Jayex Healthcare set to go public with Sonic founder on board

Healthcare self-service solutions and patient flow management firm Jayex will list on the Australian stock exchange next week having raised its target of $8 million, and is now set to proceed with the purchase of its UK arm and build what it calls an end-to-end healthcare service delivery system for both the acute and primary care settings.

On board the company is Sonic Healthcare founder Michael Boyd, who will act as executive chairman of what will become Jayex Healthcare, along with Jayex CEO Rob Mantel and Rosemary and Gordon Cooper, founders of the Appointuit online appointment booking system that Jayex acquired in September.

Jayex is best known in Australia and the UK for its self-service kiosks, part of its Enlighten patient workflow platform that allows patients entering hospital to check in by scanning a barcode. Enlighten is used in 33 hospitals in the UK and at Western Health’s Sunshine Hospital and Peninsula Health in Victoria, along with 1900 UK general practices and 80 in Australia.

Jayex partnered with practice management software specialist MedicalDirector earlier this year to allow patients to check in and automatically update their record in MD’s PracSoft admin module and also has commercial partnerships with Zedmed and allied health practice software vendor PPMP. The commercial partnerships involve a revenue sharing agreement.

Jayex has also secured technical integrations with GP and specialist PMS vendors Best Practice and Genie and hospital PAS systems including Cerner, CSC ‘s iPM and webPAS and InterSystems’ TrakCare. Appointuit is also integrated with the majority of the PMS systems on the market and has over 2000 GP users. It also offers a platform called Engage, which allows patients to order repeat scripts and specialist referrals from their regular GP and includes an SMS/email reminder system for practices.

Jayex plans to boost its market share in GP clinics and hospitals but also to deploy Enlighten to allied health providers. According to the company’s prospectus, the allied health market in Australia is many times the size of the GP clinic market and presents a significant market opportunity for the Enlighten business.

While boosting the Enlighten and Appointuit arms is high on the agenda for Australia, the UK and New Zealand, Jayex also has its eyes firmly on overseas markets in Asia and North America with two of its other properties.

These are a proprietary prescription delivery service called Pharmacy Delivery 2 U (p2u), which will enable remote processing of prescriptions and the ability for patients to request an express pick-up at a participating pharmacy or for the medications to be delivered to the patient’s home, office or other location. p2u is currently in beta testing.

There is also a technology called BluePoint RDT that is currently in development and involves a pharmacist-controlled ATM-style remote dispensing terminal that remotely processes prescriptions and provides on-the-spot dispensing of standard pharmaceutical products. Mr Boyd said this product would be aimed at overseas markets.

Mr Boyd said the main aim of Jayex Healthcare was to develop an integrated suite of best-of-breed technologies that can help primary and acute care providers with increased efficiencies, with Jayex acting as one point of contact for healthcare providers.

Jayex Healthcare is expected to list on the ASX next Thursday or Friday. Jayex UK has agreed to a price of $3.75 million and will become a wholly owned subsidiary of Jayex Healthcare, with the Enlighten technology, which it developed, formally incorporated within the Jayex group and Jayex UK’s managing director Agam Jain remaining in a senior executive role.

Orion Health launches Amadeus big data platform for precision medicine

Orion Health has launched a new big health data platform called Amadeus to support its move into precision medicine, based on its Open Platform for population health.

Amadeus combines Orion Health’s data integration capabilities with technologies such as Apache’s Cassandra open source database management system, Apache’s Spark big data processing engine and ElasticSearch, an open source search and analytics engine.

Underlying it is Orion’s Rhapsody integration engine, which enables data from multiple sources to be extracted and makes use of the FHIR standard. Amadeus has a distributed architecture to handle massive volumes of data such as that being generated by genomics, proteomics and microbiomics.

The platform also incorporates predictive modelling to allow users to identify the most at-risk patients in a population, and uses machine learning to help make predictions.

Orion Health differentiates Amadeus from Open Platform in that the latter is a population health management platform that can help define cohorts of patients who are high risk and need particular attention, while Amadeus is an evolution that will enable precision medicine, which Orion says will help determine the exact prevention and treatment plans that will work for an individual.

Orion Health CEO Ian McCrae said Amadeus was an open platform with open application programming interfaces (APIs), which allowed clients and third-party developers to develop their own applications to run on the platform.

“The platform’s APIs will enable third-party applications to have access to rich data and services so that they can provide additional services that will benefit both doctors and their patients,” Mr McCrae said in a statement.

Last week, the company announced a new collaboration with practice management software specialist Medtech Global and CSC’s healthcare division, which markets the webPAS patient administration system and MedChart medications management system amongst many others.

The collaboration aims to develop what they call a world-leading, integrated, precision medicine solution for New Zealand. Mr McCrae told Pulse+IT that the key aim is to make data readily accessible so new third-party applications can be written and there can be innovation in the sector.

