Telstra Health wins $178.3m contract to build cancer screening register
Telstra Health has won the hotly contested tender to build and operate the $178.3 million National Cancer Screening Register (NCSR), which will replace the current state-based registers for cervical cancer screening programs and the national bowel cancer screening register, to go live in time for the introduction of the new human papillomavirus (HPV) testing regime that will replace Pap smears from May 2017.
The federal government allocated $148.8 million to the measure in the 2014-2015 budget and topped that up to $178.3 million over five years in the 2015-16 budget. A tender was issued last year.
The build will be led by Telstra Health's head of integrated solutions Ruth Salom, a pathologist with expertise in histopathology and cytology who ran SA Pathology for four years. Professor Salom has also taught at Monash University for many years and was formative in the establishment of the University of South Australia's Centre for Cancer Biology and the South Australian Genomics Facility.
Telstra Health's wholly owned subsidiary Emerging Systems will lead the development of the medical record and integration aspects of the project, with other Telstra Health companies such as Argus for secure messaging, the National Health Services Directory and Dr Foster also involved.
The project will involve the establishment of a single record for each person participating in cervical and bowel cancer screening, along with digitising prompts and alerts to consumers, handling the postage of bowel cancer screening kits and ensuring patients are followed up as well as the establishment of consumer and provider portals and the linking of screening records to the national My Health Record system.
The register will also be integrated into general practice desktop software systems so GPs can identify patients' screening eligibility and history to support real-time clinical decision-making.
Telstra Health managing director Shane Solomon said the contract would be a managed service rather than just the creation of a register.
“It involves the end-to-end process of identifying people who are due for cervical cancer screening, which [in May 2017] will be HPV, and bowel cancer,” Mr Solomon said. “It involves the prompts for you that you should have your bowel cancer screening, it involves sending out the bowel cancer kit, and it will involve information from GPs and from pathology and all of the decision support to make sure that people have been followed up.”
While the state-based cancer registers are all electronic the national bowel cancer screening register is still done on paper, and both require patients and providers to fill out a lot of forms. Mr Solomon said Telstra Health's role would be to digitise that, make it more streamlined and reduce data entry errors, as well as improving follow-up.
“The transformative piece of it is that at the moment bowel cancer screening is run on paper and doctors and GPs and pathologists and colonoscopists are still going about in the old, laborious way,” he said. “[The NCSR] will involve electronic forms, a consumer portal and a provider portal, and extraction of data rather than people filling out forms.
“The way we will be communicating with consumers will include letters but we'll be moving past that towards SMS prompts, emails, all of the modern ways that people get nudged into things. It is bringing public health screening programs into the digital age.”
The new register will also have an analytics capacity that is not available now, he said, powered by Dr Foster. With the paper-based bowel program it is impossible to do any decent analysis on whether the program is working with one group of people and not with another, and to find out why people do not respond to offers to be screened.
For Mr Solomon, the many capabilities that Telstra Health has been building over the last three years are now starting to be put together.
“For me it is a vindication of our strategy, which was to buy some components and find ways of combining those components to transform how healthcare operates,” he said.
“Our base system will be Emerging Systems – it is really based on Emerging's medical record capability. Emerging's great strength is that it is an open system, that it is able to pull data and push data into other systems. It has proved that it is agile.”
Emerging Systems already has a register component – it ran a cord blood register for St Vincent's Hospital – and Mr Solomon said the project would involve a configuration of Emerging Systems' capability rather than building it from scratch.
A team has been recruited and brought together under the leadership of Professor Salom, with a week-long workshop planned for next month that will bring the Telstra team together with pathologists, the cytology services and other providers to ensure the workflow fits seamlessly.
Telstra is also contracting out some of the work to its partners, including Fuji Xerox for the mail-out function and UHG to provide the contact centre.
Emerging Systems will also be in charge of integrating the register into general practice desktop systems and those used in community pathology, which currently requires a lot of manual processing, but Mr Solomon said the trickiest part will be following up with patients.
“We'll be developing the workflow decision prompts so you are checking whether, with bowel cancer for example, if someone is positive, they have been told to go back to their GP and checking that they have gone back. It is also the notification side of it and also whether they have had the colonoscopy.
“At the moment there is no data on that. You don't know the end-to-end process. Someone may have been positive but there's been no follow-up. The whole system is designed to prompt the consumer and the provider that they need to follow this through.
“What is unique is that we can bring together those range of capabilities. Public health screening people wouldn't think of a medical record as relevant but we know it is. Combined with our telco stuff such as prompts and consumer portals – I think what we put forward was a good end-to-end process, but we weren't without competition.”
The contract for the NCSR is for five years with five one-year options, and is due to go live from May 2017, when Australia will move from using two-yearly Pap smears for cervical cancer screening to the new five-year HPV test.
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