Staff Writer

The healthcare industry has, for many years, been highly dependent on technology. But with the introduction and use of new technologies such as machine learning and AI in healthcare, the issue of ethics has come into question. According to a Commonwealth Department of Health and Aged Care report, ethics is necessary where:  • healthcare services are research oriented, in that clinicians conduct or directly research using data; • healthcare services that have a wide spread of disciplines facilitate the development of cross-discipline linkages and collaborations; • high technology research and development activities are located close to major healthcare facilities, such as major teaching hospitals; • networks exist or have been encouraged to develop between healthcare services, research centres and industry partners; • opportunities for financial rewards are available for innovators in the public sector; and • venture capital and intellectual property services are readily available, and tax and other public expenditures encourage innovation. As such, even though these technologies bring huge potential and opportunities, they still need to be closely monitored. The University of New South Wales Research Ethics and Compliance Support Director Dr Ted Rohr told HITNA that issues around ethics arise when healthcare access data from medical records for research, for example. “Ethics is all about deciding whether the use of technology is appropriate and is used for public good. For example, AI has its positives, but it can be misused. So, having an ethical framework allows the proper use of medical databases for research and experiments with patients using devices,” he said. “Technology doesn’t take the ethics out of healthcare, it brings more ethics into healthcare. It enables devices to be presented safely to patients or data from apps from being misused, for example.” According to Rohr, a key part of new-age ethics is privacy legislation across both Federal and State Government legislation. “We need national guidelines and code of conduct for medical bodies to create their own codes. They’re very important in establishing a culture that whenever technology is used, that the user has understood the need to safeguard patients first.” But with healthcare being an industry that requires a human’s touch, Rohr said that it is unlikely that emotional decision making will fall into the hands of AI or robots. “There was a recent study that matched where humans see themselves against AI. The prediction was that jobs for humans are to oversee decisions made by these smart systems, because the ethical judgements made by humans is still necessary,” he said. RMIT University Associate Professor Adrian Dyer said “huge risks” around new technologies like AI and machine learning will exist if a code of ethics is not factored in during their development. “It comes down to how the technology is implemented. Protocols need to be set up when developing such technology but balances and checks need to come from people,” he said. “There are guidelines available but as soon as a system is collecting, managing or manipulating personal information, there’s national and state privacy laws that need to be obeyed. But exactly how that’s managed, needs to be looked into.” THE NEED FOR A DIGITAL CODE OF ETHICS In the move towards this future, the Royal Australian and New Zealand College of Radiologists (RANZCR) has released a draft report for the ethical use of AI and machine learning in medicine. This draft report, created by its AI Working Group, outlines eight ethical principles to guide the development of professional and practice standards with regards to AI and machine learning. These eight principles consist of considerations around safety, avoidance of bias, transparency and explainability, privacy and protection of data, decision making on diagnosis and treatment, the liability for decisions made, application of human values and governance of machine learning and AI. RANZCR President Dr Lance Lawler said these principles aim to ensure the protection of patient data, balanced with the application of humanitarian values. “New technologies such as AI are having a huge impact on healthcare, with enormous implications for both health professionals and patients. They have the ability to help doctors work in a more time-efficient and effective manner and – ultimately – provide even greater treatment for patients,” he said. Lawler said these guiding principles are necessary as the way radiology adapts to AI has a flow-on effect for patients and other healthcare professionals. “The agreed principles will, when established, complement existing medicinal ethical frameworks, but will also provide doctors and healthcare organisations with guidelines regarding the research and deployment of machine learning systems and AI tools in medicine,” he said. "There is a lot of hype and misinformation around AI; it is important to look beyond that and concentrate on… how we can best use it for the maximum benefit of patients.” Royal Brisbane and Women’s Hospital Metro North Hospital and Health Service Radiation