Pulse+IT Magazine - March 2010

Australia’s First and Only Health IT Magazine

PULSE IT 

Issue

March

16 2010

Digital Radiology Online Image Delivery Systems: What features do modern filmless image delivery systems need?

Open Source Radiology Solutions: Does Open Source Software have a role to play in Teleradiology?

Diversifying the Technology Suite: Combining best of breed solutions to better serve radiologists and referrers.

06 08 10 13 34

Readership Survey Results Computers: Friend or Foe? Australia’s Plans for a NBN Information Technology in Aged Care Introducing the iPad

www.pulseitmagazine.com.au

National E-Health Transition Authority www.nehta.gov.au

Leading the progression of e-health in Australia The National E-Health Transition Authority (NEHTA) 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.

We invite you to be a part of our mission to lead the progression of e-health in Australia by joining a team of diversely qualified, talented people who draw on a wealth of experience to make e–health a reality.

Working in one of Australia’s complex stakeholder environments with clinical, technical, business, political and consumer interests to manage and represent, every day brings new and interesting challenges as we strive towards the adoption of e-health.

It’s an exciting time to join NEHTA so if you really want to make a difference, then we’d like to hear from you.

Recruitment:

Sydney • Senior Project Officer, National Infrastructure Services (NIS) Work with and manage the NIS Project Office team to provide comprehensive project support to all Projects within the NIS Portfolio by directly supporting the Portfolio Projects Manager and NIS Project Managers. Align activities with PRINCE 2 project management methodology as required.

• Project Administrator, National Infrastructure Services Work with the NIS Project Office to provide comprehensive portfolio, program or project administrative support and a secretariat function for the relevant boards.

• Senior Terminology Analyst, Terminology Services Responsible for providing high level domain knowledge as specified and terminology expertise required for the development of terminology products fit for use in the Australian healthcare market.

The role also involves managing a team of terminology analysts.

• Senior Enterprise Architect, Architecture Services Guide and support the development of business, information and technical architectures for national e-health solutions based upon business requirements provided by domain experts.

Build a comprehensive set of architectural blue prints from which future architectures can leverage common architecture patterns.

“NEHTA’s coming at it from a fresh

new approach, so getting things up and running is quicker and easier.”

Mandy Varley Head of HR

Recruitment:

Brisbane • Developer, Reference Platform Design, develop and maintain applications. Strong focus on analysis and design work.

• Certification Lead, Compliance Conformance & Accreditation (CCA)

See how NEHTA’s work is helping to enable a better health system for all Australians by reading how the Healthcare Identifiers Service will operate – see the Model Healthcare Community feature further in this edition.

Lead the definition and development of a national certification capability in support of the NEHTA strategic initiative to establish a certification function for e-health software compliant with NEHTA specifications and complementary to the CCA function for compliance and conformance assessment.

This is a senior role with leadership responsibilities for certification outcomes across NEHTA and with external stakeholders.

• Conformance Test Lead, CCA

Coordinate a team that delivers, maintains and supports Conformance test specifications composite deliverables comprising scenarios, test cases and procedures - in support of NEHTA specifications. Coordinate team members’ work and be responsible for scheduling and reporting status to the CCA Manager. Coordinate external consultation, and testing activities in other NEHTA teams for consistent approach.

• Software Developer, Secure Messaging

Responsible for identifying and resolving technical issues related to web services, developing and documenting examples of how to develop interoperable web services with commonly used technologies (e.g. JAX-WS, WCF), developing prototype implementations of technical specifications devised by the Secure Messaging architects and developing tools to facilitate external developers to implement the specifications.

• Solution Architect, Secure Messaging

Responsible for facilitating delivery of solution architecture for service-based solutions within the e-health environment. Analyse and devise technical solutions to the problems posed by stakeholders in a diverse, cross-organisational environment.

• Test Analyst, Terminology Services

Provide highly effective test analysis services to the product and project streams in the Clinical Terminology and Information area. Design and execute quality control activities to ensure that business and functional requirements are delivered in an accurate and timely fashion.

• Applications Manager, Terminology Services Note that these opportunities were current as of: February 2010.

Up to date information on current opportunities is available from:

www.nehta.gov.au Enquiries and applications can be directed to:

careers@nehta.gov.au

Lead the Applications team to plan, execute and measure its success while providing the applications, technical tools and environment so that CTI and its development partners can build, assure and release its products and services to market.

• Content Development Manager, Terminology Services

Lead the Content Development team to plan, execute and measure its success while providing an environment where the team and its members work optimally and interface appropriately with its customers and the rest of NEHTA.

NEHTA is an Equal Opportunity Employer. Only people with the right to work in Australia may apply for these positions.

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

Pages 28 - 32 DIGITAL RADIOLOGY This edition of Pulse+IT includes three Digital Radiology feature articles.

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

Pages 24 - 25 EVENTS CALENDAR Up and coming Australian and international Health, IT, and Health IT events.

About Pulse+IT Pulse+IT is Australia’s first and only Health IT magazine. With a national distribution exceeding 44,000 copies, Pulse+IT is also Australia’s highest circulating health publication of any kind. 32,000 copies of Pulse+IT are distributed to GPs, specialists, practice managers and the IT professionals that support them. In addition, over 12,000 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 Dr Geoff Campbell, Jacques von Benecke, Janette Bennett, Mathew Hudson, Simon James, Bridget Kirkham, Renai LeMay, Jonathan Klug, Tim Martin, Peter Weston.

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.

Page 34 APPLE IPAD Simon James takes a look at Apple’s first foray into tablet computing.

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

Page 28 ONLINE IMAGE DELIVERY

Page 30 OPEN SOURCE RADIOLOGY

Page 32 DIVERSIFYING THE SUITE

Editorials

Features

News

Page 06 STARTUP Editor Simon James overviews the results of the 2009 Pulse+IT Readership Survey.

Page 28 FEATURE ARTICLE Jonathan Klug details the features modern filmless image delivery systems should provide.

Page 14 Software testing consensus statement released.

Page 08 GUEST EDITORIAL Dr Geoff Campbell asks whether clinical computer systems are best serving their users.

Page 30 FEATURE ARTICLE Mathew Hudson outlines his experiences with implementing open source in a radiology setting.

Page 10 GUEST EDITORIAL Janette Bennett and Jacques von Benecke discuss the features of the NHS broadband network.

Page 32 FEATURE ARTICLE Peter Weston suggests multiple solutions are required to best serve radiologists and referrers.

Page 13 GUEST EDITORIAL Tim Martin outlines some of the challenges with implementing IT in aged care settings.

Page 34 APPLE IPAD Simon James takes a look at Apple’s first foray into tablet computing.

Page 26 MSIA Bridget Kirkham discusses the proposed R&D tax incentive changes and their impact on the medical software industry.

Page 27 NEHTA NEHTA discuss the top priorities for their diagnostic imaging work program.

Resources Pages 24 - 25 EVENTS CALENDAR Up and coming Health IT, Health, and IT events.

Pages 40 - 46 MARKET PLACE The Pulse+IT Directory profiles Australia’s most innovative and influential e-health organisations.

Pages 16 - 17 DoHA rejects concerns about NEHTA’s future role.

RACGP to use 4th Edition Standards to drive e-health.

Doctors Control Panel commercialised to support ongoing development.

Page 18 AGPN calls for “e-health change and adoption” funding.

InterSystems appoints new regional manager.

Pages 20 - 21 HCN reaches milestone with PracSoft Easyclaim.

IHE to host secure messaging Connectathon in Canberra.

Community Pharmacy deal to fund e-prescribing adoption.

Page 22 Northern Territory DHF funds development of Web Service secure messaging.

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

Pulse+IT: 2010.1 Welcome to the 16th edition of Pulse+IT, Australia’s first and only Health IT magazine.

To kick off the year, I thought it appropriate to share some of the results from the Pulse+IT Readership Survey, which was launched in the November 2009 edition of Pulse+IT. While various third parties have collected information about the publication over the years, the survey constituted the first quantitative research effort designed specifically to steer the direction of the publication’s editorial makeup.

There were 262 completed surveys, a similar number of partially completed surveys, and several accompanying letters containing more thorough feedback received by the specified deadline. Jeff Potter, Nursing Director, Mater Adult Hospital, South Brisbane, was drawn as the winner of the Apple iPhone promotion, an unexpected Christmas surprise that I trust Jeff is making good use of. Selected findings from the readership survey are outlined below: Q3) From a Health IT (e-health) perspective, what parts of the health sector would you most like to see covered in future editions of Pulse+IT (rank 1 to 6)?

The first ranked segments of the health sector selected by respondents were General Practice (37%), Specialist Practice (25%), Hospitals (24%), and Aged Care (9%), with small single digit percentages of respondents nominating pharmacy and allied health as their first preference. As was to be expected, responses to this question closely tracked the publication’s circulation by healthcare segment.

Q4) Each edition of Pulse+IT features the following types of articles. Please rank these in order of importance and interest to you (rank 1 to 3): The first ranked article categories were Health IT News (42%), Feature Articles (34%), and Guest Editorials (24%). This editorial mix matched the framework offered throughout 2009. As such, the ratios of these three main types of articles offered through Pulse+IT won’t be altered greatly, however we will be undertaking to increase the number of articles in each of these categories in line with our plans to boost the page count of the publication throughout 2010.

Q9) How long does it usually take you to read each edition of Pulse+IT? Most copies of Pulse+IT are read within a week of them being distributed (74%), with 94% and 98% of respondents finishing the magazine within a fortnight and a month respectively.

Theoretically this leaves the door open to increase the circulation frequency of the publication to monthly, however this would be logistically challenging and not something that will be undertaken in the near term.

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Q12) Are you a member of a professional body not listed in Question 11 whose membership would benefit from receiving copies of Pulse+IT? Throughout 2009, Pulse+IT was distributed to the entire memberships of four key peak bodies, however no less than 35 additional membership-based organisations were suggested as organisations whose members would benefit from receiving the title. Amongst this proverbial acronym soup, the RACGP and RACS featured prominently, as did other clinical colleges and several Divisions of General Practice.

Q14) Would you prefer to read Pulse+IT online or in print?

The vast majority of respondents (83%) prefer the printed version of the magazine over the online representation. I found the strong preference for print interesting given the nature of the content of the magazine, however certainly understandable given the amount of time people are required to spend in front of their computers for day-to-day work and other tasks. However needless to say, Pulse+IT will be taking a close interest in how this statistic evolves against the backdrop of the forthcoming introduction of the Apple iPad and the flood of other similar devices that will inevitably follow.

Q17) If you work for a General or Specialist practice, does your organisation intend to change either clinical or practice management software in the next 12 months?

A staggering 36% of the survey respondents working in general or specialist practice intend to change clinical or practice management software this year, signalling the start of a busy year for software developers and practices alike.

Q18) If you work for a General or Specialist practice and your organisation changed clinical or practice management software in 2009, how long did your organisation contemplate and prepare for the change?

Of the survey respondents working in general or specialist practices that changed clinical or practice management software in 2009, 85% took four or more months to contemplate and undertake the switch, with only a single brave respondent commencing the process of selecting an alternative software supplier and taking the leap in less than a month.

Q19) Which secure messaging vendors provide software to your organisation?

183 responses were recorded for this non-mutually exclusive question. HealthLink registered the largest installed base (n=78), followed by ArgusConnect (n=55), Medical-Objects (n=24), eClinic (n=15), and Global Health (n=11). An additional 15 different providers of secure messaging solutions were listed in the “other” category, albeit with only single digit representation.

Q20) Please rate your overall impression of Pulse+IT. With Pulse+IT circulated throughout many segments within the health sector and acknowledging that each of these segments have different Health IT interests, it was with a sense of trepidation that this question was included in the survey. Thankfully, this apprehension proved to be unfounded with 76% of the 204 respondents to this question rating their overall impression of Pulse+IT as either a 4/5 or a 5/5. With a mode of 4/5 and a weighted average of 3.92/5, the results are encouraging yet leave enough room for improvement that will serve to keep us focused going forward.

Would you prefer to read Pulse+IT online or in Print?

Online 17%

Qualitative Data Beyond the rigid data collected in the survey, several open ended questions provided helpful insights and feedback that Pulse+IT will seek to incorporate into the publication progressively throughout the year. The survey also uncovered a string of simple and easy to implement suggestions, such as giving the calendar at the centre of each edition of the magazine an extended outlook, something that has been achieved in this edition and will be maintained going forward.

AGED CARE AND NEW ZEALAND EXPANSION During the summer months, several distribution initiatives were enacted, which will see the per edition circulation of Pulse+IT grow beyond 44,000 copies, nearly four and a half times larger than our 2006 launch circulation of 10,000 copies.

The first initiative will see all 6,400 subscribers to Australian Ageing Agenda receive all editions of Pulse+IT produced in 2010.

While Pulse+IT has long enjoyed a following from within the aged care sector, this initiative will dramatically increase the availability of credible e-health reporting in the space.

In addition to the dozen or so conferences at which Pulse+IT has traditionally been distributed, copies of the magazine will also be available from over thirty IIR health conferences held throughout the year, an initiative that should serve to raise awareness of Australia’s e-health happenings amongst a diverse range of people from all corners of the health sector.

Since its inception, Pulse+IT has attracted a number of subscribers from all corners of the globe, however two complementary initiatives represent our first major foray into international expansion. Firstly, this and future editions of Pulse+IT will be distributed to the entire NZ Doctor readership, a sister publication of Australia’s Medical Observer, which has a paid subscriber base of around 3,500 New Zealand GPs and other interested parties. Secondly, Pulse+IT will now be distributed to the Health Informatics New Zealand (HINZ) membership under a trial arrangement that, pending a favourable response from the HINZ membership, will form the basis of an ongoing collaboration.

As the arrangements to bring Pulse+IT to New Zealand were finalised just days prior to the production of this publication, the flavour of this particular edition remains very much Australian.

Going forward however, the editorial scope of the publication will expand to ensure relevance for all readership segments.

As always, if you would like to provide us with any feedback, have any suggestions for future articles, or would simply like to discuss your experiences with e-health, don’t hesitate to get in touch.

Print 83%

Rank the types of articles presented in Pulse+IT in order of importance and interest to you (1st preference).

Guest Editorials 24%

Feature Articles 34%

Health IT News 42%

Does your practice intend to change clinical or practice management software in the next 12 months?

