Pulse+IT Magazine - July 2010

Australia’s First and Only Health IT Magazine

PULSE IT 

Issue

July

18 2010

Secure Messaging E-health’s Quiet Achiever: Secure messaging can deliver enormous efficiency benefits, but is it receiving the respect it deserves?

A National Picture of Secure Messaging: An overview of secure messaging activity as presented by the Australian GP Network.

The Non-Messaging Parts of Secure Messaging: Secure messaging involves more than just the transport of data.

NHS Electronic Prescribing: As Australia builds its electronic prescribing capacity, learnings from the NHS will prove valuable.

08 18 20 26 50

Health System Integration The History of ACHI Secure Message Delivery Specification Healthcare Identifier Implementation Redundant Internet Connections

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Publisher Pulse Magazine PO Box 7194 Yarralumla ACT 2600 Australia ABN: 19 923 710 562 www.pulseitmagazine.com.au

Editor Simon James Australia: +61 2 8006 5185 New Zealand: +64 9 889 3185 simon.james@pulseitmagazine.com.au

Pages 8, 12, 15, 20, 26, 31, 36, 44, 47 SECURE MESSAGING This edition of Pulse+IT includes a guest editorial, two organisational contributions, four feature articles, and several news pieces relating to Secure Messaging.

Subscription Enquiries subscribe@pulseitmagazine.com.au

Advertising Enquiries ads@pulseitmagazine.com.au

About Pulse+IT Pulse+IT is Australia’s first and only Health IT magazine. With an international distribution exceeding 37,000 copies, it is also one of the higest circulating health publications in Australasia.

32,000 copies of Pulse+IT are distributed to GPs, specialists, practice managers and the IT professionals that support them.

In addition, over 5,000 copies of Pulse+IT are distributed to health information managers, health informaticians, and IT decision makers in hospitals, day surgeries and aged care facilities.

ISSN: 1835-1522 Contributors Jacques von Benecke, Jannette Bennett, Tom Bowden, Paul Bruce, Ross Davey, Martin Forrest, Greg Holden, Simon James, A/Prof Terry Hannan, Lauren LeClerc, David Millichap, Geoffrey Sayer, Glenn Stephens, Craig Szucs, Gary Tucek, Klaus Veil, Brendon Wickham, Marilyn Wood and Richard Wylie.

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, Health Scope, UBM Medica, the New Zealand College of General Practitioners, or the Kimberley Aboriginal Medical Services Council, all who produce publications that include the word “Pulse” in their titles.

Copyright 2010 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.

Looking ahead The next three editions of Pulse+IT will feature a selection of articles covering the following themes: • September 2010 - Telemedicine and Mobility • November 2010 - E-Health Infrastructure • March 2011 - Electronic Prescribing Pulse+IT welcomes feature articles and guest editorial submissions relating to these themes, as well as articles relating to e-health more broadly.

Submission guidelines and deadlines are available online: http://www.pulseitmagazine.com.au/editorial

Pulse+IT acknowledges the support of the following organisations, each of whom supply copies of Pulse+IT to their members.

Page 26 HEALTHCARE IDENTIFIERS

Page 47 ELECTRONIC PRESCRIBING

Page 50 INTERNET REDUNDANCY

Editorials

Features

Resources

Page 6 STARTUP Editor Simon James introduces the 18th edition of Pulse+IT.

Page 31 FEATURE ARTICLE Gary Tucek and Ross Davey detail the valuable role secure messaging providers are undertaking.

Page 30 EVENTS CALENDAR Up and coming Health IT, Health, and IT events.

Page 8 GUEST EDITORIAL Tom Bowden outlines the need for a market environment that promotes Health-system Integration.

Page 18 ACHI The Australasian College of Health Informatics’ President Klaus Veil and Immediate Past President Terry Hannan overview the history of ACHI. Page 20 NEHTA The National E-Health Transition Authority provides an introduction to the Secure Message Delivery specification (SMD).

Page 26 MSIA The Medical Software Industry Association President Geoffrey Sayer outlines the opportunity cost associated with a delayed rollout of Healthcare Identifier functionality in clinical software.

Page 36 FEATURE ARTICLE The General Practice Network eHealth Support Officers provide an overview of the state of secure messaging across Australia.

Page 44 FEATURE ARTICLE Glenn Stephens details some of the often overlooked complexities associated with secure messaging.

Page 47 FEATURE ARTICLE Jannette Bennett and Jacques von Benecke provide an update on the progress of electronic prescribing in the NHS.

Off Topic Page 50 INTERNET REDUNDANCY Simon James encourages practices to consider establishing a second Internet connection to mitigate the chance of costly outages.

Page 53 MARKET PLACE The Pulse+IT Directory profiles Australia’s most innovative and influential e-health organisations.

News Page 11 HISA prepares for 18th Health Informatics Conference Page 12 Health-e-Nation conference coming to Sydney in September DCA acquires ArgusConnect Page 15 IHE releases Connectathon results, prepares for conference Showcases Page 16 Australian doctor releases iDoctor app for iPhones, iPads and iPods Spellex releases Australian Medical and Pharmaceutical spelling software

EDITORIAL

Pulse+IT: 2010.3 Simon James

BIT, BComm Editor, Pulse+IT Phone (AU): +61 2 8006 5185 Phone (NZ): +64 9 889 3185 simon.james@pulseitmagazine.com.au

Welcome to the 18th edition of Pulse+IT, Australia’s first

proposed benefits of the Healthcare Identifier Service

and only Health IT magazine.

will be delivered to healthcare providers and their

patients.

Amidst the political ructions of recent weeks, only

those with a particular interest in Australian e-health

will have noted the recent passing of the Healthcare

is warranted, it need look no further than its own track

Identifiers Act, a piece of legislation that has facilitated

record of vendor-reliant e-health initiatives for examples

the switching on of the Medicare Australia-run

of the types of funding models that provide value for tax

Healthcare Identifier Service.

payers and bring about the desired results quickly, and

those that don’t.

Taking several years longer to bring to fruition

than Tony Abbott — the then Health Minister — was

Should government decide that market intervention

promised at the conception of the National E-Health

This edition

Transition Authority (NEHTA) five years ago, the

Owing to the complexity and importance of the

allocation of unique identifiers to patients, providers

subject matter, this edition features a selection of

and healthcare organisations represents a significant

relatively lengthy feature articles and a guest editorial

milestone in Australia’s journey towards e-health

about secure messaging. A somewhat related article

maturity.

on Internet redundancy is included as a conversation

starter for practices and their IT support professionals.

Milestone though it may be, the infrastructure

that is currently in place is perhaps better described

as a foundation stone upon which future e-health

of the Australasian College of Health Informatics,

development is intended to occur. The pace at which

the Medical Software Industry Association presents

such development will occur rests largely in the hands of

a business case for the rapid rollout of healthcare

medical software developers, however presently there

identifiers, and NEHTA overviews the Secure Message

appears to be only a handful of vendors committing

Delivery specification.

resources to enable their products to integrate with the

Klaus Veil and Terry Hannan provide a brief history

Identifier Service.

Looking ahead

The low development priority software companies

With a focus on “Telemedicine and Mobility”, the

are currently placing on the new healthcare identifier

September edition of Pulse+IT will examine the use

system is not surprising given the fact that customer

of technology in the remote delivery of healthcare,

demand for such functionality has not yet had time

and also the current and future applications of mobile

to build up in the market. Further, with government

computer technology.

having not yet revealed a plan to either spike demand

for systems that interact with the Healthcare Identifier

articles, would like to contribute to an edition, or would

Service, or fund software developers to bring such

simply like to discuss your experiences with e-health,

functionality to market, it is unclear at what stage the

don’t hesitate to get in touch.

As always, if you have any suggestions for future

Pulse+IT eNews & Twitter Service To receive the latest Australian Health IT news delivered free to your Email inbox or Twitter client, visit www.pulseitmagazine.com.au

6

Pulse+IT

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EDITORIAL

Forget electronic messaging — think Health-system Integration Tom Bowden

Dip BIA, MBA CEO, HealthLink tom.bowden@healthlink.net

Why are we writing articles about electronic messaging?

messaging is only hindering the development of a more

Reading about it must be like picking up a car magazine

suitable and sustainable business model.

and finding an article about tyre valves. As long as they

work reliably and don’t cost much, who really cares

and encouraging its implementation is a useful

about them? Isn’t that the way messaging is, or should

start. However, nothing will actually happen without

be?

implementing, testing, fine-tuning and supporting

Defining a standard from a theoretical stance

From everyone’s point of view, electronic messaging

the standard’s use in a multiplicity of complex and

is (or certainly should be) a highly automated process

challenging workday situations. Trying to make a large

that enables clinical information to flow from provider

number of health sector systems “talk” to one another

A to provider B. Apart from a few highly technical folk

on any scale is a complex task; doing so in today’s

earnestly debating which version of HL7 to use, whether

fragmented and disruptive health environment is

or not a specialised or generalised Web Service is best

especially challenging.

and at which point to introduce Representational State

Transfer (REST), we should be onto better and brighter

interoperability on any scale have by one means or

things! The real discussion should be about how to

another encouraged the evolution of “Health‑system

stimulate a market for the provision of integrated IT

Integrators”

services and at which point(s) in the health system,

organisations capable of designing, overseeing and

interoperability and seamless real-time information

supporting the exchange of clinical information and the

exchange will occur?

integration of the end-user systems in a manner that

healthcare providers will find truly useful day in and day

The Australian Health IT environment is cluttered

The few countries that have successfully mastered

(HSI).

These

are

highly

focused

with regulatory and advisory bodies earnestly telling

out.

each other what they should be doing, but when

it comes down to groups of people dedicated to

patient information in an interoperable, seamless,

assisting clinicians to share and exchange patient

dependable and well-supported manner. Software

information, the landscape is fairly bare. There is simply

development, integration with Electronic Medical

not enough activity happening at the grass‑roots

Records (EMR) products, and provision of user training

level. What is needed is an industry structure that

are just some of the ingredients needed to make

encourages development of suitable services and

e-health useful at a grass-roots level. Exchange of

support capabilities, in particular organisations that are

information must be underpinned by a wide range of

capable of taking responsibility for ensuring that health

highly disciplined activities, including product testing

information is exchanged in a seamless and dependable

and readily accessible and well-managed customer

manner. Theoretical micro-management of the specific

support. At a strategic level the hallmarks of a successful

processes we have become used to describing as

Health‑system Integrator are specialised expertise,

HSIs enable clinical computer systems to exchange

active promotion of standards compliance, and a

Author Info

track‑record of continuous innovation. Countries that Tom Bowden is CEO of HealthLink Ltd, a 70 person company providing Health-system Integration services to more than 9,000 individual healthcare organisations across New Zealand and Australia. In November 2009 Tom presented a paper on e-health strategy at The Commonwealth Fund’s International Symposium on “Developing high performance health systems” in Washington DC.

have encouraged adoption of this market paradigm, have found it to be an effective means to implement new and useful technologies for the exchange of clinical information between computer systems used across their health sectors.

8

Pulse+IT

Three countries that have encouraged the

www.pulseitmagazine.com.au

emergence of HSIs are Denmark, Holland

of a number of HSI companies that provide

and New Zealand. All three countries

services to the health sector. Privately

capabilities is having a government policy

have realised that for their health systems

owned Topicus’ speciality is the provision

that encourages it. In too many countries

to become efficient they must embrace

of electronic referrals to hospitals, a task

there is still a paradigm in which central

information technology at a grass-roots

which it has accomplished with enormous

government or a government-owned

level in many thousands of independent

success.

agency feels it must dictate exactly how

healthcare provider entities. In all three

In New Zealand, there is a hefty

HSI services should be developed and

countries, private sector organisations have

emphasis on primary care. HealthLink is

run. By and large this has proven to be

been given strong encouragement and

one of three organisations set up in 1994

an extremely wasteful and unproductive

financial incentives to invest in connecting

in response to government’s request to

strategy.

their health sectors. In order to achieve the

industry to develop specialised services for

results that they have, the governments of

the sector. Fifteen years on, New Zealand’s

details of interconnection and trying to

these countries stimulated development

general practices use a wide range of

develop and run IT projects themselves,

of industry structures which fostered,

HealthLink’s e-health services to exchange

governments should focus upon overall

recruited, educated and trained the

50 million messages annually. Just as in

health system strategy and look at how

right breadth and depth of technical and

Denmark, New Zealand’s primary care

best to foster and encourage investment in

marketing skills to make things happen. In

practices exchange electronic information

and development of an open and dynamic

each of these countries strong HSIs have

with a large number of organisations

HSI marketplace.

emerged and successfully designed and

throughout the sector. A typical New

implemented services that integrate their

Zealand

exchanges

discussed at length in TCP/IP Quarterly and

health sectors.

information electronically with between 50

the bodice ripping Exciting Developments

and 60 other parties in any given month.

in SMTP. However, for those of us

Governments have each encouraged the

Now, building upon a sound foundation

actually interested in applying electronic

development of market-driven initiatives

of core electronic messaging services, New

communications to the health sector, let’s

by private sector organisations that

Zealand’s general practices are beginning

get where the real action is — development

are happy to work toward execution of

to use Web Services-based technology for

and support of complex, standards-based

a national strategy and content to be

online hospital referrals and radiology and

services — also known as Health-system

constrained by national and international

pathology service ordering, with many

Integration.

standards. In each of these countries there

more new and useful services currently in

has been an enormous upsurge of e-health

the pipeline.

development.

The Danish, Dutch and New Zealand

International

studies1,2,3

medical

Evolution

practice

rather

than

revolution

A key ingredient in developing HSI

Rather than focusing upon the minute

And electronic messaging? It should be

References 1. Protti D. Comparison of Information

demonstrate that these countries are the

is the key to successful Health-system

Technology in General Practice in

ones that have made the most significant

Integration.

10 Countries. http://bit.ly/c6dPDt

progress in delivering e-health.

every

In Denmark, Medcom is a government

funded

but

independently

run

routine

In

Denmark, healthcare

almost

transaction

is automated. In New Zealand, Web

(accessed June 2010).

2. Protti D, Bowden T, Johansen I.

HSI

Services‑based electronic referrals and

Adoption of information technology in

that has been established for 15 years.

referred services ordering are widespread,

primary care physician offices in New

Medcom works closely with the Danish

as they are in Holland. HSI companies in

Zealand and Denmark. http://bit.ly/

health authorities and with a network of

both countries have been steadily building

cqiHCC (accessed June 2010).

specialist IT development groups to build

their capabilities since 1993-4. They have

3. Davis K, Schoen C, Schoenbaum

and support services for general practice,

recently begun working together to share

SC, Doty MM, Holmgren AL, Kriss

among them pathology and radiology

technology. In Holland, the growth of

JL, Shea KK. Mirror, Mirror on the

ordering and reporting, e-prescribing and

electronic services has been dramatic,

Wall: An International Update on the

GP to specialist referrals using the EDIFact

Topicus Health is one of the fastest growing

Comparative Performance of American

standard. All of the above services are used

companies in the country and has recently

Health Care, The Commonwealth

by 100 percent of general practices.

commenced offering services in nearby

Fund, May 2007. http://bit.ly/k1PsE

Belgium.

(accessed June 2010).

In Holland, Topicus Healthcare is one

www.pulseitmagazine.com.au

Pulse+IT

9

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BITS & BYTES

HISA prepares for 18th Health Informatics Conference The

of

access to a range of proceedings on

Australia (HISA) is preparing for the peak

Health

Informatics

Society

Tuesday, August 24. The organisers have

group’s Health Informatics Conference

pitched this registration at people that are

2010 (HIC2010), which will commence on

new to the field of Health Informatics, and

Tuesday, August 24, at the Melbourne

also at those that are unable to attend the

Convention and Exhibition Centre.

entire conference.

With a theme of ”Informing the

Following

the Q&A

session,

the

business of healthcare”, the conference

HIC2010 Exhibition — which the organisers

has attracted an impressive contingent of

are flagging as the largest in the event’s 18

local and international keynote speakers,

year history — will be opened.

including Dr Mark Britnell (UK), Prof

Michael Georgeff (Australia), Prof Trish

Interoperability Showcase will be held as

Greenhalgh (UK), A/Prof Ross Lazarus

part of the HISA event. To be positioned in

(USA), Dr Donald Mon (USA), Dr Paul

the exhibition hall, the Showcase will allow

Tang (USA), Fran Thorn (Australia), John

vendors to demonstrate the interoperability

Thorp (Canada) and Prof Michael Ward

capabilities of their products to conference

(Australia).

attendees. IHE Australia has increasingly

For the sixth consecutive year, an

Held in association with the HIC2010

gained attention in recent months on

conference proper are several Health

account of its work with the conformance

Informatics

IT-related

testing of the Secure Message Delivery

conferences dealing with nursing, aged

specification, which will be on display at

care and hospital design.

the event. Against the backdrop of the

The

and

conjoined

Health

program

recently announced national program

commences on Monday, August 23, with a

events

for patient controlled health records, the

pair of concurrently held events, namely the

Showcase will also focus on the capacity of

Nursing Informatics Australia Conference

the IHE Cross Enterprise Document Share

and the Inaugural Digital Hospital Design

(XDS) and Imaging (XDS-I) profiles to be

Conference and Workshop.

positioned as a standards-based foundation

for this initiative.

The formal opening of the HIC2010

conference will be directly preceded by a

series of 12 health informatics workshops

will be held on the morning of Friday,

and tutorials. To be held alongside these

August 27, with the busy week of

sessions,

academic

an

Aged

Care

Informatics

An invitational E-health Roundtable

and

industry

proceedings

Symposium will be convened with the

complemented by an array of social and

event theme: “Advancing Informatics

networking engagements. Among these

Research and Practice to Support Aged

are the Networking Reception and Official

Care in Australia and the Region”.

Exhibition Hall opening (Tuesday, August

Following an introductory address by

24), the HISA AGM Breakfast (Wednesday,

conference chair David Rowlands, ABC

August 25), and the HIC2010 Gala Dinner

television presenter Tony Jones will host a

(Wednesday, August 25).

Health Informatics Q&A session, which is

open to all conference delegates including

the other events and functions associated

purchasers of the “Health Informatics

with the conference is available from: www.

