The 2021 Australian eHealth year in review: part three

The rise of virtual care was undoubtedly the feature of 2021 in digital health, but it was in the more mundane and yet essential area of online appointment booking and patient management solutions that characterised the third quarter of the year in Australian and New Zealand eHealth. Both countries experienced delays in rolling out technology to manage vaccination bookings that we believe should have been solved in 2020, when it became clear that a global mass vaccination effort was the only way to manage it.

While booking systems were rolled out just in time, but it seems that at the end of 2021, more work still needs to be done. Just this week, HotDoc was adding Pfizer bookings for five to 11-year-olds across Australia and all services were working hard to add slots for booster shots to their systems. It’s pretty clear that we will have to live with the novel coronavirus as new infections rise across an increasingly jaded global populace, not defeat it. Omicron may not be as severe as delta, but it appears we will all get a bit more familiar with the Greek alphabet as we move into the new year.

As the year ticked over into its second half, the vaccine stroll-out caused quite a few problems for its political masters in the Australian government. A lack of federal and state coordination became obvious as the much-lauded national cabinet disintegrated and the “national booking solution” went live too early for the 1000 GPs who were in the first tranche of the roll out to primary care. While Healthdirect’s eligibility checker and vaccine clinic finder went live to the surprise of quite a few receptionists in March, it quickly became obvious that the difficulties people were finding in getting up to date info on where to get a particular vaccine for a particular eligibility group and then to book it needed to be sorted out.

While state-based vaccination efforts managed the early load, once GPs and pharmacies joined the program it was obvious that proper coordination was needed. Healthdirect saw this and poached a few brains from ADHA to help out, leading to an industry offer in September to try to sort the problem out.

Way before it got into gear, however, a couple of young whippersnappers with IT skills and an hour or two on hand came to the rescue. We were most impressed with Kenneth Tsang’s COVID-19NearMesite – Ken spent an inordinate amount of time providing real time availability of appointments – as well as CovidQueue and vaxx.nz in helping people find an available booking as soon as possible.

We were also impressed with gpvaccinesearch.com, which scoured the HotDoc system for available appointments. All of the online booking and patient engagement platforms had busy years, but none more so than HotDoc, which rolled out plethora of updates to its platform in quick time throughout the year and developed a great following on social media, particularly Twitter, where “check out HotDoc” became shorthand for finding availability at a vaccine clinic.

The various jurisdictional systems were rolled out in parallel, including Microsoft’s solutions in Victoria and Queensland, ACT Health’s Epic-based MyDHR, Tasmania’s Oracle solution and Salesforce in WA – we’re still not sure what the deal is in SA or the NT – and quite a few disparate solutions in NSW that caused no end of trouble. In fact, it was Pulse+IT publisher Simon James’ struggles with the multitude of “broken” systems in NSW that proved to be the most popular story of the year by far. While technology from Microsoft and Whispr was rolled out for bookings, along with Cerner’s help in uploading data to the AIR, it all seemed to be just far too confusing, leading to the aforementioned ad hoc solutions to help punters with actual availability.

A solution rolled out by Queensland firm Five Faces for NSW’s mass vaccination centres, particularly the one at Sydney Olympic Park, was much lauded, but it too had similar problems when Pulse+IT tried to book. In September we learned that ServiceNow had been given a $6.3m contract for a statewide vaccine management solution. We were assured it was a public tender, but for some reason we still can’t find the details on NSW Health’s tender site.

Back to HotDoc and the online booking systems, February saw the announcement that HotDoc was developing new features to help with the COVID-19 vaccination roll-out to primary care, including pre and post-appointment communications to patients, digital consent forms and new patient forms and appointment reminders to reduce no-shows. It already provided the booking solution for the Commonwealth respiratory clinics, and when they joined the vaccination effort, HotDoc helped them out.

At the end of June, HotDoc announced it was entering the acute care market, rolling out vaccination booking solutions for Austin Health and St Vincent's Hospital in Sydney. In October, it was putting out feelers for some serious investment just as rival HealthEngine appeared to be drowning its sorrows.

In early July, consulting firm Deloitte won a contract worth $17.9 million over three years to build ADHA’s new API gateway, the first phase in its health infrastructure modernisation program. The new gateway will be based on modern web services and standards for health information exchange and clinical terminologies, such as FHIR, and is replacing an Oracle system. ADHA then went to market for a new mobile-native app for the My Health Record. The app will be built for iOS, iPad OS and Android devices and will use the My Health Record’s mobile optimised FHIR standard gateway. The contract was awarded to Adelaide’s Chamonix in November, with the first release promised for early next year.

Remote monitoring technologies continued to be rolled out, including in one notable project a new telehealth service for Western Australia’s Kimberley Aboriginal Medical Services (KAMS), using Visionflex’s ProEX telehealth system. It uses real-time, high-definition video conferencing along with medical devices that allow healthcare professionals to examine, diagnose, monitor and treat patients, with particular emphasis on ear, nose and throat conditions, as well as cardiac and respiratory consults. Visionflex also deployed its telehealth units with new unattended access capability to remote communities, truck stops and cattle stations, allowing patients to present to a clinic after hours and contact a remote doctor by video link.

