The 2015 eHealth year in review: part three

July got off to a bright start with the go-live of the electronic referral and central client record aspects of the My Aged Care (MAC) system, or so it would seem. Some early teething problems became quickly apparent as an underestimation by the Department of Human Services (DHS) of demand for the system caused a backlog of referrals, and a failure to consult GPs on how they’d like to use the system caused an explosion of complaints.

These petered out quickly enough after a month or two but they may have been behind the decision to delay adding aged care assessment teams (ACATs) to the assessor portal until next February. In the meantime, the aged care industry continued to call for a link to be established between the MAC and the PCEHR systems.

On the PCEHR, the Department of Health released a report by Deloitte that summarised the outcomes of a series of public consultations held last year following the release of the Royle review into the system. The paper found that a significant majority of those consulted supported the concept of the PCEHR and wanted to see much more widespread adoption. There was also support for the opt-out model, and we began to hear a lot more about the concept of “meaningful use”.

The RACGP made its opposition known on linking uploads to the PCEHR with receiving certain payments – in this case, claiming MBS items for creating care plans. The reaction of several groups later in the year to suggestions that ePIP payments be tied to meaningful use could only be described as going ballistic.

In the ongoing EPAS saga, SA Health revealed that contingency plans were being developed to ensure legacy systems could be used at the new Royal Adelaide Hospital should EPAS not be ready in time for the hospital’s opening. This news came just months after it was announced that SA Health was abandoning plans to implement EPAS at the existing hospital to wait for the new one to open.

SA auditor-general Andrew Richardson reported that there were also potential risks for the $19 million state-wide medical imaging system ESMI and its implementation at the new RAH, and it later became clear that the problems with EPAS would have a flow-on effect on the Enterprise Pathology Laboratory Information System (EPLIS), as the latter was reliant on an interface with the former.

The federal government has never admitted it made a mistake when it axed the after-hours GP helpline run by Healthdirect Australia in the May budget. Some GPs deplored the service as a waste as there was no evidence it was reducing low acuity presentations at emergency departments, but it soon became obvious that the service was valuable enough for rural and remote areas as the decision was quickly reversed. Funding, albeit for a reduced scope, was quietly restored.

The Queensland government then began to roll out a few announcements about health ICT, delivering a nice $179 million in the July budget along with some money to ensure that the operational commissioning of the Sunshine Coast Public University Hospital (the ‘public’ in the name has since been dropped) did not suffer the same ill fate as Lady Cilento Children’s Hospital.

Upon further inquiries, it turns out that most of the money was for the continued roll-out of the Cerner integrated electronic medical record (ieMR) as well as an oncology management system and an interoperability platform for information sharing. There was no money this year for a replacement for the ancient HBCIS patient administration system, although Queensland Health said this was a priority and was being planned.

Six weeks later, Queensland Health would unveil an immense, detailed and far-reaching strategy for health ICT, set to cost a seemingly immense $1.26 billion over 20 years. The strategy estimates that $730 million will be required for clinical software alone, with a further $300 million for ICT infrastructure, $100 million for business systems and $130 million for the interoperability platform and related standards.

Of the $730m for clinical software, a probable $210m will be required to replace HBCIS, $75m will be needed for a new pathology system, and a further $376m will be needed to roll out the ieMR to a further 25 hospitals. This will be a huge job for eHealth Queensland CEO/CIO Colin McCririck, who was appointed to the role just last week after acting as CTO since the start of the year.

Mr McCririck has already had to fend off accusations put to him by we reptiles in the media that the budget for the ieMR at the first nine hospitals it was implemented in had been massively overrun. He rejected those claims – although our source is sticking to their guns – but did admit that the move to roll out release three of the ieMR, aka the Digital Hospital release, at Cairns Hospital would be delayed until next February. The release went live at Princess Alexandra Hospital in November and we reptiles have heard nary a peep of discontent.

While Queensland continues on its bold path towards digitisation of its hospitals, the dramas surrounding the original and the best have never stopped. An independent review into clinical services and patient care at Perth’s Fiona Stanley Hospital (FSH) found that IT systems, which were blamed for delaying the opening of the $2 billion facility in 2014, were still causing headaches for clinicians and patients.

The review found problems with the patient entertainment system, the cardiac telemetry system, the BOSSnet digital medical record and with the IT helpdesk. This report was then followed by a parliamentary inquiry into the transition to and operation of services at FSH, which heard explosive evidence from a senior doctor in August that little if any of the clinical IT worked as hoped. While the criticism of the IT may have been a bit harsh, it was nothing like the tongue-lashing he gave to the health department.

Later in the year, this committee would report that many of the problems with clinical IT seem to have been overcome, but even the Liberal members of the committee were critical of the performance of Health Minister Kim Hames.

Back in Queensland, a state coroner echoed her counterparts in Victoria and South Australia in calling for a new system to be implemented with some urgency to provide information in real time to doctors and pharmacists dealing with potential prescription shoppers following the death of a Toowoomba nurse from an overdose of prescription opioids. The calls were backed by the RACGP the the same week, and the Pharmacy Guild also began to ramp up the pressure.

Queensland also hosted this year’s Health Informatics Conference (HIC), where state health minister Cameron Dick announced the formation of eHealth Queensland, bringing together the responsibilities of the Health Services Information Agency (HSIA) with the office of the chief health information officer. Also at HIC, federal health minister Sussan Ley argued that the PCEHR did not need to be perfect but it did need to be functional, practical and beneficial, which it clearly wasn’t.

