Claydata aims to fill the gaps with private eHealth network

Sydney-based eHealth systems vendor Claydata is gearing up to tackle the aged care, allied health and medical specialists markets with its modular, cloud-based offering, which it calls the “intelligent cousin of the PCEHR”.

Claydata recently signed implementation agreements with two large aged care providers in Australia and its Putty system is also being used by a number of medical specialists and allied health practitioners. The company has developed a full range of eHealth platforms, applications and gateways based on the Linux operating system, from which it has developed its own programming language called QandaX.

Claydata has been active in the US for a number of years and is planning an IPO later this year, but in the meantime has turned its attention to the Australian market, where it has been refining its platforms in action with the North Shore Medical Group in St Leonards, where company co-founder and inventor, Joseph Grace, practises as a vascular surgeon.

In development since 2005, the Putty system contains a full EHR package, a communications package for cross-platform communications and secure messaging, a front-desk package for administrative and financial transactions, and a document management package, which was the first package developed.

Underlying these packages are a range of platforms that drive the Putty product range, including the PuttyEnterprise enterprise management system; PuttyMe, a contact and social networking engine that links users with enterprises, fellow users and other platforms; PuttyConnect for telemedicine, alerts, messages, VoIP, chat, file transfer and video conferencing; and PuttyShare, an HL7-compliant secure sharing solution.

Attached to these platforms are an array of apps, including lab test requesting and receipt, clinical measurements charting and a number of financial and administrative apps that can be purchased and used separately. Linking the platforms and the apps packages is a series of gateways that can interoperate with other vendors' products and systems and allow clinicians to share information with other practitioners and with patients securely.

All platforms and gateways can be hosted in the cloud and can be purchased separately or in packages as software-as-a-service. It is envisaged that healthcare providers using the system will introduce it to their patients and give them access to their own patient files and records, but consumers can also purchase the system if they so wish and are able to choose who to share it with. According to co-founder and chief marketing officer Paula Saad, the Putty system is “the PCEHR by default”.

While the Putty system is relatively new, Dr Grace himself has been tinkering with health IT since he first began practising in 1991. Becoming frustrated with paper-based systems, he learned to program in early PC and Mac languages and developed an automated report generator for workers compensation and personal injury reports.

"My first program was built on a floppy disk and it was mainly for personal use,” he said. “Then life gets in the way and further medical training gets in the way and I didn't revisit anything to do with PC-based electronic health records until about 2002, 2003.”

He then started developing document management solutions in Microsoft Access and Excel. “What was the big deal in the early 2000s was you had thousands of image files belonging to your patients sitting on a computer and then you had a hard paper file and there was a disconnect there,” he said.

“What I did was produce an Access system that enabled you to file automatically your documents and I developed little robotic routines within the system. You just plug in your USB and it would automatically collect all the files, cut them, place them into the patient directory and delete everything off the USB. Today we still use that in MRI and CT and ultrasound technology and it's our eCabinet application.”

However, by 2005 he began to see the limitations of consumer-grade Microsoft platforms and instead turned his attention to the open source Linux operating system and the LAMP bundle of software – Linux, Apache, MySQL and PHP – which together support web application services.

“This configuration drives the likes of Google so I was very lucky that I went to that, as there are so many options,” he said. “I employed programmers to completely emulate the systems that I'd already built in Microsoft. We completely reduplicated it and built it right from scratch.”

By 2008, the company had built a number of the platforms that would become the Putty system, so Dr Grace and Ms Saad headed to the US and launched Claydata LLC, which is currently being prepared for listing on the US OTC stock exchange.

In the US, the Putty platform has gone through the rigorous ONC-ATCB certification process which ensures all of the software is standards-based and is compliant with the US Department of Health and Human Services requirements.

In 2009, Dr Grace and Ms Saad turned their attention back to Australia with a view of using the small market here as a testing ground for the system. A full research and development and manufacturing office was set up at North Shore Medical Group, which has used the system to develop its own private eHealth network.

“I decided to fully fit-out an entire procedural centre, which is run as an independent medical centre but is also a fully fledged testing facility for all of the Claydata products,” Dr Grace said.

There, the company set out to map the workflows and processes of a range of medical specialties with a view to further developing the system so it is immediately useful to individual healthcare practitioners and sectors – including not just specialists but GPs, allied health practitioners and aged care – based on their workflows.

“Putty is a very plastic system, and its genius comes from its power and ability to learn of your workflow processes, map those workflow processes, and provide you an infrastructure and a platform to drive your workflow,” Dr Grace said.

“Workflow process for physician one is in no way concurrent with physician two, let alone a surgeon. That's when the magic of our computer language was pretty much concocted. We needed to be able to build a system that would learn of your workflows, emulate them and provide you with a seriously robust, Linux-based platform. And that is what we developed with QandaX.”

Dr Grace said the PuttyEnterprise platform is the engine that drives all of the applications, while PuttyConnect is a connectivity platform which drives all the intercommunications. There is also a PuttyBiz platform that practices can use as a virtual shopfront.

For example, the North Shore Medical Group website is a template of how practices can use the system to set up their own private eHealth network, as it is capable of doing online bookings, online health records and online payments.

