Fiona Stanley committee calls on minister to come clean on clinical ICT

A parliamentary committee that has been investigating problems with the operation of ICT services at Perth’s Fiona Stanley Hospital (FSH) has called on WA Minister for Health Kim Hames to report to parliament on the roll-out of digital medical records throughout the state, along with the implementation of a closed loop medications management system at FSH and the stability of its paging system.

The committee also recommended that the WA Department of Health add an acknowledgement of receipt function to its Notification and Clinical Summaries (NaCS) application for discharge summaries following the distressing death of one patient, and took a swipe at WA Health for its failure to provide relevant information to the committee on the performance of ICT at the hospital.

The Education and Health Standing Committee, chaired by former GP and Liberal MP Graham Jacobs, has a great deal of knowledge in this area, having conducted hearings into the commissioning of the hospital that resulted in the comprehensive More than Bricks and Mortar report in 2014. That report showed that the complexity of the ICT systems chosen for the hospital, particularly clinical IT, was the main reason it failed to open on schedule.

In July this year, an independent review of the hospital’s operational clinical and patient care carried out by the Australian Commission on Safety and Quality in Health Care (ACSQHC) and MMK Consulting found that ICT was still causing problems less than a year after it opened, with the patient entertainment system, cardiac telemetry system and the BOSSnet DMR system all singled out.

The parliamentary committee decided to do a follow-up inquiry into the operation of the hospital and the transitioning of patients following media reports about alleged failings at the hospital, including some horror stories about the breakdown of sterilisation services in operating theatres, claims of staff dissatisfaction from the Health Services Union, the Australian Nursing Federation and the Australian Medical Association, and the tragic death of a 41-year-old patient, Jared Olsen, from medication misadventure.

Dr Jacobs said it was important to undertake a further inquiry to determine whether the alleged failings were just teething problems or indicative of more systemic problems, and whether there were associated costs to taxpayers or risks to patient health and safety.

In addition to evidence from Mr Olsen’s father and the three unions, the committee heard evidence in August from FSH intensive care specialist Ian Jenkins, who lashed out at the ICT capability of the hospital. Dr Jenkins told the committee that the BOSSNet DMR frequently crashed, support for IT applications was inadequate and discharge summaries being issued to GPs were “appalling”.

The committee, which handed down its report yesterday, found that while action has been and continues to be taken over many areas of concern in the report, there were certain aspects of the transitioning of patients and services to Fiona Stanley from other hospitals that did cause risks to patient care, with particular concern over medical records.

“Aspects of the patient transition since the facility’s staged opening were not well managed, with delays in patient records being transferred between sites meaning a treating clinician had limited information on which to base his or her consultation,” the committee found.

“The transfer of patient records following the opening of Fiona Stanley Hospital was poorly managed by the Department of Health and put patients at risk.”

While these problems seem now to have been largely overcome and the required information is now appearing within the DMR, the committee recommended that the Minister for Health provide an update on the status of the transfer of medical records for patients attending FSH from other hospitals in WA.

Digital medical record

The DMR came in for a fearsome tongue-lashing from Dr Jenkins in his evidence as well as from hundreds of other doctors working at Fiona Stanley who the AMA surveyed for a written submission to the parliamentary committee.

There were complaints that the system frequently froze or crashed, that it could not interface with other clinical software such as the MetaVision ICU system, and many complaints about the length of time that it took to admit a patient into a ward or load patient notes in outpatient clinics.

The operational review carried out by the ACSQHC and MMK also expressed concerns about the lack of integration capabilities of BOSSnet. However, industry sources told Pulse+IT at the time that as the software was a digital or scanned medical record rather than a fully integrated electronic medical record, it was being blamed for lacking functionality it was not meant to have.

The Department of Health also backed the system, telling the committee that the DMR had in fact delivered significant benefits including the visibility of medical records across FSH simultaneously by multiple users and at other sites, that notes were legible, date and time were accurately recorded and access to the record is auditable.

“Other witnesses, however, told the committee that the medical records were not accessible at other hospitals,” the committee reported.

“This does seem to be another example of an issue where the expectations on either side are not in alignment. The committee understands that medical records are accessible at the other major hospitals in [South Metropolitan Health Service, including Fremantle Hospital and Royal Perth] but that smaller general hospitals do not yet have access.

“Similarly, no hospital in the North Metropolitan Health Service is able to electronically access a medical record created at FSH. Ideally, the medical record system would be rolled-out across the state, but the reality of limited budgets and IT capabilities means that the solution so far implemented is appropriate in the circumstances.”

Despite WA Health committing to rolling out a DMR throughout the state – and that it would be installed at the new Perth Children’s Hospital – the committee reported that it was actually not clear whether or not that would be the BOSSnet DMR.

It recommended that the Minister for Health report to parliament on the adoption of digital medical record systems, including BOSSnet, across the rest of the health system, including:

“Although the DMR system would clearly benefit from further integration, it is clear that the system as it currently exists is a vast improvement compared to existing paper-based systems,” the committee reported.

“It is the committee’s understanding that improvements to BOSSnet’s level of integration have taken place since the system first went live, and that a number of documents now publish directly into the medical record including discharge summaries.

“Furthermore, the DMR is not a static build; it will experience progressive upgrades that should address many of the early concerns so far expressed. A simultaneous upgrade was intended to address an issue that reportedly accounts for at least 70 per cent of the incidents reported for BOSSnet — namely problems arising from print requests for radiology.”

As to the system’s reliability, the committee said it was not in a position to provide definitive commentary on the matter, but it was important to put on the public record that WA Health believes that issues with the network and infrastructure built and maintained by Serco and BT had affected the performance of the system and were quite often the reason for problems assigned to BOSSnet.

