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Ochre Healthcare stops regional paper trail

Ochre Health’s expanding network of health services switched to portable ehealth records and broadband to improve patient care in regional areas. Joshua Gliddon reports.


The challenge: Ochre Health supports health services in 12 rural and regional centres across Australia, billing around 150,000 consultations per year. The challenge facing Ochre was to integrate the back-office systems of these healthcare organisations and provide a portable electronic healthcare record for clients.
 
The approach: Initially Ochre set up a central server connecting the GP practices and hospitals in each town. The server was linked to terminals in the hospitals and practices by a conventional telephone modem (broadband was not available). As technology improved, Ochre dabbled with using satellite communications, however the latency of the satellite (that is, the time it takes for the signal to make a round-trip to the satellite) proved cumbersome. An ADSL (Asymmetric Digital Subscriber Line) service from Telstra, which provides broadband over conventional phone lines, has now solved this problem. Each community Ochre serves now has fast broadband between hospitals and GP practices, ensuring that when a patient’s record is updated at one end it is automatically updated at the other end.
 
The outcomes: Many GP practices in regional areas do not have extended-hours staffing. Now, if a patient presents at hospital after hours, the clinical staff on duty have access to their GP records, and are able to update those records with whatever treatment the patient underwent at the hospital.
 
Lessons learned: Not all areas have fast broadband. For example, parts of Tasmania are connected using Telstra’s NextG wireless broadband service. Ochre has also learned lessons from its experience in creating a single patient record within each community. The next step is to take the system into the cloud, which will provide even greater access to medical records for clinicians, nurses and practitioners.
 
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The upside for:
 
Clinicians: Patients visiting a clinician after hours are no longer required to remember and explain their medical history. The clinician now has access to medical records via fast broadband links that tether the hospitals, clinics and GP practices together. Patients receive better service and are less likely to receive inappropriate treatment due to the clinician’s lack of knowledge about a patient’s medical history.
 
Nurses: As with doctors, nurses can now access full medical records for patients, particularly those patients that present out of hours at the hospital. This ensures that treatment is timely and appropriate for the patient and their medical condition.
 
Patients: Many patients in rural and regional areas - particularly those of an indigenous background - are highly mobile, and don’t always attend the same clinic or hospital, even within their own home area. The Ochre Healthcare solution means that medical records are accessible and up-to-date, ensuring appropriate healthcare for the patient, regardless of where they present, or at what time.
 
The organisation: Ochre’s technology infrastructure allows it to centralise back-room operations (such as accounting, medical software) as well as offer a single medical record for patients across its 12 regional centres. The upshot is both time savings and cost savings, as well as better outcomes for patients.
 
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Ochre Health’s story
 
Ochre Healthcare was started in 2002 as a GP recruitment service by founders Dr Ross Lamplugh and Dr Hamish Meldrum. The doctors were driven by a need to find locums who would keep their Burke, NSW, practice running when they went on holidays.
 
As the business grew they gradually employed more doctors to the point where the Area Health Service asked them to take over managing the provision of health services in Burke.
 
The way that they employed doctors was also quite radical, Dr Lamplugh said. Although medical services are usually provided on a fee-for-service basis, many of the doctors they recruited wanted to be paid a fixed daily rate. “We were asked to take over running the health services in Brewarina, NSW, and to provide the doctors for the service,” said Dr Lamplugh. “We recruited a male and a female doctor - a husband and wife - which was quite a breakthrough for that area, because they had never had a female doctor.”
 
Over time, Dr Lamplugh and Dr Meldrum began running the healthcare provisions for more regional and rural areas to the point where Ochre now looks after 12 areas across Australia. Recruitment has also begun to play second fiddle to the medical service provision business.

The challenges faced by Ochre as it grew were both logistical and technical. Often people living in rural and regional areas, and in particular indigenous populations, are highly mobile which  makes it a challenge if one of them presents to a hospital out of hours and is unable to inform the clinician of their medical history.

Dr Lamplugh said the initial response to this situation was to set up a terminal in the hospital that was linked by phone line to a central server holding patient records and notes. That way a clinician could access, and annotate, a patient’s file regardless of when or where they presented.

“When we got the contract for Bourke everything was paper based,” recalls Dr Lamplugh. “It was a schemozzle. We amalgamated the practices and the hospital onto a single copy of [Health Communication Network’s] Medical Director [software], and then created a system so that if you presented to the hospital out of hours, the clinician could access your medical records and also add whatever treatment you had been given there.”

The initial systems were connected by phone line. As technology progressed they experimented with a satellite internet connection but it proved unsatisfactory. “By that point,” said Dr Lamplugh, “ADSL had come along so that we could have fast, permanent connections between hospitals and practices.”

Today Ochre Healthcare is considering moving towards a cloud-based system, and Dr Lamplugh is avidly looking forward to the roll-out of the National Broadband Network. According to Dr Lamplugh, a cloud-based solution would help reduce the cost and maintenance issues associated with running a server and a network in each community that they serve. Cloud computing applications typically run inside a web browser and do not require an organisation to run their own computer servers.

“Technology skills are often hard to come by in rural areas,” he said. “Going to the cloud will help reduce those costs, and further our goal of having one set of notes for a patient, regardless of where they present.”

The National Broadband Network also holds great promise for Ochre, especially in terms of telehealth. However, Dr Lamplugh said Medicare needs to change its rebate practices so that teleconsultations can be billed in the same way that a conventional face-to-face consultation is billed.

“We are already doing some teleconsults with psychiatrists in the bush,” said Dr Lamplugh. “With the NBN, and with changes to the way Medicare does business, I am sure that telehealth will take on an even greater role in rural communities.”

 

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