GPs like their electronic systems but can’t share electronically: survey

Most Australian and New Zealand GPs are more than happy with their practice management systems but the majority still struggle to communicate electronically with patients and healthcare providers outside their practice, an international poll has found.

And while they believe their practices are well prepared to manage the care of patients with multiple chronic conditions, that confidence begins to decline when it comes to patients who may need more multi-disciplinary care coordination, including patients who need palliative care, who have dementia, who need long-term home care or care in the community, and those with severe mental health or substance misuse problems.

Less than half of Australian GPs believe the health care system works well and only needs minor changes, one in five find the job very or extremely stressful and just over one third are dissatisfied with their income, but only 12 per cent are somewhat or very dissatisfied with practising medicine.

The numbers are similar for New Zealand GPs, although they seem to like their PMSs less, communicate electronically with the outside world more, are much more unhappy with the time they get to spend with patients, and aren’t so bothered about their incomes.

The results come from the 18th edition of the US-based Commonwealth Fund international health policy survey of primary care physicians, which annually polls GPs in 10 countries: Australia, Canada, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States.

This year, the survey assessed the experiences of primary care doctors regarding the preparedness of their practice to manage the care of patients with complex needs (both children and adults), offer patient access, communicate with other specialty and community-based providers, and use health information technology.

The survey also asked about their views of their health system and satisfaction with aspects of their practice. The results are published online in Health Affairs this week.

The survey found that the vast majority of primary care doctors in all 10 countries think their practice is well prepared to manage the care of patients with multiple chronic conditions – in Australia it is 85 per cent, for New Zealand 81 per cent.

However, that confidence begins to drop away as they are asked whether they are well prepared to manage patients requiring palliative care (48 and 62 per cent respectively), patients with dementia (46 and 41), patients needing long-term home care services (41 and 48), patients needing social services in the community (41 and 48), patients with several mental health problems (34 and 24) and patients with substance use-related issues (19 and 20).

The authors write that evidence is mounting that health IT can help improve care coordination, but while Australian GPs in particular were satisfied with their electronic medical record – 80 per cent of Australian GPs said they were satisfied or very satisfied with their EMR/PMS, compared to 69 per cent of Kiwi doctors, 52 per cent of US doctors and a very low 37 per cent of Swedish doctors – there appeared to be very little electronic communication to and from Australian general practice. New Zealand general practice fared quite a lot better.

For example, 58 per cent of Australian GPs and 69 per cent of NZ GPs always or often received timely and relevant information when one of their patients was seen by a specialist.

However, only 18 per cent of Australian GPs were always notified when patients were discharged from hospital. For Kiwi GPs, it was 56 per cent.

Likewise, only 18 per cent of Australian GPs were notified when a patient was seen in an emergency department, compared to 56 per cent of Kiwi doctors.

Both countries reported low rates of communication with home care providers about a patient’s needs and services (29 and 28 per cent respectively).

Differences between countries were quite stark when it comes to electronic sharing of information with patients. A surprisingly high 30 per cent of Australian GPs reported that patients can email them about medical questions or concerns, compared to 53 per cent of NZ GPs. Switzerland had the highest rates at 80 per cent.

But only 11 per cent of Australian GPs and 24 per cent of New Zealand GPs allowed their patients to view online, download or transmit information from their medical record. The highest rate was in the US (60 per cent), where primary care doctors have been incentivised to do so under the meaningful use provisions of the Affordable Care Act.

As the authors write, the mere fact of having an electronic medical record does not ensure electronic flow of information with doctors or patients outside of one’s practice. Australia, New Zealand, the Netherlands, Norway, Sweden and the UK have had near universal EMR/PMS adoption for some time, but there is a great deal of variation in uptake rates of more advanced electronic functionalities.

Ninety-two per cent of Australian GPs and all Kiwi GPs surveyed used an EMR/PMS, but just over half (56 and 61 per cent respectively) routinely receive computerised reminders for guideline-based intervention or screening tests and only 34 per cent of Australian GPs can electronically exchange patient clinical summaries with doctors outside the practice. New Zealand leads the pack in this category with 75 per cent able to share clinical summaries.

On some of the other measures surveyed:

The survey included 747 Australian GPs and 503 Kiwi GPs. It was conducted between March and June this year.

