ASIA News

The Ministry of Health (MoH) of New Zealand has chosen MidCentral and Southern District Health Boards (DHBs) as pilot sites for implementing digital maturity assessments. The pilots will include three HIMSS Analytics maturity assessments: the electronic medical record adoption model (EMRAM), outpatient-EMRAM (O-EMRAM) and the continuity of care maturity model (CCMM). MoH group manager digital strategy and investment Darren Douglass says the assessments cover digital maturity across multiple care settings, which will create useful information to inform where DHBs focus in terms of digital investment.  HIMSS EMRAM scores hospitals internationally on their adoption and use of electronic medical records on a scale from 0–7, and O-EMRAM is used to evaluate services provided outside of a hospital or acute care environment. CCMM focuses on the capabilities needed in order to “seamlessly coordinate patient care across a continuum of care sites and providers,” the HIMSS website says. Douglass says the two DHBs were chosen as pilot sites because they have both recently developed digital health strategies and have strong linkages within their districts across hospitals, primary care and community services. The timing of pilot programmes to implement HIMSS digital maturity assessments has yet to be confirmed. The success of the pilot programmes will inform whether the assessments are rolled out nationally. All DHBs have previously completed the EMRAM hospital inpatient maturity assessment. According to MoH’s eHealth website section on Digital Hospitals, HIMSS Analytics provided a report on the findings within New Zealand in June 2016. Evidence from implementations overseas has shown a strong correlation in improvement in productivity and quality as hospitals move up the EMRAM model to Stage 7. A version of this article first appeared on eHealthNews.nz.  

At the Mental Health Awareness Singapore Learning Series “Healthy Mind , Better Life” Seminar organised by charity group Brahm Centre held on 25th October, Dr. Amy Khor, Senior Minister of State, Ministry of Health, announced the launch of the Dementia Friends mobile app. The app allows users to easily access information about dementia, receive updates on upcoming events on caregiving, and most importantly, use it to search for loved ones who have lost their way home. Since its soft launch, more than 1,500 mobile users have downloaded the app and signed up as Dementia Friends. The mobile app is co-developed by the Agency for Integrated Care (AIC), Nanyang Polytechnic and IHiS (Integrated Health Information Systems), which is the national technology agency for healthcare in Singapore. “Caregivers can activate this network of Dementia Friends in times of crisis, as the community of Dementia friends can help to keep a lookout for loved ones once they get a notification from the app,” said Dr. Khor. She also said that to date, six Dementia-Friendly Communities (DFC) have been formed. DFCs are support networks that help seniors with dementia live and age well, as well as provide much needed support to caregivers. Under the DFC initiative, residents, grassroots leaders, business owners and frontline government agencies are trained to help persons with dementia and their families. The six DFCs are at Yishun, Hong Kah North, MacPherson, Queenstown, Fengshan and Bedok. The Dementia Friends mobile app is available for download on the Apple App Store and Google Play Store. In August, the National Institute on Aging in the US awarded a US$4.5 million grant to the University of California Berkeley and People Power, an IoT software provider, to support research on smart home solutions for caregivers of dementia patients. People Power is creating customised systems through behavioral research on targeting everyday stressors for caregivers and dementia patients. The new technology gives caregivers proactive alerts that identify abnormal qualities in patient activities.

In 1995, the Singapore Armed Forces (SAF) Medical Corps introduced a large scale Electronic Medical Records (EMR) system, the first of its kind in Singapore. In less than a decade, the improved second generation of the EMR was implemented and most recently, the latest generation of its EMR system was rolled out in April 2016. In an interview with Healthcare IT News Asia Pacific, RADM (Dr) Tang Kong Choong, Chief of the SAF Medical Corps, gave an update on the recent developments at the organisation as well as some of the lessons learnt behind the implementation of the third generation EMR system. Could you share with us briefly about your role as Chief of Medical Corps (CMC)? How has it been thus far since your appointment in May 2015? As the Chief of the SAF Medical Corps (CMC), I am overall responsible for the provision of quality healthcare services to all SAF servicemen and women and robust medical support to enable the SAF to conduct safe and realistic training. Since assuming the appointment of CMC in May 2015, I have had the privilege of setting the vision and driving the implementation of projects and initiatives to improve the quality of care and medical support