In some positive news for the PCEHR, a NEHTA report found that the benefits being experienced with the Northern Territory’s My eHealth Record “validated the value proposition” of the PCEHR if the national system could follow the local solution in gaining a critical mass of users.

There was also positive news for telehealth, with the results of the CSIRO’s NBN-enabled telehealth project showing that at-home monitoring of vital signs in older patients with chronic disease can lead to significant savings over time and can also reduce mortality rates by up to 37 per cent.

The Abbott government went through with its threat to defund research body National ICT Australia (NICTA), in effect forcing it into a merger with the CSIRO to have any chance of surviving. To be renamed Data61, the merged entity was then later partly re-funded by the Turnbull government as a piece in its $1.2 billion innovation program. Mr Turnbull therefore had the odd experience of both defunding and re-funding ICT research within the space of four months.

Taking a gamble due to a distinct lack of information emanating from the minister’s office, we reported that no decision had been made on the location or design of the trial sites for opt-out models of the PCEHR, and there was no sign of the bill that would enable an opt-out model to happen. We were right on the first claim but looked pretty foolish three days later when the minister popped up in parliament with some name-changing legislation.

As we looked forward to the last quarter of the year, the Department of Health put a cat among some very unhappy pigeons when it released a discussion paper suggesting that the eHealth Practice Incentive Program payment (ePIP) be tied to real and meaningful use of the PCEHR. DoH figures showed that despite the majority of general practices claiming the ePIP, very few were using the system. While the discussion paper canvassed other options, it was this suggestion that got some blood boiling and a mooted start date of February 2016 caused some extreme hyperventilating.

Acute care

The Sydney Adventist Hospital announced it had chosen EpiSoft’s Cancer CareZone cloud-based clinical information system for the new Integrated Cancer Centre the San is building as part of its $200 million redevelopment.

Significant delays in building and commissioning Brisbane’s Lady Cilento Children’s Hospital (LCCH) caused excessive workloads on ICT staff both during the build and at the time of practical completion, leading to a budget blow-out and reduced scope of integration, the final report into the commissioning of the hospital found.

Embattled WA Health Minister Kim Hames announced he’d delay the opening of the $1.2 billion Perth Children’s Hospital (PCH) if necessary if it meant avoiding the same problems experienced with the commissioning and opening of Fiona Stanley, while his Queensland counterpart Cameron Dick hired a commissioning expert for the Sunshine Coast University Hospital try to avoid the problems that plagued Lady Cilento.

Primary care

General practices were abuzz with incoming advice from software vendors in July when Windows 10, the well-received replacement for the disastrous Windows 8, was released. Over-enthusiastic early adopters of new operating systems have been known to break software, especially programs that have interfaces with third-party, external systems such as Medicare. It all seems to have gone quite smoothly, however, with no reports of blue screens of death.

Primary Health Care’s new MD Peter Gregg announced his first financial results following the retirement of founder Ed Bateman. The company is looking to increase its portfolio of multi-disciplinary medical centres in Australia as well as use the strategic position of its wholly owned health IT subsidiary MedicalDirector to develop new income streams or to potentially find a buyer for all or part of MD. Mr Gregg alluded to potential problems as uncertainty over the federal government’s intentions on bulk billing for GP and pathology services undermined confidence in the profitability of the primary care sector. Primary’s share price took a hammering later in the year.

There were also some interesting moves in terms of mergers, acquisitions and investments in companies active in the primary healthcare sector, including the the purchase of online booking system Appointuit by Jayex Healthcare, which would go on later in the year to list on the stock exchange. Sonic Clinical Services, the Sonic Healthcare division that also includes IPN, made a strategic investment in Tasmania’s GP2U, along with Medical One founder Andrew Pascoe. Sonic Clinical Services was also busy buying Precedence Health Care at this time in an interesting move that we will keep our eye on. A bit of trivia: the original founder of Sonic Healthcare, Michael Boyd, is the new executive chairman of Jayex Healthcare.

Aged care

The aged care industry is a very patient one, not known for getting antsy, but even the nicest of sectors has its limits. In late July, the two aged care peak bodies took the extraordinary step of asking for an apology and, heaven forbid, financial restitution from DSS and DHS over two years of breakdowns in electronic claiming. Some not-for-profit aged care providers were owed up to $3 million at one stage, causing massive cash flow problems.

The 2013 decision to move aged care from the Department of Health to the Department of Social Services (DSS) was reversed in late September following new Prime Minister Malcolm Turnbull’s ministerial reshuffle, with Health Minister Sussan Ley quick to claim ageing and aged care back to her portfolio once former aged care minister Mitch Fifield was diverted to the communications portfolio. Ageing moved back in dribs and drabs in November and December, raising the question of why the split had been ordered in the first place.

The Queensland government funded a new portal called the Community Care Smart Assistive Technology Collaborative Platform that its developers plan to use as a one-stop-shop for information on smart assistive technologies. The project won an ITAC award later in the year. While wearables are the technology du jour for the fit and the worried well, it’s in aged and community care where they are most likely to have a lasting effect.

In a big year for Telstra Health’s wholly owned subsidiary HealthConnex, the Victorian company launched a new version of its The Care Manager (TCM) case management software for aged and community care that can interoperate with the company’s MyCareManager client portal through a FHIR interface. HealthConnex also designed the MyCareManager device to work with FHIR and has been at the forefront of releasing it into the wild. It also launched a new version of its ConnectingCare secure messaging and referral platform for community care organisations that is interoperable with the Argus secure messaging service widely used by GPs, which HealthConnex also owns.