Yes 36% No 64%

Simon James, Editor +61 2 8006 5185 / +64 9 889 3185 simon.james@pulseitmagazine.com.au

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GUEST EDITORIAL Dr Geoff Campbell MB BS, DipRACOG, Microsoft Certified Systems Administrator g.campbell@langparkmedicalcentre.com.au

Computers: Friend, foe or something in between?

Let us consider the mishmash that is medical computing in 2010.

Computers, either love them or hate them, have become a valuable tool for medical practitioners. Medical computing can be a real timesaver with vast capabilities in many areas including fast filing and retrieval of medical records, searching for medical information, and rapid communication: all with the benefit of improved legibility (misspelling aside). The better office support, for activities such as billing, bookkeeping, banking and payroll, facilitates the financial return to doctors.

However it is extremely disappointing that so much potential gain in productivity has not been realised due to inertia and lack of innovation from both the medical software industry and government, at all levels. Think of the sort of activities that computers excel at: counting, repetitive tasks, data storage, transfer of information, and doing exactly what they are told to do! Why then does the computerised medical practitioner spend so much time doing menial dull recurring tasks?

Part of the answer lies in the lack of significant change in business rules since computers have been introduced. We work in an environment replete with forms: examples such as Centrelink reports, disabled parking applications and insurance reports come to mind. All too often in a day doctors receive a piece of paper that is currently to be completed by hand, knowing full well that with a modicum of programming the information could have been quickly and legibly generated directly from computerised records. Prescriptions, referrals to other practitioners, and pathology or imaging requests may well be generated electronically but invariably that marvellous invention called the printer is set to work. Oh the joys of the paperless office! We could have a paper free desk at both ends of the working day but still have been overwhelmed between times by a deluge of paper. Things will not change while business rules demand hardcopies of information. Other areas of business have achieved minimisation of paper usage: just think of Internet banking. Business is business: let’s not be too precious about how special the practice of medicine is!

Another part of the answer is the lack of analysis of business efficiency in the medical setting: a good old fashioned time and motion study would provide the evidence base from which a Continuous Quality Improvement Program could be used to raise productivity. Consider that at the start of each day I log on to my computer and start email, clinical software, appointment book, waiting room and internal messaging software: entering four passwords along the way! A simple bit of programming would log me in to all these programs using my Windows logon!

One password entry and I could press the button on the coffee machine and let it process the grinds, while my computer prepares itself for the daily grind of medical practice!

Think about the daily repetitive typing of the same words

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and phrases. Think also about the number of clicks required to complete some basic tasks in your clinical software. When did your software supplier last improve the interface of your clinical software? Please note that there are respected worldwide guidelines that can assist the software industry to develop and enhance the usability of their programs.

Finally, but not exclusively, consider the part of the answer relating to the availability and sharing of medical knowledge.

The World Wide Web, commonly known as The Internet, has dramatically changed access to information across the world.

Information can be shared at the click of a mouse but the spread of knowledge has not increased at the same pace. According to Wikipedia — courtesy of the Internet — we should use the term knowledge to mean the confident understanding of a subject with the ability to use it for a specific purpose if appropriate.

So how do we and our patients sort the wheat from the chaff?

Search with Google, remembering the company motto of “Don’t be evil”, and be dismayed in two ways. Initially be amazed and exhilarated at the speed and volume of the response but rapidly become overwhelmed by the sheer number of “matches”. Then through a combination of good luck and good refinement of your search, narrow down the results and quickly become despondent at the lack of answers to your specific problem.

Is the answer out there? If it is, why can’t I find it? Is it locked up in some commercial database with no realistic way for me to access it? Current best practice relates to evidence based medicine. Try (actually don’t try) to access relevant evidence such as the “Cochrane Collaboration”. Reflect that the government doesn’t fund access to such wonderful resources as “Therapeutic Guidelines” and “Australian Medicines Handbook” while cajoling medical practitioners to be responsible for the blowout in the cost of the PBS. So where do computers sit on the Friend/Foe scale at the beginning of 2010? Overall I would not like to return to medicine as practised in the pre-computing era: I am convinced that computing aids me in my medical work. The Total Cost of Ownership (TCO) of the computers in my practice is certainly decreasing with the passing of time. I will get more bangs for less bucks in 2010 than ever before! However that does not mean that I am satisfied with medical computing’s current Return on Investment (ROI), mostly in terms of the time that I spend in front of my computer: I think that I should be getting a lot more results for a lot less effort.

As clinicians we should challenge government and industry to provide better electronic tools. Our responsibility, as clinicians, is then to use such tools to improve the health of all Australians.

I hope that it is not just a swing of the pendulum further towards the Friend end of the scale, but rather a substantial sustainable positive gain.

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GUEST EDITORIAL Janette Bennett and Jacques von Benecke Janette Bennett MSc Healthcare Policy and Organisation, CITP MBCS, BSc Hons, PgCM, RN, is Clinical Director Asia Pacific, BT Health.

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

Australia’s plans for a National Broadband Network In the last edition of Pulse+IT [Edition 15, November 2009, pp10] we outlined some of the services provided by BT as part of the English National Programme for IT. The article focussed on some of the successes that rarely make it to media headlines and lessons learnt that informed that success and are pertinent to Australia and its e-health and health reform agenda.

One such service that meets these criteria is N3, one of Europe’s largest Virtual Private Networks with more than 40,000 connections throughout England and Scotland. This secure broadband National Network for the National Health Service (NHS) connects every NHS organisation in all settings across England serving over a million NHS employees. It enables the secure, accurate and efficient transfer of data between clinical and non-clinical systems used within the NHS. BT completed the network in January 2007 and the service has been 100 percent available for over three years on a 365x24x7 basis.

N3 provides the foundation for other frontline applications, supporting, for example: • The complete transfer of a patient’s complete GP record in the fraction of the time it used to take — a day as opposed to what at best often took six weeks.

• Electronic referrals.

• Electronic Prescription Service.

• NHS Care Records Service.

• Picture Archiving and Communication Systems (PACS).

• Creation of Communities of Interest Networks (COINs) such as that within Kent, allowing moving cardiac images to be sent electronically from local hospitals and care centres to cardiac specialists in London. Tertiary care consultation is now only sub-seconds away, significantly changing patient experience and outcomes as well as enhancing clinician to clinician support and education.

• N3 is also helping the NHS to make efficiency and quality improvements through voice enablement, making it possible for organisations which have facilities over multiple sites, to converge their voice and data over a single network, reducing the cost of internal phone calls and calls to mobile phones.

Another key strength is the ability to alter usage of the network

to meet certain conditions. In November 2009 in the UK there were severe floods in Cumbria in the north-west of England. The N3 team increased the bandwidth to the local Cockermouth Community Hospital so that the increased demand for transmitting patient information could be dealt with.

BENEFITS So why is this of relevance to Australia? Clearly the Federal Government also believes a broadband network is a key enabler of health reform and valuable to rural communities, noting: “e-Health is a means of delivering health information and services in a secure electronic form for the purpose of optimising the quality and efficiency of health care. Services such as electronic clinical messaging (discharge, referrals, pathology, and prescriptions) and remote diagnosis and monitoring can revolutionise the way we access health care. This will be essential as our population ages to reduce the costs of health care, improve quality of life and sustain regional communities”1.

This belief is well founded. In addition to the services already mentioned, benefits of the N3 Internet capabilities identified so far in the NHS include: Benefits for patients and clinicians • Faster and more efficient treatment, with secure online access to records and visual images available when and where they are needed.

• Convenience of specialist care available locally through remote diagnosis, rather than having to travel to specialist centres.

• New broadband connections brought to NHS sites in rural communities through combining purchases of network connections.

• Secure, confidential and reliable clinical messaging.

Benefits for clinical education • N3 is the first shared service to work across the health and education networks allowing video conferencing so that health and medical education sites can conference for teaching purposes.

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

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Benefits for NHS organisations • A robust network, ensuring that current and new NHS systems and services run smoothly.

• Sufficient capacity to implement new approaches to healthcare such as remote working.

• Organisations can consolidate their network management facilities into a single network and communications stand point — integrating of email services with telephony allowing callers to check the availability of others on the system before placing a call, making it easier for everyone to plan their day and enabling employees to log in, talk or retrieve messages from wherever they are.

• Reduced telecommunication costs.

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TECHNOLOGY The N3 core network uses a Six-Layer Quality of Service digital network solution which enables such things as prioritisation of applications ensuring critical applications are always readily available to patients and clinicians irrespective of demands on the N3 service.

However whilst N3 is a dedicated health network, the Australian National Broadband Network (NBN) will not be. As a result, the design of NBN will directly affect e-health development.

So what are the lessons learnt from the UK that can be used to inform how NBN needs to be implemented in order to safely and reliably achieve the potential of e-health and health reform?

There are three elements needed to ensure success: 1. Policy Prioritisation matters especially in commercial broadband model.

If e-health is to succeed it must have protected bandwidth to avoid any network conflict and performance issues. Within that protected environment it must still be able to flex demand but within agreed parameters so that a local crisis can be coped with but not to the detriment of other health services.

Fundamentally if NBN is intended to be relied upon for the carriage of clinical data then there is a need for NBN to be regarded as a Healthcare related solution, and that brings with it clinical safety requirements for design and implementation. An emerging international standard, already adopted by Canada and under review for adoption by the US Food and Drugs Administration is IEC: 80001-1, the application of risk management to IT networks that incorporate medical devices. Australia’s NBN needs to be cognisant of this evolving work which was applied to the design, implementation and ongoing support of the UK N3 programme.

2. Classification Health traffic such as remote monitoring, conferencing and PACS using the network must ensure it hasn’t affected, or is affected by, the speed at which other traffic — non-critical applications such as web browsing — reaches its intended recipient(s). For example in England there are six classes of traffic, each has an assigned use for the NHS based on business need and network requirements. These classes are defined as four critical services: • Multimedia (e.g. Video conference) • National Transactional Applications (e.g Electronic Prescription Service) • Community Transactional Applications.

• Bulk file transfer (e.g. PACS) In addition, two non-critical applications that can tolerate network delay or are of low business priority receive classifications,

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namely email and web browsing.

Early agreement is needed on classification — example “all voice traffic goes in class X” — because voice transport has tight network requirements and each phone call is a flow of small packets with relatively small bandwidth needs. Looking at each service type in this manner enables service prioritisation to be agreed, anticipated and the service planned so that the minimum service under all circumstances is guaranteed. This then becomes the values used in network planning 3. Implementation Network monitoring needs to be in place to detect not only complete loss of a site or service but latency and delay to ensure continuous services for e-health such as remote monitoring, robotic surgery and consultation. NBN Disaster Recovery and Business continuity plans must have response times that reflect the criticality of healthcare services as opposed to that of TV channel availability. In addition each healthcare organisation will still need to have a disaster recovery and business continuity plan in place.

Fault Call Progression is the usual imperative placed on support services for broadband to answer all calls within a given timeframe, or be subject to penalty payments. This potentially leads to concentrating efforts on answering telephone calls rather than resolving faults. For e-health purposes it is the prevention of faults through proactive (not reactive) monitoring and resolution of a fault that is crucial.

Maintenance activity may reduce the ability to deliver safe levels of care so timing of this must be agreed upon with the clinical services or better still mechanisms devised that avoid any

disruption of service.

Virus Protection Polling is needed across the network. It needs to be a facility over and above any virus protection provided by other Service providers, and is intended to trap and detect viruses. In any service, corrupt data can be sent, which may result in misleading or unreadable conditions when viewed at the receiving end. All clinical based applications using the system, or data of a clinical nature should be passed through a virus checker before using NBN for clinical care and services. Virus protection should be in place at all health locations — which should either prevent virus transmission, or notify the recipient that a virus is present on receipt.

Clinical Applications planned to run on NBN should pass a Wide Area Network Worthiness Test to assess their effectiveness to operate on NBN. Clinically critical applications not tested through this process may operate at a level unacceptable to clinicians and this could lead to a reduction in ability to deliver an appropriate level of care. Clinical applications may interfere in some way with NBN itself or other services delivered over NBN. It should be a requirement placed on all suppliers of clinically critical applications with appropriate testing facilities for conformance, compliance and accreditation verifying capability. No network can manufacture bandwidth or make poorly written applications work.

In conclusion there is no doubt that NBN can fully enable health reform. However the decisions being made now are critical to fulfilling that ambition.

REFERENCES 1 - http://www.broadbandfuture.gov.au/streams.html#e-health

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• National Broadband Network • Gerontechnology • Infrastructure – The Future of Software Delivery • Home Care/Hospital in the Home/Doctor in the Home • Medicine Management SILVER SPONSORS

ITAC 2010 Conference Office Health Informatics Society of Australia (HISA Ltd) 413 Lygon Street East Brunswick Vic 3057 T: 03 9388 0555 F: 03 9388 2086 E: itac2010@hisa.org.au

GUEST EDITORIAL Tim Martin Acting Deputy Director of Nursing, Bass Coast Regional Health tim.martin@bcrh.com.au

Information Technology in Aged Care: An Oxymoron?

A discussion about the ability of Aged Care staff to supply care within an ever expanding information technology framework.

Aged Care is an industry that is steadily expanding to try and keep up with our ageing population. The industry is under constant public scrutiny and operates within the realms of very closely monitored standards. Aged care facilities must constantly audit and review their practices to ensure they continue to meet these standards. To this end, many aged care organisations have introduced IT platforms that streamline the process of recording care as it is provided, and reporting this raw data to meet the ever looming standards.

Introducing such IT systems into the aged care environment is a change management process that can be lengthy and challenging for both staff and management. Aged care providers often have concerns about recouping the high level of capital outlay required to install such systems, in addition to the costs associated with ongoing system maintenance and staff training. Aged care settings are less technically complex in relation to care delivery than other areas such as ICU and ED, which are more focused on meeting the needs of residents with highly challenging behaviours. A lack of technical expertise can result in huge aversion to change, some aged care staff having never turned on a computer before. With many providers looking to IT platforms to meet their documentation and regulatory compliance needs, this is a real and ongoing issue. Despite staff concern, information technology infrastructure is part of every day life and it will not go away — it is the way of the future. Aged care providers face many challenges relating to the uptake of new technology, which may range from a quiet grumble to flat refusal to use the equipment, and even destruction of said equipment, e.g. “accidentally” dropping it in the toilet.

