Australian Institute of Health & Welfare

Implementing AI at a national scale, particularly in such critical industries as healthcare, is no easy feat. In the HIMSS24 APAC session, "Implementing AI-Powered Triage for a National Virtual and Digital Front Door," Dr Nirvana Luckraj, chief medical officer of Healthdirect, described how they chose, tested, and deployed an AI-powered clinical decision support system to augment its national helpline services. Healthdirect offers a range of free 24/7 helpline services, including nurse triage and GP telehealth. It has dedicated lines for pregnant persons, the elderly, and most recently, people dealing with mental health problems. Additionally, Healthdirect provides information on medicines and curated health content on their website and features online booking and referrals, which directly integrate with national care pathways including My Health Record. THE PROBLEM Acquiring a CDSS is part of the actions Healthdirect took when it recently migrated its technology stack to its own operating platform. It required the tool to consider multiple symptoms at the outset. "We needed a CDSS that could tolerate and analyse multiple symptoms. We also wanted it to reflect real consultation that considered risk factors such as predisposing factors, chronic history, and travel history." "We also wanted something that was next generation that could provide a more comprehensive and accurate triage," Dr Luckraj added. Previously, the service used a CDSS based on a decision tree-type algorithm which required "extensive maintenance" and "could only tolerate a single symptom input." PROPOSAL The organisation then went to the market to seek a provider of an AI-based CDSS. It initially shortlisted five global vendors whose offerings were subjected to clinical testing. To test the AI system's applicability in the Australian public health system, Healthdirect worked with AI experts at Macquarie University's Australian Institute of Health Innovation. They adopted a test methodology from a recent study that used case vignettes to check a CDSS's accuracy. "We ran these vignettes through the CDSS and found the performance was consistent with the recently published study. We also ran the same vignette through our old CDSS to compare and found that the old and new CDSS had similar results but that the new one was more accurate," Dr Luckraj noted. Eventually, Healthdirect went with the Polish firm Infermedica's AI CDSS, which runs on a probabilistic Bayesian inference engine that considers symptoms, risk factors, and diseases, an updated medical knowledge base, and an API that connects to its CRM. MEETING THE CHALLENGE Immediately after launching the new CDSS on its helpline in March 2023, the implementing team encountered resistance from staff. "We had underestimated the change management required when getting healthcare professionals to use new technology to perform old tasks," Dr Luckraj admitted. From inputting one symptom to the CDSS, their nurses now have to enter multiple symptoms of patients. "The nurses initially were frustrated with the tool because it seemed to ask seemingly unrelated questions to the presentation of the patient. They also had to determine their past history to determine individual risk factors and the questions also seemed more advanced than the previous." In dealing with nurses' initial frustration, the team took on their feedback and assisted them in adapting to the new tool. One of the key areas for improvement here, according to Dr Luckraj, was working with their vendor on a feedback loop mechanism where nurses do not have to agree with every CDSS output. "It's a support system, not a diagnostic system. So the nurses can either upgrade or downgrade the triage outcome giving a reason for their change of disposition. We also looked at those flows where the nurses disagree with the CDSS output to continuously improve the tool." RESULTS A year after improving the CDSS, the implementing team observed that nurses are changing triage output less and agreeing more with the CDSS outcomes and that they are more satisfied with its new user interface. The tool's accuracy is constantly improving, Dr Luckraj noted, as nurses also continue to provide feedback. On the consumer side, no serious clinical incidents attributable to the CDSS have been reported; they are now more satisfied with the service, with satisfaction scores reaching the highest in three years. In December last year, the same AI-powered CDSS was introduced in Healthdirect's consumer-facing online symptom checker, making it a "digital front door to numerous alternative care options, including direct access to urgent care services and virtual emergency departments." "In the future, we're also looking to provide consumers with tailored information specific to their symptom input to provide an even better consumer experience," Dr Luckraj shared. Since incorporating AI into their helpline, Healthdirect claims to divert half of emergency calls to less acute services. From July 2023 to June 2024, it connected 44,000 calls to a virtual emergency department. It also booked nearly 5,500 people online for GP-led urgent care services. Meanwhile, almost 350,000 people were advised on safely managing their symptoms at home. Overall, Healthdirect nurses helped book over 370,000 GP service appointments.