provided to our servicemen and women. In April 2016, the 3rd generation of the SAF’s Electronic Medical Records System, known as the PAtient Care Enhancement System 3 or PACES 3, was rolled out. PACES 3 is an entirely new EMR system that connects seamlessly with Singapore’s National Electronic Health Records (NEHR) system. PACES 3 contains clinical decision support features and enhances patient safety by allowing the SAF to share allergy information and other key medical information with Singapore’s healthcare providers through the NEHR. Its user-friendly mobile eHealth portal has allowed our soldiers to conveniently book their own medical review appointments, retrieve information about their health visits and investigations, and enabled greater health ownership amongst our soldiers. In 2017, the SAF Medical Corps reviewed the SAF’s approach to the promotion of health. We collaborated with external partners such as the Health Promotion Board on useful national-level health initiatives such as the National Steps Challenge (Corporate) and introduction of healthier dietary choices for the SAF. The SAF Medical Corps also hosted the 3rd Asia Pacific Military Health Exchange, which saw more than 500 participants from the military medical services of Asia-Pacific nations gather in Singapore to share and learn from one another in the field of military medicine. We also enhanced our cooperation with the Singapore Civil Defence Force (SCDF), with the SAF Medical Corps embarking on a pilot partnership with the SCDF; 12 SAF medics were deployed to work alongside SCDF personnel on their ambulances for three months from October to December 2017. The SAF’s new Electronic Medical Records (EMR) System – PAtient Care Enhancement System (PACES) 3 was launched in April 2016 and was the winner of the “Digitalised Care to Support One Healthcare System” category at the National Health IT Excellence Awards 2017. Unlike its predecessors which was hosted internally on the SAF intranet, PACES 3 is now also connected to national healthcare systems such as the National Electronic Health Record (NEHR) and Critical Medical Information System (CMIS). What were some the considerations and challenges behind implementing an EMR that could easily integrate with other health systems/infrastructures? The key impetus for hosting PACES 3 on an Internet-facing platform was to integrate our medical care records with that of the national healthcare system. Introduced in 1995, PACES was upgraded to PACES 2 in 2005 to have networked capabilities over a secured intranet system. The Ministry of Health’s articulation of the national vision of “One Patient, One Record” and the introduction of the National Electronic Health Record (NEHR) in 2011 was a strong impetus for us to develop PACES 3 onto an Internet-facing platform that is integrated with the national healthcare system. This provided a seamless and safe transition of medical care between healthcare providers. The choice of the health IT solution and the partner agencies was a key consideration in the SAF’s EMR System. After an open tender and robust evaluation process, the SAF Medical Corps awarded the contract jointly to Allscripts and National Computer Systems (NCS). Prior to this partnership with the SAF, Allscripts had partnered Singhealth for their electronic medical records system and had a strong presence in Singapore, while NCS had worked with the SAF Medical Corps for both earlier versions of PACES. With PACES 3 on an Internet-facing platform, we had to ensure the security of the medical data. To address this challenge, the project team built in multiple layers of protection and defences to ensure the robustness of the system against cyber threats. A second challenge was the migration of 20 years’ worth of electronic medical records stored over the lifespan of PACES and PACES 2, to PACES 3. The project team worked closely with our vendors to ensure the fidelity of data transfer as this was important in patient care and safety. Looking to the future, even as PACES 3 was rolled out in April 2016, it is necessary to start thinking about PACES 4 and the next generation of EMR systems for the SAF. I am cognisant that PACES 3 will need to be upgraded or refreshed to meet the health needs of the SAF in the next decade. The SAF Medical Corps will keep abreast of the developments in medical IT through participation in relevant medical IT events and conferences, development of our people in medical IT literacy, and also putting in place a system of continual review and improvements. Are there any collaborations /projects between SAF and other medical organisations with regards to health IT? The SAF Medical Corps is currently in dialogue with the Singapore Ministry of Health to better understand the development and implementation of Smart Healthcare initiatives for Singapore. We want to ensure that the SAF’s future developments in medical IT continue to be aligned with the nation’s push towards Smart Healthcare. RADM (Dr) Tang Kong Choong is a speaker at the inaugural International Military Health IT (IMHIT) track at HIMSS AsiaPac 18 in Brisbane this November.

