Pulse+IT Magazine - May 2008

PULSE IT ®

AUSTRALIA’S FIRST AND ONLY HEALTH IT MAGAZINE

ELECTRONIC PRESCRIBING

ISSUE 8: MAY 2008

F) F B M U I

DAY 1 – 14 May 2008 TECHNICAL EDUCATIONAL SEMINAR 8.00 8.45

Registration and Coffee Welcome address From Enterprise Architecture to Connectivity in e-health (IBM)

SNOMED CT – The basics (NEHTA)

PKI for beginners (AGIMO)

Introduction Morning Tea Enterprise Architecture in detail Lunch and Networking Enterprise Architecture & NEHTA Showcases Afternoon Tea

Introduction

Introduction

SNOMED CT in detail

PKI in detail

SNOMED CT & NEHTA Showcases

PKI & NEHTA Showcases

3.30

Discussion re Implementation issues

Discussion re Implementation issues

Discussion re Implementation issues

4.30

Wrap up and Close

9.00 11.00 11.30 12.30 1.30 2.00 3.00

DAY 2 – 15 May 2008 CONSULTATION SESSIONS 8.00

9.00 11.00 11.30 12.30 1.30 3.00 3.30 4.30

Registration and Coffee Unique Healthcare Identification

National Authentication Ser vice for Health

Pathology Package

Introduction Morning Tea UHI in detail Lunch and Networking Workshop Afternoon Tea Open discussion Wrap up and Close

Introduction

Introduction

NASH in detail

Pathology package in detail

Workshop

Workshop

Open discussion

Open discussion

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Publisher Pulse Magazine PO Box 7194 Yarralumla ACT 2600

PAGES 10 & 17 ELECTRONIC PRESCRIBING This edition of Pulse+IT contains coverage of two significant e-prescribing initiatives.

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

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

About Pulse+IT Pulse+IT is Australia’s first and only Health IT magazine. With a national distribution exceeding 40,000 copies, Pulse+IT is also Australia’s highest circulating health publication. 32,000 copies of Pulse+IT are distributed to GPs, specialists, practice managers and the IT professionals that support them. In addition, over 8,100 copies of Pulse+IT are distributed to key IT decision makers in hospitals, day surgeries and aged care facilities.

ISSN: 1835-1522 Contributors Elizabeth Hanley, Gary Holzer, Simon James, Jane London, Dr Peter MacIsaac, Dr Paul Mara, Brent Maxwell, Xavier Toby, Greg Twyford Non-Commercial Supporting Organisations Australian General Practice Network (AGPN), National E-Health Transition Authority (NEHTA), The Royal Australian College of General Practitioners (RACGP), Standards Australia.

Disclaimer The views contained herein are not necessarily the views of Pulse Magazine or its staff. The content of any advertising or promotional material contained herein is not endorsed by the publisher. While care has been taken in the preparation of this magazine, the publisher cannot be held responsible for the accuracy of the information herein, or any consequences arising from it. Pulse Magazine has no affiliation with any organisation, including, but not limited to Health Services Australia, Sony, CMP Medica or the Kimberley Aboriginal Medical Services Council, all who produce publications under the title “Pulse”.

Copyright 2008 Pulse Magazine No part of this publication may be reproduced, stored electronically or transmitted in any form by any means without the prior written permission of the Publisher.

Subscription Rates Please visit our website for more information about subscribing to Pulse+IT.

PAGE 30 MOBILE BROADBAND Simon James discusses the clinical applications of modern mobile wireless broadband technology.

PAGE 34 MOBILE COMPUTING Simon James outlines the myriad of mobile computing alternatives available to clinicians.

EMAIL ETIQUETTE PAGE 38

SCANNING PAGE 40

VPN REMOTE ACCESS PAGE 42

WINDOWS VISTA PAGE 44

REGULARS PAGE 06 STARTUP Editor Simon James introduces the eighth edition of Pulse+IT.

PAGE 21 PULSE+IT SUBSCRIBER OFFER There has been no better time to subscribe to Pulse+IT, find out why.

PAGE 25 STANDARDS AUSTRALIA Elizabeth Hanley overviews IT-014’s eHealth work program.

PAGE 08 GUEST EDITORIAL Dr Peter MacIsaac discusses Health IT planning and the potential role of IHE methodology in the process of implementation.

PAGE 22 AGPN Gary Holzer outlines the SADI’s Health Provider Registry initiative.

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

PAGE 10 BITS & BYTES Pulse+IT’s news section, delivering the latest eHealth developments from Australia and abroad.

PAGE 23 NEHTA Xavier Toby reports on NETHA’s involvement with the Open Health Tools community.

PAGE 28 INTERVIEW: TOTALCARE Pulse+IT checks in with Totalcare’s Managing Director, Mr Nat Wong.

PAGE 24 RACGP Jane London discusses eRedbook, a joint initiative between the RACGP and Pen Computer Systems.

PAGE 46 MARKET PLACE Australia’s most innovative and influential eHealth organisations.

PAGE 30 MOBILE BROADBAND Simon James discusses the clinical applications of modern mobile wireless broadband technology.

PAGE 38 EMAIL ETIQUETTE Dr Paul Mara offers some tips to ensure a harmonious email experience.

PAGE 42 VPN REMOTE ACCESS Greg Twyford outlines his experiences with hardware VPN remote access solutions.

PAGE 34 MOBILE COMPUTING Simon James outlines the myriad of mobile computing alternatives available to clinicians.

PAGE 40 SCANNING WORKFLOWS Simon James discusses scanning workflows for GP and Specialist practices.

PAGE 44 WINDOWS VISTA Brent Maxwell takes a look a Microsoft’s not so new operating system, Windows Vista.

FEATURES

www.pulsemagazine.com.au

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

Pulse+IT: 2008.2 Welcome to the eighth edition of Pulse+IT, Australia’s first and only Health IT magazine.

The last few months have heralded what are likely to be pivotal developments in Australia’s eHealth landscape.

Electronic prescribing (e-prescribing), having languished in the collective thought bubble of the Health IT industry for many years, is now very much on the agenda.

In what may best be described as a pre-emptive e-prescribing strike, a powerful consortium of prescribing and dispensing vendors have announced their intention to launch a national e-prescribing service under the moniker, “ScriptX”. It is proposed that prescribers will be able to upload an electronic copy of their scripts to a centralised prescription “hub”, allowing pharmacists to download these scripts into their dispensing software when the patient presents to collect their medication.

Whether the consortium’s ambitious and somewhat controversial strategy will evolve from press release to implementation remains to be seen, however what is clear is that the development of the system will be watched closely by the pharmacy profession and Health IT pundits alike.

The ScriptX announcement came just weeks before the launch of a live e-prescribing pilot in the Northern Territory. By the time you read this, the system will have been in operation for over a month, with electronic scripts flowing between a general practice and two participating pharmacies.

THIS EDITION In addition to coverage about both of the aforementioned e-prescribing initiatives, this edition’s Bits&Bytes section contains a diverse mix of articles covering several recent Health IT developments from around Australia and New Zealand.

Dr Peter MacIsaac has contributed a guest editorial canvassing his ideas about the need for not only Health IT planning, but more importantly — action! Organisational contributions by NEHTA, Standards Australia, the Australian General Practice Network, and the Royal Australian College of General Practitioners are also included.

Pulse+IT interviews Nat Wong from Totalcare, and Dr Paul Mara contributes his thoughts on email etiquette. Two related

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AMA SUPPORT Under a one-off trial arrangement, this edition of Pulse+IT has been produced and distributed with the support of the Australian Medical Association (AMA). It is intended that all AMA members will receive a copy of the magazine you are now reading, bringing the total circulation of this edition of Pulse+IT to a massive 40,000 printed copies.

Whether or not this circulation arrangement continues on an ongoing basis will be largely dependent on whether this trial partnership initiative is well received by the AMA membership.

With this in mind, if you are an AMA member and would like to continue receiving complimentary copies of Pulse+IT for either yourself or your practice staff, I would encourage you to take a few moments to make this interest known to the AMA. Such feedback can be provided using the form in the accompanying edition of Australian Medicine, or by sending a brief note via email to memberservices@ama.com.au.

LOOKING FORWARD In addition to a significantly expanded Bits&Bytes section, the next edition of Pulse+IT will contain feature articles encompassing secure messaging for specialists, physical IT security, open source software, VoIP for the home, desktop Virtualisation technology, multiple monitors and work space ergonomics, Personal Health Records (PHR), hospital communication systems, and modern appointment systems.

More information about these proposed articles is available on our website under the “About” section — as always, your feedback and suggestions are most welcome.

Simon James, Editor simon.james@pulsemagazine.com.au

Subscription packages to Pulse+IT start at just $99.

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articles on mobile wireless broadband and mobile computing options are also included in this edition, as is a brief discussion about scanning workflows.

Greg Twyford outlines his experiences with VPN and remote access technology, while Brent Maxwell rounds out this edition with a discussion about Microsoft’s not so new but still controversial operating system, Windows Vista.

For more information about Pulse+IT and our special iPod subscription offer, turn to page 21.

www.pulsemagazine.com.au

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GUEST EDITORIAL Dr Peter MacIsaac FRACGP, MPH, is coordinator of the IHE initiative in Australia, and an experienced health practitioner and clinical informatician.

Dr MacIsaac is an independent e-health consultant and is soon to join the EDS team in developing a statewide e-health architecture for Queensland Health. peter@macisaacinformatics.org

E-health: turning plans into action?

“The method of the enterprising is to plan with audacity and execute with vigour” Christian Nevell Bovee (1820-1904) Electronic communications and data management systems are widely adopted in almost all sectors of business and society — except healthcare. While most baby boomers are happy to relate to friends and live in the “real world” with mobile phones, the Internet and email, Gen X and Y are hooking up in ways that we can barely imagine. The real world of healthcare still involves paper records, heavy reliance on verbal communication, memory, and information which is locked away and unable to be used for improving patient care or health system management. E-health is meant to make a difference, yet is somewhat stuck at the starting gates.

Despite the cries that we need a national e-health plan, in reality we have been drowning in plans, reviews and consultancies. Previous plans suffered from the following problems: • A tendency to be narrowly focused within one of the many health silos; • Planning can become an alternative to implementation; • Plans should spread from goals to execution. Often an interlocking series of plans is required, not just one plan or strategy; • High turnover of staff in the Government sector impacts on corporate memory; • E-health is infrastructure and difficult to justify when the waiting lists of sick to be treated are long and there is a track record of failure to deliver in Health IT projects.

In April 2008, Deloitte Touche Tohmatsu were engaged on behalf of state and federal health departments to deliver a comprehensive e-health strategy in some 16 weeks. This work is in progress and readers may wish to contribute by making submissions when the opportunity arises.

This plan is the latest of a long string of planning efforts.

Frustration at the lack of progress has lead several organisations such as the Health Informatics Society of Australia (HISA), the newly formed Coalition for E-health, and the Australian Healthcare and Hospitals Association (AHHA), to develop their own plans in the hope of influencing the policy agenda.

Canada and Sweden have developed national e-health plans.

With so much planning going on, how might a good plan be recognised?

Such a plan might: • identify the core business objectives of the health system and its components and align these with e-health developments; • focus on applications and function rather than technology; • be truly inclusive of consumers, healthcare providers and the IT industry;

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• address immediate problems, justifying the investment in infrastructure, with outcomes that have political appeal; • be practical and lead to solutions which are implementable in stages with short time frames; • cover the whole health sector; federal and states, hospital and community; public and private; individual and population health; • start with current technology, yet have a development pathway; • understand key consumer factors such as expectations of delivery, engagement and reasonable privacy and security standards, and the need to minimise change management challenges for users; • support a viable market in solutions and applications; • support verifiable interoperability between systems using Australian and international standards; • learn from international and other industry experience.

The plan must provide a strategy that recognises and tackles the disconnected nature of our system, allowing e-health to link up different services for patients moving along their healthcare journey. This is nowhere seen better than in cancer care where patients are treated in many facilities, by many providers using the multidisciplinary care process, and where the nature of condition, the care and follow-up is complex.

The aphorism, “if you can’t measure it, you can’t manage it” prevails, yet the same thinking does not apply to the same extent in clinical care. What is measured are processes of care such as diagnoses made, bed days occupied, medications prescribed, and tests ordered — most of this to support financial management and reporting. If we can’t recognise and measure patient outcomes and good care processes, where is the incentive or business case to install e-health systems? It is a “catch 22” situation.

At the risk of being considered a cynic, there is a certain level of comfort for all involved in healthcare (except the patient) in using the “head in the sand approach”. Practitioners can believe that they are doing their best and poor results are put down to external factors; the health service does not see aggregated reports which reflect on their inadequate systems of care; the political process is happy when a lack of such data keeps healthcare off the front pages. As a GP, I am reinforced in my belief that I know how to practice good medicine every time I remember to do a smear test or treat diabetes according to the best evidence. I am oblivious to the times I forget to do these things; without outcomes data and systems to prompt me in real time, how can the situation improve?

BITS & BYTES Plans must also be informed by a large dose of reality.

Australia is not a country that accepts radical change or will adopt high risk strategies. Failure is not well tolerated and second chances are hard to come by. E-health systems will be rolled out gradually as the political will and resources permit, and do so at a different pace across the country and with different priorities. The market model will ensure that there are competing products, and in the long run, this is a good thing to spur improvement.

In this type of scenario, it is vital that a consistent architecture can link the various systems, both up, down, and across the traditional information silos. This goes further than just standards for messages (HL7), or terminology (SNOMED-CT).

Standards are necessary, but not sufficient in themselves to achieve interoperability. We are in a “post-standards age” that is starting to focus on the integration of the many standard components, privacy, business objectives and workflow to effectively join the different e-health applications into a workable clinical system. There is no reason why an Emergency Department system in a Victorian public hospital should query a patient identity server differently to one in a Queensland private hospital. Getting agreement about how to achieve this is critical, and once decided, the policy makers and users can move on to implementation.

Radiology led in interoperability a decade ago when it sponsored the development of a process called Integrating the Healthcare Enterprise (IHE – www.ihe.net). IHE has solved the integration of many systems within single services or departments, and is now tackling the problem of health record and document sharing and standards-based communication through an innovative approach known as Cross Enterprise Document Sharing (XDS). This is based on standard document centric technologies used to index and access information on the world wide web. As new issues emerge such as how to handle e-prescribing or e-referrals for radiology and pathology, the XDS model can be expanded to support this, providing one communication infrastructure rather than several.

IHE is both a governed process and creator of profiles to support implementation. It reduces the costs of interfaces, and supports patient care in a tangible way through the delivery of information from the many different health records at the time it is needed. IHE responds to, and solves industry problems, accepting user input into the problem definition and requirements phase. Vendor experts then define the interoperability profile using underlying standards. Systems are conformance checked and available for public demonstration in a little over a year from the start of the process. Over time, an impressive array of profiles and infrastructure have developed and been adopted in international standards and systems development.

At some, stage e-health has to move beyond planning and make decisions about a direction, even if we are not sure of the destination. Making decisions means accepting some uncertainty and taking some risks, which can be mitigated by working in collaboration with users, vendors and the international e-health community. Perhaps a more open, systems based, engaging, and international approach such as that offered by IHE could be that direction. It is vital that IHE is recognised as a way of supporting the implementation of systems based on existing standards and industry collaboration, and not an alternative. It is the next step and rather than asking, “is IHE the one?”, we could just make it happen.

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GPCOMPLETE

BITS & BYTES STAT READIES PRACTICE MANAGEMENT SOFTWARE Stat Health Systems have announced the impending release of their Practice Management solution for Specialist and General Practice.

The product will include appointments, billing and reporting functionality, all of which will be incorporated into Stat’s fully integrated clinical and practice management solution which is scheduled to be released later in the year.

It is anticipated that the Stat practice management module will be deployed in its first live site in June.

According to Carla Doolan, Stat Health Systems’ Marketing Manager, “The overriding goal for the design and development of the Practice Management module was to provide an uncluttered, fresh approach to traditional reception functions.

The software development has tested a combination of new development tools with original workflow theory to produce an innovative software application with a streamlined, intuitive interface.”

Ms Doolan went on to say, “The feature that sets the Practice Management module apart from other products is a multi-function interface that allows the user to commence a new action without completing the previous action. The user has the flexibility to return to the incomplete task at any time, and can be progressing an unlimited number of tasks.”

The Stat Practice Management solution is the company’s third major offering to the market and closely follows the release of the Stat Online Claiming Solution, a software product designed to provide Medicare Online functionality to IBA Classic, which relies on the soon to be defunct Medclaims electronic claiming system.

Initiated in 2007, the organisation also offers a premium IT support service to medical practices.

Division coordinated initiative blazes e-prescribing trail in the Northern Territory The Cavanagh Medical Centre, Stuart Park Pharmacy, and the Darwin Mall Pharmacy are the first participants in a promising electronic prescribing (e-prescribing) trial being conducted in the Northern Territory.

Launched publicly on 14th May, the system has been in development for 18 months, with the first electronic prescriptions transmitted from the medical centre to a centralised prescription server on 10th April.