For example, of 40 failures apportioned to BOSSnet since the start of the year, 10 related to the radiology print function, four to servers, 11 to lack of storage space, one where the issue related to remote access, one caused by Windows patching and one in which a user tried to print an exceptionally large report.

The committee concluded that the DMR in place at Fiona Stanley Hospital represents “a significant improvement on existing paper‐based records systems”.

“Ongoing upgrades will help to address some usability issues, including the level of integration with other clinical information technology systems,” it said. “As user familiarity improves the committee expects increased acceptance of the system by clinical users.”

NaCS and discharge summaries

The committee also made a strong recommendation that changes be made to WA Health’s Notification and Clinical Summaries (NaCS) application so that receipt of electronic discharge summaries by GPs can be recorded.

The recommendation follows evidence by Jared Olsen’s father Philip. Jared Olsen died after being prescribed drugs for inflammatory bowel disease that he was unable to metabolise. He was treated and discharged from FSH, but a discharge summary emphasising that he receive additional blood tests to check for toxicity from the medication never reached his GP.

“Unfortunately, FSH’s database had the wrong address for Jared’s doctor, meaning that the discharge summary never arrived anywhere and Jared’s doctor was never able to follow up with him the importance of having that second round of blood tests,” the committee reported.

“The department told the committee that there is no capacity in the electronic discharge summary system to receive a ‘delivery receipt’ once a discharge summary has been sent. This means that the clinician generating the summary has no means of confirming whether it has reached its destination.

“The promise of technology in the health care system must be that it can help to improve outcomes for patients. Merely replacing the traditional mail-based delivery of discharge summaries with its electronic equivalent does not improve patient outcomes, especially when the additional functionality available in electronic systems, such as delivery receipts, is not incorporated.”

The committee found that relying upon giving a hard copy of the discharge summary to the patient was insufficient as a failsafe, and recommended that WA Health find a way to add a delivery receipt notification to NaCS to ensure the patient’s GP has received it.

Waiting times for discharge medications have also caused problems for patients at FSH, which the committee said should be resolved when the promised closed loop medication management system (CLMMS) is rolled out.

However, exactly when this will happen is still unclear, and the committee has recommended that Dr Hames report to parliament regarding the status of the roll-out and the current wait times for dispensing of discharge meds.

As the committee reports, it has some history with the medications system, finding from its inquiry into the commissioning of the hospital that delays in making a decision on CLMMS contributed to the overall delay in opening the hospital.

“Ultimately, FSH did not open with CLMMS in place; however, the system is expected to go live through the remainder of 2015 and into 2016. It was not implemented at the time of hospital opening because it was felt that implementing the process changes necessary whilst simultaneously opening the hospital would have introduced unnecessary clinical risks.”

The committee found that the lack of a CLMMS was not the sole reason that discharge meds were being delayed, finding that uncertainty involving prescriptions from patients transferring from other hospitals was also to blame.

Paging and communications

Paging and communications at the hospital have also raised concerns. While there have been reports that there is a mobile phone black spot in the hospital, there also appears to be a problem with the internal hospital WiFi network.

The AMA told the committee that clinicians were resorting to walkie-talkies because neither the paging system nor the duress system worked properly, and the HSU said there were problems with wireless connectivity in the mobile communications system used by its members.

These sorts of complaints led to WA Health conducting a review of the hospital’s WiFi network last year, which found that the network had trouble supporting the number of devices that were used at the campus at any particular time.

The committee reports that WA Health commissioned an independent consultant to help fix the problem and ensure that the system is robust enough, but it has also recommended that Dr Hames report to parliament on the reliability of the paging system for a three-month period. It wants details on the uptime of the system, the dates, times and lengths of any outages, the extent of those outages and the abatement and/or failure points incurred by Serco as a result of any outages.

While Serco was criticised in the report for some of its failings – for example, the committee concluded that it should never have been given responsibility for sterilisation services, there are major concerns over its cleaning contract and its use of porters rather than orderlies has resulted in 170 nursing assistants having to be hired at a cost of $1.82 million – the committee was unable to discover whether its management of non-clinical ICT had an adverse effect on clinical activities.

WA Health measures Serco’s key performance indicators (KPIs) closely and does not think network problems have badly affected clinical activities, but as the committee reports, the same can’t be said for clinical software provided by its own IT branch, Health Information Network (HIN).

WA Health reported to the committee that FSH had been affected a number of times by its internally managed ICT systems, which it says may have then adversely affected clinical services.

However, the committee reports that WA Health was not forthcoming with more information.

“Unfortunately, the department did not provide additional information about the problems or their potential impact upon clinical care in its response,” the committee reports.

“Given the nature of the committee’s question, it would have been of greater assistance if the answer had outlined the nature of the ICT problems that were [affecting] FSH and whether they were [affecting] the delivery of clinical services.

“It is entirely possible that the problems encountered were minor, and that their impact on clinical service delivery was insignificant, but the answer in no way assures the committee that this is the case.”

The committee put on the record that it was concerned that WA Health “did not always provide materially relevant information in the answers to some of the questions put to it regarding the performance of the information and communications technology systems at the hospital”.

Managing the transition? The report of the inquiry into the transition and operation of services at Fiona Stanley Hospital is available from the WA parliamentary website.

Govt to build digital mental health gateway, PHNs to plan regional services

The federal government will develop an integrated web-based portal with a single phone line as part of a digital gateway program to help people navigate mental health services, with work to begin this financial year and the gateway progressively rolled out from 2016-17.

As part of its response to the ‘Contributing Lives, Thriving Communities’ review of mental health programs by the National Mental Health Commission, delivered a year ago, the government will also redirect $350 million per annum in funding for various programs coordinated by the Department of Health to Primary Health Networks (PHNs), which will now be in charge of planning and commissioning mental health services on a regional basis.

