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The 2023 Australian Digital Health Year in Review: part two

13 December 2023
By Kate McDonald
Sydney LHD chief nursing and midwifery information officer Aaron Jones and nurse manager of skin integrity Michelle Barakat-Johnson. Image: Sydney LHD

Much of the second quarter of the Australian year in digital health was taken up with two big events on the horizon: the May federal budget, which when all totted up provided over $1 billion in funding for digital health over the next few years, including modernising the My Health Record, ongoing funding for ADHA, some nice bits and pieces for interoperability through the new FHIR accelerator, serious money for ePrescribing, and a renewal of the four-year intergovernmental agreement which saw money and commitments to shared digital health initiatives.

The second was preparations for the international MedInfo conference in July, which saw the world’s health informatics community gather in Sydney and where ADHA and DoHAC made some announcements on interoperability, sharing by default and the ramifications of the Strengthening Medicare Taskforce report, which have all guided decision making in 2023.

One of the biggest stories of 2022 concerned the poutrage over a joint investigation by the Nine newspapers and the ABC that claims complexity, mistakes, inadvertent overcharging and the odd bit of fraud were all costing Medicare $8 billion a year in wastage. The RACGP and AMA went to town on this at the time, claiming it was a slur on all GPs and they would all desert the profession in a huff. The main claim – that the Medicare claiming system was archaic and massively prone to error – was overlooked in the face of much tearing of hair and rending of garments.

In 2023, an independent review into Medicare compliance and integrity by Pradeep Philip found the $8b figure didn’t stack up, but that a more realistic figure of $3b in wastage and fraud was much more likely. Dr Philip recommended that the Medicare payments system needed a significant revamp along with the replacement of the ageing Medicare Common Assessment rules engine, which is now underway. The poutrage, meanwhile, has moved elsewhere.

WA Health’s $47 million enterprise medical imaging platform (EMIP) began its roll-out in April, going live at Rockingham and Murray District Hospitals. It then went live at Fremantle and Fiona Stanley hospitals, followed by King Edward Memorial, Osborne Park, Sir Charles Gairdner and Perth Children’s Hospital, and culminating at Royal Perth Hospital in November. The EMIP, consisting of a PACS from Intelerad, a Kestral RIS and a Canon vendor neutral archive (VNA), is the centrepiece of WA’s $127m medical imaging replacement program (MIRP), led by Health Support Services (HSS).

It was a major year for aged care data and digital, with big progress being made in modernising DoHAC’s aged care systems, including its new Government Provider Management System (GPMS), which first went live to handle the new aged care star rating system and a preview of which went live in April. The Aged Care Industry IT Council released a number of new reports into aged care digital maturity and the software systems used, and in April, the Digital Health CRC-funded Aged Care Data Compare (ACDC) project for standardising and sharing aged care data started a new project called ACDC Plus, trialing a FHIR-powered quality indicator app with aged care provider Regis and software vendor AutumnCare. The app is a prototype quality indicator application that may be used as a quality benchmarking and reporting solution for the residential aged care sector.

In May, a landmark federal budget was handed down which saw hundreds of millions put into digital health, including $429m over two years for the My Health Record, $325.7m for ADHA, $111.8m for ePrescribing, $139.9 million over four years for the aged care star rating system and $59.5m for ICT infrastructure for the national worker screening and registration scheme. Other funding in the budget included $126.8 million over four years to develop a national Health Information Exchange (HIE) architecture to enable the real-time data sharing between primary, acute and aged care settings, and $13.1 million was set aside for a two-year initiative to ensure the sharing of key information to the My Health Record system by default, beginning with pathology and diagnostic imaging reports. The budget would prove to be a major event as momentum built during the year towards a truly interoperable healthcare system. The full ramifications were discussed by DoHAC and ADHA officials at the MedInfo conference in July.

The day after the budget, Fred IT Group was named the winner of a contract to deliver the national electronic prescription delivery service (PDS) on behalf of the Department of Health and Aged Care. Funding of $111.8 million over four years and $24.2 million ongoing to provide electronic prescription delivery infrastructure and services was announced in the federal budget and followed the issuing of a tender for prescription exchange service providers by the department in March 2022 as part of its review of the electronic prescription ecosystem. DoHAC said the decision to choose one provider – which would ultimately kill off its rival, MediSecure – was in order to simplify the electronic prescription system and improve security. It will also allow the government to mandate the use of ePrescribing for high risk and high cost medicines subsidised under the PBS. The funding also includes money to cover the cost of sending eScript tokens by SMS.

