Staff Writer

As the Federal Government today pushes the button to create My Health Records for every Australian who wants one, the industry has stepped out asking for more transparency around security and secondary use of the records to enable people to make more informed decisions about it. The industry has also voiced out about data de- and re-identification, a global approach to cybersecurity issues as healthcare digitises, information security requirements of the future and blockchain as a way to alleviate some of the challenges associated with the My Health Record system.   On 26 November 2018, the Federal Parliament passed legislation to strengthen privacy protections in My Health Records Act 2012 without debate or division. The new legislation means that Australians can opt in or opt out of My Health Record at any time in their lives. Records will be created for every Australian who wants one after 31 January and after then, they have a choice to delete their record permanently at any time. The date of 31 January follows much deliberation from the Federal Government to extend the opt-out date. Australians initially had until 15 October 2018 to opt out of the national health database, or a My Health Record was to be created for them by the end of that year. But following the opposition calling for an extension to the opt-out period, the public outcry against the potential for the data to be shared with police and other government agencies, a leaked government document detailing the Australian Digital Health Agency’s response to concerns and a raft of changes recommended by the Senate Inquiry into My Health Record, the Federal Government pushed this date back and relaxed its stance on when Australians can opt in or opt out of the system. Australian Academy of Technology and Engineering (ATSE) President Professor Hugh Bradlow said the collection of health data across the population will result in better health outcomes as it not only shows how effective interventions are, but also allows treatments to be personalised based on the experience of thousands of other patients. “New forms of measurement (based on artificial intelligence) will also give patients far more significant information about institutional performance, practitioner performance, the outcomes of specific interventions, etc.” he said. The Society of Hospital Pharmacists of Australia (SHPA) Chief Executive Kristin Michaels said the My Health Record debate highlighted the need for an integrated ehealth system, accessible only to health professionals and set up at the request of health organisations, for the benefit of all Australians. "All Australians, regardless of any illness or condition, deserve to get the highest-quality care,” Michaels said. “More often than many would think, patients are unable to explain the medicines they are already taking and for what conditions they are already being treated, particularly after a seizure or if unconscious. Many of these patients are unaccompanied. Sometimes this lack of information leads to errors that have serious impacts on people’s lives. “[Hence] hospital pharmacists have long called for a shared, electronic patient data system that links up a fragmented health system and empowers patients in their own care." THE ISSUE OF SECURITY However, University of Melbourne Department of Computing and Information Systems Cybersecurity Senior Lecturer Associate Professor Vanessa Teague expressed her concerns around the privacy implications of secondary uses of My Health Records not being accurately explained. "The My Health Record privacy policy says: ‘It is expected that most applications which are assessed will be for the use of de-identified data. This is where your personal details are removed from the dataset and you cannot be identified.’ Unfortunately, removing obvious personal details (such as name, location, and date of birth) does not securely de-identify the data,” Teague said. “Both doctors and patients can be easily and confidently identified in a dataset… In the case of patients, this means that a few points of information, such as the patient's age and dates of surgeries or childbirths, is enough to identify the person and thus, retrieve all their Medicare bills and PBS [Pharmaceutical Benefits Scheme] prescriptions for many years. “Easy and confident re-identification has been demonstrated on numerous other datasets that were shared in the mistaken belief that they were de-identified. It is probably not possible to securely de-identify detailed individual records like My Health Records without altering the data so much that its scientific value is substantially reduced.” [Read more: My Health Record system data breaches rise | Game changer: Creator of FHIR writes about approaching critical mass and a growing data sharing revolution] Teague said patients may choose to opt out of secondary uses of their data but are unable to make a “genuinely informed decision” if they are inaccurately told that their detailed record cannot be identified. “Even more importantly, those whose identifiable MBS [Medicare Benefits Schedule]-PBS records were already published in 2016 should be notified, because the earlier release could make re-identification of their My Health Records much easier,” she said. Harvard Medical School International Healthcare Innovation Professor Dr John Halamka also previously criticised the system for relying on outdated technology, saying that the $2 billion My Health Record was nothing more than “digitised paper” as it uses such “out-of-date” technology that crucial patient information on test results and diseases are unable to be read or shared by computers. University of Wollongong School of Computing and Information Technology Professor Katina Michael said health data breaches, for some, could have a huge impact. She used the recent example from Singapore, where 1.5 million Singapore health records were breached in a highly targeted effort on SingHealth. Among the breached health records was Singapore Prime Minister Lee Hsien Loong's personal records. “What does this tell us when one of the world's most advanced cybersecurity nations suffers such a large-scale attack? Plainly, that no one's personal information is safe, no matter the measures in place,” she said. "If we have learnt anything over the last four months, it is that electronic health records are hackable. We need not have to look too far to see that no system is impenetrable.” Michael also speculated that there is the possibility of a ramp up of blockchain initiatives to beef up on My Health Record security. “We will likely be told in the not too distant future that we wildly underestimated our security requirements and as such, must go one step further and protect our credentials,” she said. According to Professor Michael, this involves the implant of a 16-digit Personal Health Record (PHR) ID number into people that also reads vital signs while embedded. This technology then alerts first responders of ailments and medications without the need for the person to provide any information.     [Read more: Australia leads the world in personal control of electronic health records | Is the My Health Record technology out of date?] ATSE’s Bradlow said the industry needs to be “realistic” about it as the danger of data leaking due to cyber hacking is as true as hacking any other data system. “Let’s remember that many [healthcare professionals] have easy access to today’s paper-based health records – an electronic record is actually a step up in privacy. Within My Health Record, we can make it the default to require a patient access code,” he said. “A well-designed record system which is managed by a professional security organisation and has a clear audit trail, for example, provided by blockchain, can mitigate this risk significantly."

