The 2015 eHealth year in review: part one

It was a bright and shiny new minister who ushered in a bright and shiny new year for the eHealth and health IT industry in 2015, with the albatross around the neck of the previous minister that was the GP co-pay finally dislodged and the new one able to start afresh.

Sussan Ley then proceeded to spend the year on a magical mystery tour – better known in Canberra circles as “wide-ranging consultations with stakeholders” – racking up five or six wide-ranging reviews over the course of her travels. Whether any actual decisions are made or policies are developed based on the results of these reviews before the next election arrives is still to be seen, but health does look to be, yet again, a fertile ground for battling ideologies.

As most of the review work on eHealth policy had been set in train by Ms Ley's unfortunate predecessor, it was mainly left to her to announce in the May budget a very large amount of money for the ongoing operation of the PCEHR and a change of name to the more palatable My Health Record. NEHTA is set to go but the PCEHR will stay for another round.

The year also got off to a quick start in the primary care sector with the summer release of MedicalDirector Clinical and PracSoft. Still the market leader in the GP sector, MedicalDirector added some new functionality this year such as its own online appointments booking module and a specialist referral service from Healthshare to its Sidebar. It also launched a cloud-based managed service in late January, with MD CEO Phil Offer predicting that most users would in time migrate to the cloud.

The very slow progress of the roll-out of the national Electronic Reporting and Recording of Controlled Drugs (ERRCD) system was a constant theme throughout the year, with yet more coroners calling on state governments to pull their fingers out and get the system going. In the meantime, electronic prescription exchange service MediSecure continued the roll-out of its Dr Shop service, announcing in January that it would be integrated into the next version of Best Practice.

Problems with the PCEHR emerged yet again early in January – surprising no one – with the long debate over how to get pathology reports uploaded still causing angst after several years of debate. The consumer view of the PCEHR got new spots for pathology reports and diagnostic imaging reports, but there was nothing to fill them as few if any pathology or DI providers were registered with the system and the design to upload them has yet to be agreed upon.

Our story on the practical issues facing pathology providers covered some of reasons behind the challenge, from the inability of GPs to order tests electronically to disagreements over who would fund the private pathology sector to change their systems to what to do with sensitive tests and results. The Northern Territory might have come up with a solution by the end of the year, but little if any progress beyond that was apparent.

Also in January, the Department of Human Services (DHS) belatedly added an option for two-factor authentication to the MyGov website, the portal through which consumers get access to their PCEHR and Medicare data. The whole system is still causing headaches with regular stories bemoaning its bugs, not just for eHealth but for Centrelink and most particularly the new online tax return functionality from the ATO. Bring back e-tax was the general consensus of opinion.

DHS didn't fare much better later in the year when it launched the referral functionality in the My Aged Care website – those bugs are still being squashed in an industrial-sized laundry press. DHS's access reform branch – then part of the Department of Social Services (DSS) following an unnecessary move after the 2013 election that was quickly reversed by new Prime Minister Malcolm Turnbull upon his ascension in September 2015 – gave a series of sector briefings about the new capabilities of My Aged Care (MAC) in March, promising to build a business-to-government between aged care service providers and the department which hospitals and other healthcare providers could also use.

The government thought it was catering for the peculiarities of GP and specialist referral practices when it decided to allow doctors to continue to use fax machines and the phone to make referrals to the new MAC call centre while everyone else had to do it online. Little did they expect the uproar when told later in the year that GPs wanted an electronic referral template integrated into their practice software and the ability to send the referral using a secure messaging service. My Aged Care wasn't geared up for those capabilities at launch and isn't ever likely to, with the government looking at some variation of a web form for hospitals and GP referrals instead.

Any news about SA Health and its struggles with its ambitious eHealth program, especially the fraught enterprise patient administration system (EPAS) roll-out, dragged in many eyeballs this year. The SA government got the fodder-for-tabloid-outrage ball rolling early on in the year with the release of its Delivering Transforming Health paper, which foreshadowed hospital closures, including some or all of the beloved Repat General. It is a brave – or foolhardy – politician who closes a hospital or reduces its scope, but the SA government ploughed on nonetheless. It perhaps made a clever decision in keeping IT out of its Transforming Healthcare plans, knowing full well that dramas with SA Health's IT strategy might only just be starting.

