The 2020 Australian eHealth year in review: part three
Virtual care was again at the forefront during the third quarter of the 2020 eHealth year, with telehealth and remote monitoring being harnessed across the country as the second wave of the coronavirus pandemic arrived.
Victoria, the hardest hit state, rolled out a number of initiatives to help manage the pandemic, including Alfred Health and Monash Health, which introduced a intelligent decision-support system called CovidCare to monitor patients who had tested positive for COVID-19 and were self-isolating at home.
The University of Melbourne launched a clinical trial of a remote monitoring solution also called CovidCare in general practices and respiratory clinics, with patients in self-isolation or quarantine provided with an app to self-monitor their physical symptoms and to identify mental health needs. By October, this trial had recruited 24 clinics around the country and was being expanded to use the app to help patients deal with long COVID – patients who continue to suffer COVID-related symptoms for weeks and months after infection – and in future with common chronic diseases.
NSW Health said it was developing a new virtual care strategy that lays out the health service's plans for the next five years. The strategy has been informed by the rapid expansion of telehealth and video conferencing during the COVID-19 pandemic. NSW uses a number of video conferencing applications, from Cisco and Polycom equipment to Skype for Business and Pexip, which is used to connect between different applications and with patients at home. Before the pandemic, NSW Health had about 1500 Pexip accounts across the state. It now has over 10,000.
Murrumbidgee Local Health District signed two contracts with ASX-listed health information software vendor Alcidion Group that will see it roll out Alcidion's Miya MEMRe mobile EMR solution and a COVID-19 monitoring dashboard for Miya Precision that has been designed to enable the monitoring of COVID-19 positive and at-risk patients, both in hospital and remotely. The project now includes the use of a remote monitoring solution from Biofourmis and involves combining data from wearable devices with data from Wagga Wagga Base Hospital's Cerner eMR to give a complete picture for remote monitoring of patients in the home. A similar project is about to go live at Sydney LHD's rpavirtual.
Virtual health applications for non-COVID purposes also moved swiftly. The CSIRO's Australian e-Health Research Centre (AEHRC) partnered with Brisbane's Metro South Hospital and Health Service to develop a remote monitoring platform for pregnant women with gestational diabetes that is being trialled at Mater Mothers' Hospital and Redland Hospital. The platform involves a mobile app that the patient uses to monitor key readings such as blood glucose levels, blood pressure and weight. The readings are automatically sent to a web portal where the patient’s clinical team can regularly track the readings and intervene if further help is needed. Also in Queensland, Caloundra Health Service is running a program to remotely monitor women with gestational diabetes using technology from Queensland firm Net-Health to track clinical signs. Patients use common bluetooth-enabled blood glucose monitors such as LifeSmart or Accu-chek and their associated apps, with the data collected and sent to Net-HealthData's platform.
In July, the Australasian Telehealth Society (ATHS) – now the Australian Telehealth Society – called for a thorough evaluation of the effectiveness of the many new telehealth services that have emerged during the pandemic. The fear is that the ad hoc adoption of technology-based innovations may result in them being short-lived and later discarded, due to their lack of integration with existing infrastructure. Back in March, the ATHS had issued a warning about the use of consumer-grade video conferencing for telehealth, saying patients and clinicians needed to be aware that apps like Skype and Facetime are not standards-based platforms.
Also in July, the federal government gave into some heavy lobbying from doctors' groups and agreed to restrict Medicare-subsidised telehealth services to a patient's regular GP or medical practice, citing concerns about continuity of care and the practices of the so-called ‘pop-up’ telehealth providers. The temporary items were due to expire in September, but after even more lobbying the government extended them for another six months and removed the bulk billing requirement. Late in the year, Health Minister Greg Hunt said they would be made permanent, but as yet there is no detail on what exactly they will entail.