Oncologist Professor Liz Kenny said the ethical principles outlined around AI algorithms and machine learning will help guide industry in decision making. “We’ve never been at greater risk of having machine learning and AI algorithms take us down the wrong path if we don’t get the ethics of them right. Today, because software such as AI and machine learning are not considered medical devices, there’s no regulation or ethical requirements around them,” she said. “So, we’ve got an opportunity to do this right – to do this solidly thinking through from patient safety, security of teams caring for them, the overall healthcare system, etc. “But today, we’ve got no handle on it and if we continue this way, we’re going to lose trust and the technological potential in front of us.” ETHICS AND THE STAKEHOLDERS' INVOLVEMENT And for a standardised set of regulations around these technologies, governance and stakeholder involvement is necessary, according to Dyer. “There are many stakeholders involved in new technologies. Before providing recommendations, researchers need to think about input from a variety of stakeholders. This shifts the burden of ethics across a number of stakeholders,” he said. “For example, shareholders in a healthcare company may be interested in maximising profit. Their perception of ethics may be more relaxed as they’re intending on using that data to make a profit. Someone interested in privacy legislation may be interested in protecting patient information. “So, there’s the general public – knowing what they expect, the wants of the healthcare industry and the way our governments manage that when determining the correct balance of ethics.” The University of Auckland Health Systems Lecturer Dr Monique Jonas previously said ethics plays an important role in emerging health technologies as it is “crucial in determining which health technologies should be funded, for which patients, upon what terms”. “The reason is that at least some emerging technologies promise to improve life and to extend life in a way that existing technologies are unable to do. So they carry potential benefits for patients,” she said. “Decisions about health technologies are inevitably ethical – they involve people’s interests, societal values and distributive justice. The acute importance of the end-point – the decision about whether to fund a given technology – means that the whole lead-in process that informs that end-point must be defensible in ethical terms. But it is not always clear what decisions are most defensible in ethical terms.” Kenny said governments need to address the ethical concerns arising from technologies like machine learning and AI algorithms by learning from the efforts of other countries. “There’s currently no principles around the use of AI algorithms and machine learning in Australia. If this flows in a completely unmanaged environment, it will be detrimental. The opportunity is not tomorrow, it’s right now,” she said. “It needs to start with something as simple as an agreement of terminology. For example, the UK has been very clear, through the House of Lords Select Committee, around a set of descriptors of these technologies. We don’t even have that remotely right here, which is resulting in ethical issues.” Kenny added that policy must lead the ethical discussion and said the draft report for the ethical use of AI and machine learning calls on “government of the highest level” to help industry get it right. “There needs to be a set of guiding principles for industry, vendors, researchers, care providers, and government themselves to set us on the right path,” she said. “With the Human Rights Commission and TGA having set out consultations, there’s serious work that needs to be done. This is an opportunity for government and regulators to come together and see it through.” GOING INTO THE FUTURE Rohr said that ethics in technology will continue to be an ongoing discussion given the rate of technological advancements. “There will need to be constantly evolving regulations in place to consistently ensure that there is no abuse of technology,” he added. Dyer suggested that conversations around what industry expects out of AI and machine learning should be brought up with the general public as a starting point, which can then be used by governments to make decisions and set up a legal framework. “It’s both a bottom-up and top-down approach. Research and industry have to advise government on what fits best, and government needs to act. Which one comes first, is interesting to see and will determine how we navigate this path going forward.” However, Dyer said there needs to be a greater understanding of the capabilities of AI and machine learning before a set of standards are set out and that ultimately, technology should only be an enabler of change. “The technologies are too new at the moment. I would advocate that for now, any time an important decision is made regarding human health, that it is always done by a perfectly-trained healthcare practitioner,” he said. “Technology can guide decisions but you need a human who is ethically trained to make that decision.”