“Our survey results show that information exchange in all countries is a work in progress, with issues around data decentralization, security, and privacy often creating stumbling blocks,” the authors write.

“Furthermore, while the findings show that the vast majority of primary care doctors across countries are satisfied with their practice and income, the themes of frustration with administrative burden and insurance hassle resonate across many of the countries. This is particularly true among those with multi-payer private insurance systems (Germany, the Netherlands, Switzerland, and the United States).”

CSIRO and NEHTA join forces for free access to terminology service

The CSIRO and the National E-Health Transition Authority (NEHTA) have signed a licensing agreement to make tools for implementing and using clinical terminologies such as SNOMED more freely available.

The tools include CSIRO’s Ontoserver, a terminology server that provides a means of querying, searching, filtering and ranking SNOMED CT AU and other standard clinical terminologies.

Ontoserver has an application programming interface (API) that allows a quick and easy way for implementers to add SNOMED CT-based data capture fields to their system.

It also includes CSIRO’s Snapper mapping tool, which allows users to map legacy terminologies to SNOMED, and NEHTA’s Lingo, an authoring tool used by the National Clinical Terminology Service (NCTS).

The NCTS manages the licensing of SNOMED CT in Australia on behalf of the International Health Terminology Standards Development Organisation (IHTSDO) as well as the development of the Australian Medicines Terminology (AMT), which is a sub-set of SNOMED.

A NEHTA spokesperson said the terms of the agreement between CSIRO and NEHTA were confidential, but that it was an IP licence agreement.

The spokesperson said it would enable NEHTA to set up a fully ‘syndicated’ terminology server service which will share terminology content like SNOMED CT-AU to other terminology servers operated by participating parties such as state health departments.

“The connected terminology servers may choose which content they would like to receive,” the spokesperson said.

A web portal and request submission service will also be established by the NCTS along with a registry to enable users to collaborate and share locally developed content. The NEHTA spokesperson said these users could include sub-licensees such as the jurisdictions, software vendors, private hospitals, universities and individuals.

The service will also use the HL7 FHIR standard as part of the design. FHIR provides a standards base for representing clinical terminology resources as well as an API to support the provision of terminology services.

FHIR can also be used by sub-licensees to load their own local content as long as it conforms to the FHIR value set specification, the spokesperson said.

Besides SNOMED CT and the AMT, other nationally recognised terminologies such as the pathology code sets developed through the Royal College of Pathologists of Australasia’s Pathology Information, Terminology and Units Standardisation (PITUS) project could be included.

David Hansen, CEO of CSIRO’s joint venture Australian e-Health Research Centre, said he saw the agreement as an opportunity to deepen CSIRO’s relationships with state and federal health agencies and with industry.

“CSIRO has developed scientific expertise in clinical terminology over the past eight years, demonstrated with the adoption of Snorocket to maintain SNOMED CT internationally, and now through the licensing of these software tools for Australia,” Dr Hansen said.

Stephen Moo, NT Health CIO and chair of the National Health CIO Forum, said ensuring these tools were deployed and integrated within core clinical electronic health record systems was “a huge leap forward in getting all the computer systems involved in our healthcare system to talk to each other in the same language”.

NEHTA will be running pilots in early 2016 involving early project partners such as government departments, hospitals or vendors who will implement and administer a server prior to a national roll-out from mid-2016.

It will also hold three connectathons, with the first scheduled for next February. Anyone interested in attending an information session or a connectathon can email help@nehta.gov.au.

The NEHTA spokesperson said the organisation expects that the new national digital health agency being established next July to take over its role will inherit the agreement.

Meaningful use and IP transfer the last hurrah for NEHTA

The National E-Health Transition Authority (NEHTA) plans to spend its last months in operation concentrating on getting the pathology and diagnostic imaging sectors connected to the PCEHR and ensuring its IP is handed over to the new Australian Commission for eHealth (ACeH).

NEHTA’s annual report for 2014-2015 shows the not-for-profit corporation had an operating surplus of $5.3 million for the financial year, from revenues of $79.26m and expenditure of $73.94m. It had assets of $77.82m at the end of the $2014-15 financial year, including $70.71m in cash.

According to Pulse+IT’s calculations, this brings NEHTA’s total funding over 10 years to $979,577,083.

