ASIA News

New figures show that one in 10 Australians have opted out of the My Health Record (MHR) system, leaving participation rates at 90.1 per cent. 

Dr NT Cheung has been the Chief Medical Informatics Officer (CMIO) of Hong Kong’s Hospital Authority (HA) for the past 26 years. The HA is a statutory body established under the Hospital Authority Ordinance in 1990 and has been responsible for managing Hong Kong's public hospitals’ services since December 1991. As the CMIO, Dr Cheung has been key in driving the IT transformation of the organisation from one which began with a very rudimentary use of IT in the 1990s to one which is able to continuously roll out new initiatives, very quickly and at a high degree of standardisation not just to improve the work processes of clinicians, but ultimately for the benefit of patients under their care. “Looking forward on healthcare - the pressures on healthcare, which all of us share in any advanced economy now, it's the same, which is that people live longer, you have more chronic disease, you have more demands, and healthcare people expect more and your healthcare manpower is not growing at the same pace.  You can't just keep on doing more and more healthcare in the old way, you have to change the way that you are doing it – you have to change your service models, you have to add significant amounts of automation to this very labour-intensive sector of the industry. And so again, that's what health IT is able to deliver. And there are very few other options to be honest. So it's becoming an increasingly important part of getting us into a more sustainable model for the whole healthcare in the future,” Dr Cheung explained. HA’s Clinical Management System (CMS) – 1990s till present Currently in its fourth generation, the CMS at HA started off modestly in the 1990s with convincing the frontline to start using these tools with a very basic digitalisation of hospital wards. By the year 2000, the second phase of development for CMS began when HA linked together the various hospitals, as well as linking the outpatient and inpatient records together. More tools were also built to support the healthcare process with features such as order entry and rudimentary forms of decision support. Phase three of the CMS was about rebuilding the entire platform to a more modern one which allowed for a much greater integration/standardisation across the board. “So from CMS two, we had this integrated electronic record but in terms of functionality and functional modules, they were all pretty much stovepipes and they would then contribute data into the central repository but they were separate stovepipes. So CMS three was trying to build it as a platform using the then newest technology of putting the applications on the server side rather than the client side of approach, and then build that platform using a more modern Java-based platform,” Dr Cheung said. The fourth phase of development of the CMS has a ring to it – with a slogan called the 5Ps approach: Paperless – Dr Cheung shared that the HA has hit an inflection point where in many cases, the paper workflows are now going to be more cumbersome than the digital workflows that they can now design, Protocol-based – introducing clinical intelligence from people, guidelines, websites, books into the CMS Closed looP - in a very complex workflow like a high volume hospital, things get missed out, the loop does not get closed because nobody can keep track of everything all the time. Communication tools at the clinical side will be strengthened to make sure everything is followed up and the loop is closed. Personalised - to allow for a greater degree of personalisation for every single individual user across different hospitals, depending on their particular situation. Patient-centricity - a reminder that the patient is still the centre of the healthcare universe. A unified patient app One of the five portfolios under HA’s IT 5-Year Strategic Portfolio is Enhanced Patient Experience & Outcome, which focuses on new patient-centric service models with disruptive technology. Dr Cheung said that one of the key deliverables that HA is working on now is a unified patient app. HA has been releasing patient apps since 2011 and a portfolio of apps have been built but there are simply too many apps for patients to keep up with. “We are building a single patient app that we call HA GO - it does several things more than the previous collection of apps. So first of all, it's a one stop shop. So you would download the single app from HA, and then you would register as an app user once and all the apps will know who you are. Secondly, it functions as a conduit - it's not just a collection of little apps, it is a framework for allowing your health care which is delivered in the hospital or clinic to extend out to the rest of your life when you're in the community or at home,” he added. The HA GO single patient app is slated to be launched this year with a modular design consisting of ‘mini apps’. For instance, diabetic care would be a mini app and the app will be pushed to the phones of diabetic patients who need it.

