The 2020 Australian eHealth year in review: part two
Just as big uptake of telehealth marked the first quarter of the eHealth year in Australia, developments in electronic prescribing increased in pace in the second. As part of a range of measures to help get medications to patients quickly and safely, the federal government announced it would fast-track the roll out of electronic prescribing, having made the legislative changes allowing eScripts as a legal alternative to paper late last year.
In March, the Department of Health proposed a development sprint with prescribing and dispensing software vendors to get the majority of GPs and pharmacies with the capability within eight weeks. While our survey of GP software vendors showed a couple would be ready with their fast-tracked versions, there was no way it would reach 80 per cent within two months. The department's agreement to allow image-based prescribing, with photos of scripts emailed or faxed to the pharmacy, proved a bit more useful.
The medications package also included $25 million for home delivery, with pharmacies paid directly by the government for the delivery to at-risk patients. This spurred some app developers to bring forward their home delivery plans, while others used Australia Post.
New apps for telehealth continued to be rolled out in the second quarter, spurred by announcements like that from private health insurers that they would cover a variety of telehealth services, including telephysiotherapy and telepsychology. Oculo launched video conferencing technology in its platform to support teleophthalmology and teleoptometry, while ResApp partnered with telehealth provider Phenix Health to integrate ResApp's acute respiratory diagnostic test into Phenix’s telehealth app. Real-time remote monitoring and shared care platform CareMonitor released a new telehealth system that users can access through Pen CS's Topbar app, while patient engagement platform HotDoc released new payment functionality to its booking system that allows clinics to apply their normal billing practices to telehealth appointments.
Among this flurry of activity – MedicalDirector released a telehealth system integrated into its Helix cloud-based product for general practices, and Genie Solutions did the same for its medical specialist base – it began to emerge that the majority of telehealth consultations were being done on the phone, not by video. Data gathered in March and April using Outcome Health's POLAR GP data analytics tool showed that face-to-face consultations made up 60 per cent of volume and 40 per cent was delivered by telehealth, but only five per cent of that involved video, with GPs far preferring telephone consults.
These numbers were backed up by analysis of MBS item numbers by research groups such as the Centre for Online Health, which set up a webpage to track Medicare-funded telehealth activity, and by Victorian GP Andrew Baird, who has done sterling work tracking Medicare figures for telehealth and providing valuable analysis. Dr Baird's article, and one by Margaret Faux and Heather Grain arguing that using SNOMED codes should be a requisite for ongoing MBS telehealth, were two of the most read on Pulse+IT for the year.
Seemingly under the cover of COVID, Queensland Health terminated its $64 million laboratory information system replacement project, cancelling a contract with US vendor Sunquest and instead upgrading to the latest version of its existing Auslab system from Citadel Health. Queensland Health spent $37.5m of the $64m budget for the project. A Queensland Health spokesperson stretched credulity by insisting that the decision to discontinue the project was to allow Queensland Health and Pathology Queensland to focus on the response to the Covid-19 pandemic. Queensland Health has used Auslab since 1996 and cited the age of the system in looking for a replacement. Citadel always disputed that it was at the end of its life. It has now got an extension to 2029.
In late April, the government launched its COVIDSafe contact tracing app, which was downloaded by a million people in the first day. It has not proved overly successful and its use was abandoned by Victoria when the second wave hit in July. Questions have also been asked as to why the government did not adopt Google and Apple's exposure notification framework. Australian researchers said the need to contact people who may have been exposed to the coronavirus in a hurry means enhanced manual contact tracing apps might not be much use. Nonetheless, by mid-May it reached 5.6 million downloads.
Australia's first fully electronic prescription was successfully sent in the Victorian town of Anglesea, prescribed and dispensed by a doctor and pharmacist using the token model developed by industry and regulators as an alternative to paper scripts. The successful exchange was achieved using the Best Practice prescribing system, prescription exchange service eRx Script Exchange, Fred NXT Dispense and MedView Flow, a desktop tool that gives pharmacists a consolidated view of their medications workflow.
Best Practice promised to have eScript capability live in June in the Jade service pack 3 version of its Bp Premier practice management system, making eScripts available to users in around the country. Zedmed released its fast-track version in June, and Minfos began trialling its eScript workflow with a TerryWhite Chemmart pharmacy in regional NSW. Zedmed, dispense system vendor Simple Retail and prescription exchange service Medisecure then facilitated a fully digital workflow, with the patient seen by telehealth and the medications delivered to his home.
South Australia would exchange its first eScript in July, between Chandlers Hill Surgery in Happy Valley and TerryWhite Chemmart in Old Reynella. GP Danny Byrne (pictured above with pharmacist Chris Tsamandanis) described the process as a piece of cake.
Much of the attention on remote monitoring for COVID patients was in the acute care sector, but there were also some concentrating on primary care. COVID positive patients in Western Sydney who were at low to medium risk of serious illness were being remotely monitored at home by GPs as well as hospital-based community health teams using CareMonitor's shared care software and biometric measurements such as temperature, oxygen saturation, blood pressure and heart rate. Gippsland PHN was helping GPs to remotely monitor patients with suspected or confirmed cases of COVID-19 in their homes using the LifeguardMobile platform from US firm Lifeguard Health Networks, which includes a web portal and mobile app for health providers and a mobile app for patients that allows them to report their outcomes and vital signs.
