Feeling the heat at
Burning GP
 
 

Feeling the heat at Burning GP

MediRecords joined the sun-starved throng flocking to the Tweed for the Wild Health Burning GP conference last week.

Here are 10 takeaways from two days of robust and enlightening conversations.

1. GPs are divided on the impact of Urgent Care Centres (UCC)

Are nascent UCCs an attempt to woo voters in outer suburban marginal seats, a means to divert a few people from crowded hospital emergency departments… or an example of government spending that would be better invested in primary care? The Royal Australian College of General Practitioners (RACGP) past president Adj Prof Karen Price also pondered whether UCCs are turning away “non-urgent” patients and referring them back to their family GPs.

2. There’s a great divide between GPs and hospitals

Healthdirect Australia is trialling a way to send NSW hospital discharge summaries to GPs and patients and Queensland discharge summaries are uploaded to The Viewer … but the data disconnect between primary and tertiary care remains vast*.

Associate Professor Alam Yoosuff, the Rural Doctors Association NSW vice president, said GPs were often left in the dark about hospital outcomes for their patients.

“We don’t always know if person has died, been discharged, or been sent home with only six (tablets)… We know the system is not right. It may be better than other countries, but we know it should be even better, given what (governments) are spending.” 

– Associate Professor Alam Yoosuff, the Rural Doctors Association NSW vice president

Judging by the overall vibe at Burning GP, GPs feel much of the government cash spent on shiny new hospitals could be better spent on disease prevention led by community-based primary care practitioners.

3. Workforce scaling

The RACGP warned Australia has a “whole of health” workforce crisis, exacerbated by insufficient medical students coming through, so we’re going to have to import doctors, nurses and specialists from overseas. (The ever-resilient Health Department Assistant Secretary Medicare Benefits and Digital Health, Mr Daniel McCabe, said he preferred “critical juncture” to crisis, triggering a running joke for the entire conference.)

Grampians Health Chief Strategy & Regions Officer Dr Robert Grenfell said the shortage of GPs in western Victoria was so acute he was planning based on having none. He said: “If we have (GPs) I will use them” but it was now prudent to make alternative plans.

4. Medicare misery is multiplying

Several conference panels highlighted the challenges of determining the correct, optimally reimbursed Medicare item codes for complex consultations. Mr McCabe conceded all billable items are due for review, with an aspirational goal of improving access to healthcare for people who can least afford it.

5. Telehealth – supplementary or threat?

If young and tech-savvy consumers keep opting for online access to quick prescriptions, medical certificates and more, community GPs will be left with older, sicker, more complex clients, including those with mental ill health. Whitebridge Medical Centre owner Dr Max Mollenkopf said GPs needed to understand why consumers are switching to digital health companies such as Eucalyptus and adapt fast. He said, “Our old patients who love us will die off and all the young ones will be (Eucalyptus patients) unless we do something different.”

6. The numbers speak for themselves

The Australian National University Associate Professor (and GP) Louise Stone highlighted a 42% pay gap between men and women GPs. She said this was compounded by women GPs shouldering a majority of longer, underfunded consultations with complex patients, (who may have been released from hospital prematurely to reduce bed blockages).

7. But metrics may deceive

Associate Professor Stone cautioned that ‘evidence-based solutions’ in healthcare may not be what they seem. Analysis had shown the typical participant in clinical trials is a privileged white male, the researcher is likely to be a white urban male and even the average lab rat is a white furred male. This means clinical metrics may not be representative … and AI tools risk exaggerating biased data even further.

Evrima Technologies CEO and Founder Charlotte Bradshaw said that 80% of clinical trials are delayed in Australia because eligible people can’t be found and paired with researchers.

8. The My Health Record (MHR) will grow exponentially

Mr McCabe confirmed legislation is imminent to mandate sharing diagnostic imaging and pathology with the MHR. The government will also “push very hard” for every medication event – prescribing and dispensing – to be uploaded. The CSIRO-led Sparked community will need to lead the software industry to a FHIR (Fast Healthcare Interoperability Resources) standard to achieve this. Mr McCabe said Australian healthcare was hamstrung by “a lot of technology built in the 1990s that is not fit for purpose”. The recent MediSecure data breach showed, “We need to make sure we set the bar a lot higher than it is today”.

9. Technology knowledge is variable

When you’re a time poor GP, technology is rarely top of mind. You just want it to work. GPs still need reassurance from healthcare influencers that cloud technology is as safe (or safer) than server-driven desktop tech and that switching brings cost and time savings on hardware, hosting, back-ups, security, software patches, electricity and more. As one GP said to us, “You mean I can sack my IT guy?”

As for innovations such as Artificial Intelligence (AI), there’s a sense that while there are time, safety, revenue and efficiency gains to be made, the early adopters and innovators will be waiting a while for their conservative colleagues to join them.

10. Summing up

Based on our conversations and observations at Burning GP, community general practitioners feel underfunded, overworked, undervalued, and under siege from telehealth providers and pharmacists. They’re a resilient mob though, and still passionately defending their role as number one for longitudinal patient care.

