The 2021 Australian eHealth year in review: part two

Innovative solutions to help with the COVID-19 vaccination program continued to come thick and fast as we entered the second quarter of the year, and few were bigger than ACT Health’s solution. It went live with a full version of its new Epic EMR 18 months earlier than scheduled to help manage COVID-19 vaccinations for the ACT public health system.

While a full version of the EMR hosted on infrastructure provided by NTT is live, ACT Health only configured those parts of Epic required to manage the vaccine program as well as an online booking system using Epic’s MyChart patient portal, which has been branded as MyDHR (digital health record). Nursing staff administering the vaccines used Epic’s Rover smartphone app on Spectralink Versity handsets, with data from Epic and the territory’s iPM patient administration system then uploaded to the Australian Immunisation Register. The booking system for the ACT’s two COVID-19 mass vaccination clinics was up and running in May.

The full EMR will go live in a big-bang implementation in September 2022. We had a chat to ACT Health CIO Peter O’Halloran about the plans, which he says will be the deepest and broadest implementation of Epic in Australia. It includes Epic’s Beaker laboratory information system, its Radiant radiology information system and its patient administration system, the first time these will be implemented here.

In 2020, the COVID-19 pandemic spurred the development of virtual care models in the hospital sector, including the rpavirtual service run by Sydney Local Health District and staffed by hospital-based clinicians. In 2021, virtual care moved well into the community, with GPs offered incentives to care for COVID-19 patients at home. One innovative example was the Care in the Community program run by WentWest, the Western Sydney Primary Health Network (PHN) in association with Western Sydney LHD.

This project uses the CareMonitor remote monitoring platform used for virtual care to patients with no known GP by contracted general practices. CareMonitor was already being used to support multidisciplinary care for patients with chronic conditions, but according to WentWest CEO Ray Messom, the difference with Care in the Community is its utilisation of primary care rather than hospital services. The program is funded by NSW Health under its Collaborative Commissioning program rather than through the MBS.

UnitingCare Queensland (UCQ) was another health service suffering the horrors of a cyber attack this year, with its digital systems offline throughout its hospital and aged care services in Queensland and the Northern Territory following a ransomware attack in April. UCQ runs the 535-bed Wesley Hospital in Brisbane, St Andrews War Memorial Hospital Brisbane, St Stephen’s Hospital at Hervey Bay, Buderim Private Hospital on the Gold Coast and Blue Care’s residential aged care facilities. UCQ confirmed the following week that it was the victim of an attack by Russian ransomware-as-a-service (RaaS) operation Sodinokibi, which also trades under the name of REvil/Sodin.

The attack was the first known one by this particular organisation on healthcare systems in Australia or New Zealand. REvil later claimed responsibility for the attack on Macquarie Health in October – although so did another group – but its business was severely disrupted by the US Department of Justice and the FBI, which made a number of arrests and seized millions in cryptocurrencies as part of a concerted operation. Its activities have been disrupted and it has been quiet for a while, but is likely to morph into something new next year.

More practice management software vendors rolled out electronic prescribing capability this year, including Global Health’s PrimaryClinic Medical in April, Best Practice for customers using the MediSecure electronic prescription exchange in June, and Shexie in August. Shexie Platinum is one of the few prescribing software systems for specialists that can produce eScripts that are compliant with the new ADHA specifications.

Another is Medical Wizard, which released the functionality in November. The increased uptake follows two rounds of funding from ADHA to help clinical information system vendors and mobile medications management app developers implement full electronic prescribing functionality. “Full” functionality includes active script lists (ASL) capability and what ADHA describes as increased technical functionality for clinicians through the introduction of chart-based requirements.

Late in April, then-NSW Premier Gladys Berejiklian said the state would open up bookings for COVID-19 vaccinations at its new mass vaccination centre at Sydney Olympic Park in Homebush in May, two weeks after the centre opens, to allow time to get a booking system up and running. While this solution proved a good one, the other booking systems in use in NSW caused no end of drama, leading Pulse+IT to lament a couple of months down the track that the whole system was broken.