Some of the more interesting software, apps and new players in the market that caught our eye in the third quarter included:

As we will cover in the final instalment of our eHealth year in review tomorrow, a vague threat to the legislation enabling an opt-out PCEHR arose in October when a federal parliamentary committee on human rights asked some questions about the privacy implications of the model. This caused a minor sensation in some media quarters but we pretty much ignored it. The legislation had bi-partisan support and despite Labor in the lower house asking its colleagues in the upper house to hold a quick-fire inquiry, the legislation was always going to pass. And so, as we saw when the year came to an end, it did.

Missed the first instalment in this series? Here it is: The 2015 eHealth year in review: part one

Then get a load of the second: The 2015 eHealth year in review: part two

Pharmacy error again to blame for incorrect scripts on My Health Record

A series of errors by a pharmacist has been blamed for incorrect data about six prescriptions appearing on one consumer’s My Health Record last month.

The consumer contacted Pulse+IT after finding six scripts that were not prescribed for her in the Pharmaceutical Benefits report section of her My Health Record (MyHR, formerly PCEHR). The section receives an automatic feed of new dispensed prescriptions for that patient from the PBS.

In this case, six prescriptions for a combination antibiotic, a contraceptive pill, a different antibiotic, an asthma inhaler and an oral corticosteroid were incorrectly recorded as being dispensed to the consumer on three different days in 2014.

The consumer was advised by Pulse+IT to ring the PCEHR hotline to have the data removed from her record as soon as possible, but when she rang on a Sunday, was told to ring back on Monday as weekend staff did not have access to individual records. When she rang back on Monday evening, she was told to ring back during business hours.

Like Pulse+IT’s own situation, the consumer was told it was likely an error at her regular pharmacy and that she herself would need to contact the pharmacist to find out how the data was added to her record. Unhappy with this, the consumer pressed for more information and was given a number to ring at the PBS. When she rang that number, she was referred back to the PCEHR helpline again.

She then rang the MyGov helpline, given the same number for the PBS and was transferred to another line, which turned out to the PCEHR helpline again, where she was put on hold.

Not impressed, the consumer contacted Pulse+IT again. We raised a bit of a stink with a Department of Health contact, who then arranged for someone at DHS to call the consumer personally, and she was soon contacted, given instructions on how to remove any incorrect documents from view, and told that the situation had been referred for investigation by Medicare.

She was then contacted by email and told that Medicare had investigated the six items in question and had spoken to the pharmacy.

“The pharmacy had submitted incorrect patient information resulting in the items appearing in your record,” a DHS representative wrote in the email. “This has now been corrected and the items have been removed from your record.

“It would be appreciated if you could please log on to your eHealth record and confirm these items are no longer appearing. On receipt of your confirmation we will consider the issue resolved.”

However, the consumer wanted some more answers on exactly why and how this had occurred, so was provided with the number of a person at the PBS – the same PBS that she had previously tried to call but had been passed back to the PCEHR helpline.

The PBS representative confirmed that it was a pharmacy error but could not say which pharmacist or pharmacy due to “privacy reasons”. It appears that another person with the same name as the consumer presented at the pharmacy and their script was put against the consumer’s name in the pharmacy system, but that does not explain why it happened again four months later, as the scripts were not a repeat.

Finally defeated in trying to understand the intricacies of the PBS claiming system, the consumer now considers the situation resolved.

Chemo for rural patients safe to deliver under remote supervision

Chemotherapy can be delivered to patients in rural settings under the supervision of remote medical oncologists as safely as to their urban counterparts, new research shows.

Researchers led by Sabe Sabesan and Bryan Chan of the Townsville Cancer Centre (TCC) compared the dose intensity and toxicity profiles for patients undergoing chemotherapy at the TCC with those for patients treated at Mt Isa Hospital, who were supervised by the same medical oncologists by video.

Dr Sabesan, an associate professor at James Cook University and the director of the department of medical oncology at TCC, has developed several teleoncology models of care, including the Queensland Remote Chemotherapy Supervision (QReCS) model that is being used in Townsville and Cairns to help treat patients throughout the far north.

Patients are assessed for fitness to undergo chemotherapy and video conferencing is used to make decisions about admitted inpatients. Medical oncologists are supported by the rural-based doctors and nurses during the video consults, and chemotherapy-proficient nurses administer the chemotherapy agents prescribed by the TCC oncologists.

Previous research has shown that the service is acceptable to both rural patients and healthcare providers and can achieve net savings through major reductions in travel costs for patients and specialists.

However, there are still differing rates of chemotherapy in rural and urban populations, with poorer survival rates in rural regions compounded when they have high populations of indigenous people.

Reasons for these poorer outcomes could include the limited access to chemotherapy closer to home and clinicians being concerned about the potential toxicity of chemotherapy. In a paper published today in the Medical Journal of Australia, Dr Sabesan and his team compared the dose intensity and toxicity profiles for patients in two sites – TCC and Mt Isa Hospital.

Eighty-nine patients received chemotherapy at Mt Isa under the remote supervision of TCC medical oncologists while 117 were chosen for the comparison group at Townsville. Most solid tumour types were treated during the study with the three most common being breast, colorectal and lung cancers.

They found no significant differences between the Mt Isa and TCC patients in a number of factors, including side effects and hospital admissions.

“Our study is the first to show that many types of chemotherapy can be administered in rural centres, without compromising safety and quality, by teleoncology models of care,” the researchers write.

