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The 2023 Australian Digital Health Year in Review: part three

14 December 2023
By Kate McDonald
AIDH CEO Louise Schaper (right) interviews Google chief health officer Karen DeSalvo at MedInfo in Sydney in July 2023.

All eyes were on MedInfo as the second half of the year kicked off, but making big news in early July was the resignation of ADHA chief technology officer Mal Thatcher. In charge of the multi-million dollar My Health Record modernisation program, Dr Thatcher, a former Queensland Health CIO, joined the agency in January 2021 and was also overseeing the modernisation of the technology underpinning Australia’s digital health infrastructure, including its Health API gateway and the new FHIR-based national repository platform funded in the May budget. His role was filled in by former Queensland Health chief information security officer John Borchi, who took on the CTO role permanently in November. The new branch manager for the agency’s Connected Care interoperability program – which would take on major importance during the year – was announced as Ryan Mavin, a former ACT Health enterprise architect, also in November.

The MedInfo conference in July, organised by the Australasian Institute of Digital Health and the International Medical Informatics Association (IMIA), proved to be huge. Digital health platform vendor Alcidion announced it had partnered with hospital automation specialist Olinqua to build what it says is the world’s first plug-and-play hospital operations product, aimed at providing real-time metrics and visualisation of the current state of a healthcare facility. Oracle Health announced it was set to implement its HealtheIntent data and insights platform in Australia to help detect people with undiagnosed diabetes who slip through the system. And EMR vendor MEDITECH announced it was bringing its MEDITECH-as-a-Service (MaaS) subscription model to the Australian market. Built on Google Cloud, MaaS includes a new set of cloud-hosted applications including the Expanse NOW mobility app for doctors, a virtual care solution, and a high availability snapshot to provide healthcare organisations with immediate access to key patient data in the event of unexpected or planned downtime.

We heard from most of the states and territories about their digital health plans during a terrific state of the nation panel session, and from NSW Health in particular about its plans to develop a single digital front door to its health services with the assistance of national health advice line provider Healthdirect Australia. (SA Health also announced it was investing in the digital front door concept through a $7.5 million grant from the federal government for the establishment of two new services to divert patients with non-life-threatening illnesses and injuries away from EDs.)

The big news at MedInfo though was twofold: the release of the national health interoperability plan by ADHA chief digital officer Peter O’Halloran, and a full overview of the extent of the 2023 investments in digital health by ADHA CEO Amanda Cattermole and DoHAC first assistant secretary Daniel McCabe. Mr O’Halloran said the Connecting Australian Healthcare plan was backed by the states, territories and the Commonwealth, along with standards bodies such as HL7 Australia and the wider industry. It will be accompanied by a digital health standards catalogue and includes 44 actions across five priority areas relating to identity, standards, information sharing, innovation and measuring benefits.

ADHA also set up an independent Council for Connected Care to guide progress over the next five years, which has already met three times and has spurred a promise to release quarterly updates on the ambitious goals of the national healthcare interoperability plan. 40 of the actions are the responsibility of the agency to deliver, one of which is procurement guidelines that will allow healthcare organisations to easily find and use relevant standards and compliance requirements.

Mr McCabe said the Strengthening Medicare Taskforce report released in February provided the strongest direction in 10 years on the importance of data and digital to enable a modern healthcare system and inform value-based care, recognising that with the right policy settings, incentives and regulatory framework, digital health represents a great opportunity.

He also said the $1.1 billion investment in digital health in the May budget will be used to allow Australians to better participate in their own healthcare and ensure that patients’ health information can be made available to their care teams in near real time, no matter where the information is created or stored. This is through the policy of sharing by default, which he described as Australia’s next frontier for connected healthcare.

And as MedInfo wrapped up, we heard from conference co-chairs Martin Seneviratne and Farah Magrabi on the other topic that would dominate the rest of the year in digital health: AI. “Today there is a window of opportunity for Australia to rise and lead in this new era of health AI,” they wrote in an op-ed for Pulse+IT. “We must leverage our homegrown data assets, build an intersectional workforce, and create the regulatory landscape to safely translate these technologies to the bedside.”

