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

Google Nest, Apple Pay, holograms, robots and connected homes lead us to the future
The Australian ~ Chris Griffith ~ 10/12/2015

Holograms, virtual reality and augmented reality will be growth areas for tech next year. In general, we will see technology that already is embraced by some become more refined and widely adopted.

---

Health funding and terrorism on COAG agenda
ABC News ~ Naomi Woodley ~ 11/12/2015

State and territory leaders say they’re united in the need for the Commonwealth to reverse cuts to long-term health funding.

---

Kim Hames says he ‘won’t be bitter’ if he leaves cabinet
ABC News ~ Jacob Kagi ~ 10/12/2015

Western Australian Health Minister Kim Hames insists he is not bitter over his likely departure from Cabinet next year, after announcing he will resign as Deputy Premier in February.

---

NDIS: Staff shortages, lack of government co-operation flagged as roll-out problems
ABC News ~ Libby Hogan ~ 10/12/2015

Two-thirds of the nation’s disability service providers say the Federal Government is not co-operating with them on some of the problems they have flagged with National Disability Insurance Scheme (NDIS) trial sites.

---

World-first robot surgery in Toowoomba gives cancer patient new voice
ABC News ~ Peter Gunders ~ 10/12/2015

Toowoomba surgeons Dr Suresh Mahendran and Dr Roger Grigg performed the operation with a DaVinci robotic system, with assistance from Professor Suren Krishnan from the Royal Adelaide Hospital, who is considered a leader in robotic ear, nose and throat surgery.

---

Fremantle Hospital’s intensive care unit in danger of closing as Government attempts to cut costs
ABC News ~ Jacob Kagi ~ 10/12/2015

The future of Fremantle Hospital’s intensive care unit is being closely looked at, as the Government attempts to cut costs at the facility.

---

Changes to free up Victorian ambulance services, stop them being ‘treated like taxis’
ABC News ~ Jean Edwards ~ 10/12/2015

People who demand to be seen by paramedics for minor health complaints like headaches and toothaches will be directed to doctors, under changes designed to stop Victorians using ambulances as taxis.

---

Room for private insurers in general practice: RACGP
Medical Observer ~ Paddy Wood ~ 09/12/2015

The RACGP is willing to explore the involvement of private health insurers in general practice, provided GPs maintain their clinical independence.

---

GP frustrations: How Australia compares
Medical Observer ~ David Rowley ~ 09/12/2015

Australian GPs are struggling with the increased demands of chronic care in an ageing population, a new report shows.

---

Sods turned on Adelaide’s controversial Repat Hospital replacement
ABC News ~ Tom Fedorowytsch ~ 09/12/2015

The controversial closure of Adelaide’s Repatriation General Hospital is a step closer, with construction beginning on its replacement at the Flinders Medical Centre in the city’s south.

---

Barwon Health hunts for tech chief to lead BYOD overhaul
iTNews ~ Andrew Sadauskas ~ 09/12/2015

State-owned public health operator Barwon Health is looking for a new chief knowledge and information officer to lead a mobile push following the departure of its former head of IT.

---

Two-thirds of major NSW Health IT projects are running late
iTNews ~ Paris Cowan ~ 08/12/2015

Six of the NSW Department of Health’s nine largest technology projects are running behind schedule, prompting the state’s auditor-general to call for a review into the way IT initiatives are managed.

---

Queensland can’t sue IBM over health payroll system: judge
Brisbane Times ~ AAP ~ 08/12/2015

The Queensland government’s lawsuit against IBM Australia over the disastrous health payroll system has stalled, after the Supreme Court upheld a legal challenge by the technology giant.

---

New virtual clinic offers specialists referrals for $20
Australian Doctor ~ Paul Smith ~ 08/12/2015

A new virtual medical clinic is selling repeat specialist referrals for $20 when a patient’s usual GP referral has expired.

---

Australian public service failing to share information
Sydney Morning Herald ~ Phillip Thomson ~ 08/12/2015

A report signed off by top Canberra bureaucrats has revealed stunning examples of public service inefficiency when it comes to releasing and managing data.

---

Sector encouraged to collaborate on new 10-year reform framework
Australian Ageing Agenda ~ Natasha Egan ~ 07/12/2015

A 10-year aged care roadmap will be launched next year and service providers and technology vendors can help shape the development of a framework for further reform, a senior departmental bureaucrat has said.