Spanning a long and varied three decade career in military medicine with the Royal Australian Air Force (RAAF) and Australian Defence Force (ADF), Air Vice-Marshal (AVM) Tracy Smart demonstrated her versatility and capabilities in both local and overseas appointments in places such as the United States, Timor Leste and the Middle East. Ahead of the HIMSS Asia Pacific conference in November, AVM Smart talks about her role as Surgeon General ADF and Commander Joint Health, the ongoing digital health developments at the organisation and some of the most rewarding moments in her distinguished military career. Could you share with us briefly about your role as Commander Joint Health and Surgeon General ADF? Essentially, my Surgeon General ADF and Commander Joint Health roles are quite distinct, with different responsibilities. As the Commander Joint Health, I am responsible for health support to the Australian Defence Force in the National Support environment to ensure the health preparedness of our members. This means that all military members not deployed on operations are receiving their health support health centres around the country under my command, and are accessing specialist civilian services through our ADF Health Services Contract. It’s my aim to ensure that our people are fit to deploy and that those who become wounded, ill or injured receive timely, high quality health care, when required. As Surgeon General ADF I am the senior doctor, and the authoritative source of strategic health advice to Defence and the Government. I also exercise technical authority across all Defence health services, where ever they are delivered. This includes those health services delivered by our single Services - Navy, Army and Air Force – in the operational space. Some of the key functions that are executed through Joint Health Command headquarters in Canberra in support of both these roles are: •             The provision of health advice to Commanders at all levels •             Developing health policy and programs •             Delivery of health services to the ADF through a network of facilities in Australia and overseas •             Coordination of the joint health capability domain •             Coordination of health research •             Capability coordination of health material The roll out of ADF’s own e-Health information system throughout Australia was completed in December 2014. Could you give us some key updates/developments on the e-Health information system since its launch almost 4 years ago? Defence electronic Health System (DeHS) is the first and only nation-wide digitally connected primary healthcare system in Australia. Since its roll out in December 2014, there have been significant improvements in patient episode data entry and reporting to enable the comprehensive health care system delivered by the ADF within Australia, on exercises and on operations. We have seen major improvements in patient care, due to the availability of a holistic eHealth record that is accessible by all clinical craft groups, when they need it, regardless of geographic location. Patient privacy and confidentiality have also improved due to role based access. Clinical governance has been improved due to the implementation of patient recall and follow-up workflows and system diary entries. Additionally, we now have superior health intelligence and reporting, supporting both clinical decision making and health administration as well as driving workplace efficiencies and rates of effort. Over the past 12-18 months, DeHS functionality has enabled Joint Health Command to pursue a number of initiatives such as enhanced mental health screening via the Patient Portal, and inter-agency information sharing agreements with Department of Veterans’ Affairs and the Commonwealth Superannuation Corporation to enable prompt processing of member claims for compensation and entitlements when they are transitioning from service. As well as being implemented across our Australian-based health centres, DeHS is now in use on overseas deployments at some of our fixed based locations. What do you think are the key challenges and opportunities in the Digital Health Strategy of the ADF? Digital health systems will enhance the ADF’s capability through a prevention focused, and rehabilitation oriented approach to Defence health care. As with the implementation of any major strategy, the ADF Digital Health Strategy will present some challenges along the way. Some of the challenges include financial constraints on health care delivery and adoption of technologies, and the rising demand for health care services within the ADF and in the Australian community. Despite the challenges, I see some fantastic opportunities in the ADF Digital Health Strategy including enabling patients and providers to make informed treatment decisions, whilst also improving clinical outcomes, health business efficiencies, and human performance through disease prevention and injury rehabilitation. Overall, these opportunities contribute directly to ADF capability through health readiness, and ensure members are receiving care that is command responsive and member centric. How is the ADF working with the Australian Digital Health Agency with regards to the recently launched National Digital Health Strategy & Framework for Action? Defence has been working very closely with the Australian Digital Health Agency for many years, and particularly as we plan for the implementation of our future system. Our recently developed ADF Digital Health Strategy complements the National agenda led by the Australian Digital Health Agency and is consistent with both the Agency’s Strategy and Framework. It also builds upon Joint Health Command’s existing leadership in digital healthcare, recognising the Defence electronic Health System (DeHS) as the first and only nation-wide digitally connected primary healthcare system. The Strategy has been developed in alignment with the My