How Smartpage clinical messaging adds to Alcidion's patient flow...

How Smartpage clinical messaging adds to Alcidion's patient flow
Written by Kate McDonald on 27 September 2018.


Earlier this year, ASX-listed firm Alcidion made the first of two strategic acquisitions that has radically changed the Adelaide company, best known for its Miya health informatics platform that counts Western Health and the Northern Territory Department of Health among others as long-term customers.

Having signed a reseller agreement with New Zealand start-up Oncall Systems for its Smartpage clinical messaging and mobile task management system in 2017, Alcidion then purchased the company outright in February 2018, integrating Smartpage into the Miya platform, where it is providing added functionality to the Miya Patient Flow and Miya Access bed management products.

Then in April, Alcidion announced it would buy IT services and integration specialist MKM Health, which has long-standing trans-Tasman contracts and is the distributor in the region for the well-regarded early patient deterioration warning system Patientrack.

MKM Health's Kate Quirke has taken over as CEO of the combined entities, with former CEO and co-founder Ray Blight moving into an executive chairman role.

The move quickly bore fruit when the companies put in a bid for one of ACT Health's digital transformation projects, a five-year, $4.75 million contract to roll out an electronic patient journey board solution that will combine Miya, Smartpage and Patientrack to provide patient flow, tracking of vital signs and staff communication.

Now, the company is gearing up to finalise the full implementation of Smartpage at Monash Health, the first site in Australia for its Clinical module. Monash Medical Centre and Monash Children’s Hospital have already implemented it for after-hours mobile task management, and Casey and Dandenong hospitals are preparing to roll it out too.

Smartpage has three different modules – Clinical, Orderly and Emergency – which were first developed by Aidan Gill when he was a junior doctor at Wellington Hospital. The Clinical and Orderly modules are still used there and at nearby Kenepuru Hospital, while the Clinical module has been live at Auckland's North Shore Hospital since 2013. It is also used at Waitakere Hospital in Auckland.

Dr Gill, who had studied software engineering before switching to medicine, first discovered the dubious delights of old-fashioned paging systems when he was in his first year out of medical school at Wellington Hospital.

“Wellington in particular was incredibly busy after hours and you would get eight pages an hour,” he said. “That page was just a number, so you had to go and ring the nurse back and you'd end up spending 20 minutes, half an hour, every hour just to ring nurses back when you are supposed to be doing all the jobs they are giving you. You end up just not answering them. It is very stressful.”

The idea to use emerging smartphone technology was obvious at the time and is now commonplace, he said, but at the time no one had actually done it and it turned out to be quite difficult to do. The main problem is not simply replacing a pager with a phone, but how to handle all of the tasks that accompany each page, which even today are pretty much all written down on a piece of paper.

“We had these paper lists with scribbles everywhere and that was our task management system,” Dr Gill said. “If you lose your piece of paper, you are in a bad position, because you have 50 jobs on that.”

As Dr Gill began building what became Smartpage, it became obvious that adding elements such as the patient’s observations and early warnings scoreboard, their triage level and their NHI or UR number to the system would make sense. It also made sense to be able to chat back and forth about that particular patient,” he said.

“Then it made sense to have a list of all these different messages for all these different nurses. Then they are no longer messages, they are now individual tasks. To be able to sort them, send them around, share them with other doctors, it just all made sense.”

Smartpage became not just a clinical communications system but a mobile task manager as well. The technology uses the ISBAR format (identify, situation, background, assessment and recommendation) widely used in the hospital sector to provide structured clinical messages. It also lets the nurse instantly see that the appropriate doctor has received the message on their device and has read it.

On their mobile device, the doctor can see whether they have eight or 10 jobs that the nurses are have requested of them but they can also see the clinical situation for each of those jobs. Then instead of having to find a phone, they can send back a message instantaneously that can also provide clinical advice.

While paper lists and one-way paging systems are a long-standing problem, Dr Gill said when he looked around the market, there wasn't anything really suitable. “Doctors at the moment often use Whatsapp, but you are not actually allowed to do that. It needs to be clinical, it needs to be secure and it needs to cover all these health protection laws. And it needs to be hospital-specific.”

Technology in practice
Smartpage Clinical is generally used by different clinicians in different ways, Dr Gill said. Nurses access it on their PCs or their ward tablets, while doctors use an app on their smartphone.

It has been built for health-grade security and users log in through their hospital log-in system. Once they log out, everything is deleted off the phone.

For example, the app lets clinicians text photos to each other, but they are recorded against a UR number and not stored on the phone itself. The app integrates with the hospital's patient management system as well as observations data from systems like Patientrack.