The company also offers a PuttyPass, a smartcard with an embedded QR code that identifies the user and allows them access to the different parts of the system. Patients can also be given a pass to access their medical records. “It's the intelligent cousin of the PCEHR,” Dr Grace said.

While Dr Grace is happy to continue developing the system and has the title of product developer, the commercialisation of the product range has been handed over to Ms Saad and executive officer James Flynn.

Ms Saad said the team realised quite quickly that the going to market in Australia with the whole platform could prove difficult, so it has targeted a number of sectors, particularly aged care, to get its foot in the door. It is also offering the different applications as separate modules for individual purchase.

Claydata has also decided not to seriously attack the GP market, even though the products are entirely applicable to general practice.

“The GP market is not the market we are looking to go into right now – aged care and small hospitals more so,” she said. “What we are finding in Australia is that while they love it, there is so much resistance to change, in the medical industry in particular.

“In the US we are finding it a lot easier, because the dominant market vendor is usually only about 10 per cent in any sector. Here it's a lot different, so the GP market is not our focus – it is the specialty market.”

The company has since scored two aged care organisations – the names of which it cannot yet reveal – and is also active in allied health specialties such as physiotherapy and psychology.

“What we are doing is a very fastidious implementation process and we are finding the response successful,” Mr Flynn said. “The aged care industry, that's where we are concentrating. We have a medical side but also a care package within the system, so we take care of not just ACFI requirements but ensuring that medical standards are met as well.”

For aged care, Mr Flynn has put in place a change management and training process for the end users of the system, in particular nurses who only need to use a few parts of the system and who often get overwhelmed by large IT packages.

“With change, we understand that it doesn't come from the top,” he says. “Any boardroom can choose to have a new system but it's about the people on the floor. We are big believers in pre-training and we have done that with our biggest client. When you do it thoroughly and provide all of the resources, and then attach that to a change management program, it works very effectively.”

The team has also developed a macro function, so for nurses who only need to use specific actions don't need to be bothered with the rest of the system. “For aged care, we have basically mapped 150 core processes and we put them in different groups,” Mr Flynn said. “What it means is that like a drag and drop on your iPad, you can say these are five essential things to that action and you do one and it will take you through a workflow of all five. It means that no only do we find out how the system works for the end user, but it is really simple for the end user.”

Ms Saad said enthusiastic users can also be trained to learn the QandaX language and program their own apps, or to develop forms or templates that they use regularly. “If they have a plethora of forms, which most aged care facilities do, they might not want to use our stuff so they can do it themselves,” she said. “We also have a Wiki where all of these forms sit so other facilities can use them.”

The Wiki also includes mapped workflows for a number of allied health disciplines, including physiotherapy, dentistry and aged care, and the team is now working on workflows for chiropractors.

“For instance, with psychology, not only have I got a private eHealth network, I also have treatment plan sets for a type of depressive patient, for example, and I will know with that treatment plan set how many consults they'll need with a CBT therapist,” Ms Saad said.

“If I want to send notifications every day to that patient or put them on a smoking cessation program, I can. I can set up a six-week program combined with the treatment plan, plus setting up their medical record plus sharing that with their GP, and intervening with the patient using notifications. Not only are we holding a medical record and having the ability to share it, but it is also a therapeutic intervention tool.”

In addition to aged care and allied health, the team is investigating the pharmacy market, as the product suite has a number of medications elements, Mr Flynn said.

“Medication distribution is something we do. Our competitive edge is interconnectedness, so that means that not only does my chemist know exactly what my drugs are, I know what my drugs are and my family can securely query those drugs and they can now be shared with my doctor.”

GPs who use popular clinical software like Medical Director or Best Practice can also interact with the system, in two ways, Mr Flynn said.

“One is that it is an HL7-compliant system and you are able to interoperably drag data in and out of our system. It is there to be interlinked and used securely. The second thing is, with a PuttyMe account, the GP is able to identify themselves and have one-off or repeat access to the system. Because it is internet-based, it is really straightforward.”

Patients themselves will also be able to set up their own eHealth record and give their GP access to it if they so wish, which Mr Flynn likens to a private PCEHR. “We working with one of our clients to allow their residents' families to access the data and change it if necessary – not the medical data obviously, but things like social data – and keep that within the system just like a PCEHR.”

For the public PCEHR, Claydata is currently working with NEHTA on the compliance process, and will probably be registered as PCEHR-ready later this year or next. The company is still deciding on whether it really wants to become registered, however.

“We think of ourselves as the eHealth network that people want, but we'll probably become interoperable [with the PCEHR],” Mr Flynn said. “In the US, they did it right by setting a standard and paying an incentive. We want the government to set a standard and then let the market do its work.”

One unintended benefit of the PCEHR policy has been that it may now open up the market to new vendors like Claydata, as a number of standards have been agreed upon, he says. “For example, anyone who is using Medical Director or Best Practice now can easily come across to our system with their data intact to a PCEHR standard, which mind you is quite low. Hopefully in the next few years you should see a change in competition and that's where we come in.”

Posted in Australian eHealth

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