Dean Koh

The Northern Territory (NT) Department of Health in Australia will soon become the first pathology provider to link the online tests results it is sharing via My Health Record (MHR) with Lab Tests Online, a not-for-profit website funded by the Australian Government under the Quality Use of Pathology Program (QUPP). MHR is an online, electronic summary of one’s key health information. The Australian Digital Health Agency (ADHA) announced in February this year that 9 out of 10 Australians have a MHR following the conclusion of the opt-out period.  Why it matters Pathology providers across Australia have started uploading reports (such as blood test results) to the online record. The aim is that by having direct access to their results, anyone with an MHR can keep track of the tests they have had, the dates when they had them and be able to monitor results over time. The ADHA has recognised that as people have direct access to their test results – many of them for the first time – they need help to understand what the results mean. It has turned to Lab Tests Online to deliver this service. All those in the Northern Territory receiving their results report on their MHR will now have a direct link to the opening page of the Lab Tests Online website. The front page of the website is being redesigned to accommodate this new audience. As part of the redesign, a predictive search function and quick links will be included to the most commonly searched tests to make navigation easier. Lab Tests Online is working with a number of pathology providers to assist them in following the NT Health initiative and embed links in their reports. What’s the trend According to Lab Tests Online, there is a growing public appetite for information about pathology tests. Traffic to their website has increased at more than 50 per cent annually in recent years and reached 2.6 million-page views in 2018.

The National Neuroscience Institute (NNI), the national specialty centre for the management and care of neurological diseases in Singapore and Iota Medtech, a local medtech company specialising in AI and surgical robotics, signed a Memorandum of Understanding (MoU) to develop a system to sort brain scans of head injury patients in order of urgency. What’s it about Currently, there is a significant waiting time for head injury patients requiring urgent treatment, especially when scans were received after radiologists' working hours. The 70 to 100 brain scans received daily are interpreted by radiologists in chronological order. The development of the priority sorting system will help ensure that patients requiring immediate medical attention receive the care they need. Radiologists will be able to interpret brain scans faster and their work will be more efficient. NNI will develop the algorithm to sort brain scans using a “triage system”, with each scan labelled red, amber or green according to the urgency of medical attention. The system will also be tested in a clinical setting, with its accuracy compared against that of radiologists in NNI. Before being implemented in hospitals, it will have to go through regulatory approval processes by the Health Sciences Authority, the national regulator for health products, which will take some time. In the future, the system developed by NNI and Iota Medtech can be modified to treat other common conditions such as stroke and glioma (a type of brain tumour).  On the record “Head injury was chosen as the initial focus of the system in accordance with current patient demands”, said Mr Benjamin Hong, CEO of Iota Medtech in a statement. Associate Professor Ng Wai Hoe, medical director of NNI said, “Iota Medtech's algorithm has already passed laboratory tests for accuracy and NNI will be providing data of brain scans to continually increase the accuracy of the system. The sharing of the data will be in accordance with guidelines in the Personal Data Protection Act.”