Global health IT giant Dedalus had a massive year in 2023. The Italian-headquartered company made big move out of Europe with the acquisition in 2021 of the healthcare assets of DXC, which had itself inherited them in the merger that became CSC, and before that iSoft. Well-known brands in Australia and New Zealand such as webPAS, iPM, Care Suite, MedChart and iPharmacy/ePharmacy become part of the Dedalus family. Dedalus also continued with reseller agreements with specialist software such as Metavision. In 2022, Dedalus started introducing its global suite of products to ANZ, starting with the amPHI electronic pre-hospital care record (ePCR) from Danish firm Amphi Systems, followed by Irish firm Swiftqueue’s enterprise appointment and scheduling platform and the Pharmoduct robotic oncology compounding system.

In 2023, Dedalus added extra capabilities to its Digital Connect 4 Health (DC4H) interoperability platform, which includes an enterprise master patient index, an integration engine and a Patient Synoptic Viewer, described as a browser-based view that gives users a window into the broader patient record. At the MedInfo conference in July, it officially launched ORBIS, its new EMR offering for the ANZ region. ORBIS is hosted in the Amazon public cloud and includes all of the foundational components expected of a contemporary EMR, along with added extras such as Composer, which allows an organisation to develop their own workflows. In July, it also announced it was extending its reseller agreement for the CSIRO’s Ontoserver, which is now used in Australia, New Zealand, the UK and the Netherlands.

In late July, people working in the increasingly broad sector of digital health were invited to take part in a census of the specialist digital health workforce, which is thought to have expanded massively since the COVID 19 pandemic. The Global Specialist Digital Health Workforce Census 2023 followed the first census in 2018, organised by health workforce researchers Kerryn Butler-Henderson, now at RMIT University, and the University of Melbourne’s Kathleen Gray. The 2018 census aimed to help identify workforce shortfalls and training and career pathways, and define who and what the health information workforce involved in Australia and New Zealand. A second, smaller census was conducted in 2021 to validate the data items and to offer it to the global sector. For the 2023 census, those job titles have been expanded to 21, adding in areas as diverse as biomedical engineering, digital health infrastructure, health cyber security, health AI, health interoperability, and health innovation. (Download the report here.)

In August, industry groups called for a national strategy to regulate the use of AI in the healthcare sector, emphasising risk mitigation as a primary concern but also warning against stifling innovation. The federal Department of Industry, Science and Resources issued a discussion paper on the safe and responsible use of AI in Australia in June, asking for guidance on how the government can mitigate any potential risks of AI while supporting safe and responsible AI practices. The Digital Health Cooperative Research Centre (DHCRC) backed the call for a unified approach to AI, reinforcing its support for the development of a national AI in healthcare strategy, which was first proposed by the Australian Alliance for Artificial Intelligence in Healthcare (AAAiH) and argued for a dedicated AI in healthcare roadmap that would provide a unified approach to the design, development, testing and delivery of AI. It proved a hot topic at the AI.Care conference in November, where a roadmap for AI in healthcare was released.

What turned out to be the most popular story of the year was our report from an Australian Association of Practice Management webinar on how patients and practices will register for the federal government’s new MyMedicare voluntary patient enrolment system, and how it will link to myGov and My Health Record. Patients who register with their regular general practice MyMedicare will have those details visible on their My Health Record as soon as they register. Patients were able to sign up to the new service through the Medicare section on myGov and to choose a practice and a lead GP from October 1. A recommendation of the Strengthening Medicare Taskforce, MyMedicare enrolees are eligible for longer telehealth consults, and from next year, their GP and practice for the general practice in aged care (GPAC) incentive.

Nine PHNs will be chosen for the first phase of the promised frequent hospital users element of MyMedicare, which will aim to connect frequent hospital users to a general practice to receive multidisciplinary care in the community to reduce re-admissions. The plan is to identify patients with chronic conditions who are attending hospital more than 10 times a year and work with their GP or connect them to a GP if they don’t have one. The general practice and lead GP will be eligible for new blended funding arrangements that may – or may not – include outcomes-based payments.

In September, a consortium including HL7 Australia officially launched Sparked, the new FHIR accelerator program that aims to deliver a core set of FHIR standards for use in Australian healthcare settings over the next two years. Sparked is being led by the CSIRO’s Australian eHealth Research Centre and will play a leading role in the development of the FHIR AU Core, which will support the use of FHIR in an Australian context. Other members of the consortium are the Department of Health and Aged Care (DoHAC) and the Australian Digital Health Agency (ADHA). Funding for the initiative was provided in the 2023 federal budget. Sparked will adopt the Australian FHIR community process (AFCP), a consensus-led approach that sees members of the FHIR community come together to develop national standards.

