ASIA News

In support of a paperless industry, the Australian Digital Health Agency (ADHA) has launched an initiative to enhance secure messaging functionality by 2020. The initiative, an A$30,000 boost to software vendors, aims to enable clinical software providers with the support necessary to adopt and integrate new secure messaging standards into existing clinical information and messaging systems. All private vendors that currently operate a clinical information or secure messaging system with secure messaging capabilities at two different sites as a minimum are eligible for the funding. The move is expected to help health professionals using different platforms to securely send important health information, such as referrals, specialist letters and hospital discharge summaries, to patients and other health professionals. Eliminating paper-based messaging in healthcare has been a priority for the National Digital Health Strategy, which was approved in 2017 by all states and territories through the Council of Australian Governments (COAG) Health Council. Since then, the ADHA has been working with software and healthcare providers to develop a set of standards that will improve the secure exchange of healthcare information. A trial of the co-designed standards was run in 2018, overcoming what were then the two final hurdles to making different platforms interoperable: universal message formats and the ability to search multiple databases of healthcare providers. “The industry has agreed to the same interpretations and allowed their systems to display messages in a number of formats: RTF, PDF, CDA, and HL7 version 2,” ADHA Chief Operating Officer Bettina McMahon said previously. Being able to find the details of a healthcare provider was the other major hurdle, as different healthcare vendors maintain their own databases and a GP using a platform from one vendor often can’t find clinicians using a different one. The set-up of a distributed directory would allow clinicians with one vendor to be able to search all databases, according to McMahon. Following the success of the trial, the agency is now encouraging widespread adoption. ADHA Chief Medical Adviser Clinical Professor Meredith Makeham said many healthcare professionals are already using secure messaging platforms; however, many of them are not compatible with one another, resulting in these professionals using fax machines or the post to send information to one another.   “The inability of healthcare providers to share information quickly can lead to communication breakdown, which can contribute to poor health outcomes and unnecessary duplication of care,” Makeham said.  “This is a significant step toward ensuring healthcare providers can use the tools they already have to send information to their patients and other clinicians providing those patients care, and in turn provide safer and more comprehensive care.” Consumers Health Forum of Australia Chief Executive Officer Leanne Wells said a modern, connected health system requires modern communication technologies and interoperability. “Manila folders of paper records and fax machines aren’t good enough in the 21st century – secure, robust and interoperable messaging is fundamental to creating the patient-centred health system Australia needs and deserves,” she said. General Practitioner and Advisor to the ADHA, Dr Nathan Pinskier said the initiative is an “important next step” on the path to mainstream adoption of secure electronic communications in healthcare. “Secure communications will provide more efficient, safer and direct transfer of clinical information between healthcare providers,” he said. “Numerous coroners’ reports have highlighted the risks of a continued reliance on legacy systems such as fax and post. It’s time for healthcare as an industry and profession to adopt 21st century communications solutions.” Vendors interested in the initiative can express their interest on ADHA’s website. This article first appeared on Healthcare IT News Australia.

