Telehealth

American Well is integrating with Netsmart’s EHR, Resideo Technologies is refreshing its platform, Yorktel is moving into acute care and SOC Telemed was selected by 45-hospital Prime Healthcare.

Faxes have been used to send documents over phone lines since the mid ‘60s, and while many medical practices have changed since then, the fax continues on with many health systems still depending heavily on the technology.  The healthcare industry has begun understanding that fax can present a clinical risk when dealing with sensitive patient information as the faxed content can be misplaced or fall into the wrong hands. Hence, replacing outdated fax machines with secure messaging systems has been a focus for some in the Australian healthcare industry as information sent via the latter is sent directly to the receiver. But there is still resistance in the uptake of secure messaging even though there is a proliferation of medical referrals in the industry, requiring the use of secure messaging systems. The Australian Journal of Medical Practice recently found that in 2014-15 alone, general practitioners made 15.9 referrals per 100 patient encounters, sending 9.7 million more referrals than in 2005-06, highlighting the scale of exposure to risk. In addition, a Microsoft report in collaboration with Harvard Business Review Analytic Services, Embracing the Change Mandate: The 2020 Digital Transformation Agenda for Australia’s Health Care Sector, studied how a digitally augmented system could improve Australian healthcare and barriers to change. The report found that 44 per cent of respondents said one of the top barriers to digital transformation was resistance to change. As such, eradicating faxes in healthcare has been a key focus for the Australian Digital Health Agency (ADHA), with the statutory authority extending its its Secure Messaging Program across the industry over the last three years.  The Secure Messaging Program aims to help healthcare providers across Australia communicate quickly, easily and securely, and to reduce the sector’s current reliance on outdated technologies like the fax machine. But even though a number of vendors do offer secure digital messaging services, interoperability issues and the lack of a universal format have resulted in hospitals like Ipswich Hospital, GPs and specialists still continuing to send referrals and discharge summaries using fax. Late last year, a panel of speakers at the Wild Health Summit in Sydney stressed the importance of digital change, but supported the use of the fax machine, saying that the industry is still in its infancy in eradicating it and that its usage could still benefit some players in the sphere.   “We are quite conservative in healthcare. To rid the fax machine in a bigger network, we’re not there yet. There’s still a long way to go to have secure messaging systems rolled out and working efficiently in larger hospital settings,” UnitingCare St Stephen Hospital General Manager and Director of Clinical Services Darren Rogers said during the discussion. “It’s hard to change a system that works a great deal of the time but a unified approach is needed for improving the quality and delivery of care.” VIEWS OF THE INDUSTRY The Royal Australian College of General Practitioners (RACGP) President Dr Harry Nespolon told HITNA that while some providers are using secure electronic communications more frequently, faxes are still required to communicate with parts of the healthcare sector that do not use electronic communications.  “For many years, the healthcare industry has been heavily dependent on paper, so moving away from paper and fax is a significant change,” he said.  “The majority of health services and government agencies communicating with general practice do not currently use electronic communication systems that are compatible with those existing in general practice, so the fax machine is currently as sophisticated as it gets with electronic messaging.” [Read more: “Living in the dark ages”: NHS hospital trust launches ‘Axe the Fax’ campaign | UK’s Royal College of Surgeons calls out the NHS reliance on “archaic” fax machines] Dr Nespolon added that there are technical challenges in searching for healthcare providers to communicate with and creating a solution for interoperability that supports communication across healthcare providers. “General practices are often required to manually transfer information from their clinical or administrative systems into paper-based or online forms. This information is then sent to the relevant agency via an online upload, by post, fax, or via standard and unsecured email. Information leaving general practice through these methods requires significant manual processing,” he said.  “Most organisations fail to consider the implications and costs for general practices to manage information transfers safely, reliably and efficiently. The inefficiencies of current processes creates a heavy burden on GPs, diverting their time away from providing essential medical care for patients.”   According to Dr Nespolon, there needs to be broader support to adopt and implement secure messaging across the healthcare industry to make it a success. “Faxed reports which are scanned into clinical records and saved as an image are not easily searchable. Standard and unsecured email is not considered suitable for routine communication between healthcare providers and patients due to inadequate privacy and security features, and because the content of these messages has to be copied and manually transferred,” he said.  “Information manually obtained from web portals presents similar issues. Documents received by general practice provide the most clinical value when they can be searched and interrogated by general practice clinical software.” UPDATE ON THE SECURE MESSAGING PROGRAM The ADHA is aiming to alleviate the problems associated with secure messaging systems.  