How to measure meaningful use

It was a big week this week for the announcement of new digital health projects and updates on existing ones, and it got us to thinking about whether we can adequately measure the success or otherwise of this troublesome endeavour that is digital health.

A case in point was one of our top stories this week, in which Stephen Duckett from the Eastern Melbourne PHN called for the fax to be axed by 2025. (And we'd urge caution on the use of this saying, considering the UK's problems with it.) The PHN has set itself a target of helping to get rid of faxed referrals to local hospitals in five years' time, and is helping by supporting an eReferral project in its catchment area, which has seen more than 60 per cent of eligible general practices start using smart forms technology from vendors HealthLink and BPAC Informatics.

This technology is now widely available in general practice software and can be used anywhere in the country, but uptake appears to be more a matter of getting hospitals onboard than any reticence on the part of GPs. A similar project using similar technology is rolling out in Queensland, with hospitals leading the way.

These eReferral projects are happening in parallel with the increasing ability of secure messaging services to interoperate, but while a particular organisation like EMPHN or Eastern Health can keep a track of the volume of eReferrals being sent and received in their specific catchments, we're not sure how to gauge any increase in electronic communication between providers using secure messaging on a wider scale besides asking the vendors if their volumes are going up. And the question has to be asked: is this an adequate measurement?

We also heard from the Australian Digital Health Agency on the offer it made to software vendors in the medical specialist market back in May. Nine vendors have been chosen to participate in a co-design project with ADHA that will see them add or improve My Health Record functionality. This is part of ADHA's desire to see digital health tools more widely used in the private specialist sector. Again, how that will be adequately measured we are not sure.

Our top story this week was the pre-launch of a new medications home delivery service called Rosemary. Its founders have already developed an app and a business model and are looking to raise some money later in the year for a full launch.

This will coincide with the federal government's plans to begin allowing electronic prescriptions to be a legal form of script, rather than the current system where paper is the legal version. Rosemary is pitching its service as one of convenience for consumers, particularly for those on multiple medications, and as a way for community pharmacies to better connect with their customers.

Heading off the threat of Amazon before its inevitable move into pharmacy distribution is also a selling point. We'll be interested to see what the take-up is.

Elsewhere, Apple has made moves to allow more healthcare providers to offer their patients access to their medical records through the Apple Health Record app on their iPhones. US healthcare providers using compatible software such as Epic, Cerner or athenahealth can now self-register on Apple's website if they have made the capability available.

Apple's technology uses FHIR APIs to connect the EMR and the patient's app, as well as the OAuth 2.0 authentication service to create an enduring link to the API. The Health app then periodically connects to pull in any new records and notify the patient. As well as compatible software the providers must have a patient portal, with patients using their log-in credentials to access both the portal and the app.

This capability is still restricted to the US at the moment and there doesn't seem to be much momentum from Apple to expand it elsewhere, although the standards work has already been done through the Argonaut project, a local version of which is up and running here through HL7 Australia.

In the US, over 300 healthcare providers now offer the capability, including some huge, multi-hospital health services, but again, there is scant detail on how many patients are regularly using it. Download numbers really don't tell the whole picture. This is something that confronts the My Health Record too: content may be rising but how many patients and providers are actually looking at that content, and more importantly, is it doing any good?

That brings us to our poll question for the week: is it possible to adequately measure the meaningful use of digital health tools?

Sign up to our weekend edition or Pulse+IT Chat to vote, or leave your thoughts below.

Last week we asked, should the federal government or the states be in charge of RTPM? This was a pretty strong showing for the federal government, with 84 per cent saying it was better positioned than the states.

Comments  

# Troy Bailey 2019-07-06 19:42
The Eastern Melbourne PHN eReferral project is indeed a good story to promote the use of Secure Message Deliver, however when you scratch the surface their are some series flaws. Sending 1000 eReferrals a month sounds impressive but when you count the number of GPs it may account for 1 per GP per month.

It is always important for PHNs to promote their activity and justify the public money spent on projects. The main concern with these eReferral projects popping up in PHN land is that they are creating a splintering of effort and manipulating the market. No we have the existing players who are trying to become interoperable and a public system who decided to find the best product on the day an brought in an overseas player never before seen in Australia. IT interesting to note that HealthLink is by far the largest SMD vendor in New Zealand so why has BPac jumped across to OZ, perhaps there is little market space for them.

Which raises the next biggest question of why did PHNs choose BPac?, could it be because it was the only vendor that integrated with HealthPathways owned by another NewZealand based company called Streamlines. The concern is that PHNs are pushing eReferral (BPAC) simple to add value to their HealthPathways investment an not to solve the problem of paper in healthcare organisations.

In my region with a 10th the number of GPs as EMPHN we are sending 3 times the number of GP referrals to 1000 different Specialists both public and private. Where does the top story usually lie, not with the well funded bureaucracy but with small business that innovate because they have to.

The concern going forward it that the next round of government funding will select an even better product of the day and the PHNs start all over again.
# NSW Health staffer 2019-07-09 09:23
Perhaps a measure of conversion rate. The rate at which signed-up/opted -in GPs (to the trial) use eReferrals compared to fax.

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