Tuesday, February 28, 2017

A Must Not Miss Discussion Of Some Of The Issues That Surround Clinical System Development In Australia.

This appeared a few days ago.
22 February, 2017

Patient apps: pipedream or reality?

Posted by Jeremy Knibbs
You could forgive your average GP for starting to tire of hearing about the promise of the cloud and connected patient medicine.
It’s a promise that this newspaper talks about a lot, which the government has spruiked, spent a fortune on, and not delivered, and which seems increasingly to look like that elusive pot of gold at the end of a rainbow.
After the launch of Australia’s first true cloud architected patient-management system, MediRecords, late last year, and a brief response to that launch by MedicalDirector, promising their own cloud version, things have been eerily quiet.
MediRecords may have made a rookie start-up error. The company built a working cloud system, and what it thought were all the necessary components required for a stand-alone practice. The suite includes the core patient-management system, a booking and kiosk system, application programming interfaces to two of the approved secure-messaging systems and to the major payment systems, and what is probably the only currently working patient-connected mobile app. And, it all works.
The problem is, most practices have a lot more complexity in their operational systems than even this seemingly comprehensive suite provides. As an example, Sonic won’t accept Healthlink as a secure messaging system from MediRecords so MediRecords has had to write something that talks to Sonic’s custom-built Fetch system, which, incredibly, is not even secure.  Another example: MediRecords doesn’t talk to payment gateway Tyro, which for some bulk-billing surgeries, is the payment system of choice.  So the group has had to go back to their code cutters and start working on meeting the additional needs of an average general practice, which run a plethora of legacy systems.
The irony for the backers of this interesting start-up is that they are having to spend money on coding so that an advanced cloud system can talk to lots of older, non-cloud architected systems, which in a few years probably won’t exist.
MedicalDirector is lucky that MediRecords has found itself stuck in legacy-connectivity mud. Its patient management system, and that of competitor Best Practice, have had years to develop all the quirky connectivity that makes most general practices work, even at a base level. And both Best Practice and MedicalDirector* have the luxury of “big brother” owners, who also own pathology labs, so that part of their connectivity tends to be locked down.
But that isn’t all of it. MedicalDirector launched its cloud-version of its market-leading patient-management system, Helix, way too early – probably prompted by a fear that MediRecords might take market share if MedicalDirector did not act. But Helix was, very likely, what is termed in the software trade “vapourware”. It didn’t really exist in a working format. No-one was able to get a hold of the product to actually test it, and when questioned about pilot and launch sites, the iconic and longest-standing patient-management system brand-owner wasn’t ready to talk. To date, no one has reported a working and properly architected cloud-version of Medical Director.
MediRecords is the only patient management vendor today with a working mobile patient app that talks to its patient management system. The problem with that however, is that they have only a few practices using the core system so far because of legacy connectivity issues.
Until now, it had been thought that in order to provide a fully functional and flexible patient-side app for a practice, a cloud-based patient-management system would be needed.
But The Medical Republic has learnt that a large-scale patient app play is being tested right now by at least one of the major corporate vendors, IPN, and probably by Primary Health Care and MedicalDirector as well.
Somehow, someone has worked out how to get a mobile device to talk through the web to the major, deskbound patient-management systems.
Pages more of fun, frustration and complexity here:
This is a real view from the coal face – by someone who is in the swamp and hoping to move forward.
Compulsory reading in my view. I would love to know what the ADHA makes of all these barriers to progress and what they have in mind to help ease the pain?
David.

11 comments:

Anonymous said...

The Agency is working to fix secure messaging and we are developing FHIR API for the My Health Record. There are apps being developed. We have to get the foundations right, we cannot go chasing after Clouds and every other technology fad that turns up for goodness sake we are only 300+ staff

Anonymous said...

... and we are working out how to do opt-out without frightening the people, but it's going to be a hard slog because many people are starting to realise that the best use for data in MyHR is to stop people criticising the government - oh and linking it with census data and ATO data and Centrelink data and immigration data and meta data. We have a lot to do and nobody's going to stop us. We are on a mission from god.

Oliver Frank said...

Medirecords might not be the only cloud-based clinical and administrative package that Australian GPs can use. The vendor of Visual Outcomes http://visualoutcomes.com/ has been responding to my current series of articles in Medical Observer about how to improve software, and showing in its responses various features relevant to my articles. Visual Outcomes has a portal for patients that lets them interact with the practice and their clinical record.

Anonymous said...

It does beg the question why the government in Canberra is continuing down this path?

While Canberra slept and removed the last drops of value from NEHTA the market has clearly moved on and producing choice for customers.

As a patient and being in the majority of patients I have a close circle of healthcare providers and apart from occasional holidays (which are less these days thanks to Canberra) I stay within my community, my GP is great and I feel comfortable talking about my condition and treatment options and feel I am as informed as I could possibly be (as I did not invest my 20's in long hours of didication and sacrificed a youthful scocial life study medicine)

My GP allows be to book online, I get reminders, even the specialists call me, everything I keep in a family calendar in office 365, if you can't work hotmail out the PCEHR is going to give you major stress. My GP gets results and views these through portals etc.

