iCOPE

This Federally funded program is to support the implementation of routine, universal pre and postnatal screening using the iCOPE Digital Screening tool. The Program was funded from May 2021 to June 2025, and commenced, in May 2021. Read more about the program

iCOPE was developed in response to the current recognised barriers to screening across health services, together with the absence of data to inform the extent to which screening is undertaken and the outcomes of screening under Australia’s National Perinatal Depression Initiative (NPDI).

The iCOPE tool has been designed to replace pen-and-paper approaches to screening. COPE has the rights to digitally deliver the Edinburgh Postnatal Depression Scale (EPDS) and Antenatal/Postnatal Risk Questionnaire (ANRQ/PNRQ) in Australia. These reflect the recommended screening tools in the Australian Perinatal Mental Health Guidelines (COPE, 2017).

• Increases efficiency – average screen time 6-8 minutes (no scoring time).
• Ensures 100% accuracy– through instant, automated scoring. Automated reports eliminate scorer error (studies have shown a 32 per cent error rate).
• Guides best practice – through the production of instant clinical reports containing clinical advice relative to screening scores and outcomes.
• Encourages disclosure – the use of digital devices including tablets (iPad) and smartphones encourages patients to respond more honestly to questions because it takes away the potential bias inherent in person to person screening.
• Mobile and time saving – patients can undertake the screen in the waiting room prior to consultation. The screen can also be done via SMS link on a patient owned mobile device (in-person or remotely) or on a tablet device supplied by the clinic. The event summary is available to the clinician at the beginning of the consultation (or video consultation).
• COVID safe – as patients can undertake the screen on their own device.
• Empowers the consumer – through the provision of sensitively written client summary report which the client can nominate to receive via email or SMS.
• Is culturally inclusive – enables patients to undertake the screen and receive their own report in their preferred language, increasing accuracy and minimising the need for translators. Current languages include: English, Arabic, Vietnamese, Mandarin, Cantonese, Punjabi, Tamil, Chin Hakka, Turkish, Dinka, Persian, Dari, French, Hazaragi, Hindi, Indonesian, Japanese, Karen, Central Khmer, Korean, Burmese, Nepali, Thai, Tagalog, Urdu.
• Patient record systems integration– clinical reports (event summaries) can be uploaded and integrated into patient record systems, including My Health Record.  Automated collection and collation of identified patient data (pre-consultation) saves time and provides clinicians with an event summary instantly, including patient profile, clinical status and item responses.
• Approved MBS billing: Antenatal consultation MBS# 16590/MBS 16591; Postnatal MBS# 16407; Complex birth MBS#16552 and allows patient consent for bulk billing and tele and video health consultation.

There are three ways that a patient can be screened using iCOPE:

1. Digital tablet device (iPad) – for in-person appointments, the screen can be completed on a tablet device supplied to patients either in the waiting room prior to the consultation, or within the consultation. These tablet devices are registered with the service, locked down and cannot be used for any other purpose.
2. On the patient’s own mobile device via SMS (smartphone, tablet or computer) – a link can be sent to the client at, or prior to their appointment via SMS. This enables the client to complete their screen in the clinic waiting room, or at home prior to a tele or video health consultation.
3. Clinician’s desktop – the clinician can access the screening tool on their desktop computer and complete the screen with the patient during the consultation (either in person or via tele or video health consultation).

In line with the National Guidelines, the recommended screening tools in the iCOPE solution include a psychosocial risk assessment using the Antenatal/Postnatal Risk Questionnaire (ANRQ/PNRQ) and the Edinburgh Postnatal Depression Scale (EPDS).

Patients that indicate they are postnatal (i.e. they have had their baby) are asked the additional three postnatal items as recommended in the National Guidelines (PNRQ). These questions pertain to:

• birth experience – whether frightening or disappointing,
• parenting experience – whether this has been a positive one;
• baby wellbeing – whether unsettled or feeding poorly.

• English
• Arabic
• Burmese
• Cantonese
• Chin Hakka
• Dari
• Dinka
• French
• Hazaragi
• Hindi
• Indonesian
• Japanese
• Karen
• Central Khmer
• Korean
• Mandarin
• Nepali
• Persian/Farsi
• Punjabi
• Tamil
• Thai
• Turkish
• Tagalog
• Urdu
• Vietnamese

Clinical reports meet all MBS auditing requirements.

The iCOPE screening tool facilitates universal screening for the following:

GPs

• MBS #16590 and #16591 – claimed at 28 weeks gestation.
• MBS #16407 – postnatal screen. To be conducted 4-8 weeks postnatally.

Obstetricians and Gynaecologists (private)

• MBS #16590 – claimed at 28 weeks gestation.
• MBS #16522 – complex birth item. Can be claimed on or after 26 weeks gestation if the patient screens positive for mental health history items, family violence or drug and alcohol misuse.
• MBS $16407 – postnatal screen. To be conducted 4-8 weeks postnatally.

