My Health Record to become mobile-compatible from next year

The federal government plans to turn the My Health Record into a mobile-capable platform at some stage next year, allowing app developers access to the platform through a set of conformant application programming interfaces (APIs).

The Department of Health’s special adviser on eHealth Paul Madden told a national Primary Health Network (PHN) forum in Sydney last week that the government will not be developing apps itself, but will make the platform compatible so app developers can have access to it and begin using the data it contains.

“The platform, some time next year, will be turned into a mobile-capable platform,” Mr Madden said. “I don’t mean we will turn out a whole bunch of apps from the government perspective, saying here is the My Health Record on a mobile device, but we will make the platform compatible for apps developers to be able to access the platform, to use the data, to make views of it for clinicians under the current use regime, or for individuals who wish to use that kind of service.”

There is one approved app for the system formerly known as the PCEHR: the Child eHealth Record app, of which there have been 15,731 downloads.

“There are lots and lots of different use cases for apps,” he said. “We want this to be something that apps developers can use and make sense of.”

External software such as GP clinical information systems are able to access the My Health Record system through conformant portals, and this is the plan for mobility as well, he said.

“At the moment, everything is transacting information in and out of the gateway, so we will give it a set of APIs that will make the data accessible and those will become conformant portals.”

Mr Madden also said there were new system releases planned for early next year to support more usability for both consumers and healthcare providers. These are like to be released in March or April.

He also said the department was still working to get pathology and diagnostic imaging providers linked to the system, but that diagnostic imaging reports were now flowing in from the Northern Territory. The NT’s My eHealth Record (MeHR), which has the capability to receive pathology and DI results and reports, is transitioning over to the national system under the M2N project.

There is also work going on with software vendors to map and use terminologies such as SNOMED CT-AU and the Australian Medicines Terminology (AMT) within their own systems.

“We have a lot of codified information in the system,” he said. “The way that works at the moment is for a software developer to create a clinical document to send to the system, they have to structure the data in a way that goes to our system so when you interrogate it or when it goes to another system, you will absolutely have certainty that it will look the way it was intended to.

“There is work going on with some of the software vendors to consume the terminologies instead of some of their own terminology sets so that they are able to not only provide information to us in a standard and codified way, but also to use those standards and codes inside their own systems.

“That takes us to another level of the utility of the data across the system, whether it is intended for the eHealth system in a clinical document sense or sharing into the future using techniques and technologies like FHIR, for example.

“Information which is stored both within a clinical information system or an eHealth system of a national kind or an EMR for a hospital, if all of those were carrying information about a medication using the same coded terminology, we are in a much stronger place than where we are at the moment.”

He also revealed that work was currently ongoing involving NEHTA and some of the secure messaging service vendors to keep trying to solve the seemingly intractable problem of lack of technical and commercial interoperability between vendors.

While there are quite a few technical problems to be overcome to allow one brand of clinical software to send and receive messages using different secure messaging services to another brand of clinical software, those problems are seen as surmountable.

What don’t seem to be surmountable are the commercial considerations of the vendors. Mr Madden said NEHTA was currently working with them and the jurisdictions to try to solve the impasse.

He said planning for the two trials of opt-out models in northern Queensland and the Nepean Blue Mountains region of NSW has begun, with the first planning session taking place the week before last. Planning will start to ramp up as we head into Christmas, he said.

The vexed issue of revised incentives for GPs to use the system is still under consideration, he said. The RACGP has been lobbying hard against proposals that the Practice Incentive Program payment for eHealth (ePIP) be linked to actual use of the My Health Record.

Mr Madden said a decision on whether to proceed with those proposals had yet to be made.

Also yet to be decided is the role that PHNs will play in the system. While eHealth is listed as one of the six priority areas for the PHNs, they have not received the sort of special funding for eHealth activities that marked the Medicare Local years.

Mr Madden said key performance indicators for PHNs and their role in eHealth will be discussed at another national PHN conference next month.

In the meantime, close to 2.5 million people are now registered to use the My Health Record, with between 1500 and 2000 signing up each day.

Telstra Health launches image management service for radiology practices

Telstra Health has launched a vendor neutral image and data management service that provides radiologists with the ability to view x-rays, MRIs and other radiology studies regardless of the system used to capture the image.

The service is a hybrid cloud/on-site solution which will see radiology studies transmitted to a centralised storage facility through Telstra’s data connectivity links and then managed using the Mach7 vendor neutral archive (VNA) software, provided by Telstra Health’s third-party supplier, 3D Medical.

The service will also provide long-term image storage including back-up of all images at a secondary site.

It already has one large customer in Capital Radiology, which provides diagnostic imaging services throughout Victoria and NSW. Capital Radiology signed a four-year contract with Telstra Health in July 2015 as the foundation customer and the solution has already been deployed and is archiving data for 55 of Capital’s 72 clinics.

