ANZ News

With many real-world problems still present in Australian healthcare, the time for change in healthcare is now, according to Australian Digital Health Agency Chief Executive Tim Kelsey. Speaking at the recent AFR Healthcare Summit, Kelsey said the industry must make take the action needed to improve access to digital health instead of disrupting it. “Delivering on digital health is not easy, there are many challenges ahead of us. The reality is, the world of fax machines is not safe and does not empower us to take more control of our health environment. A world of fax machines is not a world for precision medicines,” he said. “The time for action is now. We’ve got the mandate and we have the strategy. We just need to get the digital basics right and quickly.”  A key issue, Kelsey said, was the need for secure digital messaging.  “So far, secure digital messaging has had interoperability issues. But now, we have industry agreements in place to share information securely. That now will be the basis in which secure messaging will be an important step forward,” he said.  Kelsey said this is the result of a new digital health strategy that the federal and state governments committed to 18 months ago in the aim to deliver safe, evolving healthcare and the creation of modern healthcare in Australia. Last year, the governments inked a new four-year inter-governmental agreement to oversee this delivery. The strategy identified seven key priorities, of which providing registered clinicians with the ability to securely communicate with each other without resorting to paper or fax machines by the end of this year is one of them.   “By 2022, providers in Australia will have connected all their care services so that clinicians in and out of hospitals have access to the right patient at the right time.” Another key part of the strategy, according to Kelsey, is the My Health Record (MHR). “A recent report identified, quite astonishingly, that in today’s high-quality healthcare in Australia, that 1.2 million Australians will have experienced an adverse medication event in the last six months. 250,000 hospital patients are seen each year because of medications misadventure. A key cause is the absence of real-time medical records at the point of care – a key benefit of MHR,” he said. According to Kelsey, more than 50 per cent of pharmacies are now uploading to MHR – an “enormous shift” from the start of the year. “What this means is comprehensive coverage. A GP will have the most up-to-date information currently available on the patient and in that way, we will reduce the number of accidental misdiagnoses,” he said. [Read more: The Australian health system “will fail” if the pace of change is not met: KPMG | CSIRO lays out action plan for Australia’s digital health future] he next step for MHR, Kelsey said, is to work closely with the specialist communities and aged care to build connections.  “Recent PSA research found that over half of residents in an aged care facility in Australia are exposed to at least one potentially inappropriate medication. Technology can be a very strong support to reduce those instances,” he said.  “And the MHR provides those rights to citizens to decide with whom they share their data and at what time.”

NBN Co needs to do more in the delivery of broadband services to the bush, especially as broadband shortfalls still massively limit the care rural patients receive, according to the Royal Flying Doctor Service of Australia CEO Dr Martin Laverty. Laverty told HITNA that whilst NBN Co and other platforms have broadband access in the bush and serve some areas, they “simply don't serve everywhere”. “The perception is that, because we've got NBN, it works everywhere. You can’t just tie two tin cans together with a bit of string. Even satellite connections to the NBN are not yet reliable enough for our clinicians to have confidence in supervising patients or supervising other clinicians in the field from a base location,” he said. As the Royal Flying Doctor Service of Australia (RFDS) provides emergency and primary health care services for those living in rural, remote and regional areas of Australia, Laverty said a clinical-grade reliability of broadband is necessary for the organisation to properly utilise telehealth around the nation. RFDS currently uses broadband where available in country Australia for delivering telehealth, managing patient records and keeping medical teams in contact with patients, hospitals, and back-to-base operations. “There’s a difference between consumer and clinical-grade. For Netflix, for example, if it’s interrupted, it's inconvenient. But if a surgical procedure is interrupted, it's life or death. We haven't achieved clinical-grade, even if we've got patchy consumer-grade broadband access across remote areas today,” Laverty said. “In remote Australia, it's not even possible to have a fully functional electronic medical record (EMR) when you don't have a fully functional broadband system. “We’ve got a Band-aid around our EMR at present. We download records, we fly them out to location and manage them there. They're manually uploaded when we get back because that’s when we get access to broadband and cloud systems. If the pipe doesn't work between city and bush, you don't have information flowing through it, therefore, you don't have a functional EMR,” he said. In 2017, RFDS and NBN Co inked a partnership to have 300 of its remote area clinics and 24 RFDS bases, which previously had limited internet connectivity, benefit from broadband supplied by Sky Muster satellites. In addition, 14 remote RFDS clinics were expected to use telehealth services as a result of this partnership, allowing patients to video conference with RFDS’ clinicians. However, the demand for remote services is high, with an RFDS report identifying that one in six remote patients are waiting at least two days to see a doctor for urgent medical care. “We’re a healthcare organisation, not a broadband provider. We just want it to work. We don't have the tech expertise to be specific about what we need. We just know it doesn't work today, and we're looking to the suppliers to deliver it soon,” Laverty said. [Read more: Federal Government Budget sweetener to boost Flying Doctors services and new mental health outreach | EMRs and the Royal Flying Doctor Service – how the iconic institution approaches innovation] According to Laverty, the next layers of development in broadband delivery will solve the clinical-grade reliability challenge that currently exists with the existing satellite and mobile reach of broadband connectivity. “We're heading in that direction and when NBN gets there, it changes the dynamic, particularly as artificial intelligence is likely to jump ahead and make telehealth even more customer-responsive. But you've got to have the nuts and bolts in place – the broadband has got to work before you can even think about a greater reliance on telehealth,” he said. “With the last few hundred miles' connectivity issue, we’ll be able to deliver the pipe into remote