Staff Writer

The Australian Government has invested a further $6.3 million towards developing the Health Data Portal, used to report on Indigenous health data. The portal, used by Aboriginal and Torres Strait Islander health services and funded under the Indigenous Australians’ Health Programme (IAHP), allows healthcare providers to publish reports for public consumption or exchange data and other files with authenticated individuals, businesses and other government agencies. It aims to provide a simplified and streamlined process for organisations to deliver health services in communities. The portal is also used by Aboriginal and Torres Strait Islander health services to submit National Key Performance Indicators (nKPIs) and from July 1, will include the Online Services Report (OSR) and the Health Care Provider (HCP) number report. The Australian Institute of Health and Welfare maintains and reports on the nKPI data collection. nKPIs are determined to improve the delivery of primary healthcare services by supporting quality improvement activities among service providers. They also support policy and planning at the national and state/territory level by monitoring progress and highlighting areas for improvement. According to Minister for Indigenous Health Ken Wyatt, the extra funding comes as a result of the success of data collected in January. “In January 2019, 100 per cent of 238 reporting health services successfully submitted their nKPI data through the portal,” he said, in a statement. “The success of the January 2019 data collection can be attributed to the co-design approach, which saw the Aboriginal and Torres Strait Islander health sector involved in the development of the portal. This included working together on the design, prototype and user testing of the portal.” [Read more: ‘Reputations on the line’: NT digital health record roll out approaches the halfway mark | All-women team set to improve Indigenous health with “highly unusual” grant win] Wyatt also said the funding signifies the Federal Government’s commitment to working with Aboriginal and Torres Strait Islander health services to develop practical, evidence-based policy and deliver programs that will make a difference to the lives of First Australians. “This collection is one of the most advanced primary healthcare data sets available as it gathers care and outcome data from all IAHP health services. It is part of our focus on closing the gap and supporting culturally appropriate primary health care and programs,” he said. “Ensuring high quality primary healthcare is delivered in a culturally and competent way is a key to improving the health and wellbeing of First Australians in communities across Australia.”

Monash Health and Sunraysia Community Health Services (SCHS) are the latest healthcare providers to embark on EMR journeys. Monash Health has commenced the rollout of Global Health’s MasterCare EMR solution across its drug and alcohol services division, while SCHS will implement a suite of software applications centred around Global Health’s client management and data collection EMR system. Both organisations join the ranks of Bass Coast Health, Justice Health Victoria, Fremantle Hospital and the Black Dog Institute for their recent MasterCare EMR deployments. Global Health said Monash Health is the third Victorian Alcohol and Other Drug (AOD) service to adopt the platform. Windana Drug and Alcohol and Bass Coast Health were the two early adopters for Victorian Alcohol and Drug Services (VADC) in mid-2018. MasterCare General Manager Kye Cherian said core function for Monash Health Drug and Alcohol services will be to ensure that it can effectively manage clients, in line with new VADC data capture and reporting requirements. The requirements were amended in November 2018 to remove identified discrepancies between data element definitions and ensure that data quality is fit for purpose. “With the concentration of the Australian Government in this area and a Royal Commission in Victoria, highly sophisticated and flexible platforms which allow for electronic connectivity, data collection and retention, secure messaging, coordination of services and recordings necessary for government compliance are increasingly essential in this complex area,” he said. Cherian also said the company is starting to see trends in data reporting requirements across both state and federal programs that require more structure and data integrity. “MasterCare… has a robust episodic framework that supports these structured community programs,” he said. As for the SCHS deployment, the deal also includes features modules from Global Health’s new-generation mobile-optimised, SaaS-based MasterCare+ solution. These include the Lifecard consumer health record, ReferralNet for secure message delivery, Patient Portal for online admissions and the HotHealth engagement portal. MasterCare Data Warehouse will also be deployed to support real-time data analysis using dashboards. The new platform is scheduled to be operational by July 1. [Read more: Fremantle Hospital deploys EMR system for better support of care in WA | University Hospital Geelong improves ED clinical workflows] Cherian said implementing MasterCare EMR across SCHS’ various health services will enable the organisation to produce a complete electronic health record for each patient using a standardised ‘Collect Once – Use Often’ methodology, which aims to collect patient information only once. SCHS’ broad range of state and federally funded programs in North West Victoria include the Community Health Program, Commonwealth Home Support Program, Home and Community Care Program for Younger People, Alcohol and Other Drug programs, National Disability Insurance Scheme and Primary Health Networks. “Each program has different minimum dataset requirements and reporting processes. By broadening the scope of the engagement beyond standard data collection criteria, SCHS will experience the combined benefits of taking a holistic approach to patient management, data capture and reporting through a single platform,” Cherian said. “These include streamlined data collection, electronic patient records, enhanced community health program reporting and improved patient engagement.”