Jointly funded by the Department of Health and Ageing and the Northern Territory Health Department, the development of the e-prescribing solution was coordinated by the Top End Division of General Practice.

The technical development of the system was undertaken by ArgusConnect, Genie Solutions and Symbion Health.

ArgusConnect was responsible for the architectural design of the system, developing the e-prescription hub infrastructure, providing digital signing and encryption functionality, and defining the electronic script transport protocols to be used by the prescribing and dispensing software. As the prescribing package selected for the trial, Genie Solutions enhanced the clinical functionality of their Genie software to communicate with the ArgusConnect e-prescribing components.

The Minfos (minfos) dispensing solution, developed by Symbion, was updated to identify scripts using a bar code scanner, and in turn, download electronic scripts from the prescribing server.

When using the e-prescribing system, the prescribing clinician specifies the drug and dosage in Genie as usual, then presses the “print” button to generate a hard copy of the script - this process also commences the generation of the electronic script.

The ArgusConnect e-prescribing software component installed on the clinician’s computer presents a graphical representation of the script in a web browser for the clinician to verify. After verification, the electronic prescription is digitally signed, encrypted and transported to the centralised prescription server, where it is stored securely until the patient presents at a pharmacy.

On presentation of the paper script by

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the patient, the pharmacist is able to scan the unique bar code on the script using minfos. The script is then downloaded by the ArgusConnect e-prescribing module, which displays a graphical representation of the script in a web browser for the pharmacist to review. The data from the electronic script is imported into minfos, eliminating transcription errors and streamlining the dispensing process by negating the need for the pharmacist to have to manually enter the information on the paper script into their dispensing software.

To prevent paper scripts from being fraudulently copied, “Modulated Digital Image” technology, developed by the CSIRO, is used to print a hidden image on the script. If the dispensing pharmacist has any doubts as to the legitimacy of the script, the pharmacist can place a special plastic covering over the script which will reveal the hidden image if the script is an original copy. If the script has been photocopied or scanned, the hidden image will not display correctly, indicating that the script is not legitimate.

After the medication has been dispensed, the minfos software uploads an acknowledgement of this fact to the prescribing server, allowing repeat prescriptions to be accurately tracked by the system.

While the functionality required to access the prescription server is currently only implemented in one prescribing package (Genie) and one dispensing package (minfos), the system’s standards-based technical architecture and public ownership are designed to facilitate interoperability and encourage the participation of multiple prescribing and dispensing solutions.

Prescribing and dispensing software vendors not currently involved in the trial will be given the opportunity to interface with the prescription server following a postimplementation review of the system.

Unlike the announced, but yet to be released, ScriptX e-prescribing system that proposes to levy a fee on pharmacists of as much as 25 cents per script, there are no plans in place to charge pharmacists or GPs to use the system.

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Te l : ( 0 7 ) 4 1 5 3 1 2 7 7

BITS & BYTES NEHTA APPOINTS INTERIM CEO Three and a half years after commencing duties with the National E-Health Transition Authority (NEHTA), founding CEO, Dr Ian Reinecke, has resigned from the organisation to pursue opportunities in the private sector.

Under Dr Reinecke’s stewardship, NEHTA has grown rapidly, the company now employing over 150 staff in Sydney, Brisbane, Adelaide and Canberra.

In a statement announcing Dr Reinecke’s resignation, NEHTA Chair, Dr Tony Sherbon, highlighted the outgoing CEO’s achievements during his time with the organisation.

“Following funding support from COAG, Dr Reinecke has negotiated the contract to establish unique health identifiers for all Australians as well as their health care providers. This project is now well underway and Dr Reinecke’s efforts will prove to be of great benefit in the near future to millions of Australians,” said Dr Sherbon.

Speaking about NEHTA’s adoption and support of SNOMED-CT, Dr Sherbon went on to say, “Dr Reinecke has also overseen negotiations for Australia to join the world’s most significant alliance for the international coordination of clinical terminology development. This development has significantly accelerated the development of information standards throughout Australia.”

Andrew Howard has been engaged as the organisation’s interim CEO while an international recruiting effort is undertaken to find a replacement for Dr Reinecke.

Mr Howard has 15 years experience as a consultant with Accenture, and prior to accepting the role as NEHTA’s interim CEO, fulfilled the role as Chief Information Officer of the Victorian Department of Human Services.

Emerging Health Solutions CIS selected for South Australian public hospitals Emerging Systems has been commissioned by the South Australian Department of Health to roll-out their Emerging Health Solutions (EHS) Clinical Information System (CIS) in 16 public hospitals across South Australia.

The deployment of EHS forms part of the South Australian Government’s strategy to develop Australia’s first fully integrated statewide electronic health record system.

Dubbed “careconnect.sa”, the initiative is designed to improve communications between patients, doctors, nurses, midwives and other health care professionals operating in the public health system.

The careconnect.sa program comprises 65 inter-related information technology projects, all of which are scheduled to be implemented by 2017.

The Emerging Health Solutions’ CIS has a lineage stretching back to 1993, having been first deployed at St Vincent’s Private Hospital as a product named “deLacy”. Originally developed and maintained in-house, St

Vincent’s Private Hospital transferred the deLacy intellectual property to Emerging Health Solutions. As part of the transfer, the program was rebuilt using modern web technologies in an effort to improve the scalability of the product and reduce ongoing maintenance and support costs.

The CIS was recently rebranded and remains in operation in St Vincent’s Private Hospital. Deployments at St Vincent’s Hospital, Sydney and The Mater Hospital, North Sydney are currently underway.

The EHS CIS is modular in design, allowing the system to be customised to suit different settings. Available components include a multi-disciplinary patient care plan system, medical history, variance tracking and risk assessment modules, staff allocation and pre-admission functions, as well as maternity and management screens.

Clinical messaging and discharge summary components are also included in the product suite.

Russel Duncan (left) and Richard Hutchinson from Emerging Systems pictured at St Vincent’s Private Hospital with system trainer and nurse Elizabeth English.

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BITS & BYTES The EHS CIS will replace ExcelCare, a nurse-centric system that has been in operation in South Australian public hospitals since 1993.

According to David Johnston, Chief Information Officer of SA Health, Emerging Systems’ track record in an Australian setting was an important factor in the selection process.

“Emerging Systems was chosen for the project after its success in developing a

Web-enabled clinical information system for medical and nursing staff at St Vincent’s Private Hospital in Sydney,“ said Mr Johnston.

It is intended that the Lyell McEwan hospital will be the first South Australian hospital to have the EHS CIS implemented, with the state-wide installation scheduled to be completed by the end of 2009. EHS will be deployed in parallel to OACIS, a CIS utilised by doctors in the South Australian public hospital system.

HISA prepares for annual e-Health and informatics event The Health Informatics Society of Australia (HISA) is preparing for their national Health Informatics Conference, HIC’08. The annual event will be held at the Melbourne Convention and Exhibition Centre, with the conference running from Sunday 31st August to Tuesday 2nd September.

The theme for HIC’08 is “the person in the centre”, and will examine the theme from the perspectives of consumers, healthcare providers, policy and infrastructure developers and managers, and researchers and academics.

During the course of the event, keynotes will be presented by a range of international and Australian Health, eHealth and Health Informatics luminaries. Among these presenters are Mike Bainbridge (UK), Lyle Berkowitz and David Whitlinger (USA), with Helen Hopkins, Michael Legg, Loane Kene, Merrilyn Walton and Beth Wilson providing local perspectives. In addition to hosting these keynote presentations and promoting scientific papers, the conference will feature a stream dedicated to the presentation of technology and systems implementation.

For the fourth consecutive year, the HISA event will feature an Interoperability Showcase designed to demonstrate the integration capabilities of Health IT vendor applications. This year, the philosophy and execution of the Interoperability Showcase and preceding “Connectathon” will draw upon the methodologies prescribed by the Integrating the Healthcare Enterprise (IHE) initiative.

According to the IHE Australia website, “IHE is an initiative by healthcare professionals and Health IT industry to improve the way healthcare computer systems share information. IHE promotes the

coordinated use of established standards such as DICOM and HL7 to address specific clinical need in support of optimal patient care. Systems developed in accordance with IHE communicate with one another better, are easier to implement, and enable care providers to use information more effectively.”

In Australia, the IHE initiative is being supported by a host of organisations, including HISA, HL7 Australia, the Medical Software Industry Association (MSIA), the Royal Australian and New Zealand College of Radiology (RANZCR), and the Australian Diagnostic Imaging Association (ADIA).

The focus of the Interoperability Showcase for 2008 will be the sharing of x-ray images as well as HL7 messages for pathology and radiology orders and results, ADT messages and referrals.

Several related eHealth and Health Informatics events will be co-located and held in conjuction with the HIC’08 conference. The main program will be preceded by a one day Nursing informatics conference hosted by Nursing Informatics Australia, a HISA Special Interest Group. A consumer-centric program will be held on Sunday, with the CHIK Services’ Health-eNation event immediately following HIC’08 on 3rd September. HIC’08 and Health-eNation are running a unified exhibition hall, with promotional floor space available for approximately fifty organisations.

A busy week of eHealth and Health Informatics events will conclude on 4th September with Information Technology in Aged Care (ITAC 2008), an event “designed to provide useful IT planning and implementation information for executives and managers working in Aged Care”.

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TELSTRA ENABLES ADSL2+ IN MORE EXCHANGES After receiving assurances from the Federal Government that they would not be required to wholesale the capacity to competing telecommunication companies, Telstra has enabled ADSL2+ technology in an additional 907 exchanges across the country.

According to Telstra’s head of Public Policy & Communications, Dr Phil Burgess, approximately 80 per cent of the exchanges that received the upgrade are “located outside the major metro areas”.

The infrastructure deployment dramatically increasing the number of households and businesses that now have access to the faster Internet connectivity option. According to Telstra, their ADSL2+ footprint now exceeds 1400 exchanges serving 16.6 million people nationally.

Prior to the upgrade, Telstra limited itself to only providing ADSL2+ in exchanges that housed competing ADSL2+ infrastructure.

Because of Telstra’s stated stance towards other Internet Service Providers (ISPs), households and business in regional and rural areas interested in upgrading to ADSL2+ are likely to have little choice but to switch to Telstra for their Internet service.

Telstra’s ADSL2+ offering has a theoretical top speed of 20Mb/s in the downstream direction, and 1Mb/s in the upload direction. While the quality of the phone line and the distance of the connection to the exchange diminish the real-world performance to varying degrees, the speed of the technology is significantly greater than older ADSL technologies that top out at speeds of 8Mb/s and 384Kb/s for download and upload throughput respectively.

Telstra’s ADSL2+ plans start at $59.95 for a 600MB transfer allowance per month, and ranging up to $149.95 for 60GB.

BITS & BYTES HEALTH INFORMATICS JOURNAL RELEASED The fourth edition of the electronic Journal of Health Informatics (eJHI) has recently been published online.

The eJHI is a peer reviewed publication and is the official journal of the Health Informatics Society of Australia (HISA) and the Australian College of Health Informatics (ACHI).

Guest edited by Professor Peter Croll, this instalment of the eJHI includes eight papers focussing on Health Information Privacy and Security. A ninth paper titled “Designing digital documents to support medication management” is also included in the publication.

All content published in the eJHI is freely accessible after registering at the journal’s website (www.ejhi.net).

ZEDMED UPDATES PRACTICE SOFTWARE In April, Zedmed released Version 9 of their GP and Specialist clinical and practice management solution.

Zedmed Office now features a “Cancellation Waiting List” to allow reception staff to easily re-book appointments, more patient demographic fields, a streamlined internal mail system, improvements to the Eclipse billing functionality, improved user security features, and several other minor enhancements.

The Zedmed clinical component has also been refreshed, touting improvements such as the ability to easily record more than one clinicians involvement in a patient’s clinical care, and the ability to generate pap smear records from electronic results. The document handling capabilities of the application have been significantly enhanced, with several improvements made to the way multiple recipients are accounted for. The program’s audit tracking features have also been improved.

MMEx secure messaging project set for expansion in WA Having reached the end of a Government funded establishment phase, the Western Australian based Greater Southern Managed Health Network (GSMHN) is preparing to roll out its services in other parts of the state.

GSMHN is a not for profit joint venture established via the collaboration of the Greater Southern GP Network and the University of Western Australia’s Centre for Software Practice.

The project has been facilitated through a $1.5M Managed Health Network Grant, with work on the project commencing in April 2007. The GSMHN has developed a range of services for General Practices and other healthcare organisations located in the Great Southern region of WA, an 87,000 square km region located to the South-East of Perth.

Most notable of these services is a secure messaging solution dubbed the Medical Message Exchange (MMEx). Developed by The University of Western Australia’s Centre for Software Practice, MMEx is accessible via a web browser and is outwardly similar to a web-based email system. According to Dr David Glance, Director of UWA Centre for Software Practice, the decision to base the solution on web technology was made with a view to minimising costs and technical barriers for users.

After authenticating to MMEx via the web portal with a username and password, users are able to interact with the system independently of their clinical software.

Optionally, MMEx users can install client software to facilitate the downloading of attachments from the MMEx server into preconfigured directories on the users computer, and in-turn, into the user’s clinical software.

A secure email gateway has also been developed to facilitate the uploading of clinical information to the system. This solution intercepts emails sent from the users clinical software or email client, encrypts them for secure transport over the Internet, and sends them to the MMEx server. In keeping with the projects philosophy of minimising technical barriers, these emails can contain attachments of any file type.

The MMEx system has a built-in address book, and also features pre-configured online forms to allow clinical documents such as discharge summaries, patient progress notes and pathology and radiology requests

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to be entered into the system. These forms can currently be pre-populated using HCN’s Medical Director software to minimise data entry errors and increase the efficiency of the system. It is anticipated that other clinical software will offer similar integration functionality in the near future.

The MMEx service is currently being offered to users at no charge on a trial basis.

When the trial period expires in September, it is proposed that access to the GSMHN will be costed at $120 per year per user. In addition, a 10 cent per message charge will be levied on users for each message sent and received through the MMEx system.

In addition to MMEx, the GSMHN offers several other services to practices and the wider community. Among these are an online directory of health professionals and healthcare organisations located in Western Australia. Users of the directory can search by locality, clinical speciality or clinician name, with search results plotted on an interactive map to allow the user to select from the most appropriate site of service.

The GSMHN also offers registered practices the opportunity to backup their clinical data over the Internet to a secure data centre managed by the GSMHN. As an extension of this service, the practices are able to install their clinical and practice management data on a server hosting their preferred clinical software. In the event that a practice has difficulties with their own server, doctors and staff will be able to connect to the remote server and continue working with only minimal disruption.

Using the same infrastructure, the GSMHN is offering to convert practice data from one clinical system to another to allow practices to trial other clinical and practice management solutions via a remote access connection.

Since commencing operations in December 2007, the GSMHN has expanded its reach and is now providing secure messaging in the Kimberly region through a collaboration with the Kimberley Division of General Practice, the Kimberly Aboriginal Medical Services Council and the WA country Health Services. The GSMHN also plans to roll out secure messaging service in the Mid West Wheatbelt region using funding assistance from the Australian Better Health Initiatives program.

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BITS & BYTES GENIE IMPLEMENTS 2-WAY SMS APPOINTMENT REMINDERS Genie Solutions have announced the impending release of 2-way SMS appointment reminders for practices running their flagship integrated practice software, Genie.

After receiving an SMS appointment reminder from their practice, patients are able to use their mobile phone to reply with a confirmation or cancellation message. This information is automatically reflected in the practice’s Genie appointment book, saving reception staff from having to manually confirm appointments. In the event that the patient cancels the appointment, reception staff have the ability to reallocate the appointment to a patient on their waiting list.

Genie Solutions have established their own gateway to process SMS reminders for practices running their software. The SMS gateway will communicate with installations of Genie using webservices technology to allow practice appointment books to be updated in a timely fashion and without the need for third-party software.

The enhanced appointment reminder functionality has been in development and beta testing for several months, and will be rolled out as part of an impending software update in the coming weeks.

GOOGLE PROFIT GROWS In its first quarterly report for 2008, Google has announced a profit of $US1.31 billion or $US4.12 per share. On revenues of $US5.19 billion for the quarter, the windfall represents a 30% rise in profit compared to the same quarter in 2007. The earnings announcement marks the 12th time since Google was publicly listed that the Internet search giant’s performance has eclipsed analyst expectations.

Wedgetail open source shared EHR takes flight Wedgetail, a fledgling open source Shared Electronic Health Record (SEHR) system is to be deployed in Lismore for use by clinicians and healthcare organisations in the Northern Rivers region of NSW. The Wedgetail SEHR has been developed by three practicing clinicians, namely general practitioners Dr Tony Lembke and Dr David Guest, and psychiatry registrar Dr Ian Haywood. Hailing from Victoria, Dr Haywood is the project’s technical lead and is responsible for overseeing the contributed program code. Drs Lembke and Guest are GP Advisors to the IM/IT project at the Northern Rivers General Practice Network, are contributing programmers and are coordinating the first live deployment of Wedgetail.

