Virtual clinic in the palm of the patient's and the GP's hand

NSW GP Ash Collins is getting set to launch a new app-based telehealth service called MyOnlineClinic which he says will be able to offer patients a completely portable medical service, with a portable medical record, 24 hours a day wherever they are in the world.

In addition to allowing patients to book an appointment, video-conference with a doctor, receive a prescription and see pathology and radiology results all through the one platform, MyOnlineClinic has also been designed to receive, chart and store vital signs data from Bluetooth-enabled devices and to allow the patient and the doctor to update the medical file in real time.

Set to launch imminently, Dr Collins describes MyOnlineClinic as “the entire Australian primary care system delivered to you on the palm of your hand, for both doctors as well as patients.”

Dr Collins, who practices in the Riverina town of Temora and has run the TeleMedicine Australia (TMA) medical technology service since 2010, has received the support of the University of NSW's Asia-Pacific Ubiquitous Healthcare Research Centre (APuHC) and NSW Trade & Investment to develop the MyOnlineClinic application.

Dr Collins first began designing it in 2012 as an all-in-one platform that doesn't require plug-ins or other software. It has been designed for iOS and Android tablets as a simple app that can be downloaded, as well as a web interface through the website.

“The application for the doctor and the patient is the same,” Dr Collins said. “They download it to their device and the patient logs into their profile, the doctor does the same thing, but when they log in they will have a different view. Obviously doctors see the clinic from the doctor's point of view, and the patient will see the clinic from a patient point of view.”

Via a single platform, patients can book a doctor online and video conference with that doctor through WebRTC. That technology also allows the patient and the doctor to share documents and images in real time through the same app.

“The patient can also add their medical history to their profile and that history is a live history,” Dr Collins said. “By this I mean that when the doctor updates one part of the history at the time of the consult, that gets reflected into the patient file. Whenever the patient opens the file, regardless of the location in the world, they have access to their latest health summary.

“The problem with something like the PCEHR is that someone needs to log into the system, update it and click that it is been updated, whereas in MyOnlineClinic all of those components of the health summary get updated constantly by the patient and during the consult by the doctor. And it gets reflected automatically in the patient's health summary.”

Medical device data

In addition to a live health summary, the platform allows patients to upload vital signs data via Bluetooth devices that is then collected, stored and graphed for both their and the doctor's use. Measurements include vitals such as blood pressure, pulse rate, temperature, oxygen saturation and blood sugar, but there is also the capability to take and upload images from the throat or ears and recordings of heart and lung sounds.

“MyOnlineClinic will collect all of these results and the results all appear on graphs, charts and tables,” Dr Collins said. “Another thing that the doctor may need during the consultation in order to have a proper diagnosis is for example they want to have a look into your ear or throat, through certain equipment the patient can connect the device to the computer or their iPhone and it will take a picture or listen to and record heart and lung sounds.

“You don't have to be a doctor to do that as we have short videos explaining how a process needs to be done so they can collect an accurate reading. All of the results are kept in a results page for the patient in their profile and they can delete or share them.

“If the patient is consulting with the doctor about their blood pressure or blood sugar, they don't have to share the images taken from the ears, so they just tick them. But at the time of the consult if the doctor says they need to see that part of your history that is not visible, just take the tick off and that will appear to the doctor as well.”

Dr Collins and his team have put together a range of approved devices that can be purchased outright, but if the patient has their own device, the data can be uploaded manually. A large range of devices from more than 15 manufacturers were tested and reviewed to see if they were fit for purpose, from which three manufacturers were chosen.

MyOnlineClinic will provide a basic set of devices including blood pressure cuffs, blood glucose meters and thermometers that will cost around $150 to purchase. There will also be a full range of devices, including a portable ECG device, oximeter, scale, stethoscope and otoscope that will sell as a package for about $600.

“It is all packed in a suitcase so if they need to take a trip, the patient can take that with them if they are travelling. If they need to see a doctor they open the suitcase, do the measurement on the phone, collect the results, see the doctor and they can do it all at the caravan park.

