The eHealth year in review: part 4

The result of the September federal election was never really in doubt, but you couldn't say the same for the future of the PCEHR. As expected, newly elected Health Minister Peter Dutton set up a review of the system, the discussion about which dominated the last quarter of the year.

As expected, long-time opposition health spokesman Peter Dutton was named Minister for Health in the new federal cabinet, although two former parliamentary secretaries with medical degrees, Andrew Southcott and Andrew Laming, missed out. One of Mr Dutton's first actions was expected to be the stocktake of the PCEHR first mooted back in February.

The announcement of the review duly took place on November 3, and in the meantime everyone lined up for a say, including the Pharmacy Guild, which had been advising members not to sign the PCEHR participation agreement. The guild told Pulse+IT that it would wait until the outcome of the review was known before reconsidering its position.

General practice representatives had a go as well, with umbrella group United General Practice Australia (UGPA) calling for the focus of the PCEHR to be redirected to clinical utility and standardisation.

NSW GP and Australian Medicare Local Alliance representative Tony Lembke said what UGPA wanted to see was a system that is practical and usable in the clinical context by grassroots GPs.

“We realise that's a work in progress but it needs to remain a focus of development,” Dr Lembke said. “I think the shared health summary as designed being uploaded and curated by GPs is quite an appropriate first step because it's clinically relevant and useful and we should focus on making that work before we move on to more high level functioning.

“Let's do one thing, build it, make it work and move on.”

Meanwhile, federal, state and territory health ministers were expected to examine a review of the 2008 national eHealth strategy by Deloitte at the halfway point of the strategy's 10-year roadmap.

A lot of the work carried out in western Sydney through the Wave 2 program and NSW Health's HealtheNet project began to bear fruit when a clinical portal to the PCEHR opened up for clinicians working in five NSW local health districts.

In addition to viewing patients' PCEHRs, clinicians can upload discharge summaries, and also have a view of diagnostic images and reports contained in NSW Health's enterprise imaging repository (EIR), which went live last year. All this is possible from within hospital and community clinical software.

Most of the other states and territories committed to allowing acute care clinicians to view clinical documents and send discharge summaries to the PCEHR system by the end of the year under NEHTA's rapid integration project (RIP).

South Australia has already begun sending discharge summaries from nine public hospitals through its HIPS software, which is now being used by other states.

Northern Territory hospitals followed the lead of Queensland and began rolling out the Multiprac infection control system, based on the openEHR standards developed by Ocean Informatics. Multiprac is able to interface with pathology and patient administration systems to draw in demographic and clinical data to track hospital-acquired infections and infectious diseases.

Telstra continued on its recent investment splurge by taking a 50 per cent stake in pharmacy vendor Fred IT, which also owns the eRx Script Exchange. Telstra told an analysts' meeting in November that it planned to build on its strengths in connectivity and secure data storage and to assemble specialised eHealth capabilities, including provider applications, telehealth, care coordination, consumer health portals, enabling technologies and data analytics.

In an interview with Pulse+IT, Telstra head of health Shane Solomon said Telstra had identified six “big-ticket” issues in health, and “if you can put together the six capabilities, you can bring to the mainstream health system a solution”.

Mr Solomon said Telstra was on the lookout for companies to work with, including software solutions that can be integrated into a package.

The Department of Human Services (DHS) took the welcome move of renaming the eHealth record PKI certificate for individual access to the provider portal of the PCEHR as the National Authentication Service for Health (NASH) PKI certificate for healthcare provider individuals.

It is also working to create a distinct look for NASH PKI certificates to differentiate them from Medicare PKI certificates used for claims and payments.

iMDsoft was announced as the winning bidder for a $43 million tender to provide a new intensive care system throughout NSW public ICUs, and will over the next few years begin rolling out its MetaVision system, already in use in the ACT and Queensland.

One of our favourite stories of the year was that of the CAReHR, developed by Victorian clinicians with a commitment to the health of refugees and newly arrived immigrants. The CAReHR has linked up four different refugee clinics and is also linked to the primary care sector through the cdmNet chronic disease management solution for GPs.

It can also provide infectious disease surveillance and work as a clinical research tool for hospital clinicians.

The Victorian Auditor-General has released a scathing report into the implementation of the HealthSmart project in Victorian public hospitals, adding to the criticisms made by the Victorian Ombudsman in 2011.