Primary care

Cloud-based EMR software vendor MediRecords piloted its brand new MediRecords 2.0 system this year, promising a completely new user experience along with a new patient engagement platform and a universal communications bar that will allow for SMS and email on demand. MediRecords 2.0 will also be able to support complex care, including inpatient admissions, charting, clinical escalations, progress notes and discharge summaries, which have in part been built for its big contract with the Department of Defence as part of the Leidos-led consortium building the new eHealth system replacement. MediRecords has moved beyond primary care this year and into the hospital and outpatients sectors with its ePrescribing solution for the Victorian Virtual ED service and the Northern Health mental health team. It also announced it was providing the new clinical record system for MQ Health outpatient clinics, where it will integrate with the hospital’s TrakCare electronic medical record.

Magentus’s Genie Solutions and pathology provider Sonic Healthcare unveiled their jointly developed interoperable eRequests solution in August, which is rolling out to Sonic’s Sullivan Nicolaides Pathology laboratories. eRequests is said to be the first open FHIR API standards solution in Australia that allows referring specialists to provide labs with all relevant patient information electronically, and patients to receive a digital version of their request. Development is also underway with fellow diagnostics giant Healius. The solution is built using a FHIR-based open API for greater interoperability and aims to enhance pathology requests and lab processes through real-time digital tracking.

Acute care

Northern Health’s is using algorithms for its Patient Watch program that may be able to predict the deterioration of complex patients living in the community up to seven days before hospital admission. The hope is to identify and support the two per cent of patients who generate a disproportionate percentage of costs because of frequent use of NH’s emergency department and admitted inpatient services. It uses a bespoke algorithm based on known factors for readmission, patients who are at risk of three or more admissions in the next 12 months based on administrative and routinely collected clinical data. Technology assistance for the project has come from Smart Health Solutions and Curve Tomorrow.

It was a big year for oncology information management solution Charm Evolution, which is part of the Magentus group. It kicked goals up and down the country with new implementations at Peninsula Health, South Metro in Perth, and the entire St John of God network. Last year, it was the first oncology solution to connect to the My Health Record for chemotherapy event summaries.

Melbourne’s Western Health went live with phase 2.1 of its Oracle Health (Cerner) electronic medical record, rolling out across intensive care, emergency departments and operating theatres at Williamstown, Footscray and Sunshine hospitals and Sunbury Day Hospital. Western Health first implemented four core modules of the Cerner Millennium EMR in 2018 including clinical documentation, medications management, and radiology and pathology ordering. It has since been planning a second phase roll-out to ED, perioperative and critical care, women’s and children’s, specialist clinics and cancer services. The implementation also includes a patient portal that will allow patients to see their appointments and some of the clinical documentation that is recorded about them.

Private hospital provider Ramsay Health Care is trialling a digital solution to provide patients with a single point of entry to the organisation and their specialists, including a pre-admission dashboard, digital consent capabilities and payment system. Ramsay also announced it is planning to build a centralised data hub to provide a single source of truth for patient data to record, store and analyse real-time data. The work is part of the first phase of Ramsay’s ambitious transformation and digital enablement program across its 70+ hospitals, which also includes signing on with Google Cloud as its data and innovation partner. This will include adopting Google Cloud’s artificial intelligence and machine learning tools. Ramsay also signed on with InfoMedix and TIMG to deliver InfoMedix’s Digital Patient Chart across its private hospitals nationwide as part of the 2030 digital strategy. While there is no official word yet, we hear an EMR is on the cards too.

Some of the largest hospitals in Queensland are planning to roll out Nuance’s Dragon Medical One (DMO) voice recognition system following a widely applauded pilot at Mackay Hospital and Health Service (HHS) in 2021, which saw the turnaround time for GP and specialist letters in the outpatient department reduced from 30-40 days to one day during the pilot. The solution has been integrated with the statewide Oracle (Cerner) ieMR as well as the MetaVision ICU system following the successful in Mackay Base Hospital’s emergency department.

