The 2018 eHealth year in review: part two

Pulse+IT has been covering the interesting adventures of the My Health Record week in and week out since the PCEHR was first dreamed up back in 2010-11, and twice now we have became part of the story rather than just reporting on it.

In April this year, we discovered that incorrect PBS data had again appeared on one of our records, following a similar episode in 2013. We editorialised about this issue and recommended that PBS data be removed from the system as it was very often incorrect, but it has remained. When those Australians who haven't opted out get their My Health Record created for them in February 2019, it will be interesting to see what appears.

A couple of days later, Australian Digital Health Agency (ADHA) CEO Tim Kelsey was telling the Australian Telehealth Conference in Sydney that the My Health Record would hold useful clinical content and have comprehensive coverage of the patient population by the end of the year, finally giving clinicians a reason to use the system. The first element is slowly coming true – there are now 2.2 million shared health summaries, 2.4 million discharge summaries, 3.4 million pathology reports and 20 million prescriptions – but as we now know, the opt-out process didn't quite go to plan and comprehensive coverage will have to wait until the new year.

At the same conference, sociologist Deborah Lupton revealed that from her research, most consumers had a profound lack of interest in the My Health Record. Professor Lupton also found that despite the received wisdom that consumers are very concerned over health data privacy, people were not particularly interested or concerned about who could access personal health data generated from their online interactions or app use.

The mid-April COAG Health Ministers meeting saw the federal government and the jurisdictions agree on a federated model for real-time prescription monitoring. This would entail the states and territories rolling out the national ERRCD system or building new ones, as Victoria did with SafeScript. In June, the federal Department of Health issued a tender for a national data exchange NDE system to support the federated model. To the surprise of no one, Fred IT was awarded the $23 million contract to build the NDE in October.

ASX-listed Alcidion announced it was buying IT services and integration specialist MKM Health, along with the Patientrack early warning system technology that MKM had helped build. Having also bought New Zealand-based Oncall and its Smartpage clinical messaging system, Alcidion is now able to offer a range of products aimed at improving patient flow and monitoring inpatients, in addition to its foundational Miya informatics platform. As part of the deal, MKM Health's Kate Quirke took on the role of CEO, while Alcidion's Ray Blight moved into an executive chairman role. The move quickly bore fruit, with the combined company winning a contract with ACT Health to roll out an integrated patient journey board solution in July, another to install the Patientrack bed board module for the University of Canberra Public Hospital in November, and a $12 million contract to roll out the NextGate provider registry software for Queensland's statewide referral service directory (RSD).

A taste of the massive online meltdown that would mark the beginning of the My Health Record opt-out period came in late April, when News Corp erroneously reported that MedicalDirector was “requiring” that doctors using its clinical software share patient data with the vendor. That set off a storm on Twitter with digital rights activists claiming data was being shared without consent, despite the fact that the story was wrong. The change was in fact an upgrade to MD's long-running General Practice Research Network (GPRN) study and was simply an easy way for GPs to opt into sharing de-identified data. News Corp conflated this with the My Health Record and the new mandatory data breach notification scheme, and Twitter went into a frenzy.

Another big story this year was the announcement that the Parkville precinct in Melbourne will be getting a new electronic medical record, although it will not go to an open tender for it. Royal Melbourne Hospital, the Royal Women's and the Peter MacCallum Cancer Centre will join fellow Parkville resident the Royal Children's Hospital in rolling out an Epic EMR. The Victorian government is giving the project $124 million, part of a pre-election health budget spend that also included $461.6m for the redevelopment of Ballarat Base Hospital.

And yet another big story was our interview with ADHA's Ronan O'Connor about the agency's plans to re-platform the My Health Record. Built in 2010-11 using HL7's clinical document architecture (CDA) standard, the technology underpinning the system is getting a bit creaky and newer, more agile technologies are now available. The plan in May was to go to market with a request for information this year, but the uproar over the My Health Record going opt out has overtaken events somewhat. FHIR developer Grahame Grieve said last year that the aged architecture meant the My Health Record was “doomed”. This year, he recommended a federated model using new standards such as FHIR and OAuth, but he was not confident this would be taken up.

