Pulse+IT Magazine - May 2009 by Pulse+IT Magazine

PULSE IT 

AUSTRALIA’S FIRST AND ONLY HEALTH IT MAGAZINE

E-prescribing RELOADED

ISSUE 12: MAY 2009

Electronic health records Home health monitoring systems Health games and interactive media Online information and community

7 May 2009 Telstra Dome, Melbourne

Invitation to all Healthcare Providers HealthBeyond HealthBeyond is a one-day e-health event looking at how consumers can improve their health and general wellbeing through the better use of information and communication technologies (ICT). The entertaining and information-rich day features plenary speakers, concurrent content presentation streams and interactive demonstrations.

Who should attend? Anyone who influences the health habits and practices of Australians including General Practitioners, Nurses, Allied Health Workers, Psychologists and Carers. HealthBeyond will educate clinicians, care-givers and other healthcare providers and gain commitment to influence their patients around the ways to improve health through the use of ICT. It will also engage with the health consumers who are early adopters of new healthcare technologies. HealthBeyond is being delivered by the Health Informatics Society of Australia (HISA).

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Publisher Pulse Magazine PO Box 7194

PAGE 14 E-PRESCRIBING Electronic prescribing initiatives have made great strides in the past few months — our cover story brings you up to date.

Yarralumla ACT 2600 ABN 19 923 710 562 www.pulsemagazine.com.au Editor Simon James 0402 149 859 simon.james@pulsemagazine.com.au Editorial Enquiries editor@pulsemagazine.com.au Advertising Enquiries ads@pulsemagazine.com.au About Pulse+IT

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

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 of any kind. 28,000 copies of Pulse+IT are distributed to GPs, specialists, practice managers and the IT professionals that support them. In addition, over 12,000 copies of Pulse+IT are distributed to health information managers, health informaticians and IT decision makers in hospitals, day surgeries and aged care facilities. Contributors Ben Armstrong, Linda Bâgu Batson, Jane Gilbert, Vanessa Hohan, Simon James, Paul Mara, Professor Jon Patrick, Dianne Pelletier, Robyn Peters, and Mark Worsman. Disclaimer The views contained herein are not necessarily the

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

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 2009 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. ISSN: 1835-1522 Subscription Rates Please visit our website for more information about subscribing to Pulse+IT.

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

E-HEALTH PIP PAGE 30

ONLINE PROMOTION PAGE 32

INTERNET BACKUP PAGE 46

CLOUD COMPUTING PAGE 43

REGULAR Sections PAGE 06 STARTUP Editor Simon James introduces the twelfth edition of Pulse+IT.

PAGE 13 GUEST EDITORIAL Professor Jon Patrick outlines the complexities associated with the analysis of clinical notes.

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

PAGE 08 GUEST EDITORIAL Jane Gilbert discusses e-health standards and the problems associated with their lacklustre implementation in Australia.

PAGE 14 BITS & BYTES Pulse+IT’s news section, delivering the latest e-health developments from Australia and abroad.

PAGE 29 NEHTA NEHTA announces a collaboration between pathology groups to advance e-health standards.

PAGE 10 GUEST EDITORIAL Dianne Pelletier discusses the migration of Australian Health IT experts drawn to the Middle East.

PAGE 24 INTERVIEW: eRx Pulse+IT checks in with eRx Script Exchange spokesperson, Mr Paul Naismith.

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

FEATURE Articles PAGE 30 E-HEALTH PIP Simon James details the recent changes to the e-health Practice Incentives Program (PIP) requirements.

PAGE 36 INTERNET BACKUP Simon James provides an overview of Internet backup technology and its application in the medical practice.

PAGE 32 ONLINE PROMOTION Ben Armstrong outlines the various online options available to practices seeking to promote their medical services.

PAGE 38 THE BIG PICTURE Linda Bâgu Batson challenges the reader to think about how their new software will interoperate with their existing infrastructure.

PAGE 40 PAYROLL WITH MYOB Robyn Peters continues her series on accounting for the medical practice. PAGE 43 CLOUD COMPUTING Mark Worsman and Vanessa Hoban detail the potential problems associated with cloud computing. PAGE 44 CONTINUITY OF CARE Dr Paul Mara discusses the role of EHR as it relates to continuity of care.

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

Pulse+IT: 2009.2 Welcome to the twelfth edition of Pulse+IT, Australia’s first and only Health IT magazine. Readers who have been with us for a while may notice something familiar about the e-prescribing themed cover of this edition. And with good reason! In the May 2008 edition, I hypothesised that “e-prescribing was threatening to step out of the periphery”. A full 12 months on, I have much the same prediction, only this time the threats are much less veiled and backed by thousands of lines of software code. Fanned by the enthusiasm of the Pharmacy Guild of Australia, the pace at which the 2009 e-prescribing push has progressed from press release to deployed software has been difficult to keep up with. To bring our readers up to speed with these recent developments, a comprehensive news piece is included in this edition, as is an interview with Paul Naismith, CEO of Fred Health, the organisation behind eRx Script Exchange. Beyond e-prescribing, a number of other major e-health related developments have emerged since our last edition. Most significant of these was the release of updated eHealth Practice Incentives Program requirements. Our coverage of this scheme was originally framed under the working title of “20 grand in 20 minutes”, however it was ultimately decided that the readership would be better served by some practical adherence advice than a blow by blow description of what might have been. Following shortly after the release of the eHealth PIP incentive announcement, a $6 million incentive package was introduced by Medicare Australia in an effort to spur the integration of Easyclaim-capable EFTPOS terminals with practice management software. The deadlines for both grant funding applications and the delivery of completed integrated solutions would appear to be much less generous than the grant funding itself, casting doubt over the prospects of any new integrated solutions finding their way to market. In related news, HCN has commenced the widespread rollout of an Easyclaim-enabled version of PracSoft, the company’s GP practice management solution. When combined with EFTPOS terminals from Tyro, the solution allows practices to process Easyclaim transactions without necessitating that practice staff

re-enter information into their EFTPOS terminal. Finally, on the eve of our print deadline HCN announced plans to remove pharmaceutical advertising from its flagship product, Medical Director. According to the company, the decision to forgo this revenue stream has been made in response to ongoing pressure from the Australian Medical Association, the Royal Australian College of General Practitioners and the National Prescribing Service, each of whom have campaigned against the inclusion of pharmaceutical advertising in clinical software. HCN have indicated that existing advertising contracts will be honoured, with the ultimate removal of full screen and strip advertisements being completed by August this year.

This Edition In addition to further coverage about the aforementioned developments, this edition includes guest editorials from Jane Gilbert, Dianne Pelletier and Professor Jon Patrick. NEHTA announce a collaboration between three peak pathology organisations designed to advance the adoption of relevant e-health standards, and Ben Armstrong discusses ways to promote your medical practice online. In the wake of the recent fires and floods, I overview Internet backup solutions, a technology that all healthcare organisations should evaluate as a possible complement to their existing backup procedures. Linda Batson challenges the reader to think about how their new software will operate in the wider context of their organisation’s IT infrastructure, and Robyn Peters continues her series on accounting with an instalment on payroll in MYOB. Mark Worseman and Vanessa Hoban outline some of the legal and privacy issues associated with Cloud Computing, and Dr Paul Mara commences a series on continuity of care by discussing the importance of the electronic patient health summary. Simon James, Editor 0402 149 859 simon.james@pulsemagazine.com.au

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

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GUEST EDITORIAL Jane Gilbert BComp, GDip PM, is Director of the Australian Healthcare Messaging Laboratory, an independent, not-for-profit online testing facility for the technical evaluation and certification of conformance to standards in healthcare software. Jane is a member of the HL7 Australia Board, the MSIA Committee, and co-chair of the HL7 International Implementation and Conformance committee. j.gilbert@ballarat.edu.au

Why aren’t standards being implemented properly? Regardless of your status — whether you are a clinician, consumer, health care worker, software developer, or from industry, government or special interest groups — health informatics standards are vital to ensure quality of patient care through interoperability of healthcare information.

What are standards? According to the International Organisation for Standardization, “Standards are documented agreements containing technical specifications or other precise criteria to be used consistently as rules, guidelines, or definitions of characteristics, to ensure that materials, products, processes and services are fit for their purpose.” Standards make our lives easier, safer and cheaper. Without them, many everyday actions we take for granted would be unpredictable. Standards help to make many of the products we use safer and more reliable. They are the fundamental building blocks for interoperability.

Which ones apply to e-Health? I have often heard the comment that, “the great thing about standards is that there are so many to choose from” and it is true, but with such complex information as in healthcare to represent it’s any wonder. Health informatics standards cover all aspects of electronic healthcare information including patient administration, referrals, prescriptions, scheduling and supplies. There are a range of standards to cover this information developed by many organisations around the world. • Health Level Seven (HL7) provide standards for the exchange, integration and sharing of electronic health information. • Digital Imaging and Communications in Medicine (DICOM) is a standard for handling, storing, printing, and transmitting information in medical imaging. • International Organisation for Standardisation (ISO) provides standardisation in the field of information for health, and health information and communications technology (ICT) to achieve compatibility and interoperability between independent systems, covering data structure and interchange, semantic content, security, health cards, pharmacy, medicines and devices. • European Committee for Standardisation (CEN) standards relate to the application of information and communication technology in healthcare, social care and wellness. • International Healthcare Terminology Standards Organisation (IHTSDO) develops and promotes the use of SNOMED CT to support safe and effective health information exchange.

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Who coordinates these standards? Standards Australia is the nation’s peak non-government Standards organisation. It is charged by the Commonwealth Government to meet Australia’s need for contemporary, internationally aligned standards and related services. Australian standards are developed by expert committees using a consensus-based process that facilitates public input to ensure standards are robust and fit for purpose. Standards Australia’s IT-014 Health Informatics Committee (www.e-health.standards.org.au) publishes national standards in health informatics that will support the sharing of information across the health care sector and align with international e-health developments. It prepares or acquires, for adoption as Australian Standards, documents relating to the secure acquisition, storage and transfer of patient related data. IT-014 and its sub-committees cover the areas of health concept representation, pharmacy concept representation, information security, messaging (patient administration, prescription, diagnostic, collaborative care communications), EHR interoperability, supply chain and telehealth. The working committees are made up of volunteers with representatives from all relevant stakeholders.