NSW Health, the University of Sydney and the Digital Health Cooperative Research Centre (CRC) have partnered to deliver a new Massive Open Online Course (MOOC) which shows how clinical health data can be harnessed for better patient care. Members of the existing and future health workforce can now access this new foundational curriculum, which the state’s digital health agency eHealth NSW developed in collaboration with the University of Sydney and NSW Health’s Health Education and Training Institute (HETI). What’s it about To complete the course, learners will use more than 30 videos and associated learning resources in 12 to 25 hours of self-directed learning, over an estimated four to five weeks. Access to the MOOC via the online learning platform Coursera is free, with learners having the option to purchase a certificate of completion. Around the end of June, staff of NSW Health will have free access and certification through its state-wide learning platform My Health Learning. In development for the past 18 months and featuring input from Monash Health Partners in Melbourne, the MOOC is being launched as international reports predict that clinical staff will need the skills to navigate an increasingly data-rich healthcare environment. For instance, by 2039, 90 percent of all jobs in England’s National Health Service (NHS) will require some element of digital skills, according to the Topol Review, a recently released independent report delivered on behalf of the UK’s Secretary of State for Health and Social Care. The MOOC is guided by the eHealth Capability Framework, which outlines foundation-level expectations for health graduates and workforce, as well as the workforce expectations for clinical and non-clinical staff, as outlined in the NSW Health Analytics Framework. On the record The ‘Using clinical health data, information and knowledge for better healthcare’ MOOC provides a rich and context-relevant experience for all students undertaking health and medical degrees, the NSW Health workforce, as well as teaching staff who seek quality curriculum resources, said Adjunct Professor Annette Solman, Chief Executive of HETI in a statement. The MOOC explores how digital health is transforming health service delivery in clinical practice “and the tremendous potential offered by growing pools of data being captured in our digital systems,” said Dr Tim Shaw, Professor of eHealth at the University of Sydney and Director of Capacity Building at the Digital Health CRC. Dr Zoran Bolevich, eHealth NSW Chief Executive and NSW Health Chief Information Officer said, “NSW Health alone creates over 100 terabytes of clinical and corporate data each month. Increasingly, skills and knowledge in basic data analysis are required of our workforce to inform practice, and this MOOC will help to demystify an area that is growing in importance.”

Ping An International Smart City Technology (PAISCT), a subsidiary of Ping An Insurance (Group) Company of China, has signed a research agreement with Medical Artificial Intelligence Lab Program (MAIL) of the Department of Diagnostic Radiology at the University of Hong Kong (HKU) to clinically evaluate their AI-based optical coherence tomography (OCT) retinal disease screening system. OCT is a high-resolution, non-contact and non-invasive diagnostic technique that renders an in vivo cross-sectional view of the retina. The AI OCT system is a screening and referral system for eye diseases, combining the analysis software employing AI trained on input from clinical experts, OCT eye imaging technology and colour fundus photography. What’s it about The one year research project will commence from May 2019 to April 2020. All clinical studies will be led by MAIL, under Professor Michael D. Kuo, Director of (MAIL) Program, together with Dr. Vince Vardhanabhuti, Clinical Assistant Professor from the Department of Diagnostic Radiology, HKU, and its clinical partner Dr. Jasper Wong, Clinical Assistant Professor from the Department of Ophthalmology, HKU. The project initially involves the recruitment of 500 patients, with continuous enrollment of consenting subjects. Both eyes OCT and fundus data generated by PAISCT’s OCT and fundus AI tools will be collected. PAISCT provides AI models to do screening and generate reports. MAIL will be responsible for the clinical study design, implementation and analysis.    This cooperation aims to estimate the effectiveness of AI algorithm based on OCT multimodal imaging and fundus photography for disease screening and diagnosis and jointly explore the new workflow of patient management. What’s the trend In January this year, Deqing county hospital in Guangdong Province, China launched free consultations featuring AI cameras to detect ocular fundus diseases. Co-developed by Baidu and Sun Yat-sen University, the instrument is capable of diagnosing three types of fundus disorders -- diabetic retinopathy, glaucoma and macular degeneration. In India, Google and its sister organisation Verily, the life sciences division of Alphabet, have been developing a new machine learning algorithm to help expand access to and efficacy of screening for diabetic retinopathy and diabetic macular edema. The algorithm has been refined and is now in clinical use at the Aravind Eye Hospital in Madurai, in the southern state of Tamil Nadu.