“Precision medicine is enabled when all information unique to an individual is combined to identify preventative care and treatments which will be effective for them based on genetic, environmental and lifestyle factors,” Mr McCrae said.

“Today many factors [affect] health outcomes, yet currently, only a few will be taken into account when healthcare decisions are being made. Amadeus will enable doctors to get the insights they need to help them make accurate diagnoses and provide the optimal treatment.

“In addition, patients will increasingly have the information they need to be active participants in their own healthcare.”

He said Amadeus features an advanced privacy service that provides granular access to data elements based on user roles and the sensitivity of the data.

File transfers and software updates causing new hazards for GPs

A small study analysing safety risks to patients from errors and workflow disruptions caused by general practice software systems has found that while many of those risks are the same as experienced with paper records, new risks arise that are unique to IT.

These include problems of lost or missing data when transferring historical electronic records to new software packages, delays due to software updates such as monthly PBS or drug database updates, and known problems caused by overloaded drop-down menus, particularly when it comes to mixing up medication brand names.

GPs involved in the study also reported spending a surprising two hours a week dealing with IT issues, causing frustration and workflow disruptions.

The results are from the TechWatch study, first launched in 2012 by well-known health IT researchers Farah Magrabi, Siaw Teng Liaw, Enrico Coiera and Michael Kidd.

The idea was to look at new risks introduced into clinical workflows in the general practice setting by IT systems, including clinical software, networks and hardware peripherals such as printers.

Dr Magrabi told Pulse+IT at the time that the information collected would be used by researchers to gain a better understanding of how to improve the safety of IT in clinical practice.

“Computers have huge benefits in general practice in terms of the quality, the safety and the efficiency of care,” Dr Magrabi said. “But at the same time, problems with computers can also introduce errors that may harm patients.

“What the TechWatch study is aiming to do is to look at the safety of IT in general practice, and we want to do that in routine care.”

While they had hoped to recruit about 200 GPs, they had to settle for 87 in total. Over the 19-month course of the study, between May 2012 and November 2013, 94 incidents were reported, of which four were discounted for a total of 90.

Some incidents were very serious – in one, an elderly patient was prescribed the wrong medication due to similar-looking brand names in a drop-down menu and ended up in hospital for week, and in another a patient was administered an incorrect dose when clinical data was affected when transferring from one software package to another – while there were a number of near misses.

Almost half of the incidents had an observable effect on the delivery of care but did not actually cause patient harm. A few had the potential for patient harm, and about a quarter were near-misses, mainly involving medication errors that were picked up by the GP, a pharmacist or the patient themselves.

However, 15 incidents were associated with potentially hazardous circumstances and some involved misidentification of patients and test results. They also disrupted clinical workflow, wasted time and caused frustration, the researchers report.

“Waste of time was identified as a major consequence in 30 out of 46 incidents that affected care delivery,” they write. “The time spent by GPs in dealing with IT issues was considerable.”

They write that in the post-study survey, which was completed by 49 participants, GPs estimated spending about two hours per week solving IT problems.

“GPs solved IT problems by troubleshooting on their own, seeking assistance from their practice manager and colleagues, contacting IT support and by using help desks provided by vendors,” they write.

“Problems with software updates were generally referred to vendors, either directly by GPs or via practice managers. IT support was consulted about issues with network connections, email and problems with downloading test results.”

Workarounds that GPs had to resort to included handwriting scripts when the networks was down or the printer wasn’t working, but also because updates to drug databases weren’t current.

Some GPs complained about the frequency of software updates – not just to the PBS but to the clinical software itself – and one practice reported that it took over 18 months to successfully overcome the problems of migrating from a legacy software package to a new one.

There were also reports of being unable to access patient-related correspondence for 10 months following a software update, which affected many practices in the study.

As in the previous studies into prescribing software in the acute setting, drop-down menus, similarities in medicine names and autocomplete functionality caused problems. One doctor in the study intending to prescribe the antidepressant clomipramine 50mg for a male patient mistakenly prescribed clomiphine 50mg, a medication that induces ovulation, due to an autocomplete feature in the software.

The very busyness of general practice also had safety hazards. A slip in concentration caused Avanza to be prescribed instead of Avandia, the wrong medication was prescribed to one patient because the GP had two patient files open simultaneously, and in another case a phone call interrupted the doctor and they returned to the wrong patient record.

“While IT has many advantages, this study shows that problems with it can and do give rise to hazardous circumstances for patients and may disrupt the delivery of care and lead to patient harm,” they write.

“While the broad categories of problems we identified are similar to those previously reported in hospitals, we found that routine updates to software can be particularly problematic in general practice.

“At present, clinical software in Australia is not built to any common safety standard and there is no systematic operational oversight of software that is used in care provision. Our results therefore reinforce previous calls for safety standards as part of sound governance of health IT at a national level.”

