Pulse+IT Magazine - August 2008 by Pulse+IT Magazine

PULSE IT ®

AUSTRALIA’S FIRST AND ONLY HEALTH IT MAGAZINE

PERSONAL HEALTH RECORDS

ISSUE 9: AUGUST 2008

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Publisher Pulse Magazine PO Box 7194 Yarralumla ACT 2600

PAGE 28 PERSONAL HEALTH RECORDS Simon James provides an introduction to Personal Health Records.

ABN 19 923 710 562 www.pulsemagazine.com.au Editor Simon James 0402 149 859 simon.james@pulsemagazine.com.au Sub-Editors Tara Feeney, Ben Tallboys, Sarah Hughes Editorial Enquiries editor@pulsemagazine.com.au Advertising Enquiries ads@pulsemagazine.com.au

PAGE 26 EVENTS CALENDAR Up and coming Australian and international Health, IT, and Health IT events.

About Pulse+IT Pulse+IT is Australia’s first and only Health IT magazine. With a national distribution exceeding 40,000 copies, Pulse+IT is also Australia’s highest circulating health publication. 32,000 copies of Pulse+IT are distributed to GPs, specialists, practice managers and the IT professionals that support them. In addition, over 8,100 copies of Pulse+IT are distributed to key IT decision makers in hospitals, day surgeries and aged care facilities. ISSN: 1835-1522 Contributors Linda Bâgu Batson, Scot Connolly, Paul Giacometti, Sam Heard, Simon James, Louis Joseph, Isaac Levido, Jane London, Fiona MacTavish Non-Commercial Supporting Organisations Australian General Practice Network (AGPN), National E-Health Transition Authority (NEHTA), The Royal Australian College of General Practitioners (RACGP) Disclaimer The views contained herein are not necessarily the views of Pulse Magazine or its staff. The content of any advertising or promotional material contained herein is not endorsed by the publisher. While care has been taken in the preparation of this magazine, the publisher cannot be held responsible for the accuracy of the information herein, or any consequences arising from it. Pulse Magazine has no affiliation with any organisation, including, but not limited to Health Services Australia, Sony, CMP Medica or the Kimberley Aboriginal Medical Services Council, all who produce publications under the title “Pulse”. Copyright 2008 Pulse Magazine No part of this publication may be reproduced, stored electronically, or transmitted in any form by any means without the prior written permission of the Publisher. Subscription Rates Please visit our website for more information about subscribing to Pulse+IT.

PAGE 31 VOIP FOR THE HOME Scot Connolly outlines technology that can assist to drive down telecommunication costs in a home environment.

PAGE 42 PROJECT MANAGEMENT Linda Bâgu Batson discusses the importance of enlisting Executive project support.

MOBILE SOFTWARE PAGE 34

MYOB PAGE 36

OPEN SOURCE PAGE 39

VIRTUALISATION PAGE 44

REGULARS PAGE 06 STARTUP Editor Simon James introduces the ninth edition of Pulse+IT. PAGE 08 GUEST EDITORIAL Guest contributor, Dr Sam Heard, outlines his vision for the future of Australia’s e-health data landscape. PAGE 10 BITS & BYTES Pulse+IT’s news section, delivering the latest eHealth developments from Australia and abroad.

PAGE 20 AGPN Paul Giacometti announces the launch of the APGN’s self-help broadband guide for medical practices.

PAGE 24 INTERVIEW: HOUSTON MEDICAL Pulse+IT checks in with Houston Medical’s Managing Director, Mr Derek Gower.

PAGE 21 NEHTA NEHTA discuss their recently released IEHR privacy blueprint.

PAGE 26 EVENTS CALENDAR Up and coming Australian and international Health IT, Health, and IT events.

PAGE 22 RACGP Jane London discusses the Clinical Audit Tool, a joint initiative between the RACGP and Pen Computer Systems.

PAGE 47 MARKET PLACE Australia’s most innovative and influential eHealth organisations.

FEATURES PAGE 28 PERSONAL HEALTH RECORDS Simon James provides an introduction to Personal Health Records.

PAGE 34 MOBILE CLINICAL SOFTWARE Simon James overviews some of the clinical software options available for smart phones.

PAGE 42 PROJECT MANAGEMENT Linda Bâgu Batson discusses the importance of enlisting Executive project support.

PAGE 31 VOIP FOR THE HOME Scot Connolly outlines technology that can assist to drive down telecommunication costs in a home environment.

PAGE 36 MYOB Fiona MacTavish provides an overview of transaction processing in MYOB.

PAGE 44 DESKTOP VIRTUALISATION Louis Joseph outlines the benefits virtualisation technology can deliver to end users.

PAGE 39 OPEN SOURCE SOFTWARE Simon Ingram introduces the reader to free open source software.

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STARTUP Simon James BIT, BComm Editor, Pulse+IT simon.james@pulsemagazine.com.au

Pulse+IT: 2008.3 Welcome to the ninth edition of Pulse+IT, Australia’s first and only Health IT magazine. This edition is being launched at a busy time for e-Health in Australia, with many developments emerging that are likely to prove pivotal in the months and years to come. Details of the “work in progress” National e-Health Plan have started to appear, electronic prescribing is threatening to step out of the periphery, and Open Source software is beginning to gain traction in Health IT circles. Personal Health Record solutions are garnering attention, and the National E-Health Transition Authority (NEHTA)— under the recently refreshed stewardship of an interim CEO and newly appointed Chair — continues to reorientate in the lead up to the Council of Australian Governments meeting to be held in Perth in early October. The release of this edition marks the second anniversary of the launch of our publication, and based on the aforementioned developments, the start of what I expect will prove to be a very busy third year for us at Pulse+IT. Having founded the publication with a respectable distribution of 10,000 hard copies, subsequent interest in the publication has seen it quadruple in circulation and expand in scope, with magazines now sent to all corners of the health sector. Strong coffee and late nights aside, this unprecedented growth would not have been possible without the ongoing support of our writers, advertisers and subscribers. So to all those who have been supportive of our publication to date, I offer my sincere thanks and gratitude.

THIS EDITION This edition’s Bits&Bytes section includes significant coverage of numerous e-Health events, including the recently held HL7 Australia Conference and the IHE Connectathon. Coverage of several forthcoming events, including the Health Informatics Conference 2008 (HIC’08), Health-e-Nation, ITAC08, the Nursing Informatics Australia Conference, and the Health Information Managers Association of Australia Symposium also feature in this edition. A first look at a Red Book guidelines utility is also included, as is coverage of a recently commenced electronic cohort study, which is seeking to examine the factors influencing the career decisions of Australian doctors and medical students.

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LOOKING FORWARD In-line with a planned page count boost, the next edition of Pulse+IT will contain a significantly expanded Bits&Bytes section, featuring detailed coverage of HIC’08 and the other e-Health related conferences scheduled for the coming quarter. The edition will also feature a large selection of technical articles, including instalments encompassing secure messaging for specialists, physical IT security, healthcare related open source software, VoIP for medical practices and other small healthcare organisations, and server virtualisation technology. Fiona MacTavish will conclude the series on MYOB for the medical practice, and Linda Batson will continue her series on Health IT project management. More information about these proposed articles is available on our website under the “About” section — as always, your feedback and suggestions are most welcome. Simon James, Editor simon.james@pulsemagazine.com.au

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The Australian General Practice Network announces the release of their self-help broadband Internet guide, and the Royal Australian College of General Practitioners contributes an article about the Pen Computer Systems’ Clinical Audit Tool. This edition also contains an organisational contribution from NEHTA, which discusses some of the privacy implications of their Individual Electronic Health Record (IEHR) proposal. Dr Sam Heard has contributed a guest editorial canvassing his views about what Australia’s future e-Health data landscape will look like, and Pulse+IT interviews Derek Gower from Houston Medical. Linda Batson commences a series on Health IT project management, and a follow-up to last edition’s article on mobile computing hardware is included, this instalment highlighting some examples of clinical software designed specifically for smart phones. Scot Connolly takes a look at some technologies that can help readers reduce their home phone bills, while Louis Joseph shares his thoughts on Virtualisation technology as it applies for use on the desktop. Fiona MacTavish delivers an overview of transaction processing in MYOB, and Simon Ingram introduces the reader to free open source software.

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GUEST EDITORIAL Dr Sam Heard MBBS, MRCGP, FRACGP, FACHI, is a clinician, the CEO and Clinical Director of Ocean Informatics, and a director of the openEHR Foundation. sam.heard@oceaninformatics.com

Why is it taking so long? I have been working in Health Informatics my entire career as a doctor and I plan to see interoperable health records somewhere in the world before I retire (don’t worry I have more than 10 years to go). Where to concentrate my time? Australia? It may well take some time to recover from the past 5 years. The UK is trying much harder, but the environment is hostile and legalistic and only those companies with massive purses or undue cunning are surviving (actually these features are necessary but not sufficient). Denmark and Sweden are taking up the archetype approach of the new ISO standard much championed by my close colleague Dipak Kalra, who like me, has been very involved in developing the openEHR specifications. Other countries, like Australia, are betting on HL7 CDA and IHE for access. Actually, we need messages, stand-alone documents and service protocols. And, it is now being realised, standard expression of clinical content. This is something that openEHR is good at but it is not clear that it is necessary until people really start to share information. It is interesting that openEHR, with its development largely in Australia, began to be taken seriously in countries like the UK and the Netherlands who had already embraced HL7 version 3 and CDA. There are two broad visions of the e-health future that people now embrace: 1. A world where every vendor goes out and builds a system just how they want and makes it do everything that their users want. “Nothing should get in the way of that”. Other users and patients can then get access to this information and share it via messages. “Just tell us what you want and we will give it to you”. Vendors and clinicians spend years configuring these systems: all unique and each working with a variety of messages that are sent in the local environment. 2. A world where there is a standard format for personal health information and a standard service interface for reading and writing that information. How personal health information is actually stored behind the service is up to the vendor of that EHR service. There will be bells and whistles to go with each flavour. Application vendors will write their applications based on the standard EHR and configuration will be done in a collaborative and cooperative space. Hospitals and even general practices (if they wish) will be able to have their records independent of any clinical application. Patients will too! Clinicians take a key role in determining what content is required and how it may be structured effectively and efficiently to “boost” their performance. At times, data to be collected will be for the person’s long term benefit, such as determination of risk of stroke or other preventable catastrophe. Other times, it will be structured to ensure the best possible outcome for the patient, such as an emergency presentation of chest pain. I have chosen to work on the second approach since

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1986. Why am I working on this when the first is the massively dominant approach at the moment? The answer is: because I believe it will get there first. “How?” you might ask. Simply because the first approach cannot deliver. Imagine if we worked in a world with thousands of word processor applications — actually hundreds of thousands — which did whatever you needed to allow you to write things that were important to you in just the way you wanted. And then each vendor could get together and agree how to use XML or other standards to extract the paragraphs about your family, those about your medication, or those with pictures so you could share them with colleagues doing the same sort of work. Each of these messages would be specific to that type of information and ideal for exchanging these. We could even have special messages for sending information about more complex groupings of the information in these agreed messages — which could be slightly different if required in different jurisdictions. Does it sound plausible? Well, if you consider the complexity of health information compared to word processing documents, then you begin to realise why it is not attractive to me. So where to start? The first problem is to agree about what is needed clinically, how to allow structure and narrative to coexist in a manner that helps clinicians find relevant information. To do this we must be sure that the critical things that computers need to provide the functionality we seek are done in a consistent manner throughout. The rest, in openEHR, is in the archetypes: the clinical statements or models of what is to be recorded and how it may be structured. These statements are formal and can be used, in the first instance, to provide system developers in our current setting with a very helpful indication of what is required and what will be shared. The approach allows us to decide what we want to share and how to structure the information. Once we have decided upon the information that we want to share, we can involve a broad range of clinicians, consumers and other users in what we might want to say in a structured way about this thing that is to be shared. These requirements can be pulled together in a collaborative manner over the web using the new openEHR Knowledge Manager to provide an inclusive and maximal data set. This can be tailored later for local use. Ian McNicoll has discovered in his work with clinicians in the UK NHS that they find it easy to say what they don’t want in a data set but find it much more difficult to say what they do want when presented with a blank sheet. The “maximal dataset” archetypes provide the ideal starting point. The natural sponsors for specifying content are national jurisdictions and the international clinical community. The engagement of clinicians is crucial: it must work for them or it will not be used. What is next? Well, hospitals and jurisdictions can now choose to hold their records in a standard format; not just an

exchange but at the heart of their system. Their purchasing then requires applications to read and write to their records, just like a locum clinician is expected to use the clinic’s record system. But now they can bring in an intensive care application best suited to their needs, the ophthalmologists can use their own application with all the features they require and the gastroenterological researcher can even collect their research data in the clinical environment (after all 95% of it is straightforward clinical data). So far this has only happened twice, but this year it looks like more will take the step. After all, if we are to have any progress we need early adopters. If the collective “configuration” is available through shared sets of clinical archetypes then system developers can choose to build their product on a standardised EHR. The benefit is that all the transformations required can be cooperatively determined with shared tools and the evolution of the information is not their responsibility. There are now 3 clinical application vendors taking this approach in Australia and 2 in the Netherlands. These applications then become the choices for the hospitals and others with standardised health records. There is another important benefit to agreeing upon the logical record and archetypes. For the last 30 years or so we have been trying to use terminology effectively. Initially ICD and ICPC provided terms suitable for classifying morbidity and reasons for encounter. The UK and the College of American Pathologists were more ambitious and have brought their diverse individual efforts together to provide a very large bag of medical phrases and a proposal of how to string these together to provide unambiguous meaning. The fact is that free floating terminology will always be potentially ambiguous and determining the meaning of phrases that are constructed from such a large set needs considerable computing power. I have no doubt that it is an intellectually satisfying task and does what Galen, the pioneering project in the field, described as “making the impossible very difficult”. Archetypes provide a context for terminology and massively reduce both the processing demands and requirements. This is being acknowledged by many thought leaders, particularly those who are trying to work with current messaging

technologies. An archetype agreed by clinicians in a few minutes which is quite unambiguous can send SNOMED CT experts into a frenzy trying to determine which codes relate to which part of the archetype. If we want system developers to use SNOMED CT any time soon in their products then it is beholden on us to make this feasible and empowering for communication and automatic processing. Agreeing on a “logical record architecture” and a significant set of archetypes (in the hundreds) provides a foundation for health informatics that has not been available to this point. It will take a while before the real benefits are obvious. It will, after all, be like having Microsoft Word files — even if you use Open Office or whatever. Different tools and applications will be able to work on the consistent platform; not just any arbitrary platform but the platform of consistent representation of personal health information. Decision support can now work on information captured at different locations, population data is available in a straightforward manner and the representation of clinical data is no longer conjured in small backrooms of thousands of hospitals around the world. Health care’s greatest asset in providing quality health care, the longitudinal health record, can be available in a manner that suits the environment and the patient it supports; the patient may choose to hold it on a memory stick or phone, in a secure EHR bank, or with their general practitioner or favoured provider. It may be distributed in large part for convenience or due to privacy concerns. Importantly, it may hold different summaries at different points of care or different types of users. And all of this is multilingual from the ground up. Australia was on the brink of taking this route — “common sense” pulled us back. With Denmark and Sweden now joining the UK and pursuing this path and with changes at the helm at many levels in Australia, it might be time to look over the precipice again. It feels safer when you jump with others.

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BITS & BYTES PDF NOW AN ISO INTERNATIONAL STANDARD The popular Portable Document Format (PDF), is now accessible as an ISO International Standard. This development follows a decision by Adobe Systems Incorporated, original developer and copyright owner of the format, to relinquish control to ISO, which is now in charge of publishing the specifications for the current version (1.7) and for updating and developing future versions.

TV CONTENT NOW AVAILABLE THROUGH ITUNES STORE IN OZ Apple Australia has made a limited selection of TV content available for purchase and download via its popular iTunes store. Each TV program retails for $2.99, and can be viewed on a computer using iTunes, on Apple iPods and iPhones, or using an Apple TV device. The availability of TV programming through the iTunes Store is seen as a logical step towards the introduction of iTunes movie rentals in Australia, a service that Apple’s North American customers have had access to since January this year.

HEALTH IT COALITION LAUNCHES WEBSITE The Coalition for eHealth has launched a website to focus attention on the goals of the organisation, most notably the advocation for the development of a comprehensive national plan for e-Health. A diverse group of over 45 member organisations are listed on the site: www.ceh.net.au

OPEN SOURCE HL7 VIEWER RELEASED New Zealand Health IT software developer, Les Ferguson, has publicly released a HL7 message viewer and editor. Dubbed “QuickViewHL7”, the software is released under an Academic Free License and is available on SourceForge.