In May, ADHA released an RFI for a series of digital health test beds that would explore the potential of the My Health Record. Up to $600,000 for each project was on offer, but they all had to use existing technology and be scaleable across a big population. Fifteen successful bidders were chosen in July to share in $8.5m, with projects including a rapid access cardiology clinic at Westmead Hospital, the use of Precedence Healthcare's MediTracker app in association with My Health Record, and the integration of My Health Record data into Outcome Health's hospital admission risk predictor tool.

Also in May, the Australian Institute of Health and Welfare (AIHW) was named as the custodian of My Health Record system data for secondary use. Releasing its framework to govern secondary use, the federal government ruled out allowing system data to be used for commercial or non-health-related purposes or by insurance companies. The following week, ADHA announced that the opt-out period for the My Health Record would begin on July 16 and run until October 15. That was ultimately pushed back by a month to November 15 following a furore over the system's privacy provisions, and was then extended even further as the November 15 deadline approached. It is now due to end on January 31. We think.

The dawn of the opt-out period was supposed to be a good one for Sydney start-up Tyde, which is one of four apps authorised to link to the My Health Record. Tyde also has the capability to store My Health Record data on its app rather than just provide a link to myGov as the others do, but the company was holding off releasing this capability until opt-out was over. Tyde's business model was based on its capability to bring disparate health records together, manage appointments and prescription data and to receive tailored preventative health messages. This capability was aimed at care coordination programs such as those run by health insurers for their frequent flyers. However, the drama about who can access the My Health Record that erupted during the opt-out period and the subsequent Senate inquiry has in effect torpedoed Tyde's hopes, as the government moved to rule out allowing insurers any access to My Health Record data, even with the express permission of patients. Tyde is now re-evaluating its future.

The headache that the National Cancer Screening Register has caused for the government and the vendor continued into 2018, with the revelation at Senate estimates in June that Telstra Health had been paid less than $11 million of its $200 million+ contract because it missed several milestones. Telstra Health's Mary Foley told us later in the year that the company was proud of the work that had been done on the NCSR, but another parliamentary committee recommended in October that the Department of Health consider pursuing other options for the register or terminating the contract entirely. With the system now pretty much working that seems unlikely, but there is no doubt Telstra Health will not receive the full amount that was budgeted for.

The middle of the year saw a series of horror stories for online booking appointment service HealthEngine. Once a start-up darling, the company stumbled badly this year, first when it was revealed in the Sydney Morning Herald that the company had been moderating comments on its review site so heavily that negative reviews appeared to be positive. The ABC then revealed it had been selling details provided when users booked an appointment, such as whether it was for an injury, to personal injury law firms. HealthEngine insisted it was all done with the patient's consent, but the look was not good. That HealthEngine users can also access their My Health Record through the app did not help matters. HealthEngine has since cleared out its review site and reassessed its “referral partnership” arrangements.

Rounding out the quarter was some huge news for the medical software industry with the announcement that the secure messaging vendors had finally achieved interoperability. Two groups of vendors have been working together on proof of concept trials showing they can securely exchange electronic referrals and discharge summaries between a range of different systems. The vendors agreed on a federated search capability using FHIR APIs that will mean healthcare providers can search for electronic addresses across the healthcare sector. One of the trials involved Telstra Health and its Argus secure messaging system along with HealthLink to test the delivery of discharge summaries from Royal Melbourne Hospital to GPs using clinical software such as CorePlus, Genie and Zedmed. Global Health and its ReferralNet system are also involved. HealthLink, ReferralNet and Argus were involved in the other consortium, which tested the delivery of referrals from GPs to specialists using MedicalDirector, Best Practice and Genie.

It was a rare enough piece of good news for the Australian Digital Health Agency, which sponsored the trials. The second half of the year would be completely dominated by the My Health Record opt-out debacle, which may have permanently damaged many people's trust in the system.