The study, Identifying patient safety problems associated with information technology in general practice: an analysis of incident reports, is published in BMJ Quality & Safety.

Rescheduling OTC codeine could cost $316m a year: Guild

An independent economic evaluation of proposals to reschedule over the counter (OTC) combination analgesics containing codeine shows that it could cost the federal government up to $316 million a year, while the cost of an alternative real-time monitoring system would be negligible.

The Pharmacy Guild commissioned Canberra-based applied quantitative economic analysis firm Cadence Economics to look into the costs of the proposal, due to be decided by the Therapeutic Goods Administration (TGA) Advisory Committee on Medicines Scheduling this month.

The proposal is that OTC medicines containing codeine, such as combination painkillers and cold and flu tablets that are currently Schedule 2 (pharmacy only) or Schedule 3 (pharmacist only), be rescheduled to Schedule 4, which requires a doctor’s prescription.

Figures from healthcare data firm IMS Health show that in 2014, there were approximately 16.4 million packs of analgesics containing codeine dispensed, and 5.2 million packs of codeine-containing cold and flu medications.

Cadence estimates that if OTC codeine rescheduling went through, 53 per cent of patients would elect to visit a GP to get a script for a codeine-based analgesic. Split between Level A and B consultations, this would cost the MBS an extra $316 million a year or over $1.26 billion over the final four years of the Sixth Community Pharmacy Agreement (6CPA).

The figures do not take into account patients seeking a script for the 5.2 million codeine-based cold and flu symptom relief medications – the conservative assumption is that most will instead purchase an alternative remedy at the pharmacy – and nor does it take into account losses in time and productivity for patients.

Costs to the PBS are also not included as these medications would not be subsidised, although Cadence says there is the potential that higher strength, PBS-subsidised alternatives such as Panadeine Forte might be prescribed more often.

Cadence Economics recommends that the federal government carefully consider the net costs of the rescheduling proposal, particularly in light of obvious lower-cost alternatives such as a register of OTC codeine medicines.

Pharmacy Guild executive director David Quilty said this suggestion referred to the prototype real-time monitoring and clinical decision support tool that the Guild’s technology arm GuildLink has developed.

This system would allow pharmacists to record patients’ details when purchasing OTC medications and review any other recent purchases in real time. If the patient doesn’t consent, then the pharmacist will not supply.

A 2015 survey shows that 95 per cent of consumers would be willing to have their details recorded when buying OTC codeine products if it meant they could continue to be bought without a prescription.

A Guild spokesperson said the development costs for the system are about $300,000, with an estimated ongoing maintenance cost of about $300,000 a year.

“The Guild is not asking the government to pay these costs,” the spokesperson said. “They would be borne by industry.”

Microsoft Kinect and its use with rehabilitation motor therapy in the home

Since its deployment in November 2010, Microsoft’s Kinect technology has been investigated for its potential therapeutic use in motor skill rehabilitation. Kinect’s motion tracking is sufficiently accurate for the task of gauging movements during rehabilitative exercise.

A breakthrough benefit for motor rehabilitation therapy is the technology’s ease of use in the home environment.

Studies indicate monitoring accuracy at 98.26 per cent (measured on 15 individuals over 1050 psychomotor movements, with 98.26 per cent correct realisations of the exercises by the technology). This means Kinect’s tracking ability is comparable to larger, more costly specialist systems that track motion for rehabilitation purposes, at a fraction of their price.

The technology allows for connection to a personal computer and calibration to 32-bit resolution, meaning it is fine enough to detect facial feature movement if required. The system uses C++ programming and is able integrate with add on applications, and customised programs for various therapeutic uses.

There are many studies on the benefits of using Kinect technology to rehabilitate patients by tracking and measuring motor skill movement with the potential for use in the home. Benefits include the technology’s low cost, ease of access as an off the shelf product, and low social stigma associated with its use, due to its popularity for games.

Kinect’s compatibility with applications written for specialists, which enable them to write their own tailored therapy programs, gauge responses and monitor and measure progress, and its potential for social application for support groups and group games which can be played remotely, make Kinect an attractive product for rehabilitation in the home.

However, the technology is still young and long-term studies are yet to be conducted or concluded. Most studies to date are small and discrete trials in clinical environments, such as clinics, hospitals, aged care facilities and schools. A larger number of patients are yet to be studied in their homes in order to gain a realistic perspective of the effects of the use of the device in the home environment.

Factors such as limited exposure to technology and social isolation can negatively influence the rehabilitation experience by using in home technology as opposed to real group interaction. There are groups of patients who this technology will not benefit, but rather be detrimental.

Methodology

This paper reviews and critiques some of the literature from scholarly articles and industry magazines and journals, specifically regarding the areas of cost, the ability to access data remotely and ease of access to the device for patients, given its ability to be used in the home for rehabilitation.

