The 2021 Australian eHealth year in review: part one
The 2021 Australian eHealth year in review was, as expected, dominated by news relating to the COVID-19 pandemic, but there were a host of topics of interest in the first quarter of the year, including online appointment booking systems, the embrace of telehealth and remote monitoring, progress in real-time prescription monitoring, and a number of big-ticked announcements with electronic medical record implementations.
The year kicked off with a new face at the Australian Digital Health Agency (ADHA), with former Queensland Health chief health information officer and Mater Health CIO Mal Thatcher named as the agency’s new chief technology officer (CTO). Taking over from former CIO Ronan O’Connor, Dr Thatcher is in charge of system operations including cyber security, core systems testing services and operational events.
Meanwhile, over at Western Australia’s Health Support Services, former Lotterywest and Curtin University CIO Christian Rasmussen was appointed as HSS CIO. Tasked with leading the transformation and modernisation of ICT across the WA health system, he didn’t last too long, resigning after less than a year.
In early January, the ABC revealed that someone had been posting copies of pager messages from Ambulance Tasmania on a public website, most likely having stumbled across the right radio frequency. Private details of ambulance call-outs were listed on the site each time paramedics were dispatched, with the messages containing patients' personal details, condition and addresses. The site was voluntarily shut down by its administrator after a talking to by Tasmania Police.
There was quite a bit of activity in real-time prescription monitoring this year, with the ACT government announcing plans in January to replace its DORA controlled drug monitoring portal with the national real-time prescription monitoring system (RTPM) developed by Fred IT for Victoria’s SafeScript system. South Australia went live with its ScriptCheckSA system system in April, while Queensland’s version, QScript, became mandatory in October. In November, NSW Health said it would roll out SafeScript NSW – using the same technology – beginning with a first phase in the Hunter New England and Central Coast regions before a statewide implementation next year. Canberra Script is due to go live next year.
MBS-funded telehealth in primary care was also a hot topic this year, as it was last year. GPs overwhelmingly continued to choose the telephone as the primary modality, but in an MJA Insight+ article, Melbourne GP Andrew Baird argued forcefully that in future, video consultations may potentially replace the in-person consult as the default in Australian general practice. The Department of Health seemed set on avoiding that at all costs by restricting access to funded telehealth as much as possible. In October DoH signalled it will tie funded telehealth to its voluntary patient registration proposal, and while at the end of the year Health Minister Greg Hunt was boasting that telehealth would be “permanent”, it is only so for patients known to the GP who have attended the practice in person in the previous 12 months.
The COVID-19 vaccination program was top of mind for the whole country, with community pharmacies applying to take part in Phase 2 of the national Covid vaccination program told they will be required to have a patient management system and a PRODA account for access to the Australian Immunisation Register, along with similar physical site requirements to general practices applying to take part. Pharmacies will also need to use the promised national booking system, despite details about how the system will work or who is building it are still not available. It is also uncertain how it will interface with other pharmacy systems.
Online appointment booking systems were a feature of the year, with state, territory and national governments all getting into gear to have platforms ready for the start of the COVID-19 vaccine roll out – or stroll out, as it became known. Each state and territory took their own path for hospital vaccinations and mass vaccination centres, using mixtures of existing and new technology. In early February, however, the federal government didn’t make matters easy by announcing it would introduce a new national booking system, confusing an already confused state of affairs. It turned out that existing online booking systems, Healthdirect’s National Health Services Directory and direct appointments with GPs and pharmacies would instead be used.
HealthEngine was eventually awarded a contract to use its system hosted on HealthDirect’s vaccination finder site, for those clinics that did not have their own booking system. This would be taken up by about 200 sites around the country. In the meantime, the booking system vendors all got to work adding vaccine management capabilities to their systems, while the states and territories put their various solutions in place.
A host of vaccine booking solution vendors and medical software vendors released new apps and functionality to help with the vaccine roll-out, some of which we listed in our technology resources for COVID-19 section. The big EMR vendors came to the party too, including InterSystems and Cerner.
ADHA also helped out, developing what became known as the clinician vaccine integrated platform (CVIP) to assist healthcare providers to upload vaccination details to the Australian Immunisation Register (AIR). Early adopters included NT Health’s clinic in Alice Springs.
In an interview with Pulse+IT in February, ADHA CEO Amanda Cattermole outlined what would be the priorities for the agency in the coming year, including the new API gateway to provide a single point of access to its digital health systems and services, including the My Health Record. The gateway would be the first big piece work in ADHA’s the national infrastructure modernisation (NIM) program, she said.
Getting secure messaging interoperability up and running on a big scale was also a priority, with the statewide South Australian system being rolled out by HealthLink the test for the ability to perform a federated search of other vendors’ provider directories using a FHIR API.