Difficulties with the use of information technology usually come down to a lack of familiarity with such technology, and a high lack of self confidence about the ability to learn to use IT systems, i.e. “I am too old to learn that now”. Managers should also be aware of other challenges that staff may face when attempting to adopt modern day equipment. Such equipment can be difficult to interact with if the user has eye sight problems or fine motor skill deficits for example. These issues can usually be overcome with appropriate education and processes that boost self-confidence and familiarity with information technology solutions.

For any new product to achieve success in an organisation it needs a “champion” — an employee who has real faith in the success of the product. It is very important that this person is not a senior manager as this can invalidate the role. This person can buoy other staff along and motivate them in the times when

the product’s usefulness is being questioned. Such employees can make or break the success of a product implementation.

Once staff see the value of a product that has been evangelised by a product champion, they themselves become product champions. It is this change in perception that facilitates the success of the introduction of a new product.

Another viewpoint that can be espoused to motivate staff is that the implementation of information technology in an aged care setting provides staff with the opportunity to empower themselves with knowledge of the types of technology they are likely to be confronting in all facets of every day life. Information technology follows you out the door when you leave work via your phone, it is with you at the petrol station and the supermarket when you make a purchase and then it follows you home when you want to communicate with friends and family with an email or a web based video call.

Clearly education will play a major role in the success of any information technology project and training must be presented in a format to which the target audience is receptive. Adults who have worked in their chosen field for many years do not wish to return to the classroom for such education and probably don’t have much time to leave their place of work. It is for these and more reasons that effective education in the workplace can take the form of small group education that facilitates questions and enables staff to leave the session if urgent matters arise. This education should be a stepped process that slowly introduces the system to the new users. Information overload is very easy to achieve with IT systems.

The use of a projector to display the interface being demonstrated is highly valued as all staff can follow the instruction, with any questions able to be addressed for multiple people simultaneously. That such education can be repeated as often as required due to its flexible, small group on-site nature is an invaluable resource. To further enhance this learning, staff should not be given physically large and heavy user manuals as these only scare people and end up as door stops. Small summary reference sheets make such learning more achievable. These materials can reference the complete user manual for those who wish to read further.

Author’s Note The points I have raised in this discussion are based on my personal experience of introducing an electronic care planning IT platform to three facilities and in excess of 150 staff within our organisation and the challenges we faced along the way.

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BitS & BYTES AUSTRALIAN SNOMED CLINICAL TERMINOLOGY RELEASED In December 2009, the National E-Health Transition Authority (NEHTA) launched the first release of SNOMED CT-AU to Australian licence holders.

A standard clinical terminology enables the terms used as part of clinical communications to be clearly recorded and interpreted and gives healthcare providers and developers of e-health applications a common language to ensure consistency and clarity in information that is recorded and exchanged. SNOMED CT (Systematized Nomenclature of Medicine-Clinical Terms) is such a clinical terminology.

SNOMED CT is considered the most comprehensive, multilingual clinical healthcare terminology in the world and was endorsed by NEHTA as the preferred terminology for Australia shortly after the organisation’s foundation in 2005.

According to NEHTA, the way patient clinical information is captured and shared by healthcare providers is vital to improving the quality and safety of healthcare delivery and is fundamental to the success of e-health.

SNOMED CT-AU is the Australian version of SNOMED CT, which contains additional customised content for the Australian healthcare market. Specifically, the initial release of SNOMED CT-AU includes relevant components from the SNOMED CT international release, a list (known as a reference set) of the Australian English preferred descriptions, and context specific reference sets designed to support the data requirements for NEHTA’s clinical information specifications.

Documentation and terminology viewer software to access the files on Windows and Macintosh operating systems are also available.

According to NEHTA, this first release of SNOMED CT-AU provides the product platform for the incorporation and release of newly developed Australian terminology content. NEHTA is working on additional sets of new content to be incorporated into ongoing releases. The next release will be available in May 2010 with updated international and Australian content. Subsequent releases will then be available every six months.

NEHTA administers SNOMED CT licensing in Australia on behalf of the International Health Terminology Standards Development Organisation (IHTSDO).

E-health software testing consensus statement released Four peak industry groups have joined with the National E-Health Transition Authority (NEHTA) to develop a standards assessment approach for medical software in Australia.

A statement released in December defines ten key principles on which compliance, conformance and certification of software products will be based and outlines a cost-effective pathway to standards development using existing industry mechanisms.

NEHTA described the consensus statement as a “landmark agreement between heavyweights in Australia’s medical software and standards compliance industry.” Signatories to the agreement include the Medical Software Industry Association (MSIA), Australian Information Industry Association (AIIA), National Association of Testing Authorities (NATA) and Joint Accreditation System of Australia & New Zealand (JAS-ANZ), in addition to NEHTA itself.

NEHTA Chief Executive Peter Fleming touted the agreement as a milestone in private-public sector collaboration and a significant step towards the development of national e-health infrastructure for Australia.

“The development and adoption of national specifications, and a supporting standards framework, is critical for improving patient care and healthcare delivery for all Australians,” he said.

“When systems work better together, the efficiency and accuracy of transactions improve, which creates a positive flow-on effect for clinical safety and quality.”

Dr Geoffrey Sayer, President of the MSIA, said the consensus statement reinforces the industry’s approach to medical software development.

“The commitment by the MSIA is an extension of the medical software industry’s existing commitment to quality and safety in product development and service delivery. The consensus statement supports an effective partnership for the medical software industry to deliver innovation in the best interests of patients and clinicians,” said Dr Sayer.

The signatories to the statement have achieved consensus on the following: 1. The focus in e-health for Conformity

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Assessment will be on specific functional capabilities of software products.

2. International and Australian standards will be used as the basis for conformity assessment.

3. A tiered approach to conformity assessment will be undertaken when applying conformity assessment for quality, safety and risk-based measures. àà Contingent on the risk involved, conformity assessment may consist of options from self- assessment through to accredited external assessment. àà Conformity assessment will be commensurate with risk and geared to minimise resources and time.

4. Accredited conformity assessment bodies (CABs) will be responsible for accredited external testing and certification.

5. Accreditation of CABs will be carried out by internationally recognised accreditation organisations, such as NATA and JAS-ANZ. 6. It is not the intention of NEHTA to become or perform the function of a CAB. 7. Existing and future conformity assessment bodies, such as AHML, will be leveraged as the basis for e-health conformity assessment.

8. Successful completion of an appropriate CCA process will be publicly recognised.

9. Whilst the CCA Framework’s primary focus is safety and quality, it will guide and assist other processes such as procurement and healthcare practice improvement.

10. The CCA Framework will focus on the foundations for e-health underpinning innovative development.

Building on the agreement, NEHTA has indicated the organisation is working on an assessment framework for each of its major e-health specifications. The documentation will provide guidance on matters such as whether self assessment or third party assessment is appropriate, test specifications and test tools, and appropriate ways in which conformance claims may be presented to the market.

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BitS & BYTES iSOFT looks to USA while Australia plays “catch-up” iSOFT has noted what it says are “early signs” of action on e-health by Australia’s Federal Government but indicated its major growth driver would be the United States’ US$34 billion stimulus investment in Health IT systems, leaving Australia to follow other countries in the provision of e-health funding.

“In Australia … we have seen the early signs of the Government preparing the foundations for e-health, with the legislation for patient unique identifiers,” said iSOFT chief executive Gary Cohen in a briefing after the release of the company’s half-yearly financial results.

Cohen also noted encouraging signs in Europe, China and Latin America for the company.

“However, the major growth driver is the US$34 billion stimulus investment in Healthcare IT,” he said. “This will lead to the re-shaping and the transformation of the US Healthcare IT market, as well as most likely lead to the rest of the world playing catch-up.”

Cohen said it was likely that Australia “will follow the lead of others” in the area of e-health.

The comments came as iSOFT revealed it had suffered diminished revenues in the six months to 31 December last year compared with the same period the year before, with Cohen attributing the fall primarily to currency fluctuations. iSOFT’s revenues sank 13.1 percent in the period to reach $239.29 million, down from $275.38 million in the half-year to the end of 2008. Net profit after tax was also down 44.2 percent to $5.2 million.

“These results should be viewed in the light of a significant currency translation effect on revenue and earnings when compared to [the first half] of financial year 2009,” said Cohen. “You may recall that over half of our revenue is in UK pounds and a further quarter is in Euros.”

“The substantial drop in these two currencies vis-a-vis the Australian dollar has meant that we have reported a lower revenue and earnings when these amounts are translated back to Australian dollars.”

Despite the falls, Cohen said in general that each of iSOFT’s segments performed “as expected or better” in local currency, which he said demonstrated the underlying strength of the global Health IT industry.

— Renai LeMay with SJ

DoHA rejects concerns about NEHTA’s future role The Department of Health and Ageing has rejected as “laughable” opposition questions about whether there were plans for the National E-Health Transition Authority (NEHTA) to ever function as a commercial entity in the e-health marketplace.

During a Senate Estimates Committee hearing held in mid February, Liberal Senator Sue Boyce queried the future status of the authority in a prolonged period questioning Department of Health and Ageing officials about the Health Identifier legislation that was recently introduced into parliament.

“This concern has been put to me by people from private companies or who are stakeholders who are concerned that they are being asked to share secret commercial information with an organisation that they are not entirely confident may not at some stage be in competition with them,” said Boyce, after asking whether there was any intention that NEHTA would function as a commercial entity — “when we drop the ‘T’ [Transition] out, presumably”.

The line of questioning is believed to have been prompted by industry concerns about NEHTA’s role in the Northern Territory

Government’s development of a secure messaging solution, which has led to the decommissioning of software developed

by ArgusConnect in some NT clinics.

Department of Health and Ageing secretary Jane Halton said the Commonwealth, state and territorial governments had not had a discussion about NEHTA’s future governance arrangements.

“I have to say, my personal opinion is it is unlikely it would function in a commercial way,” she said. ” I cannot say one way or the other, but certainly given its function is quite specified and its owners are Commonwealth and state ministers, I cannot see why that would be the case.”

Halton further added that the notion that governments could supplant commercial organisations or play in the commercial e-health sector was “frankly … laughable”.

“If I, in my case as a director, with my state and territory colleagues were interested in building some vast monolith, we would have indicated that. That is not what we are interested in,” she said. ” It is not our business, core or otherwise, to be competing with the commercial sector.”

— Renai LeMay with SJ

RACGP to use 4th Edition Standards to drive e-health The Royal Australian College of General Practitioners (RACGP) is currently developing the fourth iteration of its standards for General Practice, flagging an intention to use the revised requirements to increase the utilisation of information technology in general practices.

While the current 3rd Edition Standards contain criterion that relate to information technology, the 4th Edition Standards are purported to contain more stringent and specific requirements that fall under the “e-health” banner.

The RACGP Standards for General Practices is the benchmark against which general practices are surveyed for accreditation. Two organisations, AGPAL and GPA Accreditation Plus, engage both GP and non-GP surveyors to assess

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practice compliance with the standards every three years.

According to the RACGP, around 80 per cent of Australian general practices are formally accredited against the RACGP Standards, a milestone that enables practice owners to access lucrative Practice Incentive Program (PIP) payments, some of which are devoted to e-health initiatives.

The latest revision of the then IT/IM (now e-health) PIP requirements drew criticism from within the medical software industry, with representatives describing them as a wasted opportunity that did little to advance the utilisation of information technology in medical practices. These comments were made in reference to the situation where practices were effectively

BitS & BYTES paid to “adopt” secure messaging solutions that they were already using, and to register for — but not necessarily use — individual PKI certificates issued

by Medicare Australia. Compounding the controversy, subsequent to the commencement of the rollout of these certificates, Medicare Australia indicated that certificates were no longer required to digitally sign electronic referrals sent by GPs to specialists, leaving a question mark over their potential uses going forward.

According to the RACGP, the 4th edition of the Standards will lead the way in showing general practitioners how e-health will work within their practice and assist them to incorporate the necessary changes as primary care continues to rapidly evolve in Australia.

Dr Chris Mitchell, RACGP President and GP in northern New South Wales said that Australia is at the forefront of GP accreditation in the world and a benchmark against which other countries have based their systems.

“GPs are at the centre of the health care system in Australia. They work at a

very high capacity, requiring a high level of skills in a variety of environments. Within that they provide a continuity of care and their work has become increasingly complex.

“GPs use a variety of different systems and the RACGP Standards must allow for a high level of interoperability to allow data to be moved safely and without errors.

“GPs are increasingly reliant on computers for patient care and there are immense benefits that could arise from an Australian health sector operating as an inter-connected system, avoiding duplication and reducing errors,” he said.

In a statement issued by the RACGP, the organisation said that it is “ensuring that the National E-Health Transition Authority (NEHTA) is informed of what is reasonable, workable and useful for GPs when leading the progression of e-health in Australia”.

The 4th edition of the RACGP Standards for General Practices will be launched at the RACGP annual conference — GP’10 — that will be held in Cairns in October 2010.

DCP commercialised to support ongoing development Dr Anton Knieriemen, a GP who has developed the Doctors Control Panel (DCP) software utility has announced plans to commercialise the product, which has been freely available until now.

The DCP is designed to act as an adjunct to clinical and practice management software, delivering access to summarised patient information in a pop-up panel. The DCP utilises a “traffic light” system to indicate areas of noncompliance with the RACGP Red Book guidelines. Additional functions, such as an interface to Skype Internet telephony and Google Maps, have also been incorporated into the software.

The DCP is currently compatible with Medical Director (with or without PracSoft) and Best Practice (with or without Best Practice Management or PracSoft). Dr Knieriemen has indicated he is open to developing compatibility with other clinical and practice management packages, however collaboration with the developers of such software is likely to be necessary and has so far not been forthcoming.

According to Dr Knieriemen, the costs

associated with the development of the product have reached over $30,000, not counting the thousands of hours of development time that the GP has invested in his product.

Under the new subscription arrangements, users are able to run the software in an unrestricted trial mode for a month, after which time selected features are disabled pending the purchase of a subscription.

Sold on an annual basis, subscriptions retail for $110 for the full version of the DCP or $75 for users that don’t require the billing functionality provided in the solution.

In a letter to DCP users, Dr Knieriemen said, “There are many more features on the drawing board. Some of these may change our ideas and methods of implementing preventive care. To bring these to fruition, commercialisation will provide me with added incentive and means. I believe it is in the best interest of the DCP’s current and potential users for the DCP to progress down this path.”