As announced by Health Minister Sussan Ley in May, the agency will be dissolved from June 30, 2016, and its functions handed over to ACeH. Ms Ley recently announced the formation of an implementation taskforce steering committee chaired by former NSW Health director-general Robyn Kruk, which will oversee the transition and new governance arrangements.

In his forward in the annual report, NEHTA CEO Peter Fleming said that for the rest of the year, NEHTA’s work program would be directed to “projects with jurisdictions to embed the national infrastructure in their day-to-day activities, with software vendors to stimulate further uptake, and with the pathology and diagnostic imaging sector to make those records available.

“NEHTA is also working to ensure the significant intellectual property and knowledge built up over the past ten years of investment is handed over to the Australian Commission for eHealth (ACeH), such that the Commission is well placed to lead national eHealth into the next phase.”

He said that in its final 12 months of operation, NEHTA was focused on driving meaningful use of the national infrastructure. “The highways have been built; now we need to get the cars to drive them.”

Mr Fleming named the Healthcare Identifiers (HI) Service, the National Authentication Service for Health (NASH) and clinical document specifications as foundations that have been delivered. NEHTA was also responsible for design and specification work for the PCEHR.

The annual report also says there is “significant activity” for its eHealth product range, including the Australian Medicines Terminology (AMT), which has been implemented by the Tasmanian Department of Health and Human Services and as a component of electronic medications management (EMM) systems in some hospitals.

It has also worked to establish the use of the SNOMED clinical terminology by Australian healthcare organisations.

“NEHTA is now working with a number of hospital pharmacy software vendors to incorporate AMT and SNOMED CT-AU into their software, which will enable hospitals using these software packages to send AMT-coded discharge summaries, prescription records, and dispense records to the [PCEHR],” it said.

It also reports that since claims made back in 2013 by US-based firm MMRGlobal that NEHTA might be infringing MMR’s patents, NEHTA has had no correspondence since with MMR’s lawyers.

MMRGlobal reported revenues of just over $2m last year, up from $500,000 the year before. Its shares are currently being traded at 0.005c and the company appears to be attempting a reverse stock split to shore up its price.

Health& signs on with Validic for device data feeds

Melbourne-based digital health information provider Health& has partnered with US firm Validic to use its application programming interface (API) capabilities to connect data from fitness and medical devices with the personal electronic health record Health& is building.

Validic is a North Carolina-based start-up that is doing some of the hard yards in developing APIs for the numerous medical and wellness devices now on the market.

The company says it is now supporting more than 215 devices, including new digital health technologies such as activity devices and wellness applications from Microsoft, Sony and Epson, remote ‘wellness station’ or health kiosk Higi, and Visiomed’s BeWell Connect, which provides several medical-grade devices to remotely manage patients’ health and wellness.

For Health&, Validic will take care of the technology required to upload data from apps and devices to Health&’s planned personal EHR. Health&’s portal, which is due to be released early next year, will include a personalised dashboard with links to health records and data from devices and apps, a content library and the ‘dynamic digital doctor’ that allows consumers to receive truly personalised information and is the core of Health&’s ambitious technology platform.

Health& CEO John Stewart said that by using Validic’s technology, Health& will be able to deliver its application far more quickly, with better results and functionality, at a lower cost.

“Validic is building the links between apps and consumer devices and the sort of software that we are building,” Mr Stewart said.

“To create links for all of the consumer health devices out there is a huge undertaking for software companies like ours so Validic has taken on the job of building APIs for all of those devices, and then we’ll build an API to Validic. It is the connectivity that digital health needs.”

Validic also offers the capability to capture digital health data from Bluetooth-enabled devices and new technologies like Apple Health directly into its clients’ own mobile applications.

It has built an Apple Health library and a HealthKit API that can be connected to iOS mobile applications for healthcare organisations.

Canterbury DHB at the sharp end of SI PICS roll-out

Canterbury District Health Board is at the “sharp end” of preparations for the implementation of the South Island Patient Information Care System (SI PICS), with the first go-live at Burwood Hospital expected in the first half of next year.

SI PICS is being developed by the South Island Alliance (SIA) in partnership with Orion Health and will be rolled out to all five DHBs, replacing eight different patient management systems currently in use.

It will integrate with the Health Connect South (HCS) clinical portal, also built by Orion Health and which most of the DHBs are already operating, and will provide access to patient demographics, the master patient index, appointment booking, wait list management, patient transfers, admissions and discharges and alerts and allergies.