Note: each MBS item cannot be claimed more than once for the same patient.

With the ability to undertake screening just prior to the consultation, the iCOPE solution allows for family violence question(s) to only be asked in the presence of the health professional, ensuring a safe environment to ask this information.

In this setting, the clinician is prompted to indicate if the client is alone, (and it is safe to be asked questions pertaining to family violence). If alone, the clinician answers yes to patient being on their own, then the family violence questions are presented to the clinician for completion with the patient.

As jurisdictions have varying family violence screening tools, these have been incorporated into the iCOPE screen. Responses to individual family violence questions are detailed on the clinical report and not included in the patient report for safety reasons.

Yes. COPE and Diginostic work with hospitals and their IT developers to facilitate the integration of the patient event summary (clinical report) into the Hospital Health Record System.

The iCOPE event summary (clinical report) is currently in beta testing with Diginostic and the National E-Health Transition Authority (My Health Record) and will go live at enterprise level in July 2021. This will allow all the participating provider’s patient records to filter to their medical record file.

Yes. Currently, the instantly generated clinical event summary (structured PDF) can be accessed via a secure individual login and password to the Diginostic administration portal. The report, which details clinical scores, outcomes and guidance in line with best practice, can be downloaded from the Diginostic administration portal, then uploaded into the patient’s medical file as an attachment.

The PDF allows easy upload into patient medical records into most software systems (including Best Practice, Medical Director Genie, Obstetrix, and Clinic to Cloud).

Yes.  We are currently working with the National E-Health Transition Authority (My Health Record). The iCOPE event summary (clinical report) is currently in beta testing and will go live at enterprise level in July 2021. Once integrated, each event summary will be linked to, and automatically uploaded to the patient’s My Health Record.

Yes. It is possible to automate the link to be sent to the client via the service’s booking reminder system. This involves us creating an API to the clinic’s patient booking system.

By the end 2021, the Ready to COPE app will be made available to patients and clinicians as part of the iCOPE platform. Those using the Ready to COPE app will receive a notification (prompt) at 4-6 weeks to schedule an appointment and undertake the postnatal iCOPE screen.

Yes.  The iCOPE solution will be available to professionals operating in both the public and private sector. All medical health professionals play an integral, and shared care role in monitoring the mental health and wellbeing of expectant and new parents during the perinatal period.

COPE is leading the roll-out of the screening tool to all public hospitals and maternal and child family health clinics across the country. The implementation of iCOPE in the public sector is funded by the Federal Government until 2025.

Diginostic, exclusive provisioning partner of the iCOPE solution, is leading the national roll-out to private sector medical practitioners (GPs, private specialists and private hospitals).

Screening using iCOPE is a shared responsibility between the private and public sector.

The Australian Guidelines recommend that the initial screen be conducted as early as possible in the patient’s perinatal journey. It is also recommended that the patient undertakes the screen at least once during the antenatal period (ideally twice) and at least once during the postnatal period (ideally twice).

It is also recommended that the screening is undertaken at any time throughout the pregnancy and postnatal period should any concern arise regarding the patient’s wellbeing, in line with clinical judgement.

This depends on individual circumstances and current screening practices across services and jurisdictions.

In the private sector, the first prenatal iCOPE screen can be claimed from 28 weeks gestation.

The second screen (postnatal screen) can be claimed 4-8 weeks postnatally.

In the public health sector, depending on the patient journey, the prenatal screen can be conducted between weeks 13 and 18 weeks of the pregnancy, and the postnatal screen at approximately 4 weeks post birth.

Currently, the clinician is required to directly enquire with their patient if and when they have undertaken the iCOPE screen. The screen can (and should) be undertaken more than once, but the MBS items for the pre and postnatal screen can only be claimed once.

From July 2021, the clinical reports will be available via My Health Record, which will enable the clinician to check if the screen has been done as the ‘event summary’ will be available in the patient’s my health record.

As outlined in the Australian Guidelines (2017) the initial assessment in the primary setting is not diagnostic, it aims to identify women who would like help with their distress or systems, or who need further assessment for possible psychiatric condition, so that they receive the care (including diagnostic assessment) they need.

The iCOPE screen scores are categorised as follows:

• Low risk (9 and under) – an iCOPE screen score of 9 and below is a low risk score and no ongoing support or mental health assessment will be required.
• Medium risk (between 10-12) – an iCOPE screen score between 10 and 12 indicates that the patient is at moderate risk of experiencing perinatal depressions and anxiety. It is recommended that the screen is repeated in two weeks to monitor possible symptoms.
• High risk (13 and over) – an iCOPE screen score of 13 and over indicates that the patient is at high risk of perinatal depression and anxiety. Further mental health assessment must immediately be arranged (such as mental health care plan and referral to relevant mental health professional).
• These cut-off scores are lower for those conducting screening in languages other than English. This is automatically reflected in the clinical event summary, where the presented advice is provided in accordance with the score and language in which the screen was conducted.