Taster Registration” option, which provides

hisa.org.au/hic2010

www.pulseitmagazine.com.au

Further information about HIC2010 and

Pulse+IT

11

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BITS & BYTES DCA acquires ArgusConnect Database Consultants Australia

(DCA)

has entered into an agreement to acquire

Health-e-Nation conference coming to Sydney in September

ArgusConnect, the developer of the Argus suite of secure messaging solutions.

In 2010 the pressing need for Health reform

professionals.

The acquisition was announced prior to

unites the world. Australia is one of many

the formal process taking place in response

countries seriously considering alternatives

allows authenticated users to obtain a

to market speculation in early May, with the

to our current model of care delivery with

faster and better overview of their own

acquisition being completed in early July.

an increasing emphasis on connecting care

patient data drawn from multiple sources.

communities from hospitals to home‑based

It aims to help Danish citizens take more

has been retained to head up the Argus

care.

responsibility for their own health.

software business within DCA, with the

combined entity indicating it is committed

healthcare, politicians and consumers alike

Managing

to

Ross

Davey,

continuing

ArgusConnect’s

the

existing

CEO

While hospitals remain a core facet of

The “My Health Summary” service

According to Sally Glass, CHIK’s Director,

some

of

the

business

are recognising the need to deliver more

Health‑e‑Nation

operation along previous lines. Specifically,

effective and coordinated care outside

underlying elements include the need to

the business unit will remain head quartered

hospital walls and to link clinicians with

recognise that the viability of our health

in Ballarat, with all existing ArgusConnect

relevant information at local, regional and

system affects every aspect of Australia’s

staff offered re-employment by DCA.

national levels.

future, and the need to recognise the

Two additional support staff have been

critical role that e-health plays in achieving

added to the ArgusConnect ranks since the

annual Health-e-Nation conference will

successful health reforms.

acquisition, and the DCA technical support

showcase innovative healthcare models

desk has had its duties expanded to act

from Denmark, the US and Asia, examining

economic

as overflow capacity for times when the

how they are linking clinicians and

our nation, it is appropriate that the

ArgusConnect support desk is unable to

delivering improved patient care.

transformation

respond to customer enquiries.

The Danish eHealth Portal, Sundhed.

constrained to discussion and review

In a statement, Mr Davey said, “The

dk, is one international healthcare system

within a health paradigm but is given due

synergies between the businesses will

represented on the single-day program,

recognition as a national priority. The

bring real benefits to our valued customers

with Sundhed’s Managing Director, Mr

health sector is eager to get behind national

and we look forward to demonstrating

Morten Elbaek Petersen joining the line‑up

e-health leadership to move forward with a

our commitment to the industry over the

of keynote speakers.

common vision and purpose, as well as a

coming months. I am certain that this is

sense of urgency,” Ms Glass said.

good news for all Argus users as the benefits

result of joint national and regional efforts

of a more substantial organisation such

to support online interaction between

increased focus on information sharing

as DCA will provide a solid footing for the

healthcare professionals and consumers.

and networking. With lively emcee Julie

Argus initiative into the future.”

A comparatively modest investment in

McCrossin at the helm, the organisers

With these thoughts in mind, CHIK’s

Established in 2003, Sundhed.dk is a

conference

program’s

“With direct impact on the productivity,

This

health of

year’s

and

prosperity

healthcare

conference

is

has

of not

an

Mr Davey has also indicated that DCA

infrastructure and a shared system has

are warning attendees to prepare to be

will assist with the implementation of the

resulted in the development of services

engaged and active whether they are

Secure Message Delivery (SMD) technical

that are now used across municipalities and

seated in the audience or standing at the

specification into a future iteration of the

regions all over Denmark.

podium.

Argus software suite, the parent company

having already undertaken work with the

create a single point of access to the Danish

session, exhibit hours have been extended

specification for its “The Care Manager”

health service for consumers and healthcare

to include a networking reception plus a

community care software. It is understood

professionals by gathering existing as well

breakfast and two invitational workshops

that DCA intends to demonstrate their

as future information and communication

the following day.

SMD functionality at the forthcoming IHE

within the healthcare sector. Sundhed.dk

Australia Showcase, which will feature at

serves as a public, Internet-based portal

Auditorium at the Sydney Convention and

HISA’s HIC2010 conference, to be held in

that collects and distributes healthcare

Exhibition Centre on 9 September 2010:

late August in Melbourne.

information among citizens and healthcare

http://www.health-e-nation.com.au

The idea behind Sundhed.dk was to

12 Pulse+IT

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AG

PA L

BITS & BYTES

IHE releases Connectathon results, prepares for conference Showcases IHE Australia has released the official

results during the course of the event.

results from its “Connectathon”, which was

held over the course of a week in late April.

Department of Health and Ageing to run

During an IHE Connectathon, software

the Connectathon under established IHE

developers endeavour to enhance their

rules and procedures. To support the event,

products and demonstrate an ability to

IHE Australia commissioned the expertise

exchange data with other relevant systems.

of the Australian Healthcare Messaging

If successful in this process, software

Laboratory (AHML) to develop procedures

vendors are able to publish a conformance

and a secure messaging test facility.

statement, providing purchasers with an

authoritative, independent guide to their

has commenced preparations for its annual

product’s abilities.

IHE Showcase, which provides vendors

Thirteen participants took part in the

with an opportunity to demonstrate

Connectathon, which focused on achieving

the interoperability capabilities of their

interconnectivity using the new Standards

products to HIC2010 conference attendees.

Australia

Technical

Specification

IHE Australia was contracted by the

Since the Connectathon, IHE Australia

for

Pending sufficient interest by participating

E-Health Secure Message Delivery (SMD).

vendors, for the first time, the Showcase

The Specification was developed during a

may also be rolled out at other relevant

collaborative process involving Australian

conferences later in the year.

Health IT software developers and the

National E-Health Transition Authority

will focus on the capacity of the IHE Cross

(NEHTA) and was released in its final state

Enterprise Document Share (XDS) and

in early March this year.

Imaging (XDS-I) profiles to be positioned as

a standards-based foundation for personal

Of these, the eight vendors shown in

Table 1 were able to achieve successful

In addition to SMD, this year’s Showcase

health records initiatives.

Table 1 - Results from the 2010 IHE Australia Secure Message Delivery Connectathon.

Company

Sender

Receiver

Database Consultants Australia





Emerging Systems



 

Episoft

NEHTA

Smart Health Sonic Healthcare

  

Receiver Intermediary

  

Global Health

Pen Computer Systems

Sender Intermediary





 = Successful full IHE testing with three or more test partners  = Successful IHE testing with one or two test partners www.pulseitmagazine.com.au

Pulse+IT 15

BITS & BYTES Spellex releases Australian Medical and Pharmaceutical spelling software

Australian doctor releases iDoctor app for iPhones, iPads and iPods

The US-based Spellex Corporation has announced an Australian version of their

In collaboration with developer Bonobo,

the interface options available to iPhone

medical

spelling

Dr Rhys Clark from Sir Charles Gairdner

app developers, including customisable

software, which integrates with products

Hospital in Perth has released “iDoctor”, a

ticker wheels that allow users to enter their

from Microsoft as well as a range of other

software application (app) for Apple iPhone

own procedures or operations specific to

programs.

and iPod Touch devices, and also the iPad.

their speciality, and quickly select these

Primarily targeted at junior doctors

from a graphical pick list when required.

medical and pharmaceutical words with

working in hospital settings, iDoctor offers

Common procedures and supervising

proper spelling specific to Australia.

a suite of five different logging systems

doctors are also stored and pre-populate

The products are pitched as an

that allow clinicians to keep track of their

the relevant fields, streamlining data

alternative to paper medical dictionaries,

procedures, hours worked, patients seen,

entry.

pharmaceutical word books, and medical

education attended and consults given.

spellers that are based on American English

The need for such a solution became

their logbooks via email in a spreadsheet

words. According to the developers, by

apparent to Dr Clark after witnessing his

format, which can then be edited, printed

adding “Spellex Medical 2010” and “Spellex

colleagues’ attempts to use paper systems

or forwarded on via email to another

Pharmaceutical 2010” to the common

and various generic spreadsheet-driven

interested party, such as the hospital‘s

Australian English language lexicon, the spell

solutions.

administration.

checkers will verify correctly spelt medical

and pharmaceutical words and provide

surgical logbook and also saw other doctors

ensure patient and doctor confidentiality is

correct spelling choices for incorrectly spelt

battling to run clunky spreadsheets on their

maintained, and all data stored within the

terms.

iPhones. I found I had lots of different pieces

application is automatically backed up to

and

pharmaceutical

The release includes thousands of new

“I was struggling to keep track of my

The app allows users to easily export

The app can be password-protected to

The spell checkers also allow users

of paper and patient stickers in my pockets

the doctor’s computer each time the phone

to verify unsure spelling of medical and

and was always missing out on cases that

is synchronised with iTunes.

pharmaceutical words by phonetic or

needed to be included,” said Dr Clark.

typographical search as they type. Both

doctors who are not required to keep a

iDoctor takes advantage of several of

the standard Australian English language dictionary and the Spellex medical and pharmaceutical dictionaries are checked

According to the developers, junior

logbook can use iDoctor to keep track of The iDoctor app home screen, providing access to five electronic log book functions.

operations performed or assisted with in preparation for college interviews.

simultaneously.

iDoctor is currently retailing for $12.99

Spellex Medical 2010 adds more than

from the iTunes Store, with a portion of

300,000 medical words from over 70 medical

each sale donated to Australian Doctors for

specialties to the basic speller. Spellex checks

Africa, a charity providing volunteer doctors

for accurate spelling of medical and surgical

and nurses to areas of need in Africa.

terms, procedures, diseases, drug names, acronyms,

eponyms,

medical

The iDoctor Overtime log screen, showing both claimed and unclaimed sessions.

devices,

abbreviations, Greek terms and diacritical markings such as Behçet’s syndrome and Legg-Calvé-Waldenström disease.

Prices

for

the

medical

and

pharmaceutical dictionaries start at $99 AUD for single users, with multi-user and enterprise licenses also available.

Further information and a free evaluation

version of the software is available from: http://www.spellex.com.au

16 Pulse+IT

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ACHI

ACHI: A brief history How ACHI began

In July 2001, a group of Australian health informaticians

possible involvement in ACHI and gave E. Hovenga the

lead by Prof Enrico Coiera including E. Hovenga, B.

task of preparing the initial education accreditation

Cesnik (deceased), B. Celler, M. Kidd and M. Pradhan

strategy document for review to be endorsed by the

with guest J. Turley from the USA meet to develop

inaugural Fellows. It discussed the establishment of a

the concept of a professional Health Informatics

Centre for Health Informatics in the University of New

college. This initiative found financial support by the

South Wales and the promotion of the e-Journal of

then Australian Department of Health and Aged Care.

Health Informatics (eJHI) that had been developed by

President, ACHI president@achi.org.au

Senior Australian Health Informaticians were identified

Central Queensland University.

Terry Hannan

Foundation Fellows of the College. The initiative to form

ACHI grows

a College was based on the realisation that the time had

In August 2003, ACHI held its first AGM in conjunction

come to establish a formal professional organisation to

with the HISA Health Informatics Conference “HIC2003”

expand the discipline of health (medical) informatics —

in Sydney. Fourteen Foundation Fellows were present

a new and emerging worldwide discipline.

and were awarded their certificates. New office bearers

Klaus Veil

Immediate Past President, ACHI

and a consensus process established to determine the

Organisational setup

The meeting considered International Fellows for

were elected: President B. Cesnik, Vice President E. Hovenga, Secretary T. Hannan, Treasurer S. Heard,

In November 2002, the “Australian College of Health

Membership representative E. Coiera. It was agreed to

Informatics” was incorporated under the Victorian

convert ACHI to a national organisation and to continue

Associations Incorporations Act. The College conducted

with a primary focus on “capacity building”.

a full day meeting in Coogee, Sydney, at which the

Foundation Fellows defined the ACHI Mission, reviewed

approximately

the rules of association and established the initial

Members and Student Members. While the number

criteria for becoming members of the College. The

of members may appear small, each College member

Australian Computer Society (ACS) gave permission

has passed a formal evaluation of their professional

to use its nomination criteria format as a basis for the

qualifications, experience and contribution to Health

development of the four levels of ACHI membership:

Informatics before being accepted.

Fellow, Member, Associate Member and Student

Member. Peter Williams and Peter Schloeffel were

across the Tasman, in 2009 the College agreed to extend

nominated as returning officers for the first election of

its remit to include New Zealand and renamed itself to

office bearers.

“Australasian College of Health Informatics”. As a result,

Since then the membership has grown to 60

Fellows,

Members, Associate

In response to persistent requests by colleagues

Author Info

a number of senior Health Informatics experts from the Klaus Veil’s background is medical technology development and economics. After serving as Chairman of HL7 Australia from 2002 to 2009, he was elected as ACHI President in 2009.

Terry Hannan is an Associate Professor at the University of Tasmania and a long-time Fellow of the Australasian College of Health Informatics and served as its President 2007-09.

Asia-Pacific region have joined the College.

ACHI’s involvement in Scientific Programs Following ACHI’s involvement in HIC2003, ACHI Foundation Fellow B. Cesnik chaired the Scientific Program Committee for HIC2004, held in Brisbane, and

18 Pulse+IT

www.pulseitmagazine.com.au

Fellow Heather Grain chaired the Scientific

Australia pursues initiatives to enhance

across all its sub-disciplines (education,

Program Committee for HIC2005, held

professional standards, which include

technology, software, implementation,

in Melbourne. This partnering with HISA

maintaining and developing the ethical

research, etc). [Refer to the work of E.

has continued through to this year’s

standards of professionals as well as

Coiera and J. Westbrook as examples

HIC2010 event with the Scientific Program

working in partnership with the higher

for research and innovation]

Committee largely “staffed” by ACHI

education sector to ensure excellence in

Fellows under the guidance of Fellow David

professional education.

policy and legislation, in particular the

Hansen.

recent Health Identifier debate (see

• Constructive comment on government

This fits closely with the initiative

ACHI Fellows were also significantly

headed by Don Detmer in the USA to

www.ACHI.org.au/Documents.htm)

involved in hosting and organising the

recognise Health Informaticians as a

• Input to technical architectures such as

Scientific Program for the 2007 international

professional speciality discipline similar to

NEHTA’s recent Electronic Transfer of

MedInfo Conference in Brisbane.

the medical colleges.

Prescriptions (“ETP”)

ACHI Partners

ACHI is also a formal Member of the

peak

Australian

committee

the

ratification

of

•

In education ACHI has a direct role in defining health informatics educational

ACHI is an Academic Institutional Member

development

of the International Medical Informatics

standards for health information systems

Government-recognised and supported

Association, providing the College and its

interoperability and e-health, Standards

Australian Health Informatics Education

members with the following privileges:

Australia IT-014 “Health Informatics”.

Council (www.AHIEC.org.au). [T. Liaw,

• Participation in the IMIA General

IT-014 publishes national standards in

E. Hovenga and H. Grain]

Assembly, IMIA’s governing body.

• Access to the IMIA website’s online News and Announcements.

• Ability

to

network

with

standards

through

its

Federal

response to the health sector’s information

• The direct involvement of ACHI Fellows

needs and ensure a consolidated approach

in Primary Care e-health [M. Kidd AM,

in areas such as electronic health records, peer

messaging, terminology, representation of

client/provider

involved in crossing the ‘digital divide’

interchange of ideas, collaborative

identification and health supply chain.

for developing nations (The Great

efforts, student/faculty exchange etc.

Its standards enable the exchange and

South Land) through the involvement

longitudinal

health

of ACHI Fellows in the International

of the IMIA Yearbook.

information to support integrated clinical

Affairs Committee of AMIA. [T. Hannan,

It is worth noting that four ACHI

care.

T. Liaw]

members are also Fellows of the American

health

concepts,

Teng Liaw] • The policy and implementation project

organisations on a global level for the

• Free access to the full electronic version

and

for

management

of

ACHI Contributes to Policy Debate

Summary

responsibility to advance and recognise

Due to its members’ extensive involvement

College of Health Informatics and its

Health

in

and experience in e-health, ACHI can now

members have established themselves

Australasia, ACHI is a full member of the

be considered as the home of the regional

as significant contributors to Health

Australian Council of Professions Ltd,

health informatics thought leaders and

Informatics research, education, policy

the national organisation of professional

a peak source of expert knowledge

and debate in the region. As e-health is

associations advancing and promoting

providing:

now politically “centre-stage” in Australia,

professionalism for the benefit of the

• An authoritative knowledge resource

it is expected that these contributions will

community. Also known as “Professions

for governments and industry in

increase in influence.

Australia”, it has around 30 member

e-health policy

College of Health Informatics (ACMI).

In recognition of the College’s role and Informatics

professionals

associations representing over 350,000

• International leading-edge research

professionals across Australia. Professions

and innovation on health informatics

www.pulseitmagazine.com.au

Over the last eight years, the Australasian

The requirements and benefits of

College involvement are available at the ACHI website: www.achi.org.au

Pulse+IT 19

NEHTA

Secure Messaging: Making the connection The

electronic

exchange

of

patients’

medical

information across the health sector requires the highest level of information security — just as when we

refinement, consultation and expert review managed

by Standards Australia.

exchange financial information with our bank. This is part

Overview

of the work being undertaken by the National E-Health

The SMD specification defines four roles and six

Transition Authority (NEHTA) in developing practical

interfaces used for delivery of messages. Roles are used

solutions for Australian e-health requirements.

to specify the required behaviour of parties involved in a

message delivery interaction. The roles are:

In March 2010, Standards Australia published three

technical specifications dealing with key aspects of

• Sender: the organisation sending a message.

e-health secure messaging:

• Receiver: the intended organisation receiving the

• ATS 5820 - 2010: E-Health Web Services Profiles (WSP)

message.

• Sender Intermediary: an intermediary that performs

• ATS 5821 - 2010: E-Health XML Secured Payload

routing and service hosting functions on behalf of

Profiles (XSP) • ATS 5822 - 2010: E-Health Secure Message Delivery

Author Info

a Sender.

