ANZ News

Traditional ways of patient care need to be turned on their heads when it comes to implementing clinical genomics. They now require technology platforms that support data streams, according to an expert in the field. Melbourne Genomics Health Alliance Program Manager Kate Birch, who will be speaking at the upcoming HIMSS19 conference in Orlando, told HITNA that the alliance is examining ways to make data support part of a standard practice. In doing that, it aims to bring global knowledge to individual care for Victorians. “We aim to do it through a few ways: both delivering the clinical tests where they’re indicated and also making sure that the data is put in a way that can be used for research in future,” she said. “Patients are asked about their preferences in the use of that data at the beginning, so it means that we’re not just diagnosing patients now but can translate that data into the future as we learn more.” The Melbourne Genomics Health Alliance was established in 2013, encompassing Victorian organisations across healthcare, academia and research to establish systems that support genomics in practice and producing evidence to guide genomic medicine in Australia and internationally. “Every day there are new discoveries being made about genes or particular new patients and because we don’t have that genomic information stored, we can’t look into that over time and provide diagnosis in the future. That’s what we aim to reduce,” Birch said. According to Birch, there are two schools of thought when it comes to clinical genomics – people who say clinical genomics will change everything in healthcare and those that say it’s all hype. “Like most new technologies, the first promises are always an overblow. This is not going to completely change the way we think about the future health system but it’s going to have a significant change in care for a big proportion of patients,” she said. “Melbourne Genomics sits in the middle. We’re trying to find the right genomic test for the right patient and when in that care that should happen. We have found that some particular clinical indications do make a difference into the future of these patients. “But what’s important is that we don’t think the answer is in genomics all the time; it’s actually about finding the right conditions to use data from these tests for.” DOING IT RIGHT The Federal Government’s $30 million investment in funding for the Parkinson’s Disease Mission, which integrates clinical trials and genomics research led by the Garvan Institute of Medical Research, is one example to the potential of clinical genomics, according to Birch. This involves the sequencing of genomes of about 1000 people with Parkinson’s disease over five years to potentially use the data to recognise unknown causes, identify biomarkers and assess if there are Parkinson’s subtypes to target with specific drugs. [Read more: Genomics for all Australians could revolutionise crisis focused healthcare; governments urged to prepare | Genome.One seeks investors as it scales up for a 2018 trial of genomics in GP software] Birch said another example is the use of clinical genomics in pediatrics for children suspected with genetic conditions. “We’re finding that we get five times the rate of diagnosis at less than half the cost to the healthcare system. So, genomics will change things for patients by providing diagnoses more quickly and at a cheaper cost for the healthcare system.” Joint partners that have collaborated in the work with children with suspected genetic disorders, Royal Children’s Hospital and The Murdoch Children's Research Institute, are leaders in the use of clinical genomic data, according to Birch. “A lot of times, children who may benefit from a genomic test have been to four or five clinicians. Some of these children have lots of health problems but are still relatively healthy, while other children may end up in the ICU. So, the Royal Children’s Hospital realised that it needed a program that turns around these tests quickly for those who need them,” she said. “That resulted in the creation of a whole new model of  delivering genomics – acute care genomics, which has delivered on lifesaving genomics in the ICU.” From this example, Birch said that it’s important to understand that implementing genomics is going to take a whole-of-system approach. “You need to think across all of your systems and all of the players in these very complicated organisations. The other part is the technologies that underpin it. We’re dealing with massive amounts of data when we talk about genomics and we need the right technologies to be able to support it. “It’s quite different to what the hospitals have done before in other areas – probably most akin to radiology in terms of the volume of data,” she mentioned. THE WAY FORWARD The Melbourne Genomics Health Alliance previously received $25 million in investment over four years from Victoria’s Department of Health and Human Services to ingrain genomics into practice, but Birch said there’s more that needs to be done in this space. “We’re getting to the end of that four-year program now and we’re not quite done. We’ve seen other national implementation projects and those have taken 10 years or so to shift the system. So, we think we need another four years for this to be fully embedded,” she said. “Clinical genomics provides a huge potential going into the future. As we generate more knowledge, we collect more genomic data and we understand it better.” [Read more: Data analytics is the “gold mine” for operations improvement | How Sydney Children’s Hospital Network improved pediatric physiotherapy with telehealth] Birch highlighted the way the US uses data for clinical genomics, especially in understanding the underlying mutations that has driven a particular cancer so as to find treatments for the molecular makeup of that particular tumour. “This is the move into precision medicine and it’s going to change care in the future. Getting the technology to keep pace with the development in genomics is important to focus on in managing the data that comes out of it.” Birch claimed that healthcare organisations are currently “incredibly interested” in adopting these technologies, but the only thing that’s slowing them down is the plethora of tech in the industry. “We’re in the midst of EMR implementations across Victoria, which are big and involved projects that take up a lot of time and effort. So the appetite for clinical genomics is there, but we’re just one of many needs of digital support in health at the moment,” she said. In improving this support, she addressed the need for industry, academia and governments to come together to supporting this future. “The Victorian Government has made early investments into genomics and I would hope it sees the value in continuing those investments. Victoria has done a great job in positioning ourselves as a leader in this space and we’ve got a good opportunity to maintain that,” she said. “In academia, we have big research organisations that are part of our alliance that hold the position to take advantage of the clinically generated data into the future. And as for industry, there are now some members moving into the space, but we could use further investments.” Birch will be speaking about how a collaboration of hospitals and research centers in Victoria was formed to bring concerted effort to overcoming the challenges associated with clinical genomics and ways to implement it into everyday standard care at the upcoming HIMSS19 conference in Orlando. Her session is on February 13, at 8.30-9.30am, and is titled Technology to Enable the Clinical Genomics Revolution in Australia.