In support of a paperless industry, the Australian Digital Health Agency (ADHA) has launched an initiative to enhance secure messaging functionality by 2020.  The initiative, a $30,000 boost to software vendors, aims to enable clinical software providers with the support necessary to adopt and integrate new secure messaging standards into existing clinical information and messaging systems.  All private vendors that currently operate a clinical information or secure messaging system with secure messaging capabilities at two different sites as a minimum are eligible for the funding. Eliminating paper-based messaging in healthcare has been a priority for the National Digital Health Strategy, which was approved in 2017 by all states and territories through the Council of Australian Governments (COAG) Health Council.  Since then, the ADHA has been working with software and healthcare providers to develop a set of standards that will improve the secure exchange of healthcare information.  A trial of the co-designed standards was run in 2018, overcoming what were then the two final hurdles to making different platforms interoperable: universal message formats and the ability to search multiple databases of healthcare providers. “The industry has agreed to the same interpretations and allowed their systems to display messages in a number of formats: RTF, PDF, CDA, and HL7 version 2,” ADHA Chief Operating Officer Bettina McMahon said previously. Being able to find the details of a healthcare provider was the other major hurdle, as different healthcare vendors maintain their own databases and a GP using a platform from one vendor often can’t find clinicians using a different one.  The set up of a distributed directory would allow clinicians with one vendor to be able to search all databases, according to McMahon.  Following the success of the trial, the agency is now encouraging widespread adoption. ADHA Chief Medical Adviser Clinical Professor Meredith Makeham said many healthcare professionals are already using secure messaging platforms; however, many of them are not compatible with one another, resulting in these professionals using fax machines or the post to send information to one another. “The inability of healthcare providers to share information quickly can lead to communication breakdown, which can contribute to poor health outcomes and unnecessary duplication of care,” Makeham said. “This is a significant step toward ensuring healthcare providers can use the tools they already have to send information to their patients and other clinicians providing those patients care, and in turn provide safer and more comprehensive care.” [Read more: Paving the way for interoperability in Australian healthcare | To fax or not to fax?] Consumers Health Forum of Australia Chief Executive Officer Leanne Wells said a modern, connected health system requires modern communication technologies and interoperability. “Manila folders of paper records and fax machines aren’t good enough in the 21st century – secure, robust and interoperable messaging is fundamental to creating the patient-centred health system Australia needs and deserves,” she said. General Practitioner and Advisor to the ADHA, Dr Nathan Pinskier said the initiative is an “important next step” on the path to mainstream adoption of secure electronic communications in healthcare. “Secure communications will provide more efficient, safer and direct transfer of clinical information between healthcare providers,” he said. “Numerous coroners’ reports have highlighted the risks of a continued reliance on legacy systems such as fax and post. It’s time for healthcare as an industry and profession to adopt 21st century communications solutions.” Vendors interested in the initiative can express their interest on ADHA’s website.

