2022 represented a pivotal year in IT for the aged care sector as a number of recommendations of the Royal Commission into Aged Care Quality and Safety began to be realised and money became available to fund improvements in digital health for residential aged care. The annual ITAC conference covered a lot of this ground and was a highlight of the second half of the year in eHealth in Australia, and there was real progress in standardisation of aged care data requirements and software solutions. More developments in electronic medical records, big moves in electronic referrals and the continued roll out of virtual care systems also dominated the headlines.

July kicked off with the formal renaming of the Department of Health to the Department of Health and Aged Care to reflect the new government’s priorities for the department. Hopes were high that a new government would take a fresh look at funding for the health system overall as well as aged care. There was progress in new solutions for aged care as well, such as the LenexaCare pressure injury management system that assists clinicians and carers by providing targeted real-time monitoring for patient position, enabling personalised pressure injury prevention. Lenexa Medical hopes to roll out at least 1000 units of the technology in hospitals and aged care facilities over the next three years.

WA Health went to market to replace its Microsoft SharePoint solution for handling external referrals into its public hospitals with a new solution it is calling Smart Referrals WA (SRWA), which will see general practices, private specialists referring into public outpatient services and Aboriginal Medical Services use a contemporary, automated system. According to WA Health, while electronic referral forms are available through GP practice management systems, only about 26 per cent are sent via secure messaging. It wants to make the process more efficient through a contemporary, off the shelf solution that can be accessed by GPs through the most commonly used PMSs.

It turned out to be a pretty disastrous year for health insurer Medibank, but back in July it announced it had partnered with medical centre group Myhealth and telehealth provider Medinet to pilot a new telepsychology service to try to reduce waiting times for psychology consults. Medibank, which is an investor in the Myhealth Medical Group and announced an investment in Medinet in March, said it wanted to give people greater access, choice and control when it comes to mental healthcare. According to Medibank, the telepsych clinic will provide virtual consultations and a digital and phone concierge service to manage all aspects of the referral, booking and Medicare claims process. Patients still need to see a Myhealth GP in person to get a referral, however.

DoHAC announced it would begin a series of consultations from August on an aged care data strategy that will develop an overarching vision for the digital future of aged care and inform sector-wide digital investments to 2030.

The ITAC conference got underway in Sydney in July, with NSW Minister for Customer Service and Digital Government telling the conference that the NSW government was building a new patient app that will initially provide information in real time on emergency department waiting times and availability of hospital car parking. There are further plans to become a booking platform for outpatient services and to provide access to the patient’s health data, and to build an eReferral hub to act as an electronic dashboard for referrals and allow consumers to view and be notified of their outpatient appointments.

The Department of Health and Aged Care (DoHAC) told the conference it was planning to improve the platforms it uses for client and aged care provider management with two new Salesforce-based systems as part of its digital transformation program. It is also building a new business-to-government gateway to complement the one the Australian Digital Health Agency is developing for the My Health Record, and will replace the current National Approved Provider System (NAPS) identifier that DoHAC and Services Australia use for providers in relation to aged care.

DoHAC also announced it would begin a series of consultations from August on an aged care data strategy that will develop an overarching vision for the digital future of aged care and inform sector-wide digital investments to 2030. The department said it was also progressing work on a national minimum data set and an aged care data asset, working with the Australian Institute of Health and Welfare to deliver on data-related recommendations of the Royal Commission.

ADHA CEO Amanda Cattermole told the conference that there had been a significant increase in views and uploads to the My Health Record from consumers and healthcare providers since the pandemic struck, particularly in the last year as immunisation and pathology results began to be automatically added. Since June 2020, she said, documents uploaded to My Health Record increased by 37 per cent, and since June 2021, consumer views of the record have increased by nearly 300 per cent. The COVID effect was largely behind the increase as people accessed their records to check on their immunisation and pathology records. However, there was also an increase in clinician uploads and views as well, including cross-organisational views. Hospital staff are the most prolific viewers of My Health Record documents, with a 160 per cent increase over the last financial year. GPs increased their views by 120 per cent and specialists by over 400 per cent, albeit off a very low base.