The health sector has topped the list of notifiable data breaches for the fourth consecutive quarter, as identified by the Office of the Australian Information Commissioner. In its latest Notifiable Data Breaches Quarterly Statistics Report, which captures data notification breaches received between 1 October and 31 December 2018, the Office of the Australian Information Commissioner (OAIC) said the private health service provider sector reported the most data breaches, accounting for 54 of the 262 breach notifications received. Of these notifications, 54 per cent were the result of human error, including incidents involving communications sent to the wrong recipient, insecure disposal of personal information, or loss of paperwork or a data storage device. Malicious and criminal attacks was the second largest source of data breaches from the health sector, at 46 per cent. Cyber incidents were the most common type of attack, accounting for 44 per cent, while theft of paperwork or data storage device was the second most common type of attack (32 per cent). The OAIC said these notifications do not include those made under the My Health Records Act 2012 as they are subject to specific notification requirements set out in the act. In addition, it stated that most of the health sector notifications in the period involved the personal information of 100 individuals or less (59 per cent of breaches). The report also showed that the number of notifiable data breaches are on the rise. Between 22 February 2018 (when the notifiable data breaches scheme commenced) and March 2018, the sector reported 15 cases. Between April and June that year, there were 49 cases and between July to September 2018, there were 45 such cases. The latest quarter’s results are the highest to date. INDUSTRY RESPONSES As one of the most data rich and vulnerable sectors when it comes to cybersecurity, the health sector faces a unique challenge of balancing security with accessibility to patient records, while at the same time, coordinating care that supports a patient-centric approach to healthcare. Zscaler ANZ Country Manager Budd Ilic said it was becoming increasingly clear that traditional security solutions are no longer up to the task when it comes to protecting organisations.  “Our environments and architectures are now so complex it’s difficult, if not impossible for practitioners to effectively monitor their environments and is a contributing cause to incidents like these,” Ilic said. “The growing usage of mobile devices and cloud-based applications and services means users are not protected, and internet gateways are unable to handle advanced threats.” [Read more: Is your healthcare ecosystem cyber resilient enough? | "Humans are not the weakest link": Shifting the cybersecurity narrative to fend off healthcare hacks] Ping Identity Asia-Pacific Chief Technology Officer Mark Perry said balancing security with customer convenience and employee productivity has never been an easy exercise. “But, there is really no excuse these days as modern authentication solutions provide the means to secure the most common enterprise attack vectors without getting in the way of the employees, partners and customers who need access,” Perry said. “As a result, IT professionals need to understand the value and effectiveness of the appropriate security controls for their businesses before taking a one-size-fits-all approach to protecting data.” CQR Consulting Co-Founder and Chief Technology Officer Phil Kernick said the mix of human error and malicious attacks composing the source of majority of data breaches will see an “expensive enforceable judgement” against at least one Australian company which finds itself in breach of the legislation. “If this should happen, there will be a scramble among businesses to adopt a heightened data security, risk and compliance culture, who until now may have taken a rather laissez-faire approach to their cybersecurity footing,” Kernick said. "The good news is that Australian businesses will continue their mass migration to the cloud in 2019 and while the cloud is not without its vulnerabilities, the security measures which cloud providers offer as standard will be a positive step forward." Aura Information Security Australia Country Manager Michael Warnock agreed and added that the healthcare industry should understand the data risk if insecure cloud practices aren’t addressed with robust security measures and ongoing workforce education. “Many [organisations] will remain a happy hunting ground for cyber criminals as company management continue their reluctance to allocate investment for high-tech protection. At the same time, they don’t expect an attack to happen to them, so they refrain from elevating the issue on their training agendas,” Warnock said.  “The harsh reality is, cyber attacks will continue to grow in both frequency and complexity over the coming year. [Organisations need to] implement ongoing training to teach employees to recognise potential threats, adopt responsible data protection behaviour and allocate sufficient funds to cover protection measures commensurate with their risk profile.” [Read more: Greg Hunt announces legislative changes to tighten privacy and security protections for My Health Record | Tyde set to become the first digital health company to earn the government’s top cybersecurity accreditation] LogRhythm Asia Pacific and Japan Senior Regional Marketing Director Joanne Wong addressed the need for healthcare providers to take a more holistic approach to cybersecurity and practice good IT and security hygiene such as patching systems and applications, updating and modernising their systems, applications and infrastructure, and controlling access to only those that need access. “They also need to be able to validate identities, and encrypt or apply other safeguards to critical business systems and data,” she said.  “There’s no doubt that any company having anything of digital value will eventually be compromised. The question is, how fast can a security operations team detect these compromises and neutralise threats? Businesses don’t stand a chance without sophisticated analytics and modern workflow automation that can drive accurate threat detection.” LOOKING TO THE FUTURE SailPoint Chief Product Officer Paul Trulove said with only four OAIC notifiable data breaches reports issued and spanning a period of less than a year, it’s “impossible to determine” if these patterns will continue into the future, especially as Australian businesses continue to learn how to report breaches. “Health service providers are a gold mine of valuable personally identifiable information for cybercriminals, especially as more health information is digitised,” he said. Trulove added that the report findings highlight that healthcare has a long way to go to improve its security posture.  “The report reiterates that an organisations’ users have become the easiest route into an organisation for hackers. This is a trend we do not expect will ease up, as hackers now know that users offer them the keys to the proverbial kingdom, once compromised,” he said. “The most secure path forward for organisations today continues to be taking a comprehensive approach to security, one that puts identity governance at the centre, ensuring visibility and governance over all users and their access to all applications and data.” WatchGuard Technologies ANZ Country Manager Mark Sinclair said for healthcare organisations to stay out of these quarterly reports, they will need to have in place business continuity plans and a “well-balanced cybersecurity strategy”. “This strategy will spread funds across threat prevention, detection and response, user education, business continuity and disaster recovery,” he said. “And why not test that plan in 2019 to see your technology and employee response in the event of a disaster? Prior preparation could be the difference between picking up the pieces and closing your doors.”