NSW Health partnered with patient education specialist Healthily to enable digital information packages on COVID-19 to be sent to patients by SMS from 51 NSW emergency departments and COVID clinics. The multi-lingual packages are sent through Healthily's GoShare patient education platform and provide hospitals with access to three interactive information packages about prevention, symptoms and diagnosis of COVID-19.Getting COVID test results out to patients quickly became a priority. NSW Health Pathology worked with Amazon Web Services, Deloitte Australia and Microsoft to send results to patients on the same day via text messaging, following the lead of Western Australia, which launched SMS notifications in March. SA Pathology used local firm Personify Care, building a secure online platform so patients could register to receive negative COVID-19 test results faster. Full results were sent to the patient's GP and their My Health Record.
Brisbane's Metro North Hospital and Health Service (HHS) planned to shift 30 per cent of its outpatients clinics to virtual services as the pandemic continued, moving beyond traditional telehealth to a virtual care system that allows for the real-time exchange of information. The HHS also developed its own tracing app for patients arriving in Australia with suspected coronavirus, a workforce attendance tracker to keep a handle on clinical staff, a screening outcome notification app to let patients know by text of a negative diagnosis, and it even began biofabricating its own protective equipment, with TGA approval for its 3D printed face masks.
Bendigo Health rolled out a telemonitoring solution built on Siemens Healthineers' teamplay myCare Companion platform to care for suspected COVID-19 patients at home. The solution, which includes symptom tracking and monitoring devices and which can alert clinicians that the patient is deteriorating, is also being deployed for people with chronic disease who are at high risk and residents of aged care facilities to try to avoid the need for hospital admission.
In May, Melbourne's Royal Children’s Hospital announced it was delivering almost 70 per cent of its specialist clinic appointments by telehealth, with the average of 1200 face-to-face appointments per day dropping to 250 during the coronavirus pandemic. For the month of April 2019, it provided 231 consultations by telehealth. In April 2020, it was more than 11,200.
Emergency department doctors from Royal Melbourne Hospital developed their own platform for home monitoring COVID-19 patients using the REDCap data collection tool. The platform allows the hospital to send an SMS prompt twice a day to patients at home to submit their heart rate, temperature and oxygen saturation, store and analyse these vital signs and alert staff to patients that should be reviewed because of high or low readings. RMH made its adaptation available for free to other hospitals.
Card payment technology provider Medipass, which was set up to allow allied health, general practice and specialist practices to make claims and process card payments without having to use a physical terminal, entered the telehealth market through integrations with MyHealth1st, Cliniko, Nookal, Doctors on Demand, Coviu, and Owner Health, an online booking service for home and mobile physiotherapy consultations. Medipass expects psychology and mental health services to be one domain that will be continue with telehealth, but areas like speech therapy and physiotherapy also lend themselves to telehealth, along with follow-up consultations.
Telehealth for physiotherapy was also a feature of the year. COVID-19 saw take-up of Online Prostate Physiotherapy's (OPP) service service jump by 50 per cent almost overnight. The service uses a mix of technologies, including the PhysiTrack remote patient engagement app, the Cliniko practice management system, which is integrated with PhysiTrack, and the Stripe payments system for an end-to-end browser-based service for patients.
The Aged Care Industry IT Council (ACIITC) launched a survey of software and technology vendors servicing the aged and community care sectors as part of its CARE-IT project, which will provide a benchmark for aged care provider technology capabilities. The survey of vendors followed one for the industry and aimed to discover the range of technologies and services available to the sector from the vendor community. The research was used to inform the CARE-IT report, released in late November, which found that the aged care sector continued to experience a large divide in digital maturity, with about 40 per cent of providers still not using electronic clinical systems, half not using telehealth or telecare and a big disconnect between the My Health Record system and My Aged Care.
Some of the more interesting software, apps and new players in the market that caught our eye this year included:
- Northern Health expanded the use of its Medtasker clinical communication and task management platform to 4G in addition to the onsite WiFi at its four facilities, allowing staff working in the community to receive and respond to tasks, including those caring for COVID-19 confirmed patients.
- NSW Health begun the roll-out of its $21.7 million telestroke service, with hopes to expand the service to up to 23 sites across the state over the next three years.
- Patient engagement platform HotDoc and practice management software provider Genie Solutions have gone live with their new co-developed online bookings solution for medical specialists. It lets patients book a specialist appointment through HotDoc but also gives specialists appointment triage capability in Genie.
- Sydney Adventist Hospital is using artificial intelligence to automatically populate its cancer multidisciplinary team meeting (MDT) system with pathology information using natural language processing from local company Health Language Analytics (HLA).
Want to know what happened next? We'll have part three of the 2020 Australian eHealth year in review tomorrow. If you're looking for part one, here it is.
Posted in Australian eHealth