What benefits DO standards DELIVER? The benefits of standards differ slightly depending on whether you are a provider or consumer of products which utilise standards. Standardised products and services are valuable user confidence builders, being safer, secure, higher quality, more reliable and more likely to interoperate with other products, leading to lower implementation costs. Standards provide building blocks for interoperability allowing providers to spend more time developing new technologies and to compete in areas other than basic functionality and interoperability. Another benefit of standardisation is that it provides detailed technical specifications that both developers and purchasers can reference — it’s much easier for a tender document to reference a standard than pages of detailed requirements. A better way to explain the benefits of standards is to explain what happens if standards aren’t in place. In the General Practice setting a common problem resulting from lack of standardisation is in pathology reporting. Most pathology laboratories deliver results in either proprietary formats or incorrectly implemented standardised formats meaning that the GP’s software is unable to receive and interpret the reports and requires manual intervention and site by site negotiation, costing not only dollars but time and safety. But it’s not only the

laboratories who need to implement the standards correctly, it’s just as important for the GP software to interpret the messages in a standard way. If pathology laboratories produce conformant messages and the software consuming the messages do not, then we are no closer to interoperability. Within hospital settings there are often a multitude of disparate systems in use from patient admission to medication management. To enable sharing of information hospitals install and manage large integration engines which map information between the various formats, usually costing millions of dollars.

What is the solution for problems relating to standards? It is important that the right standards are used, but using any standard correctly and consistently is better than using no standards at all. For robust, fit for purpose standards to be developed there needs to be involvement from real world experts. This is not an easy task as experts in their field are usually overworked and unable to find time to volunteer for standards development, which is a time consuming and thankless task. Some countries invest millions in standards development, conformance testing and certification — perhaps we just aren’t committing enough resources to produce the outcomes required?

Conformance Testing and Certification It is one thing to have standards but another to ensure their correct implementation. I have heard many times that “if you have seen one HL7 implementation, you really have only seen one HL7 implementation!” Conformance testing is vital to ensure correct use and implementation of standards. Which purchaser hasn’t had a vendor claim to use standards, to only find out after implementation that their new system can’t communicate with their existing technology? To ensure the correct use of standards, there has to be conformance testing and certification to keep the vendors honest. Purchasers need to start demanding that any new systems purchased are certified. In my capacity as Director of the Australian Healthcare Messaging Laboratory (AHML) (www.ahml.com.au), I have seen first hand the problems encountered with incorrect implementation of standards. I’m not saying that all standards are perfect — some are quite ambiguous — but if we could at least get the correct implementation of some standards, like HL7, it would eliminate basic interoperability problems and allow time to tackle the more important semantic interoperability issues. AHML have provided a free online testing facility for developers and purchasers to validate HL7 messages against

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national and international standards for the last ten years. AHML have over 470 users from 38 countries utilising the free service. Encouragingly, our users are not only software developers, but also purchasers testing out prospective software. AHML was setup in 2000 with a funding grant from the Department of Health and Ageing (DoHA). Since initial setup the University of Ballarat have been supporting AHML financially to ensure the valuable service continues to be freely available. However, developing the technologies to keep up with testing new standards is not cheap. For AHML to remain viable, financial support from key stakeholders — most notably government — will be required to ensure AHML can continue to offer an independent, cutting edge, free, testing service to the e-health industry. Another interoperability testing service is Integrating the Healthcare Enterprise (IHE) (www.ihe.net.au), a framework for the implementation of standards. IHE describes real-world scenarios, or specific sets of capabilities of integrated systems, applying to a specified set of actors and for each actor, specifying the transactions necessary to support those capabilities. IHE hold events called connectathons where vendors get together for a week and implement the specifications provided by IHE. Developers work together during the week and the end result is software exchanging information without smoke and mirrors or millions of dollars for customisation.

Barriers to adoption Barriers to the conformant adoption of standards in e-health have been the lack of incentives, mandates and availability of robust conformance testing facilities. In the last month we have seen a change in the incentives area with new requirements being introduced for the Practice Improvement Program (PIP), an Australian Government initiative to encourage the uptake of e-health technologies in general practices. The new requirements have components that practices need to meet in order to qualify for payments through this incentive. This is the first (of hopefully many) incentives provided for the use of products which meet specific requirements relating to secure messaging.

Be aware, informed and ask questions! To ensure the uptake of conformant implementations of standards everyone involved needs to be aware, informed and ask questions about standards usage when purchasing systems. If you don’t understand the answers then engage someone who does, or look for tangible evidence of standards compliance like AHML certification — it may save you a great deal of time and money in the long run.

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GUEST EDITORIAL Dianne Pelletier RN BScN DipED BEdStud MSciSoc, is the Education Co-ordinator, HISA NSW, an Honorary Associate, Faculty of Nursing, Midwifery & Health, University of Technology Sydney, and the Critical Care Coordinator, Sydney South West Area Health Service, University of Technology Sydney. dianne.pelletier@uts.edu.au

The Middle East beckons to Australian IT leaders The brain drain of Australian talent to overseas countries is not a new concept in Australia. The loss of our scientists, researchers and alternative energy entrepreneurs to the US and Europe is well recognised. As Australia grows its pool of experienced IT professionals, a similar phenomenon is emerging. The efforts of the last 15 to 20 years to introduce IT systems (clinical, administrative or others) at various levels or environments in the health care system has produced a reasonably extensive and valuable pool of IT savvy human resources. In terms of the attraction of going overseas, particularly to the Middle East, financial incentives (high salaries and low or no tax) are evident and no doubt important. The cultural experience and travel opportunities influence some. Highly significant for others are the professional opportunities not readily available in Australia. Overseas projects are often large “green field” (totally clean scope) and well funded. To serious informaticians, these characteristics are significant. Many here struggle with the problems of legacy systems, disparate systems, interconnectivity issues and of course, funding constraints and bureaucratic and government factors. The challenges of introducing systems into established clinical environments where staff may have had mixed experiences with previous initiatives or uncertainty regarding the value of the system presents further challenges. Many Middle East projects will be freshly staffed with a clinical workforce expecting to operate within an IT environment. These IT professionals — well experienced and knowledgeable leaders in this fledgling industry — are drawn from professional disciplines such as nursing, medicine, computer sciences and other fields. This is important as the clinical voices must be both available and professionally distinct to ensure good clinical judgment and avoid any loss of these professional aspects to the technical side of the action in their work environment, particularly if they are a clinical voice. One other aspect of the departure of this group is the loss of their professional contribution and voice beyond their working milieu to the wider realm of the informatics community. As an exemplar, consider the recent departure of Robyn Cook who left her position as Manager, Knowledge Management Unit in NSW for a position in the Middle East. Beyond the loss of her clinical knowledge, management and technical expertise, a professional leader has been lost, temporarily it is hoped. The importance of all nurses embracing IT in health care, at whatever level it comes into their practice, is well recognised. As is the importance of nursing input in the processes of selection, implementation and evaluation of new information systems. The preservation of nursing elements in the electronic medical

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and health records not only ensures nursing activities are well documented but also assists in the recognition that some activities can be overlooked in the evaluation of the whole health care picture. The need for some nurses and others to position themselves as IT professionals or informaticians is growing as job opportunities and numbers increase. The importance of supporting fledgling communities such as the Health Informatics Society of Australia (HISA) Nursing Specialist Interest Group grows accordingly. Informatics bodies such as HISA, with active state branches in four states, is an example of a valuable multidisciplinary and industry partnership organisation. A further five special interest groups widen its role and voice. HISA is becoming an increasingly dynamic voice and gaining credence with government and other bodies as an invaluable and informative voice of the wider Informatics community. Readers are likely to be familiar with the organisation’s annual Health Informatics Conference (HIC) but may not be aware of the value of educational meetings held regularly in some states including NSW, VIC and WA and the value of the networking that goes on at these. With Robyn’s resignation from her roles as Chair of HISA NSW and Chair of the HISA Nursing Informatics Special Interest Group, a significant voice has been silenced or at least quietened as Robyn no doubt will maintain professional contacts. Readers relatively new to the Informatics scene, may not be as aware of the well established International Medical Informatics Association (IMIA). Fortunately Robyn can maintain her role as Australian representative on the IMIA Nursing Informatics Special Interest Group for the time being. This may prove invaluable as one of Robyn’s intentions is to assist the rapidly growing numbers of IT using nurses in the Middle East in their development of a nursing informatics group so they can both learn and contribute to the wider world of Informatics. If successful, this will be a worthy professional contribution on Robyn’s part and Australia can be proud of such a contribution from an expat “on loan” to the Middle East. Flagging HISA and its activities here is intended to both introduce the organisation to the wider community and to demonstrate areas where Robyn’s contributions will be sorely missed, perhaps encouraging engagement of others. While the temporary loss of some of our IT leadership is regrettable in some ways, one consolation is that these Aussies may return refreshed, reinvigorated with increased expertise and experience to bring to the Australian IT health care environment. We can only hope so.

Problems to probe, tough nuts to crack, General Practice has it all. At Best Practice we’ve pledged to develop the tools you need not only to survive but to thrive and fly through the day.