Health Record initiative and will assist in the development of digital health systems that enable improved and more transparent access to and personal control of Defence health information and records. It will inform our future system to ensure that it provides secure, instant access to a patient’s information – whether it is within our health care centres, on board our ships and aircraft, or on exercises and deployments. For our health care providers, digital health systems will provide the necessary technology to reduce their administrative burden so that they can spend more time with patients. You have a vast experience and long service record both within the ADF and also in international peacekeeping duties such as in Timor Leste. What would you say are the most rewarding experiences in your distinguished career with the military? I have had many rewarding experiences during my career. It is an honour and a privilege to serve my country and I reflect on this every day when I put on my uniform. It is particularly satisfying to be in the top job and drive strategic and cultural change across our health system and the broader ADF. A particular highlight for me was serving as part of the United Nations Assistance Mission in Rwanda. My role was Officer Commanding Clinical Services and Aeromedical Evacuation Operations Officer, and as a Squadron Leader I was also the senior RAAF Officer in what was primarily an Army mission. Although our main job was to provide health care to the UN troops, most of our work was humanitarian – caring for the local population. This included people who we rescued from around the country by aeromedical evacuation or by road, and those we chose to treat who had presented to the Kigali General Hospital but who were too sick to be managed there. This was an incredibly difficult deployment. We saw many clinical problems that were beyond our previous experience – from the effects of war, such as machete wounds, grenade and mine injuries, to all number of tropical diseases. We also saw lots of kids, many of them orphaned and suffering from malnutrition and diseases, and some of whom died on our watch. We sometimes had to “play God” – allowing people including children to die due to our limited capacity, many of whom would have lived in a first world country. This was very hard on our people, particularly those with kids back home. The toll this mission has taken has been extreme. A 2014 Department of Veterans’ Affairs study found that over 32% of those who served now had an accepted claim for a mental health condition. However, there were many positive aspects and it was an incredibly rich experience for me. A personal highlight was caring for the children of Rwanda, including those from the Mother Teresa orphanage in Kigali. As I saw it, each child we saved or left a positive imprint upon had the potential to grow up and make a positive difference in their country, and so represented a small victory. I feel very proud of the work myself and others did over there, how we contributed to stabilising what has become a successful nation, and of how courageous our people were. I don't think I'd be where I am now, Surgeon General ADF and Commander Joint Health, without my experience in Rwanda. I may not even still be in the ADF. I learned a lot about myself, about leadership, and about resilience, embracing the view that “whatever doesn't kill you makes you stronger”. In other words, while some tragically have developed PTSD, I believe that I have experienced “post traumatic growth”. It has given me confidence that I can challenge myself in extreme situations and survive. Air Vice-Marshal Tracy Smart is a speaker at the inaugural International Military Health IT (IMHIT) track on Day 2 of HIMSS AsiaPac 18 in Brisbane this November.

HealthHub, a one-stop portal and mobile application for Singaporeans to access a wide range of health content, rewards and e-services, which was launched in 2015, had experienced a series of unauthorised log-ins, according to the Health Promotion Board’s (HPB) recent statement. The portal is an initiative by the Ministry of Health, and Health Promotion Board, supported by Integrated Health Information Systems (IHiS), the national technology agency for healthcare in Singapore. HPB and IHiS had detected the unauthorised log-ins during investigations into unusual activities on the portal. The agencies had found “higher than usual attempted log-ins” to the HealthHub portal on four days – Sept 28, Oct 3, Oct 8 and Oct 9 – using more than 27,000 unique IDs or email addresses. Although 98 per cent of the email addresses used were not related to existing HealthHub accounts and the log-in attempts were unsuccessful, 72 accounts were successfully logged in during those time periods. These accounts were subsequently locked and HPB had contacted the account holders to inform them of the suspicious activity, and to check if they had made the attempts themselves. HPB was first alerted when a user suspected her email account had been used without her permission to log in to the portal, and informed HPB. The agency also added that no evidence of a breach in the HealthHub system has been found. Healthcare cybersecurity in Singapore has been in the limelight since the SingHealth cyberattack, which occurred in June 2018. Described as one of the worst cyberattacks in the country, the incident saw the personal information of 1.5 million SingHealth patients being stolen by sophisticated hackers over the period between June 27 and July 4. Singapore Health Services or SingHealth is Singapore’s largest group of healthcare institutions, which consists of 4 public hospitals island wide, 5 national specialty centres and a network of 9 polyclinics. An ongoing Committee of Inquiry (COI) for the SingHealth cyberattack which was convened on July 24, held a series of public and private court hearings since last month and is expected to submit a report of its findings by the end of 2018.  