NEHTA releases Individual EHR Privacy Blueprint On 3rd July, the National E-Health Transition Authority (NEHTA) released their “Privacy Blueprint for the Individual Electronic Health Record”. Weighing in at 36 pages, the document has been made available for public comment via the NEHTA website. The release of the Privacy Blueprint constitutes a step along NEHTA’s path to develop a business case for a national electronic health records system. Such a business case will be presented to the Council of Australian Governments (COAG) for consideration in late 2008. Sharing many functional similarities with the myriad of emerging industry-driven Personal Health Record (PHR) systems, NEHTA’s proposed Individual Electronic Health Record (IEHR) system centralises the storage of key clinical information to facilitate timely access when such information is required by clinicians. A typical patient IEHR will include a health summary including details about the patient’s allergies, current and past medications, problems and diagnoses, family and social history, immunisations, implanted devices, screening results, key physiological measurements, and care plans. Pathology results, radiology reports, referrals and discharge summaries will also be included in the patient’s IEHR. In a departure from typical cliniciancentric EHR systems, patients will have the ability to input their own information into a

designated part of their record. In keeping with its moniker, individuals will be responsible for controlling access to their own IEHR. If the patient desires, different access privileges could be assigned to different parts of the record, allowing a patient to limit access to sensitive parts of their record to selected clinicians. It is proposed that in the event of a clinical emergency, health care workers will be able to temporarily override these access restrictions to ensure that they have access to all relevant clinical information included in the record. Such emergency access would be stringently monitored using audit functionality to deter abuse of such privileges. In their Privacy Blueprint, NEHTA have stressed that the IEHR system is designed to complement — rather than replace — clinician managed health record systems such as those found in private practice and hospital settings. As with NEHTA’s proposed Individual Healthcare Identifier (IHI) initiative, patient participation in the IEHR system will be optional. It is intended that patients will be able to enroll in the scheme via a website, over the phone, at a general practice, or in person at offices staffed for this purpose. If their application to COAG for IEHR funding is successful, NEHTA expect that the IEHR program will commence deployment in three years, with roll-out taking up to five years to complete.

Australian Telehealth Society commences membership drive Formed in early 2008, the Australasian Telehealth Society (ATHS) is now calling for members. According to the ATHS website, “the society has been formed to provide a forum for information sharing, investigation and promotion of Telehealth for those involved in providing healthcare over a distance in Australia and New Zealand”. The price of an individual ATHS membership has been set at $50, with students expected to pay just half this amount. Bulk corporate memberships, which include promotional benefits, are also

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available. Society President, Professor Kanagasingam Yogesan, Director of the Centre for eHealth at the Lions Eye Institute in Perth WA, leads a committee that has been established to take the ATHS through its formation stages. Founding committee members include Dr Anthony Maeder (eHealth Research Centre, CSIRO), Dr Laurie Wilson (ICT Centre, CSIRO), Dr Colin Carati (School of Medicine, Flinders University), Anne Galloway (New England Area Health Service), and Dr Anthony Smith (Centre for Online Health, University of Queensland).

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BITS & BYTES HISA NSW HOLDS AGM HISA’s NSW Branch held their Annual General Meeting on 31st July. Robyn Cook was returned to the Chair, with Marie Cameron, Vineesh Thanna, Di Pelletier, Malanie Ford, Cathy Doran, Steve Tipper, and George Margelis accepting the other positions on the Executive Committee.

NEHTA LAUNCHES RECRUITMENT PORTAL The National e-Health Transistion Authority (NEHTA) has launched a new website to showcase the organisation to potential employees. NEHTA, which currently has over 170 staff spread across four offices, hopes the portal will assist it to attract suitably qualified clinicians and IT professionals to work on its various eHealth work programs. The recruitment portable is accessible at http://www. myehealthcareer.com. au, and is linked to a list of currently available employment opportunities on NETHA’s primary website.

HISA prepares for 2008 Health Informatics Conference The Health Informatics Society of Australia (HISA) is preparing for the peak group’s Health Informatics Conference 2008 (HIC’08), which will commence on Sunday, 31st August, at the Melbourne Convention and Exhibition Centre. Having been incorporated into the triennial MedInfo conference last year, the Health Informatics Conference returns as an independent event with a conference theme of ”The Person in the Centre”. The conference has attracted an impressive contingent of local and international keynote speakers, including “2007 UK Health ICT champion”, Dr Mike Bainbridge. A former general medical practitioner, Dr Bainbridge currently leads the Clinical Architecture, Assistive Technology, and Clinical Decision Support teams at NHS Connecting for Health. Speakers from the USA include Neil Jordan, Microsoft’s senior executive, chief strategist and spokesperson for healthcare Provider initiative worldwide,

David Whitlinger, President and Chair of the Continua Alliance and a Director of Healthcare Device Standards and Interoperability for the Intel Corporation, and Dr Lyle Berkowitz, a practicing internal medicine physician and founder of the Szollosi Healthcare Innovation Program, a not for profit organisation with a mission to “use creative thinking and diverse technologies to produce a better healthcare experience for patients, physicians and others associated with their care”. Local keynote speakers include Dr Ken Harvey, the Adjunct Senior Research Fellow, School of Public Health, La Trobe University, and a member of the National Prescribing Service Electronic Prescribing Study Guidance Group and their Research and Development Working Group, Loane Skene, a Professor in the Law Faculty and an Adjunct Professor in the Faculty of Medicine, Dentistry and Health Sciences at the University of Melbourne. Beth Wilson, Victoria’s Health Services Commissioner,

Below - A scene from last year’s MedInfo Interoperability Showcase. The Showcase will be convened for a fourth consecutive year at a joint industry exhibition run in parallel with the conjoined Health-e-Nation and HIC’08 conferences.

HOLLYWOOD HOSPITAL DEPLOYS HYBRID COMMUNICATIONS Perth’s Hollywood Private Hospital, has commenced deployment of new telecommunications infrastructure developed by Nortel. According to a statement released by Nortel, the CS 1000 IP PBX was selected by the hospital because its ability to interface with the hospital’s existing legacy telecommunications infrastructure, whilst still allowing the facility to take advantage of modern IP-based functionality.

NEHTA RELEASES FACT SHEETS NEHTA has released a pair of fact sheets. The first provides an overview of the proposed IEHR, while the second discusses SNOMED CT and its importance in a shared EHR environment.

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BITS & BYTES and Helen Hopkins, the Executive Director of the Consumers Health Forum of Australia will also be delivering keynote presentations, as will Michael Legg, current President of the Health Informatics Society of Australia. Flanking both sides of the HIC’08 conference proper are several Health Informatics and Health IT related conferences dealing with nursing, aged care and policy domains. The conjoined events program commences on Saturday, 30th August, with the Nursing Informatics Australia 2008 Conference. Hosted by HISA Special Interest Group, Nursing Informatics Australia, the theme selected for the conference is “eHealth: Where do Nurses Fit?” In addition to panel discussions and vendor presentations, the event will feature presentations on patient centred care, electronic medication systems, and “I-Folio”, an online professional development program for nurses. Representatives from NEHTA are also scheduled to present at the conference. On Wednesday, September 3rd, CHIK Services will host their annual Health-eNation conference. The theme for the event is “ICT enabled Quality of Care and eQuality of Access”. Notable presentations will be delivered by Dr Sarah Muttitt, who will share her ideas on national program adoption drawn from her Ministry of Health Holdings role in Singapore and her previous position as Vice President Innovation and Adoption at Canada Health Infoway, and Dr Martin Harris, CIO of Cleveland Clinic Foundation, the healthcare organisation selected by Google as its first Personal Health Record test site. Representatives from NEHTA will also be in attendance, with Mr Andrew Howard, NEHTA’s Interim CEO, and Dr Murkesh Haikerwal, NEHTA’s recently appointed Clinical Lead, confirmed as speakers. In addition to these and other presentations, Health-e-Nation will feature two extended panel sessions with invited participants drawn from health care organisations, Government, and the Health ICT industry. To complement their conference, CHIK Services will host an invitational CIO workshop to follow Health-e-Nation on Thursday, 4th September. In an initiative which appears to have

been welcomed by industry participants, the organisers of Health-e-Nation and HIC’08 have teamed up to co-host a joint industry exhibition, which will run for the duration of both conferences. The organisers report that exhibition space sold out months in advance of their prescribed deadline, highlighting the growing attention both local and international vendors are affording the Australian e-Health sector. For the first time at a HISA event, the exhibition will feature a service dubbed “Expo TV”. This will consist of a large projection screen hung from the ceiling at the rear of the exhibition hall, in addition to plasma monitors positioned in other key locations. Using these screens, the exhibition organisers intend to broadcast interviews with keynote presenters, academic and industry paper presenters, and other people of interest. The filming of such material will take place at the event in a studio established for this purpose. For the fourth consecutive year, an interoperability showcase will be held at the HISA event. To be positioned prominently at the centre of the exhibition hall, the showcase will allow participating vendors to demonstrate the interoperability capabilities of their products in real time. The string of showcase e-Health events concludes on Thursday, 4th September, with the Information Technology in Aged Care 2008 conference (ITAC 2008). ITAC has been convened to provide useful IT planning and implementation information for executives and managers working in Aged Care. According to the organisers, the event will cover broad business and strategic issues, as well as hints and techniques to help attendees implement IT solutions to improve the efficiency and quality of the aged care services they provide. The busy week of academic and industry proceedings will be complemented by an array of social and networking engagements. Among these are the Nursing Informatics Conference cocktail party (30th August), the HIC’08 Welcome Reception and Official Exhibition Hall opening (31st August), the HIC’08 Gala Dinner (1st September), CHIK’s Health-e-Nation Invitational Dinner (2nd September), and the Aged Care Industry IT Awards Dinner (3rd September).

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BITS & BYTES NEHTA APPOINTS NEW CHAIR David Gonski AC has been appointed Chairman of the National E-Health Transition Authority (NEHTA). Having originally trained as a solicitor, Mr Gonski is an accomplished business man, and currently the Chairman of Investec Bank (Australia) Limited and Coco-Cola Amatil Limited. Mr Gonski also holds many directorships, occupying seats on the boards of the Westfield Group, Singapore Airlines and the ASX Limited. Mr Gonski is NETHA’s first independent director, and the fourth person to occupy the position in the organisation’s closely scrutinised three year history. Outgoing NEHTA Chairman, Dr Tony Sherbon, welcomed his successor’s appointment. “With the appointment of Mr Gonski NEHTA is indeed fortunate to have an independent director with exceptional experience and skill as a company Director and Chair, and who has the capacity and time to take on the key leadership role of Chairman” Dr Sherbon said. Mr Gonski’s appointment comes just three months before COAG will meet to consider funding proposals for a range of e-health related initiatives, including NEHTA’s Individual Electronic Health Record scheme.

Doctors’ Control Panel software utility released for MD3 Dr Anton Knieriemen, a GP from Ormond, has publicly released a software extension for HCN’s Medical Director 3 (MD3). Dubbed the Doctors’ Control Panel (DCP), the software utility is designed to facilitate compliance with Red Book guidelines and diabetes management guidelines. While many clinical software solutions now include automated alert and reminder functionality, according to Dr Knieriemen, to comprehensively encompass all script checks, MBS Item prompts and Red Book preventative care prompts via individual popup boxes would require over a dozen such alerts to appear. Such an arrangement would significantly impact on the ability for the clinician to quickly interact with the electronic patient record for the purpose of rapid data entry or script generation. Dr Knieriemen’s solution, the DCP, is built around a single panel interface that unobtrusively conveys a snapshot of selected clinical information. This panel can be configured to popup automatically when patients records are opened in MD3, or it can be manually summoned using a button in the Microsoft Windows task bar. Using a “traffic light” colour scheme to indicate the status of clinical measurements, clinicians are able to determine at a glance whether Below - The DCP popup panel showing a selection of the visual prompts that can be displayed by the utility. On a per patient basis, red flags indicate tasks that have not been completed, yellow signifies overdue tasks, and green indicates that an item is up-to-date.

NATIONAL E-HEALTH STRATEGY PRESENTATION AVAILABLE FOR COMMENT Deloitte, the consultants engaged to formulate a National E-Health Strategy for Australia by the National e-Health and Information Principal Committee (NEHIPC), have made available a slide pack from a recent stakeholder briefing session. At the time of writing, the Health Informatics Society of Australia (HISA) is making the document available on request via a form on the HISA website: www.hisa.org.au

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additional information needs to be collected from the patient and subsequently entered into the database. Hovering over specific items on the panel with the mouse pointer triggers a popup bubble that provides more information about the status of the patient and the applicable guidelines. In addition to the panel itself, the DCP utility allows statistical data analysis to be performed on the entire clinical database. Summary data relating to the practice’s performance against Red Book guidelines can be displayed in a tabular form, or rendered into a series of pie charts. Separate functionality allows Diabetes PIP sheets to be generated, and copied back into a MD3 letter or medical report. An early adopter of the solution, GP Dr David Guest, has found the tool to be a worthwhile addition to his core clinical software, stating, “We have found Anton Knieriemen’s, Doctors’ Control Panel very useful in the management of our diabetic patients. It clearly highlights clinical and biochemical parameters that are not to target, or worse, have been completely overlooked.” The DCP can be freely downloaded from the product website (http://www. pracsoftutilities.com) and installed on any workstation running MD3. While early versions of the software required that both MD3 and PracSoft 3 be installed, recent iterations of the software can provide clinical alert functions to practices using other billing packages. A version of the DCP intended for use with Best Practice is understood to be in development. As the DCP does not have write access to the clinical database and does not transmit data outside of the practice network, Dr Knieriemen reports that the software can be safely used on a live practice database, or first tested on the MD3 “Samples” database. Released for general consumption just three months ago, the software has evolved rapidly in-line with feature requests from an enthusiastic and burgeoning user base. Integration with Google Maps has been recently added, allowing directions from the practice to the patient’s home to be displayed in a web browser for reference or printing. Maps displaying driving directions from the patient’s home to another clinician’s practice can also be generated.

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HIMAA Symposium to be held in September The Health Information Management Association of Australia (HIMAA) will host its annual symposium on the 25th and 26th September. With a focus on eHealth and Standards, the event, to be held in Canberra, is expected to attract over 130 Health Information Managers and industry representatives. A preliminary program for the event has been released on the symposium website, which promises an impressive line-up of speakers. The event will commence with an opening address from Katy Gallagher, ACT Minister for Health, who will precede keynote presenter, Julie Roediger, Deputy Director of the Australian Institute of Health and Welfare (AIHW). At a time when the Health Information Management industry is undergoing significant change, HIMAA President, Trish Ryan will review the status of the association and profession. Heather Grain will present on the subject of clinical terminologies, and will later co-facilitate a workshop on SNOMED CT with Elizabeth Moss. Other workshops on “Effective Communication Skills” and “Privacy Issues for Health Information Managers” will be hosted by Mary Durkin and Sue Read respectively. The second day of the symposium will commence with a presentation from NEHTA. Dr Michael Legg, President of the Health Informatics Society of Australia (HISA), will then present “A vision for an Australian Healthcare System Transformed by Health Informatics”. Professor Jon Patrick of the University of Sydney will discuss the clinical systems development work being undertaken by the Health Information Technologies Research Laboratory. Among the specific technologies to be outlined are the Ward Rounds Information System (WRIS), Clinical Data Analytics Language (CDAL), Handovers Information Systems (HOIS), and Patient Workflow System (PWFL). Chris Mount, Director of Clinical Communications at the Department of Health and Ageing eHealth branch, will discuss the importance of “Aligning Health Information Standards with the National eHealth Agenda”. Professor Bruce Barraclough, eHealth Medical Director, CSIRO will discuss the CSIRO’s ICT healthcare research, which is carried out under the auspices of the Australian eHealth Research Centre. President HL7 Australia, Klaus Veil, will provide an update on the Integrating the Healthcare Enterprise (IHE) initiative, an organisation, which, by the time of the HIMAA symposium, will have recently held a technology “Connectathon” and interoperability showcase. Representing the National Data Development and Standards Unit, AIWH, Miriam Bluhdorn and Sally Goodenough will discuss the “Impact of eHealth on Australian Statistics”. The symposium will conclude with a presentation by Cheens Lee of La Trobe University titled “How prepared are Health information services for System Failures?”. The academic discussions will be complimented by a trade exhibition and vendor presentations from 3M Health Information Systems, InfoMedix, File Technology, InterSystems and BITG Health.

