Communication the key to reducing hospital readmissions

Communication the
key to reducing
hospital readmissions

Can health tech help reduce hospital readmissions?

 

According to a global research review, telehealth and virtual wards can certainly make a difference.

The Deeble Institute — the research arm of the Australian Healthcare and Hospitals Association (AHHA) — reviewed international research on the role of primary care in reducing hospital readmissions.

In its Evidence Brief no. 24, the Institute says telehealth can be used to boost general practice involvement in hospital discharges and subsequent multidisciplinary virtual care, resulting in fewer unplanned readmissions.

Unplanned readmissions are associated with poorer health outcomes, dissatisfaction with healthcare, increased costs, and bed blockages.

The report highlighted research that showed improved communication and coordination of care between GPs, hospitals and/or pharmacists is effective.

“Effective interventions included … electronic tools to facilitate quick, clear, and structured (health) summary generation… use of electronic discharge notifications; and web-based access to discharge information for general practitioners,” reported the Netherland’s Hesselink and colleagues.

Virtual wards are another way to reduce risk of hospital readmissions and improve outcomes during hospital-to-home transition, with research indicating these can be effective with specific disease cohorts but less so with non-specific, complex diseases.

The Evidence Brief contrasted virtual wards with Hospital in the Home (HITH). HITH is a form of remote hospital inpatient care whereas virtual wards facilitate transition from hospital care to home care.

“Compared to HITH, virtual wards typically have a higher degree of interdisciplinary care coordination and review, are simpler in design and implementation, and have a broader scope of activities,” The Deeble Institute reported.

“Transitional care is similar to virtual wards, but usually implemented within existing systems. Virtual wards typically require a completely new care pathway and potentially new organisations to manage its implementation.”

MediRecords Connect provides FHIR (Fast Health Interoperability Resources) and API options for connectivity with hospital systems, including patient administration systems (PAS). MediRecords is deployed as an ePrescribing system at two Australian virtual emergency departments and as an outpatient billing and claiming system for Queensland Health. New functionality enabling multidisciplinary case management and inpatient care will be released later this year.

MediRecords is also integrated with the Coviu telehealth platform for streamlined virtual consultations.

Top three Technologies that reduce hospital admissions:

Further reading

‘A wonderful day’: telehealth to become permanent

Improving Patient Handovers From Hospital to Primary Care

Consumer adoption of digital health in 2022: Moving at the speed of trust

PARR++ is dead: long live predictive modelling

Impact of ‘Virtual Wards’ on hospital use: a research study using propensity matched controls and a cost analysis

Applying the Integrated Practice Unit Concept to a Modified Virtual Ward Model of Care for Patients at Highest Risk of Readmission: A Randomized Controlled Trial

Effect of post-discharge virtual wards on improving outcomes in heart failure and non-heart failure populations: A systematic review and meta-analysis

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    MediRecords on FHIR at Northern Health
     

    MediRecords on FHIR
    at Northern Health

    Mental Health teams at Northern Health now have access to the MediRecords e-Prescribing platform, following successful integrations with the hospital’s patient administration system (PAS) and Clinical Patient Folder (CPF) software.

     

    The pioneering FHIR (Fast Health Interoperability Resources) connections mean doctors don’t have to search a second database for patient records and can generate electronic prescriptions quickly, informed by current clinical information, including allergies and medication histories. Prescription records are then sent to CPF in real time, and no longer have to be posted to patients or manually scanned and uploaded to hospital digital records.

    The FHIR go-live signals Phase 2 of MediRecords’ implementation at Northern Health, following an initial launch as a stand-alone system for Victorian Virtual Emergency Department (VVED) doctors in July 2022. Wider use of the e-Prescribing system is being adopted, with Northern’s Outpatient clinics and mental health included in a staggered roll out from 31st January 2023. This implementation was the first FHIR implementation performed at Northern Health.

    MediRecords Chief Executive Officer Matthew Galetto said Northern Health had demonstrated the benefits of using industry-leading FHIR technology to streamline data interoperability and support efficient patient care in a hospital setting.

    “It is important for healthcare organisations investing in new digital health projects to future proof their investments by adopting the latest standards. Implementing FHIR will help organisations stay ahead of the curve and meet near future regulatory requirements,” Mr Galetto said.

    Mr Galetto said MediRecords would be releasing additional FHIR integration pathways for clients throughout 2023, as part of the Connect pillar underpinning the MediRecords platform.

    “We are fortunate to be at the forefront of FHIR development in Australia, thanks to our role in the Leidos-led consortium delivering a new Health Knowledge Management (HKM) system for the Australian Defence Force,” Mr Galetto said.