This deployment is targeted at patients in Residential Aged Care Facilities and those requiring palliative care. A wider roll out to interested patients with chronic conditions will follow. As with all SEHR initiatives, the Wedgetail system is designed to improve the ability for health professionals and healthcare organisations to share and access important information about patients in a timely and secure fashion.

Wedgetail is a web-based system, with the electronic health record for each patient presented on a single page. Key patient demographics, a health summary, a medication chart and an allergies and immunisations list are all displayed on this screen, as are sections to display patient encounters, pathology and radiology results, letters and discharge summaries. A “scratch pad” to record unclassifiable notes about the patient is also included.

Clinicians are able to enter text manually into the patients health record, or can upload text files containing information about the patient into the relevant section of the record. Wedgetail servers can also be configured to interact with the Argus secure email system, allowing doctors using clinical software that supports Argus to send and receive messages to and from the Wedgetail server. A Wedgetail API is currently in development that will facilitate the use of webservices as another integration option.

In addition to hosting patient records, Wedgetail includes an electronic messaging system that allows clinicians to communicate in a secure online environment. Clinicians are

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able to have discussions in relation to specific patients, or correspond in more general terms using the system. New messages are automatically reflected in the system, with email notifications being sent to the recipient to alert them to the fact that a new message has arrived.

Clinicians are able to “subscribe” to patients of interest, enabling the system to send them a notification each time the patient’s health record is modified.

Clinicians are able to communicate with their patients using the messaging system, and Wedgetail also supports the notion of clinician care teams, a feature that allows communications to go to a group or “role” such as the Accident and Emergency Department rather than a specific person.

The Wedgetail SEHR is built upon the notion of a patient-controlled health record.

Patients can determine which clinicians can access their records (using “white lists”), and which clinicians can’t (using “black lists”).

An audit trail is readily available to patients to allow them to determine who has been looking at their information.

Patients can generate “one-time access” passwords to supply to practitioners who are not registered with the Wedgetail server.

For instances when the patient is travelling outside of the SEHR’s catchment area, this functionality allows the patient to provide clinicians access to their health records on a temporary basis. Patient’s are also able to print out a ‘Wedgetail Card’ to carry in their wallet which contains a password for one-time access to their record for use by clinicians in the event of an emergency, or when travelling. Like all other parts of the system, this functionality is audited to ensure that data access privileges are not being abused.

Before a patient can be added to the Wedgetail system, the clinician generates a consent form for the patient to sign. This document is then provided to the Wedgetail administrator (affectionately dubbed the “Big Wedgie”), who ensures the patient does not already exist in the system. After this verification process is performed, the patient record is activated in the system, allowing the patient and their authorised clinicians to interact with their electronic health record.

A Wedgetail SEHR installation can be accessed from any computer with a web

BITS & BYTES browser and an active connection to the Wedgetail server. The developers have reported success with a variety of hardware systems, including the diminutive ASUS Eee PC, and the soon to be ubiquitous Apple iPhone.

Requirements to host a Wedgetail SEHR server are also modest, requiring only that a collection of free open source software

components be installed and configured on either Mac OSX, Linux or Microsoft Windows.

Among these core components are Rails and MySQL, in addition to a web server such as Apache or Mongrel.

In keeping with the project’s open source philosophy, all Wedgetail source code has been made freely and publicly available in a Sourceforge CVS repository.

ScriptX electronic prescribing system slated for March 2009 ScriptX, a new electronic prescribing (e-prescribing) initiative was announced at the Australian Pharmacy Profession Conference in late March.

ScriptX is a joint venture between Health Communication Network (HCN), Fred Health and Corum Health. HCN is the developer of Australia’s marketing leading prescribing software, Medical Director, with PCA NU Systems and Corum together providing dispensing software to over 80% of Australian pharmacies.

The Pharmacy Guild of Australia, which holds an equity stake in Fred Health, has endorsed the ScriptX consortium’s plans, highlighting the proposed e-prescribing system’s potential to improve the prescribing process.

Kos Sclavos, National President of the Pharmacy Guild said “ScriptX will improve the safety and efficiency of prescribing in Australia, with the aim of more effective medicine management and better health outcomes for patients.”

Technical details about the solution are scarce at the time of writing, however it is understood that ScriptX will utilise a centralised server infrastructure model, with electronic scripts being encrypted before being uploaded from the prescriber’s computer to the ScriptX hub to ensure patient privacy is protected. Prescriptions will be stored securely until the patient presents at a pharmacy, at which time the pharmacist will retrieve the script from the ScriptX hub using their pharmacy dispensing software.

Once the prescription is filled by the pharmacist, the prescribing clinician will be sent a notification by the ScriptX hub to alert them to this fact. This functionality extends to repeat prescriptions, improving the ability for prescribing clinicians to monitor the medication usage of their patients.

It is proposed that, during the establishment phase, the entrenched paperbased prescribing system will shadow the ScriptX system to allow software vendors, prescribers and pharmacists time to become comfortable with e-prescribing. Pending Government approval of the e-prescribing workflow, it is intended that prescribers will have the option to cease generating traditional paper prescriptions and utilise the electronic system exclusively.

ScriptX will operate under a “recipient pays” model, with pharmacists required to pay as much as 25 cents each time a script is downloaded from the hub. It is likely that Pharmacy Guild members will be entitled to receive discounted pricing. Prescribers will not be charged to use the service.

The Pharmacy Guild of Australia has pledged to purchase 10 million script transactions from the ScriptX consortium on behalf of its members to kick-start the initiative. While the ScriptX consortium have indicated that their business model is not reliant on Government funding assistance, the Pharmacy Guild has not ruled out the possibility of seeking Government funding to minimise the ongoing transaction fees levied on pharmacists.

While specific details have not been released, the consortium has indicated that all software vendors who undertake a certification process will be entitled to access the ScriptX hub.

According to Graham Cunningham, the ScriptX consortium’s Chairman, software vendors that wish to undertake certification will be charged on a cost recovery basis. To offset this nominal cost and to encourage software vendors to support the ScriptX initiative, Mr Cunningham indicated that software vendors will be incentivised to utilise the ScriptX hub, most likely through a per script payment arrangement.

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HEALTH IT RESEARCH LAB LAUNCHES NEW WEBSITE The University of Sydney’s Health Information Technologies Research Laboratory (HITRL) has launched a new website (www.it.usyd.edu.au/~hitru) to showcase its research projects and promote the Laboratory’s growing list of Health IT related enhancement technologies.

The website incorporates what the Laboratory has dubbed a “TTOC Viewer”, so titled to encompass the various terms used to refer to “systems of description or knowledge resources used in the world of health”, namely Thesaurus, Terminology, Ontology and Classification.

The Laboratory launched the TTOC Viewer with SNOMED-CT as the first available terminology in the system, but has since incorporated APACHE IV, a classification for ICU usage.

The Nursing Interventions Classification (NIC) and the Nursing Outcomes Classification (NOC) are being prepared for implementation presently.

Users of the system are able to choose their desired classification system and input a natural language phrase, and then view the results of the natural language conversion within a matter of seconds.

When asked about the benefits the TTOC Viewer offers both clinicians and the Laboratory, Professor Jon Patrick, the University’s Chair of Language Technology, said “Clinicians are able to get access to these TTOCs from there own sources but not with interactive browsers for the most part. This project is part of the HITRL’s programme to deliver more IT functionality to the clinician. The terminology server that we use for our web service is the same server that we incorporate into our systems in hospitals demonstrating the generality of our technology, an important aim of the Laboratory’s work.”

BITS & BYTES COMMUNICARE ADDS DATA SYNCHRONISATION Communicare Systems has updated their software to improve its ability to synchronise data between laptops, remote installations, and centralised Communicare servers.

First released in 1995, Communicare is an Electronic Health Record and Practice Management system used by many of Australia’s Aboriginal Health Services.

Despite the recent expansion of mobile telephony and broadband services in most populated areas of the country, many of the regions in which Communicare is routinely deployed do not enjoy reliable network coverage.

“Telstra’s Next G network might cover 98% of the population, but that still leaves many vast, sparsely populated areas of the country without coverage. Many Aboriginal people live in these areas. These are the people who will benefit most from this new release,” said Brian Dunstan, Managing Director of Communicare Systems.

Before travelling to an area without Internet access, clinicians are now able to transfer a copy of their entire Communicare database to a laptop. Despite being disconnected from their centralised server, the user has access to all core clinical and billing functions offered by the Communicare application.

When LAN or Internet access next becomes available, the clinician can synchronise any changes made to their laptop’s copy of the database with their primary Communicare database.

Dr Pascall Burton, of Wirraka Maya Health Service in Port Hedland, has been beta testing the new software. He said, “It provides an extra certainty that Communicare access will be available remotely. It also saves data input time for staff who work in remote areas because they don’t have to input data when they come back.”

University of Sydney hosts Health IT research showcase In late February, the University of Sydney’s Health Information Technologies Research Laboratory (HITRL) held an information session showcasing selected research projects being undertaken by students of Professor Jon Patrick, the University’s Chair of Language Technology.

The showcase was well attended, with the audience comprising members of academia as well as Health and Health IT industry representatives.

With an emphasis on practical application, the research projects were facilitated through the HITRL’s partnerships with various industry and health organisations.

Following an introduction by Professor Patrick, Chris Leong, a second year student undertaking a Bachelors Degree in Science, discussed a spelling and grammar checking solution designed for use in Intensive Care environments.

The solution is being developed for implementation at Royal Prince Alfred Hospital’s Intensive Care Service, where a previous collaboration between the hospital and the university yielded a SNOMED-CT enabled Clinical Information System (CIS).

Dubbed the “Ward Rounds Information System” (WRIS), the application is designed to interface with existing clinical information systems, providing clinicians with a tailored extract of the patient’s clinical record from the ICU’s information system, CareVue, relevant to the needs of completing the ward round. This extract includes pertinent haemodynamic and laboratory data which is presented on a monitor for the clinician, who is then able to input relevant progress notes. After analysing the progress notes, WRIS computes the SNOMED-CT codes in real-time, which the clinician then verifies.

The correct codes are then able to be stored back into CareVue. Elaborating on the systems functionality, Professor Patrick said, “The results can also be used to index the records so that when staff are searching for particular cases, or notes within a case, they can be retrieved directly in the same fashion that Google gives us access to relevant content across the Internet.”

It is anticipated that implementing spelling and grammar checking functionality in the WRIS will minimise clinician data entry

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issues, and in turn, will improve the accuracy of the natural language to SNOMED-CT conversion routines built into the WRIS. The processes involved with the retrieval of data from a legacy anatomical pathology information system located at the Liverpool Hospital was presented by Kiran Abraham.

The project, sponsored by Professor David Davies, Joint Director of Pathology at the South West Pathology Service, involved the “rescue” of data from a legacy installation of HOS-REP. After reverse engineering the HOS-REP system’s legacy data model, Mr Abraham developed a new data model that reflected the present day requirements for archiving the data. After data cleaning routines were performed, the new model was created in the MySQL and populated with data from the legacy system.

This is the fifth major “data rescue” completed by the HITRL, a competency that the group has developed due to increasing demand for such services.

“The Laboratory finds the problem of reverse engineering data models complementary to the work it has to do to install its other enhancement technologies in clinical information systems, and has pushed on to make it a key competency,” said Professor Patrick.

Since the project was completed, the interfacing of the HITRL’s Clinical Data Analytics Language (CDAL) system to the new archival database has been undertaken, enabling a large range of analytics to be performed over the data, particularly the free text reports.

Tomek Rej discussed his experiences with the trial deployment of WRIS in the Paediatric ICU at the Children’s Hospital Westmead (CHW). While WRIS was originally designed to interface with other clinical systems following only minimal interface development, this research project was the first time the HITRL tested a live deployment of WRIS outside of the RPAH. Mr Rej worked in collaboration with the WRIS’s lead developer, Yuzhong Cheng, to integrate WRIS with the Eclipsys Critical Care Information System. This particular CIS was introduced at CHW in 1995 and remains in active use today.

With a view to minimising the learning curve for clinicians, and in a departure

BITS & BYTES from the way WRIS is configured at the RPAH, Mr Rej implemented a tabbed user interface in WRIS in an effort to make the program appear somewhat similar to the Eclipsys CIS. While the WRIS implementation at CHW is still being trialled, Senior Staff Specialist at the CHW Paediatric ICU, Dr David Schell was impressed with the project outcomes, and is hopeful that the system will be deployed in the near future pending further product testing.

“The IT student Mr Rej was, in the short time available to him, able to develop an interface that is potentially of great benefit to the junior medical staff. Not only does it save time by overcoming some of the limitations of our old software, but has opened the possibility of other uses, including with some modification, use as a handover tool. Handover is an area of great concern in intensive care units and is often poorly performed, with failure to communicate vital information,” said Dr Schell.

Following the live deployment of WRIS, the CWH also plan to implement the HITRL’s CDAL system in their Paediatric ICU. A project concerned with the automatic conversion of ICD-10-AM indices into concept descriptions was discussed

by Yan Shvartzshnaider & John Zizhuo Huang. The National Centre for Classification in Health (NCCH) funded the students for a 10 week summer scholarship, during which time the students analysed the structure of ICD-10-AM index entries with a view to preparing the terms to be processed by the HITRL’s natural language to SNOMED-CT conversion routines.

The students were provided with the ICD-10-AM index as a flat file in Microsoft Access format, and subsequently migrated the index to a relational model hosted in a MySQL database. The ICD-10-AM terms were structured into a tree arrangement to negate the need for ongoing complex text parsing.

Using various algorithms, attempts were made to extract full procedure and disease terms from the ICD10-AM index arranged as you would expect them to appear in natural language. After each conversion was attempted, the extracted results were forwarded to the NCCH for verification. By implementing the NCCH’s feedback throughout the project, the accuracy of the extraction algorithms improved significantly, placing the HITRL and NCCH in a position to build upon this research and continue towards their ultimate goal of using natural language processing to map the ICD-10-AM index to SNOMED-CT. Concluding the showcase, Professor Patrick presented an overview of several research projects planned for the future. Among these are work programs concerned with the automatic generation of structured pathology reports, the automatic computation of clinical subsets of SNOMEDCT for intensive care settings, and the automatic coding of ICD-10-AM from clinical notes using SNOMED-CT as an intermediary language.

Further research and development into the portability of WRIS and CDAL is also slated for future attention, with an expectation that the applications will be rolled out throughout the South West Area Health Service in the coming year.

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BITS & BYTES ALVAREZ JOINS E-HEALTH RESEARCH CENTRE One of the major contributors to the development and implementation of Canada’s electronic health records system, Richard C Alvarez, has been appointed an Honourary Fellow of the Australian e-Health Research Centre in Brisbane.

A joint venture between CSIRO and the Queensland Government, the Australian e-Health Research Centre is a leading national research facility for health care innovations in ICT. The Centre’s CEO, CSIRO’s Gary Morgan, says much of Canada’s success in becoming a world leader in the implementation of health information technologies can be attributed to Mr Alvarez who is currently the President and CEO of Canada Health Infoway.

“Through his vision and efforts, he has helped to position Canada as a world leader by reforming the health care system through innovation and technology,” Mr Morgan says.

“Mr Alvarez is a longstanding friend of the Centre and has previously served on our Research and Investment Advisory Committee. His many efforts on its behalf have significantly advanced the Centre’s international collaborations - particularly in forging links with Canadian health agencies and research institutions which have mutual areas of interest.”

The Centre’s e-Health Medical Director, Professor Bruce Barraclough, said “Mr Alvarez is helping the Centre to ensure that our world-class people will create the health solutions applicable to new forms of chronic disease management well into the future.”

The Centre bestows Honourary Fellowships on individuals who have distinguished themselves through achievements in health information technology and/ or activities in support of the Centre’s aims and objectives.

Shared electronic health record project extended from Brisbane to the Goldfields region in WA The Goldfields Esperance GP Network (GEGPN) has commenced the rollout of a Shared Electronic Health Record (SEHR) in remote areas of Western Australia.

The deployment has been made possible though funding provided by a Managed Health Network Grant, which was awarded to the GEGPN by the Department of Health and Ageing in the middle of 2007. In addition to licensing the SEHR technology from Extensia Health Solutions, the funds were used to assist practices to upgrade their General Practice clinical systems to a recent version of HCN’s Medical Director 3 that is compatible with the SEHR architecture.

As with other network services offered in the region, the system will utilise the Gold Health secure network infrastructure to connect the various sites of service involved in the project. The Gold Health Network connects approximately thirty sites of service across the region, and among other services, provides secure Internet access, VoIP, and desktop video conferencing functionality.

While the GEGPN has not yet adorned their SEHR with a catchy name, the system

utilises the same technology as that deployed in Brisbane by GP Partners, the country’s largest division.

Dubbed the Health Record eXchange (HRX) in its Brisbane deployment, the SEHR was originally built using a combination of components from the Brisbane South and Tasmanian HealthConnect trials, and Extensia’s Record Point application.

The GP Partners division coordinated the development of the solution, and also piloted the technology in hospitals and general practices in their region.