According to Telstra Health, the service bundles vendor neutral archiving capability with a curated storage solution and Telstra’s data network. This combination of software and the Telstra IP network allows very large studies to be rapidly fetched from the archive by any site in the network, reducing idle time and improving efficiency.

It promises to reduce costs to radiology practices by avoiding duplicate imaging as well as reduce time waiting for images to load. Telstra says the solution lends itself to radiology providers who outsource their reporting services to teleradiology organisations.

Michael Boyce, Telstra Health’s head of provider applications, said the service means more convenient access to images and reports and reduced time taken for a diagnosis to be delivered to patients.

“For radiologists and the business it means more efficient use of skills and resources, allowing images to be automatically routed to the most appropriate radiologist available depending on the type of image or skill set required,” Mr Boyce said.

“When a patient sets an appointment the service can pre-fetch prior studies of that person, making the patient’s history available at the radiologist’s fingertips.”

He said the key to the service was interoperability: where radiologists previously had to be using the same imaging system, they can now use different systems but share files, regardless of location, software or hardware.

“In the future this will mean patients will be able to create a holistic image history, pulling files and images from different providers, in different locations and have one, single source of their radiology history,” Mr Boyce said.

Telstra Health formalised an agreement with 3D Medical earlier this year to become a reseller of the US-developed Mach7 image management software.

3D Medical, better known for its capabilities as a medical printing service that can print anatomical parts such as Australia’s first ever 3D printed prosthetic jaw, entered into a merger agreement with Mach7 last month that will see the merged entity listed on the Australian stock exchange and trade as Mach7 Technologies.

Capital Radiology CIO Chris Germon said the Mach7 solution allows the company to better manage its large amount of imaging data.

“Our business workflow requirements change regularly but using this platform we can adjust our workflow rules within seconds and deliver images to clinicians promptly,” Mr Germon said in a statement.

“The security and reliability of the Telstra Health hosted platform, together with the enterprise imaging expertise of Mach7, ensured the implementation process was completed on time and to Capital’s expectations.”

NZ to kick off design phase for national EHR and digital hospital blueprint

New Zealand’s National Health IT Board will convene the first co-design workshop for its national electronic health record (EHR) and digital hospital blueprint next month, as it seeks to have a design for the EHR finalised by the middle of next year and undertake a survey on hospital electronic medical record (EMR) maturity at the same time.

Health Minister Jonathan Coleman announced at the HINZ conference in Christchurch last month that the government would build a single, national EHR that would draw on existing, regionally based EMRs as part of a move from a best-of-breed model to a “hybrid/best of suite” strategy, as recommended in an independent review he commissioned from Deloitte.

He also outlined plans to introduce a common blueprint for digital hospitals that will measure all hospital and specialist services against the HIMSS electronic medical record adoption model (EMRAM).

Unlike troubled national projects such as those experienced in the UK and Australia, New Zealand believes it is at the right level of maturity to implement a national EHR, which National Health IT Board director Graeme Osborne described as a longitudinal record with a base set of information about the consumer available to every clinician and health provider who engages with them.

While several attendees at the conference speculated that the cost of implementing an EHR for 4.5 million people would run into the hundreds of millions of dollars, Mr Osborne told Pulse+IT that the investment will be incremental over a number of years, with funding to follow the normal budget process.

“Budget estimates will be directly dependent on the design and scope of the EHR, which will be determined at the end of the design phase, expected to be mid-2016,” Mr Osborne said.

The design of the system will be an iterative one over the next six to nine months, with the co-design phase involving a series of workshops that will result in the preliminary design and scope for the national EHR and a plan for creating a digital hospital blueprint.

“The first discovery workshop, to be held in early December, will involve consumers, clinicians, healthcare professionals and cross-agency representatives,” he said. “We have also invited younger clinicians and consumers to participate in the workshop to bring a fresh perspective on the table.”

The Deloitte report cited a number of international EHR implementations that it recommended be examined for lessons on how to implement a New Zealand system. Mr Osborne said the board will be looking at notable EHR implementations in Singapore and Scotland but also at other industries that manage customer relationships over their lifetime.

“The wide engagement across the social and health sectors, as part of the update to the New Zealand Health Strategy, highlighted the ongoing concerns about the speed of implementing digital eHealth solutions,” he said.

“There was a strong call for a single trusted source of health information. The National Health IT Board balanced this advice with the mixed results achieved by overseas national EHR initiatives which did not meet expectations such as those in the UK and Australia.

“Their assessment is that the NZ health landscape has matured to a point where investing in a single EHR solution is achievable. Rather than defining a single repository we have design requirements, i.e the information in the EHR must be accurate, real-time and be able to interact seamlessly with clinical and consumer-facing systems across the sector.”

The co-design phase will also involve examining potential solutions that could be purchased off the shelf or built from scratch, as well as the potential to build a single EHR out of existing regional solutions such as Health Connect South (the Orion Health clinical workstation), HealthOne (formerly eSCRV) or TestSafe.

