The 2020 New Zealand eHealth year in review
One of our first stories of what has turned out to be a true annus horribilis was also one of the most read, but like 2020, the plan didn't turn out quite as expected. Last year, the Ministry of Health decreed that analogue fax machines would be phased out for healthcare organisations by the end of 2020, but when the deadline approached, it had to change its mind. Might try again next year.
The establishment of an online pharmacy called PillDrop that organised home delivery to Auckland residents was a spooky harbinger of what was to come in 2020. The company was able to secure government funding and contracts with multiple DHBs and boasts it has become a critical part of New Zealand’s COVID-19 response. There are a number of medication home delivery companies now in the market, including Zoom Health, a subsidiary of online pharmacy pioneer Zoom Pharmacy.
It was an interesting year for Patients First, which in March announced it was selling off its Conporto Health commercial arm and concentrating on being a not-for-profit IT services provider for its shareholder, GPNZ. Its main role would be managing the GP2GP medical records exchange service. In November, Patients First announced it would close down its hMael secure email service after five years, citing a decrease in new accounts as a result of the coronavirus pandemic. Changes in work practices were not likely to see that improve, it said.
In mid-March, the COVID-19 pandemic was officially serious and a number of health IT vendors sprang into action, including Orion Health, which developed a virtual care pandemic outbreak monitoring platform that it was offering its customers for free. It also released a screening solution for the general public to check their symptoms. Vendors came up with some rapid solutions, such as Core Schedule's in isolation feature, which allowed staff to be tagged as “not available – in isolation” so managers could see who was able to work during the pandemic.
Pulse+IT put together a COVID-19 resources page that listed the new technologies that vendors were offering to help out with the pandemic, including for hospitals and health services, general practices, aged and community care and pharmacies.
The big success story, of course, was telehealth. The NZ Telehealth Resources Centre and Health Navigator NZ quickly moved into action and released online information to help providers and patients to use telehealth. The government then allocated $50 million in support for GPs and primary care as well as $20m to improve video conferencing and telehealth consultations as part of its $500m package to combat the coronavirus pandemic. There was also an extra $20 million for the Healthline national advice line. As movement restrictions and then full lockdown loomed, the RNZCGP told GPs to go virtual first.
The hospital sector also joined the party, moving as many outpatients clinics to virtual as possible. Remote monitoring equipment was also high on the agenda, with Waitematā DHB purchasing equipment for at-risk patients to keep them at home and limit exposure.
As New Zealand moved into lockdown, the Institute of Environmental Science and Research (ESR) and health IT solutions vendor Sysmex got together to set up a national clinical data repository (CDR) for all COVID-19 test reports from testing labs across the country. Data is loaded into a data warehouse where it is then used in intelligence reporting for the National Health Coordination Centre (NHCC) and the Ministry of Health in the daily COVID-19 update to the nation. Orion Health was awarded funding to build and deploy an algorithm hub to provide infrastructure, tooling and resources to support modelling, risk prediction and forecasting throughout New Zealand’s COVID-19 response.
COVID restrictions gave a boost to electronic ordering of tests as well as telehealth and eScripts, with Nelson Marlborough reporting it was seeing a swift adoption of electronic test ordering during the pandemic. Well over 80 per cent of tests were being ordered electronically from pathology provider MedLab South in May, a jump from 25 per cent in 2019. GPs in the region use the eOrder system developed by Sysmex New Zealand, which is integrated with the Medtech, Medtech Evolution, MyPractice and Indici practice management systems.
Also in May, Microsoft announced it would set up its first data centre region in New Zealand in what will be a significant investment in NZ's digital infrastructure.
New Zealand launched its contact tracing app that month, dubbed the NZ COVID Tracer, which was developed by Kiwi company Rush Digital and uses the Amazon Web Services platform. The app allows users to take a scan of QR code posters to record where they have been. The MoH also released the Âwhina mobile app tailored for healthcare workers to give them up to date access to information on COVID-19.
Some of the biggest news in health IT in the year occurred in June, with a private equity consortium buying up the NZ and Australian PMS assets of Medtech Global. Founder Vino Ramayah held onto the ManageMyHealth personal health platform but passed on the PMS to new CEO Geoff Sayer, who brokered the deal through his health technology advisory firm Acclivis. At the end of the year, Dr Sayer launched a new FHIR-based platform called ALEX for third-party software integration with Medtech that sparked a lot of interest.
Also in June, the final report of the Health and Disability System Review chaired by Heather Simpson was released. The report recommended a massive restructure of health service provision in New Zealand, including the establishment of a new Health NZ agency responsible for operational health delivery, including implementation of digital and data policy, nationally standardised datasets and interoperability standards. NZ's new Health Minister Andrew Little will now grapple with the ramifications of the review, the previous minister, keen mountain biker David Clark, having stood down in July.
