measure the effects on safety and quality of care of its integrated electronic medical record and medical devices.

The $96 million, 96-bed St Stephen’s, which opened in October last year, has implemented 29 applications in the Cerner Millennium suite including Cerner’s CareAware iBus solution for device connectivity, with 20 medical devices now integrated with the EMR and using it as the single source of truth.

Patricia Liebke, eHealth learning and change manager with UnitingCare Health, told the Health Informatics Conference (HIC 2015) in Brisbane recently that while there is a view that a high-tech hospital could mean healthcare becomes less personal, St Stephen’s is finding the opposite.

US research has shown that device integration in particular can improve patient outcomes and length of stay, as well as freeing up nurses to provide hands-on care at the bedside, Ms Liebke, herself a nurse, said.

St Stephen’s is being used as a showcase of what the digital hospital can look like in Australia. UnitingCare Health successfully bid for $47.1 million in funding for the hospital under the Commonwealth Health and Hospital Fund for regional and rural health services in 2010, with $25.9m going towards the construction cost and $21.2 million specifically for eHealth.

The idea was to build a fully digital hospital featuring an integrated eHealth solution with medical device integration and as few interfaces as possible, and with the ambition of becoming the first hospital in Australia to be awarded HIMSS Level 6. This it achieved six weeks after opening.

In addition to the 29 Cerner Millennium applications, including PowerChart, medications management, Surginet and anaesthesia, St Stephen’s is using the CareAware suite for medical device connectivity, alarm management and care team communication.

CareAware has plug-and-play capabilities for connecting any medical device to any EHR system, and places the EHR at the centre of all information about the patient to create a single source of truth.

St Stephen’s also has bi-directional interfaces to the hospital’s pathology, radiology and pharmacy systems, meaning orders can be sent from the EMR to external providers and the results are sent back to Cerner. St Stephen’s works with Sullivan Nicolaides and QML for pathology, and Queensland Medical Imaging for radiology. While radiology reports are pulled into the EMR, QMI stores the image, which is accessed by a hyperlink.

The EMR also has several bi-directional interfaces to manage the closed loop medication management system, Ms Liebke said. Doctors order medications through Cerner, which interfaces with the Omnicell automated dispensing cabinets (ADCs) and the Pharmhos pharmacy system.

Pharmhos itself has interfaces with the pharmaceutical wholesaler’s (Symbion) system, the SAP billing system and also to the PBS for paperless claiming. St Stephen’s has been given special authorisation to trial paperless claiming by the Department of Health.

In terms of workflow, the doctor enters the order into the electronic medications chart. The medication is then verified by a pharmacist through Cerner, and the order then shows up on the nurse’s task list at the time that the medication is due. It then interfaces with the Omnicell and the nurses are only able to take out the medications that are due in that time period, which Ms Liebke said substantially reduces the chance of error.

The medications are all unit packaged, and before the nurse administers the dose both the patient’s and the package’s barcodes are scanned. Ms Liebke said she expects to see a huge reduction in medication errors as part of the benefits realisation study.

The closed loop system has also helped with pharmacy material supply management and with nursing workflows, she said.

“We actually know exactly how many of each medications we have in the cabinet, when they are due to expire, stock can be rotated, it can be refilled. And from a nursing workflow point of view, if I go to a cabinet and I can’t find the medication there, I can quickly find where else it’s being stored in another ADC, without having to call other wards trying to track them down.”

Nurses are also very much enjoying the benefits of the meal management system, she said. Diet orders and allergies are placed in the EMR, which interfaces with the electronic patient meal ordering system. Patients can order their meals using the touchscreen patient entertainment system, but as there is an interface to the EMR, they are only able to order meals based on their prescribed diet.

“The nurses love this,” Ms Liebke said. “No more diabetic patients who are on modified carbs and we’re trying to keep their blood sugars down being shown the dessert list, thinking they can order three or four desserts delivered from the kitchen and we explaining why they are not allowed to.

“And the other huge safety feature is the allergy documentation. Prior to the implementation of our electronic meal ordering, if a patient was allergic to something, how would we know if the kitchen was using that item in a meal? If the patient does have an allergy to something it is documented as an allergy, and they can’t order anything that has that in the recipe whatsoever.”

Infusion pumps and vital signs monitors are also integrated into the system. Ms Liebke said a bi-directional interface is possible for the infusion pumps but St Stephen’s is only using it in one direction at the moment, from the pump to the EMR for populating the fluid balance chart.

For vital signs, St Stephen’s has integrated its Welch Allyn portable machines and GE monitors, which send their data by WiFi to the EMR. “We’ve found some studies from the United States that shows the amount of time saved because of this,” Ms Liebke said. “For a nurse on an eight-hour shift, they should be saving 25 minutes just from taking vital signs.

“The other benefit that we’ve being seeing is in the known phenomenon in nursing called rounding, where nurses attempt to round up observations. We saw this a lot with our vital signs. Their temperatures were all coming across hypothermic, and we have rules in the background for alerts and triggers to the clinicians that there is a risk of sepsis.