Patient records stored on the HRX server can be accessed using either a web browser, or GP clinical software. The web interface is typically used by allied health professionals and in environments where the penetration of technology is less than optimal.

Currently, HCN’s Medical Director 2 and 3, and Practix IBA’s are the only clinical software packages with the functionality to integrate with the system, however work is ongoing with other software vendors to increase the number of compatible applications.

E-referrals ramp up in NZ Australasian Health System Integrator, HealthLink Ltd, has successfully piloted an electronic referrals (e-referral) system which is now live across the Hutt Valley Health Region of Wellington, New Zealand.

The system is now being used to submit more than 60% of all hospital referrals in the region. GPs are able to select from and download any of 35 referral form templates, automatically populate them from within their clinical software, then submit a HL7 message in real time to the hospital. On arrival, the e-referral is parsed and inserted into the hospital’s patient management system.

Taking two years to develop and implement, the project was undertaken by a consortium managed by HealthLink. Staff from leading New Zealand EMR vendor, Medtech Global, were also involved in what has been described as a complex undertaking.

“The first 18 months was all hard work,

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but we really started to see the results in November when the proportion of electronic referrals began to climb sharply, reaching the 60% mark in February this year,” said HealthLink CEO, Tom Bowden.

The current phase of the project includes a system review, technology refinement, and a benefits realisation study, which is being undertaken with the assistance of the Australian National e-Health Transition Authority (NEHTA).

The New Zealand Government has made implementing e-referrals a key strategic priority for the next two years, Tony Cooke, CIO of the Hutt Valley District Health Board stating, “The electronic referrals system provides a more structured framework which improves the consistency and completeness of information for all parties. Furthermore, because the referral process is fully electronic, it can be tracked and monitored continuously — this improves the service for clinicians and patients alike.”

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ISSUE 7: FEBRUARY 2008

SPECIALIST COMPUTING

AGPN Gary Holzer B Ed, works for the South Australian Divisions of General Practice Inc as the Project Manager for the Health Provider Registry. gary.holzer@sadi.org.au

The Health Provider Registry In 2001 SA Divisions of General Practice Inc (SADI) identified a need for more timely and accurate discharge summaries. SADI recognised that a statewide central and authoritative address book of provider and practice details would help to address this need. In 2002, the SA Health’s careconnect.sa program, provided funding for the address book to assist in the delivery of electronic separation (discharge) summaries sent from the careconnect.sa clinical information system across the Adelaide public hospitals.

In 2003 the Health Provider Registry (HPRy) began providing the address book for the electronic separation summary and SA Health has continued to provide ongoing funding since this time. Today the HPRy facilitates the delivery of over 8,000 discharge summaries per month across South Australia, Northern Territory, Broken Hill, Mildura and Western parts of Victoria (South Australian patient catchment area).

To build and maintain the HPRy, a model of engagement was adopted, with individual doctors being asked to consent to be part of the HPRy. This consent allows the HPRy to use their information only for direct patient care and public health alerts Today approximately 98% of GPs and 90% of private specialists have individually consented to be on the HPRy. They have consented because: 1. The 20 divisions, 7 specialist colleges and 13 allied health groups who represent health care providers support the HPRy. 2. The healthcare providers realise their consent relates to the care of patients: timely communications i.e. discharge summaries and public health alerts.

3. It is one place for practice managers to notify the health system when their healthcare provider’s move or practice details change.

4. Healthcare provider’s information is not going to be used for general mail outs or appear in mailing lists.

5. The registry is available to all practices who participate free of charge as a service directory to locate specialists and/or GPs. In a recent HPRy survey to practices over 74% responded that the quality and timeliness of discharge summaries had improved or greatly improved since the inception of careconnect.sa and HPRy. One critical requirement of a registry related to patient care is that it can be maintained to ensure patient safety. The HPRy does this by a “many fingers in many pies” approach, as follows: 1. The key source of updates is the use of the HPRy data by SA Health (careconnect.sa and Communicable Diseases Control Branch). 8,000 discharge summaries per month and a public health alert, faxed to the entire database on average once

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per month continuously validate the data.

2. Participating divisions, colleges and allied health groups notify the HPRy of member updates.

3. Through the practice access interface (see point 5 above) practices are able to update their details online. Currently 36% of the GP practices in South Australia have applied to have this access.

4. An annual validation confirming all health provider’s details is conducted.

Now that the HPRy has been operating for 5 years, the brand and importantly the trust of the HPRy at the practice level has been established. This means the practices know who we are and see us as an important part of the communications for their practice. The HPRy has expanded to include other providers at the location level such as aboriginal medical services, aged care facilities and prisons for the purpose of discharge planning. Private hospitals including Calvary HealthCare Adelaide Ltd. also use the registry to distribute discharge letters to doctors.

SADI is currently working with HealthConnect SA to include Allied Health care providers in the HPRy as part of the development of a web-based care planning system. This will allow GPs who create online care plans to communicate electronically with other health care providers involved in their patients care via the HPRy address book.

Delivery of separation summaries from careconnect.sa so they can be directly imported into a specialists or GPs’ electronic health records will shortly be available, eliminating the need to scan.

The HPRy is currently working with General Practice Queensland in the development of their iHealth Care Directory and is in discussions with other states. There is the potential here for a national network of provider directories based on the South Australian model and technology.

The HPRy utilises open standards (HL7) and open source software (Linux). The HPRy is a professionally managed service that is governed by a Service Level Agreement with users of the data ensuring a high availability but also a sustainable user pays model. This inspires a level of confidence in such registries by organisations responsible for delivering patient care.

The HPRy is neither just a piece of technology nor an address book. It is an enabler of communications and a core piece of infrastructure that is required by any statewide or national system aiming to improve the flow of information between health care providers. It is also a tangible and practical achievement that the divisional network has delivered to its members and that they and their patients benefit from on a daily basis.

NEHTA Xavier Toby

Australia joining the world to develop open source e-health tools Imagine a health system where patient information is shared between a doctor’s office, hospital, lab and even equipment like a heart monitor. That’s the goal of interoperable electronic health (e-health), and Australia, through NEHTA, is working with international organisations on the building blocks that can make this happen.

“The goal is that health information will be available to healthcare professionals regardless of where you are in the country,” said Andy Bond, chief architect for the National E-health Transition Authority (NEHTA). Once an interoperable health system is fully operational, patient information can be shared.

“The end result will be that patients receive a higher standard of care,” Mr Bond said.

An international project involving national health agencies, government-funded organisations, businesses and academic institutions from the UK, US, Canada and Australia was announced on April 8. These organisations will share expertise and work together to produce Open Health Tools (OHT), the building blocks necessary for an interoperable e-health system.

“Previously, work in e-health has been fragmented. OHT will set up a common set of tools for creating the infrastructure.

There is no better way to build interoperability than to begin with that common toolset,” Mr Bond said.

“The point of interoperability is not to link the whole community together from the get-go, but to create an environment in which linking different systems together is simple,” explained Andy Bond.

“The telephone network and the Internet are examples of successful interoperable platforms. These systems enable people using a range of different devices to communicate using one platform. Each system might be built in isolation, but because they are built on common standards and infrastructure, they work with other systems without much modification,” Mr Bond added.

The OHT platform is the “health service’s spine” and conceptually, will work in a similar way to the power grid.

Power is produced in many different forms, then provided as electricity to appliances and equipment that plug into the grid. In the same way, software components based on the OHT framework will be able to plug into the platform. The open source nature of the OHT code means there will be many

thousands of developers contributing to and testing it, ensuring high quality.

Executive director of OHT, Skip McGaughey commented, “Advancements in medical procedures and patient care have changed the way the world views health. However, modern healthcare information technology has not kept pace with the complexity of today’s healthcare systems. Research suggests annual savings of $77.8 billion in the United States alone from the introduction of healthcare information exchange and interoperability.”

The development of an international database of clinical terms is one of the first applications of OHT. SNOMED CT (Systematised Nomenclature of Medicine Clinical Terms) is being developed internationally, with NEHTA the custodian of the Australian license. It contains about one million phrases, and different nations will be able to edit and add to that terminology. Only by adopting a common toolset is this possible.

In Australia, applications developed using the principals of OHT are slowly being introduced.

“At the moment we are creating building blocks with the ability to communicate. When these blocks start working together people will notice the biggest difference,” Andy Bond said.

The first tangible benefit of e-health most people will notice is the introduction of a unique health identifier or eHealth ID, due around 2010. At the moment hospitals, clinics and other health services all identify patients in different ways.

“The eHealth ID is necessary for the new systems to properly communicate. It’s one of the fundamental building blocks, and is a voluntary program. No one will be denied healthcare if they have no eHealth ID, but using one will allow a new level of care,” Andy Bond explained.

As e-health applications are rolled out, some patients may notice their clinicians are better informed as early as 2009, as a result of the new systems. Early e-health innovations will include the ability to receive pathology results and referrals electronically, and prescriptions being sent directly from the doctor to the pharmacist.

“Co-ordinated health care and the ability to share records on a national level to improve the healthcare system for all Australians is the ultimate goal,” Mr Bond said.

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

eRedBook v1.0 The Australian Government focus on preventive health care is welcome news. The RACGP’s Red Book is undergoing an e-makeover that will ensure that GPs remain at the centre of any preventive care strategy.

INITIAL DEVELOPMENT In 2005, as part of its Phase Two Work Program, the General Practice Computing Group (GPCG) contracted Pen Computer Systems (PCS) to develop an electronic prototype of the Guidelines for preventive activities in general practice (colloquially known as the Red Book). The purpose of this project was to demonstrate that a clinical guideline of this type could be developed into a decision support tool. The eRedBook would be interoperable with GP clinical software and deliver patient-appropriate clinical reminders for preventive health activities.

In that project, interoperability specifications were developed to assist clinical software vendors in configuring the eRedBook software to their respective clinical systems. This resulted in an eRedBook that was demonstrable with three clinical packages (Medical Director, Locum and MedTech32).

Each package delivered the Red Book advice in a consistent and reproducible manner using a published interface. This project was acknowledged as a successful step in electronic decision support from the Integrated Care Program Phase 2 project in which DoHA and its Joint Venture Partners invested between 2001 and 2004.

At the conclusion of this pilot, it was recognised by the GPCG that there was still more to be done to complete the delivery of the eRedBook from a paper-based resource to an e-format that can be widely and reliably used in general practice.

CURRENT DEVELOPMENT With funding from the Managed Health Network Grants, the RACGP and PCS have continued development of the eRedBook based on the 6th edition guidelines. The end point of this project will be an XML version of the eRedBook ready for integration with clinical software packages. The second deliverable is an eGuideline Editor to remotely update eRedBook content. This eGuideline Editor will be a technological solution to outdated paper-based resources.

This second phase is not a pilot, but an actual implementation of an electronic decision support tool

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designed to improve the quality and consistency of advice clinical software packages offer during patient consultations.

HOW ARE WE GOING? The further you get down the path, the more you can see just where you are headed, and this path has a few speed bumps.

Development of the eRedBook has highlighted a number of issues that require further attention from a range of parties.

Once again, it gets back to the need to build firm eHealth foundations.

Demographic rule sets are able to refine risk data sets to a certain level. However, the development of complex decision support matrices is dependent on reliable and “usable” information relating to a range of histories and diagnoses being available in clinical software. Whilst some data may exist in a format that is reliable (e.g. tick boxes and pick lists), there is still a lot of data that lives in free text boxes. This may be relatively common in clinical packages, but it does make data useless for any number of interrogation tools, including the eRedBook.

In looking to future versions of the eRedBook, the RACGP and PCS will continue to develop complex rule sets that — using the eGuideline Editor — can be integrated as clinical software packages change and evolve. A “mapping” exercise also needs to take place, to be confident that all possible locations for eRedBook related data within the clinical software are recorded.

Version 1.0 of the eRedBook is an example of the tremendous steps that can be taken toward competent and reliable decision support tools that are interoperable with clinical software. Thinking about Version 2.0 is equally as exciting, but we need to create headway on other fronts in order for that to happen.

Just the other day I caught myself at my desk looking off into the distance and wistfully imagining a world of functional specifications for clinical software packages and the widespread uptake to SNOMED-CT. That’s not too much to ask, is it?

GPCG eRedBook Project http://tinyurl.com/5ldlyj RACGP Redbook http://www.racgp.org.au/redbook

STANDARDS AUSTRALIA Elizabeth Hanley Senior Project Manger, Human Services, Standards Australia elizabeth.hanley@standards.org.au

Standards Australia: Health Informatics IT-014 STANDARDS AUSTRALIA Standards Australia is recognised by the Government as Australia’s peak Standards body. It coordinates standardisation activities, develops internationally aligned Australian Standards of public benefit and national interest, and facilitates the accreditation of other Standards Development Organisations.

Standards Australia is a not for profit organization Over the past few decades, as trade liberalisation has brought down tariffs in many parts of the world, Standards have been applied in international trade with growing intensity.

Standards Australia, as the nation’s official representative at the International Organisation for Standardization (ISO) and International Electrotechnical Commission (IEC), plays an important role in developing these new International Standards and in ensuring our interests are heard.

IT-014 HEALTH INFORMATICS TECHNICAL COMMITTEE Standards Australia’s IT-014 Health Informatics Technical Committee, supported by ten subject area sub-committees / working groups, develops Australian Standards and related materials that will support the national goal of interoperability across the health sector, and align with and influence international e-health developments. The integration of the IT-014 program of work into the national e-health agenda has been supported by acceleration funding from the Australian Government since 1999.

Standards Australia has, through the leadership of IT-014, now published over sixty standards, technical specifications and related documents in e-health to enable sharing and communication of clinical and administrative information between health care providers, and to contribute to health service improvement and patient safety.

The Standards Australia e-health website provides quick access to published standards and guidelines, information about IT-014, its work program and documents for comment, and links to organizations and activities in e-health. The site gives direct access to current Australian e-health publications for free download via the SAI Global Webshop.

E-health focuses on the use of information and communication technologies to improve the delivery of health services, and its uptake is growing rapidly. Most developed nations now have substantial e-health programs. Australian interests at key international health informatics standardization meetings are represented through targeted participation

of Australian delegates to progress the national priorities for international e-health standardization.

GLOBAL HEALTH INFORMATICS STANDARDIZATION Because of the globalisation of trade, and healthcare, as well as the pervasiveness of information and communication technologies, International Standards are in demand more than ever. Increasingly, the use and referencing of International Standards, based on stakeholders consensus, form part of good regulatory practice and good public governance around the world.

International Standards Development Organizations (SDOs), their respective technical committees and their stakeholders for health informatics standardization have collectively identified a need and opportunity to collaborate, coordinate and cooperate in delivering global, implementable standards. CEN/ TC 251, ISO TC 215 and HL7 have agreed to collaborate in the spirit of mutual appreciation, respect and openness to seek pragmatic solutions to obtain unification of their set of standards for healthcare communication and to make the results globally available to ISO. The Joint Initiative on SDO Global Health Informatics Standardization has been formed to enable common, timely health informatics standards by addressing and resolving issues of gaps, overlaps, and counterproductive standardization efforts. Standardization is the only real solution to semantic interoperability in health informatics and by working together, SDOs will increasingly achieve interoperability on a global scale.