Orion Health’s senior vice president for Smarter Hospitals, David Hepburn, said the first go-live at the sub-acute Burwood Hospital in Christchurch was scheduled for around April or May 2016.

“Canterbury right now is really getting into the sharp end with the go-live preparation for Burwood Hospital, which we expect to probably be the fourth or fifth month of next year,” Mr Hepburn said.

“We’re going to deliver a software load, which is the Burwood instance, in December, which we’ve been working towards over a number of releases. This is the one that Burwood will take to go-live, and then we go into [user acceptance testing] in January or February and then hopefully into production in April.”

Nelson Marlborough DHB will then roll out the system at Nelson Hospital in September next year, followed by phase two of the Canterbury DHB project in early 2017. After that, SI PICS will roll out to South Canterbury, West Coast, and then Southern DHB.

While SI PICS is currently one of its largest projects, Orion Health is also rolling out its clinical workstation throughout the country as part of the national health IT plan. In addition to overseeing Smarter Hospitals on a global scale, Mr Hepburn is also responsible for Orion Health’s New Zealand strategy.

As such, he said he was intrigued to hear Health Minister Jonathan Coleman’s announcement at the HINZ conference last month that NZ will introduce a single electronic health record in the next five years, as well as a common blueprint for digital hospitals that will measure them against the HIMSS electronic medical record adoption model (EMRAM).

Dr Coleman told the conference that he wanted to see the National Health IT Board’s foundational programs such as the clinical workstation and CSC’s MedChart medications management implementation completed, as well as to leverage existing, regional shared care projects to create a single national EHR that can tap into the many smaller EMRs being used.

While details are still scarce, Mr Hepburn said the plan had the ability to “supercharge” programs such as the clinical workstation and medications management, and would enable the four regional areas – Southern, Midland, Central and Northern – to take up the latest technology.

Medications management is a hugely complex area that the health sector as a whole will have to work collaboratively on, Mr Hepburn said.

“The medications area is one where we’ve got to work out how to align with the sector’s goals and health outcomes, with the DHBs and the Minister’s target,” he said.

“It’s about how we collaborate with the likes of IBM, CSC. How we work with Simpl around ePrescribing, there’s Sysmex out there with Testsafe – all these things need to work together. So what I’m trying to work out, as part of our NZ strategy, is how we interact to create great sector alignment and collaboration that works towards creating the outcomes.”

The digital hospitals blueprint announcement and the idea of rating hospitals against the HIMSS EMRAM model would also align well with Orion’s strategy, he said. The company’s Enterprise platform is positioned in the HIMSS Stage 4 to 5 range and is part of how the company markets and sells the software globally.

Through what Mr Hepburn calls the Commonwealth model, Orion Health is concentrating on developing regional health platforms such as SI PICS and Health Connect South in markets such as New Zealand, Australia, Northern Ireland, Scotland and Canada.

For the growing South East Asian market and others such as Turkey that Orion is active in, the strategy is more about offering a mid-market, full hospital solution that can be implemented on an enterprise basis across groups of five or seven hospitals.

“It’s something that can be rapidly deployed, it is functional, it meets HIMSS EMRAM level 5, and it can work most importantly across the whole system,” he said.

Govt announces eHealth taskforce with real health IT experience

Former NSW Health director-general Robyn Kruk has been appointed as the independent chair of the steering committee for the taskforce charged with setting up the Australian Commission for eHealth, joining what has been greeted as a pleasing number of seasoned practitioners with real experience of eHealth and health IT implementations on the committee.

In addition to federal Department of Health special advisor and former CIO Paul Madden, the committee includes Stephen Moo, CIO of the Northern Territory Department of Health, and Michael Walsh, currently director-general of Queensland Health and a former eHealth NSW CEO/CIO.

As reported by Pulse+IT earlier this week, former AMA president and current NEHTA chairman Steve Hambleton, Queensland GP and telehealth advocate Ewen McPhee and UnitingCare Queensland executive director Richard Royle – who oversaw the building of Australia’s first digital hospital in a regional area and chaired the Royle review into the PCEHR – have also been appointed to the committee.

And in what is thought to be one of the first appointments of a health informatician to a committee overseeing eHealth, Chris Pearce, vice president of the Australasian College of Health Informatics (ACHI), director of research at Melbourne East General Practice Network and a practicing GP, has been appointed to the committee as a health informatics representative.