Two Australian doctors have collaborated in creating a new telehealth web portal to provide dermatologist services to rural and regional Australia. Dermo Direct Co-founders Dr Christopher Ross and Dr Dev Tilakaratne decided to band together for a real-time telehealth video consultation service as they aimed to bring dermatology to those who would otherwise struggle to access such care – due to distance, mobility, being short on time or other issues. “We created Dermo Direct to help with the follow-up of our pre-existing country patients and for any rural patients that have limited access or have to pay a lot of money to travel and see visiting dermatologists across various parts of Australia,” Ross told HITNA. “A lot of dermatology diagnosis is visual, so this service speeds up diagnosis and management.” Dermo Direct covers all dermatological cases but has limitations on skin cancer checks or skin lesions suspected of being connected to skin cancer. Ross said unlike other telehealth platforms, Dermo Direct brings the web-based portal direct to patients, as the GP isn’t also required to be present to coordinate care. “We ask the GPs for referrals direct to our service. All the patient then has to do is log on to our website and input their information, photos, or any other data necessary and book an appointment with a dermatologist,” he said. “Using a smartphone, tablet or computer with the usual microphone, camera and speakers that you would use for a standard video call such as Skype, Gruveo or Facetime, we then have that consultation with the patient. “The resulting bloodforms are electronically sent to the patient’s email, while a letter of diagnosis goes to the patient and to their GP. Not all pharmacists accept electronic copies, so at this stage, we also send them a hard copy of the prescriptions through mail,” he said. [Read more: Mobile app brings specialist advice to burn victims | How can Australia do remote healthcare better?] Ross said none of the teleconference videos are recorded but the notes and photos from the telehealth consultations are kept on a server in Darwin Dermatology, a private clinic that Tilakaratne runs. “We treat patient information just as how we would in a face-to-face consultation. As for the photos sent through the system, they are stored in a compliant program and the patients are given the option of uploading them when they first book online. “From a patient’s perspective, nothing changes because we treat the photos that they send us how we would if we took them ourselves in a clinic and uploaded them onto the system,” Ross mentioned. Dermo Direct is predominantly targeted at Australians living in rural and remote parts of the country, but isn’t only limited to patients in those areas. “As the Medicare rebate still exists for rural patients, and those in nursing homes, for example, the out-of-pocket cost isn’t as much as them having to see a visiting dermatologist. The website is set up to see if a patient is eligible to use the rebate, using their postcode. “The service is also eligible for those residing in cities, but they wouldn’t be covered by the Medicare rebate, so their out-of-pocket would be much higher. But sometimes the waiting time to see dermatologists can be up to six months in cities, so they can opt to use this service instead.” Currently, Ross and Tilakaratne are the only two dermatologists currently available on the platform, but Ross mentioned that there is capacity to bring on board other dermatologists if the platform picks up pace. Moving forward, Ross also said he envisions for Dermo Direct a reach beyond just dermatology. “We would like to get other specialists involved with telemedicine as well, to amplify efficiency for both a business model and a patient model,” he added.

Clinical and non-clinical staff of today spend too much time on things that do not interoperate, according to Royal Australian College of General Practitioners (RACGP) President Dr Harry Nespolon. “Let me give you what a normal day in general practice is like without interoperability. I see a patient, who has been to the hospital the night before, first thing in the morning. The patient tells me that the hospital advised him to get some ‘stuff’ done. I check my inbox, but there isn’t a discharge summary,” he said, at a recent Australian Digital Health Agency (ADHA) event. “If I am lucky enough to have a discharge summary, there may be just some vague instructions to contact a particular department, which may not know of this patient’s needs. This wastes my non-clinical time, which sometimes even results in achieving nothing. “So much time is spent ringing up other departments, scanning, faxing, moving paper from one side of the room to the other, etc. It’s very inefficient and I rather have my clinical and non-clinical staff talking to patients instead of waiting on machines to do things. As a practice owner, I can’t wait for this to be right,” he said. Nespolon addressed the pressing need for interoperability, saying that it enables healthcare to spend more time on patients and producing better outcomes, rather than chasing things up. “If we were able to access the hospital’s pathology or appointments, for example, we can see what was written on the notes. That would save us so much time; one thing that you can’t compress in medicine is time.” eHealth NSW CEO Dr Zoran Bolevich said there has been some skepticism around interoperability in healthcare, but mentioned that interoperability issues exist in the paper world as well. “Even in the paper world, there are issues with communication and how departments work