The eHealth year in review: part 3

Rumblings under the surface of the NEHTA clinical leads team over the direction of the PCEHR erupted in the third quarter of the year, when the bulk of the team abruptly resigned. Despite the acute care and aged care sectors making PCEHR progress, the resignations looked ominous as the federal election loomed. In the third part of our eHealth year in review, we trace developments up to September 7.

AMA president Steve Hambleton got the ball rolling in early July with his thoughts on the anniversary of the roll-out of the PCEHR. While he reiterated the organisation's support for clinical information sharing and electronic decision support, he criticised the clinical usefulness and usability of the system, calling for a clinical advisory group to be formed to oversee and advise the government on the practical implementation of the PCEHR and its use in clinical practice.

The federal, state and territory governments signed a memorandum of understanding (MOU) committing them to developing a nationally agreed business case for funding for eHealth beyond July next year.

As part of the MOU, the federal government committed to rolling out and operating national specifications, standards and infrastructure such as the PCEHR, while the states and territories committed to work on implementing health systems in public hospitals such as discharge summaries to be uploaded to the PCEHR, medications management, diagnostic testing, patient administration and scheduling, master indexes and implementing Individual Healthcare Identifiers into public hospital and healthcare services.

A survey of 500 doctors by Accenture found that despite the vast majority wanting patients to actively participate in their own healthcare by updating their electronic health records, only a minority supported giving patients full access to those records. In fact, 16 per cent said patients should have no access at all.

Despite the importance of community pharmacy to the national eHealth agenda and the work done on electronic transfer of prescriptions and the National Prescription and Dispense Repository (NPDR), Pharmaceutical Society of Australia (PSA) Grant Kardachi said the sector was still in the ”getting ready” phase for eHealth.

“Pharmacy some years ago got on the front foot in terms of software for dispensing and we were probably ahead of general practice at one stage, but as everything is becoming more sophisticated, there is probably a lot more that pharmacy needs to do,” Mr Kardachi said.

“At the moment we are trying to get pharmacists to increase their uptake of the electronic prescriptions, which has been varied, and then I think there is still work to be done around things like secure messaging and privacy so that pharmacy is fully prepared for what is an important step before we jump into the PCEHR. It is a readiness thing.”

Community-based health pathways are becoming increasingly popular, following the lead of similar developments in the UK and New Zealand. The Hunter New England region has run a health pathway system for GPs for a number of years, and has been joined by the Barwon region in Victoria, the NSW central coast and in western Sydney, where a HealthPathways project got up and running in July.

Undercurrents of discontent with the direction NEHTA and DoHA were taking with the PCEHR began to bubble to the surface, although NEHTA's clinical leads team put a brave face on it by introducing a steering committee for its clinical usability program (CUP).

Then head of the clinical leads team, Mukesh Haikerwal, told Pulse+IT that the idea was to assess problems with the usability and usefulness of the PCEHR and find ways to fix them.

“The idea is that something has been delivered, it has got some great potential but it needs to be made more useful, usable and safe,” Dr Haikerwal said. “This is to call out the various parts of the current build to try and address the problems of usefulness, usability and utility.”

Asked if this should have been done while the PCEHR was being designed and before it was launched, he quoted Francis Urquhart of House of Cards fame, saying “you may say that but I couldn't possibly comment”.

That would prove to be the last hurrah for the majority of the clinical leads, who next month pulled the plug and resigned en masse. Two later returned to the fold, but the resignation saga finally brought to public notice the tensions that had been plaguing relationships between the developers, the administrators and the clinicians.

Progress marched on nonetheless, with NSW Health announcing at the Health Informatics Conference (HIC) in Adelaide that it planned to allow clinicians in its public hospitals and community health services to view clinical documents and images held in the PCEHR and in its statewide repositories through a portal integrated into the Cerner acute care EMR system and the CHIME community care solution.