The Auditor-General's report found that the project has run enormously over budget, has only been fully implemented in one health service and has drawbacks that potentially pose a threat to patient safety.

The report came in the same week that the Ministerial Review of Victorian Health Sector ICT was released, which recommended greater devolution of decision making to health boards and that Victorian health organisations have a greater say in choosing and developing health IT systems.

One of our most popular stories of the year was our interview with medical software trainer Katrina Otto, who seemed to voice what many in the primary care sector have been calling for, which is a focus on ensuring interoperable secure messaging.

“At the moment everyone is still drowning in scanning; privacy is compromised and we are still chasing vital patient information,” Ms Otto said.

“Across Australia I hear practices complaining about the scanning workload because we don’t yet have an easy interoperable secure messaging system in place. Once all that medical information is received electronically, hopefully it will become a seamless process.”

Cue the review

The end of the year was dominated, however, by the federal review of the PCEHR by a three-man panel, headed by Uniting Care Queensland's Richard Royle.

Mr Royle told the HITWA conference in Perth that the panel had no intention to “kill off” the PCEHR, but intended to ensure it was a useful and workable clinical tool.

To the great joy of all involved in the eHealth sector, the Australian College of Rural and Remote Medicine (ACRRM) broke ranks and publicly released its submission to the PCEHR review, instigating a flurry of public releases from a range of organisations despite the review panel's request that they be kept confidential until after the review is over.

ACRRM recommended that the federal government widen the focus on electronic sharing of health information from the PCEHR to more foundational elements, such as interoperable secure messaging, incentivising medical specialists and allied health to implement clinical information systems, and increasing the value of clinical documents.

ACRRM did aim a barb at the RACGP, the AMA and some of the former members of NEHTA's clinical leads team for seeming to advocate for the uptake of the PCEHR in its current form while at the same time criticising NEHTA and DoHA for not consulting with the profession and for producing what it called “a critically flawed product”.

The RACGP was a bit peeved and called the criticisms unfair, and released its own submission, which called for the development program for the PCEHR to be suspended immediately in order to consolidate the existing system and test for clinical benefit, usability and safety.

RACGP president Liz Marles said she “sincerely hoped” the PCEHR was fixable and salvageable, but that it needed a refocus.

The AMA and the Consumers Health Forum, meanwhile, had a bit of an argy-bargy over doctor versus patient control of record, with the former calling for more control for doctors and the latter insisting on personal control. Both agreed, however, that an opt-out system would see higher uptake and clinical use.

HISA and HIMAA released the results of a survey of almost 700 people on their thoughts on the PCEHR, the overwhelming majority of whom said there were barriers to further take-up and that there are many cases of usability issues that require further analysis.

However, few respondents believed there are existing software products available that could replace the PCEHR, and very few agreed that the private sector should host the system or manage the data it holds.

As the year drew to a close, NEHTA revealed plans to modify the PCEHR infrastructure to allow a new overview to be presented in clinical software, and finally launched a training environment to let organisations give the PCEHR a test run with simulated data and patients.

It also announced a new team of “clinical governance advisors”, who seem to resemble the former clinical leads team in all but name and visibility.

Aged care, allied health and telehealth

NBN Co's new management handed down a strategic review of the roll-out in late December that not surprisingly pushed for a mix of technologies to be used, as spruiked by Communications Minister Malcolm Turnbull.

Healthcare services in regional Victoria have been using microwave broadband for years, and while it is certainly not an option for built-up metro areas as it relies on line of sight, it did keep the local hospital functioning when Telstra's exchange in Warnambool melted down.

Cost efficiency as well as improved access to care are two of the benchmarks often set to measure the benefits of telehealth. In one study published in the MJA in September, the vast distances rural Queenslanders have to travel for oncology follow-up services, as well as the travel costs for visiting specialists, showed that telehealth can be a cost saver as well as a potential life saver.

In aged care, personal care technology company mCareWatch launched a monitoring and support system called ConnectiveCare for aged and other care facilities, an extension into a platform for the technology it has developed with its SOS Mobile Watch, a wristwatch that also functions as a mobile phone, a GPS tracking device and a medical alert system.