An Australian-developed app is combining mobile phones with telehealth principles to bring burns sufferers fast, accurate and secure specialist advice from clinicians. Telehealth researchers from CSIRO’s Australian e-Health Research Centre have collaborated with the Fiona Stanley Hospital, part of the South Metropolitan Health Service in Perth, to develop and pilot this mobile app – Mobile Image and Communication Exchange, named ‘the MICE app’ for short. As recovering from a burn can be a slow process, the Fiona Stanley Hospital runs a Burns Early Discharge Programme for patients to leave hospital and receive ongoing care from home. The MICE app is being trialed as part of this program to let a visiting nurse take photos of the patient’s wounds and send those photos to clinicians and specialists for ongoing monitoring and advice without having to visit hospital. The specialist can then take a closer look at the wound and send back real-time advice on clinical decisions and treatment through the app, enabling the visiting nurse to administer immediate care to the patient. CSIRO Senior Software Engineer Janardhan Vignarajan told HITNA that the app aims to reduce unnecessary patient wait times, enable them to receive quick and timely specialist advice, and bring efficient healthcare to remote Australians. “For people with burn injuries, getting fast and appropriate treatment is critical. But some patients live far from the closest burns specialist. So, digital technology can help bridge the gap in healthcare delivery for people who live far from medical care,” he said. “Burns can also take a long time to heal and patients need ongoing advice to support their healing process, which the app helps with.” The MICE app also complies with patient confidentiality requirements, only storing treatment advice and images in the hospital’s systems, while automatically deleting a patient’s burn photos from the phone used. “Patient’s images stored in a clinician’s private phone raises lot of issues related to confidentiality. Our MICE app has been developed with patient care in mind, while also alleviating privacy, security and data integrity concerns that come with using mobile phone images,” Vignarajan said. “The image and related diagnostic data needs to be stored and archived for future references but doesn’t need to remain on a mobile device. The MICE app solves this by allowing the records to be stored where they should be – secure within a hospital IT system. “The technology behind the app ‘talks’ to internal hospital systems and protect patient’s images, which is a huge leap towards improving Australian healthcare.” [Read more: New burns app gives instant assessment of scars | Australian developed spray-on skin for burns treatment seeks FDA approval] CSIRO Australia intends to soon extend the use of the MICE app to patients instead of just clinicians. “At this stage, our focus is to enhance communication between specialists, doctors and healthcare workers by providing the app to these health professionals. But we are working on ways to deliver this technology to patients themselves,” Vignarajan said. Vignarajan also mentioned that there’s potential for the app to reach other areas of specialist healthcare, such as wounds or dermatology. “Wounds can be monitored by viewing previous images taken from different time points. This is very important for a proper treatment. By allowing a close look at the image in an easily accessible and secure platform, the treatment can be provided efficiently without delays,” he said.

Data is a critical asset in the healthcare industry – our medical professionals rely on accurate and up-to-date clinical information in order to best assist patients. But in Australia, there have been concerns around the use and management of this data in healthcare. There is an ongoing debate surrounding the security of the government’s digital record-keeping system, My Health Record. This has been compounded by the Australian Digital Health Agency (ADHA) recently reporting 42 breaches which affected My Health Record during the 2017-2018 financial year. Following this, critics have called for the full rollout of My Health Record to be further delayed in order for the platform’s architecture to be better assessed – if it’s simply a ‘honey pot’ of personal and compromising clinical data or can the potential for privacy breaches be limited to an acceptable level? The My Health Record conversation is following a familiar pattern: a debate between privacy and innovation. The question is whether the benefits of data sharing, collaboration and open innovation can be balanced against concerns about security, identity, trust, governance, consent and transparency. This debate has brought the value of clinical data, and the need to protect it, into sharp focus across the industry and Australia at large. And as the healthcare industry is digitally disrupted, there’s no doubt that sustaining technological innovation will be critical to maintaining both national and international standards. BLOCKCHAIN AND SMART CONTRACTS One of the concerns around My Health Record is its centralised record system that could potentially be viewed by anyone with access to login credentials. Is there technology available that could securely store clinical data, ensuring only the right people can access only the information they need, when they need it? Blockchain could very well be part of the solution. The much-lauded digital distributed ledger-based technology, originally deployed to underpin the exchange of cryptocurrencies, has the potential to revolutionise the use and protection of clinical and personal data across the board. In international markets, for example, blockchain is already being trialled for processing insurance transactions. The healthcare industry, at large, is bloated with cost, red tape and inefficient protocols for verifying and handling transactions. There is little doubt that blockchain could become the favoured method for conducting, verifying and recording secure online transactions, without a middle man. What blockchain offers to organisations is the ability to simplify and automate processes, including verifying, handling, and authorising payouts using predefined parameters. This could all be done using a permissioned distributed ledger, with the added benefit of securing customer data in the process. As an example, insurance provider MetLife is trialling an initiative in Singapore with a blockchain-based parametric insurance product for expectant mothers with gestational diabetes. The technology allows the patient’s condition to be confirmed by their OB-GYN via the smart contract system. Once the patient’s condition is verified, their payouts can be expedited and automated to ensure the expenses aren’t out of pocket. This example showcases how blockchain can streamline and automate interactions between health insurance stakeholders, resulting in reduced costs and improved transparency. Clinical and user data can also be secured via a blockchain, with the addition of tools like digital wallets, keys, and signatures. Utilising these tools in conjunction with blockchain constructs and approaches, users can have the ability to maintain more control over their information, revoke access as desired and ensure that only authorised people have access to the right information, which may also be