Primary care

Cloud-based PMS vendor MediRecords had a big win in April when it won a five-year, million dollar contract to replace DXC's now unsupported practiX PMS for private practitioners who also work in the state system. Most HHS are using MediRecords for its billing capability but some are using the clinical module as well. The availability of cloud systems such as MediRecords, MedicalDirector's Helix, Genie's Gentu, Medtech's Evolution, Clinic to Cloud and others on the market calls into question the move by the RACGP to partner with a Canadian PMS vendor to build a completely new system for GPs. That saga would dominate discussions in the GP software market towards the end of the year.

In June, leading GP software vendor Best Practice launched the Indigo release of Bp Premier, promising significant management and clinical enhancements including the introduction of Tyro bulk billing, additional support for multi-location sites and improvements to the Medicare Online module. There is also new graphing functionality, a subpoena tool to assist with providing complete and accurate records when requested, enhancements to My Health Record functionality and emergency access to confidential material within the patient's clinical record via a secure password. The Bundaberg-based company is now working on its promised Best Health app, and planning a longer term release of a cloud version of Bp Premier dubbed Titanium.

Acute care

WA Health's long, fruitless search for a new medical imaging platform was resurrected again this year, with a tender released in April. A similar tender was issued in 2016 for a replacement for the state's ageing Agfa system, with $52 million in the kitty for the purchase, but all offers were declined. The tender closed in May but there's still no word on the winner.

SA Health's long and difficult journey with its Enterprise Patient Administration System (EPAS) had another diversion in April, with the newly elected Liberal government calling a halt to the roll-out of its clinical modules while an independent assessor could take a look at the system. A team including former Telstra Health MD Shane Solomon and former eHealth Queensland CIO Mal Thatcher was called in to assess whether the system should continue to be used. They were expected to release a full report in November, although that has not yet appeared. An interim report in September seemed to suggest that the existing roll-out would not continue in its current form.

ACT Health is in the middle of a significant investment in its digital health infrastructure. In addition to a number of patient journey projects for the new University of Canberra Public Hospital, the territory went out to tender for a new pathology system as well. ACT Health wants a cloud-based system and is stumping up $11 million for it.

NSW Health went live with its statewide Wireless Core capability, part of a long-term plan to enable mobility, allow for secure Wi-Fi roaming across the state and to prepare the system for integrated medical devices and the Internet of Things. It will allow all 160,000 NSW Health staff to connect seamlessly to Wi-Fi and will also support the expansion of telehealth.

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

  • Mobile patient monitoring system vendor Personify Care got together with fellow Adelaide firm Chamonix to use its HIPS technology to integrate the Personify Care platform with their existing clinical systems and the My Health Record, and to upload data as an event summary. Personify Care aims to detect when a recently discharged surgical patient is at risk of a complication and readmission to hospital.
  • Chamonix also launched a new version of its Healthi app with new security features including fingerprint and facial recognition. Healthi is one of the four apps authorised to tap into the My Health Record, allowing consumers to view their record on their phone.
  • West Moreton Hospital and Health Service in Queensland was able to boast of a good success story with the implementation of the MeCare remote monitoring program it introduced in association with Philips in 2016. Ipswich Hospital has seen a reduction in of almost 30 per cent in potentially preventable hospitalisations of chronically ill patients.
  • WebRTC-based telehealth platform Coviu had a good year, picking up $1 million from the CSIRO's innovation fund to further roll the system out. Currently mainly used by allied health professionals, Coviu is keen to get GPs using the platform as it integrates directly into their existing systems and allows for the secure exchange of documents and images as well as video conferencing.
  • Swedish medical imaging software provider Sectra and Australian radiology information system specialist Kestral won a $750,000 contract with NSW Health to build a proof of concept for a new enterprise-level RIS-PACS. The proof of concept trial will run until December 31, after which NSW Health plans to sign a 10-year contract with Sectra for the implementation and ongoing support of the solution.
  • Eurofield Information Solutions' TurboGrouper appeared on the market, ready to take on the market leader in clinical coding and grouping software, 3M. First it had to develop an interface with DXC's webPAS – it already has one with iPM – which can be a long and difficult process. EIS will be eyeing off Queensland's PAS replacement project, which looks set to remove the aged HBCIS with either iPM, webPAS or Cerner's PAS.

We'll have part three of the 2018 eHealth year in review tomorrow.

Posted in Australian eHealth

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