Workforce, eHealth and classification

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

In addition to a number of workforce issues, eHealth and clinical classification emerged as key themes at the HIMAA NCCH National Conference in Darwin in October. Research was also high on the agenda, with a number of speakers urging the health information management and clinical coding professions to consider the value of research.

In her keynote presentation, Joanne Callen, a senior research fellow at the Centre for Health Systems and Safety Research (CHSSR) at the University of New South Wales, took delegates through examples of research into ICT implementations undertaken by the centre that have demonstrated benefits of eHealth to those managing the change, and to patients.

In one example, a Sydney hospital’s rheumatology department reduced seven information systems – four manual and thee electronic – into the one electronic medication management (eMM) system. Associate Professor Callen’s team was engaged to evaluate the impact of the eMM system on nurse work processes, and was able to demonstrate to management that nurses spent less time monitoring and more time on patient care.

Qualitative research with the nurses themselves revealed that, while they valued the improvement to their practice facilitated by eMM, what they particularly valued was its patient safety benefits – itself a positive outcome that decision makers might not otherwise have realised.

In another example, research with emergency department clinicians involved in the integration of electronic data systems into ward rounds across hospitals in two NSW local health districts found that not only did they value the ability to electronically capture clinical information at the point of care for immediate input by remote physicians, but their own documentation skills improved – an unexpected benefit.

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

Bug in MetaVision ICU system potentially catastrophic

A bug in the MetaVision intensive care software package being rolled out in several Brisbane hospitals has been identified as having the potential to seriously harm or even kill patients, several media outlets are reporting.

Fairfax’s The Brisbane Times reported that a risk assessment by the Metro North Hospital and Health Service – which covers Brisbane’s Prince Charles and Royal Brisbane and Women’s (RBWH) hospitals – had found potentially catastrophic problems with prescription errors caused by the system that had a 60 to 90 per cent likelihood of causing a patient death.

MetaVision, from US vendor iMDsoft, is one of the few specialist critical care software packages on the market. It is able to capture information from medical devices and contains a full medical record specific to ICU patients.

It also contains medications management and decision support, and is able to interface with the complex IV infusion pumps used to administer medications to patients in intensive care.

The ABC reported that according to the risk assessment report, “monitoring of patient records by pharmacists has revealed several potentially serious prescription errors specifically caused by the system”.

“Large volume prescriptions and high acuity of patients overlayed [sic] with functional risks of the system increases the likelihood of a SAC 1 (serious harm or death) event.

“There is no record of robust regression or functional testing at vendor, Queensland Health corporate or facility level.”

MetaVision has been rolled out in the ICUs at the Canberra and Calvary hospitals in the ACT, and at the Gold Coast, Prince Charles, Townsville, Rockhampton, Cairns and Logan hospitals in Queensland, where it has been installed for over a year.

It went live at Brisbane’s Royal Children’s in June, RBWH in September and at Princess Alexandra Hospital (PAH) just last week.

It is live at the Sydney Adventist Hospital and has also been chosen for a statewide roll-out in all ICUs in NSW.

iMDsoft issued a statement late on Monday saying that the problem was unique to the version implemented at Queensland Heath and does not affect any other installations in Australia.

“Late last week, certain clinicians from Queensland Heath highlighted potential risks as a result of prescribing with the MetaVision clinical information system,” iMDsoft’s director of marketing, Anne Belkin, said.

“iMDsoft is aware of this issue, and has already provided a solution to Queensland Heath. The software fix has been in testing at the site for several weeks and will be implemented in the near future.

“The risks highlighted by the report were originally identified during testing and, with close cooperation between iMDsoft and the clinicians at the Hospital and Health Service sites, a mitigation plan was immediately put into effect.

“The underlying risk is unique to the version implemented at Queensland Heath, and does not exist in any prior or subsequent releases for Australia. MetaVision is used at more than three hundred sites worldwide and is regulated by stringent international standards to ensure patient safety.”

Brent Richards, director of intensive care at the Gold Coast Hospital and then chairman of Queensland’s Statewide Intensive Care Clinical Network, told Pulse+IT last year that the system delivered improvements in workflow and safety.

“ICU is incredibly complex and can be quite hard to computerise, because we have a lot of data flow,” Dr Richards said. “You want to capture all of that data including the data from the equipment interfaces, which is transferred minutely in MetaVision.

“Giving drugs is a lot more complex because ICU patients frequently have numerous infusions, and there is frequent real-time management of infusions – titrating medication infusions is normal in ICU – and the system has got to be able to capture it.”