“It is still too early to determine how the national EHR will be developed and delivered,” Mr Osborne said. “The procurement approach will be confirmed at the end of the design phase.”

Maturity model

At the same time as the co-design phase for the EHR, the board is also planning to conduct a survey of the nation’s hospitals to rate them according to the HIMSS EMRAM model. Most are judged to be at about Stage 2 out of the seven stages, with electronic nursing documentation or lack of it keeping the score low.

Mr Osborne said the EMR adoption survey was familiar to the board as it completed a trial involving surveying five hospitals in 2013. That experience will be used for the national survey planned for May/June 2016.

“[EMRAM] is about quality, digital maturity and optimisation,” he said. “We want to measure our performance against international benchmarks to ensure our hospitals are keeping up with best practice for digital capability. In addition, it will give the sector a standard way to measure readiness to connect to the single national EHR.”

To reach the higher stages of the EMRAM model, closed-loop medication management systems are a must. New Zealand is well down this path, having adopted CSC’s MedChart as a national solution following successful trials at Dunedin Hospital.

“We are pleased that the early adopter DHBs – Southern, Taranaki, Waitemata, Canterbury and South Canterbury DHBs – are continuing to widen the use of MedChart in their hospitals,” Mr Osborne said.

“Auckland DHB’s MedChart implementation is expected to go live in the first quarter of 2016, while Counties Manukau DHB is expected to complete their business case in early 2016.”

New Zealand is also fortunate to have a very robust standards setting body in the Health Information Standards Organisation (HISO), which Mr Osborne said had created a strong base on which to build the EHR. The key standard, he said, will be the SNOMED clinical terminology, while emerging standards such as FHIR are likely options for EHR APIs.

Clinical engagement

While the maturity of the secondary care sector is essential to the success of a national EHR, so too will be the use of it in the primary care sector.

The government’s campaign to have patient portals adopted throughout the country has gone a bit slower than expected but is now gathering some steam. It had hoped that all general practices would offer a portal by the end of last year, but to date about a quarter of the estimated 1000 practices in the country have taken the technology up.

However, there have been a number of successes in the primary care sector on which to build, both at a national and a regional level, Mr Osborne said.

“To be successful, digital eHealth solutions must be designed with the consumer and clinician in mind, and the solution must be acceptable to clinicians from a clinical quality and workflow point of view.

“The National Health IT Board has had real success with engaging with GPs with projects such as GP2GP and eReferrals. Our design workshop will include GP leaders to make sure we get their support and buy in to the EHR design.”

Govt still open to opt-in model for PCEHR as private hospitals connect

The federal government is still open to receiving proposals from Primary Health Networks (PHNs) for innovative ideas on boosting consumer and provider participation in the PCEHR under the current opt-in model but has yet to make a final decision on where to hold trials of opt-out alternatives.

Health department officials told a Senate Estimates committee hearing on Wednesday that there was still no final decision on how many trials will take place or where, but up to six may be conducted, of which some will be of opt-out participation and others of “innovative approaches” to opt-in.

The number of consumers registered for the system is close to 2.5 million, and 452 public hospitals and community health centres have also connected.

National E-Health Transition Authority (NEHTA) CEO Peter Fleming told the committee that 22 private hospitals were now able to access the system. NEHTA signed agreements with some private hospital groups in April and is providing funding to help defray the cost of the integration work.

The private hospitals include five from the St Vincent’s group, four from Healthscope, Chris O’Brien Lifehouse in Sydney, one from Adventist Healthcare, four from Little Company of Mary, four from the Epworth group, two from the Cura day hospitals group and one from Mater Health Services.

The Department of Health is also likely to deliver its advice on changes to the eHealth Practice Incentives Program (ePIP) to the government by next week, DoH first assistant secretary for eHealth Bettina Konti told the committee.

The department issued a discussion paper last month and held some webinars for GP groups about the proposed changes, which seek to tie future payments to active and meaningful use of the PCEHR, potentially including the setting of targets for uploads of shared health summaries (SHSs.)

The majority of general practice groups strongly oppose those recommendations, including the AMA and the RACGP. The Australian College of Rural and Remote Medicine (ACRRM) says that while it supports moves to link active and meaningful use to the ePIP, the system needs to be robust and usable before doing so.

This week, the Australian Association of Practice Management (AAPM) told Pulse+IT that while it had been a strong advocate for the development of the eHealth platform and had actively promoted the PCEHR, it did not agree with the proposed timing of the changes to the ePIP, which the department has floated as beginning from February next year.

“AAPM fully supports the intent of the discussion paper in terms of promoting the active and meaningful use of the MyHealthRecord,” AAPM CEO Gillian Leach said.

“However, it has serious concerns about mechanisms that have been recommended in this paper and particularly object to proposed timeframes for implementation.

“The start date of February 6th is not practical as it does not allow sufficient time to properly consult with stakeholders or to implement new processes. To push through these changes while the MBS review, PHC Advisory Group and Opt-out MyHealthRecord trial are all pending is premature and adds further to the disjointed nature of the healthcare system.