with each other to communicate information,” he said. Bolevich said the current systems in many healthcare organisations are challenged in: Information flowing seamlessly between systems, resulting in new sources of patient safety risk Continuity of care where various departments or organisations share information seamlessly for better patient-centric experiences Enabling a learning system that uses data to improve patient safety, healthcare quality and outcomes. “A lot of systems have data hoarded in fragmented IT systems, so we need a system we can mobilise for analytics and research. But for that to happen, we need to develop our workforce. We need more data scientists, clinicians with digital health skills, technologists that understand health and clinicians that understand technology,” he said. A SYMBIOTIC RELATIONSHIP Queensland Aboriginal and Islander Health Council Independent Director and GP Dr Steve Hambleton, said while it is true that healthcare needs to evolve with changes in technology, the same should be said of technology.  “Technology too, needs to evolve to support healthcare. Computerisation by itself is not the solution; software needs to be able to fit into the clinical workflow. Computers are good at doing routine things but healthcare isn’t routine – every patient is different and that’s why it’s challenging to build software that works for everyone,” he said.  “We’ve got to think about the way our health system is set up, who it’s focused on and the data repositories that we have. A lot of them are still paper-based and data is locked up in paper. It’s very hard to get it out. “The lack of connection and availability of data is reflective of the way we practice. With a patient ending up in hospital because of medication misadventure every two to three minutes, it’s worth reflecting on what we’re trying to solve.” [Read more: We need to get the digital basics right and quickly: Tim Kelsey | What’s needed to drive innovation and improve affordability in healthcare?] As a result, Hambleton called for a future-looking, interoperable system that moves today’s “average care” to one that is universal and personalised. ADHA Chief Executive Tim Kelsey said interoperability is the solution to making the future of health digital. “The momentum [of digital] is growing. My Health Record is just a part of the solution in Australia. The solution is interoperability – broadly, a modern, person-centered health service that has dealt with all the inequities introduced by paper-based health provision and no longer supported by fax machine in care delivery,”  he said. CORE VALUES Kelsey addressed four core values required for a modern connected health service: Participation: Empowering the recipient of healthcare to be able to fully participate in health decisions by providing them with access to health information in a consumable way.  Collaboration: Having a broad consensus behind the delivery of digital tools.   Transparency: Creating meaningful, understandable information about the availability and quality of local care services and understanding the balance between the responsibilities of the recipient of care and opportunities in an information rich, modern service. Trust: Having the social license in place for digital services healthcare will provide in future. Kelsey said secure messaging would play a large role in the uptake of interoperability. “We can’t possibly imagine a world full of precision medicine when we’re communicating ubiquitously using fax machines. It will never happen and it calls out for the development of secure messaging. We need to start… building the necessary foundations in the standards we propose around interoperability for the future.” But there is also a broader challenge of health literacy in Australia, according to Kelsey. “How do we ensure that people are not disadvantaged by the arrival of some digital services? We need to think about how we can support this agenda. The tipping point for that conversation is going to be the arrival of meaningful care facilitation through My Health Record and other infrastructures in Australia, which will hopefully take place in the next year,” he added. GETTING THE FOUNDATIONS RIGHT Software Industry Association Medical CEO Emma Hossack said technology isn’t the only aspect to come under review when it comes to interoperability. She mentioned that the industry needs to ensure that “foundational considerations” are set right.  “We need to make sure that we don’t rush into it driven by a timeframe that’s unreasonable,” Hossack said. “For this, we need to have an environmental scan of all the projects that are currently working, or not; a test bed of areas where there is interoperability, where there’s patient benefits, where efficiencies or sustainabilities lie, etc. That’s absolutely key.” Hossack also addressed the issue of culture and cynicism, saying that those two areas need to be looked into. “We can work it out, but we can’t expect people to take on interoperability and be enthusiastic about it unless it’s going to be sustainable for their business. And let’s get our priorities right because we need to make sure that we’re getting what patients want right,” she said.   “It’s also worth remembering that while we’re an industry, it’s not always all about the money. It’s about making a health system better, more accessible and enabling better outcomes for Australia. And none of that is possible without managing data.” [Read more: “Lifeblood” of modern healthcare: New report looks at urgent need to overcome barriers to data use | After interoperability: FHIR is the gateway for AI] According to Health Intersections Principal Grahame Grieve, interoperability is about information management and people. “It’s not a technology problem; it’s a people problem and an information management problem. Technology comes and goes but information management is where the hard stuff is,” he said. “I talk about interoperability a lot, and about FHIR [Fast Healthcare Interoperability Resource]. But a lot of people misunderstand what FIHR is. It’s not so much about technology. It is two important things – a community of people and a set of technical agreements about information management and exchange. “The FHIR standard and the FHIR community don’t deliver solutions to real-world problems; they exist to enable other people to do it. The challenge then, and the biggest challenge by far, is developing the right story, the right solutions and deploying it.” Grieve addressed three stages to deploying interoperability:  Getting basic capabilities into international standards: These consist of platform standards to build solutions on. Taking those standards and applying them to the Australian context: This involves industry collaborating to figure out what these local guidelines or rules should be, testing them and integrating that process into a sustainable standards cycle. Turning those local agreements into operating software.  “FHIR is scoring goals in the first and second stages around the world, but it’s the third stage that’s the hardest stage, by a long shot. The challenge is that each of these stages means different people, different cultures, different processes and the handover between stages cause potential disconnect,” he said. “Getting continuity to run the process to the ground is the hard part, and it’s increasingly our focus. But in Australia, we’re starting at the back of the pack.  “What we need is the belief that we can collectively get it properly moving and solved. Interoperability can be done, but we have to be realistic about the issues and roadblocks faced in Australia and start navigating our way around them.” To lead a productive conversation around interoperability, the ADHA has released a National Health Interoperability Roadmap Co-design paper, which is currently open for consultation.

SA Health has made improvements to its troubled electronic medical record (EMR) system, in an attempt to lay the foundation for progressive implementation of new features and functionality. The move is an upgrade from the version the healthcare organisation was using since 2014, and follows an independent review of the program that found its Enterprise Patient Administration System (EPAS) failed, as it “contrasts with other successful EMR implementations in Australia”. The review identified that SA Health’s billing module was “not fit-for-purpose”; and the EPAS has a “flawed governance model” that didn’t empower clinicians to be key decision-makers or allow the system to be tracked, measured or managed, amongst other findings. Following the review, SA Health was expected to scrap and reconstruct its beleaguered electronic patient records. The upgraded EMR version installed at SA Health’s facilities now consists of Allscripts Sunrise EMR and paperless administration system (PAS), which was a key recommendation in the EPAS Review. Recommendation 13 of the review identified that “the existing Sunrise EMR/Allscripts PAS 14.3 software version be upgraded to 17.3, with the progressive implementation of its new features (not ‘like with like’), and that subsequently there be a regular upgrade path”. Allscripts ANZ General Manager Todd Haebich said the upgrade provides SA Health with a more contemporary, versatile and risk-resilient EMR platform. “The latest version of the Sunrise EMR 17.3 offers many functional benefits, but from an interoperability perspective, it enables SA Health and third-party vendors to extend the EMR with new apps and initiatives, including products from the global Allscripts Application Store,” Haebich said. “The upgrade also brings increased security and resilience, as it provides administrators with greater and more effective capabilities to keep the platform functioning when servers and networks fail.” The upgrade also allows SA Health to introduce the following: • Timeline: A patient-centered graphical view of the continuum of care, where the clinician receives a visual view of the patient’s visit history across all settings of care. For a more detailed view of a specific encounter, the clinician can open the desired block to launch the new visit record web portal. • Sunrise Compass: A solution that enables it to build upon and combine the workflow management tool and tasking infrastructure into a single new UI. A new Smart Engine analyses patient conditions such as results, vital signs, problems and observations to dynamically suggest tasks, workflows and actions. Compass aims to increase the quality of care and decrease time to treatment and diagnosis by decreasing manual interventions in the EMR. • Sunrise Mobile: A solution that lets clinicians manage their daily activities. [Read more: Fremantle Hospital deploys EMR system for better support of care in WA | University Hospital Geelong improves ED clinical workflows] “The upgrade is the first step in ultimately providing SA Health with a system to rival what we have achieved in other geographies like the US, UK and Singapore,” Haebich said. “We welcome the EPAS Review’s recommendation that we play a much greater role in delivering SA Health’s EMR, and we look forward to working more closely with SA Health to fulfil what it has set out to achieve.”