encrypted as needed. THE FUTURE POTENTIAL IN AUSTRALIA While international organisations are demonstrating the potential for a worldwide digital overhaul of the healthcare industry using blockchain technology, there is still a long way to go in Australia. Countries like Estonia are setting the bar with an increasing number of national services opting to use blockchain to carry out transactions. However, the technology remains in comparative infancy in Australia. The relatively slow uptake of the technology is further fueled by the recent declaration from the Australian Government’s Digital Transformation Agency (DTA) that, while the technology has potential, it still requires compelling evidence that blockchain can deliver better value for government services. In addition to concerns about the security of digital records, many Australians are also frustrated by the cost of private healthcare, the time it takes to process claims, and the changeability of their insurance cover. As shown by MetLife, the use of blockchain-powered smart contracts has the potential to remove the middleman in transactions, enabling a more secure, efficient and cost-effective outcome for the end customer. This further supports the use of blockchain to optimise the handling of clinical data and deliver on outcomes in the healthcare industry.   Nelson Petracek is the Global CTO of integration server software company, TIBCO.

The current processes around many clinical information systems are “not patient or GP-centred” and is “highly inefficient and frustrating for general practice”, according to a report by the Royal Australian College of General Practitioners (RACGP). The RACGP Practice Technology and Management report claimed that current clinical information systems (CIS) tend to be a “heavy burden for GPs and their teams”, diverting their time away from providing medical care for patients. As such, the peak lobby group for GPs is calling for industry to meet a number of general practice CIS requirements to improve usability in the collection, management, use and sharing of information and deliver on efficient patient care. The report outlines recommendations for better digital patient health records, systems to improve the exchange of patient information across the healthcare sector, patient consent in the secondary use of their data and amplified information security. RACGP said with the increasing use of shared care models and the potential increase in use of My Health Record, the quality of information is now more important than ever. “No longer serving only individual GPs or practices, information in a patient’s health record is likely to be shared between, and relied upon by primary, secondary and tertiary healthcare services, and the patient themselves. “Maintaining high-quality health records is not always regarded as a priority by general practices or GPs. Competing demands on busy clinicians and practice staff means the importance of quality health records is often overlooked, and some may not be aware of what is expected of health records,” RACGP reported. To improve usability, it recommended that CISs facilitate the input of data by displaying core clinical information in a way that makes it easy for users to access and view, adopting a GP reference set for core general practice data, aligning with clinical workflows and enabling structured data entry. As for the communications of health records, RACGP said all electronic communications must correspond with secure data handling principles to protect patient privacy and confidentiality, and that any electronic communications sent externally must be capable of seamlessly populating with existing data from the local CIS. “Despite most general practices using electronic clinical and practice management systems, patient information is still being faxed, mailed in hard copy or provided in an electronic format not compatible with clinical software,” the report identified. “In most circumstances, when patient information is transferred to a general practice, the details need to be manually transcribed into the local CIS. This is not only very time consuming, but also results in a significant risk of transcription error.” [Read more: RACGP claims gaining patient consent for My Health Record uploads is not the job of doctors and calls for improved incentives | There’s “a long way to go” before we eradicate fax in healthcare: panel] As for the challenge of patient consent for secondary use of general practice data, RACGP suggested that CISs must allow users to record patient consent for the secondary use of both identified and de-identified data in a secure manner and provide opt-out mechanisms to exclude patients and healthcare providers who do not want their data or subsets of their data shared for secondary purposes. “General practices are custodians of patient data, with a responsibility to ensure it is accessed and used appropriately. Practices must protect patient rights and privacy when providing data for secondary use. “This will be aided by implementing policies and procedures specifically for managing requests for access to data which can be supported by CIS,” the report stated. RACGP also addressed the need for beefed-up security requirements within a CIS, recommending identity management and access control frameworks consistent with industry best practice, as well as mechanisms to ensure software currency. It also identified the importance of being able to back up and recover data either natively or via a third-party product. “CISs should support quality practice in terms of identity management, access controls, role-based permissions, software redundancy, failover, data security, audit trails and in maintaining software currency,” it identified. “Information security is critical to the provision of safe, high-quality healthcare and the efficient management of a general practice. It is a fixed cost of doing business, and requires adequate allocation of financial and human resources to ensure business continuity and the protection of information assets.” According to RACGP, designing CIS to support general practice can be challenging, as a balance is required in the design of CIS between comprehensiveness and utility. “If CIS are too complex, with too many detailed structure and content requirements, users often take shortcuts (e.g. avoiding documenting what they consider to be less relevant types of information),” it said in the report. [Read more: Better access to health data could save $3bn and improve Australians’ health | What’s needed to drive innovation and improve affordability in healthcare?] It addressed the need for the transfer of information between care teams, across disciplines and between care sites in modern healthcare delivery models to alleviate challenges. “As the volume of information generated and held within CIS grows, it is becoming increasingly difficult for systems to respond to the needs of GPs and patients as part of normal clinical workflows,” the report identified. “For GPs to work safely with any CIS, information needs to be collected, managed and used in a standardised way, which will also contribute to creating a positive user experience. “There is now growing recognition from users and developers that a set of minimum requirements could, in the future, become standards governing the design and development of CIS,” it added.