“The industry is already fatigued by constant changes.”

Opt-out, opt-in

DoH special adviser Paul Madden told the committee that while the opt-out sites were still a matter for the government to decide, they will be held from July next year, with communication activities set to start in February-March.

An evaluation of the trials will be conducted with an independent assessor from July through to October, which will then inform the advice given to government on whether to proceed with opt-out. Legislation that passed the House of Representatives last week gives the minister for health the authority to introduce such a system.

Asked why the government had not made provision for the operation of the PCEHR from 2018-19, despite the overall $485 million package announced in the May budget set for four years, Mr Madden said the three-year funding for the system would keep it operational while certain measures such as opt-out and whether to roll this out nationally were considered.

He also said it was possible that the technology underpinning the system could change, which would then have an effect on the cost structures. The department will return to government in early 2017 with proposals on opt-out and future budgetary requirements, he said.

Ms Konti said up to six trials of participation arrangements may be conducted and of those, there will be between two and four trials of participation for opt-out. The others could be “innovative approaches to opt-in participation, or participation as part of the current opt-in system,” she said.

Mr Madden said the government had received proposals from the states and territories on possible locations for opt-out trials, but for the opt-in trials, he said the department would be inviting PHNs to submit proposals on ways that they might inspire healthcare providers and consumers to sign up.

There were no hard rules on what those proposals may contain, he said.

“We will be looking for guidance from the PHNs on this … [T]here could be innovations in looking to focus on people with particular chronic illnesses who have got lots of touch points with the health community as a point of a trial, but again it’s more about how a PHN would do that, what would their own boundaries be, would they sector-limit it or seek to grow it.

“Again, we won’t be telling them how to do it – we will be asking them for their innovations.”

Asked about recent reports that a parliamentary committee on human rights had raised concerns over the privacy elements of an opt-out system, Mr Madden said a privacy impact assessment had been completed which raised issues and risks from a privacy perspective, but it also provided some proposed mitigations for those risks.

Medtech Global brings on an evolution for time-poor GPs

Medtech Global has launched an evolution in its product suite with its new Medtech Evolution clinical and practice management software, which is aimed at putting GPs in control of their valuable time and enabling them to customise the system for their own workflows.

Medtech Evolution has been available to New Zealand users for almost a year but the Australian version is a slightly different technology with a different support base, Medtech Global chief technology officer Rama Kumble said.

Launched at GP15 in Melbourne this week (pictured), the first goal in developing the new software was to build a 64-bit database to align it with the move towards the now widespread use of 64-bit hardware. Mr Kumble said this meant the product will run a lot faster and more efficiently than its predecessor, Medtech32, and there is also a revamped user interface to make the system look as fresh and modern as possible.

But the main goal is to make it as efficient as possible to allow GPs to make the best of its clinical and practice management capabilities so it can free up GPs’ valuable time, Mr Kumble said. The company is using the concept of a Time Lord to illustrate its intentions.

“Doctors are time poor; that’s a given,” he said. “The pressure on GPs is ever-increasing and they are really under the pump in many ways. It’s my opinion that their real income is eroding in terms of the value that they get out of their time.

“For us, the goal is to provide them with great clinical software so GPs can do their work reliably and quickly. The concept of the time lord reflects on how we can help GPs become the master of their own time.”

Medtech Evolution has been built with two emerging trends in mind: the concept of structured care, where GPs are able to follow pathways that ensure nothing is missed during a consultation; and the move towards larger practices and a more corporate environment, where uniformity of care is important but where freedom to run a practice as the GPs see fit is equally important.

To balance these competing demands, Medtech has developed new technology called Advanced Forms, which allows users to configure their own forms, screens and dashboards while still being powered by Medtech Evolution.

“If you go to a normal Windows application on all other practice management systems, what they do is they predetermine for you the menus and the workflows,” he said. “It’s sort of like a straitjacket.

“We on the other hand allow you to design the forms and the screens in your own way. They have our technology driving them it in the back-end but you can make them look and feel as you’d like.

“No two practices do things the same way or do the same thing so consequently this will allow them to run the practice the way they want to do it, control their workflow the way they want it, and yet use the back-end functionality of Medtech Evolution.

“Like any other product we have lots of functions and menus, but if you put these Advanced Forms on top of it you can literally transform it into something that you want.”

The second major feature is a new series of configurable patient dashboards that aim to enhance opportunistic care, where in addition to treating the primary diagnosis the GP can also look the patient in a more holistic manner during the consultation.

Medtech Global has developed a set of configurable patient dashboards that provide an easy to read overview of the patient that the practice can customise for their own needs.

“Opportunistic care is where the patient presents themselves and you think what else can I do besides treat the acute condition that the patient has presented with. If I go in with a cough and cold, the doctor will want to deal with what might be an upper respiratory tract infection and that’s pretty straightforward, but they should also look at my age, have they looked at my cholesterol, have they checked my care plan if I’m a diabetic – all of that can comes up in the consultation through the patient dashboard, enabling them to do their job efficiently.”