Eastern Health has rolled out a new trial across its Box Hill Hospital to help patients better manage their medication after they leave hospital. DC MedsRec, the community pharmacy-based service for patients discharged from Box Hill Hospital with four or more medicines, aims to reduce the risk of harm from dangerous drug interactions. The trial, conducted in collaboration with the Australian Digital Health Agency (ADHA) and Monash University, will enable eligible patients to meet with trained community pharmacists, who will look at their hospital discharge summary via My Health Record (MHR), along with a range of other medication information on their Electronic Medical Records (EMRs). The pharmacist will then check the patient’s understanding of the drugs they are taking, resolve any potential medicine safety problems and ensure any medication-related recommendations from the hospital are followed up. The pharmacist will also offer to dispose of any discontinued medications and prescriptions for the patient, with their consent. The move follows Eastern Health’s successful EMR implementation at Box Hill Hospital In October 2017, in partnership with Cerner, as part of its Great Digital Information Strategy 2015-2020. ADHA CEO Tim Kelsey said the service was part of a $8.5 million program that trials innovative and new approaches to post-hospital support, palliative care and the management of chronic health conditions using digital technology. “Pharmacists involved in the Box Hill project will be able to access their patients’ hospital discharge summaries quickly and easily using My Health Record,” he said. “The ultimate aim is to ensure patients with complicated medication regimens don’t end up back in hospital after taking a bad combination of medicines.” Monash University Project Lead Greg Duncan said the trial was initiated as a result of poor medication management during or immediately after a hospital stay, which becomes a risk factor in 28 per cent of potentially avoidable hospital readmissions within 30 days. “We know medication errors often occur when patients leave hospital and can mean patients end up being readmitted – so we will assess the impact of this new service on 30-day unplanned readmission rates to hospital,” he said. [Read more: Inability to meet patient engagement demand is “hobbling” Australian healthcare providers: study | NSW’s hospitals enroute to state-wide Electronic Record for Intensive Care (eRIC) implementation] Eastern Health Chief Executive Adjunct Professor David Plunkett said the trial positions the organisation to “provide both excellent clinical care and research”, with real-world benefits. “Community pharmacies from the Eastern Health area will take part in the pilot, with up to 5000 patients potentially involved,” he said. The success of the service will be evaluated after 12 months, with Kelsey adding that the results could potentially shape future projects, helping patients throughout Australia better manage their medicines.

The Royal Australian and New Zealand College of Radiologists (RANZCR) is on a mission to improve decision-making transparency, data privacy and ethics in the industry’s use of AI and machine learning. In its draft Ethical Principles for AI in Medicine report, RANZCR calls for the “correct use” of AI and machine learning, specifically with regards to clinical radiology and radiation oncology, and includes the following eight guiding principles: Safety: Patient safety and quality of care should be the first and foremost consideration in the development, deployment or utilisation of AI or machine learning, with an evidence base to support it.   Avoidance of bias: As AI and machine learning systems are limited by their algorithmic design and the data they have access to, they are prone to bias. To minimise bias, RANZCR suggests that the same standard of evidence used for other clinical interventions be applied when regulating machine learning systems and AI tools, with their limitations transparently stated.   Transparency and explainability: As machine learning and AI can produce results which are difficult to interpret or replicate, RANZCR suggests that a doctor must be capable of interpreting how a decision was made and weighing up the potential for bias.   Privacy and protection of data: Storing a patient’s data must be done securely and in line with relevant laws and best practice. RANZCR suggests that patient data isn’t transferred from a clinical environment of care without the patient’s consent or approval from an ethics board. Where data is transferred or otherwise used for AI research, it should be de-identified in a way that the patient’s identity cannot be reconstructed.   Decision making on diagnosis and treatment: While machine learning and AI can enhance decision-making capacity, RANZCR suggests that final decisions on patient care are recommended by a doctor with due consideration given to the patient’s current state, history and preferences.    Liability for decisions made: The liability for decisions made about patient care rests with the responsible medical practitioner, while the potential for shared liability needs to be identified and recorded upfront when researching or implementing machine learning and AI.   