SA Health is expected to scrap and reconstruct its troubled electronic patient records system following an independent review of the program. The EPAS Independent Review found that the beleaguered Enterprise Patient Administration System (EPAS) failed as it “contrasts with other successful EMR implementations in Australia”. This conclusion was reached after an expert panel assessed the software solution supplied by Allscripts, its configuration and management by SA Health, and the implementation and governance of the program. The report identified that SA Health chose to implement the system without the assistance of “expert organisations including the Allscripts vendor” resulting in the billing module not being fit-for-purpose. In addition, it found that EPAS has a flawed governance model with “accountability for outcomes poorly understood and managed” and a lack of current governance arrangements empowering clinicians to be key decision-makers. It also found the governance model doesn’t enable the implementation of the system to be tracked, measured or managed, amongst other determinations. “The Review Panel concludes that all three factors have contributed to EPAS not meeting user expectations,” the report stated. The South Australian Government commenced implementation of EPAS in 2011, which it expected to deliver by 2014 at a cost of $421.5 million. But, by 2018, it claimed that 78 per cent of the funds for the original scope “had been expended.” Following public debate and change of government in March 2018, the rollout of EPAS was paused to commission an independent review to inform decisions on the most appropriate way forward, which resulted in the EPAS Independent Review. “The review finds that the EPAS program has been a failure and should be discontinued and replaced. The review has determined that the EPAS program should not continue as planned,” the South Australian Government said in response to the review. “The review recommends that SA Health completely overhaul the program, reconfigure the underlying information technology and commence a roll out at two exemplar sites before a final decision is made on whether to continue to use the Allscripts suite of products.” [Read more: SA Health launches taskforce after claims of lost and delayed pathology results caused by new IT system | Xenophon calls for SA’s EPAS to be paused and investigated, while new RAH suffers a power outage mid-surgeries] The EPAS Independent Review also made 36 recommendations for a proposed way forward. “Every effort should be made to optimise the underlying elements of the EPAS program,” it stated. This includes improvements to Sunrise EMR (Electronic Medical Record), an integrated suite of clinical and financial solutions that is also used by hospitals and health systems in the US, UK, Canada and Singapore, and Allscripts PAS (Patient Administration System) implementation – terms that will replace EPAS. Allscripts ANZ General Manager Todd Haebich said the company welcomes the independent review into EPAS. ‘We look forward to working more closely with SA Health to fulfil what it has set to out achieve – the establishment of a state-wide electronic medical record,” he said in a statement. Other recommendations include the creation of an SA Health Digital Strategy with a Digital Health Board and “significant governance reforms” that put control into the hands of clinicians. “The Government will transition from the EPAS project to a new electronic medical record project, which will utilise two Allscript software programs, a patient administration program and an electronic medical record program,” the South Australian Government said. “Deployment to the exemplar sites will be the focus of immediate action for Government, with deployment to take place during 2019.”