HL7 http://www.hl7.org International Organization for Standardization http://www.iso.org International Electrotechnical Commission (IEC) http://www.iec.ch Joint Initiative on SDO Global Health Informatics Standardization http://www.e-health.standards.org.au/cat.asp?catid=43 Standards Australia http://www.e-health.standards.org.au

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EVENTS CALENDAR CeBIT 20th - 22nd May Sydney, NSW P: 02 9280 3400 W: www.cebit.com.au

MAY

Redesigning Healthcare for the Ageing Population 2008 20th - 21st May Brisbane, QLD P: 02 9223 2600 W: www.iqpc.com.au/ShowEvent. aspx?id=61336

2008 Hospital Bed Management Conference 7th - 8th May Sydney, NSW P: 02 9080 4000 W: www.iir.com.au

General Practice Conference and Exhibition (GPCE) 23rd - 25th May Sydney, NSW P: 1800 358 879 W: www.gpce.com.au

7th Australian Wound Management Association Conference Darwin, NT 7th - 10th May P: 02 6281 6624 W: www.awma.com.au/conferences/ conference.php

7th Annual Electronic Records Summit 26th - 27th May Wellington, New Zealand P: +64 09 379 5892 W: www.brightstar.co.nz

2008 RACP Congress 11th - 15th May Adelaide, SA P: 02 9265 0700 W: www.racpcongress.com HospiMedica Australia 13th - 15th May Sydney, NSW P: 03 9699 4699 W: www.hospimedica-australia.com National Medicines Symposium 2008 14th - 16th May Canberra, ACT P: 07 3848 2100 W: www.nps.org.au/events

HISA VIC Annual Conference 30th May Melbourne, VIC P: 03 9388 2086 W: www.hisa.org.au 2008 AMA National Conference 30th May - 1st June Hobart, TAS P: 02 6270 5459 W: www.ama.com.au

JUNE 8th Annual Adverse Events Management Conference 23rd - 24th June Melbourne, VIC P: 02 9080 4090 W: www.iir.com.au/adverse

ACD 41st Annual Scientific Meeting 18th - 21st May 2008 Sydney, NSW P: 02 8765 0242 W: www.dermcoll.asn.au/public/ meeting_and_conferences.asp

Hospital in the Home 2008 25th - 27th June Melbourne, VIC P: 02 9080 4090 W: www.iir.com.au/HITH

HIMSS AsiaPac08 20th - 23rd May Hong Kong P: +65 6330 6888 W: www.himssasiapac.org

Green Hospitals 26th - 27th June Brisbane, QLD P: 02 9080 4307 W: www.informa.com.au/greenhospitals

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JULY Brisbane Carex 9th - 10th July Brisbane, QLD P: 03 9571 6506 W: www.totalagedservices.com.au/ agedcare.asp 17th Annual Wireless and Mobile Comms Conference 2008 23rd - 25th July Melbourne, VIC P: 02 9080 4090 W: www.iir.com.au

AUGUST ACHSE 2008 National Congress, Health Services Management 6th - 8th August Alice Springs, NT P: 02 9878 1222 W: www.achse.org.au National Public Health Reform Summit 7th - 8th August Sydney, NSW P: 02 9080 4307 W: www.informa.com.au Health Informatics Conference - The Person in the Centre 31st August - 2nd September Melbourne, VIC P: 03 9388 0555 W: www.hisa.org.au/hic08

SEPTEMBER Health-e-Nation 2008 3rd September Melbourne, VIC P: 03 9388 0555 W: www.health-e-nation.com.au ACSA 08 28th September - 1st October Adelaide, SA P: 08 8354 2285 W: www.alloccasionsgroup.com/ACSA

To view more Health, IT, and Health IT events, please visit the Pulse+IT website. Events can be submitted for consideration via the calendar on the website, or via email to: editor@pulsemagazine.com.au

2008 C

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

August 31 - September 2, 2008 Melbourne Convention Centre

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

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

www.hisa.org.au/hic08

INTERVIEW: TOTALCARE

In our second interview for 2008, Pulse+IT checks in with Nat Wong, Managing Director of Health IT software developer, TotalCare.

Pulse+IT: What products does Totalcare develop for the health care sector?

Our primary product suite Totalcare is an integrated Administrative and Clinical system for GPs, Specialists, Day Hospitals and Hospitals. At its most basic, that means everything from registering a patient, booking appointments, all the billing, payments, claims, practice and statutory reporting and financial stuff, to prescribing, diagnostic requests, and the other tools for a comprehensive electronic medical record.

Ancillary to, and extending this, are a number of infrastructure modules such as document management, communications agents and gateways, and even a client relationship management module that records the source of prospective patient contacts, and then can track and analyse these contacts through to surgery.

Pulse+IT: What Totalcare features are new users attracted to?

That really depends on the type of client. I guess our experiences with different types of medical environments have refined several areas of the suite. Running 20+ user GP practices teaches you that you need to be able to book, track and bill patients quickly and accurately. Running a national call centre for specialist appointments hones your booking systems. Running a centralised day hospital group with over 100 concurrent users and several campuses teaches you all sorts of things, as does providing a complete integrated, admission, billing, scheduling, tracking and clinical systems for an overnight stay hospital.

So what does this distil to? Ease of use. Sheer functional power. Reliability.

Pulse+IT: Which competing programs can you import data from?

All the ones that we’ve been asked to!

Over a decade and a half, that’s been a few. Systems change over time, so I guess the most current conversions

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we’ve done have been from Medilink, MSS, Rx, Shexie, Locum, PracSoft and Medical Director.

recipient and generator of messages, so we’re reasonably confident that what we’re doing works.

Pulse+IT: How is the data conversion performed?

In a couple of phases. Typically we run an initial conversion, analyse the results and then refine the process.

We’ve spent a considerable amount of money on virtual infrastructure in recent times, so we’ve been able to leverage this to build complete virtual test environments. This means that a client can see what their converted system will be like. The final conversion typically repeats this process from a dataset snapshot done at the close of business on one day, with all the data converted and loaded for “go live” the next business day.

Has NEHTA’s work program had an impact on the functional direction of your product, and the strategic direction of your business?

I think every vendor is keeping an eye on NEHTA - You tend to do that with the elephants in the room, particularly the ones with the smart people. I must admit to personally being unsure about whether NEHTA are trying to assist the industry to move forward in a timely manner, or trying to design and build the nation’s health records themselves.

From a functional perspective, hats off to their initiatives with SNOMED-CT.

Pulse+IT: Does Totalcare interface with other clinical or practice management solutions?

Yes. Some of the more common interfaces we have in place are for Medical Director, Best Practice, Locum and ProMed. We also have more generic HL7 ADT interfaces for InHospital environments.

Pulse+IT: Which secure messaging products does Totalcare integrate with?

All the usual suspects. Most closely however with Medical-Objects as they seem to have smartest tech around.

Does Totalcare make use of the Australian Health Messaging Laboratory (AHML) HL7 message testing facility, and do you have any plans to have the HL7 message generation and handling functionality of Totalcare certified by the AHML? No, not currently, but it’s something that we’d consider in the future if the environment required it. Pragmatically, we’ve been working on HL7 systems for a decade in outpatient and inpatient settings across the country as both a

From your perspective, which of NEHTA’s work program objectives are you most interested in seeing come to fruition?

We’re keen on the programs that promise simple interoperability. By that I mean, a standardised universal way to identify a drug pack, a diagnostic test or report, a patient, or a service provider. If these ‘simple’ things can be sorted out, I think that all the more complex compound objects such as health summaries and referrals will sort themselves out...and if not, well at least conversions between systems will be simpler and more accurate!

Pulse+IT: How is training and support provided?

We’re one of the few full service vendors, so we like to do these things well. Training is typically done onsite, though we have the facilities for both training in our offices, and for remote group presentation and training over the Internet.

Support is provided both by phone, fax, email and through our website.

Almost everything we can manage remotely, and on the very rare occasions that a physical onsite presence is required, we can organise this too.

Pulse+IT: How many people make up the Totalcare team?

Right now, nine directly. Another 3 in contract roles. Admin aside, we have four software engineers and three on help desk, and perhaps surprisingly, none in sales yet. I say “now”, because we’re still advertising for more staff...so if you work for one of our competitors, you know your stuff and your clients love you, contact us!

Where are your staff and contractors located and what parts of Australia does your organisation service?

Our head office is in sunny Brisbane, Queensland. Most of our team are based there, with a few of our contractors based on the Gold Coast.

We primarily service clients up and down the east coast of Australia, with the odd representations as far afield as Perth and Kuala Lumpur.

Pulse+IT: Overview your pricing structure.

Typically device/seat based. We have some large clients on ‘unlimited’ per facility licensing. The core Totalcare suite

itself is tiered (Professional, Hospital, and Enterprise editions), with the professional edition starting at around $1500 a seat.

We’re not the cheapest, but our value proposition for most clients is normally pretty compelling.

Pulse+IT: In addition to the Totalcare licences, what other costs may organisations have to meet?

For sites that prescribe, there are drug database costs - typically MIMS. We use commercial SQL relational databases, so these also come into the picture.

Hospitals also need DRG Grouper software.

Pulse+IT: How frequently does Totalcare release program updates?

Our build release cycle is typically monthly. However, we are much more conservative when it comes to GA (General Availability) releases. We give our GA releases 4 to 6 months of field testing before widely deploying them. This gives us scope, if need be, to respond to the ‘early adopters’ group daily. In general, being at the bleeding

edge of Health IT isn’t a sensible place for either our clients or ourselves to be.

Pulse+IT: Is professional IT assistance required to perform these updates?

Yes. This gets back to our notion of full service. IT is our core business. It’s not the core business of our clients. We don’t typically consider it a good use of a doctor’s time to be updating IT systems.

In this instance, we can do it more efficiently and effectively.

Pulse+IT: What new features are you working on that Totalcare users should look forward to?

Lots! Expect more Medicare Online functionality for outpatient and inpatient centres. Unified communications.

SNOMED support. Clinical compliance, protocols and Surgical audit. This is on top of the ‘normal’ requirements for changes to state government and health fund extracts, ICD-10-AM Edition 6 and DRG 6.0 support.

TotalCare www.totalcare.net.au

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

Mobile broadband for clinicians INTRODUCTION While 10 years ago, using a laptop outside of your home or typical workplace could be classified as “mobile computing”, truly mobile computing these days infers mobile Internet connectivity.

Unlike the wireless (Wi-Fi) networks found in many homes and small businesses, which sport coverage areas of up to only a couple of dozen metres, mobile Internet solutions utilise mobile phone networks to provide vastly greater coverage zones. Basically, anywhere you are able to use your mobile phone, you should also be able to access the Internet.

BENEFITS While the relatively poor performance of older wireless mobile broadband technologies limited their usefulness, modern iterations perform extremely well with all but the most network intensive applications.

Clinicians can access their email, browse the Web, update their blogs, relax in front of YouTube, download music, and email holiday photos within minutes of them being taken.

Thanks to recent performance improvements, the use of Skype and other computer-based Voice over IP (VoIP) and video conferencing solutions is now also feasible, albeit with slightly lower voice and video quality when compared to wired Internet connections.

Remote access Over and above these generic computing tasks, the most obvious benefit mobile broadband affords clinicians is the ability to access their practice database remotely, regardless of their physical location. Typically this access can be facilitated via remote access solutions such as Terminal Services, VNC, pcAnywhere, Citrix, or one of the myriad of other proprietary solutions available.

With some practice software products, directly accessing the database is also feasible, although it is advisable to check with your practice software vendor and IT support professional to ensure adequate security measures are in place.

Mobile remote access can be particularly beneficial to clinicians in settings such as hospitals and aged care facilities where suitable Internet access is typically either heavily restricted, or nonexistent.

While many clinical software packages have long had “briefcasing” or off-site synchronisation functionality, remote access negates the need for databases to be copied from

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the practice’s server to the laptop, and later synchronised. By alleviating the need for clinicians to transport their clinical data on their laptops, the chance of such data being stolen along with the laptop is effectively eliminated.

Redundant Internet connectivity With the exception of medical practices that host their practice software in a remote data centre, the temporary loss of Internet connectivity in most medical practices is typically classed as an annoyance rather than a catastrophe. Despite this, there are an increasing number of clinical and administrative functions that cannot be completed in a timely fashion during periods of Internet downtime.

Online verification of patient details and other Medicare Online functions, the downloading of pathology and radiology results, secure messaging, automated bank reconciliations, and online backups cannot be performed in the absence of an active Internet connection. Coupled with the fact that both Shared and clinician accessible Personal Electronic Health Records are starting to emerge, medical practices will be in less of a position to tolerate Internet outages.

With these considerations in mind, many practices may find the instigation of a redundant Internet connection that is not dependent on the copper wire telephone system to be a worthwhile exercise. An automatic “fall over” system that will utilise a wireless connection in the event that the practice’s primary Internet connection fails can be established with minimal investment in hardware and IT expertise.

TECHNOLOGY While all mobile broadband technology is often referred to as “3G”, this umbrella term encompasses a range of telecommunication technologies that have widely varying capabilities and performance profiles. The confusion generated by this term is compounded by the fact that many mobile wireless broadband solutions are able to connect to multiple network types, and seamlessly switch between these based on the signal strength of the available networks. In short, the term 3G does not convey any useful information and should be dismissed as a marketing buzz word.

The two terms that would-be purchasers of mobile broadband solutions do need to be aware of are HSDPA (High Speed Downlink Packet Access) and WiMax. WiMax was the wireless network technology that the now defunct OPEL consortium had planned to roll out to

complement an investment in ADSL technology. With the OPEL contract having recently been cancelled by the Federal Government, the chance of WiMax becoming a widely deployed network infrastructure in Australia in the near future is slim at best.

A significant investment in HSDPA technology has occurred in recent times, with most of the deployed infrastructure forming part of Telstra’s Next G national mobile network. Optus, Vodafone and Three are also deploying HSDPA technology, however presently, the network coverage provided by these Internet Service Providers (ISPs) is restricted to capital cities and a few major metropolitan areas.

MOBILE BROADBAND HARDWARE Mobile broadband hardware comes in many shapes and sizes: USB As essentially all computers (mobile or otherwise) have USB ports, this interface is the default option for mobile broadband solutions. The modems vary in shapes and sizes, but are all typically around an inch wide and two to three inches long.

ExpressCard This portable expansion technology emerged a few years ago, but is not yet a feature in all laptops. ExpressCards are inserted into a slot, which means the awkwardness of having an external device can be minimised (however note that most have antennas that protrude outside the laptop case).

Because the technology is geared towards mobile devices, an ExpressCard can’t easily be used with a desktop computer, limiting its flexibility somewhat.

PC Card (PCMCIA) The long-lived precursor to ExpressCard technology, the PC Card interface is still supported by several ISPs. It should be noted however, that ExpressCards can be inserted into PC Card slots using an adapter. For this reason, if the user wishes to purchase a card-based modem, the author recommends

Left - A Linksys WRT54G3G wireless broadband router designed to provide Internet access to multiple computers. Right - A Bigpond 7.2 USB Mobile Card for use with a laptop or desktop computer.

purchasing an ExpressCard and an adapter instead of a PC Card to minimise the chance that the modem will be made obsolete by the purchase of a new laptop without a PC Card interface.

Desktop solutions Desktop solutions are also available, but their size and requirement for an external power source limit their suitability for mobile use.

Wireless broadband routers Hardware solutions exist that can route the connection from a wireless mobile broadband modem to an entire Wi-Fi or cabled

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Ethernet network. Similar to an ADSL router in appearance, these devices typically contain either a USB port, or a PC Card or ExpressCard slot to allow one of the aforementioned types of wireless broadband modems to be connected.

While not suitable for mobile use, this type of device is ideal for establishing a redundant Internet connection of the type described earlier in this article.

Internal capabilities As occurred with short range wireless (Wi-Fi) networking solutions some time ago, laptop manufactures are starting to include wireless mobile broadband capabilities in their core feature sets. Smartphones, Ultra-Mobile PCs and laptops are emerging that support HSDPA networks, requiring only that the user inserts an ISP SIM card into the designated slot. As the antenna and modem technology is fully integrated into the device, the user will not require any additional hardware to access wireless broadband networks.

Mobile phones For many years, it has been possible to share a mobile phone’s network connection with a laptop or desktop computer using a USB or Bluetooth connection. As you would expect, many present day phones also offer this functionality, albeit at much greater speeds and lower costs than their ancestors facilitated.

Before purchasing a wireless mobile broadband modem for use with your laptop, it is recommended that you check to see if you could instead utilise the network capabilities in your phone to access the Internet.

PERFORMANCE The theoretical capacity of Telstra’s Next G network is currently 14.4MB/s, however this is slated to be increased to an impressive 40MB/s in 2009.

Despite the capacity of the network, currently shipping mobile broadband modems top out with theoretical download speeds of 3.6MB/s and 7.2MB/s, however Telstra quote lower “typical speeds” for their service.

As with all wireless technology, real world performance will vary greatly, and is dependent on many factors such as the distance of the modem from a mobile tower, whether you are indoors or outside, what the surrounding buildings are constructed from, whether you are using an external antenna, and how many people are accessing the network simultaneously.

Using Bigpond’s “7.2 USB Mobile Card” in Canberra, the author was able to download a 100MB file in 250 seconds.

Uploading the same file took 670 seconds, for real-world download and upload speeds of 400KB/s and 152KB/s respectively.

For the purpose of comparison, the same file was transferred using an ADSL2+ connection registering a link speed of 12MB/s and 1MB/s in the download and upload direction respectively. Downloading the file took 90 seconds and uploading it took 980 seconds. While the ADSL2+ connection out performed the wireless technology in the downstream direction, the performance of the wireless connection was still impressive, soundly trouncing the ADSL2+ connection in the file upload test.

It should be noted that pure upload and download performance is not the only indicator of the performance of a

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network connection — a characteristic of mobile broadband solutions that needs to be pointed out is that they have a higher latency profile than cabled connections.

Ad hoc testing of the performance of the author’s Bigpond Next G connection produced ping response times of around 90ms, however on the odd occasion, the response time slowed to as much as 400ms. By way of comparison, the author’s ADSL2+ connection registered a ping response time of 20ms, 33% better than an ADSL connection that clocked in at 30ms.

Technical jargon aside, the higher latency basically results in an Internet experience that is slightly more “jerky” than that associated with a modern hard-wired connection. For many typical tasks such as email and web browsing however, the difference between an ADSL or cable connection and a wireless broadband connection will barely be noticeable.

While Telstra’s Next G network touts a coverage footprint of around 99% of Australia’s population, other ISPs offering mobile broadband services rely on slower GSM networks to provide Internet access to their customers outside of their broadband coverage areas. The net result is that when a user of one of these services travels outside of the coverage area, the performance of their Internet connection will dramatically decrease, and they may be liable for exorbitant “roaming” data charges.

COSTS Compared to wired Internet services, the costs associated with wireless mobile broadband are not trivial. Prices have been steadily falling since Optus, Vodafone and Three deployed HSDPA technology, however it is made apparent by Telstra’s pricing structure that the organisation does not consider the smaller mobile broadband ISPs as serious competition at this point in time.

