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:
- Market-leading aged care software vendor iCareHealth said it was working on redeveloped versions of its medications management app and had 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
- Melbourne’s Management Advantage released a major new version of its Manad Plus aged care software along with three native apps for Apple, Android and Windows devices
- Sydney Adventist Hospital implemented the new CliniSearch clinical text search platform from Sydney firm Health Language Analytics (HLA) to quickly find, retrieve, code and use the vast amount of health data that is stored as text
- Telstra Health subsidiary Emerging Systems signed a memorandum of understanding to form a strategic alliance with Brisbane-based oncology software specialist Charm Health
- Zedmed released version 24 of its clinical and practice management software with a new version of MIMS’ drug-health interaction clinical decision support module and an integrated online appointments booking service
- Alcidion announced it would go public in a reverse listing on the stock exchange with a view to expanding into overseas markets; and
- InterSystems announced it would be launching a next-generation laboratory business management system (LBMS) that would take the laboratory into the big data age.
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