“These results … may reassure many urban clinicians that high-quality cancer care can be provided at rural centres by teleoncology models.

“By expanding the scope of practice and capabilities of rural health care systems through the use of telehealth models, rural patients may gain access to chemotherapy and other complex medical therapies similar to that of urban patients.”

Medtech goes mobile with ManageMyHealth app

Practice management system vendor Medtech Global has launched an app for iOS and Android devices allowing mobile access to the ManageMyHealth patient portal being rolled out in New Zealand.

The app is being offered first to patients of GPs in Wellington’s Compass Health primary health organisation (PHO), which has contracted with Medtech to provide the patient portal to all interested general practices in the greater Wellington region.

The company also plans to introduce its VitelMed telehealth product to the New Zealand market shortly and will make it available on ManageMyHealth. VitelMed has been available in Australia since 2012, when Medtech purchased the rights to the technology.

In Australia it is being used for video conferencing between specialists, GPs and aged care residents and in a chronic heart failure model of care project in Victoria.

NZ patients can use ManageMyHealth to access their medical records online, view lab tests, book appointments and communicate securely with their GP team.

Local GP Richard Medlicott, who is also a National Health IT Board patient portal eHealth ambassador, said his practice has about 2000 patients using the portal.

“Increasingly the world is mobile and smart device-enabled,” Dr Medlicott said in a statement. “Having this available on the smart phone is a good step forward.”

Compass Health CEO Martin Hefford said the app would give patients easy online access to their health information as well as providing a secure interface for booking appointments and communicating with the practice.

“We are pleased to be able to offer a patient portal that links directly to the shared care record and that will, in future, include a shared care plan capability,” Mr Hefford said.

Medtech chairman Vino Ramayah said the benefits of a patient portal to practices and PHOs included an increase in efficiency and savings in administrative costs through functionality such as online appointments and electronic medical records management, secure messaging and appointment reminders.

“All of this can now be done on mobile phones,” Mr Ramayah said.

ACRRM supports moves towards meaningful use of PCEHR

The Australian College of Rural and Remote Medicine (ACRRM) has come out in support of moves by the government to transition from rewarding GPs for connecting to the PCEHR/My Health Record to actually using it, but says meaningful use must be predicated on the creation of a clinically relevant and operational system.

The college also believes that changes to the changes to the eHealth Practice Incentives Program (ePIP) and those outlined in the government’s recent legislation discussion paper must be considered in association with the wider policy deliberations about primary care currently taking place.

ACRRM president Lucie Walters said the college welcomed the re-examination of the ePIP and supports a transition from rewarding GPs for establishing the ability to connect to the MyHR to actually using the system to upload health summaries of consenting patients with the most to gain – those with chronic and complex conditions.

“This is an essential step in sharing information with other health professionals and the patients themselves via the system,” Professor Walters said. “Clearly, other strategies are required to support other health professionals to participate fully.”

Professor Walters said the significant policy deliberations currently taking place at the federal level could also potentially affect GPs and eHealth use.

These include the work of the Primary Health Care Advisory Group (PHCAG) and the MBS Review Taskforce, which are exploring changes to the funding and administrative models associated with the management of chronic disease.

“This is an area where there are potentially close links with the My Health Record and eHealth initiatives generally,” Professor Walters said.

“In addition, the National Strategic Framework for Chronic Conditions is currently being developed and will be informed by the work of parallel work streams and these government reviews.

“eHealth is an essential consideration and the outcomes of this work will be aimed at policy makers at all levels of government, peaks and health professionals who care for people with chronic diseases.”

While other medical groups have outright opposed linking ‘meaningful use’ of the MyHR to the ePIP by means of a targeted number of shared health summaries uploaded, ACRRM has taken a more measured approach.

“The Practice Incentives Program (PIP) was initiated to encourage short and long term changes to general practice through a form of blended payment,” Professor Walters said.

“It was designed to complement fee-for-service by providing another funding stream for eligible practices, which met quality and accreditation standards on the assumption that incentivising enhanced quality of care, in addition to fee-for-service, will facilitate improvements in health outcomes.

“Whilst the ePIP incentive was successful in encouraging the majority of practices to become ‘My Health Record ready’, a much smaller percentage actually used the system, due to a range of issues, including clinical usability and utility, uncertain medical leadership, controversy and political uncertainty.”

The government has since committed itself to a redeveloped PCEHR and to changes recommended by the medical profession and others as part of the PCEHR review, she said.

ACRRM has also since become an active participant in redefining clinical usability and content via NEHTA’s clinical usability program (CUP) and other arrangements. As such, Professor Walters said, ACRRM supports the move from rewarding GPs for establishing the ability to connect to the MyHR to active and meaningful use of such health information.

“ACRRM believes that meaningful use is predicated on an efficiently configured, clinically relevant, secure and operational system,” she said. “Meaningful use comes from the curation and sharing of appropriate health information and the use of that information by clinicians to who provide clinical care for these patients and by the patients themselves and their support network in improving self management of their conditions.

“The ePIP could be amended to encourage and incentivise participation in the MyHR, by rewarding uploading shared health summaries by general practice as an early step in establishing meaningful use of clinical information.”

She said broader issues as outlined by the AMA in its response to the ePIP changes could form key points for the Australian Commission for eHealth (ACeH) to address when it comes into being.

Rural doctor and ACRRM Fellow Ewen McPhee (pictured above, left) has been appointed as a clinical representative on the implementation taskforce steering committee set up to guide the development of ACeH, a decision that Professor Walters warmly welcomed.