Pulse+IT crowned last year as the year of Telstra Health for the massive interest shown in its every move and this year could have been the same, but one of its big rivals for reader interest was the move to fast-track the draft standard Fast Healthcare Interoperability Resources (FHIR) into use in the wild. Some of our best-read stories for the year looked at the challenges of healthcare interoperability and how FHIR might be one of the solutions, starting off with our report on a presentation FHIR developer Grahame Grieve gave on why eHealth interoperability is so hard in early February. In March, we looked at the first moves by vendors to actually use FHIR in their systems, including Cerner and Orion Health and even in primary care through Brett Esler's Hiasobi independent middleware platform. (In April, Telstra Health would join the FHIRstorm and give Pulse+IT headline heaven – Telstra and FHIR together.)

Anything to do with Telstra was always of interest and this year some of its acquisitions began to return the favour. In February we reported that its investment in eHealth so far was over $100 million – it would be close to double that by now.

The PCEHR roared back into contention with Telstra and FHIR as a topic of intense interest in late February, when the traditional pre-budget lobbying period begins in earnest. The Consumers Health Forum (CHF) urged the government to come up with a long-term commitment rather than a one-off annual grant to maintaining the PCEHR, as well as incentive payments for GPs through the ePIP to get them to use the system. As things turned out, the CHF was successful with its first wish but the second became a huge bone of contention later in the year.

It may not have been obvious to many in the wider eHealth industry but there has been a groundswell of unrest in the eHealth standards community in the last few years. Some standards experts cannot quite manage to hide their contempt for NEHTA's attempts to develop technical specifications and standards over the years, and despite the federal Department of Health providing several years' worth of specific funding for eHealth standards development through Standards Australia's health informatics technical committee IT-014, it all came to a head last year when Standards Australia decided to drop IT-014's special status and chuck it back into the mix with the rest. In February, HL7 Australia decided to remove its valuable property from the clutches of Standards Australia and manage it by itself.

Also in February, Greens health spokesman Richard Di Natale voiced what most in the industry were thinking when he showed his exasperation at the secrecy behind the government plans for the future of the PCEHR, a decision on which still seemed not to have been made despite the Royle review being handed to former health minister Peter Dutton in December 2013. “What was Mr Dutton doing for all of the time he was health minister?” Senator Di Natale asked. Quite.

March saw news of a pretty terrible blow-out in the budget for what was originally known as the Joint eHealth Data and Information System (JeHDI) system, the contract for which was won by CSC in 2010. It is based on the EMIS system used by about half of all UK GPs but also by the UK's Ministry of Defence (MOD). According to a report by the Australian National Audit Office (ANAO), the final bill for the project is $133.3 million, a mind-blowing $110 million higher than originally planned in 2009. The ANAO was not backward in coming forward with its criticisms of the Department of Defence.

By far the most curious – or better yet, notorious – event was the famous “GP labelled a meat inspector by PCEHR” yarn in late March. While some readers took us to task for our childish headline, we couldn't resist, despite the gravity of the situation. Poor old software vendor Zedmed was inundated with calls from a baying health media pack but eventually recovered, and the fault was also eventually fixed. And as Pulse+IT found out, it's amazing what photos come up when you search for “doctor meat inspector”. The one that we found was sheer perfection.

Rounding out the quarter, Telstra Health made a significant move when it acquired outright the Dr Foster health analytics firm. It was Telstra's moves to licence Dr Foster back in 2013 that first alerted the industry that Telstra was beginning to make a serious, long-term play in healthcare beyond buying up successful local software companies. At the end of the year, Telstra announced that one of the former journalists who set up Dr Foster, Tim Kelsey – who had since gone on to play a leading role in moves to digitise the NHS – would move to Australia to take up a senior role with the company. Mr Kelsey starts in January 2016.

Acute care

The Sydney Children's Hospitals Network (SCHN) announced it was building a patient portal and increasing the use of Microsoft's Lync – now known as Skype for Business – to better manage the unique needs of its patients and their families. One aim is to create a lifetime eRecord, particularly for its chronically ill patients, and to share information between its providers, from the Children's Hospital at Westmead in western Sydney to the Sydney Children's Hospital at Randwick in the east.

It was a huge year for New Zealand's Orion Health following its listing on the Australian and New Zealand stock exchanges. In February, it announced it would use the roll-out of the unified patient information system known as SI PICS in the South Island as a reference site for its activities in the Australasian and south-east Asian markets for its Enterprise solution.

It was also a big year for US EMR giant Cerner, which would later in the year figure large in Queensland Health's plans for the next 20 years of health IT investment. In February, eHealth NSW announced it had won a tender for a large part of the the state's ambitious, $170 million electronic medications management (EMM) project. Cerner's EMM system will be implemented at 28 major hospitals using its EMR, which includes the bulk of the state's Local Hospital Networks (LHNs). There may be some scraps for another EMM vendor to service the Hunter New England LHN, which uses an Orion EMR, but Cerner has most of the meat.