As New Zealand emerged from lockdown, there was a noticeable reduction in telehealth. A research team at the University of Auckland conducted a series of surveys between May and October to try to understand and monitor NZ general practice responses to the pandemic, finding that most consults were done by phone and there were real challenges using video conferencing. Half of the practices surveyed said patients struggled with telehealth.
A trial of the Bluetooth-enabled CovidCard technology began in Rotorua in August, to test it for community acceptance and as an adjunct to the NZ COVID Tracer app. COVID Tracer itself got an upgrade and it became mandatory to display app-linked QR codes on posters on most forms of public transport in September. At the end of the year, the Bluetooth exposure notification framework developed by Apple and Google was added to the app as figures showed the amount of QR code scanning had plummeted.
In September, the Health Information Standards Organisation (HISO) released a roadmap outlining the steps needed to take the health and disability system towards interoperability. The roadmap solidifies HL7's Fast Healthcare Interoperability Resources (FHIR) specification as the main standard underpinning an API-based architecture. It includes a set of guiding principles shaping NZ's approach to interoperability, such as no blocking of data and a commitment to data sharing, nationally agreed standards, common capabilities and an adaptive, data-driven system.
The pandemic forced the Ministry of Health to suspend work on the national Health Information Platform (nHIP) program, but it started up again at the end of the year with the release of a request for information to inform the investment case for the first round of proposed capabilities. The RFI outlined a number of foundation requirements, including a data service, a consumer service, a provider service, an event notification and record locator service and a consent service. The nHIP will be built using a federated approach to providing access to healthcare data for consumers and providers, consisting of an API ecosystem of services and data.
As the horrible year drew to a close, it emerged that the MOH had to give up on one of its main targets for the year: moving the healthcare sector away from analogue fax machines. The ministry had hoped to have it done and dusted by December, but the move has been postponed indefinitely as the migration to digital methods was taking longer than originally envisaged. Paper lives to fight another day.
New Zealand's market-leading general practice and pharmacy software got together to launch an integrated electronic prescription messaging service called Secure Script that will allow GPs to send signature exempt eScripts directly to pharmacies. It was kicked off by RxOne, Indici and My Practice using Clanwilliam Health as the messaging service, and was then joined by the market leaders in Toniq and Medtech.
ACC announced it was funding the roll out of the Conporto Event Detection & Mitigation (EDM) system to all Kiwi GPs to help reduce medication-related harm events. Powered by Dr Info, Conporto EDM is triggered by an appointment, a prescription, an ED triage or other encounter and analyses the patient’s medical records in all locations at once to identify if a risk of harm is likely from contraindicated or high-risk treatments.
Telehealth came of age in 2020 and a number of commercial ventures began to offer virtual care, including a virtual GP service called CareHQ set up by ProCare PHO and Southern Cross Health Insurance. Video consults will be offered to patients when their own GP is not available or after hours and will be accessible by the patient on a CareHQ app or through My Southern Cross. GPs will use the video capabilities in the Indici practice management system.
Canterbury DHB went live with an automated system from Strata Health that directs referrals for home-based nursing care and community support automatically to the most appropriate provider. It is using Strata's Prism patient flow and resource matching technology, which is integrated with the South Island's electronic request management system (ERMS) and with HealthPathways, to allow GPs to make a referral from within their practice management system.
Southern DHB released a Click to Tick checklist checklist for patients with COPD being discharged from Dunedin Hospital, that will see them receive referrals and advice for correct medicine and inhaler use and a follow-up visit to their GP.
Southern DHB also rolled out a cloud-based transcription system from iMedX. Introduced to replace the legacy MedDocs system, iMedX was introduced in a matter of weeks under the pressure of the COVID-19 pandemic, with the implementation largely done remotely.
Northland DHB rolled out intra-hospital eReferrals using Clanwilliam Health's SmartForms platform integrated into Whangarei Hospital's Orion Health Clinical Portal.
All five South Island district health boards are now live with DXC's ePharmacy electronic pharmacy management solution, replacing the end-of-life WinDose system. It is also live at Auckland, Northland and Counties Manukau DHBs, all five Midland DHBs and the six Central region DHBs.
Some of the more interesting software, apps and new players in the market that caught our eye this year included:
- Wellington-based software vendor Core Schedule raised $1.2 million from early stage technology venture capital firm the Punakaiki Fund to expand its hospital staff rostering solution.
- Breast Cancer Foundation NZ (BCFNZ) partnered with Auckland patient reported measures company Cemplicity to trial a new PROMs platform at Waikato DHB that combines online patient symptom surveys with clinical decision support.
- Skin cancer diagnostics service MoleMap launched a virtual triage service during COVID-19 lockdown to assess patient lesions remotely and refer high priority cases for further diagnosis
- Christchurch aged care technology developer Spritely was funded to run a trial of its technology to screen for COVID-19 in retirement villages. The tablet-based technology, which can monitor for falls, also supports medication adherence and can track vital signs such as blood pressure, heart rate and weight wirelessly.
Posted in New Zealand eHealth