New technology using AI to tell the difference between harmless moles and dangerous melanomas has hit the market. Created by FotoFinder Systems, Moleanalyzer pro is a portal that lets physicians confirm their skin cancer diagnosis using evaluation techniques, combining specialist expertise with AI and including the option of receiving a second opinion from international skin cancer experts. FotoFinder Systems Global Brand Director Kathrin Niemela told HITNA that the technology aims to aid skin cancer diagnoses. According to the Cancer Council Australia, every year skin cancers account for around 80 per cent of all newly diagnosed cancers in Australia, with GPs seeing more than a million patients per year for skin cancer. In addition, the Australian Government identified that there were 14,320 new cases of melanoma skin cancer diagnosed in 2018, accounting for 10.4 per cent of all new cancer cases diagnosed. “The earlier skin cancer is detected, the better the prognosis. The leisure behaviour of sunbathing in many parts of the world makes early detection of skin cancer more important worldwide,” Niemela said. FotoFinder Systems first calculates and compares size, diameter and structure of moles and quantifies their percentage deviations. Moleanalyzer pro works with deep learning. Its Convolutional Neural Network was ‘trained’ with a large data collection of dermoscopic images and corresponding diagnoses. Through growing experience and its own autonomous rules, it then distinguishes between benign and malignant lesions. “Moleanalyzer pro features the possibility to manually evaluate lesions according to acknowledged checklists and optionally contains an innovative algorithm based on AI, allowing a risk-of-malignancy evaluation,” Niemela said. “In the last few years, the new algorithm has been trained with a large number of dermoscopic images. FotoFinder Systems has an international network of partners who contribute to the training of the algorithm with their pictures of histologically proven lesions.” The analysis then determines a risk assessment score of both melanocytic and non-melanocytic skin lesions, allowing physicians to verify their diagnoses. FotoFinder Systems is working towards making this AI score available for doctors on mobile devices. “When this technology becomes available for mobile devices, rural physicians, for example, who practice far away from clinics or specialist centers can use the Moleanalyzer pro's deep learning algorithm on their mobile phones to get a second opinion on their diagnosis of skin lesions,” Niemela said. The application also allows physicians to request a second opinion from skin cancer experts. “The AI represents a ‘silent virtual colleague’ that delivers a virtual opinion simply, uncomplicatedly and at any time. But together with the human experience delivered by the optional second opinion service, the tool helps to increase diagnostic accuracy.” [Read more: New bid to map AI’s impact in radiology | New AI imaging solution to accelerate critical patient diagnoses] According to Niemela, a man-against-machine study involving 58 dermatologists from 17 nations found that whereas the experts correctly identified 86.6 of malignant skin tumours, Moleanalyzer pro successfully detected 95 per cent. In addition, the technology identified 82.5 per cent of benign naevi correctly, while the experts identified 71.3 per cent as benign. However, Niemela said the technology was not expected to replace specialists. “As fascinating as AI is, it cannot take the place of human experience in the matter of skin cancer. AI will increasingly find its way into dermatology and mole examinations by supporting physicians, not by replacing them,” Niemela said. “Doctors need to combine total body mapping with video documentation of single moles and AI-based evaluation. The combination of these three elements are the pillars of early skin cancer detection. Only a physician with profound knowledge and experience can map this complex process. “In addition, patients do not want to do away with doctors under any circumstances and want to combine high-tech solutions with specialist competence.” And the future potential for AI in skin cancer detection is huge. “The aim of AI is to bundle global knowledge and consistent diagnostic standards – independent of the practice location – all over the world. The combination of human experience and AI can contribute to a drastic improvement in diagnostic accuracy in early skin cancer detection, with the potential for almost 100 per cent accuracy,” Niemela added.

The Sydney Children’s Hospital Network has taken a pioneering approach to telehealth for physiotherapy, with the department leading the hospital network in the use of video to improve its patient- and family-centered approach. By using telehealth in its Hospital in the Home (HITH) specialised service, the department has, by far, provided the most number of telehealth sessions across the whole hospital network, according to its Senior Physiotherapist, Cloe Benz. HITH is clinical care that reduces the length of stay in hospital or in some instances, avoids an admission altogether. Benz told HITNA that physiotherapy via telehealth, especially in pediatrics, has generally been limited in Australia but that the hospital embarked on a journey to navigate to new borders and demonstrate to other services that big changes can be made and succeeded in within a pediatric physiotherapy population. “It’s significantly hampered by the fact that physiotherapists, as their name suggests, like to be physically available. That has given a lot of skepticism to the use of telehealth in our line of work,” she said. “But we have rolled out the program at Randwick and Westmead for a little over a year and have experienced many improvements in our patient- and family-centered approach.” Through the program, the hospital provides access to specialist care and treatment from home using telehealth, as an alternative to institution-based care. “Children with chronic respiratory conditions need a very high level of care, in addition to a consistent level of physiotherapy as part of their monitoring and treatment program. So we run a program where kids are admitted to our service and they are seen with what is equivalent to the amount of time they would be seen if they were in hospital.” she said. This involves physiotherapists setting up a daily timetable with patients’ families. The first daily visit involves a personal visit for observations and checks, while the second daily session is done via video call. [Read more: What are the barriers to widespread telehealth adoption? | Data from telehealth to play “critical role” in consultations] “Most chronic respiratory pediatric patients have two physiotherapy sessions that they are meant to do every day of their lives. This is a huge battle for both the children and their parents,” Benz said. “So, the ability of telehealth is for us to be able to access these patients at home and provide support while they’re trying to do these sessions. It means that patients and their families can have expert advice, support and feedback, while we make sure what they’re doing is done in the most effective and efficient way possible.” CHALLENGES BATTLED THROUGH But rolling out telehealth to a pediatric patient base had its own set of challenges. “We had to put in a relative age group that we consider is most appropriate for telehealth. We start our telehealth sessions with kids aged between eight and 18 years. We found that children under that age aren't able to engage appropriately with the therapists across a video call,” Benz explained. Because