    “Data sharing for the HKM project has applicability throughout Australian healthcare and means we will be able to connect health care records in primary care all the way up to hospital, or tertiary care. This will help provide patients and clinicians with access to the right data at the right time, with significant safety benefits.”

    Mr Galetto thanked Northern Health for being an early adopter of the technology, the first time MediRecords has been deployed in a hospital setting supporting virtual care.

    “The Northern Health team are pioneers in virtual care and are now leading the way in connecting patient information systems.”

    Northern Health’s Mental Health Division provides hospital-based, community and specialist mental health services to youth, adults and aged people across northern and western Melbourne. The introduction of ePrescribing means prescriptions can be sent instantly and electronically to patients or carers, with a QR code to be scanned at pharmacies for dispensing. This provides significantly faster access to new and repeat medications for mental health clients.

    Media inquiries

    For further information, please email Matthew Galetto on matthew@medirecords.com or Tim Pegler at tim.pegler@medirecords.com

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      The Clinician Interviews Matthew Galetto, CEO at MediRecords

      The Clinician Interviews
      Matthew Galetto, CEO at MediRecords

      This article was originally created and shared via The Clinician. The original article can be found here.

       

      The Clinician sat down with Matthew Galetto (founder and CEO, MediRecords) for a conversation on interoperability, adoption issues for regulatory standards, and our recent collaboration on a FHIR-based integration.

       

      Thanks for being here, Matt. Could you describe your background and maybe some current or upcoming initiatives you’re particularly excited for?

      Matthew Galetto: I founded MediRecords in 2014, but my background in health technology spans over 20 years. I started my health tech journey working in primary care, working with a health technology company consolidating GP clinical systems through acquisition during the dotcom boom. In fact, my job was to integrate a dozen or so different applications into a single consolidated platform—I was a lead technical architect in that endeavour.

      I worked there for a few years and then set up a company called AsteRx, which was a data analytics and clinical data business that collated information from multiple GP systems and provided insights and reports back to corporate practice groups and industry generally.

      How do you define and approach interoperability, both within MediRecords and in the larger context?

      Matthew Galetto: Interoperability is information exchanging freely across different systems. There’s the technical implementation of interoperability, which is the systems themselves enabling the transfer of information across technology boundaries and platforms and in different healthcare settings, and there are also the regulation and legal structures that support information exchanges.

      In the context of MediRecords, the interoperability piece is making sure that the system that we’ve developed in the platform that underpins our products and services can connect to the broader Australian health ecosystem. To do that, it needs to connect to different players in the market that provide certain services, so it might be diagnostic services, My Health Record, Medicaid-claiming type services, payments and those sorts of things.

      So, I would describe the interoperability piece as that free-flowing information across systems.

      What do digital health systems and organizations need to be doing to ensure that’s possible: to ensure information can be easily shared and used by other systems? What are the key barriers, or where do you see some organizations falling short?

      Matthew Galetto: In the Australian market we have a bunch of these legacy technology providers, both in the GP/specialist arena and even in the hospital market. Systems are not geared for supporting the latest standards of interoperability—things like FHIR and SNOMED terminology services to underpin the ontology mapping of information across systems.

      There’s been insufficient adoption of those standards here in the Australian market, and no incentives provided by government or industry to adopt those technologies, partly because so many of the existing market players still operate on old technology platforms.

      In our recent collaboration, a bidirectional FHIR-based integration was able to be established between MediRecords and ZEDOC within a matter of a few days. From your perspective, what was the process like and what would you identify as the key success factors?

      Matthew Galetto: Sure, that was a particular problem case that we needed to solve. ZEDOC was providing a PREMs and PROMs solution patient engagement platform and MediRecords was the underpinning electronic health record and system of record; we don’t have the same level of patient engagement capability that ZEDOC offers.

      This particular customer was looking at integrating a patient-engaging PREMs and PROMs platform as well as MediRecords capability. To achieve that, as part of a proof of concept delivered in that very short timeframe you described, we were able to connect MediRecords in a bidirectional way to ZEDOC, with MediRecords providing the source of truth for the patient record.

      Very quickly, were able to put into the clinical workflow a feeder of the patient record through to the ZEDOC platform enrolling that patient in a particular program. ZEDCO would then handle the patient engagement capability.

      Information that was captured as part of those PREMs and PROMs would then make its way back into MediRecords’ platform as long-form patient summaries and patient-centered observation data, using remote patient monitoring devices. This information would also be added to the longitudinal health report of the patient.