Towards the end of last year, it held a workshop in Sydney for more than 50 State and Federal Government officials, industry stakeholders and international experts, to discuss the future of secure messaging and interoperability across the Australian health sector. The workshop also saw the Medical Software Industry Association and ADHA ink a communique, committing to further collaboration on the adoption and implementation of secure messaging. ADHA Chief Operating Officer Bettina McMahon said the deal was made to “implement a nationwide [secure messaging] solution that embraces existing solutions and unifies them seamlessly”. [Read more: Victorian man dies alone after test results faxed to wrong number – coroner slams use of “antiquated” tech | RIP the fax: Successful secure messaging trials solve final problems heralding fax-free future for healthcare, ADHA says] “Secure messaging is a foundational capability enabling interoperability and safe, seamless, and secure information sharing between healthcare providers,” she said. “Nationwide adoption of secure messaging will enhance the security, safety and efficiency of clinical information sharing across all sectors – ultimately aiding the provision of better healthcare for the community. “To realise this goal… the ADHA is working collaboratively with industry, suppliers of secure messaging solutions and clinical software vendors to reduce existing barriers to adoption and to provide pragmatic and implementable solutions.” A key priority for the ADHA, moving forward, is the creation of a transparent, national directory of service providers – the equivalent of a national ‘yellow pages’ for all registered healthcare providers – that can be used for securing messaging, enabling healthcare personnel to easily contact each other.  The agency is targeting to deliver a “minimum viable product” by June. “We will continue to work together collaboratively to strengthen and develop secure messaging and interoperability within the healthcare landscape, for the benefit of all Australians,” McMahon added.  The ADHA has also started working with HealthLink, Telstra and a range of healthcare providers in the development of solutions that allow secure messaging between healthcare providers with different clinical information systems messaging vendors, in a way that can be scaled nationally. STEPS THAT NEED TO BE TAKEN Global Health National Sales and Marketing Manager Deborah Hudson said with healthcare professionals and organisations just starting to scratch the surface of moving to a paperless system, the industry as a whole needs to come together to push for change.  “Although faxing has worked for some time, healthcare professionals are coming to the consensus that as an industry, we have outgrown the fax machine and its limited capabilities; there is a clear need to move forward and secure messaging is the answer,” Hudson said.  “As an industry we are all working towards the same goal. There are ongoing projects and working groups involving several different secure messaging vendors and clinical system vendors, all aiming to address interoperability challenges.” Hudson said the integration of secure messaging was an initiative that needed to be directed by a collaboration between government and industry. “The government has set national standards for health organisations and the industry as a whole will facilitate this. Like any industry, the healthcare industry will grow and adapt as technology improves.” The next step, Hudson said, is industry working with clinical and practice management system providers to achieve better integration in exchanging clinical information.  “There are two main challenges we still face. Firstly, the need for all secure messaging vendors to be able to exchange messages between each other, such as the interoperability that now exists between ReferralNet and Argus,” she said.  “Secondly the seamless integration with other health software vendors’ clinical and practice management systems. As an industry, we need to work on these challenges in collaboration with the ADHA.” Hudson said for the benefits of secure messaging to be fully realised in future, there needs to be in place a system that connects all health organisations and practitioners, allowing for the effective flow of information throughout the system, which then improves the overall patient journey and experience. “With the support of governing bodies such as the ADHA and the RACGP we hope to be fax free by 2025,” she said.  “Secure messaging is growing quickly and organisations are seeing real benefits. As the volume of information exchanged and organisations using secure messaging grows we expect to see others adapting to the change quickly.”

Blockchain credentialing for rapid deployment of virtual care.

The provider of case management services to various Indiana Medicaid programs linked family caregivers with remote coaches to relieve caregiver burden and improve outcomes.

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.

Stephen Wellman, vice president of content strategy at HIMSS Media, discusses what to look for and the best ways to stay informed of all the news and happenings at the massive HIMSS19 Global Conference.

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

Northwell is transforming how it delivers standardized and personalized information to patients outside its facilities, says Northwell VP Sabina Zak and Conversa Health founder Philip Marshall.

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

There’s a need for health systems to prove with scientific rigor which new apps and innovations work, says Dr. Ashish Atreja, chief innovation officer at Mount Sinai and founding chair of NODE.Health.