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The 2023 Australian Digital Health Year in Review: part one

12 December 2023
By Kate McDonald
Stephen Fabbro with his Cardihab app. Photo: Mater Private Hospital Townsville.

2023 may go down as an exemplary year for digital health in Australia, one in which serious funds and serious progress was made towards realising the goal of a digitised healthcare sector. There were major developments in electronic medical records and virtual care in acute care, real progress in aged care, a bit of a return to business as usual in primary care, and some real momentum in interoperability that should be well underway in 2024. All that and the AI revolution too.

The year started with a bang with the news that the South Australian government had approved $31 million to extend the roll out of the Sunrise electronic medical record (EMR) and patient administration system (PAS) to the state’s regional local health networks, which have been functioning on paper and a very elderly digital system for pathology results called Chiron. The small regional hospitals join the metro and some large regional hospitals in adopting Sunrise from vendor Altera Digital Health (formerly Allscripts), including Lyell McEwin Hospital and the Women’s and Children’s later this year.

The NT’s Acacia EMR, which uses InterSystems’ TrakCare technology, also made some progress, going live at the remote 30-bed Gove Hospital in Nhulunbuy along with four Top End renal dialysis services. It follows the go-live at Katherine Hospital in 2022, but there’s no doubt the project is proving extremely complex and difficult, taking in not just a hospital EMR but new, interoperable systems for primary and community care as well.

ACT Health CIO Peter O’Halloran, who guided the territory through the planning, purchasing and implementation of the Epic Digital Health Record (DHR), jumped ship to the Australian Digital Health Agency (ADHA) after six years. Mr O’Halloran was appointed in January as the agency’s chief digital officer (CDO) and quickly settled in, taking charge of its interoperability work program including the mid-year release of the national healthcare interoperability plan and the soon to be released digital health standards catalogue. He is also heavily involved in the agency’s work on standards-based health information exchanges to enable the real-time data sharing between primary, acute and aged care settings and the establishment of a meaningful use index for the My Health Record.

Patient reported outcome and experience measures, better known as PROMs and PREMs, were a highlight this year. In January, Kiwi firm The Clinician won a $2.6 million contract to roll out its ZEDOC digital solution to support South Australia’s statewide patient reported measures (PRM) project, which is led SA’s Commission on Excellence and Innovation in Health (CEIH). Digital patient pathways would also be a big feature of the year. In late March, local firm Personify Care won a $5.6 million, two-year whole of SA Health agreement to offer its digital patient pathways platform across the state.

One of the most controversial issues of the year was the restrictions placed on online prescription services following a proposal from the Medical Board of Australia to recommend against doctors prescribing by telehealth for patients they have not seen before. The Medical Board said the move was to protect patient safety and it was backed up by the medical colleges, but was fiercely opposed by telehealth companies, particularly those caring for vulnerable patients and those in rural and remote Australia. Companies such as Medmate and InstantScripts made a good argument for asynchronous prescribing using text-based questionnaires for these populations, but the decision ultimately went against them. In February, even the Pharmacy Guild got into the action, describing online services as “cowboys”. In March, Avant pulled the plug on indemnifying practitioners for any claims for asynchronous telehealth, and in June, the Medical Board recommended against it altogether.

In early February, the Strengthening Medicare Taskforce report was released, recommending the modernisation of My Health Record, which was already underway, as well as a policy recommendation of ‘sharing by default’ that would become actual policy later in the year. The report also called for the regulation of clinical software and an uplift in primary care IT infrastructure, as well as strengthened digital health literacy and navigation. Pulse+IT gave the thumbs up to the report, but its importance would become much more clear following the May budget.

Also in February, Victoria resurrected its plans to legislate for a state health information exchange, which amended the Health Records Act to enable hospitals and health services to quickly access accurate patient information in one centralised location irrespective of where the patient previously received care. One of the driving forces behind the move has the restructure of Victoria’s pathology services to ensure diagnostic data is available across health services. A health information exchange to link up disparate EMRs is also part of Victoria’s digital health roadmap. Altera Digital Health then won a $9 million contract to implement the HIE for the Victorian Department of Health’s LISConnect pathology reform program, using its dbMotion interoperability platform.

Tasmania released its long-awaited tender for its statewide EMR and ambulance electronic patient care record (ePCR). The Tasmanian government allocated $150m in the May 2022 budget for the procurement, which is the first tranche of a 10-year, $475 million plan to modernise the health system through digitally enabled technologies. The tender called for an EMR with full capabilities as well as integration capability typical of a health information exchange (HIE) and that patients should have access to their information. The procurement was still underway at year’s end, with a chosen supplier expected to be announced in 2024.

ADHA announced in March that it had partnered with HL7 Australia to support a series of free training courses in the FHIR standard, aiming to rapidly upskill the software developer community to fast-track the march towards interoperability. The partners have set a target of 370 supported places in the first year for the training, which is being developed in association with the Australian eHealth Research Centre (AeHRC) and the University of Melbourne’s Centre for Digital Transformation of Health. It will be localised for the Australian digital health environment. It will cover areas such as the foundations of FHIR, the difference between HL7 version 2 and FHIR, and the use of SMART on FHIR apps for secure access to clinical information systems.

Stoushes between the RACGP, the AMA and the Pharmacy Guild were ongoing this year, particularly over pharmacy prescribing and later in the year, 60-day dispensing. In late March, the Queensland branch of the Pharmacy Guild went to market for an IT solution with prescribing capabilities to support the North Queensland community pharmacy scope of practice pilot, which will allow specially trained community pharmacists to treat patients – including writing prescriptions – for 23 health conditions. The winning vendor was MedAdvisor, which is going to adapt its PlusOne software platform to allow community pharmacies to participate. Later in the year, a battle between the prescription exchange services would be fought, with eRx the ultimate victor over MediSecure to provide a single prescription delivery service for the country.