The WA government allocated almost $100 million in the state budget to completing stage one of Western Australia’s electronic medical records (EMR) project, with an additional $8.2 million spent on its electronic referral management system and money already announced for its WA Virtual Emergency Department (WAVED) program. Continued funding of $24.4 million for the WACHS mental health emergency telehealth service was also a feature, along with $28.2 million to modernise WA Health’s network infrastructure and $11 million to provide higher overall cyber resilience across the health system. WA Health is currently rolling out its digital medical record (DMR) across all public hospitals and went live in a number of new sites this year as a precursor to the eventual purchase of the EMR.

Another big story for the year was the launch of the federal government’s MyMedicare voluntary patient enrolment scheme. The government announced it was aiming to go live with the first iteration of MyMedicare in October, with the scheme to ramp up over three years from next July to identify and connect with frequent hospital users. Almost $100 million over four years was announced in the budget for the frequent flyers scheme, which aims to connect frequent hospital users to a general practice to receive comprehensive, multidisciplinary care in the community to reduce re-admissions. MyMedicare system will also be integrated into practice management software.

There were a few interesting mergers and delistings for digital health companies this year. In June, ASX-listed Hills Ltd entered administration following the loss of a multi-year lawsuit over the proceeds of a 2014 contract for a patient infotainment system for the Western Sydney LHD. Hills’ health IT division Hills Health Solutions won the Federal Court case last year brought by Sydney-based Stellar Vision, but in May the Court of Appeal found in favour of Stellar. As Hills’ largest unsecured creditor, Stellar offered to buy the company in August, and it is now delisted and an affiliated company of Stellar Vision.

Meanwhile, Australian telemedicine provider My Emergency Doctor bought Hobart-based GP2U Telehealth for $3 million, taking it off the hands of struggling ASX-listed, UK-headquartered Doctor Care Anywhere, which bought GP2U for $11m less than two years ago. Also in June, ASX-listed conglomerate Wesfarmers announced it would buy digital health business InstantScripts for $135 million, adding the telehealth firm to the growing Wesfarmers Health division, which also owns several pharmacy groups. Wesfarmers Health was set up in March 2022 following the acquisition of Australian Pharmaceutical Industries (API), which owned the 470-strong Priceline Pharmacy banner group and 975 independent Soul Pattinson Chemist stores.

As the second quarter of the year drew to a close, the power of generative AI began to make its mark on the local health sector. ChatGPT for healthcare became the topic du jour, and was a feature of the MedInfo conference in July and the Australasian Institute of Digital Health’s AI.Care conference in November. Interoperability and AI would dominate the rest of the year.

Primary care

In March, medical specialist software vendor Genie Solutions and laboratory medicine giant Sonic Healthcare got together to develop a draft FHIR implementation guide (IG) for pathology and radiology ordering, which they hope will pave the way for a new FHIR specification to define how electronic orders (eOrders) are sent between healthcare providers in Australia. The two companies presented their draft IG at a connectathon hosted by HL7 Australia in Sydney in late March.

In April, Royal Flying Doctor Service (RFDS) Victoria went to market for an integrated electronic health record (EHR) as part of its new My Flying Doctor platform, looking for a single, commercially available system that will predominantly service the charity’s range of primary and allied health services. The new system will involve a single clinical record, patient administration system, unique patient identifier, telehealth, ePrescribing, eReferrals, secure messaging, industry data standards, and internal and external integration capability.

A new 24/7 nurse triage and advice service managed by Medibank’s Amplar Health that aims to provide a digital front door to healthcare across the NSW North Coast was rolled out in 2023. North Coast Health Connect includes a free 1800 phone number and live web chat for residents to speak with a registered nurse any time of the day or night, as well as access to appointments with doctors and pharmacists through an integrated booking system developed in association with HealthEngine and HotDoc. If needed, residents are connected with a local GP, pharmacist, hospital or a third-party telehealth provider for a 24-7 virtual care GP appointment. Participating general practices and pharmacies are asked to share the patient’s consultation record with their usual GP and to upload to My Health Record.

NSW Health announced it is expanding its Engage Outpatients digital referral management solution to most of its local health districts (LHDs), using HealthLink’s SmartForm and secure messaging technology and an electronic referral management system (eRMS) co-developed with eHealth NSW. The solution has been trialled by several LHDs over the last few years and will be available to GPs and medical specialists through HealthLink’s SmartForms and secure messaging, which are integrated into the Best Practice, Medical Director, Genie, Medtech, Zedmed and Shexie practice management systems.