• Receiver

an

intermediary

that

(SMD)

performs routing and service hosting functions on

This suite of specifications describes an approach

behalf of a Receiver.

to e-health communication using widely supported

industry standards for Web Services.1 The SMD

various roles are defined using Web Services Definition

specification focuses on the secure delivery of messages

Language (WSDL) supplemented with functional

between healthcare organisations, either directly or

requirements for implementing both invokers and

indirectly using one or more intermediaries.

providers of those interfaces. Two modes of interaction

are supported by the interfaces:

These specifications are a result of working with

The six interfaces required to implement the

industry stakeholders and standards organisations.

• Deferred: where the messaging process is one-way

In particular, the SMD specification resulted from

and any application or human response is a separate

an intensive six month process of collaborative

messaging

development between NEHTA and members of

confirmation is provided through a Transport

the Medical Software Industry Association (MSIA),

Response mechanism.

interaction.

End-to-end

delivery

stimulated by the Department of Health and Ageing

• Immediate: where the messaging process is two-way

through the current e-health Practice Incentive

and an application response is returned immediately

Program, followed by a three-month process of

in a single interaction.

The National E-Health Transition Authority was established by the Australian Commonwealth, State and Territory governments on 5 July, 2005 to develop better ways of electronically collecting and securely exchanging health information.

To learn more about NEHTA’s work go to www.nehta.gov.au or contact securemessaging@nehta.gov.au for additional information.

Application The SMD specification defines an approach to e-health communication which is applicable to a wide range of message types and formats, in scenarios where the intended receiving organisation is known to the sender at the time of initiating the communication.

20 Pulse+IT

Intermediary:

This is a fairly common e-health scenario and would

www.pulseitmagazine.com.au

apply to situations such as a hospital sending a discharge

role currently played by intermediaries in e-health

summary to a GP clinic, a GP clinic sending a referral to

communications in Australia, while also providing

an identified specialist practice, a laboratory sending

the option of direct communication between sender

pathology results to the requesting GP clinic and so

and receiver organisations without the assistance of

on. The specification does not define specific message

intermediaries. The use of intermediaries allows either

types and formats, but provides the means to identify

sender or receiver, or both, the option of not hosting a

payload characteristics from a list agreed by the SMD

Web Service exposed to the Internet (and the technical

community.

infrastructure associated with this). Hence, the

The SMD specification would not apply to situations

specification is designed to apply equally to parties who

where the intended recipient is not known at the time of

are able to provide the technical capacity for hosting

sending the communication, such as when a GP sends a

Web Services themselves and to those who wish to

prescription to be filled by an unspecified pharmacist

have this capacity provided on their behalf by others.

— unspecified, because (in most cases) the choice of

Typically, a healthcare organisation would implement

pharmacist is made by the patient after he/she leaves

both Sender and Receiver capabilities and similarly,

the GP’s office. In these situations, a different model of

most intermediaries would support both Sender

communication is required to ensure the end-to-end

Intermediary and Receiver Intermediary capabilities.

security of the communication and this will require

alternative specifications (which are being drafted by

ensure the message contents are secured end-to-end

NEHTA for consideration by Standards Australia).

from sender to intended receiver, regardless of how

many other parties may participate in the transport

The SMD specification explicitly recognises the

The specification uses a mechanism (XSP) to

2-4 November 2010 - Wellington Town Hall

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This programme carries 17 CME points

For exhibition and sponsorship opportunities contact admin@hinz.org.nz

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Pulse+IT 21

of the message and independently of the transport

rather than being limited to the scope of the messaging

mechanisms used by these intermediary parties. In

technology used by a particular party. Any healthcare

addition to payload security, interactions are also

organisation that implements the specification, either

supported by point-to-point Transport Layer Security

directly or indirectly via an intermediary, will be able

(TLS) to ensure that only legitimate healthcare

to connect to and exchange a broad range of message

organisations and intermediaries are able to participate

types, securely and reliably, with any other healthcare

in messaging interactions.

organisation that also uses the specification. Parties

will be able to communicate even where the sender and

The use cases supported by the specification are

illustrated in Figures 1-4.

receiver use different intermediaries to host services and route messages.

Benefits

The

specification

itself

will

not

result

in

Adoption of the SMD specification will enable healthcare

“interoperability�, because it does not define the

organisations to communicate in a standardised way,

content, format and meaning of messages nor the

Figure 1 - Deferred mode with both parties hosting Web Services. message

Receiver

Sender delivery confirmation

Figure 2 - Deferred mode with Sender and Receiver Intermediary hosting Web Services. message

retrieve

Receiver Intermediary

Sender confirmation

Receiver confirmation

Figure 3 - Deferred mode with Sender Intermediary and receiver Intermediary hosting Web Services. message

message

Sender Intermediary

Sender retrieve

retrieve

Receiver Intermediary confirm

Receiver confirm

Figure 4 - Immediate mode with Receiver hosting a Web Service.

message

Sender

22 Pulse+IT

response

Receiver

www.pulseitmagazine.com.au

rules of exchange. However, it will enable a basic

level of connectivity between all endpoints, which is

possible now using currently available means of

While SMD deployments of a limited scope are

a significant foundation upon which to build toward

identifying the parties and existing PKI certificates,

semantic interoperability.

deployments across large numbers of endpoints (especially involving parties not previously known to

Ongoing work

each other) will become possible only after NEHTA’s

Since the publication of the SMD specification, NEHTA’s

Healthcare Identifiers Service (HI Service) and National

secure messaging team has focused on supporting the

Authentication Service for Health become operational.

adoption of the specification by e-health software

developers. NEHTA provides support by:

to all e-health communication scenarios. Additional

• developing and publishing a free open source

specifications will be necessary to define solutions for

implementation of the SMD specification;

e-health communications in other situations. However,

• offering implementation workshops to provide technical assistance to implementers;

where it can be applied, NEHTA will ensure that these other specifications are aligned with the SMD.

• developing test specifications and test tools to enable

In the longer term, under the auspices of Standards

developers to test whether their implementations

Australia’s Health Informatics committee IT14-06,

conform to the SMD specification; and

NEHTA will:

• offering consultancy services to organisations seeking to implement the specification.

As noted above, the SMD specification does not apply

• collaborate with IHE International to harmonise the SMD specification with IHE’s Cross-Enterprise

In April 2010, NEHTA participated in the Secure

Document Reliable Interchange (XDR) profile

Messaging Connectathon conducted by IHE (Integrating

• refine the SMD specification based on feedback

the Healthcare Enterprise) Australia to test its own

from implementation experience and progress

implementation of the SMD specification alongside

the specification to becoming a full Australian

those of other participants and to provide technical

Standard.

assistance to early adopters.

Progressively, more e-health vendors will have

Notes

products that implement the SMD specification.

1 - Web Services refers to a set of technologies using the

Potential users of this capability should contact vendors

Simple Object Access Protocol (SOAP) and eXtensible

of clinical systems or messaging systems to determine

Markup Language (XML) as well as the transport

whether and when they would be able to supply and

protocols and infrastructure of the Internet to enable

install conformant products.

communication between software applications.

Health Information: The Golden Thread in Health Reform

HIMAA National Conference 2010 27th - 29th October

Harbours Edge Events Centre, Darling Harbour, Sydney, Australia

www.pulseitmagazine.com.au

www.himaa.org.au/2010/site/landing.html

Pulse+IT 23

Want to know more about e-health?

Whether you are a consumer, healthcare manager, healthcare provider or vendor, you need a central location to quickly find and access e-health information.

Welcome to:

www.ehealthinfo.gov.au Your gateway to the emerging world of modern healthcare.

Discover how information technology is delivering a more reliable and efficient health system.

Featuring: • The Healthcare Identifiers (HI) Service • How e-health systems are being designed to maximize security and privacy • Why a national certification capability is an essential foundation for safe, secure and interoperable e-health solutions in Australia • The latest Federal, State and Territory government e-health initiatives • The delivery of a standard clinical language for use across Australia’s e-health implementations and how it is a significant step towards improving the quality and safety of healthcare.

www.ehealthinfo.gov.au is jointly brought to you by Australia’s Federal, State and Territory health authorities and the National E-Health Transition Authority (NEHTA) to help you explore the e-health concept and stay in touch with the latest innovations as they unfold

The Healthcare Identifiers Service (HI Service) One of the key foundations for a national approach to e-health will be a standard process across the health sector to accurately identify everybody involved in a healthcare transaction.

This includes the person receiving healthcare, the person providing healthcare, and the place where the care is given. The National E-Health Transition Authority (NEHTA) is the lead organisation supporting the national vision for e-health in Australia and tasked with developing the foundations which will underpin a national e-health infrastructure.

One of these is the HI Service.

What is the HI Service?

The HI Service will implement and maintain a national system for uniquely identifying healthcare providers and individuals.

The service will assign three types of healthcare identifiers: • Individual Healthcare Identifier (IHI) – for individuals receiving healthcare services.

• Healthcare Provider Identifier – Individual (HPI-I) – for healthcare professionals and other health personnel involved in providing patient care.

• Healthcare Provider Identifier – Organisation (HPI-O) - that will uniquely identify organisations that deliver healthcare such as hospitals or medical practices.

Why introduce Healthcare Identifiers?

How will the IHI improve healthcare communication?

Is this a health record?

Who will be responsible for assigning healthcare identifiers?

When will IHIs be available?

Mismatching of patients with their records and results is a documented problem for the health system and a clear link has been established between avoidable harm to patients and poor medical records management. Using an IHI provides a way for healthcare providers to more accurately match the right records to the person they are treating and improve accuracy when communicating information with other healthcare providers. This will help to avoid medical mix-ups or one person’s information being recorded on another patient’s file.

There are four key areas where the use of IHIs to support the electronic exchange of information will deliver immediate benefits for patients: • • • •

Discharge summaries Pathology tests Prescriptions Referrals.

No. The information held will be limited to demographic information such as name and date or birth needed to uniquely identify individuals and providers. Identifiers will provide a much more reliable way of referencing patient information, particularly in healthcare providers’ electronic information management systems.

Medicare Australia will be the initial operator of the HI Service.

Subject to legislation, operations will commence on 1 July 2010.

Visit www.nehta.gov.au or www.ehealthinfo.gov.au for further information

MSIA

Numbers, statistics and probability: the role of chance and Healthcare Identifiers Since October, 2009 I have had the opportunity (or

for implementation that in the past haven’t

burden depending on one’s perspective) to participate

• Patients don’t need to know their IHI — or be

processes, reference groups, opinion leads and cross

concerned about it — but are expected to demand

industry working sessions with the mixed and varied

the benefits of an IHI from their Healthcare

objectives that e-health has promised, on behalf of the

providers.

Medical Software Industry Association (MSIA).

Geoffrey Sayer

BSc(Psychol), MCH, PhD President, MSIA president@msia.com.au

worked.

in various stakeholder meetings, vendor engagement

• E-health is considered deterministic in nature, i.e.

Within these forums e-health has been consistently

its use will guarantee a specific result yet healthcare

described as an exciting future, long overdue and is

is probabilistic, i.e. some people get better some

gearing up to deliver widespread benefits to patients,

of the time with some treatments with differing

clinicians and funders of healthcare. Through these encounters I have made a number of observations on

degrees of effects.

• E-health doesn’t face the same effectiveness

e-health: • There is an urgent desire to hurry up and deliver e-health but we are asked to wait — again.

• E-health has to combat silo mentality but most

analysis as other healthcare interventions do.

In contrast to these at times conflicting paradoxes,

there has been one consistent position that the MSIA has had in regards to the proposed Healthcare Identifier

e-health initiatives are silo-based and not aimed at

(HI) Service to be run by Medicare Australia:

the intersecting points in healthcare.

• The HI Service provides clear benefits to the

• E-health is an enabler of change — Primary Care is fundamental to healthcare — but GPs are latecomers for rollout engagement.

• Every Australian will have an Individual Healthcare Identifier (IHI) — industry, Government and the

Australian people and establishes a critical building block for an e-health enabled healthcare system.

• The passing of HI Service legislation is a significant step forward in the e-health agenda for patient safety and care.

profession agree on the benefits of IHIs — but we

• However, while everyone will have an IHI, few

are not looking to fast track the benefits that have

patients will receive any benefits for many years

underpinned the reasoning behind having IHIs.

to come under the proposed implementation

• The recent budget initiative for Person Controlled

approach.

Electronic Healthcare Records (PCEHR) has two

• From the outset Medicare Australia will be incurring

years to demonstrate benefits of PCEHR, but there

cost of production and support regardless of

is a longer time table to deliver the actual building

whether anyone is accessing the HI service or not.

blocks that will underpin the initiative.

• The estimated savings and benefits will not be

• We have examples of what works and what doesn’t

realised unless the IHIs are functioning across

work in e-health but seem to pursue the approaches

the whole sector in the actual exchanges of

Author Info

information.

As well as being President of MSIA, Geoffrey is General Manager Australia of HealthLink. He has spent the past 20 years working as an epidemiologist in academia, and the public and private sectors. For the past 10 years Geoffrey has occupied senior management positions in medical software companies.

GPs and community-based care key to success It is obvious to many that GPs and community-based care will need to play a significant role in implementing and using IHIs in their existing patient management systems and in the sharing of health information across

26 Pulse+IT

www.pulseitmagazine.com.au

the Healthcare system if we are to realise the benefits

• A strategy of relying on a “controlled release” and

of IHIs.

“lessons learnt” from early adopters that have the

right to refuse to share their learnings with other

One only has to consider the numbers of events that

occur around GPs per year to realise their importance in the bigger scheme of things:

organisations under confidentiality clauses.

• A lack of effective evaluation of any impact or

• 100 million GP consults

benefits of HIs.

• 100 million GP prescriptions

• 200 million medications dispensed

initiatives that focus on the inter-sectorial points (e.g.

• 40 million GP pathology requests

GP and Pharmacy, GP and pathology, GP and radiology,

• 60 million pathology reports to GPs

GP and specialists) as these are the connecting points

• 10 million GP imaging requests

where patients are crossing over the boundaries of care

• 10 million imaging reports to GPs

that need to make sure that the right patient’s data is

• 8 million GP specialist referrals

being matched with the information exchange event.

• 8 million specialist reports to GPs • 7.5 million hospital separations (4.5 million public hospitals, 3 million private hospital) • 7.5 million hospital discharge reports (4.5 million

It is probably even more important to look at

Opportunity costs associated with a controlled roll-out It is not too hard to put together a conservative

public hospitals, 3 million private hospital)

Opportunity Cost Model for the intended approach to

However the described Implementation Approach

gain an understanding of the impact of a controlled

for Health Identifiers is focused on hospital-based

release with Innovators, Early Adopters, Fast Followers

initiatives under state jurisdictions rather than

and Late Followers once the HI Service has been

widespread deployment across the community-based

established and healthcare providers can begin to

care sector.

populate and share patient data with IHIs attached.

The MSIA has been very clear in vendors’ desire

There are some simple assumptions to take into

to deliver the benefits of the HI Service. At the recent

consideration in building this model that are based on

MSIA’s CEO Forum the member companies made it

evidence:

clear to the executive that it supports:

• It is estimated that there are at least $360

1

• Timely delivering of capability across all sectors.

million healthcare costs that are associated with

• Well specified requirements.

miss‑identity.

• The use of standards.

• Miss-identity in medications is estimated to be at

• Robust testing and infrastructure capabilities.

• Appropriate

Compliance,

Conformance

least 0.2 percent of the 200 million medications and

Accreditation (CCA).

dispensed.

• Miss-identity in pathology is estimated to be at least

• Effective support and education of end users.

• Appropriate business and financial drivers.

0.3 percent of the 40 million pathology requests.

• Miss-identity in discharge summaries is estimated

In response to the Implementation Approach for

Health Identifiers there is:

to be at least 1 percent.

• Assume that 25 percent of miss-identity errors

• Acceptance of an extremely slow uptake of the HI

($90 million healthcare costs) can be prevented by

Service.

implementation of IHIs through the HI Service and

• A lack of community-based initiatives i.e. GPs, Specialists, Diagnostic services.

the exchanging of information that contains IHIs. • The cost of implementing the HI Service by Medicare

• Talk of a tipping point with no evidence beyond jargon buzz word terminology.

• A lack of understanding of business drivers that

Australia is assumed to be $25 million each year.

Based on these assumptions, an Opportunity Cost

Model for the proposed controlled roll-out approach

have successfully worked before in driving e-health

has been constructed and is displayed in Table 1.

initiatives (e.g. MBS online, PBS online).

www.pulseitmagazine.com.au

Basically the model works this way. Assume that

Pulse+IT 27

coverage reflects the actual proportion of records in

think about how much we should be prepared to invest

the various patient management systems that have

to fast track implementation of IHIs because unless you

an IHI and is largely random. Imagine for Year 2 if a

achieve the extremely high coverage levels, you will not

request is made from a GP who has a probability that

achieve the population effect benefits expected.

the patient record has an IHI is 30 percent (probability

is considered to be 0.30) and the intended pathology

demand this of vendors due to patient pressure and

system patient record also has a probability of an IHI

foot the bill? A succinct commentary from one of our

as 30 percent (probability is also considered to be 0.30).

leading vendors:

The probability that both sides for the patient have

an IHI that can be matched is 0.30 x 0.30 = 0.09 or 9

is demand from our users. Perhaps that will see me

percent. If this is reflective of the total population the

implement it sometime between 2015 and 2020.”

reduction in the costs of miss-identity across the total

population is 9 percent, or alternate view is 91 percent

number of vendors then the benefits will not be realised

of healthcare costs associated with miss-identity will

and will limit the effectiveness of this important building

occur ( $81 million approximately). In the mean time the

block for many of the other e-health initiatives that

investment cost for establishing and maintaining the

have been planned.

Medicare Australia Healthcare Identifier Service is only

Will GPs, Specialists and Diagnostic Services

“If there’s no funding, then my only business driver

If this is an accurate assessment shared by a wide

being partially realised ($22.8 million approximately).

Acknowledgement

The cumulative opportunity cost by Year 2 end is

The author wishes to acknowledge the contribution of

estimated at $217 million.

Jenny O’Neill, Secretary, MSIA and Bridget Kirkham,

CEO, MSIA in sourcing figures used in Table 1.