Important: when a patient is identified as at risk of suicide (through clinical assessment and/or Question 10 on the EPDS), the service provider needs to manage immediate risk and arrange for mental health assessment and consider immediate crisis support and treatment options.

It is the responsibility of the medical health professional who conducts the screen to arrange a mental health assessment and ongoing support. Where possible, the patient’s regular GP should always be notified.

The Australian Guideline (2017) states that the general principles for referral are the same in all settings. However, referral pathways will depend on the setting and the access to services available in the area and by the patient. In all situations, there is a need for documentation. Coordinated care and inter-professional communication as well as clear communication with the woman and her significant other. This is supported by the ability to include patient notes into the event summary, which may then accompany a referral, as well as the provision of personalised screening outcomes to the patient in the patient report.

Example of referral pathways and ongoing care, depending on which service has provided the iCOPE screen:

• GP – to discuss mental health care and support options, including a mental health care plan and referral to appropriate mental health care professional (e.g. psychologist, psychiatrist, counsellor),
• Private hospital midwife and private Obstetrician and Gynaecologist – to refer the patient to appropriate in-house mental health practitioners, or to external mental health care providers, preferably via the patient’s treating GP.
• Public hospital Obstetrician and Gynaecologist or Midwife – to refer the patient to the appropriate in-house mental health practitioners; local mental health team, in-house psychiatrist, mental health nurse or in-house social workers, or to external mental healthcare providers, preferably via the patient’s treating GP.
• Maternal health nurse – refer patient back to GP for follow-up and referral to appropriate mental health care professional and ongoing support.

Information about referral pathway options can also be found on the e-COPE Directory. The e-COPE Directory is an online directory that enables practitioners and patients to locate perinatal mental health service providers and support services in their local area. The e-COPE Directory also provides information about services that bulk-bill and have translators available.

If you require further information call COPE on 1300 740 398 or email info@cope.org.au.

As part of the Prime Minister Scott Morrison’s election commitment, screening will also be offered to fathers and partners.

A review of the literature is being undertaken to determine the most clinically appropriate screening and assessment tools and timing for fathers. To facilitate the screen outside of the hospital setting, an app is under development to enable screening of fathers in line with the recommended tools.

Once downloaded, the application notification process with an algorithm will prompt at the appropriate time and serve a digital screen invitation to the father. When downloading the application, the patents GP/medical provider details will be captured ensure that any screen results conducted on the Diginostic smartphone platform will ensure a copy of the screen results (event summary) to be sent to the GP/ health provider.

This provides the appropriate sensitivity rules (screen score), as well as prompting and flagging to providers the need for follow up of fathers/partners in relation to iCOPE identified and administered score ratings, as needed. Established referral pathways will be integrated into the patient reports to support identification of appropriate services via the e-COPE Directory.

There are currently three mental health screening tools that have been developed specifically for Aboriginal and Torres Strait Islander women in the perinatal period: the Mt Isa Postnatal Depressions Scale, the Kimberley Mum’s Mood Scale (KMMS) and Baby-Coming-You-Ready?

The KMMS and Mt Isa Postnatal Depression Scale screening tools are fully integrated into iCOPE, and available to health services across the country via the iCOPE program. COPE is also working with the developers of Baby Coming You Ready? to make it available via the iCOPE program.

The Kimberley Mum’s Mood Scale (KMMS), is a two-part screen, specifically designed for Aboriginal and Torres Strait Islander women in the perinatal period. The screen is delivered by the healthcare professional in a conversational setting. Results from the Kimberly Mum’s Mood Scale implementation project found that Aboriginal women consistently reported that it was important to have someone to talk to.

Part one of the screen mirrors the EPDS, using language and graphics as determined through the Kimberley consultation. Part two of the screen contains a psychosocial component which involves talking or yarning to explore important psychosocial protective and risk factors.

The Mt Isa Postnatal Depression Scale was developed and validated under the National Perinatal Depression Initiative for use with Aboriginal and Torres Strait Islander women. The Scale mirrors the EPDS, using language identified to be more culturally appropriate for First Nations peoples. The psychosocial risk factors are then explored using the traditional ANRQ questions delivered by the iCOPE screening tool.

‘Baby-Coming – You Ready?’ (BCYR) is an interactive approach to screening and assessment undertaken in a conversational format with the health professional. Developed by researchers at Murdoch University, the tool is pictorial in format and is accompanied by audio. This tool has been programmed onto the iCOPE system and will soon also be made available via the iCOPE screening program.