Associate Professor Pearce was also clinical design lead at NEHTA for five years and he has an academic appointment with Monash University.

ACHI president Klaus Veil said health informatics as a distinct profession had been poorly recognised in the past and A/Prof Pearce’s appointment was timely recognition of the necessary skills needed for eHealth policy-making and implementations at federal, state and local levels.

“We have for a long time expressed the view that only a sound, evidence-based approach will realise the benefits of the PCEHR that were originally sought and expected,” Adjunct Associate Professor Veil said.

“In particular, we believe the PCEHR needs to be transformed into a useful and effective tool for general practice and the broader clinical community. ACHI has regularly contributed and provided this type of input to the national healthcare reform policies, including the PCEHR.”

Dr Pearce, Dr Hambleton and Dr McPhee are all practising GPs and fellows of the RACGP. Dr McPhee is also a fellow of the Australian College of Rural and Remote Medicine and treasurer of the Rural Doctors Association of Australia.

The committee also includes tech start-up advocate Peter Cooper, professional company director Eileen Doyle and consumer advocate Jan Donovan, who is a board member of the Consumers Health Forum and a former policy officer with the Council on the Ageing.

Officially known as the eHealth Implementation Taskforce Steering Committee responsible for the establishment of the Australian Commission for eHealth (ACeH), the names of committee members were released late this afternoon by federal health minister Sussan Ley.

Ms Ley said in a statement that the committee will design, implement and oversee the transition of functions and resources from the Department of Health and NEHTA to ACeH.

“The Australian Commission for eHealth will simplify and streamline the current governance arrangements and will ensure better accountability, greater transparency and improve stakeholder engagement throughout,” Ms Ley said.

ACeH will also oversee the operation and evolution of national electronic health systems and will be the system operator of the PCEHR, soon to be renamed My Health Record, she said.

 

   

   

 

 

   

   

 

 

   

   

 

 

   

   

 

 

   

   

 

 

   

   

 

 

   

   

 

 

   

   

 

 

   

   

 

 

   

   

 

 

   

   

 

Members of the implementation taskforce steering committee
Robyn Kruk independent chair
Steve Hambleton clinician
Ewen McPhee clinician
Chris Pearce health informatician
Richard Royle private hospital sector
Paul Madden Commonwealth
Michael Walsh Australian Health Ministers Advisory Council
Stephen Moo Australian Health Ministers Advisory Council
Jan Donovan consumer matters
Peter Cooper IT and innovation
Eileen Doyle governance and organisational design

Best Practice prepares to let the Lava flow after successful summit

Best Practice Software (Bp) is gearing up for the imminent launch of the next version of its clinical and practice management solutions following a sneak preview at the company’s annual summit on the Gold Coast on the weekend.

Bp’s chief relationship officer Lorraine Pyefinch said the company had wanted to have the full version – dubbed Lava, one of the colours of the company’s finch mascot – available at the event but it was still in the final stages of quality assurance.

Lava promises to be a big release, with over 880 development items added, the most significant of which includes improvements to the financial reporting capabilities of Bp’s Management module, in particular to adjustments.

“It’s complex but it is a flexible approach to being able to handle all of the vagaries that can happen sometimes when you’re dealing with payments in a surgery,” Mrs Pyefinch said. “Not only receiving payments from customers and how that might be apportioned but also making adjustments when there have been issues with Medicare claiming. There is a lot more rigour but also flexibility.”

Mrs Pyefinch said the company expected the financial improvements to be well received by those practices that use Bp Management as well as Clinical, which is now upwards of 85 per cent of the user base. In the past, many Bp Clinical customers have used the PracSoft practice management module from rival MedicalDirector because the latter had full integration with the Tyro payments system.

Bp added full Tyro integration in late 2013, with many customers waiting until it was available before opting for the full clinical and management package from Bp, Mrs Pyefinch said.

“We have multi-merchant support with Tyro included in Lava as well so we are expecting another big influx of customers once that goes in.”

Other features include improvements to device integration and document handling, along with multi-location support for practices with more than one site.

There are also some new commercial partners on board and updates to existing relationships, including HealthLink’s Aduro smart forms.

“We’ve also integrated a product called HealthShare, which has a facility where you can access online, credible sources of information you can then print out for the patient,” Mrs Pyefinch said.