An upstart in Irish firm Slainte Healthcare made some headway in 2015 with a happy customer in Calvary Health Care Bethlehem for its Vitro electronic patient chart. Vitro is also being used at Bendigo Health for its hybrid approach to implementing a digital medical record (DMR).

Primary care

A couple of wins flowed through to indigenous healthcare practice management software specialist Communicare this year, including a roll-out throughout the vast North West Hospital and Health Service in Queensland. The Telstra Health-owned firm would also later win a healthy contract for an Aboriginal health service in Cairns.

NEHTA released version three of its clinical usability program (CUP) for the PCEHR in general practice software in March, although few seemed to really notice, while Telstra Health took its first steps in developing a software solution for radiology practices by signing a letter of intent with Melbourne firm 3D Medical.

Bringing primary and acute care together to offer integrated care is the philosophy behind NSW Health's four-year, $120 million Integrated Care in NSW strategy. Underpinning a demonstrator site for the strategy in western Sydney is the LinkedEHR developed by Ocean Informatics for the Western Sydney Medicare Local, now PHN (WentWest). This project is a long-term one that will see extra support offered for chronic care patients and the divide between primary and acute care bridged with the help of the web-based shared care planning tool.

Aged care

It was an interesting year for Hills Health Solutions to say the least. The company that signalled in 2014 that it wanted to dominate healthcare delivery platforms in both the acute and aged care sectors got off to a great start to 2015 in March, holding a big tech expo in Sydney to showcase a number of new technologies it planned to introduce throughout the year. Hills then-CEO Ted Pretty was on hand to talk up the new range, but mid-year machinations would see Mr Pretty depart, and later in the year its head of health solutions, Peta Jurd, followed suit. Hills' share price was not looking too healthy towards the end of the year, but the company soldiered on and was a noticeable presence at the ITAC conference on the Gold Coast in November.

By far the biggest topic in aged care this year was the ramifications of the move to consumer-directed care (CDC). For community and at-home aged care providers it has been a particularly difficult transition, and problems with IT systems haven't helped. Aged, disability, mental health and carer support services provider Care Connect took an agile approach to not only reconfiguring its IT systems but its business as well.

Always at the forefront of technological innovation in aged care is Feros Care, which in February announced it was taking part in a federally funded trial to investigate whether paying GPs to conduct video consultations with residents could improve patient care. Lifesize's ClearSea mobile application is being used as part of the trial.

Allied health and pharmacy

In January, allied health practice management software specialist coreplus announced a bit of a breakthrough, partnering with secure messaging vendors HealthLink and HealthConnex to create a secure message delivery (SMD) service built into the coreplus platform, meaning allied health practitioners can avoid having to install different vendors to receive eReferrals from GPs as coreplus is handling it all through a hub in the cloud.

The quarter also saw something rare in the launch of a new pharmacy dispensing system. Called Dispense Works and marketed by Queensland-headquartered point-of-sale technology specialist POS Works, the system features natively integrated Australian Medicines Terminology (AMT) and the ability to detect and warn of 'triple whammy' drug interactions.

Some of the more interesting software, apps and new players in the market that caught our eye in the first quarter included:

  • NetHealth, a new entrant in the highly competitive online appointment booking market with vital signs monitoring and online video consultations planned in the future
  • Dragon Claw, in its first iteration designed as an interactive information source for people with rheumatoid disease, the plan is to make telehealth consultations between patients and specialists available through the platform
  • The developers of the PicSafe Medi secure mobile medical image system released a free version to encourage wider use of the app, which is currently being trialled and evaluated by a number of state health departments
  • Cloud-based credentialing software start-up Osler Technology ultimately failed in its very ambitious plan to raise money through crowd-funding, but the technology is still being developed in association with some hospital groups and went into pilot trials later in the year
  • Telstra picked up a contract to deliver its iScheduler product to the WA Country Health Service's Statewide Telehealth Service in a deal worth $3.2m over five years
  • The new automated document import module called Dvorak in Totalcare's clinical and practice management software has the ability to automatically detect barcodes on incoming correspondence

The second quarter of the year, which we'll take a look at tomorrow, would be dominated by budget night, with the government committing enormous funds – and some political capital – to keeping the PCEHR going. NEHTA got its marching orders, and the industry was taken back to 2010 with a reheat of the opt-in or opt-out debate.

Posted in Australian eHealth

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