Thanks for the inspiration,

Charles…

Evolution. An idea that changed the way the world thinks and the reason we’re celebrating the 200th birthday of Charles Darwin this year and the 150th anniversary of his world changing book On The Origin of Species. Evolution is also the principle that has driven the ongoing development of Best Practice, Australia’s fastest growing GP software. Go to Best Practice Forum and watch it in action. Best Practice is designed and developed by Dr Frank Pyefinch, the pioneer of clinical software in Australia. The finches of the Galapagos showed Darwin the way to the theory of evolution. The soaring finch logo is the personal stamp of Dr Frank Pyefinch and represents his personal guarantee that the Best Practice Software will continue to evolve in response to the particular needs of Australian doctors. Check our web site for the full range of features. Send for the trial conversion demo DVD now. Best Practice:– Clinical, Management and Top Pocket (BP software for your PDA). Unique, fully integrated whole-of-practice software. www.bpsoftware.com.au

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Go to the website to order your FREE evaluation DVD, email sales@bpsoftware.com.au, phone (07) 4155 8800 or mail the coupon below to: Best Practice Software Pty Ltd PO Box 1911 BUNDABERG QLD 4670 Address:

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GUEST EDITORIAL Professor Jon Patrick DipLandSurv, MSc, PhDMonash, BSc, DipBehavHealthCare, FACS, MACHI, MAMIA, is Chair of Language Technology, University of Sydney. jonpat@it.usyd.edu.au

Analysing Clinical Notes – Harder than it seems The release of the Garling report on Acute Care Services has put the spotlight on the use of doctors’ notes and the demand that they be better written, organised and easier to automatically search and use for the continuing care and safety of the patient. Most patients in hospitals are cared for by many staff, which continually changes by medical specialties and staff shifts. The notes left behind by each staff member are a key component of knowledge for the decisions made by the incoming staff taking up the patient case. In fact more often than not, the next act of care to be taken by a Doctor or nurse or allied health staff is more dependent on the previous act of care than anything else in the patient’s case. Clinical notes in many cases can be the most important information available for deciding on the next act of care. Mr. Peter Garling SC has to be congratulated for his vision and emphasis on the need to improve the use and quality of IT in our health system. However, the technological challenges around the automatic processing of clinical notes are not insignificant and need to be given consideration. In particular, improvements in written content is needed so that it may be better understood computationally (for the purposes of identifying specific medical concepts), and perhaps more importantly, improvements in the ability to search and analyse the content. A partnership between Dr Robert Herkes, Director of the Intensive Care Service of the Royal Prince Alfred Hospital (RPAH ICU) and the author at the University of Sydney have been involved in researching, developing and trialling effective technology for ready search and reuse of clinical notes over the last three years. The work is unfunded by any of the agencies with most to gain from an effective process for reusing the notes, but nevertheless it has made steady progress. A reading of the Garling Report could readily lead one into believing that it is just a matter of rolling out a ready-made technology for managing and searching clinical notes, but this is far from the case. In fact the technology has to be developed for each different clinical discipline and has to be continually improved over a series of stages to achieve effective and efficient value for the staff and patients. Our analysis of 6 years of notes recorded in the RPAH ICU produced a collection of 60 million language tokens — a language token is either a word or a non-word, where non-words are meaningful combinations of letters, punctuation and digits, often used as abbreviations e.g. BP120/70 for a blood pressure reading of 120/70. These texts consist of about 70% words and 30% non-words. The notes showed us that about 10 million language tokens are written per year in the ICU using about 200,000 distinct items. In these notes about 35,000 words and 15,000 non-words

could be recognised automatically from existing dictionaries but over 130,000 could not be recognised and needed to be manually corrected or identified as true words or tokens. Many of these tokens are part of the special language of intensive care doctors and thereby idiosyncratic. Similar collections need to be conducted for other medical specialties. The processing of clinical notes to allow better automatic understanding of the contents involves getting words written down in a meaningful way, and ensuring that the specific medical concepts the notes are talking about are accurately identified. Once the notes are in reasonable order in terms of accurate spelling the next stage is to analyse them for recognisable medical concepts. While we have large dictionaries to assist us in this work it is not simply a task of looking up the dictionary. All natural languages allow the speakers to be creative in their construction and invention of words and the medical profession uses their skills in this capacity as much as any other profession, hence even a simple term can be expressed in many different forms, for example, heart attack, cardiac arrest, coronary thrombosis or coronary occlusion are the same phenomena. The largest dictionary has over 350,000 concepts and this still does not cover many of the terms used in the ICU. Our trials, with a small set of 300 clinical notes, show that we can identify reliably about 69% of the clinical concepts with our current technology. The process of improving our use of IT to deal more efficiently with clinical notes involves a series of cycles of technological development and live implementation in the clinical workplace to obtain feedback from doctors working at the frontline of care. The first stage for creating an improved technology involves identifying the common typing and spelling mistakes, acronyms, abbreviations and misuse of punctuation to build automatic correctors of written text. The next stage involves creating systems that can accurately identify complex medical concepts so that staff can quickly and reliably find automatically the right information for its examination and consideration in their next act of care. The third stage requires a process of comparing a patient’s record of care against an appropriate protocol of care for their condition so that alarms can be sounded if some care deviates from the protocol and these variations can be reviewed by more expert staff for their appropriateness. It is the continuous cycle of research, development, trialling and revision of the technology that will bring it to the bedside and give productivity gains to the clinical staff and greater safety to the patients. Support and investment in developing and trialling this technology needs to be paramount on the agenda of responsible bodies like the Clinical Excellence Commission and the National e-Health Transition Authority, and the Minister of Health, to get the real value from Mr. Garland’s recommendations.

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BitS & BYTES

Electronic prescribing gathers momentum in Australia Electronic transmission of scripts between prescribers and pharmacists is not a new concept and one that has been advanced as a worthy pursuit in the past by both government and the private sector. The potential benefits of e-prescribing are well understood, and include reduced transcription errors, increased efficiency at the pharmacy and the ability for improved medication management to occur. Combined, these characteristics culminate in improved care for patients and more efficient use of PBS resources. Despite these recognised benefits, widespread e-prescribing deployments have not eventuated. In the past few months however, a flurry of software development activity has established the foundations for the next generation of prescribing technology, advanced by two competing e-prescribing providers jockeying for the attention of the market. The first to launch was eRx Script Exchange (eRx), the successor to the defunct ScriptX collaboration between Fred Health, Corum Health and HCN. eRx is owned by Fred Health and endorsed by the Pharmacy Guild of Australia. MediSecure, an e-prescribing initiative that lists founding partners ArgusConnect, Medseed, PSLnet and MPSnet, publicly launched shortly after eRx Script Exchange. The MediSecure solution is based on technology developed by ArgusConnect for the ongoing Northern Territory e-prescribing trial. From a high technical level, eRx and MediSecure have similar models with both organisations utilising centralised “script hubs” to act as the gateway between prescribers and pharmacists. This model is widely regarded as the only feasible way to initiate e-prescribing as it preserves the patient’s ability to present at the pharmacy of their choice, something that a direct prescriber to pharmacist transfer system would not easily permit. Under the current e-prescribing arrangements, paper scripts are still generated by the prescribing software, with the only visible change to these documents being the addition of a prominent barcode. The doctor is still required to sign this script to approve its

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veracity, a step that may one day be negated by the use of PKI certificates. At the moment the paper script is printed, the data from the script is encrypted and uploaded to the prescribing hub. Throughout this process, the only change the doctor will notice to their usual workflow is the presence of a patient consent dialogue screen. This window asks the doctor to acknowledge that they have the patient’s permission to upload the script to the hub, and optionally, acknowledge that they permit the hub to notify the doctor when the script — or a subsequent repeat — is filled. On presentation of the script at a pharmacy, the pharmacist scans the barcode using their existing Point of Sale hardware, which instructs their dispensing software to poll the script hub for the corresponding script data. This data is downloaded into their dispensing system, negating the need for the information to be transcribed from the paper script as happens currently. After verifying the information is correct, the prescription is dispensed. As with their basic technical architectures, both e-prescribing providers have similar revenue models, with pharmacists required to pay a per script fee to download the script data from the hub. The fee currently being touted by both e-prescribing providers is 25 cents per script, however eRx has been able to negotiate an exclusive arrangement with the Guild that will see the peak pharmacy body cover the costs of the first 10.6 million scripts dispensed from their script hub. Being heavily dependent on the uptake of e-prescribing by both prescribers and pharmacists, it is unclear how many months the subsidy will last. In addition to the ongoing per script fees, MediSecure are charging a $250 joining fee to pharmacies wishing to download scripts from their hub. Given that most of the efficiency benefits of e-prescribing accrue to the pharmacist, prescribers are not required to pay any fees to send scripts to either hub, nor will they receive any financial incentives to do so. To encourage software developers to integrate their prescribing and dispensing solutions with the new e-prescribing

BitS & BYTES infrastructure, both eRx and MediSecure are committing to pay a share of the script transaction revenue to vendors whose customers utilise their e-prescribing hub. Enjoying first mover advantage and Guild support, eRx Script Exchange have successfully recruited every major Australian pharmacy dispensing software vendor to their cause. Assuming, given time, that all customers of these vendors upgrade their software to compatible versions, eRx will be able to lay claim to a 99% coverage in the pharmacy market. Clinical software developer, Best Practice, has also committed to eRx, demonstrating their completed e-prescribing integration work at the recently convened Australian Pharmacy Professional Conference. In discussions with Pulse+IT at the event, Dr Frank Pyefinch, Managing Director of Best Practice, likened the pharmacists’ interest in e-prescribing to the response of GPs to early versions of Medical Director, software that Dr Pyefinch developed and subsequently commercialised in the early days of GP computing. The Best Practice eRx e-prescribing functionality is currently in live use in a practice in Anglesea, VIC. The MediSecure venture has received commitment from CDC and Minfos, the pharmacy software vendor that participated in the Northern Territory e-prescribing trial. On the prescribing side, MediSecure has received commitments from Best Practice, Zedmed, and Genie Solutions, the clinical software developer whose solution was used by GPs in the Northern Territory e-prescribing trial. Notably, Minfos was the first vendor to announce plans to support both e-prescribing hubs, a move that is likely to be followed by both prescribing and dispensing software developers seeking to maximise their share of the e-prescribing transaction revenue stream. Bipartisan script hub support by

prescribing vendors may not be a simple proposition however, especially in the absence of arrangements to allow scripts to be seamlessly exchanged between script hubs. Unless such arrangements are enacted in the near term, it follows that multiple barcodes will need to be printed on the script by prescribing software to maximise the chance the dispensing pharmacy can download the script data from a hub compatible with their own arrangements. Beyond the confusion this may cause pharmacy staff, concerns have been raised about the capacity for typical barcode readers to differentiate between multiple barcodes printed in close proximity. HCN, the largest provider of clinical software to GPs, has not yet made a commitment to either e-prescribing initiative. Without ruling out such participation in the future, HCN CEO, Mr John Frost has indicated that his company is awaiting more certainty from government and a directive from his customers. “HCN continues to follow the current developments in e-prescribing. However there is no clear direction being given by government at this point in time, with multiple areas of the Department of Health and Ageing currently looking into e-prescribing. Further, our customers have not yet expressed any interest in e-prescribing. When clarity is provided from both government and our customer base, HCN will undertake to support e-prescribing,” Mr Frost said. Responding to suggestions that some organisations may seek to preempt this official support by extracting script data from Medical Director systems using methods not supported or endorsed by his company, Mr Frost said: “From a patient safety point of view, prescribing is the most important feature of clinical software. As such, HCN will not condone anything that risks the patient’s safety or exposes the doctor to medico legal risks.” Left - A window from the Best Practice prescribing interface demonstrating the recently incorporated eRx e-prescribing patient consent functionality. After e-prescribing is activated by the practice, this window will appear the next time a doctor generates a prescription for each patient. The settings are stored for subsequent scripts on a per patient basis, negating the need for this window to re‑appear until the patient retracts consent.