Unsigned prescriptions are now legal when created with an electronic system that is integrated with the New Zealand e-Prescription Service (NZePS). The Director General of Health Ashley Bloomfield has approved a waiver for unsigned prescriptions to be recognised as legal prescriptions when strict criteria are met, including the use of an electronic system that is integrated with NZePS. Ministry of Health Group Manager of Digital Strategy and Investment Darren Douglass says the Ministry is working with partners across the health system on pilot implementations to “ensure that processes fully comply with the legislation and maintain patient safety and confidentiality." “The Ministry recognises the opportunity to move to a paperless system in the future, and the waiver for unsigned prescriptions is one step in that direction,” he said. The ePS allows prescribers to generate a barcoded prescription to give their patients to present at a pharmacy. The barcode is scanned, and all the prescription information is made available electronically. Royal NZ College of General Practitioners Medical Director Richard Medlicott envisions a paperless future where repeat prescriptions ordered via a patient portal app could be sent to people’s phones as a barcode to present to a pharmacy for scanning. However, he acknowledges that uptake of the service by GPs has been slow. Rollout began in 2013, and all community pharmacies have access, of which 75 percent are now scanning barcoded prescriptions but only 150 general practices are using the service. Medlicott says that early on there were some sector leaders arguing that because GPs had to pay for ePS, it was not worth it. With a practice population of 12,000–13,000 patients, Medlicott pays $120 a month and estimates savings of around $1,500 a month. Not having to do triplicate controlled-drug forms is a particular timesaver. “It’s really easy, it will save you money, it will decrease fraudulent scripts and you can see whether medications are being dispensed or not,” he says. “It’s a no-brainer. There’s this idea that GPs are business-savvy, but they just see the cost and not the benefit.” Pharmacy Guild CEO Andrew Gaudin says the NZePS reduces a pharmacy’s administrative workload and increases efficiencies in the dispensary, allowing pharmacists to spend more time with patients. “As uptake of the service by general practice has been slow, pharmacies are not yet able to fully utilise the benefits the NZePS system could deliver,” he says. “Currently only 14 percent of general practices are generating electronic prescriptions. It would be great to see this number increase.” Ministry of Health figures show that more than 1.2 million e-prescriptions have been generated by GPs in the past six months. This article first appeared on eHealthnews.nz.

SA Health, the public health agency of South Australia, has made improvements to its troubled electronic medical record (EMR) system, in an attempt to lay the foundation for progressive implementation of new features and functionality. The move is an upgrade from the version the healthcare organisation was using since 2014, and follows an independent review of the program that found its Enterprise Patient Administration System (EPAS) failed, as it “contrasts with other successful EMR implementations in Australia”. The review identified that SA Health’s billing module was “not fit-for-purpose”; and the EPAS has a “flawed governance model” that didn’t empower clinicians to be key decision-makers or allow the system to be tracked, measured or managed, amongst other findings. Following the review, SA Health was expected to scrap and reconstruct its beleaguered electronic patient records.  The upgraded EMR version installed at SA Health’s facilities now consists of Allscripts Sunrise EMR and paperless administration system (PAS), which was a key recommendation in the EPAS Review. Recommendation 13 of the review identified that “the existing Sunrise EMR/Allscripts PAS 14.3 software version be upgraded to 17.3, with the progressive implementation of its new features (not ‘like with like’), and that subsequently there be a regular upgrade path”. Allscripts ANZ General Manager Todd Haebich said the upgrade provides SA Health with a more contemporary, versatile and risk-resilient EMR platform. “The latest version of the Sunrise EMR 17.3 offers many functional benefits, but from an interoperability perspective, it enables SA Health and third-party vendors to extend the EMR with new apps and initiatives, including products from the global Allscripts Application Store,” Haebich said. “The upgrade also brings increased security and resilience, as it provides administrators with greater and more effective capabilities to keep the platform functioning when servers and networks fail.” The upgrade also allows SA Health to introduce the following: Timeline: A patient-centered graphical view of the continuum of care, where the clinician receives a visual view of the patient’s visit history across all settings of care. For a more detailed view of a specific encounter, the clinician can open the desired block to launch the new visit record web portal.   Sunrise Compass: A solution that enables it to build upon and combine the workflow management tool and tasking infrastructure into a single new UI. A new Smart Engine analyses patient conditions such as results, vital signs, problems and observations to dynamically suggest tasks, workflows and actions. Compass aims to increase the quality of care and decrease time to treatment and diagnosis by decreasing manual interventions in the EMR.   Sunrise Mobile: A solution that lets clinicians manage their daily activities. “The upgrade is the first step in ultimately providing SA Health with a system to rival what we have achieved in other geographies like the US, UK and Singapore,” Haebich said. “We welcome the EPAS Review’s recommendation that we play a much greater role in delivering SA Health’s EMR, and we look forward to working more closely with SA Health to fulfil what it has set out to achieve.” This article first appeared on Healthcare IT News Australia.