The IT journey in clinical systems in Singapore dates back to the 1980s and by the early 2000s, two distinct electronic medical record (EMR) systems emerged from the two integrated clusters. However, this meant that sharing of patient information, especially those moving from different clusters, was a big challenge. In 2008, the National Electronic Healthcare Record (NEHR) was conceived out of a “one patient, one record” vision based on a concept paper. Critically, NEHR differs from previous EMR systems as it is a repository of visit summaries specific to an individual. While EMR systems contain detailed information of a patient in their respective institutions, NEHR collects key subsets of health information from these multiple healthcare encounters. NEHR went live in 2011, with the successful uploading of healthcare information from public hospitals in the same year. By the first year, all restructured hospitals, specialist centres and polyclinics, six community hospitals, eight nursing homes, and an increase from an initial 50 to 250 GP clinics had access to NEHR. HealthHub, a one-stop portal and mobile application for Singaporeans to access a wide range of health content, rewards and e-services was launched in 2015. Users can also log-in to HealthHub through their SingPass to view their health records and medical appointments across different polyclinics, public hospitals and other public health institutions. The information from HealthHub is drawn from a few IT systems, which include the NEHR, the School Health System, School Dental System and National Immunisation Registry. As of November 2017, only three percent of the more than 4,000 private healthcare providers – including specialist clinics, nursing homes and hospices – contribute to the NEHR scheme. Additionally, a study of private healthcare institutions done by the Integrated Health Information Systems (IHiS), the national technology agency for healthcare, found that two in 10 private GPs and specialist clinics still use written medical record systems, rather than an electronic one. At the time of writing, the Ministry of Health (MOH) website has a list of 1230 healthcare institutions/organisations (public and private) who are participating in NEHR. Due to the slow uptake by private healthcare sector in the NEHR, MOH wants to make it compulsory for all healthcare providers to upload data to the NEHR. Early adopters who start contributing data by June 2019 will be able to claim a one-off from MOH to offset their costs of upgrading their systems and a S$20 million fund has been set aside by the ministry for this purpose. One of the unique developments is that the latest generation of the Singapore Armed Forces (SAF)’s EMR system, Patient Care Enhancement System (PACES) 3, which was launched in April 2016, connects to healthcare infrastructure outside of Ministry of Defence (MINDEF)/SAF via the internet, such as the NEHR. This helps to provide more holistic care for SAF servicemen. Traditionally, the first two generations of PACES operated independently on their own with no ability to connect to external healthcare infrastructures. While there has been a progressive development in health IT in Singapore in terms of the NEHR and HealthHub, the nation-state suffered a setback in its goal to becoming a Smart Nation when a cyberattack occurred to SingHealth, Singapore’s largest group of healthcare institutions, which consists of 4 public hospitals island wide, 5 national specialty centres and a network of 9 polyclinics in July 2018. Described as one of the worst cyberattacks in the country, the incident saw the personal information of 1.5 million SingHealth patients being copied and stolen. Plans for compulsory contribution to NEHR has been suspended temporarily after the SingHealth incident and a four-member Committee of Inquiry (COI) was set up promptly to look into the events and factors that led to the attack. In response to the incident, Prime Minister Lee Hsien Loong shared, “If we discover a breach, we must promptly put it right, improve our systems, and inform the people affected. This is what we are doing in this case. We cannot go back to paper records and files. We have to go forward, to build a secure and smart nation.” PM Lee’s response reflects Singapore’s ongoing journey in continually advancing healthcare IT infrastructure – in fact, there are already plans to develop and implement the Next Generation Electronic Medical Record (NGEMR) by 2020.

Healthcare IT News Asia Pacific hears from Marcus about what healthcare organisations can learn from National Geographic's consumer engagement experience.

At HIMSS18, HIMSS Analytics and SCAN Health announced its collaboration on the Health-Supply Information Maturity Management (H-SIMM), a supply chain maturity model to help organisations advance their digital maturity in supply chain infrastructure. As part of this collaboration, SCAN Health designed and created the health supply chain maturity tool while HIMSS, with its global network of 73,000 partners, is helping build awareness and knowledge.  This November, Dr. Anne Snowdon, Developer of the H-SIMM, Academic Chair of the World Health Innovation Network (WIN) and Scientific Director and CEO of SCAN Health, is speaking at HIMSS AsiaPac18 in Brisbane, Australia. Dr. Snowdon is a clinician-turned-innovator. Her early career as an emergency department nurse brought her into contact with many children entering the ER with serious car accident injuries, motivating her to partner with the automobile industry to devise a more effective booster seat. Since then, she has combined her sharp clinical eye with innovation to foresee and resolve challenges across the healthcare system. Ahead of the November conference, Dr. Snowdon gives us a preview of the H-SIMM model and shares how supply chain is critical to patient care. What can you share about the H-SIMM model with us? The H-SIMM model is designed to provide health organisations with a strategic "road map" to guide the integration of supply chain infrastructure (i.e., tools, technologies, processes) into clinical care environments to support quality and safety of patient care and at the system level it strengthens performance of health systems.  The H-SIMM is often described as a clinically integrated supply chain strategy - the challenge is that this has many different meanings for different stakeholders in health systems.  I define clinically integrated supply chain as an organisational strategy, whereby leaders (i.e., CEO and executive team) view supply chain as a strategic asset that is leveraged to strengthen the performance of the organization - specifically to improve quality and safety while at the same time reducing cost.  