Mr Kumble said the patient dashboards also use the Advanced Forms technology so practices can design their own rather than someone else determining what dashboard they should be using.

“There are some that are a good baseline but now we are customising it based on the patient’s condition. This is what we provide through these Advanced Forms. In that way, doctors can also be sure that when the patient presents they’ve done everything possible, and you can also do reminders and recalls that they need to come back.”

Mr Kumble and his team have also added new data analytics capabilities that are built-in to the system, both for clinical data and business data. There is a built-in query builder for clinical data so GPs can quickly look for all of their diabetic patients or all of those on warfarin, for example. With this capability, clinicians can gain insight into their own clinical practice, he said.

Practices are also small businesses and have to be profitable, so the company is planning to add easy to use business intelligence queries to the system and allow GPs to run their practices better and improve their processes.

The system is also integrated with some of Medtech’s other technology such as the ManageMyHealth portal, which can be used both as a patient portal and a provider portal. ManageMyHealth has telehealth capability built into it to allow for GP and specialist teleconferencing, but it also functions as a patient-facing two-way communications portal.

While patient portals are taking off in New Zealand, where the government is actively encouraging them but where the funding model is also more supportive of the technology, patient portals are not yet in widespread use in Australia.

Mr Kumble said most of his customers using ManageMyHealth were using it for its online appointments booking capability.

“Some of our practices have trialled it and have started using it and some will start using it for sharing more useful information with patients,” he said.

“It’s very useful for reminders, for instance, and this will only increase in uptake. In New Zealand the funding model is different but it will begin to grow in Australia because they will see the value that’s in it.

“There is also the potential to use it for GP to specialist connections. There are lots of little business steps that happen when you want to refer to a specialist. They may not be able to see the patient for three or four months or the specialist may say they need to be referred to somebody else.

Things like that happen all the time but through a portal like ManageMyHealth, the specialist and the GP can quickly triage the patient before the specialist accepts them. We’ll be working with other companies to make that capability more nationwide.”

The Australian GP market is slow to change but Mr Kumble said Medtech’s technology was now able to help GPs embrace new directions such as telehealth and patient portals, especially if the funding models are improved.

“It is a very slow-moving market and it takes a long time for the market to embrace this sort of stuff,” he said. “In the US for example about 24 of the 50 states treat telehealth on par with face-to-face consultations. Those drivers will definitely influence Australia in the long run, and with the NBN roll-out and things like that, things will start to change and by then we will have a very mature technology.”

Appointuit acquired by patient flow specialist Jayex Healthcare

Appointment management and patient engagement application developer Appointuit has been acquired by the newly formed, Australian-based company Jayex Healthcare, best known for its range of self-service kiosks for the primary and acute care markets.

Appointuit, which was launched in 2011 by Brisbane-based practice managers and owners Rosemary and Gordon Cooper, still holds the record for having Australia’s most popular medical appointment app in the Apple App Store and on Google Play.

As well as its elegantly designed appointment bookings app, Appointuit is integrated into leading general and specialist practice management software systems Best Practice, Pracsoft, ZedMed and Genie and interfaces seamlessly with their appointment books.

The company’s Engage! suite of products also includes a patient engagement tool that provides practices with the ability to not only send out proactive health reminders in line with national health campaigns, but also assists practices to meet the requirements of RACGP standards such as emergency response planning (ERPT).

The system also allows a practice to send out individual health reminders to patients via email and/or SMS for reminders for Pap tests, skin checks and immunisations.

CEO and co-founder Gordon Cooper said Appointuit can turn a task that once took several hours and had significant costs such as postage into a simple and cost effective task, with measurable improvements to patient health outcomes and engagement in their own care.

The technology suite also includes full patient registration, one and two-way SMS reminder systems and a patient portal that allows repeat scripts and referral requests.

Mr Cooper said the company had fielded a number of offers from parties keen to establish a strategic partnership before deciding to merge with Jayex Healthcare.

“Healthcare experience and knowledge and continuity of care has always been paramount to Appointuit,” Mr Cooper said. “The products and services offered by the merged group will only enhance this philosophy.

“The acquisition of Appointuit will allow Jayex Healthcare to offer a full range of products and services to GPs, specialists and allied health, and will enhance connectivity to their patients.”

The Coopers and their team remain with the new company, which plans to develop and distribute a range of technologies along the continuum of care, from booking an appointment to patient check-in kiosks and into the pharmacy sector with services and technologies including P2U and BluePoint.

Jayex’s patient check-in kiosks are widely used in both primary and acute care, and the company has relationships and integrations with the likes of MedicalDirector, Best Practice, Genie Solutions, PPMP, iSoft (CSC), Cerner and InterSystems.

“With each business unit within Jayex Healthcare continuing to focus on and develop products within their area of expertise and experience, and a highly experienced senior management team and board, we see the merger as a positive move, and as a team, we see ourselves as a significant force in the connected care space,” Mr Cooper said.