As Australia goes through the inevitable digitisation of hospitals, moving away from paper into the digital environment, data-driven approaches are key to informing system evaluation and redesign, improving flow through hospitals and delivering improved patient outcomes. CSIRO Australian E-Health Research Centre Principal Research Scientist Justin Boyle told HITNA that this digital environment is a “gold mine” for the industry in terms of improving hospital operations and offering better, more personalised patient care.  “Data analytics is not just icing on the cake as a nice-to-have, but in the current climate of value-based care and performance frameworks in hospitals, particularly in the areas of safety, quality and access in the face of a tsunami of patient demand, there is an urgent need for analytics-based solutions to deliver high value care,” he said. According to Boyle, who will be speaking at the upcoming HIMSS19 conference in Orlando, to meet this demand, healthcare organisations need to work on strategies that will help “decongest the patient flow system”. “There is no one silver bullet that can solve all problems and implementing several capacity management strategies is a good point to start. Most hospitals in the public system have low numbers of beds per capita, so given that constraint, we need to figure out how to use data to improve flow efficiency and productivity.” As capacity management is one of the more visible barometers of the performance of a health system, Boyle said “statistical rigour” needs to be put into analytics of patient flow, but it also needs the engagement of clinicians. “It needs to start with behaviour changes within an organisation. Clinical champions are needed to get staff behind an initiative as the early stages can be hard. It’s also important to have a solution that’s scalable and personalised to an organisation's needs,” he said. “There are three steps to this: determining the predictive accuracy of a particular tool, embedding it into workflows, and as a result, enabling healthcare professionals to make better decisions in support of clinical judgements.”     Boyle provided a few examples where data analytics can come into play to improve clinical workflows: The first is to use historic clinical data to get efficiency improvements. He suggested healthcare organisations look at target occupancy rates for hospitals as it’s not a “one-size-fits-all” approach. “It’s important to have targets that are specific to hospitals that allow us to identify specific occupancy bottlenecks where flow performance declines. The whole goal is to avoid patients waiting and adverse outcomes that include mortality,” he mentioned. [Read more: To deploy AI tech, healthcare needs to first be data literate | Ambulance Victoria aims for better resource allocation with predictive analytics tech] Another approach is by accelerating the time of patient discharge. Boyle said this is based on the idea that patient flow can be improved when patients are discharged an hour or two earlier, which is then quantified by the impact it has on the emergency department. “We can’t add more beds so we need to look into what else we can do, such as analyse situations around discharge timing or the configuration of beds.” Predicting demand is the third approach. “What we do here is forecast patient arrivals and departures resulting in hospital preparedness. For example, we work with health departments on early warnings of outbreaks like influenza from a number of data sources. So in this case, being aware of the timing of the flu season and its magnitude from numerous data sources could provide early warning,” he said. MOVING INTO THE FUTURE Boyle said there’s potential for this technology within areas such as telehealth, mobile health and genomics as the intelligence derived from the data enables clinicians to prescribe healthcare that’s targeted to individual patients. “It’s great to get insight about what happened last week or is happening now, but the aim should be to use this data to predict what is going to happen in future,” he said. “Looking at things like vital signs data that are recorded routinely within the digital environment, for example, will provide lots of potential in future. Not feasible in the paper environment, this would provide a significant advantage with regards to early detection and risk stratification. [Read more: Engaging the power of data for smarter drug development and clinical trials | How Sydney Children’s Hospital Network improved pediatric physiotherapy with telehealth] “In the long-term, this may support the delivery of advancements like clinical genomics, where genome-based outcomes can be tailored to an individual. “But in the foreseeable five-year future, data analytics will revolve around delivering care for a specific patient – so using their health contact data, social media data and internet footprint as useful indicators will aid in personalising their healthcare experience.” Boyle mentioned that the biggest challenge, looking into this future, is the change management that needs to happen to make it work – who needs to use that information, what time they need to use it, and workflow procedures that need to be created from it. “Sustainably embedding solutions into business-as-usual workflows is the greater challenge compared to the mathematics of developing and validating predictive models,” he added. Boyle will be joined on stage by CSIRO Australian E-Health Research Centre Senior Research Scientist Sankalp Khanna and together, they will be presenting on the topic of Deriving Value from Patient Flow Analytics at the upcoming HIMSS19 conference in Orlando. Their session is on February 14, at 8.30-9.30am.