Application of human values: As machine learning and AI tools are programmed to operate in line with a “specific world view”, RANZCR says it is the role of the doctor to apply humanitarian values (from their training and the ethical framework in which they operate) and consideration of that patient’s personal values to any circumstances in which these technologies are used in medicine.   Governance: RANZCR says that machine learning and AI are fast-moving technologies with the potential to add great value but also do harm. It suggests that a hospital or practice using these technologies have accountable governance committees in place to oversee implementation and ensure compliance with ethical principles and standards. [Read more: TGA draft guidance calls for heightened cybersecurity for medical devices | Standard bearers: The RANZCR’s journey to establish teleradiology protocols] These guiding principles were developed by RANZCR’s AI Working Group, which was recently established to determine how the technologies fit into the world of radiology and healthcare, and best practices around them. RANZCR President Dr Lance Lawler said these principles are “the first of their kind” devised by a healthcare body and that they aim to ensure the protection of patient data, balanced with the application of humanitarian values. “New technologies such as AI are having a huge impact on healthcare, with enormous implications for both health professionals and patients. They have the ability to help doctors work in a more time-efficient and effective manner and – ultimately – provide even greater treatment for patients,” he said. Lawler said these guiding principles are necessary as the way radiology adapts to AI has a flow-on effect for patients and other healthcare professionals. “The agreed principles will, when established, complement existing medicinal ethical frameworks, but will also provide doctors and healthcare organisations with guidelines regarding the research and deployment of machine learning systems and AL tools in medicine,” he said. "There are lots of hype and misinformation around AI; it is important to look beyond that and concentrate on… how we can best use it for the maximum benefit of patients.” The principles are out for public consultation, with submissions due before April 26.

South Australia will soon be home to a new $100 million healthcare precinct, with aims to bolster health and medical innovation, services and employment in northern Adelaide. The Northern Health Consortium – a syndicate consisting of Barwon Investment Partners and developers Leyton Property and Accord Property – will build this new health and medical precinct as part of the Healthia site adjacent to Lyell McEwin Hospital. The consortium said it will construct two purpose-built multi-level, clinical buildings for public and private ambulatory care services, mental health services, diagnostic imaging, pathology, general practice services, medical consulting rooms and childcare. The precinct also aims to support private, public and not-for-profit healthcare services, and forms part of the Barwon Institutional Healthcare Property Fund, which has invested about $500 million into Australian healthcare real estate. According to the consortium, the development will create “one of the largest health and medical precincts in South Australia”, in addition to creating approximately 150 ongoing jobs once the precinct opens. Accord Property Managing Director Lachy Hogarth said the build is a positive step for the community and will drive better healthcare and research for economic and social benefits in the region. “There’s a clear shortfall in community medical services in the region. As such, we will work closely with key public, private and non-for-profit stakeholders throughout the development process to deliver a first-class facility for the community,” he said. “This project will create local jobs, not only during construction, but offer long-term skilled employment for the area. We’re delighted to be able to work in collaboration with such an experienced project team to deliver these vital health and medical facilities.” Construction is scheduled to commence in early 2020 ahead of its anticipated completion in 2021.   [Read more: NSW showcases its vision for a healthcare precinct combining clinical care, research and academia | SA Government plunges funds into healthcare facilities in a Budget designed to heal wounds] The creation of this healthcare precinct is similar to the vision that the NSW Government presented in 2017, with the proposed combination of the University of New South Wales and Randwick hospitals into a mega-campus. Commissioning of this building is planned for early 2023. The NSW Government also recently contributed $740 million towards a new world-class health, research and education precinct in Liverpool in Sydney’s west. Located at Liverpool Hospital, the precinct aims to create a hub for innovation and emerging technologies, boost the economy and create jobs growth. The move also follows the Victorian Government announcing plans to create the Australian Medical Robotics Academy in Melbourne’s Parkville precinct, to train surgeons to conduct minimally invasive surgery for prostate cancer and other conditions. The Australian Medical Robotics Academy is expected to be completed by the end of this year.