Oncall also has an Orderly module, which has been built to streamline the ordering and tracking of equipment and patient transfers and to bring coordination to the often chaotic nature of hospitals, Dr Gill said.

“The way it works in most hospitals, they've got two or three people or senior orderlies sitting in an office somewhere, taking constant phone calls from people all around the hospital and no one knows what is going on.

“They are getting fax messages and written orders, and then they have to somehow coordinate that. They are often using very ancient Excel spreadsheet systems to try and track all these jobs that come in, and then they walkie talkie it to the orderlies, which is just incredibly inefficient.

“Half the calls they get are 'are you coming?' 'Is this booked? 'This is CT, there is no one here, it has been an hour, I have just wasted $10,000 on CT time.' It happens every day.

“The orderlies go to the ward and they don’t have the right information, or the nurse didn’t know they were coming, so the patient is not ready. It's an amazingly bad system, but there was nothing good to replace it.”

Integration with Alcidion
Mr Blight has been in the business for more than 40 years, almost 20 of those with Alcidion, and while he has seen other clinical messaging tools and task managers emerge on the market, especially in North America, he says he has yet to see one as elegant as Smartpage.

“The basic issue is you have well meaning IT professionals, looking at how to solve a problem without the deep understanding of the realities of clinical risk management for individual patients, without understand the realities of rapidly deteriorating patients, without understanding the regulatory environment,” Mr Blight said.

“When I first saw Smartpage, I was just so impressed by the depth of understanding of hospital operations, hospital activities, that was apparent in the product.

“The second thing is the most important thing with health IT products in my view: the ability to be able to engage the end user. In this case, you have got overworked, stressed, very busy doctors, you've got overworked, stressed, very busy nurses.

“And if the interface that the doctors and nurses have to use is not in tune, if it is not giving them instantly the comfort of the information that they need to know, then it is not a useful tool.”

Mr Blight said the purchase of Oncall Systems has also added to Alcidion's patient flow solutions. “That is a key area focus in terms of our technology,” he said. “How do we continuously alert the care team as to the patients’ clinical risk? How do we give them guidance on how that risk?

“One of the big frustrations for nurse unit managers is actually being able to get medical support as soon as the patient’s deterioration has been noticed and get a rapid early intervention. That is the clinical risk management aspect.”

Written by Kate McDonald on 27 September 2018.


Earlier this year, ASX-listed firm Alcidion made the first of two strategic acquisitions that has radically changed the Adelaide company, best known for its Miya health informatics platform that counts Western Health and the Northern Territory Department of Health among others as long-term customers.

Having signed a reseller agreement with New Zealand start-up Oncall Systems for its Smartpage clinical messaging and mobile task management system in 2017, Alcidion then purchased the company outright in February 2018, integrating Smartpage into the Miya platform, where it is providing added functionality to the Miya Patient Flow and Miya Access bed management products.

Then in April, Alcidion announced it would buy IT services and integration specialist MKM Health, which has long-standing trans-Tasman contracts and is the distributor in the region for the well-regarded early patient deterioration warning system Patientrack.

MKM Health's Kate Quirke has taken over as CEO of the combined entities, with former CEO and co-founder Ray Blight moving into an executive chairman role.

The move quickly bore fruit when the companies put in a bid for one of ACT Health's digital transformation projects, a five-year, $4.75 million contract to roll out an electronic patient journey board solution that will combine Miya, Smartpage and Patientrack to provide patient flow, tracking of vital signs and staff communication.

Now, the company is gearing up to finalise the full implementation of Smartpage at Monash Health, the first site in Australia for its Clinical module. Monash Medical Centre and Monash Children’s Hospital have already implemented it for after-hours mobile task management, and Casey and Dandenong hospitals are preparing to roll it out too.

Smartpage has three different modules – Clinical, Orderly and Emergency – which were first developed by Aidan Gill when he was a junior doctor at Wellington Hospital. The Clinical and Orderly modules are still used there and at nearby Kenepuru Hospital, while the Clinical module has been live at Auckland's North Shore Hospital since 2013. It is also used at Waitakere Hospital in Auckland.

Dr Gill, who had studied software engineering before switching to medicine, first discovered the dubious delights of old-fashioned paging systems when he was in his first year out of medical school at Wellington Hospital.

“Wellington in particular was incredibly busy after hours and you would get eight pages an hour,” he said. “That page was just a number, so you had to go and ring the nurse back and you'd end up spending 20 minutes, half an hour, every hour just to ring nurses back when you are supposed to be doing all the jobs they are giving you. You end up just not answering them. It is very stressful.”

