ATC 2015 to explore the uberfication of healthcare

Technologists and clinicians will demonstrate how technology is reinventing the house call through the “uberfication” of healthcare at the Australian Telehealth Conference 2015 (ATC 2015), being held in Sydney in February.

The conference, which has the theme of integrating care: bringing health services and people together through telehealth, will feature a number of practical demonstrations of existing and emerging technology in the fields of home-care delivery, mental health and consumer tech and wellness management.

Organised by the Health Informatics Society of Australia (HISA), the Allied Health Professions Australia (AHPA), the Australasian Telehealth Society (ATS), the Australian College of Rural and Remote Medicine (ACRRM), the Health Information Management Association of Australia (HIMAA) and the Royal Australian College of General Practitioners (RACGP), the conference will open with an address by conference chair Gary Morgan and a short speech by health minister Peter Dutton.

Speakers include eHealth NSW chief clinical information officer John Lambert on the role of telehealth in NSW; and Martin Seers, director of Homecare Medical in New Zealand, on how telehealth can integrate and support mainstream care delivery.

The use of telehealth in allied health and nursing will feature on the first day, while Catherine Daley, CEO of integratedliving Australia, will discuss the successful enhanced aged care for Aboriginal and Torres Strait Islander Australians project her organisation is running in Queensland and NSW, on the second day.

There will also be a session on state-based telemedicine approaches, including NSW, Victoria and Queensland, as well as a presentation by the University of Queensland’s Bruce Chater on bridging the divide between state systems and MBS arrangements for telehealth.

Another will involve a number of CEOs and researchers discussing how to use new technologies to make mental healthcare more accessible.

The final day will feature the “uberfication” of healthcare session, which will include technologists and doctors demonstrating their technology.

The last session will involve TED-style 10 to 15-minute presentations on consumer tech and wellness management.

ATC 2015 is being held in Sydney from February 22 to 24, 2015.

Appointments in the palm of your hand

This article first appeared in the November 2014 issue of Pulse+IT Magazine.

The ability to book an appointment online – and preferably through a smartphone app – is usually in the top three when patients are asked to rate what they value most in electronic interactions with their healthcare providers. There are now a number of online booking systems out there, many accompanied by a searchable or practice-specific app.

Online appointment services have been around for a number of years and most can be integrated into practice management systems to streamline the appointments process and free up reception staff. Not all practices have taken advantage of these systems, but the ones that do often report productivity gains as well as providing an extra service to patients as the main benefits.

And with patients increasingly expecting to be able to search for or book appointments online or through an app, for practices open to new patients these services are becoming a must have. Even practices that don’t take new patients are being encouraged to offer an appointment app or at least an online booking capability to realise some of those productivity benefits.

The online appointments market itself is hotting up, with MedicalDirector recently announcing that it has built its own internal system within PracSoft and HealthEngine announcing it is offering its booking service for free to AGPAL-accredited practices, which account for approximately half of all general practices in Australia.

Many are now also accompanied by an app, with the majority of online booking services now making them available either as a consumer app in which patients can search for the nearest practitioner or the best appointment time, or as practice-specific apps, which directly link to the practice’s online system. We take a look at what’s on the market.

To read the full story, click here for the November 2014 issue of Pulse+IT Magazine.

Opinion: Practices need customised IT, not sales pitches

Selecting the best IT provider is perhaps the biggest challenge for practices that need to outsource their IT support or are simply unprepared to invest in their own IT team.

Initial interaction, whether by phone or in person, must involve a two-way conversation rather than a prepared monologue or quick elevator pitch from the prospective provider. Of course, the term ‘pitch’ also has its negative connotations, implying a means of falsifying the virtues of a product and service and is unlikely to generate a favourable reaction without advance research on the client issues that need resolving.

The reality is that clients are not interested in forming beneficial partnerships with so-called 24/7 customer service or cheesy promotional gifts if the core product or IT service offers little practical benefit. They want a solution that works, is cost-effective, solves a problem for them, or provides a function that increases efficiency. Rather than using the term ‘pitch,’ clients are more open to ‘suggestions’ or ‘recommendations’ that will benefit the business.

