Tuesday, May 24, 2016

Here Is The Approach That Is Going To Make The myHR Totally Obsolete - And Soon.

This release appeared a few days ago:

MedicalDirector Helix: The new cloud-based platform for Australian medical practices

Australia’s largest medical software and information provider, MedicalDirector, has announced its next generation cloud-platform, MedicalDirector Helix, delivering a new approach for patient-centred care.
“The Australian health sector is on the cusp of major change as it moves to using cloud-based software. We have developed MedicalDirector Helix to help practices adapt to this anticipated change, and with this platform we aim to transform their everyday patient and clinical interactions,” says Phil Offer, Executive Director at MedicalDirector.
“We’ve listened to clinicians and designed the new platform from the ground up to provide world-class useability and agility, while ensuring efficacy, patient safety and privacy,” Mr Offer says.
The new platform reflects a simple principle to let doctors be doctors and spend more time with patients during consultation. It will cover the needs of the entire practice, enabling significantly faster performance of recurrent clinical processes.
“Good technology allows practitioners to focus more on the patient and deliver more directed care. Through MedicalDirector Helix, all aspects of the patient’s interaction with the practice, from booking to consultation, to payment, will be integrated,” Mr Offer says.
According to Mr Offer the agility of the new platform will provide doctors with unprecedented flexibility in their work.
“Using the new system, a clinician can see a patient in their practice and update that patient’s record through a web browser on their desktop computer. Another patient might be seen in an aged care facility, with their records updated using a mobile device or tablet. The clinician could later be at home reviewing urgent results from laboratories and specialists,” he added.
With security of patient data the organisation’s highest priority, MedicalDirector has used world-class bank-grade security and advanced levels of threat management to ensure data is protected. All data will be stored and backed up in Australia and will be encrypted using the highest levels of data encryption.
The platform will provide seamless practice management support; with automatic software updates taking the hassle and worry away regarding server storage and backups.
Moving forward, customers will have a choice of using the current on-site version or MedicalDirector Helix. Existing MedicalDirector customers will easily be able to migrate to the new platform. MedicalDirector Helix will be previewed at this month’s General Practice Conference & Exhibition in Sydney (May 20-22).
For more information or to register your interest in the new platform and be one of the first to participate in the first release program visit www.medicaldirector.com/helix.

The release is found here:
There is commentary on all this found here:
19 May, 2016

Let the cloud games begin!

Posted by Jeremy Knibbs
Medical Director has declared itself a starter in the race for the future of the connected health ecosystem
The company, one of the country’s major patient management system providers, announced today that they are going to launch a “cloud” version of their iconic desktop management system – Medical Director Helix.
If it is a properly architected cloud version they intend to launch – truly non-device dependent, mobile and with seamless communication and data exchange features though a secure cloud environment – then Medical Director is putting a stake in the ground that indicates an intent to take on disruptive cloud patient-management start-ups head on, and in the very near future.
The timing of the announcement, at the precise date of the formal launch of much mooted cloud based start-up, MediRecords, at GPCE today, is not likely to be a co-incidence. It looks targeted directly at their customer base to at least put some doubt in the minds of anyone who is thinking of switching to the MediRecords system in the near term.
MediRecords, which has had been secretly building their system with a development team of over 30 people for the past three years, has a sophisticated cloud offering which they claim has all the functionality of both Medical Director and Best Practice, plus a swathe of new features associated with its key differentiating feature – it’s connectivity. It also has a fully integrated back-office billing system.
It’s a high-risk strategy on the part of Medical Director to announce they, too, have a cloud version, but one that they probably needed to pursue. By declaring they have a cloud version, they are going to need to deliver that product quickly to their customers or face the sort of cynicism and backlash that affected the long-standing market leader in the SME accounting software market MYOB, when they were caught off guard by the launch of XERO, a fully functional cloud offering for small business.
Lots more here:
Additionally we have this provider of health cloud based services:
With all this activity we will surely see a market shake-out as well as seeing that once you have your records in the cloud it is possible to make the records accessible for the individual patient - as is happening in the UK. With the appropriate controls agreed with the patient just where does myHR fit?
And of course, once this happens why would anyone - other than the Government - need the myHR.
This is especially so when you consider the money being spent on the myHR and the model being used to implement it - brute force.
Times are changing and the myHR is looking more and more like a ‘white elephant’.
David.