“It will be important that the Commission has the scope and latitude to engage and design a National eHealth Strategy that addresses privacy; quality and meaningful use focused on delivering improved health outcomes for Australians.”

She said a curated shared summary is a key ingredient for improved care between teams at this time, and that as general practice should be the repository of truth for patients with chronic disease, ACRRM’s submission identified that the meaningful use of eHealth must be about improving communication of care needs and goals with others in the care team.

“Pragmatically we cannot ‘throw the baby out with the bathwater’,” she said. “There has been major investment of public funds, and we have a duty to guide integration of eHealth into day-to-day care. Nowhere is this more critical than in rural and remote, resource-poor areas where health outcomes are poorer than that in metropolitan and provincial areas.

“The future will be about ensuring that a core dataset of real time measures is available across sectors to underpin decision support, quality and safety, reduced duplication of investigations. However right now we need to underpin this with a common shared and agreed care plan for those with chronic disease and disability.

“An available curated relevant shared health summary must be the foundation and we cannot have meaningful use if there is nothing for health teams, specialists and other professionals to utilise and respond to in their deliberations.”

She said ACRRM would encourage the new ACeH, the MBS review and the PHCAG to set a common theme around shared data, remote consultation, and home monitoring so that the healthcare sector can reduce the equity gaps that rural and remote people are challenged by every day of their lives.

Many of these issues will be up for discussion at the eHealth stream being held as part of the Rural Medicine Australia (RMA) conference in Adelaide from October 22 to 24.

Dr McPhee and another member of the ACeH implementation taskforce steering committee, former AMA president and current NEHTA chairman Steve Hambleton, will debate some of these issues as part of the forum. Dr Hambleton is also chair of the PHCAG and on the MBS review committee.

The forum will debate which are the key issues and opportunities arising from the National Reform Agenda and consultation that will affect rural and remote practice.

Considerations will include:

eHealth bill passes lower house, opt-out PCEHR likely in 2017

A bill amending the PCEHR and Healthcare Identifiers Service acts has passed the lower house with bipartisan support and will now be sent to the Senate.

Labor is requesting its upper house colleagues inquire into some of the privacy aspects of the legislation but will not block its passage.

The Health Legislation Amendment (eHealth) Bill 2015 changes the name of the PCEHR system to My Health Record (MyHR) and clears the ground for the creation of the Australian Commission for eHealth (ACeH).

It also provides the minister for health with the power to make rules for trials of opt-out models for participation in the system.

During parliamentary debate yesterday, Liberal MP Jane Prentice said the trials will be accompanied by an education and communications strategy that will seek to mitigate any community concern.

“Following the trials, it is anticipated that the government will be in a position to make a final decision on whether to transition to a full opt-out system by late 2017,” she said.

Health Minister Sussan Ley said an evaluation of the trials will also be conducted next year. They are due to kick off in April, although the government has yet to announce what sites have been chosen.

Labor MP Justine Elliott said she understood one is most likely to be in northern NSW, where her electorate of Richmond is located, and that another would be held in metropolitan Queensland.

Her colleague Stephen Jones said Labor accepted that a number of the changes in the bill were very sensible – including allowing palliative care and aged care service providers to be included – but said it was of the utmost importance that patients’ privacy be given the highest regard possible.

“It is for this reason that Labor believes these provisions do require further scrutiny,” he said. “Whilst we will not be opposing the bill in this House, we would like to see more scrutiny of this particular aspect of this bill.

“When the bill reaches the other place, we will be calling upon our colleagues in the Senate to have it referred to an inquiry so that some of these issues can be further adumbrated.”

The Senate has subsequently referred the bill to the Senate Community Affairs Legislation Committee for inquiry and report. Submissions are due by October 28 with the committee set to report on November 9.

Submissions can be emailed to the committee secretary.

Training courses provide a fast track to FHIR

Training provider eHealth & HL7 Education Partners has launched Australia’s first courses in evaluating and implementing the FHIR (Fast Healthcare Interoperability Resources) standard, which has been described as a ‘paradigm shift’ in connecting healthcare IT systems.

The first one-day course will be held in Brisbane next month and will be taught by health informatician Brett Esler, who has built his own independent middleware platform called Hiasobi that uses FHIR to allow easy integration of apps to general practice management systems such as MedicalDirector and Best Practice.

FHIR was first developed by Australian healthcare interoperability pioneer Grahame Grieve, who was frustrated by the shortcomings of existing methods to often painstakingly interconnect healthcare systems.

Mr Grieve has taken modern internet technologies such as XML, HTTP, REST, JSON, openID and OAuth2 and combined them with the most successful features of the existing healthcare standards HL7 version 2, v3 and CDA to develop a new standard that many believe will allow interoperability to happen faster, easier and cheaper.

FHIR has gone from concept to a full-blown published draft standard (DSTU) with implementations by over 70 organisations in 20 countries in just two and a half years.

eHealth & HL7 Education Partners managing partner Klaus Veil said the new course would take Australian healthcare connectivity to the next level.

Mr Veil, also an adjunct associate professor at the University of Western Sydney and recently re-elected president of the Australasian College of Health Informatics, said his team was inspired to develop the course when recently attending an HL7 FHIR update session in Brisbane.

“We have helped well over 400 people in the Australasian region build their health informatics and eHealth integration skills, but FHIR is now rapidly moving into the implementation phase,” Mr Veil said. “It is time to actively support these efforts with focused FHIR implementation training.”