So-called sales pitches can vary widely, often failing to consider the actual requirements of the client or simply becoming the epicentre of a yawn-generating speech, with listeners often losing the will to live or comparing their predicament to attending a timeshare presentation in ancient Egyptian.

Sales professionals can avoid this situation by inviting audience participation in the form of questions or observations, by using visual aids that demonstrate practical knowledge of the client company’s processes and by identifying where improvement is possible.

No company will admit that their competitors offer more attractive options. In a world where everyone claims to be experts and guarantees personalised customer service or timely delivery, how can those seeking a competent provider actually make an informed decision?

A little research goes a long way and even the briefest of online searches will yield results that can be used as a shortlist. Each company can then be researched a little more. How does the website look? Does it speak to healthcare professionals? Are case studies and testimonials offered? Is contact information available? If the answer is “Yes” to all of these, then proceed to the next step.

Check with industry colleagues and contacts and ask their opinion, as they may have dealt with these companies in the past and have firsthand experience of the service provided. Case studies and industry testimonials are a valid indicator of expertise and local support is another key consideration.

If feedback is positive, make an initial enquiry. Most companies provide an information pack that will highlight the main service advantages, with poor quality marketing material acting as a warning. Any company that fails to produce professional brochures, catalogues or documentation is unlikely to inspire confidence, even if their IT services are top-notch.

The use of trials or demos can aid a decision but not all service providers offer these options.

Flexibility is important and sales executives need to tailor their pitch to their audience rather than work from a predefined template. Droning on about the technical advantages of a service means little to a non-technical audience. Management speak, legal jargon in contracts, and industry-specific terms only serve to confuse people.

Medical professionals should ask direct questions and test the claimed expertise of the provider. A service provider for healthcare customers will understand the processes involved, the hardware and software used and can readily suggest improvements once an audit has taken place.

Healthcare is a niche market and support solutions must involve providers that are familiar with medical IT requirement, processes and software. Some providers claim expertise but then recommend enterprise solutions or are unwilling to change processes, due to their own lack of knowledge when it comes to dedicated medical software, whether for billing, medical records or security issues for data storage.

Clinics and hospitals that identify their need for customised IT solutions due to problems with existing services will entertain alternatives that work, even when more expensive than off-the-shelf solutions.

Those without IT expertise in-house are unlikely to be impressed by a technical sales pitch. Similarly, those with technical know-how are keenly interested in the technical side of the service. Savvy sales professionals will know their audience and make their suggestions accordingly.

Most clinics are merely seeking a functional service that enhances remote collaboration, reducing costs and improving efficiency. The majority will agree that cost is not the only factor in the decision-making process and in many cases you “get what you pay for”.

By exercising due diligence and targeting providers that specialise in healthcare support, clinics are more likely to find the support they need, without being tied to a solution that simply does not work.

Rob Khamas is an eHealth solutions strategist with REND Tech Associates.

GP co-pay software changes going ahead despite deadlock

The Department of Human Services (DHS) is proceeding with changes to electronic Medicare claiming to accommodate the proposed $7 GP co-payment despite the legislation not having been introduced to parliament.

In an email sent to software vendors from DHS’s eHealth and government to business systems branch last Friday and seen by Pulse+IT, DHS says vendors will need to make changes to their practice management software to accommodate the co-pay and allow practices to check if a concessional patient has reached the annual service cap of 10 visits to a GP or community pathology or diagnostic imaging provider.

The federal government announced in the May budget that it would introduce a $7 co-payment for GP consults and out-of-hospital diagnostic services. The Medicare rebate would be cut by $5, with healthcare providers encouraged to charge an up-front $7 fee per consultation.

Health Minister Peter Dutton said providers could then directly bill the patient $5 to make up for the rebate cut as well as a $2 “windfall” for the provider. The $5 cut would then be directed into the government’s proposed medical research fund.