The funding will be redirected into a ‘flexible primary health care funding pool’ and will include programs such as Access to Allied Psychological Services (ATAPS), Early Psychosis Prevention and Intervention Centres (EPPIC), Headspace service delivery, the mental health nurse incentive program, mental health services in rural and remote areas, and various fragmented suicide prevention programs.

The government wants to take a regional approach to mental health care delivery, with better integration with primary and secondary health services through a stepped care model. A specific priority for regional service integration and delivery led by PHNs will include better sharing of consumer history and information between service providers and consumers through the My Health Record, formerly known as the PCEHR.

The government’s response to the commission’s review says the new digital mental health gateway will be aimed at providing a first point of call for mental health needs and will include an online triage element. It will include links to existing online forms of self-help for mild to moderate mental health needs.

Health Minister Sussan Ley said the idea of a single national mental health phone line was not to replace existing phone lines but to help direct callers to the appropriate phone or online mental health service they need.

Ms Ley said there were currently over 30 individual federal government-supported phone and online mental health services available to the public, which have been described as fragmented, confusing and difficult to access for people needing quick access to a specific support service.

“There are many fantastic phone counselling and advice services in Australia, but with so many different numbers available, it can be difficult for people to navigate themselves to the right service in their time of need,” Ms Ley said in a statement.

She said a direct help phone service would also help reduce the number of people ringing a service which may not be able to provide the best assistance for their specific needs, which, in turn, could prevent other people getting through.

“Evidence shows that for some phone counselling services, over 300 people each month cannot get through. Other services have answering rates of about 60 per cent.”

The web portal part of the gateway would provide links to digital mental health services offering a range of products from mobile applications that can help to detect the onset of anxiety to professional online counselling and psychological services where people can chat with mental health professionals in a discrete setting.

Ms Ley said the government wanted to harness these digital innovations and provide the easiest possible access to people who may be seeking help.

“These are evidence-based services that deliver real help to people at a low cost,” she said. “They are easily accessible and allow people who might not otherwise access services to get help in a private, discrete setting.

“Whether people are accessing peer-to-peer forums, self-help information or accessing professional services online, we want to make sure we can direct people to the right service as easily as possible.”

Digital service delivery

The government describes digital mental health as the delivery of services targeting common mental health problems through online and mobile phone interactive websites, apps, sensor-based monitoring devices and computers. The term also extends to telephone crisis lines and online crisis support services.

The plan is for the gateway to also provide links to online mental health services and information offered by portfolios such as the departments of Veterans’ Affairs, Social Services, Defence and Education.

According to the government’s response, enhancements to the gateway will be explored “to more comprehensively reflect the potential for digital service delivery in mental health over time, to support fully integrated information and service pathways becoming available for both consumers and service providers”.

While the gateway will be directed at people with or at risk of mild to moderate mental illness, the government is planning to introduce integrated, ‘stepped care’ packages tailored to individual needs for people with severe or complex mental health needs.

Ms Ley said the government plans to identify demonstration sites for these new packages this financial year, with arrangements phased in over three years from early 2016-17.

The government’s response to the review says it will give priority to resolving the fragmentation of service delivery for people with severe and complex mental illness who are being managed in primary care, and address their need for coordinated clinical and social supports, by promoting the use of a single eHealth record.

It also plans to provide better, joined up support for child mental health through a new networked system to help reduce the effect of mental illness on children. This will include a single, integrated, end-to-end, school-based mental health program and new pathways to services including online-based support.

Ms Ley said work would begin on the digital gateway this financial year (2015-16), with it being progressively rolled out from 2016-17 as part of the government’s broader three-year reform plan.

Guarded support

Shadow health minister Catherine King said Labor was pleased the government had finally responded to the commission’s review, and in broad terms supports the general direction of devolving mental health service delivery to a regional level through PHNs.

However, Ms King said the government’s response was light on detail and provided very little information of funding allocations and the timeframes for implementation.

“It is very difficult to see how many of these reforms can be implemented without additional funding,” she said.

The Australian Medical Association (AMA) also said questions remained about new funding, on-the-ground service delivery, and the ongoing role of the federal government in the mental health sector.

AMA president Brian Owler said the success of the new direction in mental health service delivery will depend very much on the capacity and capability of PHNs and it would be important to ensure that the system did not lock people into a package of care decided upon by a PHN based on the services it has chosen to organise.

Professor Owler also insisted that GPs must remain at the centre of care, citing BEACH data that estimates that around 13 per cent of GP encounters are mental health-related.

He said an underlying concern of the new framework was the withdrawal of the federal government from funding and program delivery to assume a ‘strategic leadership’ role.

“The AMA will be closely watching the government’s reviews of primary care and private health insurance to see if this approach is going to be replicated, with greater responsibilities going to the states and territories and the private sector,” he said.

Lady Cilento Children’s gets a $5.8 million top-up for ieMR

The Queensland government has come up with an extra $5.8 million to support the roll-out of the Cerner integrated electronic medical record (ieMR) at Brisbane’s Lady Cilento Children’s Hospital (LCCH) as part of an overall $70 million three-point plan to try to solve some of the problems affecting the $1.5 billion hospital.

LCCH was plagued by poor planning before it opened in November last year and by bad publicity since, with claims of problems ranging from not enough beds to not enough parking spaces.

An independent review of the building and commissioning of the hospital released in August found that the rush to open the doors on the designated date had compromised proper processes, with medical equipment not turning up, staff still being hired and a malfunctioning phone system.

It also found that the rushed opening had affected the ICT systems, which required extensive data integration, convergence and information sharing requirements as the new hospital saw the closure of the Royal Children’s Hospital (RCH) and the Mater Children’s Hospital (MCH) and merger of its administrative and medical records.

