The DoD healthcare system contract might provide us with a view of what we could do in a connected healthcare system which is free of complex market factors such as vendor commercial imperatives, state vs federal politics, legacy funding models and so on


If you get a bit frustrated with how much the potential connected health has for Australia is getting bogged down by state versus federal politics, doctor association and college priorities, projects such as the My Health Record, and the commercial dictates of incumbent technology vendors, then you might want to take a look at an unfolding Department of Defence tender to “futureproof” its healthcare provision.

It’s a fascinating project for the fact that it may provide us with a an idealised look into what is actually possible if you take all of the above debilitating market factors out of connected health technology implementation, and just get on with integrating best-of-breed technologies in a closed ecosystem.

In this case, that system is the Department of Defence, both in the field and in all other aspects of delivery, all the way up to a field hospital situation and a single electronic medical record for the whole department.

Other key  elements of the tender include a replacement primary care practice management system, a critical care patient management system, a new Defence eHealth Record for all Australian Defence Force members, and an overall health knowledge management system.

Eventually Defence wants the system to be all encompassing, adding to the above closed loop ePrescribing and eDispensing diagnostic imaging and pathology service, emergency and inpatient hospital care, surgical and ICU care, and sterilisation services, and a overriding communications system for it all.

What makes this tender so interesting in the context of digital health in Australia is that Defence has the will, the money, and apparently a mandate, to simply get on with implementing what is actually possible across the board of connected health, with very little interference from the myriad of market factors holding back the rest of the country’s health systems.

If Defence succeeds, and the department intends to have the new project up and running within 18 months, we may just get a look into the future of what is possible, and with that, start clearing a better path for the rest of us.

Earlier today, we got our first key insights into the project, when one of the leading tenderers, Leidos Australia, announced details of its project and its approach. The partners include cloud patient management system vendor MediRecords, telehealth provider Coviu, pharmacy system provider FRED IT (Telstra Health), organisational change management group Nous, and a yet-to-be-identified local systems provider for longitudinal patient record management and patient data integration.

In the same team is global hospital EMR provider Cerner, which together with Leidos won a 2015 contract for a similar project for the US Department of Defence.

Imagine if you could integrate all these systems so that they worked and talked to each other seamlessly? Given the footprint of Cerner throughout Australia’s tertiary care system, that certainly might make for a generational leap in interoperability in the public hospital system with primary and allied healthcare.

The other aspect of this tender is that it putting together arguably the best of breed of local system suppliers for each of the key elements of the project other than tertiary care. MediRecords and Coviu are both leading-edge providers in their fields and wholly future-focussed, both with a philosophy of open systems cloud-based architecture, open APIs and modularity.

Less is known about other remaining teams tendering at this stage, other than one is being led by Deloittes in partnership with international EMR and US ambulatory vendor Allscripts.

Allscripts already has some interoperability projects up and running in Australia, one with South West Sydney PHN and the local LHD, and one in South Australia, which is possibly where it expect to impress Defence with some local credentials. Allscripts also has a US-based defence healthcare solution called Sunrise, which boasts functionality for primary and acute care, referral management, allied health, surgery, pharmacy and medical imaging, ward coordination and a patient portal.

The challenge likely for this team will be localising their systems for Australian healthcare and perhaps facing off against the best-of-breed local suppliers, all of whom are well advanced in terms of delivering modular and cloud- based solutions, although local suppliers do not have to choose one tender team only.

It is believed that there are one or two other teams tendering, one of which is likely to include local leading GP patient management group MedicalDirector, possibly with its Helix cloud GP product. We contacted MedicalDirector for a confirmation and comment, but none was forthcoming at the time of going to publication.

It is believed that leading PMS vendor Best Practice was also a part of one tendering team, but that team has since broken apart.

Of the Leidos tender, local CEO Christine Zeitz commented that: “Leidos has created an exceptional team to deliver this critical capability to the ADF. This includes partnering with leading Australian SMEs within the health sector, who we will further support through our global supply program.”

The project is now a serious “watch this space” for digital health system professionals in Australia  given its mandate, funding, and closed-system dynamics.

It’s the sort of project that you suspect the Australian Digital Health Agency will be following closely with an eye to how it should be continuing to guide the various interested parties in the development of connectedness in our public health system.

If this project works, there will be less excuse for waiting to see success overseas with open-systems solutions, and possibly a very useful roadmap for how our primary care and allied health systems could work to deliver seamless interoperability within and across the whole of Australia’s healthcare ecosystem.

Declaration of interest

Jeremy Knibbs, the publisher of The Medical Republic and author of this article,  is also a non-executive director of MediRecords. He also holds interests and positions in a number of other health technology companies, none that relate to this article.