26 comments:

Anonymous said...

Mr Madden is leading the MyHR push on behalf of the Department. The ADHA is arms length removed - so far. Medical Director Helix and MediRecord are welcome new initiatives.

It will not be politically impossible for MyHR to reinvent itself as a cloud based alternative to these new comers. Re-architecting the MyHR to become a ubiquitous cloud-based offering is both impracticable and cost prohibitive. At long last market forces are about to prevail. Mr Madden needs to speak-up quickly to reassure the MyHR pilot customers (consumers and their doctors) that a MyHR cloud-based system is on the drawing board - not.

Anonymous said...

If you meant to say ..... it will not be politically possible .... then I would agree with everything you say. The white elephant is dead if it isn't cloud-based. Hats off to Medical Director Helix - I like your DNA.

Anonymous said...

Do these new systems support interoperability? Can I, as a patient, go to whatever clinician I need to and know that they will have full access to my medical record if I choose to let them?

Dr David More MB PhD FACHI said...

As long as your chosen clinician can access the web, then if you provide access to your information, it will be possible in a properly designed access regime.

David.

Anonymous said...

I was at the GPCE and MediRecords by far supersedes Medical Director in functionality and usability. MD publicly say their Helix product will be ready in October, but when I spoke to one of their reps they said it would be ready to everyone till 2017. What tops MediRecords off nicely is their patient app. That app will completely revolutionise the patient experience and engagement between us (providers) and them! I'm excited that finally some really smart technology will make our job much easier!

Peter said...

The technology is not particularly new - CRM systems have been doing this sort of thing for years. The difference is in: 1) the underlying database being structured to cross-link medical data into the patient/customer record and 2) having a well designed user interface to minimise the learning curve for the providers (and others). Both are known problems with well understood approaches to solve.
In short - there is no reason this can't be a really useful system for handling medical records.
However, it also means that there will also be more than one offering on the market and not every clinic (and hospital and nursing home etc.) will pick the same one. That means we still need some means of linking the different databases so a single view of patient is available.
This is the role that MyHR always should have been designed to play. Not storing medical records but providing connections between records stored elsewhere.

Anonymous said...

David, what is the big deal here?
If the cloud is the CATALYST for developing a newly architected system which is superior to legacy systems of days gone by tehn that has to be a significant advance.

BUT, surely if the MyHR was properly and competently architected in the same way as these new comers are claiming their systems to be what would be the REALLY BIG difference?

Does it REALLY MATTER matter WHETHER the system is in the cloud or not? Isn't that more hype than anything else. Surely the cloud is just another location for the system. Does MyHR HAVE TO BE in the cloud?

Isn't THE CLOUD just another latest marketing ploy? or is it something more fantastic that I have not understood?

Dr David More MB PhD FACHI said...

" BUT, surely if the MyHR was properly and competently architected in the same way as these new comers are claiming their systems to be what would be the REALLY BIG difference? "

Sadly it wasn't and using a cloud based solution is usually cheaper and easy to access from anywhere - recognising that this is also possible with other approaches.

My core point remains - we have spent a motza on a badly designed solution that can be functionally replicated both more cheaply and much better!

David.

Bernard Robertson-Dunn said...

Having helped the federal government develop its cloud and data centre strategies, I claim to know a bit about this.

Cloud is a technology marketing term. Under the covers all it is is standardised technology, often virtualised, but that's not essential, just nice.

Combine technology standardisation with a secure communications network so that desktop, hospital/pathology and/or cloud based systems can talk to each other along with standards for ID and data interchange and that's a real Health IT infrastructure.

It's also a hell of a lot cheaper, flexible and safer than any national, additional, personally controlled, database system.

IMHO the myHR will die of its own accord because it will never be used to deliver any sort of health care value.