The personal data of 4,297 people has been compromised after a website hack, according to a statement by the Singapore Red Cross (SRC) on May 16.  Last Wednesday (May 8), SRC said it was alerted by its web developer to an incident of unauthorised access to the part of its website which supports the recruitment of interested blood donors. Information of 4,297 people who registered their interest on the website was compromised. Their names, contact numbers, e-mails, declared blood types, preferred appointment dates and times and preferred locations for blood donations were leaked.  Investigations to determine the cause of the incident are ongoing but preliminary findings show that a weak administrator password could have left the website vulnerable to the unauthorised access, said SRC. A police report was made on the same day and the incident was also reported to the Personal Data Protection Commission and Health Sciences Authority (HSA), a statutory board under the Ministry of Health.  “Our immediate priority is to ensure affected individuals and partners are notified, while working with the relevant parties to restore and strengthen our IT systems, safeguard our data, and mitigate any future risks,” said SRC CEO Benjamin William in a statement. SRC has temporarily disconnected the website from internet access and replaced it with a temporary webpage until security checks are completed. External consultants have been engaged to conduct a forensic investigation on the hack. The latest healthcare-related data breach at the SRC comes after a series of similar events in Singapore earlier this year – in January, the confidential information of more than 14,000 HIV-positive individuals were leaked and in March, the HSA reported that the personal information of 800,000 blood donors were left exposed by their vendor.

[Correction: An earlier version of this article misstated that Bumrungrad launched the Foundation One CDx panel. The system developed its own panel. The article is now updated. We regret the error.] Bumrungrad International Hospital, a private multiple-specialty medical centre founded 1980 in Bangkok, Thailand, announced the launch of its own genomic profiling panel for cancer treatment. A Core Genomics Facility has been established to produce validated panels in-house. Since all patients are different, specific individual treatments, often called targeted therapies or precision medicine, are customised to each patient and can be more effective than standard cancer treatments. What’s the trend Earlier in February this year, BC Platforms, a company which specialises in powerful genomic data management and analysis solutions, partnered with Bumrungrad International Hospital to provide 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. Bumrungrad will also participate in providing its extensive Asian data and samples to BCRQUEST, providing additional sample diversity and data resources for researchers. On the record “It is a misconception that cancer is mostly hereditary. In many cases, personalised cancer treatment is better. Everybody has a different genetic make-up which makes us susceptible to different diseases therefore medication can work in different ways for different people. In some cases, we can use targeted therapy to help control the cancer,” said Dr Surasit Issarachai, an Oncology Specialist at Horizon Regional Cancer Centre, Bumrungrad International Hospital in a statement.

Private hospitals in Thailand will have to display the price of medicines so that consumers can make better-informed decisions prior to purchase, starting from this week. According to a report by the National News Bureau of Thailand, the country’s Ministry of Commerce has implemented a new measure after announcing medicine and medical supplies as controlled items, requiring hospitals to display pricing of some 3,000 items via QR codes allowing the general public to make comparisons. Deputy Minister of Commerce Chutima Bunyapraphasara said that the central committee on pricing of goods and services’ meeting has agreed to authorise the Department of Internal Trade to implement control measures for pricing of medicine, medical supplies and medical services. The measure will require private hospitals, manufacturers, importers and wholesalers to report sales prices to the department, which will then later be published on the department’s website. Any changes to pricing must be informed 15 days in advance. On January 9 this year, the Ministry of Commerce approved plans to put medical-related fees, including drugs, supplies and service charges, on the price control list of the government’s central committee on prices of goods and services. The order for private hospitals to display prices of drugs is a direct follow-up from the subcommittee formed to work out measures to control medical-related fees. Failure to comply with the new measure will result in up to 1 year imprisonment or up to 20,000 baht fine, or both. Private hospitals, which refuse to issue prescriptions to patients for medicine purchases outside the hospital, will face up to 5 years imprisonment, up to 100,000 baht fine, or both. The Department of Internal Trade will be inviting representatives from hospitals to explain the measure, and will consider further measures to control medicine and medical service pricing in the future.