In mid-May, the federal government was saying its allocation of $503 million worth of measures in the 2021-22 budget would “transform digital health in Australia”. The money included funds for My Health Record, the Healthcare Identifiers Service, electronic medication charts for aged care and the Health Products Portal. The My Health Record system received the lion’s share of funding, with $301.8 million allocated over two years to ongoing operations and enhancements. ADHA received $87.5 million in operational funding, and there is $32.3m in continued funding for the 2018-2022 Intergovernmental Agreement on National Digital Health (IGA), which supports the Healthcare Identifiers Service, the Clinical Terminology Service and the National Authentication Service for Health. New initiatives include $45.4m to roll out electronic medication charts in residential aged care facilities, drive use and integration of My Health Record, and establish digital support for transitions between aged care and hospital settings.

There was a bit of fun and games at ASX-listed appointment booking system 1st Group this year. First of all there was an apparent coup by certain shareholders, who knocked off long-term CEO Klaus Bartosch and replaced him with technologist and strategist Louise McElvogue in April, before a counter operation saw Mr Bartosch sensationally returned and the insurgents booted out in May. The federal government’s mismanagement of the vaccine stroll-out and booking system roll-outs were brought home to the whole medical software industry this year and things would only get worse.

We’ve been following the dramas surrounding the $35 million Regional eHealth Project (ReHP) in far north Queensland for close on a decade, and things got seriously weird this year. The project involves a shared electronic health record based on Telstra Health’s Communicare primary and community care software and has been rolled out to 28 rural and remote sites in the Cairns and Hinterland Hospital and Health Service (CHHHS) and Torres and Cape HHS (TCHHS) catchments. It was formerly planning to roll out ISA Solutions’ MMEx technology but this idea was dropped in conditions that still remain murky. In June, patient safety concerns were raised by clinicians and two of their unions, with one telling members to use alternative systems and another calling for a complete pause in the roll out.

Now dubbed the Regional Information via Electronic Records (RIVeR) project, an independent review was ordered to examine if RIVeR is fit for purpose and whether there are any clinical governance issues that have not been addressed. That review was yet to report by year’s end.

In late June, the NSW government allocated $141 million in the forthcoming financial year to pay for its single digital patient record (SDPR) project, which aims to unify the electronic medical record solutions currently in use to enhance care coordination. NSW Health went to market last year for the solution, envisioning a six-year process for a statewide roll-out of the system and encompassing a clinical health information exchange (CHIE) platform, which is now up and running. While no one is commenting publicly, it seems a lay down misère that Cerner – or at least a consortium involving Cerner – will win the project considering it provides an eMR and a medication management system to most LHDs. The consolidation of the several pathology laboratory information systems are also in the offing.

And finally this quarter, ADHA released more information on what it previously was calling its service registration assistant (SRA) tool and which is now known as Provider Connect Australia. ADHA is planning to roll it out nationally following a successful proof of concept trial in northern NSW last year. PCA is aimed at streamlining the process for healthcare organisations to keep contact details such as provider numbers and secure messaging addresses up to date. It was first conceptualised by ADHA’s product manager for connectivity and informatics Kieron McGuire and is part of the agency’s secure messaging program. In early July, ADHA spokespeople said PCA was due to launch in January 2022, but it will be several years until Medicare is added as a business partner due to the ongoing healthcare payments modernisation project. More on that tomorrow.

Primary care

The federal government continued to laud the uptake of telehealth during the pandemic, rolling out the “10 years in 10 days” spin, but stark reality showed that the vast majority of GPs were using the phone only and weren’t going anywhere near video consultations. An analysis of Medicare data for general practitioner services over the last year GP Andrew Baird showed that fewer than one per cent were provided by video. Of the almost 150 million GP services conducted between April 2020 and March 2021, 72 per cent were conducted in person, 27.4 per cent were by phone and just 0.6 per cent were by video.

Tasmania expanded its new statewide electronic referral system to private specialists following a proof of concept trial with GPs and three hospital outpatient clinics last year. The system has been built by secure messaging vendor HealthLink and Hobart eHealth firm Healthcare Software in close partnership with Primary Health Tasmania, the Tasmanian Department of Health and the Tasmanian Health Service. The project has developed standardised, statewide digital templates that can be auto-populated with key referral details using HealthLink’s Smart Forms technology from within the Best Practice and MedicalDirector practice management systems and sent to hospital outpatients departments as well as between private practitioners.