*MediRecords new Admissions module means we can provide a longitudinal record connecting primary and tertiary care in one secure, cloud-hosted software system. We can send Discharge Summaries from our Admissions module and store them against the central patient file. Please reach out to us at sales@medirecords.com if you’re trying to solve these types of connectivity problems!

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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      Big updates – Just in time for Christmas!

      Devices

      Big updates – Just in time for Christmas!

      Matthew Galetto MediRecords banner

      Matthew Galetto

      We thought long and hard to find the perfect gift for our MediRecords subscribers this Christmas.  We checked our list twice (our ideas list) for all the requests for improvements and new features, and pulled together a bumper update to bring plenty of Christmas cheer to all clinics in the MediRecords community.

      If you’d prefer to watch and listen to the smooth dulcet tones of Michael showcasing the recent enhancements, you can check out a short video here:

       

      Appointments Enhancements

      The appointments calendar is a highly visited section in MediRecords, so it’s no surprise we receive loads of suggestions on how to make it even more powerful.  Drum roll please…
      View calendar by appointment type Do you prefer to manage your appointment calendar by type, instead of status?  Well, now you can in MediRecords!  If you prefer to keep your calendar by appointment type, you can leave it just the way it is.  Make your choice under the new “Colour Palette” option under the Appointment settings for your clinic:
      Operating hours

      Go to More, Settings, Appointments, then your Clinic to view the calendar by “Appointment Status” or “Appointment Type”

      Customised appointment types

      Previously, you could only choose from a set list of appointment types in MediRecords. We’ve recognised that you know what is best for your clinic, so we have given you complete control. Yep, you can go to town with custom appointment types, including name, default time, colour and even choose an icon! The great thing is, these changes aren’t just restricted to the MediRecords practice management system, they flow down to the online Appointments booking system and the Patient Mobile App.

      Customised appointment sessions

      You can now create custom appointment sessions for the entire practice or for individual practitioners. This means you can create custom names, times, and colours for each session. This functionality is particularly handy if you only want to accept particular types of appointments at particular times.

      Holidays by practitioner

      Just in time for the Christmas holidays! We have extended out the holiday capability in MediRecords to now allow holidays for individual providers. In the past, you could only set holidays for the entire practice.

       
       
      Online Appointments and Patient Mobile App

      We’ve spoken with so many practitioners who see the benefits of offering online appointment booking to patients, but have resisted because they want greater control of what appointment types are booked where.  Well, resist no more – we have solved that problem!

      Do you only want to allow patients to book initial consults at specific times with specific practitioners?  How about offering online appointments for customised durations?  It’s all possible now in MediRecords!

      You will not see this level of real-time, integrated complexity made so simple with any other online booking system in Australia, and you have access to it today.  Thanks Santa!

      Find out more about the MediRecords Online Appointment Bookings and check out the interactive demo via this link.

      To learn more about how to use all of these new features in the appointment calendar check out all these new knowledgebase articles:

      Secure Messaging

      You can now send outbound messages via Health Link, and also connect with Medical Objects.

      Letter-writer

      Did someone say more letter-writer enhancements?!  We’ve listened carefully to your feedback, and made it much more user-friendly by simplifying certain areas and making some changes behind the scenes. We have also resolved some bugs that caused issues with text not playing as nice as it should.  Oh, and, we have also done some housekeeping within the letter-writer to make it easier to create your own templates.

      Even more updates!

      New Knowledgebase
      Our new knowledge base is up!  With close to 1,000 help articles, this is where to go if you need to know something about MediRecords.  Our shiny new Knowledgebase is easier to navigate, nicer to look at, faster for us to update, plus you can leave comments if you want clarification on particular articles.

      If you have a suggestion for a new article, please contact us at support@medirecords.com

      You might also notice the help question marks linked to the old knowledge base have been removed throughout MediRecords.  You can access our knowledgebase via support.medirecords.com, or click on the Person icon in MediRecords, then “Help and Support”:


      Access the new  Knowledgebase at support.medirecords.com, or via “Help and Support” in MediRecords

      Additional Support Packages
      Even though MediRecords is intuitive and self-service, sometimes it’s just not possible to block out the time from your busy schedule to configure things the way you want.  Never fear! Leave it with us to make things run just the way you need it.  For more information, check out our “Service Packages” at this link.

      Status Page
      As we continue to invest in monitoring capability and developing at MediRecords, we now have a Status Page: status.medirecords.com.  Here you can monitor any known issues with MediRecords, and also subscribe for technical updates such as planned maintenance.  We encourage everyone to subscribe to the status page by clicking here.

      Subscribe for important updates about planned maintenance at status.medirecords.com

      The beauty being in the cloud is that all of these updates are now live in MediRecords; you don’t need to do anything except dive in and get busy!

      Thank to all our valued member of the MediRecords community this year.  We wish you a wonderful Christmas and New Year break.  If you’re not using MediRecords yet, you can register for an interactive webinar by contacting support@medireccords.com, or start up a free trial of MediRecords here.

      We will be working hard on the business days between Christmas and New Years, so if you do need support during that time please get in touch via chat, email or phone as usual.  Otherwise, we look forward to speaking with you again in 2018!

      Matthew Galetto MediRecords banner

      Matthew Galetto

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