of the nature of their work, the department also had to put in some risk-related considerations such as the requirement for adult consent to be in the telehealth program and for an adult over the age of 18 to be present with the child during the session. “Because we were dealing with children, parents initially felt anxious and apprehensive about setting up these programs. We needed to educate them on the safety of using our telehealth solution,” she said. “We use a program provided by NSW Health called healthdirect, which doesn’t record any of the information from the caller’s side – the only information that the program records is who the therapist is, in addition to what time they entered and ended the call.” Benz added that the caller’s details are initially required to be input into the system at the time of call in order for the therapist to know who’s on the call, but that information is then purged from the system as soon as the call is over in order to keep confidentiality. Another issue that the department initially faced was delays in engagement as a result of patients and their families joining the program later than expected. “When we used to schedule a telehealth session, we wouldn’t re-engage with the family until they call in. Because of that, families used to only start the computer at the stipulated session time and by the time they sign in or get out of any technical difficulties, many minutes get wasted,” she said. “Our families then provided us with feedback that they preferred to get a reminder message a few minutes before their appointment to make sure they’re on time. We rolled that out and now, deliver on a more streamlined process.” FUTURE POTENTIAL According to Benz, the telehealth feature has resulted in better patient engagement and responsibility for their own healthcare. [Read more: Standard bearers: The RANZCR’s journey to establish teleradiology protocols | Call for Medicare to catch up, as the momentum of telehealth uptake grows] “They engage better than they would stuck in a bed all day if they were in a hospital setting. Telehealth requires a more active engagement, and for them to be more proactive about their health, rather than taking a more traditional, passive approach to recovery,” she said. “And there are many different areas within acute care that can deliver on potential using telehealth, and I’ll be talking about this at HIMSS19.” Benz also expects more regional reach with the use of telehealth, both in terms of patient care as well as smaller regional healthcare providers following the hospital’s footsteps. “We expect telehealth to be used on a much bigger scale. Nearly all of the patients that walk through our doors have a smartphone, or at least, one person within a family does. So the access of video, across the world, is huge and health is only just getting on to how much we can do with video to provide a better, more congruous service.” Benz will be speaking about the Sydney Children’s Hospital Network’s telehealth journey and the potential of the technology for other healthcare areas at the upcoming HIMSS19 conference in Orlando. Her session is on February 13,  at 2.30-3.30pm, and is titled Virtual Acute Care: Pediatric Physiotherapy with Telehealth.

Brisbane-based real-time precision dosing software company DoseMe has gone from strength to strength in its company growth and success since it was founded in April 2014, following two years of prototype development.  The company, which aims to improve patient care through proper dosing using a tool built on the principles of Bayesian dose forecasting, is an ANDHealth+ alumnus, having received both funding and support from the Australian digital health business accelerator. Bayesian dose forecasting involves the analysis of patient data and laboratory results to gauge a patient's metabolism rate in relation to how they process a drug in their system. In operation for two years, ANDHealth aims to help mid-stage digital health companies prepare for investment and international market entry through its ANDHealth+ program. The organisation said that since October 2017, ANDHealth+ cohorts have raised more than $14 million, generated over $2.4 million in revenue, undertaken new market launches, created new jobs, commenced multiple clinical trials and studies, secured new customers and served new patients. DoseMe Founder and Chief Scientific Officer Robert McLeay told HITNA that the ANDHealth+ program exposed the company to more customers and professional relationships that enabled it to beef up its operations. “We went from being an early-stage business pushing product through to scaling the company,” he said. “The program not only helped us in terms of funding, but we also received in-kind support across a range of business areas from the additional members of the program. A lot of people underestimate the value of this but for us, it proved to be very valuable. “For example, that included legal support around strategies that we could take to protect and continually develop our intellectual property.” DoseMe’s solution involves digitally constructing a virtual model of a patient’s individual pharmacokinetics, then analysing and comparing it with thousands of data points from clinically validated pharmacokinetic drug models. A virtual patient model is built, followed by the solution calculating an individualised dose specific to the patient, using the Bayesian dose forecasting method. [Read more: Supercharged sector as the Federal Government backs $200 million Digital Health CRC | Tech development, regulation, investment and implementation key to digital health] Using this model, it aims to simulate potential outcomes of different dosing regimens to ensure that a clinician can provide the best possible advice for every patient. The company also claims that the platform can, over time, learn and refine its dose recommendations. The solution also integrates into EHR platforms and patient management software and supports a wide range of users. THE MOVE TOWARDS ACQUISITION DoseMe was recently acquired by US-based Tabula Rasa HealthCare for up to US$30 million. Since joining the program, the company has gone from having about a handful of US customers to now having more than 95 customers in the region. “The US is the world’s largest healthcare market. It’s complicated, but a very critical one for our company to get right. Today, the US makes up more than 80 per cent of our customer base,” McLeay said. “ANDHealth gave us a lot of support for this move in terms of intellectual property – enabling us to make sure that we are well protected – and have a future strategy in place to continually grow our product portfolio. “It moved us from not having the ability to get into the US market to rapidly expanding, and make sure that as we do so, we globally protected our IP. These were all critical milestones for our company to reach.” Following the acquisition, McLeay said the company will work towards expanding its solution set and integrating its synergies with Tabula Rasa HealthCare. “We expect our growth to continue, particularly in the US, and this is an excellent opportunity to accelerate that further across more geographic locations. We’re looking forward to putting DoseMe in every hospital around the world to more effectively dose patients,” he said. RENEWED BACKING FOR DIGITAL HEALTH COMMERCIALISATION Following the success of previous cohorts like DoseMe, not-for-profit medical technologies and pharmaceuticals growth centre, MTPConnect, has again awarded ANDHealth with a new round of funding. It has invested $250,000 towards the delivery of digital health market