“The patients do not have to buy the equipment as the application allows them to add their results manually, but we've designed it in a way that the doctor can see if the results have been added manually or through the Bluetooth device. We don't want anyone to trick the doctor.”

Path, rad and scripts

While there are is no third-party software that the patient or the doctor has to buy, MyOnlineClinic will have full integration with essentials such as HealthLink secure messaging and eRx Script Exchange, as well as an external SMS provider. (When a patient wants to see a doctor, the doctor is informed by SMS.)

However, all of these are tightly integrated into MyOnlineClinic and are hosted on the company's server rather than the external provider's.

What this allows is the ability to request pathology and radiology tests and receive the results electronically, just as a GP normally does, as well as write and send electronic prescriptions. Patients will also be able to see results after the doctor has checked them as they will be added to the patient's file.

“If the doctor requests a blood test, in physical practices all of the results come back electronically through a messaging service but that is not visible to the patient," Dr Collins said. "There is the fear of the wrong interpretation of the result. So what we have done is that results coming back will be passed through our administrators and then sent to the doctor.

“The doctor checks the results – this is all online and in one single application – and then the doctor can take the appropriate action. If the result is normal, they can notify the patient and add the results to the patient file, but if it's abnormal then they can notify the patient to have an appointment.

“If the patient is travelling around Australia and they get sick and they don't know if there is a pharmacy close to them, the application identifies the closest pharmacy within 50km of the patient and just by one single tap, you can add that pharmacy to the file – there is no data entry as everything is done online – and the prescription will be sent to the pharmacy that the patient has selected.

“If a doctor needs to write a prescription, when they hit print it comes out, with the digital signature of the doctor, in our office and one of our admins will fax it to the pharmacy. Hopefully over the next couple of years that will all change so that it can be done electronically and you don't have to have the paper script.

“We've already built that functionality and we're just waiting for it to change legally. The admin faxes the prescription to the pharmacy so the pharmacy can dispense the medication and then we post the paper prescription over the next few days so the pharmacy can claim from Medicare.

“Regarding pathology and radiology, it is the same process. The doctor hits print and it comes out in our office, it is put in an envelope and gets posted to the patient's home afterwards. When the results are ready, they'll come back into our office electronically.”

Fee for service

In terms of payment, while there are telehealth services offered on a subscription basis around the world, including a new one in New Zealand, Dr Collins doesn't believe the Australian market is ready for this model. The plan is to offer MyOnlineClinic on a fee for service basis.

“We are only operating on minimal margin but for TMA and now for MyOnlineClinic, the passion has been for the technology, not for the money,” he said.

“In America there are plans and different types of packages that you can purchase but we don't think anyone here would want to do the contract thing where you pay per month, so we've done something different. We decided to give the full platform for free for people to use and they just pay for the consultation when they want to see a doctor.

“They don't pay for keeping the medical record in the cloud or to see all of their results online. Everyone can use that for free, so they will have their medical record in the palm of their hand regardless of their location in the world.”

The platform is set for a six-month trial to test user acceptance in association with APuHC, which is part of the UNSW Australian School of Business, with recruitment being handled by general practice digital marketing specialists eGP Solutions.

In the meantime, Dr Collins and his team are setting up offices in Sydney and Queensland to handle the back-end needs of the business, including a nursing team and a technical team. The business will be overseen by a board of governors who will be on hand to review any medico-legal issues that arise.

There will also be the capability for a GP to raise a medico-legal issue during a consultation without the patient noticing.

Dr Collins is confident the technology platform is unique and is not overly concerned about the threat posed by Telstra Health, which announced its own telehealth business last year.

“I know the platform that Telstra is going to implement but the technology is not really the issue – it is how you get people to contribute. It could be successful or not.”

Interested parties can register for more information online, and GPs interested in taking part in the trial can email [email protected]. There is also a YouTube video explaining the service.

Posted in Australian eHealth

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