“We already supply a lot of information from various parties and the users can also save documents that they might use regularly, but this has the ability to get the very latest information because it is being updated all the time through HealthShare.”

She said delegates at the summit were interested in future developments in terms of portability and mobility, and many were also interested in Bp’s acquisition of New Zealand software company Houston Medical in April.

Houston had some general practice customers for its VIP.net product but was predominantly used by medical specialists and allied health practitioners, with a thriving market share among ophthalmology practices.

Mrs Pyefinch said Bp was about to move the former Houston operations into new premises in its home town of Hamilton, where the company plans to establish a training hub similar to its new training centre in Brisbane.

“We’ve spent the last few months engaging with our new customers from Houston, obviously to get a better understanding of what their experience has been of Houston and how we can improve on that,” she said. “A lot of that work is now under way.

“We have appointed another four staff and we’ve basically been doing some scoping work with regard to the New Zealand market. Obviously we are looking at growth across the board in Australasia for all of our products, and we are preparing a product positioning strategy at the moment to determine our product range and pricing.”

App provides guidance on behavioural symptoms of dementia

The Dementia Collaborative Research Centres (DCRCs) have launched a dementia care app to provide guidance to carers about the behavioural changes that can occur in dementia.

The Care4Dementia app is based on printed guides developed by the DCRC for Assessment and Better Care (DCRC ABC) at the University of NSW, which are also available in app form for clinicians.

Project coordinator Kim Burns said carers wanted nformation and advice at their fingertips, in language that is clear and easy to understand.

“The app was developed after extensive consultation with experienced carers and expert clinicians,” Ms Burns said.

“It covers an array of potential behavioural scenarios that might arise in dementia and strategies to manage these.”

More than 90 per cent of people with dementia display some form of behavioural or psychological symptoms during the course of their condition. These can include aggressive behaviours, agitated behaviours, anxiety, apathy, calling out, depression, delusions and hallucinations, resistance to care, socially inappropriate behaviours, sleep pattern changes and wandering behaviours.

Henry Brodaty, project leader and director of the DCRC ABC, said that for behaviours of concern, carers should always seek individual guidance from a GP or other health professional who is experienced in the management of behavioural changes in dementia.

As with all guidelines, recommendations may not be appropriate for use in all circumstances; help for the person with dementia is best tailored to the person’s unique circumstances, he said.

The app was launched at the 9th National Dementia Research and Knowledge Translation Forum in Sydney this week, where Ms Burns presented results from an evaluation study that investigated clinicians’ use of an app designed specifically to support health professionals in the management of behavioural and psychological symptoms of dementia (BPSD).

“Our findings suggest that this type of technology has the potential to support health professionals caring for persons with dementia and is being used successfully alongside traditional methods such as the printed guides,” Ms Burns said.

Both the Care4Dementia and BPSD Guide apps are available via the iTunes and Google Play app stores.

EMR promotes entrepreneurship and innovation in India

Healthcare providers in India are slowly recognising the benefits of electronic medical records (EMR) to deliver efficient, advanced and cost-effective healthcare.

The growth is led by increased participation by private healthcare providers, advancements in digital technology, adaptation of smartphones, improved government reforms, and a pressing need for delivering patient-centric care, according to Ahimanikya Satapathy, CEO of DocEngage, which markets software aimed at helping clinics and home care providers into optimise operational workflow.

“Physicians want a framework that simplifies their day-to-day operations and enables them to deliver valuable experiences to patients,” Mr Satapathy said. “Patients, on the other hand, want outcomes that improve their decision making. The expectation gap between physicians and patients can be narrowed down through technologies like EMR.”

DocEngage is one of the innovative start-ups in the Indian digital healthcare space that is trying to empower healthcare providers with an integrated framework that provides EMR storage, laboratory management, inventory tracking, appointment scheduling, invoice management and revenue analytics.

Mr Satapathy said that while the popular motive for using EMRs was cost-reduction and process optimisation, healthcare providers are looking beyond the ROI-based model and focusing on delivering value-based care.

“Lots of IT companies try to build an EMR infrastructure with the focus on storing medical records using avant-garde technologies in order to reduce operational costs, without taking into perspective the outlook of patients towards it,” he said. “Frankly speaking, I don’t think that’s the right way to approach it.