success bootcamps for up to 40 Australian digital health companies. MTPConnect was formed in November 2015 as part of the Federal Government’s $248 million Industry Growth Centres Initiative and aims to accelerate the rate of growth of the medical technologies, biotechnologies and pharmaceuticals. [Read more: Health tech funding injection to propel Australian innovations to market and into Asia | “We could lead the world”: Australia’s MTP sector shows it's punching above its weight] MTPConnect CEO Dr Dan Grant said ANDHealth’s focus is on equipping digital health innovators with the skills needed to turn ideas into commercially successful products. “Through ANDHealth’s curriculum, representatives from digital health companies will take a deep dive into clinical evidence, regulation, business models, intellectual property, partnering, attracting investment and exploring new international markets,” he said. “These are the real-world skills that underpin successful companies, allowing them to build the capital they need to continue innovating, market their products to the world and employ more Australians.” According to ANDHealth Managing Director Bronwyn Le Grice, the funding will boost the business acumen of digital health companies. “ANDHealth [supports] digital health companies prepare for investment and international market entry. With this renewed support from MTPConnect, we will be able to expand the impact across a greater number of companies, from earlier in their evolution,” she said. “The funding will allow us to leverage our existing skills and programs and the capabilities of our members, partners and global networks to continue building a evidence-based digital health industry in Australia.” [Read more: Australian and US tech leaders enter alliance to boost health innovation | Australian Government grants to fund pioneers in 3D printing and precision medicine] McLeay supported the move, saying that it helps accelerate a health technology company’s business strategy. “If you’re at that inflection point in your business where your product is clinically validated and has reached commercial viability, the ANDHealth+ program will help you move away from just thinking about the technology to getting the business aspect of it right. “Businesses should be aware of the markets that they want to move into, have an idea of the strategy required and have a team that’s able to execute on this strategy before joining the program, which then ties it all together and builds growth possibilities around it,” he added.

In an effort to deliver on safety for patients through the establishment of protocols around AI, the Royal Australian and New Zealand College of Radiologists (RANZCR) has created a working group that determines how the technology fits into the world of radiology and healthcare. Composed of practicing radiologists, data scientists, computer scientists and professionals in AI, the working group will explore what AI means for radiologists, the safety of the technology and training needed for doctors to use it. RANZCR President Dr Lance Lawler told HITNA that the group will also be working towards evaluating the impacts of the technology, the ethics of it, as well as how it fits into accreditations and regulatory frameworks. “We’re trying to be proactive with it so that we don’t end up in a situation where implications are not thought through,” he said. “Nowhere have we seen anyone seriously looking at these issues, which is often the way that regulations and new technologies come about. We want the technology to be used so that the benefits of it are reaped without being exposed to undue risk.” According to Dr Lawler, AI is of huge potential to radiology as it’s “very good at image recognition and pattern recognition”, which the field uses for image analysis to diagnose and follow up on diseases. But, even with the increasing hype around AI, there has not been enough work done to understand what the technology is, what it will be good for, what the risks of it are and how it can be applied to deliver better quality, lower cost healthcare to Australian patients, he said. As such, the organisation is embarking on a multi-layered approach to the issue. Dr Lawler said it will be looking into how AI is working in other countries, particularly in the US, with the FDA approving certain AI algorithms for use under certain conditions. “We want to understand their approach, and how that applies to us,” he said. On the other hand, it will be looking at bringing to market a training element that educates medical practitioners about the technology. “This new technology will be a tool that doctors use, so they have to know about this technology in order to deliver safe healthcare to their patients. The training element will look into what they need to know, how it will be delivered, how it will be assessed, etc.” [Read more: Standard bearers: The RANZCR’s journey to establish teleradiology protocols | AI gives robotic wheelchair facial recognition upgrade] The working group is also collaborating with Standards Australia to focus on standards and regulation. “We’re working with Standards Australia to decide what the standards are that need to be met, as well as the minimum standards for the applications of the technology, and then use those standards as the basis for safely regulating it, the way that everything else is regulated in healthcare,” Dr Lawler said. He addressed the need for a more combined, coherent response from government departments to actively investigate the use of this technology and involving medical academia and healthcare providers in strategy for it. “The ministries and regulatory bodies have been conspicuously quiet with AI, so we’d like to start engaging them in even basic discussions about this technology because it will make a very big impact, it’s only a matter of when.” IS AI REPLACING RADIOLOGISTS? Dr Lawler also spoke about concerns that roles will change significantly with AI infiltrating the market, in terms of machines replacing work done by radiologists. “There has been a lot of hype around this technology, some resulting in statements made about the future of radiology. They suggest that radiologists will be replaced by machines. Hypes aren’t based on facts and this is just an assumption,” he said. “There’s always going to be work for radiologists and it may just be an issue of reapplying people to different areas. There is fear of the unknown and the purpose of the working group is to put some shape around this whole issue so that people aren’t afraid of it.” [Read more: AI and machine learning – how soon will it be key to a learning health system? | AI algorithms show promise for colonoscopy screenings] At the moment, there’s very little impact of AI on health and radiology because it’s not being used to its full potential and is still under development, according to Dr Lawler. But he said AI is the “next big thing for the industry” and “is a great move for society as a whole”. “This is because there are some things that AI can do better than humans, but there are also some things that humans do better than AI so, we need to find a way to balance the two to deliver better quality healthcare overall,” he said. “And the best way to do that is to get ahead of the curve than be chasing our tails, which happens a lot in healthcare. “We want to get to a point where there’s an accepted and routine use of certain AI tools for some clinical circumstances. For radiology, that may be for breast cancer or lung cancer screening, or comparing responses to treatment – basically in high volume, repetitive cases that machines can do easily.”