It also serves to highlight gaps in research and outline some areas where further study is required. Literature reviewed on Kinect technology has been published within the past five years, to ensure relevance to current trends.

Review

Low-cost device

Research supports the use of the Kinect device as having benefits such as low cost to patients who may be already experiencing high costs from consultations and equipment during therapy and, at the same time, perhaps not earning an income. This is a major benefit of the product for consumers and therapists.

Remote access to data

Being accessible remotely saves patients (sometimes) expensive travel costs to see specialists. Kinect avails remote therapy, delivery of individualised and group exercises and instructions, monitoring and gauging movements and recording and reporting on progress. It also has the potential to provide remote appointments with specialists.

Under Medicare, laws prevent remote appointment administration unless the appointment is inaccessible in any other manner (e.g. terminal illness), thereby limiting Kinect’s full potential as a consultation medium.

There is a need for significant research into the benefits of remote access to specialists and potential reform to the healthcare system due to the positive effect the availability of more remote consultation types would have on the cost of healthcare. As our ageing population become less mobile and our overall population grows, demand for medical services is expected to increase while access to specialists decreases.

Kinect is small and portable. The technology can be easily installed and used in the home environment, technical support is good and customisable reporting features can be built in for specialists. Applications are continually being developed to enable non-programming specialists (therapists) to maintain exercise schedules and change rehabilitation programs as required.

Being remotely accessible means specialist consulting fees could be pooled if there were online, group therapy sessions available. Group sessions and games are a positive reinforcer of motivation in rehabilitative therapy.

More research needs to be done to identify candidates who fit the use of home-based rehabilitation and establish a criteria for which patients will not benefit from its use. For example, patients who are unfamiliar with technology may become too frustrated to engage with the device in a positive manner.

Some patients may become further isolated using home-based rehabilitation. Real, social interaction provided by group interactions (such as support groups outside the home) could be more beneficial than pseudo gatherings provided virtually, especially if patients are already isolated from work colleges, family and friends during rehabilitation.

It is known that physical human interaction is good for mental health. Mental health affects recovery and isolation can lead to depression, an inhibitor to motivation towards rehabilitating.

Ease of use in the home

Another benefit of having the games accessible in the home is the potential for an increase in regular exercise due to ease of access, as well as independence and integration into the home and family, promoting a positive attitude to using the system.

Adversely, there is the potential to over-exercise and cause damage as well, especially given patients are not necessarily monitored in every session by a specialist. More research and development is required into the delivery of built-in safeguards and the ability for specialists to customise and individually assign limits for patients in the software, when exercise is being over- or under-used, and the development of alerts to specialists for over- or under-use.

Conclusion

Kinect technology provides a very promising tool for motor rehabilitation in the home. It is portable, easily set up and maintained, and accurately monitors and reports on motor movement remotely. Giving remote access to specialists has the potential to significantly reduce costs and increase independence for users and the healthcare system overall.

However, more research into areas where implementing in-home rehabilitation technology may be detrimental to rehabilitation is needed. As the technology is young, long-term results are yet to be published.

Research encompassing greater numbers of participants using technology in their homes is, to date, lacking. Most studies reviewed had fewer than 100 participants, and most were in school, clinical, aged care or therapist office environments.

Research into categorising individuals who may be adversely affected by using in-home rehabilitation technology is also required to ensure rehabilitative strategies are being delivered in a way that positively influences patients’ recovery.

References

References are available on request.

Older Kiwis take to gaming for fun, health and positive ageing

More than two in five New Zealanders over the age of 65 now regularly play video games, many for the positive effects gaming can have on their thinking skills, coordination and mental stimulation but also for fun and maintaining social connections, the latest Digital New Zealand report shows.

The report is compiled every second year by Bond University lecturer on emerging and interactive media industries Jeff Brand, on behalf of the Interactive Games & Entertainment Association (IGEA).

The 2016 report shows that 43 per cent of New Zealanders aged 65 and over now play video games, compared to 32 per cent in 2013. This number included 44 per cent of people aged between 75 and 84 and 17 per cent of those aged between 85 and 94 saying they played video games.

While video games are first and foremost a form of entertainment, some are using games for their benefits to health and positive ageing.

“The use of games-based technology is increasingly finding its way into physical and mental health applications,” Professor Brand said. “I continue to marvel at the growing adoption of video games beyond just entertainment.”

When asked if playing games improved thinking skills, 84 per cent of adults agreed. 70 per cent agreed video games increased mental stimulation, 76 per cent said video games helped improve coordination and dexterity and 47 per cent said video games could help fight dementia.

Those over the age of 50 make up the fastest growing segment of the population new to games, accounting for 47 per cent.

“The significant growth spurt in this segment of the population means that New Zealanders are increasingly using games as a preventive measure to healthy ageing and the benefits are undeniable,” Professor Brand said.