The Brisbane Times reported that concerns over the software were identified in the past month by the ICU directors at the PAH, Royal Children’s and RBWH.

It said the system has been manually over-ridden with medical charts being reviewed daily by ICU specialists.

Microsoft opens up the cloud to sensitive healthcare data

Microsoft has officially opened two new data centres in Victoria and NSW for its Azure cloud platform, hoping to encourage organisations in the government and healthcare sectors to further adopt the cloud while easing concerns over data sovereignty.

The two new Azure Australia geographies bring to 19 the number of regions around the world with similar capacity. Each data centre can hold up to 600,000 servers.

Microsoft’s executive vice president for cloud and enterprise, Scott Guthrie, characterised the capabilities of Azure as “hyper-scale, hybrid and enterprise grade”, with only Google and Amazon able to compete in terms of cloud capacity on a global scale.

Microsoft Australia managing director Pip Marlow said a number of industries had adopted the public cloud over the last few years, but certain sectors had historically shown a greater level of resistance.

“Financial services, financial information, healthcare – those areas have been historically ones that have had a higher level of risk management,” Ms Marlow said. “Bringing Azure into the country, where data sovereignty is in certain industries higher in the context of their risk management decision-making framework, is going to open the doors up ever more for customers taking advantage of savings and innovation models. I think it is going to be very positive.

Mr Guthrie said Azure had achieved a key milestone earlier this month when it successfully completed an assessment through the Information Security Registered Assessors Program (IRAP), an Australian Signals Directorate (ASD) initiative that provides the framework to endorse individuals from the private and public sectors to provide cyber security assessment services to Australian governments.

“The IRAP assessment basically provides assurance for any public sector customer, as well as the partners and ISVs that serve them, that Microsoft has appropriate security controls in place for the processing, storage and transmission of sensitive data for the Australian state governments as well as federal government healthcare, education and other data,” he said.

“Microsoft is the first and only public cloud provider based here in Australia that provides this level of security assurance in the Australian market.”

The importance of an assurance that data never leaves Australia was highlighted by several Microsoft customers at the official announcement in Sydney today, including audit and tax firm BDO, accountancy software provider MYOB and the market leading aged care clinical and management software vendor, iCareHealth.

Mr Guthrie said that for the smaller aged care providers that don’t yet have an IT system locally, iCareHealth will be able to offer a cloud-based solution using Azure to provide a full set of IT solutions that can be purchased cost effectively.

“By having Azure here in Australia, not only does iCareHealth not have to worry about infrastructure and be able to stand it up, but they can also make sure that all of their healthcare data can always stay here in Australia and be able to satisfy any concerns around data movement,” he said.

iCareHealth’s chief technology officer, Craige Pendleton-Browne, said the cloud removed the need to worry about infrastructure.

“It allows us to really concentrate on business innovation,” Mr Pendleton-Browne said. “You can run up as many instances as you like, you can experiment, you can try different things, and then when they work, you can bring them down very easily.

“With the launch here in Australia, one of the big issues we talk about is around data sovereignty, so having the services here [means] we can finally put our clients live in Australia. If you look at the smaller service providers out there who haven’t been able to afford to have a solution, having Azure we can offer cloud hosting. The cost of doing that really does drive a whole new set of clients and a whole ability to drive a better service and deliver better care.”

Mr Pendleton-Browne said that currently, iCareHealth has been running all of its development and test environments in Azure but hosted in Singapore. “In order to go live with any of our clients, we would have do that here in Australia,” he said. “We have been waiting for this day before we can say ‘here is a cloud-hosted solution’.”

iCareHealth’s managing director Chris Gray said cloud-hosted IT solutions offered aged care clients the ability to improve clinical governance and remain financially viable.

“People talk about the ageing of the nation, but what it is really about is the complex needs that people are presenting with,” Mr Gray said. “You are not going to go in if you are lonely anymore. You are going in with high cases of dementia, very complex healthcare, end of life, and what that really means for aged care providers is that clinical governance becomes more important.

“The other thing is they have to be financially viable. They’re the two things that are driving the aged care providers at the moment – the need for clinical governance and the need for financial stability – so they need to apply technology that is up to date but at a total lower cost.”

Mr Pendleton-Browne said cloud solutions will allow the company to move from what it is today, offering infrastructure as a service, to running a platform as a service.

“It allows us to drive quicker solutions, mobile solutions, where it would have been more difficult,” he said. “It’s much simpler, much quicker.”

Microsoft also announced that in addition to bringing Azure to the region, it was also expanding its ExpressRoute networking support in Australia.