University Hospital Geelong is upgrading its emergency department clinical workflows with the aim of delivering quality, patient-centred clinical care. The healthcare organisation will soon go-live with its new FirstNet ED Information System (EDIS), from Cerner, and replaces the Symphony ED System that it used previously as it is no longer supported in Australia. Cerner FirstNet is an integrated emergency solution that supports a wide range of functions including registration, triage and tracking, checking nursing documentation, managing physician transfer of care, and integration of documentation into a patient's Electronic Health Record (EHR), all in one system. It also lets the healthcare practitioner include and manage a patient’s past medical, family, social or surgical history, in addition to keeping a record of a patient’s transfer movements. Barwon Health Chief Information Officer Associate Professor Sharon Hakkennes told HITNA that Cerner’s emergency information system was picked following a comprehensive procurement process and will be critical in supporting its goals of high-quality, patient-centred clinical care across the entire care continuum into the future. “We have worked closely with Cerner to ensure the system functions with our current workflows and processes,” Hakkennes said. “The switch to FirstNet has required staff training and preparation in order to minimise clinical disruption and maximise the benefits of the new system when we go live.” According to Hakkennes, implementation of FirstNet at the University Hospital Geelong is aligned to Barwon Health’s strategy to implement a fully integrated EHR over the coming years. “The EHR will enable seamless transfer of health information across Barwon Health services, general practice and other health services, and will support upload of information to My Health Record,” Hakkennes said. “The importance of such functionality cannot be underestimated given the growing population of the Barwon region and the increasing burden of chronic disease.” [Read more: Allscripts and Cerner offer glimpses at tech priorities in new earnings reports | Cerner tops the EHR global market share with almost double that of closest rival Epic] Most recently, Bass Coast Health migrated its systems to experience the benefits of a complete EMR solution, having equipped its healthcare facility with MasterCare EMR. The solution will be used by Bass Coast Health clinicians to govern the assessment and management plans of clients, along with the monitoring and measuring of ongoing outcomes. The contract between Cerner and University Hospital Geelong also follows the former’s largest ever EHR undertaking in the US, announcing in October last year that it will support the US Department of Veterans Affairs’ transition from its legacy VistA EHR, alongside 24 vendors.

Healthcare has previously been one of the industries hesitant to shift to the cloud, but that trend may be changing for the better. Healthcare hesitated on adopting cloud in the past, due to a number of issues, such as interoperability, data security and privacy concerns, infrastructure availability and regulatory compliance worries, amongst others. The sensitive nature of data within the industry – ensuring that health data like medical histories, allergies, blood types and other health records aren’t compromised – means interoperable sharing or keeping biometric data secure is high-stakes. And regulatory compliance can be a difficult space to manage. In 2010 itself, the Australian Centre for Health Research identified more than 22,600 pages of combined state and federal legislation across 305 different Acts of Parliament covering the health sector. These regulations have created disparities between states, sometimes causing confusion and increasing the barriers to cloud. These challenges can’t be overcome immediately, but the industry has shown a surge of interest and more flexibility in cloud adoption. A recent report by GlobalData, Cloud Computing in Healthcare – Thematic Research, has found that in recent years, the global healthcare cloud computing market size is forecast to be almost US$35 billion in 2022. This amounts to an annual growth rate of 21.7 per cent between 2018 and 2022. Findings also identified that the pharmaceutical cloud computing market size is predicted to grow from $4.7 billion in 2017 to $12.1 billion in 2022. INDUSTRY SUPPORT FOR CLOUD Global industry partnerships signify this uptake of cloud. Microsoft and Allscripts subsidiary Veradigm recently announced a deal to develop a new product to help researchers conduct studies via Allscripts cloud-based electronic health record (EHR), aimed at improving time to market for new drug therapies and slashing costs on research and development. One of Australia’s preeminent clinical trials research centres made a move to consolidate electronic data capture systems into a unified cloud platform. The National Health and Medical Research Council Clinical Trial Centre at the University of Sydney has adopted Medidata’s eClinical platform for studies, said to help simplify, improve and accelerate research. In addition, Australian cancer institute Peter Mac has deployed two new cloud-hosted systems to replace a suite of systems and supercharge precision medicine in Australia. This enables the consolidation of multiple sources of information into a single data repository, stored in Microsoft Azure and accessible by multiple concurrent users. MedicalDirector’s Helix solution, built on Microsoft’s Azure cloud service, also aims to improve the delivery of healthcare, increase the efficiency and flexibility of medical organisations and improve evidence-based decision-making. This shows that investing in cloud computing technology has become an increased priority for healthcare organisations and networks. “For healthcare, a prominent shift is expected in cloud systems from simple data storage to using the technology to lower costs and increase efficiencies within the system,” GlobalData Managing Pharma Analyst Alexandra Annis said.    “It is foreseen to lead to a fully integrated platform in pharma that can compute tasks such as personalised patient care and clinical trial optimisation.” Snowflake Healthcare Strategy Vice President Todd Crosslin said there are three types of cloud that has become popular with the healthcare industry – infrastructure-as-a-service (IaaS), platform-as-a-service (PaaS) and software-as-a-service (SaaS). Crosslin explained that these forms of cloud are sought after for their various capabilities. [Read more: What’s needed to drive innovation and improve affordability in healthcare? | Future healthcare tech may be beneficial, but also poses risks: report] “IaaS, PaaS and SaaS are all in demand. IaaS enables the lift and shift of existing technologies, but while not the most efficient, is well-established due to the flexible nature of the cloud and the potential cost savings of having to purchase or maintain infrastructure at various locations,” he said.  “SaaS is for companies that want the business value without the IT overhead and can compromise on customisation. As for PaaS, why build components from scratch when they are available and can be built upon?” WHAT DOES CLOUD OFFER? The majority of healthcare organisations have historically hosted their applications and data on-premises. With the adoption of virtualisation and automation, on-premise infrastructure hosting has transformed. Crosslin said disruptors born in the cloud are forcing incumbents to embrace the cloud so as to achieve speed and agility. With the speed of technological advancement, healthcare too has been under the pump to adopt it.  For GlobalData’s Annis, cloud is the bridge for the healthcare industry to enable their organisations with the latest technologies and innovation. “The industry will be able to drive to the next level of innovation and analytics, for example by using the cloud’s functionality to match data effectively with patients. This personalised approach will provide physicians with the tools to make the best treatment decisions for patients,” she said. “The power of the cloud also offers the potential to speed up the drug development process [in pharmaceuticals], without compromising efficacy or safety. This will draw from its ability to collect data from patients around the world in real-time.” [Read more: How to explain the real cost of cloud computing to your C-suite | What are the barriers to widespread telehealth adoption?] Zscaler ANZ Country Manager Budd Ilic mentioned that cloud also enables organisations to deploy applications to customers faster and provides an easier exchange of information with third parties for access to update healthcare data. “Traditionally, a patient went to a health care provider’s location to receive care or treatment. Now, with the emergence of things like telemedicine, wearable monitoring devices and remote sampling devices, patients and physicians no longer have to be in physical proximity to deliver and receive care,” Ilic said.  “Cloud allows organisations the ability to better and more quickly share information regardless of where the patient is located, while also providing better security for patient records.” CHALLENGES OF CLOUD, AND A DIFFERENT APPROACH NEEDED Ilic said cybersecurity has been done the same way for 30 years or more and the industry needs to think about and implement it in a completely different manner.  “We can no longer secure the network, as evidenced by continual breaches and data loss. We can, however, secure access to cloud applications and data by ensuring that individuals trying to retrieve that data are authorised to do so and then securing that access,” he said.  “This among other things, such as reducing complexity and utilising the cloud to provide traditional security stack services, are the way to mitigate the risks of cloud deployments.” [Read more: Big leap forward as the cloud transforms GP technology | Peter Mac looks to the cloud to supercharge tech help for cancer treatment] Other vendors, like Snowflake, said there is a need for heightened security offerings. “Many vendors, like us, have made security part of their DNA. Security concerns can be addressed with Tri-Secret Secure (three-key) encryption and fine-grained data access controls to securely and performantly store customer data,” Crosslin said. “The current mechanisms of sharing data between customer and client, or partner to partner, is typically done via file transfer protocol (FTP). The drawbacks of this method are widely understood – security, staleness, time, etc.  “But security-focused companies ensure that data sharing is done by allowing accounts to share data by query. The data does not get copied from one account to another. This can be done securely through specifying the method of access and limitations,” he added. THE FUTURE OF CLOUD IN HEALTHCARE Ilic said the next level of innovation and analytics is where healthcare’s move to cloud will have a global effect on care delivery, diagnostics and treatment.  “The ability to use large historical data sets to make preventative health care interventions based on millions of individual datasets will drive our ability to end many diseases that plague mankind today,” he said.  “The ability to draw correlations between epidemics we’ve never seen before will have a large scale impact on global health that we haven’t seen since the discovery of penicillin.”