Among the uses of video games for positive ageing, respondents cited attributes such as increasing mental stimulation, maintaining social connections, encouraging open-mindedness, fighting dementia, increasing mobility and reducing arthritis.

For health, they cited improvements to thinking skills, coordination, emotional wellbeing, balance and physical fitness.

Another emerging trend identified by this year’s report concerns watching video games as a form of entertainment. Just like people watch movies, TV shows and documentaries, they are now watching other people play video games. This trend is not limited to eSports as nowadays, games enthusiasts, including children, are interested in watching and learning from ‘professional’ players.

One in two (48 per cent) Kiwi players watch gameplay videos online and 15 per cent have created walkthroughs to share with others.

“What this means is that video games have become a mainstream activity in New Zealand, and they are a game-changer in the way New Zealanders consume digital and interactive media,” Professor Brand said.

”Two thirds (67 per cent) of the population play, and video game devices are present in 98 per cent of New Zealand family homes.”

Other key findings of the Digital New Zealand Report 2016 include:

IGEA CEO Ron Curry said this year’s report reinforces the breadth and depth of New Zealand’s gaming community.

“When we conducted the first report in 2010, video games were still seen as just an entertainment medium aimed at the younger children,” Mr Curry said. “Today, the profile of the typical New Zealand gamer is an adult of 34 years old and the reasons for playing video games are no longer one-dimensional.

“We are witnessing significant changes in the realm of digital interactive entertainment where games have become an amazing medium to supplement healthy aging and reinvigorate the way we engage with digital media.”

Plunket delivers baby book in the cloud through ePHR

Child health support organisation Plunket has officially gone live with its new cloud-based electronic Plunket Health Record (ePHR) application, which has been built on Microsoft technologies and will eventually be deployed on around 800 Windows tablets to clinical nurses across New Zealand.

The app will replace the paper-based processes familiar to generations of New Zealand families. Nine out of every 10 newborns are seen by a Plunket nurse, accounting for between 50,000 and 60,000 babies every year.

The ePHR app has been piloted in Northland since March and is being used for the free Well Child Tamariki Ora health checks, starting when the baby is two to six weeks old and lasting until the B4School check at four years.

According to Plunket, the objective of the Northland pilot was to confirm that the process of a nurse collecting and entering data about a baby into the system occurs accurately, and to gain insight into the challenges a nurse faces in using the new technology.

Around 180 families in Northland took part in the trial with 31 Plunket nurses accessing the app on tablets while on visits to the family home.

Plunket’s chief executive Jenny Prince said the ePHR had the power to help the charitable organisation to improve children’s health outcomes by connecting families more quickly with the services they need, and by reducing administration to allow nurses more time to focus on care.

Currently, Plunket nurses take a child’s health check paper record out on their home visits, but by having instant access to data via the tablet, nurses will be able see health information at a glance, which can help ensure children don’t slip through the cracks.

“It will mean that when a Plunket nurse is out on a home visit and they see another child in the family who needs a health referral, they can do that on the spot,” Ms Prince said. “Or if they get talking to a neighbouring family and find they’re not registered with Plunket, or they’ve missed an appointment, they can do it there and then.”

The new ePHR app has been built utilising an array of Microsoft cloud technologies, including Dynamics CRM Online, Azure Active Directory, Exchange Online, Skype for Business and Microsoft System Centre.

Plunket’s COO Andrea McLeod said the organisation’s paper-based systems had become cumbersome and there were a number of opportunities to improve data quality, reporting, compliance and auditing.

“You can imagine how difficult managing and auditing over 60,000 clinical records per annum is,” Ms McLeod said. “Being electronic means we will have real-time data to enable us to provide a more efficient and effective service to our customers – the children and families of New Zealand.”

Microsoft worked with specialist Windows app developer Marker Metro and Microsoft Dynamics CRM specialist Koorb Consulting on the bespoke system.

Microsoft’s public sector architect, Terry Chapman, said Microsoft’s cloud platform was chosen for the ePHR because of its ability to meet Plunket’s business needs without extensive and costly customisations.

He said Plunket was among the first public healthcare services providers in New Zealand to move its business to the cloud.

Plunket is now fundraising for the remaining $7 million required to roll out the app nationwide. When it is live nationally, around 600 Plunket frontline health staff will use the ePHR.

Photo courtesy Marker Metro.

Territory’s MyEHR points to potential value of PCEHR: report

The feat of registering 50 per cent of the Northern Territory’s indigenous population for its My eHealth Record (MyEHR or MeHR) back in 2010 appears to have been the point at which critical mass for the system was achieved, leading to a surge in clinical use and the service becoming embedded into routine clinical and administrative workflow in the NT health system, a new report has found.

The report, an evaluation of the MyEHR system carried out by Mitch Burger and Andrew Ingersoll from the National E-Health Transition Authority (NEHTA) and presented at the COAG Health Council meeting in Darwin last Friday, weighs up the benefits of the NT’s system and compares them with the potential benefits of the national PCEHR.