Ineffective central systems and processes for managing patient lifecycle are resulting in a “significant gap” between patient expectations and healthcare provider reality, according to a new industry study. The Taking The Pulse Of Patient Experience: Why Australian Healthcare Must Change study by Forrester and Salesforce found that 61 per cent of healthcare providers said ineffective central systems and processes for patient lifecycle management are currently in place. This, according to the report, is “hobbling” Australian healthcare providers. Fifty eight per cent said inefficient hospital-to-patient communication mechanisms exist, while 54 per cent said they encounter limited capabilities to gain meaningful insights from patient data in relation to patient service. The survey of 202 local healthcare providers also identified that even though 84 per cent of healthcare providers understand that patient experience technologies will help them share and apply patient data in a meaningful way, 38 per cent are not aware or don’t know about any patient experience technology in their hospital. In addition, 48 per cent don’t realise the financial value of using patient experience technologies. This is despite patients demanding more connected experiences, with 38 per cent of patients saying a strong need for quick and convenient service is a top priority from their healthcare providers. Salesforce Chief Medical Officer Dr Joshua Newman said while patients expect to connect with companies through personalised, modern, mobile, social and intelligent technologies, healthcare has been slow to adapt. “It’s clearer now more than ever that healthcare providers need to manage patients in new ways. Patient experience technology can help make them feel better cared for, more engaged and healthier as a result,” he said. “Patients demand smoother, frictionless, predictable experiences and services from their healthcare providers. They want quick and convenient access to healthcare, and timely and ongoing communications regarding their health.” Newman said healthcare practitioners shouldn’t be relying on disconnected systems for patient management and that healthcare providers need to modernise to relate with patients using a new standard. “Many industries have completely transformed how they deal with customers. The future of healthcare will depend on how providers transform to ensure patient experience is at the centre of their care, coupled with a strong patient data management foundation to scale and contextualise each and every patient interaction.” [Read more: Vendor tech support, evolving with AI and automation, must be more customer-focused | Hospital developments struggle despite “exciting” digital buildouts: report] The report identified that the opportunity lies in investing in patient experience technologies to meet business priorities, as well as patient expectations. Integrating electronic medical record (EMR) data with patient engagement platforms is one of the keys to this approach. The report found that 90 per cent of healthcare providers are planning to implement, expand or have implemented patient experience technologies. However, 39 per cent of those surveyed said they are not aware or don’t have the capabilities to adequately maintain, update and secure patient data. “In order to truly harness the power of patient experience technology and scale across hospitals, providers must build a patient-centric culture with a strong patient data management foundation to scale and contextualise patient experiences,” the report stated.  

GPs, specialists and hospital staff are said to be facing challenges in accessing patient records from other practitioners, resulting in unnecessary medical tests, treatments or procedures performed. In a study by Choosing Wisely Australia,  it was found that 54 per cent of GPs, 61 per cent of specialists and 36 per cent of health service providers said difficulties accessing information from doctors in other settings, including results, was a key reason for requesting unnecessary healthcare. The 2018 Choosing Wisely Australia Report: Conversations for change study also identified that health professionals said patient expectations, potential for medical litigation and uncertainty of diagnosis are common factors for low-value healthcare. NPS MedicineWise CEO Steve Morris said moving forward, there is a need to reduce unnecessary tests, treatments and procedures, especially in primary and specialist care and in hospitals. “Ultimately, the goal is ensuring less people are undergoing healthcare they don’t need and improving the quality and safety of our healthcare system. Improving communication across different care settings and empowering consumers to be active partners in their healthcare can help overcome barriers to optimal care.” Interoperability, a common repository for electronic health records and seamless communication between care settings have been some of the more common solutions to the challenge. A recent report by CSIRO supported these findings. “Ensuring new health software adheres to standards around language, terminology, openness, and data security and privacy will help facilitate the effective and safe sharing of individual health data across Australian service providers as well as with international organisations,” CSIRO said, in the report. The CSIRO study also explored the value that can be unlocked from digital data, most pertinently through the facilitation of electronic health record engagement. “The digitisation of the Australian healthcare system will go a long way towards improving integration and efficiency, but the shift needs to be more than just data sharing,” it stated. “It requires multidisciplinary and co-located teams and networks for improved decision making, treatment, and health management services.” [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 for electronic health records, a report tabled by the Queensland Audit Office (QAO) highlighted the benefits of the digital hospital program in Queensland. It found that medical staff can access clinical information faster and that patient records are more legible. “We can see digital hospitals are reducing the average length of stay and unplanned readmissions,” Queensland Chief Clinical Information Officer Dr Keith McNeil said. “Doctors are telling us the new system means they can spend more time on patient care and less time on paperwork. “Nurses are saying that the system means they have a huge amount of readily available information and they are not having to waste time searching for notes. This means the system is working.”