It will have cost billions in real dollars and even more in lost opportunity value.


Anonymous said...

Thank you Bernard.
Much obliged, that is the answer I was looking for. All too often (remember the Y2K hype) the new marketing terms change people's perceptions and expectations raising their hopes that something super magic has arrived.

"Cloud is a technology marketing term. Under the covers all it is is standardised technology, often virtualised, but that's not essential, just nice." Succinctly put.

Anonymous said...

The quote I herd was "There is no such thing as 'the cloud' but just someone elses computer".

Bernard Robertson-Dunn said...

re: "There is no such thing as 'the cloud' but just someone else's computer".

Even that isn't true, you can build your own cloud - usually known as a private cloud.

Or, get someone else to build and operate a cloud for you on your premises, which you pay for by usage.

On an individual level you can buy a Raspberry Pi (<$100) and implement a dropbox equivalent using free software.

Dr Ian Colclough said...

re: "There is no such thing as 'the cloud' but just someone else's computer".

That's a good position to hold. However it should be appreciated that 'the cloud' does offer some real benefits such as cutting ICT overheads for medical practices, of giving a software vendor greater flexibility in providing better controlled access to My Personal Health Record (MY PHR) in close collaboration with me and my primary care medical practitioner.

It also opens up a whole new range of possibilities for other authorised health providers to write to and to read designated parts of My Personal Health Record to which they have been given access. This includes pathology and imaging services where the reports are deposited for the requesting practitioner to first read, approve or reject, before filing them into the appropriate part of MY PHR for others to see.

With Affinity Equity Partners now backing Medical Director it should enjoy a rejuvenated wave of considerable loyalty from its medical practitioner users spread across an extensive footprint in the medical practice space. MD now has the financial resources to add to its deep well of knowledge and experience in order to bring a challenging new and exciting dimension to eHealth in Australia.

Anonymous said...

May 27, 2016 10:15 AM said "With Affinity Equity Partners now backing Medical Director it should enjoy a rejuvenated wave of considerable loyalty from its medical practitioner users". I agree, but don't overlook MDs competitors.

They will push Medical Director hard to outperform, although with the impending release of Helix a new contender like MediRecord will have its job cut out to entice MDs customers to move away from MD. Better the devil you know than the devil you don't. Another plus for MD is that it has some well established strong alliance partners. Good luck to them all - MediRecord, Medical Director and other newcomers; it's been a long time coming.

These new cloud developments and freshly architected medical practice solutions will quickly energise the market and undermine the government's naive compulsory Opt-out approach to force the uptake of its My Health Record redundant. Sticks and carrots PIP incentives are outdated and no longer needed to drive change.

Market forces are now mature enough to drive change in today's brave new eHealth world where the imperative for business survival is efficiency, underpinned by good technology.

Bernard Robertson-Dunn said...

Focusing on Ways to Improve Electronic Health Records
IEEE
http://theinstitute.ieee.org/benefits/ieee-groups/focusing-on-ways-to-improve-electronic-health-records

It's about the American environment and health records in general, but here's a couple of interesting quotes:

“EHR systems don’t consistently support clinicians providing real care” and “substantially change the ways doctors think and access information, dividing tasks in ways not consistent with how physicians work."

“Engineers and software designers think they are designing these systems to meet our needs; clinicians disagree. There is clearly a need for communication to help both sides.”

"...doctors have to use EHR technology that isn’t really ready yet: 'It makes our work more difficult, increasing the cognitive burden while decreasing efficiency. Physicians feel increasingly frustrated and demoralized by cumbersome technology that interferes with their ability to provide first-rate patient care.'"

The Americans have the HITECH act to contend with, Australia has the MyHR; but it all sounds so familiar.

Anonymous said...

"but it all sounds so familiar"

Like "I am from the government and I am here to help" - The scariest words in the English language according to Ronald Reagan.

Anonymous said...

May 27, 2016 12:31 PM said "Market forces are now mature enough to drive change in today's brave new eHealth world where the imperative for business survival is efficiency, underpinned by good technology."