This organisational strategy introduces supply chain tools and technologies (ex. inventory management software, point of care scanning or RFID) into care delivery processes to capture product data, care process information and patient and provider data, all uploaded into patient health records to enable automated tracking and traceability of care linked to patient outcomes. This integrated system then creates what I refer to as "real world evidence" of the care processes and use of products (ex. implants, medications) that offer the best outcomes for specific patient populations.  Supply chain staff become fully integrated into clinical program teams whereby the supply chain staff are an integral part of the clinical team working to advance quality, safety and value in every program across the organization.  When such a system is scaled across health systems, it creates a robust flow of data in near "real time" to inform system leadership decisions on delivery of programs and care processes that offer the best outcomes for the population the health system is mandated to serve.  What are the outcomes of clinically integrated supply chain?  Automated tracking and traceability of every patient, care process, products used in care linked to outcomes which creates a transparent, powerful data resource to support leadership decisions on how best to strengthen organizational performance.  Evidence emerging from health systems already implementing a clinically integrated supply chain include the following:  a) Safety: Significant reduction (70% reduction reported by Mercy, U.S.) in serious, harmful adverse events often called "never events" - errors that should never happen in healthcare (ex. surgery on the wrong patient, leaving a product in a surgical wound). b)​ Quality: Variation in care is widely viewed as a challenge for health systems as some patients receive different care than others, with limited ability to standardize to ensure only best practices are delivered in patient care settings.  The traceability of every care process, procedure and product delivered by clinician teams enables leaders to track care being delivered and link it to outcomes to inform clinician teams using objective data what practices are achieving the best results for patients.  Evidence to date has identified significant change in clinical practices that offer greater standardization and use of best practices to support quality of care.  c) Value: Health organisations struggle to manage growing costs of supplies, high cost products (ex. implants) and labour costs to sustain a workforce of highly specialized health professionals. Integrated supply chain infrastructure automates care processes which reduces burden on clinician teams and has resulted in reduction of labour costs by 16 FTE's in perioperative programs (ex. NHS, UK).  Costs are also reduced as much as 30% per case due to reduced waste of products (ex. Mercy, U.S.) when products are expired and must be thrown out.  What is the current state of digitisation in healthcare supply chains in U.S. and Canada? We’d like to hear about the findings from your qualitative research. I have not specifically studied digitisation in health systems. However, the key challenges identified by many health systems includes multiple IT systems across organisations that do not connect or interface with each other. The challenge this presents is that a patient's journey of care is never captured in a way that all care providers or clinician teams can identify what care has been delivered, what products (ex. medications) have been prescribed or used and what outcomes have been achieved. Thus, there is no record of the patient's care journey to date.  For example, the primary care physician or team uses a patient record that does not interface with a hospital EMR, hence the hospital teams cannot identify key patient needs and no access to patient information that is needed to inform care decisions.  Adverse events occur often during transitions in care when patients receive care from one team (i.e., primary care) and then transition to another team (i.e., hospital team).  Digitisation needs to connect care across a patient's journey to advance quality and safety across health systems. The integrated supply chain infrastructure addresses this system level challenge by enabling tracking and traceability across the patient's journey of care to reduce the risk of error, to identify what care is associated with the best outcomes and under what conditions best outcomes are achieved. In your research at WIN, you are creating empirical evidence of the impact and value of supply chain maturity in health systems. What have you found out? I would like to share the outcomes for three global health systems: Alberta, Canada; NHS, UK and Mercy, U.S. below. You can view the entire slide deck here. SCAN Health has become a key opportunity for knowledge mobilisation to disseminate these outcomes so that global health systems can learn from each other, avoid duplicating lessons others have already learned and to accelerate progress globally. Supply chain transformation is both internal and external. Can you share about these internal and external factors and how to achieve success?  Internal: There are two key factors internally that advance supply chain transformation. First is the senior leadership of health organisations who must create the vision and strategy to  mobilize teams to advance integrated supply chain infrastructure across the organisation - hospitals or community care settings.  Leadership is the single most critical factor that either drives the supply chain strategy or almost always ensures no progress is made if leadership is not driving the initiatives and strategy.  The second key factor is clinician leadership.  Clinicians so often have little or no line of sight in to what supply chain is and what it can achieve.  Our research has demonstrated that not only engaging clinicians in the strategy, but also creating the conditions for successful clinician leadership is a second internal key condition for success.  Clinicians and especially physicians play a pivotal role in supporting the changes in clinical workflow that is needed and championing the use of supply chain data to inform decisions on quality, safety and standardisation of care processes that offer the best outcomes for patients.  Physicians are in a unique leadership position to mobilize clinician teams, evidence from both Mercy and the NHS demonstrate clinician leadership as foundational to successful integration of supply chain tools, mobilizing data to create real world evidence that then supports and informs quality and safety initiatives for patients.     