Aged care

It was an important year for aged care medication management platforms, which are rolling out transitional electronic National Residential Medication Chart(eNRMC) conformant systems under a $45.5m government program. Bestmed announced it was implementing its system across Regis Group’s 64 residential aged care facilities and at Arcare’s 50 sites in May. Fronditha Care rolled out Telstra Health’s MedPoint system that month. The implementations have been supported by round one of DoHAC’s eNRMC adoption grant funding. A second round was launched in July, helping RACFs to defray the costs associated with implementing a conformant eNRMC product.

Recommendation 68 of the Royal Commission into Aged Care Quality and Safety, which called for the universal adoption of digital technology and My Health Record, has proven to be the stimulus for some remarkable movement in digitising aged care, including the development of the new aged care star ratings system. Researched by the University of Queensland, the Aged Care Industry IT Council and PricewaterhouseCoopers and developed using Salesforce technology, the first iteration went live in late 2022 and the plan is to keep adding new data sets. Providers can check their star ratings through DoHAC’s new Government Provider Management System (GPMS), which also had a big roll-out throughout the year.

Primary care

Melbourne-based general practice research network Outcome Health announced it will use its POLAR data extraction and analysis tool as part of a new Digital Health CRC research project looking at the emergence and management of long COVID in primary care. The project involves de-identified general practice data from over 700 practices in the catchments of Outcome Health’s four PHN partners in Melbourne and Sydney, which support over three million patients.

The Australian Digital Health Agency’s Provider Connect Australia system, which is aimed at helping healthcare organisations to streamline the registration and maintenance of their details and be a single source of truth for provider data, kicked off a nationwide roll-out in February. Healthdirect Australia’s National Health Services Directory (NHSD), Telstra Health’s secure messaging offering and 31 PHNs were part of the pilot. Later in the year, NSW Health came on board and a proof of concept began with Services Australia for Medicare. In August, the intergovernmental agreement on national digital health committed to the funding and use of PCA as well as the NHSD.

In March, we learned that more than 630 general practices or about one in four in NSW have enrolled in NSW Health’s Lumos data linkage and analytics program, which provides insights on the patient journey through the state’s health system. Lumos is understood to be Australia’s first state-wide linked data asset across primary care and other settings. It extracts de-identified data from general practices and links it to patient records from acute and other health services to provide a more comprehensive view of patient pathways.

The WA Department of Health’s new ScriptCheckWA system for monitoring controlled drugs was released to GPs and community pharmacists in late March, completing a nationwide roll-out of real-time prescription monitoring (RTPM). ScriptCheckWA uses the same technology first developed for Victoria’s SafeScript RTPM system by Fred IT and is integrated with the National Data Exchange (NDE). SafeScript was the first to go live in 2019 and has since been followed by QScript, ScriptCheckSA, Canberra Script, NTScript, TasScript and SafeScript NSW.

Acute care

eHealth NSW revealed plans to standardise its unified communications platforms for clinical and non-clinical collaboration on Microsoft Teams, include the statewide platforms Skype for Business, Avaya and video conferencing platform Pexip. The move comes as eHealth NSW rolls out a new function within Teams called MedSync, developed in association with Microsoft, that allows clinicians to upload clinical photography securely from a mobile device into a patient’s health record. MedSync can be used on personal and NSW Health devices and is accessible through Teams. It supports instant messaging and chat between clinicians as well as the sharing of clinical images and the ability to upload images and video into a patient record.

One of the more unusual security stories this year was the data breach at Canberra Health Services, which revealed a staff member had been leaking clinical records with the ACT branch of the nurses’ union. The leaking had gone on for years and ultimately affected 13 patients.

Virtual care

ASX-listed Global Health made the news when it partnered with supermarket giant Woolworths to offer GP telehealth consults through Woolies’ HealthyLife site, using Global Health’s HotHealth platform and Teledoc telehealth service. Woolworths launched HealthyLife as a digital start-up in 2021 to provide a range of health services and advice along with fitness and nutrition tracking, vitamins and sports nutrition products, having bought the brandname of a bricks and mortar health retail business in 2019. The story caused a bit of a stir, with retail analyst Steve Kulmar telling Channel Nine that he suspected the new offering from Woolies was a way to secure a backdoor to offering pharmacy services in-store. RACGP president Nicole Higgins described the new venture as “an opportunity to make dollars out of people’s healthcare”.

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

Northern Health went live with FHIR-enabled ePrescribing for its mental health teams, using the MediRecords module that is used by the Victorian Virtual Emergency Department (VVED). Prescriptions can be sent instantly and electronically to patients or carers, with a QR code to be scanned at pharmacies for dispensing.

Mater Private Hospital Townsville is rolling out a virtual heart rehabilitation program across North Queensland featuring the Cardihab digital cardiac rehabilitation platform and smartphone app, which is said to be able to boost cardiac rehabilitation participation rates.

Sydney Children’s Hospitals Network (SCHN) has gone live with a new electronic referral system from Sydney-based start-up Consultmed, aiming to replace fax and paper for outpatients referrals to Sydney Children’s Hospital Randwick and the Children’s Hospital at Westmead.

Falls detection technology developer HomeGuardian has partnered with aged care provider Villa Maria Catholic Homes (VMCH) and Deakin University’s Applied Artificial Intelligence Institute to run a three-year, $10 million project to try to predict and prevent falls.

The Australian Digital Health Agency released my health, the first mobile app that can directly download and display key information from My Health Record, using the new Health API gateway to allow consumers to download their health data as soon as it’s available on the main system.

We’ll have part two of the 2023 Australian Digital Health Year in Review tomorrow.

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