In Big EMR news, ACT Health announced it would implement the Epic electronic medical record for its $151 million Territory-wide digital health record project, aiming to achieve HIMSS Level 6 in three years' time. Epic will be rolled out in a big bang implementation at Canberra Hospital, Calvary Public Hospital Bruce and University of Canberra Hospital, along with community health centres, walk-in centres and Justice Health centres some time in 2022-3. It is the centrepiece of a huge plan of work for ACT Health to digitise its services under its 10-year digital health strategy.
In other Big EMR news, the WA government allocated $8.1 million from its coronavirus recovery scheme to begin planning for its statewide electronic medical record. WA Health issued a request for information from EMR vendors on the feasibility for implementing a contemporary EMR across the state last year. The Parkville precinct went live with its EMR in August, and later in the year there was news from Bendigo Health and the Northern Territory about their new EMRs from InterSystems, Northern Health signed with Cerner, and South Australia gave the go-ahead for the completion of the Allscripts Sunrise EMR program in metropolitan hospitals.
Online appointment booking service HealthEngine got a heavy rap over the knuckles from the Federal Court, which ordered it to pay $2.9 million in penalties for publishing misleading patient reviews of medical practices and sharing patient contact information with private health insurance brokers. In action taken against it by the Australian Competition and Consumer Commission (ACCC), HealthEngine admitted that between April 2014 and June 2018 it gave the names, dates of birth, phone numbers and email addresses of over 135,000 patients to third-party private health insurance brokers. It also admitted that between March 2015 and March 2018 it edited about 3000 practice reviews to remove negative comments and did not publish 17,000 reviews. It promised not to do it again.
As cross-border movement restrictions began to be eased, the states and territories began rolling out check-in apps for businesses and venues that are required to capture customer contact details. NSW and the ACT released theirs in September, with the ACT's Check In CBR app later adopted and adapted by the Northern Territory and Tasmania. By early December, all but Queensland had all but Queensland.
The federal Department of Health announced it was going to delay its $448.5 million voluntary patient enrolment (VPE) scheme due to the COVID-19 pandemic response. The initiative was aimed at patients aged over 70 and Aboriginal and Torres Strait Islander people aged 50 years and over and was expected to herald a universal telehealth scheme to better support flexible access for enrolled patients. The plan is to allow general practices to provide consultations, referrals, scripts and test results remotely, with usual services continuing to be rebatable for the patient under Medicare. A modified version of the scheme may be introduced next year.
The roll out of electronic prescribing in primary care staggered along, with general practices located outside the electronic prescribing communities of interest regions asked to wait until pharmacies in their region were able to accept eScripts before issuing them. The Australian Digital Health Agency then asked GP software vendors to suspend access to ePrescribing functionality in their systems while a plan was worked out to scale the new capability nationally.
A week later and practices in the greater Melbourne area, which was then under stage 4 restrictions, were encouraged to use them, along with the rest of Victoria in September. WA issued its first eScript in late July, and the NT issued its in September meaning every state and territory had done so. About 600,000 tokens had been issued by the end of the year but paper scripts still reigned supreme.
Sydney's Northern Beaches Hospital went live with DXC Technology's MedChart electronic medication management system, with all wards and departments swapping from paper to digital in just 11 days at the at the height of the coronavirus pandemic. eMeds is the culmination of close to 16 months of digital implementations since the hospital's somewhat troubled opening, including optimising the Telstra Health electronic medical record, building a health information exchange with the Cerner EMR used in other hospitals in the local health district and eHealth NSW's HealtheNet system, and implementing the MOSAIQ oncology management system.
Royal Hobart Hospital (RHH) went live with the Medtasker clinical communication and task management platform, bringing forward its planned planned start date in advance of a potential influx of patients with COVID-19. The hospital is now using Medtasker in its emergency department, surgical and medical inpatient wards, new K-Block theatres, 24/7 services and Hospital at Night. RHH is using broad Medtasker capability, including clinical photography, messaging and result notification.
iMedX partnered with Kodak Alaris to develop a scanning and remote coding solution to enable hospitals with paper-based records to access a remote coding workforce if onsite staff are quarantined or forced offsite due to COVID-19 and back-up is unavailable.