Cerner’s system was already in use at the RCH while MCH used a scanned medical record. The ieMR was chosen for Lady Cilento but the report found that MCH staff struggled to access enough training and paper records were still being scanned into Cerner long after the hospital opened.

A clinical review of the hospital undertaken in March also found there was confusion over the different outpatient booking systems and the transfer of multiple versions of data contained in spreadsheets had to be done manually.

The hospital’s ICT budget also blew out from the originally envisioned $40m to $93 million, the commissioning review found.

As part of a new support plan for the hospital announced today by Queensland Health Minister Cameron Dick, up to $70 million will be made available over four years to support the hospital.

Mr Dick said the three elements of the plan involved an extra 31 beds, more support for the hospital’s IT systems, and doubling the hospital’s capacity to retrieve sick patients by air from rural and regional Queensland.

Mr Dick said the 31 new overnight beds would cover a range of specialty areas, including more paediatric intensive care unit (PICU) beds. The hospital opened last year with 300 beds so funded beds will now rise to 331.

The new funding is in addition to the $19 million provided in the 2015-16 budget to address structural deficit issues identified at the hospital.

“This is about ensuring the hospital is properly equipped to deliver frontline services to those Queenslanders who need them,” Mr Dick said.

“The Department of Health is conducting a detailed examination of the hospital’s ongoing financial and operating situation, and I have also been listening to the concerns being raised by some parents and some clinicians. And we’re responding.”

Up to an extra $20 million a year will be available for the new beds, along with an extra $1.3 million in annual funding for air retrieval. The $5.8 million for ICT is a one-off investment, Mr Dick said.

Recruitment for extra staff to support the additional beds would begin immediately and the beds would open as soon as they can be safely staffed, he said.

“New beds means more staff and the department has asked Children’s Health Queensland to begin the recruitment process as soon as possible.”

In its first year of operation the Lady Cilento Children’s Hospital is expected to admit more than 38,000 children as inpatients and see around 190,000 children through outpatient clinics.

International health IT week in review: September 27

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

A new way of ‘tagging’ the EHR
mHealth News ~ Eric Wicklund ~ 24/09/2015

A new partnership is using RFID to connect hospital clinicians and patients to the EHR.


Docs are paying more for technology than ever before
HealthcareITNews ~ Erin McCann ~ 24/09/2015

Medical practices across the U.S. are now spending a lot more on technology this year, up nearly 34 percent from four years ago, according to a new MGMA report.


5000 GP practices offer e-prescriptions
Digital Health News ~ Rebecca McBeth ~ 24/09/2015

More than 5000 GP practices in England offer electronic prescriptions and 15 million patients have signed up for the service.


ICD-10 go-live: nightmare or non-event?
HealthcareITNews ~ Tom Sullivan ~ 23/09/2015

The ultimate irony of a long standing ICD-10 to Y2K comparison is that – after all the years of debate, disdain and doomsday predictions – it now appears that the go-live will likely pass after the same fashion that Y2K did: imperfectly but more or less quietly.


Lawmakers push telestroke bill to increase access for Medicare patients
FierceHealthIT ~ Katie Dvorak ~ 23/09/2015

When someone is suffering from a stroke, time is of the essence, which is why two House lawmakers are proposing a bill that would change when Medicare beneficiaries can receive telestroke services.


Docs at odds with patients in use of digital health tech
Health Data Management ~ Greg Slabodkin ~ 22/09/2015

Physicians and consumers differ significantly and broadly in their views about emerging medical technology, with more enthusiasm and support expressed by consumers rather than clinicians.


Updated federal HIT strategic plan focuses on person-centered care
FierceHealthIT ~ Dan Bowman ~ 22/09/2015

An updated version of the Department of Health and Human Services’ federal health IT strategic plan will focus on ensuring care is more person-centered, federal officials said on a call Monday.


Care.data delayed by 2 years
Digital Health News ~ Thomas Meek ~ 22/09/2015

Final approval for the ‘pathfinder’ stage of the controversial care.data programme to go ahead is not expected until early next year.


Using the survey as a patient engagement tool
mHealth News ~ Eric Wicklund ~ 21/09/2015

When patients leave a medical appointment with unanswered questions or concerns, they’ll look for answers online. Then they’ll look for a new doctor.


Why hospitals should buy IT start-ups
HealthcareITNews ~ Jack McCarthy ~ 21/09/2015

Lots of hospitals are snapping up clinics and physician practices. One major consultancy recommends they also consider acquiring digital health start-ups and other vertically integrated companies.


Industry groups pressure feds to delay stage 3 EHR rule
Health Data Management ~ Greg Slabodkin ~ 21/09/2015

Support continues to grow among industry groups for delaying Stage 3 of the federal government’s electronic health records Meaningful Use program.


HITECH Act falls short of overall goals
FierceEMR ~ Marla Durben Hirsch ~ 21/09/2015

The HITECH Act has helped initiate “significant” progress in the use of health IT, but has fallen short of its goal to create an efficient and effective healthcare system with the advanced use of health IT, according to a Robert Wood Johnson Foundation report.


CommonWell signs 4 more vendor members
HealthcareITNews ~ Mike Miliard ~ 18/09/2015

The newest batch of health IT companies to join the CommonWell Health Alliance has brought the interoperability group’s total membership to 33 – quadruple the number as of this time last year.


Patient access to medical records remains hindered
Health Data Management ~ Greg Slabodkin ~ 18/09/2015

Patient access to their own health information continues to be a major challenge despite widespread adoption of electronic health records by healthcare providers and the availability of patient portals.