Mr Guthrie said Australian companies can now purchase dedicated fibre connectivity to Azure through data centre and co-location provider Equinix. Microsoft has also signed a new partnership with Telstra to automatically connect its data centres to Azure as well.

“We now provide a wide range of capabilities and solutions that enable you to connect any on-premises server or any on-premises data centre to the cloud,” he said. “You can now have a single identity system with Azure Active Directory that spans your on-premise applications and PC system but you can then also use it in the cloud to enable single sign-on to any [software as a service]-based solution and to any number and type of devices as well.

“With our new ExpressRoute networking service, you can basically ensure that all of your network traffic between your on-premise facilities and Azure runs over a dedicated, private network fibre that gives you total security as well as guaranteed, quality service.”

Opinion: Cloud adoption stimulates telemedicine growth

Healthcare professionals in today’s internet age have access to a wide variety of tools that previous generations could only dream of. Unfortunately, many are unaware of the benefits technology can bring to their practice, are unwilling to make the transition from paper-based data to a digital format or are intimidated by a myriad of IT terms and definitions associated with eHealth.

Like Steve McQueen says in The Magnificent Seven, “We deal in lead, friend”. Medical staff are trained in a specific area – patient care – and are unlikely to embrace a process that requires a new skill set or may look like a complex new process.

However, it is worth noting that providers of eHealth solutions understand the problems facing practices and clinics in Australia and it is these providers that manage the infrastructure required to increase efficiency. By not having to worry about supporting new technology, medical staff can devote more time to their core business and ultimately save or prolong more lives.

Providers that have no knowledge of healthcare are likely to recommend solutions they are familiar with – solutions normally used in traditional companies – rather than those that are best suited to clinics and practices.

Most small clinics will not retain an on-site IT team and will avoid the problems of maintaining servers, back-ups and archives by utilising the cloud. In this situation, all maintenance, security and staff are the responsibility of the provider.

Telemedicine is a term used to define the use of technology (whether mobile or other internet-enabled devices) that allows easier collaboration. Whether it is between medical teams in multiple locations, between patients and doctors or between mobile clinics and their primary base, the use of telemedicine applications can allow video conferencing, remote consults, immediate access to EHRs and eliminate geographical issues, where patients are far from the nearest healthcare facility.

The use of cloud services ensures connectivity anywhere and is ideal for those in remote or rural areas where it is necessary to travel for days to visit a clinic or consult with a specialist. The use of video conferencing, for example, eliminates the need to travel and results in a service comparable with that received by patients in large cities.

As mentioned previously, the cloud makes the most sense when rolling out a telemedicine infrastructure as any internet-enabled device can connect easily, with user permissions and access levels easily added and removed.

In addition, the collaborative elements of the cloud ensure that geographical distances are no longer a consideration, as even follow-ups can be facilitated online. Security concerns are also reduced as data is stored in a central location and never on a portable device.

Additional cloud benefits include:

Bear in mind that not all cloud service providers are created equal and perform your research, availing of trials where possible to evaluate the service before committing to a contract and paying careful attention to ‘exit clauses’.

As for telemedicine, apart from data management and document control features, software applications are available that overcome clinic shortages, improve patient care and allow remote monitoring of patients after treatment.

ICT allows patients to send clinical statistics (such as weight, blood pressure, blood sugar levels and activity) to their healthcare provider, without an outpatient visit. This frees up a consulting room for another patient. Physicians can consult with their peers, sharing charts, x-rays and other information to ensure an accurate diagnosis before treatment begins.

With benefits like these and with ongoing legislation that will ultimately embrace technological advances in eHealth, clinics need to implement a telemedicine solution sooner rather than later, especially if their patients and peers are in other locations. Government services are already in place for eligible aged-care homes and to patients of Aboriginal Medical Services across Australia.

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

CCMS to be rolled out for at-risk patients in Counties-Manukau

Counties-Manukau District Health Board will roll out HSAGlobal’s CCMS connected care platform to all general practices in the district by June next year to allow them to provide a care plan to up to 30,000 patients with long-term conditions.

Counties-Manukau DHB’s At Risk Individuals program (ARI) is aimed at providing earlier intervention and patient-centred care by allowing primary carers to identify at-risk patients and better coordinate their services.

The DHB will enrol people in ARI who have one or more long-term conditions, such as diabetes or heart disease, as well as other risk factors like inadequate housing or low health literacy. It will support ill support up to 30,000 at-risk people with a CCMS-based care plan by the end of 2015.