Cambridge-headquartered InterSystems today announced that MediWay Technology, a China-based healthcare software company, has built and deployed its new iMedical Cloud healthcare IT ecosystem platform using InterSystems IRIS for Health. IRIS for Health was launched in October 2018 and is built upon the InterSystems IRIS Data Platform (which was made generally available in February 2018), combines transaction processing and analytics with embedded interoperability to offer a fast development platform for building mission-critical applications at scale. Some of the IRIS for Health data platform’s features include: An application framework for rapid development of solutions using Health Level Seven (HL7) Fast Healthcare Interoperability Resources (FHIR), including FHIR Server and SMART on FHIR capabilities. Out–of-the-box support for every major U.S. and regional l healthcare interoperability standard and certification, including HL7 Versions 2 and 3, Consolidated CDA (C-CDA), integrating the Healthcare Enterprise (IHE), ASTM International, X12, NCPDP, DICOM, and others. A normalised and extensible healthcare data model that allows for seamless transitions between standards. Why it matters MediWay’s iMedical healthcare information system (HIS) is used by around 500 healthcare organisations, including more than 300 tertiary hospitals and 30 top-100 hospitals in China. To accelerate the digital transformation of healthcare, however, MediWay and its partner Tencent Cloud require higher levels of accessibility, scalability and interoperability. Two iMedical Cloud applications, available to all healthcare stakeholders hosted on Tencent Cloud, have been launched with two core functionalities – transactional cloud collaboration (Cloud HIS) and data cloud collaboration (HealthChain). iMedical Cloud can be used within a region for real-time healthcare information exchange, centralised management control and unified allocation of resources. IRIS for Health supports the vastly increased data volumes required with features like sharding. This distributes data across a number of cloud-based servers to provide flexible, inexpensive performance scaling. IRIS for Health’s support for cloud-first development using container technology also allows MediWay Technology to take full advantage of the strategic partnership between its parent company, DHC Software, and Tencent Cloud. This enables MediWay to continue to integrate technologies such as AI, blockchain, and speech input with its cloud-based healthcare solution. On the record “A cloud solution solves many pain points in healthcare,” said William Han, Chairman and CEO of MediWay Technology. “For example, it can provide a healthcare information system for county clinics, community healthcare centres and small-to-medium sized hospitals without the need for computer rooms, local servers or maintenance staff. By supporting our strategic pivot, InterSystems and its IRIS for Health technology have yet again shown the true partnership we’ve come to expect after 20 years of collaboration.”

A group of Kiwi clinicians with a passion for technology driving changes in healthcare has created a Clinical Informatics Leadership Network. The new network is being supported logistically and financially by Health Informatics New Zealand and held its first meeting during the HiNZ 2018 conference in Wellington. It now has 74 members from a range of health professions such as medicine, nursing, allied health, midwifery and pharmacy. It provides an online forum for members to share expertise and ideas as well as national networking events. Network organiser Karen Blake is the regional manager for health informatics at shared services organisation healthAlliance and has worked as a midwife in both New Zealand and Australia. “There have been lots of failed IT projects in health and there’s enough evidence now to demonstrate that clinical leadership is absolutely fundamental to the success of these projects,” she says. “Our IT solutions need to be clinically led to solve clinical problems, as it’s not about solving more and more IT problems.” Similar networks have been set up in Australia and the UK, where NHS trusts routinely have a chief clinical information officer and there is a national CCIO for Health and Care. Fellow network organiser and clinical director information services and virtual healthcare at Waikato DHB Ruth Large says in New Zealand there are a variety of ways that DHB information services use a clinical reference point, but there is no consistent clinical IT role in DHB leadership models. “There has been a gap in terms of clinical leadership around the development of our digital technologies,” she says. Large says CILN members do not need to have IT qualifications or a role involving informatics, but an interest in using technology to drive change, efficiency and good patient outcomes. Large wants New Zealand to avoid the US experience where the wide implementation of electronic health records has seen many clinicians become disengaged, feeling they are entering patient data into computers to “feed the machine”, rather than for improved patient outcomes. “We need a cohesive and supportive voice for clinical IT, otherwise we are just going to get the technologies we are given,” Large says. This article first appeared on eHealthNews.nz.