---

Innovation plan: CSIRO comes in from the cold with funding boost
Sydney Morning Herald ~ Judith Ireland ~ 07/12/2015

When CSIRO officials looked at the budget papers in May 2014, they could see that winter was coming.

---

Turnbull to restore CSIRO funding, shake up govt IT procurement
iTNews ~ Allie Coyne ~ 07/12/2015

Prime Minister Malcolm Turnbull will give $90 million back to the cash-strapped CSIRO and make it easier for IT start-ups to do business with the government as part of his $1 billion innovation plan.

---

Genome future is mapped out
The Australian ~ Mitchell Bingemann ~ 07/12/2015

The Garvan Institute is in talks with Telstra and the government to create a project to decode the human genome.

---

New online service giving sick notes without seeing a doctor
Sunday Herald Sun ~ Jane Hansen ~ 06/12/2015

A service offering online medical certificates in just five minutes has been blasted by the Australian Medical Association as potentially dangerous and by business groups who say it is open to misusing sick leave entitlements.

---

Industry organisations have called for active involvement in the “rebooting” of the PCEHR from consumers and health information professionals as well as clinicians following the announcement late last week of a new committee charged with clearing the way for an independent government agency responsible for eHealth.

The government is setting up an implementation taskforce to oversee the transition of responsibility for eHealth, including operation of the PCEHR and the roles currently fulfilled by NEHTA, to a new body called the Australian Commission for eHealth (ACeH).

On Friday, Health Minister Sussan Ley announced a steering committee for the taskforce, to be chaired by former NSW Health director-general Robyn Kruk along with NT Health CIO Stephen Moo, federal Department of Health special adviser Paul Madden and Queensland Health D-G Michael Walsh.

The committee also includes three GPs: Melbourne-based Chris Pearce, Emerald-based Ewen McPhee and Brisbane’s Steve Hambleton.

Last week, the Australasian College of Health Informatics (ACHI) welcomed the appointment of Associate Professor Pearce in particular, saying it represented an increasing recognition of the importance of health informatics in driving the eHealth agenda.

A/Prof Pearce has expertise in the usability of clinical systems and data quality and governance and also worked on the clinical design of early releases of the PCEHR.

ACHI president Klaus Veil said health informatics as a distinct profession had been poorly recognised in the past and this appointment would do much to prevent past problems in large-scale implementations.

“The college is delighted about A/Prof Pearce’s appointment,” Mr Veil said. “We have for a long time expressed the view that only a sound, evidence-based approach will realise the benefits of the PCEHR that were originally sought and expected.”

Health Information Management Association of Australia (HIMAA) president Sallyanne Wissmann said she also saw the appointment as a big step forward.

“Just recently, HIMAA, ACHI and the Health Informatics Society of Australia (HISA) issued a joint statement on the importance of health informatics and health information management expertise on the Australian Council for eHealth (ACeH),” Ms Wissmann said.

She said HIMAA will continue to take a coordinated approach along with ACHI and HISA.

HISA CEO Louise Schaper also welcomed the appointment of a health informatician to the committee.

“Having senior expertise in health informatics, system architecture, semantic interoperability, health data, and system evaluation, testing and credentialing in the governance of Australian Commission for eHealth is essential if we are to have success in eHealth in Australia,” Dr Schaper said.

“A fully connected, digital health system is what HISA members are working towards and we are pleased to see so many HISA community members on this taskforce, and in particular Dr Pearce.”

The Consumers Health Forum (CHF) said it looked forward to active consumer involvement in the design of the “rebooted” PCEHR, or My Health Record as it is expected to become known.

“An effective eHealth system has the potential to transform health care in Australia, making it not only more safe and effective, but also enabling the development of more personally focused care,” CHF CEO Leanne Wells said.

Ms Wells said the fact that Dr Hambleton, who is also chair of the Primary Health Care Advisory Group, was also on the committee would help link policy and implementation.

There is also a consumer representative in Jan Donovan, a member of CHF’s board.

“The importance of consumer involvement in the development of My Health Records cannot be understated,” Ms Wells said.

“The lukewarm public response so far to eHealth development in Australia underlines the need for vigorous community education and participation. eHealth is not merely a matter of streamlining medical records and making them more accessible to consumers.

“This will be a tremendous benefit to those living with chronic illness, enabling clinicians and practice managers to share and act on patient information more effectively, reducing duplication of diagnostic tests and the risk of medication mistakes.”

Ms Wells said CHF had long advocated for an opt-out approach so that a population-wide system can be implemented more rapidly.

“The current ‘opt in’ approach has proven to be too slow and cumbersome,” she said.

