Pulse+IT Blog

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.

EMRs: too big to fail?

One of our top stories this week was the retirement of Queensland Health director-general Michael Walsh after four years in the role, having had a few stints previously with NSW Health. Some in the Brisbane media thought they had a scalp following recent revelations that Mr Walsh had admitted that the roll-out of the state's Cerner integrated electronic medical record had been a big more challenging than acknowledged publicly.

Quelle surprise. Implementing an EMR in a large hospital system is enormously difficult and fraught, as numerous examples here and around the world attest to. And in Queensland, the ieMR roll out has never been smooth. Some clinicians still loathe it and would far prefer to stick to existing software or to try something different. That's highly unlikely at this stage, and we think Mr Walsh's comments were basic common sense.

Last big hiccup for WA Health?

The WA Department of Health got a a bit of a rap over the knuckles this week from WA Auditor-General Caroline Spencer, who noted in her report into a two-year delay rolling out PathWest's new laboratory information system that this sort of thing had happened perhaps one too many times before.

It was a gentle rap considering some of the horrors WA Health has had with IT projects over the last few years – Fiona Stanley Hospital and the centralised computing projectimmediately spring to mind – but you get the feeling that Ms Spencer agreed with former under-treasurer John Langoulant's comments last year that the state really has to pull up its socks when it comes to project governance.

GP to chase results no more?

There's a lot about working at the pointy end of the healthcare system that annoys GPs, but “GP to chase” test results ordered while the patient was in hospital has to be up there with the worst of them. Even when prefaced with the word “kindly”, reading a discharge summary written by a junior medical officer with a demand that the GP do the work the hospital doctors should be doing is enough to drive many of them to distraction.

While no one is saying that the My Health Record will put an end to this, the ability to see a patient's results with the click of a button or two and not have to spend time on the phone with the hospital is one of the system's selling points for GPs. Last month, SA Health joined most of the other jurisdictions in beginning to upload pathology and diagnostic imaging reports to the My Health Record from its hospitals, but in a new move SA Pathology is also doing so for tests that GPs themselves have requested from the public provider.

Setting the standard for messaging

Brisbane turned on a late autumn stunner for an HL7 Australia meeting that Pulse+IT attended in the Queensland capital this week to hear all about the localised pathology and referral messaging standard that has been published by HL7 Australia. The turnout was pretty good too considering the esoteric nature of the meeting, which covered all things HL7 v2, along with FHIR, PITUS, NCTS, NCSR, NPAAC and other acronym allsorts.

The expert crowd smiled knowingly when mention was made of previous attempts at developing standards that would miraculously bring interoperability to secure messaging over the years. Jared Davison, the chief technology officer of secure messaging vendor Medical-Objects, began his presentation with a slide from back in 2007 that could easily be used today, and pathology informatics expert Michael Legg went even further back when he mentioned there'd been a mention of standards in Hammurabi's code back in 1754 BCE.

Point of no return

It's been a big week in national eHealth projects with the Australian Digital Health Agency announcing some serious growth in connections to the My Health Record in the community pharmacy sector. More general practices have also connected over the last year to register a substantial 92 per cent of all general practices – we don't think there will be any more growth there as some GPs will permanently opt themselves out – but it looks like the pharmacy sector is seeing some benefit in signing up, even without financial incentives.

There was also some news in the pathology sector, with NT Health revealing it hopes to be the first jurisdiction in the country to add links in the pathology reports it uploads to the My Health Record to the Lab Tests Online (LTO) website. This excellent little resource has been around for a decade or more and provides a wealth of information about the often obscure world of pathology, so much so that the rumour is more medical students use it than the general public.

NZ goes back to basics

It was always on the cards but New Zealand has confirmed that it will not follow the lead of certain other countries we might mention and purchase or build a single electronic health record for its citizens.

Some may argue that it actually makes sense for such a small but relatively widespread population to have a single record, but even back in 2015 when the idea was first floated, there was a recognition that there were perhaps easier, less expensive ways of digitising the health system using existing technologies.

It looks likely that New Zealand will instead pull together its four regional systems and underpin them with a national health information platform (nHIP)). This makes a lot of sense, as in two of those regions there is already what amounts to a functioning shared record for most people.

It is perhaps the South Island experience that has shown why a new, single EHR is not necessarily the way to go. While it has taken time, the South Island has managed to use existing technologies such as its acute care clinical workstation and GP and pharmacy systems to open a window to data held in other systems. Through HealthOne and Health Connect South, hospital clinicians can see a patient's primary care data while GPs can see not just hospital data but community pharmacy and some community nursing data too.

The greater Wellington or Central region has a similar set-up through its shared care record, although it uses patient portals rather than an extract to share GP data. The Midland region is working on its eSPACE program, and the Northern region, covering Auckland, has decided against going with a single EMR covering primary and secondary care and looks likely instead to follow the rest of the country. Auckland's public hospitals are still on paper, so it still has quite a way to go.

A lot of this has come about because in primary care in particular, New Zealand has certain advantages that it has cleverly harnessed. A single national health identifier is one, an openness to using patient portals is another, as is the decision some years ago to set up the GP2GP system so patient medical records can be transferred electronically as patients move practices. For most of the last two decades there has also been one major GP software supplier and one secure messaging provider.

This doesn't make the system perfect and patients still don't have access to much of their data digitally. And as RNZCGP medical director Richard Medlicott told the Emerging Tech in Health conference this week, primary care data is still very much produced and used on a PHO basis, rather than nationally. He is also somewhat surprised to see how slow the uptake of the New Zealand ePrescription Service has been, and he is rather disappointed that the hoped for National Primary Care Data Service may take a bit longer to get up and running than first expected.

As is often the case, it is the price that appears to be holding this initiative back, but if it actually does cost just $10 million over five years, that amounts to an absolute pittance. Australia would spend more than that on workshopping the idea.

So despite the chaos that NZ's Ministry of Health has seen over the last five years or so, with several rounds of restructuring, the disbanding of the National Health IT Board and what appears to be significant underfunding of the health system since about 2009, New Zealand does seem to be getting on with it.

In Australia, we are getting on with it too but we are still grappling with some serious interoperability challenges. Next week in Brisbane, HL7 Australia is holding a workshop to tackle some of these technical dilemmas through the localisation of HL7 standards covering pathology, diagnostic imaging and referrals. Pulse+IT will be attending and we'll bring you all the news over the next few weeks.

Meanwhile, despite the outcome of Australia's federal election showing that you should never trust public opinion polling or market research ever again, we've made the decision to keep running our thoroughly unscientific and yet quite interesting polls anyway. Last week we asked: Will there be major changes in digital health policy this year? Our readers said a big no to that, even before the election result was known. 82 per cent said no while 18 per cent said yes.

This week, our poll question is: Do you think NZ's decision not to pursue a single EHR is the right one?

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

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