After a delay to strengthen privacy and security protections, the expansion of the government’s centralised digital medical records system is complete. The rollout of My Health Record reflects a significant shift towards the digitisation of healthcare and Australia’s vision to make patient records more accessible. This has resulted in the creation of new opportunities to improve care across a range of health services. The possibilities, while endless, also open up a range of challenges regarding privacy and consent – challenges which nearly 300,000 Australians aren’t prepared to face, having opted out of the system by November 2018. CONNECTED BUT SECURE Using digitised services ranging from online health records to remote monitoring tools such as wearables or apps, organisations are seeking to improve patient outcomes. On the flip side, this heightened level of connectivity also creates additional points of exposure. It may be a bitter pill to swallow, but Australians have shown that they are unwilling to comprehensively divulge all medical information due to privacy and security issues. What is required the establishment of a proper trust relationship among patients, care providers and digital services. The two critical pieces in doing this are authenticated identity and consent management. Systems must be secure whilst also facilitating immediate access to patient data and history to inform care regimes. They must also maintain certain levels of user control to ensure that only relevant information is shared with the authorised third party. As connected care becomes more commonplace, the potential for identity theft also increases, especially if access and controls systems aren’t established from the onset. Ensuring privacy and security of patient data means verifying user identity and permissions to ensure that the mantra “no data about me, without me,” rings true. CREATING A BETTER SYSTEM Balancing health data interoperability with patient privacy is another challenge. Case in point: Sweden’s rollout of electronic health records (EHRs) and the resulting increased regulatory pressure spelt out the need for open healthcare API standards. The use of data from clinical trials, registries and patient outcome databases for research purposes also came under scrutiny when the General Data Protection Regulation (GDPR) was being finalised. However, in every challenge there is an opportunity. Researchers are now able to undertake research and apply deep learning on EHRs to predict healthcare-associated infections. It is these kinds of developments that Australian researchers can look to emulate through secure access to EHR databases. Regardless of the outcome, this kind of progress shouldn’t come at the detriment of meaningful patient control. A simple opt-in checkbox restricts sharing capabilities, limiting a patient's ability to direct how their data is accessed and used on a daily basis. A patient’s health status can deteriorate or improve in a matter of minutes, and their ability to consent needs to be able to adapt in the same way. User-Managed Access (UMA) offers patients a simple and powerful way to manage health data ecosystem impacts, allowing them to determine who gets access, for how long and under what circumstances. Implementing the Health Relationship Trust (HEART) standards, which profile UMA, helps promote patient control and ensure the secure exchange of patient information. A SEAMLESS EXPERIENCE With the My Health Record, patients want to interact with a single health portal. This brings with it the expectation that patients want to take charge of their health and digital identity. In this situation, reducing friction from secure authentication experiences becomes more important than ever. The continued digitisation of the healthcare system, beyond the creation of digital records, means providers must establish systems which accommodate users, devices and the systems which securely facilitate data sharing and recording. This transformation needs to factor in the consolidation of once-isolated systems and devices to create a unified patient profile across all digital channels. This ensures that services are consistent and personalised, delivering better health outcomes. A robust customer identity and access management (CIAM) strategy can enable strong authentication and authorisation, while offering a single view of the patient and relevant data, and keeping controls firmly in the hands of the patient in a way that makes managing their health and relationship with healthcare providers seamless. As digital transformation continues to drive advancements in healthcare, safeguarding patient data will influence widespread adoption. Whether data collected is by devices and apps or through a visit to the doctor, an effective CIAM strategy is critical for organisations wanting to deliver connected care and foster trust with patients.   Eve Maler is Vice-President of Innovation and Emerging Technology at ForgeRock.