Further information about the Doctors Control Panel is available from: http:// www.pracsoftutilities.com

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BitS & BYTES ASADA INTEGRATES MIMS DATA INTO ANTI-DOPING WEBSITE The Australian Sports Anti-Doping Authority (ASADA) has integrated the MIMS medicines database into the “Check your substances” section of its new website.

According to the organisation, making this information available through the website will provide athletes and sports administrators with peace of mind when looking for the latest information about medications and substances. The online resource will help Australian athletes, doctors, coaches and support personnel to anonymously and immediately find out if their medications and substances are permitted or prohibited in sport.

The website provides specific information against the sport type and gender of the athlete, as the status of medications and substances can be different from sport to sport.

National Business Manager for MIMS, Margaret Gehrig said that having the MIMS medicines database integrated into the ASADA website will provide athletes and their support personnel with 24 hour access to an online medication information service.

MIMS editors are responsible for adding new medicines, along with their sport status, to the database each month and reclassify medicines annually against the revised WADA prohibited list.

Designed primarily to provide relevant anti-doping information, ASADA’s new website has improved design and navigation features making it easier to find relevant information. The resource also provides a means for students, media and other interested groups to find out more about anti-doping issues.

“MIMS Australia has worked with ASADA for many years so it has been exciting to see them make use of the integrated data to launch this terrific resource,” said Ms Gehrig.

ASADA Chairman, Richard Ings said that ASADA views its relationship with MIMS as crucial to achieving its commitment of delivering up-to-date information about medications to athletes.

“Athletes and their athletic careers rely on having access to accurate information about medications to ensure they do not breach the World Anti‑Doping Code,” said Mr Ings.

The “Check Your Substances” portal is available at: https://checksubstances. asada.gov.au

AGPN calls for “e-health change and adoption” funding The Australian General Practice Network (AGPN) has called for $31 million in funding over three years to assist general practices to meet the ever-growing IT demands being placed on these organisations.

As part of a broader submission to the Federal Budget, AGPN said e-health initiatives such as the E-Health Support Office Program (EHSOP) — which was initiated in 2005 and has been funded until June 2010 — had aided the network in increasing the uptake of e-health infrastructure across the health care sector.

However, the group said barriers such as the lack of a nationally consistent approach to e-health, variable levels of e-health literacy, and fragmented funding had resulted in an e-health landscape which, “while containing pockets of excellence, lacked consistency”.

The AGPN praised the Federal Government’s recently unveiled National E-Health Strategy as a remedy for these ills, however it claimed the success of the strategy would be reliant on GPs adopting e-health initiatives — an aim that the organisation recommended be targeted by expanding EHSOP to incorporate 60 e-health officers working at the GP level as “change agents”. Currently, e-health personnel are funded at the State Based Organisation and AGPN level, but individual divisions are currently required to fund any e-health initiatives or expertise

via other funding channels if they wish to offer such services to their member practices.

Such a program would cost $31 million over three years, the AGPN estimated.

While the wages of the 60 e-health officers would not consume the requested amount in its entirety, Dr Emil Djakic, AGPN Chair, acknowledged the prevailing skills shortages in the Health IT sector and highlighted the need for e-health officer salaries to be attractively positioned.

While the specific duties these staff are likely to perform are not yet available, the AGPN envisages the e-health officers will “encourage and support general practices and GPs to adopt best practice e-health tools and systems while encouraging participation in e-health initiatives such as Individual Electronic Health Records, Unique Health Identifiers and secure messaging via Public Key Infrastructure”.

Indicating a desire to engage with the software industry via peak bodies such as the Medical Software Industry Association, the AGPN rejected concerns that the funding of an expanded e-health officer program would lead to market interference, the organisation pointing out that the hands-on deployment and support of specific software solutions would fall outside the charter of the e-health officer program.

— Renai LeMay with SJ

InterSystems appoints new regional manager InterSystems has appointed Stan Capp to the position of Country Manager, Australia, New Zealand and South East Asia. Capp has been charged with managing and growing InterSystems’ regional business, which he indicated will be aided by leveraging InterSystems’ achievements in international healthcare markets.

“InterSystems technology is at the heart of so many successful electronic healthcare projects around the world,” said Capp. “By providing cost-effective solutions for rapidly connecting healthcare, InterSystems is making a real

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difference in the quality of care delivery.”

With over 25 years experience as a CEO for healthcare organisations in Australia and internationally, he returns to Australia following recent positions in the United Arab Emirates as Project Leader for the review of Dubai’s Public Health Services and Technical Director for VHA Global Pty Ltd, overseeing health management initiatives including the commissioning and management of the new Sharjah Teaching Hospital. Prior to his relocation to the Middle East, Capp was Chief Executive, Southern Health.

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MEDICAL FAIR AUSTRALIA is set to confirm its position as Australia’s hub medical event!

With the challenge to improve patient care and tightening up treatment procedures to relieve the burden of costs, all sectors of the medical industry are being pushed to attain a truly high level of performance.

Your visit will present the perfect opportunity to keep one step ahead, make informed purchasing decisions, stay on top of the latest trends and get to know all the new players.

Set to feature over 160 Australian and international exhibitors representing manufacturers, wholesalers and distributors from innovative small businesses to medium-sized companies and global players, what’s on show will have the dual effect of both improving your treatment procedures and rationalising costs.

Visit and you’ll see many of the innovations launched at MEDICA ‘09 and be able to explore both new high-tech and familiar, reliable equipment, products and services used in the diagnosis, prevention, treatment and management of disease and disability.

You’ll be able to explore all that’s new in medical IT and test trendsetting software to control and link administrative and medical procedures in clinics, new telemedicine applications for the efficient, remote monitoring of patients, as well as software and hardware to link up clinics and out-patient care units.

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BitS & BYTES HOSPITAL GROUP DEPLOYS SAAS TO CONTROL SPAM EMAIL A group of hospitals in Sydney has selected a Software-as-a-Service (SAAS) solution to handle the detection and processing of spam email.

St Vincent’s & Mater Health Sydney is one of Australia’s largest not-for-profit, non-government health care providers.

Its hospitals — St Vincent’s Public, St Vincent’s Private, St Joseph’s and The Mater — provide specialist and general health care on a state-wide and national basis.

Encompassing three major and several minor Sydney campuses, as well as pathology laboratories in regional NSW, the information and communications technology infrastructure supports all the clinical information systems, patient care systems, administrative systems and diagnostic equipment used by 2,500 medical, nursing, allied health and administrative staff.

Prior to the recent deployment of Symantec Hosted Services, St Vincent’s & Mater Health Sydney’s IT Department was managing messaging security internally, using several products and to scan 216,400 incoming emails each month, consuming between five and ten hours each week.

“Our principal concern is ensuring the confidentiality of the information crossing our network — by eliminating the risk of information loss, identity theft and cybercrime such as social engineering,” said Peter Param, Manager IT Security.

“Effective confidentiality is essential to the welfare of our patients, our staff and to our brand.”

Prior to the deployment of the new system, benchmarking was conducted to compare the existing system against the hosted service.

“St Vincent’s Hospital is publicly funded and we needed to demonstrate bang for our buck,” said Mr Param. “A two week trial where we tracked spam captured by Symantec Hosted Services against our in-house solution showed Symantec Hosted Services were 100 per cent accurate in identifying unsolicited and dangerous emails. Our in-house solution had been identifying only about 75 per cent of spam.”

The new system is reported to eliminate around 34,000 spam messages each month from St Vincent’s & Mater Health Sydney’s email before it enters the corporate network.

HCN reaches milestone with PracSoft Easyclaim HCN has announced that it now has over 1,000 practices actively using the Medicare Easyclaim functionality in its PracSoft practice management solution.

The software has been designed to work with EFTPOS terminals from Tyro, which connect to the practice’s network instead of a telephone line.

According to HCN, throughout January more than 440,000 Easyclaim transactions were processed using PracSoft, delivering Tyro over $100,000 worth of government funded Easyclaim transaction fees.

Tyro CEO Jost Stollmann said, “The Integrated EFTPOS solution took longer than anticipated to bring to market, but the speed of uptake since launch clearly shows that it has been what busy practices really want”.

According to research conducted by Medicare, more than 80 percent of paying patients want an easier way to claim their Medicare rebate. This research led to the introduction of per transaction incentive payments for practices using either Medicare Easyclaim or Medicare Online, and a multi-million dollar campaign to drive patient adoption. Practices are no longer paid transaction fees to use either channel, however it is unclear at this stage what impact the withdrawal of this program has had on the utilisation of these services as Medicare’s first quarterly report following the cessation of the practice incentive at the end of 2009 won’t be available for another month.

Feedback gathered from practices

by HCN has indicated that Easyclaim transactions performed with its system

can be completed in around 20 seconds, significantly faster than the two minutes typically required to complete a transaction using Easyclaim via a stand‑alone EFTPOS terminal.

HCN CEO, John Frost, believes that the adoption of Easyclaim for patient claims is occurring at a much faster rate when compared with the uptake of Medicare Online for the same purpose.

“Anecdotally we have heard Medicare staff say the uptake of the Integrated Easyclaim solution has been ten fold that of the uptake of Medicare Online claiming over a similar period.

Based on the current speed of uptake we predict that by the end of 2010 well over 50 percent of PracSoft users will be using Integrated Medicare Easyclaim as their primary claiming channel, which represents a significant proportion of the GP market,” said Mr Frost.

Medicare Online was introduced by several software developers in 2004, however utilisation of its patient claiming functionality, which allows patients to have their rebates paid directly into their bank account within a few days of the service, has only recently started to increase in-line with the growing number of providers that are offering electronic patient claiming. As of November 2009, nearly 22,000 providers had either submitted a patient claim via Medicare Easyclaim or Medicare Online, up 6,000 from a year prior and 14,000 from November 2007. Medicare Australia report that as of Christmas 2009, 2.7 million Australians had registered their bank details with the government organisation.

IHE to host secure messaging Connectathon in Canberra The Integrating the Healthcare Enterprise (IHE) initiative is preparing to host a secure messaging “Connectathon” in Canberra.

To be held between 19-23 April, the event will provide software developers with an opportunity to test their products’ ability to interconnect with the products of other companies participating in the event. Interconnectivity describes the ability for software to communicate with

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other software, however the term does not necessarily imply that the data transmitted between the software products can be interpreted correctly by the receiving software.

The Connectathon is being convened to test vendor implementation of the Secure Message Delivery specifications developed by the eHealth PIP Working Group in the second half of 2009, a

BitS & BYTES collaboration between the Medical Software Industry Association (MSIA) and the National E-Health Transition Authority (NEHTA). Nearly 50 companies signed a commitment to the process, the outcomes of which are currently being reviewed by Standards Australia. As has occurred in previous years, the Australian Healthcare Messaging Laboratory will supervise the functional testing at the Connectathon.

It is envisaged that the event will be open to the public on Friday 23 April,

giving interested parties the opportunity to see the extent to which software from various developers is able to interact.

As has occurred following previous IHE Connectathons, participants will be able to demonstrate their products’ capabilities to a much wider audience as part of the IHE Showcase at the forthcoming Health Informatics Conference, to be held in Melbourne in late August this year.

Further information about the event is available from: http://www.ihe.net.au

Community Pharmacy deal to fund e-prescribing adoption of the subsidised script period, however it is not known if this price will be revised in light of the new source of funding.

The eRx service commenced public operation in April 2009, with Best Practice being the first clinical software developer to enable their system to interact with the script hub. Accelerated by the progressive rollout of eRx infrastructure in more pharmacies and general practices since the service was launched, the volume of scripts sent and dispensed via the system has risen dramatically, particularly in recent months. By the middle of January this year, 7.5 million scripts had been sent to the eRx script hub by prescribers, with 1.7 million of these having subsequently been dispensed. Significantly, these volumes are more than double the total number achieved by the system at the end of November, indicating that roughly 1.5 million scripts per month are being transmitted to the eRx script hub alone.

It is expected that this transaction rate will increase dramatically in the coming weeks on account of HCN’s expected release of an eRx compatible version of its market leading Medical Director clinical software. Other clinical software developers, including Genie Solutions, Houston Medical, Virtual Practice and Zedmed are also expected to support eRx throughout the year, having signed agreements with the company at various stages throughout 2009.

Capacity at the pharmacy end of the electronic script journey has also been bolstered during the summer months, with five pharmacy dispensing software developers now accredited to commence rolling out interfaces to the eRx system, namely Fred Health, LOTS, Simple Retail, minfos and AMPAC.

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Announced as part of the “in principle” agreement reached between The Pharmacy Guild of Australia and the Federal Government in January, the Fifth Community Pharmacy Agreement is to include provisions for the funding of electronic prescribing. While prescribers in Australia have long used computers and clinical software to print scripts, modern electronic prescribing systems introduced by eRx Script Exchange and MediSecure in 2009 now also allow prescription data to be transferred to community pharmacies via centralised “script hubs”.

In response to the prospect of funding, Chairman of eRx Script Exchange, Graham Cunningham, said, “We congratulate The Pharmacy Guild of Australia and the Federal Health Minister on their foresight in backing the e-prescription concept and benefits that will result. This ongoing support endorses the benefits of e-prescriptions and will make a significant difference to patient care by ensuring that the most accurate and efficient dispensing becomes available to all Australians.”

Dispelling an inaccurate report published in the Financial Review shortly after news of the Agreement emerged, the Pharmacy Guild confirmed that all commercial e-prescribing services — as opposed to only the Guild-endorsed eRx venture — will be eligible for 15c per script government funded payments.

Current funding for the operation of the eRx infrastructure is being provided by the Guild and the Australian Friendly Society Pharmacies Association, who have funded the dispensing of 10.6 million and 500,000 scripts respectively. Previous to the government funding revelations eRx had plans to charge to pharmacists 25c per dispensed script at the completion

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BitS & BYTES TELSTRA PREVIEWS FASTER WIRELESS BROADBAND MODEM Telstra has unveiled a new USB modem that will allow customers to take advantage of the speed upgrade it activated on its Next G mobile broadband network last month, saying the device would go on sale “later this year”.

The infrastructure upgrade will allow Telstra customers to send and receive wireless data using two channels simultaneously. Theoretically the device will allow peak network download speeds of 42Mbps, although actual performance will vary depending on a range of factors.

