Digitising healthcare: The state of e-health in Australia

If there is one industry experiencing rapid change right now, it is healthcare. Whether it’s the shift from paper to electronic records, face-to-face consultation to telehealth diagnosis, or instructing patients to empowering them, the industry is evolving fast.

Here, we look at several examples of how digitisation is transforming the healthcare industry.

Integrated digital hospital

UnitingCare Health is rolling out Australia’s first fully integrated digital hospital, which will connect up e-medical records, X-rays, pathology results, vital sign machines and other health information.

St Stephen’s digital hospital in Hervey Bay, Queensland is set to open on 13 October and is receiving $47 million from the Federal Government's Health and Hospitals Fund, with UnitingCare contributing $49m.

The hospital has a goal to reach Healthcare Information Management System Society (HIMSS) level 6 when it opens, and then level 7 about a year after. This global benchmark for IT maturity is aimed at improving patient care.

The hospital is working with its main technology provider, Cerner, to allow healthcare workers to not only access e-medical records but also gain a broader picture of patients to improve patient outcomes.

“The meal ordering system, for example, will be integrated so if a patient has a diabetic condition we can alert staff whether the patient needs a different diet ... or it will only show certain [food] choices to diabetic patients in hospital,” says UnitingCare Health’s chief medical information officer, Monica Trujillo.

More than 1,000 clinician hours went into designing the systems, she adds. “As I say to the technical team, they are there to facilitate the design of what the clinicians want, not the other way around.”

The hospital will use a closed loop medication system, Trujillo says. When a doctor prescribes medication to a patient, the nurse can use a scanner from the automatic drug dispensing cabinet to check if it’s the right medication, the right dose, for the right patient and if the patient has any allergies before opening the cabinet. The cabinet not only connects to patients’ e-medical records but also a pharmacy stock database to alert staff when the hospital is running low on particular medications.

Trujillo says having this system in place is vital to patient care, as one of the biggest issues in many hospitals is medication errors, which can be life threatening.

Workstations on wheels will also be supplied at the hospital when it opens. The 22-inch computer screens, running on a Citrix platform, are attached to lightweight carts that allow nurses to access information on patients wherever they are in the hospital.

For doctors, speech recognition software, Dragon Dictate, will be used to translate voice instructions into text and record them on a patient’s e-medical record, so they won’t have to waste time manually typing out notes, reports and letters. Trujillo says doctors are training with the software now to become familiar with their different nuances and voice patterns. “Doctors can spend more time with patients and less time documenting,” she says.

Trujillo says the hospital will also supply iPads to doctors in 2015 so they can access patient lists, once the software’s iPad version is released in Australia.

When it comes to security and privacy, Trujillo says users tap their ID cards and enter their password code to log onto any system. Users are asked to declare the reason for logging in, and the date and time is recorded.

Fingerprint biometrics will be used when staff log into the automatic drug dispensing cabinets, too.

“We have also built this on all the national privacy law requirements,” adds Trujillo.

On the spot pathology

NSW Health Pathology is rolling out point-of-care devices in its rural and remote emergency departments where there are no 24/7 laboratories onsite. The devices allow emergency staff to do pathology tests such as blood, lactate and haemoglobin on the spot within nine seconds, or up to 10 minutes for more complex tests.

Andrew Sargeant, point-of-care manager at NSW Health Pathology, says laboratory testing offsite can take hours, so the new solution cuts waiting time down substantially.

By December, 175 NSW emergency departments will be supplied with the devices. A tender was also released in August for more devices to do further types of testing, which are expected to be implemented beyond emergency departments in 2015.

Inside the devices are cartridges that carry out different types of testing. All devices connect to Radiometer’s AQURE middleware, where results are delivered not only to the device’s display screen but also to NSW Health Pathology’s laboratory information systems and e-medical records.

“The smaller sites may have to send that patient on somewhere else, usually a larger facility, for treatment. Now they can treat the patient at the site without having to transfer them, which saves on costs to the local health district but also to the patient,” Sargeant says.

“Also, without the full clinical picture of the pathology involved, a patient might not be treated appropriately. Or, a patient might have pain around the chest and arm area, but it might not look like a cardiac event and maybe he/she will be sent home without that piece of evidence.”

The devices are set up with a lock out feature, which means only trained and competent staff can use them. “We manage that remotely, and each operator is uniquely identified, so you can’t run a sample unless it recognises you as a competent operator,” Sargeant explains.

To run a test, users put in their operator ID then a patient ID, which matches that result to that patient’s record.

Next page: Telehealth

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Telehealth care

One organisation leading the telehealth space is Hunter New England Health (HNEH), which has rolled out 800 Avaya Scopia user licences for Clinical Virtual Meeting Rooms, 65-plus videoconferencing end points and room integrations, and 45 clinical care cameras.

HNEH uses videoconferencing mostly for check-up consultations in remote and regional areas of the Hunter, New England and Lower Mid North Coast regions. These patients have to face the tyranny of long distances, which means they are unlikely to want to get check-ups, says HNEH clinical business analyst, Owen Katalinic.

“A lot of people travel up to 10 hours each way to come to our tertiary hospitals – John Hunter Hospital, John Hunter Children’s Hospital and Calvary Mater – all located in Newcastle. Often these consultations last five to 10 minutes,” he says.

“Say a patient is going to have a gall bladder removed, and he/she lives in Tamworth. The patient needs to travel to Newcastle to be told by a surgeon that it’s going ahead and then they go home. They go to Newcastle again for pre-operation tests and advice, and return home. They go to Newcastle for the operation, they go home. They return again for a post-surgical appointment, they go back home,” adds Ashley Young, who works with Katalinic as a clinical business analyst.

