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Patient Apps: Pipedream or Reality?

The Medical Republic, 27 February 2017
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, desk bound patient-management systems.
This isn’t easy, as the architecture and workings of MedicalDirector and Best Practice, were never designed for “always on” web communication. The basis of their technology and software is more than 20 years old, and complicated to talk to via the web.

But some innovative software vendors, who as we go to print, wish to remain unnamed, have apparently managed a neat hack of these older systems. They are using a web-based application which descends onto the desktop patient-management system in a surgery and interrogates its databases to find important patient-side information, mainly, their health summaries. It will do this only with the permission of the practice, doctor and patient. Presumably the web connectivity is intermittent, so the updating isn’t actually live, as it would be with a true cloud-based system such as MediRecords.

Best Practice has announced that it is working on its own patient app and that the company will be talking about its functionality at its upcoming user conference on the Gold Coast, Queensland, in April.

MedicalDirector is presumably working on its own app as well, but like its cloud-based patient-management system, we will believe not when we see it, but when we touch and use it.
But both vendors look like they will be beaten to the starting line by independent software vendors who simply ask the doctor and practice to load a local app or widget onto their systems so that the app can interrogate those systems for data. The app then takes this data into the cloud, and does the rest via the web.

Having a web-based app descend on your deskbound scriptwriter and interrogate it for data is not new. It’s been going on for years, conducted mainly by third party-data vendors, who use de-identified patient data to on-sell to primary health networks for analysis, or to commercial third parties.

But interrogating for longitudinal de-identified patient data intermittently, and interrogating for a patient-side app, are two quite different tasks. The latter is far more complex. Which might explain why it has taken so long.

The other reason is likely to be that building such an application was probably not worth the cost and effort until enough surgeries in Australia were connected to sufficient bandwidth to tolerate such an application.

The system in question is reportedly in trial now and potentially only weeks away from a formal release.

IPN is one of the corporates, which is likely to use the app to enhance its services to patients and its surgeries. Among a few other things the app will allow any patient of the IPN group to wander the country and always have access to their medical record, from their current surgery. It will also potentially talk to surrounding allied health professionals in a network that will be able to manage a patient’s chronic health plans on their mobile phone in real time. Not to be thwarted, Health & Co, which is the new upmarket private-billing practice group launched by Primary Health Care a few weeks ago, is promising to offer services to practices which would deliver something similar.

So are we finally at the starting line of having patients using their mobile phones for their GP and healthcare needs, in the casual and constant manner that many of us currently do things such as banking on our phones?

If we are, then GPs better brace themselves for potentially seismic shifts in how they acquire and retain their patient populations.

Does this sound like someone chasing another rainbow that you don’t have to worry about?

Think about what might happen if the surgery down the road can actually offer its patients an app that connects them digitally to their surgery.

The independent app we are hearing about will initially only offer access to a patient’s health summaries and critical data for them around the management of their chronic illnesses, if they have any.

But once an app such as this is successfully talking to desktop patient-management systems, the leap to talking to the appointment system and providing live mobile alerts for appointments, and to sending specialist letters, reporting test results, and even doing tele-consults, is not far away.

If, and when, this happens, the odds are that for the first time since the big corporates started to disrupt the lives of hard-working, small-group and single-doctor practices, the competition for patient acquisition, will be well and truly back on the table.

It seems entirely feasible now that if the major corporates get these apps working, then a patient’s world is going to change reasonably quickly, just like their banking experience changed five to six years ago.

If you talk to people in the banking industry and ask, was technology a game changer in client acquisition when introduced, and does it still play a part today? The answers will be: yes and yes.

In the banking industry you don’t have to guess “which bank” got the technology jump on its three major competitors and still maintains a technology lead today, and, as a result, a huge competitive advantage in consumer banking.

If there is a moral to this story it might be that “leprechauns are real”. The cloud and connected technology in medicine are too.

Despite doctors somehow having earned themselves the tag of “digital laggards”, they are going to have very little trouble embracing the technology, if any of these groups do get it working soon.

Doctors are often blamed, in large part, for the lag of digital technology in making medicine more efficient. But the truth is very different.

Medicine is a market which is very complex and which has presented natural barriers to the march of digital and connected technologies. Your average doctor is no less digitally competent than your average lawyer, accountant or plumber. They’re just in a market that is inordinately complex.

How close are we really?

The immediate past chief executive of MedicalDirector, who was having to deal at the time with the threat of the launch of MediRecords, summed it up when he said:

“Doctors are accepting and ready for these changes. But changes like this usually follow an ‘S’ curve. Because things in this market are so complex, the start will be painfully slow while early adopters iron out the key issues. But when it breaks, the speed of change will be frightening, and for that we will all need to be there.”

MedicalDirector is not owned by Primary Health Care anymore but it has a supply deal with the company.

This article was first published by The Medical Republic. Click here to read the original: http://www.medicalrepublic.com.au/patient-apps-pipedream-reality/