External: The role of policy is critical for creating the momentum for health systems to implement supply chain infrastructure across the many organizations.  When legislation requires adoption of global standards, both industry and health organisations are incentivised to implement supply chain infrastructure.  For example, the FDA in the U.S. has now required use of global standards on products such as implants to enable traceability and reporting outcomes.  The EU legislation similarly requires use of global standards and automated e-commerce which has now motivated automation of these key processes.  These policy frameworks are critically important in building awareness, knowledge and creating the incentives to implement integrated supply chain infrastructure. The second external factor that is a key factor for success is establishing a collaborative model that brings all the key stakeholders together to mobilise their respective expertise and leadership to create momentum and accelerate progress.  The collaboration model at both WIN and SCAN Health engages industry, government, academia and health sector leaders, which when all working towards a common goal, can support success.  Each of these key stakeholders are critical to the system vision and perspective and policy must be framed to support and drive progress. Health system leaders need to drive the strategy and mobilise resources, clinician leaders need to bring their expertise to ensure supply chain tools strengthen work environments and meet patient care needs and industry must bring their tremendous supply chain expertise to the collaboration to support and ensure global traceability across borders is achieved at the system level. This collaborative model considers those internal and external factors to achieve successful adoption. About SCAN Health SCAN Health is an international knowledge translation platform funded by the Government of Canada, Networks of Centres of Excellence (NCE) and hosted by the University of Windsor’s Odette School of Business. Spanning five countries, including Australia, the Netherlands, the United Kingdom, the United States and Canada – and with over one hundred partners from industry, healthcare, government and academia – SCAN Health will advance global capacity to adopt and scale best practices in healthcare supply chain to offer traceability of products and care processes from bench to bedside to patient outcomes. About WIN The World Health Innovation Network is based at the Odette School of Business at the University of Windsor, under the leadership of world renowned researcher Dr. Anne Snowdon. WIN brokers partnerships between key stakeholders to source, embed and scale innovations in health systems. WIN develops the evidence of impact and scalability across health systems and disseminates this information to accelerate health system transformation, drive economic growth and improve patient outcomes. Dr. Anne Snowdon is a speaker at HIMSS AsiaPac 18 in Brisbane this November. To learn more about this event, click here.

Silvia Pfeiffer, CEO and co-founder of Coviu spoke with Healthcare IT News Asia-Pacific about her team's experience developing technology at the Women in Tech (Asia) conference in Singapore.

As healthcare providers worldwide strive to provide a more seamless experience to their patients through the better integration of information systems and shift from paper-based medical records to electronic medical records, the successful implementation of Health Information Exchange (HIE) projects becomes a critical part of this process. However, this is a daunting task at both local/regional and national levels, requiring collaboration from various stakeholders from a technical and policy standpoint. Jürgen Brandstätter spoke to Healthcare IT News about his experiences and insights in HIE implementation in Europe and the Middle East. "Integrating the Healthcare Enterprise" (IHE) is a global not-for-profit initiative with regional and national branches. It provides a pragmatic methodology ensuring interoperability between healthcare IT systems resulting in a body of technical and semantic specifications, which are published by IHE as Technical Framework(s). IHE Europe engages clinicians, health authorities, industry and users to improve healthcare interoperability. This is done through helping national and European stakeholders and policy-makers in adopting, promoting and implementing IHE specifications, as well as developing tools and services in support of interoperability testing. Could you tell us more about your role as vendor co-chair at IHE Europe? How has the journey been like for the past 2 years? As co-chair of IHE Europe, together with the user co-chair and the other members of the executive board, we are responsible for the management of the organization on behalf of the IHE Europe Steering Committee. The executive board is supported by chairs and directors of the different sub-committees, such as IHE Services, EU Affairs or MarCom. The IHE-Europe Connectathon provides a unique opportunity for vendors to test the interoperability of their products in a structured environment with peer vendors. Credit: IHE Europe IHE Europe is a fabulous organization and it was a pleasurable ride the past 2 years. We have conducted two Connectathons, which are growing in size by every year and we see our operative arm IHE Services getting involved in more and more national programs, consulting in architecture and strategy and covering the interoperability task by its vast experience out of the development of our testing tool Gazelle. Our relationship to the European Commission is excellent and we are involved into several European projects. All in all, I am happy to have been recently re-elected for a second term to continue my engagement to further advance IHE Europe and the IHE mission. You have been a consultant on various e-health exchange projects in Europe and the Middle East. What are some of the common challenges experienced by healthcare providers that you work with in these projects? Do you have any memorable examples or case studies? During my engagements in various Health Information Exchange projects globally it was not much surprising to see that eHealth interoperability use-cases are pretty much similar everywhere. If you examine closer Patient Identification, Clinical Document Sharing, e-Prescription, e-Immunization or other use-cases, you realize that they are similar in its core, no matter where you want to implement