The 2020 Australian eHealth year in review: part four
In September, the federal government announced a new $2 billion COVID-19 health measures package that extended the temporary MBS item numbers for telehealth for a further six months. It also included an extension to the subsidised home delivery of medicines measure, as well as continued free access to the Healthdirect video conferencing system for GPs and SMS messages for electronic prescriptions.
The special arrangement for image-based prescriptions was also extended, as was the end-date for software with fast-tracked (FT) eScript capability. Towards the end of the year, vendors such as MMEx began rolling out ffully conformant versions, and by December, Health Minister Greg Hunt was announcing that item numbers for telehealth would be kept permanently.
2020 saw telehealth embraced not just by clinicians but by patients as well, with a study published in September showing that patients who had received a telehealth consultation either by phone or video rated the experience well, with 62 per cent saying their telehealth experience was just as good or better than a traditional in-person medical appointment. Another survey of more than 1300 doctors found they too rated the experience well, with 87 per cent saying they were interested in continuing to use telehealth if there was ongoing MBS funding.
In October, NSW Health released a tender for its statewide single digital patient record, which will bring together the different instances of its electronic medical records, patient administration systems and laboratory information systems on a single platform for a state-wide view of patients. It also includes a requirement for a clinical health information exchange (CHIE) platform to facilitate integration and interoperability between the various specialist clinical systems in use as well as the EMRs used by non-NSW Health providers such as Northern Beaches Hospital.
In November, funding was secured to implement an integrated statewide laboratory information management system (LIMS) for NSW Health Pathology, which currently uses three main systems in Auslab, PathNet and OMNILab that handle more than 70 million pathology tests a year across NSW Health. eHealth NSW has a massive program of work underway, including rolling out a new $85 million medical imaging platform from Sectra. The first two local health districts went live in November. Auburn Hospital's director of medical services Chun Yee Tan is pictured above with the new system.
Getting medical specialists to use the My Health Record system has been a hard slog over the years mainly due to its dubious value to them, so in 2019 the Australian Digital Health Agency made an offer to specialist software vendors to help them connect to the system or to come up with some ideas about how to better integrate their systems if they were already connected. Software for Specialists was first out of the blocks in October 2020, designing its integration so that an active icon shows the doctor that a patient has had new documents uploaded to their record since the last consultation as soon as they open the patient's clinical file. Clinical and billing software solution Medical Wizard followed in November, releasing functionality that enables My Health Record documents and standard clinical documents to be presented on the same page.
ADHA's annual report, released in October, showed there had been an increase in the number of clinical document uploads and views of the My Health Record, albeit from a low base, but also that the vast majority of GPs, pharmacists, public hospitals and pathology labs were now connected to the system. A big breakthrough was the news in December that Dorevitch and Abbott Pathology were now connected and uploading, the first two Healius subsidiaries to do so. The system will get a new platform, with the Australian Digital Health Agency issuing a request for tender to replace its existing Oracle application programming interface (API) gateway with a new Health API Gateway to provide services for the My Health Record and in future for other national digital health systems.
In addition to the token model of electronic prescriptions being rolled out, pharmacies are also being introduced to the active script list (ASL) model, which will allow pharmacists to view all of a patient's active scripts and repeats. Active script lists are aimed at patients on multiple medications who normally leave their scripts with their regular pharmacy and is an alternative to the token model. The prescription exchange services eRx and MediSecure have worked together to build the infrastructure underlying what eRx owner Fred IT is calling My Script List (MySL), which will be offered to other vendors, including medications apps such as MedAdvisor and GuildLink. Doctors will also be able to access MySL, with the patient's consent. It's not all hunky dory with ePrescribing though, as this analysis by Melbourne GP Nathan Pinskier makes clear.
In Big EMR news, Bendigo Health announced that it had restarted its EMR implementation, having postponed it from March. Bendigo is rolling out InterSystems' TrakCare, which also forms the basis for the huge CCSRP system the Northern Territory is rolling out. That includes primary as well as acute care, and was expected to go live at Katherine Hospital last year. It is only in read-only mode at the moment, however, with the first live version not planned until next year.
Latrobe Regional Hospital went live with Allscripts' Sunrise EMR in November, the first implementation of its EMR solution in Victoria. In South Australia, where Sunrise has rolled out to a number of hospitals, including Royal Adelaide, it will now be implemented in the rest of the metropolitan hospitals, including Flinders Medical Centre, after the state government put aside $196.8 million over three years in the state budget. Allscripts will also roll out its patient administration system.
In November, the managing director of specialist healthcare and digital health consultancy The Checkley Group Bruce Pedersen gave one of his now regular updates of the state of the EMR nation at the Australasian Institute of Digital Health's summit, estimating that EMRs are now used by about 65 per cent of Australia's public hospitals. Northern Health in Victoria will get one in 2022, having signed on with Cerner.
One of our most read stories for the year was an Epic one, detailing how the three Parkville precinct hospitals went live with their new EMR overnight.
But the year belonged to telehealth, remote monitoring and virtual care. At the end of the year, we learned about eHealth NSW's new multi-agency Virtual Care Accelerator unit, which is focused on coordinating the flood of innovations prompted by the COVID-19 pandemic, particularly in the areas of telehealth and remote monitoring. NSW has rolled out an enhanced video conferencing platform for specialist outpatients care, and has set a target for local health districts of delivering 10 per cent of non-admitted patient activity through virtual care in this financial year. As eHealth NSW CEO Zoran Bolevich told the Australasian Institute of Digital Health's virtual summit recently, virtual care would be the lasting legacy of the pandemic, which had forced health systems around the world to turn to telehealth. “All of a sudden, out of necessity, we have embraced telehealth with gusto and it has gone leaps and bounds,” he said.