In keeping with its commitment to the ongoing improvement of patient experience and in attempting to rebuild trust following last year’s scandal, HealthEngine has created a new advisory group. HITNA reported, mid-last year, that the future of the organisation appeared uncertain after patients and doctors rose to condemn its privacy practices and its operations came under review for possibly funnelling private patient information to legal firms searching for personal injury cases. In order to restore the public’s confidence in HealthEngine, the organisation has since been making “substantial changes” to its business model and company direction. HealthEngine Founder, CEO and Medical Director Dr Marcus Tan told HITNA that in ensuring the interests of practices and patients remain top priority, the newly formed advisory group will consult on both macro and micro levels of the HealthEngine business and the industry it operates in. In addition, the group will aim to provide independent industry guidance and counsel on business strategy, product direction and services, strategic issues and perceived risks around digital healthcare. “We’re at a point in healthcare now where people were with online banking and ecommerce. Everyone is nervous about having their health information online. The broader conversation is around people understanding the benefits of digital health; and that’s the purpose of this group,” he said. “We need to reach the point where the benefits of digital far outweigh the risks and it’s our role to educate patients and industry.” Tan said the focus could be on specific technologies and products in development, and identifying areas of opportunity or concern for the broader healthcare industry. “Advisory groups exist to provide more diversity of industry and consumer perspective. Our constituents aren’t just GPs anymore; our expansion into allies, dental and specialist warrants more views from those parts of the health sector,” he said. “This group was created to address industry issues that go beyond just the practice level, like policy. Just seeing where the pain points are when it comes to patient experience is valuable for our industry. Initiating these conversations is important to us, instead of having them swept under the rug.” Tan identified two key areas of concern where the working group can play a vital role: The first is helping patients and industry understand the benefits and opportunities of digital health. He said the negative aspects of digital health are prevalent, resulting in the group being able to identify strategies for gains. This includes increased efficiency, decreased waste and enhanced patient experiences. “For example, there have been concerns in the industry around electronic health records and what to do with it. So, it’s up to leaders in the market, as well as peak bodies, to help address these challenges and drive change.” Another example is learning from the negative reviews healthcare providers are facing in the industry. “Reviews online seem to be very popular for hotels and other kinds of industries, so why is there such a big backlash against health providers online? Knowing this will allow us to change behaviours that benefit patients,” he said. [Read more: Hyper-growth at HealthEngine as it looks to expand globally and transform to a one-stop online health shop | Unblurring the lines and rebuilding trust: HITNA talks to HealthEngine’s CEO] Tan said another area of concern is the unintended consequences of technological advancement. “This is something that we need to be aware of at a business level and within the wider industry at large. Technology is making great improvements to the world, but can often have some very unintended consequences, namely, diluting personal interactions and relationships,” he said. “We need to ensure that this is not lost as digital technology continues to drive positive change in healthcare. The patient journey must not become transactional and we need to protect the continuity of care.” Security and privacy of data are some of the key areas of concern, according to Tan. “Security and privacy, what constitutes consent, etc. are issues that all organisations are facing now. Whilst we are in a sensitive environment, these issues are something industry should be proactive instead of reactive to,” he added.