Due to the variable nature of prices and data plans, a comprehensive cost comparison of the various mobile broadband services available is outside the scope of this article. As with mobile telecommunications, there are a wide array of plans available and it pays to shop around and take advantage of the try-before-you-buy options on offer.

CONCLUSION Mobile broadband technology has, and continues to, evolve rapidly, improving in both performance and coverage. As with the introduction of mobile phones, mobile broadband will give rise to new products, services and workflows that were not previously feasible.

The technology promises positive implications for the delivery of healthcare, providing clinicians with timely access to information at the point of care, where ever that may be.

With computer and phone manufacturers starting to build the technology into new hardware offerings, mobile broadband will rapidly become more pervasive, and ultimately, common place.

Presently, viable competition for the wireless broadband capabilities of Telstra’s Next G network only exists in capital cities, and the recent unwinding of the Opel contract by the Federal Government means that this situation is unlikely to change in the near future. Baring regulatory intervention or a significant investment in HSDPA infrastructure by a consortium of smaller ISPs, the mid-term prospects of national mobile broadband competition emerging are not much better.

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

An introduction to mobile computing hardware for clinicians INTRODUCTION This article is the first in a two-part series designed to outline some of the mobile computing options available to clinicians.

According to Wikipedia, “mobile computing is a generic term describing one’s ability to use technology ‘untethered’, facilitated by devices which provide mobile computer functionality”.

In this instalment, the author will outline some of the hardware options designed for mobile use, with a subsequent article to feature in the August 2008 edition of Pulse+IT providing coverage of the various clinical software applications developed specifically for these devices.

HARDWARE OPTIONS Even as late as the turn of the century, the vast majority of computers fell into either “desktop” or “laptop” categories.

Since then however, the lines between computer classifications have blurred, with a wide variety of devices of different shapes and sizes deserving recognition within their own computing class.

Following is an overview of some of the mobile computing options now available, arranged (roughly) in form-factor size from smallest to largest: Smart phones With similar dimensions and computer processing requirements, Personal Digital Assistants (PDAs) and mobile phones were always destined to converge. With very few exceptions, traditional PDAs without phone capabilities are no longer developed, the market having been superseded by a booming smart phone industry.

While the term “smart phone” is flexible and difficult to define, for a modern phone to qualify as being “smart”, it would usually have email, Internet, calendar and address book functionality, the ability to synchronise calendar and address book information with a computer over Bluetooth or USB, and the ability to share it’s mobile network connection with a computer using these interfaces.

Smart phones typically feature QWERTY keyboards or allow the user to interact with the device using a stylus, and also feature relatively large screens (over 200 x 200 pixels)

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compared to less capable and less expensive phones.

Modern smart phones typically run either the Microsoft Windows Mobile operating system, the Symbian OS, or RIM’s BlackBerry OS. Portable versions of the Linux operating system are also beginning to emerge on some smart phone hardware platforms. As these operating systems are more functional than the simple interfaces found in cheaper mobile phones, and because the hardware upon which they run is also superior, developers are able to build reasonably sophisticated applications for smart phone devices.

While not yet distributed officially in Australia, Apple’s iPhone is likely to have a dramatic effect on the smart phone market in this country. Featuring a sophisticated touch screen interface, the device has attracted the attention of millions of consumers overseas.

Software developers have also shown great interest in the iPhone, and indeed, ever since the launch of the device, programmers have gone to extreme lengths to make the iPhone more compatible with new and existing mobile software products.

Noting this interest, Apple has recently released an officially sanctioned Software Developer Kit (SDK) that was downloaded by over 100,000 would-be iPhone developers in the first four days of its availability!

Ultra-Mobile Personal Computers (UMPCs) According to Wikipedia’s definition, “Ultra-Mobile PCs have “a 20cm or smaller touch sensitive screen with a minimum resolution of 800 x 480 pixels”. They are larger and more powerful than smart phones, and usually run fully-fledged operating systems such as Microsoft Vista or Linux. Users interact with UMPCs using either a stylus or a miniature keyboard.

As their name suggests, the devices are designed for mobility first and foremost. They typically utilise diminutive processors with lower power requirements than those found in laptops in an effort to off set the small battery size and maintain a reasonable running time between charges.

Many UMPC manufacturers are starting to integrate high-speed mobile broadband Internet capabilities (typically HSDPA technology), allowing the user to get online where ever they may be.

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Tablet PCs Touted as the “next big thing” several years ago, Tablet PCs have, to date, only accounted for a minute fraction of all PC sales. That said, improvements in hand writing recognition technology, falling costs, and more streamlined industrial designs have sparked a resurgence in interest in this class of computer.

Tablet PCs can be generally classified as either being a “convertible laptop”, or a “slate” Tablet PC. As the name would suggest, convertible laptops look outwardly like typical laptops, but allow the screen to swivel 180 degrees horizontally, and then fold down over the keyboard. In this configuration, the user is able to carry the device in one arm, and use a stylus to write directly onto the screen.

Slate Tablet PCs, on the other hand, lack keyboards, requiring that the user interact with the system using a stylus

Anti-clockwise from top left - Apple iPhone running the iPhone OS, a modifed version of MacOS X (left) and a HTC S310 Smartphone (right), HTC Shift Ultra Mobile PC running Microsoft Vista, Motion Computing LS800 Slate Tablet PC, Fujitsu Lifebook T2010, Philips CliniScape Mobile Clinical Assistant.

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pen or voice recognition software. Slate Tablet PCs are usually thinner and lighter than convertible laptops with the same screen size, and are therefore more suitable for mobile use.

Due to their lack of a built-in keyboard, slate Tablet PCs are usually offered with an optional docking station to allow the user to connect a keyboard and other devices such as an optical drive, which are also typically omitted from this class of device.

Handwriting recognition was first bundled with Microsoft Windows as part of the XP Tablet PC Edition, first released in 2002. Since then, Microsoft’s handwriting recognition technology has improved and is now included in all versions of Microsoft Vista except the entry level “Home Basic” flavour.

Clinical Tablets Spurred by Intel’s promotion of a “Mobile Clinical Assistant” reference model, at least two hardware manufacturers are producing Tablet PCs designed specifically for deployment in healthcare environments.

Motion Computing was first out of the gate with their “C5” device, however Philips have since developed a competing product called the “CliniScape”. Both devises are similar in appearance to slate tablet PCs, lacking keyboards and relying on digital pen technology for interaction with the device.

Designed for use in Hospitals and Aged Care facilities, they are and sealed to allow them to be wiped down and disinfected. The devices can be configured with RFID and barcode readers, and also feature integrated digital cameras to allow photos to be taken and transmitted to other clinicians in the hospital via built-in wireless networking capabilities.

Laptops Having been around for over two decades, this form factor requires no introduction.

Despite the rise of more capable smart phones and UMPCs, the balance of power, functionality and portability laptops provide is likely to ensure they remain the form-factor of choice for most mobile computer users.

PURCHASING CONSIDERATIONS While it is easy to get drawn in by a new computer’s “cool gadget” factor, the hardware is actually the last thing you should think about when selecting a mobile computing device.

Instead, it is advisable that you first identify the software applications that you would like to use. Once you have this information, you should be able to identify the operating systems supported by this software, and find out whether the application has any specific system requirements that may limit your options (e.g. a minimum screen size or Wi-Fi features).

Armed with this information, you should then be able to identify the form-factor that will be most suitable for your purposes, and finally, make a decision as to the brand and model of the device.

CONCLUSION Never before have consumers had a greater range of mobile computing hardware options to select from. With continually falling hardware prices, a strong Australian currency, and rapidly maturing technology being released all the time, it is conceivable that many consumers will ultimately end up with not one, but several mobile computing devices in their arsenal.

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FEATURE Dr Paul Mara MBBS, FRACGP, FACRRM, Dip RACOG, is a rural doctor practising in Gundagai, NSW.

Email etiquette tips It is amazing to consider the extent to which computers have entered all facets of our lives, and the fact that our adoption of technology has happened in such a short space of time. But one man’s boom is another man’s burden and more than most technologies, this reliance dichotomy comes to the fore with email.

Whereas ten years ago, sending and responding to email may have occupied only a few hours of our time per month, many people now spend a similar amount of time devoted to these tasks each day!

Coupled with the burden of legitimate email, spam can be a significant headache. Now representing the vast majority of emails sent worldwide, spam burns up bandwidth and is costly and time consuming to control. But spam is only one of a number of things I find frustrating about email — following is a collection of email etiquette tips that may help to minimise the others:

subject lines, and it is difficult to sort email without them.

Another pet hate of mine is people who classify all their emails as urgent or put “READ THIS NOW” in bold. I usually ignore these.

To, CC and BCC We’ve all seen this and it is my pet hate. When sending email, if you absolutely must send the same email to a group of people, do not include everyone’s email address into the “To” or “CC” fields. I do not want my personal email address promoted to the world and this is what happens when it gets sent to people I don’t know or don’t want to know.

Even worse is when the limited few on your email list send a “reply all” and include their own email recipients — propagation of your email becomes exponential. This is a problem perpetuated by some of our medical organisations and local divisions of general practice, and seems to come in waves. Worse still is when my personal and private email address is used by people who send the latest email joke, or pass on a virus report (usually with the virus), or make a political statement to everyone in their address book. This is a cry for attention, not a public service.

Use the “BCC” field (but see below) and include your own email address in the “To” field, or better still, use a proper email list system designed for efficient group correspondence.

The “To” field should be only for those you are directly sending the email to. The “CC” field is only for those you indirectly wish to be included in the correspondence.

The “BCC” is seen in some quarters as being unethical and fraught with danger. What’s to stop a “BCC” recipient simply acknowledging receipt using “reply all” thereby telling the world “Hey I got this too”?

Formatting and graphics Emails can be sent as either simple text or in format rich HTML. People like to express themselves, and we all think we’re the world’s best designers, but do we really need email to confirm our identity?

Of course we never say never but is it always absolutely necessary to use six fonts in twelve different sizes and multiple colours to make our point? And adding graphics to your email to make it look like a book or including a background with your kids, dogs, bird or latest holiday snap is just too much. Save the fancy stuff for your personal website.

Email priority and the subject line Make sure you put an appropriate heading in the subject line of your emails. Some spam filters block emails with blank

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Block letters In email parlance, capitalising significant passages of an email is akin to shouting aggressively. Not good form.

Flaming Flames are simply verbal attacks that are usually, but not exclusively, associated with email lists and web forums. Think before you write. If someone writes something that really gets up your nose it may be better handled over the phone or simply ignored. The immediacy of email means that the heat of the moment can become a bushfire, destroying trust and relationships and preventing considered discourse.

Abbreviations Public servants love acronyms. Ever been in a meeting with people talking about the GPRG or the RIPIC etc? My head spins. And BTW, FWIW and IMHO, TNSTAAFL so TIOLI, TTYL. Use smilies and other character strings that are meant to represent emotions, sparingly. The fact that you think what you have just written is funny or sad doesn’t really interest me. :-D Make your signature useful and secure Ever had those “get back to me soon” emails, but you think a phone call is more appropriate but don’t have the number?

I include my name and contact numbers on all emails where ongoing dialogue is needed.

And a word of warning: you probably shouldn’t include a scanned version of your signature in your emails. Some people might find it useful to access your bank account one day.

Keep attachments to a reasonable size Just because you have the latest high-speed broadband

technology, it doesn’t mean that your recipients enjoy the same access to the Internet. Many ISPs and mail systems are now quite generous when it comes to the size of the attachments they allow to pass through their systems (5-20MB or more), but this doesn’t mean you need to use it.

With this in mind, don’t send full sized photos of your holiday.

While you’ve been slacking off, I’ve been working and don’t want to see them anyway! Reduce the size of those pictures using the software provided with your camera or operating system before emailing them.

Check the size of your attachments before sending - if they are large, check with the intended recipient before bombarding their inbox. Alternatively, consider using a free web service designed specifically to store documents for subsequent download by the intended recipients.

Security Unless, and sometimes even if, you use encryption the contents of your emails are not secure. Don’t send something to someone you wouldn’t like going further. Even if you do encrypt the email what guarantee have you that the recipient’s computer is electronically or physically secure? They may download the email, unscramble it, and then accidentally or mischievously forward it to someone else.

Don’t send personal emails using the office system or use your work email for lists or personal communications. Using your work email for personal correspondence means that at least part of every working day is spent replying to friends instead

of working. Not only are organisations able to monitor email usage, but some consider that an email sent from work is an official company communication.

Be cautious with patient information While the previous etiquette rules can probably be ignored without severe consequences eventuating, the same cannot be said for this tip — standard unencrypted email should not be used to send patient information to other health professionals.

All emails you send and receive are susceptible to being intercepted during their transmission throughout the Internet.

While the chances of this happening to you is unlikely, email snooping is not a technically complex operation for a determined miscreant to perform, and more over, there is no way you will know that it is even happening.

Fortunately, there are a number of products and services dedicated to secure electronic messaging that will integrate with most modern clinical software packages. Speak to your clinical software vendor, the colleagues with whom you most frequently correspond, and your division, with a view to selecting and implementing one or more secure messaging solutions to reduce the amount of paper flowing in and out of your practice.

If you happen to receive an email correspondence containing potentially sensitive patient information from a colleague, congratulate them for taking steps to reduce the burden of paper, but then strongly advise them of the potential breaches of patient privacy that may result by their actions.

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

Scanning workflows While the scanning functionality implemented in the various clinical software packages vary somewhat, nearly all software options on the market allow documents to be scanned directly into a patient file one at a time, or scanned using third-party scanning software and later linked to the appropriate patient records in a batch.

This article outlines these approaches in more detail, and also includes some tips for practices considering the process of scanning their patient record archive.

SCANNING TO THE PATIENT FILE DIRECTLY This workflow typically involves opening or nominating a patient record in the clinical software, scanning a document, and finally, giving the resultant file a name or description. The file is automatically linked to the patients record for subsequent retrieval by the clinicians in the practice.

This approach is often utilised in Specialist practices as it allows, for example, a referral to be scanned by reception staff at the time the patient presents for their appointment. GP practices may find this “real-time” approach to be effective also, however results will vary widely due to factors such as patient throughput, staffing levels, and front desk ergonomics.

This ad hoc scanning approach is also efficient when only a few documents need to be scanned, however it isn’t a recommended workflow when a large collection of documents require digitization due to the overheads associated with manually opening or nominating patient records.

BATCH SCANNING Batch scanning describes the process of scanning a collection of documents and saving them as files, and at a later time, linking these files to the appropriate patient records in the practice’s clinical software. Batch scanning will be the most efficient way to process a collection of documents associated with a set of different patients.

Most scanning software will allow the user to fill the document hopper with pages, press a button, and walk away and attend to other tasks. Under this arrangement, the following is possible: 1. each page can be automatically saved as a discrete electronic document; or 2. all pages can be saved into a single electronic document.

It will be well understood by practice staff, however, that neither of these outcomes are ideal. In the first case, multi-page documents are separated into multiple electronic documents.

While each page can be linked to the patient, or the files may be first merged into a single document prior to linking to the patient record, this is ultimately another step in a process that is arduous enough! In the case of the second option, staff are restricted to putting a single document associated with

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a single patient into the hopper before scanning. As a result, the process needs to be repeated for each document and the efficiency of this “batch scanning” workflow is undermined significantly.

Fortunately, scanning software exists that allows “separator pages” to be placed between each document in the hopper, allowing documents for different patients of to be scanned sequentially, regardless of their length.

These separator pages are typically generated and printed to A4 paper by the scanning software, and simply feature a unique image or bar code that, when scanned, indicates to the software that a new electronic document needs to store the subsequent pages.

By using software that supports separator pages, practice staff are able to place an entire hopper load of pages into a document scanner, initiate the scanning process, and have created for them a single file for each logical document placed in the hopper. The resultant electronic documents can then be linked to the patient records in their clinical software.

For this process to work, clinicians and practice staff need only be “trained” to place a separator page on top of each document placed in the “to be scanned” tray.

While a detailed discussion is outside the scope of this article, it should be noted that separator pages can convey far more information to the scanning software than just the fact that a new electronic document needs to be started. By no means an exhaustive list, different separator pages and associated scanning scripts can be created to tell the scanner to do one or a combination of the following: • Scan the subsequent document at a specific resolution.

• Scan the document in colour instead of black and white.

• Scan both sides of the page or just the front.

• Use a specific naming convention for the document.

Regardless of the clinical software package you use, it is advisable to attempt to establish a workflow where only one of the following has to occur manually: 1. The naming of the scanned document file.

2. Entering a description (meta data) of the file in the clinical database to facilitate easy identification of the document by the clinician.

Given that it is feasible for scanning software to automatically name each document with a date and time stamp (or other naming convention), but not possible for said software to intelligently input meta data into a clinical database, it is the author’s recommendation that practices use an automated file naming process and undertake to manually enter meta data about each newly imported document. Once stored in, or linked to, your clinical database, and superseded by document meta data, the file name of the electronic document will cease to have any relevance to the clinician.

