Pulse+IT Blog

Misfortune or carelessness: the year 2020

Along with “novel coronavirus”, “social distancing” and “hydroxychloroquine”, “contact tracing apps” will go down as one of the most notable additions to the pandemic lexicon. They have certainly proved controversial as privacy concerns run headlong into public health necessities, and few if any have proved overly useful.

New Zealand's COVID Tracer app hasn't been hugely successful so far with fewer than 600,000 downloads, but thankfully it hasn't really needed to be. However, with one eye on the second wave plaguing Victoria, the NZ government has announced it is going to trial a new wearable Bluetooth alternative called CovidCard that has been strongly promoted by business groups and some academics.

Epic leap for ACT Health

Pulse+IT's top story for this week was the announcement that the ACT had chosen Epic's EMR for the territory's ambitious digital health program. This came as little surprise as the health service had used the term “big bang implementation” at a vendor briefing not long after the release of the tender last year.

The most successful big bang in Australian healthcare – the only one, come to think of it – has been at the Royal Children's Hospital, which went live with Epic in 2016. RCH's neighbours in the Parkville precinct will be girding their loins next weekend for their big bang, with Epic set to go live at Royal Melbourne, Royal Women's and Peter Mac on Saturday, August 8.

Telehealth restrictions a retrograde step

Debate over telehealth continued this week as the new restrictions ordered by the Department of Health came into force in a hurry. Some online appointment booking services are now asking patients trying to book a telehealth conference if they have seen a GP at that practice in the previous 12 months, with one reader telling us she had tried to book a telehealth conference to get a new referral but was knocked back because she hadn't presented there in person in over a year.

We had a lot of debate on the topic on our blog from last week, with numerous examples given of different cohorts of patients, especially vulnerable groups, who will now be prevented from accessing MBS-funded telehealth services just when they were finally given access to them. In an article in this week's MJA Insight, Elwood Family Practice GP Andrew Baird detailed a number of cases where vulnerable patients will be disadvantaged by the new rules and provides a great deal of food for thought.

Barriers to telehealth in danger of being rebuilt

Just as a long-awaited breakthrough occurred when the Australian Department of Health opened up the Medical Benefits Schedule to telehealth item numbers to help GPs deal with the coronavirus pandemic in March, that breakthrough may very well be in danger of being severely curtailed with new restrictions being placed on telehealth provision.

Under pressure from the doctors' lobby groups, Health Minister Greg Hunt announced on July 10 that restrictions would be placed on who can receive MBS-funded telehealth consults from July 20, limiting them to patients who have an existing relationship with a GP or practice and have been seen face to face in the last 12 months. Children and people at risk of homelessness remain covered.

Turf wars pop up over telehealth

As has been widely reported here and elsewhere, the COVID-19 pandemic has seen a huge increase in telehealth provision in primary care. In Australia, MBS figures showing that 36 per cent of all GP consultations were done by telehealth in April alone, and that number is expected to remain high when the May and June figures are released. But now that the restrictions on movement are being lifted in many countries, doctors' groups like the RACGP are running a campaign to get patients back into general practice and not put off seeing their GP any longer.

In Australia, the RACGP is also running a campaign against what it is calling “pop-up” telehealth services, claiming that some of the new services are potentially providing sub-standard and inappropriate care. The AMA has joined the party and is actively lobbying the government to tighten the rules in order to prevent these services from potentially undermining the relationship between patients and their regular GP.

COVID second wave threatens to swamp Melbourne Health's big bang

There's probably any number of excuses that people make to get out of training for new workplace IT systems, but “EMR training gave me the plague” is certainly a novel one. Something similar to that claim was made in a story in the Sydney Morning Herald and The Age newspapers this week, in which an unnamed doctor said Royal Melbourne Hospital was “putting staff in danger in order to satisfy their own timeline” for the roll-out of the new Epic EMR, which is due to go live next month.

Royal Melbourne, the Royal Women's and the Peter MacCallum Cancer Centre are all rolling out Epic in a big bang implementation as part of the $124 million Parkville Precinct project, which is using Royal Children's Hospital's 2016 implementation as a template. The Epic emergency department module is live at RMH and planning and training for a May go-live for the full system in the other facilities was well underway when the pandemic struck.

My Health Record, eight years on

It's birthday time again for Australia's My Health Record system, which will next week celebrate eight years in operation following two years of gestation. And a difficult birth it was, as we not-so-fondly remember. Our reminiscing was inspired not just by its approaching birthday on July 1 but by a press release from the Australian Digital Health Agency, proudly boasting of a surge in use of the system during the COVID-19 crisis.

The term “surge in use” took us back to 2011 and 2012, when we were breathless with anticipation about the new baby, then known as the PCEHR. Some of our first online stories were about how the medical software industry was approaching the impending birth: first with trepidation, followed by alarm, and then with horror.

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