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HL7 Australia hosts conference

In what Tobin Brothers Funerals are claiming as an Australian first, the company now offers future customers the opportunity to prearrange their own funeral via the company’s website. Tobin Brothers Funerals Managing Director Martin Tobin said that offering the online funeral planning service, in addition to the traditional faceto-face meeting with a funeral planner, reflected the changing demands of clients. “More and more people are choosing to communicate with us through our website and via email, so we see this service as a natural extension to provide an online alternative to plan their funeral,” Mr Tobin said. “Not everyone has the time to sit down with our funeral planners and go through the detail of planning a funeral, and some people just aren’t comfortable talking about their own funeral. Sitting at the computer in their own home, they can now go online with complete anonymity and at their own pace to plan their funeral.” Mr Tobin said traffic on the Tobin website has doubled each year since it was first established in 2001. It currently receives 87,000 unique visitors a year, and he expects this growth to continue with the introduction of the online funeral planning service. “More and more people of middle age regularly use the internet today and we believe this new funeral planning service will suit their needs,” Mr Tobin said. “Also, the nature of funerals is changing, with increasing emphasis on the celebration of the life of the deceased. This online service allows people to plan every detail of the funeral: from the style and colour of the coffin and the music from our library of 1,300 tunes to who should be pallbearers,” Mr Tobin said.

HL7 Australia held a national conference in Brisbane in early July. Commencing on Tuesday 8th and concluding on Wednesday 9th, the conference attracted over 70 delegates and featured several presentations on Clinical Document Architecture (CDA), in addition to a variety of technical presentations on other HL7related subject matter. Representatives from two of HL7 Australia’s newest major benefactor member organisations, NEHTA and EDS Australia, were in attendance. NEHTA’s interim CEO, Mr Andrew Howard delivered a presentation on the organisation’s work program, which included a discussion about the recently proposed Individual Electronic Health Record. Mr Steve Wagner, a US Health IT expert currently working as an Enterprise Architect with EDS Australia, delivered a presentation on the importance of standards in Enterprise Architecture. Dr Peter MacIsaac, an eHealth Architect for EDS Australia, provided attendees with an overview on CDA as it pertains to discharge summaries. HL7 Australia Chairman, Klaus

Veil, brought attendees up to date on the progress of the Integrating the Healthcare Enterprise (IHE) Connectathon, an interoperability event that was subsequently held in Canberra in late July. In his capacity as President of the Medical Software Industry Association (MSIA), Dr Vincent McCauley provided an update on the industry group’s Desktop Systems Interoperability Project. This presentation was complemented by another, delivered by Dr Andrew Magennis, which dealt with GP software standards and conformance guidelines. Two presentations on clinical archetypes, delivered by Heath Frankel and Andrew McIntyre, were also included in the conference program, which concluded with a “virtual” tour of the Australian eHealth Research Centre, the facility in which the conference was hosted. Convenor, Klaus Veil, expressed delight with the strong attendance and participation at the conference, stating, “The recent reorientation of NEHTA and the holding of the first formal IHE Connectathon are important steps forward for eHealth in Australia.”

Doctors’ e-cohort study calls for participants A research project has been established to examine factors influencing the career decisions of Australian doctors and medical students, and the recruitment and retention of doctors in metropolitan, rural and remote regions. By replacing paper-based data collection methods with online surveys, the “Doctors’ e-Cohort Study” plans to adapt traditional longitudinal epidemiological research methods to follow cohorts of medical students and graduate doctors through their careers. The study is funded by the Australian Research Council in partnership with Queensland Health and the Royal Australian College of General Practitioners, and is led by researchers from The University of Queensland. The study will follow a similar methodology to that used by the Nurses and Midwives electronic cohort study — a workforce research project that commenced in 2006 and has, to date, attracted over 10,000 participants from

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Australia, New Zealand and the United Kingdom. Participants will be asked to respond to a web-based survey once per year for five years that seeks information related to basic demographics, patterns of employment, workplace environment, job satisfaction, personal health and lifestyle issues, and stress-related conditions to explore how these factors impact upon the recruitment and retention of doctors. The final results of the study will be published at the end of the 5-year study. Participants will be able to maintain their contact details online, and newsletters will be sent at regular intervals to keep participants informed about the progress of the study. All medical practitioners living or working in Australia and all students studying medicine in Australia are invited to participate in the study. Doctors interested in participating in the study can enlist via the e-Cohort website (http://doctors.e-cohort.net).

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BITS & BYTES APPLE RELEASES 3G IPHONE IN AUSTRALIA On 11th July, Apple Inc released its much anticipated 3G capable iPhone. The phone, which retails in 8GB and 16GB versions, is capable of connecting to HSDPA networks, facilitating mobile broadband web access when used in conjunction with the included Safari browser. The phone was launched alongside a new software store dedicated specifically to the iPhone and its less capable sibling, the iPod Touch. Hundreds of applications have already been sanctioned by Apple for distribution via the store, the majority of these costing only a few dollars. Notably, within three weeks of the iPhone software store’s release, over sixty healthspecific applications had been made available for purchase or download.

MOZILLA RELEASES FIREFOX VERSION 3 Mozilla has released a major update to its popular open source web browser, Firefox. Now in its third iteration, the software includes several major enhancements, and over “15,000 improvements”. The browser is faster and contains more security features than both its predecessors and competitors, and also includes several user interface enhancements designed to provide users with a more efficient web browsing experience. Firefox 3 is available for MacOS X, Microsoft Windows and Linux.

IHE initiative delivers successful interoperability “Connectathon” Integrating the Healthcare Enterprise (IHE) Asia Pacific hosted the first Australian Interoperability Connectathon in Canberra during the last week in July. In IHE’s own words, “A Connectathon entails systems exchanging information with complementary systems from multiple vendors, performing all of the transactions required for the roles they have selected, called “IHE Actors”, in support of defined clinical use cases, called “IHE Profiles”. The Connectathon provides detailed validation of the participants’ interoperability and compliance with IHE profiles. Participating companies prepare for the event using testing software — the MESA test tools — developed specifically for this purpose.” IHE Asia Pacific is governed by a consortium of organisations, including HL7 Australia, HL7 New Zealand, the Medical Software Industry Association (MSIA), the Health Informatics Society of Australia (HISA), the Royal Australian and New Zealand College of Radiology (RANZCR), and the Australian Diagnostic Imaging Association (ADIA). Twelve vendors participated in this years Connectathon, namely AGFA, CDN, GE Healthcare, Initiate, Intel, Kestral, McCauley Software, MediNexus, Oracle, RadLogix and Voyager PACS. These vendors submitted a

total of seventeen products for testing during the event. During the Connectathon, twelve IHE Profiles were tested in the areas of Portable Document Imaging (PDI), Australian Diagnostic Reporting, and Cross-Enterprise Document Sharing (XDS). The first PDI profile tested was the “Portable Media Creator” profile. Vendors looking to comply with the Portable Media Creator profile were required to demonstrate that their software could generate a diagnostic image CD according to the profile, which has been designed to maximise the compatibility of compliant CDs with recipient clinical computer systems. The need for such compliance testing in Australia was highlighted at last year’s 2007 Royal Australian and New Zealand College of Radiologists (RANZCR) Annual Scientific Meeting, where a “CD Challenge” was convened by several diagnostic imaging stakeholder groups. During this process, thirty three CDs containing diagnostic images were volunteered for testing by radiologists and diagnostic imaging software developers. Following compliance testing against the IHE PDI Portable Media Creator profile, it was discovered that there was a significant amount of variability in the way these CDs performed when inserted into computer

Below - Visitors touring the IHE 2008 Connectathon Open Day, which was held in Canberra in late July. Twelve vendors participated in the four day event designed to test the interoperability capabilities of their systems. Photo supplied courtesy of Warrick Jackson, Oracle.

WINE V1.0 RELEASED After 15 years of development, the developers of Wine have released their first non-beta version of the enduring Linux program loader. Wine is distinguishable from most modern virtualisation products, as it does not require a copy of Windows be present to run software coded for Microsoft’s operating systems.

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BITS & BYTES systems typically used by GPs, specialists and other healthcare organisations. These findings support anecdotal evidence, which suggests that CDs are currently of limited use and are generally not reliable for the purpose of storing and transporting diagnostic images between healthcare providers. During the IHE PDI profile testing in Canberra, seven products from five vendors were tested, six of which were being scrutinised by the IHE process for the first time. In addition to CD generation capabilities, two other IHE PDI profiles were tested. The first of these, dubbed “Image Display”, was used to test the ability of the participating software products to read and display images directly from an inserted CD. The final IHE PDI profile, dubbed “Portable Media Import”, was used to test the ability for clinical systems to seamlessly import images and their associated patient demographics from IHE PDI compliant CDs. The second group of profiles tested during the Connectathon were the Australian Diagnostic Reporting profiles. These profiles are based on the HL7 version 2.3.1 Australian Standards for patient identification (AS 4700.1), pathology reporting (AS 4700.2), and diagnostic imaging reporting (AS 4700.7), and include additional implementation details. Profiles dealing with both message creation (Image Report Creator) and message processing (Image Report Processor) were used to benchmark the HL7 message handling capacity of nine software products involved with the Connectathon. The remaining seven IHE profiles tested during the connectathon were associated with Cross-Enterprise Document Sharing (XDS) including use of Web Services. XDS is a collection of profiles concerned with the provision and access of patient information that is of common interest to health service providers involved in the provision of care for patients. XDS profiles cover global patient identification, document registry, document repository, submitting documents, consuming documents, audit services, and signing and encrypting documents. XDS allows for all components to be individually federated including registries and repositories. This supports a de-centralised deployment model where infrastructure can be

established regionally and linked together to provide ubiquitous access across a state or a nation. Vendors involved in testing included Initiate Systems, GE Healthcare, Oracle and Intel. Intel’s recently released SOE-Expressway solution provided a “HL7 on-ramp”, which converted HL7 messages to CDA before matching to a global patient identifier using Initiate System’s PIX/PDQ Manager, and then storing in Oracle’s HTB clinical repository. A similar “HL7 off-ramp” service was provided to retrieve a document and convert it to HL7 to be consumed by a clinical application. GE Healthcare also supported the Connectathon as a document source and document consumer. Profiles for XDS also exist to support a publish-subscribe model (using Web Services) that allows interested parties (such as a provider waiting for a test result, or a provider as part of a care team) to be pushed new information or updates when submitted. A free Connectathon “Open Day” was held on Wednesday, 30th July, with the Connectathon program concluding with a Web Services forum the following day. Facilitated by Mark Angove, the forum explored the challenges of implementing Web Services to securely exchange patient sensitive information. The forum provided a platform for open discussion between organisations such as NEHTA, health jurisdictions, health policy makers and the health software industry. Speaking at the conclusion of the event, the IHE Asia Pacific Connectathon Manager for 2008, Klaus Veil, said “I’m delighted with the success of the participating local and international companies, of which a number will now have international IHE certifications, which gives them access to the global market. Additionally, local and international vendors, for the first time, are IHE certified to the Australian diagnostic reporting profiles.” This year’s IHE Asia Pacific activities will culminate with a prominent public showcase at the Health Informatics Conference (HIC’08), which commences in Melbourne on 31st August and runs for several days. Convened for the fourth consecutive year, the showcase will provide at least fourteen vendors with the opportunity to demonstrate — in real time — the interoperability credentials of their Health IT solutions.

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Connecting general practice to broadband Many readers will be aware that the Broadband For Health (BFH) incentives for using “qualified” broadband Internet services in GP clinics ceased in December 2007. As a result, the majority of practices in Australia that accessed the program will need to review their contracts with Internet Service Providers (ISPs) when existing contracts expire. Therefore, the inclusion of the “Connecting general practice to broadband” guide with this edition of Pulse+IT, is a timely initiative. The broadband guide, which is also available online at http://www.agpn.com.au/broadbandguide, was developed by the Australian General Practice Network (AGPN) and a network of eHealth officers who supported access to the BFH program, within the Divisions Network, in each state and territory. AGPN acknowledges the financial support of the Australian Government Department of Health and Ageing for enabling this work. During the course of the BFH program, it was clear that accessing accurate information about the details of a broadband service could be difficult for practices. At the same time, the number of affordable options for high-speed broadband services available to practices has increased, primarily because of the introduction of ADSL2+ and the increasing availability of SHDSL. Nevertheless, purchasing a plan advertised as “business grade broadband” — the term used to define services available under the program, but also in common use in the industry — will not guarantee that the ISP will offer a reliable and consistent service. What does general practice use broadband services for? Many applications are not affected by short delays or variations in the amount of available bandwidth, such as web browsing, reviewing evidence-based medicine resources on the Internet, downloading software updates, or using secure clinical or billing communication services. However, there are an increasing range of applications where such delays are not tolerable, such as Voice over Internet Protocol (VoIP) or remote access, which suffer from small delays. The BFH program also provided incentives for ISPs to adapt to the needs of general practice through “value added services”. Over the last two years, many ISPs have begun including similar services to those that were offered under the BFH program, such as online data backup, VoIP services, SPAM filtering and antivirus options as part of many business and domestic grade broadband plans. A review of websites from 12 ISPs previously regarded as “qualified” shows that several continue to offer ADSL2+ business

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plans that are targeted at clinics. AGPN offers this information as a starting point for research only, does not endorse any particular ISP, and encourages practices to investigate their options fully as suggested in the broadband guide. Options include: • Telstra’s “business broadband” advertises 99.85% reliability and 24x7 support, online backup services, options for MIMS on PDA, SMS messages (integrated with Outlook), hosted email bundled with security features to avoid the risks and overheads associated with running an email server, and options for the management of networking equipment. • Optus also terms its offering as “business broadband”, though directs customers to services such as SHDSL (which advertise 99.9% reliability) for mission-critical or delayintolerant applications. • Pacific Internet’s health offering advertises a range of business benefits, including 99.9% network availability and 24x7 support, a redundant communications link, 5 static IP addresses, and options for managed networking equipment. The Divisions Network has been active in facilitating the adoption of appropriate connectivity in general practice. For example, as previously reported in Pulse+IT, Hunter Urban Division of GP partnered with Pacific Internet to provide integrated support to clinics. This has enabled free data traffic across the network to leverage services including remote desktop support, secure electronic messaging, and online backup services, and secure access to clinic systems from GP homes. The HUDGP service won the Australian Telecommunications User Group “Best Broadband Solution for Small to Medium Business” in March 2007. Broadband access in rural and remote areas faces particular challenges, and for many communities, satellite is the only available solution. The Commonwealth Government’s Australian Broadband Guarantee (ABG), ensures the availability of “metropolitan equivalent” pricing for broadband for eligible customers, which includes small businesses with less than 20 employees. Satellite services have been successfully used by practices for broadband Internet access, and the ABG now includes options for services with speeds in excess of those available under BFH. It is likely that higher levels of service should be considered to enable mission-critical or real-time applications, which are increasingly available in the market, and for some applications, non-satellite or terrestrial broadband has significant advantages. Increasing access to mobile wireless services is creating new opportunities in these areas.

NEHTA

IEHR Privacy Blueprint released The Australian public has been given its first glimpse of how an individual electronic health record (IEHR) may work with the release of a document detailing the proposed privacy considerations for a national IEHR system. The Privacy Blueprint for the Individual Electronic Health Record (Privacy Blueprint) has been put together by the National E-Health Transition Authority (NEHTA), the organisation that has been charged with the task of developing the national foundations for the electronic exchange of information for healthcare purposes. An individual’s privacy and how that is protected is integral to the proposed design of the IEHR. “NEHTA has a responsibility to ensure privacy risks are minimised. The Privacy Blueprint shows how NEHTA takes this commitment a step further by identifying areas where we can take a privacy-positive approach. This is important as it shows how a proactive approach to privacy can become a positive building block in realising the full range of benefits of an IEHR system,” said Dr Bridget Bainbridge, head of policy and privacy, NEHTA. The Privacy Blueprint was released for public comment in July this year to members of the health sector, industry groups, governments, privacy advocates and health consumers to provide feedback on privacy. “The success of an e-health system depends on making sure that privacy protection issues are addressed. If consumers have trust and confidence in the system, and they have a degree of control over how their health information is handled, then we are likely to see a greater uptake of the IEHR,” said Dr Bainbridge. Below: Dr Bridget Bainbridge speaking at a recent clinician and consumer consultation event.

