Shock! Practical solutions offered for long-term problems

Much has been said over the last 18 months about how the COVID-19 pandemic has ushered in a revolution in digital health adoption, but there’s a chance these predictions might turn out to be a bit overhyped, particularly when it comes to telehealth (or telephone health as it probably should be named for now).

What has become more obvious as the pandemic has drawn out is the benefit of automation when it comes to health service efficiency, especially in under-the-radar areas like practice management system interoperability, which may well trigger longer term benefits than the tech du jour.

A few examples from just this week are obvious, and two are FHIR-related. On Wednesday, we heard from New Zealand and Australian PMS vendor Medtech Global on how it is faring with the roll out of its new ALEX platform, which promises to simplify the way third-party apps like secure messaging services, clinical decision support apps and appointment booking systems integrate with clinical information software.

The continuing effort to keep these apps integrated is normally a tedious and very expensive affair for vendors, particularly niche app developers, and as often as not when a PMS has a major update, some of the third-party apps break. A better idea would be a standards-based middleware approach that all PMS vendors could adopt to simplify third-party app integrations on agreed technical standards and cut out the plague of software “hacking” through the database back door, and this is what Medtech proposed with its new ALEX platform last year.

Things have moved on apace, and in the six-month period since work began in earnest, the first third-party app is integrating with Medtech in a Kiwi practice. Medtech expects this to pick up quickly with a handful expected to go live over the next six to eight weeks, and fellow Kiwi PMS vendor MyPractice is due to come on board using the methodology for its own third-party app integrations in that time. It remains to be seen whether Medtech rival Indici gets involved, but in the meantime Medtech sites in Australia will be using it and Dr Sayer is confident the Australian PMS vendors are also taking an interest.

A standards-based approach is always the soundest one, and this has been a big feature in the development of the Australian Digital Health Agency’s Provider Connect Australia tool, formerly known as the Service Registration Assistant. We’ve always thought this was a pretty good idea, and it may be the case that this is one piece of technology that ADHA rolls out efficiently and effectively.

The PCA has been conceptualised by someone who actually understands the workflows of general practice and the administrative burden they work under, but who also can see how contemporary standards can be harnessed to improve efficiency and interoperability. There’s no doubt that the agency sees the PCA as progressing its stated goals in increasing uptake of federally mandated healthcare identifiers and helping with its federated directory for secure messaging aims, but it is also obvious that improving efficiency for practice managers when keeping provider details up to date is going to make a hell of a difference.

The figures tell the story. When the PCA was trialled in about 250 practices in northern NSW in late 2019 and early 2020, all but one had incorrect information. Fifty practices alone had a new practitioner working with them whose details were not known by the local hospital, and most others contained incorrect information. The idea behind the PCA is that once a new practitioner joins, then their details are uploaded once and this will then flow to whatever organisation the practice chooses. If the data changes, it is changed once and is then published out in near real time, whether it be to the local hospital or allied health practitioners for referrals, secure messaging endpoint location services, eOrders for pathology companies, online booking and directory services, along with Medicare, AHPRA, medical indemnity and private health insurance companies, and the Healthcare Identifiers Service.

The proof will be in the pudding but if ADHA can pull this off and it works, it will prove to be a step-change in medical practice efficiency and data quality in Australia. The National Health Services Directory was always envisioned as being capable of doing this but it never could, as it relied on practices to update their details constantly or paying PHNs to keep on top of them. Publishing once and to many in near real time is obviously a better option.

As ADHA’s secure messaging project manager Neeraj Maharaj told us, most practices will speedily update Medicare details for new practitioners as this means people will get paid, but other services will quite often be forgotten or put on the back-burner. Many will remember that when the NHSD went live, some medical specialists practices were listed with practitioners who had been deceased for a decade because no one knew of its existence or how to update it.

With the PCA automating these sort of processes, and practice managers only having to publish once to organisations it chooses to publish to, this may well prove to be one of the better ideas ADHA has put into practice.

The other big news this week was the allocation of $141 million in the NSW state budget for the state’s single digital patient record (SDPR) project. While we have seen an RFI and an EOI issued, it appears that despite the January to June 2021 timeline, no contract has been signed. Everyone expects the existing solution providers to be involved anyway – Cerner for the EMR, Dedalus for the PAS, Cerner and/or Citadel for the LIMS – but as always, COVID has got in the way. With four local government areas of Sydney going into lockdown today, don’t expect to hear much on this front for the next month or so.

We asked about a ranking of smart hospitals in last week’s poll and whether Newsweek had got it right in its top 250, which included seven in Australia. NSW Health likes to boast about its eHealth prowess, although it only got one hospital in the top seven. That being said, Sir Charles Gairdner Hospital doesn’t even have an EMR and it got a guernsey, so doubt has immediately been cast on the rankings. Our readers agree: we asked last week whether the Newsweek smart hospital rankings were on the mark. Nope, 84 per cent said.

This week, we ask:

Will ADHA be able to successfully deliver the Provider Connect Australia tool?

Vote here and feel free to leave your comments below.

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