The 2021 Australian eHealth year in review: part four

As the second year of the COVID-19 pandemic began to wind down and vaccination rates shot up, technologies to support the removal of restrictions on movement came to the fore. Vaccine certificates from the Australian Immunisation Register (AIR) were made available through the Medicare Express Plus app and MyGov and could be stored in digital wallets, but concerns over the ability to fake the certificates began to rise.

The states and territories were taking their own road for vaccination passes, with NSW beginning a trial of a state-wide solution linking the certificates to the NSW government’s Service NSW app. Others were working to add COVID vaccination certificates to each jurisdiction’s check-in apps, with the federal government saying this approach was necessary as public health orders and check-in QR codes are controlled by the states.

The Australasian Institute of Digital Health (AIDH) threw its support behind the international Vaccine Credential Initiative’s (VCI) SMART Health Card framework, which uses HL7’s FHIR specification. The world’s leading software developers, including Microsoft, Oracle, AWS and Salesforce, along with EMR vendors Cerner and Epic and standards organisations like The Commons Project, were all on board.

An HL7 Australia-hosted webinar in October heard that SMART Health cards promised a standards-based, secure way to issue and verify test results and vaccination records. Apple now allows SMART Health cards to be added to both the Wallet and Health apps with the release of iOS 15.1, and the VCI was working on a framework of trusted issuers to allow SMART Health cards to be verified immediately.

Sydney Local Health District announced it will be the the first Australian public health service to provide COVID-19 vaccination certificates using the technology, in addition to the existing PDF certificates. Sydney LHD CIO Richard Taggart described the latter as clunky, and not really suitable for non-Australian residents who have been vaccinated here.

Following the very large sum of $350 million paid by Telstra Health for GP practice management software vendor MedicalDirector in August, the Citadel Group then shelled out $260 million for specialist medical practice management software vendor Genie Solutions in October, more than five times the price that former majority owner IFM Private Equity paid for it four years ago.

Citadel Group also paid $200 million for UK software vendor Wellbeing Software Group in 2020, adding radiology and maternity systems to its Citadel Health product suite, which includes the Evolution laboratory information system, previously known as Auslab, and the Charm oncology solution. Together, Citadel Health and Telstra Health represent over a billion dollars in medical software assets.

In November, Telstra Health managing director Mary Foley updated the market on the company’s plans, saying it was aiming for revenues of $500 million by the 2025 financial year. It has also set its sights on further international expansion following its joint venture with PowerHealth Solutions. In addition to revenue from its recent purchase of MedicalDirector, the company is seeing rapid growth in its virtual health and remote monitoring solutions, as well as in residential aged care, where it is the market leader.

A great deal of progress was made this year in real-time monitoring of drugs of addiction. South Australia went live with its ScriptCheckSA system in April, using the same technology from Fred IT that was first rolled out for Victoria’s SafeScript in 2019. ACT Health announced in May that it will replace its existing DORA system with Fred’s technology, which it is calling Canberra Script. Queensland’s QScript went live in September and is now mandatory for prescribers and pharmacists to check, and in November, NSW Health kicked off the first phase of its roll-out of SafeScript NSW. It will not be mandatory for clinicians to use as yet but NSW Health is also putting in place a clinical advice line in partnership with St Vincent’s Hospital in Sydney to advise prescribers, pharmacists and hospital doctors if they need support.

In October, Melbourne’s Alfred Health went live with SafeScript in The Alfred’s emergency department, with plans to roll it out to all wards and outpatients in the next month. The system is integrated into Alfred Health’s Cerner electronic medical record with a link to the Victorian instance of the National Data Exchange (NDE), allowing clinicians to be alerted if there is a concern about the patient relating to the drug that’s been prescribed. When a doctor goes to place an order for a prescription to be dispensed either at a community pharmacy or that the hospital is dispensing for them to take home, a check is sent from Cerner to the SafeScript system to see if there is an alert in SafeScript for that patient.

By year’s end Health Minister Greg Hunt and his boosters were lauding a move to make MBS-funded telehealth permanent. Why this proved so ground-breaking we don’t know, as he could have enabled it years ago with the stroke of a pen. The Department of Health has proved a significant barrier of course, allowing open slather on telehealth in the early stages of the pandemic before bowing to the demands of doctors’ lobbies, fearful of losing low hanging fruit to private telehealth providers, forced it to place restrictions on eligibility to those patients who had seen their regular GP or practice in the 12 months preceding the first telehealth call. In October, the release of the draft 10-year plan to reform primary healthcare foreshadowed further restrictions, including that a patient must be “voluntarily” registered with a practice in order to receive subsidised telehealth.