The Privacy Blueprint has generated a lot of interest and elicited a wide range of views from consumers and different areas of the health sector. “Importantly, NEHTA acknowledges that privacy protection not only requires an appropriate legal framework, but that it must also be embedded into the design and operation of the IEHR. NEHTA is working to ensure that privacy standards are incorporated into the technical design of the IEHR from the outset, and that mechanisms are in place to prevent and detect potential privacy breaches in the future, such as thorough audit mechanisms,” said Dr Bainbridge. In addition to a detailed description of how the IEHR will work and be used by consumers, healthcare providers and healthcare provider organisations within Australia, the Privacy Blueprint also provides detailed information about how each of these sectors will access and use the information stored in the IEHR. The IEHR will be voluntary and consumers can choose to participate by registering in a number of ways, such as through a website or via their GP. Once registered, an electronic health record will be created on their behalf which is then ready to start receiving information from healthcare providers. The individual will be able to choose which healthcare providers may access their IEHR, and request that certain information not be included on their IEHR. The IEHR is also expected to give healthcare providers greater confidence in treating patients by giving them access to more accurate and up-to-date medical information, enabling them to make better healthcare decisions in relation to their patients. A Summary Health Profile will be the core document in the IEHR and will contain key facts about an individual at a glance, such as allergies and alerts, current medications and problem history, and will be used by a wide range of providers to assist in clinical decision making. As the Summary Health Profile may contain potentially sensitive data, NEHTA has given considerable thought to the protection of privacy of consumers using the IEHR at the same time as supporting healthcare providers and organisations in using the IEHR data to provide an improved healthcare service. According to the Privacy Blueprint, one of the key considerations in constructing a privacy framework is “balancing the improved healthcare practice and security that a national approach to IEHR brings, against the potential privacy risks that may arise from the IEHR design.” NEHTA is in the process of reviewing all of the feedback it has received in response to the release of the Privacy Blueprint. Once all this data is compiled, a summary report on all the feedback received will be produced and made available on the NEHTA website (http://www.nehta.gov.au).

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RACGP Jane London Jane London works in the Quality Care Unit of the RACGP. jane.london@racgp.org.au

CAT: King of the jungle The development of the Clinical Audit Tool (CAT) by Pen Computer Systems has put GPs, practice managers and practice nurses back in the drivers seat by giving them easy access to their own data. Groups such as pharmaceutical companies and Government have a long history in harnessing the power of data and taking advantage of its myriad uses. However, till now, general practices have had to be content with having a “feel” for what their practice is like but never actually knowing for sure. Enter stage right, the Clinical Audit Tool. Developed by Pen Computer Systems, the tool works by extracting practice data and enabling analysis at a population level. Pen Computer Systems became the RACGP’s preferred supplier of health informatics in March 2008. CAT is distributed via Divisions of General Practice who provide much of the technical and training support. The RACGP’s role is to coordinate this work at a national level. There are many Divisions doing great work and the College would like to help in sharing that knowledge where possible.

A PIECE OF THE PIE CAT works by taking a “snapshot” of a practice population and extracting data related to a number of filters and clinical measures. This allows data to be filtered by demographics (age, gender, timeframe, postcode etc.), condition (diabetes, respitory, cardiovascular etc.), medication and provider. Once data is filtered by the appropriate channels you can explore your population through specific clinical measures. These include those that are relatively straight-forward (eg. allergy status) through to structured information (eg. diabetes SIP item).

DATA SOLUTIONS Many doctors use their desktop systems to suit their consultation style. Not all doctors fill in specific data fields, and where the user is not forced to enter information by the software (eg. to enable a record to close) human nature dictates that variability will occur. Previously this has not been of great importance, as the record was used for individual care. Using the CAT enables practices to identify gaps in their data and “clean” it for future use. By cleansing data, each extraction will enable the CAT to delve further into your practice data and identify even more opportunities for improving the quality of care provided. A simple example of this is selection of gender. Previously some desktop systems did not force gender as a choice. By looking at the broad practice demographics, you can identify those with the sex “other” and code these patients appropriately.

BUSINESS SOLUTIONS The other immediate benefit of the CAT is the identification of new business opportunities. By exploring practice data with the CAT, you can quickly and easily see where you might effectively utilise practice staff time and effort. A simple example of this is use of the CAT by a practice nurse specialising in diabetes or a diabetes educator. This tool will enable them to improve the quality or their patients’ care whilst making the most of enhanced primary care and service incentive payments (SIP) available to the practice. Tracking Below: Easily identify those in your practice population who have had their allergy status recorded.

QUALITY SOLUTIONS The development of the Clinical Audit Tool by Pen Computer Systems has put GPs, practice managers and practice nurses back in the drivers seat by giving them access to their own data. Exploring patient data enables practices to identify discreet cohorts that may not currently receive consistent care. A simple example is pap smear. The CAT will automatically identify the practice’s female population between 16 to 70 and note all ineligible candidates (eg. hysterectomy). It then presents a simple pie chart coded by patient number or percentage that displays those who have a pap smear recorded, not recorded, or are ineligible. You may wish to start with your active patients (at least 3 visits in the last 2 years) and recall those who do not have a pap smear recorded. Once you have the “no pap smear recorded” figure at a level the practice is happy with, you might decide as a next step to explore the pap smear data by last date recorded. You could then recall patients whose last pap smear was over 4 years ago and so on.

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Allergy Status [population = 7498] 4,675 (Nothing Recorded)

2,387 (No Known Allergies)

436 (Allergy Recorded)

Count of Patients with Diabetes SIP Item Recorded in Care Cycle [population = 238] 250

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eligibility of SIPs is less time consuming and frustrating. The reason that the CAT is so exciting is that previously, practices operated in a feedback vacuum. Traditional audits are unattractive due to the administrative burden and cannot be performed across a whole practice population. The CAT enables practices to get a feel for what services they are performing and which populations they should target for improvement. With quality care, data cleansing and business solutions it is a win/win/win situation.

• • •

To read more about the Clinical Audit Tool (CAT), visit www.pencs.com.au. If you would like to use CAT in your practice, contact your local Division of General Practice. Should you want some further information relating to the RACGP’s involvement with CAT, please contact Jane London at jane.london@racgp.org.au.

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AUSTRALIA’S FIRST AND ONLY HEALTH IT MAGAZINE

ISSUE 7: FEBRUARY 2008

SPECIALIST COMPUTING

STREAMLINED AUTHORITY

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INTERVIEW: HOUSTON MEDICAL

In our third interview for 2008, Pulse+IT checks in with Derek Gower, Managing Director of Health IT Software developer, Houston Medical. Pulse+IT: What products does Houston Medical develop for the healthcare sector? Houston supplies software to every sector and while we do have a considerable exposure to general practice, our strength is certainly in the higher priced end of the market where we try to provide a lot more bang for a few more bucks! Houston started in New Zealand in 1988 providing software for physiotherapy where today we still look after about 70% of the installed base. In 1995, at the invitation of a prospective client we developed a fully integrated product for ophthalmology where we are now undoubtedly the market leader in both New Zealand and Australia. Houston works very closely with the major manufacturers from all over the world. Our exclusive EyeMach(c) interface allows DICOM and other digital images, fields and OCT readings to be viewed on any workstation on the practice network. Our expertise with software for specialists led to an invitation to supply cardiology software for clinics in Darwin and Flinders Medical Centre in Adelaide. From this base we now have clients in every state and territory of Australia, as well as Dubai, the Solomons, Fiji and New Zealand, caring for every part of the human anatomy or as I sometimes joke, because of the unique user defined forms, from podiatry to psychiatry Houston does NOT have a problem! Pulse+IT: What Houston Medical features are new users attracted to? A fully integrated program, regardless of whether you wish to couple your digital camera or the latest equipment from Zeiss, Topcon, or other equipment suppliers, book patients in DayStay or send an electronic referral or discharge summary, bill or write a letter. It is usually only one mouse click or one key stroke away. For power users we have a bit of a mantra: “From wherever you

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are to wherever you want to go with only one keystroke!” For hospitals, the Adelaide team have developed a special Java interface which passes selected information to and from the main hospital system, avoiding any double entry. This means that the legacy software (in this case Homer) can share information to and from the state of the art cardiology clinic running Houston. Pulse+IT: Which competing software products can you import data from? We have been supplying and installing software in Australia since 1992 and are delighted to say that our first clients are still clients today. During this we have converted over clients from almost all the mainstream products including Medical Director, Genie, Zedmed, RX, Blue Chip, The Specialist, and several more that have now disappeared in the mists of time. Pulse+IT: How is the data conversion performed? Depending on the complexity, it can be done by the user with special tools provided free by Houston, or, as with a large Eye Clinic and DayStay complex recently completed in Melbourne, the backups are sent to our engineers who complete a trial conversion, this is returned to the practice well in advance of the go live date. Any errors are noted and corrected and the final conversion is usually done over the weekend so installation is completed before the first training session. We are getting better at this with each new conversion and our most recent conversions have brought over all future appointments, letters, prescriptions, clinical notes and patient balances. Pulse+IT: Which secure messaging products does Houston Medical integrate with? We currently fully integrate with HealthLink, CNS and Argus and are developing with Medical-Objects.

Pulse+IT: Does Houston Medical make use of the Australian Health Messaging Laboratory (AHML) HL7 message testing facility, and do you have any plans to have the HL7 message generation and handling functionality of Houston Medical’s products verified by the AHML? Up until now, we have done all our testing with HealthLink, CNS and ArgusConnect. We find that in Australia there really does not appear to be any such thing as a “standard” and we have had to write an interface specific for each carrier and in some cases with the individual software vendor. Houston is registered with the AHML and it will be interesting to see if their “standard” can be enforced as I believe the secure electronic transmission of health information between providers, just like pathology and radiology are now doing, to be the most important next step. While we can provide integration and a paperless environment within the practice, it is essential that the same concepts can now be provided between practices and this depends on standards being agreed and enforced. Pulse+IT: Has NEHTA’s work program had an impact on the functional direction of your products, and the strategic direction of your business? Certainly, as mentioned, Houston passionately believes in standards. We completed an installation of SNOMED CT coding for the SA Division of General Practice and then I delivered the results at a NEHTA sponsored conference. I heard recently that a plumber registered in NSW cannot work in VIC! We are counting on NEHTA not to let that sort of nonsense happen in health. Pulse+IT: Does Houston Medical interface with other clinical or practice management solutions? According to Cam Hawke of Carl Zeiss, we were the first PMS package to interface to their new Visupac software.

We have a button on the medical desktop called â&#x20AC;&#x153;Software Linksâ&#x20AC;?. This allows Houston, with a bit of preparation, to fire a batch file to any third party application, start the application and find the patient information therein. Pulse+IT: How is training and support provided? Initial training is done on site by staff from offices in Australia or New Zealand or, if possible we â&#x20AC;&#x153;borrowâ&#x20AC;? skilled staff from other practices to assist. We can bring in experienced practice managers who provide specialised skills that can only be gained over time. For a recent DayStay installation in Melbourne we were able to â&#x20AC;&#x153;borrowâ&#x20AC;? the manager from a practice in Launceston. If any of our clients would like to register their interest in helping in future installs or even sales, please get in touch! Pulse+IT: Overview your pricing structure. Because Houston is made up like a Lego set with different components for different specialities it is priced per practice requirement. As an indication of policy, the client licenses the parts they need and these can be installed as many times as they like at no additional cost as we only monitor the concurrent users. As the number of users go up, the per licence cost goes down. We donâ&#x20AC;&#x2122;t mind if access is from the comfort of their home, the laptop or the surgery desk.

Pulse+IT: In addition to the Houston Medical licences, what other costs may customers have to meet? In addition to the upfront cost there is the monthly licence fee which gives access to toll free support lines and our website where templates and updates can be downloaded. We also subscribe to a Remote Assist service which is provided to clients free of charge and which allows support staff remote access to provide training and support on the clientâ&#x20AC;&#x2122;s own computer. Pulse+IT: How frequently does Houston Medical release program updates? As required by government legislation and as improvements and suggestions get incorporated. This means usually between three and four times a year. Pulse+IT: Is professional IT assistance required to perform these updates? Only if something goes wrong! We encourage clients to download updates from our website. In most cases it is a simple process of clicking on the install icon and all workstations on the network upgrade, however sometimes expert help is required. Pulse+IT: What new features are you working on that Houston Medical users should look forward to? We are just releasing a completely new build, redone from the ground up, aimed at larger practices and hospitals. Built as a three tier application on a

Microsoft SQL database in C# with .NET, VIP.NET takes VIP to a new level, allowing a group of specialists, doctors and allied health providers in a mixed medical centre to each have their own unique medical desktop, autotext, letters and billing. Wish to combine a group of professionals in sexual health, dermatology, diabetes, retinal screening, ophthalmology and cardiology? No problem. Notes can be shared or kept confidential as the doctor and patient desire. Eventually the specialist will be able to allow patient access to their own notes and further development will allow patients and referring providers to access notes, but of course, all governed by permissions granted by the health provider concerned. I see the next big breakthrough as software as a service, perhaps not over the Internet yet but certainly in the big medical centre. Why not put a big server in the basement providing all services on demand and all the individual practices need to do is to plug the terminal into the outlet just like the electric power or the telephone. All services like backing up, updates and network servicing taken care of by experts in their field. While still to be proved, and I hope not too far ahead of its time, that is where VIP.NET is aimed. Houston Medical www.houstonmedical.net

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EVENTS CALENDAR 6th Annual Australian Telecommunications Summit 27th - 28th August Sydney, NSW P: 02 8908 8555 W: www.acevents.com.au

AUGUST

Security 2008 26th - 28th August Sydney, NSW P: 03 9261 4500 W: www.securityexpo.com.au

Back To The Beginnings: 34th Annual Scientific Meeting 1st - 2nd August Adelaide, SA P: 08 8344 0805 W: www.aspog.org.au

AAPM QLD Practice Managers Conference 2008 29th - 30th August Cairns, QLD P: 07 3257 3930 W: www.aapm.org.au

ACHSE 2008 National Congress 6th - 8th August Alice Springs, NT P: 02 9878 1222 W: www.achse.org.au

Health Informatics Conference 2008 The Person in the Centre 31st August - 2nd September Melbourne, VIC P: 03 9388 0555 W: www.hisa.org.au/hic08

National Public Health Reform Summit 7th - 8th August Sydney, NSW P: 02 9080 4307 W: www.informa.com.au 12th Australasian Medical And Legal Conference 10th - 17th August Perisher Blue, NSW P: 07 3254 3331 W: www.conferences21.com Health & Productivity Management Congress 11th - 12th August Sydney, NSW P: 02 8586 6115 W: www.interpoint.com.au Enterprise 2.0 for Information Professionals 13th - 14th August Sydney, NSW P: 02 9436 4255 W: www.keyforums.com.au Australian Health Congress 2008 20th - 21st August Sydney, NSW P: 02 8908 8555 W: www.acevents.com.au/health2008

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SEPTEMBER Health-e-Nation 2008 3rd September Melbourne, VIC P: 03 9388 0555 W: www.health-e-nation.com.au Information Technology in Aged Care (ITAC08) 4th September Melbourne, VIC P: 03 9388 0555 W: www.hisa.org.au/itac08 Australian & New Zealand Society For Geriatric Medicine Annual Scientific Meeting 2008 8th - 10th September Melbourne, VIC P: 02 9256 5460 W: www.anzsgm.org/asmnews.asp AAPM NSW Branch Workshop 12th - 13th September Sydney, NSW P: 02 9954 4400 W: dcconferences.com.au/aapmnsw

2008 HIMAA Symposium 25th - 26th September Canberra, ACT P: 02 9887 5001 W: www.himaa.org.au AHHA 2008 Congress 25th - 26th September Canberra, ACT P: 07 3210 1646 W: www.ahha2008congress.com.au Smart Cards 2.0 Forum 30th September - 1st October Sydney, NSW P: 02 9238 7200 W: www.marcusevans.com

OCTOBER National Preventive Health Summit 15th - 16th October Sydney, NSW P: 02 9080 4000 W: www.iir.com.au MWIA Wester Pacific Regional Congress 17th - 19th October Melbourne, VIC P: 02 9265 0700 W: www.afmw.org.au Australian General Practice Network Forum 29th October - 1st November Darwin, NT P: 02 6228 0835 W: www.agpn.com.au

NOVEMBER GPCE 14th - 16th November Melbourne, VIC P: 02 9422 2794 W: www.gpce.com.au NET. Health Asia 2008 18th - 20th November Shanghai, China P: +86 21 5236 0030 W: www.nethealthasia.com To view more Health, IT, and Health IT events, please visit the Pulse+IT website. Events can be submitted for consideration online.

2008 C

Australia’s Leading e-Health Conference HIC’08 brings together a broad community of those involved in health care, the information sciences and industry to explore the critical issues that sit at the interface between health care and information technology.

August 31 - September 2, 2008 Melbourne Convention Centre

The Person in the Centre This year HIC’08 will look at the changing role of consumers and providers in health care and the systems that support them.

