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cdmNet takes on central role in Health Care Homes reform

Precedence Health Care has been selected to provide crucial enabling technology for the Australian Government’s new Health Care Homes initiative, a major health system reform proposed by the Primary Health Care Advisory Group’s Report into “Better Outcomes for People with Chronic and Complex Health Conditions”.

Precedence will provide the risk stratification tool used by all Health Care Homes from October 2017 onwards, including general practices and Aboriginal Community Controlled Health Services.

The solution, which uses Precedence’s cloud-based coordinated care platform, cdmNet, will determine an individual patient’s eligibility for the Health Care Home. It will identify and stratify patients based on their disease complexity and other factors so that health care services can be targeted accordingly.

The Prime Minister, the Hon. Malcolm Turnbull MP, described the implementation of Health Care Homes as one of the biggest health system reforms since the introduction of Medicare.
The new model of care targets the millions of Australians with chronic and complex conditions – aiming to keep them out of hospital and living happier and healthier lives at home.
Professor Michael Georgeff, CEO of Precedence Health Care, said: “The cloud-based solution we proposed is revolutionary. The choice of this approach shows that the Commonwealth is now well ahead in moving to agile digital technologies for improving the health of Australians.

“Our tool will make it easier for general practice to incorporate the Health Care Home into their traditional practice and will lead to greater efficiencies in the system.”
The first stage of the stratification process uses a Predictive Risk Model (PRM) running on cdmNet to identify and automatically target populations based on practice data. The

Precedence solution enables the PRM to be run on the entire practice population or whenever an individual patient visits their GP.
If the PRM algorithm identifies the patient as potentially eligible for the Health Care Home, an alert will pop up to the GP or practice nurse who, with a single click, can proceed to the second stage of the enrolment process.

The second stage automatically creates a questionnaire using Precedence smart forms, pre-filled with clinical and other data obtained from the practice and other sources. Non-clinical information, such as data on psycho-social factors, is added to the questionnaire during conversations with patients, family members, carers and providers.
These smart forms automatically check for consistency and then calculate a risk score based on an eligibility algorithm. This enables patients to be positively identified for enrolment while determining a risk stratum for optimising treatment.

The solution is highly secure, using smart encryption techniques to ensure no personal health information is stored in the cdmNet cloud.
The use of the cdmNet platform enables a Health Care Home to include the risk stratification and eligibility checking into their existing practice workflows while at the same time off-loading all the management overheads to the cloud.

CSIRO will be engaged by Precedence to validate and re-calibrate the PRM algorithm for Australian conditions.

About Precedence Health Care
Precedence Health Care Pty Ltd (Precedence Health Care) is an Australian software company providing advanced digital healthcare technologies for connecting healthcare professionals and patients and facilitating the coordination of care. It was established in Australia in 2007 and acquired by Sonic Clinical Services, the primary care division of Sonic Health Care, in late 2015.
Precedence is also behind the recent launch to health professionals of a breakthrough app, MediTracker, which runs on a patient’s smartphone and displays their medical summary so that after hours, or in an emergency, they can be treated safely.
Dr Michael Georgeff is Founder and Chief Executive Officer of Precedence Health Care and Professor in the Faculty of Medicine, Nursing and Health Sciences at Monash University. He has been at the forefront of software innovation and commercialisation in the USA and Australia for over 30 years.

About Precedence’s Coordinated Care Platform
Precedence’s Coordinated Care Platform (cdmNet) is an established cloud-based system for connecting and coordinating teams of health care providers across the full continuum of care.

The cdmNet platform currently coordinates the care of over 100,000 patients involving over 30,000 registered health care professionals, including General Practitioners, nurses, allied health professionals, pharmacists and specialists.

The platform is also being used in a trial of the patient-centred medical home by the Sydney North Health Network. It provides an end-to-end solution involving risk stratification, electronic shared care plans, care coordination, patient engagement, and care monitoring. These capabilities have been identified as the key elements of the Health Care Home by the Commonwealth’s Primary Health Care Advisory Group.

The cdmNet platform links to Precedence’s MediTracker mobile app and the Commonwealth’s My Health Record. It is the only care management system endorsed by the RACGP for supporting quality improvement in general practice.