2021 was also a year in which virtual home monitoring came to the fore, not just for traditional hospital in the home but for monitoring COVID-19+ patients and for chronic conditions. South Australia's My Home Hospital service went live in February, offering remote care and hospital in the home services for conditions such as kidney or respiratory infections. My Home Hospital is a joint venture between Calvary Health Care and Medibank, with Telstra Health supplying its virtual health monitoring solution to enable My Home Hospital to monitor the health and wellbeing of patients remotely and in real time, with biometric devices, in-person and virtual check-ups through videoconferencing on touch-screen tablet devices, along with digital care plans with medication and appointment reminders.
The idea of vaccine certificates or passes became a hot topic, with the federal government announcing that it planned to use the Australian Immunisation register and its immunisation history statements as the basis for digital and paper-based vaccination certificates. Australian residents could access and download their immunisation history statement through Medicare online services in myGov and the Medicare Express Plus app. They would later be added to Apple and Google’s digital wallets, and to some state-based check-in apps.
As these certificates looked set to become the basis of vaccine passports, the Australasian Institute of Digital Health (AIDH) began lobbying for agreement on global standards to record vaccination status and avoid interoperability challenges and released a position statement in February. A number of international groups were working on digital documentation, including the World Health Organisation (WHO) on its Yellow Card project; the Vaccination Credential Initiative, which involves technology firms such as Cerner, Epic, Microsoft and Oracle; the Commons Project Foundation and its Common Trust Network, which will consist of a global registry of trusted laboratory and vaccination data sources; and the International Air Transport Association (IATA) and its Travel Pass.
In addition to vaccine passports, everyone got used to using check-in apps. The federal government’s COVIDSafe app having proved a dud, QR code-based check-in apps became all the rage. ACT Health developed its own system last year that was then adopted by the Northern Territory and Tasmania, and in March, Queensland became the last jurisdiction to roll one out.
The National Cancer Screening Register (NCSR) was readied this year for integration with general practice software systems. Healthcare providers can now manage their patients’ participation in both the bowel and cervical cancer screening programs, including viewing and printing a patient’s test results and screening history, their screening status, and to view and update a patient’s details. First off the bat was Best Practice in January, followed by MedicalDirector in September and Communicare in December.
Active ingredient prescribing (AIP) was a bit of a hot topic this year, with teething problems noticeable in the two main GP prescribing software systems. New rules requiring that doctors prescribe by active ingredient rather than brand became mandatory on February 1 but some prescribers seemed to be unaware of the changes. Genie Solutions went live with AIP in January, but by March we were hearing that both Best Practice and MedicalDirector were having a few problems, most notably with the List of Excluded Medicinal Items (LEMI), and the List of Medicines for Brand Consideration (LMBC).
Doctors’ groups began lobbying the federal government for an extension to the temporary MBS items for telehealth which were due to expire on March 31. The feds came to the party and extended them for another another three months. In April, they agreed to extend the items until the end of the year, and as 2021 drew to a close, Health Minister Greg Hunt announced they would be permanent. Image-based prescribing arrangements were also extended, but will come to an end on December 31.
Melbourne’s Eastern Health fell victim to a cyber attack in March, forcing its IT systems offline and leading to the cancellation of non-urgent elective procedures. Described as a “significant” attack, IT systems were still off line a week later and communication with GPs was also affected. Discharge summaries couldn’t be sent electronically or by fax, and nor could pathology and radiology results. Outpatients referrals could not be received. The incident was confirmed as a ransomeware attack but there was no sign of any exfiltration of data, the organisation said.
Telstra Health announced a big upgrade to its EMR, with Northern Beaches Hospital in Sydney and St John of God Midland Hospital in Perth adopting the upgrade. Telstra Health said the upgrade included a number of key functionality improvements including new multi-tasking capabilities, and working natively on mobile devices. Other sites were expected to follow.
Allscripts announced it will roll out its Sunrise EMR across Victoria’s Gippsland region following the go-live at the 300-bed Latrobe Regional Hospital (LRH) last year. The Sunrise ED module will be rolled out in the emergency departments of the Central Gippsland Health Service, Bairnsdale Regional Health Service, West Gippsland Healthcare Group and Bass Coast Health, and then across inpatient services at all four hospitals.
Sydney Children’s Hospitals Network (SCHN) went live with a new solution integrated into its Cerner EMR that provides a direct communications link between multiple clinicians and their patients or carers through an app on the patient’s mobile device. The Cartula Health solution allows clinicians to send information such as care plans and discharge summaries to the patient’s app from an MPage within the EMR, and to receive communication back from the patient or carer directly in the EMR through HL7 messaging. It also syncs with the phone’s calendar so notifications of appointments can be sent, along with information about what patients should be doing to prepare for the appointment or procedure and what do bring with them.
It was a big year for the team behind the myBeepr clinical communication platform, with implementations at 14 sites in 2021, including St George Hospital in Sydney and Western Health in Melbourne. Medical indemnity insurance provider Avant Mutual announced later in the year that it had made an investment in myBeepr, which allows staff to create individual and group chats, conduct role-based messaging, manage tasks and transmit secure clinical photos.