The proposal has received strong opposition from consumer and healthcare groups, with the Australian Medical Association putting forward its own co-payment plan that does not include a cut to the Medicare rebate.

The AMA revealed independent modelling last week that showed that the extra red tape involved in collecting the co-payment would cost between $1.41 and $1.61 per transaction, effectively wiping out the “windfall”.

In addition to opposition from Labor and the Greens, PUP leader Clive Palmer has stated his party will not pass the co-pay legislation in the Senate, although Mr Dutton says negotiations are ongoing and he hoped the legislation would be passed. He has yet to introduce the legislation to the lower house.

In the meantime, DHS has been told to begin developing a client adaptor for electronic claiming systems to accommodate the new co-pay, as well as a verification service to allow practices to check if a concessional patient or child under 16 has reached the proposed 10-visit service cap.

This will theoretically allow the practice to revert to the previous bulk-billed arrangement for those patients once they have reached the cap.

The government also proposes to rename the bulk-billing incentives paid to general practices as the low gap incentive, which will be paid to practices that bulk bill concessional patients and children under 16 as long as they also charge the co-pay.

Changes to the electronic claiming system will be required to allow practices to continue to receive the low gap incentive after concessional patients reach the service cap.

While it is understood the changes to software will not be onerous, it is not clear if practice management software vendors will be paid for the integration work required. DHS and Mr Dutton’s office have been approached for comment.

In the email to vendors, DHS proposes to develop a new client adaptor that will interact with the Medicare Online and Eclipse electronic claiming systems.

DHS says it will develop new logic packs that are compatible with existing client adaptors – of which there are several versions going back to 2009 – as well as a new client adaptor to be released next year that will accommodate the co-pay provisions.

Software vendors need to undergo an integration process and receive a notice of integration (NOI) with Medicare to use the client adaptors. DHS says that those vendors that don’t have an NOI will need to upgrade to a newer client adaptor and receive an NOI.

Those vendors that have an existing NOI will still need to implement the logic pack changes and receive a new NOI. DHS says vendors can choose to wait until the latest client adaptor is released in June 2015, the month before the co-pay is proposed to start, or to implement the logic pack changes earlier.

It proposes to release a beta client adaptor in January next year to allow for NOI testing and a final version in May. The full “patient contribution” release is scheduled for June.

Pulse+IT has approached both the department and the minister’s office for more information on the costs associated with developing the new system, and whether software vendors will be remunerated for their integration work.

Darling Downs Health-e-Regions project expands to new towns

The small towns of Tara and Wandoan in the western Darling Downs region have been added to the University of Queensland’s Health-e-Regions telehealth project, joining Dalby, Chinchilla and Miles in receiving improved access to specialist care.

Half a million dollars in extra funding has been contributed by coal seam gas company QGC, the main sponsor of the project, to expand it to Tara and Wandoan, allowing patients and local clinicians to video conference with specialists from hospitals in Toowoomba and Brisbane.

Health-e-Regions has been running for over a year and in that time has seen a doubling of telehealth services provided. Elderly patients in Dalby Hospital and residents of the Illoura aged care facility in Chinchilla are now receiving regular sessions with geriatricians from the Princess Alexandra Hospital (PAH) in Brisbane.

The project is also working with local GPs to help improve the referral process for specialist consultations by video.

As with the services being developed for the three original towns, the Health-e-Regions team, led by UQ’s Centre for Online Health (COH), will work closely with the new additions to develop services based on need, COH deputy director Anthony Smith said.

“We’ve had an overwhelmingly positive response from patients who have had a telehealth appointment as part of the Health-e-Regions project, and are looking forward to engaging with the Tara and Wandoan community to generate telehealth services specific to their needs,” Associate Professor Smith said.

QGC’s vice-president for sustainability, Brett Smith, said the service would also benefit employees living and working in the region.

“From our own experience, we have staff living in the region whose families are benefitting from not having to travel to Brisbane for regular specialist appointments,” Mr Smith said. “They are able to live their lives without having to constantly plan around those visits.’’