Meanwhile, Tasmania completed the roll out of its statewide eReferral system to all four public hospitals as well as GPs, private medical specialists and allied health professionals. Tasmania began the project in 2020, led by the local PHN Primary Health Tasmania and using technology from HealthLink and Hobart firm Healthcare Software (HCS). It uses HealthLink’s SmartForms and HCS’s hospital referral management system, with centralised templates with mandatory fields and business rules that guide referrers to provide the requested information for the referral. The eReferral project is part of the Tasmanian government’s $475 million, 10-year Digital Health Transformation, which is aimed at delivering a new statewide fully integrated care platform.

And South Australia announced it would begin the first phases of its statewide electronic referrals project from August, initially implementing the system at metropolitan hospitals and the Riverland Mallee Coorong Local Health Network. The program will use the existing HealthLink platform that SA Health currently uses for secure messaging with GPs as well as a referral management system using the Salesforce platform that is used broadly across the Department of Health and Wellbeing.

Acute care

In advance of MedInfo, we had a great story on progress on Sydney Local Health District’s (LHD) plans to go live with a virtual wound care command centre, which is now being rolled out to rpavirtual’s virtual wound care centre after a successful trial at rpavirtual, along with Concord, Canterbury and Balmain hospitals, community nursing and some hospital in the home programs. Sydney LHD has been trialling Tissue Analytics’ artificial intelligence-powered wound care app for use in hospital and remotely, working with local distributor Virtualcare to integrate it into Sydney LHD’s Oracle Health (Cerner) electronic medical record.

The idea of command centres that can provide clinicians and managers will a full view of the status of all patients across all facilities in real time took off in 2023. One example was Alfred Health, which implemented three modules from Alcidion across its three hospitals, providing all wards and departments with an overview of upcoming patient volume, patient movements, bottlenecks and discharge barriers. The system is also used by Western Health, ACT Health and NT Health.

The new Victorian Heart Hospital (VHH) at the Monash Health campus at Clayton opened this year without traditional pagers, instead rolling out the Baret role-based messaging app developed by digital consulting service FiveP built using Microsoft Teams technology. Baret was first piloted at Monash Health last year and has also been trialled at Austin Health, where it has now successfully seen off more than 300 pagers and eliminated paging for urgent clinical reviews. Next up is task management, role-based chat groups and integration with Austin’s Oracle (Cerner) EMR, which will involve urgent clinical review messaging and significant results communications.

The new $140 million Sunshine Private Hospital in Melbourne went live with Telstra Health’s Kyra Clinical electronic medical record, along with MedicalDirector Clinical and MedicalDirector Bluechip in specialist consulting suites. The hospital, operated by Unitas Healthcare, is part of the Sunshine Health, Wellbeing and Education precinct that also includes the Sunshine Public Hospital, the new Joan Kirner Women’s and Children’s Hospital, and a $51 million health teaching and training campus. The doctors and specialists at Sunshine Private Hospital’s consulting suites are using MedicalDirector Clinical as the electronic health record and MedicalDirector Bluechip for practice management.

Aged care

A plain English guideline to the adoption and use of My Health Record in residential aged care facilities was released in May, providing concise information and guidance for RACFs on the appropriate use of the system. Developed by the Aged Care Industry Information Technology Council (ACIITC) in association with ADHA, the guidelines are aimed not just at those who are new to the system or need a refresher but to the wider use group, including clinicians and carers, technologists, senior management and owners, and admin staff. The guidelines are partly a result of 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.

Sixty RACFs in northern Sydney signed up to use a secure video consultation and remote vital signs monitoring system developed by local company Health Teams. The program is being funded through a $1.1 million funding package from the federal government and provided by the local PHN, Sydney North Health Network (SNHN), with 60 out of 103 RACFs already signed up. According to SNHN, the new RACF Virtual Care Service is intended to support non-urgent, routine and scheduled care for aged care residents with their healthcare providers. All PHNs have been funded to assist RACFs in their catchments with training for virtual care, along with money to invest in telehealth equipment.