“I believe that technology should not break the existing healthcare system, but rather cater new ways to improve it. In geographies like India, where affinity towards technology is low, digital healthcare solutions like EMR should focus on delivering value-based care to the patients, while providing simplified and composable workflows that improve the overall productivity of physicians.”

Mr Satapathy defined value-based care as digital healthcare solutions that should focus on creating outcomes that matter most to patients and physicians, while mitigating the cost to deliver it.

“With the Indian healthcare sector getting more competitive, healthcare providers need to shift towards delivering faster, better and cost-effective healthcare,” he said. “The decision making now needs to be proactive and data-driven.”

According to a recent Gartner report, Indian healthcare providers are estimated to spend $US1.2 billion on IT products and services in 2015, an increase of seven per cent from 2014.

However, citing the fact that Indian healthcare is a $100 billion market, Mr Satapathy said that the overall IT spending in the healthcare sector is largely disproportionate, and would only gear up in the next few years.

“If you look at the numbers, they tell you a different story,” he said. “Sure, we have increased our spending on technology, but Indian healthcare is a huge market, with great upside potential. If healthcare providers have to keep up with the pace, they would need a scalable architecture to support their sprightly growth.”

A recent report from Equentis Capital showed that the $100 billion Indian healthcare sector is expected to grow rapidly in the next few years at an impressive annual rate of 15 per cent, with projections expecting it to reach $158 billion by 2017.

Mr Satapathy said the biggest challenge for EMR-based solutions in the Indian healthcare sector was not adaptability, but rather the lack of a centralised and regulatory approved digital healthcare infrastructure.

“We say that health is wealth, but in practice, we don’t imbibe it,” he said. “We have a centralised wealth repository tracking the monetary transactions of every citizen in the country, but we don’t have a centralised healthcare repository that keeps a record of every citizen’s medical transactions.”

India’s Office of the Registrar General (ORG) runs two initiatives on open health data: one called Sample Registration System (SRS), a demographic survey with a sample size of eight million people and Annual Health Survey (AHS), which collects data on 161 indicators from 25 million participants.

Though there have been certain moves towards encouraging open health data by the Indian government, including the recent collaboration at Healthcare DataPalooza with HSS for leveraging national level health and demographic data, that data is yet to be made accessible enough to tech-entrepreneurs for developing innovative healthcare solution.s

The problem seems to be a lack of sophisticated digital infrastructure that can collect anonymous patient data and provide secure access to IT providers for extracting actionable healthcare insights.

“The first step towards creating an effective open health infrastructure in India is to create a standardised healthcare repository that’s accessible to every healthcare provider in India,” Mr Satapathy said. “We need to ensure that healthcare providers commit to sharing patient data anonymously and we need to provide secure means for allowing tech entrepreneurs to access it.”

Although western healthcare systems have been actively adapting EMRs and open health data initiatives, there have been lapses in security that has led to compromises of sensitive medical information. Mr. Satapathy believes that, since India in the initial phase of adaptation, it needs to take cues from these systems, and develop clear, secure and regulated ways on how open health data can be accessed and used.

“We need to find a balanced approach for our digital healthcare system, rather than being too socialistic like UK or Canada, or too capitalistic like the US. The government needs to create a pragmatic model that not only looks good on paper, but is also secure, implementable and scalable.”

The National Knowledge Commission (NKC) is actively working towards establishing a uniform national standard and developing a common EMR repository for India.

In addition, the recently launched Digital India campaign is also expected to trigger technological transformation in the lot of diverse sectors in India, including healthcare, with Indian companies pledging to invest more than $70 billion in the campaign.

With 70 per cent of Indian healthcare being unorganised, the large influx of capital, combined with government reforms and revived entrepreneurship spirit, would only boost the growth of India’s traditional healthcare sector through smart digital solutions like EMRs.

International health IT week in review: August 9

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

St George’s first with the NEWS
Digital Health News ~ Rebecca McBeth ~ 07/08/2015

St George’s Healthcare NHS Trust is piloting the use of vital signs monitoring equipment that integrates with its Cerner Millennium electronic patient record and new whiteboards.


IBM to acquire Merge Healthcare in $1B deal
FierceHealthIT ~ Katie Dvorak ~ 06/08/2015

IBM is taking its Watson technology one step further through a $1 billion acquisition of medical image management platform Merge Healthcare.