areas. The worst thing we could do would be to invest in the hardware or the training of clinicians and patients and for the pipe to continue to be too thin or incomplete because we wouldn't be delivering the point-of-care health outcomes.” Laverty also said that only with NBN efficiencies and upgrades is the RFDS able to deliver on some of its future goals. “When the pipe is fixed, we'll add more to [our services]. We've had a telehealth infrastructure that has evolved over 90 years, and it's going to continue to evolve as the capacity of broadband doing more is proven,” he said. “Our barrier to future expansion is broadband reliability in remote areas at a clinical-grade level. And when it gets to that level, we will have less reliance on telephone. And as we shift to broadband, we're able to put more share of diagnostic information from patient to clinician, making RFDS more reliable. “Today, we can't do that because we can't trust broadband to be at this efficient bandwidth 24 hours a day. When it gets to that, we will invest more and be able to deliver more,” he added. An NBN Co spokesperson told HITNA that the company is "committed to regional and remote Australia and helping to ensure the NBN network enables social and economic prosperity" in these regions. "Our team is currently working with retailers to launch a new business-grade satellite service, which will be available later this year. The service is designed for businesses with complex networking requirements including wide-area network connections to multiple locations and those requiring more broadband data, higher speeds and business-grade service levels," the spokesperson said. 

Australian homes currently have an average of 17 connected devices, including smartphones, tablets, watches, TVs, wearable devices and even connected fridges. And with Schneider Electric Smart Home Spaces Director Ben Green predicting that this number is going to rise to 37 connected devices per household by 2021, the potential of these devices is huge. While the majority of these devices are currently used for safety – such as security systems, energy monitoring or comfort management like blinds, lighting and heating – we are slowly seeing a rise in connected health devices enter the home, either as direct clinical tools such as blood pressure cuffs, or secondary use devices that collect data and provide better insights into a patient’s activities and needs. In addition, the proliferating number of mobile health apps in the market supports future potential. In 2017 alone, there were more than 325,000 mobile health apps available, with that number set to rise. Patients use these mobile health apps to understand and manage their health needs, be it for their general wellness or managing specific diseases, or for operational purposes such as managing their health insurance or provider specific services. Clinicians are also increasingly looking to use these applications to support clinical care delivery or general work process efficiencies. As such, it’s becoming an increasingly crowded marketplace to attract and retain the attention of potential customers and investors. The commercial players who have long been exposed to the market forces of changing consumer demands and expectations understand the value of strong design. To stand out, as well as deliver a great product or service and a smooth experience for users requires commitment and use of design. THE CHALLENGE Many health organisations and senior leaders within healthcare still think of design as the ‘colouring-in’ department – a nice to have if they’ve got some extra money. Yet it’s prevalent, in an increasingly competitive commercial space, that the organisations that prioritise and include design from the outset emerge as the leaders. In Australia, when speaking to stakeholders across the sector, sentiments that the healthcare industry struggles to translate health and medical research output into commercially viable, scalable and usable solutions still exist. There are, of course, some brilliant exceptions. Companies such as Blamey Saunders, ResMed, Attend Anywhere, DoseMe and Seer Medical have led the way. While we have seen the emergence of many incubators and startup hubs, only one, ANDHealth, has developed specific programs that enable digital health innovators to create commercially scalable, successful companies on a global level. Collaborative research centres (CRCs), innovation hubs and accelerators have also been a core part of the innovation landscape in Australia, as they partner industry with academia to encourage the translation of research into commercially viable, scalable solutions. But even then, the role of design in enabling innovation is yet to be fully realised. Many research grant recipients face challenges when trying to incorporate design into the planning and development of their activities. In many cases, the grant stipulates that funds cannot be spent on design or commercial advice and support services. This leads to poorly designed and difficult to use products and services being developed and used in trials or other research initiatives. This may create a number of risks not only for the insights generated by the trial, but also in the ability to translate the research into market ready solutions. Many are also aware of the 1:10:100 rule in terms of costs escalating – that $1 spent on prevention will save $10 on correction and $100 on failure costs. This applies to the chain in healthcare. As one moves along the stream of events, from design to delivery, the cost of errors escalate and failure costs becomes greater. BENEFITS AND WHAT'S REQUIRED TO SUCCEED? Design can and should be a key part of fuelling the future innovation economy, from ideation and research, all the way through to implementation and growth. There is significant evidence supporting the investment of good usability and design. Some benefits include: increased sales, a decrease in user error, task times and training times, and reduced development, maintenance and support costs. Research pilots can achieve success in the open market, but these institutions will often need to seek investment, gain customers and provide a usable, efficient and effective solution for the end user. For this, design is essential. The World Economic Forum, in its Future of Jobs Report, identified creativity as one of the top three skills workers will need in 2020. Creativity was ranked number 10 on the list in 2015. As such, with the avalanche of new products, new technologies and new ways of working, the healthcare industry is going to have to become more creative in order to benefit from these changes.   To explore this area of discussion further, digital health strategy, design and innovation agency, codesain, will be hosting a panel as part of the Sydney Design Festival on March 5 at the George Institute in Sydney from 4pm to 7pm.   Rachel de Sain is the CEO and lead advisor of codesain and was previously the Executive General Manager of Innovation and Development at the Australian Digital Health Agency.