While demonstrating the number of errors not

being prevented, this simple model does not include human costs in terms of Disability Adjusted Life Years

References

(DALYs), Quality Adjusted Life Years (QALYs), morbidity

1 - http://www.nehta.gov.au/component/docman/doc_

or mortality. However, it does provide a simple way to

download/1012-hi-service-implementation-approach

Table 1 - An Opportunity Cost Model for a 5 year roll-out plan of Individual Healthcare Identifiers in Australia.

Year 1

Year 2

Year 3

Year 4

Year 5

15%

30%

55%

75%

98%

2%

9%

30%

56%

96%

Medicare Australia investment not utilised

$24,437,500

$22,750,000

$17,437,500

$10,937,500

$990,000

$76,552,500

Identity errors not reduced

$87,975,000

$81,900,000

$62,775,000

$39,375,000

$3,564,000

$275,589,000

$112,412,500

$217,062,500

$297,275,000

$347,587,500

$352,141,500

$352,141,500

Medications (0.2% of 200 million)

97,750

91,000

69,750

43,750

3,960

306,210

Pathology (0.3% of 40 million)

29,325

27,300

20,925

13,125

1,188

91,863

Discharge summaries (1% of 7.5 million)

18,328

17,063

13,078

8,203

743

57,414

Actual take-up rate Effective take-up rate

Cumulative Opportunity Cost

Total

Errors not prevented

Assumptions • $360 million healthcare costs are associated with miss‑identity.

• Individual Healthcare Identifiers are effective in 25% of cases resulting in $90 million annual savings.

• Assumed market penetration at the end of 5 years.

28 Pulse+IT

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FEATURE

Secure Electronic Messaging: The non-sexy, quiet achiever of e-health Gary Tucek

The late comedian Rodney Dangerfield was known for his

information are well known, including:

quip “I get no respect”. He could easily have been talking

• High staff and resource costs for organisations

on behalf of secure electronic messaging in Australian

in printing, faxing, logging, handling, scanning,

e-health. Operating largely in the background, secure

shredding, filing, storage and retrieval, backup and

messaging quietly facilitates clinical data exchange

risk management;

quickly and more efficiently than all paper-based

• Higher

methods, but its contribution to efficiency and change However experience is already showing that secure

Manager, Argus Business Unit, DCA

of

vulnerability

to

security,

email, faxes, postal mail; • Poor fax rendering and scanning — open to

electronic messaging is possibly the most cost-effective

misunderstanding or misinterpretation;

e-health initiative adopted by the health sector to

• Slower & inefficient delivery;

deliver improvement to practitioner work practices and

• Follow up, delivery assurance and audit trail issues;

quality of communication in the past 20 years.

The aim of this article is to acquaint readers with

and • Environmental costs — paper, consumables and

the significant practical impact that secure electronic

electricity.

messaging is already having in healthcare settings and

to show by example those implementations and

flows between healthcare providers.

adoption strategies that deliver success both at

Figure 1 provides a simplified diagram of message

implementation level.

Building Connectivity between Heath Providers

the clinical practice level as well as the regional

Ross Davey

confidentiality and privacy breaches — unencrypted

in Australian healthcare is largely unrecognised.

degree

BA, GDipComp Market Development, Argus Business Unit, DCA

While this article will concentrate primarily on

GPs are frequently at the hub of primary healthcare.

the implementation of secure electronic messaging

Enabling GPs to receive reports electronically is the

between GPs, specialists and allied health practices —

foundation for:

this in no way ignores the significance of other areas of

• Engaging with specialists and allied health

secure messaging, such as the electronic provision of

practitioners to send reports to the GPs and, when the

diagnostic imaging, pathology, and hospital discharge

time is right, to encourage GPs to provide electronic

reports.

referrals in return; and

Secure messaging is much more than just the

• Creating a compelling business case for larger

technology. We should never get so caught up in the

organisations, such as Area Health Services, Hospitals

technology aspects that we forget that technology

etc to utilise the same messaging facilities being used

(hardware and software) is but a tool. It is people (fleshware, if you will) that are of most importance staff. Technology should assist people and improve efficiencies and outcomes and secure messaging should be a catalyst for change to help improve daily work flows between healthcare providers.

Gary Tucek has been responsible for Market Development for ArgusConnect for over three years, with a focus on the Argus Affinity program for Divisions of General Practice. Ross Davey has over 35 years experience in the Health sector and Health information technology. He is the former Director of the Collaborative Centre for eHealth (CCeH) at the University of Ballarat and CEO of ArgusConnect. ArgusConnect was recently acquired by Database Consultants Australia (DCA).

Author Info

— the patients, the practitioners and their practice

The problems of paper-based exchange of clinical

www.pulseitmagazine.com.au

Pulse+IT 31

by GPs, specialists and allied health practitioners.

electronic clinical messaging by:

àà identifying other GPs/GP Practices from whom

There are two proven strategies for building secure

messaging connectivity between health practitioners:

they receive high volumes of referrals and in return send high volumes of reports in paper

Organic Strategy

formats;

The Organic Strategy is a viral marketing approach

àà indicating in correspondence or at the bottom

aimed primarily at the practice/practitioner level and

of reports their desire and capability to provide

typically takes the following sequence:

reports securely and electronically.

1. First Level GPs/GP practices influence their

4. After installation and training in secure electronic

specialist and allied health practitioner colleagues

messaging is completed, Second Level GPs/GP

to take up secure electronic clinical messaging by:

Practices then proceed to recruit Second Level

àà identifying key First Level Specialists and Allied

Specialists and Allied Health as indicated in the first

Health with whom they have high volumes of referrals and in return receive high volumes of

stage above.

5. The above cycle then iterates through subsequent

reports in paper formats; and

levels

àà indicating in correspondence or at the bottom

of GP, Specialist

and Allied

Health

practitioners.

of referral letters their desire and preference to receive reports securely and electronically.

2. After installation and training in secure electronic messaging

is

completed,

these

First

Regional Strategy The Regional Strategy is based on building relationships

Level

and partnering with regional entities. It has been found

Specialists and Allied Health practitioners start

that Divisions of General Practices have been excellent

providing reports electronically to the First Level

enablers and partners with whom to work on secure

GPs/GP Practices.

messaging connectivity.

3. First Level Specialists and Allied Health practitioners

Divisions have been effective catalysts for change

then seek to influence other GPs/GP practices

by undertaking a range of activities to foster the uptake

with whom they interact, and to who they are still

of secure messaging, including:

sending paper-based reports, to take up secure

• Facilitating

e-health

and

secure

messaging

Figure 1 - Referrals and Reports provides a simplified diagram of message flows between healthcare providers.

Our approach has been to progressively work on building communications in the order of the numbered flow arrows.

This staged strategy for facilitating change focuses on delivering early and easy wins to build momentum and a sound foundation for subsequent stage progression.

32 Pulse+IT

www.pulseitmagazine.com.au

information sessions for GPs, specialists and allied

There is little in the way of definitive published

health practitioners and practice staff;

modelling of the costs-savings-benefits for health

• Provision of information through newsletters;

practices shifting from a paper to electronic paradigm.

• Incorporating secure messaging as part of change

Due to many assumptions and variables, not least of

management during practice support visits and

which is that few practices operate exactly alike, the

training;

exercise is somewhat akin to the perennial ‘How long is

• Some Divisions have arranged for their staff or

a piece of string?’ question.

staff from local IT support companies to undertake

training in messaging software installations; and

indicated that their modelling of receiving costs yielded

• Extending Division engagement and interaction

savings of between $4,000 to $6,000 per GP per year

beyond just GP practices to encompass specialists

— simply from the receiving of electronic reports from

and allied health practices — something of particular

specialists and allied health and not including diagnostic

impact where Divisions are employing clinicians or

imaging, pathology or hospital discharge summaries.

running clinical programs in areas of chronic disease

or mental health.

savings on annual sending costs of between $1,000

The Regional Strategy, done in parallel with the

to $2,500 per GP per year and of between $3,000 to

Receiving practices: A number of GP practices have

Sending practices: Unpublished modelling indicating

Organic Strategy, provides a very effective framework

$10,000 per specialist per year.

for managing and nurturing a regional secure

messaging deployment project. Our experience with

$5,000 per equivalent full-time practitioner this would

various Divisions of General Practice around Australia

equate to annual savings of around $100 million just in

has repeatedly shown this approach is like putting the

the Australian GP sector alone. Inclusion of specialist

Organic Strategy “on steroids” — facilitating faster take

and allied health practitioners would at least double

up of secure messaging.

that figure to $200 million per year.

The accompanying case study, presented on page

In broad terms, if practices achieved savings of

Due to variable levels of connectivity between (and

34, of two Divisions of General Practice in the Northern

levels of use by) health practitioners as well as current

Sydney region reflects the application of both of the

interconnectivity

above strategies.

between different messaging software suppliers, it

Return on Investment

and

interoperability

constraints

is clear that the full savings and benefits of secure electronic messaging for GP, specialist and allied health

There is a lot of anecdotal and speculative estimation

practices have yet to be realised.

of costs and savings associated with the use of secure

messaging in the private practice setting. Intuitively,

requests and reporting from pathology, diagnostic

there is ample scope for cost savings as indicated in

imaging, hospitals and community health and electronic

Table 1. Quantifying it is another matter.

prescribing, and pretty soon you are talking about some

Add the full range of electronic referrals and

Sending Sites

Receiving Sites

Postage



Faxing





Printing





Stationery (paper, envelopes etc)





Handling and follow-up





Scanning



Shredding



Paper filing, storage and retrieval

www.pulseitmagazine.com.au





Table 1 - Savings for Sending and Receiving sites indicates key areas where use of secure electronic clinical messaging can provide efficiencies and savings.

Sites that send and receive in volume with a high proportion of their clinical communication partners will maximise business benefits and savings.

Pulse+IT 33

Case Study: Electronic Messaging between GPs, Specialists and Allied Health Practitioners For almost 12 months, two Divisions of

to build momentum for the secure

General Practice — Manly Warringah

messaging deployment projects.

sessions were by a local GP (Dr Kiril

Division of General Practice (MWDGP)

NSGPN also decided to engage and

Goring-Siebert or Dr Susan Allman), a

and Northern Sydney General Practice

pay local IT services to undertake free

specialist (Mr Keith Tish or Dr Steven Tan),

Network (NSGPN) — have worked

Argus installations for GP, specialist and

a Practice Manager (Ms Emma Doherty),

collaboratively to build secure messaging

allied health practices in their region. Rob

and an ArgusConnect representative

connectivity and use in their region.

Khamas, IT Program Officer from NSGPN

(Gary Tucek).

has co-ordinated this.

MWDGP joined the Argus Affinity

also

years, the number of health practitioners

achieved a solid take up of Argus secure

collaborated to host two information

enabled for secure messaging across

messaging among GP practices they did

sessions for interested GPs, specialists,

these two Divisions of General Practice

not have the staffing to support a formal

allied health practitioners and practice

has increased from:

e-health

staff:

• 55 to 273 GPs

• 16 September 2009 – approximately

• 7 to 152 specialists, allied health and

User

connectivity

growth was purely organic.

In 2008 MWDGP employed Sue

Cummins, under the Australian Better Health

Initiatives

(ABHI)

Program.

Sue assisted the MWDGP’s eHealth committee to review secure messaging benefits and costs. The committee recommended ongoing use of Argus to the Division and GP colleagues in the area and also developed a plan for strategically identifying and recruiting key specialists in the MWDGP and NSDGP area to start sending reports to GPs by Argus.

Many MWDGP GPs refer patients

to specialists in the NSGPN region, where there is a high concentration of specialists.

NSGPN joined the Argus Affinity

program in 2009. Dr Susan Allman, a local GP and member of the NSGPN Board, had vigorously championed Argus secure messaging since visiting the ArgusConnect trade display at the AGPN Forum in Darwin during November 2008.

As part of the Argus Affinity program,

each Division was given 10 free Argus installations with three months support to a strategic mix of GP and specialist practices identified by each Division.

These practices would “prime the pump”

34 Pulse+IT

and

MWDGP

As shown in Figure 2, in just over two

relationship program in 2007. While they

project.

NSGPN

Presentations at the information

86 attendees

Others

• 27 April 2010 – approximately 75

• 62 to 425 GPs, Specialists, Allied

attendees

Health and Others

Figure 2 - Argus secure messaging connectivity among practitioners in the MWDGP and NSGPN areas since 2008. Information sessions in September 2009 and April 2010 had a particular focus on specialist and allied health connectivity with GPs, which helped boost subsequent take up.

450

Secure Messaging Uptake in MWDGP and NSGPN 400

350 NSGPN Specialist, Allied Health & Other NSGPN GP

300

MWDGP Specialist, Allied Health & Other MWDGP GP

250

200

150

100

50

0

8

00

h2

rc Ma

ril

Ap

09

20

pte

Se

9

00

r2

e mb

0

01

h2

rc Ma

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Ap

10

20

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Ju

10

20

www.pulseitmagazine.com.au

pretty serious money in annual Australia-

fruit” or easy, early wins that are key

as the major Federal Government

wide savings and efficiencies arising

to building confidence and momentum

reform of primary healthcare unfolds

from the electronic exchange of clinical

in

— especially the expanded role flagged

documents.

secure

messaging

throughout a region.

The market segment for electronic

referrals

deploying

and

reports

between

for emergent Primary Health Care

• Staff organisational, administrative,

Organisations (PHCOs) morphing from

GPs,

project management, communication

the current network of Divisions of

specialists and allied health is a complex

and inter-personal skills are more

General Practice.

niche space that has seen a number of

critical to a successful secure messaging

companies come and go over the years.1

deployment project than Information

secure

This is not surprising as this niche is one

Technology training or experience.

invisible to users, is not something that

of the hardest areas to service for clinical

• Neighbouring Divisions of General

just automatically happens by itself.

messaging — with nowhere near the

Practice working collaboratively on

It takes resources to develop, deploy,

high volumes (and greater revenues)

e-health programs such as secure

of electronic reports distributed from

messaging achieve quicker outcomes

• Practitioners and practice staff need to

pathology,

or

than Divisions working in isolation

be supported. For many of them secure

hospitals. And yet there are potentially

— particularly when referral patterns

messaging is actually scary — they

transcend Division boundaries.

worry about their clinical and other

diagnostic

imaging

more end‑points to be installed, trained, maintained and supported and dozens

• Many people fail to recognise that largely

business software systems crashing or

of clinical applications to interface in this

programs

part of the market. It is notable that two

should use secure messaging too.

major health messaging companies with a

This models the very behaviour that

• While all consumers are sensitive to

combined workforce of around 20 staff and

they seek to encourage in others as

cost, a fair price relative to costs of

supporting approximately 60 percent of

well as increasing the efficiencies and

provision of that product or service is

the GP market between them only have a

benefits to them and their health

not price gouging — especially when

combined annual turnover of less than $2

communication partners.

the savings and benefits to a consumer

million. Talk about punching above your weight!

Key Drivers and Lessons Our experience in working with Divisions of General Practice and a wide range of health provider practices and organisations has provided many lessons and clues on

employ

while

maintain and support software.

• Divisions that provide clinical health and

messaging,

clinicians

slowing down, or about loss of clinical information.

• Face to face contact and honest, candid

may be more than 50 times the price

communication between customers,

(or even 100 times when Government

suppliers and partners is critical to

subsidies such as the PIP E-health

building networks of trust.

incentive payment are included).

• Word

of

mouth

and

personal

When working as intended, secure

recommendation are the most effective

messaging should be largely invisible. It

marketing tools.

should facilitate, not intrude or impede for

the daily workflow processes of health

those things which can help (or hinder)

practitioners and staff organised by

practitioners, administrative staff and

the growth of secure electronic messaging

Divisions it is far more valuable for the

organisations.

connectivity.:

audience to hear from their local peers

• Leadership

and

Champions

• At

information

sessions

Secure electronic messaging may not

are

and colleagues about their secure

be sexy, but it is of significant and increasing

crucial — from Divisions of General

messaging experience, rather than

importance — and it deserves respect.

Practice, practices and other health

only hearing information from a vendor

organisations such as Area Health

representative.

Services and hospitals.

• Connectivity is not usage. People need

• Practices and Divisions play a critical role

training and support to maximise their

in identifying and recruiting healthcare

effective use of technologies such as

practitioners and organisations —

secure messaging.

“paving the road” between healthcare

• Divisions that recognised and nurtured

providers who already have high levels

secure messaging in their regions in

of interaction are the “low hanging

recent years will be well positioned

www.pulseitmagazine.com.au

Footnotes 1. In recent times there has been an expansion of new entrants to this niche, no doubt encouraged by, and seeking to tap into, the PIP eHealth incentive payment to GP practices which, among other things, requires a secure messaging capability.

Pulse+IT 35

FEATURE

A national picture of secure messaging activity Craig Szucs

Australian General Practice Network cszucs@agpn.com.au

Marilyn Wood

ACT Division of General Practice m.wood@actdgp.asn.au

Paul Bruce

General Practice NSW paulbruce@gpnsw.com.au

Brendon Wickham General Practice Victoria b.wickham@gpv.org.au

Martin Forrest

General Practice Network NT martin.forrest@gpnnt.org.au

David Millichap

General Practice Queensland dmillichap@gpqld.com.au

Greg Holden

General Practice South Australia greg.holden@gpsa.org.au

Richard Wylie

General Practice Tasmania rwylie@gptasmania.com.au

Lauren LeClerc

WA General Practice Network LLeclerc@wagpnetwork.com.au

Introduction

of the electronic records system of a large hospital in

Australia’s healthcare system is considered to be

the USA found that it generated 500,000 electronic

one of the best in the world. It is however a complex

messages per day.

and distributed system made up of disparate parts.

Such disparity would benefit from an efficient

systems and messaging products have developed to

communications system, particularly when taking into

meet communication needs. But these products can

account that communication is an essential aspect

not communicate with each other, leading to silos of

of healthcare. Yet in 2010, the prevalent method of

disconnected health information.

communication between providers is by fax. Referral

letters and laboratory results sent as hardcopy place an

contribute to systematic healthcare, but to be effective

extra burden on both sender and recipient alike. Secure

and efficient they must guarantee that the right

messaging is therefore an important e-health function,

information is securely sent to the right person at the

but it seems to be a long time coming.

right place at the right time. Some of this assurance

What is Secure Messaging?