Interoperability between My Health Record and the My Aged Care system came a little closer following the announcement of funding for the Australian Digital Health Agency to work on adding aged care assessments to the MyHR as part of the new measures for in-home aged care support in the 2023 federal budget. ADHA’s senior project manager for aged care Julie Khoury said work was expected to start in July next year on the project. In the meantime, the aged care transfer summary (ACTS) was in the technical delivery phase and was currently being worked on by vendor partners. It is hoped that will be finished by October this year, and would be accompanied by another industry offer to facilitate the implementation of the ACTS by vendors.

Faxed referrals to the My Aged Care system from GPs and community health services would finally come to an end in July in a long-awaited move by the Department of Health and Aged Care. Referrals by phone and through the My Aged Care website will continue, along with electronic referrals through practice management software. The department is encouraging the use of My Aged Care eReferrals, which use HealthLink’s SmartForm technology and are integrated into Best Practice, Genie, MedicalDirector, Medtech Evolution, Shexie and Zedmed.

Virtual care

Virtual care also continued to expand on its virtual boundaries, with WA Health investing heavily in a number of initiatives to help reduce unnecessary visits to the ED and alleviate bed block. The WA Virtual ED (WAVED) pilot was extended to community and aged care and a new State Health Operations Centre (SHOC) established to improve monitoring and coordination of emergency care. The WA Department of Health has been trialling the WA Virtual ED through three different pilots that it plans to bring together through a single entry point with a centralised ICT platform.

The researchers behind an electronic referral service that enables GPs to receive specialist advice about patients via secure messaging hope the program will extend to more rural and remote areas throughout Queensland by the year’s end. The program allows GPs to tap into specialist advice from remote Mater Health specialists through an asynchronous secure messaging system. GPs can send a request for advice, consisting of a clinical summary with specific clinical questions, and receive a response within three days by secure messaging platform Medical Objects. Trials showed that patients could avoid a face-to-face outpatient visit in 87 per cent of cases. Study lead Claire Jackson said the approach doesn’t involve a doctor to doctor synchronous connection because finding a time for both GP and specialist to be available is difficult. Instead, the asynchronous option allows doctors to reply in their clinical downtime.

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

Specialist practice management software vendor Genie Solutions worked with practice intelligence platform developer Cubiko to launch Insights powered by Cubiko, a practice analytics tool that presents practice data in easy-to-understand dashboards to view and interpret practice financials and overall performance. Insights is the first Genie Solutions product to launch on its interoperability platform, which is supported by HL7 FHIR’s open standards for the exchange of healthcare data.

Digital patient education specialist Healthily launched a new conversational voice AI solution called GoShare Voice that enables outbound and inbound phone calls with patients in multiple languages to provide information, surveys and patient support. Healthily is working with Western Sydney Local Health District (WSLHD) to use the technology to develop online and voice AI surveys to screen and identify people in western Sydney with Long COVID and provide support to those with ongoing symptoms.

Telstra Health launched what it says is Australia’s first FHIR-native virtual care solution, aimed at hospital in the home, rehab in the home, remote chronic disease management and palliative care programs. Branded as the Telstra Health Virtual Health Platform, it is an evolution of Telstra Health’s existing virtual health monitoring capability which is used around the country, including for SA Health’s My Hospital Home program. Telstra Health has added patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs) capability, and patients can also view their active or previous care pathway activities, including results of completed activities, through a patient portal.

Clinical communications specialist Foxo has launched a new app integrated with Microsoft Teams that will allow healthcare organisations to seamlessly connect patients with their network of referrers and external providers on an enterprise level. The app enables task and role-based communication for healthcare providers within Teams but also leverages Foxo’s capabilities to use SMS and email-based communication with patients to allow them to communicate with their healthcare team without a Foxo or Microsoft account.

The AI-powered advance warning system for patient deterioration developed at the Sydney Adventist Hospital to improve on NSW Health’s Between the Flags program has been shown to cut preventable deaths and the length of time patients have to stay in hospital. Known as the Ainsoff Deterioration Index (ADI), the technology was developed by two doctors at the San as a smart, trend-based early warning score that can be integrated with a hospital’s electronic medical record to effectively predict patient deterioration.

GPs are able to view their patients’ active script lists in the next release of the Bp Premier practice management system, which will also feature conformance with the new national prescription delivery service (PDS). Bp Premier Orchid Service Pack 1 (SP1) allows prescribers to view their patients’ active script lists, known as MySL, and are aimed at patients with multiple prescriptions who may find it difficult to manage their scripts, especially if they are receiving electronic prescriptions with repeats.

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