The Health Information Management Association of Australia (HIMAA) conference kicked off virtually in Melbourne in late October, with Victoria’s new five-year digital health roadmap taking centre stage. The roadmap, released in August, includes five programs of work, of which three are well underway, including the roll-out of a statewide unique patient identifier, as well as the plan for statewide sharing of clinical information. Victorian’s chief digital health officer Neville Board told the conference that 75 per cent of Victorian public health services had now integrated the new patient identifier system, 63 per cent of Victoria’s health services were now on electronic medical record, and all were now connected to the new security operations centre.

Victoria had a contentious new bill to amend to the Health Services Act 1988 before parliament to allow for its new health information exchange project, which aims to securely store and present clinical information to support patient care across the public healthcare system. Some privacy advocates were aghast, but the tender, released in November, limits the HIE initially to pathology data under the new laboratory information system consolidation project.

It went to market in November for a commercial off the shelf system, initially restricted to the sharing of pathology data across the Victorian public healthcare system but likely to be extended in future.

The eHealth year in Australia ended in moves that we think herald the future of healthcare provision to the vast majority of people. While developments in remote monitoring and telehealth in acute care are endlessly fascinating, it is in the primary care and allied health sectors that the effects of virtual care will be most felt. There were some substantial breakthroughs in out of hospital care this year that we hope will be retained in the future. For instance, Coviu partnered with The Clinician for an integrated telehealth and remote patient monitoring solution for general practices for the management of COVID-19 patients in the home. Ballarat Health Services (BHS) expanded its existing BHS at Home model of care to roll out the cloud-based Patient Watch system to help monitor COVID-19 positive patients at home. And Gippsland PHN rolled out a new model of care for GPs to help them use existing technology to monitor low risk COVID+ patients at home using the LifeguardMobile platform. And at the end of the year, we reported on a terrific project by Loddon Mallee Health Network to roll out a virtual home monitoring solution for low- and medium-risk COVID-19+ patients across 16 health services covering 25 per cent of regional Victoria, designing and implementing a module within its regional care coordination platform (RCP) in just two weeks, using the DC2Vue home health monitoring technology from Melbourne’s Data Capture Experts. This is the future.

Primary care

MedicalDirector announced it will manage the new Provider Digital Access (PRODA) authentication process for Medicare Web Services on behalf of its users. Services Australia is moving to a new web services system for claims and authentication, replacing the existing client adaptor and public key infrastructure systems that require a manual authentication process by each practice. PRODA is the new online system that Medicare Web Services uses to verify each person’s identity and organisation. The PRODA authentication system is replacing the PKI system, and verifies users through the Australian Business Register.

In a move that upset the medical software industry, the WA Primary Health Alliance (WAPHA) applied for an exemption from the Australian Competition and Consumer Commission (ACCC) to competition rules in order to develop and roll out a new GP data extraction tool and supply it to other Primary Health Networks (PHNs). The PHNs are planning to develop a new tool called Primary Sense 2, building on the existing Primary Sense tool developed by the Gold Coast PHN, which performs a similar function as Pen CS’s Cat4 and Topbar and Outcome Health’s POLAR tool for extracting data for programs such as the quality improvement practice incentive (PIP QI).

In November, the Department of Health warned prescribers and dispensers for what it said was the last time that image-based prescribing will come to an end on December 31. The temporary measure was introduced at the start of the COVID-19 pandemic to allow prescribers to send a photo or fax of a prescription to pharmacists without the need to post a paper copy. As expected, it was forced to backtrack on this edict as well.

Secondary care

SA Pathology signed a $25 million, seven-year contract renewal with Cerner for its statewide Enterprise Pathology Laboratory Information System (EPLIS), which will see the statewide public pathology provider move to a cloud-hosted, managed services environment. The renewed contract will include Cerner’s remote hosting option (RHO) including disaster recovery, application managed service (AMS) for systems enhancements and upgrade services to ensure the software remains current, as well as other enhancements. EPLIS was incredibly controversial when rolled out, causing a huge backlog in sending results to GPs, but SA Pathology assures us the problems have been resolved.