A patient-flow system implemented at MidCentral District Health Board (DHB) in New Zealand is helping to streamline patient journeys through Palmerston North Hospital and allowing clinical staff to view important patient information at the bedside. The MIYA patient flow system, from Alcidion, is live in 17 wards and the emergency department at Palmerston North Hospital and one ward at the Horowhenua Health Centre. Alcidion is an Australian-based provider of Clinical Decision Support Systems, including Patient Flow Software, EDIS, Mobile EMR and Outpatient Solutions. MIYA gives real-time updates of bed management and patient flow throughout the hospital and health centre, showing a patient’s progress from the time they arrive to the time they are discharged, as well as an overview of hospital occupancy. Charge nurse Sarah Donnelly says, “The mobile technology is a godsend on ward rounds and has helped improved patient flow in and out of the ward, making discharges more evident and timely. I love it and wouldn’t be without it now”. The system was tested on two wards for three weeks in early November 2018 before being rolled out to all clinical areas later that month. Acute care and hospital operations service manager Carrie Naylor-Williams says the next phase of the implementation involves looking at how to use the data being collected by the system on a day-to-day basis. The hospital also plans to go live with MIYA in theatres before the end of this year. The data can be used to predict future demand, so staff know what to expect on different days and can plan accordingly. It’s also used to forecast operations for surgical patients. “We can see the cohort of patients currently admitted and what their predicted length of stay is and therefore what surgeries we can do. It will give us greater understanding to be able to manage the capacity of the hospital,” says Naylor-Williams. Bed management and capacity planning was previously done on paper and whiteboards and experienced staff getting a “general feel” for how things were looking, she explained. “We want to put be able to put a science to it and not be dependent on someone with experience being able to do it, but anybody can look at the board and see what the day’s like,” says Naylor-Williams. MIYA pulls data from the hospital’s clinical portal, so clinicians can securely view a current patient’s history, including admissions, demographics and results, on mobile devices at the bedside. The software platform has successfully integrated with five clinical information systems at Midcentral DHB, including WebPas, CareStream Radiology, Clinical portal and Pathology to provide clinical staff with detailed patient information displayed on the ward’s journey board. Naylor Williams says this means doctors can discuss results with patients face to face and make immediate decisions while on their ward rounds. They can also quickly view immediate bed availability in suitable wards. A version of this article first appeared on eHealthNews.nz.

Last week, BC Platforms, an MIT Whitehead project spinoff which specialises in powerful genomic data management and analysis solutions, announced that it will be providing its genomics platform to Bumrungrad International Hospital, a private multiple-specialty medical centre founded 1980 in Bangkok, Thailand. WHY IT MATTERS BC Platforms will be providing its customisable end-to-end Software-as-a-Service (SaaS) platform to enable Bumrungrad to offer personalised healthcare solutions for their patients in the clinic. The core system will be seamlessly integrated in the hospital infrastructure from laboratory to electronic patient records. To support advanced patient care, the ability to handle all types of genetic data from Genotyping and Next Generation Sequencing (NGS) instruments into clinical reporting is essential. Bumrungrad will also participate in providing its extensive Asian data and samples to BCRQUEST, providing additional sample diversity and data resources for researchers. BCRQUEST is a global network of healthcare service providers and biobanks that provide genomic and clinical cohort data for pharmaceutical and medical research and development. THE LARGER TREND Precision medicine, of which genomics is a subset of, was a key topic addressed at the recently concluded HIMSS19 Precision Medicine Summit. At the event, Dr. John Halamka, CIO of Beth Israel Deaconess Medical Centre, said that precision medicine, at its core, is "the right care in the right setting from the right provider at the right time." Data – structured, complete, well-governed and easy to see – will be key to precision medicine becoming more widespread and Dr. Halamka added that on the precision medicine journey, having the data accessible is going to be hugely important. He also pointed out that besides technology, there are also other challenges such as "interesting politics and policy issues that are part of the precision medicine journey.” While precision medicine offers huge promises, policy, technology, clinical processes and patient engagement need to evolve to make it a reality for primary care. ON THE RECORD “We are excited to be partnering with BC Platforms to bring personalized healthcare solutions into our clinical practice and research. We are looking forward to working with BC Platforms to set a new standard for predictive medicine complementing conventional treatment for our patients and clients across the globe,” said Artirat Charukitpipat, Chief Executive Officer at Bumrungrad. Tero Silvola, CEO of BC Platforms, said, “We are pleased that Bumrungrad has chosen to adopt our genomics platform for their clinical practice and to benefit research. We aim to build comprehensive collaboration programs with Bumrungrad to facilitate projects where patients will benefit from the latest innovations and thereafter gain access to clinical trials relevant to their individual disease status. Bumrungrad is one of the largest healthcare providers in South East Asia and by contributing their data mainly focusing on Asian haplotypes to BCRQUEST we can greatly improve the diversity of our offering to research organisations worldwide.”