In a statement issued as part of its visit to the Mobile World Congress trade fair in Barcelona in February, Telstra claimed the new device would deliver typical speeds in selected locations “around double” those seen with the fastest 3G devices available in Australia today. The modem was built by Sierra Wireless and has been dubbed the “Ultimate” edition.

“With HSPA+ Dual Carrier technology we expect to offer speeds that are comparable to the initial speeds we have seen reported from some fledgling 4G LTE networks,” said Telstra chief executive David Thodey. LTE stands for Long Term Evolution, with the technology viewed by many as the successor to existing 3G mobile phone and data networks.

Thodey added that while LTE remained on Telstra’s technology roadmap, there was a “huge amount of potential” remaining in the High-Speed Packet Access (HSPA+) technology the telco currently uses.

“We will take full advantage of this by again doubling our peak network speeds to 84Mbps through the implementation of HSPA+ Dual Carrier plus MIMO (Multiple Input, Multiple Output) technology during 2011,” Thodey said.

The news comes as Telstra’s Next G network continues to gain traction with consumers. Revenues from the company’s mobile division were up $145 million in the second half of 2009 over the same period in 2008. Contributing to this additional cash flow was a 31.9% increase in revenue generated from mobile broadband services.

Unfortunately for the company, these inroads appear to have been offset by a six percent decrease in fixed line sales revenue resulting from a net decrease of 156,000 fixed line customers.

— Renai LeMay with SJ

Northern Territory DHF funds development of Web Service secure messaging Clinics in the Northern Territory have commenced rolling out a new secure messaging solution designed to improve their ability to connect to the Territory’s Shared Electronic Health Record (SEHR).

Dubbed the Web Services Messaging Application (WSMA), the technology has been released as an Application Programming Interface (API), which allows developers of clinical software to tightly integrate secure messaging functionality into their products, potentially removing the need for stand alone messaging software. Communicare Systems and Pen Computing Systems — both of whom develop software to service remote health clinics in the Northern Territory — have integrated WSMA into the latest versions of their software.

Due to an inherent lack of software compliance with existing technical e-health standards, most practices and healthcare facilities currently rely on several secure messaging solutions to communicate electronically. Most of these messaging products are developed, supported and rolled out by vendors dedicated to the task, with clinical software developers traditionally shunning the labour intensiveness of providing such services in addition to their core clinical products. As such, WSMA represents a departure from the secure messaging status quo in Australia.

As WSMA’s name implies, the solution uses Web Services technology to facilitate communication with remote systems, including the Northern Territory SEHR. Unlike the email based version of Argus that WSMA was commissioned to replace, WSMA allows for real time communication with both remote systems, and the software within which it is integrated. According to Brian Dunstan of Communicare Systems, this characteristic allows users to receive instant feedback from their software in the event of a transmission problem, dramatically reducing the amount of technical support his company is required to provide to keep communication channels in operation at each of Communicare Systems’ 27 sites throughout the Northern Territory.

Having already developed solutions

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using Web Services in the past — including an interface with the Royal Australian College of General Practitioners Red Book — John Johnson of Pen Computing Systems also praised the Web Services underpinnings of WSMA, saying such technology represented the future of electronic healthcare communication.

The development of the WSMA was funded by the Northern Territory Department of Health and Families (NT DHF) and undertaken by Diverse Systems Consulting, an independent software company from the Northern Territory. Development of the WSMA API commenced in July last year and was completed over a four month period. Due to constrained budgets and time frames, the API was crafted to be compatible with Microsoft Windows operating systems only, a platform that, while prevalent in remote clinics in the Northern Territory, is no longer ubiquitous in many parts of the health sector.

WSMA was built with reference to a draft version of NEHTA’s Clinical Document Delivery specification. While this specification has subsequently been superseded by the work of the Medical Software Industry Association (MSIA) and NEHTA through the eHealth PIP Working Group, NEHTA’s Industry Communications Manager, Marie Howarth has indicated that future versions of WSMA will be brought into line with the latest version of the specification, which is currently before Standards Australia.

“The next phase of development and implementation by Northern Territory Department of Health and Families will see WSMA upgraded to conform to the finalised national Secure Message Delivery (SMD) specification and integrated into NT DHF’s remaining remote health clinics’ information systems (PCIS) as well as the public hospitals’ clinical information systems. This implementation will enable participating health facilities to send information to the Northern Territory SEHR, electronic referrals from remote health centres to public hospitals, and electronic discharge summaries from public hospitals to remote health centres,” said Ms Howarth.

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EVENTS CALENDAR Clinical Documentation, Coding & Analysis Conference 18 March - 19 March Melbourne, VIC P: +61 2 9080 4300 W: www.iir.com.au World Congress of Internal Medicine 20 March - 25 March Melbourne, VIC P: +61 2 9265 0700 W: www.wcim2010.com.au

FEBRUARY National Dementia Congress 22 - February - 23 February Melbourne, VIC P: +61 2 9080 4300 W: www.iir.com.au 3rd Annual Hospital Bed Management & Patient Flow Conference 22 - February - 23 February Melbourne, VIC P: +61 2 9080 4300 W: www.iir.com.au Dental Health Policy Forum 24 February - 26 February Sydney, NSW P: +61 2 9080 4300 W: www.informa.com.au ICT Research Forum Event 28 February Auckland, NZ P: +64 4 472 4691 W: www.healthit.co.nz

MARCH HIMSS10 1 March - 4 March Atlanta, USA P: +1 312 664 4467 W: www.himssconference.org 12th Annual Health Congress 3 March - 5 March Sydney, NSW P: +61 2 9080 4300 W: www.informa.com.au Open for Business 10 March - 11 March Auckland, NZ P: +64 9 366 4768 W: www.investmentnz.govt.nz

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19th Annual Medico Legal Congress 22 March - 23 March Sydney, NSW P: +61 2 9080 4300 W: www.iir.com.au Introduction to Governance and Change Management 23 March - 26 March Brisbane, Sydney, Melbourne, Perth P: +61 2 9224 6000 W: www.tonkincorporation.com Rural & Remote Health Congress 24 March - 25 March Brisbane, QLD P: +61 2 9080 4300 W: www.iir.com.au 6th Annual Public Private Partnerships in Healthcare 24 March - 25 March Adelaide, SA P: +61 2 9080 4300 W: www.informa.com.au 2nd Annual National Telemedicine Summit 24 March - 25 March Sydney, NSW P: +61 2 9080 4300 W: www.iir.com.au Cloud Computing Twenty Ten 24 March - 25 March Sydney, NSW P: +61 2 9080 4300 W: www.informa.com.au Meaningful use of standardized terminologies to support the EHR 29 March Auckland, NZ W: www.hinz.org.au

The Inaugural Australian Obesity Summit 29 March - 30 March Sydney, NSW P: +61 2 9080 4300 W: www.informa.com.au Operating Theatre Management Conference 30 March - 31 March Auckland, NZ P: +61 2 9080 4300 W: www.iir.com.au

APRIL eHealth National Co-ordination and Alignment 14 April - 15 April Sydney, NSW P: +61 1300 316 882 W: www.national-ehealth.com IHE Secure Messaging Connectathon 19 April – 23 April Canberra, ACT P: +61 418 487 081 W: www.ihe.net.au Pharmaceutical Benefit Scheme Forum 22 April - 23 April Sydney, NSW P: +61 2 9080 4300 W: www.informa.com.au The National Disability Summit 29 April - 30 April Melbourne, VIC P: +61 2 9080 4300 W: www.iir.com.au

MAY National Stroke Units Conference 6 May - 7 May Melbourne, VIC P: +61 2 9080 4300 W: www.iir.com.au Medical Fair Australia 11 May - 13 May Sydney, NSW P: +61 3 9699 4699 W: www.medicalfair-australia.com Australian 4G Summit 18 May - 19 May Sydney, NSW P: +61 2 9080 4300 W: www.informa.com.au

EVENTS CALENDAR General Practitioner Conference and Exhibition 21 May - 23 May Sydney, NSW P: +61 2 9211 7454 W: www.gpce.com.au Managing Ward Finances & Budgets 24 May - 25 May Brisbane, QLD P: +61 2 9080 4300 W: www.iir.com.au

JUNE 10th Anniversary Hospital in the Home Conference 21 June - 22 June Melbourne, VIC P: +61 2 9080 4300 W: www.iir.com.au Population Health Management 21 June - 23 June Brisbane, QLD P: +61 2 9229 1000 W: www.populationhealth.com.au

JULY

OCTOBER

ITAC’10 26 July - 27 July Melbourne, VIC P: +61 3 9388 0555 W: www.itac2010.com.au

GP’10 6 October - 9 October Cairns, QLD P: +61 3 8699 0414 W: www.gp10.com.au

AUGUST

HIMAA National Conference 27 October - 29 October Sydney, NSW P: +61 2 9887 5001 W: www.himaa.org.au

HIC’10 24 August - 26 August Melbourne, VIC P: +61 3 9388 0555 W: www.hisa.org.au/hic2010

SEPTEMBER Health-e-Nation 2010 9 September - 10 September Sydney, NSW P: +61 2 4365 7500 W: www.health-e-nation.com.au MedInfo 2010 12 September - 15 September Cape Town, South Africa W: www.medinfo2010.org

NOVEMBER HINZ Conference 2 November - 4 November Wellington, NZ W: www.hinz.org.nz General Practitioner Conference and Exhibition 12 November - 14 November Melbourne, VIC P: +61 2 9211 7454 W: www.gpce.com.au

10th Anniversary

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21– 22 June | Hilton on the Park Melbourne For the latest program updates & event news visit: www.iir.com.au/hith/it

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MSIA Bridget Kirkham CEO, Medical Software Industry Association (MSIA) ceo@msia.com.au

R&D tax changes will impact across health Australia’s pool of skills for creating and innovating in the health software sector, as well as the opportunities to develop applications that can exploit the potential of the National Broadband Network, are likely to be severely compromised by the proposed Research and Development (R&D) tax changes. The opportunity to improve health and create export opportunities by developing world leading applications seems to be lost as misguided changes to the R&D tax regime will make it extremely difficult for the Small and Medium Enterprises (SMEs) in our industry to continue to research and develop within Australia.

As one software vendor reported to the Medical Software Industry Association (MSIA): “I get at least 30 approaches from India and Indonesia to do this work for an hourly rate that makes it seem very attractive, but the cost of managing these outsourced projects makes it a line-ball call. However, the loss of the certainty around the R&D tax incentives means that I will need to seriously consider the outsourcing option”.

Such revelations point to the loss not only of jobs but also the experience and skill-sets that are developed during such projects.

Such R&D experience is lost forever to Australia if outsourced overseas.

The relevant legislation causing concern amongst the software industry is contained within the Exposure Draft [Tax laws Amendment (Research and Development) Bill 20101.

Whilst there is an increase in the rate of benefit under the new “tax credit regime” it appears that the level of genuine R&D that can satisfy the various new tests and definitions has been substantially reduced. This seems to fly in the face of the Government’s 2010 Intergenerational Report, where the relationship between R&D and innovation is clearly made: “Innovation is a key element to productivity growth. A major input into innovation is research and development, which increases the stock of knowledge in the economy….The Government is supporting innovation in critical areas, including innovations by business, collaboration between private and public sector researchers and investing in the research capacities of our universities and public research agencies”2.

Innovative software development is fundamental to the development of a robust and growing digital e-health rollout and the flow on impact of innovation for the rest of the health sector is well recognised.

Australia is already at the lower end of the OECD comparisons — it seems that there is a disconnect between government policy and intention, and the new tax regime. Not only does the increased compliance burden outweigh any benefits, but it is at variance with the OECD’s Frascati Manual3, which sets out the following widely accepted working definition of what constitutes R&D: “Research and experimental development comprise creative work undertaken on a systematic basis in order to increase the stock of knowledge, including knowledge of man, culture and society, and the use of this stock of knowledge to devise new applications”.

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What does it mean for the software vendors?

The proposed changes to the R&D tax incentives have several implications for software vendors operating in the e-health space: • Revised definition: The revised definition of R&D now requires compliant activities to exhibit both “novelty” and “high levels of technical risk”.

• Multiple sale test: This seems an anachronism — much software distribution and development models such as those associated with Cloud Computing, for example, have largely replaced the traditional sales and licensing system that allowed the reasonable use of the multiple sales test many years ago.

• Dominant purpose test: This is a further narrowing of the definition of R&D and there is considerable concern over the qualitative and uncertain nature of the concept of “dominance”. As SMEs often use scant resources to maximise returns, it may not be possible to set up R&D functions to which a dominant purpose may be ascribed.

The following types of research and development projects are unlikely to be able to take advantage of the new R&D tax regime if the proposed legislation is passed: • Internet based health services.

• Collaborative research with customers who provide funds to develop niche products or resolve problems — these are at the core of improving the quality of the services and enable SMEs to be more competitive (globally as well as locally) but may not have immediate pay back in terms of licensing or multiple sales. These improved services or or solutions do not necessarily have a discrete “price tag”.

• A services company supplying the services to manage and run business processes — fees are based on transaction volume and meeting defined service levels. The software vendor invests heavily in research and development of software and algorithm to provide end-to-end integration.

These capabilities will be used to provide services to additional clients.

• Research involving open source software such as the Linux Kernal, where the developments are not offered to the open market but are incorporated into the company’s hardware or middleware products to enable them to operate in the open source area.

If you feel that innovation is vitally important to the health sector generally, and the current proposals in the draft legislation send the wrong message to those innovators and developers that support your health care delivery, please contact your local member of parliament.

References 1 - http://bit.ly/7hYbXr 2 - http://bit.ly/9SKL30 3 - http://bit.ly/bYhQQB

NEHTA

e-Diagnostic Imaging: Improving information flow The National E-Health Transition Authority (NEHTA), through a series of consultative workshops with industry stakeholders, has determined the top priorities for their 2010 e-Diagnostic Imaging program of work.

NEHTA’s Strategic Plan, released in October last year, clarifies NEHTA’s role in e-health adoption and implementation.

The strategy was formed considering the Deloitte National E-Health Strategy and the National Health and Hospital Reform Commission recommendations. With the release of the strategy, there is a clear understanding of the directions NEHTA is taking to drive the take-up and adoption of e-health. One of NEHTA’s strategic initiatives is to “enable improved access to and use of diagnostic information”. NEHTA has commenced work on the following activities in line with this initiative: • Developing e-Diagnostic Imaging specifications using a collaborative approach and supporting material based on priority areas identified by professionals and industry stakeholders; and • Identifying and recommending implementation opportunities for e-Diagnostic Imaging.

