The only FHIR you want in a hospital

No more multiple instances: virtual care is interoperable.

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Australia now has its first home-grown, virtual care platform built on a Fast Healthcare Interoperability Resources data model – but what does it do and what did it take to build it?

Telstra’s Virtual Health Platform is cloud-based and provides virtual health monitoring for patients at home.

It has two portals; one for the healthcare team with customisable templates and a dashboard of the entire patient cohort; and another portal for patients, which is available on smartphones and laptops.

The portals are said to provide a single source of patient data which is drawn from health monitoring devices, such as wearables, and patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs).

Telstra Health said the platform included functionality such as secure video and phone calls, delivery of self-management resources to patients, a history log, and alerts when an at-home patient is deteriorating.

However, beyond the long list of functionalities there’s an architectural difference that Telstra says is an Australian-first.

It’s interoperable.

Telstra Health said the platform provided near real-time data exchange and storage utilising FHIR within a clinical data repository.

Being hosted in the cloud by Azure gives the platform seamless integration with electronic medical records (EMR), electronic health records (EHR) and other clinical systems.

So, what does it take to create interoperability that is built-in, not bolted on?

Telstra Health told Health Services Daily that it took more than a year to create the platform.

“We have relied on a range of experienced FHIR experts – both internally and externally – in the architecting and designing of our solution to use the FHIR data model,” a Telstra spokesperson said.

Getting into the technical nitty gritty, the solution uses FHIR Release 4 (R4), and was designed and built to adhere with the WCAG2.1 AA standards for accessibility (pending a compliance certificate).

It also integrates with the CSIRO’s Ontoserver for SNOMED CT-AU code sets for standardised terminology.

TMR asked Telstra about its interoperability strategy and the budget needed to back seamless data sharing.

“Interoperability is one of the key elements of our technology strategy,” the spokesperson said.

“We believe this is consistent with the expectations of governments, other payers and health care providers in the way that digital health solutions are developed.

“Our technology strategy is to provide a more connected and interoperable ecosystem, and FHIR is part of the strategy to achieve this vision. There was a cost to building the platform to this standard but one we see as an investment that can be redeployed within our ecosystem of products.”

The spokesperson said Telstra Health consulted with clinical, security and technical subject matter experts, in the development of the Virtual Health Platform. Customer feedback was also considered.

“With regards to PREMs/PROMs, these have been incorporated to also include other options such as observations into the branching logic of the feature,” the spokesperson said.

Community care, hospital-in-the-home and telehealth have trended upwards in Australia and abroad, especially since the covid pandemic.

Telstra Health is not new to provision of solutions for these models of care in Australia.

The company also appears to be targeting an export market with its Virtual Health Platform.

Christopher Norton, hospital care executive at Telstra Health, said he was proud to introduce a “highly interoperable, next generation” solution that “provides near real-time, high-quality remote healthcare regardless of a patient or clinician’s location”.

“Enhancing our virtual care technology continues our commitment to investing in innovation and brings us one step closer to realising a connected and improved digital experience for all,” he said.