Acute care

Victoria’s Goulburn Valley Health (GV Health) signed up with emergency specialist telehealth support service My Emergency Doctor to provide remote after-hours emergency medicine services. GV Health – which operates the Shepparton Hospital and health clinics, community and aged care services in Shepparton, Rushworth and Tatura – joins regional and metro healthcare organisations in using My Emergency Doctor, which is staffed by fellows of the Australasian College for Emergency Medicine (FACEM). My Emergency Doctor will provide senior specialist doctors to conduct board rounds during the overnight period with onsite ED doctors and nurses.

Royal Adelaide Hospital and The Queen Elizabeth Hospital have implemented eight digital patient pathways co-designed with local firm Personify Care to relieve pressure on frontline staff by digitising previously manual clinical protocols. Personify Care worked with the Central Adelaide Local Health Network (CALHN) on the roll-out for CALHN patients in more than 20 speciality areas across the two hospitals, as well as SA Dental.

Six hospitals in the Loddon Mallee region of Victoria went live with the Charm Evolution shared electronic oncology solution from Citadel Health in November. Loddon Mallee signed a five-year agreement with Citadel to streamline more than 10,000 chemotherapy treatments episodes each year using Charm Evolution, including Mildura, Bendigo, Echuca, Swan Hill, Kerang and Kyneton hospitals. The oncology services are now using a centralised patient record with access to treatment plans, appointment scheduling and simplified reporting.

A year after its go-live with its TrakCare electronic medical record from InterSystems, Bendigo Health is reaping the benefits of the ability to implement a new way of managing clinical data and integrate it across the hospital with a range of other clinical information systems. The $650 million Bendigo Hospital went live with the EMR last November, having delayed the planned implementation in March 2020 due to the coronavirus pandemic. It is now live and interfacing with 96 other systems, including disparate patient administration systems used in the 16 smaller hospitals in the Loddon Mallee region of Victoria.

And in what will prove to be a fascinating program as it rolls out, Melbourne’s Austin Health set the foundations to implement Cerner’s Fast Health Interoperability Resources (FHIR) service, allowing it to access both Cerner and third-party SMART on FHIR apps as part of its interoperability strategy. Austin Health is also taking advantage of Microsoft’s FHIR capabilities to exploit the capabilities of the Microsoft suite it uses, including Office 365, Azure and in another innovation for a health service, Microsoft’s Dynamics customer relationship management (CRM) platform. Austin Health is expected to be a test case for other Cerner users to connect their domains to the FHIR service, which is hosted in the AWS cloud.

Pharmacy

Online appointment booking service HealthEngine scored a big coup when it announced in October that community pharmacy banner group Sigma Healthcare will roll out HealthEngine’s Patient Appointment Management System (PAMS) to support online bookings, scheduling and voucher management at its Amcal and Guardian outlets. Sigma joined TerryWhiteChemmart, which rolled out the system earlier this year, integrated into MedAdvisor’s PlusOne system. Other Sigma brands such as Discount Drug Store, PharmaSave and WholeLife will roll out the technology over the coming months and into early next year.

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

• A telemedicine-powered network was launched to support the roll-out of the Vectra 3D imaging system for melanoma detection in Australia. The technology uses integrated software to map and monitor pigmented lesions and diseases of the skin and represents the world’s first use of 3D imaging for melanoma detection. Medical researchers can access a national database of up to 100,000 patient images taken by 3D full body imaging systems located in Queensland, NSW and Victoria.




• Sydney LHD expanded its contract with Alcidion to use its Miya Precision remote patient monitoring platform to monitor patients with acute diverticulitis in addition to those with COVID-19, and will also deploy a patient app to better engage with patients. Sydney LHD first signed an agreement with Alcidion to use Miya Precision to support COVID-19+ patients at home through virtual care, managed by the RPA Virtual Hospital (rpavirtual), at the height of the first wave of the pandemic.




• Personify Care partnered with Propell Health, distributors of iHealth devices in Australia, to integrate its system with wireless pulse oximeters to support virtual models of care for COVID-19 patients isolating at home.




• In one of the most interesting developments of the year, artificial intelligence firm harrison.ai raised $129 million from private investors and announced a further partnership with Sonic Healthcare for pathology solutions. It already had a deal to roll out an AI solution to Sonic’s medical imaging centres, but this deal is on another level. Something to watch next year.

Check out tomorrow’s blog for our 2021 Australian eHealth year in review most popular stories.