Healthdirect Australia has integrated its Video Call telehealth service with the Commonwealth's Translating and Interpreting Service (TIS National) and the after hours GP helpline it runs on behalf of the federal Department of Health. TIS National has a specialty team helping GPs, specialists, nurse practitioners and allied health professionals who require assistance communicating with patients from culturally and linguistically diverse backgrounds during a clinical consultation.
MedicalDirector was the first GP software vendor to release active ingredient prescribing capability. Prescriptions will now list only the active ingredient or ingredients of each medication unless the prescriber specifies that the brand name should be included as well. The changes become mandatory from February 1, 2021. MD also added a care planning tool to its MedicalDirector Clinical system, promising to allow GPs to more easily develop care plans for patients with chronic illnesses.
Nine Queensland hospital and health services (HHS) are now registered to use a referral service directory (RSD) based on NextGate's provider registry software as part of the state's integrated Referral Management Solution (iRMS) program. The system gives GPs access to an online statewide directory of public hospital services to better inform and direct their referrals into public hospitals and health services. It is being allied with smart referral technology built into their practice software to allow them to create and submit eReferrals directly and more efficiently.
Melbourne's Royal Children's Hospital (RCH) went live with a unified communications project involving secure messaging functionality embedded within its Epic EMR, which can be accessed through the same native app on mobile devices that is used to access patient medical records. RCH also built a dynamic staff directory that lets clinicians select the appropriate person or group of clinicians to send instant secure messages to, based on their role and availability. It tells the user who is in charge of the patient, who is on shift in what role, and whether they are available, all embedded in the main clinical record system.
Perth's St John of God Midland Public Hospital launched a pilot program that allows clinicians to “prescribe” an information pack specifically tailored for Aboriginal and Torres Strait islander peoples and send it to them directly from the hospital's Telstra Health EMR. The project involves Healthily’s GoShare digital platform and has supported over 1000 maternity and emergency department patients and patients requiring support for mental health issues. Content includes culturally tailored storytelling and shared experience videos, and information about COVID-19. St John of God also signed a contract with clinical software vendor InfoMedix to expand its digital patient record in six hospitals in Western Australia, following the implementation of the digital patient record in seven St John of God hospitals in Victoria over the last 12 months.
Sydney-based obstetric and maternity software developer Meridian Health Informatics was bought by Canadian software corporation Harris, part of the Constellation Software group, one of North America’s biggest acquirers of software businesses. Meridian users include NSW Health, Queensland Health, the Tasmanian Department of Health and Mater Health Group. Harris later bought UK firm K2 Medical Systems, a maternity ward software solutions vendor that is used by Mater, Monash Health, Healthscope, Gold Coast University Hospital and RPA Women and Babies/Canterbury Hospital.
The CSIRO signed a licensing agreement with ASX-listed aged care technology provider HSC Technology Group to integrate its Smarter Safer Homes sensor-based in-home monitoring system with HSC's platform. HSC, formerly known as HomeStay Care, plans to roll out the technology to customer sites in Australia, New Zealand and Singapore and will integrate it with its TALIUS smart analytics platform. The technology will provide a decision support system for clinicians and healthcare workers that delivers alerts and triage for the care of older people and a communication and support system for families and carers.
Melbourne-based artificial intelligence technology start-up Pearlii raised $1.25 million in seed investment to continue the development of its smartphone-based app that provides fast and painless dental check-ups. Pearlii uses image processing and machine learning technologies in the app, which scans each user’s dental photos and checks for common dental problems such as tooth decay and gum disease. The app is aimed not just at children but at the aged care sector, where poor oral health is a major issue.
Some of the more interesting software, apps and new players in the market that caught our eye this year included:
- Microsoft released a new Cloud for Healthcare platform, its first industry-specific cloud offering that incorporates its Azure FHIR service and FHIR converter. It also features a Microsoft Teams EHR connector that lets clinicians and patients launch Teams virtual visits from within electronic medical records, the first of which will be integrated into Epic's patient and provider portals.
- Medical billing API specialist Claiming.com.au was offering its API as a business-to-business service to other software vendors developing medical claiming capabilities after Medicare rolled out its new web services interface. Medicare has been using a client adapter-based system running on Java since the 1990s but has been modernising its online claiming systems using web services and will shut down the client adapter in March 2022. Claiming.com.au was one of the first to connect to the new interface.
- Alfred Health's Victorian Melanoma Service is running a trial into the effectiveness of artificial intelligence for assessments of skin cancer, directly comparing AI results with those of doctors. The researchers want to see if the MoleMap algorithm can be used as a diagnostic aid in a specialist setting prior to conducting a much larger trial of the intervention in primary care.
- rpavirtual started a trial of an AI-powered wearable device to monitor COVID+ patients at home. The Biofourmis remote monitoring system involves a wearable armband called Everion that monitors vital signs such as heart rate, respiratory rate, oxygen saturation, skin temperature and activity, with data sent to an app by Bluetooth and then onto a clinical dashboard for clinicians to monitor remotely. It is also being used by Murrumbidgee LHD and the Howard Springs quarantine facility in Darwin. Biofourmis is distributed in Australia by Device Technologies.
- The University of Sydney launched the Australian arm of a US-led study that is looking at whether data from wearable devices such as smartwatches and activity trackers can provide early indications of COVID-19 and other infectious diseases such as influenza. DETECT will also help determine how mental health and behaviours like exercise, diet, sleep and alcohol intake vary during pandemics.
- Telstra Health launched an advisory services business to provide strategic advice on how healthcare organisations can use technology to support more integrated models of care. The move follows a restructure of Telstra Health's business into seven market segments earlier this year, adding a new division dedicated to analytics and artificial intelligence and expanding its virtual care solutions division in the face of the COVID pandemic.
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