CCMS is used throughout New Zealand for care coordination and forms the technological basis of Auckland’s shared care program. It is also used by Canterbury DHB and has a small but growing footprint in Australia.

Once enrolled by their GP, every person will have a designated care coordinator responsible for developing individual care plans in CCMS and monitoring progress in consultation with other providers of health and social services.

Care team members including community nurses can secure message each other and the patient through the shared care record. A summary health record will be available to healthcare teams through their existing Concerto patient record software so that key information relating to the patient is visible to everyone involved in their care.

Counties-Manukau has an existing program using CCMS that targets 3000 intensive healthcare users at high risk of readmission to hospital. The DHB uses CCMS under a licence covering the Northern region DHBs.

CCMS is licensed on a population basis, so DHBs can use the care platform for as many programs as possible.

HSAGlobal managing director Matt Hector-Taylor said the ARI program would allow the DHB to respond to demands on the health system from long-term conditions.

“It demonstrates new thinking applied in New Zealand in designing and managing large scale, whole of system connected care models to ensure improved and more accurate delivery of health and social services,” Mr Hector-Taylor said.

Benedict Hefford, director of primary health and community services with Counties DHB said that rather than reacting after people needed hospital care, health services will be supporting them to manage their health problems so they can stay well and at home.

Midlands eReferrals hit 500,000 mark

More than half a million electronic referrals have been sent between general practices, community specialists and hospitals in NZ’s midland region since 2010.

The eReferral system first went live in June 2010 and was designed by the Midlands Health Network in association with the Best Practice Advocacy Centre (BPAC) and primary and secondary healthcare practitioners.

GPs can automatically populate the referrals through their patient management systems and send them in the appropriate format.

Midlands Health Network CEO John Macaskill-Smith said the BPAC eReferral system allows for the electronic transfer of information between primary, community and secondary healthcare providers and enables real-time updates on how the eReferral is being managed.

“Almost all eReferrals now contain the right information which may have been previously missing,” Mr Macaskill-Smith said. “The 500,000 achievement is evidence that this is a system the GPs see value in and enjoy using.”

Over 180 general practices across five midland DHBs are using the system, with over 180 service providers receiving eReferrals. Over 19,000 eReferrals are made each month.

Mr Macaskill-Smith said enhancements were planned for the system, including integrating clinical pathways into the referral platform.

Smoking cessation support by text approved in MOH guidelines

Text messaging is now an acceptable method for assisting with smoking cessation programs under new guidelines from the New Zealand Ministry of Health.

First developed in 2007 as the New Zealand Smoking Cessation Guidelines, they have been revised this year and renamed as The New Zealand Guidelines for Helping People to Stop Smoking.

The guidelines still use the ABC pathway developed for the 2007 guidelines, which prompts healthcare workers to Ask about and document every person’s smoking status, give Brief advice to stop to every person who smokes, and strongly encourage every person who smokes to use Cessation support.

The guidelines state that the most effective components of cessation support are multi-session behavioural support and stop-smoking medicines. Behavioural support can be delivered face-to-face, by telephone, through text messaging or online.

There are several text-based support programs available, including the New Zealand Quitline’s Txt2Quit, which was adapted from the STOMP system developed by the Clinical Trials Research Unit at the University of Auckland.

Smoking cessation texts can also be sent through Vensa Health’s TXT2Remind SMS-based patient reminder, which is integrated within general practice patient management systems including Medtech32, VIP and myPractice.

TXT2Remind allows practice teams to deliver appointment, screening and medication reminders as well as key health messages direct to the patient via text message and interactive mobile content delivery. In addition to smoking, it is being used for immunisations, cervical screening and heart health.

According to Vensa Health, over 80 per cent of general practices in Canterbury are using TXT2Remind with the support of Pegasus Health, Rural Canterbury PHO and Christchurch PHO to routinely ask about smoking status as a clinical vital sign and then to provide brief advice and offer quit support.

Moorhouse Medical Centre in Christchurch has just begun using TXT2Remind for its six-monthly smoking status checks. Practice manager Kate Verpoorten said the practice sent messages to thousands of patients and over half responded within the first day.

“For those that wanted advice we could immediately book an assessment appointment at the clinic,” she said. “We can also reinforce advice by text after that.”

Shirley Medical Centre practice manager Leanne Verdellen said she simply had to run a query builder of patients it wanted to target, construct a text and merge the two. “The replies come rolling in,” she said. “It’s the most efficient way of updating our records and allowed us to reach more patients who may require help with smoking cessation.”