      That was achieved through applying those FHIR open standards capability. And given that there was a common language and common understanding and protocols we were able to achieve them in pretty quick time.

      What role do standards like HL7 or FHIR play in enabling PMS like MediRecords to tightly integrate with solutions like ZEDOC?

      Matthew Galetto: They’re vitally important. I’ve just come back from the US, having attended the HIMSS conference in Orlando. In the US in 2016 the government initiated the 21st Century CURES Act, which essentially removed barriers to the flow of information across systems so the patient could access their clinical record, regardless of where they travelled or the health care facility that they attended.

      That regulation mandated FHIR as the protocol for exchanging information, and also supporting HL7 (version 2). But essentially, it was saying OK, these systems need to talk to each other, we need to define some common protocols and terminology for that information to share, so we’re going to regulate this. And what we’re seeing in the US is that the innovation that’s come from that initiative has resulted in interoperability across different systems.

      We actually saw live demonstrations of some examples of patient records being shared, across continuums of care and across competitors, using HL7 and FHIR combinations. It was shared from primary care or ambulatory care, through to secondary care, through to tertiary care, and then even to some patient engagement platforms as well.

      Those standards are critical in order for information to exchange with the known set of terminology, and also for defining how those systems can communicate.

      In fact, we’re currently undertaking an integration with a hospital group in Victoria using a combination of HL7 and FHIR protocols. Those protocols are well documented, supported by the international organizations like HL7 and the FHIR community, so we have a clear understanding of what those standards and protocols are. This means we’re able to build confidently, understanding the protocols in place and that they’re reliable and safe to implement.

      And what is the other side of that coin—what are the key barriers to adoption of those standards by the industry?

      Matthew Galetto: If we look at FHIR, there are a couple of barriers. One is actually accessing resources and skills that have that knowledge, particularly in Australia. That’s a problem because of poor adoption. And then the other barrier is really a technical barrier.

      FHIR is a web-based protocol—it’s designed for systems that are built and implemented in the cloud. The Australian market isn’t really cloud-ready at the moment, with 95-plus odd percent of the vendors operating in the old legacy client technology.

      But the main barrier would really be the regulation. There’s just no government regulation to say, these are the standards that we need to implement, we want the industry to shift and pivot and implement these particular standards, and give us a roadmap to doing so. The regulatory barriers are significant in maintaining the status quo and not encouraging the adoption of these new standards.

      With an eye to the future, can you give us your thoughts about the ability to capture data from patients at home and then bring that data into the system, what could that make possible?

      Matthew Galetto: Well, if all of the systems are talking the same language and adopting the same protocols, regardless of whether they’re patient-facing or clinical-facing, then you have a clear understanding of the context of the information shared across those systems.

      In terms of the Australian market, one of the things I noticed in the US is the challenges identifying a patient across states and/or healthcare settings. They don’t have the concept of a master patient index as such.

      In Australia, we’re blessed with some of the initiatives that the ADHA have implemented, like My Health Record. These unique identifiers are tagged not only to the patient, but to the clinician and also to the practice.

      We already have some of the foundations in place in Australia to identify the various participants in the healthcare system: patient, provider, practice, and location. If we’re talking about information flows from the patient to the clinician right through to the tertiary system, we do have those identifiers.

      If we can find a way to then implement some of these standards, FHIR in particular, and identify the resources that need to be supported and implemented across these different settings, including the patient engagement setting, then I’m very encouraged about where we can go, provided that regulation comes into play.

      What’s coming next as far as interoperability? What ought industry be considering in order to stay ahead of the game?

      Matthew Galetto: Essentially, build those connected platforms and open up the systems. Be less protective of your information because it’s not your information—understand I’m talking as a vendor at the moment. Vendors have a tendency to lock the data in and feel that’s good for business when, in fact, it’s not.

      This is the journey that MediRecords is going on—we will open up our platform to expose APIs. MediRecords’ platform will open up to and encourage third parties. Of course, through a curated process verifying their use case, but we’re opening up that system. Allowing third parties to connect and exchange and share information from the platform is the way to go.

      So I think it’s a question of breaking down the technical barriers, but also the business models that are out there.

      If you actually look at some of the vendors that are operating in the Australian market, understanding that they want to protect not only the customer list, but also the information that sits in those systems and maintain those silos of information.

      If we can break that down, and also the business models that support those old siloed systems, then I’m pretty confident. If multiple vendors, like MediRecords and The Clinician, are prepared to open up those systems and support the exchange of information across those platforms, then there’s going to be a net benefit to the healthcare sector generally, but particularly to the patient, as well as a pivot from a clinician-focused to a patient-focused or patient-centric model.