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BitS & BYTES MSIA APPOINT CEO Dr Vincent McCauley, Medical Software Industry Association (MSIA) President, has announced that Bridget Kirkham has been appointed as the inaugural CEO for the MSIA. Bridget has a broad background in health and not-for-profit association management in the UK and Australia. She has an established record of successful engagement with the political process in Australia, most notably as CEO of the Arthritis Foundation of Australia. She was also a Board member of Research Australia for a number of years as well as having senior roles in area health services, breast screening, IVF, public health, and other related health organisations. With the increasing number of government and non-government forums with which MSIA engages, and the increasing complexity and rapidity of change that has occurred in this sector recently, MSIA has decided that there was a need for greater representative capacity. According to the organisation, this will enable negotiations to be completed more effectively and rapidly and facilitate prompt and effective communication with both the MSIA membership and external stakeholders. In addition, the MSIA anticipates that the creation of the CEO position will enable the organisation to undertake a number of vendor lead projects and partnerships.

PATHOLOGY INDUSTRY TO WORK TOGETHER ON E-HEALTH Pathology groups will work together to promote the adoption of national e-health standards and specifications following the signing of a national consensus statement. The Australian Association of Pathology Practices Inc (AAPP), National Coalition of Public Pathology (NCOPP), Royal College of Pathologists of Australasia (RCPA) and the National E-Health Transition Authority (NEHTA) have agreed to cooperate on implementation of e-health standards and specifications. NEHTA CEO Peter Fleming said the consensus statement was a milestone achievement that would stimulate dialogue with the profession. “The adoption of national e-health standards in Pathology will improve the safety and quality of healthcare for all Australians”, Mr Fleming said.

Australian e-Health Research Centre appoints new CEO In early April, Dr Phil Gurney was appointed CEO of the Australian e-Health Research Centre (AEHRC). Established in 2004, the AEHRC is a joint venture between CSIRO and the Queensland Government. With over fifty staff, the organisation is the largest e-Health research organisation in Australia. Dr Gurney takes over the role at the AEHRC from founding CEO, Gary Morgan, who has been appointed Deputy Director (Operations) for CSIRO’s ICT Centre. Dr Gurney said the challenge for the AEHRC in the next few years is to extend its engagement with the medical community nationally. “We want its research outcomes to deliver real world benefits to patients, and ensure they are adopted throughout the Australian and global healthcare system,” Dr Gurney said. As a consultant, Dr Gurney has advised executive teams at SMEs, not for profit and government organisations. This includes consultancy work for the charity, Brotherhood of St Laurence, where he advised on the establishment of the Innovation Hub to support the Brotherhood’s vision for an Australia free of poverty. More recently, he was a senior executive at Leica Biosystems in Melbourne, where he was focused on strategic development to build market opportunities in tissue pathology. Highlights of his tenure include leading the acquisition of a US pathology image-analysis company, and steering the development of technologies for error minimisation in pathology sample handling. In 1996, Dr Gurney co-founded Virtual Photonics Pty Ltd (now called VPIsystems Inc), a network planning software company. He held the position of Managing Director of the Asia-Pacific region, and was a board member of the Australian and US companies. Recent achievements of the AEHRC include the development of a new tool for rapidly classifying medical records, which is known as SNOrocket. The technology is being incorporated in the International Health Terminology Standards Development Organisation (IHTSDO) workbench and will underscore

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the development of clinical terminology in electronic health records worldwide. The AEHRC is also involved in research designed to aid in the early detection of the onset of Alzheimer’s disease. The research utilises both MRI and PET scans, with the latter technology used in unison with PIB, a PET amyloid-imaging agent. Collaborating with clinicians from Gold Coast and Toowoomba Hospitals and Griffith University and Queensland University of Technology, the AEHRC has developed a software package to assist hospital emergency medical staff predict demand on their services. The Patient Admission Prediction Tool (PAPT) will allow on-the-ground staff to see what the patient load will be like in the next hour, the rest of the day, into next week, or even on holidays with varying dates, such as Easter. PAPT uses historical data to provide an accurate prediction of the expected load on any day. The PAPT research has recently been acknowledged with a QLD iAward, which qualifies the group for consideration in the national iAward program, the winners of which will be announced on May 27 at an IT industry gala dinner to be held in Melbourne. Below - Dr Phil Gurney, incoming CEO of the Australian e-Health Research Centre.

Improving patient care and safety with eRx e-scripts You can now feel even more confident about your patient’s health with e-scripts available right around Australia for the first time. Electronic scripts improve patient safety and care, as a result of reduced risk of prescribing and administration errors. With eRx, you can send e-scripts knowing that they can be dispensed in 99% of pharmacies around Australia. Key benefits include • Notification of dispense events can strengthen confidence about your patient’s care (based on patient consent) • More efficient management of new prescription and emergency supply prescription requests • A better patient experience, as a result of improved communication and coordination of care between GPs and pharmacists • Paving the way for individual electronic health records (based on patient consent) • Patient and medical information is retrieved direct into dispensing software, reducing the risk of re-keying errors • There is no change to the prescribing process. The only difference is that there is an eRx logo on the patient’s prescription From the time you prescribe until the script is dispensed, e-scripts are encrypted with three layers of security, so you can have full confidence that your patient’s personal and medical information is safe. Available now.

To find out more about sending e-scripts, visit www.eRx.com.au or call 1300 700 921 eRx Script Exchange. Improving patient safety and care with e-scripts.

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Alphastudy clinical research platform released A knowledge creation, management and dissemination platform specifically designed for the healthcare industry has been released. Dubbed Alphastudy, the system was developed by David Dinh who built the foundations of the platform to assist him with his work with the Asthma Clinical Assessment Form and Electronic decision support (ACAFE) research project. This project was formally recognised last year with the researchers receiving a Don Walker award at HISA’s 2008 Health Informatics Conference (HIC’08). After the completion of the ACAFE research project, Mr Dinh generalised the Alphastudy platform for wider consumption. Discussing Alphastudy’s potential impact in healthcare, Mr Dinh said: “Alphastudy captures the essence of ‘wisdom of the crowd’ where sharing and dissemination of knowledge is accelerated via the engagement of participants. Users and consumers are increasingly looking for higher quality material on the web which they can reference or participate in. By creating a medium of expert communities and the right tools, researchers will be able

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to quickly conduct studies and release them faster to the wider public.” In its current form, Alphastudy enables users to create “online workspace sites”, which unifies a set of research tools designed to enhance communication and make research faster and more efficient. Functionality includes tools for data collection such as surveys and quizzes, training and development resources, as well as document repositories and discussion forums. Alphastudy allows clinicians to setup and host data collection forms, testing modules are also included with the ability for users to feature a variety of multimedia content (pictures, MP3, Videos), text and links to other web-based material. Users are able to create discussion forums and leverage the personal file storage repository for the sharing of presentations, images, audio, and other project files. These features have enabled clinicians to conduct a wide variety of research, ranging from quality assurance studies, surveys and article reviews, up to major scientific studies and healthcare projects. Web-based, the Alphastudy platform

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BitS & BYTES has been designed to accommodate multiple projects, each with their own user communities. The developers have also created a standalone solution for institutions wishing to deploy in-house instances of Alphastudy. These instances can be rebranded and run locally across an organisation’s intranet. Access to Alphastudy workspaces is governed by username and password, allowing authorised users to access the system from any computer with an Internet connection. Each workspace’s security settings are configurable allowing public users to join, or access to be restricted. Alphastudy was first deployed in a clinical pilot study in December 2008, underwent further development iteration in January 2009 and subsequently went live in March 2009 for use by clinicians both in the hospital and other environments. Early adopters of Alphastudy include a major Sydney trauma and emergency training department, which is using the platform to assist with clinical training, evaluate and assess new treatment regimes’ relevance to clinical practice, and identify key performance improvement areas through regular “quick” clinical studies. Senior clinicians

are also able to assist junior staff by using Alphastudy to disseminate expert knowledge. For example, students are mentored by senior clinicians on patient case studies, journal discussions and exam preparation questions. Dr Clare Richmond, an emergency clinician from the Royal Prince Alfred Hospital, is using Alphastudy as part of a study being conducted with the Australian Commission on Quality Safety in Health Care National Clinical Handover Project. As part of the WHOs “High 5 on Patient Safety”, data collected using Alphastudy has been used to collate information regarding previously unidentified issues, improve patient satisfaction through the effective use of senior clinicians, identify missed clinical signs and ensure observations are documented and variation identified. Dr Richmond said: “Our study aims to look at ways of improving patient safety. Alphastudy contains a powerful set of tools allowing me to manage the data for statistical analysis so much faster and easier”. Further information about the Alphastudy research platform can be found at: www.alphastudy.com

GPA releases interactive online accreditation resource GPA ACCREDITAITON plus (GPA) has launched an online solution to assist practices to prepare for their accreditation visits. Dubbed A+, the web-based solution allows practice staff to undertake a practice self assessment against each of the RACGP standards for accreditation. Progress is monitored through visual indicators and at any stage, a preliminary report can be generated to identify the practices preparedness for their accreditation visit. Throughout the process, practices can direct questions to their GPA client manager using the online service, who can respond and actively identify areas where the practice requires additional support. Comments from the client manager are included in the report. In addition to the self assessment process, the A+ platform allows practices to upload documents necessary for accreditation, including procedure manuals, practice information sheets and

other important practice information, such as after hours care provisions. Practice information is password protected, with data transfer encrypted using SSL technology. Dr Paul Mara, GPA Managing Director said that A+ gives practices another option to prepare for accreditation. “Our aim is not to replace the current paper based program but to provide practices with more choice,” said Dr Mara. “Since our inception GPA has been committed to making the accreditation process as simple and as streamlined as possible, while assisting practices to adopt and maintain ongoing quality improvements. Practices undertaking accreditation through GPA are still assigned their own client manager and A+ gives practices yet another way to access this personalised support.” General practices can trial A+ via the GPA website after contacting the organisation: www.gpa.net.au