“We found that the nursing staff weren’t using the Welsh Allyn machines and taking the vital signs properly. They had been in the habit of having patients with a temperature of 35.5 or 35.7 and just rounding it up to 36 in the paper world.”

St Stephen’s has also integrated its ECGs, allowing clinicians to view them from anywhere in the hospital but remotely as well. If a doctors isn’t available, nurses can contact HeartCare Partners in Brisbane to interpret it for them.

Clinical images can also be captured through integrated cameras, which upload the image directly to the patient’s record. “Where I previously worked we went through a process of getting cameras to take pictures of pressure injuries and wounds but we found that by the time we got the pictures printed … and they made their way to the paper chart, it could take up to a week and you really couldn’t track it.

“At St Stephen’s we’ve got a Ricoh camera, it’s barcode scanned – you take a picture of the patient’s barcode and the nurse’s ID as well – and we have that image in the chart for every one to look at.”

The CareAware iBus also handles the Vocera hands-free communication device and integrated nurse call system. Ms Liebke said the Vocera devices were some of the nurse’s favourite gadgets. If an alert from a deteriorating patient is issued, it can go straight to the nurse’s badge.

The hospital has real-time tracking through RTLS for both patients and equipment – and the nurses would like to see it attached to medical staff as well, Ms Liebke said – Imprivata’s tap-on and tap-off sign-in system and workstations on wheels – or “the nurses’ entertainment system, as we like to call it”, she said.

What this all adds up to is an expectation that not only is safety improved through better medications management and reducing rounding, but that nursing time is freed up for more bedside care.

“One of the biggest issues and challenges we have is that people think all of this technology is going to make healthcare more impersonal,” Ms Liebke said. “We are finding the opposite.”

Queensland coroner calls for real-time doctor shopping system

A Queensland coroner has echoed counterparts in Victoria and South Australia in calling for a new system to enable real-time access to relevant prescription and doctor attendance history following the death of another person from an accidental overdose of prescription drugs.

Brisbane coroner Christine Clements yesterday released a report into the death of Katie Lee Howman in late 2013 from an overdose of the opioid fentanyl.

Ms Howman, a critical care nurse at Toowoomba Base Hospital, was known to the Australian Health Practitioner Regulation Authority (AHPRA) and was under supervision and restrictions regarding access to certain drugs after self-administering fentanyl at work in 2010.

While she was never prescribed fentanyl and appears to have sourced it from work, she did suffer from chronic pain, depression and anxiety and had been appropriately prescribed opioid painkillers such as tramadol and oxycodone by her regular GP.

However, between the 2010 episode and her death in 2013, she had visited 30 other doctors and numerous pharmacies in the Toowoomba area. This included 20 different doctors and 15 different pharmacies in the 13 months between October 2012 and November 2013.

“It was during these visits that she obtained 71 prescriptions providing her with 1705 doses of oxycodone,” the coroner reported. “In those last three months she had also obtained prescriptions for 340 doses of tramadol.”

Her long-standing GP was not aware of her behaviour and the coroner found that he had prescribed appropriately. However, she also found that only one of the 30 doctors Ms Howman visited had suspected she was doctor shopping and checked with Queensland Health’s Medicines Regulation and Quality unit, which provides advice to doctors if they have detected a pattern of obtaining prescriptions which raises concerns about dependency.

The MRQ unit can also assist doctors with information on a patient’s history for controlled drugs, whether the patient is consulting other doctors, whether they are on an opioid treatment plan, their drug dependence status and whether other GPs have raised questions about the same patient.

The coroner also pointed to Medicare’s prescription shopping information service, which can identify in any given three-month period if a patient has consulted six or more doctors for PBS prescriptions or has obtained 25 or more PBS prescriptions for controlled drugs or drugs of dependence.

“The tragedy is that there was an undeniable record of [Ms Howman’s] growing dependency and reckless behaviour in accessing prescriptions for opioids,” Ms Clements reported. “She was doctor shopping within the wider Toowoomba area and beyond, sourcing oxycodone as well as tramadol.”

However, Ms Clements said one deficiency in existing information systems is that they are reliant on a doctor or pharmacist forming a suspicion that then prompts a request for information, and the information is not available in real time.

She pointed to Tasmania and the NT, which she said were both using real time information software retrieval systems to inform decision making, and the New Zealand model, where information of concern was sent to the treating doctor rather than relying on the doctor to contact the information service.

“There is undoubtedly a huge human and fiscal cost in the way the Pharmaceutical Benefits Scheme is currently being misused to source and subsidise controlled drugs and drugs of dependence,” she said.

“There have been many previous inquests throughout Australia that have highlighted deaths due to overdose, usually inadvertent, of people who have developed a dependency on prescribed medication. Countless more deaths have been reported to coroners where findings have been made without a public inquest.

“And there have been repeated previous recommendations made by coroners to improve the real time accessibility of information for doctors and pharmacists about their patient’s prescription history.”

She strongly recommended that there be statutory change to enable real-time access to relevant prescription and doctor attendance history.

“No doubt there would be ways to accommodate privacy issues while still safeguarding patients from harm and the abuse of a publicly funded resource. These matters should be urgently investigated and considered by government.”