Due to an error in the software administered by NCS Pte Ltd., about 7,700 individuals received inaccurate healthcare and intermediate and long term subsidies, said the Ministry of Health (MOH) on Feb. 16, 2019. The individuals affected were those who had their Community Health Assist Scheme (CHAS) card applications and renewals processed from Sept. 18 to Oct. 10, 2018. CHAS enables Singapore citizens from lower to middle-income households and all Pioneers* to receive subsidies for medical and dental care at participating GP and dental clinics near their home. Specifically, the error occurred in the computer system when it calculated means test results. MOH said it is working with healthcare service providers and scheme administrators to reach out to the affected individuals. About 1,300 of them who received lower subsidies will have the difference reimbursed to them and another 6,400 individuals received higher subsidies due to the error. However, they do need to return the additional subsidises disbursed. The means-test system calculates the healthcare subsidies which individuals are eligible for, based on their income information. Timeline of key events (as stated by MOH and NCS) Sept. 24, 2018 : First means test discrepancy was detected by CHAS processing team and incident reported to NCS. Oct. 10, 2018 : Software version issue detected was fixed. Oct. 10 to Nov. 29, 2018 : 5 more cases of inaccurate means-test results were detected, NCS applications support team investigated since Sept. 24 but could not pinpoint the root cause. MOH was informed. Nov. 29 - Dec. 5, 2018 : MOH and NCS worked together to assess the impact to individuals and the extent of impact was assessed to be thousands of individuals, and scheme beside CHAS. Jan. 14, 2019 : Correct subsidy tiers for each scheme were generated and provided to MOH. Jan. 18, 2019 : Measures were implemented to contain impact on non-CHAs schemes. Feb. 10, 2019 : Number of unique individuals affected all schemes were determined. Feb. 16, 2019 : Subsidy tiers of affected individuals were fully corrected and affected individuals were to be progressively informed. Reimbursements to commence. MOH expects all the affected individuals to be informed by mid-March 2019. Just last month, MOH announced that the confidential data of 14,200 individuals with HIV were illegally leaked online and the information is in the possession of American Mikhy K Farrera Brochez, who used to reside in Singapore. A police report was made and investigations are still pending. *The ‘Pioneer Generation’ is defined as living Singaporeans who meet 2 criteria: i. Aged 16 and above in 1965 (born on or before 31 Dec 1949, which also means they are aged 65 and above in 2014); and ii. Obtained citizenship on or before 31 Dec 1986.

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.” 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. 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. This article first appeared on Healthcare IT News Australia.

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 (AEHRC) have collaborated with the Fiona Stanley Hospital, part of the South Metropolitan Health Service in Perth, to develop and pilot thi 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 said 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 added.  “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.” s mobile app – Mobile Image and Communication Exchange, named ‘the MICE app’ for short. 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. Elsewhere in Australia, a similar app called the ClinMAPS PRO was developed by AusHealth, a private Adelaide company that commercialises medical research in South Australia in November 2018. The digital scar assessment app is based on a photographic standard to assess the healing of scars. A version of this article first appeared on Healthcare IT News Australia.

In May 2018, Health Minister Dr Dzulkefly Ahmad said that the Health Ministry will be setting up an independent Health Advisory Council within 100 days to advise the ministry on strengthening healthcare delivery. The Health Advisory Council was finally established in January 2019 and “several private hospitals have expressed their wish to cooperate (with the Health Ministry)”, according to Dr Dzulkefly when he visited Ampang Hospital, a government hospital yesterday. He also added that the public-private healthcare collaboration would help public hospitals, in particular, to tackle various issues like shortage of specialists and facilities as well as heavy workload and rising cost of treatment. The Health Advisory Council’s role is to generate ideas towards empowering the nation’s healthcare system as well as assisting the government in formulating a new direction that will steer the Health Ministry to provide world-class services. Dr Dzulkefly also urged the public to undergo early screening and detection tests for cancer as the disease had become the second highest cause of death among the people in Malaysia. He said in an article by The Sun Daily that an estimated 60% of cancer cases in the country are detected at late stages, either at Stage III or IV. Last November, Dr Dzulkefly announced that the Ministry of Health is committed to ensuring that the electronic medical record system (EMR) can be realised within three years at 145 hospitals nationwide, as a way to improve the country's health service to a better level.

