The 2018 eHealth year in review: part one

There's no doubt that the My Health Record yet again dominated the headlines during the 2018 year in eHealth, but there was loads more happening in the sector that kept us all busy. Pulse+IT has put together its now traditional four-part series reviewing the past year, with all the highlights and missteps that make this such an intriguing industry.

The new year started off with some concerning news about Ocean Informatics, which announced it was going into voluntary administration. Ocean was always best known for its informatics expertise and its work on the openEHR specification and clinical modelling methodology, along with the Northern Territory electronic health record. It also built the LinkedEHR shared care system used in Western Sydney.

While things looked a bit dodgy for a while, a hero came to the rescue in March in the form of Tom Wenkart's Pen Computer Systems, which became a major shareholder and bailed Ocean out of administration. How the two disparate companies would fit together was not immediately obvious, but Mr Wenkart said Pen and Ocean's respective suites would work together on shared care planning tools.

One of our most popular stories for the year was the announcement by Queensland Health that it would develop a statewide integrated Referral Management Solution (iRMS), issuing tenders in January for an internal and external eReferrals solution and an online service directory for referring doctors. The iRMS is a big part of the $361 million Specialist Outpatient Strategy launched in September 2016 to tackle outpatient waiting lists.

These tenders were later won by NZ firm BPAC Informatics for the external eReferrals solution and by Alcidion, which is a reseller for NextGate's technology and will use it for the provider directory.

Queensland's integrated electronic medical record (ieMR) had a lot of exposure this year, both good and bad, but back in January it was all good, with Cairns Hospital rolling out the state's iVitals system for paediatric patients, using a customised early warning system built into Welch Allyn vital signs monitors that is then wirelessly sent to the ieMR. It means nurses will no longer have to document vital signs manually into the medical record.

One of our most popular stories for the year wasn't local per se although we will never tire of reminding the world that the Fast Health Interoperability Resources (FHIR) standard was created by Melbourne's Grahame Grieve. Things have moved incredibly fast since Grahame first announced his idea at an HL7 meeting in 2011, and by the start of 2018, Apple had got wind of the capabilities that FHIR offers and launched a new function allowing people to link their iPhones to their medical records. As of January it was only in beta and only American patients of 12 hospital systems could use the app, but the number of healthcare organisations taking part continued to grow throughout the year as Apple Health Records became a reality. In June, Apple opened its API to third-party developers, which should see numerous apps being able link to Apple's.

While the Apple developments are limited to the US at the moment, Australia should not be too far behind as the local industry gets behind an Australian version of the Argonaut Project, the US initiative that has worked to advance the adoption of standards such as FHIR and OAuth and includes the major EMR vendors. HL7 Australia will be in charge of localising Argonaut specifications as they come out of the US to ensure an agreed version is available for local implementations.

In February, the Royal Australian College of General Practitioners (RACGP) kicked off one of its long-term desires: a project to determine minimum clinical functionality requirements for general practice software. The announcement had the support of the Australian Digital Health Agency, but the vendors' peak association was a bit blindsided, saying no business case had been put forward to support the idea. A disagreement between the vendors and the college over the latter's move to develop new software in competition with the existing players was in danger of poisoning the relationship between the two sectors as the year came to a close.

Back in Queensland and after more than 20 years in operation, the fate of the veteran Auslab system was finally officially decided. A replacement for Auslab had been discussed for a number of years but the complexity of the process was always a disincentive, but last year, Queensland Health finally bit the bullet and went out to tender. It did have the choice of upgrading to the latest version of Auslab or implementing Cerner's laboratory system, which most people's money was on, but as Pulse+IT revealed last year, the state eventually plumped for US software vendor Sunquest. In February, QH officially announced the supplier for the project, which will cost $68.5 million over 10 years.

It was a big year for Victoria's $29.5 million SafeScript real-time prescription monitoring (RTPM) program, with a trial in Western Victoria scheduled for the end of the year. In February, the state government released the proposed regulations governing the system, which will become mandatory for prescribers and pharmacists in the near future. At the same time, the ACT government announced it would roll out the national ERRCD system by 2019.

While ERRCD has been available for a number of years no state or territory has fully taken it up, Victoria deciding instead to build its own. In March, the Pharmacy Guild backed SafeScript as a better alternative than ERRCD, saying its use of cloud technology and better UX meant it would fit into clinical workflows much more easily. In August, the NSW Opposition said it too would back SafeScript should it win next year's state election.

It was a big year for pathology and medical centre provider Primary Health Care, which kicked off a major shift in strategy under the guidance of new CEO Malcolm Parmenter. In addition to completely rewriting its policy on recruiting and retaining GPs, Project Leapfrog also entails a big uplift in the company's technology, including – eventually – rolling out MedicalDirector's cloud-based system Helix, a new radiology information systems and PACS, and going to market for a new pathology system.

While the Helix roll-out isn't going as fast as expected, Primary has moved practices using other software such as Medtech32 to MedicalDirector 3, which is now called MedicalDirector Clinical. Primary has also dropped its walk-in policy and is allowing appointments, with practices using MD's online appointments capability. By the end of the year, Primary had changed its name to Healius and was close to signing on with a global provider for its $100m laboratory information system.

In March, we reported on the National Children’s Digital Health Collaborative, which has four projects under way that will eventually lead to a longitudinal record for all Australian kids. The first initiative is to begin the digitisation of baby books, something NSW Health first began back in 2012 and which the Northern Territory is also working on. We spoke to Sydney Children's Hospitals Network (SCHN) CEO, paediatrician Michael Brydon, about the potential of this project, which he believes could be a key element in an aspiration for Australia to be the best place in the world to raise a child.