The 400-bed Northern Hospital at Epping in north Melbourne went live with its new electronic medical record in October following a successful roll-out at Broadmeadows Hospital and Bundoora Centre. Northern Health first announced plans to implement the full Cerner stack, now known as Oracle Health, in 2020 with a view to a late 2022 roll out, but pushed the date back in September 2021 due to Covid disruptions. The EMR has replaced EDIS in the ED and is integrated with the health service’s iPM patient administration system from Dedalus, Northern Pathology’s Ultra system, the Visage radiology system and iPharmacy.

Aged care

In July, the Department of Health and Aged Care released round two of its grant program to assist residential aged care services to adopt electronic national residential medication chart (eNRMC) software. The first round of grants was released in June 2022 as a paid transitional program before fully conformant software rolls out. Grants of between $5000 and $20,000 per service are again on offer in round two for software programs listed on the Australian Digital Health Agency’s electronic prescribing conformance register. Transitional arrangements have been in place as the new national prescription delivery service (PDS) is rolled out.

ADHA released a second industry offer worth up to $200,000 each to aged care software vendors to help develop a new aged care transfer feature on the My Health Record. The ACTS feature will likely include links to a number of documents, including a residential care transfer reason document that can be uploaded from the residential aged care facility’s CIS with the aim of informing the receiving healthcare provider of the primary reason for transferring the resident and the transfer date. At the end of the year, we heard that a capability for the ACTS was released in My Health Record, and ADHA and the vendors were now working together to get each CIS up and running with the same capability.

Virtual care

PHNs continued their work with residential aged care facilities to upskill workforces for telehealth, as well as providing grants for equipment. Western Victoria PHN commissioned telehealth technology provider Visionflex to deploy its telehealth carts to residential aged care facilities in the region. The telehealth carts are equipped with Visionflex’s Vision video call platform and Bluetooth-enabled devices, and it allows clinicians and healthcare providers to monitor residents’ vital signs and manage imaging for wounds and skin ailments. The devices enable live monitoring of vital signs, and all data is saved for integration into practice management software. Visionflex is also being rolled out to 75 RACFs in Western Australia with the assistance of the WA Primary Health Alliance.

Allied health

The peak professional body for optometrists, Optometry Australia (OA), is building Australia’s first large-scale national optometry dataset using big data to identify eye health and practice trends. OA has developed software to extract a range of de-identified clinical information from optometry practice management systems Sunix and Optomate every six months. The data will be securely centralised into a national database owned and managed by OA. OA hopes to begin rolling out the software to practices nationwide this year following pilot trials. The dataset will be analysed nationally using clinical indicators focused on measuring common community diseases to reveal how and why people access optometry care, and track what occurs in individual consultations and outcomes.

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

SA Health signed a contract with healthcare software company Modeus to roll out its HS8 electronic controlled drug (eCD) register application across SA public hospital pharmacy sites. The project follows a similar statewide contract with WA Health’s Health Support Services to roll out it out across the WA hospital network.

The developers of the Clinimetrix practice intelligence platform added new practitioner payment tools, improved analytics and clinical insight to the system, which is being targeted at practices looking to sign up for the MyMedicare voluntary patient enrolment scheme. CMH Practice Management says Clinimetrix is able to identify patients who fit the criteria for MyMedicare or who have visited a hospital multiple times.

The Australian MedicAlert Foundation (MedicAlert) worked with the SA Ambulance Service (SAAS) to develop a digital solution using QR codes to give paramedics immediate access to personalised health records. The new QR code service is designed to provide health professionals with instant access to critical health records by scanning in the QR code, which is engraved on the bracelet or wristband or other wearable, on their mobile phone.

eHealth Queensland has issued a request for information on solutions to replace the Queensland Radiology Information System (QRiS), the foundation of which was first installed in 1999 using Cerner and Agfa technology. eHealth Queensland expects to go to market next year for the new RIS, and will also replace the state’s various picture archiving and communication systems (PACS) and a vendor neutral archive, which are also at the end of life.

Sydney Children’s Hospitals Network (SCHN) opened influenza vaccination clinics assisted by integrated technology from electronic referral vendor Consultmed and digital front door platform HotHealth. Consultmed’s referral system, which SCHN has been trialling since 2021, is being used to refer patients with special requirements to the clinics. Consultmed integrates with GP and allied health practice management systems.

St John of God Midland Public and Private hospitals in Perth rolled out modules in Telstra Health’s Kyra Flow platform, including electronic journey boards to provide staff with real-time patient journey updates from admission to discharge, and bed management dashboards within its operational command centre.

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