An antibiotic prescribing app developed at Capital and Coast District Health Board (DHB) has improved doctors’ adherence to prescribing guidelines. Developed by the DHB’s Infection Services with computer science students from the Victoria University of Wellington, the Empiric app gives prescribers easy mobile access to antibiotic guidelines and assists with clinical decision making. Empiric prescribing is when a doctor chooses an antibiotic before knowing exactly what micro-organisms are involved, so they prescribe according to the symptoms. Between 35–50 per cent of hospital inpatients are on antibiotics at any one time. Most large DHBs will have their own empiric antibiotic prescribing guidelines, which are often used by the smaller local DHBs. Previously these guidelines were either in a booklet or on a website, which meant doctors had to either carry a paper copy or find a computer terminal to look them up. Infection Services clinical leader Dr Michelle Balm says that while adherence to the guidelines was good, there was room for improvement. “We wanted to make it a lot easier for prescribers to make good clinical decisions about antibiotics use as close to bedside as possible,” Balm said. Empiric is automatically downloaded on to all the DHB smartphones that are given to junior doctors in place of the traditional pager. Figures show all junior doctors are using it weekly and most on a daily basis, and adherence to the guidelines has increased since the app was introduced. Doctors report that it increases confidence around prescribing. The app is also free to download on the Apple and Android app stores and has been downloaded 700 times outside the DHB. Balm says that while there are regional differences, the prescribing guidelines are broadly applicable across New Zealand, and that the DHB made Empiric freely available for anyone to use, “in the interest of transparency and to try and get a national discussion going on this topic”. Empiric takes prescribers through a set of questions to produce a personalised – rather than generic – prescription recommendation. Features include options for when a patient has an allergy and where there is a risk of multi-drug resistant organism. This article first appeared on eHealthNews.nz.

An implementation plan for a nationally consistent Electronic Oral Health Record (EOHR) will be presented to the country’s 20 district health board (DHB) chief executives by the middle of this year. Professional services organisation TAS is leading the implementation on behalf of the DHBs after recently signing a contract with the Ministry of Health. Chair of the EOHR programme board Robin Whyman is clinical director oral health at Hawkes Bay DHB. He says the programme started around 2015–16 because staff operating oral health services recognised that, while nearly all DHBs are using the same clinical system, differences in local implementations mean they are unable to get nationally consistent information out of it. “When trying to get information for a national picture of what’s going on in oral health and around service quality improvements, we were struggling to compare things and be confident we were interpreting things in the same way,” he added. All but two small DHBs are using Titanium Solutions and the remaining are paper based. A number of Māori health providers contracted to the DHBs are also using the software. The Titanium system contains critical information about the status of patients and treatments provided to nearly all children up to the age of 12 and some adults. However, each DHB has made its own decisions with the vendor, resulting in boards being on different versions of the software and two slightly different code sets for treatments being used. A Request for Proposal for a national EOHR system was released in November 2016, but the EOHR Programme Board recommended not to award a contract. Instead the programme team is working with Titanium to make improvements and move towards a nationally consistent system. “One of the early pieces of work is to work with the sector to allow a nationally agreed code set for the system,” Whyman says. “By having a consistent coding set and interpretation we believe we will start to have conversations about quality improvement, looking at outcomes of treatment and oral health status and how that’s linked to interventions put in place.” He hopes to have a national coding set in place and in use by mid-2019. Whyman says the board is also looking to develop regional groupings of DHBs using the same instance of the software. These will evolve over the next couple of years. “Part of the work of TAS is to work with the sector on the best way to do that,” he says. An implementation plan that’s “achievable within the resources of the DHBs” will be presented to the 20 DHB chief executives by the middle of this year for approval, he says. A TAS statement says a nationally consistent EOHR is expected to help improve New Zealanders’ oral health through improved capture and quality of oral health information. It says the programme of work underway will see DHBs implementing consistent business, system and information management processes. It will also enable DHBs to benefit from national economies of scale and achieve efficiency benefits. This article first appeared on eHealthNews.nz.