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

CSIRO uses to 3D printing to create new ribs for cancer patient
Computerworld ~ Rohan Pearce ~ 11/09/2015

A Spanish cancer patient has a new, customised titanium sternum and ribcage, thanks in part to a collaboration between the CSIRO and a Melbourne medical device company.

---

Ministry sets deadline for DHB sugar ban
NZ Doctor ~ Cliff Taylor ~ 11/09/2015

Director-general of health Chai Chuah has told all DHBs to get rid of sugar-sweetened drinks from their premises by the end of the month.

---

Decision support tool Nexxt makes finals for NZ Innovators Awards
NZ Doctor ~ Rachel Wattie ~ 10/09/2015

Electronic decision support tool Nexxt has today been announced a “health and science” finalist in the New Zealand Innovators Awards 2015.

---

Apple wows IT crowd with product launch, but investors nonplussed
ABC News ~ Neal Woolrich ~ 10/069/2015

Apple’s latest product launch went off with a bang in San Francisco overnight, but the reaction is less enthusiastic on Wall Street.

---

What patients think when you pull out your mobile phone
Medical Observer ~ David Rowley ~ 09/09/2015

Almost three-quarters of patients and carers approve of doctors using smartphones and other mobile devices in hospitals, as long as it’s for patient care and not personal use, a survey shows.

---

Scathing cancer services report an ‘exaggeration’, says WA Premier Colin Barnett
ABC News ~ Andrew O’Connor ~ 09/09/2015

A high-level medical task force report that described WA’s cancer services as “fragmented” and “degraded” exaggerates the problems it identified, Premier Colin Barnett says.

---

Adult cancer treatment services ‘in crisis’ by shift to Fiona Stanley Hospital, taskforce finds
ABC News ~ Andrew O’Connor ~ 08/09/2015

Adult cancer treatment services have been left in crisis by the shift in services to Fiona Stanley Hospital, with patient safety and clinical outcomes “significantly compromised”, a taskforce has found.

---

The NBN: why it’s slow, expensive and obsolete
The Conversation ~ Rod Tucker ~ 08/09/2015

The Abbott Coalition government came to power two years ago this week with a promise to change Labor’s fibre to the premises (FTTP) National Broadband Network (NBN) to one using less-expensive fibre-to-the-node (FTTN) technologies, spruiking its network with the three-word slogan: “Fast. Affordable. Sooner.”

---

My Aged Care site: Pledge to improve GP referrals
Medical Observer ~ Julie Lambert ~ 07/09/2015

The Department of Social Services says it will roll out a new webform for doctors’ referrals on the My Aged Care website after a flood of complaints about the system.

---

At-home monitoring of vital signs in older patients with chronic diseases can lead to significant savings over time in terms of MBS costs, PBS dispensing costs, costs associated with hospitalisations and average length of stay, and it can also reduce mortality rates by up to 37 per cent, new CSIRO data shows.

The data from the CSIRO’s NBN-enabled telehealth project also shows that home telehealth services on an annual subscription model, including internet connection, home telehealth device and nurse wages, can be viably offered for about $2400 a year.

With annual savings of about $8000 in MBS, PBS, hospitalisation and visiting nurse costs, this represents an estimated return on investment of between two and three, the figures show.

Lead researcher Branko Celler, formerly principal scientist at the CSIRO Centre for Computational Informatics who has been heading up CSIRO’s NBN Telehealth Research Group, told the Health Informatics Conference (HIC 2015) in Brisbane last week that the results will make a significant contribution to government understanding on how to nationally deploy telehealth services and how to develop cost-effective and sustainable models to fund them.

Professor Celler’s team was one of the winning bidders for the NBN-enabled Telehealth Pilots Program announced in 2013. The $3 million randomised control trial recruited hundreds of patients in several states who were provided with a free internet connection and Telemedcare device, which allows for video conferencing and vital signs monitoring through peripherals including blood pressure monitors, pulse oximeters and ECGs.

The participants had an average age of 71, had one or more chronic illnesses such as congestive heart failure, chronic obstructive pulmonary disease, diabetes, hypertension and coronary heart disease, and had been hospitalised twice in the preceding year.

They were asked to take their measurements once a day, with a compliance rate of 68.2 per cent, and over the course of the trial about 111,000 measurements were taken, including 9000 ECGs, 20,000 blood pressure measurements and 20,000 pulse oximetries.