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IBA acquires HATRIX Pty Ltd On April 17, IBA announced that it had acquired Australian-based HATRIX Pty Ltd. HATRIX develops medication software solutions for acute care, aged care and community health care providers in Australia and New Zealand. As part of the acquisition, IBA will pay HATRIX shareholders an initial consideration of $2 million. A further earn-out, capped at $13 million, may be paid over three years in cash or shares. In a statement issued to the ASX, IBA indicated that: “Through its iSOFT business, the company will leverage its global customer base to boost sales of HATRIX’s flagship MedChart medication management solution.” MedChart is already integrated with iSOFT software products at a number of iSOFT’s installed customer sites, and the company plans to use HATRIX’s expertise

in further developing its own LORENZO medication management solution. MedChart also underpins a new solution that iSOFT will bring to market, initially in Australia, called MedShare. The new product will enable authorised clinicians from different health provider organisations to review and update a shared patient medication record that is held in a secure repository. IBA Executive Chairman & CEO, Gary Cohen, said: “This is the kind of acquisition that allows us to leverage our global footprint with a proven and innovative medication management solution that will deliver real patient and carer benefits. We also believe this will position the company to work with the Australian government in its desire to rollout medication management solutions to the Australian public hospital sector.”

APCC add new measures to practice reporting program The Australian Primary Care Collaboratives (APCC) Program has introduced new measures to help practices improve patient care. Following review by the Australian Primary Care Collaboratives Program’s Expert Reference Panels and consultation with national expert organisations, the Program is improving how practices report by introducing a range of changes to the Program measures this month. In 2005 the APCC Program (then National Primary Care Collaboratives) introduced measures to support and track practice improvement. These measures have proven to be a sound basis for measuring key aspects of the Program, including the care provided by practices. “The current APCC Program measurement set has now been updated to reflect the latest evidence and also introduces new measures that are all designed to help produce better outcomes for patients and practices”, said Colin Frick, Chief Operating Officer, Improvement Foundation Australia. Mr Frick said the Program “is also taking the opportunity to introduce additional clinical areas of measurement, such as COPD and prevention measures. Many APCC practices have achieved significant

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improvement in CHD and Diabetes and will now have the capacity to measure improvements in other clinical areas”. While the Program has introduced the capacity to collect and report on additional measures, and encourages practices to do so, it is not a Program requirement. APCC Program coordinator, the Improvement Foundation Australia (IFA), has worked with the RACGP and national bodies, such as the Heart Foundation, Diabetes Australia and the National Lung Foundation, to ensure consistency in the measurement approach adopted by the APCC Program. The APCC has reached an agreement with the RACGP to customise reports within the Pen Computer Systems’ Clinical Audit Tool (CAT), with IFA providing the APCC reporting function within CAT at no cost to participating practices and Divisions. As an adjunct to this arrangement, Pen Computer Systems is providing APCC practices with a two month trial of the unrestricted version of CAT. In other developments, IFA is making it easier for practices to submit data by introducing electronic data submission to the Program’s secure reporting website. The website also allows practices to

BitS & BYTES review feedback graphs and access a broad range of Program materials. “IFA is making the technical specifications for the new measurement set and electronic submission available to all software vendors. All software vendors will have the opportunity to continue supporting quality improvement within their products. While some of the new measures require changes in the clinical software before data capture and reporting can occur, we are confident that clinical software vendors will see the significant benefits for their customers in

the suggested approach and schedule changes,” says Mr Frick. The first phase of the Program achieved significant outcomes for practices and patients and new APCC Program waves will be starting soon. Practices involved in the current phase are also achieving excellent results and IFA looks forward to continuing to work with the Divisions’ network to further spread quality improvement across primary care. Practices interested in participating in the new APCC Program waves can visit: www.apcc.org.au

Houston to demonstrate new Day Surgery module at IAAS Ambulatory Surgery Congress Houston Medical will demonstrate their new Day Surgery module at the International Association for Ambulatory Surgery (IAAS) Congress, to be held in Brisbane starting on July 3. The software developer is best known throughout Australia and New Zealand for its specialist practice software solution, Houston VIP, which is widely adopted by ophthalmology practices drawn to the products tight integration with relevant medical devices. According to Managing Director of Houston Medical, Derek Gower, the company’s research into the Day Surgery market identified a niche that wasn’t being appropriately serviced. “Before embarking on this major development Houston’s market research and consultants found there were plenty of applications to do the basics — products that used a relatively simplistic approach. There were also bigger products at the top end from vendors such as McKesson from the USA and iSoft/IBA from Australia. But nothing in the middle at a reasonable price,” said Mr Gower. The solution is designed to assist staff to manage the complex funding arrangements prevalent in Day Surgery environments. “Taking ophthalmology as an example the patient can visit the doctor for a standard eye examination and all the usual, prescribing, billing and Medicare claiming can be completed. If the doctor recommends a procedure in an associated day surgery the patient can be immediately booked or placed on a

waiting list. As information for each fund is stored in a contracts area from which the rules, applicable to the patient, health fund and hospital, are automatically applied, the Health fund can be checked for eligibility and insurance level of cover recorded,” explained Mr Gower. When booking the operation MBS codes are recorded by reception for later conversion to the linked ICD-10 codes. A quote is produced, insurance excess billed and the appropriate NPHCF claim forms printed for the patient and later, the surgeon to sign. Time in theatre is recorded and the appropriate accommodation and theatre bands applied. Once the diagnosis has been recorded the program then uses the integrated DRG Grouper from Visasys to create the required diagnostically related groups. Entries are validated at all stages and if any required information is missing the program alerts and guides the user to the required field. Finally, the recorded health fund insurer contract is consulted and case base, DRG or per diem rules are applied and an invoice to the appropriate health fund is produced. Automatic journal entries move the excess originally received from the patient to the health fund concerned and a full audit trail produced. Having spent four years developing the Day Surgery functionality, the company is pleased with the pre-launch response to the solution. “Contracts have been received for specialities as diverse as oral and facial, endoscopy, urology and ophthalmology,” said Mr Gower.

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BitS & BYTES AMA HIGHLIGHTS PATIENT BENEFIT OF FASTER BROADBAND A national broadband network would create new opportunities for Australians in rural and regional areas to benefit from medical services delivered using Internet technology, the AMA said following the Government’s new “fibre to the home” broadband strategy announcement. AMA Federal President, Dr Rosanna Capolingua, said faster broadband would make it easier for doctors in rural and regional areas to consult with city colleagues when diagnosing and treating patients. “To improve medical care in the bush, broadband services should be rolled out as far as possible into rural and regional Australia and be able to support the transmission of high-quality medical images thousands of kilometres. This would speed up diagnosis and perhaps reduce the need for some patients to travel long-distances for specialist consultations,” Dr Capolingua said. “The range of medical services which can be delivered remotely will increase as technology improves in coming years. Dr Capolingua said the Government should increase funding for electronic health infrastructure in the May Budget to ensure that doctors and hospitals would be ready to take advantage of improved broadband services. “E-health infrastructure and better broadband services will enable patient information to be securely shared electronically between health care providers. This will deliver real improvements to patient care,” she said.

USyd HIT SUMMER SHOWCASE PRESENTATIONS NOW AVAILABLE Videos and presentation slides from the University of Sydney’s Health Information Technologies Research Laboratory Summer Showcase are now available online: http://www.it.usyd.edu.au/~hitru/ Convened for the fourth consecutive year and held in late February, the event provided the students of Professor Jon Patrick, Chair of Language Technology, School of Information Technologies, with an opportunity to present the results of their Summer work program to a group of Health Informaticians, clinicians, and Health IT industry representatives. Most of the research and development conducted by the students concerns the practical application of SNOMED CT in live clinical environments.

MEDI Vault Internet backup solution for health launched File Pty Ltd has launched a secure online backup solution designed specifically for the health sector. Dubbed MEDI Vault, the system allows practices and other health care organisations to encrypt and upload their important data to redundant MEDI Vault servers located in multiple hosting facilities spread across Brisbane. The system is designed to perform backups incrementally, which means that only files that have been modified since the last backup need to be transferred. To expedite the client’s initial backup, MEDI Vault allows users with large amounts of data to provide an initial “snapshot” of their data on an external hard drive. Subsequent daily backups are then conducted via the user’s Internet connection. The MEDI Vault system is compatible with all major operating systems including Microsoft Windows, MacOS X and Linux. Interaction with the system is achieved via a web interface that allows the user to select which files to backup and at what

frequency. In addition to static data, the system can also replicate SQL databases and backup Exchange email servers. According to the company, the technology deployed by MEDI Vault is used by over 100,000 customers in the US, where the technology complies with HIPAA privacy requirements. Kevin Burdette, MEDI Vault Business Development Manager, said the same technology can aid compliance with relevant Australian health data requirements also. “In the Australian context, the solution will allow general practices to comply with the RACGP Accreditation Standards for Management of Health Information (4.2.2) with a simple, cost effective, secure capability,” Mr Burdette said. Prices for the service start at around $2 per day for workstations, and $4 per day for servers. Users are able to upload unlimited amounts of data each month. More information about MEDI Vault can be found at: www.filevault.com.au/ medivault

Easyclaim subsidies offered to incentivise integration Senator Joe Ludwig has announced subsidies totalling $6 million will be made available to parties who design, develop or rollout integrated Medicare Easyclaim solutions. The incentive package was announced at the Australian Pharmacy Professional Conference held in early April, a curious venue for such an announcement given that Easyclaim has no current application in community pharmacies. According to the Medicare Australia website, the subsidies are being provided to “stimulate development of integrated Medicare Easyclaim solutions.” In its standalone form Easyclaim has only achieved a 1% adoption rate since it was introduced in 2007. Software vendors pursing grant funding are required to have completed development and rollout of their solution by August 31, a time frame that would appear to be challenging given the two

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year integration journey undertaken by Health Communication Network (HCN) and Tyro to develop and release the market’s first integrated Easyclaim solution. Having undergone several months of live testing by selected practices, PracSoft’s integrated Easyclaim solution is now generally available and being rolled out to other HCN customers that wish to utilise the system. Despite Medicare Australia’s intention to “level the online claiming channel playing field”, some have questioned why Easyclaim is being pursued at all. Citing the functionality present in the Medicare Online Private Patient Claim system, the intrusive grant funding requirements, and the lack of user demand for this feature, Dr Frank Pyefinch of Best Practice Software indicated that he does not intend to undertake Easyclaim integration work at this time.

