News roundup UK, AU, NZ: BMA England’s concerns on digital medical records; Australia and NZ’s health connectivity initiatives advance

November 3, 2022 | by

The British Medical Association (BMA) has expressed several concerns on NHS England’s ‘Data Saves Lives’ patient record access that is part of the NHS Long Term Plan and ‘Data Saves Lives’ Data Strategy. Data Saves Lives requires practices to offer, effective 1 November, patients aged 16+ access to their health records at their GP. Practices were notified back in April of the access available to them starting with care as of 1 November. The information includes consultations, documents (sent and received), problem headings, lab results, immunizations, and free text entries made by GPs plus secondary care, community services, and mental health services that go into the GP record. Patient access is currently working for practices with TPP and EMIS systems, with Cegedim (previously Vision) in progress.

The concerns in the BMA letter to GP practices center around protecting and redacting information from patients. This may sound contrary to the intent of Data Saves Lives, but in certain circumstances, such as risky situations with harm to the patient (example, a coercive situation or domestic violence) or to another individual. Practices are obligated to identify patients who could be at risk of serious harm.

The workaround identified is to add a specific SNOMED code to the patient’s full record before 1 November.  Practices will then need to 1) monitor if the patient requests access and 2) can schedule reviews on a case-by-case basis at a future date to identify if access can be provided. If third parties are mentioned without permission, this is also inappropriate to view and that information has to be redacted. 

The BMA also considered the Law of Unintended Consequences in these areas:

  • Specific consults can also be redacted, but there are clinical safety concerns that the current software apparently does not function well and hides too much.
  • Redaction does not remain in place following a GP2GP transfer
  • There has been no public campaign that warns patients that the NHS app now can become a portal to their detailed health records. Users have passwords saved in their smartphones, and their family members who know the patient’s phone PIN can have easy access to health records. 
  • Some practices may not be ready for opening their patient records
  • Workload will at least for a time increase

BMA letter to practices, HISTalk 28 Oct, GP practice letter from Dr Ursula Montgomery at NHS Digital

Take a look back at the convoluted history of Data Saves Lives going back to June 2021.

Forming a “centre of excellence” for Australian healthcare connectivity is the Australian Digital Health Agency (ADHA) and the Australian e-Health Research Centre under the Commonwealth Scientific and Industrial Research Organisation (CSIRO). Terminology and interoperability are central to connectivity and governance. A third agency, the National Clinical Terminology Service (NCTS), will provide terminology services and tools, including an online browser, a mapping and authoring platform, and CSIRO’s national syndication server Ontoserver. According to the release, “under the new partnership, ADHA will retain responsibility for governance and the strategic role of end-to-end management, SNOMED CT licensing and the relationship with SNOMED International, while CSIRO will deliver the services and functions required to manage the NCTS, as well as content authoring and tooling” over the next five years. Healthcare IT News

And over in New Zealand, Te Whatu Ora – Health New Zealand and Te Aka Whai Ora – Māori Health Authority have developed the 2022 interim national health plan. Te Pae Tata New Zealand Health Plan identifies greater use of digital services as part of their six critical areas. Actions to be taken in the NZ$600 million (US$400 million) data and digital budget include:

  • Create and implement actions to deliver national consistency in data and digital capability and solutions across Te Whatu Ora including streamlining duplicate legacy systems
  • Implement Hira, a user-friendly, integrated national electronic health record, to the agreed level
  • Scale and adapt population health digital services developed to support the COVID-19 response to serve other key population health priorities
  • Improve the interoperability of data and digital systems across the hospital network, and between primary, community and secondary care settings
  • Improve digital access to primary care as an option to improve access and choice, including virtual after-hours and telehealth, with a focus on rural areas

Healthcare IT News

Telehealth the way forward for chronic disease treatment – Australian report

September 10, 2016 | by
  1. Telehealth has been confirmed as the way forward for sustainably treating the leading chronic diseases in Australia says a report published following a scientific study. The study, which analysed the effects of monitoring a mixed group of patients with chronic conditions using home-based telehealth equipment, concludes that use of home-based telehealth will not only reduce the hospital admissions but will also reduce the length of stay when admitted. The analysis of the data from the trial has shown that for chronically ill patients, an annual expenditure of AU$2,760 could generate a saving of between AU$16,383 and AU$19,263 representing a rate of return on investment of between 4.9 and 6. This is equivalent to a saving of AU$3 billion a year, says the report.

The Australian study, carried out by the Commonwealth Scientific and Industrial Research Organisation (CSIRO) is reminiscent of UK’s Whole System Demonstrator (WSD), the world’s largest randomised control trial of telehealth. Although the Australian study is much smaller with a total of 287 participants over 5 sites (covering the 5 States) compared with over 6,000 in the WSD, the principles are similar. Due to the smaller sample sizes and the need to have patients connected to the National Broadband Network (NBN) the selection of patients was not random but other techniques were used to obtain statistically significant results. Patients selected had unplanned acute hospital admissions indicationg one or more of Chronic Obstructive Pulmonary Disease (COPD), Coronary Artery Disease, Hypertensive Diseases, Congestive Heart Failure, Diabetes and Asthma.

The TeleMedCare Systems Clinical Monitoring Unit (CMU) was used as the home-based unit although not all features offered by the device were utilised in this study. The CMU system deployed in this study was developed in Australia, registered with TGA (Therapeutic Goods Administration) and has been extensively used and tested in previous trials.

Typically patients would have some or all vital signs measurements scheduled at a convenient time, typically in the morning. These measurements were blood pressure, pulse oximetry to measure arterial blood oxygen saturation, ECG (single channel), lung capacity, body temperature, body weight and blood glucose concentration. In addition to scheduled times, patients could take their vital signs at any time. A full suite of clinical questionnaires was also available.

The full report Home Monitoring of Chronic Diseases for Aged Care is available to download here.

Excellent new report on using digital tech in health

March 27, 2014 | by

An excellent new report is out now on the use of digital technologies in health systems covering all the [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/03/A-digitally-enabled-health-system.jpg” thumb_width=”150″ /]key areas of application. A digitally-enabled health system studies the Australian health system and how it is to be improved by the use of various digital technologies.

Published by the Commonwealth Scientific and Industrial Research Organisation (CSIRO), Australia’s national science agency, this is a well researched and written report with the underlying analysis applicable to most countries, not just Australia. With contributions from eight experts, and presented in clear language, this is well worth a read. A free download of the report and links to infographics are available on the CSIRO report page.

Australia, in common with many other countries, faces pressures on its health system: “Treasury estimates suggest that at current rates of growth, and without significant change, health expenditure will exceed the entire state and local government tax base by 2043, and require almost half of all government taxation revenue” says Sarah Dods in the introduction to the report. CSIRO suggests several developments to meet this challenge – no surprises here, but nevertheless useful to remind ourselves of these: reduce reliance on hospitals, better manage hospital resources, make in-home patient monitoring (telehealth) the norm and introduce rigorous data security and privacy.

On hospital admissions there is a discussion on managing CSIRO logoEmergency Departments and re-routing ambulances to hospitals with shorter queues, a practice that is already taking place in some parts of the country. There is a section on the use of RFID tags to manage both equipment and continuity of care in hospitals. Another section looks at telehealth and self-monitoring. Other sections look at video conferencing (“tele-presence”) and remote diagnosis.