Healthcare costs for this cohort of patients can add up very quickly. The CSIRO trial found that over a 100-day period, patients visited the GP 5.7 times at a cost of $245; they had 0.6 visits from allied health, which cost them $30; they had 1.6 visits to specialists for a cost of $159; and they had 28 medications dispensed over the period at a cost of $959.

“The total cost of procedures and tests was $625,” Professor Celler said. “When you look at a total cost of PBS and MBS items, it’s about $2029, and they spent $44.40 travelling to see the GP.”

While there is plenty of international evidence that telehealth might be able to reduce some of these costs, there has not been enough local evidence to sway the government to seriously invest in and fund in-home monitoring for chronic illness.

However, the evidence from this trial is very persuasive. It shows that costs to the MBS for chronically ill patients over the age of 71 can be reduced by about $800 or up to 31 per cent per year, PBS dispensing costs by $200 or 10 per cent per year and substantial reductions in the avoidable costs of hospitalisations and length of stay.

Reductions in mortality rates for this cohort were comparable to those from international studies such as the UK’s Whole System Demonstrator, Professor Celler said.

“We compared the mortality between our test and our control patients and the calculation is that the probability of death for our test patients was 3.75 per cent and the probability of death for our control patients was 5.95 per cent,” he said.

“This means that telehealth reduced the mortality by 37 per cent against the control [group].”

In terms of hospitalisations, there was a reduction of about 0.6 to 0.7 presentations over a year, for a saving of about $3000 on average. Acute care beds can cost well over $1000 a day.

There was also a significant change in length of stay for those who did end up in hospital, Professor Celler said. “Patients that were being monitored at home and that did go to hospital spent less time in hospital by about a day, or a day and a bit. These data are statistically significant.”

He described the MBS and PBS data as “very gratifying”.

“This has never been shown before, that telehealth actually has an impact on MBS expenditure, which is all procedures, visits to GPs, visits to specialists,” he said. “It does reduce it.”

And the return on investment is likely to be between two and three, he said. The initial estimate of cost for a subscription-based telehealth model was about $12 a day, which includes $7 a day for video conferencing, messaging and a comprehensive suite of instruments, $1 a day for the internet and $4 a day for monitoring and triage.

“Telehealth, to be run professionally, had to be around $12 per day on a subscription based model,” Professor Celler said.

“However, we followed that discussion further and at the end of the trial we re-evaluated the likely costs. The cost per month for a chronically ill patient of some significant severity, we believe the monitoring, hosting and maintenance cost will be that of $150 per month. The nurse coordination, at 0.5 hours per week per patient, it is about $50 per month.

“And that means that the cost of running a telehealth service ought to be around the $2400 mark. The annual savings estimates, the savings in PBS dispensing that were shown to be $200, the savings in the MBS items of $800 … even if you consider the rate of hospitalisation to be only half per annum, for chronically ill patients that’s a saving of $3000 per year, because for chronically ill people, hospitalisation are typically around $6700 per year.

“And the reduced demand on community nursing. This is based around a saving of five per cent [full-time equivalent] per patient for a community nurse, based on the fact that a community nurse would … have a caseload of about 10 patients, and this could be increased [using telehealth].

“So that is a total saving of about $8000 and that gives you an estimated return on investment of about three. We believe this is a fairly realistic figure, although quite preliminary still. We are doing some of the final calculations.”

Clinical and practice management software vendor MedicalDirector has added a new widget for users of the Standard Practice document management system to the MedicalDirector Sidebar.

Standard Practice markets what it calls an intelligent document management framework that allows practices to keep important documents, files and reference materials, as well as policy and procedure manuals, in a centralised repository.

It also has an integrated task management module that lets practice managers define, schedule and assign responsibility for routine tasks, as well as resources to help with compliance and accreditation.

MedicalDirector users who have a Standard Practice licence will now be able to access the framework and task list through the widget.

MedicalDirector CEO Phil Offer said practices using the solution have seen notable improvements in practice efficiency and processes.

Katrina Otto, owner of Train IT Medical and approved MedicalDirector trainer, said having practice policies and procedures integrated into MedicalDirector would be a significant practice efficiency improvement.

“Rather than staff searching for written instructions or accreditation folders we can now have relevant practice information such as policies, procedures and instructions accessible directly from MedicalDirector,” Ms Otto said.

“This integrated solution enables us not only fast access to relevant information but we can also be assured staff are accessing the most up-to-date protocols.”

The widget provides access to documents, files and reference materials and enables daily tasks to be viewed and signed off from the task list directly via the MedicalDirector Sidebar.