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Many organisations embarking on the journey of transformation in healthcare do so from the perspective of the technology and all too often focus on transferring current ways of working, says Sam Shah, director of digital development at NHS England.

Hospitals that reach the pinnacle of the HIMSS Analytics EMR Adoption Model have more satisfied docs, more widespread personalization of EHRs and better teamwork between clinicians, according to a new survey with HIMSS Analytics.

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

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.

VivaLNK debuted an Internet of Things-enabled wearables sensor platform, TriFin Labs unveiled a patient engagement platform, eMDs launched a revenue cycle management system and Philips introduced an epidemiology system that uses genomics and deep learning.

Hologic has launched a new tool that manages mammography devices, while SPH Analytics has partnered with Medecision with the aim of improved quality of care and lower costs.

At HIMSS19, DeVore mapped out the five problems that must be addressed to transform the industry.

Also: FarGen project initiator wins achievement award in Orlando; Health secretary calls on the NHS to stop using paper and fax machines.

In October 2018, Mayo Clinic achieved a historic milestone with the final Epic implementation in Florida and Arizona. The epic (pun intended) implementation of Epic across the Mayo Clinic’s network of 90 hospitals and clinics began in July 2017 when 24 of its sites in Wisconsin went live. Subsequently, campuses in Minnesota went live in November 2017, followed by Mayo’s Rochester facility in May 2018 and finally in Arizona and Florida. The Epic EHR rollout at Mayo Clinic was dubbed the Plummer Project in honour of Henry Plummer, MD, who developed a patient-centred health record at Mayo in 1907. While the movement to a single Epic EHR and revenue cycle management system to replace 3 separate EHR instances, multiple disparate revenue cycle systems and a total of 287 applications was impressive from a technical and execution standpoint, what was more impressive was the training of 51,000 Mayo Clinic employees to be onboard the Epic system. Mayo Clinic has a total of 65,000 employees of which 51,000 had to go through training in Epic as it was essential for their day-to-day duties and operations. Dr. Steve Peters, co-chair of the Plummer Project, shared lessons learnt from the EHR rollout in a Mayo Clinic Radio video in July last year: “We’ve learn a lot from the earlier implementations – we’ve modified the training and made it more focused to the tasks or some of the scenarios that an individual needs. We’ve increased the number and the training of the super-users – those are individuals embedded in the practice whether it’s a physician, nurse or desk staff who help to understand the local workflow rather than just how they navigate the tool. We then fine-tune where more support would be needed and which types of workflows. For example, moving from one setting to another from an outpatient to inpatient or emergency room to an interventional radiology procedure to the operating room, these are opposed kind of special challenges where we can focus some of the training and some of the build-up of Epic so that it is more easily done.” Dr. Patrick H. Luetmer, chair of Clinical Systems Oversight for Mayo Clinic, responsible for governance of the converged Epic electronic health record and of clinical departmental systems will be at the HIMSS Singapore eHealth & Health 2.0 Summit on April 24 2019 to share about the key lessons learnt from the massive EHR rollout. In particular, Dr. Luetmer will emphasise the importance of rigorous tracking of co-dependent projects and careful management of a separate team to support legacy systems prior to go lives. Keen to explore more about the lessons learnt from the Plummer Project? Sign up here to enjoy early bird rates for the upcoming HIMSS Singapore eHealth & Health 2.0 Summit held from April 23-24 2019!