One of Australia's largest juvenile justice departments will soon streamline its health services under a single Electronic Medical Record. Justice Health Victoria is working towards implementing Global Health’s MasterCare Electronic Medical Record (EMR) in the support of clinical workflows across mental health, primary care, and alcohol and other drug services in its centres. Specifically, MasterCare EMR will be used by Justice Health clinicians to handle clients’ medical assessments and management plans, along with the monitoring and measuring of on-going service activity outcomes. MasterCare EMR comprises of an EMR and practice management solution with integration to MasterCare Data Warehouse for data analytics and ReferralNet for the secure exchange of clinical documents with external colleagues. According to a spokesperson for the Department of Justice and Community Safety, Justice Health Victoria had multiple programs in place for its youth justice system, which all needed to be streamlined into one platform. “This will ensure continuity in the healthcare services provided to young people in custody. Electronic medical records within the adult prison system are [and will continue to be] managed by Intrahealth,” the spokesperson told HITNA. The initial deployment will see the Department of Justice and Community Safety business unit roll out the Global Health solution for these three service divisions across Melbourne. This includes Malmsbury, Parkville and other community outlets around Melbourne across the youth justice sector. The Department of Justice and Community Safety spokesperson said the partnership came off the back of the Victorian Government’s $18.72 million investment for additional doctors, nurses and clinical staff to administer medication, as well as for extra allied health services. [Read more: SA Health to overhaul EPAS | Bass Coast Health integrates clinical and administrative system using MasterCare EMR] MasterCare EMR Product Manager Kye Cherian said the agreement will run for a minimum term of three years, with two further extension options. “It’s important to note that our project with Justice Health does not end here. Global Health and Justice Health are committed to continuing the partnership in order to further improve client care and data capture to support the continued improvement of Youth Justice Health services in Victoria,” Cherian said. Bass Coast Health also most recently equipped its healthcare facility with MasterCare EMR. Following rollout, the solution will be used by its clinicians to govern the assessment and management plans of clients, along with the monitoring and measuring of ongoing outcomes.

Australia is in an unprecedented period of technology innovation where data, analytics and artificial intelligence (AI) is impacting all sectors including the life sciences industry. AI is defined as the broad field of new technologies that enable software to sense, comprehend, act and learn. It is disrupting how life science organisations operate and compete, while also accelerating the delivery of business outcomes in the ‘as-a-service’ economy. Analyst firm IDC has predicted that the worldwide content analytics, discovery and cognitive systems software market will more than double from US$4.5 billion in 2014 to US$9.2 billion in 2019. And using AI on the commercial side of the business offers tremendous opportunities. In a recent Accenture survey, more than 90 per cent of life sciences’ executives recognised AI as important in driving innovation and achieving outcomes, such as hyper-personalised experiences, new sources of growth and new levels of efficiency. So, what kind of use cases might arise? Accenture’s experience in AI shows just how broad the possibilities are with examples in commercial, marketing and sales operations as well as patient engagement: SPEEDING UP COMMERCIAL OPERATIONS By including AI as part of commercial operations, companies can automate processes that are repetitive and time consuming for staff. This could result in an increase in the overall process efficiency of the organisation. Accenture’s experience shows that Robotic Process Automation (RPA) can increase work efficiency by 20 per cent and increase accuracy by 40 per cent. For example, Medical Legal Regulatory (MLR) Review Automation uses RPA and machine learning to screen all MLR submissions in the identification and alerts of compliance issues before they reach reviewers. This is made possible by the AI algorithm which can scan materials, identify possible gaps based on a checklist and make pre-approval recommendations based on precedents. The benefits of using this technology is significant, as it notably speeds up the time to market and improves consistency because the process minimises human error whilst increasing the MLR reviewer’s capacity. OPTIMISING MARKETING CAMPAIGNS Perhaps the most mature use case of machine learning is the ability to leverage data science to create more personalised interactions with customers. Today, applications can predict the next best channel, message and timing for customer engagement. AI has the ability to bring together data from across business units using technologies that automate tasks associated with traditional marketing activities. This allows marketers to concentrate on higher order tasks such as developing a creative campaign, resulting in direct benefits such as improved customer satisfaction, retention and more sales. Life sciences organisations also invest a significant amount in marketing promotions. Through AI, organisations can generate useful customer insights to ensure these efforts are highly targeted and generate ROI. HELPING SALES REPS BECOME TRUSTED ADVISORS The key to a company's’ sales success is building trusted relationships with the right prescribing doctors; so, having access to the right data can make all the difference. Data such as the doctor’s prescribing habits, demographics of the area they serve, managed care impact on the drug they are selling and new treatments that are available is very valuable. Most importantly, AI enables the pharmaceutical sales representative to provide personalised recommendations to the doctor. AI could enable sales reps to have greater insights into the prescribing doctors’ profiles and provide the right drug information including benefits, safety and side effects. The technology could also make real-time content recommendations for a sales representative, tailored to where they are in the sales cycle, and greatly improve their chances of a successful outcome. ENGAGING MORE PATIENTS One of the