Precision Medicine framework outlines project’s opportunities
FierceHealthIT ~ Susan D. Hall ~ 180/09/2015

The National Institutes of Health is moving forward with plans to enroll 1 million volunteers for U.S. President Barack Obama’s Precision Medicine Initiative.


Med organizations urge ‘pause’ of MU Stage 3
FierceEMR ~ Marla Durben Hirsch ~ 18/09/2015

The American Medical Association (AMA) and 41 medical societies have asked Department of Health and Human Services Secretary Sylvia Mathews Burwell and Office of Management and Budget Director Shaun Donovan to pause the rule implementing Stage 3 of the Meaningful Use program.


Adherium breathes easy following positive ASX listing

Auckland-based medical device developer Adherium had a successful listing on the Australian Securities Exchange (ASX) this week, with its stock closing at 60 cents a share on its first day of trading, valuing the company at $A84 million.

Adherium, which was founded by CEO Garth Sutherland in 2001 and was formerly known as Nexus6, makes a range of sensor devices called Smartinhalers that attach to prescription inhalers that deliver corticosteroid and combination therapies for asthma and COPD.

The sensors monitor inhaler use and send audio and visual medication reminders. They also send data via Bluetooth to Adherium’s SmartinhalerLive software platform, which includes an app, a smartphone hub and cloud-based software that allows for remote monitoring and for data tracking through a personal electronic health record.

The product range has some excellent clinical trial data behind it, with the results of a four-year New Zealand trial conducted by Cure Kids, the Health Research Council and the University of Auckland of 220 children between the ages of six and 15 with asthma published in January.

That trial showed children who had audio reminders were 180 per cent more likely to take their medication than those in the control arm, and had a 45 per cent reduction in rescue/relief or ‘blue inhaler’ use.

Other research has shown the Smartinhaler increases adherence in adults by up to 59 per cent, important in a chronic illness where fewer than half of all patients adhere to their prescribed preventative medications.

Adherium issued an IPO earlier this month looking to raise a maximum of $A35 million. It was oversubscribed, having already secured $25m from institutional investors, including $US3m from key commercial client AstraZeneca.

Adherium signed an agreement in July to provide AstraZeneca with new devices and sensors, which will be offered along with the pharma company’s respiratory medications.

Adherium’s business model does not involve direct to consumer sales, but rather to sell the platform directly to pharmaceutical companies that then provide the device and supporting applications to end users via their own distribution channels.

It also supplies its Smartinhaler platform to disease management organisations and for clinical trials.

It has marketing approval from the US FDA, Australia’s TGA, NZ’s MedSafe and CE Mark approval in Europe.

Adherium describes the platform as providing a sophisticated integrated remote patient management system for people who have a chronic disease.

It says the use of the system reduces use of rescue medication and the amount of severe exacerbations; can track overuse of rescue medications and notify patient and physician that the disease is becoming poorly controlled; and its app can provide patients, parents, caregivers and doctors clear indications of inhaler usage and adherence to treatment plans.

The Smartinhalers clip onto the regular inhaler and record the date and time of medication use. They automatically send usage data to an app, hub or PC via Bluetooth, and they sing a song when medication is due.

Beyond the silver surfer to the platinum power wheel

The fundamental change towards consumer-directed care (CDC) that has radically reshaped the aged care sector over the last few years offers great opportunities to the ICT industry above and beyond traditional residential or home-based aged care.

Lynda O’Grady, a former Telstra executive who is now the chair of the Aged Care Financing Authority (ACFA) and independent director of the National E-Health Transition Authority (NEHTA) among other director roles, told the Health Informatics Conference (HIC 2015) in Brisbane earlier this month that ICT companies interested in exploring the huge growth expected in aged care should look to the vast majority of people who will not require personal care but who are interested in using technology to keep active and have fun.

Ms O’Grady has worked with Bond University professor of communication and creative media Jeff Brand to create what they call a “platinum power wheel” framework that concentrates on three “magic elements” of positive ageing: someone to love, something to do, and something to look forward to.

“We tend the focus on ‘my person’, which is my body, my mind and my medical and health records,” she said. “But frankly, someone to love, a coterie people who are in a community who we are interacting with, is equally important for positive ageing and longevity.

“There’s a lot of research, including by the American Society of Ageing that shows that boomers, that people in the cohort we are speaking about, the over 50s but particularly the over 60s, when researched they call out that their main objective in those later years is simply to have more fun.”

She said Professor Brand’s research showed that gamification is likely to provide not just huge opportunities for older people to keep active and healthy and gainfully employed, but will also provide a wealth of commercial opportunities for the ICT industry she said.

Professor Brand is also the author of the Digital Australia Report, the 2016 version of which showed that video games are played by many older people: primarily, they say, to keep their mind active. He is due to publish a new book, Purposeful Ageing for the Digital Economy, early next year.

Ms O’Grady also recommended that the ICT industry use the blue ocean strategy to open up new markets and create new demand, and to be aware that the move to CDC had enormous ramifications for building these new markets.

“Research is showing that there’s a new breed of elder consumer leaders,” she said. “They are more affluent, they are more vocal and educated and most particularly, more demanding.

“They will increasingly assert themselves not as being people who are invisible and voiceless, but from the silver army to a platinum status with buying power and from senior citizens to senior activists.

“So any ICT developer who does not have people, that is consumers and staff, at the centre of the development process, is likely to lose any future battle in terms of successful offerings.”

Ageing population paradigm

As the head of the ACFA, Ms O’Grady was able to reel off a number of statistics on the aged care industry, from the people it cares for to its huge – and growing – assets.

While there are about a million people of government-subsidised aged care and care assistance, either in their home or in residential aged care, the vast majority of older people are living independently in their homes with no specific government aged care subsidy.

And the people who are in residential aged care, of which there are about 180,000, are contributing billions in terms of their day-to-day living expenses but also in residential bonds.