      In the scenario you’ve just described, would that diminish the reliance on regulation, or is there a way that industry could make this happen—to a point—without waiting for regulation to come in?

      Matthew Galetto: My personal view is that we need regulation. And my personal view is that we need the government setting the example on some of the infrastructure and rails that support the exchange.

      I’ll give you an example: there’s a tender out now for the prescription exchange which is currently managed by two private operators. They’ve done a wonderful job in the last 10 years implementing a particular framework to support electronic prescribing.

      The government have now issued a new tender, and they’re looking to undercut the commercial model of those existing vendors by maybe 20%. The original value of that contract will disappear, and all the business models out there supporting the electronic prescribing with money flowing through to the PMS vendors and to the dispensary systems.

      That’s an example of some infrastructure that I think could be owned and operated by the government, which seems odd, but I think it’s something that might benefit the ecosystem just generally. One other area that’s a bit of a problem in Australia is around the exchange of information messaging between pathology companies, specialist to GPs and vice versa. These are private enterprises and I’ll give you an example of one of the challenges…

      There are three particular brokers in the market that provide services supporting the exchange of information across systems. So that’s the pathology companies, radiology and diagnostic reports, and requests and specialist letters and referrals and those sorts of things.

      The ADHA formed a common directory service a couple of years ago and all the brokers were encouraged to upload their contacts list to this new directory service implemented by ADHA. None of them uploaded because they were afraid of sharing their customer lists with their competitors.

      In that example you have a bit of innovation around FHIR, implementing and documenting it, and then in the end the private sector didn’t conform and participate.

      I think there’s an example where some regulation needs to come in and mandate a few things. I don’t think we’re going to get the change without the regulation.

      Considering the digital health landscape through the lens of interoperability, is there an element of the current conversation that you think is not getting enough attention, or is given short shrift? In other words, what are you thinking about that we all should be thinking about?

      Matthew Galetto: For any health technology company hosting information, security will be what keeps them up at night. That’s certainly the case for us: making sure our system is secure.

      And as you open up your systems through the interoperability play, including these new standards, security has to be absolutely front of mind, because you are actually opening up your systems to the market generally.

      Some context for the Australian market: we don’t actually have any security standards that are like a HIPAA compliance standard. So going back to one of your previous questions around some of the barriers and the regulation, we definitely need to see an uplift in the security protocols and accreditation services to support the interoperability piece, and the opening up these systems using FHIR and so forth.

      Learn more about The Clinician and MediRecords’ recent FHIR-based collaboration in this case study here

      This article was originally created and shared via The Clinician. The original article can be found here.

       

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        Could virtual care ease the pressure sores in healthcare?
         

        Could virtual care ease the
        pressure sores in healthcare?

        How can the burden on Australian healthcare be eased? Tim Pegler says thinking beyond the hospital walls may help

         

        People and resources in the Australian healthcare system are under unprecedented pressure. Demand for hospitals beds continues to rise, due to a combination of COVID-19, influenza, and other illnesses.

        Ambulances can often be seen stuck ‘ramping’, waiting outside Emergency Departments because there are insufficient empty beds to transfer patients to. This affects response times for other emergencies; ramped ambulances are effectively offline until they can offload patients.

        Healthcare clinics and hospitals struggle to fill their rosters because so many staff are unwell or home caring for sick family members. Those available to work are likely to be overstretched, covering for absent colleagues, and generally running on empty.

        As for patients, lockdowns and fear of infection led many to defer check-ups or investigations perceived as non-urgent. Consequently, illnesses are being detected later and people may have more advanced conditions at diagnosis, creating further pressure on the healthcare system and adding to elective surgery waitlists.

        Psychological distress and domestic violence also proliferated during the initial years of the pandemic, ratcheting up demand for mental health care, crisis, and support services that were already under-resourced.

        Shaking things up

        Much has been written about how the pandemic accelerated adoption of telehealth and other forms of virtual care. Pre-pandemic, leading international hospitals such as the Cleveland Clinic, New York Presbyterian, and Mercy Virtual pioneered varying models for remote care but the take-up in risk-averse, budget-poor Australia was slow. It would take leadership, determination, and a fertile mind during a period of isolation, to catalyse Melbourne’s Northern Health, with the city’s busiest Emergency Department, into thinking differently.