biggest challenges healthcare practitioners face today is in the area of patient compliance, particularly in the case of chronic conditions. Research has shown that during treatment of chronic illnesses, approximately 50 per cent of patients fail to comply with their doctors’ long-term therapy recommendations. Being able to improve patient engagement is an important area of focus for life sciences companies and one where technologies such as AI play a key role. AI, when embedded in wearable devices, smartphones and tablets can be highly effective at keeping patients on track with their treatment pathway. Intuitive apps empower patients to self-manage their medication regimens and appointment schedules from their mobile or tablet devices. When connected to cloud-based platforms, these technologies allow doctors and pharmacists to communicate with these patients to clarify their understanding of conditions, complex drug regimens and potential side effects. For example, medical device company, Medtronic recently launched Sugar.IQ, a personal diabetes assistant exclusively available to Guardian Connect CGM customers on insulin injections. The mobile app leverages the power of AI along with Medtronic’s diabetes knowledge. The app provides real-time information to the patient, helping them monitor their glucose levels and know when and how much insulin to use. Another example is HealthTap, a World Economic Forum Technology Pioneer. It launched Dr. A.I., a personal AI-powered chatbot which operates like a ‘doctor’, translating a person’s symptoms into personalised, doctor-recommended courses of action. Dr A.I. leverages HealthTap’s repository of data and doctor knowledge and, applies complex algorithms to shape clinical expertise and inform patients to the level of doctor recommended care. KEY SUCCESS FACTORS The best way to capitalise on AI’s potential is to start small, with highly targeted use-cases. Here are some guiding principles to consider:  Treat AI as a co-worker, collaborator, trusted advisor and enabler of rapid response to patients’ and the healthcare ecosystem’s needs Ensure you have the appropriate budget and a task force to support AI development  Accept that failure is an option Have enough data to draw conclusions or generate recommendations Know what questions you would like your computer model to answer and what the next steps are once you know the answers.  If companies’ leverage the value of AI, they could propel themselves into a new level of efficiency, revenue making, customer personalisation and patient outcomes. Those that do not take on board these new technologies are at risk of being left behind, which may have profound effects on their business. Dhannu Daniel is Accenture’s ANZ Life Sciences Lead.

Faxes have been used to send documents over phone lines since the mid ‘60s, and while many medical practices have changed since then, the fax continues on with many health systems still depending heavily on the technology.  The healthcare industry has begun understanding that fax can present a clinical risk when dealing with sensitive patient information as the faxed content can be misplaced or fall into the wrong hands. Hence, replacing outdated fax machines with secure messaging systems has been a focus for some in the Australian healthcare industry as information sent via the latter is sent directly to the receiver. But there is still resistance in the uptake of secure messaging even though there is a proliferation of medical referrals in the industry, requiring the use of secure messaging systems. The Australian Journal of Medical Practice recently found that in 2014-15 alone, general practitioners made 15.9 referrals per 100 patient encounters, sending 9.7 million more referrals than in 2005-06, highlighting the scale of exposure to risk. In addition, a Microsoft report in collaboration with Harvard Business Review Analytic Services, Embracing the Change Mandate: The 2020 Digital Transformation Agenda for Australia’s Health Care Sector, studied how a digitally augmented system could improve Australian healthcare and barriers to change. The report found that 44 per cent of respondents said one of the top barriers to digital transformation was resistance to change. As such, eradicating faxes in healthcare has been a key focus for the Australian Digital Health Agency (ADHA), with the statutory authority extending its its Secure Messaging Program across the industry over the last three years.  The Secure Messaging Program aims to help healthcare providers across Australia communicate quickly, easily and securely, and to reduce the sector’s current reliance on outdated technologies like the fax machine. But even though a number of vendors do offer secure digital messaging services, interoperability issues and the lack of a universal format have resulted in hospitals like Ipswich Hospital, GPs and specialists still continuing to send referrals and discharge summaries using fax. Late last year, a panel of speakers at the Wild Health Summit in Sydney stressed the importance of digital change, but supported the use of the fax machine, saying that the industry is still in its infancy in eradicating it and that its usage could still benefit some players in the sphere.   “We are quite conservative in healthcare. To rid the fax machine in a bigger network, we’re not there yet. There’s still a long way to go to have secure messaging systems rolled out and working efficiently in larger hospital settings,” UnitingCare St Stephen Hospital General Manager and Director of Clinical Services Darren Rogers said during the discussion. “It’s hard to change a system that works a great deal of the time but a unified approach is needed for improving the quality and delivery of care.” VIEWS OF THE INDUSTRY The Royal Australian College of General Practitioners (RACGP) President Dr Harry Nespolon told HITNA that while some providers are using secure electronic communications more frequently, faxes are still required to communicate with parts of the healthcare sector that do not use electronic communications.  “For many years, the healthcare industry has been heavily dependent on paper, so moving away from paper and fax is a significant change,” he said.  “The majority of health services and government agencies communicating with general practice do not currently use electronic communication systems that are compatible with those existing in general practice, so the fax machine is currently as sophisticated as it gets with electronic messaging.” [Read more: “Living in the dark ages”: NHS hospital trust launches ‘Axe the Fax’ campaign | UK’s Royal College of Surgeons calls out the NHS reliance on “archaic” fax machines] Dr Nespolon added that there are technical challenges in searching for healthcare providers to communicate with and creating a solution for interoperability that supports communication across healthcare providers. “General practices are often required to manually transfer information from their clinical or administrative systems into paper-based or online forms. This information is then sent to the relevant agency via an online upload, by post, fax, or via standard and unsecured email. Information leaving general practice through these methods requires significant manual processing,” he said.  “Most organisations fail to consider the implications and costs for general practices to manage information transfers safely, reliably and efficiently. The inefficiencies of current processes creates a heavy burden on GPs, diverting their time away from providing essential medical care for patients.”   According to Dr Nespolon, there needs to be broader support to adopt and implement secure messaging across the healthcare industry to make it a success. “Faxed reports which are scanned into clinical records and saved as an image are not easily searchable. Standard and unsecured email is not considered suitable for routine communication between healthcare providers and patients due to inadequate privacy and security features, and because the content of these messages has to be copied and manually transferred,” he said.  “Information manually obtained from web portals presents similar issues. Documents received by general practice provide the most clinical value when they can be searched and interrogated by general practice clinical software.” UPDATE ON THE SECURE MESSAGING PROGRAM The ADHA is aiming to alleviate the problems associated with secure messaging systems.  Towards the end of last year, it held a workshop in Sydney for more than 50 State and Federal Government officials, industry stakeholders and international experts, to discuss the future of secure messaging and interoperability across the Australian health sector. The workshop also saw the Medical Software Industry Association and ADHA ink a communique, committing to further collaboration on the adoption and implementation of secure messaging. ADHA Chief Operating Officer Bettina McMahon said the deal was made to “implement a nationwide [secure messaging] solution that embraces existing solutions and unifies them seamlessly”. [Read more: Victorian man dies alone after test results faxed to wrong number – coroner slams use of “antiquated” tech | RIP the fax: Successful secure messaging trials solve final problems heralding fax-free future for healthcare, ADHA says] “Secure messaging is a foundational capability enabling interoperability and safe, seamless, and secure information sharing between healthcare providers,” she said. “Nationwide adoption of secure messaging will enhance the security, safety and efficiency of clinical information sharing across all sectors – ultimately aiding the provision of better healthcare for the community. “To realise this goal… the ADHA is working collaboratively with industry, suppliers of secure messaging solutions and clinical software vendors to reduce existing barriers to adoption and to provide pragmatic and implementable solutions.” A key priority for the ADHA, moving forward, is the creation of a transparent, national directory of service providers – the equivalent of a national ‘yellow pages’ for all registered healthcare providers – that can be used for securing messaging, enabling healthcare personnel to easily contact each other.  The agency is targeting to deliver a “minimum viable product” by June. “We will continue to work together collaboratively to strengthen and develop secure messaging and interoperability within the healthcare landscape, for the benefit of all Australians,” McMahon added.  The ADHA has also started working with HealthLink, Telstra and a range of healthcare providers in the development of solutions that allow secure messaging between healthcare providers with different clinical information systems messaging vendors, in a way that can be scaled nationally. STEPS THAT NEED TO BE TAKEN Global Health National Sales and Marketing Manager Deborah Hudson said with healthcare professionals and organisations just starting to scratch the surface of moving to a paperless system, the industry as a whole needs to come together to push for change.  “Although faxing has worked for some time, healthcare professionals are coming to the consensus that as an industry, we have outgrown the fax machine and its limited capabilities; there is a clear need to move forward and secure messaging is the answer,” Hudson said.  “As an industry we are all working towards the same goal. There are ongoing projects and working groups involving several different secure messaging vendors and clinical system vendors, all aiming to address interoperability challenges.” Hudson said the integration of secure messaging was an initiative that needed to be directed by a collaboration between government and industry. “The government has set national standards for health organisations and the industry as a whole will facilitate this. Like any industry, the healthcare industry will grow and adapt as technology improves.” The next step, Hudson said, is industry working with clinical and practice management system providers to achieve better integration in exchanging clinical information.  “There are two main challenges we still face. Firstly, the need for all secure messaging vendors to be able to exchange messages between each other, such as the interoperability that now exists between ReferralNet and Argus,” she said.  “Secondly the seamless integration with other health software vendors’ clinical and practice management systems. As an industry, we need to work on these challenges in collaboration with the ADHA.” Hudson said for the benefits of secure messaging to be fully realised in future, there needs to be in place a system that connects all health organisations and practitioners, allowing for the effective flow of information throughout the system, which then improves the overall patient journey and experience. “With the support of governing bodies such as the ADHA and the RACGP we hope to be fax free by 2025,” she said.  “Secure messaging is growing quickly and organisations are seeing real benefits. As the volume of information exchanged and organisations using secure messaging grows we expect to see others adapting to the change quickly.”