The Health Sciences Authority (HSA), a statutory board under the Ministry of Health (MOH) in Singapore, said in a statement on March 15 that one of its vendors, Secur Solutions Group Pte Ltd (SSG), had failed to properly secure a HSA database against access over the Internet. The database contained registration-related information of 808,201 blood donors which includes name, NRIC number, number of blood donations, dates of the last three blood donations and in some instances, blood type, height and weight. According to the HSA, the database did not contain any other sensitive, medical or contact information. A cybersecurity expert discovered the vulnerability on March 12 and alerted the Personal Data Protection Commission (PDPC) on the next day - HSA worked with SSG immediately to disable assess to the database. A police report has also been made by HSA and is in contact with the expert on deleting the information. Investigations are pending and preliminary findings indicate that other than the cybersecurity expert who raised the alert, there were no other unauthorised access to the database. The information provided to SSG was placed on an unsecured database in an internet-facing server on January 4 this year and the vendor did not put in place adequate safeguards to prevent unauthorised access. “We sincerely apologise to our blood donors for this lapse by our vendor. We would like to assure donors that HSA's centralised blood bank system is not affected. HSA will also step up checks and monitoring of our vendors to ensure the safe and proper use of blood donor information,” said Dr Mimi Choong, CEO of HSA in a statement. Including this latest case as reported by HSA, the Minstry had experienced four IT-related incidents since the SingHealth cyberattack which happened from June to July 2018. The other two incidents occured in January 2019 in which the confidential information of 14,200 HIV-positive individuals were leaked and last month, MOH said that a computer error had resulted in 7700 people receiving inaccurate CHAS healthcare subsidies.

Last month, Indonesia’s Ministry of Health (MOH) announced the launch of their Sehatpedia app to facilitate the public’s access to health information. The app (currently only available on Android platforms) has an interactive consultation (live chat) feature and provides access to health articles, medical journals and health policies. Users can also register for outpatient appointments through the app but this is only limited to hospitals under the MOH. With the live chat feature, the public can consult doctors on health information needs such as disease complaints, health tips, and other medical consultations. “Sehatpedia can be accessed by all Indonesian people. Physicians from 32 vertical hospitals of the MOH will respond to the consultation queries,” said Secretary of the Directorate General of Health Services, Dr. Agus Hadian Rahim, Sp.OT (K), M.Epid, MH. Kes. In terms of the content for health articles, Sehatpedia is assisted by three communities: Health for Junior Indonesia (Kejora), which produces health articles relevant for young children, GARASI KITA community, and the FKG UI Teaching Staff Association. According to the MOH, about 8000 people have downloaded the app as of mid-February 2019.

The Belt and Road Initiative (BRI), also known as One Belt, One Road, is the Chinese government’s development strategy that was introduced in 2013 to build ties along the overland Silk Road Economic Belt and the naval trading route known as the 21st Century Maritime Silk Road. Although health is not at the core of the initiative, Ruwei Hu and his colleagues at the Sun Yat-sen University in Guangzhou and from the University of Utah in Salt Lake City, US, state that the BRI provides a common platform for regional public health emergencies through epidemic information sharing, exchange of preventive and interventional methods, and training health professionals. In China, there are both start-ups and big companies (including jianke.com, a Chinese B2C internet drug company, see featured image) looking to expand their knowledge and expertise in healthcare through internationalisation and collaboration with foreign companies, making the country a potential global innovator in healthcare, which is the theme of the latest HIMSS Insights eBook. The full article on China’s digital health Silk Road project can be found here.