QGC provided $1.3 million for the original project, which covers the cost of equipment installations and development costs. As part of the COH philosophy, however, the plan is to devise telehealth models that are financially sustainable.

Telstra gives Verdi a boost as it pursues mobile strategy

When Telstra was looking at building a new health division last year, one of the first companies it began talking to was IP Health, the Melbourne-based firm best known for developing the Verdi suite of products in association with the Peter MacCallum Cancer Centre.

Now known just as Verdi, the company has designed a range of products that are in extensive use not only at Peter Mac but also at the Mater hospital group in Brisbane. They include the original capability of providing clinicians with a single view into all of a hospital’s clinical software, including the patient administration system, radiology and pathology systems, pharmacy and specialist clinical databases. Originally called the Patient Browser, this is now known as V-Chart.

Since then, Verdi has gone on to develop extra capabilities, such as its V-Referrals system. It also has V-Notes, a mobile solution that allows clinicians to digitally write and sign notes or to dictate them for transcribing, and V-Photo, which allows clinicians to take a digital image and upload it straight to the patient record.

The future, of course, is mobile, so in addition to the latter two solutions Verdi has also developed V-Mobile, which provides much of the same capability as V-Chart in accessing the required clinical programs but does it through the clinician’s mobile device. The information is tailored so the clinician only sees information that is relevant to their workflow.

Now, the company is also working on a new solution to provide access to digital forms, and as well as a way to harness the explosion in medical apps and mobile medical devices, such as endoscopes that can be attached to an iPhone, to see how that can be integrated with Verdi.

It is also harnessing the vast resources of Telstra to broaden its reach. Telstra is the largest investor in the company and is leveraging its long-standing partnerships throughout the acute care sector in Australia to get a number of proof of concept trials up and running.

Verdi’s CEO, Ashley Renner, said that with the “Telstra machine” behind the company, the product can now be implemented even faster.

“Telstra is engaged with pretty much every public and private hospital across Australia, so we’ve now got proof of concepts in very large hospital groups on both private and public sites,” Mr Renner said.

He said that at the heart of Verdi is the ability to link in to the many diverse databases found in hospitals and pull them up in real time. “Instead of having to replace all the existing systems and put in a one-vendor approach, you can put this in as an overlay across the existing departmental systems.

“To clinicians, the key part of the product is that they can easily get to the information with the fewest numbers of clicks or touches. That’s what they want, and that’s where we’ve put all the effort in the product.”

Mr Renner said the technology has the ability to access a range of different clinical software from different vendors, including ultra-specialist databases that a clinician with research interests may have developed over time using consumer products like Access.

This isn’t something that an EMR can do, he said. “An EMR just looks at a single vertical and it doesn’t actually solve the problem in hospitals of this heterogeneity of databases. We call them popcorn databases.

“We can quickly go into the existing departmental system using our service-orientated architecture and we lift that data directly out of those systems. We link into the PAS as a source of truth and then we link into the RIS and the PACS and the pharmacy system and the allied health systems.

“So we’ve got the access, which is any mobile device – Android phone, Windows phone, the iOS ecosystem – then there’s the desktop client, and then there’s a middleware server. That’s where we spent our time, in writing that middleware server, so that we can link in.”

It is the middleware server that provides the real value proposition, he said. Hospitals have a tendency to invest large sums in different clinical systems that are unable to integrate with each other, but by sitting on top of or overlaying these systems and extracting pertinent data from them, Verdi can then offer that information up to the clinician.

And with the move to mobility, it can do that at the point of care or anywhere else for that matter. Mobility is an area the company jumped on early, and is something that suits both it and the workflow of clinicians intuitively.

“To run out a desktop hardware environment across hospitals is prohibitively expensive, so with bring your own devices, BYOD, clinicians now are essentially subsidising their own devices, but it gives these clinicians the right type of access,” Mr Renner said.

“It’s the ability to look at the patient record from wherever they are, whenever they want. Clinicians tend not to want to enter data, they can’t stand it, and the ability to quickly implement new features is the kind of driver that we have around our modules. It is easy to use and quick to implement.”