A Melbourne-based medical technology company has been granted a US$3 million contract to use digital health technology and AI to drive personalised medicine for the Epilepsy Foundation of America. The company, Seer Medical, specialises in products and services to make the diagnosis and management of neurological disorders easy. The My Seizure Gauge project will be done in collaboration with the US-based Mayo Clinic and London-based King College Hospital, and will use Seer Cloud to enable patients to gauge the likelihood of an epilepsy seizure occurring via an app.  The Seer Cloud platform will collect data from wearable devices that measure the activity of a patient’s brain, heart and other important vital signs. The data will then be interpreted by AI on the cloud to automatically generate clinical insight. Seer Medical CEO Dr Dean Freestone told HITNA that today, AI interpretation of brain signals highlight parts of data that are likely to be important for diagnostic purposes. What Seer Medical’s technology aims to do, through this project, is speed up the review process. The algorithms discover complex combinations of seizure triggers that otherwise appear random as seizures can be influenced in subtle ways, and by many things. For example, sleep, stress, alcohol, diet, weather, and other behavioural and environmental factors affect the odds of it occurring. “Traditional diagnostics require patients to be monitored in hospital for a week. Seizures can be rare events, so it takes a long time to catch them. Patients can be waiting around in hospital for weeks and seizures are less likely to occur in a setting that’s so far removed from normal,” he said. Using personalised data recorded over a long time period is expected to reveal the triggers for a person and moves neurology out of the clinical environment to the home, reducing the reliance on overburdened hospital infrastructure. “Seer’s at-home diagnostic service allows patients to be recorded in the home environment, so there is no longer a need to be stuck in hospital for a week. This frees up beds for patients in greater need,” he added. “In the future, AI will enable automated diagnosis of epilepsy, which will be revolutionary. AI will also be able to recommend what therapy will work best for an individual in future. This new type of personalised therapy is a while off, but we are working to build the infrastructure to make this a reality.” [Read more: Research into the genetic risk factors for stroke uncovers game-changing discoveries | Ground-breaking collaboration creates world-first smart home for people with intellectual disabilities] Founded in 2017, the company’s immediate focus is on epilepsy, with the project aiming to harness the collective knowledge of medical professionals and curating one of the world’s largest medical dataset. “There are 65 million people living with epilepsy worldwide. Approximately one third cannot control their seizures effectively. These people live in persistent anxiety and everyday tasks like driving or cooking can become life-threatening,” he said. “Using the Seer Cloud, patients will be able to gauge the likelihood of a seizure occurring soon via an app, bringing back control into their lives.” According to Freestone, the project also represents the convergence of a range of technologies, with the potential for more in the near future. “We are living in an incredible time of change in technology and the rate of change is increasing. Advances in wearable devices, high speed mobile networks and cloud storage and computing means that Seer can collect and organise personalised health data at unprecedented scales,” he said. “The convergence of machine learning, AI, high-speed mobile networks, wearables devices and cloud computing will democratise healthcare. Soon, we will have 5G mobile networks, enabling rapid transmission of information  from wearable devices across the web. “The 2020s will see these technologies coming together, leading to the democratisation of healthcare and patient empowerment.” 