Webstercare and NPS partner for antibiotic review report in aged care

Medication management software specialist Webstercare has joined forces with NPS MedicineWise to develop a second Medicinewise report, aimed at assisting residential aged care facilities to review of the use of antibiotics for urinary tract infections (UTIs).

The RACF Medicinewise reports are available for free in the latest update of Webstercare’s Professional and Professional Plus medication management software to enable RACFs to identify patterns of medicine use.

The first report was released in 2013 for antipsychotic medications for residents with dementia. The reports allow pharmacists to work with aged care nurses to identify patterns of use over time.

The new report aims to help RACFs tor egularly review antibiotic use for UTIs, compare medicine use against comparator data and identify residents who may benefit from a review of their medicines.

NPS MedicineWise CEO Lynn Weekes said reflecting on a facility’s current practice of prescribing of antibiotics for UTIs is highly beneficial.

“For many people, treatment of asymptomatic bacteriuria is usually not required,” Dr Weekes said. “Excessive use of antibiotics may be contributing to the high levels of antibiotic resistance seen in residents of aged care facilities.”

Webstercare founder and managing director Gerard Stevens said the report offers new information to help facilities and their healthcare teams make more informed and collaborative treatment decisions for residents.

The report can also be used to undertake the latest NPS MedicineWise medicines use review quality improvement activity, which is aimed at helping nurses and pharmacists working in RACFs to reflect on and improve current practices, as well as earning CPD points.

Text to prevent repeat heart attacks

Sydney researchers are calling for the implementation of a simple text message system to improve the health of heart attack survivors after it was shown to help reduce weight, blood pressure and cholesterol and was well received by patients.

Westmead Hospital cardiologist Clara Chow said the Tobacco, Exercise and Diet Messages (TEXT ME) trial used a very simple mobile health strategy that could be provided routinely by hospitals as part of a discharge program for heart attack survivors as well as other conditions like stroke.

The TEXT ME trial used an automated, computerised message management system to send texts selected from a bank of messages to trial participants. The messages gave advice and motivational reminders about diet and nutrition, exercise and smoking, based on freely available resources such as those provided by the Heart Foundation.

The trial involved 710 people attending Westmead Hospital with proven coronary heart disease. Half received four text messages a week for six months in addition to standard care, while the remainder received their standard care.

At six months, levels of LDL-C were significantly lower in the intervention group, with concurrent reductions in systolic blood pressure and body mass index. It also saw significant increases in physical activity and a significant reduction in smoking.

Patients also received the intervention well, with 91 per cent reporting that the program was useful, easy to understand (97 per cent), and appropriate in frequency (86 per cent).

Associate Professor Chow, also the director of the cardiovascular division at the George Institute for Global Health, said people often just needed ongoing encouragement to change their lifestyles, especially when they are confronted with the daily challenges outside of hospital, and this program addressed that problem.”

“It’s also cheap, with the text messages costing just $14 per patient for a six-month period,” she said.

This is in comparison to the $281,000 that each heart attack costs the community, a figure that includes direct healthcare costs as well as lost productivity.

“Ultimately we’re trying to save lives,” Dr Chow said. “We know that more than 4000 incidents and 1880 deaths could be stopped every year if we reduced repeat heart attacks by 25 per cent. It would be great if we could achieve this.”

She said mHealth strategies such as this could be introduced by governments with immediate results.

“We are committed to rolling this program out to hospitals around the country, and continuing to test the benefits.

“It is something that hospitals could routinely provide as part of the discharge program for patients with heart attacks or even other conditions such as stroke.

“This is one of those relatively rare things in medicine that saves money and could save lives also, so given its simplicity and the results of this research, it really is a no brainer.”

The TEXT ME study was published in the Journal of the American Medical Association (JAMA).

International health IT week in review: August 23

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

Does it matter if docs don’t like EHRs?
HealthcareITNews ~ Michelle Ronan Noteboom ~ 20/08/2015

Physician satisfaction matters, but not nearly as much as improving the quality of patient care.


New cloud platform seeks to accelerate cancer care collaboration
Health Data Management ~ Joseph Goedert ~ 20/08/2015

Intel has launched Collaborative Cancer Cloud, a new service to enable providers and researchers to securely share genomic, imaging and clinical data among participating organizations across the globe.


Salisbury selects Lorenzo
Digital Health News ~ Rebecca McBeth ~ 20/08/2015

Salisbury NHS Foundation Trust has chosen CSC as preferred bidder to provide its Lorenzo electronic patient record system.


Allscripts, CoverMyMeds partner
HealthcareITNews ~ Bernie Monegain ~ 20/08/2015

The partnership aims to increase the number of health plans available for Allscripts eAuth software clients.


Barts cancer patients use Skype
Digital Health News ~ Rebecca McBeth ~ 19/08/2015

Cancer doctors at Saint Bartholomew’s Hospital are monitoring patients from home via Skype video link.