In a bid to better understand the molecular mechanisms underlying cancer, several healthcare organisations have banded together to develop the use of VR in its diagnostics. The team, composed of CSIRO Australia, the Garvan Institute of Medical Research, the Children’s Cancer Institute and Start VR, is using VR to create 3D models that visually represent what’s happening within cancerous tumours on a molecular level. Sony Foundation and Tour de Cure have provided $240,000 in funding. The research involves genomic sequencing (the information encoded in a cancer’s DNA), giving researchers more detailed insights into the molecular mechanisms of a particular cancer. The project draws on Aquaria, a web-based protein visualisation tool that was jointly developed by the Garvan Institute and CSIRO. Aquaria provides details of millions of proteins and allows these models to be assembled into dynamic representations for interactive exploration. “The Garvan Institute will be drawing on our online resource, Aquaria. Software development will be driven by Garvan’s BioVis team, in collaboration with CSIRO’s Immersive Environments Lab,” the Garvan Institute of Medical Research Project Leader Seán O’Donoghue told HITNA. “Planning, testing and validation of the developed system will be completed with researchers from Garvan’s Cancer Division and UNSW’s Children’s Cancer Institute. Deployment of the platform for use in VR environments will be completed by Start VR.” DERIVING OPPORTUNITIES FROM CHALLENGES According to O’Donoghue, cancer is an extremely complex disease of the genome and requires an overwhelming amount of data sets when it comes to researching it. “Adding to the complexity, the initial DNA mutations that first lead to a tumour undergo subsequent mutations, further altering the cancer. Recently, it has become feasible to detect these changes via DNA sequencing; this offers us unprecedented detail on a specific cancer,” he said. “But the volume and complexity of the resulting datasets can be overwhelming. Researchers are still trying to work on how to condense this information down to the most essential. One of the main strategies involves mapping the consequences of DNA mutations onto 3D models of proteins, and this is what our current project aims to do.” O’Donoghue said the new tool will automatically identify protein structural states related to specific DNA mutations seen in a patient’s cancer. “In many cases, the available 3D-model data can provide insight into the molecular mechanisms causing the cancer, as well as information relevant to treatment. Our new tool will use VR and web-based technologies, with the goal of helping researchers arrive at a clear visual hypothesis that describes what they believe is going wrong in a specific cancer, and then how it could be treated,” he said.  “Our tool will also be designed to help researchers clearly communicate their visual hypotheses to colleagues, clinicians and to patients.” [Read more: Mobile app brings specialist advice to burn victims | CSIRO lays out action plan for Australia’s digital health future] Although it’s primarily a research tool, O’Donoghue said the platform will also be designed for use in hospital scenarios. He also mentioned that the technology will pivot the future potential of VR for cancer research. “By combining good user experience design and graphic design, together with DNA sequencing and structural biology, VR and AR will give researchers new insight into the molecular mechanisms underlying specific cancers, thereby enabling the discovery of new treatment options. This could transform practises in oncology,” he said. O’Donoghue added that it has the potential to be used in other areas of research. “VR can be useful for helping researchers explore other unfamiliar territories. Very similar approaches to ours will be useful for addressing a range of problems in the life sciences,” he said. “This includes other diseases, as well as research aimed at improving our understanding of the fundamental processes of living cells.”

Mental health records at the Black Dog Institute’s clinical services arm will soon go digital. The Australian institute for research and services in mental health will deploy Global Health’s MasterCare EMR solution across clinical services, using the clinical and practice management software to transition processes. Black Dog Institute joins a number of other healthcare providers that have recently transitioned over to MasterCare EMR, such as Justice Health Victoria and Bass Coast Health. MasterCare EMR General Manager Kye Cherian said the solution was chosen for being a team-based, client-centric record that supports multiple programs and services. As Black Dog Institute has a number of clinical services – such as a child and adolescent health unit, psychology clinic, and depression and bipolar unit – he said the solution can be configured to suit different workflows within these individual organisations, enhancing workflow functionality across the multi-program community. Specifically, according to Cherian, MasterCare EMR’s mental health modules, such as risk assessments and assessment wizards, would benefit the organisation. “[The] platform can be implemented either as is, or adapted easily for specific client needs and requests,” he said. “The area of mental health is one that requires continuous research, innovation and investment to meet growing demand. the Black Dog Institute clinical services arm’s use of MasterCare EMR will support their research-based approach to delivering and improving mental health services. “Often people with a mental health condition have lifelong needs, and it is essential these services are coordinated and tracked for optimum outcomes and continuous improvement,” he said. [Read more: Fremantle Hospital deploys EMR system for better support of care in WA | University Hospital Geelong improves ED clinical workflows] MasterCare EMR also allows for customised program support across minimum data sets, streamlined data collection, support for more than 25 common federal and state-funded programs, and has an inbuilt practice management system for clinic appointments, billing, online claiming, staff rostering, client management and secure messaging.