TUESDAY, Aug. 12, 2024 -- At least 20 million hernia surgeries are performed globally each year, making it one of the most common medical procedures in the world. But does gender matter when it comes to hernia risk? New Australian research says yes: Half of the nearly 436,000 hernia repair procedures performed in adults in that country between 2017 and 2021 were for inguinal (groin) hernias, with men accounting for 89.6% of those operations. And the age-standardized prevalence in men was more than seven times that of women. Inguinal hernias were the most common type of hernia seen in the study. Why are men more susceptible? Researchers say the gender difference is due to higher rates of smoking, heavy exercise, bladder issues, chronic airway disorders, hypertension and heart disease. It’s important that doctors know "those patients who have higher risks of hernia repair, so we can develop health campaigns and policies to improve their quality of life and lower their risks of developing hernias,” study co-author Dr. Marianne Gillam , from the University of South Australia, said in a university news release. A hernia occurs when one of your organs pushes through the muscle or tissue that contains it. This can trigger discomfort and abdominal pain and in severe cases can strangulate the bowel, which requires emergency surgery. In the study, the team turned to data from the Australian Institute of Health & Welfare (AIHW) to crunch the numbers for five different types of hernia operations, identifying what age groups and genders were at highest risk. What did they find? Males had a far higher incidence of inguinal hernias compared to females, with lifetime risks of 27% and 3%, respectively. While folks between the ages of 60 and 64, and particularly men in that age group, were at most risk overall for any kind of hernia surgery, women were more prone to repairs of femoral hernias in the upper part of the thigh, and incisional hernias, a common side effect of abdominal surgery, the researchers found. Still, when it came to surgery for abdominal hernias across all age groups, men were at much higher risk, although women between the childbearing ages of 20 and 39 were more likely than men in their age group to have an epigastric hernia operation (performed between the sternum and belly button). The findings were published recently in the Critical Public Health journal. Gillam noted that despite high annual rates of hernia surgery worldwide, few studies have tried to break those numbers down by age and gender. Whatever your topic of interest, subscribe to our newsletters to get the best of Drugs.com in your inbox.

A multi-institutional research team is set to build what could be Australia's first national system for injury surveillance, leveraging emergency department data to gain a comprehensive view of existing and emerging injury patterns nationwide. The project has recently obtained a A$2.98 million ($2 million) grant from the Australian government's Medical Research Future Fund. The research team comprises academic researchers from the University of New South Wales (UNSW), the University of Melbourne, the University of Sydney, Macquarie University and the Royal Prince Alfred Hospital Green Light Institute for Emergency Care. They are also supported by the Australian Institute of Health and Welfare, the Australian Competition & Consumer Commission, the Australasian College of Emergency Medicine and the Monash University Accident Research Centre. WHAT IT'S ABOUT Based on a media release, the project will em ploy AI techniques to collate emergency department data across states and territories in the country to build the injury surveillance system. The system will be able to identify risks not currently captured in existing data, including domestic violence, child maltreatment, alcohol or drug misuse, intentional self-harm and workplace risk. It will also better identify priority populations, including low-income individuals and people living in rural and remote areas. WHY IT MATTERS Injuries made up 1.9 million emergency department presentations in Australia last year, based on the latest data by the Australian Institute of Health and Welfare (AIHW). Different states have varying state-wide injury surveillance systems with some not having any collection of injury data at all, UNSW noted. A national data system that provides more reliable and timely access to injury data is expected to critically inform prevention activities, as well as guide policies, standards, and legislations aiming to reduce injuries in communities. "For example, our system will pick up certain drug-related harms in some areas of the country, possibly even linked to a new street drug. We will be able to use the data to inform public health initiatives and take prompt and targeted action to reduce the burden of death and disability from injury," Dr Lisa Sharwood, an epidemiologist and the project lead from UNSW Sydney, explained. "When we have a better idea of what causes injuries, it is easier to try to prevent them," she added. THE LARGER TREND Based on AIHW data, injuries account for 8% of the total disease burden in the country last year, causing over 500,000 hospitalisations. In 2021, nearly 15,000 lives succumbed to injuries. Moreover, it is said to make u p 7.3% of the total health spending in 2021. Most injuries that lead to both hos pitalisations and deaths are caused by falls, the AIHW data shows. There are already initiatives to prevent falls, especially in residential aged care settings where it ha ppens often, including the use of data analytics and autonomous sensors by a consortium of aged care sector organisations. Meanwhile, Victoria's Transport Accident Commission is now collecting patient-reported outcomes and experiences to inform the clinical decisions of their physiotherapists, particularly in gaining an understanding of how an injury affects their patients and delivering tailored treatments.