Samitivej Hospital Group, a private hospital brand in Thailand with a network of eight hospitals and owned by Bangkok Dusit Medical Services (BDMS), recently announced the launch of its one-stop Virtual Hospital app, offering three key services: Teleconsultation – a remote telemedicine consultation service that provides round-the-clock medical advice via a video call with Samitivej’s doctors and nurses. Test@Home – patients can have their blood samples taken in the comfort of their home and blood samples will be sent to the laboratory immediately. Medicine Delivery – medication will be delivered to patients with absolute data security as Samitivej adheres to the data protection standards mandated by the Health Insurance Portability and Accountability Act (HIPAA). Samitivej Virtual Hospital will be available on April 1, 2019, with services 24 hours a day, seven days a week. The consultation fee is 500 baht (approx. US$15.78) per 15 minutes, and patients using the service will receive a 20% discount on medications. In addition, the services of the Samitivej Virtual Hospital do not require appointments to be made in advance. Samitivej Hospital Group teamed up with six leading companies to launch the virtual hospital services: Advanced Info Service, Line Thailand, Muang Thai Life Assurance, Siam Commercial Bank, Sansiri and SCG Cement-Building. There is also a Samitivej Virtual Hospital control room (see featured image) located at Samitivej Srinakarin Hospital that has been designed with the specific purpose of enhancing the Samitivej Virtual Hospital experience. “A significant challenge in today’s healthcare industry is to move beyond digital disruption and service providers need to keep up with trends, innovate and develop new service models to continuously meet the needs of consumers in all sectors,” said Chairat Panthuraamphorn, Managing Director and Chief Executive of Samitivej Hospitals and BNH Hospital, in a statement. There are also plans to expand the Virtual Hospital service to BNH Hospital in the future, he added. Last month, BC Platforms announced that it will be providing its genomics platform to Bumrungrad International Hospital, a private multiple-specialty medical centre founded 1980 in Bangkok. In January this year, the Thai government added medicine, medical supplies and medical services to its price control lists. While there has been outcry from the private hospital industry that the price controls would adversely affect Thailand’s reputation as a medical tourism hub, the effects of the price controls remain to be seen.

Eastern Health has rolled out a new trial across its Box Hill Hospital in Melbourne, Victoria, to help patients better manage their medication after they leave the hospital. DC MedsRec, the community pharmacy-based service for patients discharged from Box Hill Hospital with four or more medicines, aims to reduce the risk of harm from dangerous drug interactions. The trial, conducted in collaboration with the Australian Digital Health Agency (ADHA) and Monash University, will enable eligible patients to meet with trained community pharmacists, who will look at their hospital discharge summary via My Health Record (MHR), along with a range of other medication information on their electronic medical records (EMRs). The pharmacist will then check the patient’s understanding of the drugs they are taking, resolve any potential medicine safety problems and ensure any medication-related recommendations from the hospital are followed up. The pharmacist will also offer to dispose of any discontinued medications and prescriptions for the patient, with the patient's consent. The move follows Eastern Health’s successful EMR implementation at Box Hill Hospital In October 2017, in partnership with Cerner, as part of its Great Digital Information Strategy 2015-2020. ADHA CEO Tim Kelsey said the service was part of a $8.5 million program that trials innovative and new approaches to post-hospital support, palliative care and the management of chronic health conditions using digital technology. “Pharmacists involved in the Box Hill project will be able to access their patients’ hospital discharge summaries quickly and easily using My Health Record,” he said. “The ultimate aim is to ensure patients with complicated medication regimens don’t end up back in the hospital after taking a bad combination of medicines.” Monash University Project Lead Greg Duncan said the trial was initiated as a result of poor medication management during or immediately after a hospital stay, which becomes a risk factor in 28 percent of potentially avoidable hospital readmissions within 30 days. “We know medication errors often occur when patients leave the hospital and can mean patients end up being readmitted – so we will assess the impact of this new service on 30-day unplanned readmission rates to the hospital,” he said. Eastern Health Chief Executive Adjunct Professor David Plunkett said the trial positions the organisation to “provide both excellent clinical care and research,” with real-world benefits. “Community pharmacies from the Eastern Health area will take part in the pilot, with up to 5,000 patients potentially involved,” he said. The success of the service will be evaluated after 12 months, with Kelsey adding that the results could potentially shape future projects, helping patients throughout Australia better manage their medicines. This article first appeared on Healthcare IT News Australia.