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.
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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
In addition to the full day plenary
The event will be held in the Parkside
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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).
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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
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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
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00
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rc Ma
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Ap
09
20
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Se
9
00
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0
01
h2
rc Ma
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20
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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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© Copyright 2010 by GE Healthcare. All rights reserved. No part of this publication may be reproduced, transmitted, transcribed, or stored in a retrieval system in any form or by any means, electronic or mechanical, including photocopying and recording, without written permission of GE Healthcare.
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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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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,
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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
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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
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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
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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
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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
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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
AAPM
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. The Australian Association of Practice Managers: • Represents Practice Managers and the profession of Practice Management throughout the healthcare industry. • Promotes professional development and the code of ethics through leadership and education. • Provides specialised services and networks to support quality Practice Management.
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P: +61 2 9889 1311 F: +61 2 9889 1411 E: info@carbonelle.com.au W: www.carbonelle.com.au
Best Practice
Carbonelle support over 600 clients Australia wide. We have 21 years of experience in Medical IT and run a dedicated Help desk.
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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P: +61 3 5335 2220 F: +61 3 5335 2211 E: argus@argusconnect.com.au W: www.argusconnect.com.au ArgusConnect provides and supports Argus secure messaging software that enables doctors and healthcare organisations to exchange clinical documents securely and reliably.
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P: +61 8 8234 1600 F: +61 8 8234 6785 E: medilink@esquare.com.au W: www.esquare.com.au One stop shop IT Solutions Provider: • Official Medilink Dealer for sales and support in South Australia • Computer hardware and software sales, support and servicing • Computer Networking solutions and troubleshooting • Web Site design and development • Email solutions • Web Site Hosting • Domain Name Registration and Hosting • Friendly and highly responsive team
52 Pulse+IT
Argus can be used to send specialist reports to referring doctors but it can also exchange pathology and radiology reports, hospital discharge summaries and notification between healthcare providers. Healthcare practitioners can use any of the popular clinical software packages to send reports and other clinical correspondence via Argus. Argus is the messaging solution chosen by over 50 percent of all Divisions of General Practice across Australia through the ARGUS AFFINITY DIVISIONS program.
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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.
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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.
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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
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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
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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.
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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.
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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
C
P: +61 2 8014 4573 E: info@spellex.com.au W: www.spellex.com.au
M
Syber Scribe
Y
CM
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. K
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.
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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).
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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