Ms O’Grady said that of those one million consumers of government-sponsored aged care are receiving three different types of services. The most common are the three-quarters of a million people receiving what was formerly known as Home and Community Care (HACC) program, which provides assistance such as Meals on Wheels or subsidised activities.

The second category is Home Care Packages, which require an assessment from an Aged Care Assessment Team (ACAT) and aims to keep people at home for as long as possible by providing nursing care within the home.

The third category is residential aged care, which cares for about 180,000 people in residential facilities.

“Now, in 2013/14 the whole industry recognised revenue of almost $18 billion,” Ms O’Grady said. “Most of that, $12.8 billion, was funded by the Commonwealth with the rest provided by the consumers, primarily consumers in the residential care sector.

“As of the 30th of June 2014, the total assets of the industry were $33 billion. It is a huge industry. That was largely financed by residents by way of their residential bonds. $15.6 billion, or almost 46 per cent of all assets in residential care have been financed by the residential bonds.

“Of the remainder, $11 billion is owned by the [providers] or residual equity, and just over $7 billion by external financiers.”

While the industry is huge, what those figures don’t show is that the million people receiving some government-funded care or assistance are a minority. The people in residential aged care are only four or five per cent of the market, she said, and the majority of those are aged over 85.

“At the moment there are three and a half million people over the age of 65, and 70 per cent of them are actually living at home without government subsidised aged care services. Living at home without any money being spent from the aged care system.

What is now looming is the mass of people aged between 50 and 65 who will be entering that target market in the next 20 years. Ms O’Grady said that is estimated to about 4.2 million people.

“In 20 years’ time, there will be 6.2 million, or almost another four and a half million people, who won’t be accessing the government-funded or government-sponsored aged care system,” she said.

“That will require a change in paradigm in terms of the provision of all kinds of services outside of those which are funded by the government. There will be a great deal more focus on keeping people in their homes and providing the services needed to keep them enabled, or re-enable them.”

Government-funded care

For many years, the role of the government in the aged care system has been to regulate licences, packages and places and to stump up about 70 per cent of the funding required for home, community and residential care.

It will still provide the bulk of the funding, but under the move to CDC, first instigated by the Labor government under its Living Longer Living Better reforms and carried through by the Coalition government, the role of service providers has fundamentally changed.

From July 1 this year, the HACC program has merged with other community-based services to become the Commonwealth Home Support Program.

“The most substantial foreshadowed change is planned to occur in July of 2018, which is likely to see the integration or merging of the Commonwealth Home Support Program with the home care packages,” Ms O’Grady said.

“So effectively that will mean there is one single program, remembering that’s a total of $1.3 billion funding into those two separate programs. There is foreshadowed to be a single, consistent fee policy, with a means-tested contribution from the recipients.”

All of this is now offered on a CDC basis, she said. “The most profound change has been foreshadowed by the recent announcement, which is that from February 2017, packages will be actually allocated to consumers.

“So effectively, instead of the licenses being provided to a home care provider, essentially a consumer will apply for a package, and then they will go looking for a provider who is prepared, able and willing to provide the services that they become entitled to.

“In terms of residential care, the most fundamental change is the change to the accommodation payments. And primarily that was about putting for the consumers at the centre of the universe, with the consumer having visibility of the rate card for the different types of rooms so they could compare them with competitive providers.”

The My Aged Care gateway has also been launched to effectively provide a single government portal where a prospective care recipient can go to identify what services are available, and there is now a My Aged Care record, “which effectively will be one’s individual CRM about you as a care recipient and will register your details, only so far as they contain to the aged care system and your registration and movement through the system”.

There has also been established an Aged Care Sector Committee, which Ms O’Grady serves on.

“The reason that I cite this, is because it is most critical, because it continues the focus on the consumer. At the centre of the aged care industry will be empowered consumers and informal carers who will have full information and discretion.

“And that is designed to motivate much greater innovation and responsiveness from providers in the development and delivery of services, and frankly to underpin and ensure a much more prosperous, robust and diverse industry.”

Opportunities for ICT

CDC means that not only service providers but product providers like ICT developers need to start innovating around the consumer and their informal carers rather than the provider, Ms O’Grady said.

She and Professor Brand have developed the platinum power wheel as a framework for innovation around the consumer, she said.

“It basically leverages the colloquial description of the three magic elements of positive ageing, which are: someone to love, something to do, and something to look forward to.”

While their main objective may be to have more fun in their later years, people in this cohort of over 50s and over 60s also want to retain purpose.

“There’s the tendency to think that when we leave the workforce that we’ve got nothing to do,” she said. “Once we’ve finished our trip around Australia or get sick of playing golf, what do we do? The research similarly shows that over 70 per cent of people want to remain in a productive employment.

“If you want some empirical and quantifiable evidence of what that’s likely to do for the Australian economy, take a look at the excellent research that’s on the Age Discrimination Commissioner’s website. It has a piece of modelling done by Deloitte which identifies the value of staying in the workforce an extra five years, including part time, to be up to three per cent additional GDP. So it’s not only good for us oldies, but it’s also very good for society and the economy.

“But we live in the 21st century, a digital era, and there’s a bit of a myth that older people are not computer or digitally literate. Well, that’s simply not factually correct. Not only do we use computers for monitoring our bodies and our minds, but connecting any to many, seeking information from the ubiquitous Mr Google, transactions, net-banking, travel, etc.”

But older people are also interested in fun, which is where Professor Brand’s research for the Interactive Games and Entertainment Association comes in. His research shows that more than 50 per cent of over 50s play video games.

“Take a look at his report, because the really important sleeper that’s themed throughout his research, is that gamification is likely to provide huge utility to many commonplace activities including lots of mundane business and work-type activities, from finding what you’ll cook for dinner to something more significant.