Acute care

In April, Telstra Health announced it was rebranding its suite of digital health solutions for hospitals as Kyra, following several years of development work that included a complete upgrade of its electronic medical record in 2020. The Kyra suite is available on mobile devices and uses data visualisation to optimise models of care and patient experience as well as decision support and predictive analytics. Assets in the Kyra portfolio include EMR functionality, patient flow and queue manager products, secure messaging and provider directories.

Brisbane’s Metro North Hospital and Health Service opened its new 182-bed Surgical, Treatment and Rehabilitation Service (STARS) in February, live with the full stack of the statewide Cerner integrated electronic medical record (ieMR). The first in Queensland to integrate Masimo’s medical devices with the ieMR, it is also using Cerner’s Enterprise Scheduling Management (ESM) solution to handle referrals, integrations with the Pyxis automated medication dispensing system and Cerner’s surgical and anaesthesia (SAA) modules and ECG management.

It is also using the ESM system to help manage ophthalmology referrals from neighbouring Royal Brisbane and Women’s Hospital (RBWH), using Zeiss’s FORUM server to provide an integrated service across both hospitals. STARS also went live with its own instance of Queensland Health’s HBSCIS patient administration system, full RIS-PACS and VNA integration, as well as Auslab for pathology. The ieMR roll out to the rest of Metro North was paused 2019, but the public private partnership-built STARS was designed to be a digital hospital, so it opened up with the ieMR in place.

A known error that intermittently duplicates keystrokes when using Microsoft’s RemoteApp feature is understood to have caused an issue affecting medication dosages in South Australia’s Sunrise electronic medical record in May. The error appeared to replicate the last digit for dosages on medication orders, with 10mg being displayed as 100mg and 15mg as 155mg. Nurses using the Allscripts EMR at Queen Elizabeth, Royal Adelaide, Noarlunga, Mount Gambier and Port Augusta hospitals were warned to be on the look out for high dose prescriptions and to follow up medication orders with the prescribers.

Melbourne’s Alfred Health had a notable year, implementing 3M’s 360 Encompass clinical documentation integrity (CDI) and computer-assisted coding system across its facilities in what is the first deployment in Australia. It also signed a contract with medical device manufacturer BD and EMR vendor Cerner to implement the first bidirectional integration between BD’s Alaris infusion pumps and the Cerner EMR in Australia. Later in the year it integrated the SafeScript real-time prescription monitoring system in its emergency department, and rolled out the cloud-based ZEDOC platform from The Clinician to automate the collection and analysis of patient-reported outcome measures (PROMs) for patients with colorectal cancer undergoing surgical treatment.

In May, the new structure of healthcare software vendor Dedalus began to take shape in the ANZ market. Formerly the healthcare IT business of DXC and before that CSC, and tracing its history back to iSoft, Dedalus is now European owned and forms one of the world’s largest healthcare IT businesses. Known best for its WebPAS, iPM and CareSuite products, along with medication management through MedChart and hospital pharmacy system iPharmacy, this year it also took on the distributorship of iMDsoft’s MetaVision clinical information system for Australia and New Zealand. It also named former DXC director of healthcare and life sciences for ANZ Daryll Goodall as its new managing director for Asia Pacific. Further acquisitions are expected.

Pharmacy

Fred IT’s new My Script List (MySL) active script list went live in Tasmanian pharmacies using Fred's dispensing system in April, with plans to roll it out to the other states – and other pharmacy and GP software systems – over the coming months. MySL is the first Department of Health-conformant active script list (ASL) to go live. It will work alongside the new electronic tokens as well as existing paper prescriptions and will hold an electronic list of medications, allowing patients, their doctors and their pharmacists to view all of the active prescriptions the patient is on.