“At least two of those appointments could be done through telehealth, which would save 1200 kilometres in travel for the patient and the associated time and expense.”

Katalinic and Young are using a variety of business intelligence tools to analyse data from HNEH’s patient administration system and calculate travel savings patients have made using videoconferencing. They found patients save an average of 406km of travel per telehealth consultation.

“We are hoping to use a lot of this data as KPIs for encouraging [clinicians] to change some of their practices and do things differently,” says Young. “But it’s to supplement and enhance the service we provide, rather than about providing a new service.”

HNEH also loans out 200 iPads to families in low socio-economic groups for up to three months. Besides being able to make video calls, users can participate in games and exercises designed for therapy such as improving memory.

CIO for home care provider Silver Chain Group, Lee Davis, is using tablets and a combination of Polycom and Telstra IP Telephony (TIPT) videoconferencing to reach a huge geography of 27 bases spread over country Western Australia. The organisation is approaching 4000 Samsung devices in its fleet, the majority of which are supplied to staff.

“Our primary objective is, and always will be, about improving client outcomes,” Davis says. “Of course, a side benefit we can’t ignore is we can maximise productivity, reduce travel costs and reduce time wasted travelling.

“The trend in e-health at the moment is moving the provider from being central to everything, to putting the consumer and the client at the centre. Empowering the client is driving a lot of change.”

About 100 patients in South Australia are using Silver Chain’s tablets and videoconferencing for when they need a nurse to witness them taking medications. The patient simply holds their medication up to the high-definition camera and the nurse confirms if it’s the right type and amount before the patient takes it.

Silver Chain’s ComCare – its internal e-medical record developed by EOS Technologies, which is part of the Silver Chain Group – has been developed for Android devices, and uses SOTI for its mobile device management.

“We chose to develop on Android because it is an open platform, as opposed to others which are more of a closed, walled garden style of ecosystem. We can remote control those devices, which makes it great from a support point of view,” says Davis.

“Everything in the device is secure and encrypted. We only keep transient data on the devices, so each nurse only sees the information that they need to see. Everything uses SSL to transmit.

“With videoconferencing, we work with Telstra and its TIPT network to have a secure private network for videoconferencing as well.”

Electronic records

Sydney Children’s Hospital Network (SCHN), alongside several other local health districts, was part of a pilot for the NSW HealtheNet portal – a state funded project that links multiple hospital databases to give clinicians a single view of repositories. It also integrates with the national Personally Controlled Electronic Health Record.

CIO of SCHN, Bill Vargas, says HealtheNet has improved decision making between hospitals, improved accuracy of information, reduced time investigating or searching for information, and minimised duplication of documents and tests.

SCHN was also a pilot for the NSW Health Enterprise Image Repository, which allows medical images such as X-rays to be shared by health providers across the state.

“If a patient has an X-ray in Dubbo, and then they get flown to Sydney or to the SCHN, we have access to that X-ray when they arrive, and potentially the clinical summary as well if it has been done,” says Vargas. “In the past, if a patient was transferred, the images were not transferred with them, so they would have to be X-rayed again.”

In addition, SCHN has its own internal e-medical record and is building an e-medications management system and full electronic record for oncology (cancer) patients.

To make all these systems integrate, Vargas is using clinical document architecture (CDA), an HL7 standard that allows the communication of clinical documents in a mark-up language.

“The CDA standard has provided us with a fair amount of flexibility to communicate clinical information across the systems. Beyond the organisation, at state and national level, it’s the way we are moving forward. And from the initial [HealtheNet] pilot, it was deemed quite successful,” Vargas says.

All result entries, notes and views are recorded so SCHN can tell who has accessed a record, as well as when and how they interacted with it.

“We also have role-based access levels, so a nurse cannot do the same things with the record that a clinician can,” says Vargas. “When staff access our records externally, we use VPN over Internet with two-factor authentication using physical tokens.”

Silver Chain’s internal e-medical record, ComCare, is currently being integrated with the PCEHR. “We are moving with ComCare towards a complete electronic record across the group,” says Davis.

Like SCHN, Silver Chain also records users’ login times and activity, and assigns different user level access rights to different types of healthcare workers. E-records mean information is more secure than in paper form as there’s always a digital trace and it’s more securely stored than in a filing cabinet, Davis says.

Opt-out model planned for national electronic patient record

A review of the Personally Controlled Electronic Health Record (PCEHR), released in May, has recommended switching to an opt-out model. This will mean all citizens are automatically registered for the system but can choose not to participate. This is planned to come into effect on 1 July 2015.

The PCEHR was launched in 2012, and is the national infrastructure allowing citizens to have a single medical history record. It failed to meet the Government’s self-set target of 500,000 registered users by 1 July 2013.

“Individuals would not make the effort to opt-in, so opt-out will create a critical mass very quickly,” says SCHN’s Bill Vargas. “Very busy clinicians are assured that when they look in the PCEHR, the likelihood is they will find useful clinical data on their patients.”

Having an opt-out system is good, but more focus should be on encouraging people to share their information, says Silver Chain’s Lee Davis.

“You could have 24 million registered, but that doesn’t deliver value until we start getting more shared health, event and discharge summaries,” he claims. “If a GP opens my record and can see I have a record but there’s no history or information in there, then it doesn’t deliver the clinician any value.”