Western Australia’s Fremantle Hospital has transitioned from paper to digital records with the implementation of BOSSnet Electronic Medical Record (EMR). The healthcare provider joins the list of other providers that have made their move into the EMR space. Most recently, Justice Health Victoria and Bass Coast Health deployed Global Health’s MasterCare EMR. Fremantle Hospital deployed Allscripts’ BOSSnet EMR platform as it required a seamless transition of records across its mental health, aged care and elective surgical services, and when patients get transferred to and from the Fiona Stanley Hospital. “With patients being transferred between Fiona Stanley and Fremantle hospitals daily, the EMR standardises clinical access to a patient’s medical record and medical history,” Fiona Stanley Fremantle Hospitals Group (FSFHG) ICT Program Manager Jonathan Langdale said. “The EMR will help us work more efficiently and effectively without the delays and risks associated with copying, storing and retrieving paper records across both sites.” The Fiona Stanley Hospital was the first site in Western Australia to deploy the BOSSnet EMR, paving the way for other installations across the region. Langdale said the deployment not only supports continuity of care across the group, but also improves communication across disciplines. “Allied health staff, nurses and doctors from both hospital sites can immediately access and enter details into a patient’s digital medical record, read previous admissions and outpatient notes, and access some procedure and investigation results,” he said. In addition, according to Langdale, getting ‘BOSSnet-ready’ involved an enormous hospital-wide effort, with more than 1000 staff undertaking training to familiarise themselves with the new program. [Read more: EMRs and the Royal Flying Doctor Service – how the iconic institution approaches innovation | SA Health to overhaul EPAS] BOSSnet Strategic Business Development Director Narelle Portakiewicz said the implementation in Fremantle Hospital required 12 months of intensive planning and that all inpatient wards, outpatient and community services, day patient areas, theatres and procedural areas are now successfully using the BOSSnet platform. “The implementation of BOSSnet required an extensive upgrade of the hospital’s infrastructure, which included the introduction of 35 new workstations on wheels, 55 PCs, 654 widescreen monitors and four enterprise-grade document scanners,” she said. “The system is performing as it should and we have received very positive feedback from clinicians.” Most recently, Allscripts subsidiary Veradigm inked a partnership with Microsoft to develop a new product that would help researchers conduct studies via Allscripts’ cloud-based electronic health records, broadening it to include automated “match-making” between study protocols, patients and providers who may qualify for studies.

Patients across some of Australia’s rural and regional areas now have access to advanced medical imaging technology that aims to help with the early detection and treatment of cancer. Royal Darwin Hospital (RDH) and Siemens Healthineers have partnered in a venture to expand oncology services available in the Northern Territory, providing the hospital with an advanced PET CT scanner that offers patients the capability to scan faster using lower doses of radiation and personalises scans to a patient’s specific medical condition. Siemens Healthineers A/NZ Molecular Imaging Business Manager Tim Lagana told HITNA that the Biograph mCT Flow Edge scanner features advanced capabilities such as improved lesion detectability and reduces unnecessary exposure to radiation with two features. The first is FlowMotion, which eliminates the need for bed-based imaging used by traditional PET scanning forms. “As a result, examination parameters such as speed, image resolution and motion management can be easily adjusted to the precise dimensions of organs and routinely incorporated into a single scan for every patient,” Lagana said. The second feature he identified is the Definition Edge CT scanner. “Due to the full electronic integration of Siemens’ Stellar detector, electronic components like microchips, conductors, etc. are integrated directly at the photodiode. This reduces electronic noise coming from the detector elements and thus, improves the signal-to-noise ratio (SNR) for optimised image quality.” According to the RDH, the new service will be the “first of its kind” available in the territory and is one of only four in Australia. NT Health Senior PET Technologist Jack Anderson told HITNA that following installation, patients who had to previously travel up to 3400km interstate for access to diagnosis and treatment monitoring equipment can access these services much closer to home. “Previously, Northern Territory patients would have to travel interstate to have a PET scan in order to diagnose or help manage their medical condition,” he said. “The new RDH PET service can make a huge impact for these patients by reducing delays to diagnosis and treatment due to the need for interstate travel; better access to specialist diagnostic services for patients with geographic, physical mobility, language or income barriers; and reducing the costs to patients, carers, families and friends incurred during interstate travel for diagnostic services and treatment.” [Read more: New AI tech reshapes skin cancer detection | New bid to map AI’s impact on radiology] Anderson said this installation also puts the Northern Territory on the map with one of Australia’s most advanced medical imaging systems on the market, providing treatment options and pathways for the region’s most complex diagnostic and disease requirements. “RDH now has equivalent medical imaging services to the major hospitals in other capital cities, with enhancement to its provided services,” he said. “The new equipment has the potential to position the territory as a hub for PET research in Northern Australia and the Asia Pacific region, and furthers medical specialty in the territory, increasing the capability and integration of the local cancer services.” Although currently geared towards oncologic applications, Anderson said the system also has the capability to image neurological disorders such as alzheimer's, dementia and epilepsy, and assist in the diagnosis and provision of care for patients with other medical conditions like infections and inflammatory disorders.

