Open source approach for patients arriving at the clinic with Clinic Arrivals

A team of Australian software developers has come up with an open source approach to help medical practices handle patient arrivals and infection control during the coronavirus outbreak, working to turn around a minimum viable product in less than two weeks.

Dubbed Clinic Arrivals, the solution is a mixture of open source video conferencing, SMS messaging and integration with practice management system appointment books to manage telehealth consults and to automate the process of instructing patients what to do when they arrive for a face-to-face visit.

The team behind the solution was led by Melbourne-based health interoperability expert Grahame Grieve, creator of the FHIR standard, and several IT professionals who are part of the FHIR community.

This includes Telstra Health's Brian Postlethwaite, who as Mr Grieve puts it “wrote the guts of the program”; Oridashi's Brett Esler, who has developed a FHIR access library that links to commonly used PMSs Best Practice, MedicalDirector and Zedmed; Shovan Roy, a former Accenture staffer on the My Health Record who is now working with NSW Health on the child health record project and worked with Mr Grieve and James Berry on the video conferencing requirements; and Europe-based FHIR consultant Vadim Peretokin.

Together, they have developed an application that solves two problems for practices in the face of the coronavirus: how to more easily handle video consults that fit in with the GP's workflow and have zero impact on the patient; and how to get high risk patients to stay in the car park so the doctor or nurse can triage them before they come into the building.

“It says to the patient from the start, do you qualify for a virtual appointment rather than physically coming to the doctor,” Mr Grieve said. “If they choose it as a video consult, then we set it up a few minutes before. We send them a message saying the doctor's appointment is coming up, be ready and if the doctor wants to see you, this is the video link to click on.

“The doctor will then talk to them and if the doctor decides that they want to see the patient, then the doctor has a copy of that link in the appointment details in the PMS and the patient has it in their SMS. If there is a translator or a third party in the call they can add the translator into the call as well.”

The second element is communicating with patients when they arrive for a face-to-face consult. The system can send an SMS to them telling them to stay in their car when they arrive and a nurse or doctor will come out to them. It can also tell them to enter via a rear door or go directly to a room set aside for potentially infected patients, thereby automating a process that most clinics are doing manually now.

All of this is done with existing technology that does not require the patient to download an app and that is easily integrated with the PMS through APIs.

Video conferencing is being done through the open source OpenVidu, which means patients simply have to click on a link in the SMS and there are no apps to download.

The SMS gateway is provided by Twilio, which lets users send and receive text messages using web service APIs.

Mr Grieve said OpenVidu was deliberately chosen as unlike other free offerings, it does not require patients to sign up or be given an ID, and instead allows them to get straight to the appointment.

“This is a link that takes them straight to a website and straight into the video call on the website,” he said. “There is zero impact on the patient's end and that was really important to me. There is no app, no set-up.”

The team has uploaded the solution to GitHub with instructions on how to use it.

While his company Health Intersections is managing the project, the product has been built so quickly that normal product development and costing have been turned on their heads.

“This has been done entirely backwards,” Mr Grieve said “It makes no commercial sense to be doing but we just looked at it and said, GPs really really need help right now. We said we are going to do this and then figure it out, because that is the nature of things right now.”

The hope is that rather than a commercial product, the approach is adopted by the PMS vendors themselves.

Posted in Australian eHealth

Tags: FHIR, Grahame Grieve, COVID-19

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