The new system will use Salesforce Health Cloud, implemented in partnership with software integrator Mav3rik and MuleSoft’s integration platform.

Meanwhile, Salesforce notched up another win in digital health, winning a tender with Victoria’s Barwon Health to roll out a community health electronic medical record using Salesforce’s Health Cloud. The new solution will replace the legacy The Care Manager (TCM) clinical system, a patient administration system and paper-based processes in inpatient mental health services. The new system will use Salesforce Health Cloud, implemented in partnership with software integrator Mav3rik and MuleSoft’s integration platform. There are a number of integrations, including with University Hospital Geelong’s iPM patient administration system, BOSSnet digital medical record and Cerner FirstNet emergency department system. It will support the Hospital Admission Risk Program (HARP) and all community health services.

Salesforce has been making a name for itself in digital health predominantly for its vaccine management and booking system, which New Zealand adopted for its COVID-19 vaccine system and is keeping for its new National Immunisation Solution. Its booking app, Skedulo, was used by NZ and Western Australia, and New Zealand is also using its technology for its national breast, cervical and bowel cancer screening programs. Its CRM platform is also being used by the Australian Department of Health and Aged Care client and aged care provider management.

The newly elected federal government is running a user audit of the myGov system, as promised before the election. Minister for Government Services and the NDIS, Bill Shorten said the audit will take a fresh look at how well myGov is performing for the public when it comes to reliability and functionality for a user-friendly experience. He envisaged a myGov portal that unifies government digital services by making it more valuable for the jurisdictions and service providers to use myGov, and had particular ideas for health care, including using the system to notify GPs of a patient’s hospital admission and reminding users to book in for a cancer screen by interfacing with GP booking systems.

In August it appointed former Telstra CEO David Thodey to lead a panel overseeing the user audit, which links Australian residents to Medicare, the My Health Record, My Aged Care and the National Disability Insurance Scheme. Mr Shorten was able to announce the first consumer app for myGov in December, allowing international COVID-19 vaccination certificates to be added to its digital wallet, along with certain concession cards.

Meanwhile, the new government officially called a halt to the COVIDSafe contact tracing app amid claims the total cost has risen to over $21 million. The app, launched with much fanfare in early 2020, was only ever able to identify two positive cases and 17 close contacts that had not previously found by manual contact tracing. Health minister Mark Butler issued an order to decommission the app and wipe all of its data, saying it was a “wasteful and ineffective app” that had cost more than $21 million.

Accenture was originally awarded the contract to build and operate the then PCEHR in August 2011.

In August, consulting firm Accenture was awarded a $100m, three-year extension to its contract with the Australian Digital Health Agency to continue as the national infrastructure operator (NIO) for the My Health Record system. The contract is in addition to the initial eight-year contract thought to be worth over $500m, which was extended by $42.7m in 2019 for two years to June 2022. It will now be extended to 2025. Accenture was originally awarded the contract to build and operate the then PCEHR in August 2011, working with Oracle to manage patient records, Orion Health to build provider and consumer portals and Telstra to host the system. The contract was due to end in 2019 but was extended as the Australian Digital Health Agency established its national infrastructure modernisation program, which envisages a complete re-platforming of the system.

The first implementation of the Northern Territory’s $259 million, territory-wide electronic health record went live at the 60-bed Katherine Hospital in August. Now known as Acacia and built using InterSystems TrakCare software, the technology will be rolled out in all of the NT’s public hospitals, remote health centres and community care settings and is the biggest project of its type ever undertaken in the NT. It is replacing clinical information systems that have been in place for over 20 years, including an inpatient and outpatient clinical system, a clinical workstation, a primary care system used in remote clinics, and a community care system used for aged care, mental health, disability, sexual health, and alcohol and other drugs services. Originally dubbed the core clinical systems renewal program (CCSRP), it was hoped to be live for the opening of the Palmerston Regional Hospital in Darwin in 2018 but was subsequently changed to Katherine Hospital. The timeline was also hampered by the COVID-19 pandemic.