        During one such iso period Northern Health emergency physician Loren Sher fleshed out the model for what would become Australia’s first virtual emergency department. Goals for the virtual service included:

        • reducing avoidable ‘presentations’ at the hospital’s Epping ED by triaging and assisting non-urgent patients remotely
        • reducing the risk of COVID-19 infections to hospital patients and staff
        • enabling ambulance crew to focus on urgent cases
        • enabling doctors with COVID to work remotely

        The virtual ED means that non-urgent patients using a computer or mobile device can speak with a triage nurse online. The nurse determines whether the patient needs to attend hospital, can be helped with medication or by speaking to a telehealth doctor or physiotherapist, or can safely wait to see their usual GP.

        Ambulance crews responding to 000 calls can also contact the virtual ED for advice on whether the patient can be helped at home. If the case is non-urgent, the ambulance crew can be dispatched elsewhere.

        The virtual ED opened in 2020 and, by early 2022, was assisting more than 300 patients per day. Importantly, more than 70% of these do not need to attend hospital or use an ambulance.

        In April 2022, the Victorian Government provided $21 million so Northern Health could extend the service state-wide. By July, the Victorian Premier announced further funding to enable care for an estimated 500 patients per day and help improve ambulance response times.

        The model is also being extended to residential aged care facilities and COVID positive patients being cared for in the community. It will soon add outpatients and people experiencing mental ill-health.

        Strategic partnerships

        Northern Health partnered with best-in-class vendors to bring together key elements of the Victorian Virtual Emergency Department (VVED).

        MediRecords is at the heart of the solution, enabling VVED doctors to send electronic prescriptions direct to patients or their carers, virtually eliminating piles of paper scripts, expediting access to medications, and slashing postage and courier costs.

        MediRecords’ use of FHIR technology (Fast Healthcare Interoperability Resources) means medication requests and prescriptions are fed seamlessly into Northern Hospital’s electronic record systems.

        The VVED also uses the ZEDOC digital care pathways platform for patient registration and feedback measures, and the Coviu-powered healthdirect video conferencing system.

        There’s a long-term vision for the VVED to partner with primary and community care providers so that virtual ED patients can be referred to specific GP practices. These organisations could then direct complex cases, via the VVED, back to the hospital as needed. It’s this kind of thinking – and data sharing – that Australia’s healthcare system desperately needs more of to treat its current pressure sores.

        Tim Pegler is Senior Business Development Manager at MediRecords.

        This article was originally shared via The Medical Republic. The original article can be found here.

        References:

        ePrescribing now available to patients – Northern Health

        Victoria doubles virtual emergency department capacity to cope with COVID and flu surge – ABC News

        Patients waiting more than 24 hrs in emergency departments – ABC Radio National

        Victorian Virtual Emergency Department – Northern Health 

        If you would like to find out more about our e-Prescribing solution, click the below link:

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          MediRecords powers paperless prescribing at Australia’s first virtual Emergency Department

          MediRecords powers paperless prescribing at Australia’s first
          virtual Emergency Department

          Leading Australian cloud health software company MediRecords is playing a vital role in the Victorian Virtual Emergency Department(VVED), helping to reduce pressure on hospitals and ambulances across the state.

           
          From today, MediRecords will enable VVED doctors to send electronic prescriptions direct to patients or their carers, reducing paperwork and postage and transportation costs.
           
          As the project progresses, MediRecords’ commitment to FHIR technology (Fast Healthcare Interoperability Resources) will mean the hospital’s patient administration system and data warehouses are seamlessly updated with information such as medication requests.
           
          Northern Health launched Australia’s first virtual emergency department (ED) in 2020, aiming to reduce avoidable ‘presentations’ at the hospital and minimise infection risks for patients and staff.
           
          The virtual ED has been so successful the Victorian Government expanded it to a statewide service, and last week announced additional funding to enable care for up to 500 patients per day. The VVED is also supporting people in residential aged care and COVID-positive patients being cared for in the community.
           
          More than 70 per cent of patients using the VVED do not need to attend at the hospital or require ambulance transport. Patients are initially triaged by a nurse who assesses whether the patient can be assisted with medication or by an online doctor or physiotherapist, can wait to see their usual GP, or need to go to hospital.
           

          MediRecords CEO Matthew Galetto said integrated electronic prescribing gave patients quicker access to medication while reducing paperwork for the VVED team.

          “Hospitals and ambulances are under incredible pressure as COVID-19 cases rise. MediRecords is proud to help reduce this stress by supporting the vital work of the Victorian Virtual Emergency Department.”

          Media inquiries

          To arrange to speak with Mr Galetto, or for further information on the VVED project, please email tim.pegler@medirecords.com.

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