Course participants will be introduced to the FHIR specifications, learn how to evaluate FHIR for their organisation and experience hands-on how simple implementing FHIR is, Mr Veil said.

“FHIR is a refreshing break from other standards that require ‘insider’ technology and tooling that are only found in healthcare. FHIR enables even young IT graduates to easily implement connections between healthcare systems.

“And if you have followed the recent media reports about the low uptake of our national electronic health record, the PCEHR, due to the lack of meaningful data content, then FHIR looks like what is needed.”

Mr Esler said he had been watching the development of FHIR very closely since he first heard Mr Grieve propose taking a ‘fresh look’ at interoperability in 2012, with the first public review of FHIR held in September 2012.

HL7 International then published the first FHIR interim standard in February 2014 and is now working on publishing the second, updated interim standard.

“We should not forget that FHIR is a global standard, so all the FHIR implementations we do here in Australia will allow us to interface with systems around the world,” Mr Esler said.

FHIR is already being used on both large and modest scales both here and internationally. Orion Health added FHIR support to its Rhapsody integration engine earlier this year and Australian firm HealthConnex, part of Tesltra Health, is just about to launch a new version of its The Care Manager (TCM) community care software package using FHIR to allow data exchange between TCM and Telstra’s MyCareManager telehealth solution.

Orion Health’s product strategist David Hay recently predicted in a white paper that FHIR was likely to become like the internet of healthcare – ubiquitous, largely invisible but ‘just there’.

“No one questions the use of the Internet and the standards that support it …” Dr Hay wrote. “It seems probable that this could be FHIR’s future also – as the ‘lingua franca’ of healthcare data exchange.”

Mr Grieve said he had been concerned for some time about FHIR’s rapid growth and how it would continue to be supported, so he was pleased to see training courses starting up.

“The further development and implementation of FHIR very much relies on a strong community supporting it, but I am not sure if we can grow the community for FHIR developers and implementers quickly enough,” Mr Grieve said.

“I myself am spending more and more time on US-based projects, which are now increasingly getting funded, so I am quite glad that local implementer training is now happening.

“When a new technology becomes popular, it is important to have good quality training. I have worked with [Mr Esler] on a number of FHIR projects and his implementation knowledge is one of the best in the country.”

The FHIR Evaluation and Implementation Fast-track courses will be held in:

Mr Veil said two-day intensive implementation courses that build on the fast-track courses are in development.

Registrations are open now.

Pulse+IT launches Asia Pacific edition

Pulse+IT has today launched its long-awaited Asia Pacific edition, which will be sent to thousands of Pulse+IT’s 18,000+ total subscribers.

To be sent once per fortnight initially, existing Pulse+IT subscribers can elect to receive this edition at no cost by adjusting their subscriber preferences using the link at the bottom of any Pulse+IT eNewsletter. If you are not currently subscribed to the free Pulse+IT eNewsletter service, you can sign up via www.pulseitmagazine.com.au/subscribe#enews

While the scope of the Asia Pacific edition will evolve as we develop our capacity in Malaysia, Hong Kong and India, our launch edition takes a look at some of the developments occurring in Singapore’s health start-up community, in addition to the healthcare challenges its ageing population will unleash on the country in the coming decades.

In addition to independent health IT reporting, Pulse+IT Asia Pacific editions will include links to conferences, webinars, employment and business opportunities, and other health IT resources.

The newsletters will also feature a hand picked selection of articles from Pulse+IT’s reporting from Australia and New Zealand to promote the sharing of health IT knowledge throughout the broader Asia Pacific region.

If your organisation has operations in any of the countries mentioned above, now is a great time to get in touch with Pulse+IT to discuss your health IT initiatives with us.

To support this expansion, Pulse+IT is building a new team of journalists spread throughout Asia tasked with staying abreast of, and reporting on, the region’s latest health IT developments as they unfold.

Pulse+IT’s nine-year lineage as the Asia Pacific region’s only specialised health IT publisher stands us in good stead for the expansion ahead, and we look forward to feedback from our readership as our offering evolves.

Organisations looking to grow their profile in Asia may like to review our discounted and very competitive pre-launch eNewsletter advertising rates for our Asia Pacific edition via this page

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Using IT to help solve Singapore’s biggest healthcare challenges

As Singapore progresses to become one of the fastest growing economies in the Asia Pacific region[1], there are concerns about how it will scale up its healthcare architecture to address the increasing number of urban challenges.

Despite the fact that government has nearly doubled its spending from $4 billion to over $7.5 billion in the last three years[2], Singapore’s healthcare system is still struggling to improve productivity and reduce operational costs.

One of the biggest challenges for Singapore, as it moves into the next decade, is to scale up its healthcare system to cater to the unprecedented increase in the number of elderly citizens. It is estimated that number of elderly citizens in Singapore could nearly triple by 2030, taking the count to 800,000[3].

A sharp increase in the sedentary lifestyle of the populace has also further threatened the overall integrity of the healthcare system in the long-run, putting them at a higher risk of chronic health disorders.

With a large chunk of population becoming increasingly prone to urban healthcare problems, there is a pressing need to establish a strategic model that emphasises on disease prevention and community care.

In a recent talk at Smart Nation Innovations Forum 2015, Steve Leonard, Executive Deputy Chairman of the InfoComm Development Authority of Singapore (IDA)[4], discussed how information technology would help solve some of the biggest healthcare challenges and how it would transform Singapore into world’s first smart nation.