The unattended access solution allows patients who present after hours when the local nurse is off duty to press an intercom button. Remote doctors can view the patient through a door camera, open the door and Visionflex’s telehealth cabinet remotely, and the patient can then touch the screen on the ProEx unit to enter into a video call with the doctor via a secure video conferencing link. Visionflex also partnered with Coviu on a project that will see its digital examination tools integrated with Coviu’s telehealth platform to target the aged care sector and develop real-world evidence for remote examinations in aged care.

Elsewhere, Telstra Health rolled out its Virtual Health platform for the Tasmanian Health Service to help look after guests in hotel quarantine in Hobart. Monitoring devices were deployed to digitally monitor and record the guests’ health status and to help reduce the opportunity for transmission of COVID-19, and the MyCareManager app was also deployed to store data from the devices in a hosted monitoring platform. Meanwhile, Western Victoria Primary Health Network (WVPHN) started a year-long trial of remote monitoring technology in general practices in the region, subsidising 30 licences for the CareMonitor remote patient monitoring solution. The trial aims to determine the viability of the ongoing use of real-time remote monitoring technology for patients with chronic conditions in western Victoria.

ADHA began the process of guiding the medical software industry through the new SHA-2 security standard, which will affect interfaces with the My Health Record, the Healthcare Identifiers Service, secure messaging services and other applications that require secure digital signatures. The change will hopefully simplify the renewal process for National Authentication Service for Health (NASH) certificates. From March next year, all NASH PKI certificates that are issued from that date will be signed using SHA-2. In September, ADHA set up a SHA-2 readiness register listing which software was compliant. The new certificates became available later that month.

It was another big year for Telstra Health, which made two significant acquisitions in 2021 to cement its position as a powerhouse in the industry. In July, it announced it was taking a 70 per cent stake in Adelaide-headquartered billing, costing and revenue solution vendor PowerHealth, paying $95 million. PowerHealth’s managing director Patrick Power joined Telstra Health’s senior executive team as head of international growth, with the acquisition giving Telstra Health a footprint in Canada, Saudi Arabia, New Zealand, Ireland and the US.

The following month Telstra Health confirmed long-standing rumours that it was in the hunt for MedicalDirector, paying an eye-popping $350m for the venerable GP software vendor. Telstra Health board chair Brendon Riley said the GP sector was a missing piece of the digital health ecosystem puzzle for the company. Managing director Mary Foley said she had MedicalDirector in her sights for some time, and both acquisitions would fill gaps in the Telstra Health portfolio.

Another powerhouse in EMR vendor Cerner made some big headlines with an internal restructure of its Asia Pacific executive, replacing long-serving managing director Cameron Burt with another long-term staffer in Julie Hoare in July. It then made its three state-based general manager positions redundant, losing NSW general manager Paul Willma, Queensland general manager Trina Adams and Victoria and South Australia general manager Israel Armstrong. Cerner has a dominant position in the Queensland, NSW and Victorian EMR markets.

In August, ADHA kicked off the first stage in the development of the next national digital health strategy, which it plans to have in place in mid-2022. The new strategy follows the 2018-2022 version which involved seven strategic priority areas, including access and use of My Health Record, electronic prescriptions, secure messaging channels and agreed standards for interoperability. The new strategy will be informed by an online survey on digital health asking consumers, healthcare providers and the industry to about their experience with the healthcare system and any ideas about how technology can make a difference.

The federal government’s COVIDSafe app was one technology that didn’t make any difference at all. An independent report by Abt Associates and Bdna found it did not prove useful for contact tracing in the first 10 months of the pandemic, was cumbersome to use and was adding to public health unit workloads without much benefit. The evaluation was initially released under freedom of information laws in heavily redacted form in July. A more complete version was then released in September, showing that Abt had urged the government to explore options for enhancing the app and to acknowledge the performance barriers that are limiting its effectiveness and efficiency. The government does not appear to have heeded the advice.

Primary care

UK-based telehealth provider Doctor Care Anywhere made a strategic investment in the Australian market, buying Tasmanian-headquartered virtual GP and mental health service GP2U Telehealth for $11 million. Doctor Care Anywhere listed on the Australian stock exchange in January 2021, raising $102 million, with a stated intention to explore the establishment of an Australian arm of the business this year.

Secondary care

Specialist medical practice management software vendor Genie Solutions plans to make three more integrated products available in its cloud marketplace, including a new specialist version of Cubiko’s business analysis and insights tool, MetaOptima’s DermEngine AI-enabled dermatology software, and a full integration with Nuance’s Dragon Medical One for automated speech recognition. Genie Solutions, which recently signed up the 1000th practice to use its Gentu cloud solution, has been developing the cloud marketplace over the last 18 months and went live with its first new integration, a booking and billing solution developed in partnership with HotDoc, last year.