Also in March, as it waited for the cue from the Health Minister to go ahead with opt-out arrangements for the My Health Record, the Australian Digital Health Agency released a draft of its Framework for Action, which is a roadmap for implementing the National Digital Health Strategy. Big-ticket items were the My Health Record expansion program, the national provider addressing service, a national interoperability strategy and a national health technology strategy. A lot of the hopes for the coming year depended heavily on the MyHR expansion program, which as the year wore on, turned into a bit of a disaster for the agency.

The wider health sector was also gearing up for the MyHR program, with ACT Health announcing it would begin uploading pathology and diagnostic imaging reports using its Rhapsody integration engine. Private pathology provider InfinityPATH then became one of the first private labs to begin uploading pathology reports to the My Health Record. WA Health said it was eyeing off year's end.

Over the six years of operation of the My Health Record the issue of the risk to patients if they see their test results before their doctor has been raised as a potential challenge for the system that might lead to doctors demanding results are not uploaded at all. However, ADHA's pathology program director Paul Carroll laid this fear to rest when he told a webinar that only three in every thousand orders had the “do not send” to My Health Record box ticked. The ability for patients to have access to their test results has long been a selling point for the system, even if it has only recently become available.

The first quarter of the year ended with no announcement of when the opt-out period would begin, and with the Department of Health accepting that it would have to do better when it comes to releasing de-identified data after it embarrassed itself last year by releasing a data set with massive holes in it. DoH promised to continue to enhance its data governance and release processes with oversight from the Office of the Australian Information Commissioner.

Pharmacy

The year for the community pharmacy sector got off to an interesting start when the Pharmacy Guild finally pulled the plug for good on its MedsAssist system, which it rolled out in a hurry – and paid for itself – in an attempt to hold off the up-scheduling of codeine. While the system worked and was proof that the pharmacy sector can introduce an IT system with great rapidity (and small expense) when one of its cash cows is threatened, the move was ultimately unsuccessful. Codeine was rescheduled in February and the world does not seem to have come crashing down for community pharmacy.

Primary care

Patient engagement technologies are of increasing importance across care settings and early in the year, GP software vendor MedicalDirector got together with online booking, recall and reminders provider HotDoc to integrate HotDoc's engagement suite into MD for shared customers. The partnership started with free in-app appointment reminders.

In February, the federal Department of Human Services announced it would take a staged approach to the replacement of Medicare PKI certificates by the Provider Digital Access (PRODA) system. PRODA is more secure and much easier to use, and DHS hopes to have all providers moved to it by the end of 2020.

In March, the federal Department of Health announced it was delaying the implementation of the new Practice Incentive Program Quality Improvement Incentive (PIP QI) by another year to allow general practices adequate time to prepare. The incentive, which requires practices to share de-identified data extracted from their clinical software on certain chronic illnesses as well as vulnerable and high risk groups, was originally to be introduced in May 2017. It will now be May 2019 before it gets started.

Acute care

The Victorian Department of Health and Human Services announced the winner of its enterprise master patient index (EMPI) project, which aims to unify Victoria's disparate medical record indexing systems. Orion Health and MKM Health are working together to roll out US firm NextGate's MatchMetrix for the project. The two companies are also working on the state's JCAPS replacement program.

Over in WA, that state's storied history with health IT was recalled by a former under-treasurer in a report on some of the projects that had gone wrong in the recent past. The report issued a warning about the $408.8m HealthNext centralised computing project which is set to replace the much-maligned one with Fujitsu, which went $80m over budget despite not needing to. The very next week, however, another report into the health system recommended that WA look at rolling out a statewide EMR and the immediate expansion of the state's already expansive telehealth system. Later in the year, Deloitte was handed a $530,000 contract to develop a digital strategy for WA Health.

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

  • InterSystems launched a new data platform called IRIS aimed at any industry needing to do real-time analytics on live data. It later launched a FHIR-enabled version dedicated to the healthcare industry called IRIS for Health, signing up Sydney start-up RxMx to develop its technology on the platform.
  • Another start-up in Brisbane firm DoseMe also had a big year, announcing in February that its DoseMeRx software would be available in Epic's App Orchard and integrated into Epic using FHIR. DoseMe has a similar agreement with Cerner in the US. And in December, the company announced it had been acquired by US firm Tabula Rasa.
  • Four years ago, Melbourne GP Peter Demaio and his team built an in-house self check-in system that they commercialised as Automed in 2016. They also added caller ID so the receptionist can call up the patient's admin details when they ring for an appointment. And in March, they teamed up with MedicalDirector to offer an integrated system to MD customers.
  • Western Victoria PHN rolled out the GoShare patient education platform from Healthily in March. Healthily is also working with WentWest in Sydney and later in the year was part of one of the successful bids for ADHA's digital health testbeds. It will be providing customised health information to Aboriginal people in WA that can be sent directly from St John of God Midland's Telstra Health EMR.
  • The Sydney Children's Hospital Network (SCHN) went live with the integration of its new Connect app with its EMR, allowing messages sent by patients to be directly accessible by the clinical team within Cerner's PowerChart module.
  • As part of the Victorian eReferrals program, GPs can now send referrals directly to Northern Health from their desktop software, joining Austin Health and Eastern Health. The system is using HealthLink's SmartForms technology.

Want to know what happened next? We'll have part two of the 2018 eHealth year in review tomorrow.

Posted in Australian eHealth

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