2018 New Zealand eHealth year in review
Problems finding a suitable IT solution to handle the $77.8 million National Bowel Screening Program (NBSP) was an ongoing saga that dogged the year in eHealth for New Zealand, with the national roll-out of the program delayed by over a year. It also had an unexpected flow-on effect on the cervical cancer screening program, with the introduction of the HPV test for cervical cancer delayed as well.
Deloitte would later be awarded a contract to handle the design phase of the National Screening Solution (NSS) but in the meantime, problems with the interim solution meant that up to 15,000 people missed out on an invitation to be screened due to the inability to track people's changes of address. An independent review of the program called by Health Minister David Clark recommended that the eventual solution should have real-time integration with GP systems.
By year's end, a revised schedule for the roll-out of screening by each DHB was adopted, with the expectation that the NSS would be ready by August 2019. The DHBs already screening will transition onto the NSS progressively.
The implementation of the Health Care Home model of care throughout New Zealand has been a success story, pioneered by Pinnacle Midlands PHO in Hamilton. It has since been enthusiastically adopted in Wellington, with about 50 per cent of all practices in the greater Wellington region using the model as of January 2018. The NZ model has a big focus on using IT to better support patients, with several studies showing it stacks up. In May, Pinnacle released a report from Ernst & Young that showed a reduction both in avoidable admissions and emergency department presentations. Early results from the Wellington roll-out showed a statistically significant drop in ED admissions post-implementation of HCH. And in early February, Southern DHB and WellSouth PHO released a strategy recommending a move to the model, along with greater use of telehealth.
Waikato DHB made a quick recovery after the much-maligned HealthTap debacle by providing its clinicians with access to patients' GP records through Medtech's ManageMyHealth portal and the new Indici system being used by some Hamilton practices. GPs are also able to access their patients' hospital records through the same portals, which provide access to the DHB's Clinical Workstation. The Midlands region is slowly moving all of its hospitals onto a single instance of Orion Health's Clinical Portal solution as part of the the eSpace project, which will eventually allow patients to have access to some of their hospital records through a patient portal.
Speaking of HealthTap, an independent review of the SmartHealth program found that Waikato was right to end it, finding that the app was a poor fit with the NZ public healthcare system and had no interoperability with primary care systems. The DHB was right to cancel the contract, it found.
It turned out to be a pretty horrible year for New Zealand's largest health IT company, Orion Health. Once the darling of the stock market and compared favourably with Xero, Orion has seen its share price plunge from the highs of $5.70 to as low as 60c in April. That led to a restructure of the company into three business units – Rhapsody, population health and hospitals – but it became increasingly obvious that the only way forward would be to sell part or all of the company to realise some value for shareholders. Rhapsody is the only division that makes a profit and has over 600 customers throughout the world, many of them large health organisations.
In February, Rhapsody was launched as a full service cloud offering, running on Amazon Web Services (AWS), joining Orion's population health platform Amadeus. In March, Orion added a new machine learning service to Amadeus to help predict patient costs and readmission risk. Orion also announced in March that it had won a tender to supply a clinical portal for the north of Scotland.
However, while Orion celebrated a big win with the go-live of the South Island Patient Administration Care System (SI PICS) at Nelson Marlborough Health in May, its financial year results released that month showed that it had still not achieved profitability, with revenue of $170 million but an operating loss of $40m. Rhapsody stood alone, generating $55 million in operating revenue and $27 million in operating profit, and the company began to hint that it was working on “potentially significant transactions”.
In July, those transactions became a reality, with the announcement it had come to terms with British private investment firm Hg to sell Rhapsody for $205m. Orion announced it would keep a 25 per cent stake in Rhapsody and plough the proceeds of the sale into population health and hospitals, and a share buyback scheme.
Pulse+IT's top NZ story for the year came in October, when Orion shareholders overwhelmingly voted for the sale. Orion Health chairman Andrew Ferrier described himself as “bitterly disappointed” that the company could not deliver the big rewards it had once aspired to. The sale duly went ahead in November, with Rhapsody taking up new headquarters in the US.
It is a far cry from the heady days when the company boasted it was going to take on the big guys, but while much diminished, Orion Health remains a viable business. In November it went live with SI PICS at Christchurch Hospital and in December it announced it would dedicate a five-person team to its South Island customers.