In addition to providing both desktop and mobile solutions, Verdi has also developed the V-Referral system. This is quite complex and is one reason why there are few if any purpose-built software packages on the market that can handle the hospital end of the referral process.

Verdi has designed a solution that can ‘receipt’ a referral from a GP by fax, email or secure messaging, triage that referral and then book it into the hospital’s internal system. It also automatically sends a notification back to the referring physician, meaning they don’t have to send out the same referral to different hospitals with the hopes of getting their patient seen quickly or their receptionist playing phone tag.

This solution also has a mobile component so the receiving doctor can triage the referrals on the go. “The biggest issue is that doctors don’t like to sit down and triage either lots of paper or on their desktop, so we’ve enabled a mobile side of this so that they can do this from the coffee shop or wherever they are,” Mr Renner said.

“If you’re a registrar and you’re not sure about triaging your referral or you’re a clinical nurse, you can then escalate it up to a senior consultant. If you allow over-booking, because the person’s obviously got melanoma and they need to be seen right away, it can be seen across lots of different clinics, which is how it’s being used today.

“This is one of the areas that we’ve seen where there’s a strong return on investment argument for moving toward the electronic format.”

In addition to the product suite, Verdi has a software development kit that has been used by customers like the Mater to develop a hospital-based personal health record and to link to the PCEHR. The company is further developing its portfolio to develop the capability to use digital forms that are completely mobile and finally do away with much of the paper that still plagues the acute care sector.

“We’re not believers in scanning other than for information such as incoming correspondence that you can’t get away from. Everything we do is atomic, and because we’re linked into all these databases, we can actually pre-populate a lot of the forms and the clinicians only have to enter the pertinent parts, not the whole form.

“When I first started this journey, I had a professor say to me ‘the thing you’re fighting against here it 800 years of evolution of paper’. There’s nothing easier today than scribbling on a piece of paper and handing it to a nurse.

“That’s always been a part of our ethos: we must make this better than paper.”

TEDMED Live comes to Melbourne

The University of Melbourne in association with the StartUpHealthTech community is hosting a stream of TEDMED Live from San Francisco and Washington DC this weekend.

TEDMED is the health and medicine arm of the Technology Entertainment Design (TED) series of conferences and is being held in the two US cities over the next few days.

TEDMED Live, which provides streaming video access to medical schools, teaching hospitals, selected non-profit organisations and government agencies free of charge, will broadcast the unified stage program to the University of Melbourne/StartUpHealthTech event this Sunday.

The Australian event will also feature leading researchers, academics and entrepreneurs in a series of interactive panel discussions.

StartUpHealthTech is 750-strong community of local health and technology researchers and entrepreneurs.

The event is being held at the Sidney Myer Asia Centre in Parkville on Sunday, September 14 from 10am to 3pm. Tickets are available online.

Integrated infection control for primary and secondary care

West Coast District Health Board is tracking patterns of infectious disease outbreaks in both general practice and hospitals through its new ICNet infection control system.

Implemented in April, ICNet can be applied across both primary and secondary care to monitor and assist with real-time management of infections.

West Coast DHB can use the system in both settings as it operates most of the regions general practices and its laboratory is part of the Lab Net Group, which also includes Canterbury, Taranaki and Hawke’s Bay laboratories.

Julie Ritchie, West Coast DHB’s clinical nurse specialist for infection prevention and control, said the software has replaced a previous paper-based system that was far less efficient.

“There is a big push on about antibiotic overuse,” Ms Ritchie said. “This system would pick something up as soon as the lab result was out, identifying antimicrobial resistance organisms such as MRSA.”

The software automates the collection of laboratory results, surgical and patient admission details into a browser-based display.

If a patient is carrying MRSA, a notification is added to ICNet and Ms Ritchie then contacts the health professionals dealing with the patient.

Advantages of using the system include significant time savings for infection control teams, increased patient contact, a reduction in ward outbreaks, increased education at the ward level and quicker interventions preventing relapses and cross infection.