RETROSPECTIVE SCANNING While many practices are now endeavouring to scan all new incoming documents, a much lower number have undertaken the task of scanning their existing patient files.

Typically undertaken using a workflow that resembles the batch scanning process outlined above, the shear size of the task of retrospective scanning warrants the mention of some specific tips: â&#x20AC;˘ It goes without saying that the scanning of oneâ&#x20AC;&#x2122;s paper patient records archive is unlikely to be a trivial exercise. Before committing to such a task in earnest, it is recommended that the practice pilots the endeavour by scanning a selection of their patient files â&#x20AC;&#x201D; all patients with a surname starting with â&#x20AC;&#x153;Aâ&#x20AC;? for instance. The hours involved in this pilot should be tracked to allow for an accurate cost projection to be calculated for the scanning of the remainder of the patient records. â&#x20AC;˘ Donâ&#x20AC;&#x2122;t even consider retrospectively scanning patient files with anything less than a $1000+ dedicated document scanner â&#x20AC;&#x201D; a lesser device will simply not have a duty cycle capable of handling the shear volume of documents. Even if you are in possession of a scanner purchased in this price range, hiring a more robust scanner with a purchase price tag of over $5000 for the period is likely to provide the best results. â&#x20AC;˘ Due to variable paper sizes, paper condition, staples, paperclips, glue, sticky tape, and other â&#x20AC;&#x153;scanning nastiesâ&#x20AC;?, practices should expect that the preparation of patients files for scanning will takes longer than the actual process of scanning the file. For this reason, assigning two staff members to work on

the task simultaneously is advised where possible. â&#x20AC;˘ While selectively scanning parts of a patients file is possible, the fact that a clinician would need to be involved in the process of vetting each file relegates this to being unlikely.

Further, scanning only a portion of the file effectively prevents the files from being destroyed, and for these reasons, it is the authorâ&#x20AC;&#x2122;s opinion that scanning entire patient records is the only practical approach.

Practices that have done this, and have subsequently destroyed or archived their paper notes off-site, report having benefited from increased space in their practice and have effectively eliminated the administrative time spent retrieving and storing paper files.

CONCLUSION From a high level, this article has outlined three well known and established scanning workflows, and made some recommendations as to how each of these may be optimised.

Of course the ideal scanning workflow is the one where scanning doesnâ&#x20AC;&#x2122;t have to be performed at all! Secure messaging can reduce the amount of paper flowing into and out of the practice. While admittedly not a simple undertaking due to the variety of competing, non-interoperable solutions available on the market, there are recurring and exponentially increasing efficiency gains to be realised by practices that are able to open secure electronic communication channels with the healthcare organisations and providers with whom they currently correspond with using paper.

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WZlWdY[Z d[nj ][d[hWj_ed c[Z_YWb YWh[ iebkj_edi # mmm$jejWbYWh[$d[j$Wk PULSE + IT

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FEATURE Greg Twyford Greg Twyford is an independent consultant/technical support provider who has worked in practice IT for nine years, with private practice and a Division role side by side for much of that time. gtwyford@internode.on.net

Remote access using VPN There are a range of approaches to remote access that are used by government departments, large business, and smaller businesses like general practices. One approach that is costeffective and fits the remote access needs of practices is hardware-based Virtual Private Network (VPN) technology for security, with free or proprietary remote control software, such as VNC or pcAnywhere, running inside the VPN “tunnel”.

This two-level approach of hardware-based VPN with remote control software running inside the tunnel has a number of benefits, including good security, moderate hardware and set-up costs, robustness, and ease of maintenance and use.

The VPN can provide a temporary or permanent connection, as desired, with desktop-level access control provided through the remote control software.

I have set-up and maintained a number of these for some time now, and it is clear that the users find them simple to use and that they afford excellent security, so long as appropriate safeguards are maintained.

What I particularly like about hardware-based VPN technology from a philosophical as much as a technological viewpoint is that remote access security is independent of the PCs on either network, especially those holding the practice’s data. Practices so far have chosen to keep all the data at the practice, which facilitates it as being used as part of their backup solution.

HOW IS IT USED? A couple of examples of how the technology has been used follow: Example 1 The husband and wife principals of a nine GP medical centre can both log in after hours from their own PCs at home.

One primarily does the checking and transmitting of Online Claiming batches and accounting for the practice, while care planning and other clinical reporting is done by both doctors.

Occasional out of hours phone requests for clinical information can be satisfied very easily. Server maintenance is performed remotely at times as well.

Individual PCs at the practice are accessed through a single tunnel, with a choice of either VNC or pcAnywhere for remote control, depending on whether remote printing is desired.

Example 2 A GP and his Physiotherapist wife both access their practice server. The physiotherapist mainly uses MYOB for accounting, while her husband does reporting, batching and other clinicalrelated recording and reports.

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WHAT VPN TECHNOLOGY IS IN PLAY? For those not familiar with VPN technology, I will be discussing the flavour known as IPSEC VPN. Essentially, this uses a matching private key at each end of the tunnel to encrypt each packet transmitted over the Internet. It can be contrasted to solutions that use PKI, where the data inside the IP packet has been encrypted before transmission, but the packet itself is not.

The VPN packet is sometimes referred to as a “superpacket”, which is decryptable only at each end of the tunnel. Whilst some IPSEC VPN implementations use software at the remote end of the connection, what I’m describing is an approach using VPN routers at both ends.

The VPN routers in question offer Network Address Translation (NAT), and Stateful Packet Inspection (SPI) firewalling technologies in addition to the VPN itself, so they provide protection to the whole networks at either end of the connection as well.

For more information about VPN and lots of other security technologies, have a look at the Gibson Research Corporation’s weekly “Security Now” column. Episode 17 addresses various flavours of VPN technology.

WHAT THE END-USER SEES Anyone who has used any form of remote control software would be completely at home using this form of remote access.

For those that haven’t used remote control software, try to imagine you are opening another PC’s screen on your desktop and using it as if you were sitting at the remote PC’s console.

The users interfaces with VNC or PcAnywhere software, and the VPN itself is invisible to the end-user.

VNC remote control runs faster over ADSL, and is freeware, but PcAnywhere can allow remote printing as well. This adds flexibility for circumstances where hard copies of financial summaries, reports or care plans are needed for mailing or accounting purposes. Or even printing scripts for home/nursing home visits without returning to the practice first. For many, the extra cost of PcAnywhere may be worthwhile.

THE HARDWARE I’m currently deploying $84 Linksys AG-300 ADSL modem/ router/switch devices. They support IPSEC VPN and the various flavours of ADSL very well. They come with all ports configured in stealth mode and you don’t need to manually touch any port settings when setting-up the VPN. I have practices either using the AG-300, or D-Link DI-804HV VPN routers with ADSL modems in bridge mode. One VPN connection set-up between two Division offices used an existing Linksys router with an existing Cyberguard firewall/VPN router.

THE CONNECTIONS Remote access using the technology outlined works adequately with ADSL 512/128 and better with faster connections. To date I’ve not attempted to use VPN routers with Telstra cable. Perhaps it should stay that way, except that some potential VPN users’ homes may already have it.

The connected networks, even if the remote “network” is a solo PC, require different IP address ranges. Ping works remotely to test connections, the remote network isn’t visible in “network neighbourhood” in Windows and the relevant IP address details and the “pre-share key” are needed when setting up the VPN. VNC and PcAnywhere both use usernames/passwords for desktop security. The VPN routers do likewise for both local and remote administration, so the risks of tampering by persons with access to the remote PC are minimised. Remote administration of the routers adds flexibility, especially during the set-up stage.

Re-enabling it for periods if problems, such as repeated ADSL outages are occurring, can also be very helpful.

THE OPTIONS ADSL connections with static IP addresses are great because they are very simple to set-up in the router. On the other hand, both types of routers I’ve used support the use of dynamic IP addresses and this seems to work reliably as well. For practices still enjoying their Broadband for Health connections, it’s perfectly feasible to just use dynamic IP addressing at the remote site or a service like DynDNS.com. Both ends or one end can use DynDNS successfully.

Configuration options can be varied. The routers support multiple tunnels, which would allow connections to or from several locations. To date, the prevalent option has been the use of a single tunnel with one or more instances of remote control connections running through it. A “many to many” scenario is still possible.

The number of available hosts at either end of the connection may become a consideration in larger installations, where a number of simultaneous connections are desirable.

THINGS THAT END-USERS MUST AND MUST NOT DO The importance of quarantining the kids from the computer used for remote access can’t be stressed enough to end users.

Nor is the importance of closing the remote desktop access when it’s not in use. The worst consequence I’ve seen of not exercising enough care is the deletion of a host configuration, preventing access.

As in any business environment, good security practice is

vital both at the practice and at the remote site, though the risks of a nasty going down the tunnel to the practice should be limited with this configuration.

Can practice “security” ever be guaranteed, or is “good practice” ultimately the adoption of procedures and an implementation that covers as many issues as are known?

THE SHOW-STOPPERS Not actually a show-stopper but a lousy quality ADSL connection that keeps dropping out in mid-VPN session is a big pain in the butt. This is not the place to try to save a few dollars by taking up a “special deal”. Have a look at the Broadband Choice ISP directory and select from one of the ISPs rated highly there.

MTU (Maximum Transfer Unit – the maximum size of a TCP segment/packet) issues may prevent the VPN connecting with some flavours of ADSL2+ until you reduce the MTU settings on the routers and the attached PCs. This occurs because IPSEC wraps and encrypts the packets and adds to their length, so starting with a shorter packet before this occurs can prevent you ending up with a packet whose size is too big for some part of the system. Tools like “Dr. TCP” make this easy on Windows PCs. Optus cable is out. Optus don’t open ports on the cable network full-stop and port 500 is blocked. Don’t waste your time trying to talk them around, like I’ve done.

Various brand-specific VPN implementations aren’t necessarily compatible. For example, the D-link VPN router and the Linksys AG-300, won’t play together, alas. For a simple life, I now use the Linksys at either end.

ACKNOWLEDGMENTS I would like to acknowledge Paul Crewe of Talltrees Consulting, who first introduced me to this approach at a Blue Mountains IT Expo in 2004 and has subsequently given me invaluable support when learning to implement this technology.

Broadband Choice ISP directory bc.whirlpool.net.au Dr TCP www.dslreports.com/drtcp Gibson Research Corporation www.grc.com/SecurityNow.htm

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FEATURE Brent Maxwell BSc (IT, Psych), MACS, is a Sydney-based IT professional working at a multinational IT consulting firm. brent@brentmaxwell.org

An introduction to Microsoft Windows Vista Microsoft’s Windows Vista operating system was released in January 2007, the fruits of a development cycle whose commencement predated the release of Windows XP. With such a long time in development, readers may be led to assume that Vista must be a significant and impressive piece of software. But is it?

effect of this on the user is that during typical (and at times fairly benign), computer use, you are confronted with an endless stream of dialogue boxes prompting you to enter your administrative username and password credentials. One of the risks with this approach to security is that many users are likely to simply disable UAC, thereby nullifying the feature entirely.

ADVANTAGES

Shiny interface Most people agree that the Vista user interface looks nice, and for many, this appears to be one of the major selling points for the operating system. It should, however, be noted that the Vista interface can easily be replicated in Windows XP by using a simple application like “WindowBlinds”, which completely alters the user interface. The obvious benefit of Vista is that the operating system has the theme applied by default, whereas to get the same effect in another operating system requires the installation of a third-party application.

To help you weigh up whether Vista is a sensible purchase for your own home or practice, let’s look at the features likely to effect performance, productivity and usability.

Improved memory management Vista has made minor changes to the way that applications are handled in memory. If you look at your Task Manager in Vista, you’ll find that you have very, very little physical memory free. Compare the exact same hardware configuration, with the same applications running in XP, and you’ll have significantly more memory free. The reason for this is that Vista uses a technology called “SuperFetch” to predict what you are going to do by preloading parts of commonly used applications into memory. This is an evolved version of the ‘Prefetching’ technology used in Windows XP, except that it is far more aggressive and sophisticated in Vista.

Built-in file protection At some point in every PC user’s life, they will be confronted with the accidental deletion of an important file. Vista tries to lessen the chances of this problem impacting people adversely by backing up their files automatically. In the event that the user overwrites a file, or “permanently” deletes it, they will have the opportunity to retrieve a backed up version of the file.

Although most modern productivity applications already have similar recovery methods, this new safety net should decrease the chance of lost data.

Increased security The promise of increased security is one of the main Vista features touted by Microsoft to organisations looking to upgrade operating systems.

Unfortunately, the main method they have employed in upgrading security in Vista is through a feature called User Account Control (UAC). The practical result of UAC is that whenever an application tries to perform system level functions, the user will be forced to authorise the action. The

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Improved search functionality The process of finding files in Vista is quite simple. The Start Menu has a search field embedded that gives you the option to look for files in one click. Vista indexes all the files on your computer, so that you can find files not just by looking for file names, but also by other attributes, or words contained within documents.

This approach has been available in third-party software products such as Google Desktop for a few years now, and is comparable to Apple’s MacOS X Spotlight functionality.

Again, the main advantage here is that with this feature being installed in Vista by default, you do not need to recruit third-party applications for what are considered fairly key features of a modern computing environment. A drawback of the system is that the file index consumes space on your hard disk, and will slow down your system functionally whilst indexing is taking place.

Built-in DVD burning support One of the frustrating shortcomings of Windows XP is that third-party software like Ahead Nero is required to burn DVDs. Conveniently, Vista supports DVD within the operating system natively.

Hard disk level encryption Vista has a hard drive encryption tool called ‘BitLocker’.

This is another security feature which Microsoft has touted, however the feature is only included in the pricey Vista Ultimate

edition. Additionally, volume encryption can be performed by freeware tools like TrueCrypt, so although it is a very powerful tool, it doesn’t fare as a particularly strong selling point for Vista.

ISSUES Despite the aforementioned improvements, Vista has been derided for its shortcomings, some of which are detailed below: System requirements Many customers who have bought Vista pre-installed on laptop computers have complained passionately about how slow their systems run. The reason for this is simple: Vista has higher system hardware requirements than any other operating system.

Many benchmarks have been conducted, the results usually demonstrate that on computers with higher specifications, Vista and XP perform fairly similarly in common tasks such as starting up the computer and opening applications. On computers with lower specifications however, Vista runs much slower than the operating system it has been designed to replace.

There are a large number of features that Vista provides, but a large number of these features are never touched by an everyday PC user.

Software support Across the entire software spectrum, many vendors have been working hard to release updated versions of their applications that are compatible with Vista. Despite their efforts, there are still many that have not yet completed this process.

Cost Vista comes in several flavours, the “Business Edition” being positioned as the equivalent of XP Professional. However, the prices are vastly disparate. Vista Business is priced at $AU565, whereas Windows XP Professional can be had for $AU190.

When evaluating the costs and benefits, many would agree that Vista Business is not three times the product Windows XP Professional is!

The high price of Vista and competitive pressure from the Apple platform has been flagged as reasons several major computer hardware manufacturers have started to offer the free Linux operating system as a bundled alternative to Vista.

Laptop battery life Vista uses a feature called “Aero” to improve the visual style of the user interface. However, this feature is quite resource intensive, causing many internal computer components (CPU, graphics card etc) to draw significantly more power than an identical laptop running Windows XP. It is possible to switch Aero off, but having to disable functionality to achieve acceptable performance is not an attractive proposition.

CONCLUSION Vista’s biggest strength is that it brings together a large number of incremental improvements and tools attractive to the everyday user and bundles them under a refined interface.

From a cost-benefit perspective however, it is hard to justify the purchase of a Vista licence unbundled from new computer hardware, as many of the touted improvements present in Vista are available to Windows XP users via free and low cost thirdparty add-ons.

As tends to be the case with new operating systems however, the choice to upgrade is usually not “if”, but “when”.

With most PC hardware manufacturers having made Vista the default shipping operating system over a year ago, and Windows XP becoming increasingly difficult to find, the number of computer users switching to Vista is going to steadily increase in the coming months. While currently, this does not necessarily mean that existing Windows XP licences can’t be installed on newly purchased hardware, there is no guarantee that Windows XP will be compatible with hardware released in the months and years to come.

With this in mind, Microsoft Windows users are advised to ensure that all the important software applications that they use in their organisation are (or will soon be) available in versions that are Vista compatible.

Put your practice at the forefront by choosing to be accredited with GPA ACCREDITATION plus.

Australia’s most innovative and cost effective accreditation provider; The smart alternative with a proven record of serving General Practices in Australia; An accreditation system that can be individually tailored to meet your needs and add value to your practice; A committed team providing access and support throughout the process of accreditation.

GPA ACCREDITATIONplus From the Top End to Tasmania...The Choice is Yours!

Free call 1800 188 088 www.gpa.net.au

GPA Accreditationplus

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2HIPPO

P: 1300 789 828 F: 03 8660 2530 E: info@2hippo.com W: www.2hippo.com 2Hippo uses modern software and methods to deliver intelligent digital communication solutions to healthcare professionals that reduce medico-legal risk and operating costs.