The report concludes that the success of the MyEHR, which is currently undergoing a migration to the national PCEHR in what is known as the M2N transition, provides evidence “validating the value proposition” of the PCEHR, but highlights that the NT system took 5.5 years to reach critical mass, after which there was a noticeable upsurge in both adding to and viewing the clinical content stored on the system.

However, on current rates of consumer registrations, the PCEHR would take a further 12 years to reach critical mass, and usage figures show that even early on there were higher levels of clinical viewing and accessing of the MyEHR than the PCEHR.

The federal government is planning to move the PCEHR to an opt-out system, running trials beginning next April to find the best model. It is also planning to change the name of the system to My Health Record.

The MyEHR, formerly known as the shared electronic health record (SEHR), was first developed by the NT Department of Health in 2005 and was aimed predominantly at the indigenous population of the NT, although it is available to the wider community. In addition to the NT, it is also used by some indigenous people in central Australia and northern WA.

While both are a shared EHR, the main differences between the MyEHR and the PCEHR are that the former is not controlled by the consumer, and it is not GP-centric. Most document uploads are done by nurses and most views are carried out by hospital-based pharmacists, predominantly to check on medications.

The system aims to allow a variety of healthcare providers, including community nurses, Aboriginal health workers, GPs and hospital-based clinicians, to easily access healthcare information on consumers. It contains pathology reports – still lacking in the PCEHR – as well as overall health summaries, event summaries, discharge summaries and antenatal information.

The NEHTA evaluation shows that one of the real successes of the MyEHR has been that the vast majority of all documents viewed in the system are accessed at facilities that are not the person’s place of usual care, meaning the system is fulfilling its original purpose of allowing sharing of information no matter where or what healthcare facility the person is treated in. This overcomes the limitations of point-to-point communication, it says.

It has also become embedded in routine workflow, with clinicians using the system in four different ways: targeted use, in which they are seeking specific pieces of information; investigative, where it is used in preparation for unknown patients or for recalls and tracking; opportunistic use, in which access is triggered by a prompt such as a recent hospitalisation; and supplementary, in which it is used to update the data in other clinical information systems.

Another success factor is that almost a third of all MyEHR records have been accessed by more than two providers in the last 12 months. The most viewed documents are the health profile (or shared health summary), event summaries, pathology reports, emergency department discharge summaries, inpatient hospital documents and antenatal reports.

The NEHTA report says that the evaluation provides “very strong” qualitative and quantitative evidence of the value that the MyEHR provides, including increased access to health information, reduced time spent sourcing information, support for clinical decision making, improvements to continuity of care and an increase in the capacity to deliver population-based primary healthcare. However, there is no evidence as yet of improved health outcomes.

“Importantly, providers across all professions who currently use the MyEHR service reported receiving immediate benefits,” the report says.

“For example, by acting as a bridge between unconnected clinical information systems, the MyEHR service facilitates vast flows of clinical information between different sectors.”

It has also got to the stage where consumers expect healthcare providers to use the system and to know what their medications or medical history is without having to repeat that information at each encounter, the report found.

This all provides lessons for the PCEHR roll-out, the report says. “[T]his evaluation provides strong evidence validating the value proposition of the national PCEHR system,” it says.

“With continued enhancement, benefits realisation management, and initiatives to stimulate use, there is good cause to believe the PCEHR system will become core eHealth infrastructure, and a valuable tool for clinicians.”

NT Health Minister John Elferink said that the evaluation showed for the first time in Australia that there was strong evidence of the benefits of eHealth records in bridging the gaps in information that occur as patients move between different healthcare providers.

Mr Elferink said the NEHTA evaluation provided a clear case in support of the national PCEHR system.

“The Northern Territory government is committed to providing the highest level of care to Territorians and we are extremely pleased to be leading the way with online health records,” he said.

“The evaluation showed that eHealth records reduced the time clinicians took to find information, and supported improved clinical decision-making and continuity of care for patients.”

The report is available from the eHealth NT website and the NEHTA website.

Development of health IT an “unyielding principle” for China

China has seen huge growth in health information technology (HIT) adoption in the last five years, with 71 per cent of hospitals now having implemented an electronic medical record (EMR) – up from less than 30 per cent in 2009-10 – with a flow-on effect of greater adoption of other clinical information systems and applications.

However, while the growth has been large in pure numbers, the maturity of the EMRs in use is quite low and China faces the same obstacles to wider use of HIT as countries like Australia and the US do, according to Shen Tao, deputy director of the Chinese Hospital Information Management Association (CHIMA).

Mr Shen told the Health Informatics Conference (HIC 2015) in Brisbane last week that a lack of investment, lack of skilled IT staff and a plethora of vendors that are not delivering the advanced capabilities that governments, healthcare providers and consumers are now expecting and demanding are some of the major obstacles to further adoption of HIT.

