The 2014 eHealth year in review: part one

In 2014, as in previous years, the trials and tribulations of the PCEHR dominated developments in the eHealth sector, although this year there was the added frisson of a new government, an independent review and the very real prospect that the whole thing would be dumped by a minister with his eye on the bottom line. While the PCEHR survived to live another day, 2014 was also notable for some very interesting moves by a couple of big players in the market, including Orion Health, Hills and the growing giant that is Telstra Health.

Pulse+IT must admit that it thought the move by IT news site Delimiter to put in a freedom of information (FOI) request for the release of the Royle review into the PCEHR in early January was a little premature, coming as it did just a couple of weeks after it was first delivered to the newly elected Minister for Health, but the move proved prescient as the months stretched out with not a sniff of what it contained.

The review, written by UnitingCare executive director Richard Royle, former AMA president Steve Hambleton and Australia Post CIO Andrew Walduck, was finally released in May, a week after the budget, but in the meantime the lack of news had most of the industry on tenterhooks for months, allied to the uncertainty over the fate of Medicare Locals.

While confusion reigned, work on the system changed focus from the primary care sector to acute care, with public hospitals continuing to connect, mainly to upload discharge summaries. The National E-Health Transition Authority released a list showing 200 hospitals had connected, a figure dominated by Queensland Health – which also provides a view of the PCEHR through its The Viewer technology – while some of the other states gradually came online over the year.

In South Australia, problems would begin to emerge with its Enterprise Patient Administration System (EPAS), although back in January it all looked hunky dory as Port Augusta followed Noarlunga Hospital in rolling out the system.

How the PCEHR could have all been done differently was hinted at in a story from January on New Zealand's Dr Info system, which allows emergency departments and after-hours GP services to access a patient's medical and pharmacy information simply and quickly.

The Western Sydney Medicare Local also continued its work with local shared care planning, combining its LinkedEHR system for shared care with its Health Pathways clinical decision support portal. Regionally integrated solutions for primary and community care would become more important later in the year as NSW Health Minister Jillian Skinner unveiled an integrated care strategy for the state for the next five years.

A boom in medications apps and tighter integration with pharmacy systems was a feature of the year. In February, NPS launched a new MedicineList+ app that allows users to scan in barcodes and email a full medicines list. This would later be expanded in a partnership with generic pharmaceuticals firm Apotex, allowing the app to link directly to the pharmacy dispensing system.

Electronic prescription exchange provider eRx also began to roll out QR code scanning capability for its Express app, with the codes printed directly onto the paper script through GP desktop software.

Adding pathology and radiology reports to the PCEHR would become a big topic for discussion later in the year, as it had been the previous year. In the meantime, Adelaide-based eHealth technology expert Eric Browne developed a prototype viewer through which patients themselves can read their pathology results and see diagnostic images. The system can potentially link to resources such as LabTestsOnline to allow patients to cross-reference their results to better understand why the test has been taken and what the results mean.

Despite being in a bit of a hiatus, the PCEHR continued to experience problems, with clinicians reporting that the provider portal that some prefer to use rather than their clinical information systems was booting them out for using an unsupported browser. Other clinicians vented their frustrations at having to reapply for a NASH certificate by fax of all things.

Developments from the work done through the Wave 2 sites for the implementation of the PCEHR began to seem like a distant memory this year, although one of the those projects came a cropper as health insurer Medibank announced it was closing its personal health record healthbook.

At the end of February, it emerged that while the federal health minister had a copy of the PCEHR review report, the department responsible for implementing had had to wait along with the rest of us. Pulse+IT lodged an FOI request for a copy, but after being refused on the grounds that its contents were still under consideration, we also had to wait until the official release in May.

March saw Tasmanian hospitals hook up to the PCEHR, while clinical and practice management software vendor Zedmed became the third, after Communicare and Genie, to add functionality to link to the National Prescription and Dispense Repository and to release software with in-built assisted registration capability. The other vendors would gradually release this capability throughout the year.

The Victorian branch of the Australian Medical Association began agitating in earnest in March for the roll-out of real-time prescription monitoring, which turns out to be a much harder exercise than many imagined. The topic would rear its head again later in the year following yet another coroner's report into the accidental death of a person from a combination of prescription drugs.

At the end of March, consumer registrations for the PCEHR hit 1.5 million, but as would become clear later in the year, many clinicians had simply turned off.

Telehealth and mobility

In telehealth, many were expecting it to be the year of WebRTC, and indeed there were some developments, with telehealth provider GP2U releasing a new version of its iPhone app with in-built WebRTC functionality.

WebRTC is a developing telecommunications standard that will allow people to conduct video conferences and transfer images and documents in real time through common internet browsers without the need to download a separate application such as Skype.

A number of telehealth conferences were held throughout the year that reported sure and steady progress, although telehealth researcher Victoria Wade became every eHealth headline writer's favourite person when she described telehealth in Australia as having ”more pilots than Qantas”.

Melbourne Health made progress with its well-regarded home therapy utilising telehealth guidance and monitoring (HUG) trial, while the University of Queensland’s Centre for Online Health (COH) established a new commercial business called RES-e-CARE for residential aged care facilities.

Some of the more interesting software, apps and studies that caught our eye this year included:

  • a maternity information system used at St Vincent's Private Hospital in Melbourne for electronic maternity assessments and designed by Emerging Systems to be delivered in the cloud
  • The Australian release of the Figure 1 app, dubbed “Instagram for doctors”, which allows doctors and medical students to upload and share clinical images
  • South Australian cardiologist Alistair Begg's What's Wrong with My Heart app, which allows patients to track, store and graph key data such as blood pressure, cholesterol, INR and medications and send it to their doctor
  • A study by the Centre for Health Systems and Safety Research at the Australian Institute of Health Innovation found that the introduction of an electronic test result acknowledgement system from Verdi ensured that all test results were acknowledged, most within 24 hours
  • Zed Technologies' My Film Bag, a new technology that will allow patients to easily access all of their radiology images when they are on the go
  • Zedmed released a new function called Clinician GroupShare that allowed practices to better manage access to progress notes across different clinical groups.

The second quarter of the year, which we will look at tomorrow, would be dominated by the release of the Commission of Audit report, the shock and awe that was the May federal budget, and the belated release of the Royle review. A little bit of certainty was restored, but the drama continued to unfold.

Posted in Australian eHealth

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