As the Federal Government today pushes the button to create My Health Records for every Australian who wants one, the industry has stepped out asking for more transparency around security and secondary use of the records to enable people to make more informed decisions about it. The industry has also voiced out about data de- and re-identification, a global approach to cybersecurity issues as healthcare digitises, information security requirements of the future and blockchain as a way to alleviate some of the challenges associated with the My Health Record system.   On 26 November 2018, the Federal Parliament passed legislation to strengthen privacy protections in My Health Records Act 2012 without debate or division. The new legislation means that Australians can opt in or opt out of My Health Record at any time in their lives. Records will be created for every Australian who wants one after 31 January and after then, they have a choice to delete their record permanently at any time. The date of 31 January follows much deliberation from the Federal Government to extend the opt-out date. Australians initially had until 15 October 2018 to opt out of the national health database, or a My Health Record was to be created for them by the end of that year. But following the opposition calling for an extension to the opt-out period, the public outcry against the potential for the data to be shared with police and other government agencies, a leaked government document detailing the Australian Digital Health Agency’s response to concerns and a raft of changes recommended by the Senate Inquiry into My Health Record, the Federal Government pushed this date back and relaxed its stance on when Australians can opt in or opt out of the system. Australian Academy of Technology and Engineering (ATSE) President Professor Hugh Bradlow said the collection of health data across the population will result in better health outcomes as it not only shows how effective interventions are, but also allows treatments to be personalised based on the experience of thousands of other patients. “New forms of measurement (based on artificial intelligence) will also give patients far more significant information about institutional performance, practitioner performance, the outcomes of specific interventions, etc.” he said. The Society of Hospital Pharmacists of Australia (SHPA) Chief Executive Kristin Michaels said the My Health Record debate highlighted the need for an integrated ehealth system, accessible only to health professionals and set up at the request of health organisations, for the benefit of all Australians. "All Australians, regardless of any illness or condition, deserve to get the highest-quality care,” Michaels said. “More often than many would think, patients are unable to explain the medicines they are already taking and for what conditions they are already being treated, particularly after a seizure or if unconscious. Many of these patients are unaccompanied. Sometimes this lack of information leads to errors that have serious impacts on people’s lives. “[Hence] hospital pharmacists have long called for a shared, electronic patient data system that links up a fragmented health system and empowers patients in their own care." THE ISSUE OF SECURITY However, University of Melbourne Department of Computing and Information Systems Cybersecurity Senior Lecturer Associate Professor Vanessa Teague expressed her concerns around the privacy implications of secondary uses of My Health Records not being accurately explained. "The My Health Record privacy policy says: ‘It is expected that most applications which are assessed will be for the use of de-identified data. This is where your personal details are removed from the dataset and you cannot be identified.’ Unfortunately, removing obvious personal details (such as name, location, and date of birth) does not securely de-identify the data,” Teague said. “Both doctors and patients can be easily and confidently identified in a dataset… In the case of patients, this means that a few points of information, such as the patient's age and dates of surgeries or childbirths, is enough to identify the person and thus, retrieve all their Medicare bills and PBS [Pharmaceutical Benefits Scheme] prescriptions for many years. “Easy and confident re-identification has been demonstrated on numerous other datasets that were shared in the mistaken belief that they were de-identified. It is probably not possible to securely de-identify detailed individual records like My Health Records without altering the data so much that its scientific value is substantially reduced.” [Read more: My Health Record system data breaches rise | Game changer: Creator of FHIR writes about approaching critical mass and a growing data sharing revolution] Teague said patients may choose to opt out of secondary uses of their data but are unable to make a “genuinely informed decision” if they are inaccurately told that their detailed record cannot be identified. “Even more importantly, those whose identifiable MBS [Medicare Benefits Schedule]-PBS records were already published in 2016 should be notified, because the earlier release could make re-identification of their My Health Records much easier,” she said. Harvard Medical School International Healthcare Innovation Professor Dr John Halamka also previously criticised the system for relying on outdated technology, saying that the $2 billion My Health Record was nothing more than “digitised paper” as it uses such “out-of-date” technology that crucial patient information on test results and diseases are unable to be read or shared by computers. University of Wollongong School of Computing and Information Technology Professor Katina Michael said health data breaches, for some, could have a huge impact. She used the recent example from Singapore, where 1.5 million Singapore health records were breached in a highly targeted effort on SingHealth. Among the breached health records was Singapore Prime Minister Lee Hsien Loong's personal records. “What does this tell us when one of the world's most advanced cybersecurity nations suffers such a large-scale attack? Plainly, that no one's personal information is safe, no matter the measures in place,” she said. "If we have learnt anything over the last four months, it is that electronic health records are hackable. We need not have to look too far to see that no system is impenetrable.” Michael also speculated that there is the possibility of a ramp up of blockchain initiatives to beef up on My Health Record security. “We will likely be told in the not too distant future that we wildly underestimated our security requirements and as such, must go one step further and protect our credentials,” she said. According to Professor Michael, this involves the implant of a 16-digit Personal Health Record (PHR) ID number into people that also reads vital signs while embedded. This technology then alerts first responders of ailments and medications without the need for the person to provide any information.     [Read more: Australia leads the world in personal control of electronic health records | Is the My Health Record technology out of date?] ATSE’s Bradlow said the industry needs to be “realistic” about it as the danger of data leaking due to cyber hacking is as true as hacking any other data system. “Let’s remember that many [healthcare professionals] have easy access to today’s paper-based health records – an electronic record is actually a step up in privacy. Within My Health Record, we can make it the default to require a patient access code,” he said. “A well-designed record system which is managed by a professional security organisation and has a clear audit trail, for example, provided by blockchain, can mitigate this risk significantly."