Diagnostic Imaging (DI) services provided by both the public and private sectors are central to the Australian healthcare system, with the number of requests for DI services generated by GPs increasing by 17 per cent in the nine years to 2007/08.1 Australia is currently experiencing a fundamental shift in the way diagnostic images are produced and transmitted, as service providers transition from film to digital imaging, with only minimal standardisation or consultation between professions.

The drive for efficiencies within the DI sector has largely ignored processes outside of the production and transmission of the image, with virtually no electronic requesting occurring and considerable variability in the degree to which an image conforms to the international Digital Imaging and Communications in Medicine (DICOM) standard. As a result, it is often problematic for a “requester” (whose patients go to multiple service providers) to receive a variety of image formats (and viewing software).

Almost all requests for DI services remain paper-based.

When reporting the primary diagnosis, the ability for a radiologist to compare the current image(s) with previous images (“priors”) for the patient has a significant diagnostic impact. It has been identified that: • A review of priors may change or influence a diagnosis (in 18 per cent and 56 per cent of cases, respectively)2; • Knowledge of and access to priors is likely to increase the radiologist’s confidence in their primary diagnosis (89 per cent of cases)3; and • In many cases the existence of priors is not known to the radiologist, or they simply cannot access them for a number of reasons, including: àà legislation preventing images from being transferred between jurisdictions and/or state borders unless the patient is physically responsible for the transfer

àà

competitive issues which impact the transfer of images between private organisations àà technology issues, including bandwidth, hardware and software, which prevent a user from electronically accessing an image that is stored remotely àà a digital image has been provided in a format which the radiologist cannot access or is not of diagnostic quality àà the patient did not, or was otherwise unable to bring the film with them when the new images were taken.

There are considerable benefits for the health system in streamlining business processes by establishing standards for storing, archiving, presenting and accessing diagnostic images and reports. These are as follows: • The industry adoption of open standards for communications will simplify the complex myriad of processes through which electronic diagnostic imaging result information is received in the community; • Adoption of the connectivity model paves the way for communications associated with electronic discharge summaries, e-medication management, and referrals; • Improved patient experiences through the development of guidelines outlining detailed (patient–centric) information regarding a request to be provided to the patient by the requestor including: àà Reduction in number of instances in which a patient needs to re-present for imaging due to having not met pre-testing requirements àà Greater ability for the patient to make an informed decision regarding a diagnostic investigation, with information detailing possible out-of-pocket expenses provided prior to the test being performed àà Consistent availability to patient of appropriate preparation instructions for the requested DI procedure àà Consistent availability to patient of general information about the nature of the requested DI procedure, before the patient attends the DI practice.

• Improved patient safety through development of specifications for a requester to track the status of individual tests within a request as it moves through the Request-ImageReport process; and • The use of a unique identifier will increase confidence that images and reports can be matched to the correct person within clinical systems.

References 1 - http://www.aihw.gov.au/publications/gep/gpaa06-07/ gpaa06-07.pdf and http://www.aihw.gov.au/publications/gep/ gpaia07-08/gpaia07-08.pdf 2 - Data adapted from White et al., Invest Radiol 29 (1994) and Aideyan et al., Acad Radiol 2 (1994) 3 - Data adapted from White et al., Invest Radiol 29 (1994) and Aideyan et al., Acad Radiol 2 (1994)

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FEATURE Jonathan Klug CEO, Medinexus Pty Ltd jklug@medinexus.com.au

Digital Radiology – closing the loop between radiologists, referrers and patients The radiology industry has invested millions of dollars in equipment and software to transition itself from the old world of film‑based reporting to the digital world of onscreen reporting for all modalities. While this has improved the quality of diagnosis as well as their own productivity, most referrers and doctors involved in the treatment of the patients still don’t have a simple and efficient way of accessing images online. This article focuses on the issues that are holding back the implementation of such systems as well as the things that radiologists should look for when they look to close the digital gap between them and their referrers and patients.

What Is happening out there in terms of delivering images over the net?

While many radiology practices are sending electronic text reports without images, there are only a few vendors who are now offering access to reports and images directly from within the patient record of the referrer’s clinical system. This is the future of delivery systems as it provides for a more efficient process.

However, radiology facilities should be cautious to ensure that any investment they make in delivery systems delivers a solution that is going to benefit the three stakeholders in the delivery cycle: themselves, the referrer and the patient. The privacy and security of patient data is paramount at all times and any system must improve the efficiency of the entire process to ensure that healthcare continues to be affordable and efficient.

It is often assumed, incorrectly, that referrers don’t even look at the images. Where there is a normal finding — which is usual for the majority of studies — the referrer usually trusts the radiologist’s diagnosis and therefore doesn’t have the need to view the images whether they are film, CD or made available online. Where there is a negative finding, a diligent referrer will want to view the images, sometimes even discussing them with their patients. Like radiologists, most referrers prefer not to work with film as long as the alternative access to reports and images online is simple, quick and increases their productivity. CDs have proved to be problematic and are at best an interim solution until something more reliable is available.

Film and other hard copy formats are still very prevalent in Australia when compared to other developed healthcare systems, and with margins on services provided by radiologists shrinking because of the high capital outlays and running costs associated with modern practices, radiologists are looking at alternatives to film that are cheaper and more effective.

Referrers are the source of all business to private radiologists and they need to be given choice in how they wish to receive their reports and images.

There are referrers who may need film for surgical or other purposes and referrers such as Orthopaedic Surgeons who need

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access to complete CT and MRI studies for measurement and manipulation of the images using a DIACOM viewer. However, it could be argued that the majority of referring practitioners would prefer an online form of image and report delivery where only key images are sent, provided they are easy and efficient to access.

What is slowing the progress towards online delivery of reports and images Interestingly, while film is still prevalent in Australian radiology, the online delivery of diagnostic reports is more advanced in Australia than in the United States and United Kingdom. There are a number of secure messaging vendors who have been operating successfully for many years in delivering tens of thousands of reports each day, however few of them have embraced the more difficult task of delivering access to images as well.

What makes delivery of images more complex is that the vendors need to ensure that access to images happens quickly for referrers and in fact improves their productivity rather than reduces it. Referrers are always concerned that they will have to store images on their own system and they are understandably worried about the disk space these images will consume.

However, the messaging vendors providing image access generally store the images, while referrers simply view them over the web, eliminating this problem.

Messaging is not a simple process and requires specialised vendors who are independent of the radiology and clinical systems at the sending and receiving end of the transaction. Each messaging vendor needs to make sure their system works with all the leading clinical software solutions — lack of adherence to standards has made interoperability across disparate systems a more difficult process.

Whilst some clinical software developers have embraced the ability to display images alongside the reports or allow URL links to images to be embedded in the report itself, there are still vendors whose systems only allow PIT (Pathology Information Transfer) files to be imported. Others allow HL7 (Health Level 7) file import, but don’t allow the insertion of URL links in the report.

This has made it more difficult for the messaging vendors who do provide access to images to make them available from within the patient record.

Many radiologists say they have image delivery capability via web access to their PACS systems. Whilst they are correct, for the majority of referrers this access is slow and cumbersome but it does meet the need of those referrers such as the orthopods who require access to the full DICOM studies. For image delivery to work it needs to be delivered in the way that most referrers want it which means it needs to be directly accessible from within the patient record and needs to be quick and simple.

What makes a good image delivery system?

A good image delivery system should: • Be independent of the RIS, PACS and referrers’ patient management systems to ensure interoperability.

• Use international standards such as HL7 and DICOM and conform to the IHE framework where possible.

• Adhere to both State and Federal Government privacy principles.

• Be relevant and appropriate for the referrer’s needs.

• Actually be used by the majority of referrers and improve the delivery efficiency to the referrer.

• Deliver reports directly into the patient record of the referrer’s system as well as provide web access to reports and images for referrers who don’t have suitable systems or are away from their practice.

• Allow quick and simple online collaboration between medical practitioners by allowing referrers to forward reports and images to other practitioners, particularly where second opinions are required.

• Be secure with data transmitted across the public Internet encrypted with at least 128 bit Secure Socket Layer (SSL) encryption or PKI. • Have business grade firewalls protecting the servers that store the data to minimise the risk of hackers trying to access such data.

• Ensure electronic receipt acknowledgements are being managed for significant findings and for establishing an audit trail.

• Make use of lossless compression for image transmission so that no image quality is lost when viewed by the receiver.

• Have the ability to deliver key images only, or link to a DICOM viewer for those referrers that require additional functionality.

Patient access to their reports and images Wherever you turn in healthcare, the latest buzzwords are “e-health” and “patient centric care”, which implies patients having access to their own personal health information. Most state governments have initiated projects to centralise their own records of patients that have visited public hospitals. The ultimate objective of all these electronic health records systems is that patients have access to their own data so they can view it themselves and make it available to anyone they choose.

Both Google and Microsoft have invested substantial sums of money to develop online health portals in the hope that systems which create electronic diagnostic reports are eventually able to upload their content to such portals and make them available to the individuals. In addition, some overseas governments are making moves to provide such portals. Whilst the advent of the patient portal for all their health information is a long way away, giving patients access to data created by individual providers, such as radiologists, is becoming a reality.

Delivery systems where patient reports and images are stored centrally should be made accessible to patients in that they have a right to the information and should be able to use the information to pass to other practitioners.

There is evidence that studies are repeated purely because the patient or the treating doctor was not able to access reports and images which may have already been carried out and this should definitely be avoided.

2nd AnnuAl nAtionAl

telemedicine Summit Providing Quality Care and Positive Patient Outcomes From a Distance 24 & 25 mArch 2010 | Sydney hArbour mArriott, circulAr QuAy FeAturing reveAling & inFormAtive cASe StudieS From: National e-Health Transition Authority (NEHTA) • NSW Department of Health Royal District Nursing Service of SA Inc • University of New South Wales Sydney Western Area Health Service • Total Health • CSIRO St Vincent’s Hospital • Fremantle Hospital • Hunter Nursing Australian College of Rural and Remote Medicine • And Many More

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FEATURE Mathew Hudson Mathew Hudson is a director of RadLogix Pty Ltd and NetDoc Pty Ltd mathewhudson@me.com

A Teleradiology solution based on Open Source Software A teleradiology solution using Free Open Source Software (FOSS) — I can do it all for free right? Well, not really.

This article outlines lessons learned in establishing a teleradiology system for a radiology reporting firm based on FOSS. The lessons are not meant to discourage such an approach, but rather, point out a range of factors worth considering in order to make an informed decision about whether a FOSS approach is suitable for your radiology business.

So what is FOSS? Free Open Source Software “is a matter of the users’ freedom to run, copy, distribute, study, change and improve the software”1. In simple terms, the key to FOSS is that the source code is available to a user to freely examine, modify and use as they wish. To illustrate the meaning of “free”, you might have to buy a distribution of the FOSS software you want, but you get access to the source code to use within certain limits.

Need and Opportunity The reporting firm has five, geographically separated reporting sites accepting studies from clients around the country. A teleradiology system was required to do the following: • Accept an order to report a radiographic study.

• Receive and distribute study images and documentation.

• Create and return verified reports.

• Invoice and pay various entities.

Commercial solutions might certainly be found or adapted to meet the above needs. But those initially examined were expensive, as they did much more than needed, and required

significant customisation or development to be readied for use.

Time was also pressing and another opportunity presented itself enabled by a confluence of factors including: • The existence of some excellent FOSS applications.

• The availability of a director with a formal computer systems engineering background, experience in telecommunications operational and billing systems and a grounding in the software technologies used by the FOSS applications.

• Well documented standards such as DICOM and HL7, and the Integrating the Healthcare Enterprise (IHE) technical framework.

• Other directors with an intimate knowledge of the radiology domain.

The scene was therefore set to develop a system in-house to meet the need. An initial system was developed to test the feasibility before investing in further development. It is crucial to plan a “go/no-go” decision. Any project requires decision gateways, but in-house ones are prone to drifting unless firm bounds are set.

Solution Firstly, it is as important to apply good software and systems development discipline when using FOSS as it is for any development project. Whilst a FOSS application might be widely used and tested to the nth degree in practice by a large base of users, one still needs to test a system and its components to ensure it meets specific requirements.

Table 1 - Factors to consider when choosing between Free Open Source Software (FOSS) and Commercial Off The Shelf Software (COTS) solutions for implementation in a Teleradiology practice.

Factor

Free Open Source Software

Commercial Off The Shelf Software

Development

Enables high level of tailorability to meet specific needs.

In-house development effort likely to be needed.

Higher technical risk.

Minimal to no development effort required.

Solution available sooner.

Lower technical risk.

Support

Dedicated technical support effort is needed.

System knowledge likely to reside with one or two people, increasing commercial risk.

Technical support usually provided by the vendor or a third party at a price.

Long Term Support

Source code is persistent as it is open

Vulnerable if manufacturer folds or drops support unless software is held in escrow.

Training

Training material likely to be developed internally.

Vendor or a third party usually deliver initial and ongoing training at a price.

Regulation

Care needs to be taken to ensure an application is appropriately registered.

As for FOSS.

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Workflow was based on the Integrating the Healthcare Enterprise (IHE) “Reporting Workflow” profile. IHE provides a complete profile that is sufficiently adaptable for a specific context that calls on the DICOM and HL7 standards. Developing use cases from this profile greatly accelerated the development process.

The solution developed has integrated a mix of open sourced, commercial and customised components. And here is the first lesson: unless you have a very specific, very standard requirement, no single or combination of open source applications is likely to fulfill your need. Business systems generally need a level of customisation beyond the general case that most FOSS applications fulfill.

There are myriad FOSS applications for radiology, some good and some not so good. They cover most functions required for a teleradiology system, but the field of choice needs intensive research, just as selecting a commercial system does. The requirement in this case was for a Mac OS X desktop environment and a Linux server environment. The resulting solution comprised the following components: • dcm4chee DICOM clinical data manager system (Linux) • OsiriX DICOM viewer (Mac OS X) • Express Dictate dictation and transcription (Mac OS X) • MacSpeech Dictate voice recognition (Mac OS X) • A customised workflow management and billing application (both Linux and OS X)

Lessons Learned

form a complete, integrated solution. The author produced a new worklist server and middleware to meet the specific system requirements. This involved an estimated effort of around 600-800 hours, the bulk of which has been in the production of middleware to support the dictation of reports and billing. If radiologists typed or voice dictated their own reports and did not bill for their time, then the FOSS applications would have been enough!