And in this, Mr Shen said, China and the US are now experiencing similar problems. “As the biggest developing country, we are finally having the same characteristics with the biggest developed country,” he said.

Mr Shen was invited to provide an overview of CHIMA and the Chinese HIT sector to HIC following a visit by a delegation from CHIMA’s counterpart, the Health Informatics Society of Australia (HISA), to CHIMA’s annual conference in Xiamen, Fujian province, in June. HISA CEO Louise Schaper, chairman David Hansen and member Henry Zhuang all attended the conference, which hosted over 4000 delegates.

Mr Shen told HIC that CHIMA was first established in 1997, five years after HISA, and it is now the most important and influential HIT professional association in China.

Some of the details of the size of China’s healthcare system are jaw-dropping: in a population of 1.368 billion people spread over 31 provinces, there are 974,400 medical institutions including 24,700 hospitals, and 9,790,000 clinicians, including 2,795,000 licensed doctors.

“In recent years we’ve been facing a lot of challenges and difficulties and our people are now paying more attention to their own health and quality of health services,” Mr Shen said.

“With development of our economy, chronic diseases have been a big burden for the economy, such as diabetes and high blood pressure. Our urbanisation has been accelerating [and] last year 50 per cent or more of our population has been [resident] in cities.

“Our ageing population is also a challenge that we are facing: it’s over 200 million aged people in our population (15 per cent). Even though we’ve been investing lots of money in our healthcare sector, we are still having problems satisfying the requirements of our people.”

While expenditure on healthcare is growing, it is still only 5.6 per cent of GDP, compared to 9.4 per cent for Australia and 17.1 per cent for the US. There is also an imbalance in investment in different regions in China with the eastern part of the country having a higher standard and more access to healthcare than the central and western regions.

HIT development in China since 2009-10

To help overcome growing levels of inequality, chronic illness and an ageing population, in March 2009 the Chinese government set its sights on reforming the healthcare system, and one area it has taken a close look at is the promotion of HIT.

According to Mr Shen, the focus has been on building capabilities such as EMRs, interoperability and telemedicine.

“From 2009 the government has launched many important reforms in our country,” he said, “and the core of this program is the hospital management and electronic medical record. It requires the hospitals in those cities and suburban areas to interact with each other, and to develop telemedicine to support remote areas.”

In November 2013, the government issued an overall framework for HIT throughout the country called ‘46312’. The number four refers to the four levels of healthcare management – national, provincial, municipal and cities – while the six refers to six different national health focus areas such as public health, family planning, medications management and insurance.

The three refers to three different national databases that have been established for demographic information, electronic health records and electronic medical records, the one refers to one national network for the health system, and the two means two different security systems.

The development of 46312 followed a national push for EMR adoption that began back in February 2010. That year, basic national specifications were developed, trialled and implemented, and the following year, the government developed a model of ranking EMRs called the MEG (model of EMR grading).

According to Mr Shen, this is used to assess the quality of EMR adoption, which is still quite low. CHIMA runs regular surveys of its member hospitals, and the most recent found that while there had been major growth in the implementation of EMRs, there was only one hospital that reached the highest level of grade 7. Only four hospitals reached grade 6, which includes closed-loop medications management and advanced clinical decision support.

However, what EMR adoption has done is drive the development and implementation of other clinical information systems, with most hospitals having implemented or are now implementing inpatient nurse and inpatient doctor workbenches, outpatient and emergency department doctor workbenches, laboratory and radiology information systems, clinical knowledge repository systems, ICU systems, pathology systems, PACS, and a variety of other information systems for clinical pathway management, infection control/hospital acquired infection surveillance, anaesthesia, telemedicine and regional health information.

“According to our survey, compared with five years ago, at the moment we have a very large adoption of EMR,” he said. “We can see that in different occasions the application and construction of clinical information system has been adopted quite well.”

The figures from CHIMA’s 2014-15 survey show that 71 per cent of hospitals surveyed had implemented an EMR (up from 27.1 per cent in 2009-10), 7.7 per cent were planning to implement one and 21.2 per cent had no plans as yet. This was down from 38.3 per cent in 2009-10.

Mobile applications are also becoming very popular, with wireless networks, personal digital assistants, tablets, RFID, cloud and Internet of Things having a more active role compared to five years ago.

“Some examples here are the mobile nursing and mobile ward management [apps], as well as [apps for] equipment positioning and medical waste management,” he said. “We have lots of applications on our mobile phones, which allow our patients to make appointments, ask questions and do their payment.”

Self-service kiosks and single identity authentication are widely used, as is a social media application called WeChat that Mr Shen likened to Twitter.

The government has also launched a personal health information system for all patients called the Residents Healthcare Card that sounds similar to Australia’s PCEHR. “By using this card we can include all information of the patient, including his or her medical history, and we are doing trials in 29 different provinces,” Mr Shen said.