SA Health is expected to scrap and reconstruct its troubled electronic patient records system following an independent review of the program. The EPAS Independent Review found that the beleaguered Enterprise Patient Administration System (EPAS) failed as it “contrasts with other successful EMR implementations in Australia”. This conclusion was reached after an expert panel assessed the software solution supplied by Allscripts, its configuration and management by SA Health, and the implementation and governance of the program. The report identified that SA Health chose to implement the system without the assistance of “expert organisations including the Allscripts vendor” resulting in the billing module not being fit-for-purpose. In addition, it found that EPAS has a flawed governance model with “accountability for outcomes poorly understood and managed” and a lack of current governance arrangements empowering clinicians to be key decision-makers. It also found the governance model doesn’t enable the implementation of the system to be tracked, measured or managed, amongst other determinations. “The Review Panel concludes that all three factors have contributed to EPAS not meeting user expectations,” the report stated. The South Australian Government commenced implementation of EPAS in 2011, which it expected to deliver by 2014 at a cost of $421.5 million. But, by 2018, it claimed that 78 per cent of the funds for the original scope “had been expended.” Following public debate and change of government in March 2018, the rollout of EPAS was paused to commission an independent review to inform decisions on the most appropriate way forward, which resulted in the EPAS Independent Review. “The review finds that the EPAS program has been a failure and should be discontinued and replaced. The review has determined that the EPAS program should not continue as planned,” the South Australian Government said in response to the review. “The review recommends that SA Health completely overhaul the program, reconfigure the underlying information technology and commence a roll out at two exemplar sites before a final decision is made on whether to continue to use the Allscripts suite of products.” [Read more: SA Health launches taskforce after claims of lost and delayed pathology results caused by new IT system | Xenophon calls for SA’s EPAS to be paused and investigated, while new RAH suffers a power outage mid-surgeries] The EPAS Independent Review also made 36 recommendations for a proposed way forward. “Every effort should be made to optimise the underlying elements of the EPAS program,” it stated. This includes improvements to Sunrise EMR (Electronic Medical Record), an integrated suite of clinical and financial solutions that is also used by hospitals and health systems in the US, UK, Canada and Singapore, and Allscripts PAS (Patient Administration System) implementation – terms that will replace EPAS. Allscripts ANZ General Manager Todd Haebich said the company welcomes the independent review into EPAS. ‘We look forward to working more closely with SA Health to fulfil what it has set to out achieve – the establishment of a state-wide electronic medical record,” he said in a statement. Other recommendations include the creation of an SA Health Digital Strategy with a Digital Health Board and “significant governance reforms” that put control into the hands of clinicians. “The Government will transition from the EPAS project to a new electronic medical record project, which will utilise two Allscript software programs, a patient administration program and an electronic medical record program,” the South Australian Government said. “Deployment to the exemplar sites will be the focus of immediate action for Government, with deployment to take place during 2019.”

New technology using AI to tell the difference between harmless moles and dangerous melanomas has hit the market. Created by FotoFinder Systems, Moleanalyzer pro is a portal that lets physicians confirm their skin cancer diagnosis using evaluation techniques, combining specialist expertise with AI and including the option of receiving a second opinion from international skin cancer experts. FotoFinder Systems Global Brand Director Kathrin Niemela told HITNA that the technology aims to aid skin cancer diagnoses. According to the Cancer Council Australia, every year skin cancers account for around 80 per cent of all newly diagnosed cancers in Australia, with GPs seeing more than a million patients per year for skin cancer. In addition, the Australian Government identified that there were 14,320 new cases of melanoma skin cancer diagnosed in 2018, accounting for 10.4 per cent of all new cancer cases diagnosed. “The earlier skin cancer is detected, the better the prognosis. The leisure behaviour of sunbathing in many parts of the world makes early detection of skin cancer more important worldwide,” Niemela said. FotoFinder Systems first calculates and compares size, diameter and structure of moles and quantifies their percentage deviations. Moleanalyzer pro works with deep learning. Its Convolutional Neural Network was ‘trained’ with a large data collection of dermoscopic images and corresponding diagnoses. Through growing experience and its own autonomous rules, it then distinguishes between benign and malignant lesions. “Moleanalyzer pro features the possibility to manually evaluate lesions according to acknowledged checklists and optionally contains an innovative algorithm based on AI, allowing a risk-of-malignancy evaluation,” Niemela said. “In the last few years, the new algorithm has been trained with a large number of dermoscopic images. FotoFinder Systems has an international network of partners who contribute to the training of the algorithm with their pictures of histologically proven lesions.” The analysis then determines a risk assessment score of both melanocytic and non-melanocytic skin lesions, allowing physicians to verify their diagnoses. FotoFinder Systems is working towards making this AI score available for doctors on mobile devices. “When this technology becomes available for mobile devices, rural physicians, for example, who practice far away from clinics or specialist centers can use the Moleanalyzer pro's deep learning algorithm on their mobile phones to get a second opinion on their diagnosis of skin lesions,” Niemela said. The application also allows physicians to request a second opinion from skin cancer experts. “The AI represents a ‘silent virtual colleague’ that delivers a virtual opinion simply, uncomplicatedly and at any time. But together with the human experience delivered by the optional second opinion service, the tool helps to increase diagnostic accuracy.” [Read more: New bid to map AI’s impact in radiology | New AI imaging solution to accelerate critical patient diagnoses] According to Niemela, a man-against-machine study involving 58 dermatologists from 17 nations found that whereas the experts correctly identified 86.6 of malignant skin tumours, Moleanalyzer pro successfully detected 95 per cent. In addition, the technology identified 82.5 per cent of benign naevi correctly, while the experts identified 71.3 per cent as benign. However, Niemela said the technology was not expected to replace specialists. “As fascinating as AI is, it cannot take the place of human experience in the matter of skin cancer. AI will increasingly find its way into dermatology and mole examinations by supporting physicians, not by replacing them,” Niemela said. “Doctors need to combine total body mapping with video documentation of single moles and AI-based evaluation. The combination of these three elements are the pillars of early skin cancer detection. Only a physician with profound knowledge and experience can map this complex process. “In addition, patients do not want to do away with doctors under any circumstances and want to combine high-tech solutions with specialist competence.” And the future potential for AI in skin cancer detection is huge. “The aim of AI is to bundle global knowledge and consistent diagnostic standards – independent of the practice location – all over the world. The combination of human experience and AI can contribute to a drastic improvement in diagnostic accuracy in early skin cancer detection, with the potential for almost 100 per cent accuracy,” Niemela added.