To ﬁnd out more, or register online, go to:

www.hisa.org.au/hic08

FEATURE Simon James BIT, BComm Editor, Pulse+IT simon.james@pulsemagazine.com.au

An introduction to Personal Health Records INTRODUCTION Having first been discussed in academic papers in the late nineteen seventies, the concept of patient managed health records has enjoyed somewhat of a resurgence in recent times. In the space of a year, the National E-Health Transition Authority (NEHTA) has commenced engagement on their proposed “Individual Electronic Health Record” system, Microsoft and Google have drawn back the curtains on their long-awaited Personal Health Records (PHRs) solutions, and a Facebook-like PHR was lauded as one of the key ideas to emerge from the 2020 Summit, its interim report proposing: “[Government] create a ‘Healthbook’ (like Facebook) for Australians to take greater ownership of their health information and electronically share it with people they trust — for example their doctor, nurse or family members. Users could control their health ‘friends’ and their level of access, share data as desired, and ask for real time advice on health issues...” PHR solutions are designed to allow patients to compile a combination of clinician-generated documents, and supplement these with their own recordings and observations. Allergies, current and past medications, problems and diagnoses, family and social history, immunisations, implanted devices, screening results, key physiological measurements, pathology results, radiology reports, referrals, discharge summaries and care plans can all be recorded in a patient’s PHR, and subsequently shared with trusted third parties.

PERSONAL HEALTH RECORD OPTIONS According to myPHR, a US website established by the American Health Information Management Association (AHIMA) and devoted to the dissemination of information about Personal Health Records, there are over 100 PHRs available for patients in the US to choose from. While several of these would be equally suited for use outside of the US, a count of the number of PHRs on the global market would yield a far greater range of options. While this explosion in interest bodes well for the long term prospects of PHRs as a concept, it also increases the complexity for patients looking to select a PHR solution, and more significantly, for healthcare organisations and existing clinical software developers looking to integrate with such solutions. Having seemingly learnt from the experiences of the clinician-centric software industry — where the retrofitting of standards to entrenched solutions remains a “work in progress” — there has been an early acknowledgement by the Health

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IT community that the successful creation and adoption of technical PHR standards will be crucial to the widespread acceptance of PHRs by existing clinician-centric software vendors, and indirectly, by consumers and clinicians. Internationally, Health IT standards body, Health Level 7 (HL7), has commenced work on draft PHR standards, and US-centric Continuity of Care Record (CCR) and Continuity of Care Document (CCD) standards are being utilised abroad by some notable PHR vendors, however it is unclear at this time what impact these developments will have in the Australian context. The vast majority of PHR solutions fit into one or more of the following categories: Paper While much of the current attention on Personal Health Records is on electronic solutions, it should be noted that the management of health information by patients is not a new concept. Indeed, paper-based PHRs have existed in various structured and ad hoc forms for decades, and remain the dominant PHR format to this day. Paper-based PHRs have low barriers to entry, are easy to access and update, are relatively easy to copy (by photocopier), and are relatively easy to transport (by fax or post). They are, however, susceptible to loss or damage, may not be accessible on short notice, and do not allow the data contained within to be intelligently processed by computer systems for the purposes of decision support or aggregated data analysis. Devices The emergence of portable flash memory storage devices ushered in a myriad of device-based PHR solutions. Some exist as thumb drives dedicated to the purpose, while others have been integrated into personal belongings such as watches and jewellery. Regardless of the physical format, such devices usually contain an application or structured document used to store the patient’s health record. In many ways, these devices can be thought of as a modern day equivalent of the “medical alert” bracelet. They do, however, have the additional benefit of being able to store a comprehensive health record on the device itself, negating the need for the treating clinician to phone a service to retrieve the pre-recorded health information. Unfortunately, the usefulness of such devices is limited by the IT infrastructure present at the site of service — whether it

be a general practice, emergency ward, ambulance, private home, or public space. Further, it is conceivable that such devices may become infected with spyware, viruses, or other malicious software. While these risks could be mitigated using appropriate virus scanning software, the author believes that in the long term, such PHR solutions are not something that IT literate clinicians and healthcare organisations are likely to actively support. Smart phones As the vast majority of Australians now own and routinely carry a mobile phone, these devices have emerged as a potential platform on which to both store and access PHRs. In fact the technical sophistication, screen size, and storage capacity of modern mobile phones have already facilitated an explosion in the availability of health related mobile phone applications for consumers, many of which are positioned squarely as PHRs. Unlike device-based PHR solutions, modern smart phones can allow a PHR â&#x20AC;&#x201D; stored either on the phone or on a website accessible from the phone â&#x20AC;&#x201D; to be accessed without the need for additional computing hardware. Websites Of the myriad of PHR solutions available, the vast majority utilise web portals that allow the user to log in and record health related information in a purportedly secure environment. Microsoft and Google have entered the space in recent times, and while both of their service offerings carry â&#x20AC;&#x153;betaâ&#x20AC;?

stickers and may therefore evolve over time, presently they share similar feature sets, are shrouded in similar promotional rhetoric, and are both being offered to healthcare consumers at no cost. The entry of these two IT giants into the PHR market is likely to reshape the fledgling online PHR landscape rapidly, however it should be noted that while each company is clearly on a mission for both market and mind share, neither are attempting to monopolise the way in which data is entered into their PHR storage environments. Indeed, both Microsoft and Google are actively courting major healthcare facilities, clinical software developers, and medical device manufacturers, and have released Application Programming Interfaces (APIs) to encourage these parties to build interfaces to their respective products.

CONCLUSION Personal Health Records have existed in paper form for many decades. While modern technology has the potential to change the way that patients interact with their PHRs, the motivation for maintaining such records remains the same. According to Health IT commentators, what is likely to change however, is the adoption of PHR by increasing numbers of healthcare consumers. In a recent post on his Health IT Blog, Dr David More concluded that, â&#x20AC;&#x153;It seems to me virtually inevitable that over the next few years having a personal health record â&#x20AC;&#x201D; independent of your doctor but having some input from them often â&#x20AC;&#x201D; will become totally mainstream and

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as common as using electronic banking, especially for those with chronic health problems they need to manage.” If such uptake eventuates, it follows that patients will increasingly expect that their clinicians review and contribute to their PHR as a matter of course, an expectation that is likely to have a direct impact on the way healthcare providers interact with their own clinical software. Data standards that allow patients to easily migrate their PHR from one vendor to another will be important, as will the maintenance of open APIs that allow authorised healthcare providers to use their own clinical software to access, review, and input information into their patient’s PHRs. The entry of Microsoft and Google into the fragmented PHR space is likely to force a rapid consolidation and realignment in the market, a positive outcome that is likely to ensure service continuity and minimise complexity for patients, clinicians and Health IT software developers alike.

Above - A segment of the Google Health home page highlighting many of the core pieces of functionality built into Google’s Personal Health Record (PHR) system. Below - An extract of a Microsoft HealthVault screen showing initial search criteria, in addition to a selection of categorised information designed to allow the user to refine their search.

Dr David More’s Blog aushealthit.blogspot.com

Microsoft HealthVault www.healthvault.com

Google Health www.google.com/health

myPHR www.myphr.com

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FEATURE Scot Connolly BComm scot.connnolly@pulsemagazine.com.au

VoIP for the home INTRODUCTION This article outlines two different types of Voice Over Internet Protocol (VoIP) technology that may assist the reader to reduce their home telecommunication costs. A subsequent article scheduled for the November edition of Pulse+IT will discuss VoIP services suitable for small businesses such as medical centres and similar sized healthcare organisations. VoIP refers to an arrangement whereby the Internet, rather than the traditional phone system, is used to transmit voice data between callers. Having been lauded for several years as a viable alternative to traditional telecommunication products, such claims have historically been unravelled by less than satisfactory call quality. Fortunately, ongoing improvements to both Internet infrastructure and VoIP technology have significantly reduced call quality issues and entrenched VoIP as a competitive telecommunications option.

ISP VOIP SOLUTIONS For many years now, ISPs of all shapes and sizes have retailed telecommunication products to supplement their Internet revenue. While some persist with “traditional” phone packages, many now offer VoIP services in addition to these, or exclusively. To reduce the technical barriers to entry for their customers, many large ISPs bundle ADSL modems/routers into which a standard phone can be plugged. Once connected and configured, the telephone can be used as if it was connected to a traditional landline service. There is much posturing taking place in the market and VoIP call rates offered by the various ISPs differ substantially when the mandatory bundled Internet packages are considered. Universally however, the connection and call charges levied for ISP VoIP services are significantly cheaper than those offered by the same ISPs for traditional telephony services.

VOIP SOFTPHONES While the VoIP solution offered by your ISP may provide you with an easy pathway to cheaper home telephony, there exists dozens of software-based VoIP solutions that are usually even more competitive. The remainder of this article will focus on Skype, the most popular cross-platform “softphone” presently available. Skype is essentially a free software application that can be downloaded and installed on computers running Windows, MacOS X, or Linux. When used on a computer with a broadband connection to the Internet, Skype users can text chat or make voice or video calls with other Skype users, all at no cost. It is even possible to conduct conference calls for up to ten participants, again at no cost. In addition to these free services, the Skype software allows the user to dial mobile and landline telephones anywhere

in the world at competitive prices. Text messages to mobile phones can also be sent from Skype, and Skype users can optionally affix an “Online number” to their account to allow friends and colleagues not using Skype to call them using their mobile or landline phone. The Skype software includes a built-in address book, which allows the user to easily determine which of their contacts are presently “Online” and available to receive calls.

COMPLEMENTARY SKYPE DEVICES There are many microphone and speaker combinations that can be used to place and receive Skype calls: Built-in speakers and microphones As most laptops and many desktop computer configurations include speakers and a microphone, it is likely that you already have everything that is required to make and receive voice calls using Skype. Depending on your hardware however, it may be difficult to ensure good directional separation of the speakers and microphone, which can lead to audio feedback and echoing, significantly degrading the sound quality for one or all parties in the conversation. In the absence of one of the hardware alternatives mentioned below, using earphones in conjunction with a built-in microphone may serve to overcome this problem. Integrated headsets Containing either one or two earphones and a microphone, integrated headsets allow for hands free conversation and generally prevent audio feedback issues. Integrated headsets are available in configurations that connect to the audio and microphone ports on your computer, or alternatively, to a spare USB port. Diminutive Bluetooth headsets of the type typically paired with mobile phones can also be used assuming your computer supports this technology. Using such a headset theoretically allows the user to move around within a ten metre radius from their computer whilst on a call. USB handsets Designed to plug into a USB port and with an outward appearance that resembles a mobile phone, USB handsets usually feature a numeric keypad to allow phone numbers to be dialled from the handset itself, without having to interact with the Skype software installed on the computer it is connected to. For readers that require a cost effective solution, prefer the look and feel of a traditional phone, and don’t mind being restricted to making calls in proximity to their computer, a USB handset is likely to be a suitable complement to their Skype software.

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Cordless hybrids A cordless hybrid Skype phone connects to both the home’s landline connection and the Internet router, allowing both traditional and Skype calls to be made and received from a single device. As with traditional cordless phones systems, multiple handsets can be positioned around the house. Cordless hybrids natively support Skype, so there is no need to connect the phone to a computer. In fact it is not even a requirement that Skype software be used at all, a characteristic that is likely to appeal to less technically literate users that “just want things to work”. Wi-Fi handsets Similar in size to a mobile phone, these devices are designed to connect to Wi-Fi networks, allowing the user to make Skype calls from anywhere within their wireless home network’s range. Unlike cordless hybrid solutions, Wi-Fi handsets are not able to make phone calls over traditional networks, however they offer the added flexibility of being able to be transported easily and used when in range of a work place or public Wi-Fi network. Webcams While many new laptops and some new desktop monitors include built-in web cameras (webcams), there are many cost Anticlockwise from top left - USB mono Logitech headset, wireless Bluetooth “Logitech Mobile Freedom” headset, Netgear Wi-Fi Skype phone (SPH200W), Netgear Dual-mode cordless phone (SPH200D), Logitech “Quickcam Pro for Notebooks”, Logitech “Quickcam Pro 9000”.

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effective aftermarket devices available for readers that don’t own such technology. Connected via a USB port, web cameras typically contain a directional microphone, in addition to the video camera itself. When combined with a set of speakers or a headset and Skype software, a web camera can facilitate high quality video conferencing at a fraction of the cost of dedicated solutions. Readers potentially interested in purchasing a web camera should note that Skype has partnered with hardware manufacturer, Logitech, to certify some of their newer web cameras for premium resolution video conferencing. According to the Skype website, using a certified camera permits twoway video conferencing at a resolution of 640x480 pixels, an improvement over the standard Skype video conferencing resolution of 320x240 pixels.

SKYPE COSTS As indicated earlier, Skype does not charge for calls, text chat or video conferences made “Skype-to-Skype”. Calling from Skype to an Australian mobile phone costs 26.4 cents per minute, with calls billed in per minute increments. Calling from Skype to a landline phone is much cheaper at 2.7 cents per minute regardless of whether the person being called is in Australia or in many other places around the world. A 5.9 cent connection fee applies to all outgoing calls to mobile phones and landlines. Standard length SMS messages can be sent at a cost of 11.8 cents per message. For households that make a significant number of calls,

or for those that routinely make lengthy phone calls, Skype subscription plans are likely to be a more cost effective option than the aforementioned ad hoc pricing arrangements. Plans that include unlimited calls to Australian landline phones are available for just $5.95 per month, and a plan that includes unlimited calls to landlines anywhere in the world is available for $14.95 per month. Additional Skype services, such as voicemail and a “real” telephone number that facilitates the receipt of inbound calls from the traditional telephone network are included with both of these subscription packages.

CONCLUSION Assisted by steadily improving network infrastructure and a maturation of the technology, VoIP services have improved to the point where call quality is no longer the “show stopper” that it once was. When coupled with a mobile phone service, home users are likely to find that adopting either an ISP supplied or software based VoIP solution, such as Skype, will significantly reduce their reliance on their existing landline phone service, and in some cases, allow them to disconnect the service altogether. Logitech www.logitech.com

Skype www.skype.com.au

Netgear www.netgear.com.au

Whirlpool VoIP Forum www.whirlpool.net.au

Introducing HealthLink’s Partner Systems

HealthLink focuses on integration with its partners’ systems and works together with them to implement and test new communications services. HealthLink’s key concern is ensuring that HealthLink enabled systems are both easy to use and 100% reliable. HealthLink believes that compromising service quality is not acceptable in today’s healthcare environment.

Tel 1800 125 036 enquiries@healthlink.net

www.healthlink.net

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FEATURE Simon James BIT, BComm Editor, Pulse+IT simon.james@pulsemagazine.com.au

Mobile Clinical Software INTRODUCTION This article contains an overview of a selection of clinical applications designed specifically for mobile use. It concludes a two-part series on mobile computing for clinicians, which commenced in the May 2008 edition of Pulse+IT with an outline of the various categories of mobile hardware available on the market. As many of the devices outlined in the previous article are capable of running the same operating systems and applications found on full-sized laptops and desktop computers, this article will focus entirely on applications designed for mobile operating systems typically found on modern smart phones. It should be noted that all smart phones are not created equal, with hardware manufacturers utilising a range of operating systems, input interfaces, and network connectivity options. Because of the diversity in the market, it is often not practical for developers to attempt to support all hardware and software combinations, most instead opting to concentrate on specific smart phone sub-markets. While applications written for specific mobile operating systems are likely to be actively developed for some time, the author anticipates that mobile application developers will increasingly devote more of their attention to designing platform agnostic applications built using modern web technology. This transition will be assisted greatly by the increasingly sophisticated mobile data networks being deployed in Australia and around the globe.

CURRENT APPLICATIONS Following is a selection of clinical applications designed specifically for smart phone operating systems: Top Pocket Designed as a mobile extension to the Best Practice clinical software solution by the company with the same name, Top Pocket is compatible with PDAs and smart phones running Windows Mobile 5.0 or later. Top Pocket allows clinicians to download their address book contacts from their practice database, review and prescribe medications, view patient information, browse and modify a “To Do” list, and browse an integrated MIMS drug database. EMDAT Mobile EMDAT Mobile (which may be rebranded and onsold under different names by different transcription companies), is software that allows the user to dictate into their smart phone, and subsequently upload these recordings directly to a transcription service without having to first synchronise their smart phone with a computer. Once transcribed, the text version of the dictation can

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be sent back to the smart phone for mobile verification and approval by the clinician. Pending approval, the transcription company would typically send the letter to the clinician’s practice software, where it can be printed or sent to the intended recipient using a secure messaging solution. MIMS on PDA2 MIMS on PDA2 is a mobile version of the ubiquitous MIMS drug database for devices running Windows Mobile 5.0 or greater. An earlier version of MIMS on PDA is still sold and supported for older versions of Windows Mobile and the Palm OS. Unlike its predecessor, MIMS on PDA2 integrates drug reference and drug interaction checking functionality into a single application, negating the need for users to have to switch between separate applications to access these features. The database is fully searchable, with clinicians able to query by drug name, therapeutic class, action and indication, or company name. While the MIMS drug database has long been available on PDA, the latest version of the software takes advantage of modern 3G mobile networks, allowing the application to update its drug and interactions databases “over the air” each month without needing to synchronise with a desktop computer (although the option to update the databases using this method is also included). Bill for Anaesthetists Developed by Schmik, Bill for Anaesthetists is a web-based patient billing application designed with mobile devices in mind. As the clinician simply uses their smart phone’s web browser and the device’s Internet connection to access the system, no software or data need to be installed on the mobile device. Bill for Anaesthetists can be used as a stand-alone application, or interfaced using web services to a practice, billing service, or hospital quoting and invoicing system. When interfaced, the solution allows daily theatre lists to be viewed on the smart phone, simplifying data entry for clinicians who only have to record procedure start and finish times, and any variation to the procedures outlined in the theatre list. Periodically, the clinician’s nominated billing service or practice logs into the Schmik system to retrieve the Anaesthetist’s list of completed procedures, and invoices are subsequently raised. Schmik has plans to extend Bill for Anaesthetists to make it suitable for use by other procedural specialists. In addition to populating the system with a wider range of MBS Item numbers, the ability to raise invoices and receipts directly from the mobile device and have these sent to the recipient electronically is slated for inclusion in the forthcoming product.