One of the other big stories for the year was the ongoing drama over the National Oracle Solution (NOS). In March, it was revealed that additional funding will be needed to complete the $65 million project, which Deloitte estimated would breach the $100m mark and even then it doubted it would provide the promised benefits. Opposition associate health spokesman Shane Reti claimed the whole project was going off the rails and appeared to blame the government, despite the project having been initiated under National's watch. Dr Reti also criticised the Ministry of Health's decision to award the tender for the review to Deloitte, as it owns a company that is involved in the build.
A bit of a hoo-ha livened up the latter half of the year when a group of health IT vendors decided to take Auckland PHO ProCare to task over a new GP data extraction and storage system called the Clinical Intelligence System (CIS) it is rolling out that the vendors said could potentially breach the privacy of 800,000 Auckland patients. The vendors – HealthLink, Medtech Global, Best Practice and myPractice – referred the system to the Privacy Commissioner, saying they were concerned that patients didn't appear to be aware their medical records were being copied into new databases. ProCare hit back by saying it had commissioned a privacy impact assessment (PIA) that was reviewed and approved by the Privacy Commissioner's office, but the vendors said that PIA was a piece of something else. They also arced up over the issue of patient consent.
In September, Privacy Commissioner John Edwards gave the vendors a bit of a bum-smacking, saying their claims were alarmist and could cause unnecessary anxiety for patients and undermine confidence in the health system. Mr Edwards said he found no evidence to justify an investigation into ProCare.
In October, the Ministry of Health released draft papers for comment on the pathways to interoperability and a connected health network. The roadmap features a strong emphasis on developing open APIs to replace proprietary methods of integration, along with a move from closed networks to secure communication over the internet. MoH has set up an interoperability working group that has proposed an ambitious plan for the next three years, including a number of practical steps to enable real interoperability in the health sector. There is also a connected health working group that has developed a connecting health security matrix that aims to lift the security maturity of its user community.
The year in NZ eHealth was wrapped up at the HiNZ conference in Wellington, where acting deputy director-general for data and digital Ann-Marie Cavanagh outlined the recent restructure at the Ministry of Health following the appointment of Ashley Bloomfield as director-general. Ms Cavanagh also announced that what was once known as the single or national electronic health record had been rebadged as the National Health Information Platform (nHIP), which is still before Cabinet for approval.
The new data and digital directorate has five different divisions – national digital services, national collections and reporting, digital strategy and investment, emerging health technology, and business performance – as well as two new pillars of information security and data governance. Ms Cavanagh said the two pillars would inform the directorate on what it can do with people's data, how it should be managed, and what needs to be considered in terms of data sovereignty at a national level.
One of the biggest – and most contentious – issues in the New Zealand primary care sector in recent years has been the move by PHOs to assess the various practice management systems on the market and make a recommendation for their practices to make a move to a new system. Pegasus did a review in 2016 and ultimately chose Intrahealth's Profile as its PMS of choice, although the Canterbury-based PHO is calling it Sirius and describing it as an EMR. Wellington's Compass Health also underwent a similar process, and last year recommended its practices swap over to Indici, which itself was designed and developed in association with Pinnacle Midlands and Irish vendor Valentia Technologies.
In April, Auckland PHO ProCare announced it had reduced its vendor shortlist to three – Indici, Profile, and US giant Epic's PMS, which Compass also considered – dropping incumbents Medtech and myPractice from the list. Profile then dropped out of the running in June.
While there is no compulsion for practices to move if they don't want to, for some their hands may be forced. Compass, for instance, is moving the portal that hosts practice data for the Wellington region shared care record (SCR) from Medtech's ManageMyHealth to Indici's portal, to be followed by a roll out of the full Indici PMS, a new patient portal and shared care planning tools. Compass Health CEO Martin Hefford said in August that while practices aren't obliged to make the change, he thinks most will eventually do so.
Central region DHBs are well on their way to streamlining their clinical applications on the same platforms as part of the Regional Health Informatics Program (RHIP). They are all either rolling out or have implemented DXC's webPAS, along with Orion Health's Clinical Portal, a Carestream radiology information system (RIS), and ePharmacy. Whanganui rolled out the Clinical Portal two years ago, and went live with webPAS in February. With the Midland region eSpace project underway and the South Island streets ahead in joining up its clinical information systems, the Northern region finally decided on its strategy plan last year, and in 2018 went to market for a health information platform and regional workspace in mid-November.