Stanford’s ReseachKit study goes globe-trotting
mHealth News ~ Eric Wicklund ~ 06/08/2015

Stanford University researchers have announced that their MyHeart Counts app, one of the first to be launched in March through Apple’s ResearchKit platform, is now available to residents in the United Kingdom and Hong Kong.


FCC vote allows unlicensed devices to operate on same frequency as medical monitors
FierceHealthIT ~ Dan Bowman ~ 06/08/2015

Unlicensed devices will be allowed to operate on the same frequency as wireless medical telemetry service systems for cardiac and fetal monitoring, after the Federal Communications Commission voted to modernize rules to “accommodate growing demand for … innovation.”


Tech support offered to vanguards
Digital Health News ~ Thomas Meek ~ 05/08/2015

Interoperability and information governance are among the technological priorities for NHS ‘vanguard’ sites, according to a support package published by NHS England.


Primary care providers: HIT is a positive disruption
FierceHealthIT ~ Katie Dvorak ~ 05/08/2015

Primary care providers have mixed views when it comes to changes in healthcare delivery and payment, but many see health information technology as a positive disruption.


Telemedicine market to soar past $30B
HealthcareITNews ~ Bernie Monegain ~ 04/08/2015

The global market for telemedicine is expected to be worth more than $34 billion by the end of 2020.


Cerner’s Zane Burke: DoD deal won’t hinder other commitments
FierceEMR ~ Marla Durben Hirsch ~ 04/08/2015

In Cerner’s first comments since winning the Department of Defense’s coveted electronic health record modernization contract in a bid with Leidos and Accenture Federal, company President Zane Burke said that he does not expect it to impact other client rollouts.


Papworth says no to Epic
Digital Health News ~ Thomas Meek ~ 03/08/2015

Papworth Hospital NHS Foundation Trust has decided not to go with the Epic electronic patient record; in a move that coincides with Monitor’s announcement that it is investigating the installation of the clinical system at Cambridge University Hospitals NHS Foundation Trust.


FDA calls for hospitals to discontinue use of infusion pumps due to security vulnerabilities
FierceHealthIT ~ Katie Dvorak ~ 03/08/2015

Hospital systems that use Hospira Symbiq Infusion Systems should transition to a different infusion system “as soon as possible” due to cybersecurity concerns with the Hospira model, according to the U.S. Food and Drug Administration.


eHealth Exchange continues strong growth trajectory
Health Data Management ~ Greg Slabodkin ~ 03/08/2015

HIE network eHealth Exchange, a rapidly growing community of healthcare organizations who securely share clinical information over the Internet using a common set of standards and specifications, has reached 100 members and expects to connect 40 percent of U.S. hospitals by the end of the year.


NHS gets smart with contactless cards
Digital Health News ~ Thomas Meek ~ 03/08/2015

NHS trusts will have access to contactless smartcards, so staff can log into clinical systems on tablet computers, from autumn this year.


Hospital CIOs, others urge HHS to quickly finalize MU alterations rule
FierceEMR ~ Marla Durben Hirsch ~ 03/08/2015

A diverse group of electronic health record vendors, provider representatives and others have called on the Department of Health and Human Services to quickly finalize the proposed rule modifying the Meaningful Use requirements for 2015-2017 before it’s too late for them to comply with it.


Coalition urges CMS to finalize 2015-2017 EHR incentive rule
Health Data Management ~ Greg Slabodkin ~ 03/08/2015

A coalition of 18 industry stakeholders, including electronic health record vendors, health IT associations, and providers, is calling on the Centers for Medicare and Medicaid Services to finalize its proposed 2015-2017 changes to the EHR Incentive Program


Doctors in Europe using digital health — but don’t know why
mHealth News ~ Eric Wicklund ~ 03/08/2015

A new survey out of Europe finds that providers there are more supportive of digital health technologies than their American counterparts.


CIOs ‘surprised’ at Cerner DoD win
HealthcareITNews ~ Michelle Ronan Noteboom ~ 31/07/2015

Many health system chief information officers say they weren’t expecting the Cerner/Leidos team to win the coveted contract to overhaul the Department of Defense’s electronic health record system.


IBM-CVS deal puts Watson in the pharmacy
mHealth News ~ Eric Wicklund ~ 31/07/2015

A new partnership between IBM and CVS could push pharmacists to the forefront of the connected care platform.