The current Australian Guidelines recommend lower cut-off scores on the EPDS for certain population groups (e.g. non-English speaking clients, fathers). The algorithms for the lower EPDS cut-off scores are already in place for fathers and non-English speaking clients, and integrated into the algorithms to inform the advice on the clinical and client reports accordingly.

The iCOPE screening tool can also be adjusted to screen same-sex parents (and identify the biological versus non-biological parent). The same principle can be applied for same-sex partners, with the cut-off scores similarly to be informed by research.

As part of this program, an annual systematic review of the literature is conducted to determine the most appropriate screening tools and clinical cut-off points for specific population groups. Whilst there is growing research with respect to screening fathers, it is likely to be less substantive for same sex-couples.

All data collected is securely stored within Australia on secure AWS servers.

Currently all data is collected and stored in an enterprise medical purpose-built, secure Diginostic virtual private network (VPN). The Virtual Private Network (VPN) has been built with Australian medical digital data encrypted data storage facilities and secure enterprise data access protocols.

The iCOPE screening tool collects data in real time and this is encrypted and stored on the Diginostic secure enterprise medical health server.  This provides the capacity to immediately identify and respond to any technical issues experienced across locations nationally, through the de-identified screening number generated by the system. All data collected is encrypted. From HTTPS at the user interface level through to Encryption at Rest at the database.

As with paper records, all reports and data is owned by the service/practitioner that generated the record.

All deidentified data generated by the iCOPE system will be securely transferred to the Australian Institute of Health and Welfare who will be the data custodians for the Commonwealth Government.

As well as accessing data via the automatically generated patient reports, individual services will also have the capability to download their identified screening data at any point in time to inform screening rates and outcomes across sites and the service as a whole.

This is facilitated by the service being able to register all users with different levels of permissions within the system. Those deemed by the service to have Managerial or Administrator permission levels, will be able to have access and download service and location data. Two-factor authentication protocols are in place to secure this access to patient data from the secure server.

Screening and creating medical event summaries require mobile device security. The most secure mobile device platform for protection of patient data is the Apple Mobile Device Business Manager platform. This has the ability to customise the operational and security features of the device at an enterprise level.

Apple mobile devices are used by Police jurisdictions, including Victoria, Queensland, Western Australia and New Zealand, and offer the following benefits:

Security System: All iOS devices have a “secure boot chain”, negating the ability for the device to be tampered with, even during start up.  Apple also releases software updates regularly to provide fixes to any new security threats.

Apple’s Secure Enclave provides and maintains integrity of data protection.  The enclave is fused to the device’s Unique ID (UID) and Group IDs (GID) at the time of manufacturing.

Encryption and Data Protection: Cryptographic operations are implemented, as each device has an AES-256 crypto engine built in for efficient encryption, while maintaining battery life and performance.  Each device’s UID and GID cannot be read by any firmware or software directly—they can only access the results of encryption and decryption operations by dedicated AES engines.

App security: iOS provides various layers of protection to protect user’s data.  All apps must be signed, verified and sandboxed.  This creates a stable and secure platform for apps without impacting the security of the system preventing malicious apps and attacks.

Network Security: iOS devices support “Always-on VPN” which is configured through the Apple Business Manager. This ensures the device only communicates patient data through the VPN while allowing iCOPE to secure and encrypt the IP traffic transmission.

Device Controls: Mobile Device Management (MDM) provides iCOPE with the ability to securely configure and manage iPads.  Through the Apple Business Manager, the managed device can be enrolled to the iCOPE program, configured and updated by iCOPE wirelessly and remotely locked (Lost Mode) or wiped (Remote Wipe) the device if needed.

For further information regarding Apple’s iOS Security, please see: https://www.apple.com/business/docs/site/iOS_Security_Guide.pdf

For further information regarding Apple’s current Security Certifications and programs, please visit: https://support.apple.com/HT202739

The patient can the free Wi-Fi provided by the clinic, and safely and securely undertake the iCOPE screen as the iCOPE digital screening tool has built-in end-to-end encryption.

In this case, we recommend the screen be delivered on the tablet (iPad). The inbuilt Telstra SIM connectivity ensure internet access.

All devices have GPS tracking enabled and are setup to a specific location. Should the device be removed from the location, the iPad can be remotely disabled and tracked. Due to the iPad management, the GPS, tracking and remote disable ability cannot be turned off or tampered with. No patient data whatsoever is stored on any Apple tablet device.

If a tablet fails to work, the device will be replaced within a 48-hour period within metro areas, and 72 hours nationally under our Provisioning Provider Agreement.

The iCOPE digital screening tool is support by a national triage support line:1300 298 132, operating Monday to Friday 8:00 am to 6:00 pm. A-level disruption events are supported 24 hours a day, seven days a week for hospitals. Back up hardware is available for specific events.