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INTERVIEW: ERX SCRIPT EXCHANGE Pulse+IT interviews Paul Naismith, Pharmacist and CEO of Fred Health, the organisation coordinating the eRx Script Exchange electronic prescribing initiative.

What products and services does eRx Script Exchange (eRx) deliver to the health sector? eRx is first and foremost a gateway designed for the transmission of secure e-Scripts between GPs/specialists and pharmacies. eRx has the ability, based on individual patient consent, to return a dispense notification from the pharmacist to the GP/specialist who created the e-Script. eRx also helps manage new and emergency supply requests for prescriptions. Who is involved in the eRx group? Currently eRx Script Exchange Pty Ltd is a wholly owned business of Fred Health Pty Ltd. Fred is Australia’s largest provider of dispensary software with just over 50% of the market. Fred was created by Rod Unmack (Fred’s Head Programming Guru), myself and the Pharmacy Guild of Australia over 16 years ago. Today Rod and I still remain 50/50 shareholders with the Pharmacy Guild in Fred. eRx has been setup to be ultimately owned by the industry and will hopefully not remain a Fred only business in the future. This ownership model replicates our other successful industry ordering exchange, PharmX. Although eRx is totally independent to PharmX, I see no reason why eRx cannot emulate this success using a similar inclusive model. Overview the process of electronic prescribing with eRx. A patient goes to their doctor and receives a paper prescription as is currently the case. However, when the doctor prints the paper script, the doctor’s prescribing software adds an

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eRx barcode and also encrypts the script. Using the doctor’s existing HeSA PKI certificate the e-Script is sent to eRx Script Exchange. When the patient takes the paper script into the pharmacy of their choice, the pharmacist scans the eRx barcode (using their existing barcode scanner) and the e-Script is sent to the requesting pharmacy and decrypted. The e-Script data is displayed in the pharmacy dispensary software in a few seconds. Upon completing the dispensing, the e-Script is sent back up to eRx and (if patient consent was obtained by the doctor) a notification of the dispense event is sent to the doctor for inclusion in the patient’s record. The repeat form is printed by the pharmacist which also contains an eRx barcode which makes it possible for the repeat to be pulled down by any pharmacy. How is security maintained throughout the eRx e-prescribing process? Security has been a major focus of the eRx development with the solution providing three layers of security. The HeSA PKI certificate for each site is used to secure the transport of the script between the GP/pharmacist desktops and the eRx gateway. While sitting at eRx, the e-Script is retained in a fully encrypted state with just the message header containing the exposed unique script ID. This allows for the script to be located and retrieved when requested by any pharmacy. What happens if the patient loses their script? As eRx currently works as an adjunct to the legal paper script, if the patient loses their script they will need to get a replacement. As we move forward and remove the paper script this will change. The stepped approach eRx has adopted will allow time for the professions and the public to work through the legislative and process change required to successfully remove the paper Australia wide.

How much time do you envisage pharmacists will save per script by using eRx compared with existing workflows? eRx makes the dispensing process more efficient. The time saving varies by the complexity of the prescription. We need to balance the time saving against the need to maintain the professional review the pharmacist provides. What is great is the time saved can be spent talking to patients about improving medication outcomes. How much will pharmacists be required to pay to use eRx? eRx is a user pay system. The Pharmacy Guild of Australia has purchased the first 10.6 million scripts for Guild members, after which the funding model will be reviewed. It is anticipated that a payer will be found for ongoing transaction traffic, but if not, it is likely to be a figure of around $0.25 per script. Will prescribers be paid by eRx to utilise the service? No but the eRx service is free to use for all prescribers. A percentage of transaction fees will be paid to each of the IT vendors involved in the transaction (prescribing and dispensing) to cover the costs of development and providing support to users of their software. What benefits will accrue to GPs that use the eRx service? The ability for a GP to receive notification of a dispensing (with the patient’s consent) may help the GP to provide better patient care and medication management. With eRx this occurs with no change to the current prescribing process. By streamlining the message process around new and owing prescriptions we aim to reduce doctors administration and save time. And ultimately a successful e-script process can provide the medication history knowledge required for future electronic health records.

Which pharmacy dispensing vendors have committed to eRx? Vendors representing 99% of the pharmacy dispensing market have committed to eRx. These include Fred Health, Minfos, Corum (Amfac and Pharmasol), HealthSoft (PharmacyPro), Phoenix, ScriptPro, and Simple Retail (Aquarius). eRx has also the endorsement of all of the major pharmacy brands including Amcal, Guardian, Priceline, Soul Pattinson, Terry White Chemist, Chemmart, National Pharmacies, Chemist Warehouse, Pulse, ChemPlus, My Chemist, Pharmacist Advice, Advantage Pharmacy, Prime Pharmacy, ePharmacy, plus many more. Which prescribing vendors have committed to eRx? We currently have Best Practice working in real surgeries and we will continue discussions with all other prescribing vendors. How much development time is required for a prescribing software vendor to integrate with eRx? Technical design of eRx allows for rapid integration of vendor systems. While the first prescribing system took a few months, we are confident future integrations to other vendors will be even quicker. Each vendor will be provided

with a completed adaptor requiring only that the communication interface be configured between their software and the adaptor, which communicates with eRx. Which technical standards are being used by eRx? The technology behind eRx is based on open standards and uses web services as the basis of its interoperability. eRx can process various message formats such as HL7 and relies on industry adopted technologies and formats where standards are yet to be implemented. eRx uses the standard PKI/HESA message security processes and is well placed for future secure messaging protocols. The message formats include elements for the NEHTA work deliverables such as AMT and UHI. We have committed to work closely with NETHA in the development and testing of comprehensive standards for e-Health in Australia. We believe eRx is built to meet compliance and privacy requirements for the protection of patients, doctors and pharmacists and their data. Who will provide technical support to practices and pharmacies using eRx? All users of eRx will be supported by their existing software vendor. An eRx support centre is also available for the escalation

of issues that canâ&#x20AC;&#x2122;t be resolved by the vendors. Will script data sent to the eRx hub be made available for purposes other than e-prescribing? eRx will have the ability to send encrypted script data to accredited 3rd parties for purposes such as Individual Electronic Health Records (IEHRs) based on that organisationâ&#x20AC;&#x2122;s ability to gain consent of individual patients. 3rd parties will need to be accredited to receive this data and would then be granted the required security key to decrypt the script data the patient authorised. At no point will bulk de-identified data be provided by eRx to any party. Which script data elements will be made available and to whom? The patient will decide who they wish to share their medication data with. eRx only has the data that currently appears on a prescription. When will eRx be available? eRx is currently available Australia wide. As more vendors complete certification the roll out will intensify. GP/specialists and pharmacists who wish to use eRx can register online at the eRx website. eRx Script Exchange www.erx.com.au

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EVENTS CALENDAR ITAC 09 May 21 - May 22 Sydney, NSW P: 08 9409 6870 W: www. itac09.com.au General Practitioner Conference & Expo May 22 - May 24 Sydney, NSW P: 1800 358 879 W: www.gpce.com.au/sydney

APRIL Redesigning the Healthcare Workforce 2009 April 29 - May 1 Sydney, NSW P: 02 9229 1000 W: www.iqpc.com.au The 6th Annual Future Of The Pharmaceutical Benefits Scheme April 30 - May 1 Sydney, NSW P: 02 9080 4307 W: www.informa.com.au

MAY Communicable Disease Control Conference 2009 May 4 - May 6 Canberra, ACT P: 02 6251 0675 W: www.diseases.consec.com.au

Health ICT Assurance Forum May 25 - May 26 Sydney, NSW P: 02 4365 7500 W: www.kjross.com.au AMA National Conference 2009 May 29 - May 31 Melbourne, VIC P: 02 6270 5400 W: www.ama.com.au

JUNE Medical Innovation 2009 June 11 - June 12 Gold Coast, QLD P: 02 9080 4307 W: www.informa.com.au Broadband Australia June 11 - June 12 Sydney, NSW P: 02 9080 4307 W: www.informa.com.au

JULY Medical Product & Equipment Sales Forum 2009 June 29 - June 30 Sydney, NSW P: 02 9229 1000 W: www.iqpc.com.au Health Facilities Design and Development June 29 - July 1 Melbourne, VIC P: 02 9229 1000 W: www.iqpc.com.au IAAS International Congress of Ambulatory Surgery July 3 - July 6 Brisbane, QLD P: 03 9249 1273 W: www.iaascongress2009.org The 8th Annual Health Insurance Summit July 28 - July 29 Sydney, NSW P: 02 9080 4307 W: www.informa.com.au Data Centre Management 2009 July 28 - July 29 Sydney, NSW P: 02 9229 1000 W: www.iqpc.com.au Claims Processing 2009 July 29 - July 31 Sydney, NSW P: 02 9229 1000 W: www.iqpc.com.au

HIMSS MiddleEast 09 May 5 - May 7 Manama, Bahrain P: +32 2 793 7630 W: www.himssme.org/09

IADIS International e-Health Conference June 21 - June 23 Algarve, Portugal W: www.ehealth-conf.org

Health Beyond: e-Health Consumer Day May 7 Melbourne, VIC P: 03 9388 0555 W: www.healthbeyond.org.au

Brownfield Hospitals June 23 - June 24 Sydney, NSW P: 02 9080 4307 W: www.informa.com.au

Health-e-Nation August 19 Canberra, ACT P: 02 4365 7502 W: www.health-e-nation.com.au

