FHIR engines roll out for COVID-19

The quick response from the health IT sector in Australia and New Zealand to the coronavirus pandemic has been pretty impressive, with software vendors rolling out COVID-19-specific applications at a rate of knots if our technology resources page page is anything to go by.

Vendors are either tailoring new functionality to help with the crisis or in some cases waiving fees to ensure the technology is used when it's needed. An example is online appointment booking service Healthsite, which has very quickly managed to roll out a complete telehealth solution, in association with Tasmanian telehealth provider GP2U, that is integrated with Healthsite's booking system. HealthEngine also provides a similar service and both allow practices to offer private billing as well as bulk billed consultations.

There's been a lot of activity in the telehealth sector as GPs and specialists wait for the Australian government to announce the full details of its stage 4, whole of population plan for MBS-funded telehealth, which was promised earlier this week. NZ's GPs have also been told to go virtual first, and with the whole country in lockdown now, there is pretty much no other option.

Technology has never really been a barrier to telehealth provision, with the main stumbling block being funding. Often overlooked, though, is workflow, and that has never been in sharper relief than during this pandemic. As hospitals brace for an influx of desperately ill people, the frontline defence remains general practice, which is struggling with a lack of consistent guidelines, a lack of protective equipment, limitations on how and who to test, and unfamiliarity with juggling remote and face-to-face consults.

Images of GPs swabbing patients in car parks are all too real and this has spurred on a group of local digital health experts, all part of the FHIR standard development community, to get together to build a solution to a pressing problem: how to ensure patients don't come into the waiting room if they are an infection risk, and how to streamline the workflow involved in a telehealth consult.

The team, which includes FHIR notables Grahame Grieve, Brett Esler, Brian Postlethwaite, Shovan Roy and Vadim Peretokin, have put their combined expertise into building an open source solution called Clinic Arrivals, which uses a mixture of easy-to-use technologies like SMS and online video that can also – miraculously, thanks to FHIR – be integrated with practice management systems.

The solution means that when a patient makes a telehealth appointment, they are sent an SMS with instructions and a video link. Another SMS is sent just before the appointment. The link is also copied into the PMS so the doctor can click on it and away they go. The video technology is open source and free, and does not require a sign-up or anyone to download an app.

If a high-risk patient books a face-to-face consult, a message is sent to them by SMS advising them to tell the practice when they have arrived, and to wait in their car. The practice can then send a message telling them whether to go to the waiting room or to stay in the car and the doctor or nurse will come to them. The SMS technology being used allows the practice to easily customise the message to suit their needs.

The technology sounds exactly what practices need right now, and the remarkable thing is that it has been developed pretty much in the last fortnight, following a visit by Grahame Grieve to a couple of practices run by Melbourne GPs and noted eHealth enthusiasts Mukesh Haikerwal and Nathan Pinskier. Photos of Dr Haikerwal swabbing a patient in his car park have become a defining image of this pandemic.

The FHIR team has built the technology and has made it available, and is now thinking about the business aspects, in a reverse of the norm. But that's what FHIR, and this pandemic, can do. We'll have the full story on Monday.

In the meantime, we liked this story from Victoria, where the Department of Health and Human Services has rolled out some consumer-grade technology for its contact tracing team to keep an eye on people in home quarantine who have been in close contact with someone who has developed COVID-19. This – dare we say it – agile approach is to be applauded.

As we wait for the details of the new MBS telehealth promise to emerge on Monday, it is timely that our poll question last week asked: Should governments relax restrictions on telehealth even further? We are preaching to the converted here but the result was pretty emphatic: 96 per cent said yes, just four per cent said no.

Our poll question for this week is: Has the pandemic changed the way you use technology?

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

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