NSW Health also plans to begin a wider rollout of electronic discharge summaries from hospitals to GPs, promising the ability to upload them to the PCEHR by August 31.

Also at HIC, then Health Minister Tanya Plibersek announced $8 million in funding to enable pathology results and diagnostic reports to be added to the PCEHR, with diagnostic images to come online in future.

While the announcement made the headlines, it is never as easy as it sounds. The private pathology sector raised a stink, with Pathology Australia CEO Katherine McGrath saying the sector had serious concerns over the current approach the government was taking, and that Ms Plibersek's announcement was a part of a “pre-election rush”.

The Royal College of Pathologists of Australasia (RCPA) joined in the criticism, expressing its opposition to the method by which pathology results may be added to the PCEHR. RCPA president Yee Khong said the college strongly opposed any method in which atomic data from test results was separated from the pathologist's full report and interpretation.

HIC was graced by a presentation on its final morning about the personal journey with cancer of long-standing servant of HISA, collaborative care planning advocate and all-around gentleman Jon Hilton. Mr Hilton passed away in late July to the great sorrow of all who met him, including the team at Pulse+IT.

The Department of Health and Ageing bowed to the inevitable that month and extended the deadline for general practices to qualify for the secure messaging component of the ePIP to the end of October.

Practices were supposed to have an SMD-compliant secure messaging service commissioned by the end of July, but it was becoming increasingly apparent that many practices were not prepared for the process, with many unable to produce NASH certificates or passwords.

NSW Health announced plans to look at releasing a “lite” version of Cerner's FastNet EMR for smaller emergency departments in the state, and its plans to roll out Dragon's speech recognition software, which will allow ED clinicians to dictate documents straight into FirstNet.

Some more welcome evidence that clinical decision-support tools can help rather than hinder care in emergency care came with a study showing the use of the Trauma Reception and Resuscitation (TRR) system at The Alfred's Trauma Centre in Melbourne had seen the rate of clinical errors reduce by 21 per cent.

TRR is designed to be used in the first 30 minutes of trauma management and involves a scribe – usually the trauma nurse leader – entering patient data such as diagnosis and treatment via a touchscreen. Vital sign data is captured from monitors and all of this information is displayed overhead on a large LCD screen. If a step is missed, a prompt is issued.

cdmNet showed that it could help improve clinical outcomes in patients with diabetes by enabling the use of general practice management plans and team care arrangements, while EpiSoft announced it would launch a cloud-based solution for integrated cancer management and shared care.

South Australia took the lead in sending electronic discharge summaries to the PCEHR by releasing a piece of software called Healthcare Information and PCEHR Services (HIPS), which will give public hospitals access to the PCEHR system.

Telstra continued on its acquisition march by buying the assets of DCA Health, including Argus, TCM and Communicare. Marcus Tan, CEO of online appointment booking and directory service Health Engine, which Telstra made a substantial investment in earlier in the year, outlined some of the thinking behind Telstra's strategy in an interview with Pulse+IT in late August.

Well-known health informatician Jon Patrick explained the technology behind his two private ventures, Health Language Laboratories (HLL) and Innovative Clinical Information Management Systems (iCIMS), while the ACT's Calvary Hospital rolled out the MetaVision ICU system, joining the Canberra Hospital, two private hospitals in NSW and six in Queensland. The big three Brisbane public hospitals are in the process of rolling it out, and later in the year it was announced that the system would be rolled out in all NSW public hospital ICUs over the next few years.

The election loomed, neither party said very much on eHealth, and then the expected happened following the Coalition's victory.

Aged care, allied health and telehealth

The Pharmacy Guild was successful in negotiating a new electronic prescription scanning incentive (ePSI) with DoHA that will see community pharmacies paid to scan more electronic scripts.