Vendor changes increasing EHR satisfaction among larger doc practices
FierceEMR ~ Marla Durben Hirsch ~ 19/08/2015

Vendor improvements to their electronic health records are increasing large practices’ satisfaction with their systems, according to a new survey from Black Book Rankings.


HHC tech leaders out amid billing probe of EMR implementation
FierceEMR ~ Katie Dvorak ~ 19/08/2015

Four top leaders at New York City’s Health and Hospitals Corp. have left the organization after an investigation into improper billing for a revamp of its electronic medical record system.


Alberta government cancels $3 billion lab contract
Canadian Healthcare Technology ~ Staff writer ~ 19/08/2015

Alberta’s NDP government has ordered Alberta Health Services to cancel the award of a $3 billion laboratory services contract to a private-sector firm from Alberta.


Cerner to take charge of BC EHR project
Canadian Healthcare Technology ~ Staff writer ~ 19/08/2015

Cerner will replace IBM as the lead contractor in the $842 million electronic health record integration project in British Columbia.


Digital health hub Catalyst grabs RiNo block for new digs
The Denver Post ~ Tamara Chuang ~ 18/08/2015

Developers hoping to turn Colorado into the nation’s digital health capital have acquired an entire block in the sizzling River North district.


Stage 3 meaningful use: What’s next?
HealthcareITNews ~ John Andrews ~ 18/08/2015

Stage 3 of meaningful use is shaping up to be the most challenging and detailed level yet for healthcare providers


Hospitals use paper, electronic methods for summary of care records exchange
Health Data Management ~ Greg Slabodkin ~ 18/08/2015

Less than 10 percent of hospitals use only electronic means of exchanging summary of care records with outside sources.


Wye Valley second trust for openMaxims
Digital Health News ~ Thomas Meek ~ 17/08/2015

Wye Valley NHS Trust has signed a five-year deal with IMS Maxims to implement its open source electronic patient record openMaxims.


Community hospitals look to replace EHR vendors
Health Data Management ~ Greg Slabodkin ~ 17/08/2015

More than half of community hospitals across the country are unhappy with the usability of their EHR systems, and nearly 20 percent of those hospitals are actively looking to replace their EHR vendors, according to a recent survey.


NME to retain most NPfIT-era systems
Digital Health News ~ Thomas Meek ~ 17/08/2015

The end of National Programme for IT contracts in the North, Midlands and East of England is looking less and less likely to trigger an immediate, large-scale change-over of IT systems.


A no-brainer? Why digital health zombies are good for the industry
mHealth News ~ Eric Wicklund ~ 17/08/2015

Zombies aren’t just on “The Walking Dead” any more. A growing number of digital health startups are also dead on their feet, according to a new report from Accenture.


Gazan medico team 3D-prints world-leading stethoscope for 30c
The Register ~ Darren Pauli ~ 14/08/2015

Tarek Loubani, an emergency physician working in the Gaza strip, has 3D-printed a 30 cent stethoscope that beats the world’s best $200 equivalent as part of a project to bottom-out the cost of medical devices.


Meaningful use didn’t spark EHR uptake
HealthcareITNews ~ Jack McCarthy ~ 14/08/2015

Could the rise in EHR adoption be a matter of correlation to meaningful use and not causation? A new study suggests that might be the case.


Melanoma app vendor barred from making deceptive health claims
Health Data Management ~ Greg Slabodkin ~ 14/08/2015

Under a settlement with the Federal Trade Commission, a melanoma-detection app vendor has been barred from making further deceptive health claims about his products available for sale online in the Apple and Google app stores.


How CVS uses telehealth, EHRs to improve patient care
FierceHealthIT ~ Dan Bowman ~ 14/08/2015

While telemedicine and electronic health records are helping health providers to improve the quality of care delivered to patients, they also are helping pharmacy retailers stake a legitimate claim in the industry, according to Tobias Barker, vice president of medical operations for CVS MinuteClinic.


Hospital EHR adoption grows, but other care settings still lack ability to receive data
FierceEMR ~ Katie Dvorak ~ 14/08/2015

While exchange of data between hospitals and outside providers is increasing, the industry still faces many barriers when it comes to interoperability.


Natural language processing in high demand
HealthcareITNews ~ Bernie Monegain ~ 14/08/2015

The global healthcare Natural Language Processing (NLP) market is expected to grow from $1.10 billion in 2015 to $2.67 billion by 2020, according to a new report.


Coming soon to a screen near you: Doctors
Reuters ~ Beth Pinsker ~ 12/08/2015

When the great summer cold hit my family, we hunkered down with soup, tissues and TV. But then my cough started to sound more worrisome.


IT systems still causing a headache at Fiona Stanley Hospital

IT systems are still causing problems for clinicians and patients at WA’s Fiona Stanley Hospital, with the patient entertainment system, cardiac telemetry system, slow clinical and administrative software and an overloaded IT helpdesk singled out in a new report into the flagship hospital’s short but chequered history.