Radiology information system vendor Comrad received its notice of integration with Medicare Web Services in August, thought to be one of the first major healthcare vendors to achieve the feat. Comrad also recently announced the second release of its web-based patient engagement platform Aura Care Connect, featuring a co-branded app for patient pre-registration workflows to be completed and integrated back into the COMRAD RIS workflow. It also developed an API to Care Connect that it is making available to other vendors with the intention of opening up the healthcare ecosystem, including offering Care Connect’s patient engagement and billing capabilities to non-Comrad users.

Acute care

Allscripts went live with its electronic medical record at four emergency departments in Victoria simultaneously, part of its wider roll-out of the Sunrise EMR for the Gippsland Health Alliance. The Sunrise emergency care module is now live at Central Gippsland Health Service, Bairnsdale Regional Health Service, West Gippsland Healthcare Group and Bass Coast Health. The vendor also rebranded its BOSSnet digital health record to Allscripts Opal, and migrated it over to the private cloud service provided by Atos as part of WA Health’s $409 million infrastructure replacement project HealthNext. Sunrise is also now live throughout Adelaide’s second largest hospital, Flinders Medical Centre (FMC), part of a $200m project over three years to complete the roll-out of the Sunrise EMR and PAS in the remaining metropolitan local health networks.

Victoria’s South West Alliance of Rural Health (SWARH) and Geelong-based Barwon Health will roll out InterSystems’ IRIS for Health data platform to create a real-time analytics repository supporting AI and machine learning, and business and clinical intelligence. IRIS for Health will provide a single platform for the two health services, which each support different IT environments, and enable the organisations to capture data from HL7 and other messages to create a real-time health data lake.

St Vincent’s Health Australia (SVHA) showed it could reduce the number of hospital-acquired complications (HACs) across its private health network by 16 per cent in one year and achieved another 13 per cent this year with the assistance of Pacific Knowledge System’s (PKS) RISQ portal. The move to reduce the number of HACs in Australian hospitals has been driven by the Australian Commission on Safety and Quality in Healthcare (ACSQHC), which in 2019 published a list of 16 nationally agreed HACs to be targeted, in partnership with the Independent Hospital Pricing Authority (IHPA). The IHPA introduced a funding adjustment for HACs in 2018, whereby funding is reduced for any episode of admitted acute care where a HAC occurs.

Melbourne’s Royal Children’s Hospital showed that it had reduced its mortality rate over a sustained period following the implementation of Epic's electronic medical record. RCH has been monitoring clinical outcomes following the implementation in April 2016 and presented data at the Health Informatics Conference in Melbourne in 2019 that showed early evidence of a reduction in mortality rate of 25 per cent. Further analysis over an extended period that was published in the Journal of Paediatrics and Child Health this year showed that the reduction in mortality rate had been sustained over time, and consistent with early observations, the changes were not part of a pre-existing downward trend.

Pharmacy

A Society of Hospital Pharmacists of Australia (SHPA) report found that national adoption of electronic medications management systems allied to automatic dispensing cabinet (ADC) technology is likely in the near future in Australia, although widespread use of fully closed loop medications management is probably further down the track. The report estimated that 30 per cent of Australian hospitals were using an EMM system last year, which would likely grow to 50 per cent in four years’ time. Implementations of ADCs will also grow as facilities pursuing a HIMMS stage 6 accreditation will need full ADC integration into medication management systems.

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

  • UnitingCare Queensland (UCQ) announced it will roll out the InfoMedix Digital Medical Record (DMR) at three of its four not-for-profit hospitals next year, beginning the move from predominantly paper to a digital system that will give clinicians a single view of the patient record.
  • South Australia awarded a tender to Allscripts to implement the iQemo solution from UK company iQHealthTech for the long-promised statewide electronic chemotherapy prescribing solution (ECPS). The solution will be integrated with SA Health’s Sunrise EMR, provided by Allscripts.
  • Monash Health went to the market to look for a remote monitoring system to underpin its proof of concept trial of a virtual hospital service, centring initially on patients with congestive heart failure at risk of readmission to hospital.
  • The clinical data analytics company formed last year through the merger of health software vendors Pacific Knowledge Systems (PKS) and Pavilion Health rebranded itself as Beamtree Holdings, with the ASX-listed company recently buying two smaller companies to form what it says is one of the largest health analytics and decision support platforms in Australia.
  • Sydney cancer hospital Chris O’Brien Lifehouse became the first in Australia to upgrade to MEDITECH’s web-based Expanse electronic health record, going live with its ambulatory module for outpatients last December and its acute module for inpatients in September.
  • Sonic Imaging Australia rolled out the new artificial intelligence-based Annalise CXR decision support solution to a number of its standalone clinics as well as some of the major hospitals it contracts to. Annalise CXR is a joint venture between Australian healthcare technology company Harrison.ai and diagnostic imaging provider I–MED Radiology Network.

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

Posted in Australian eHealth

Tags: 2021 eHealth year in review

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