The Department and NEHTA tried the opt-in approach and it failed. In desperation they moved to force through the current opt-out approach which will also fail.

The vendors have only one option - opt-in.

The reason why the vendors will succeed with the opt-in approach while the Government has failed is plain and simple - vendors understand the market, vendors work with their clients at the coal face, vendors have to provide highly functional useful systems which will support clinical care. The government on the other hand, doesn't understand the market, doesn't work at the coal face, and doesn't understand what makes a highly functional useful system.

Anonymous said...

vendors work with their clients at the coal face, vendors have to provide highly functional useful systems which will support clinical care.

This is true but focuses only on a technology layer, they will not create and support the climate to move everyone toward a common purpose of interoperability and nor should they be asked. Vendors are not positioned to discuss intergovernmental agreements, set and implement policy, nor is it commercially viable to take part in a long term objective. They should come in when technology have a range of other agreements in place and dictated by the customer.

It seems clear from what information is available that the Digital Health Agency is well positioned and in fact seems charged with standards, interoperability and compliance. The last thing ADHA should do is become some sort of competing software vendor

Bernard Robertson-Dunn said...

Re: "It seems clear from what information is available that the Digital Health Agency is well positioned and in fact seems charged with standards, interoperability and compliance. The last thing ADHA should do is become some sort of competing software vendor"

This is from the explanatory memorandum supporting the legislation that enable the ADHA

"The Commonwealth Department of Health will retain responsibility for federal digital health policy.

Once established, the Agency will become the single accountable organisation for digital health in Australia. It will be the national body responsible for the evolution of the digital health capability, through the leadership, coordination and delivery of a collaborative and innovative approach to utilising technology to support and enhance a clinically safe and connected national health system to improve health service delivery and health outcomes for the Australian community."

However, the ADHA has carriage of the PCEHR/MyHR, which is the central system that supposedly forms the core of Digital Health (whatever that is, apart from a shiny new buzz phrase. So much for AHDA not becoming "some sort of competing software vendor". They are, and that's the bulk of their funding.

In addition, many states are creating their own Digital Health Ecosystems which provide real support for point-of-care health decision making and which are not personally controlled or even patient accessible. These are well underway and can't wait for the ADHA to get its act together.

There's so much wrong with the AHDA its not funny.

Federal State arrangements have never worked well - I've seen more than a few close-up. Often the Federal government has little or no power over the states because of the constitution. The only levers they have are financial.

If the Federal government (or a national organisation like ADHA, which in reality is only an arm of the department of health) tries to tell the states how to spend their money, they will get ignored.

Similarly, if the Federal government tries to use financial levers to control health care practices (e.g. through Medicare and/or PBS and/or TGA) they will get push back from the industry - just look at the reaction to the Medicare rebate freeze.

IMHO, there are too many fundamental flaws in the AHDA for it to work. A bit like the PCEHR/MyHR really.

BTW, I bet a lot of people in NEHTA, DoH, (the soon to be born) ADHA and consultant land read David's highly useful blog.

If they can't see the train wreck coming and get involved in the ADHA, they have nobody to blame but themselves.

This is only my opinion, of course, but I've been around a lot longer than most readers and have seen it all before, many times. To avoid the failures of the past, something different needs to happen. So far I have seen nothing different.

Anonymous said...

"It seems clear from what information is available that the Digital Health Agency is well positioned and in fact seems charged with standards, interoperability and compliance"

Really?? I thought Nehta V1 and 2 and Healthconnect was also charged with this and I might be blind and I am certainly, after a lot of first hand experience, biased, but what has changed except the name. The people leading the Digital Health Agency don't have the depth of understanding to actually know what they are doing and are all hand picked managers who are clueless wrt the technology and the needs of the medical profession. Yes the consumer is important but surely putting decent reliable standards based technology, with the data quality to support decision support into the hands of providers is the first priority if we want improved outcomes and that is far far out of their vision at the moment. This is the Matrix IV and sequels tend to get worse and lose the plot. Unlike the Matrix, even the first version was lackluster, and we have steadily gone downhill although the Hubris is at an all time high.