Simple Retail said it would roll out ASL functionality to its users on May 31 after it received confirmation of conformance with ADHA requirements for active script lists. Simple Retail has worked with parent company MediSecure and digital clinical relationship management system vendor Scrypt on the new functionality, which will allow Simple Retail pharmacies to access the My Script List system launched last month.

Aged care

A trial of artificial intelligence-enabled CCTV for resident safety got under way in two SA Health facilities in Adelaide. It is using an AI-enabled audio-visual surveillance and monitoring system developed by local electronic security solutions firm Sturdie Trade Services, which can detect falls, calls for help and one- and two-way violence. The trial – co-funded by the Commonwealth and state governments for $785,000 – had been expected to get underway two years ago but was delayed first by the withdrawal of its original technology partner.

In April, researchers proposed the inclusion of a flag in general practice clinical software that would populate the MBS and PBS datasets in order to identify residential aged care residents and enhance monitoring of aged care. They also recommended the federal government continue and expand access to MBS funded telehealth services to aged care residents following new figures showing how the COVID-19 pandemic saw a decline in face-to-face visits by GPs to RACFs.

Also in April, the Aged Care Industry Information Technology Council (ACIITC) launched a survey of residential aged care providers on their use of clinical software and what the main barriers to and influences over further uptake were. The research, commissioned by ADHA, will also investigate how clinical software interacts or interfaces with other software systems, particularly medication management and electronic prescribing software, as well as how GPs relate to aged care clinical software.

However, the recommendation by the Royal Commission into Aged Care Safety and Quality in March that there be universal adoption of the My Health Record in residential aged care facilities by July 2022 was thought to be overly optimistic and unlikely to be achieved. ADHA estimates that only 10 per cent of aged care providers are registered with the system and only one per cent are actively using it. Representatives from the ACIITC and ADHA said the idea of all RACF using My Health Record was optimistic, to say the least.

Some of the more interesting software, apps and new players in the market that caught our eye this year included:

  • Medical indemnity insurer Avant added a number of new functions to its PracticeHub healthcare management platform this year, including an app that is integrated directly with the Australian Health Practitioner Regulation Agency and alerts users that a practitioner’s Ahpra registration has lapsed. It also added a new automated certificate of insurance (COI) app to automate the process of collecting and storing annual COIs from multiple providers.
  • Pharmacy IT solution vendor Fred IT launched a WhatsApp-powered messaging solution to allow patients to request their prescriptions be dispensed and to specify pick-up or delivery times from their pharmacy. The solution uses WhatsApp’s chatbot function to let patients choose which script to request and when.
  • Townsville Hospital and Health Service launched a trial of a new artificial intelligence tool and natural language processing to scan Queensland’s Cerner ieMR for early warning signs of sepsis in patients. The health service is working with Clinical Excellence Queensland, eHealth Queensland and the Clinical Excellence Commission NSW to test the technology, which has also been rolled out at Westmead Hospital in Sydney.
  • Electronic payments and business banker Tyro bought Medipass Solutions, the digital health payments platform launched in 2016 that is now integrated with 17 cloud-based practice management and booking systems. The merged companies are expected to now offer Australia’s largest digital and terminal-based payments platform to the healthcare sector.
  • eHealth NSW will roll out its new electronic transfer of care (eTOC) medications reconciliation application to the rest of the state following successful pilots in four hospitals in NSW of the system, which automates the workflow of checking medication orders as patients move from intensive care units to wards. eTOC is a web-based application using FHIR APIs and the CSIRO’s Snapper and Ontoserver terminology systems and has been developed internally by eHealth NSW to act as a bridge between the electronic record for intensive care (eRIC) and the statewide electronic medical record (eMR).
  • NSW Health developed an app that aims to enhance the detection of sepsis in emergency department waiting rooms, using device integration and artificial intelligence to flag patients most at risk of sepsis. The project involved analysing five years of de-identified data from the state’s Cerner EMRd of patients presenting to Western Sydney LHD emergency departments and using artificial intelligence to detect complex patterns in patients who did develop the condition.

Want to know what happened next? We'll have part three of our 2021 Australian eHealth year in review tomorrow.

Posted in Australian eHealth

Tags: 2021 eHealth year in review

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