West Coast and Canterbury DHBs hospital support and laboratories general manager Trevor English said the West Coast experience was very important for DHBs around the country.

“Infections are really one of the most serious risks to both patients and the health system worldwide,” Mr English said.

“A system like this that greatly improves our ability to track and manage infections from a patient’s first visit to a doctor for tests through to their stay in hospital is going to be hugely beneficial for our patients.”

Remote access to GP clinical systems for district nurses

District nurses in Hawke’s Bay are being given remote access to patient notes held in general practice systems in a pilot project that looks likely to be opened up to more clinicians next year.

Under the pilot, Hawke’s Bay DHB district nurses are being aligned to three general practices – The Hastings Health Centre, Totara Health and Te Mata Peak Practice – and are able to remotely access Medtech32 while in their patients’ homes.

They are also able to file any actions they have taken, note anything they have observed when visiting the patient in their home, and express any concerns. They can also schedule doctor’s appointments.

The nurses are employed and resourced by Hawke’s Bay DHB within its Oral, Rural and Community Service, but they are also closely aligned to the practice, at times physically basing themselves there when not visiting patients in their home.

Hastings Health Centre GP Alan Wright said the development of closer ties with district nursing staff was long overdue and the project was well integrated.

“GPs will learn quickly, as I have, that these district nurses are at the coalface of health care, working with patients in their own homes,” Dr Wright said.

“Giving them unrestricted access to our files can only benefit general practice. The inputting of their case notes can only advance our knowledge of our patients. Previously we might not have even known that a patient had been seen by a district nurse, and more importantly, what for.”

Hawke’s Bay DHB said there were several teething problems initially, mainly around poor knowledge of roles and incompatibility with each other’s methodology and way of practising. However, with the pilot now running for 15 months, a model is scheduled to be finalised by April next year and other general practices will be invited to participate.

The pilot, which was initiated by the general practices, also involves nurses working in the areas of assessment and advice regarding wounds, catheter and bowel management, administration of prescribed medications and support for patients with the management of other health issues.

Hawke’s Bay DHB clinical nurse manager for community nursing, Maree Gladstone, said opportunities to develop the concept of integration were becoming clearer. These include the possibility of holding district nurse clinics within the practice setting, streamlining the referral process and investigating alternative nursing models.

Multilab model for Wellington as DHBs complete Delphic roll-out

The Wellington region has completed its implementation of Sysmex’s Delphic laboratory information system (LIS), which will help streamline specimen flow across labs at Wellington, Hutt and Kenepuru hospitals.

Hutt Valley (HVDHB) and Capital & Coast (CCDHB) district health boards first started planning for the implementation in 2011, when they decided to implement a common LIS to replace an ageing system that was going out of support.

Sysmex CEO James Webster said that because it is a single system shared by the three labs, Hutt and Capital & Coast DHBs have been able to standardise the testing, workflow and business process and benefit from shared infrastructure costs.

“This ‘multilab’ model has also been adopted by other New Zealand public and private laboratories on the Delphic LIS,” Mr Webster said. “Further afield in Canada, Diagnostic Services of Manitoba’s Delphic LIS is centred in the city of Winnipeg.

“This common LIS is now shared across 18 metro and regional labs with more sites scheduled to join the system over the coming months. We see similar trends emerging in medical labs in Australia as labs aim to regionalise and consolidate their service. The LIS is an essential component to achieve this.”

The implementation of a single LIS aligns with the Ministry of Health’s National Health IT plan, which encourages DHBs to integrate clinical services and achieve cost savings through the better use of IT.

Capital & Coast DHB CEO Debbie Chin said it also fits with the NHIT plan’s long-term vision of having a common laboratory system across each region, making it easier to maintain consistent standards.

“These objectives are also supported in both of our DHBs’ annual plans and the regional services plan,” Ms Chin said.

“The completion of this LIS IT project marks a significant milestone in our developing DHB partnerships in the central region.”

In addition to Delphic, Sysmex also markets the Eclair web-based clinical information system which is used as the backbone of the TestSafe system, pioneered in Auckland and also in use in Canterbury.