There’s little debating that healthcare and technology are at an interesting intersection right now. So many big ideas, so much promise. But wide-scale transformation doesn’t just happen. “All the ideas need doers, those who enable action to shift ideas to execution,” Google Cloud Director of Global Health Solutions Aashima Gupta said at the HIMSS19 Cloud Computing Forum. Three such doers also took the stage to offer a glimpse of how they are using cloud computing today and hints about the future: NewYork-Presbyterian, Mercy and Humana. “By 2022, we’re expecting to move the majority of our applications and infrastructure to the cloud, leaving just 20 percent on-premises,” Vice-President for Analytics and Clinical Systems at NYP, David Vawdrey, said. It’s not merely embracing the cloud for cloud’s sake. Vawdrey said it’s to improve patient experience, make the hardest parts of tech invisible to users and equip them with patient-facing technologies such as virtual visits. “Imagine you are asking financial advice. You call the 1-800 number, and Warren Buffett answers the phone,” Vawdrey said. “This is the vision we’re trying to create with telehealth.” Antonio Melo, Director of Humana’s Digital Experience Center, said it’s working to shift from an institution-first model to one that is person-first. “We’re interested in providing care where people spend the majority or a lot of their time,” Melo said. “How do we reinvent who is improving care in the home? How do we create contextually relevant experiences for what might be considered low-level care? We’re talking about lifecare, and it’s an entirely different thing.” While acknowledging the cultural shift required to move considerable data sets into the cloud, Curtis Dudley, Vice-President of integrated Performance Solutions at Mercy, said that moving to the cloud has also enabled the system to commercialise its cloud services and, in turn, offer them to other hospitals. Cloud-based “descriptive analytics has led to the development of data science, AI and machine learning,” Dudley said. “Our goal is analytics at the speed of thought so they can walk into meetings to actually make decisions.” NEXT UP FOR MERCY? “Our future on the cloud side is going to be more and more healthcare data in the cloud. We’re working with Epic, Azure [and] Google, and our view is the cloud analytics competent is reaching inside four walls of the hospital and accessing the data in our datacentre. We are sharing data with third parties today through the cloud, in more than 200 different places,” Dudley said. “The more we do, the more people want, internally and externally.” Humana Edge CTO Jeff Hawkins said embracing the cloud opens doors to innovation. “Cloud is important for the future of how we engage our consumers. We’re taking an approach of automation over lift and shift,” Hawkins said. “We are not moving to the cloud for speed and resiliency, though we think we’ll achieve those. The fundamental drive of the cloud is to improve the experience of our consumers.” NYP’s Vawdrey agreed that it’s about patient and caregiver experience. “We want to provide a more comfortable, relaxed environment, where caregivers can deliver high quality, high satisfaction for low acuity patients,” Vawdrey said. “That’s using tech to re-humanise rather than de-humanise healthcare.”