There is deep dysfunction in the eHealth branch of DOHA. I hope other departments are more capable, but I have an awful feeling that somewhere out there someone else is writing the same type of comments about another department. The eHealth debacle has made me see the virtues of small government.

Bernard Robertson-Dunn said...

re: "There is deep dysfunction in the eHealth branch of DOHA."

Maybe that's why the cancer screening database project that went to Telstra is being run out of the Population Health Division, rather than eHealth.

The principal contact for the cancer screening project has a Phd, her boss is a doctor and so is her boss. There are some serious smarts in that little lot, especially compared with eHealth where the predominant experience is project management. (BTW, all that information is publicly available, I have no inside knowledge)

It would seem that not even Health trusts eHealth.

Anonymous said...

especially compared with eHealth where the predominant experience is project management?

I know you have a 'thing' about project managers, but your statement is incorrect, there is predominantly a lack of skilled workers able to project and manage, that's the problem, it is lead by vision impaired and line managers.

I think May 28, 2016 10:46 AM summed it up rather well from my personal experience. There is a chance though but it will need to be quite radical. As they say, you can tell an APF member you just can't tell them much.

Bernard Robertson-Dunn said...

re: "I know you have a 'thing' about project managers, but your statement is incorrect, there is predominantly a lack of skilled workers able to project and manage, that's the problem, it is lead by vision impaired and line managers. "

My concern about project managers is when they try and make decisions outside of their areas of competence.

I think what you are saying is that, even if their experience is listed as project management, they aren't particularly good at their either. Something of a perfect storm.

BTW, re "I think May 28, 2016 10:46 AM summed it up rather well from my personal experience." that was me as well.

and re: "As they say, you can tell an APF member you just can't tell them much."
I can't tell if you agree or disagree with me. Please explain.

Anonymous said...

Hi Bernard my mistake I was referencing AnonymousMay 28, 2016 10:58 PM, blame my change of device. I do not disagree with you I simply take a different view of project management being a negative force in all this, but like many disciplines you get the good the bad and the weekend warrior

Eric Browne said...

re: "There is deep dysfunction in the eHealth branch of DOHA."

I think that all stems from not understanding their role. Public Servants should serve the public, not provide a disservice.

DoHA has been struggling to develop a national e-health strategy for years and years now. It has eschewed involvement from the community at large. It has even rejected FOI requests for access to drafts from informed citizens such as Karen Dearne this time last year: https://www.righttoknow.org.au/request/deloitte_ehealth_working_group_n

Such contempt by DoHA runs counter to all advice given to it by the community since the Health Online Action Plan of 2001 which called for collaborative governance as a cornerstone of its plan.

In 2012 the World Health Organization produced a National eHealth Strategy Toolkit to help nations develop their eHealth Strategies. This toolkit stated the following:-

"Many stakeholders, including those from sectors other than the health sector, have an interest in eHealth and are keen to contribute to the process. It is essential from the beginning to understand their views, and to gain their collaboration, support and endorsement of the outcomes of the eHealth planning process.

Such an inclusive approach not only builds relationships; it also gains valuable perspectives on what eHealth should deliver. This commitment to open communication and a willingness to consider the views and interests of diverse groups needs to be nurtured throughout the process. Understanding stakeholders’ perspectives gives a much fuller picture of a country’s technical, political and social context.”



DoHA has failed to head this sage advice. Not until they do so will Australia be able to make real progress with e-health.

Perhaps once those in DoHA have read and accepted such advice, they may truly be able to serve the Australian public.

Anonymous said...

"There is deep dysfunction in the eHealth branch of DOHA." said Eric Browne. There certainly is and it's not only reflected in NEHTA-PCEHR-My Health Record imbroglio.

A whole new frightfully sad and sorry ehealth mess has just emerged in the 26 May PulseIT article "Plans for national roll-out of real-time prescription monitoring in disarray". Those who have lost loved ones to the misuse of prescription medications and doctor shopping will be horrified at reading this very disturbing article; what a tragic saga of events.