Across Australia, a number of clinical information

Communication systems have the potential to

can be performed by a secure messaging product, but not all. By themselves, they cannot provide accurate

Secure messaging refers to the exchange of a set of

identification, nor can they generate a message that

information from one organisation to another while

is structured in a way that is understandable by both

ensuring that the information is private and readable

a human and computer recipient, nor guarantee that

only by the intended recipient. Businesses use email

the content is sufficient for a particular healthcare

as a standard communications platform to maintain

requirement.

contact with clients and colleagues. However sending

confidential patient details using email in the absence

presently refers to the secure transportation of a

of additional security measures would breach health

message that may or may not be structured for

privacy principles.

computer “readability” (and even if it is structured,

With all this in mind, secure messaging in Australia

The messaging environment in Australia is a

it cannot be read by all current systems). Going

complex one because of the wide variety of clinicians’

beyond the simple transport function to meet all the

communication needs. For example, clinicians discuss

communication requirements of healthcare requires a

patients’ cases with each other, pathology tests are

more comprehensive framework.

ordered and results sent, GPs send referrals and receive discharge summaries, and reports are sent to funders.

Benefits of Secure Messaging

Healthcare generates billions of messages, both paper

Secure messaging infrastructure is essential to facilitate

and electronic, around the world each year. One study

continuity of care activity such as eReferrals and

Author Info

eDischarge and also as an enabler of ePrescribing and Funded by DoHA’s eHealth branch, the eHealth Support Officers (EHSO) Network is comprised of 17 eHealth officers located within AGPN and the State Based Organisations.The goals of the EHSO Network are to increase the uptake and use of e-health solutions such as secure messaging across General Practice, to improve communications between General Practice and other health care providers, and to improve e-health literacy across General Practice and the broader primary health care sector.

eMedication Management.

There are a number of benefits (some real, some

aspirational) to using secure messaging systems when compared with traditional methods for information transfer. First and foremost, secure messaging aims to ensure that only the intended recipient of any information can access that information. This is not

36 Pulse+IT

www.pulseitmagazine.com.au

so easily enforced when mailing or faxing

to fax, scan and/or post messages. By

messages.

leveraging secure messaging systems we

there are a number of factors that impact on

move one step closer to a truly connected,

the uptake of secure messaging. The level

patient-centric healthcare system.

of computerisation across the different

Other benefits are derived from

the fact that when information is sent electronically, it can be read by humans and

Further to the interoperability barrier,

parts of the healthcare sectors is variable.

Barriers to uptake of Secure Messaging

While general practice is around 98 percent

“understands” the information it has received, it can process (but not interpret)

The biggest barrier to uptake of secure

example, in the private specialist and allied

the data faster and more efficiently than

messaging is the lack of interoperability

health sectors. This results in situations

a human can. For example, a test result

between the various messaging products.

where one healthcare practitioner may

sent via a secure messaging system and

Imagine what it would be like if our mobile

be ready and willing to engage in secure

structured in a standardised way could

phone system allowed only calls within

messaging, but have nobody with whom to

automatically populate the data into the

a single provider’s network. In essence

communicate.

patient’s record so they can be both easily

that is what the Australian messaging

accessed by the clinician when consulting

environment looks like. A clinician is

such as this, the technology itself is not

with the patient and aggregated for

expected to have a Telstra mobile to talk

the biggest issue. For secure messaging

longitudinal analysis.

to their Telstra contacts, an Optus phone

to be optimally effective it must be

From a safety and quality perspective,

for their Optus contacts and so on. Our

adopted and utilised by all parts of the

secure messaging can enable a better

secure messaging products need to be

Australian health system. To achieve this,

mechanism for acknowledging the receipt

interoperable, to be able to “talk” to each

the authors believe a significant “change

and processing of messages. Further, it

other, eliminating the need for practices to

and adoption” program will be required to

computers alike. When a computer system

Halfinstalled.

Page 180 allows an efficiency gain by notHealthLink/Medinexus having have multiple products

computerised, this is not the case, for

As tends to be the case with initiatives

x 120 Puse IT clinicians Mag in their understanding of support

connecting healthcare

www.pulseitmagazine.com.au

Pulse+IT 37

the benefits of secure messaging and in its

messaging activity across each state/

patient appointment details notifications

uptake and use.

territory from the perspective of each

flowing back to general practice.

region’s eHealth Support Officer.

The General Practice Network and Secure Messaging

The ACT Division is focused on adding

value for general practice by extending

Australian Capital Territory

secure messaging capability to private

Implementing a solution that is sustainable

specialists, allied health and others in the

The General Practice Network is a collection

is a challenge, but with Territory Health

health community, but funding for this

of 110 local organisations (Divisions), eight

taking the lead role in funding e-health

work is yet to be identified.

state based offices (SBO) and the peak body,

projects, the implementation and use of

the Australian General Practice Network

secure messaging has progressed at a rapid

Victoria

(AGPN). The Network is actively involved

pace and has demonstrated long‑term

In Victoria, some divisions have attempted

in a wide range of activities including

sustainability because of the value it

to address the lack of interoperability

health promotion, early intervention and

provided to all parties.

between secure messaging products by

prevention strategies, chronic disease

This is clearly demonstrated in the ACT

choosing a single product for their GP

management, health service development,

where Canberra Hospital — the region’s

members and then proactively reaching

medical education and workforce support.

major public hospital — routinely sends

beyond their member base to drive uptake

electronic discharge summaries and event

of the product by local allied health and

Current Secure Messaging activity across States/Territories

notifications (admissions, discharges and

specialist practitioners. The approach

births) to ACT and surrounding general

pragmatically assists the GPs within their

In a recent study of e-health activity across

practices in South East New South Wales.

region because without allied health and

the General Practice Network it was found

ACT is experiencing a steady increase in

specialist providers on board, they have no

that a third of all e-health activity related to

the flow of eReferrals from general practice

one to communicate with electronically.

secure messaging.

into Canberra Hospital and the resulting

However not every division can do this

acknowledgement, triage category and

(particularly in the metro areas) because,

Outlined below is a summary of secure

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www.pulseitmagazine.com.au

for example, a neighbouring region uses

sector.

Across NSW, there are two secure

a different product or is unable to support

The use of a single secure messaging

messaging suppliers that collectively cover

any product.

software solution across the whole of the

87 percent of divisions. This representation

Unfortunately it is impossible to

Territory, and the fact that the divisions

is further enhanced by the fact that the two

accurately gauge the level of use of

network has been the key player in the

suppliers have signed an interconnectivity

different

products

rollout and support of this has meant

agreement and have flexible alternatives

and analyse the message types being

secure

messaging

that relationships and communications

for bulk message source locations to send

transmitted. Anecdotally however, some

between healthcare providers have been

messages out. Some caution needs to be

broad conclusions can be made. While

substantially strengthened.

used when relying on this coverage rate,

many practices have a secure messaging

as coverage may indicate a small number

product, it is unlikely that many are

New South Wales

of practices within a specific division. The

using it for sending eReferrals. The level

Generally, the take-up of secure messaging

rate of coverage claimed by the suppliers

is expected to increase over time, but

in New South Wales is encouraging. Most

and the number of active secure messaging

widespread adoption is impossible without

divisions have some level of exposure to

divisions appears disproportional.

interoperability.

a secure messaging product, with almost

half of NSW divisions having robust secure

accessibility to 80 percent of general

summaries. One of them is a State Health

messaging initiatives.

practices across NSW despite having no

department-driven solution that will be

Success factors for these divisions have

direct involvement with divisions. The

progressively rolled out to more public

come from acknowledging that a secure

high take-up of this product is due to their

hospitals over the next few years.

messaging application is ineffective if

application’s utilisation by diagnostic labs.

Two regions have electronic discharge

Another

supplier

has

a

median

there is nothing for the general practitioner

This product is further enhanced by their

Northern Territory

to receive. This is typically addressed

investment in interoperability with several

The Northern Territory has a long

in two ways. The first is ensuring that a

key clinical applications.

involvement in secure messaging, with

good percentage of GPs have a secure

one of the major software solutions on the

messaging system installed, the second is

Tasmania

market originating from a project involving

ensuring that one organisation with large

The General Practice Tasmania Network

the division of general practice.

coverage over the division will use that

has implemented a secure electronic

in

system to send out messages. This requires

clinical messaging environment known

collaboration with the NT Government

General

Practice

Network

NT,

an investment by both the division and

as TASeHealth Messaging (TeHM). The

eHealth Branch, have used the secure

the initial organisation and goes beyond

primary purpose is to provide a secure

messaging software as an integral part of

application subscription costs.

web‑based messaging system that allows

other e-health Initiatives.

Pursuing specialists and allied health in

the secure exchange of electronic clinical

Secure messaging is an important

the first instance will often lead to failure

and patient information between healthcare

foundation for the Shared Electronic Health

if there is not already a high percentage of

providers. The system has the ability to

Record that has been a great success

GPs that the specialist can send reports to.

send and receive reports and referrals from

in the NT, particularly in the Aboriginal

Some divisions have also been successful

GPs, specialists and other health providers

Health Services. The same technology was

using a program they control to start the

and meets the requirements for the eHealth

used in a pilot of the electronic transfer

ball rolling, such as an After Hours Service.

Practice Incentive Payment.

of prescriptions, which is now being

developed and commercialised by a third

application into a specialist or allied health

usage of secure messaging in Tasmania

party consortium.

practice. This difficulty is typically due to

will take time with anecdotal evidence

The key to the rollout of secure

a combination of factors including issues

indicating that faxing is still used routinely

messaging in the NT has been the focus

associated with change management,

for forwarding referrals to specialists and

on engaging with the whole of the primary

training requirements, current IT system

allied health providers.

healthcare sector, as well as with non-GP

maturity,

specialists and all of the public hospitals.

complexities within the practice itself.

South Australia

Where possible, there has been integration

These practices typically require the most

All divisions of general practice in South

with the clinical systems, however, this is

support, and are not an area that divisions

Australia actively promote the use of

often a challenge within the allied health

provide regular assistance to.

secure

www.pulseitmagazine.com.au

Divisions do struggle to get an

and

system

Despite some progress, the uptake and

integration

messaging

systems

to

their

Pulse+IT 39

practices

although

accurate

current

allied health services through the use of

throughout

statistics on the implementation of secure

eReferrals. Even with the advancement

critical role in the deployment of secure

messaging systems in SA general practice

and use of eReferrals in some areas, faxing

messaging. A significant amount of time

are not available. The most recent statistics

still remains the predominant method of

and effort is required to install software

indicate that over 70 percent of practices

communication between providers in both

and PKI certificates and to provide training

have installed a secure messaging system,

metropolitan and rural WA.

and support to practices in relation to using

however statistics on the actual usage of

secure messaging effectively.

these systems is not yet available.

discharge summaries were successfully

Anecdotal evidence would indicate

rolled out in many of Perth’s metropolitan

messaging software was a good initial

that usage of secure messaging systems

hospitals. The implementation of electronic

motivator for GPs and other health

has plateaued and that possibly as few

discharge summaries is providing timely

providers to try secure messaging, over

as 30 percent of practices are using their

and efficient access to important patient

time GPs have seen the many benefits

secure messaging systems extensively and

health information across the public and

from adopting secure messaging including

consistently. Faxing remains a significant

private health sectors.

the receipt of pathology results, obtaining

tool for forwarding referrals between

Despite some progress, the ongoing

reports from specialists and allied health

GPs and specialists and allied health. This

development of secure messaging in

professionals and the electronic receipt

low usage is explained by the barriers of

Western Australia will take time. The

of discharge summaries from Queensland

interoperability and the low uptake by other

ABHI funding and the involvement of

public hospitals. Queensland Health’s

primary healthcare providers mentioned

WA divisions act as valuable support for

Enterprise Discharge Summary project

earlier.

the promotion and progress of secure

is now operational in over 70 hospitals

messaging in general practice.

throughout the state and as of April 2010,

SA Health is currently developing

In addition to the above, electronic

the mechanism to send their discharge

Queensland

played

a

While the provision of free secure

50 percent of all discharge summaries are

Queensland

being received electronically via secure

messaging. While no date has yet been set

Queensland GPs and other health providers

messaging by Queensland GPs.

for this implementation, it will provide a

such as allied health, specialists, aged care

major new impetus to the increased use of

and pharmacy have benefited through a

in Queensland ended on 30 June 2010,

secure messaging systems within SA.

subsidised secure messaging offering made

GPQ and Divisions expect the majority of

summaries

to

practices

via

secure

While the secure messaging subsidy

by General Practice Queensland (GPQ) and

health providers in Queensland to maintain

Western Australia

Queensland divisions over the past two

secure messaging under the user-pays

In Western Australia, secure messaging is

years. Funding received through a Managed

models offered by secure messaging

used predominantly in general practices in

Health Network Grant was directed

providers. Cost-benefit analysis conducted

rural regions. All 13 WA divisions support the

towards two projects; the establishment of

by two Queensland divisions indicate that

use of secure messaging systems, however

a statewide health provider directory, and

the break even point for a practice is the

five of the rural divisions received specific

the provision of a two year, fully subsidised

sending of at least four messages per week,

funding under the Australian Better Health

secure messaging service for all health

while a typical four-GP practice who uses

Initiative (ABHI) towards further support of

providers in Queensland. Queensland GPs

secure messaging frequently could save in

secure messaging in general practice. Due

have embraced secure messaging over

excess of $25 000 per annum.

to the availability of these resources, there

this period and usage rates have increased

has been increased uptake in each of these

markedly over the past two years. As of

Lessons learned

regions where general practitioners are

April 2010, 89 percent of Queensland GPs

By engaging in the activities outlined

receiving and sharing clinical information

have joined the new provider directory

above, the General Practice Network has

electronically.

(known as the iHealth Care Directory)

learned many lessons about implementing

More specifically, WA rural divisions

with 87 percent of these GPs also adopting

secure messaging solutions. First and

have implemented secure messaging as

secure messaging. In addition, over 1700

foremost the value proposition must be

a referral pathway between GPs and the

allied health and specialists have joined

apparent to all concerned. There must be

divisions’ allied health services. In these

the Directory, with about 80 percent

a clear understanding of the benefits and

regions where a referral pathway has

also adopting secure messaging as their

the costs associated with implementation.

been established, general practitioners

preferred mode of communication.

Further, there must be ongoing and

are electronically referring patients to

co-ordinated support provided to ensure

40 Pulse+IT

Divisions

of

General

Practice

www.pulseitmagazine.com.au

the human factors in change management

wide range of purposes and be applicable

are addressed.

at different levels. The smallest level is a

And finally, a sustainable funding

localised, vendor-specific situation. The

What else is needed in a Secure Messaging Framework?

stream must be made available to

largest is the “community” level, where

SMD handles the simple transport of a

incentivise uptake and promote the use

there is a range of vendors, healthcare

message but, by itself, a transportation

of these systems. Where there has been a

providers and governments, and which

standard is not sufficient to bring about

funded project targeting secure messaging

covers the entire country, from Carnavon

full secure messaging interoperability. To

supported by a division or SBO we have

to Tweed Heads, Hobart to Darwin.

complete the framework, we will need the

seen the most success.

This requirement for community level

following components:

applicability means that those responsible

The future is standards

for designing the standard must recognise

Message Security

Because the Australian e-health landscape

that it cannot simply be turned on, its

The message must be encrypted and

sports a variety of products that don’t “talk”

adoption will only be brought about in

authenticated so that it cannot be read

to each other, there is an interoperability

incremental stages. But first, the standard

by prying eyes and its provenance is

barrier to widespread adoption of secure

must be developed to the point where it

unambiguous.

messaging. Fortunately, this barrier has a

can be used.

panacea: standards.

Fortunately we now have a technical

called Public Key Infrastructure (PKI).

A widely adopted standard for secure

specification that appears suitable for

Many GPs and general practices have PKI

messaging would enable products to

real world implementation. In the last few

certificates but they have little reason to

interoperate. Standards development is

months, the recently published Secure

use them other than for Medicare Online

not easy. A secure messaging standard

Message Delivery specification (SMD) was

communications. The National E-Health

must be suitable for a number of computer

tested by a variety of vendors as outlined

Transition Authority (NEHTA) is developing

programming environments and allow for

in the IHE Secure Messaging Connectathon

a standard for PKI implementation that can

future innovation. It must also cater for a

box on page 43.

be incorporated into the SMD.

Encryption is enabled by a technology

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www.pulseitmagazine.com.au

Pulse+IT 41

Provider directory

query the directory to find the correct online

labs using a structuring standard called HL7.

The framework will also need to provide

location and send to it. The framework is

Unlike blobs, these messages do enable

the capability to locate and identify

designed so that clinics need have only one

specific information to be identified by the

individual healthcare providers and their

location. This is quite a benefit for clinics

recipient’s clinical software and slotted

organisations. The Healthcare Identifiers

and hospitals bedeviled by a plethora

into the right place in the database. But

(HI) Service is a system that is ready to

of “download clients”, because as more

the structure is only lightly standardised —

be switched on now that the legislation

vendors adopt the framework it will enable

different implementations work for some

to enable it passed through Parliament

clinics to progressively reduce the number

systems but not all.

on June 24. NEHTA’s intention for the

of clients from their desktops.

HI Service is that it will provide the data

NEHTA is currently developing a

number of standards for structuring

necessary for a directory for use by secure

Structuring messages

specific types of messages such as

messaging systems.