“So it provides great rewards for the individuals who’ve got purpose and pleasure, but more particularly provides a wealth of commercial opportunities for the ICT industry.”

Ms O’Grady said she had three messages for ICT companies involved in or looking to enter the aged care market. One is to innovate.

“There is a whole realm of new services which are outside or are not currently contemplated by those proscribed by the funding systems,’ she said. “Leverage other industries’ expertise to develop those.”

The second is to look for new consumers. “You don’t need to be thinking about just those consumers who are funded by the government. Many of us have the capacity and the demand for lots of other services, which are also provided by the aged care sector now, but many of us will be happy to purchase or acquire, with our own money, if you make the services sufficiently interesting and relevant.”

And third, she said those industries looking to work in the aged care sector to engage with the government and aged care providers more proactively.

“With the greatest respect to all of the software providers who have been providing systems into the industry, it would be true to say that they have been caught short and slow [by CDC], because they weren’t at the front of the development process, working with the government and the providers to ensure that the business models, the software systems and processes, were ready.”

iCareHealth to redevelop meds management app as it goes agile in Azure

Market-leading aged care software vendor iCareHealth is set to release redeveloped versions of its medications management app at the end of the year and has moved to six-monthly release cycles for its core clinical and care management software now that Microsoft’s Azure cloud platform is available in Australian data centres.

iCareHealth’s chief technology officer Craige Pendleton-Browne said the company had moved to hosting its development and test environments in Azure, which meant it was able to innovate faster and implement continuous integration.

The move has also allowed the company to move to an Agile methodology faster and more easily than expected, Mr Pendleton-Browne said.

“It allows us to spin up environments quickly and we can experiment and try things,” he said. “We can run up an environment, we can play around with a few things, we can shut it down without having to build or wait for infrastructure.”

For iCareHealth, it has helped improve the quality of their product and speed to market, he said.

“We could easily do monthly release cycles, but the reality is that when 80 per cent of your staff are using the software daily an element of change management is needed whenever you put out a new version.” Mr Pendleton-Browne said.

The company, which is now part of the Telstra Health group, plans to release a new version of its core software in the next few months and is working on new iOS, Android and Windows versions of its medications management app.

Mr Pendleton-Browne hopes to have the iOS version available at the end of the year and the Android version early next year. The aged care industry, which has long had a reputation for its glacial rate of change, is very much exploring the benefits that tablets and other mobile devices are bringing, he said.

They are also much more open to the idea of the cloud and software-as-a-service, he said. “If you look at our new clients over the last six months, the majority of our new clients have gone onto Azure, which I think is a fantastic move.”

While new clients are plumping for the cloud, it is a harder sell for existing clients, many of whom are happy to stay with their local servers for the time being.

“A couple of our bigger clients have just made some significant investments in virtualisation internally, so moving to Azure doesn’t offer them many benefits at this stage,” he said.

“But when that investment is depreciated in two, three years’ time, their plan would include not only moving our software to Azure but moving a whole lot of their infrastructure to the cloud. We have moved a couple of [existing clients] over. As we are going through and upgrading, we’re actively having the conversation that there is an alternative.”

One of the benefits for cloud-hosted software is not having to worry too much when new operating systems like Windows 10 are released. Mr Pendleton-Brown said his team had done some preliminary testing with the new OS but he isn’t seeing any urgency in the industry to move to it just yet.

However, he said when new operating systems become available, plans are built into the next release cycle to incorporate a compatible version.

Point-of-care testing for renal failure and chest pain

Flinders University researchers are planning to run a study in six remote health centres in the Northern Territory to determine the patient benefits and cost savings of using point-of-care testing (POCT) devices.

The International Centre for Point-of-Care Testing at Flinders University will undertake the research following a $95,000 grant from the Emergency Medicine Foundation.

The centre currently runs Quality Assurance for Aboriginal and Torres Strait Islander Medical Services (QAAMS), a national service funded by the federal government that provides POCT for diabetes management and treatment at more than 170 Aboriginal and Torres Strait Islander medical services.

It also runs a program in association with the NT Department of Health using the Abbott i-STAT portable blood analyser.

It now intends to specifically investigate the use of POCT for patients with acute chest pain, acute diarrhoea and acute renal failure.

Centre director Mark Shephard said the research has the potential to lead to more services in rural and remote communities, which could lead to major health benefits as well as create substantial savings for the health system.

Professor Shephard said access to portable pathology testing means that doctors are able to rule out potential acute problems, stabilise patients in their own communities or confirm when emergency evacuations were required.

“In simple terms, this research will determine whether POCT enables more people to be diagnosed and treated in their remote communities, and whether it reduces the need for unnecessary and expensive medical retrievals,” he said.

“Hundreds of rural and remote Australians are medically evacuated to city hospitals each year at a significant cost to the health system.”

In addition to research into POCT in rural and remote areas, the centre also has expertise in device selection, analysis of evidence-based outcomes for POCT and the development of software solutions for the electronic capture of POCT results.

Aged care demands apology over electronic claims breakdown

The two peak organisations for aged care have separately called for an apology and for financial restitution from the Department of Social Services (DSS) and the Department of Human Services (DHS) over breakdowns in electronic claiming systems over the last two years, which they say has taken them back to last century.

Leading Age Services Australia (LASA), which represents the for-profit sector, last week welcomed the launch of a new electronic claiming system for home care providers after what it says has been two years of inconvenience through repeated failures that have left the industry without properly functioning claims systems.

LASA has called for an apology from the minister for human services, Marise Payne, acknowledging the cost and inconvenience it has caused providers and clients.

LASA CEO Patrick Reid said system failures of a similar scale would not be tolerated in any other industry.