it - even if you consider all national specialties of the respective countries. This is actually the added-value the IHE standards initiative contributes to society, namely to cover this “common core” once-for-all on a global scale to safe costs and increase sustainability. So from a technical perspective the most common e-Health use-cases are very well worked out already and best practice and successful case-studies are available – just take a look at them here. But apart from that, also the challenges are usually overlapping, foremost the need of good and stable political governance and policy, the building of local capacity and the need of strict alignment to international standards, which can become a serious risk to the project if not considered sufficiently. One memorable example was as I engaged into the specification of the e-Prescription track of the Saudi eHealth Exchange (SeHE) project right after I accomplished the specification of e-Medication in Austria. Both countries differ so much in location, culture and the way how medications are prescribed, but in the end the course of the workshops with the doctors as well as the final specifications were so much similar. It was amazing. In terms of experience with Health Information Exchange (HIE) systems, you have been a vendor, created profiles and oversaw organizational development, which is certainly invaluable as you understand the different roles and requirements at different levels of HIE systems implementation. How do you think stakeholders at the different levels can work together towards implementing an effective HIE system? From my perspective, the success of a HIE project is mostly depending on its degree of acceptance in the short term and sustainability in the long term. So it is essential that the stakeholders of a HIE system do proper local capacity building and then seek out for international case-studies and standards to see if their intended eHealth use-case is already covered by the standardization community. Look around what works and communicate with others, before you make up your own plans. There are plenty of global initiatives out there, which could serve as a platform for such communication, as for example the recently founded “Global Digital Health Partnership” to foster this for example on government level. Also, the stakeholders should get in contact and engage with the standards community. Sustainability requires leveraging international standards and the standards community is open and ready to collaborate. Most likely the standards and even standard-compliant software ready-to-buy for the use-case is already in place, but even if not, it’s cheaper to invest into creating the required standard at this occasion rather than inventing on your own. Interoperability is one of the key priorities in the implementation of HIE systems. What are your thoughts on achieving true interoperability across different HIE systems? From my perspective, it’s important that interoperability is challenged on a global scale and in the form of actually tested systems rather than standards on paper. The IHE standards initiative, with its profiling and attached testing activities (Connectathon, Conformity Assessment), is filling exactly this gap and is covering the last mile from the base standards (HL7 CDA, FHIR, DICOM, SNOMED, …) to “real” interoperable systems, which are ready to be bought off the shelf. Today’s question is not “how” you can do it, today’s question is how you can do it in the “most sustainable and cost effective” way! What are some current notable trends or technologies that you observe in the development of HIE systems? Due to the speed and energy the FHIR development has brought to the standards and developer community, FHIR has clearly become a notable trend and there is clearly to see the attempt to leverage this standard for all kinds of HIE interoperability problems. From IHE perspective, FHIR is a great new standard, which is very suitable to a variety of interoperability use-cases, especially in the area of mHealth and we our current profiling work is strongly considering this new technology. However it shall not be forgotten that other existing standards are still in place perfectly working for the use-cases they have been created for, so we recommend to look to the future but be careful to not let any trend overcome meaningful usage of what’s already existing (this also applies to “blockchain”, another current trend). Also, the FHIR standard is still under development and requires profiling work on global scale to be fully optimal useable. This refers back to question 3, where it needs collaboration between stakeholders and the standards-community on global scale to level up the usage of FHIR from “locally created FHIR Implementation Guides” to globally used “FHIR based IHE profiles”. To tackle this profiling work, the “Gemini” project, a Joint Venture of IHE and HL7 to Advance Use of FHIR for Interoperability, has been formed to enable and foster the “joint” development of such FHIR based IHE profiles. I am honored to serve on the Gemini Steering Committee to drive forward this initiative. What do you think are some key lessons that healthcare providers in Asia Pacific can learn from based on Europe’s experience and journey in HIE systems implementation? Europe has done some substantial ground work in exploring the possibilities of national eHealth Information Exchange projects, especially when it comes to cross-border exchange of information between member states. But there are also very interesting case-studies in certain countries which are worth being looked at from an architectural/technical point of view, but also from a strategic/governance perspective. One key lesson is certainly that a standards-based and collaborative approach is always more sustainable in the end as doing an own development, which seems to be cheaper on the first view. In the meanwhile European member states are very much used to collaborate with their neighbors and know about this importance. Another key lesson is that vendor-independence is crucial for success, if the size of the project exceeds certain boundaries. That again points to the importance of international standards, which need to be profiled to lead into interoperable, standards-based, exchangeable products on the market which ideally you can buy off-the-shelf. This profiling is the part IHE is taking care of. Jürgen Brandstätter is a keynote speaker (Connect Track) at HIMSS AsiaPac 18 in Brisbane this November. To learn more about this event, click here. He will also be speaking at the IHE AsiaPac Summit happening on 5 November 2018.