The structure of an electronic message is

pathology results, electronic referral and

an important, and difficult challenge. The

electronic prescriptions. However, the

Reducing all those download clients

content of health messages is much more

current environment will have to suffice

Another key component of the NEHTA

complex than that of other sectors like

with a transportation standard only, until

secure messaging framework is a special

finance and manufacturing. For example,

locally-based structuring standards are

type of directory that points to online

compare a bank statement to the myriad

encouraged to evolve into standards that

locations on the network. General practices

possible iterations of a hospital discharge

are more broadly applicable.

and other clinics will be able to contract a

summary.

vendor to “host” their online location for

them (or perhaps even use a product that

in formats that cannot be interpreted by

How will secure messaging adoption be driven?

enables them to host their own location).

computers (such formats are colloquially

As with all technology-driven endeavours,

When other providers wish to send a

known as “blobs”). A common exception is

the SMD does not provide an “if you build it,

message to the clinic, their system will

the pathology results generated by some

they will come” guarantee. Potential users

Currently, most messages are sent

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42 Pulse+IT

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IHE Secure Messaging Connectathon

of these messaging systems need to see clear benefits gained from taking up secure messaging. A great deal of support will

Last year, a number of vendors worked with the National E-Health Transition Authority

then be required to accommodate these

(NEHTA) to refine NEHTA’s draft specifications for secure messaging. Their work was

new systems into the clinical and business

handed to Standards Australia for validation at the end of the year and published as

processes within a clinician’s organisation.

an Australian technical specification in March this year. The specification is called

e-health Secure Message Delivery (SMD).

needs to be conducted in a co-ordinated

But the standard had yet to be demonstrated in actual implementations. To

and consistent manner in order for it to

address this, an international health IT standards organisation, Integrating the

be successful. Strong messages outlining

Healthcare Enterprise (IHE), hosted a “Connectathon” in April 2010 in Canberra. The

the benefits of secure messaging need to

purpose of the Connectathon was to provide a platform for vendors to implement the

be delivered across the various healthcare

standard and prove their program worked.

sectors. On the ground support will also be

This promotion and support activity

required to assist clinicians in adopting and

Participants at the IHE Connectathon

becoming familiar with new technologies

At the Connectathon each vendor had to use their program to exchange messages

and ways of doing business.

with three other programs as well as an online testing facility, and have independent

industry-appointed monitors check the test results.

benefits are clear, the uptake and use

While the efficiency, safety and quality

Thirteen vendors attended the week-long Connectathon and worked to

of an interoperable secure messaging

implement and clarify the specification. The number of vendors willing to incorporate

system is not a trivial task. There is a

a national specification within their own systems is significant and seems to represent

cost, both temporal and financial, in

an increasing confidence in a national approach.

moving to a secure messaging solution

Eight Australian companies successfully tested their products against the SMD

for communications. Mechanisms for

specification. These companies are now entitled to publish a statement informing

incentivising this activity are needed. An

customers that they were successful in the IHE Australia process, with corroboration of

example of such a mechanism in general

such statements published by IHE Australia at http://www.ihe.net.au. It is anticipated

practice is the eHealth Practice Incentive

that the vendors of the other products that participated in the development of the

Payment (ePIP), which provides a practice

specification will incorporate SMD within their products over the course of the coming

with a payment upon signing up with a

months.

secure messaging provider.

IHE Connectathon participants preparing and testing their software against ATS 5822:2010, an Australian Technical Specification designed to improve the ability for clinical messages to be transferred between healthcare providers and organisations.

Conclusion Secure

messaging

infrastructure

is

essential to facilitate continuity of care activity such as eReferrals and eDischarge and also as an enabler of ePrescribing and eMedication Management. It provides clear efficiency and safety and quality benefits and improves communications across the various sectors of our health system.

For secure messaging to be effective

however, the systems must be capable of talking to each other. Further to this, clinicians from across the health system will need support to adopt these solutions and integrate them into their clinical and business processes.

While challenges and barriers remain,

we are moving steadily forward towards a truly connected healthcare system.

www.pulseitmagazine.com.au

Pulse+IT 43

FEATURE

The non-messaging parts of secure messaging Glenn Stephens

MBA (E-business), BCompSc CEO, Medical-Objects glenn@medical-objects.com.au

Secure messaging implies the delivering of reports,

every permutation is not feasible. So rather than

letters and results securely from one clinical site to

implement a system that translates from, for example,

another. But delivering files to another location doesn’t

Medical Director to Genie, or from Best Practice to

resolve some of the problems associated with getting

Zedmed, we have found that applying middleware

messages consumed by the practice management

techniques — so that messages are transformed from

system. There are also issues of timeliness, integration,

the HL7 variant to the approved standards — is a

maintenance and auditing. This article covers some

methodology that works.

of the challenges associated with providing secure

messaging services, and highlights some of the

to know what clinical system lives at the other end. All

techniques and technologies being used to address

you need to know is that there is a system, that you can

these challenges.

send data to it, and that the system will convert the

Integration

By using a middleware approach, you do not need

data to a format the destination can process.

Integration doesn’t stop there however. One

Perhaps the biggest issue with secure messaging in

often encounters customised databases and clinical

Australia relates to the various implementations of HL7

applications that were developed by tech-savvy

v2.3.1 in the Practice Management Systems (PMS). This

clinicians who were not focusing on HL7 messaging. As

lack of standards adherence has led to inconsistencies

a result, they often need an Application Programming

in the behaviour of the PMS’ HL7 implementations.

Interface (API) to connect to. A good messaging system

In order to overcome these variances, either

will have an API that is accessible to numerous systems,

modifications to the messages are required in order for

which may include access from COM+, DLLs, Web

them to be viewed in the PMS, or in some cases a format

Services and/or REST-based Services.

such as PIT is utilised as a lowest common denominator

format. While PIT was useful in its time, it is not as

options is what is required for successful HL7

clinically expressive as HL7 and many in the standards

messaging, and above all the organisation should

space would like to see the end of this format.

focus on standards. I would recommend the Australian

Healthcare Messaging Laboratory as a resource for

In an ideal world each PMS would adhere to the same

set of standards, however translation of the messages currently being generated need to occur to deliver the

The right mix of HL7 messaging and integration

implementers of HL7 messaging.

result. That is, minor modifications are made to the

Real-time delivery

messages to allow them to be integrated. But because

When I was at a hospital with my last child, I accompanied

there are so many different PMS, integration between

my wife to the pre-natal meetings for the baby to be born. We were there for about 40 minutes, and of that

Author Info

time around 25-30 minutes was spent waiting for copies Glenn Stephens is the CEO of Medical-Objects and in past roles has been an application architect and software development manager. Glenn holds a Bachelor of Computer Science and a Master of Business Administration with a specialization in e-business.

of reports that were sent from our radiologist to the hospital by fax. Like all modern radiologists I knew that my wife’s radiologist had electronic delivery, and had the results been forwarded electronically, it would not have wasted so much nurse or patient time.

44 Pulse+IT

There are some scenarios where results can wait,

www.pulseitmagazine.com.au

but there are others where results cannot.

less likely it is going to cause delays for

The invisible worker

Transmission of results from a pathology

either the practice or the patient. Many of

Surprisingly, secure messaging is not

to an emergency department and the

the government documents I have seen

thought of as a tangible product. In

electronic transfer of scripts are examples

suggest real-time connected systems are

the most part, sites are often receiving

where fast and efficient delivery is required.

truly what is needed in order to facilitate the

letters, results and reports that are fed

The faster the results can be delivered, the

next generation of e-health applications.

automatically into their PMS without the users being conscious of the processes

Figure 1 - A middleware approach allows HL7 communication regardless of which system you are sending to/from.

occurring to make this happen.

More visible to end users is the fact

that typical PMS get updated several times a year. Given that some are updated every quarter and there are over 14 PMS solutions on the market, secure messaging companies may need to respond to as many as 56 PMS updates a year to ensure compatibility. This number is in excess of what is required in reality, but if there are major changes to implementations then there could be a large number of updates required to ensure the secure messaging and PMS components remain compatible.

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Pulse+IT 45

For the sake of your own software maintenance and

support issues we encounter relates to sites that

to allow agility when PMS updates occur, you should

replace their practice servers without re-installing the

ensure you can readily update your secure messaging

secure messaging applications, usually because the

software if and when required.

practice IT support personnel aren’t aware that the

Auditing

secure messaging application was even there in the first place. With such problems occurring periodically, how

I remember talking to a government e-health worker

do you know if the results you sent were received by the

who had been doing some research into why results

practice you are corresponding with?

were not getting to a particular clinic. It had turned

out that they were faxing results to this site, but the

acknowledgement” allows for the receiving site to

results were not being received. They had the right

send back confirmation messages indicating that the

fax number, the fax was on for receiving but still they

result has been received successfully. Good messaging

couldn’t work it out. What it turned out to be was the

solutions will have the ability to display the status

fax was printing each page which was then falling from

of both the transmission of results and application

the fax and then straight into the shredder below!

acknowledgements. If you are sending referrals in the

While secure messaging doesn’t face the same

case of a GP, or letters/results in the case of a specialist

problems as that fax/shredder story, there are still

or lab, it is important that you periodically check to

some issues to watch out for. One of the common

ensure that your reports have been delivered. Many

Fortunately a process known as “application

practices do not have such procedures in place, giving Figure 2 – Checking your delivery report every day is recommended.

the practice no assurance that all messages sent are actually being received.

Summary What most people think of as secure messaging — simply the delivery of files — is not everything. Other aspects such as support, message delivery auditing, speed of delivery and integration are essential elements to ensure an optimum secure messaging system.

46 Pulse+IT

www.pulseitmagazine.com.au

EDITORIAL

The NHS Electronic Prescription Service In a previous edition of this publication [Pulse+IT,

are registered to provide health services.

November 2009, pp10] we outlined some of the

• Card Management System: used to ensure the

services provided by BT as part of the English National

person undertaking the service is identified as

Programme for IT (NPfIT), with a focus on some of the

someone who has previously produced evidence of

successes that rarely receive coverage in the domestic

identity as a legitimate practitioner.

English media. Lessons learnt that informed these

successes and are pertinent to Australia and its e-health

delivering the EPS are operating at over 99 percent

and health reform agenda were also presented.

availability2. While this result is excellent of course,

The Electronic Prescription Service (EPS) ranks

achieving it has required a great deal of technical

highly against these criteria, and since late 2007 when

capability, business process understanding, and

the system first started its progressive roll out:

changes to GP and pharmacy systems. So why should

• Over

other countries pursue an EPS? Well there are a few

300

million

(306,774,292)

prescription

messages have been transmitted electronically.

Jacques von Benecke MBA (Technology Management) Enterprise Architect, BT Australasia

good reasons: 1. As is the case in Australia3, before the NPfIT

to use EPS with 6,821 of these practices actively

the NHS experienced a significant amount of

utilising the EPS.

fraud in the system. The NHS NPfIT Electronic

MSc, CITP, MBCS, BSc Hons, PgCM, RN Clinical Director (Asia Pacific), BT Health

The services provided by BT that are involved in

• 7,950 GP practices have had technical upgrades

• 7,094 (85 percent) of GP practices and 9,392 (87

Jannette Bennett

Prescription Service now provides a fully electronic

percent) of pharmacies are using the EPS.

service enabling prescriptions to be generated,

During a single week in April this year, 3,527,916

transmitted, received, and once dispensed, sent

prescription messages were transmitted using the EPS1,

to the reimbursement agency for payment. A fully

which itself interacts with several other national “spine”

auditable EPS solution is now in place. Lesson learnt:

services including the:

not everyone wants to improve systems and services.

• Access Control Framework: allows systems to ensure

2. Around 1.5 million prescriptions are issued every

a relationship exists between the clinical user and

working day in England and the figure is rising by

the patient. It ensures only data that should be

around five percent each year. The situation is

available to specific users or systems is available.

similar in Australia. An EPS is needed to cope with

• Personal Spine Information Service: a system

increasing volumes especially as about 70 percent of

designed to record patient clinical information

prescriptions are for repeat medication. The EPS has

including prescription and dispensing history.

been designed to reduce the paper administration

• Personal Demographic Service: the Spine’s repository

associated with current prescribing and dispensing

of demographic and audit data, which ensures the

processes by enabling prescriptions to be generated,

correct patient is identified for the prescription.

transmitted and received electronically. Dispensing

• Transaction Messaging Service: mediates all access to the Personal Demographic Service by providing access to the audit log where every action is recorded including who created, read, updated and dispensed prescriptions.

• Spine Directory Services: used to ensure GP practice

Janette Bennett is the Clinical Director, Asia Pacific, BT Health and Jacques von Benecke is Enterprise Architect, BT Australasia.

Author Info

Web Service and messaging interfaces, including

addresses and dispensing organisation addresses

www.pulseitmagazine.com.au

Pulse+IT 47

pharmacies are able to submit reimbursement

that all vendor systems and products interacting with

endorsements electronically for payment claims for

EPS must use the NHS Dictionary of Medicines and

medication and appliances supplied. Lesson learnt:

Devices (dm+d), which ensures consistent recording,

all stakeholders including pharmacy vendors need to

storing and exchanging drug and medical device

be included in the design process.

information. The dm+d dictionary provides the sole

3. The most important reason: patient safety. Prior

form of Snomed CT concept identifiers for describing

to EPS a study by the UK National Patient Safety

medicines and devices in the NHS. Lesson learnt:

Agency found 60,000 “medication incidents”

integrated systems need standardised codes to enable

were reported by hospitals, GPs, pharmacists and

decision support tools to produce consistent results.

community health centres over 18 months up to

June 20064. This was reinforced by others such as

now safer for patients, it is also more convenient,

Gartner, who found at least 1,200 patients were

especially for those with chronic health problems.

dying each year from medication errors because of

Benefits include a more convenient service with a

paper-based prescriptions .

reduction in trips to the GP practice just to collect a

Key findings from these and other investigations

paper prescription. Patients receiving repeat medication

5

indicated that most errors were attributable to:

may have it delivered direct to their door as some

• Not having a complete and accurate prescription.

supermarkets incorporate dispensaries who do home

• Not checking the prescription and dispensing

delivery along with the weekly shopping.

correctly.

• The patient not understanding treatment and dosage.

• Not having effective communication between professionals where clarification of the prescription is necessary.

• Not having an accurate transcription of current drug therapy between primary and secondary care.

• Not appropriately monitoring the response to therapy.

The human interaction with the service is as

follows: 1. The patient visits their GP, who has implemented the EPS. Following consultation, the GP decides to issue a prescription.

2. The prescription form looks almost identical to the ones previously used — the only difference is the addition of a barcode. This barcode represents a unique code that matches to the electronic copy of the prescription, which has been sent to the

The EPS addresses most of these issues through

EPS. In Release 1 of the EPS, the paper prescription

ensuring:

form remained the legal entity. In Release 2, it has

• A legible prescription that enforces completion of

been extended to the e-prescription. Lesson learnt:

details.

• An audit trail to identify mismatch between prescription and dispensing.

it takes legislation to transition from a paper-based service, to an electronic one.

3. The patient leaves the GP surgery and goes to a

• Prescriber, dispenser and other clinicians in all

nearby pharmacy. It doesn’t matter if the pharmacy

settings (with the appropriate authority) knowing

has implemented the EPS or not — the patient will

what the patient has had dispensed, although of course that does not always mean the patient has used the medication.

still be able to obtain their prescribed medication.

4. On arrival at the pharmacy, the patient hands over the prescription form to the pharmacist. Rather

• The ability to assess, or prompt monitoring of the

than having to re-type the details of the prescription

therapy which also indicates if it has indeed been

into their system, the pharmacist simply scans the

used.

barcode using a barcode scanner. The prescription

Not all prescription-related patient safety issues

details held on the EPS are downloaded onto the

can be eradicated by EPS but it can significantly

48 Pulse+IT

Not only is the prescribing and dispensing process

pharmacist’s system.

improve the situation. Lesson learnt: a Clinical Safety

5. The pharmacist selects the medication appropriate

Management approach to development, integration

to fulfil the prescription, prints a medication label

and implementation of the service as a whole must be in

and prepares the medication to give to the patient.

place.

The medication is checked and then dispensed to

the patient and a confirmation of the medication

Further safety is achieved through the requirement

www.pulseitmagazine.com.au

dispensed sent to the EPS.

Previously, at the end of the month, the paper

prescription was sent by post from the pharmacy to the reimbursement agency. Now this interaction can take place in real time electronically.

However this significant improvement in services

is not without impact. Each GP and pharmacy system supplier has to go through: • Compliance testing by NHS Connecting for Health.

• Assessment at an “Initial Implementer” site.

• A staged, monitored roll-out.

Each system supplier is provided with their own plan

and timetable for progressing through these stages.

Lesson learnt: it takes extensive planning and time for the technology to be implemented, staff trained and the public prepared.

Extensive support is needed to safely navigate

and advance prescribing and dispensing. Key groups engaged in this process are listed on the NHS Connecting for Health website6. Lesson learnt: don’t exclude patients from service design.

The introduction of EPS has not meant that paper

prescriptions have been made redundant. Whilst a key benefit of the EPS is that it is rapidly reducing the paper administration associated with current prescribing and dispensing, paper prescriptions will continue to be used in a number of situations, where for example a patient crosses a border to Scotland or Northern Ireland and needs their English prescription dispensed there. Also not all prescribing models are fully EPS supported yet.

How to e-prescribe from a patient’s home if there is poor or no network connectivity, and how a patient can “sign” for payment/exemption declaration purposes are areas that are still being explored. However for prescriptions that are acute, repeat, or repeat dispensing, England has a world leading solution.

References 1. http://www.connectingforhealth.nhs.uk/ systemsandservices/eps 2. http://www.connectingforhealth.nhs.uk/ newsroom/statistics/availability/ncrs_stats 3. http://www.medicareaustralia.gov.au/provider/ business/audits/files/ncp-08-09-booklet.pdf 4. http://www.nres.npsa.nhs.uk 5. http://www.gartner.com/ DisplayDocument?id=673607 6. http://www.connectingforhealth.nhs.uk/ systemsandservices/eps/consulted

www.pulseitmagazine.com.au

Pulse+IT 49

OFF TOPIC

Practice Internet services — is one connection enough?

Simon James

BIT, BComm Editor, Pulse+IT simon.james@pulseitmagazine.com.au

Introduction

Risk Assessment

Practices are increasingly reliant on Internet-related

Every practice is different and each will need to

services for both administrative and clinical functions.

undertake their own basic risk assessment and cost

Whereas web browsing, email, the downloading of

benefit analysis to determine principally:

pathology and radiology results, and Medicare Online

1. How much Internet downtime the practice is

were once the mainstays of practice Internet usage,

prepared to tolerate.

remote access, secure messaging, Internet telephony,

2. The amount of money the practice is prepared to

online backup, and electronic prescribing are all services

spend to mitigate the chance of Internet downtime

that are increasingly being adopted by practices and

occurring.

depend on the availability of fast and reliable Internet

access.

practice decides that Internet downtime is tolerable

If, having quantified these two factors, the

While modern Internet arrangements are far more

and that traditional fallback arrangements such as

reliable than the dial-up connections of yesteryear, they

faxed pathology and radiology results are acceptable

are still susceptible to outages with Murphy dictating

temporary resolutions, the practice can rest easy in

that a practice Internet connection is most likely to fail

the knowledge that they foresaw and planned for any

when needed urgently.

outages in advance.