An independent review was commissioned into the hospital’s clinical services and patient care earlier this year after a string of controversies, including claims of contamination of sterilisation equipment that saw outsourced operational partner Serco stripped of responsibilities.

There were also a series of complaints about the quality of patient care, inefficiencies in the delivery of care and an unexpected volume of patients turning up at the new hospital’s emergency department.

Incredibly complex IT systems were a major reason the opening of the $2 billion facility was delayed, with what was once touted as the country’s first fully digital hospital still running on a hybrid paper-electronic system.

The independent review of operational clinical and patient care at FSH, carried out by the Australian Commission on Safety and Quality in Health Care (ACSQHC), MMK Consulting and former WA Health consumer council executive director Michelle Kosky found that problems were still bugging both the clinical IT – managed by the health department – and non-clinical functions such as the helpdesk, managed by Serco.

It was taking clinicians up to 15 minutes to open up all of the applications required in the BOSSnet digital medical record (DMR) to admit and manage a patient as it has not yet been fully integrated, the review found.

BOSSnet currently provides direct data entry through eForms including an admission form, integrated progress notes, team conference/multidisciplinary team notes, nursing risk screening tools and assessment forms.

It also allows access to electronic documents received from other clinical systems used at FSH and critical alerts from the webPAS and TOPAS patient administration systems, as well as allergies alerts sources from the statewide Notifications and Clinical Summaries (NaCS) system.

“As yet, the multiple applications that form the DMR are not fully integrated so clinicians cannot easily move from one application to the next,” the review found.

“Currently, to open all applications within the DMR to admit and manage a patient takes approximately 15 minutes due to the integration issue.

“Problems were also reported with the DMR’s inability to put an alert on the system (warning about an impending potential issue e.g. a reaction to a type of drug or the need for the patient to be seen urgently); this was seen as a safety and quality issue.”

Staff also told the review team there were concerns that work on fixing some of the problems would be delayed as the same ICT staff will be needed to work at the new Perth Children’s Hospital, which is due to open next year.

The children’s hospital is set to open with BOSSnet as the DMR before it is replaced by a full EMR, a tender for which was released last year.

The hospital will also receive webPAS and a number of other state-wide applications as part of WA Health’s stabilisation strategy, announced in May.

COWs and PES

The bedside patient entertainment system (PES) was also causing problems for patients and staff. The new PES has an iDiet software application that allows patients to order their own food.

Elderly patients and patients with disabilities found the PES difficult to use and some were unable to order meals. In a number of cases, late food orders could not be processed or patients received inappropriate food, the review found.

The bedside PES also allows clinicians to enter notes into the DMR. However, clinicians have found it difficult to navigate and most clinicians said they preferred to enter clinical data on the computer on wheels (COWS).

Technology changes are also an issue in outpatients, where it can also take in excess of 15 minutes to open all the software to manage the patient’s notes., the review found.

“One of the significant improvements for patients moving to FSH is the allocation of a specific appointment time for their outpatient treatment rather than being seen within a 4-hour session. This change has been well received by the patients and the clinicians.

“However, there appears to be no alert or triage system within the outpatient booking system to allow urgent patients to fill consultations over routine or less urgent patients. This has meant that general practitioners and specialists have had difficulty scheduling timely and appropriate consultations for the sicker more urgent patients.”

There also seems to be a major problem with the cardiac telemetry system, which is intermittently failing and requires specialist nursing staff to monitor cardiac patients in person.

The hospital cannot work out whether the fault is with the network services installed by BT, electronic equipment installed and maintained by Siemens or the Philips telemetry system.

The Serco-managed helpdesk is also causing a headache. The helpdesk handles a range of services including IT support, telephony, equipment finding, maintenance management and patient and relative enquiries.

“The number of calls exceeded expectation and the complexity of the tasks required of a person unfamiliar with the hospital setting proved distressing for families, carers, staff and others trying to navigate the system.

“The load on the Helpdesk has been diminished by better internal hospital use of the hospital intranet, and internal ‘paging’ (Wi-Fi and phone calling). Staff expressed concerns that the Helpdesk was continuing to have difficulty triaging calls to the appropriate service within FSH.

“There was also a perception from both staff and patient’s relatives that the Helpdesk is overly concerned about patient confidentiality and privacy, hindering legitimate attempts to contact patients and relatives. A careful review of the confidentiality policies within FSH is suggested.”

WA Health’s acting director general, Bryant Stokes, said the review highlighted areas for improvement around clinical and patient care.

Professor Stokes said he had met with the FSH executive team to discuss the problems and had been assured that work is underway to implement the recommendations as soon as possible.

“Patient care is always the top priority and this review will assist Fiona Stanley Hospital (FSH) management to improve their systems and policies,” he said.

“While I acknowledge that Fiona Stanley Hospital has had its challenges, it is a world class facility, delivering high quality and safe care for the population of Western Australia.”