The RDNS announced it was looking for alternative suppliers to Intel after that company withdrew its Home Guide from the market. RDNS has been using the system in its trial of video conferencing technology for medications compliance with clients in their own homes.

Aged care provider Feros Care said it had achieved a quick return on its investment in the LifeSize video conferencing suite, not just in providing better care to community clients but in cutting down on travel and accommodation costs for its staff, many of whom work from home.

Feros Care is involved in two federally funded trials, one of which is aimed at seniors with chronic illnesses living in Coffs Harbour, and involves using a touchscreen device with in-built video camera and peripheral devices to monitor health and wellness at home, assisted by high-speed broadband through the NBN.

The other project is called the Technology Enabled Multidisciplinary Care Advisory Service (TEMCAS) pilot, which is using wireless and high-definition devices at three of Feros Care's residential aged care facilities in northern NSW. The devices are not only allowing residents to do bedside video consultations with a nurse and a remote doctor, but also to Skype with family and friends.

Aged care software vendor AutumnCare took its Medicate module on the road, demonstrating how aged care facilities can create a full medications profile containing demographics, the resident's regular packed medications, non-packed medications, as-needed medications (PRNs) and stat medications.

It is also building functionality to enable general practitioners to view the full medications profile of their patients in residential aged care facilities, generated through Medicate.

As part of its submission to the PCEHR review, the aged care industry – through the Aged Care Industry Information Technology Council (ACIITC) – repeated its call for a transfer document to be designed and used on the PCEHR to improve care coordination for older people moving between aged and acute care.

In allied health, WebRTC made a splash at the Australian Physiotherapy Association (APA) conference, Melbourne-based IT consulting firm Sinapse completed the deployment of the PCEHR-enabled Penelope case management system from Canadian firm Athena Software for the Department of Veterans' Affairs (DVA), and psychology practice Life Resolutions explained its big, hairy, audacious goal to help Australians with mental health issues through its cloud-based practice management platform Virtual Briefcase, which uses the coreplus cloud-based practice management system.

Low levels of computerisation and a lack of incentive to invest in basic infrastructure were highlighted as barriers to greater uptake for allied health professionals of the PCEHR.

And despite initial enthusiasm and a $25,000 investment, allied health software vendor myPractice decided to suspend all further development of its PCEHR capabilities until the road ahead become clearer.

Apps and updates that caught our eye

  • Medical Fees Online (MFO), a quick web reference that allows doctors to look up any item on the MBS and find out the fees that apply
  • The MBS Item Browser desktop app designed by NT-based GP Cameron Edgell, which allows users to search for the correct MBS item number and sort commonly used items into folders according to personal preference
  • Bundaberg GP Pat Byrnes added full audit ability and a biopsychosocial assessment wizard for chronic pain to his Patient Assistance Tool (PAT), which is available through Best Practice Software
  • Direct CONTROL launched The OOP, a mobile web service that allows medical and allied health specialists to calculate out-of-pocket costs and generate or email a quote or invoice to billing staff or the patient themselves
  • eRx launched its promised Express app, which allows patients to scan a QR or barcode on a paper prescription with their mobile phone and SMS it to their pharmacy
  • DocAppointments launched a prescription request function that is free for patients and is included in the monthly subscription for practices
  • Best Practice integrated with MEDrefer, a web-based platform that allows GPs to search a directory of consultants and allied health providers, book an appointment for the patient then and there or generate a referral certificate listing five recommended specialists from which the patient can choose the most appropriate for their schedule and location
  • Houston Medical integrated with Xero, the cloud-based accounting package that is taking the stock market by storm
  • Send a Script took out a Gold Mobie for its pharmacy app, added QR code and barcode scanning functionality and announced a partnership with MediSecure
  • ACRRM launched a free app to help doctors help patients in pain or near the end of their life, in association with the Centre for Palliative Care Research and Education (CPCRE)
  • Digital healthcare company uHealth partnered with publicly listed device manufacturer iSonea to begin distributing the AirSonea asthma device in pharmacies
  • and HotDoc became the new kid on the block in the online medical appointment booking market.

Pulse+IT is taking a two-week break from today, although we'll be posting a few feature stories over the holiday period and will be on hand if anything exciting happens. We'll be back on January 6. Simon, Kate and Emily wish everyone a happy Christmas and a prosperous New Year.

Posted in Australian eHealth

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