As

practices

increase

their

utilisation

of

If, on the other hand, the practice decides that

Internet‑related services, any outages will be more

incurring a few hundred dollars worth of expense up

disruptive than would have been the case even a few

front, and anywhere between zero and two dollars

short years ago. This is particularly true for larger

per day in ongoing additional Internet service fees

practices, and for practices that provide remote access

represents cost effective insurance against Internet

to their clinicians and/or other staff, who may be

outages, the rest of this article will be of interest.

inconvenienced to a large extent without access to the practice network whilst offsite.

Redundancy reduces risk

This article encourages practices to consider the

While the marketing material attached to “business

implications of a disruption to their Internet service,

grade” Internet connections may suggest the practice

and offers a range of options that, if implemented

is signing up for a trouble free and inherently reliable

proactively, will serve to limit the chance of Internet

product, the reality is that ISPs are themselves reliant

outages occurring. Readers may find the article

on other businesses and external factors over which

titled “Internet Plans” [Pulse+IT, May 2010, pp50] to

they exert little control. Therefore, rather than putting

provide useful background information to the material

ultimate faith in a single connection that is prone to fail,

presented in this article.

establishing a secondary connection to the Internet in your practice is the most realistic way to ensure optimal

Author Info

levels of reliability.

Simon James is the editor of Pulse+IT, Australia’s highest circulating health publication of any kind. Prior to founding the publication in 2006 he worked in the statistics division of a clinical research organisation, in an IT support capacity for various medical practices, for a clinical software developer, and subsequently for a secure clinical messaging developer.

Requirements Having decided that the establishment of a second Internet connection is a worthwhile pursuit, the next decision to be made concerns the type of Internet connection to install. At this stage of the process the

50 Pulse+IT

www.pulseitmagazine.com.au

involvement of an IT professional may be

which makes installation and configuration

desirable to ensure the most appropriate

relatively simple.

to clinicians and staff, this scenario is

selection is made, however in the very least,

generally

likely to be the preferred option as the

practices should be aware of the following:

perform better than wireless broadband

performance of both cable and ADSL

1. Having two or more identical Internet

connections and are significantly cheaper

exceeds that of wireless broadband.

connection types is not ideal. For

on a per GB (data) basis, the ADSL

Further, beyond the redundancy offered by

example, while establishing two ADSL

connection would typically remain in place

this arrangement, practices willing to invest

connections in a practice is relatively

as the primary connection option, with the

in additional hardware are able to “join”

straight forward, this scenario will not

wireless broadband service only becoming

the two connections together to extract a

provide any redundancy if the box in

active when the hardware detects a

performance benefit. That is, the effective

the Telstra exchange into which both of

problem with the ADSL connection. Such

connection speed to the Internet from the

your connections are plugged is faulty,

devices can be configured to automatically

practice can be increased to as much as the

or the bundle of copper telephone

switch over as required, however practices

combined speeds of both connections in

wires that runs into your building is

may make a conscious decision to disable

some circumstances.

damaged.

this feature to ensure that they are aware

As

ADSL

connections

For practices that offer remote access

that their wireless broadband data plan is

iPhones and other smart phones

connections will not provide protection

being used.

Those that frequent less than stimulating

in the event that there is a problem

Practices not prepared to replace their

conferences or trendy cafes will be

with the company’s systems, or the

existing ADSL router may instead elect to

aware that it is now possible to share a

company itself.

simply purchase a USB wireless broadband

modern phone’s Internet connection with

3. For most practices, the second Internet

modem and plug this into a computer in the

a computer using either a USB cable or

connection need not be as expensive,

event of an ADSL outage. In its most basic

wirelessly. What may be less obvious is that

fast, or have a large data allowance

configuration, this arrangement will only

this process — known as “tethering” — can

attached.

deliver Internet access to a single computer,

be extended to provide an entire network

e.g. the computer that has the practice’s

with Internet access by following the same

2. Similarly, using the same ISP for both

Setup examples

pathology and radiology download clients

steps used to share a wireless broadband

While the various types of Internet

installed, or the practice server. However

USB modem’s connection from a single

connections available to practices can

under instruction from an IT professional,

computer across a network.

be combined into dozens of different

the Internet connection made available to

arrangements, the following scenarios are

the computer now sporting the wireless

approach to providing Internet redundancy

likely to be the most feasible and popular:

broadband modem can be shared across

is

the entire practice network, allowing all

characteristics that are likely to be similar

but the most bandwidth intensive Internet

to a more mainstream wireless broadband

services to continue operating.

connection option. However in practical

ADSL with Wireless Broadband Backup Given that most practices are utilising an

From a technical perspective this entirely

valid

with

performance

terms, this solution provides less protection

ADSL service and that these same practices

ADSL and Cable

than the options outlined above, if for

are almost certainly in a wireless broadband

Whereas ADSL is available to most

no other reason than the clinician or staff

catchment area, this arrangement is likely

practices, high speed cable Internet

member who was happy to volunteer their

to be the most popular choice for practices

services are only available in selected

phone during testing may not be present

looking to maintain an Internet connection

capital cities, restricting the applicability

in the practice when the device is actually

when their primary ADSL connection

of this arrangement somewhat. Cable

needed.

experiences an outage.

connections typically perform faster than

Nevertheless, practices that wish to

There are now several devices on the

ADSL connections, so generally the former

avoid the expense of purchasing additional

market that incorporate an ADSL modem,

would be established as the primary

hardware or setting up a permanently

network routing functionality (typically

Internet connection, with the latter utilised

established second Internet connection

over both Ethernet and Wi-Fi), and wireless

in the event of a problem with the cable

may like to rehearse and document this

broadband capabilities in a single device,

connection.

method as an ad hoc temporary solution.

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Pulse+IT 51

Advantech Australia

P: 1300 308 531 F: +61 3 9797 0199 E: info@advantech.net.au W: www.advantech.net.au

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P: 1800 196 000 or +61 3 9095 8712 F: +61 3 9329 2524 E: headoffice@aapm.org.au W: www.aapm.org.au The Australian Association of Practice Managers (AAPM) represents Practice Managers and the profession of Practice Management. Founded in 1979, AAPM is a non-profit, national association recognised as the professional body dedicated to supporting effective Practice Management in the healthcare profession.

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P: +61 7 4155 8800 F: +61 7 4153 2093 E: sales@bpsoftware.com.au W: www.bpsoftware.com.au 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 MD) • Integrated Best Practice (clinical/ management) • Top Pocket (PDA companion software for Pocket PC)

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52 Pulse+IT

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CH2 (Clifford Hallam Healthcare) P: 1300 720 274 F: 1300 364 008 E: marketing@ch2.net.au W: www.ch2.net.au

Clifford Hallam Healthcare (CH2) is today Australia’s largest Pharmaceutical and Medical Healthcare service provider with a catalogue of over 15,000 products servicing metro, regional and rural customers across Australia.

Supported by a National Network, CH2 utilises local knowledge and local people to provide pharmaceuticals, medical consumables and equipment products to the healthcare market.

CH2 is represented by a National Sales Force as well as a local Customer Service team in each state.

CH2 understands the value of quality data and are committed to implementing the GS1 system throughout our business and with our partners. The use of EANCOM standard messages, Global Trade Item Numbers (GTIN) for product identification, Global Location Numbers (GLN) for location information and Serial Shipping Container Code (SSCC) labels are paramount to our industry moving forward. CH2 are passionate supporters of these philosophies and believe the uplift in quality systems will result in improved patient safety.

CH2 are currently working with partners to implement the National E-Health Transition Authority (NEHTA) National Product Catalogue. “Our aim is to be a great company to do business with. The right product, at the right price, at the right time.”

WardBox® is CH2’s direct to ward distribution system. It is a just in time replenishment system where orders are created in a theatre or ward area and then transmitted electronically to one of CH2’s warehouses using SOS or an EDI interface. The service incorporates barcode scanning technology, direct delivery to individual wards or departments, monthly invoicing and comprehensive reporting. WardBox® is designed to assist our customers in reducing purchasing and supply operating costs. This valuable service increases supply chain efficiencies, improves service delivery models and assists in achieving economies of scale.

WardBox® distribution is used for pharmaceuticals, medical, surgical and general supplies at numerous healthcare facilities.

Computer Initiatives Communicare Systems P: +61 8 9332 2433 F: +61 8 9310 1516 E: info@ccare.biz W: www.ccare.biz

Established in 1994, Communicare Systems have built an enviable reputation for delivering results, supported by excellent service based on mutual respect, mutual trust and mutual benefit.

Communicare is the electronic medical records and practice management system of choice for Aboriginal Health Services employing multidisciplinary holistic healthcare, featuring: • Ease of use for all providers • Shared electronic health records • Standards based electronic messaging • Comprehensive easy to use automated reporting • Scalable from small service to multi organisational enterprise • Multi axial security and access logging

Computer Care

P: +61 2 9410 0405 (NSW) P: +61 3 9646 0141 (VIC) E: sales@computercare.com.au W: www.computercare.com.au Computer Care works as a business partner with medical practices and other health organisations to accommodate all IT needs, covering: • Experience in all major practice management software (migration, upgrades, etc) • Computer systems & networks • Security • Hardware • Help Desk support • IT consulting • Technology trouble shooting

In 2009 CH2 won the ASCLA Information Management Award and are gold sponsors for the ASCLA Awards 2010.

www.pulseitmagazine.com.au

P: 1300 85 39 39 (Melbourne) P: 1300 85 39 85 (Brisbane / GC) E: tim@cinet.com.au W: www.cinet.com.au Computer Initiatives has been supporting the medical profession for over 15 years. Providing IT consultancy services, quality hardware, professional support with qualified engineers.

Recommended and preferred by a number of Divisions of General Practice and specialist software providers we: • Supply and install of hardware/ software and peripherals • Implement disaster recovery and replication plans • Remote monitoring and diagnosis • Advanced networking deployment and support • Prompt and competitive support • Internet configurations and content filtering services • Security audits, configurations and monitoring • Regular maintenance services • Microsoft Gold Partner and a Microsoft Small Business Specialist

Cutting Edge Software

P: 1300 237 638 F: +61 3 9787 8210 E: enquiries@cesoft.com.au W: www.cesoft.com.au Cutting Edge produces affordable, intuitive billing solutions for Mac, Windows, Linux and iPad. Cutting Edge is ideal for practitioners who prefer to maintain control of their own billing from a number of sites.

Cutting Edge Software is approved by Medicare Australia to manage your electronic: • Verification of Medicare and Fund membership • Bulk Bill and Medicare claims • DVA paperless claims • Inpatient claims to Health Funds We have solutions tailor-made for • Anaesthetists • Surgeons/Surgical Assistants • Physicians • GPs • Allied Health

Digital Medical Systems P: +61 3 9753 3677 F: +61 3 9753 3049 E: inform@dgs.com.au W: www.dgs.com.au

Easier ICT is a technology partnership with DMS — we make I.T. work for you.

DIGITAL MEDICAL SYSTEMS has provided ICT solutions and services to medical practice clients across Australia since 1990. We have specialist expertise and experience in the installation and support of leading medical software applications.

DMS is a Business Partner for IBM, Lenovo, HP and Microsoft. Other leading ICT brands include Trend Micro, Symantec, CA, Cisco, Toshiba, Canon, Epson, Kyocera, Fujitsu and Brother.

Accreditation is easier with the customised DMS IT Systems Documentation. Ensure your practice has the best quality IT policy, security and maintenance program that meets and exceeds the standards guidelines from the RACGP and AGPAL and GPA. World leading DTech provides 24x7 near Real-Time Monitoring and Management that alerts and enables our engineers to quickly troubleshoot and solve problems of security, network, Internet, Server and software remotely on almost any client computer system or device.

Medical IT systems are automatically maintained by DTech to the most highly available status to minimize downtime by preventing problems from occurring or reducing their impact.

Proactive, Flexible, Consistent, Reliable, Audited, and Affordable — for even the smallest practice.

Call DMS for: • Systems Analysis & Consulting • Solutions Design • Procurement & supply of hardware, software, network and peripheral products • Installation & Configuration • Support Services inc Help Desk • DTech Monitoring, Maintenance & Management • Disaster Recovery solutions • Fully managed & automated Online Backup customised for clinical data Easier IT — we make I.T. work for you.

The software comes with up-to-date schedules for MBS/Rebate, Gap Cover (all registered health funds), Workers’ Compensation, Transport Accident authorities and DVA.

Pulse+IT 53

Direct Control

P: 1300 557 550 F: +61 7 5478 5520 E: support@directcontrol.com.au W: www.directcontrol.com.au Direct CONTROL is an affordable, intuitive and educational Medical Billing and Scheduling application for Practitioners of all Disciplines.

Seamless integration with Outlook, MYOB or Quickbooks. Direct CONTROL’s Clinical Module manages Episodes of Care and includes State, Federal and Health Fund Statistical Reporting for Day Surgeries/Hospitals.

Direct CONTROL facilitates Medical Billing Australia-wide and overseas.

Included is all Medicare, DVA, Work Cover, Private Health Insurance fee schedules with built in rules relevant to each medical discipline (allied health, general practice, surgeons, physicians, anaesthetists, pathologists, radiologists, day surgeries/hospitals). Ideal for the single practitioner or the multidisciplinary Practice.

Equipoise (International) Pty Ltd Totalcare

GPA

P: 1800 188 088 F: 1800 644 807 E: info@gpa.net.au W: www.gpa.net.au

P: +61 7 3252 2425 F: +61 7 3252 2410 S: skype.totalcare.net.au E: sales@totalcare.net.au W: www.totalcare.net.au

Equipoise International Pty Ltd (EQI) is the developer and supplier of the ‘Totalcare’ clinical and office management system. Used since 1995 by health care facilities across Australia including General and Specialist practice, Radiology, Day Surgery and Hospitals.

Totalcare is a fully integrated Clinical, Office and Management software suite. Totalcare is stable, scalable, customisable and easy to learn and use. From a small practice to a distributed, multi site, multi disciplinary corporate entity or hospital, Totalcare can provide a solution for your needs.

Genie Solutions

P: +61 7 3870 4085 F: +61 7 3870 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.

GPA ACCREDITATION plus has given general practices a reliable alternative in accreditation. GPA is committed to offering a flexible accreditation program that understands the needs of busy GPs and practice staff. GPA assigns all practices an individual quality accreditation manager to support practices with their accreditation.

Choose GPA for more support, improved service and greater choice.

Genie runs on both Windows and Mac OS X, or a combination of both. With over 1900 sites, it is now the number one choice of Australian specialists.

Health Communication Network

GE Healthcare Australia Pty Ltd eHealth Education Pty Ltd

P: +61 3 9653 9433 F: +61 3 9653 9307 E: info@ehealtheducation.net W: www.ehealtheducation.net • The Registered Training Organisation specialising in quality Health Informatics education provided by senior, education qualified HI professionals.

Educational programs are designed to up-skill clinicians, technical staff, consumers and administrators in healthcare.

• Delivery options include focused workshops, single subject courses or fully integrated programs delivered face to face or online through our extensive and quality assured online education delivery infrastructure.

• Servicing professional and education organisations, we also aim to support professional and healthcare education providers.

You can deliver your material using EHE infrastructure, or we can help you develop and/or deliver quality educational material.

54 Pulse+IT

P: +61 2 9846 4000 F: +61 2 9846 4001 E: GEHCinfo@ge.com W: www.gehealthcare.com

GE Healthcare is a $17 billion business of General Electric Co. and provides a broad portfolio of healthcare technologies and services. GE Healthcare’s ‘Healthymagination’ initiative is a $6 billion commitment to improve healthcare through innovation - reducing costs, improving quality and expanding access for millions of people. A leader in solutions for the entire healthcare enterprise.

GE Healthcare has extensive global experience in successful ehealth implementations and offers a broad ehealth solution portfolio including Personal Health Manager, Provider Portal, Master Patient Index and Health Information Exchange Solutions. GE Healthcare also provides the Centricity® suite of integrated information technology for enterprise hospital information systems and specialist clinical information solutions, for theatre, anaesthesia, intensive care, cardiovascular, radiology and maternity.

P: +61 2 9906 6633 F: +61 2 9906 8910 E: hcn@hcn.com.au W: www.hcn.com.au

Global Health

P: +61 3 9675 0600 F: +61 3 9675 0699 E: sales@global-health.com W: www.global-health.com Global Health is a premier provider of technology software solutions that connect clinicians and consumers across the healthcare industry.

ReferralNet Messaging is a secure message delivery system for sending healthcare information efficiently to industry professionals.

MHAGIC is the most comprehensive mental health electronic medical record (EMR) system in Australia.

MasterCare EMR is an electronic medical record system for specialists and allied health professionals.

Locum is a clinical information management system for GPs.

Health Communication Network (HCN) is the leading provider of clinical and practice management software for Australian GPs and Specialists and supplies Australia’s major hospitals with online Knowledge resources.

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

Market snapshot: • 17,000 medical professionals use Medical Director • 3,600 GP Practices use PracSoft • 800 Specialist Practices use Blue Chip and • 2,100 Specialists use Medical Director • Leading suppliers of Knowledge Resources to Australia¹s major hospitals

www.pulseitmagazine.com.au

HealthLink

HealthEasy

P: +61 7 5665 7995 F: +61 7 5502 6543 E: info@healtheasy.com.au W: www.healtheasy.com.au HealthEasy is a 100 percent web‑based “Cloud Computing” solution as used by leading Web 2.0 apps like BaseCamp and SalesForce.