Related to the above is the need to provide support and training for the system from within house. Open sourced applications often have extensive support sites and discussion forums to support users and developers. These are often only suitable for technical personnel or the advanced user with a technical bent. General users need someone to aggregate and reduce this information for them.

Regulation is another key issue, in this case with the viewing software. For example, anyone who wants to use OsiriX for primary diagnosis should be incorporating a commercial distribution of the FOSS application, not necessarily the version downloadable from the Internet.

In weighing up an open source solution against a commercial solution for a teleradiology service, the factors outlined in Table 1 should be considered.

So, should I adopt an open source solution for my telerad services company? The answer of course is it depends. The lessons above can guide your assessment of your options. A FOSS based solution has proven to be a successful approach for this firm, but may not be for all.

FOSS can form the core of a teleradiology system employed in References HealthLink/Medinexus Half1 Page 180 x 120 Puse IT Mag a private teleradiology services firm, but is unlikely to be able to - http://www.gnu.org/philosophy/free-sw.html

connecting healthcare

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FEATURE Peter Weston MPH, has 12 years experience in web based imaging and infrastructure software and is an independent medical software and IT consultant and non-executive director of Executive Data Systems Pty Ltd. pweston@execdata.com.au

Diversifying the digital radiology technology suite Are radiology services providing their own radiologists and their external referring doctors with appropriate medical imaging where, when and how they want them? The short answer is: ”No, not typically”.

Radiology groups, whether large or small, generally have one method for Internet delivery of medical images to their referrers, and usually only a single diagnostic platform (usually a Picture Archiving and Communication System (PACS)) for internal reporting. In both cases, multiple solutions are required to deliver all the benefits of modern digital radiology to the widest possible user group.

For the radiologist, a PACS for general reporting and image management is needed, as are advanced visualisation (AV) solutions for reporting on CT and MRI volumes as opposed to individual slices or simple “stack scrolling” of axial images.

Advanced visualisation technology is now so automated and fast that it dramatically aids in clinical diagnosis and surgery planning, where it is becoming the default interface for such studies. This technology is also needed to realise the potential provided by the high volume of slices being produced by today’s modern scanners.

Advanced visualisation technology is now available through web-based solutions, which means the data is accessed via a web browser, usually with the help of a browser plug-in. A 3D image view is displayed on the clinicians browser, but the complex graphical interpretation occurs on the server. Of course, advanced visualisation solutions also provide 2D views of the three planes (sagittal, coronal and axial) as many PACS do, however the 2D and 3D are “as one” allowing you to walk or measure a vessel in 2D and it will be traced in 3D, for example.

PACS typically use “streaming” of compressed individual images for delivery over low bandwidth connections. Some PACS pre‑cache the raw data for the radiologist to allow it to be locally accessed at a later stage. Most PACS now have web servers for remote and referrer access, though few are fully web-based.

One radiologist recently mentioned to the author that he has used a workstation-based advanced visualisation solution for the last five years and consequently uses far better clinical tools for multi‑slice studies than the standard PACS provides. Now of course he can benefit from web-based access to advanced visualisation technology (integrated with his radiology information system and/or PACS), meaning he doesn’t have to leave his “integrated desktop”, push a radiographer off their chair, or monopolise that freestanding legacy advanced visualisation workstation in the back room. And now, if desired, he can share access to this system with his specialist referrers.

When it comes to referrer delivery, Internet-based filmless

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delivery is still missing the mark. Referrers are not a homogenous group and naturally each subgroup has different requirements.

While GPs provide the bulk of imaging requests, their image viewing needs are not as demanding as many specialist referrers. GPs want seamless integration of image delivery with their clinical software, irrespective of their preferred web browser and operating system. And they don’t want additional software installed on their desktop due to increased IT support overheads.

Of course, both GPs and specialist referrers also need the report accompanying the images! So, the challenge for radiology groups and their software suppliers in the context of the GP market is platform independence coupled with GP desktop integration — no single provider to the author’s knowledge has achieved all of this yet, though some are getting close.

Specialist referrers on the other hand have the same basic requirements, but a far greater need for image access complemented by appropriate clinical and diagnostic tools.

There are some specialists that don’t require diagnostic quality images, however cardiologists, vascular and thoracic surgeons reviewing CT studies of the heart for example, love advanced visualisation from which they can automatically review or quickly create a stent plan. Oncologists could utilise web-based clinical tools for prior and current study review of, for example, lung lesion pathology characteristic interpretation and comparative volumetric measurement. And the list goes on.

None of this will be a revelation to radiology groups, so why have they not provided what the market desires? While technology change has been rapid, there are other limitations, cost being amongst them. Telecommunication costs, whilst significant, are now at least affordable, obviating this limitation.

Integration with other systems can be technically challenging and time consuming, and often underestimated by radiology groups who generally don’t provide enough resources to project manage such implementations. However in the author’s view, the simple answer is there isn’t enough awareness of the reality that several solutions are needed to meet the heterogeneous nature of referring clients. Mobile medical “tablet” computing technologies — or perhaps Apple’s iPad, given how Specialists seem to like that brand — will further increase the number of platforms referrers will inevitably utilise in their clinical practice.

Bring it on!

So, vendors you are on notice: deliver solutions that cover the myriad of viewing requirements from a single, web-based offering that includes the report. Oh, and make sure it can be accessed by any specialists that may later be involved in the patient’s care, including those specialists working in a public hospital!

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

The Apple iPad: Coming to a healthcare organisation near you?

Along with every IT journalist on the planet, the inevitable announcement of Apple’s iPad in late January did not go unnoticed by the author. Having received even more pre and post announcement hype than the iPhone a few years prior, even the most technologically uninterested reader will have no doubt stumbled across at least a mention of the device in the mainstream media.

While the iPad won’t go on sale until the end of March 2010, and has only been provided to a select number of developers since it was introduced at the start of the year, the amount of pre‑release discussion amongst clinicians and other participants in the healthcare sector has all but ensured the device will be reviewed for potential adoption by Health IT software developers and users of Health IT software alike.

WHAT IS IT? While Apple does not use the term explicitly, the iPad fits best into the “Tablet PC” category. As with tablet PCs made by Motion Computing and other companies thereafter, Apple has not included a physical keyboard on this device. However unlike the vast majority of tablet PCs currently on the market, the iPad does not ship with a stylus pen and instead relies on a finger sensitive “multi-touch” screen to receive the user’s input.

In what represents an even greater departure from the status quo, Apple has shipped the device with a derivative of its iPhone operating system as opposed to its more feature laden MacOS X computer operating system. While this will make it more difficult for developers of Microsoft Windows and even MacOS X products to bring their applications to the iPad, it does provide iPad users with instant access to over 140,000 iPhone applications, over a thousand of which are designed for clinicians (albeit US-based clinicians in many cases). As with the iPhone, users launch applications on the iPad by simply tapping on a prominent “app” icon using their finger. Once launched, the user can interact with an application by tapping on buttons or into fields, typing using an on-screen keyboard, rotating the device, or by using the device’s microphone in some instances.

By announcing the iPad prior to launch and releasing a software development kit for the device, Apple has given its existing iPhone developer community a few months to prepare their existing applications to take advantage of the iPad’s larger screen real estate and faster processor.

WHAT IT HAS The iPad weighs in at 700 grams with a height and width around an inch slimmer than the page you are now reading. The iPad is 13.4mm deep at the thickest part of its curved back, which

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encloses the devices circuitry and non-removable battery. The screen has a resolution of 1024x768 pixels and a diagonal size of 9.7 inches. A 20mm black bevel surrounds the screen’s viewable area, allowing fingers to grip the side of the device without interfering with the touch screen sensors.

Like the iPhone, the device has a large “home” button below the screen, with volume controls and a button to put the device into sleep mode positioned on its top right hand edge. A dock connector port is included at the bottom of the iPad underneath the home button, with this port used for charging the device’s battery, synchronising data with a computer, or connecting the device to other peripherals such as keyboards, speakers, external monitors, cameras, and memory card readers.

The device features Bluetooth technology, which will allow the iPad to interface with other devices wirelessly. Wireless networking is also included with all popular iterations of the 802.11 standard included, namely A,B,G and N. At the time of writing, Apple hasn’t released its pricing information for Australia, however a rudimentary conversion from the pricing announced in the US and adjusted for Apple’s usual international markup will see the entry level 16GB configuration of the device debut at around $599. Models sporting 32GB and 64GB of storage capacity are likely to retail for a little over $100 and $200 more than the base model respectively.

The optional cellular network functionality, which allows the user to access the Internet where ever they can get mobile phone reception, will add around $150 to the cost of the iPad. As with other mobile broadband devices, ongoing data charges will apply, however aggressive competition between Australian telecommunication companies seeking to attract a potentially large cohort of new customers will ensure these prices are relatively attractive.

As with the iPhone, customers who elect to join a network other than Telstra’s Next G network may not always be able to access mobile broadband at 3G speeds, particularly outside of major metropolitan areas. This is because the 3G mobile broadband components built into the iPad do not operate at 900MHz, a frequency favoured by Optus and Vodafone in regional areas. Data access will still be available in these areas via these networks, albeit at reduced speeds when compared with the throughput provided by Telstra.

WHAT IT DOESN’T HAVE Much has been made about what has been omitted from the iPad, typically by commentators making comparisons with tablet PCs costing several times as much as what Apple is asking for the iPad. Nevertheless, some of the omissions are worth noting as

they will serve to limit the utility of the device in some healthcare scenarios.

Firstly, the iPad does not include any standard USB ports, though a USB adapter can be added to the dock port. While this adapter is being marketed by Apple as a means for people to synchronise their photos directly from their camera to the device without first having to transfer them to a computer, it is unclear what other roles this or other similar adapters may play in the iPad’s future.

Secondly, the iPad lacks a user-facing video camera for video conferencing, and in fact has no camera whatsoever.

The lack of a camera represents a departure from how Apple has configured its laptops, iPhones and even its diminutive iPod Nano devices, with cameras having been a standard feature on such technology for many years. That said, the prospect of taking a photo with a magazine-sized device or attempting to video conference using a piece of hardware that would usually be operated from an orientation that faces directly up the users nose does not sound as exciting to the author as some must envisage the process would have otherwise been.

Thirdly, the iPad was developed primarily for use by consumers and not for specific fields such as healthcare. As such, the device lacks many of the specialised pieces of hardware included in devices adhering to Intel’s “Mobile Clinical Assistant” (MCA) reference design. These include RFID and barcode readers, multiple hot-swappable batteries, a handle for easy portability, and an outer shell designed to withstand both regular disinfection and occasional rough treatment. Only costing around 15 per cent of the price of a typical MCA however, the iPad’s price‑point may be enough to overcome these specialised technical limitations, particularly for organisations looking to perform large‑scale rollouts of tablet PC technology.

Finally, and perhaps the most debilitating omission, is the lack of multitasking support for applications not developed by Apple. That is, while you will be able to, for example, receive email and listen to music at the same time as browsing the web, users will be unable to run multiple clinical applications on the device simultaneously. While the author expects this limitation — inherited from the iPhone — will be overcome in a future software update, it is worth noting that if the device is used simply as a Terminal Services or Citrix client, then all the multitasking functionality inherent in the server-side operating system will be instantly available to the user. Indeed, it is in this configuration that the author expects the device will be most attractive to healthcare organisations looking to untether their clinical and nursing workforce from desktops, laptops, computers on wheels (COWS), and of course paper-based record systems.

CONCLUSION The iPad is unlikely to replace any category of computer currently deployed in a medical practice or larger healthcare facility, but it does have the potential to act as an adjunct to existing IT infrastructure in many scenarios. Ward rounds and home visits would appear to be obvious tasks that can be aided by the presence of a mobile device that provides access to patients’ electronic health records for the purposes of both review and real time updating. The form factor of the device and its positioning in the consumer market as a viable eBook reader also opens up the potential for clinicians to collect and subscribe to a myriad of clinical resources and have these presented in a fashion that makes accessing them efficient.

The iPad also has potential patient‑facing uses, with tasks such as the completion of patient enrolment forms, patient surveys, and the provision of educational material to aid in the obtaining of informed consent all possibilities.

Ultimately however, it is impossible to predict all the work flows that devices such as the iPad will facilitate. As one GP told me: “I don’t yet know what I’ll use it for, but I definitely want one!”

Left - The Apple iPad shown in portrait mode, displaying a selection of the included applications (“apps”) installed on the device. Below - The device orientated in landscape mode with its Safari web browser displaying the New York Times website.

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National E-Health Transition Authority www.nehta.gov.au

Model Healthcare Community:

"Enabling a better health system for all Australians."

The Hon Nicola Roxon MP, Minister for Health and Ageing, and Dr Mukesh Haikerwal are shown the Model Healthcare Community

by NEHTA staff.

The National E-Health Transition Authority (NEHTA) in association with Medicare Australia and with the support of the governments of Australia have launched the Model Healthcare Community.

The Model Healthcare Community is an opportunity to see what has been developed for the future HI Service. The development of the infrastructure that will deliver the HI Service has been the result of a partnership effort between NEHTA and Medicare Australia.

HI Service facts:

• A key foundation for a national approach to e-health is a standard process across the health sector to accurately identify everybody involved in a healthcare event.

• This includes the person receiving healthcare, the person providing healthcare, and the place where the care is given.

• In mid 2010, the HI Service will come into operation with three unique types of healthcare identifiers*: 1. Individual Healthcare Identifiers (IHIs) will be given to all Australians enrolled in the Medicare Australia or Department of Veterans’ Affairs programs 2. Healthcare Provider Identifiers – Individual (HPI-Is) will be assigned to healthcare providers through a staged approach 3. Healthcare Provider Identifiers – Organisation (HPI-Os) will be assigned to organisations where healthcare is provided. * Legislation is being developed to establish the HI service and will set out governance arrangements, privacy and permitted uses of healthcare identifiers.

“Healthcare providers will be able to work far more efficiently with e-health due to greater access to information, compared to paper records. The natural flow-on effect of this will be a safer and higher quality system for patients.”

Dr Christopher Pearce General Practitioner, Melbourne

Through demonstration and simulation, the Model Healthcare Community shows how the HI Service will be used to make a difference for the health of all Australians in the future.