Digital medical record solution vendor InfoMedix signed the first hospital client to roll out its new cloud-enabled DMR and also completed the acquisition of clinical communications app Clinivid, which has now been integrated into the InfoMedix product suite.
RPA Hospital and Sydney District Nursing began trialling an app from Tissue Analytics that uses artificial intelligence to help analyse, treat and monitor chronic wounds. The app is integrated with the hospital's Cerner electronic medical record so images and data can be stored, reviewed and compared.
Philips Healthcare won a $6.5m contract over five years to provide an integrated care management solution (pictured above) for WA's East Metropolitan Health Service's new Command Centre. Based at Royal Perth Hospital and also covering Armadale Hospital, the service will eventually monitor 100 beds from the new centre, which opened in April. The contract with Philips will allow EMHS to monitor its inpatient high acuity beds and includes the software solution as well as 50 medical-grade audio and visual camera systems for interactive bedside to Command Centre communication.
It was a big year for ASX-listed Global Health, which kicked a number of goals with regional health services in the community and mental health sectors. It also signed a contract with Victoria's Peninsula Health to roll out its MasterCare platform for community health, which will see it integrate with DXC Technology's iPM patient administration system and some of Cerner's clinical applications. Peninsula Health also uses Global Health's MasterCare+ referral management system and ReferralNet secure messaging system, and has seen the volume of electronic referrals to its outpatients department grow from five per cent to over 40 per cent this year.
Online appointment booking and directory service HealthEngine partnered with telehealth platform Coviu to offer an integrated telehealth solution for allied health providers and GPs. The offering brings Coviu’s telehealth technology together with HealthEngine’s booking service through the more than 25 practice management systems that HealthEngine currently connects with, including MedicalDirector, Best Practice, Zedmed, Coreplus, Cliniko, PPMP, Nookal and Smartsoft Front Desk. Coviu users will be able to access a telehealth appointment booking service from their PMS through HealthEngine. The offering is designed to provide more visibility to new patients with 24/7 appointment booking on HealthEngine’s website and app.
Aged care provider Anglicare Sydney had a run in with cyber-criminals in August, with some systems put out of action by what it says was a malicious attack. It followed a similar experience for Regis Healthcare that month and as security agencies warned of increased Emotet activity. Emotet is a banking Trojan that is also used to install other malware such as Trickbot and Qbot, or ransomware such as Ryuk and Maze. Anglicare Sydney said there was no evidence that personal data was stolen despite having identified that a 17-gigabyte data transmission to a remote location took place following the attack.
Some of the more interesting software, apps and new players in the market that caught our eye this year included:
- Secure clinical communication platform start-up Foxo launched a new broadcasting feature that lets healthcare organisations to quickly and easily disseminate information to frontline and administrative staff and bypass traditional mass emails. Foxo was set up as a platform for group messaging and offers a secure and encrypted alternative to Facebook Messenger, WhatsApp, Teams or Slack.
- Best known for its acute respiratory diagnostic test ResAppDx-EU, ASX-listed ResApp Health this year launched an at-home sleep apnoea screening app for iPhones called SleepCheck. CE marked and TGA approved, the app is able to accurately assess a person’s risk of sleep apnoea when compared to a full sleep test.
- Personal health app Wanngi added a Health Forecast feature to its platform, delivering a daily breakdown of health essentials to users such as medication reminders, appointments and weather information that may have an effect on health such as local UV levels and air quality.
- Test results from the National Bowel Cancer Screening program began to be uploaded to the My Health Records of participating patients by the program's contracted pathology service provider Sonic Healthcare. A copy of the letter patients receive explaining their results after a test is being uploaded and can be viewed by the patient on their record after seven days.
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