Addressing the talk, Leonard said that the biggest challenge for Singapore’s healthcare system in the future would be to develop solutions that provide effective and personalised healthcare, while reducing operating costs and delivery times.

Leonard believes that there’s a strong need to envision a sustainable healthcare model that’s loosely coupled with technology, and allows healthcare providers to deliver scalable solutions that balance urgency, privacy, accuracy and regulatory policies.

He feels that technologies like telehealth monitoring that allow caregivers to remotely track patients in real-time, without invading their privacy, could be a huge leap, not only for patients, but also for healthcare providers, as it allows them to provide better, faster, and personalised diagnosis.

IDA estimates that adapting a model like telehealth monitoring could allow hospitals to reduce readmissions by as much as 67%, freeing over 3500 beds per year[4].

It would also improve the productivity of healthcare professionals, allowing them to treat more patients, without the need for active participation. Since the diagnosis is now backed by intelligent health tracking, it would also infuse more transparency into the healthcare system, with suggested treatment options now supported by empirical and historical data.

The data collected from these monitoring systems could then be fed to intelligent analytical systems to discern patterns and root-cause for diseases, and to come up with smarter and better preventive strategies.

Considering the fact that Singapore currently has over 8000 people per square km[5], having a data model that can help understand the healthcare issues of its population on a granular level could be groundbreaking.

Apart from understanding patient behaviour, there is also strong emphasis on reducing medical errors, which are often cited as one of the most common reasons for treatment failure. Technology can be used to reduce human error in diagnosis and provide automated healthcare solutions.

For example, automated specimen checking and patient verification systems can be developed to ensure that correct specimens are tagged to patients, every time.

However, developing a sophisticated and sustainable healthcare architecture using technological advancements is just one part of the equation. The other equally important aspect is to ensure that these services are accessible across all income groups.

Singapore’s healthcare system is often criticised as prerogative of the rich. Despite the 3M schemes (MediShield, Medisave, Medifund), most Singaporeans end up spending as much as 55% of the total healthcare expenses from their own pockets[6].

In fact, owing to its extremely high out-of-the-pocket expenditure, WHO has put Singapore on the list of nations with “catastrophic health expenditure”.

Such proliferating healthcare expenses not only mitigate the accessibility to healthcare services to low-income groups, but also defer early detection and treatment of chronic healthcare diseases, eventually rendering the whole healthcare system inequitable in the long run.

Therefore, as Singapore looks to improve the outlook of its healthcare system by leveraging the power of information technology, healthcare providers should ensure that the benefits of reduced operating margins due to technology are passed on to patients. Government should also look to increase its spend and implement appropriate financial reforms to make smarter healthcare services affordable and accessible to the masses.

References

  1. http://sbr.com.sg/economy/news/singapore-second-fastest-growing-mature-city-in-world-2020
  2. https://www.moh.gov.sg/content/moh_web/home/statistics/Health_Facts_Singapore/Healthcare_Financing.html
  3. http://www.cpahq.org/cpahq/cpadocs/Singapores%20Changing%20Structure.pdf
  4. http://enterpriseinnovation.net/article/addressing-singapores-urban-challenges-it-1764722710
  5. http://data.worldbank.org/indicator/EN.POP.DNST
  6. http://www.imoney.sg/articles/why-singapore-healthcare-costs-can-potentially-write-your-riches-to-rags-story

Ten innovative healthcare startups ramping up in Singapore

With the aspiration to become the world’s first smart nation, Singapore is taking a lot of bold steps, including providing the right developmental framework for upcoming startups to grow on its turf and make an impact.

As a result of a lot of collective reforms taken by the Singaporean government to encourage entrepreneurship, Singapore’s startup ecosystem is growing at a rapid pace, and is widely acclaimed by analysts as Asia’s Silicon Valley.

The emerging startups from Singapore are leveraging the power of disruptive technology to solve some of the biggest challenges faced across a wide array of industries, including healthcare.

In this article, Pulse+IT takes a look at ten promising Singaporean startups that are seeking to transform the healthcare industry with innovative technology solutions.

DocDoc

DocDoc is an online medical-appointment booking and health information portal that connects patients to over 12,000 qualified healthcare professionals. In just a short span of two years, DocDoc has developed to become one of the most widely used portals for scheduling appointments.

The reason why the startup has gained so much traction in Singapore is because it makes it incredibly simple, easy and quick to find doctors based on their location and specialty, and to book appointments in real-time.

Currently, DocDoc is one of the most influential healthcare startups that has originated from Singapore. It has recently raised $11 million in its Series A funding to expand its operations to eight new geographies in Asia.

Klinify

Often labelled as ‘Evernote for Doctors’, Klinify takes writing and managing prescriptions to a whole new level with its simple, intuitive and illustrative app that simulates paper-like-experience on a tablet device.

Klinify enables physicians to draw images, pull up templates, scribble notes, and even add videos to illustrate their diagnosis.

Apart from improving the quality of interactions with patients, Klinify stores all medical information on the cloud, allowing physicians, pharmacists and healthcare providers to organise, track and manage patient information digitally.

Since the information is accessible anywhere, anytime, and across a plethora of devices, it significantly improves the productivity of hospitals, apart from providing superior convenience to patients.

With the goal of reaching more healthcare providers across different geographies, Klinify raised $600K in a seed-funding round last year to expand its operations in Southeast Asia.