ON THE HORIZON On 11th July, Apple released the second major iteration of its iPhone. Over 1 million of these 3G capable iPhones were sold on the first weekend of its release, which, unlike its predecessor, is officially available in Australia through numerous carriers. Perhaps more significant than release of the iPhone itself was the launch of the “iPhone App Store”, a clearing house for Apple-sanctioned third-party software designed specifically for the iPhone. Over 10 million application downloads were registered at the App Store during its first weekend, the vast majority of which were freely available or priced at less than US$10. At the time of writing, the App Store featured over 1,400 iPhone applications, approximately 400 of which were free. In addition to games, weather, finance, education, and social networking applications, a burgeoning “Healthcare and Fitness” category has been created. 60 applications have been published in this category to date, and while most of these are designed for healthcare consumers, a handful of clinician-centric utilities have emerged that highlight the emerging potential impact the iPhone (and other similarly capable devices) may have on the delivery of healthcare: Mobile MIM Not to be confused with the aforementioned MIMS drug database software, this clinical imaging application facilitates mobile multi-modality imaging display and fusion of various diagnostic image formats, including CT, PET, MRI and SPECT.

Using the iPhone’s touch screen interface, clinicians can change image sets and planes, adjust the zoom level and control fusion blending. Currently shipping with limited functionality, Mobile MIM is bundled with sample images to allow clinicians to experiment with the software’s user interface. According to the product’s website, “a fully featured MIM Pro for the iPhone, for physician and radiology use, will be available in the near future”. Epocrates Rx Epocrates Rx is a free US-centric drug reference and interaction checker application. Using an iPhone or another compatible smart phone, clinicians can view pharmacology information, in addition to photos of over 3,300 drugs included in the Epocrates Rx database. The software also includes a “pill identifier”, which allows the user to attempt to identify a pill by entering its key characteristics (colour, shape, etc) into the software. Bill by Schmik www.schmik.com.au

MIMS on PDA2 www.mims.com.au

EmDat Mobile www.emdat.com

Mobile MIM www.mimvista.com

Epocrates Rx www.epocrates.com

Top Pocket www.bpsoftware.com.au

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FEATURE Fiona MacTavish BSc, MBA, is a freelance writer on information technology for the medical industry. Her interests include designing dynamic, database driven websites and decision support systems for complex and interrupt driven clinical environments. fiona@mactavish.com.au

MYOB for the medical practice Part one – Processing transactions INTRODUCTION MYOB is an international provider of specialised software solutions which streamlines many day to day administrative activities in business operations. This in turn allows management to focus on the overall goals of the business.

obligations to the Tax Office in this regard. A subsequent article scheduled for the November edition of Pulse+IT will focus on the financial reporting capabilities of the system.

PURCHASES

MYOB is a cost effective tool for Australian medical practices, provided it is setup and used correctly. The software is highly customisable in terms of how information can be tailored to suit medical practices and is extremely powerful in terms of the reports it can generate to quantify the financial performance of your business.

One of the many uses for MYOB in a medical practice is to track purchases (also known as accounts payable or trade creditors). Purchases can be goods or services such as: • Surgical supplies • Stationery • Equipment hire • Capital purchases

The first instalment in this series will overview the steps involved in processing transactions in MYOB. Many of these transactions will include GST in the amount which makes MYOB an invaluable tool to keep track of your

You can use the MYOB Purchases functionality to record: • Any purchases that you have received from a supplier on credit. • Any purchase that you have returned to a supplier.

Below - The “Purchases Command Centre” of MYOB for the Game Face Medical Centre.

•

Any payments that you are making to a supplier where a purchase order exists in the system.

Steps to record a purchase on credit: 1. Select purchases 2. Select enter purchases 3. Select the supplier and check the terms 4. Select GST inclusive or exclusive 5. Select the type of purchase layout 6. Key-in the purchase details 7. Select save as recurring if this transaction is to happen often 8. Record Steps to record purchases returned: 1. Select purchases 2. Select enter Purchases 3. Select the supplier 4. Select GST inclusive or exclusive 5. Key-in negative figures to process purchases returned 6. Record 7. Select the register button at the bottom of the screen to apply the return or debit and apply against a purchase or deposit a refund cheque Steps when paying a Supplier: 1. Select purchases 2. Select pay bills 3. Select the correct bank account 4. Select the supplier 5. Enter the payment details and apply to an open transaction 6. Record Steps when making a purchase for cash: If stock is not affected and a purchase order is not required, complete the following: 1. Select banking 2. Select spend money 3. Select GST inclusive or exclusive 4. Key-in the purchase details 5. Select the cost of sales account as

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the allocation account 6. Record If stock is affected and you want to record stock movement, create a fictitious creditor called Cash Purchases and complete the following: 1. Select purchases 2. Select enter purchases 3. Select the supplier cash purchases 4. Select GST inclusive or exclusive 5. Select the item type of purchase layout 6. Key-in the purchase details 7. Key-in the total of the purchase in the Paid Today field 8. Record

SALES

3. Select the customer and check the terms 4. Select GST inclusive or exclusive 5. Select the type of sales layout 6. Key-in the sales details 7. Select save as recurring if this transaction is to happen often 8. Record Steps to record sales returned: 1. Select sales 2. Select enter sales 3. Select the customer 4. Select GST inclusive or exclusive 5. Key-in negative figures to process sales returned 6. Record 7. Select the register button at the

bottom of the screen to apply the return or credit and apply against an invoice or write a refund cheque Steps when customer pays you: 1. Select sales 2. Select receive payment 3. Select the correct bank account 4. Select the customer 5. Enter the receipt details and apply to an open transaction 6. Record Steps when making a sale for cash: If stock is not affected and a sales order is not required, complete the following steps: 1. Select banking

Sales are also known as accounts receivable or trade debtors. Sales can be goods or services; however, in a medical practice it is normally just services unless you are selling products as well. Sales may include: • Rent received • On call income • VMO Income • Other income It should be noted that Medical Practices normally have a billing program to manage their “sales”. Some of these applications can send individual transactions to MYOB, eliminating the need for double entry and streamlining the generation of your Business Activity Statements (BAS). In the absence of such a system, daily takings can be entered into MYOB and a monthly journal entry can be used to allocate to the relevant Income Accounts if need be. These journal entries will also track any GST paid, in preparation for the BAS.

Above - The “Sales Command Centre” of MYOB for the Game Face Medical Centre. Below - The “Accounts Command Centre” of MYOB for the Game Face Medical Centre.

You can use the MYOB Sales functionality to record: • Any sales that you have received from a customer on credit. • Any sales that you have returned to a customer. • Any payments that your customers are making to you where you have entered the sales details here previously. • Quotes, which can be converted into Orders and then into Invoices. Steps to record a sale on credit: 1. Select sales 2. Select enter sales

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2. 3. 4. 5.

Select receive money Select GST inclusive or exclusive Key-in the sale details Select the Income account as the allocation account 6. Record If stock is affected and you want to record stock movement create a fictitious debtor called Cash Sales and complete the following: 1. Select sales 2. Select enter sales 3. Select the customer cash sales 4. Select GST Inclusive or Exclusive 5. Select the item type of sale layout 6. Key-in the sale details

7. Key-in the total of the sale in the Paid Today field 8. Record

ACCOUNTS Accounts are also known as the General Journal. Journal Entries are used to record transactions that do not affect purchases, sales or banking. These types of entries may include: • Transferring from Clearing Account to relevant income account. • End of Financial Year accruals. • End of Financial Year prepayments. The Accounts area in MYOB is where you can generate your BAS statement

and send your financial and or BAS information to your accountant. Steps to record journal entries: 1. Select Accounts 2. Select Record Journal Entry 3. Key-in details and select the accounts to be debited and credited

BANKING Formerly referred to as the “Cash Book”, the Banking Command Centre is used to: • Record payment of expenses other than those that have been entered in the Purchases ledger. • Record receipt of deposits other than those that have been entered in the Sales ledger. • To reconcile accounts. Steps to record cash expenses: 1. Select banking 2. Select spend money 3. Select the correct bank account or credit card 4. Select GST inclusive or exclusive 5. Key-in a concise and clear memo 6. Key-in the expense details allocating the correct expense account 7. Select save as recurring if this transaction is to happen often 8. Record

Above - The “Send to Accountant” screen in the “Accounts Command Centre”, which can be used to send financial data to your accountant via email. Below - The “Banking Command Centre” of MYOB for the Game Face Medical Centre.

Steps to record cash receipts: 1. Select banking 2. Select receive money 3. Select the correct bank account 4. Select GST inclusive or exclusive 5. Key-in a clear memo 6. Key-in the receipt details allocating the correct income account 7. Select save as recurring if this transaction is to happen often 8. Record

ACKNOWLEDGEMENTS This, and forthcoming articles in this series, are based on modules from “MYOB for the Medical Practice”, which are available from the Medical Business Managers Association. MYOB Limited www.myob.com.au Medical Business Managers Association www.mbma.com.au

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FEATURE Simon Ingram BComn Director, Vision Safari simon@visionsafari.com

An introduction to Free Open Source Software INTRODUCTION This article introduces the reader to Free Open Source Software (FOSS) by discussing the philosophies, benefits, business models and licensing arrangements that the FOSS movement has either been built upon, or given rise to. In addition — and in what I anticipate will be of most interest and practical use to the majority of readers — a list of examples of popular FOSS products has been included towards the end of this article, several of which may already be in use in the reader’s home or workplace today. Given the increasing global awareness of the future role open source software is likely to play in the health sector, a comprehensive article devoted to health-related open source initiatives will be presented in the November edition of Pulse+IT.

DEFINITION It should first be noted that the “Free” part of FOSS is considered an ambiguous term in software circles. For the purpose of this article therefore, any reference to “Free” will refer to the concept of something that does not cost anything to obtain (“free beer” being the usual example provided, however “free healthcare” is perhaps a more appropriate example in light of recent Governmental directives). “Source” refers to the software code that is written by programmers, which is (usually) then compiled into a software application that can be run by the user. “Open” indicates that the source code is made available for inspection or download by interested parties, usually, but not always, via it being published online for public consumption. In totality therefore, “Free Open Source Software” refers to software that both costs nothing, and whose source code can be inspected.

MOTIVATIONS AND BUSINESS MODELS Usually the first question pondered by people trying to understand what motivates people involved with open source projects is along the lines of: “If the programmers are giving away the fruits of their labour for free, why do they do it?”. There is certainly no definitive answer to this question. However, various combinations of altruism, anti-establishment sentiment (which often manifests itself as anti-Microsoft sentiment), and a desire to improve the quality of the software available for use by participating developers are identifiable driving forces behind many open source initiatives. These motivations aside, there are many practical and financially related justifications stated by developers as to why

they participate in open source projects: • Involvement in open source projects allows the developer to enhance their programming skills and gain commercially valuable experience that may not otherwise be available to them. • While the underlying source code is freely available, it does not necessarily mean that financial gain cannot be extracted from the project. Indeed, by developing a thorough understanding of some open source projects, individuals are able to sell such expertise to the market as an implementation, integration or technical support consultant. • Developers are able to extend open source projects by writing plug-ins or releasing premium versions of the software which they can sell to the market on commercial terms.

CHARACTERISTICS With thousands of open source software projects in existence, it is only natural that there exists a wide degree of variability between them. That said, the following characteristics are typical of established open source projects with active developer and user groups: Quality It is common for people to associate “low cost” or “free” with “low quality”, however open source software is now widely accepted as one exception to this conventional wisdom. In fact it is ironic that in many instances, free open source software solutions eclipse the quality of their commercial alternatives. The explanation for this phenomena stems directly from the fact that, by definition, open source software projects allow the community to inspect and critique the work of the project’s developers. When coupled with an active user community that routinely offer feature requests and submit bug reports, any issues in the software are typically identified and rectified rapidly. While the programming quality of most popular open source applications is high, the same level of quality does not always extend to the outward appearance of software. Indeed, open source software user interfaces can look drab and exhibit ignorance of commonly accepted design principles. For example the recently superseded second major release of the Firefox Internet browser looked outwardly like a relic from the pre-Windows 95 days, spawning a plethora of alternative third-party “skins” which attempted to rectify the

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travesty. Comprehensive and current end user documentation can also be less than adequate, however it is accepted that both of these afflictions prevail in commercial software circles also. Security Unless you have the technical expertise to pro-actively monitor the outgoing network connections made by your software, it is difficult to have any certainty as to what the software may be transmitting across the Internet, and to whom. By allowing source code to be interrogated, assurances about the safety of the software can be provided to the product’s user community by suitably qualified, independent developers. While this “warts and all” openness has historically been derided by open source detractors as potentially highlighting aspects of the software open to exploitation, it is now widely accepted that this same openness allows such issues to be addressed rapidly, usually before any serious consequences eventuate. Support The quality and timeliness of technical support for specific open source software products tends to scale in proportion to the size of the project’s developer and user community. With many open source software products enjoying truly global audiences, it is not atypical to receive responses to support queries lodged on email discussion lists or web forums within a few hours, and many times, withing a few minutes! Organisations looking to deploy open source software for mission critical tasks should consider establishing a relationship with a commercial technical support organisation that specialises in providing support for the deployed solution.

OPEN SOURCE SOFTWARE LICENSING While there are a plethora of different licensing models under which open source software can be released, two of the most widely used are the Berkeley Software Distribution (BSD) license, and the GNU General Public License (GPL). In each case, the end user of the software application need not be overly concerned about the license chosen by the developer, as both permit code released under these licenses to be used, copied, and distributed without restriction. There are, however, different implications for software developers as outlined below: Berkeley Software Distribution (BSD) License Under this arrangement, software developers are free to use and modify source code released under the BSD license, but they do not have to release their coding additions or enhancements back to the community. In fact the only requirement placed on developers who utilise code released under the BSD license is that they must acknowledge the previous developers of the code, and include the text of the BSD license in their source code or distributed applications. In the development of MacOS X, Apple capitalised on the flexibility of the BSD license arrangement by “borrowing” large slabs of the FreeBSD operating system. The subsequent source code enhancements developed by Apple’s programmers do not have to be released back to the community, an arrangement which protects their commercial interests.

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Despite the fact that they are not compelled to do so, it should be acknowledged that Apple does contribute significant resources to fostering selected open source initiatives. GNU General Public License (GPL) Source code released under the GPL allows other developers to modify the code, however unlike BSD, all changes need to be made freely and readily available to the community. These derivative efforts need to be made available and licensed under the GPL, a restriction that generally appeals less to developers with commercial interests, but more to developers interested in seeing the open source initiative attract more programmers and flourish.

POPULAR OPEN SOURCE SOFTWARE Following is a non-exhaustive list of some popular free open source software applications that rival or surpass the quality of their commercial competition: Firefox With its development overseen by Mozilla, Firefox is the second most pervasive web browser used on the Internet. In fact the recently released third major iteration of Firefox was downloaded over 8 million times on the day of its release, setting a Guinness World Record for the most copies of a software product downloaded in a 24 hour period. While the latest versions of both Internet Explorer (for Windows) and Safari (for Mac and Windows) are both capable products, neither can interface with the wide array of thirdparty extensions developed for Firefox. In addition to cosmetic “skins” that allow the user to customise the look and feel of their browser, the open source underpinnings of Firefox has prompted an explosion of functional additions. FTP clients, RSS readers, advertising blockers and many other extensions can all be installed with relative ease. Readers looking to trial Firefox need not delete their existing web browser — indeed, it is probably better that this software be retained for the increasingly rare instances when Firefox is not optimally supported by a website. Thunderbird Also produced by Mozilla, Thunderbird is a fully-featured email client for Windows, MacOS X, and Linux. Outwardly similar to commercially developed competitors like Microsoft Outlook, Thunderbird features many under-the-hood improvements, such as a powerful junk mail filter that has the ability to learn which emails the user typically considers to be junk. Developed as a pure email client, Thunderbird lacks a built-in calendar and task list, however this functionality can be added using a free Mozilla extension called “Lightning”. As with Firefox, a large collection of other functional and cosmetic add-ons are available for Thunderbird. Joomla Joomla is a database-driven web Content Management System (CMS) that allows website owners to simplify the creation and maintenance of their websites. Once established, Joomla websites can be maintained through an administrator panel using a web browser, negating the need for locally installed website development tools to be used.