2Hippo provides secure messaging, automatic address book management, automated appointment management (one way and two way SMS/email), and fax services.

Contact 2Hippo for solutions that meet the needs of your busy practice.

AUSTRALIAN GENERAL PRACTICE NETWORK

P: 02 6228 0800 F: 02 6228 0899 E: agpnreception@agpn.com.au W: www.agpn.com.au AGPN represents a network of 115 local organisations (Divisions) as well as eight state-based entities.

More that 90 per cent of GPs and an increasing number of practice nurses and allied health professionals are members of their local Division. The Network is involved in a wide range of activities including health promotion, early intervention and prevention strategies, chronic disease management, medical education and workforce support.

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

AUSTRALIAN MEDICAL ASSOCIATION

BEST PRACTICE

The Australian Medical Association (AMA) is an independent organisation which represents more than 27,000 doctors, whether salaried or in private practice, whether general practitioners, specialists, teachers and researchers, or doctors in training.

Best Practice sets the standard for GP clinical software in Australia offering a flexible suite of products designed for the busy GP practice, including:

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

The AMA exists to: • promote and advance ethical behaviour by the medical profession and protect the integrity and independence of the doctor/patient relationship; • promote and advance the public health; • protect the academic, professional and economic independence and the well being of medical practitioners; and • preserve and protect the political, legal and industrial interests of medical practitioners.

AGFA HEALTHCARE

P: 03 8808 4000 F: 03 8808 4413 E: bronwyn.saville@agfa.com W: www.agfa.com/healthcare Agfa HealthCare, a member of the Agfa-Gevaert Group, is a leading provider of IT-enabled clinical workflow and diagnostic image management solutions,and state-of-the-art systems for capturing and processing images in hospitals and healthcare facilities.

Agfa HealthCare has over a century of healthcare experience related to diagnostic imaging and has been a pioneer on the healthcare IT market since the early 1990’s. The business group is a leading actor in the development of e-health solutions, including Electronic Patient Record technologies, for governments and regions.

Agfa HealthCare today employs 5,700 staff members, with sales offices and representatives in over 100 markets worldwide.

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ARGUSCONNECT AHML

P: 03 5327 9302 F: 03 5327 9307 E: c.lynton-moll@ballarat.edu.au W: www.ahml.com.au AHML is a non-aligned, not-forprofit organisation whose mission is to promote and facilitate the adoption of compliant international healthcare messaging standards. AHML is providing a world-class, easyto-access message testing environment for software developers and implementers.

P: 03 5335 2220 F: 03 5335 2211 E: argus@argusconnect.com.au W: www.argusconnect.com.au ArgusConnect provides and supports software that enables doctors and healthcare organisations to exchange clinical documents securely and reliably.

P: 07 4153 1277 F: 07 4153 2093 E: sales@bpsoftware.com.au W: www.bpsoftware.com.au Contents: 11

• Best Practice Clinical (“drop-in” replacement for MD2) • Integrated Best Practice (clinical/management) • Top Pocket (PDA companion software for Pocket PC)

COACTIVE EVENTS

P: 0413 138 024 F: 07 3878 1991 E: hazel@coactive-events.com W: www.coactive-events.com CoActive Events is an innovative event management company committed to producing professional, successful and unique events by working collaboratively to simplify your role.

With over 20 years experience, CoActive Events is a hands-on conference and events company that offers a full range of services right from the start with program planning and development, marketing and promotion, online registration and financial services along with venue and speaker arrangements.

DOCSTOCK DICTAPHONE

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

P: 02 8883 4425 F: 02 8883 4426 E: info@docstock.com.au W: www.docstock.com.au Contents: 31 DocStock is an exclusively-online store retailing quality medical equipment to Australian doctors.

As a quality medical equipment supplier, we offer you the following benefits: • Known and reliable brand names • Safe and secure payment methods • Easy access to full product information and pricing • Efficient order turn-around and delivery times • AND ALL AT DISCOUNTED PRICES!

GENIE SOLUTIONS

P: 07 3720 2801 F: 07 3720 2802 E: info@geniesolutions.com.au W: www.geniesolutions.com.au Contents: 7 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 1100 sites, it is now the number one choice of Australian specialists.

evisit DIMENSION DATA P: 1800 638 457 F: 02 8249 5369 E: info@didata.com.au W: www.didata.com.au

Dimension Data is a specialist IT services and solution provider, helping clients plan, build, support and manage their IT infrastructures.

Dimension Data’s Healthcare Collaboration Suite consists of four integrated clinical solutions that provide faster, smarter healthcare with the ability to direct, locate and prioritise information for clinicians and their patients. As a result, hospitals realise improved staff productivity, reduced capital and operating costs with extended systems, and significantly enhanced quality of care and services.

Genie has 38 built-in data conversions covering all the major practice and clinical management systems in Australia.

E: info@evisit.com.au W: www.evisit.com.au Contents: 39 evisit uses state of the art technology to provide on-line booking services to your patients, without compromising the privacy or security of your patient data.

You don’t need to change your practice management software, and your appointment availability can be online in just 10 minutes.

By using specially designed appointment control technology evisit will make over-booking a thing of the past. Having the ability to book appointments online when you are closed makes it easier to fill those early morning timeslots, and last minute cancellations.

• Email and SMS reminders reduce No-Shows and improves profitability • Reduced over-booking and more consistent appointment distribution reduces waiting times • 24/7 access helps to fill slow-spots and last minute cancellations.

• Improves patient retention through easier access to healthcare • Less stress, more profits, and improved opportunity for you to get home on time.

GPA

P: 1800 188 088 F: 1800 644 807 E: info@gpa.net.au W: www.gpa.net.au Contents: 45, 51 GPA ACCREDITATION plus has given general practitioners a reliable alternative in accreditation. GPA is committed to offering a flexible accreditation program that understands the needs of busy GPs and practice staff. GP is the only only accreditation provider that assigns an individual quality manager to support your practice with accreditation.

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

GLOBAL HEALTH

P: 03 9675 0600 F: 03 9675 0699 E: sales@global-health.com W: www.global-health.com Global Health is a premier provider of technology software solutions that connect clinicians and consumers across the healthcare industry.

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

GPCOMPLETE

MHAGIC is the latest and most comprehensive Mental Health Assessment Generation and Information Collection system in Australia.

GPComplete is the first software explicitly geared to reducing the time taken to perform common tasks in your practice, and has been shown to increase workflow by as much as 50%. It combines electronic health records, practice management and Medicare Australia Online functionality, all built on a single, open source database.

Locum replaces traditional paper records with a robust electronic filing system that manages patient information and improves the efficiency of medical practice.

P: 1300 794 471 F: 07 5569 2648 E: sales@gpcomplete.com.au W: www.gpcomplete.com.au Contents: 9

More information available at www.evisit.com.au.

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GREBINS MEDICAL SPELL CHECK P: +64 9 443 7328 F: +64 9 443 7328 E: enquiries@grebins.com.au W: www.grebins.com.au Contents: 43

Grebins was established in recognition of the lack of tools available to help Australasian organisations create clear, accurately spelt, medical documents.

Development of Grebins Medical Spell Check has been on-going since the very first versions of Microsoft Word for Windows and continues today with support for all versions including Microsoft Office Word 2007.

Grebins has been improving the accuracy of Australian medical documents for over 18 years and currently includes over 77,000 Australian English medical words and terms.

HEALTH PHONE

Healthphone Solutions is in the business of helping its customers improve the management of their healthcare operation by providing information at the point of care, wherever and whenever they need it.

HEALTHLINK

P: 1800 125 036 F: 07 3870 7768 E: enquiries@healthlink.net W: www.healthlink.net Contents: 37, 52

Join the network that more than 60% of GPs use for diagnostic, specialist and hospital communications.

P: 02 9906 6633 F: 02 9906 8910 E: www.hcn.com.au W: hcn@hcn.com.au Health Communication Network (HCN) is the leading provider of clinical and practice management software for Australian GPs and Specialists.

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

Medical Director • Blue Chip Pracsoft • iRIS

insignia pty ltd

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

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

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

HL7 Australia supports the local user and implementer community with standards, education and implementation support.

Australia’s largest effective secure communication network.

• Fully integrated with leading GP and Specialist clinical systems • Robust; Reliable and Fully Supported

HCN

Official Supporter of the Australian Olympic Team

P: 02 8875 7977 F: 02 8875 7777 E: sales.au@healthphonesolutions.com W: www.healthphonesolutions.com

HL7 SYSTEMS & SERVICES P: 0412 746 457 F: 02 9475 0303 E: admin@hl7.com.au W: www.hl7.com.au

With 40 years experience in the industry, insignia is a leading, national label manufacturer.

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

HL7 Systems and Services is a leading Australian specialist consultancy focusing on healthcare system interoperability.

HL7S&S has a comprehensive track record in successfully undertaking projects for Federal and State Health agencies, Standards Australia, private hospital groups and other healthcare organisations locally and overseas.

HISA

P: 03 9388 0555 F: 03 9388 2086 E: hisa@hisa.org.au W: www.hisa.org.au Contents: 27 The Health Informatics Society of Australia (HISA) aims to improve healthcare through health informatics.

HL7S&S has special interest in GP and Specialist data communications.

INTRAHEALTH

P: 02 9956 3827 F: 02 9901 3705 E: tom.donnelly@intrahealth.com W: www.intrahealth.com Intrahealth is a major supplier of healthcare software. Our leading edge solutions offer a family of products for use by healthcare professionals at the point of care.

Profile is a fully integrated financial, clinical and appointment practice management system used by GPs and specialists.

• Excellent robustness and reliability.

• Powerful reporting / data extraction.

• Extendable and customisable.

• Multi site access.

• 3 tier architecture.

• Load balancing redundancy.

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

JOSE and Associates are IT/IM Consultants working exclusively with General Medical Practices and other allied health organisations.

Service Model Outcomes: • Satisfying IT Accreditation Standards.

• Network standards protocols are used to ensure optimum uptime of network.

• Total ownership of all IT related problems (from Clinical s/w updates to a faulty mouse) • Disaster Recovery and Business Continuity plans and monthly reviews and test restores.

• The entire IT/IM business infrastructure is documented and updated monthly (similar to a patient record).

• Support is available 24/7 and the response in most cases is immediate. Most scheduled work is completed after the practice is closed.

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

• Initial consultations are complementary until a detailed road map is established.

• References available on request.

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

To cope with the demands of practicing healthcare in the real world, you need fast access to a pure source of knowledge.

MIMS is essential knowledge that Australian health professionals can trust, distilled down to crucial facts and easy to use.

Because of the rapid flow of information today, you can count on MIMS being up-to-the-minute with regular updates through print, CD ROM, PDA, online or integrated into your clinical software.

And because it is generated by a local Australian editorial team and backed by global resources, you can be sure MIMS is always relevant to your needs.

MOBILE COMPUTING

MOBILE COMPUTING

P: 07 3839 4321 F: 07 3839 1251 E: info@mobilecomputing.net.au W: www.mobilecomputing.net.au Mobile Computing supply and support Health Technology.

MOTION COMPUTING

P: 02 4655 9335 F: 02 4655 9336 E: sales@motioncomputing.com.au W: www.motioncomputing.com.au

MEDICAL-OBJECTS

P: 07 5445 5037 F: 07 3221 0220 E: info@medical-objects.com.au W: www.medical-objects.com.au Medical-Objects is a medical software firm specialising in secure standards based clinical messages and applications of messaging.

This includes integration to other clinical systems, clinical tools through to high-end decision support.

Motion Computing is a mobile computing and wireless communications leader, combining world-class innovation and industry experience enabling professionals in vertical industries such as healthcare, field sales/ service, government and education to use computing technology in new ways and places.

Marketed through an experienced worldwide reseller network, each Motion Tablet PC is built to customer specifications.

NATIONAL RECRUITMENT - HEALTHCARE P: 03 9509 9899 F: 03 9509 2733 E: healthjobs@natrec.com.au W: www.natrec.com.au

National Recruitment – Healthcare is a recruitment firm specialising in the Healthcare & Health IT domains.

We service the entire Healthcare industry including Healthcare Providers as well as suppliers into the industry. This holistic approach affords us a unique understanding of the Healthcare industry as well as an extensive network of potential candidates.

National Recruitment - Healthcare has within the firm over 30 years experience with healthcare providers and suppliers in Australia, Asia, Europe & USA; dealing with marketing, sales and strategy encompassing healthcare delivery tools, healthcare IT, and healthcare diagnostics and imaging. This blend of knowledge and experience means that we have a unique first-hand understanding of the dynamics of the healthcare industry as well as the needs of all of the participants.

We have developed a deep network of contacts within the Healthcare Industry both locally and abroad.

NEHTA

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

OPTIO HEALTHCARE

P: 02 6291 9953 F: 02 6291 9963 E: kburdette@optiohealthcare.com.au W: www.bitg.com.au Optio Healthcare’s forms automation, clinical document management & document process optimisation solutions help you capture, format, scan, archive and deliver real-time access to patient information across your healthcare environment.

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

ORACLE

E: john.kingsley-jones@oracle.com W: www.oracle.com.au Oracle’s business is information - how to manage it, use it, share it, protect it. For 30 years, Oracle - the world’s largest enterprise software company - has provided software and services that help organisations get up-to-date and accurate information at the lowest cost. The right information leads to good decisions - and good decisions lead to good business.

That’s why successful enterprises rely on Oracle for their information needs.

Oracle brings comprehensive, end-to-end solutions to the healthcare industry to support best practices and decrease costs. Oracle’s healthcare-specific industry applications help ensure quality care and decrease patient safety concerns through the integration of clinical data and the ability to analyse patient-specific information.

PULSE + IT

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STANDARDS AUSTRALIA

P: 02 9237 6000 F: 02 9237 6091 E: healthinformatics@standards.org.au W: www.e-health.standards.org.au Contents: 19

PACIFIC SOLUTIONS

P: 07 3378 2668 / 1300 662 178 F: 07 3378 4514 E: enquiries@pacificsolutions.com.au W: www.pacificsolutions.com.au

Standards Australia Limited is recognised by the Government as Australia’s peak standards body.

It develops Australian Standards of public benefit and national interest and supports excellence in design and innovation through the Australian Design Awards program.

Pacific Solutions is an Australian medical transcription company working with medical practices nationwide. Pacific Solutions will: • Assist you with overflow typing • Eliminate the need for in-house typists and the associated administration • Provide specialised medical typists and experienced radiology typists • Give you the option of dial-in dictation or digital audio • Format your letters to your requirements • Integrate with certain practice software • Ensure a strict level of confidentiality and privacy Contact Pacific Solutions today and let us help you achieve the ultimate in office efficiency.

Pulse+ IT PULSE MAGAZINE

P: 0402 149 859 F: 02 9475 0029 E: info@pulsemagazine.com.au W: www.pulsemagazine.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 and Health IT Industry participants Having grown rapidly from its launch circulation of 10,000 copies in August 2006, Pulse+IT’s current quarterly distribution of 40,000 printed copies ranks it as Australia’s highest circulating health publication of any kind.

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PULSE + IT

SYBER SCRIBE

P: 03 9569 4890 / 1300 764 482 F: 03 9569 5543 E: sales@syberscribe.com.au W: www.syberscribe.com.au Syber Scribe provides Internet based medical typing services for hospitals and clinics.

• Fast turn around and excellent quality.

• Connection to most Patient Management Systems, possible for filing purposes.

• Victoria’s largest supplier to hospitals.

• References available on request.

WACOM

P: 02 9422 6700 F: 02 9420 2272 W: www.wacom.com.au Contents: 15 Wacom is the worldwide market leader in graphic tablet technology and interactive pen displays.

For practices looking to move toward a paperless office system, Wacom has a number of solutions that are intuitive and easy to use.

STAT HEALTH SYSTEMS

P: 07 3121 6550 F: 07 3395 0669 E: carla.doolan@stathealth.com.au W: www.stathealth.com.au Stat Health Systems was formed in 2006 by two groups of industry specialists when they agreed on a collaborative approach to development of software required by the medical industry.

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

Stat Practice Manager will be available in the second half of the year with the Integrated product available early 2009.

EQUIPOISE INTERNATIONAL

P: 07 3252 2425 F: 07 3252 2410 E: sales@totalcare.net.au W: www.totalcare.net.au Contents: 41 Founded in 1994, Equipoise International’s focus has been the development of best of breed medical management systems.

We are a proudly Australian based and owned company, with a shareholder base including clinicians, employees, and private investors.

Our flagship product - the Totalcare suite of medical software - has been in continuous development for over 12 years.

Totalcare reflects our philosophy of providing comprehensive, flexible and reliable solutions to our clients, backed by a personal, knowledgeable support team. We seek to excel in all our interactions, and to provide not just superior software, but superior service.

ZEDMED

P: 03 9284 3300 F: 03 9284 3399 E: sales@zedmed.com.au W: www.zedmed.com.au For 30 years Zedmed has been one of Australia’s most innovative and successful, fully integrated practice management and clinical record solution providers.

• Fast • Stable • Innovative • Secure The new generation of medical software.

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