Dr. John Halamka, CIO of Beth Israel Deaconess Medical Center, traveled 400,000 miles in 2018 – jetting all over the world, from China to India to Scotland to Scandinavia. On those journeys, he has seen how care is delivered in very different ways. In China, for instance (he has been there 35 times), there is no primary care. As a result, patients can self-select any provider, leading to a scattered lifetime record across diverse provider sites. In India, where active tuberculosis is widespread, access to care is much more difficult, and treatments are often mismatched to illness. "This is not precision medicine," Halamka said, speaking at the HIMSS19 Precision Medicine Summit. What is precision medicine? It's not just genomics. It's more than just social determinants of health (although those do play a much bigger role than many realise). At its core, he said, precision med is "the right care in the right setting from the right provider at the right time." That's a easier said than done, of course. There are big differences between diagnosis and treatment, and so much depends on demographics, genetics and other biomarkers, geography, climate and more. Data – structured, complete, well-governed and easy to see  – will be key to precision medicine becoming more widespread, Halamka said: "On the precision medicine journey, having the data accessible is going to be hugely important." That's why Scotland, for instance, which has set up a single database for most of its five million-plus people, may be in a better position than, say, Australia, whose health record modernisation was at first planned to be centered around PDFs and fax machines, Halamka said -- until he raised the alarm about the need for discrete and well-groomed data that can be mined by AI-powered analytics. The good news? "In 2019 tools are finally good enough to help us realise the promise of precision medicine," Halamka said. The challenge? There's also a lot of "interesting politics and policy issues that are part of our precision medicine journey. It's not just technology." But there are some urgent imperatives that will force those issues to sort themselves out soon,  such as aging societies all over the world, falling birth rates, clinician shortages and, of course, wildly unsustainable healthcare costs, he said. In the US, we spend more than 18 per cent of our GDP on "very imprecise care," Halamka added. That's got to change, of course, and has been slowly. The pace will quicken in the years ahead, with a profusion of emerging tech, he said. "The internet of things and connected health devices are exploding; AI and machine learning are going mainstream; apps and cloud hosted services are ubiquitous; application programming interfaces are "increasing in number and sophistication," he explained. But more needs to happen to help harness those new technologies for this larger purpose on a wider scale: "Precision medicine means that we need to deliver in the context of workflow decision support to the clinician to do the right thing at the right time," Halamka said. "None of this happens without a policy driver." He listed some of the policy changes that could help achieve that – notably, ONC's long-awaited information blocking rule, which was being released at HIMSS19 as he spoke. Other policies, such as CMS' rules meant to reduce clinician burden and various other governmental nudges to encourage third-party innovation, will only help move the needle. But in the meantime, the challenges persist, said Halamka, whether related to data provenance and quality or security and privacy concerns. A subsequent panel discussion at the Precision Medicine Summit drove that point home. The promise and potential are all there, but "it's still in this very squishy phase right now," Professor and Chair of Radiation Oncology at Jefferson Institute For Digital Health Dr. Adam Dicker said. "We're not ready for prime time," agreed Jean Wright, Chief Innovation Officer at Atrium Health. Part of that has a lot to do with technology – at least as the infrastructure exists today. "Epic and Cerner are not at the leading edge of this," Wright said. There's plenty of valuable, envelope-pushing tools developed by some very creative smaller vendors, but "much of the technology is out there, but not in a plug-and-play format." That too is fast-evolving, however, as APIs proliferate – many of them mandated by ONC – and patients get more comfortable using apps and devices that can then easily integrate with electronic health records. That's creating a wellspring of genomic and social determinant information. And while interoperability and decision support still need to catch up, the data is there, more every day, and ready to be integrated into clinical workflows for personalised care. This article first appeared in the global edition of Healthcare IT News.

The cybersecurity implications of medical devices have come under scrutiny, as the digitisation of healthcare reaches a wider net of professional, personal and public environments. In the bid to consider and plan for an evolving cybersecurity landscape to maintain patient safety, the Therapeutic Goods Administration (TGA) has released a draft regulation guidance on cybersecurity for medical devices, in line with the existing regulatory requirements. The Medical Device Cybersecurity Draft Guidance and Information for Consultation report calls for a clear regulatory environment for connected medical devices and identifies strategies to influence the approaches of those who use medical devices. “Connectivity and digitisation of medical device technologies may help improve or increase device functionality. However, the connection of devices to networks or the internet exposes devices to increased cyber vulnerabilities that can potentially lead to unacceptable risk of harm to patients,” the report identified. “These include denial of service or intended therapy, alteration of personal health data or alteration of device function so that it can cause actual patient harm. “In 2016, the Australian Government released Australia’s Cyber Security Strategy, detailing priority actions to improve Australia’s general cyber security posture, alongside supporting the growth of the local cyber security industry… In line with this, the continued safety, quality and performance of medical devices impacted by cyber-related issues is the responsibility of the TGA.” According to the TGA, operating environments are highly variable and cybersecurity risks are dependent on the knowledge, expertise and approach of the users of medical devices. “A compliant medical device will only be as secure as the most vulnerable aspect of the system it is expected to operate in. Users of medical devices also have share responsibility for providing a cyber secure environment for these devices to operate in,” the report stated. WHAT IS NECESSARY? Key to the implementation of medical devices, according to the report, is the development of a “clear and well documented” risk assessment and business continuity strategy, where the goal is to develop an environment where risk to patients is minimised.  It includes an injunction for device manufacturers and users to develop a cybersecurity strategic plan, which includes a cyber specific risk assessment and response strategies.  “The plan should have clearly defined event response procedures that define the responsibilities of each department in the event of an incident, and emphasise the importance of each area being familiar with these procedures,” it said.  “The strategy will need to be revised as new types and classes of connected medical devices are added to the healthcare environment.” [Read more: Is your healthcare ecosystem cyber resilient enough? | "Humans are not the weakest link": Shifting the cybersecurity narrative to fend off healthcare hacks] Cross-functional collaboration is a tool that the report claimed is essential for effective cybersecurity control of medical devices.    The TGA said healthcare service providers should aim to facilitate an environment which drives cross functional collaboration between the biomedical, clinical support and IT teams, helping all areas develop a better understanding of the work completed within each team. “The biomedical team should… engage with medical professionals within the healthcare organisation to help broaden their understanding of the operating profile of their devices, the technology under their management, implementation of cyber security controls and the associated risk,” it said. Collaborative procurement is another area for improvement as updating procurement practices to ensure the purchase of appropriately secure devices will create greater demand for improved cybersecurity within medical devices, the report identified. “[One way is to] incentivise procurement teams to work with IT and biomedical teams on the procurement of new medical devices to help ensure that cybersecurity is a measurable factor in procurement.” The report also suggested that organisations develop an inventory and risk profile of the current state of connected medical devices, providing insight to vulnerabilities in the operating environment. This inventory could include information such as the operation and purpose of a medical device, its secondary uses, who the primary users are, expected life-span of the device, support agreements in place and support for critical components. The report also called for more general training for all staff within organisations to raise baseline security awareness and skills. “Many professionals in the health and medical sector have received little training on cybersecurity. [Organisations need to] actively work to create a culture of cyber security awareness, vigilance and reporting, and regularly communicate potential cyber security issues,” it said. Segmenting the corporate network from the biomedical network could also help improve cybersecurity attacks. “Ideally, this should be done with an internal firewall. This will significantly reduce the risk of malware spreading from one network to another. Medical devices should be segmented into logical groups (manufacturer or modality) to reduce the attack surface. When possible, medical devices should be isolated,” the report said. [Read more: World-first cybersecurity trial safeguarding medical devices from hackers to take place in Victoria | Tyde set to become the first digital health company to earn the government’s top cybersecurity accreditation] In addition, it recommended that healthcare organisations consider implementing multi-factor authentication for staff access to networks, especially in areas of high traffic, and reduce privileges to only those required. “Access to the network is critical for most medical devices, especially with an Electronic Medical Record (EMR) system. Ensuring that only authenticated access is provided is key but when credentials are compromised, it can be challenging to define authenticated but unauthorised access. “So, regular reviews of network access should be completed. These must be managed to ensure usability of systems is not adversely impacted.” The report also said that more focus should be given to securing medical devices themselves, instead of just to ICT equipments. “Monitoring the internal and external environment for medical device abnormalities and cyber security threats is important to building a stronger cyber security posture. One advantage of monitoring medical devices is that their range of normal operation is narrow. This means that anomalies can be easier to spot in medical devices than ICT equipment,” it identified. The TGA has invited industry, peak bodies, professional and consumer groups, and individuals to provide comment on the draft guidance. Submissions for comment close on 14 February and will be used to help inform the final guidance document.

Northland and Auckland district health boards (DHBs) have been given the green light for the long-awaited upgrade to their clinical record portal, according to an official release by healthAlliance, the Northern region’s shared IT service provider. The two DHBs’ current system, Concerto 6, will be replaced with the latest version of Orion Health’s clinical record viewing software Clinical Portal 8 by early 2020. The project follows the successful implementation of Clinical Portal 8 at Counties Manukau and Waitematā DHBs in 2018. WHY IT MATTERS It will result in a single, connected clinical viewing system that will deliver a patient-centric record accessible from any Northern region DHB location, including authenticated health providers. Clinical Portal 8 is a patient-centric dashboard to view health information. It includes medical alerts, radiology and laboratory results, clinical history and patient movements from a variety of clinical applications. Once rolled out at Northland and Auckland DHBs there will be 24,700 users in the region supporting a population of 1.8 million people. For the many clinicians who work across one or more DHBs, the user experience will be consistent regardless of location, and their access to information will improve. Underlying infrastructure upgrades will also provide more resilience, while single sign-on functionality means it will be faster and easier for clinicians to access patient data. The upgrade projects are being managed by healthAlliance in collaboration with the DHBs and technology provider, Orion Health. THE LARGER TREND In December 2018, a national group was formed to start work on linking New Zealand’s four regional clinical portals, with approval from the DHBs chief information officers. The group is being led by Stella Ward, chief digital officer at Canterbury DHB. If successful, the project would allow any clinician involved in a patient’s care to view that person’s computerised health data from anywhere across the country. New Zealand’s 20 DHBs are grouped into four regions that each have a shared view of their region’s patient information via Clinical Portal 8 from Orion Health. Of the 20 DHBs, three are not yet using their regional shared portal, but all have imminent plans to move on to one. ON THE RECORD Project sponsor and Northland DHB General Manager, Medicine, Health of Older People, Emergency & Clinical Support, Neil Beney, says the regionally-connected clinical portal will form the largest patient information ecosystem in New Zealand. “It will facilitate better sharing of patient information within and between the Northern Region DHBs and across care providers. It will also provide a better way for clinicians to follow their patients’ journey across all care settings.” healthAlliance Chief Clinical Information Officer Dr Karl Cole says the upgrades are part of the foundational work of the region’s IS Strategic Plan (ISSP) which aims to join up the DHBs through technology and prepare them for a rapidly advancing digital future. “A modern regional Clinical Portal is a key enabler for improving patient care in our communities so it’s a very exciting time,” Cole says. “Once implemented, it will mark a significant milestone toward a more connected health system in our region.”