And in a major breakthrough in interoperability for the primary care sector, the developers behind the Cubiko medical practice intelligence system launched a new cloud-based interoperability platform called Halo Connect to provide a single integration point that allows health data to be accessed safely and securely in Best Practice Premier in real-time via a FHIR API. The new platform has been built with the financial assistance of Best Practice Software and will be made available to Best Practice Premier integrators through the Bp partner network. Best Practice says Halo Connect is the first cloud-based, FHIR-conformant API for Best Practice Premier and has been tested using the Cubiko data analytics platform. It is now going to roll out to provide a healthcare interoperability platform to all Best Practice approved integrators.

Primary care

The argy-bargy over MBS-funded telehealth in primary care continued under the new government, which signalled in July that it would allow GPs to claim long telephone consultations for Covid-19 antiviral prescribing but only temporarily. It had earlier decided to remove MBS items for phone consults lasting longer than 20 minutes. Minister for Health and Aged Care Mark Butler announced that temporary MBS items would be made available to cover a longer consultation by phone to ensure antivirals are safely prescribed by doctors and that patients start taking them within five days of symptoms, but the items are only temporary and are due to expire on October 31.

The Hunter New England Central Coast Primary Health Network (The PHN) was quick off the mark in delivering $1.6 million in digital health grants to local general practices, allied health practices and residential aged care facilities as part of its Health-e Together initiative. RACFs were also offered a telehealth specific grant featuring a $5000 telehealth bundle which included a specially developed telehealth trolley, which is being rolled out to 80 per cent of the facilities in the region. The grants also provide funding to improve digital health capabilities and enablers such as upgrades of websites, online booking systems, eReferral and ePrescription training and cyber security.

Acute care

Healthcare software solutions provider Dedalus brought out its amPHI electronic pre-hospital care record (ePCR) to the Australian and New Zealand markets in July. Dedalus Group owns the system’s developer, Denmark’s Amphi Systems, and has integrated its Clinical Suite EHR with Amphi’s technology. The amPHI suite is described as a complete electronic pre-hospital care record (ePCR) solution unifying communication across ambulances and paramedic vehicles, the dispatch centre, and the emergency department.

PowerHealth Solutions had a stellar year following its investment last year by Telstra Health. In May, it announced it would begin replacing 16 different billing systems used across Eastern Health with PowerHealth Solutions’ PowerBilling and Revenue Collection (PBRC) and integrate it with Eastern Health’s clinical rostering solution, while rolling out mobile functionality. It completed that project in November. In July, it won a contract with Alfred Health to upgrade to PowerHealth Solutions’ latest version of its web-based clinical costing solution PowerPerformance Manager.

ACT Health was in the midst of its hugely ambitious Digital Health Record project this year, successfully going live in November. In August, the ACT budget provided more than $50 million to support the implementation, which involves the $151m state-of-the-art Epic EMR as well as a new patient administration and laboratory information system. The extra funds were used to support the implementation of the Digital Health Record, including by ensuring frontline health service staff can undertake training while minimising service disruption. The budget also allocated funds to the ACT Ambulance Service (ACTAS), including additional funding for ongoing vehicle expenses, an updated fit-out to the communications centre, and modernised ICT infrastructure.

Aged care

The University of Melbourne’s Centre for Digital Transformation of Health launched the first part of its validitron project, going live with a digital sandbox to help design workflows for the new models of care that IT systems enable. It also officially launched the Melbourne Connect Sim Lab, offering an immersive, physical simulation laboratory to allow developers to test out those workflows using their technologies. The validitron is described as a simulated digital and physical health environment that encompasses the full range of clinical settings, from patient homes to acute and primary care, so that digital health innovations can be built, implemented, tested, adapted and clinically validated.

Data routinely captured in residential aged care facility electronic management systems can be used to quantify the types and rates of adverse incidents, a Macquarie University study showed. Three years’ worth of incident management report data was analysed from 72 RACFs in NSW and the ACT operated by a large not-for-profit provider, using de-identified records of 11,987 permanent residents. Demographic information was retrieved from Telstra Health’s clinical information and care management software package. The researchers said the study demonstrates that data already collected within electronic management systems can provide crucial baseline information about the risk levels that adverse incidents pose to older Australians living in RACFs.