The rise of digital technology and the availability of data means that it’s now within the reach for consumers to be critical enablers of change in the healthcare system, a panel of industry experts said. Speaking at the recent AFR Healthcare Summit, Queensland Health Director-General Michael Walsh said a stronger focus on the consumer will improve the quality and safety of healthcare in Australia, and support a more sustainable local healthcare system. “Consumers are increasingly becoming activated to drive transformation and innovation in healthcare. As with other sectors, it is the consumer experience that counts the most; not the product or device. It is how the life and health of the consumer is enhanced, that will be the true measure of success,” he said. “Digital health allows the information asymmetry to be more equalised. As a steward of a large public health system, I’m acutely aware of the need to listen and foster this driving force.” But, with the structure of the health ecosystem changing to give patients more control over their healthcare, there are steps that government, care providers, clinicians, insurers and patients themselves can take to achieve better patient outcomes sooner in a reimagined healthcare system. According to Walsh, it is an open, collaborative and measured approach that will deliver the benefits of digital health. “Government, industry and the diverse healthcare sector have critical roles to play in openly and carefully progressing digital health. In a system where consumers are truly at the centre, the governance of health needs to be better aligned and more enabling of digital health,” he said. “Although the roles within a healthcare sector and the different levels of government are unlikely to change rapidly… we are seeing a greater shift towards shared investment models alliancing or joint commissioning programs at the local health district and primary health network level. We will see more movement to flexible investment models at a regional level, supported by joint governance.” NSW Health Chief Information Officer and eHealth NSW Chief Executive Dr Zoran Bolevich added that the organisation recently introduced patient-reported measures to its system. “There are two types of measures that we collect from patients on a weekly basis; experience measures and outcome measures. Using this, we are now starting to design and help implement the technology platform that will enable us to do that,” he said. “We have started small, and intend on growing its potential further with industry partnerships. We are also working on using that information for secondary purposes like research. We have to be aware of the need to distill data, otherwise we’ll be overloaded with it.” [Read more: Deakin Uni launches Institute for Health Transformation | We need to get the digital basics right and quickly: Tim Kelsey] AMA President Dr Tony Bartone said collaboration was a complex journey, but healthcare providers that don’t partake in it will lose out on delivering patient outcomes that they need. “It’s about using opportunities for advocacy at different parts of the system – whether it be ensuring that the centrality of primary care of general practice is part of the discussion, advocacy for appropriate funding models that need to underpin innovations, advocacy in ensuring public views are implemented or getting all players in the system together to collect best evidence to form a solution,” he said. “It isn’t just about beds and hospitals anymore, it’s about partnerships and enabling patients to make the decisions necessary for the path they wish to take. The best way for this is to give them information and health literacy.” Medicines Australia Independent Chair Dr Anna Lavelle added that ‘coopetition’ – the concept of cooperation with organisations that a business may be in competition with – is a part of appropriate healthcare. “You can agree on things that both parties want and go in together to achieve those aims, and then you can choose to agree to disagree on other things. You don't have to be 100 per cent in alignment all the time,” she said. “Being tolerant to that and respecting others’ views and needs is completely legitimate.”