Visitors walking through the Model Healthcare Community, can see the Service in action.

Reception Reception General Practice Reception General Practice Reception Hospital General Practice Hospital General Practice Reception Pharmacy Reception Hospital Pharmacy Hospital General Practice Other Healthcare General Practice Providers Pharmacy Other Healthcare Pharmacy Providers Hospital Hospital Participation Other Healthcare Providers Participation Other Healthcare Pharmacy Pharmacy Providers Participation Other Participation Other Healthcare Healthcare Providers Providers Participation Participation

The benefits of crossing the e-health frontier will only be realised once healthcare providers—whether individuals or organisations—begin to associate the Individual Healthcare Identifier (IHI) with their current and new patients. Healthcare administrators, practice managers and receptionist staff, as potential authorised users of the HI Service, have an important role to play.

Across the national e-health frontier GPs will encounter: • more timely and accurate exchange of clinical information • decision-support tools to support more effective strategies in patient care • time and cost savings associated with streamlining of current paper-based processes.

An ageing population, technological change and increasing community expectations are placing unprecedented demands on hospital resources, especially in the public sector.

E-health is the key to effectively managing the cost of hospital care while at the same time improving treatment outcomes.

Building e-health infrastructure on the foundation of healthcare identifiers will enable a three point improvement in medication management: • better choices arising from the prescriber’s knowledge of a patient’s current and previous medications • greater accuracy and efficiency in dispensing • better tools to help patients and their carers follow prescriber’s instructions.

E-health solutions for e-prescriptions, e-referrals, electronic test ordering and discharge summaries will enable improved communication between healthcare providers.

Subject to legislation, all individuals who are enrolled in the Medicare program or with the Department of Veterans’ Affairs will automatically be assigned an IHI. Individuals will be able to access their own information held by the HI Service. Subject to legislation, healthcare identifiers will be allocated to providers through a staged rollout commencing in mid 2010.

An individual healthcare provider can choose whether to participate. To be eligible the provider must provide a ‘health service’ as defined under the Privacy Act 1988 (Cth).

The information held by the HI Service 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.

National E-Health Transition Authority www.nehta.gov.au

Healthcare identifiers:

HI Service facts

• will allow healthcare information to be shared among authorised providers—but no-one else • will link healthcare information to an individual, no matter how many providers they see or how many times they change address • will reduce the risk of: - information being sent to the wrong healthcare provider or assigned to the wrong patient - medication errors - incorrect surgical interventions - diagnostic testing errors • will allow for the development of secure, person-controlled individual electronic health records.

Implementation National e-health solutions need to operate effectively across public and private sectors.

NEHTA will help ensure that local e-health initiatives are co-ordinated and aligned with national initiatives.

The e-health vision:

Through NEHTA, the Federal State and Territory governments are now looking at ways to use the world’s best technology, to create a health system that is secure, effective and accessible anywhere in Australia.

Collaborating with vendors “Vendors will play a vital role in the implementation of the HI Service.”

Vendors will provide the interface between the HI Service on the one hand and practice managers and clinicians on the other.

Implementation of the HI Service will be phased.

The process will be the same for all vendors and for all stages of the rollout.

The role of vendors

Meeting vendor needs

Vendors will play a key role in the implementation of national e-health initiatives.

NEHTA is committed to addressing vendor needs at each stage of the vendor journey:

The process will be the same for all vendors and for all stages of the rollout.

• probity

- no vendor will be given favoured consideration

• clarity

- vendor briefings will be aligned with HI Service releases

• flexibility - product development can be staged to match each jurisdiction’s e-health timetable.

The Model Healthcare Community will be in place to enable key stakeholders and the public to see what Australians will experience when the service is implemented.

For further information on NEHTAs work go to: www.nehta.gov.au

CARBONELLE CONSULTING

AAPM

P: 1800 196 000 or +61 3 8414 8225 F: +61 3 9685 7599 E: national@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.

Best Practice

Adelaide ESQUARE

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

P: +61 2 9889 1311 F: +61 2 9889 1411 E: info@carbonelle.com.au W: www.carbonelle.com.au

P: +61 7 4155 8800 F: +61 7 4153 2093 E: sales@bpsoftware.com.au W: www.bpsoftware.com.au

Carbonelle support over 600 clients Australia wide. We have 21 years of experience in Medical IT and run a dedicated Help desk.

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)

Supported Software: Medilink • Medilink Clinical • ReferralNet • Secure Messaging • Redmap Paperless and Scanning • Voice Transcription Services • Patient SMS Reminders • Medical Director • Best Practice • Secure Online Backup • Zedmed • Genie MHagic • Microsoft Terminal Services Experts Hardware and Services Division: Medical Software Installations • Hardware Maintenance Contracts • Software Support Contracts • Onsite Support and Training • Offsite backup Solutions • MD Data Conversions (MD2 to MD3) • Paperless Installations and Configurations Your Medical IT 1 Stop Shop

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

Advantech’s medical computing platforms are designed to enhance the quality and efficiency of healthcare for patients and users alike. All products match the performance of commercial PCs and tough medical safety ratings like UL606011 and EN60601-1; adding to this they are all IPX1 certified dust resistant and come with water drip-proof enclosures. Advantech offers long term support and a proven track record of reliability.

The medical range extends through: • Point-of-Care Terminals.

• Mini-PC and Medical Imaging Displays.

• Mobile Medical Tablets.

• Patient Infotainment Terminals.

Advantech is also an official distributor of Microsoft Windows Embedded software across Australia & New Zealand.

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ArgusConnect

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.

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% of all Divisions of General Practice across Australia through the ARGUS AFFINITY DIVISIONS program.

Brisbane, QLD SOFTWARE7

P: +61 412 626 769 F: +61 7 3378 4163 E: enquiries@software7.com.au W: www.software7.com.au Business Information Technology Solutions Provider. Some of our services are: • Authorised Medilink Dealer for sales and support in Brisbane.

• Deploy, manage, procure and support computer hardware, software and networking solutions.

• Web site design, development and hosting services.

• Email solutions.

Our team is friendly, professional and highly responsive with a strong customer focus.

Cerner Corporation Pty Limited P: +61 2 9900 4800 F: +61 2 9900 4990 E: AsiaPacific@cerner.com W: www.cerner.com.au

Cerner is a leading supplier of healthcare information systems and our Millennium suite of solutions has been successfully installed in over 1200 sites across the globe. Cerner’s technology has been designed so that it can be adapted to meet the needs of the very different healthcare delivery systems that exist, with a universal framework which allows clinician workflow to seamlessly span role and venue.

Our innovative leadership is allowing us to push boundaries by: • Leveraging clinical and pharmaceutical data for new discoveries in Condition Management and Personalised Medicine • Connecting the community with personal and community health records • Seamlessly connecting the patient record across the continuum of care

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 over 5,000 customers and a catalogue of over 15,000 products.

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.

In 2009 CH2 won the ASCLA Information Management award.

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 multidiciplinary 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

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

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. Genie runs on both Windows and Mac OS X, or a combination of both. With over 1600 sites, it is now the number one choice of Australian specialists.

GPA 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

DIRECT CONTROL

P: 1300 557 550 F: +61 7 5478 5520 E: support@directcontrol.com.au W: www.directcontrol.com.au Listening to what people want has resulted in the birth of a fully integrated business solution for Practitioners. The aim was to develop an affordable, intuitive, easy to use, educational business solution for Practitioners of all Disciplines that eliminates the need for double entry of data. This has been achieved with seamless integration with Outlook and MYOB.

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

Direct CONTROL facilitates medical billing Australia wide and overseas. Included is all Medicare, DVA, WorkCover, Private Health Insurance and other billing with the latest rules and fees relevant to each medical discipline (general practice, surgeons, physicians, allied health, anaesthetists, pathologists, radiologists and day surgeries/hospitals). Ideal for both the single practitioner and the multi-disciplinary Practice.

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

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Is healthcare your business?

HIC 2010 is “informing the business of healthcare”. In a federal election year, with health reform key on the agenda, securing your place at HIC 2010 will ensure your connection to the growing community of organisations and individuals who are committed to, and passionate about, health reform enabled by e-health.

2010

24 – 26 August 2010

Melbourne Convention & Exhibition Centre To register and nd out more

www.hisa.org.au/hic2010

HEALTHLINK Health Communication Network - HCN P: +61 2 9906 6633 F: +61 2 9906 8910 E: hcn@hcn.com.au W: www.hcn.com.au

Health Communication Network (HCN) is the leading provider of clinical and practice management software for Australian GPs and Specialists and supplies Australia¹s 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

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% 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)

HEALTHENGINE

P: +61 419 091 170 F: +61 8 9467 6150 E: info@HealthEngine.com.au W: www.HealthEngine.com.au HealthEngine.com.au is a comprehensive online directory of GP’s and Specialists, offering free doctor and practice listings to any Medical Practitioner registered in Australia.

Find a Doctor: Doctors can be searched Australia-wide by name, specialty, gender, and geographic location.

P: 1800 125 036 F: +61 7 3870 7768 E: enquiries@healthlink.net W: www.healthlink.net Australia’s largest effective secure communication network.

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

Find a Service: GP and specialist medical practices, public and private hospitals, day surgeries and medical test centres across Australia.

Find Information: seeks to demystify the maze of specialty qualifications, subspecialty interests, medical tests and procedures.

We do not sell search position, and Sponsored Links are clearly labeled as such.

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.

Houston Medical

P: 1800 420 066 or +61 2 9669 1844 F: +61 2 9669 1791 E: houston@houstonmedical.net W: www.houstonmedical.net

HIMAA

Doctors or Practice Managers may enhance their doctor or service listing by purchasing a Custom Profile:

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

• Display your photo or business logo • Showcase your areas of interest with specific, detailed information • Custom web address (URL): HealthEngine.com.au/dr/ YourName • Enhance your web presence: effectively a micro-website on HealthEngine.com.au benefitting from our pagerank and Search Engine Optimisation.

Link to your own website, and increase traffic to your profile by sharing informative healthrelated articles.

The Health Information Management Association of Australia (HIMAA) is the peak professional body of Health Information Managers in Australia.

HealthEngine.com.au - Getting the Right Patient to the Right Doctor

HISA

HIMAA aims to support and promote the profession of health information management.

HIMAA also conducts, by distance education, "industry standard" training courses in Medical Terminology and ICD-10-AM, ACHI & ACS clinical coding.

Houston Medical, formed 1988, leading supplier of software for Ophthalmology and Retinal Diabetic screening, installed in hospitals and practices of all types throughout New Zealand, Australia, Fiji, Dubai and Hong Kong.

After a complete re-write, Houston VIP.NET using Security Groups with User Defined Forms, allows different specialities their own desktop and workspace on a common database. Billing, appointments TXT and RSD messaging, word processing, prescribing, operating lists all integrated but separate.

Whether for day surgery, ophthalmology, cardiology, dermatology, urology, general practice, allied health, or any combination in a mixed practice, in once, out in a 1000 different ways, a truly unique concept for 2010!

For further information, please contact Mike: +61 419 091 170

Built using Open Source tools with source code available.

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

Demonstrations available under NDA due to late 2010 release.

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ISN SOLUTIONS PTY LTD P: 1300 300 471 F: +61 2 9280 2665 E: info@isnsolutions.com.au W: www.isnsolutions.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

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

JAM SOFTWARE

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.

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.

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

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

iSOFT INTERSYSTEMS

P: +61 2 9380 7111 F: +61 2 9380 7121 E: anz.query@InterSystems.com W: www.InterSystems.com InterSystems provides innovative software products that enable you to create, deploy, run, and connect healthcare applications faster. InterSystems Ensemble®, our rapid integration platform, can cut IT project times in half for enterprises that need to connect applications, processes, and people. Our health information exchange platform, InterSystems HealthShare™, enables the creation of electronic health records that share clinical data across multiple organisations on a regional or national level.

InterSystems TrakCare™ is a connected healthcare information system that is Web-based and rapidly delivers the benefits of an Electronic Patient Record.

Ensemble, HealthShare, and TrakCare all leverage the lightning speed, massive scalability, robust reliability, and rapid development capabilities of InterSystems Caché®, the world’s fastest object database.

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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 IT/ IM Consultants 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 (from clinical software updates to a faulty mouse) • New practice installation.

• 24/7 support - response in most cases is immediate. Most scheduled work is completed after the practice is closed.

• Server maintenance on a monthly basis which includes full monthly reporting.

• Satisfying IT accreditation standards.

• Data conversions • Disaster recovery and business continuity plans – monthly data restores • Initial consultations are complementary until a detailed road map is established.

• References available on request.

Medical-Objects

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.

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.

NEHTA

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

MEDILINK

P: 1800 623 633 F: +61 7 3392 1108 E: support@medilink.com.au W: www.medilink.com.au Integrated best of breed solutions: • • • • • • • • • • •

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.

Melbourne & VIC PRACTICE SERVICES P/L

P: +61 3 9819 0700 F: +61 3 9819 0705 E: Sales@practiceservices.com.au W: 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

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.

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 CARBONELLE CONSULTING

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.

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).

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 organisations current and future needs.

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SR Logo_65x42mm.pdf

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

C

M

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CM

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

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

CAT delivers enhanced data quality and patient outcomes in general practice.

14:50:20

SPELLEX

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

20/02/09

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 easyto-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 eNewletter service, Twitter and RSS feeds, an online events calendar, and an interactive website.

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THE SPECIALIST

P: 1800 803 118 E: info@healthsolve.com.au W: www.clintelsystems.com “The Specialist” is an intuitive and truly sophisticated tool that allows management of patients within: • specialist medical practices • private hospitals • day surgeries.

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

Current installations range from single stand-alone computers to networks connected to either Macintosh™ or Windows™ file servers.

The Specialist is industry standard, and readily interoperable with other systems.

STAT HEALTH SYSTEMS

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.

Stat Health Systems have formed partnerships with Ocean Informatics and First DataBank who will supply tools for clinical database management and the drug database respectively.

Fully scalable and the only medical software application to incorporate a multi-functional intuitive interface, Stat is at the forefront of computing technology.

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).

Syber sCRIBE

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.

From a single Specialist to a multisite GP Practice, we are renowned for our superior customer service and products that provide stability, security and ease of use. We also provide comprehensive data conversions from most software packages on the market today.

Zedmed is proud to be one of the longest serving Australian medical software solution providers, with clients nationwide.

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