Pharmacies can receive up to $2000 per outlet through the incentive program, which is funded through a reallocation of existing ETP funding within the 5th Community Pharmacy Agreement (5CPA).

eHealth solutions firm REND Tech Associates, meanwhile, formed a partnership with telehealth company TeleMedicine Australia (TMA) to enable telehealth consultations to be carried out in community pharmacies with secure access to clinical software in the cloud.

In telehealth, Healthdirect Australia announced it will use the open source WebRTC standards for real time video, audio and data communication as part of plans to implement video consultations for its nurse-led health advice line and after-hours GP helpline (AGPH), as well as the Pregnancy, Birth and Baby counselling service.

Health services in the Kimberley-Pilbara region were given better access to satellite broadband following a successful bid for extra funding, not from the state or federal government, but from a generous benefactor organisation in the private sector, which offered a subsidy worth $2 million to help provide reliable satellite links to remote clinics in advance of the launch of the two NBN long-term satellites in 2015.

Queensland Health Minister Lawrence Springborg doesn't hide his enthusiasm for telehealth, developments in which his large, sparsely populated state has played a leading role. In August, Mr Springborg announced that seven evaluation sites had been chosen for the state's rural telehealth service, which will use existing and under-used infrastructure as part of a $30 million project.

Telehealth in the private sector got two boosts when health insurer HCF announced that it was rolling out what it calls is the largest ever telemonitoring program in Australia, partnering with health management company Healthways and Telstra to provide wireless monitoring devices for use in the home.

Medibank Health Solutions then announced plans to have a panel of up to 30 specialists offering video consultations as part of the national roll-out of its Anywhere Healthcare telehealth service.

The service is free to GPs and offers a panel of specialists who work as part of a virtual private practice, with current disciplines including paediatrics, psychiatry, general medicine and dermatology.

In aged care, a research team from the University of Wollongong investigating the experience of nursing staff in aged care facilities following the introduction of an electronic health record published new research on the unintended adverse consequences they experienced.

Some nurses actively avoid using the system, and it had the effect of increasing complexity in information and documentation, as well as a reduction in communication. (Mind you, this research followed a previous paper on the system that spelled out its benefits.)

Scientists from the University of Adelaide discussed the development of a low-cost movement sensor alarm system to aid falls prevention in the acute care setting, with plans to trial the technology in residential aged care. Using radio-frequency identification (RFID) technology, the researchers are developing a system using very low-cost, wearable sensors allied to a customisable alarm system based on individual falls risk, along with a more intuitive, discreet alarm system that can be integrated with common nurse call systems.

Aged care software vendor AutumnCare added new functionality that allows photos to be embedded directly into residents' files, while pharmacy software specialist Webstercare worked with medicines information service NPS to develop a new reporting function that will allow aged care facilities to monitor and review their use of antipsychotic medications for residents with dementia.

iCareHealth helped its client mecwacare to become the first aged care provider to upload an event summary to the PCEHR. The vendor and the provider worked together to provide some much-needed guidance to other providers looking to register for the system.

We must admit we always liked the concept behind the Parkinson's iTest app, designed by a group of Edith Cowan University students, and so did the judges at July's WA Information Technology and Telecommunications Awards (WaiTTA). The app, designed to work on iPads and other tablet devices to test the condition of a patient and share the results with their neurologist in the cloud, went on to take out the student category at the national iAwards in August.

Other new gadgets on the scene included the new check-in app for Android tablets designed by online appointment booking service DocApppointments, aimed at helping streamline patient flow in general practice and to free up receptionists' time, and the app for the AliveCor health monitor for the iPhone.

The device is a single-lead ECG device built into an iPhone case that can take rhythm strips when the electrodes are rested on the fingers of each hand. The app senses skin contact on the sensors, analyses the readings and displays them on the phone's screen. It is being trialled in community pharmacies to screen for atrial fibrillation, and in general practices to speed up consultations.

Tomorrow, we'll wrap up the year in eHealth with a look at the government's review of the PCEHR.

Posted in Australian eHealth

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