A safe guard I use if I am ever alone and unconscious is a simple trick on my iPhone using the Apple health app you can enter important information which can be accessed via the emergency icon when your phone is locked.

The government should be investing is standards and policy and the agency should be using those to provide the market the guidelines for the next wave of healthcare needs like genomics and precision medicines. The PCEHR was a good idea 10 years ago but then so was the VCR.

In closing I am not happy paying some $500k+ a year to going on a trip around our fine country when it is quite evident there is a near 0 level of understanding of healthcare operations in Australia.

Oliver Frank said...

In response to Anonymous number 2, in today's Crikey, Bernard Keane says:

"Having gone after MPs, whistleblowers and journalists using private information, the Turnbull government has reached a new low that is simultaneously a logical extension of its abuse of power: using private information to attack a member of the public who had the temerity to criticise the government. Moreover, the bureaucrats involved actually boasted about it and warned that others would receive the same treatment."

https://www.crikey.com.au/2017/02/28/australia-2017-a-government-that-sees-citizens-as-enemies/

Oliver Frank said...

I just noticed that further down in his article, Bernard Keane asks:

"What next from this outfit? Leaking Medicare data to attack critics of its health policies?

Dr David More MB PhD FACHI said...

See here also:

https://www.itnews.com.au/news/commissioner-confirms-privacy-override-provisions-exist-452949

Commissioner confirms privacy 'override' provisions exist

By Paris Cowan on Feb 28, 2017 4:44PM

Following release of Centrelink data to media.

Privacy commissioner Timothy Pilgrim has confirmed agency-specific laws can "override" the Privacy Act and hand some public service bosses the power to disclose personal information.

Pilgrim and his assistant commissioner Andrew Solomon, were busy making calls to the Department of Human Services’ legal officers this morning following revelations that the agency gave details about an individual, Andie Fox, and her welfare debt dispute to Fairfax.

The details were handed over in response to an article criticising Centrelink written by Fox, also published by Fairfax.

It was one of many barbs pushed at Centrelink since late last year over its management of automated debt recovery proceedings using what has been described as a flawed data matching algorithm.

-----
Just dreadful!

David

Bernard Robertson-Dunn said...

The government has enormous and wide-ranging powers to disclose MyHR data. IMHO, the most insidious is that it can use or disclose data for protection of the public revenue.

There don't seem to be any constraints as to what the System Operator (or the enforcement body, e.g. ATO, Border Protection) can use the data for.

The eHealth Legislation, available here:
https://www.legislation.gov.au/Details/C2012A00063

Section 70 Disclosure for law enforcement purposes, etc.

(1) The System Operator is authorised to use or disclose health information included in a consumer’s PCEHR if the System Operator reasonably believes that the use or disclosure is reasonably necessary for one or more of the following things done by, or on behalf of, an enforcement body:

(a) the prevention, detection, investigation, prosecution or punishment of criminal offences, breaches of a law imposing a penalty or sanction or breaches of a prescribed law;

(b) the enforcement of laws relating to the confiscation of the proceeds of crime;

(c) the protection of the public revenue;

(d) the prevention, detection, investigation or remedying of seriously improper conduct or prescribed conduct;

(e) the preparation for, or conduct of, proceedings before any court or tribunal, or implementation of the orders of a court or tribunal.

(2) So far as subsection (1) relates to paragraph (1)(e), it is subject to section 69.

(3) The System Operator is authorised to use or disclose health information included in a consumer’s PCEHR if the System Operator:

(a) has reason to suspect that unlawful activity that relates to the System Operator’s functions has been, is being or may be engaged in; and

(b) reasonably believes that use or disclosure of the information is necessary for the purposes of an investigation of the matter or in reporting concerns to relevant persons or authorities.

(4) If the System Operator uses or discloses personal information under this section, it must make a written note of the use or disclosure.

(5) This section does not authorise the System Operator to use or disclose consumer‑only notes.

Anonymous said...

Just another page in the demise of liberty.

Anonymous said...

February 28, 2017 8:24 PM .." 300+ staff" !!

David - Why is there no information available on the number of staff employed by ADHA? At $90,000 + 25% on costs that equates to $112,500+++ by 300 is more than $33 million annually!!!! plus the $0.5 M paid to the CEO annually !!!.

Neither the jurisdictions or the political parties want an audit or an inquiry into the $2 billion wasted in the last 5+ years, as were that to happen and the media reported on it the public would be very very angry.

This IT project demonstrates huge incompetence and lack of any accountability on the scale of other major government IT projects over $10 M currently level now the focus of the review recently announced by the Turnbull Government.

The Prime Minister comes from a highly successful business and investment background. If this project existed in that world it would have been terminated immediately.

No wonder voters are turning against mainstream political parties. The party that bites the bullet first and demonstrates true leadership by standing up to EXPOSE this massive waste of taxpayers money will get the voters respect and support.

Anonymous said...

http://www.canberratimes.com.au/national/public-service/eric-abetz-urges-government-to-shed-4000-public-service-jobs-20170201-gu3mqm.html

Eric Abetz urges government to shed 4000 public service jobs

I wonder what he thinks about the ADHA !!!!