The Sydney Children’s Hospital Network has taken a pioneering approach to telehealth for physiotherapy, with the department leading the hospital network in the use of video to improve its patient- and family-centered approach. By using telehealth in its Hospital in the Home (HITH) specialised service, the department has, by far, provided the most number of telehealth sessions across the whole hospital network, according to its Senior Physiotherapist, Cloe Benz. HITH is clinical care that reduces the length of stay in hospital or in some instances, avoids an admission altogether. Benz told HITNA that physiotherapy via telehealth, especially in pediatrics, has generally been limited in Australia but that the hospital embarked on a journey to navigate to new borders and demonstrate to other services that big changes can be made and succeeded in within a pediatric physiotherapy population. “It’s significantly hampered by the fact that physiotherapists, as their name suggests, like to be physically available. That has given a lot of skepticism to the use of telehealth in our line of work,” she said. “But we have rolled out the program at Randwick and Westmead for a little over a year and have experienced many improvements in our patient- and family-centered approach.” Through the program, the hospital provides access to specialist care and treatment from home using telehealth, as an alternative to institution-based care. “Children with chronic respiratory conditions need a very high level of care, in addition to a consistent level of physiotherapy as part of their monitoring and treatment program. So we run a program where kids are admitted to our service and they are seen with what is equivalent to the amount of time they would be seen if they were in hospital.” she said. This involves physiotherapists setting up a daily timetable with patients’ families. The first daily visit involves a personal visit for observations and checks, while the second daily session is done via video call. [Read more: What are the barriers to widespread telehealth adoption? | Data from telehealth to play “critical role” in consultations] “Most chronic respiratory pediatric patients have two physiotherapy sessions that they are meant to do every day of their lives. This is a huge battle for both the children and their parents,” Benz said. “So, the ability of telehealth is for us to be able to access these patients at home and provide support while they’re trying to do these sessions. It means that patients and their families can have expert advice, support and feedback, while we make sure what they’re doing is done in the most effective and efficient way possible.” CHALLENGES BATTLED THROUGH But rolling out telehealth to a pediatric patient base had its own set of challenges. “We had to put in a relative age group that we consider is most appropriate for telehealth. We start our telehealth sessions with kids aged between eight and 18 years. We found that children under that age aren't able to engage appropriately with the therapists across a video call,” Benz explained. Because of the nature of their work, the department also had to put in some risk-related considerations such as the requirement for adult consent to be in the telehealth program and for an adult over the age of 18 to be present with the child during the session. “Because we were dealing with children, parents initially felt anxious and apprehensive about setting up these programs. We needed to educate them on the safety of using our telehealth solution,” she said. “We use a program provided by NSW Health called healthdirect, which doesn’t record any of the information from the caller’s side – the only information that the program records is who the therapist is, in addition to what time they entered and ended the call.” Benz added that the caller’s details are initially required to be input into the system at the time of call in order for the therapist to know who’s on the call, but that information is then purged from the system as soon as the call is over in order to keep confidentiality. Another issue that the department initially faced was delays in engagement as a result of patients and their families joining the program later than expected. “When we used to schedule a telehealth session, we wouldn’t re-engage with the family until they call in. Because of that, families used to only start the computer at the stipulated session time and by the time they sign in or get out of any technical difficulties, many minutes get wasted,” she said. “Our families then provided us with feedback that they preferred to get a reminder message a few minutes before their appointment to make sure they’re on time. We rolled that out and now, deliver on a more streamlined process.” FUTURE POTENTIAL According to Benz, the telehealth feature has resulted in better patient engagement and responsibility for their own healthcare. [Read more: Standard bearers: The RANZCR’s journey to establish teleradiology protocols | Call for Medicare to catch up, as the momentum of telehealth uptake grows] “They engage better than they would stuck in a bed all day if they were in a hospital setting. Telehealth requires a more active engagement, and for them to be more proactive about their health, rather than taking a more traditional, passive approach to recovery,” she said. “And there are many different areas within acute care that can deliver on potential using telehealth, and I’ll be talking about this at HIMSS19.” Benz also expects more regional reach with the use of telehealth, both in terms of patient care as well as smaller regional healthcare providers following the hospital’s footsteps. “We expect telehealth to be used on a much bigger scale. Nearly all of the patients that walk through our doors have a smartphone, or at least, one person within a family does. So the access of video, across the world, is huge and health is only just getting on to how much we can do with video to provide a better, more congruous service.” Benz will be speaking about the Sydney Children’s Hospital Network’s telehealth journey and the potential of the technology for other healthcare areas at the upcoming HIMSS19 conference in Orlando. Her session is on February 13,  at 2.30-3.30pm, and is titled Virtual Acute Care: Pediatric Physiotherapy with Telehealth.