The idea to use emerging smartphone technology was obvious at the time and is now commonplace, he said, but at the time no one had actually done it and it turned out to be quite difficult to do. The main problem is not simply replacing a pager with a phone, but how to handle all of the tasks that accompany each page, which even today are pretty much all written down on a piece of paper.

“We had these paper lists with scribbles everywhere and that was our task management system,” Dr Gill said. “If you lose your piece of paper, you are in a bad position, because you have 50 jobs on that.”

As Dr Gill began building what became Smartpage, it became obvious that adding elements such as the patient’s observations and early warnings scoreboard, their triage level and their NHI or UR number to the system would make sense. It also made sense to be able to chat back and forth about that particular patient,” he said.

“Then it made sense to have a list of all these different messages for all these different nurses. Then they are no longer messages, they are now individual tasks. To be able to sort them, send them around, share them with other doctors, it just all made sense.”

Smartpage became not just a clinical communications system but a mobile task manager as well. The technology uses the ISBAR format (identify, situation, background, assessment and recommendation) widely used in the hospital sector to provide structured clinical messages. It also lets the nurse instantly see that the appropriate doctor has received the message on their device and has read it.

On their mobile device, the doctor can see whether they have eight or 10 jobs that the nurses are have requested of them but they can also see the clinical situation for each of those jobs. Then instead of having to find a phone, they can send back a message instantaneously that can also provide clinical advice.

While paper lists and one-way paging systems are a long-standing problem, Dr Gill said when he looked around the market, there wasn't anything really suitable. “Doctors at the moment often use Whatsapp, but you are not actually allowed to do that. It needs to be clinical, it needs to be secure and it needs to cover all these health protection laws. And it needs to be hospital-specific.”

Technology in practice
Smartpage Clinical is generally used by different clinicians in different ways, Dr Gill said. Nurses access it on their PCs or their ward tablets, while doctors use an app on their smartphone.

It has been built for health-grade security and users log in through their hospital log-in system. Once they log out, everything is deleted off the phone.

For example, the app lets clinicians text photos to each other, but they are recorded against a UR number and not stored on the phone itself. The app integrates with the hospital's patient management system as well as observations data from systems like Patientrack.

Oncall also has an Orderly module, which has been built to streamline the ordering and tracking of equipment and patient transfers and to bring coordination to the often chaotic nature of hospitals, Dr Gill said.

“The way it works in most hospitals, they've got two or three people or senior orderlies sitting in an office somewhere, taking constant phone calls from people all around the hospital and no one knows what is going on.

“They are getting fax messages and written orders, and then they have to somehow coordinate that. They are often using very ancient Excel spreadsheet systems to try and track all these jobs that come in, and then they walkie talkie it to the orderlies, which is just incredibly inefficient.

“Half the calls they get are 'are you coming?' 'Is this booked? 'This is CT, there is no one here, it has been an hour, I have just wasted $10,000 on CT time.' It happens every day.

“The orderlies go to the ward and they don’t have the right information, or the nurse didn’t know they were coming, so the patient is not ready. It's an amazingly bad system, but there was nothing good to replace it.”

Integration with Alcidion
Mr Blight has been in the business for more than 40 years, almost 20 of those with Alcidion, and while he has seen other clinical messaging tools and task managers emerge on the market, especially in North America, he says he has yet to see one as elegant as Smartpage.

“The basic issue is you have well meaning IT professionals, looking at how to solve a problem without the deep understanding of the realities of clinical risk management for individual patients, without understand the realities of rapidly deteriorating patients, without understanding the regulatory environment,” Mr Blight said.

“When I first saw Smartpage, I was just so impressed by the depth of understanding of hospital operations, hospital activities, that was apparent in the product.

“The second thing is the most important thing with health IT products in my view: the ability to be able to engage the end user. In this case, you have got overworked, stressed, very busy doctors, you've got overworked, stressed, very busy nurses.

“And if the interface that the doctors and nurses have to use is not in tune, if it is not giving them instantly the comfort of the information that they need to know, then it is not a useful tool.”

Mr Blight said the purchase of Oncall Systems has also added to Alcidion's patient flow solutions. “That is a key area focus in terms of our technology,” he said. “How do we continuously alert the care team as to the patients’ clinical risk? How do we give them guidance on how that risk?

“One of the big frustrations for nurse unit managers is actually being able to get medical support as soon as the patient’s deterioration has been noticed and get a rapid early intervention. That is the clinical risk management aspect.”