Having started its life as a project branch of Mambo, Joomla’s popularity has grown rapidly and is now undoubtedly the most widely deployed CMS on the web. Joomla’s open source core functionality can be extended using thousands of free and commercial software plugins, which allow even novice website administrators to build highly functional web presences. Linux Perhaps one of the most comprehensive examples of a successful open source project, “Linux” does not refer to an application, but rather, an entire operating system. Having gained a foothold in the server market many years ago, the usability of Linux has steadily improved to the point where even novice computing users find the system intuitive, fully featured, and an easy to use desktop operating system. Unlike MacOS X and Windows, which are released in only a handful of configurations, Linux can be downloaded in any one of hundreds of pre-configured distributions (“distros”), each one catering to different user requirements and tastes. Ubuntu, (or its graphically differing sibling Kubuntu), are among the most popular and easy to use Linux distributions, and are arguably the most appropriate starting point for users looking to investigate Linux further. These versions of Linux (and many other) can be obtained on a “live CD”, which allows the user to simply insert a disk containing the operating system into their computer, and trial the software without having to install anything on their hard drive.

VLC Media Player VLC is a general purpose media player for Windows, MacOS X and Linux, whose principle strength is that it can play most of the video formats used by the distributors of video content over the Internet, negating the need for the user to source and download specific video extensions “codecs”. OpenOffice Supported by Sun Microsystems, OpenOffice is pitched squarely as a free alternative to Microsoft’s venerable Office suite. Whilst earlier versions lacked a certain degree of polish, the latest incarnation of the software suite could be described as being “all things to most people”. OpenOffice is compatible with Windows, MacOS X and Linux. Importantly, it supports Microsoft Office file formats, in addition to its native ISO standard Open Document Format.

CONCLUSION While it hasn’t always been the case, today, open source solutions that address the needs of a large number of computing users generally rival or surpass the quality and feature sets of their commercial alternatives. While there is certainly no need to replace already paid up commercial software that is serving its intended purpose, both individuals and organisations of all shapes and sizes would be well served by familiarising themselves with the popular free open source alternatives available before committing to commercial upgrades.

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FEATURE Linda Bâgu Batson B Comm, MACS, PCP, is is an information systems manager with experience in many sectors, including manufacturing, education, utilities, mining and is currently working in health. Linda is a member of the Australian Computer Society and a member of the Advisory Board, School of Information Systems, Deakin University. linda.batson@acslink.net.au

Executive buy in - Meet your new best friend About to go shopping for a new information system? Health care agencies, particularly large hospitals, already have a myriad of information systems, yet there is still the need for more to support extra functionality, data collection, or research projects. Sometimes it’s possible to expand an existing system to cover the need, but if it’s a shiny, brand new package of software you want, the future is fraught with danger. Driving you down the path to success in this case, is an essential person, known as the Project Sponsor. So what is a Project Sponsor? This is the person who will support your implementation from start to end and sees bringing the project to a successful conclusion as a personal responsibility. It’s absolutely imperative that your Project Sponsor is at Executive or Director level. Why? Because no one else will have the clout to push through the hard decisions. Forget the old “change is as good as a holiday” mantra - humans are substantially resistant to change. When people are at work, change is bad, very bad. Depending on the size and reach of your proposed system, there will be other departments, staff, managers and yes, other executives that will need to be involved. That makes for a lot of people that will be experiencing some sort of change to their environment. It’s great when everything’s going smoothly, but it’s not going to be the case all the time. Inevitably, there will come a point when you need support from the top end of town — your Project Sponsor.

GET ON THE SAME PAGE Always keep in mind that IT projects are far more prone to failure than success (do any Internet search to confirm this). Let’s take a minute here to consider what success means for an information system. Is “success” meeting the objectives that have been carefully set out in the project planning phase? Is it coming in on budget and on time? Does the system actually work the way the vendor led you to believe it would? These are the types of questions considered when quantitative research is conducted and normally concludes with a much larger rate of failure than success. However, most analysts agree the determination of success in this arena is in the hands of your system users. These are the people at the coalface who have to use the new system, day in, day out. If your user group finds the system too hard to learn, difficult to use, unreliable in any way or generally makes their working lives harder rather than easier, your carefully planned and executed project will be perceived as a failure. Your sponsor is there to support the project team, assist the Project Manager with presentations to the executive, give

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input on documents such as the request for proposal, business case, requirements, scope and project plan. Having this type of support is vital to getting your project off the ground and keeping the momentum going. Ensure that your sponsor is aware of the contribution that he or she will need to make and the importance it will have to keeping the project from the deep recesses of the pit of IT failures. Keep the lines of communication wide open to ensure that your sponsor is up-to-date at all times. If a problem occurs, you will want your sponsor to hear it from you first, not via the grapevine. Find out what is the preferred way for you to communicate, for example, email is always a good way to send updates and keep a written record at the same time, but if your sponsor doesn’t read email very often, a hard-copy or handwritten note in addition to the email, may be the fastest way to transfer information.

COMMITMENT IS KING I once worked on a project for an enterprise-wide data analysis system. There was a large team involved with the evaluation and selection of this critical information system. The Project Sponsor was the initiator of the project and keen to see a successful implementation. Funny thing was, he was only present at the very first team meeting. From that time on, every decision made by the evaluation team was made without executive input, including software demonstrations and the final vendor selection. It’s fortunate that there was such a high level of expertise available within that team and a good decision was made without too much difficulty. If a good decision had not been made, do you think that executive-level support would have been forthcoming? It’s doubtful. Ensure that your Project Sponsor is at every team meeting, check their diary before scheduling a date and change it to suit, if you have to. It’s vital for your sponsor to know their worth as an objective overseer. There are times when a project can hit a point where it should be put on hold until issues are resolved, or even shelved altogether. Maybe the strategic direction of the organisation has changed and the project is no longer relevant. Perhaps the vendor has become insolvent. The product you are installing may be vastly different to the one you observed at a software demonstration. At these and other times, your sponsor is the only one who can give a truly objective opinion. Let’s face it, the project team are hardly likely to render themselves unemployed. By making the sensible and difficult decisions, your sponsor may save the organisation a financial and operational disaster. If that time comes, your Project Sponsor will be worth their weight in gold.

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FEATURE Louis Joseph BComm, is an Apple Macintosh enthusiast whose work in the Microsoft Windows dominated financial sector has given rise to an interest and reliance on virtualisation technology. ljoseph@pxpam.com

Virtualisation for the desktop INTRODUCTION This article introduces the reader to virtualisation technology as it is applicable for use on a laptop or desktop computer. A discussion about the use of virtualisation technology in a server environment will be deferred to the November edition of Pulse+IT, which will contain an article dealing exclusively with the topic. Throughout this article, the terms “host” and “guest” operating system are used repeatedly. A host operating system refers to one that is installed to interact with the computing hardware directly (i.e. a “traditional” or “typical” installation). A guest operating system, on the other hand, is one that is installed into a virtualisation environment running on top of the host operating system. So what is virtualisation anyway? In the context of this article, the term refers to technology that allows operating systems and their applications to be installed and run on a “virtual machine”. This virtual machine is so termed because the software running within it does not talk directly to the physical hardware on which it is contained. Instead, the guest operating system interfaces with a “virtualisation layer”, which in turn communicates with the underlying physical hardware when appropriate. While both the host and guest operating system can be the same (e.g. Windows XP as the host and Windows XP as the guest), it is more common on desktop deployments that different operating systems are used. Indeed, the emergence of both the MacOS X and Linux operating systems as desirable and viable computing alternatives for an increasing number of end users has undoubtedly been a key driver in the rapid and recent uptake of virtualisation technology.

BENEFITS So what are the benefits of virtualisation technology? One of the primary reasons virtualisation is used on desktop and laptop computers is for the purposes of running applications that are not available for operating system installed on the computer. The author, for example, predominantly uses MacOS X for personal use, but requires access to specialised financial software that is only available for Microsoft Windows. Rather than purchase a second computer devoted to the use of these applications, the author has installed Microsoft Windows and the associated financial applications in a virtual machine environment running within MacOS X. Using similar methodology, medical practices, most of whom run clinical software written and supported only on Microsoft Windows, could conceivably retain the use of this particular program by “virtualising” their Windows environment and migrating their underlying operating system to Linux

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or MacOS X (assuming of course there was a sufficiently motivating reason to undertake such a migration). At this time it should be noted that, to the host operating system, an entire virtual machine appears to be a single file. This property has many ramifications that underpins some of the other benefits that virtualisation technology can deliver. Firstly, the file (i.e. the virtual machine) can easily be transferred to other physical hardware and used without having to perform the often tedious task of installing a new suite of drivers to ensure the system runs adequately. These issues are avoided as the operating system and applications installed in an virtual machine only directly interact with the underlying “virtualisation layer”. The virtualisation layer, in turn, handles all necessary interactions with the physical computer’s hardware resources, including graphics cards, network cards, USB interfaces, DVD drives and hard disks. The second major benefit of the “single file” characteristic of virtual machines is that snapshots (backups) of this file can be taken at any time and easily restored in the event of a computing problem. Install some poor quality software that destroys your computer? Simply roll back to the last snapshot of the system and the virtual machine will behave as if nothing had happened — for no other reason than because as far as it is concerned, nothing did!

VIRTUALISATION OPTIONS Before you can embark on your virtualisation adventure, you first need to install a virtualisation layer on your existing operating system. There has been an explosion in the uptake of virtualisation technology over the past few years, and users of all major modern operating systems are now spoilt for choice. While providing a comprehensive list or a side-by-side comparison of the various options available is beyond the scope of this article, readers would be well served by checking out the offerings from Microsoft, VMWare, Parallels, and VirtualBox (perhaps in reverse order given that VirtualBox is both free and open source!). Once the virtualisation software is installed and configured, the user is able to then install the operating system of their choice into an empty virtual machine in much the same way as if they were installing it onto new hardware. In fact, as the virtualisation layer is able to interact with the guest operating system in ways that physical hardware cannot, installing an operating system into a virtual machine is often a simpler process than performing an installation on a “real” computer.

USING A VIRTUAL MACHINE So how does virtualisation work in practice? Once an operating system is installed into a virtual machine, the user simply selects

the virtual machine and “boots it up” by clicking a button that usually resembles a “play” symbol found on a CD or DVD player. Corresponding buttons exist to “pause” (suspend or sleep) or “stop” (shutdown) the virtual machine, allowing the user to manage the status of their virtual machines as if they were physical computers. Regardless of the desktop virtualisation product selected, there are typically three main ways in which guest operating systems can be displayed on your monitor: Full screen mode When a virtual machine is configured to run in full screen mode, it maximises the possible viewing area by taking over the entire screen and hiding the host operating system below it. While it is usually a trivial matter to switch between one or more active virtual machines and the host operating system, full screen mode prevents the user from viewing programs from both operating systems on a single screen at the same time. Window mode When a virtual machine operates in window mode, the host operating system encloses the guest operating system in a window occupying a part of the main screen. This window can be moved, resized or hidden as if it were a typical application running on the host operating system. Integrated mode Integrated mode (the author’s term for an interface arrangement called different things by different virtualisation software vendors) allows the guest operating system’s desktop to be hidden from the user, whilst allowing active applications and windows running within the virtual machine to be shown against the backdrop of the host operating system’s desktop. Ignoring the cosmetic appearance of menus and title bars, this mode gives the user the impression that the guest application is running natively on the host operating system, which in turn allows the user to easily interact with a mix of native and virtualised applications seamlessly.

PERFORMANCE So how do applications perform when run in a virtual machine? While it is true that running multiple operating systems and applications at the same time invariably consumes more computing resources than running a single operating system, modern computers generally have technical specifications surplus to most user’s requirements. As such, when allocated sufficient RAM (512MB to 1GB per virtual machine), most typical computing tasks conducted within a virtual machine will perform on par with how they would perform if installed directly on identical hardware (graphic intensive games being one notable exception). While not strictly related to computing performance, it should be noted that the installation of multiple operating systems can consume large amounts of disk space, potentially necessitating that additional hard drive capacity be purchased. The user may also find that they need to spend time maintaining and learning about their virtualised operating systems, however obviously this would be the case if the operating system was installed on separate physical hardware.

CONCLUSION Virtualisation technology has rapidly matured in recent times, spurred on by increasing awareness of MacOS X and Linux, ever improving computing power, and fierce competition between the purveyors of virtualisation solutions. Despite the possibility that the user will need to spend more time maintaining a growing array of software, the ability to run applications from multiple operating systems on a single computer at near-native speeds, all without having to reboot, will be an attractive proposition for increasing numbers of computer users going forward. Microsoft www.microsoft.com

VirtualBox www.virtualbox.org

Parallels www.parallels.com

VMWare www.vmware.com

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Pulse+ IT AUSTRALIA'S FIRST AND ONLY HEALTH IT MAGAZINE

BUSINESS INFORMATION TECHNOLOGY GROUP AUSTRALIAN MEDICAL ASSOCIATION AUSTRALIAN GENERAL PRACTICE NETWORK

P: 02 6228 0800 F: 02 6228 0899 E: agpnreception@agpn.com.au W: www.agpn.com.au Contents: 20 AGPN represents a network of 111 local organisations (Divisions) as well as eight state-based entities. More that 90 per cent of GPs and an increasing number of practice nurses and allied health professionals are members of their local Division. The Network is involved in a wide range of activities including health promotion, early intervention and prevention strategies, chronic disease management, medical education and workforce support. Divisions work with general practice to improve clinical information across the range of their programs, to support improved management of chronic conditions and improve efficiency, utilizing a range of Information Management (IM) tools.

P: 02 6270 5400 F: 02 6270 5499 E: ama@ama.com.au W: www.ama.com.au

The Australian Medical Association (AMA) is an independent organisation which represents more than 27,000 doctors, whether salaried or in private practice, whether general practitioners, specialists, teachers and researchers, or doctors in training. The AMA exists to: • promote and advance ethical behaviour by the medical profession and protect the integrity and independence of the doctor/patient relationship; • promote and advance the public health; • protect the academic, professional and economic independence and the well being of medical practitioners; and • preserve and protect the political, legal and industrial interests of medical practitioners.

AHML is a non-aligned, not-forprofit organisation whose mission is to promote and facilitate the adoption of compliant international healthcare messaging standards. AHML is providing a world-class, easyto-access message testing environment for software developers and implementers.

More than 700 healthcare facilities are already reaping the benefits by: • Maintaining quality of care and patient safety • Enhancing nursing productivity and improving operational efficiency • Reducing manual processing errors (including barcoded patient documents, ID tags and wristbands) • Eliminating costly, pre-printed forms • Minimising the risks associated with critical document delivery Now there’s a better way!

DIRECT CONTROL

P: 1300 557 550 F: +61 7 5478 5520 E: support@directcontrol.com.au W: www.directcontrol.com.au Contents:17 Listening to what people want has resulted in the birth of a fully integrated business solution for Practitioners. The aim was to develop an affordable, intuitive, easy to use, educational business solution for Practitioners of all Disciplines that eliminates the need for double entry of data. This has been achieved with seamless integration with Outlook and MYOB. Direct CONTROL facilitates medical billing Australia wide and overseas. Included is all Medicare, DVA, WorkCover, Private Health Insurance and other billing with the latest rules and fees relevant to each medical discipline (general practice, surgeons, physicians, allied health, anaesthetists, pathologists, radiologists and day surgeries/hospitals). Ideal for both the single practitioner and the multi-disciplinary Practice.

CTIUM

BEST PRACTICE

P: 03 5327 9302 F: 03 5327 9307 E: c.lynton-moll@ballarat.edu.au W: www.ahml.com.au

BITG’s forms automation, clinical document management & document process optimisation solutions help you capture, format, scan, archive and deliver real-time access to patient information across your healthcare environment.

Direct CONTROL lets you get on with earning a living doing what you enjoy most … patient care.

Our aim is to ensure Australians have access to an accessible, high quality health system by delivering local health solutions through general practice.