Located in the central region of Singapore, Tan Tock Seng Hospital (TTSH), which is the largest hospital under the National Healthcare Group (NHG), announced that it will be launching a Command, Control and Communications (C3) system to manage resources efficiently, support operational decisions, optimise patient flow and respond effectively to ground situations. What’s it about Currently, the C3 system is at pre-production stage at the newly-opened TTSH Operations Command Centre located at the Centre of Health Innovation (CHI), housed at the newly opened Ng Teng Fong Centre for Healthcare Innovation. The first phase will start with streaming data from various operational systems to give a comprehensive overview of a hospital’s operations in real-time, providing operational visibility.  It will progressively use advanced analytics to generate actionable insights to provide situational sensing so that the hospital can better pre-empt and act in advance of situations before they occur. The C3 System is set to go live progressively from third quarter 2019 to support daily operations, making TTSH the first Smart Hospital enabled by C3. It will be built on a base infrastructure and will be progressively scaled to the other public hospitals over the next few years.  Additionally, the C3 System will also be integrated within the Regional Health System to allow a more seamless care experience as patients move across care settings such as from the pre-hospital phase to the acute hospital to the community hospital. Prior developments to the C3 Before 2008, bed allocation was a very manual process, which relied largely on coordination via pen, paper and phone. Since then, bed allocation in TTSH has evolved, first with the implementation of RFID tagging in TTSH, which allowed the hospital to automate admission and discharge workflows, as well as identify the location of patients in real time. In 2012, TTSH implemented an algorithm-based decision support bed allocation system, incorporating more than 350 clinical and optimisation rules to ensure that critically ill patients are admitted first, and that the right bed is allocated to the right patient the first time. This helped to reduce overflows, transfers and rework. On the record “Much like an airport control tower, the C3 Smart Hospital System is the nerve centre for the hospital. It is a real-time integrator of systems, enabling TTSH to better optimise resources and manage patient flow,” said Mr Gan Kim Yong, Minister for Health, in a statement. 

eHealth NSW in Australia has announced that it will be working with a number of industry partners to enhance the safety and quality of patient care, with clinicians at one of the state’s major rural hospitals harnessing the power of digital tools in two proof-of-concept (PoC) projects. At the 325-bed Wagga Wagga Base Hospital in the state’s south-east, eHealth NSW and Murrumbidgee Local Health District are partnering on two PoC projects which combine the expertise of Alcidion, CSIRO and Evidentli and use Apple products. PoC 1: Mobilising data to improve the safety and quality of care during a patient’s hospital stay The first PoC project is exploring how critical test results can be shared securely and in real time via mobile devices to support enhanced clinical decision-making. For Dr Stephen Wood, Director of Wagga Wagga Base Hospital’s Emergency Department (ED), this PoC has the real potential to assist clinicians with making decisions about the diagnosis and treatment of patients in time-pressured ED environments. “We want to give clinicians fast access to meaningful data insights which can help them to identify patients at risk of deterioration, and provide more timely mobile access to pathology results and X-rays,” Dr Wood said. A team of 10 ED clinicians is trialling mobile notifications of real-time pathology results and risk indicators, via Alcidion’s Miya Precision Clinical Decision Support (CDS) tool. Notifications will be delivered through Apple products, including iPad, iPhone and Apple Watch. The Miya Precision platform uses the Fast Healthcare Interoperability Resources (FHIR) to map data to standard terminology. This can form a basis for integrating other Artificial Intelligence and Predictive Analytics algorithms to monitor and detect safety problems. “The platform is able to deliver additional clinical insights including deteriorating kidney function, coagulation management, antibiotic stewardship, management of gram-negative bacterial infections, low blood glucose and sepsis monitoring,” said Kate Quirke, Chief Executive Officer of Alcidion Group. In order to prove these capabilities, the CSIRO’s ED re-admission risk algorithm will use the data supplied and make the results available via the Miya Precision platform. CSIRO is Australia’s national science agency. David Hansen, Chief Executive Officer of CSIRO’s Australian e-Health Research Centre, added: “It’s exciting to work with NSW Health to bring new technologies into everyday use in healthcare. Data-driven healthcare is very much the future of innovation in healthcare – this project is part of that transformation.” PoC 2: Creating an open platform for digital innovation in NSW Health The second PoC aims to create an open platform that provides access to simulated data, which researchers and developers can use to test functionality and feasibility of their models in a safe environment and without putting patients’ privacy at risk. Multiple yet anonymised datasets are being mined, via the Miya Precision platform, to cover common health challenges such as diabetes, cancer and cardiovascular disease. Cloud software company Evidentli is using its Clinical Research Automation software, Piano, which connects to a variety of data sources and provides security and workflows to automate research. Best-of-breed statistical, analytic, and documentation tools will enable Murrumbidgee LHD to perform clinical research in a fraction of the time it has historically taken. And, because Piano transforms data into open standards and automatically documents methods, research is immediately reproducible and ready for peer review. The platform, said Dr Wood, is “an incredibly powerful research tool which accurately captures activity to give insights into factors such as a patient’s risk of readmission as well as compliance with clinical pathways and the provision of clinically appropriate care”. “The digitisation of healthcare is ramping up and all clinicians need to embrace it with a view to developing a platform that improves access to the information they require to deliver timely and appropriate clinical care,” said Dr Wood. “We are excited to be a part of these six-month projects and I hope that both prove to be successful.” Recent digital health-related developments in Australia Earlier this week, CSIRO and GenesisCare announced a A$5.1M research partnership which focuses on an emerging area of science called theranostics to develop new therapies against some of the most fatal and difficult-to-treat cancers affecting Australians. The federal government of Australia recently announced that it will invest A$5M to facilitate the implementation of PainChek’s pain recognition app in Australian residential aged care centres (RAC’s), according to a Mobihealth News article.