RingMD

RingMD is an innovative online platform that lets patients connect to doctors instantly via a phone call or a video chat. The advanced healthcare platform provides one-touch access to interact with world-renowned specialists, experts and GPs for non-emergency issues.

Realising the system’s potential to improve access to healthcare, the Singapore government has invested $500K in the startup. Currently, Ring.MD is working to bring more doctors onboard and forging relationships with insurance providers to provide efficient and affordable healthcare.

MyFitnessWallet

MyFitnessWallet provides simplified digital solutions to help patients track their medical expenses and store their medical records in a safe and secure way.

Branded as OurHealthMate, the startup’s web-based portal lets users pay medical bills for their family online and helps them in keeping a tab of all financial activities. The product is currently affiliated with more than 11000 healthcare providers and offers over 87000 health packages.

HealthDiary, another flagship product of MyFitnessWallet, allows patients to manage and store their medical records online, eliminating the need for extensive paperwork. The digital repository makes it easier for doctors to view and manage their patient’s profile, giving them the convenience to browse through their medical history instantly.

Apart from providing simplified solutions for patients, MyFitnessWallet also looks to improve the efficiency of healthcare providers with its product – ClinicLinc – that uses digital technology to reduce extensive paperwork and streamline hospital management.

Healint

Healint provides an unified remote monitoring system for real-time tracking of patients with chronic health disorders.

The intelligent platform receives inputs from devices like body sensors, combines it with machine learning and big data to crunch the underlying patterns, and broadcasts the information to mobile devices.

The outcomes can either be translated into intuitive graphs or extensive reports, allowing patients and healthcare providers to make sense of data based on their individual expertise.

With its nifty analytics system, Healint aims at improving the accuracy of treatments, optimising clinical coverage, reducing reaction time, and providing adaptive outputs to stakeholders.

Healint has recently raised more than $1M in seed funding from Wavemaker Pacific Funding to scale its operations into new countries, like, Japan and U.K.

ConnectedHealth

ConnectedHealth aims at connecting patients, physicians and fitness providers with a remote health monitoring mechanism that focuses on improving healthcare, while optimising complex workflows, reducing costs and increasing productivity.

The startup provides a reliable and scalable mechanism for healthcare providers to provide seamless connectivity between medical devices, fitness equipments, electronic medical records and smart gadgets.

Having such a mechanism allows physicians to gain more control over treatment procedures and take decisive actions. Information is shared through regulated medical gateways, ensuring that all compliance policies are met.

Singapore Business Review nominated it as one of the 20 promising startups to watch out for in the upcoming years.

mClinica

mClinica is a platform that interconnects patients, physicians and pharma brands with the help of mobile technology.

mClinica’s pharmacy program connects fragmented pharmaceutical supply units, improving quality, accessibility and affordability of medicines and healthcare devices.

Its physician program leverages digital infrastructure to build meaningful relationships between healthcare providers and patients, thereby increasing medical literacy of patients and productivity of doctors.

mClinica’s services are used by some of the top pharma brands, including Pfizer, Abbott and Bayer Healthcare. With a fresh round of funding from 500 Startups, IMJ Investment Partners of Japan and Kickstart Ventures, it’s looking to expand its base in 25 countries across Asia and Africa.

myDoc

myDoc is a safe, secure and regulated communication service that streamlines healthcare interactions and provides a convenient way for patients, physicians, employers and partners to manage medical-records.

myDoc provides virtual consultations to patients through voice, video and text, and also lets them schedule appointments and maintain their personal health diary.

It distinguishes itself from other similar services by providing a holistic platform that delivers personalised healthcare interactions for patients, technology support for physicians, cost-reduction for employers, and easy integration for healthcare partners.

The startup is backed by Capital Partners, a Singapore based investment fund, and is currently focused on expanding its network in its home ground.

T.Jacket

T.Jacket proposes a simple and elegant solution to relieve stress and pressure levels of Singapore’s hardworking population with an app controlled jacket.

The jacket uses innovative touch technology to laterally apply air pressure to the body in order to calm, comfort and soothe the nerves. The pressure levels can be either controlled through the app or automated based on your preferences.

The startup claims that their technology can be used to alleviate stress levels and can even treat sensory modulation issues, like, Sensory Processing Difficulties (SPD), Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD) and Alzheimer’s Dementia.

TuckerMedical

Tucker Medical is a personalised healthcare platform that combines personal genetics and metabolic testing with empirical data received from medical sensors, wearable devices, and activity trackers to treat acute and chronic healthcare disorders.

Combined with conventional medicine, TuckerMedical’s mechanism aims at improving the precision of treatments and delivering tailored healthcare programs.

Dr. Tucker, the founder of the healthcare startup, is a renowned oncologist and has been ranked as one of the top doctors to use the power of social media for healthcare interactions. Currently, his startup is using leading-edge technology to deliver preventive healthcare and accurate medical prognosis.

Conclusion

From delivering personalised healthcare to enabling real-time monitoring, these healthcare startups are developing innovative solutions to improve diagnostic accuracy, automate workflows, manage medical-records, multiply productivity of GPs, bridge knowledge gaps, and create more meaningful interactions between patients and healthcare providers.

While disruptive technology can greatly revolutionise the traditional healthcare model, there’s also a considerable risk involved with providing too much autonomy to these systems. For example, if not accessed securely and effectively, these systems can put patient data at risk, thereby threatening the overall integrity of the system.

Therefore, selective human intervention is vital to ensure that safety and privacy of patients is not compromised, while devising scalable, convenient and innovative technological solutions for healthcare.