CeBIT Australia 2009 May 12 - May 14 Sydney, NSW P: 02 9280 3400 W: www.cebit.com.au

The 5th Annual Australiaâ&#x20AC;&#x2122;s Ageing Population Summit June 25 - June 26 Brisbane, QLD P: 02 9080 4307 W: www.informa.com.au

HISA Health Informatics Conference (HIC) 2009 August 19 - August 22 Canberra, ACT P: 03 9388 0555 W: www.hic.org.au

2nd Annual Green Hospitals Conference May 20 - May 21 Melbourne, VIC P: 02 9080 4307 W: www.informa.com.au

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AUGUST

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

This year is AAPM’s 30th birthday

AAPM2009 National Conference ‘The Edge of Practice Management’ Tuesday 20 – Friday 23 October 2009 Melbourne Convention and Exhibition Centre AAPM 2009 Australian Association of Practice Managers National Conference will be hosted by AAPM Victoria. The 30th registration from your State received by 30th July 2009 will receive: • Complimentary registration for the AAPM National Conference in Melbourne, 20 - 23 October 2009 • All social functions including: • Welcome Reception • Happy Hour • Party with the Penguins • Gala Conference Dinner • Bottle of Champagne Value: $1000 Visit the website www.cdesign.com.au/aapm2009 for the updated program and online registration details Conference Design Pty Ltd 228 Liverpool St Hobart Tasmania 7000

p: 03 6231 2999 f: 03 6231 1522

e: info@cdesign.com.au w: www.cdesign.com.au

19 - 21 August 2009 National Convention Centre Canberra HIC09 delivers an exceptional program of workshops, lectures and practical industry presentations from some of the world’s leaders in Health IT. HIC09 brings together a diverse collective of healthcare professionals and information specialists. This fusion of thought is what makes the event so special – something you can’t afford miss.

Go to www.hisa.org.au/hic09 to find out more and book your place.

BOOK NOW: Earlybird registration ends on June 30

www.hisa.org.au/hic09 413 Lygon Street Brunswick East 3057 Victoria Australia t: +61 3 9388 0555 f: +61 3 9388 2086

NEHTA

Leaders in Pathology collaborate to advance the national e-health strategy “The adoption of national e-health standards in Pathology will improve the safety and quality of healthcare for all Australians”, declares Peter Fleming, CEO of the National E-Health Transition Authority (NEHTA). The goal of an e-health strategy has been progressed when leaders from The Australian Association of Pathology Practices Inc (AAPP), National Coalition of Public Pathology (NCOPP), The Royal College of Pathologists of Australasia (RCPA) and the National E-Health Transition Authority (NEHTA) achieved consensus on several important issues for e-health. The signing of the declaration of consensus will result in open dialogue with the Pathology profession to discuss the strategic direction of e-health and get technical input from the industry. Pathology leaders have agreed to work together to design and develop a roadmap for the adoption of national e-health standards and specifications. All parties will cooperate

to implement these e-health standards and specifications so that they can be supported in the clinical, technical and organisational environment. Stimulating discussion and feedback will allow issues associated with their implementation in Australia and internationally to emerge. Further collaboration has been agreed to allow electronic communications in Pathology to be integrated into the overall national e-healthcare strategy. NEHTA will work in partnership with peak standard bodies and Pathology industry stakeholders to realise the goal of e-health by developing specifications and supporting material. Further initiatives by NEHTA will ensure the material developed will support interoperability and the use of Australian standards as well as multiple approaches to implementation. “Our primary focus is on delivering value and factoring in the broad cost of change to the industry”, adds Peter Fleming.

Below - Signatories to the pathology e-health declaration of consensus. A/Prof Roger Wilson (President, NCOPP), Dr Beverley Rowbotham (President, RCPA), Mr Peter Fleming (CEO, NEHTA), Dr Ian Clark (President, AAPP)

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

Complying with the 2009 eHealth PIP requirements INTRODUCTION On March 16, Medicare Australia updated the criteria for general practices seeking to maintain access to the e-health (formally IT/IM) component of the Practice Incentives Program (PIP). The scheme is intended to advance the use of computers and related technology in general practice by offering substantial payments to practices that comply with a series of criteria formulated by the Department of Health and Ageing. This article seeks to assist general practices to better understand the new e-health requirements with a view to streamlining compliance. In the hope that some of the problems associated with the design and rollout of these new requirements will not be repeated, a brief closing commentary on these issues has also been provided.

THE REQUIREMENTS Under the new PIP regime, general practices must adhere to three criteria to qualify for e-health payments equal to $6.50 per Standardised Whole Patient Equivalent (SWPE), capped at $12,500 per quarter. As a historical note, under the previous IT/IM system, the maximum payment of $7.00 per SWPE was achieved by most general practices. Requirement 1: Secure Messaging Capability To comply with this requirement, the practice must have in place at least one secure messaging software solution developed by an “eligible supplier”. To be classed as eligible, software vendors need to sign a Statement of Commitment to a National E-Health Transition Authority (NEHTA) facilitated industry engagement initiative. As a result of this low barrier to entry, it is not surprising that every major secure messaging vendor and many clinical software vendors have signed up. The first tranche of compliant secure messaging vendors was published on the NEHTA PIP website (www.nehta.gov.au/pip) in early April, and subsequently updated several times in the following days. At the time of writing, over thirty vendors were listed as eligible. It is important to note that practices are not currently required to actually use their installed secure messaging capability. While this may provide a reprieve for the less technically inclined practices, in the spirit of the incentive and in the interest of reducing the “burden of paper” for both senders and recipients, practices are encouraged to periodically assess whether secure messaging technology will assist in this regard. Practices have until July 31 to comply with this requirement, a task that should be easy for most general practices already “blessed” with a multitude of secure messaging solutions.

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Requirement 2: PKI Certificates for the Practice and each Practitioner The second requirement stipulates that the practice has (or has applied for) a “location” certificate, and that each GP working in the practice has (or has applied for) a Medicare PKI “individual” certificate. While most general practices already have a location certificate in place for the purposes of Medicare Online claiming, uptake of individual certificates by GPs has been underwhelming in comparison, something this criteria is clearly aimed at rectifying. To maintain compliance with this requirement, practices need to ensure that GPs joining their organisation apply for an individual certificate within 14 days of commencing work, assuming they don’t already possess one or are acting in a short term locum capacity. Practices concerned about the compatibility of their clinical and secure messaging software with Medicare-issued PKI technology can rest easy at this point in time — there is no current requirement that they actually start using their individual PKI certificates for any purpose. According to the Medicare Australia guidelines: “Practices will be considered to have met this requirement once they have applied to Medicare Australia for PKI certificates.” Regardless of whether clinicians commence using their individual PKI certificate, it is very important that they understand that in Medicare Australia’s eyes, using the certificate to digitally sign an electronic document is equivalent to the doctor signing the equivalent paper document using their hand written signature. As such, the possible implications of the certificate falling into the “wrong hands” need to be considered, and appropriate measures taken to properly secure the certificate. To ensure compliance with this requirement, practices must have at least applied for a PKI location certificate and PKI individual certificates before April 30. These forms are available from the Medicare Australia website: www.medicareaustralia. gov.au/pkiforms Requirement 3: Key Electronic Clinical Resources The final requirement dictates that all GPs in the practice have access to at least six “key electronic clinical resources”. Medicare’s eHealth PIP Guidelines (available from www. medicare.gov.au/pip) present two tables with various categories and examples. One resource must be selected from each of the categories in the first table, and a total of three resources must be selected from the second table. While only one example has been provided for each of

the categories in the first table — namely the e-Therapeutic Guidelines Complete, Australian Medicines Handbook, and the RACGP “Redbook” — practices are under no obligation to choose these particular resources if they feel others are more suitable for their own clinical practice. According to a Medicare Australia Practice Incentives Program Team Coach: “It is up to the practice to determine which electronic clinical resources meet the specific eligibility criteria of the eHealth Incentive and the unique needs of their patients and practice setting. To be eligible for this incentive, practices will just need to ensure that the resources available in the practice match the category descriptions outlined in the guidelines.” Regardless of which resources the doctors select, they “must be available on the computer desktop in the consulting room either on the hard drive, as a CD-ROM, or as a direct link to a website.” In reality, it is likely that most resources selected by practices will be online variants, and therefore accessible via a web browser. Storing links to such sites in the doctor’s browser is advised, as is creating a shortcut icon on the user’s desktop. Many web browsers allow the user to create a shortcut icon on their desktop by simply dragging the website address or small adjacent icon out of the browser window to the Desktop — consult Google if this procedure does not work with your software. Any resources that are stored on the local drive (such as PDF files) should be stored within the user’s “documents” folder (i.e. not on their desktop) to mitigate the chance of accidental deletion, which Murphy tells us is likely to happen on the morning of a Medicare audit. A shortcut (Microsoft Windows) or alias (MacOS X) to such resources could certainly be created and placed on the desktop to provide the doctor with easy access. As a matter of course, the practice manager or practice principal should periodically ensure that all clinicians in their practice are able to demonstrate that they know how to access these resources, and that the resources made available to the clinicians are the latest versions. To ensure compliance with this requirement, practices must have made the resources available to all of their doctors before April 30.

CONCLUSION Complying with the 2009 e-Health PIP incentives should be a relatively simple matter for most general practices. In fact according to John Frost, CEO of HCN, practices using Medical Director 3 need only actively pursue the PKI certificate requirement, the clinical software inferring compliance with the first and third requirement through its integrated MDExchange secure messaging functionality and MDReference clinical resources. While practices may welcome the ease at which their so called “incentive” money will be dispensed, the rollout of the new e-health PIP requirements has not been without issue. The now predictable lacklustre engagement by Government with key stake holder groups has caused a great deal of angst for both practices and the organisations that support them. Accreditation agencies, divisions, peak bodies, colleges, and software vendors have all reported being inundated with queries from practices concerned that they may lose their PIP payments due to non-compliance. Many of the concerns reported have arisen because practices were asked to indicate whether they were using a secure messaging solution from an eligible supplier, despite the fact that no such suppliers existed at the time the new requirements were released. Providing only a single example of suitable clinical resources in the mandatory categories in the first table of the third requirement has also caused confusion amongst practices. Without casting any dispersions about the quality or suitability of the resources listed as examples by Medicare Australia, clearly an “all or nothing” approach should have been adopted to avoid unnecessary government funded market distortion. On a brighter note, after several years in the public health wilderness, NEHTA have finally been given a meaningful mandate with which to engage general practice. According to Mr Frost, the NEHTA engagement process designed to improve secure messaging interoperability has been positive thus far. “Lots of organisations have signed up to the process which is encouraging, and there appears to be a good degree of cooperation between NEHTA, MSIA and some of the key stakeholders,” Mr Frost said.