A national tool for monitoring and sharing intensive care unit capacity that was developed during the initial COVID-19 outbreak in 2020 and called into action in Victoria’s second wave has the ability to help with other local and national public health emergencies, its developers said. The Critical Health Resources Information System (CHRIS) was made available to all ICUs, state and territory health departments, patient transport and retrieval agencies and also to ICUs in New Zealand following a fast development process. The system is a collaboration between Telstra’s IT services arm Telstra Purple, Ambulance Victoria, the Australian and New Zealand Intensive Care Society (ANZICS) and the Australian Department of Health.
The community pharmacy sector played a big part in the vaccination program, which saw a number of new platforms introduced. In February, TerryWhite Chemmart announced it planned to roll out a new online booking and appointment management platform from HealthEngine across its 450-strong chain. HealthEngine’s new solution is integrated with MedAdvisor’s pharmacy platform PlusOne, which will record and submit vaccination data directly to the Australian Immunisation Register (AIR).
The final report from the Royal Commission into Aged Care Quality and Safety was released in March, painting a bleak picture of the aged care system in Australia. It called for massive reform including a new Aged Care Act and a complete overhaul of funding for the sector. It also called for aged care providers to be required to use a digital care management system, an electronic medication management system and the universal adoption of My Health Record by July 2022.
The commissioners also recommended that an aged care ICT strategy be developed, the establishment of a National Aged Care Data Asset, and upskilling care staff to be able to use telehealth more widely. The My Aged Care system also needed a revamp, they said.
The commissioners’ recommendations were supported by a report from ICT strategy and architecture firm The Architecture Practice (TAP), which suggested that the federal government needed to set up an independent aged care data authority with a central role in the aged care system to transform the management of data in the sector.
TAP’s assessment of the current state of aged care ICT is that it contains major deficiencies which do not lead to positive outcomes for older Australians. Most of these deficiencies are linked to disconnected business processes, a lack of data collection and sharing, poor interoperability, obsolete technology, and a fundamental lack of standardisation. It also needs to extend the use of My Health Record to include aged care information, enhance the system to move from a documents-based capability to information-based capability, and it should redesign the My Aged Care website and Service Finder tool to ensure that they are fit for purpose.
In February, ADHA announced it had begun scoping an aged care transfer summary for the My Health Record system, aiming to help provide more complete information during the transition of care of an aged care resident to another healthcare setting. ADHA convenes a panel of stakeholders from Australia’s aged care industry that provides independent advice to the agency’s Aged Care and Connection Use project, which aims to drive adoption and use of My Health Record in residential aged care facilities. Later in the year, ADHA released an offer to the aged care software industry to assist it in better integrating with My Health Record, including adding the transfer summary to the system, as part of its response to the Royal Commission’s recommendations.
Some of the more interesting software, apps and new players in the market that caught our eye this year included:
- UK telehealth provider Doctor Care Anywhere listed on the Australian stock exchange, raising a substantial $102 million despite not even having a customer in the country. Later in the year it bought Hobart-headquartered virtual GP and mental health service GP2U Telehealth for $11 million.
- IT consulting firm Chamonix Health released an upgrade to its Healthi app that presented users’ COVID-19 vaccination history on its home page under the person’s name. As soon as any of the approved vaccines begin to be administered then a record will automatically appear on the home page as well as under the existing immunisation section of the app.
- Secure messaging app vendor Celo partnered with mobile app developer MedApps with a joint offering. MedApps markets the Med App mobile tool for accessing clinical and hospital guidelines and facilitating education and training, while Celo markets a secure healthcare messaging app to help teams communicate.
- Telstra Health signed an agreement with Canadian telecommunications and digital health giant TELUS to roll out its Health Exchange International (THX-i) platform in Australia. THX-i is an open standards-based platform that has identity management and aggregation capabilities as well as clinical data repositories and a marketplace of application programming interfaces (APIs) that third-party software developers can use to build new apps.
- Health management app Wanngi had a complete redesign in 2021with new features added, including the ability to store and display COVID-19 test results and vaccination details along with medical history, medications and diagnostic images. New use cases for the app were also developed, including to assist patients and doctors during telehealth consults and in the clinical trial sector to enable participants to easily share symptoms and adverse events.
- Melbourne-based research and manufacturing company Sleeptite launched a new smart monitoring system called REMi that can monitor movement and vital signs of aged care residents while they sleep. The technology has been built in association with RMIT University and is designed to enable aged care staff to non-intrusively monitor residents during the night and receive alerts at critical moments such as if a resident falls, or is at risk of falling.
- The Royal Victorian Eye and Ear Hospital in Melbourne went live with Cerner’s FirstNet system in its emergency department and its ambulatory module in the Eye and Ear’s acute ophthalmology specialist clinic. The implementation included a number of complex medical device integrations and the use of Cerner’s Camera Capture solution, which lets clinicians securely capture and store clinical images directly into the patient record.
Want to know what happened next? We'll have part two of our 2021 Australian eHealth year in review tomorrow.
Posted in Australian eHealth