Canterbury DHB has been able to lift its primary care smoking health target from around 50 per cent to 74 per cent using the system.

Bredenkamp returns to Patients First as CTO

Andre Bredenkamp has joined Patients First as its chief technology officer, having worked in the past on several projects for the organisation including the GP2GP electronic notes transfer product and the New Zealand ePrescription Service (NZePS).

Most recently country manager for Australia with HSAGlobal, Mr Bredenkamp has a long history in ICT in South Africa and New Zealand. He first began work in the health sector in 2005, when he worked on the migration of the Hutt District Health Board breast screening system to Orion Health’s Soprano system.

He also worked for Gen-i, the ICT services unit of NZ Telecom, now known as Spark.

Patients First CEO Jayden MacRae said Mr Bredenkamp had a great deal of institutional knowledge about the organisation and primary and secondary care information programs.

Working in collaboration with GP software companies, Mr Bredenkamp helped to deliver the GP2GP electronic notes transfer product in 2011. He has also contributed to the NZePS, an initiative designed to improve patient service and experience when collecting prescribed medicines.

“One of the keys to improved healthcare is sharing of critical information with the right people at the right time,” Mr Bredenkamp said. “I am looking forward to building on my established base in Patients First, and supporting integration between the various systems to deliver the promise of integrated care.”

Patients First specialises in facilitating information system integration and promoting quality information frameworks. The GP2GP system enables the electronic transfer of patient records between general practice and is used about 30,000 times each month.

The NZePS delivers electronic prescriptions directly to pharmacies, resulting in a reduction of transcription effort and improved accuracy of content. The NZePS pilot in 2012 was a collaboration between Patients First, My Practice, Healthsoft and Simpl.

Medications and dosage linked to alerts in MedAdvisor app

The MedAdvisor medications compliance app has been updated with new functions including the ability to link medication to particular alerts, new scheduling options and a summary view of alerts.

While the MedAdvisor apps for iOS, Android and web are free to use for patients, they are linked to the patient’s regular pharmacy and users must be provided with an activation code to use the system.

The platform allows patients to order refills by linking to the pharmacy’s dispensing software through the Pharmacy Guild’s GuildCare software suite, with a medication-specific electronic medical record held on MedAdvisor’s servers.

In the latest update to the apps, new functionality has been added to the Take-My-Meds section to allow one or more medications to be linked to a specific alert, which will remind patients of exactly what doses to take at different times of the day.

For privacy reasons, the app includes an optional privacy mode that means the name of the medication will not be included in the alert by default.

There are also new scheduling options that allow for alert scheduling for specified days of the week, as well as a tab that provides a list of all alerts scheduled for the day ahead.

MedAdvisor has a settings tab that allows for reminders to be set up to take the specified dose and drug at breakfast, lunch, dinner and bed time. This can now be customised in the new version of the app for more complicated medications or dosing regimes.

A ‘create new message’ button has also been added so patients can send a message to the pharmacy for review and response by the pharmacist.

MedAdvisor has also announced an agreement with health insurer Bupa to promote the app to Bupa’s customers.

The product has been developed by pharmaceutical company Actavis in association with the Pharmacy Guild and is one of four products on the market, joining eRx Express, Send a Script and NPS MedicineList+.

Anonymous peer support available online for mental illness

National mental health charity SANE Australia has launched two online peer support forums for people living with mental illness and their families, friends and carers.

SANE Australia said it had invested in the best technology available so that people whose lives are affected by mental illness can feel confident to join the conversation online on an anonymous basis and find support.

“Despite the significant and welcome investment governments have made in mental health in recent years, the majority of people living with a mental illness are not currently accessing professional help,” SANE Australia CEO Jack Heath said.

“We need to be savvy in delivering support in cost-effective and efficient ways. Late help will always be expensive help. The SANE forums can reduce mental health costs by encouraging people to seek help early on.”

Launched in Canberra today, the forums have been funded by the Department of Health. Health Minister Peter Dutton said the forums would help people by giving them trusted and anonymous access to reliable mental health information, advice and referrals.

“While almost half of the Australian population will develop a mental illness at some point in their lives, only 46 per cent of this group will seek any form of support or treatment,” Mr Dutton said in a statement.

“We know that there are many reasons that people do not seek treatment like a fear of being stigmatised, living too far from a medical practitioner and not knowing how to get information and care.

“Online mental health services like the new SANE Australia online forums can combat this to reach people who might otherwise not receive the support they need.”

The Lived Experience and Carers forums are available on the SANE Australia website.