AHML

P: 02 6291 9953 F: 02 6291 9963 E: kburdette@bitg.com.au W: www.bitg.com.au

P: 07 4153 1277 F: 07 4153 2093 E: sales@bpsoftware.com.au W: www.bpsoftware.com.au Contents: 7 Best Practice sets the standard for GP clinical software in Australia offering a flexible suite of products designed for the busy GP practice, including: • Best Practice Clinical (“drop-in” replacement for MD2) • Integrated Best Practice (clinical/management) • Top Pocket (PDA companion software for Pocket PC)

P: 03 9607 1314 F: 03 9607 1317 E: enquiries@ctium.com W: www.ctium.com Contents: 41 CTIUM is taking a fresh approach to addressing age old problems in the healthcare industry with enterprise open source solutions. CTIUM and its partners have agreed to provide a single point of access to e-health professionals with enterprise strength open source software and mission critical 24x7 support services. Our solutions are: • Affordable. Stretch your IT budget further – no license fees. • Flexible. No vendor lock in – you can collaborate to drive innovation. • Reliable. Supported by a global company – assurance to maintain mission critical systems.

DICTAPHONE

P: 1300 550 716 F: 02 9929 0815 E: dictaphone.apac@nuance.com W: www.nuance.com/dictaphone Nuance’s Dictaphone Healthcare Solutions Division is a leading provider of speech recognition, dictation and transcription solutions for the healthcare industry.

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“Innovative Document Management”

HEALTH COMMUNICATION NETWORK - HCN

“Innovative RFID Tracking”

P: 02 9906 6633 F: 02 9906 8910 E: hcn@hcn.com.au W: www.hcn.com.au Contents: 13, 19, 30, 45

“Innovative Data Storage”

FILE PTY LTD

P: 1300 306 407 F: 02 9317 0999 E: info@file.com.au W: www.filegroup.com.au The FILE GROUP offers a comprehensive suite of records storage and management services: • FILE Pty Limited specialises in open-shelf offsite storage and management of records. • FILE Technology Pty Ltd supplies a turnkey RFID tracking system for the movement of records, assets and people. • FILEVault offers a comprehensive On-line backup service using 448 bit military strength encrypted technology for desktops, laptops and servers. The availability of these services makes the FILE GROUP the partner of choice for forward looking organisations desirous of achieving the best possible outcome in records storage and management. Sydney - Brisbane - Melbourne - Perth

GENIE SOLUTIONS

P: 07 3720 4085 F: 07 3720 4462 E: info@geniesolutions.com.au W: www.geniesolutions.com.au Genie is a fully integrated appointments, billing and clinical management package for Specialists and GPs. Genie runs on both Windows and Mac OS X, or a combination of both. With over 1200 sites, it is now the number one choice of Australian specialists.

GLOBAL HEALTH

P: 03 9675 0600 F: 03 9675 0699 E: sales@global-health.com W: www.global-health.com

FILE VAULT

Secure Backup: Protection for your priceless medical data

ReferralNet takes advantage of email and the internet to provide a practical and secure infrastructure for delivering healthcare information efficiently to industry professionals.

P: 1300 306 407 F: 02 9317 0999 E: info@file.com.au W: www.filevault.com.au

What can you do to protect your irreplaceable medical data and more? FILE Vault Secure Backup offers a best-in-class security to backup your valuable data files continuously on-line. • Automatically back up your medical data, administration records and more. • Protects files against hard drive crashes, fire, theft and even accidental deletion. • Multiple layers of security are used to ensure your files are protected during online backups. • Easy to use Sydney - Brisbane - Melbourne - Perth

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HCN focuses on improving patient outcomes by providing evidence based software tools to health care professionals at the point of care. Market snapshot:

Global Health is a premier provider of technology software solutions that connect clinicians and consumers across the healthcare industry.

“Innovative Data Storage”

Health Communication Network (HCN) is the leading provider of clinical and practice management software for Australian GPs and Specialists. HCN supplies 80% of Australia’s major hospitals with online Knowledge resources. HCN employs the industry’s largest software and customer services teams, dedicated to delivering new and enhanced products for Australia’s health care sector.

ReferralNet Claims offers real time submission of claims from practices, public and private hospitals and billing agents to Health Funds, Medicare and Department of Veterans’ Affairs. MHAGIC is the latest and most comprehensive Mental Health Assessment Generation and Information Collection system in Australia. Locum replaces traditional paper records with a robust electronic filing system that manages patient information and improves the efficiency of medical practice.

• 17,000 medical professionals use Medical Director • 3,300 GP Practices use PracSoft • 800 Specialist Practices use Blue Chip and • 1,700 Specialists use Medical Director • Suppliers of Knowledge Resources to 80% of Australia’s major hospitals Visit our website to learn more about our complete offering which includes MDPlus advanced tools, GPRN data and iRIS for radiology practices.

HEALTHLINK

P: 1800 125 036 F: 07 3870 7768 E: enquiries@healthlink.net W: www.healthlink.net Contents: 33, 52 Australia’s largest effective secure communication network. • Fully integrated with leading GP and Specialist clinical systems • Robust; Reliable and Fully Supported Join the network that more than 60% of GPs use for diagnostic, specialist and hospital communications.

HIMAA

P: 02 9887 5001 F: 02 9887 5895 E: himaa@himaa.org.au W: www.himaa.org.au Contents: 25 The Health Information Management Association of Australia (HIMAA) is the peak professional body of Health Information Managers in Australia. HIMAA aims to support and promote the profession of health information management. HIMAA also conducts, by distance education, "industry standard" training courses in Medical Terminology and ICD-10-AM, ACHI & ACS clinical coding.

HISA

P: 03 9388 0555 F: 03 9388 2086 E: hisa@hisa.org.au W: www.hisa.org.au Contents: 27 The Health Informatics Society of Australia (HISA) aims to improve healthcare through health informatics. HISA: • Provides a national focus for health informatics, its practitioners, industry and users. • Advocates on behalf of its members. • Provides opportunities for learning and professional development in health informatics.

Official Supporter of the Australian Olympic Team

insignia pty ltd

P: 1300 467 446 F: 1300 780 049 E: sales@insignia.com.au W: www.insignia.com.au Contents: 11

HL7 AUSTRALIA P: 0412 746 457 F: 02 9475 0685 E: chair@hl7.org.au W: www.hl7.org.au

HL7 Australia is the local representative of the global Health Level 7 standards organisation. The HL7 standards are widely used in Australia to interconnect computer systems in hospitals, laboratories as well as GP and specialist practices. HL7 Australia supports the local user and implementer community with standards, education and implementation support.

HOUSTON MEDICAL

P: 1800 420 066 or +61 2 9669 1844 F: +61 2 9669 1791 E: houston@houstonmedical.net W: www.houstonmedical.net Contents: 15, 24-25 Houston Medical, formed 1988, leading supplier of software for Ophthalmology and Retinal Diabetic screening, installed in hospitals and practices of all types throughout New Zealand, Australia, Fiji, Dubai and Hong Kong. After a complete re-write, Houston VIP.NET using Security Groups with User Defined Forms, allows different specialities their own desktop and workspace on a common database. Billing, appointments TXT and RSD messaging, word processing, prescribing, operating lists all integrated but separate. Whether for day surgery, ophthalmology, cardiology, dermatology, urology, general practice, allied health, or any combination in a mixed practice, in once, out in a 1000 different ways, a truly unique concept for 2008!

With 40 years experience in the industry, insignia is a leading, national label manufacturer. Our focus is quality – quality award-winning labels, quality brands and quality people. We offer labels, systems hardware, software and service to support our clients labelling needs. insignia manufactures a range of prime product labels, blank labels, barcode labels and laser labels: From blank labels for barcoding through to customprinted product labels, insignia can produce a label to suit any application. insignia also carries thermal labelling equipment; applicators and ink jet systems; and ribbons and ink. As well as portable, desktop and automated printer systems, insignia provides a national service infrastructure and has equipment and software training available.

INTERSYSTEMS

P: 02 8243 0300 F: 02 8243 0301 E: anz.query@intersystems.com W: www.InterSystems.com InterSystems provides innovative software products that enable you to create, deploy, run, and connect healthcare applications faster. InterSystems Ensemble®, our rapid integration platform, can cut IT project times in half for enterprises that need to connect applications, processes, and people. Our health information exchange platform, InterSystems HealthShare™, enables the creation of electronic health records that share clinical data across multiple organizations on a regional or national level. InterSystems TrakCare™ is an advanced Web-based healthcare information system that rapidly delivers the benefits of an Electronic Patient Record. Ensemble, HealthShare, and TrakCare all leverage the lightning speed,massive scalability, robust reliability, and rapid development capabilities of InterSystems Caché®, the world’s fastest object database.

IHE ASIA PACIFIC P: 0412 746 457 F: 03 9388 2086 E: info@ihe.net.au W: www.ihe.net.au

Integrating the Healthcare Enterprise (IHE) fills the “gap” between the creation of e-Health standards and their implementation. IHE is not “Yet Another Standard” but the missing link that facilitates easy and successful connection of e-Health computer systems

JOSE & ASSOCIATES IT/IM CONSULTANTS P: 03 9850 1350 F: 1300 889 012 E: news@jose.com.au W: www.jose.com.au

JOSE and Associates are IT/IM Consultants working exclusively with General Medical Practices and other allied health organisations. Service Model Outcomes: • Satisfying IT Accreditation Standards. • Network standards protocols are used to ensure optimum uptime of network. • Total ownership of all IT related problems (from Clinical s/w updates to a faulty mouse) • Disaster Recovery and Business Continuity plans and monthly reviews and test restores. • The entire IT/IM business infrastructure is documented and updated monthly (similar to a patient record). • Support is available 24/7 and the response in most cases is immediate. Most scheduled work is completed after the practice is closed. • Server Maintenance on a monthly basis which includes full monthly reporting. • Initial consultations are complementary until a detailed road map is established. • References available on request.

MEDICAL-OBJECTS

P: 07 5445 5037 F: 07 3221 0220 E: info@medical-objects.com.au W: www.medical-objects.com.au Contents: 35 Medical-Objects are a software company with a vision of a tightly connected integrated health platform. Built on open standards and strong architectural solutions, Medical-Objects provides rich messaging between all sectors of the health sector and tools that build on that messaging such as Clinical Tools for Specialists and Hospitals, Decision Support and Executable forms of Clinical Guidelines. Medical-Objects is committed to agile software methods to deliver the highest of IT standards. Belief in the exclusive use of standards based messaging has developed our expertise and profile in standards implementation in Australia, and enables interoperability with most common clinical software including desktop and hospital systems.

MIMS AUSTRALIA P: 02 9902 7760 F: 02 9902 7701 E: info@mims.com.au W: www.mims.com.au

To cope with the demands of practicing healthcare in the real world, you need fast access to a pure source of knowledge. MIMS is essential knowledge that Australian health professionals can trust, distilled down to crucial facts and easy to use. Because of the rapid flow of information today, you can count on MIMS being up-to-the-minute with regular updates through print, CD ROM, PDA, online or integrated into your clinical software. And because it is generated by a local Australian editorial team and backed by global resources, you can be sure MIMS is always relevant to your needs.

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NEHTA

P: 02 8298 2600 F: 02 8298 2666 E: admin@nehta.gov.au W: www.nehta.gov.au Contents: 2-3, 21 The National E-Health Transition Authority identifies and fosters the development of the best technology necessary to deliver a e-health system for Australia. This includes national health IM and ICT standards and specifications.

STANDARDS AUSTRALIA

P: 02 9237 6000 F: 02 9237 6091 E: healthinformatics@standards.org.au W: www.e-health.standards.org.au Standards Australia is recognised by the Government as the peak standards body in Australia. It coordinates standardisation activities, and develops internationally aligned Australian Standards of public benefit and national interest and facilitates the accreditation of other Standards Development Organisations. Standards Australia is the nation’s official representative at the International Standards Organisation and International Electrotechnical Commission. Through the Australian International Design Awards it promotes excellence in design and innovation.

SYBER SCRIBE

P: 03 9569 4890 / 1300 764 482 F: 03 9569 5543 E: sales@syberscribe.com.au W: www.syberscribe.com.au Syber Scribe provides Internet based medical typing services for hospitals and clinics. • Fast turn around and excellent quality. • Connection to most Patient Management Systems, possible for filing purposes. • Victoria’s largest supplier to hospitals. • References available on request.

WACOM

P: 02 9422 6700 F: 02 9420 2272 W: www.wacom.com.au Wacom is the worldwide market leader in graphic tablet technology and interactive pen displays. For practices looking to move toward a paperless office system, Wacom has a number of solutions that are intuitive and easy to use.

NTS TRANSCRIPTION SERVICES

P: 1300 305 998 F: 03 5722 9388 E: info@ntstranscriptions.com W: www.ntstranscriptions.com NTS provides the very latest in secure Digital Dictation and Transcription systems and couples this technology to deliver highly accurate transcriptions within 24 hours. NTS’s technology allows you to link with your Practice management systems including, but not limited to, Direct Control, Genie, Shexie, CCOS, Blue Chip, Practix, Medical Director, Profile, Zedmed, Medical-Objects, Argus and Healthlink. With 98.5% accuracy and 24hr turnaround, our service will ensure your patient's letters arrive at their GP’s and other interested parties, sooner. Our fully secure web based systems allow Drs to dictate via hand held recorders, telephone, PDA’s or direct from the PC. We accept voice files from many of the large dictation platforms. Letters can be viewed, edited and printed from any web connected PC and filed back to your own systems patient files. An electronic copy can also be sent to the GP through our HL7 delivery system or via third party systems like Medical Objects. NTS will tailor the service and system to your current practice processes and requirements without compromising security and confidentiality. We are the leaders in our Field.

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STAT HEALTH SYSTEMS

P: 07 3121 6550 F: 07 3395 0669 E: carla.doolan@stathealth.com.au W: www.stathealth.com.au Stat Health Systems was formed in 2006 by two groups of industry specialists when they agreed on a collaborative approach to development of software required by the medical industry. The goal was to build a progressive and resilient system that introduces a new level of stability and flexibility to the medical software market. The Stat Practice program provides an uncluttered fresh approach to traditional reception functions. The software uses a combination of new Microsoft development tools with original workflow theory to produce an innovative software application with a streamlined, intuitive interface. This software is now installed and running in a specialist site in Brisbane with further installations pending. The Stat Integrated product will be available in the first quarter of 2009. Stat Services continues to provide a premium support service as well as Stat Online Claiming Solution (SOCS).

EQUIPOISE INTERNATIONAL

P: 07 3252 2425 F: 07 3252 2410 E: sales@totalcare.net.au W: www.totalcare.net.au Contents: 29 Founded in 1994, Equipoise International’s focus has been the development of best of breed medical management systems. We are a proudly Australian based and owned company, with a shareholder base including clinicians, employees, and private investors. Our flagship product - the Totalcare suite of medical software - has been in continuous development for over 12 years. Totalcare reflects our philosophy of providing comprehensive, flexible and reliable solutions to our clients, backed by a personal, knowledgeable support team. We seek to excel in all our interactions, and to provide not just superior software, but superior service.

ZEDMED

P: 03 9284 3300 F: 03 9284 3399 E: sales@zedmed.com.au W: www.zedmed.com.au Owned by Doctors who understand the challenges facing the medical profession everyday and backed by nearly 30 years of experience in medical software programming, Zedmed provides innovative, full featured and sophisticated practice management and clinical records software solutions. From a single Specialist to a multisite GP Practice, we are renowned for our superior customer service and products that provide stability, security and ease of use. We also provide comprehensive data conversions from most software packages on the market today. Zedmed is proud to be one of the longest serving Australian medical software solution providers, with clients nationwide.

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WHEN EVERY HANDOVER IS MISSION CRITICAL.

Using electronic communications for the transfer of care between healthcare providers is a complex and exacting process. Very few organisations have demonstrated the ability to do so on any scale. The stakes are extremely high. Every electronic referral that you send is mission critical and there is absolutely no margin for error. Every month HealthLink is responsible for the sending of more than 36,000 electronic patient referrals, 81,000 specialist letters and the delivery of 110,000 electronic discharge summaries. HealthLink’s services are used by more than 8,000 individual Australian and New Zealand healthcare organisations. We employ a highly skilled team of staff and employ and/or contract local support staff in many areas of Australia and New Zealand. HealthLink has demonstrated a solid track record as a manager of clinical information exchange and during the past twelve years has become a world leader in clinical messaging and health system integration. HealthLink has a deep understanding of what is needed to support its partners’ use of electronic communications. When you are ready to commence electronic ‘Transfer of Care’ we are ready to help you to do it.

Tel 1800 125 036 enquiries@healthlink.net Integration

Standards

www.healthlink.net

Scalability