“For two years providers have absorbed the cost, time and inconvenience of operating without a functioning claims system,” Mr Reid said in a statement.

“The impact of this should not be ignored or under-estimated, and the absence of an apology from the minister to both providers and their clients is further proof that aged care does not rank highly in this government’s priorities.”

However, Aged and Community Services Australia (ACSA) has gone further, asking for a meeting with Senator Payne and DHS/Medicare to discuss compensation for lost interest on outstanding amounts and additional staff time, and debt recovery for outstanding amounts.

ACSA, which represents the not-for-profit aged and community care sectors, has written a letter to Senator Payne detailing a litany of problems reported to it by members, including inaccurate amounts on statements, multiple data entry errors, adjustments to subsidies that deduct large amounts, overpayments of subsidies, and an inability to get information or follow-up in a timely manner.

ACSA says it has sent in excess of 500 emails on behalf of members to senior people in DHS for problem resolution and has also raised these issues with DSS and Aged Care Minister Mitch Fifield’s office on several occasions over the past 18 months.

Some members are owed up to $3 million and some money still owing dates back to the 2013-14 financial year, ACSA CEO John Kelly writes in the letter.

“We estimate that about 30% of members have indicated they are having cash flow problems due to issues with the Medicare payments system,” Professor Kelly writes.

“As you can appreciate the impact of such cash flow problems will have a broader impact on the communities that providers operate in. Providers have also reported a significant increase in their staff time is being spent engaging with Medicare to resolve these issues.

“Additionally ACSA members report that they are now having issues with reconciliation which is increasing the stress levels of administration staff.”

Some of the reported problems include:

As one provider wrote, “This process is very expensive for providers, needing to continually go back again over accounts and payment statements now many years old – all of this additional work has been caused by [DHS’s] mistakes – yet there has been no compensating for the cost to providers.”

In addition to meeting with Senator Payne and her department to discuss restitution, ACSA said it will also be advising members to pursue the assistance of the Commonwealth Ombudsman if the formal complaint and issues are not dealt with in a timely satisfactory manner by DHS.

LASA’s Mr Reid said that while both DHS and DSS had worked in good faith to remedy some of the issues that have arisen with electronic claiming, work is not yet complete on other system problems that are affecting aged care providers and clients.

“This is just one of several systems issues that need to be addressed, which concerns LASA and does not instil confidence in our members, who rely on effective systems to deliver the best possible service to older Australians,” Mr Reid said.

“LASA members and staff from all LASA offices have worked closely with the departments to identify and rectify problems with their systems, and will continue to do so as it’s important for taxpayers and older Australians that we get this right.”

DHS has launched a new system called Aged Care Online Services, which is now open to all providers of home care services to claim online.

However, residential aged care provides and those that provide both home and residential aged care still need to use the older Aged Care Online Claiming system.

Australasian health week in review: June 27

Pulse+IT’s weekly round-up of Australian and New Zealand health, IT and eHealth news:

Turnbull’s NBN gets ACCC green light
iTNews ~ Andrew Sadauskas ~ 26/06/2015

Telstra’s revised definitive agreements to hand over its copper and HFC networks to NBN has come into force after the competition regulator today said it had approved the telco’s migration plan.


Seniors taking to the internet to reduce loneliness
Australian Ageing Agenda ~ Natasha Egan ~ 26/06/2015

A growing number of tech-savvy seniors is using the internet to reduce the impact of social isolation, according to a survey commissioned by nbn, the company building the national broadband network.


NBN network deal with Telstra sealed
The Australian ~ Mitchell Bingemann ~ 26/06/2015

Telstra will begin handing over its copper and cable networks to the company building the National Broadband Network after the competition regulator rubberstamped the two companies’ $11 billion deal.


Australia falls in Akamai broadband ratings
Computerworld ~ Hamish Barwick ~ 26/06/2015

Australia has dipped in worldwide broadband connectivity rankings measured by Akamai according to the company’s quarterly State of the Internet report, despite a growth in average connection speeds.


Draft New Zealand Health Strategy expected next week
NZ Doctor ~ Liane Topham-Kindley ~ 26/06/2015

Primary care representatives were invited to take part in a workshop last week designed to gather information to help develop a new national health strategy.


Telstra wins big from mobile blackspot program
Computerworld ~ Rohan Pearce ~ 25/06/2015

Telstra has emerged as the big winner from the government’s $100 million mobile blackspot program. The telco will build the lion’s share of new and upgraded mobile base stations under the program, while rival Optus will build none.


IT workers in the Australian Public Service are on the rise
Canberra Times ~ Noel Towell ~ 24/06/2015

The Australian Public Service has slashed its army of private sector IT contractors by more than half, taking its tech operations nearly all in-house, according to a new Finance Department report.


War of words over Grattan Institute PBS report
Medical Observer ~ Julie Lambert ~ 24/06/2015

The pharmaceutical industry has rejected a Grattan Institute report calling for an independent federal drug-purchasing agency to bring down costs to the Pharmaceutical Benefits Scheme.


NSW Budget 2015: tech funding at a glance
iTNews ~ Paris Cowan ~ 23/06/2015

The NSW government has delivered significant new funding to bust congestion of the state’s roadways and equip cops with new technology in its 2015 budget.


After-hours GPs act as ‘mobile pharmacists’
Australian Doctor ~ Serkan Ozturk ~ 23/06/2015

An after-hours care service that has doctors moonlighting as mobile pharmacists has come under fire from some of its own GPs.


VPN providers say business will boom after anti-piracy bill passes Senate
ABC News ~ Will Ockenden ~ 23/06/2015

Providers of VPNs or virtual private networks say they’re expecting business to boom in coming days, after a bill to block piracy related websites passed the Senate last night.