The research consortium behind the Aged Care Data Compare project developed the first iteration of the Department of Health and Aged Care’s star rating system for residential aged care facilities, drawing on data that is already collected on a range of quality indicators as well as consumer experience reports and service accreditation. The consortium, led by the University of Queensland’s Centre for Health Services Research, the Aged Care Industry Information Technology Council and PriceWaterhouseCoopers, said the proposed Australian system drew on international star ratings such as those used in the US, but which potentially will provide more in-depth information. The first generation of star ratings has now been developed but in the next five years, the team will continue to work with the Department of Health to improve the data as well as the methodology behind it.

Pharmacy

Monash Health began a trial of a new pharmacist-led virtual clinic to help patients manage their medications. The Optimising One Medication with Patients (OOMPa) trial targets patients with chronic disease in managing their blood pressure, using a Bluetooth-linked blood pressure cuff that can send real-time data back to onsite Monash Health pharmacists. The data is collected on app on the patient’s phone and pharmacists can then adjust the dose of blood pressure medication virtually using a guideline-based protocol. Monash Health says the pilot is the first remote blood pressure monitoring device in Australia to automatically send data back to a tertiary specialist hospital to manage chronic liver disease.

ASX-listed medications adherence technology vendor MedAdvisor made an interesting move and bought GuildLink, the Pharmacy Guild of Australia’s eHealth arm, setting up a powerful combined player in the community pharmacy digital health sector. GuildLink has developed GuildCare, a cloud-based platform that integrates with more than 10 dispense software vendors and handles access to Community Pharmacy Agreement-funded professional services. It also provides the myPharmacyLink app for consumers, built on MedAdvisor’s technology, and is integrated with Healthdirect for vaccine bookings. MedAdvisor also made a move into New Zealand earlier in the year through a deal with Green Cross Health for its Unichem and Life pharmacies, comprising about 40 per cent of the NZ community pharmacy market.

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

• Researchers from the CSIRO’s Australian e-Health Research Centre (AEHRC) have harnessed Amazon Web Services’ RONIN research computing platform to develop a faster way to identify emerging new COVID-19 variants. The tool, known as VariantSpark, is able to analyse the DNA of the whole variant, rather than the current method of monitoring changes to the spike protein.
• Cloud-based practice management software vendor MediRecords is providing Northern Health’s Victorian Virtual Emergency Department (VVED) project with electronic prescription functionality. MediRecords will enable VVED doctors to send electronic prescriptions directly to patients or their carers, reducing paperwork and postage and transportation costs.
• Victoria’s Werribee Mercy Hospital has become the second health service in Victoria to implement the myBeepr clinical communication platform, following a major implementation at Western Health last year. Werribee Mercy decided to implement the system to reduce the reliance on LAN-paging for non-urgent communication, mitigate social media use at work and provide a unified method of communicating and sending clinical photos.
• Sydney Local Health District (SLHD) received funding from NSW Health to trial the Inca shared care planning system from Precedence Healthcare to try to improve communication between GPs, consumers and mental health services. Inca, formerly known as cdmNet, is a web-based chronic disease management and shared care planning system that is integrated with most general practice clinical and practice management software in Australia.
• Telstra Health picked up the contract for the EMR for the $140 million Sunshine Private Hospital in Melbourne’s west, which is due to open next year. Telstra Health will implement its Kyra Clinical electronic medical record at the hospital, which will open with a 30-bed medical and surgical ward and a 21-bed mental health unit, with plans to expand to 120 beds in future.
• Pharmacy software vendor Fred IT Group launched a new web-based hub called Fred Marketplace to allow pharmacies to identify and source apps approved and tested for use with Fred software. It has been designed to help pharmacies to identify tools that can support changing retail, business and technology needs in a cloud-based environment.
• Monash Health implemented the Baret role-based messaging solution first developed by Microsoft solutions specialist FiveP in association with Austin Health for clinical communication. Baret was launched last year and is built and delivered as an application within Microsoft Teams to enable closed-loop communications between frontline hospital staff.

Want to know what happened next? We’ll have part four of our 2022 Australian eHealth year in review tomorrow.