Amalgamating multiple services into one to provide a single overview of a patient is no easy feat – it requires the consolidation of multiple business process managements and the creation of a unified customer service platform, amongst other things. One organisation that recently progressed in its unification journey is Uniting Vic.Tas. With the need to combine 24 Uniting Care agencies across Tasmania and Victoria since its creation in October 2016, the organisation decided to create a “single organisation” with one customer service platform to better its service. Uniting Vic.Tas’ agencies previously had and ran their own customer service processes each, without any customer relationship management (CRM) solutions in place. But following changes to aged care, employment services and the National Disability Insurance Scheme, it saw the need to engage in a new service model to improve its servicing and have all its data housed under one system. As such, the company turned to SugarCRM’s interface platform combined with its partner, Loaded Technologies’ CRM solution, to create a “single source of truth” and deliver a “consistent approach to customer service”. “Given there was no CRM solution in place for any of the 24 agencies, it was difficult to provide consistent customer service to our clients. The merge of the different agencies highlighted how each had a different way of reporting and collecting client information,” Uniting Vic.Tas Quality and Program Performance General Manager Clare Jennings told HITNA. “As a result, it was crucial for us to streamline those different data sources if we wanted to deliver the best outcomes for our customers.” The solution streamlines business process management for Uniting Vic.Tas by bringing together data on its customers’ initial engagement, through the sales process and into the most appropriate type of care for that customer. “The community sector is constantly pressured to adapt its model of care to stay relevant in a competitive fast changing environment. In light of all the changes being made to consumer-directed care, aged care, employment services and the National Disability Insurance Scheme, we realised we needed to come up with a new service model,” Jennings said. “We came to market looking for a tool that would allow us to future-proof the work we do for our customers and their community.” [Read more: Aged care virtual clinic named Australia’s business of the year | How technology can support better aged care] Jennings said the move has helped the organisation better understand its customers’ journeys. “Partnering with SugarCRM provided Uniting Vic.Tas the solution support that was necessary to deliver on a better customer journey that we had mapped out prior to going to tender for a CRM solution. As a result of the new CRM solution, we now have the visibility to better learn about our customer journey and improve our processes.” According to Jennings, analysing data plays a crucial role in the organisation's future as it allows the organisation to better assess customer needs, which can then be used to inform future services that it delivers. “We plan to continue to streamline the systems and data we collect and use, which will optimise the use of SugarCRM. As a new entity, we have an ambitious technological building plan that will allow us to enhance our operational efficiencies, including developing a single view of our customers so we can focus on servicing them better,” she added.

Queensland Ambulance Service (QAS) has rolled out a digital system that aims to give paramedics greater access to a patient’s vital medical information in an emergency. The SafeMate emergency medical information program is under trial for Medibank customers with chronic illnesses that are living in Queensland. Patients must be enrolled under Medibank’s CareComplete chronic disease management service. The SafeMate program houses a patient’s medical and personal information that they enter online. QAS personnel can then access this data by scanning a QR code on a patient's SafeMate card using iPads. “This is crucial information that a patient wants the paramedic to know in a medical emergency,” Queensland Government Minister for Ambulance Services Steven Miles said. “Paramedics will use their operational iPads to tap the patient’s SafeMate card or device, and the medical information will appear on the screen. It eliminates the time it would normally take a paramedic to ask the patient a range of questions in order to obtain their medical history and other pertinent details.” This gives paramedics access to important information, such as details on allergies and medical history, letting them identify best courses of treatment earlier and improving patient outcomes. It also aims to reduce paramedic and patient stress, time-consuming hospital visits and costs in the health system, in addition to improving ambulance efficiencies. Prior to December 1 last year, paramedics were unable to access these records as the organisation was not in the Australian Health Practitioner Regulation Agency (AHPRA) regulated health profession registry. [Read more: EMRs and the Royal Flying Doctor Service – how the iconic institution approaches innovation | Head of eHealth Queensland on stunning ieMR stats and a future of interstate digital health collaboration] The digital system is a testament to Queensland’s ongoing digitisation journey, with the launch of a digital hospital program to improve the state’s healthcare and patient outcomes. In December last year, through findings from a report tabled by the Queensland Audit Office (QAO), Miles outlined the benefits of the digital hospital program in Queensland. He said that as a result of the digital hospital program, Queenslanders face improved health service delivery and patient outcomes, including a reduction in unplanned readmission rates, faster access of clinical information by medical staff and more legible patient records. “Digital hospitals are making Queensland hospitals safer than ever before. Doctors and nurses have told me when I’ve visited hospitals that the digital system helps them do their jobs and helps patients,” Miles said. Ambulance Victoria has also ramped up its digitisation strategy, with the organisation most recently announcing that it will soon deploy a predictive analytics platform for its paramedics to access real-time information, enhancing and accelerating its decision making as the need for emergency services grows.