Obstacles to HIT development in China

Mr Shen then outlined some of the challenges and obstacles facing the HIT industry in China, most of which will sound very familiar to other countries.

“According to our survey, the most serious obstacles that we are facing is first, money; second, staff; and third, vendors.”

CHIMA’s survey of the status of China’s hospital IT 2014-2015 showed that the challenges, in descending order, were: lack of adequate financial support, lack of staff, vendors’ inability to deliver product, difficulty proving ROI, lack of medical data standards and a lack of a strategic IT plan.

“We have compared our results against the results from the US,” he said. “It’s almost the same. As the biggest developing country, we are finally having the same characteristics with the biggest developed country.

“The other obstacle that we are facing is talent. According to our survey … on average there are nine full-time employees in IT departments in hospitals, whereas in America it’s 39 full-time employees.

“The other difficulty in talent is the training process. It is quite a long process, however the trainees cannot be well paid, and that is one of the reasons we are losing talent.”

In terms of vendors, the main problem is lack of expertise and low market concentration, he said. Of the 2622 hospitals that have undergone the MEG process, there are 320 different EMR vendors.

“The capability of our vendors is a big concern for us. They do not provide quality and enough facilities for us. One typical problem is that the vendors do not have a clear picture of how important medical information technology is to our hospital system.

“And for the vendors, they are also facing lack of talent on their side. We’ve noticed that with regards to EMR, the concentration in markets is still quite low.”

CHIMA’s survey shows that users of the top 10 EMR products only account for about 30 per cent of the market, with users of the most popular product only 5.7 per cent of the market. China would like to see more concentration in this market, he said.

He also said there was an obstacle in the adoption of standards, particularly in the public healthcare sphere. While most hospitals are using ICD10 or ICD9, only 37 per cent are using HL7 and only six and five per cent respectively were using SNOMED and LOINC.

However, with large growth over the last few years and a government that is putting more focus on HIT, Mr Shen said he expects the market for HIT to keep improving.

“At the moment both the government and the people are requiring better services and they are paying more attention to their healthcare, so on the way to improving our quality and more services and to reduce the cost of our hospital system, we are still making efforts,” he said.

“In the words of Deng Xiaoping, ‘development is an unyielding principle’. We are unyielding in this principle as well.”

Australasian health week in review: July 11

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

Fiona Stanley Hospital theatres closed, ambulances diverted after ‘serious leak’ causes more flooding
ABC News ~ Jessica Strutt ~ 09/07/2015

Operating theatres have been closed at Fiona Stanley Hospital in Perth and ambulances diverted after more flooding at the $2 billion health facility.


DHB firm inherits deficit, deals to do in HBL’s wake
NZ Doctor ~ Virginia McMillan ~ 09/07/2015

The Government’s health cost-cutter Health Benefits Ltd has passed a debt of almost $2 million to its DHB-owned successor.


Fake ultrasound pictures spark calls for industry regulation
ABC News ~ Lucy Martin ~ 08/07/2015

Imagine paying to get an ultrasound photo of your unborn baby, only to discover that other women have been given exactly the same image.


Telstra telehealth scheme a rival to all GPs: AMA
Australian Doctor ~ Serkan Ozturk ~ 08/07/2015

The AMA has accused Telstra of setting up in competition with every GP in the country following the launch of its new telehealth system.


Canterbury, West Coast practices not too bothered by discharge notes snarl-up
NZ Doctor ~ Ruth Brown ~ 07/07/2015

Canterbury and West Coast DHBs have apologised to general practices for a computer glitch that prevented 6000 hospital discharge notes being sent to GPs.


Experts call time on diagnostic glucose testing
Australian Doctor ~ Alice Klein ~ 07/07/2015

HbA1c testing should replace blood glucose testing as the primary tool for diagnosing diabetes, Australian experts say.


Telstra 2G ‘Nana phones’ living on borrowed time
Sydney Morning Herald ~ Adam Turner ~ 06/07/2015

With the proliferation of 3G and 4G smartphones it’s easy to forget that there are still plenty of people happily using an ancient GSM 2G “dumbphone” like the popular Nokia 2000 and 3000 range.


Doctors learn details of pharma pay reporting
Australian Doctor ~ Michael Woodhead ~ 06/07/2015

The pharmaceutical industry is launching an awareness campaign to explain how details of payments to individual doctors will be made public online from October 2015.


Safety campaigners urge ban on smartwatches
New Zealand Herald ~ Susan Edmunds ~ 05/07/2015

Road safety campaigners are calling for a ban on the use of wearable technology, including smartwatches, by drivers.


Govt readies e-health record push to boost adoption
iTNews ~ Paris Cowan ~ 03/07/2015

The Department of Health will renew efforts to address under-utilisation of electronic health records by the clinical community, with a training and promotion campaign due to kick off in January 2016.