Auckland private hospital and radiology provider MercyAscot has some big digital plans, announcing in May that it would roll out InterSystems' TrakCare electronic medical record to replace its existing patient administration and clinical information systems, backed by infrastructure support from NZ cloud provider Umbrellar. Mercy Radiology CEO Lloyd McCann and Umbrellar head of cloud services Dave Howden told the HiNZ conference in Wellington in November that it will be the first cloud-hosted EMR in New Zealand, and may even be the first EMR and PAS in the world to be hosted on Microsoft's Azure Stack hybrid cloud computing platform.
It was a big year for health IT procurement, with the 3DHBs – Capital & Coast, Hutt Valley and Wairarapa – looking out in May for a mobile electronic patient observations solution to capture patient vital signs. They were also on the hunt in September for an off-the-shelf eReferral solution that integrates with locally used practice management systems, their Concerto portal and HealthPathways.
Waikato went out for an off-the-shelf anaesthesia information system, while Waitemata was looking for an IT platform that could help with the secure transfer of low acuity patients from emergency departments to an alternative urgent care clinic. The five Midland DHBs were looking for a clinical portal imaging interoperability solution, while the four Northern DHBs approached the market for a data sharing and interoperability health information platform (HIP) that will provide the foundations for their regional collaborative community care (RCCC) project. This huge project appears to have replaced the Northern EHR idea that once envisaged rolling out Epic in both the primary and secondary care settings.
Some of the more interesting software, apps and new players in the market that caught our eye this year included:
- The HappyOrNot customer feedback system is taking off like a rocket, distributed in New Zealand and Australia by Auckland firm Push My Button. It is used by Auckland and Waitemata DHBs and Compass Health, as well as Alfred Health in Melbourne. West Australian general practice network WAPHA is also rolling it out to many of its practices.
- It was a big year for Canterbury's Cortex, which has developed a mobile care coordination platform that was trialled at Christchurch Hospital last year and saw a massive 20 per cent reduction in average length of stay. It has since gone on to win several awards, including one at the HiNZ conference in November. Canterbury DHB has committed to using Cortex as the inpatient communication, documentation and task management tool for its new acute services building.
- Auckland start-up Oncall Systems formed a relationship last year with listed Adelaide firm Alcidion to resell its Smartpage clinical messaging and mobile task management system, and in February this year, Alcidion purchased Oncall outright. Smartpage has been integrated into Alcidion's Miya platform, where it is providing added functionality to the Miya Patient Flow and Miya Access bed management products. Alcidion has since won a big contract with ACT Health in Canberra for Smartpage, Miya Patient Flow and another asset in Patientrack.
- Another Kiwi company making moves was publicly listed Volpara Health Technologies, which makes the VolparaDensity breast density software that has been chosen for a research project being run by the NHS's breast screening program (NHSBSP) in England.
- Irish firm Clanwilliam Group picked up another ANZ asset this year when it bought Auckland's Konnect NET, which makes the SureMed solution that manages insurance company medical requests. Konnect NET joins HealthLink, Toniq and Australian firm Medical Business Systems in the clan.
- Central's hub and spoke telestroke service is now being rolled out to Midland DHBs, with Northland implementing its own version and Canterbury DHB bidding to act as a hub for the South Island. The service involves neurologists at large metro hospitals providing advice by video link to clinicians at regional hospitals, with the former equipped with x-ray image systems on 4G/Wi-Fi-capable iPads and the latter working with a portable telestroke unit from Auckland telehealth firm Vivid Solutions.
- The South Island added a FHIR API to the HealthOne shared record system to enable it to connect to GP practice management systems and speed up the data exchange process. HealthOne, which was developed by and is managed by Christchurch PHO Pegasus in association with Orion Health and Canterbury DHB, will be able to connect to PMSs in a clean, efficient and standards-based manner without needing a customised data migration created each time.
- The Conporto event detection and mitigation (EDM) solution being developed by Patients First may become a requirement for GPs to use as it is able to survey appointments and pick up potential medication harm events and can then alert the GP. The technology has been well accepted by GPs, with the secret being that it fits within their workflow and they don't need any training to use it.
Posted in New Zealand eHealth