Australia’s national science agency CSIRO and GenesisCare, one of Australia’s largest cancer care providers, today announced a A$5.1M research partnership which focuses on an emerging area of science called theranostics to develop new therapies against some of the most fatal and difficult-to-treat cancers affecting Australians. What’s it about According to the Theranostics Australia website, theranostics uses specific biological pathways in the human body, to acquire diagnostic images and also to deliver a therapeutic dose of radiation to the patient. A specific diagnostic test shows a particular molecular target on a tumour, allowing a therapy agent to specifically target that receptor on the tumour, rather than more broadly the disease and location it presents. Treatments successfully designed in the project will be trialled locally in Australia through GenesisCare's clinical network, giving Australian cancer patients access to new treatments sooner, rather than waiting for treatments to be developed and trialled overseas first. Access to this form of treatment has historically been limited globally, and it is hoped this investment may help spark a new theranostics industry in Australia to ultimately improve patient outcomes. GenesisCare is building a network of clinical centres to support research into new therapies, and is providing compassionate access to treatment for patients who have exhausted conventional treatments for prostate cancer. Currently GenesisCare offers theranostics treatment in Hurstville (New South Wales), Perth (Western Australia), on the Gold Coast (Queensland), and in Windsor (UK), with plans to introduce the treatment to more centres in 2019. The new research project forms part of CSIRO's Probing Biosystems Future Science Platform and builds on CSIRO's expertise in cancer biomarker research. What’s the trend Cancer remains the leading cause of death in Australia, with almost 50,000 deaths from cancer estimated in 2019, including 3051 deaths from pancreatic cancer, 1549 deaths from brain cancer, and 1046 deaths from ovarian cancer anticipated this year alone. On the record “We're targeting cancers that are currently the most 'untreatable', such as brain, pancreatic and ovarian cancers and metastatic cancers, because that's where we think we can make a profound difference,” CSIRO project lead Professor Stephen Rose said in a statement. “We’re exploring a very exciting approach called theranostic cancer treatment, which is a type of precision medicine that finds and attacks individual cancer cells in a person’s body – rather than attacking both cancerous and healthy cells.” Associate Professor Peter O'Brien, Chief Medical Officer at GenesisCare, said the project builds on research and ongoing clinical trials using theranostics. "We've seen a rapidly developing body of evidence in theranostics in prostate cancer and neuroendocrine tumours, and this partnership aims to accelerate the time it takes to bring findings from the lab to the clinic for other hard to treat cancers," he said.