• • • • • •

No hardware upgrades No local Server needed No manual software upgrades No local backups required No contracts (pay monthly) Runs on Windows, Mac & Linux

eHealth Initiatives Support: • Electronic Prescribing (eRX) • Personal Health Record (IEHR) • Unique Health ID (UHI)

Health Informatics Society of Australia P: +61 3 9388 0555 F: +61 3 9388 2086 E: hisa@hisa.org.au W: www.hisa.org.au

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.

We invite expressions of interest from all sectors of the industry.

Health Information Management Association Australia

Health Informatics New Zealand (HINZ) is a national, not-for-profit organisation whose focus is to facilitate improvements in business processes and patient care in the health sector through the application of appropriate information technologies.

The Executive Committee works to maintain the purpose and service for the members, through dynamic goals of improved healthcare outcomes through the dissemination and utilisation of information, knowledge and technology.

• Fully integrated with leading GP and Specialist clinical systems • Robust; Reliable and Fully Supported Join the network that more than 60 percent of GPs use for diagnostic, specialist and hospital communications.

HealthSolve

HealthSolve provides Care Management systems for aged, acute, and community care that can be shared across all health care sectors.

Demonstrations available under NDA due to late 2010 release.

E: admin@hinz.org.nz W: www.hinz.org.nz

Australia’s largest effective secure communication network.

P: +61 8 8203 0500 E: info@healthsolve.com.au W: www.healthsolve.com.au

Built using Open Source tools with source code available.

Health Informatics New Zealand

P: 1800 125 036 E: enquiries@healthlink.net W: www.healthlink.net

Features: • Web-based.

• Flexible, dynamic, and highly configurable.

• Mirror your specific work flow and document style.

• Resident/client centric with a focus on the whole “journey.”

• Brings together administration, staff, providers, and facilities.

Houston Medical

P: 1800 420 066 or +61 2 9669 1844 P: 0800 401 111 or +64 7 834 9354 F: +61 2 9669 1791 E: houston@houstonmedical.net W: www.houstonmedical.net INTEGRATION ACROSS THE PRACTICE Houston Medical delivers one streamlined system integrating medical equipment with financial, claiming and administrative areas that works reliably and securely for small practices through to large multi‑disciplinary practices.

GREATER ROI VIP.net for medical specialists and VIP Allied for General practice/Allied Health delivers great ROI through smoother workflow, improved data quality, boosted productivity and reduced costs.

FLEXIBLE Individually configurable, Houston’s systems support you in the way you work and deliver better results.

TRUSTED Houston delivers software that you can trust - built on 20 years experience and used by many hundreds of leading practices across Australasia and beyond. Our first customer is still a customer.

P: +61 2 9887 5001 F: +61 2 9887 5895 E: himaa@himaa.org.au W: www.himaa.org.au

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 is also a Registered Training Organisation conducting, by distance education, “industry standard” training courses in Medical Terminology and ICD-10-AM, ACHI and ACS clinical coding.

HINZ acts as a single portal for the collection and dissemination of information about the New Zealand Health Informatics Industry.

Membership is for anyone who has an interest in health and informatics.

www.pulseitmagazine.com.au

Hunter Valley Anytime Computer Solutions P: +61 2 4934 8560 E: aldon@anytime.com.au W: www.anytime.com.au

Complete ICT Solutions: • Medicare Online and ECLIPSE • DVA Paperless • Medicare Easyclaim • SMS 2 way reminders • Secure eMessaging • Clinical EMR • Paperless Solutions • Online Training • Support 24/7 • Microsoft Channel Partner • Hardware & Networking • Phone and network cable systems Solutions when you need them

Pulse+IT 55

InterSystems

P: +61 2 9380 7111 F: +61 2 9380 7121 E: anz.query@InterSystems.com W: www.InterSystems.com InterSystems Corporation is the worldwide leader in software for connected healthcare. With headquarters in Cambridge, Massachusetts, and offices in 24 countries, InterSystems provides advanced software technologies for breakthrough applications.

InterSystems TrakCare™ is a connected healthcare information system that is Web-based and rapidly delivers the benefits of an Electronic Patient Record. InterSystems CACHÉ® is a high performance object database that makes applications faster and more scalable. InterSystems Ensemble® is a seamless platform for integration and the development of connectable applications. InterSystems HealthShare™ is a platform that enables the fastest creation of an Electronic Health Record for regional or national health information exchange. InterSystems DeepSee™ is software that makes it possible to embed real-time business intelligence in transactional applications.

iSOFT

P: +61 2 8251 6700 F: +61 2 8251 6801 E: company_enquiry@isofthealth.com W: www.isofthealth.com iSOFT is one of the world’s largest providers of healthcare IT solutions.

We work with healthcare professionals to design, develop and implement healthcare solutions that deliver administrative, clinical and diagnostic services to ensure continuity of care across all care settings. iSOFT provides flexible and interoperable solutions to the whole spectrum of providers, from single physician practices through to integrated national solutions supporting thousands of concurrent users.

Our capacity to embrace change and keep abreast of emerging new directions in healthcare has allowed our clients to explore the exciting potential of new technologies while securing their existing investments.

JOSE & Associates

P: +61 3 9850 1350 F: 1300 889 012 E: news@jose.com.au W: www.jose.com.au JOSE and Associates – IT Management and Support for Medical Practices • Complete IT support for medical practices: • Support for most clinical and practice management software àà Support for all network topology àà Dedicated help desk àà 24/7 support - response in most cases is immediate • New practice installation • Server maintenance on a monthly basis which includes full monthly reporting • Satisfying IT accreditation standards • Data conversions • Disaster recovery and business continuity plans – monthly data restores • Australia Wide coverage • References available on request

Medical Software Industry Association P: +61 427 844 645 E: ceo@msia.com.au E: president@msia.com.au W: www.msia.com.au

With the increase in government e-Health initiatives and NEHTA’s “Year of Delivery”, the MSIA has become increasingly active in representing the interests of all healthcare software providers.

The MSIA is represented on a range of forums, working groups and committees on behalf of its members, and has negotiated a range of important changes with government and other stakeholders to benefit industry and their customers. It has built a considerable profile with Government and is now acknowledged as the official ‘voice’ for the industry.

Join over 100 other companies across all areas of medical IT/IM so your voice can be heard.

Jam Software ISN Solutions

P: 1300 300 471 F: +61 2 9280 2665 E: info@isnsolutions.com.au W: www.isnsolutions.com.au ISN Solutions is a medical IT company that specialises in the design, setup and maintenance of computer networks for medical practices.

Our consultants and engineers are dedicated to the medical industry, understand your business needs and know what is required to run a practice. We strive to take away the pain from you, on managing the day to day IT issues regardless of which medical application you use. Our claim is supported by strong industry references.

Some of our solutions include but are not limited to: • A paperless practice • Speech Recognition • Capped cost medical support & maintenance plan • Ability to consult remotely • Linking your imaging equipment to your network • Medical application Support

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P: +61 2 9799 1888 F: +61 2 9799 4042 E: enquiries@jamsoft.com.au W: www.jamsoft.com.au MED™4i (Medical Electronic Desktop™) streamlines Health Care with easy-to-use customisable interfaces. Modular Versatility & Connectivity backed by friendly expert engineers.

Medical-Objects

Medilink

Comprehensive Patient database with multiple-format billing including electronic Online Patient Verifications & Claiming to Medicare, DVA & Health funds (paperless), Letters, Prescriptions (including MIMS), Orders, e-Results, MS Office integration & CustomDB including surgical & other audits. Now with HL7 Secure Messaging.

P: +61 7 5456 6000 F: +61 7 3221 0220 E: info@medical-objects.com.au W: www.medical-objects.com.au Medical-Objects has provided secure messaging to over 10,500 health professionals with referrals, reports, letters and discharge summaries.

Delivering directly into leading practice software, removing the need for scanning and faxing.

Integrated best of breed solutions:

Your specific needs can be accommodated easily, onsite & remote installation, training, ongoing support including upgrades to meet the ever‑changing health requirements.

Referrals are digitally signed and encrypted, moreover, compatible with Medicare’s requirements and in line with NEHTA’s eHealth PIP direction.

Using Medicare supported PKI, you can trust that referrals are digitally signed with PKI and we are working with NEHTA as an eHealth PIP eligible secure messaging vendor.

P: 1800 623 633 F: +61 7 3392 1108 E: support@medilink.com.au W: www.medilink.com.au

• • • • • • • • • • •

Medicare Online DVA Paperless ECLIPSE Medicare Easyclaim SMS 2 way Reminders Secure eMessaging Clinical EMR Paperless Solutions Online training Support 24/7 Unbeatable value

20 years of caring for practices.

www.pulseitmagazine.com.au

MEDITECH Australia

NEHTA

P: +61 2 9901 6400 F: +61 2 9439 6331 E: sales@meditech.com.au W: www.meditech.com.au

P: +61 2 8298 2600 F: +61 2 8298 2666 E: admin@nehta.gov.au W: www.nehta.gov.au

A Worldwide Leader in Health Care Information Systems MEDITECH today stands at the forefront of the health care information systems industry. Our products serve well over 2,300 health care organisations around the world. Large health care enterprises, multi‑hospital alliances, teaching hospitals, community hospitals, rehabilitation and psychiatric chains, long-term care organisations, physicians’ offices, and home care and hospice agencies all use our Health Care Information System to bring integrated care to the populations they serve. Our experience, along with our financial and product stability, assures our customers of a long-term information systems partner to help them achieve their goals.

Medtech Global

P: +61 3 9690 8666 F: +61 3 9690 8010 E: salesAU@medtechglobal.com W: www.medtechglobal.com For 25 years, Medtech Global has been enhancing the quality of patient care by working with healthcare professionals in developing and delivering award-winning industry‑proven technology products.

Our technology solutions are both sophisticated and user-friendly, designed for the comprehensive management of patient information throughout all aspects of primary and secondary healthcare, mental health and corporate health.

Some of our products include: • Medtech32 and Medtech Evolution – practice management and clinical software packages • Manage My Health – an online patient portal that holds electronic health records • MDAnalyze – a surgical audit/ clinical outcomes software • We are also able to provide training, data services and consultancy.

Melbourne & VIC Practice Services P/L

P: +61 3 9819 0700 F: +61 3 9819 0705 E: Sales@practiceservices.com.au W: www.practiceservices.com.au 15 years as Authorised Medilink Dealer selling, installing, training and supporting Medilink Practice Management Software • Fixed Cost Onsite and Remote Support • Medilink = Intuitive ease of use • Solo Drs up to Hospitals in size • Cut debtors and boost cash flow with Online Claiming via EFTPOS or Medicare Online for Funds, Patients, DVA & bulk billing • Many optional modules • Links to many third party packages and services Our Users are our best Salespeople

The National E-Health Transition Authority identifies and fosters the development of the best technology necessary to deliver an e-health system for Australia. This includes national health IM and ICT standards and specifications.

NSW & NT

P: +61 2 9902 7700 F: +61 2 9902 7701 E: info@mims.com.au W: www.mims.com.au MIMS Australia is built on a heritage of local expertise, credibility and adaptation to changing healthcare provider needs. Our information gathering, analysis and coding systems are proven and robust.

MIMS information is backed by MIMS trusted, rigorous editorial process and constantly updated from a variety of sources including primary research literature. Our database and decision support modules are locally relevant, clinically reviewed and updated monthly and compatible with a host of clinical software packages. Indeed, the majority of Australian prescribing packages and many dispensing applications are supported by the MIMS medicines data base.

MIMS is delivered all the ways you need – print to electronic, on the move, to your patient’s bedside or your consulting room desk. Whatever the format, MIMS has the latest information you need.

www.pulseitmagazine.com.au

P: 1300 550 716 F: +61 2 9434 2301 E: Vicki.Rigg@nuance.com W: www.nuance.com/au

Nuance (NASDAQ: NUAN) is a leading provider of speech and imaging solutions for businesses and consumers around the world.

Its technologies, applications and services make the user experience more compelling by transforming the way people interact with information and how they create, share and use documents.

Every day, millions of users and thousands of businesses utilise Nuance’s proven range of productivity applications which include Dragon NaturallySpeaking (speech recognition), OmniPage (OCR), PaperPort (document management) and PDF Converter Professional (PDF creation and conversion).

Carbonelle Consulting

P: +61 2 9889 1311 E: info@carbonelle.com.au W: www.carbonelle.com.au Carbonelle support over 600 clients with 21 Years of Experience.

MIMS Australia

Nuance Communications

Medilink Practice Management and Clinical Integrated Systems Specialists, General Practitioner and Allied Health Software • • • • • • • •

Medicare Easyclaim Medicare & DVA Online Electronic Appointment Book Eclipse (Health Fund Claims) 2Way SMS Patient Reminders ReferralNet (Secure Messaging) Medilink Clinical Paperless & Scanning Systems

Orion Health

P: +61 2 8096 0000 / +64 9 638 0600 F: +61 2 8096 0001 / +64 9 638 0699 E: enquiries@orionhealth.com W: www.orionhealth.com Orion Health is a global leader in integrated healthcare IT solutions. We specialise in electronic health records solutions, disease management, clinical decision support, and hospital administration tools. More than 200,000 clinicians in more than 20 countries use Orion Health products.

Using our solutions, Orion Health’s customers have reduced operational costs, reduced risk and improved patient safety, improved communications across their organisations and between primary and secondary care.

Our solutions are designed to support emerging health IT trends and standards, we work closely with our customers, clinicians, government bodies and other industry leaders to deliver elegant and intuitive solutions to meet your organisation’s current and future needs.

Pulse+IT 57

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Pen Computer Systems

P: +61 2 9635 8955 F: +61 2 9635 8966 E: enquiries@pencs.com.au W: www.pencs.com.au

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Spellex

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P: +61 2 8014 4573 E: info@spellex.com.au W: www.spellex.com.au

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Syber Scribe

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Established in 1993, Pen Computer MY Systems (PCS) specialises in developing information solutionsCYfor National and State eHealth initiatives in Primary Health that deliver better CMY Chronic Disease outcomes.

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PCS expertise extends to: • Chronic Disease Prevention and Management • Population Health Status, Reporting and Enhanced Outcomes • Decision-Support tools delivered LIVE into the clinical consult • Web-based Electronic Health Records (EHRs) • SNOMED-CT and HL7 Standards Frameworks Our Clinical Audit Tool (CAT) for example delivers an intuitive population reporting and patient identification extension to the leading GP systems in Australia. CAT delivers enhanced data quality and patient outcomes in general practice.

SmartRooms by Doctorware P: +61 3 9499 4622 F: +61 3 9499 1397 E: sales@doctorware.com.au W: www.doctorware.com.au

SmartRooms provides a comprehensive software solution for specialist practices for both Mac and Windows.

Comprising both practice management and clinical software, our all-in-one patient record and superior after-sales support provides the basis for a stable and time effective software solution for specialist practices of all sizes.

SmartRooms is available in an appointments and billing-only version for practices with uncomplicated software needs.

Spellex has been the leading provider of comprehensive medical dictionary enhancement software to thousands of the world’s most prominent healthcare companies for 21 years.

Our easy-to-use Australian medical spell checking software integrates fully with all Microsoft programmes, Web-based applications, and popular platforms.

Spellex Medical is available for end-users to ensure the medical accuracy of documents and to enhance their productivity. Spellex software development kits can also be integrated with developer’s custom programmes and Web sites. Whether you’re an individual transcriptionist or you need to provide greater medical documentation accuracy across an entire hospital or campus, Spellex has a solution that’s right for you.

For a free trial of Spellex software, go to spellex.com.au and click the Free Trial tab.

Pulse+ IT Pulse Magazine

P: +61 2 8006 5185 / +64 9 889 3185 F: +61 2 9475 0029 E: info@pulseitmagazine.com.au W: www.pulseitmagazine.com.au Pulse Magazine is the publisher of Pulse+IT, Australia’s first and only Health IT magazine.

Pulse+IT is distributed to all corners of the health sector and is enjoyed

by General Practitioners, Specialists, Practice Managers, Hospital and Aged Care decision makers, Health Informaticians, Health Information Managers and Health IT industry participants.

Having grown rapidly from its launch circulation of 10,000 copies in August 2006, Pulse+IT’s current bi-monthly distribution of 44,000 printed copies ranks it as Australia’s highest circulating health publication of any kind.

In addition to printed magazines, Pulse+IT offers a number of digital products including a weekly eNewsletter service, Twitter and RSS feeds, an online events calendar, and an interactive website.

58 Pulse+IT

The Specialist

P: +61 8 8203 0500 E: info@clintelsystems.com W: www.clintelsystems.com “The Specialist” is an intuitive and comprehensive tool that allows management of patients within specialist medical practices and day surgeries.

The Specialist includes 5 modules: • Accounting • Correspondence • Time Manager • Medical Records • Mobile Data Facility Key features: • Runs on both Macintosh™ and Windows™ platforms.

• Scales easily from stand-alone users, to multi-site networks.

• Industry standard, and readily interoperable with other systems.

• Comprehensive data migration tools for most systems.

• Unlimited training and support.

• Designed with the future in mind.

Stat Health Systems (Aust)

P: +61 7 3121 6550 F: +61 7 3219 7510 E: carla.doolan@stathealth.com.au W: www.stathealth.com.au Stat is an integrated clinical and practice management application which has embraced the latest Microsoft technology to build a new generation solution.

Fully scalable and the only medical software application to incorporate a multi-functional intuitive interface, Stat is at the forefront of computing technology. Stat has chosen to partner with First Databank for their drug database.

P: +61 3 9569 4890 / 1300 764 482 F: +61 3 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.

Zedmed

P: +61 3 9284 3300 F: +61 3 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.

Zedmed would also like to introduce to you Zedmed eXchange – a simple solution allowing Doctors to send patient’s medical information to insurance companies electronically.

Using the latest in data extraction technology and fully encrypted, this is a secure, time-saving solution to one of the most dreaded requests Doctors receive on an almost daily basis.

The Stat roll-out has begun and we are able to convert data from all existing software.

Stat also provides a premium support service and the Stat Online Claiming Solution (SOCS).

www.pulseitmagazine.com.au

GPA thinks a change would do you good‌ When it comes to accreditation, GPA’s new online program

A+

is guaranteed to change your life!

We invite general practices to trial this latest advancement in accreditation.

Call us today to find out more about A+ and the 7 day no-obligation free trial.

1800 188 088 or go online at www.gpa.net.au