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FEATURE Ben Armstrong Ben Armstrong is a business executive with Telstra Business, a non-executive director of AMPCO, the AMA’s publishing company and acts as the webmaster and IT manager at Obstetrics & Gynaecology Consulting Group - www.ogcg.com.au. The views in this article are his own and do not necessarily represent any organisation with which he is associated. ben@ogcg.com.au

Promoting your medical services online Introduction This article is the second in a two part series devoted to websites for medical practices. The first article outlined the reasons doctors might establish an online presence, such as attracting new patients or providing information to existing patients. In this article we will look at the options available to help you build your reputation online and monitor the effectiveness of your online presence. Building a reputation online is a multi-faceted process as people seek information using a variety of methods for a variety of purposes: a potential patient will typically go to a directory to find someone with relevant experience when they already know they need those services. However, where they are seeking information about a condition or treatment they may ask their friends, read books or hopefully consult a medical practitioner. As shown in Table 1, all online promotion methods have parallels to traditional advertising and promotion methods.

WebsiteS The benefits of having a website as a source of up to date information about you and your practice have been outlined previously. You need to put effort into the website itself to ensure that it, and the material you have on your website, can be most easily found by the main online search engines. Let’s face it — not many people are going to know (or remember) the website address of your practice. They will rely on typing in a few words and using a search engine to find you. According to Hitwise, the three major search engines used by Australians are Google (88%), Microsoft Live (6%), and Yahoo (4%). Combined, these search engines handle 98% of all web searches in Australia. The activities involved in making your website easily accessible Table 1 - A comparison of traditional media and their online alternatives. Online Media

Traditional Media

Website

Practice Portfolio, Patient information brochure, signage

Online directories

Print directories like White Pages and Yellow Pages, Medical Directory of Australia

Online advertising in search results and on other websites

Print, radio and TV advertising

Online networking in discussion groups, forums, social networking

Networking events, functions

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to search engines are usually called search engine optimisation or SEO for short. A detailed description of the techniques involved are beyond the scope of this article. Broadly they fall into the following activities: • Ensure your website is known by search engines. Have you submitted your website to each so they know where to find you? • Ensure the search engines know which content you believe is important. This involves submitting a sitemap, a document which lists all your important web pages and tells it how often you update particular web pages. • Ensure that the website has no broken links and uses valid web language (known as Hypertext Markup Language or HTML). This ensures that the search engine can properly interpret your page and give it due consideration. If it can’t make sense of your page it may not place it in its search database. • Optimise the structure of your website. Does it provide all the technical information expected by the search engines to properly understand the context of your web page and what other pages link from it? • Optimise the content of your website. Ensure the words you use, particularly in the title and description of each web page are relevant to your content as these will be displayed in the search results. This will form the basis on which a searcher will choose whether or not to click through to your web page amongst the other results.

Online Directories An online directory is simply a directory that makes itself accessible on the web. Examples include the White Pages and Yellow Pages online, the directories available on College websites, the AMA Victoria’s Medical Directory and Health Directory. Some directories have free listings but most apply some form of charge for premium or preferential listing. They are generally funded by advertising. Just how many people (and which people) use each directory is hard to determine and the relative worth of a listing in any particular paid directory should be carefully considered. Setting up a directory business has relatively few costs so there are low barriers to entry resulting in a proliferation of alternatives with short active lifespans. The information which you can find through a directory also varies significantly. Some just allow the listing of basic information about the practice: contact information and a map; while others provide free form text enabling you to basically write what you

like. Often online directories enable you to log in and change your information as you need which is not only a great service (and a great improvement on print directories where you have to get it right and hope it stays the same until the next printing of the directory) but it also keeps the directory’s costs down.

Online Advertising Online advertising covers any form of advertising online. However it is often used to describe search engine advertising which involves the placement of an advertisement when someone searches for a specific phrase or ‘keyword’ on a search engine

or on other websites which accept ads from search engines. An advertiser buys ads which will appear when an end user enters specific keywords and pays an amount, usually between $0.05 and $1.00, each time someone clicks on the ad. The price paid by an advertiser is determined by the degree of competition for that keyword. Basically, whoever is prepared to pay the most will have their ad appear first. The actual details of which ads appear above others and the amount you pay is slightly more complicated than this. The algorithms used typically take into consideration the response rate of users so that an ad that more people click on (a relevant ad) will tend to appear above an ad

Below - Search engine advertising example showing search results for a keyword and relevant paid advertisements for that term in the box in red.

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that less people do (a less relevant ad). An advertiser might set a daily, weekly or monthly budget ranging from less than a dollar to several hundred dollars. Search engine advertising has revolutionised advertising in general by allowing advertisers to pay based on performance and ensuring that your ad is shown to a market of people who are actively searching for information about your topic. Most of this advertising revenue comes from small to medium businesses who previously struggled to reach a wide audience on a pay for performance basis. It is believed that nearly $20bn or 95% of Googleâ&#x20AC;&#x2122;s revenue comes from online advertising. A significant

industry has established itself which helps businesses manage their search engine advertising campaigns and budget.

Online Networking Online networking is proliferating particularly in the last few years. Some online networking is purely social - such as meeting places Facebook and MySpace - although the trend is to mix business and pleasure. Other forms of online networking includes engaging in a dialogue on web discussion forums, answering questions online or even posting your personal profile on services like LinkedIn which allows you to keep tabs on professional

Below - Google Analytics reporting tool for showing key website metrics such as visitors over time, geographical location of visitors and average time spent on the website

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colleagues and their colleagues. These are activities a significant proportion of your patients are probably already doing day to day, and an increasing number of them are seeking answers to medical questions online, often from people with no qualifications or vested interests in a particular form of treatment.

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Precision, Quality, Design

Medical Advertising There are a range of special considerations for doctors advertising their services, over and above what other non medical businesses must do, owing to the special position doctors hold in society. These are documented in the Medical Practice Acts in most States and are further interpreted by the various State Medical boards. These should be carefully read and understood. They apply not only to ads but to what you put on your website.

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Monitoring Results Whatever form of online presence you have you’ll be interested in how effective it is. Do people look at it? Does it provide a useful service to current and prospective patients? Does it generate more business? Does it help you attract the patients you are best able to help or most interested in treating? There are a range of tools that can help you to automatically collect a raft of information and metrics on the performance of your website and online efforts. For example: • You can collect statistics on the number and location of visitors to your website. • You can see how long people spend on your website and which pages they visit (e.g. perhaps they look at patient educational material on a particular topic). • You can see your site’s ranking against other websites in the same category for particular search terms. • You can see how search engines rank your website’s importance relative to websites of a similar nature. You may want to combine some form of patient survey to understand whether your efforts are attracting new patients and their characteristics. This might take the form of a simple question on a patient registration form asking where they heard about you or your practice in conjunction with some analysis performed by your practice manager correlating the online sourced patients with types of presentation, outcomes, satisfaction, or profitability.

Conclusion If you have put the effort into establishing a website you should put some effort into ensuring that your audience can easily find it and are aware of its functionality and benefits to them. Many of the methods available to promote your online presence have no cost, such as printing your web address on your stationery, listing your website on free online directories or correctly designing your website to be search engine friendly. Ensuring that your website can be found on the Internet is not only important to establish an online reputation but to protect it. By periodically monitoring your website performance you will get a better understanding of how people use it and whether the website fulfils your goals.

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Further Information If you would like further information about some of the themes discussed in this article, or would like to make a comment or ask a question of the author, visit the author’s AusMedWeb blog, which is located at: www.ausmedweb.blogspot.com

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

Internet backup for the medical practice Introduction The importance of performing daily backups of clinical data is well understood by Australian medical practices. The devastation that befell a number of such organisations as a result of the recent bush fires and flooding serves as a telling reminder for the need for robust, off-site backup procedures to be in place. Reflecting on the unfortunate experiences of one practice, it has become apparent that what practices define as “off-site” needs to be carefully considered. In this case, the medical centre and the doctor’s residence where the backups were stored were in close enough proximity that both the original patient data files and the respective backups were obliterated by the same natural disaster. While such an event is unprecedented to the author’s knowledge, recent improvements to Internet infrastructure — such as the widespread rollout of ADSL2+ by Telstra and the subsequent wholesaling of this infrastructure to other Internet Service Providers — does afford medical practices the ability to mitigate the chance of total and catastrophic data loss occurring through the use of an Internet backup solution.

How do Internet Backup Solutions work? Backups in most medical practices are currently achieved through the utilisation of CDs, DVDs, tapes, USB thumb drives, external hard drives, or a combination of these technologies. Internet backup solutions retain the same principles of redundancy, however instead of utilising a local storage device, practice data is transferred across the Internet to purpose-built data facilities with redundant capacity spread across multiple cities, and potentially across the globe. While there are a vast array of companies offering Internet backup services, from the users’ perspective they work in much the same way as described below. Following the installation of some software on the computer to be backed up (usually the practice server), the user specifies the files they wish to backup and schedules the time (or times) of day they wish these backups to occur. Internet backup solutions are typically configured to backup files on a computer system incrementally. This means that only files that have been modified since the last backup occurred are copied to the remote facility, reducing the time a backup takes to execute. To optimise this incremental process even further, some solutions use sophisticated “block level technology”. This technology is designed to detect and upload the discrete parts of large files that have been modified since the last backup, negating the need for the entire file to be re-uploaded. The first time an Internet backup is performed, all the data the user wants to protect must be uploaded to establish a

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baseline for subsequent incremental backups. Depending on the speed of the practice’s Internet connection and the amount of data, this may take hours, days or even weeks! After this first upload has completed, subsequent backups occur in a much more timely fashion. To be considered a viable backup solution, ongoing backups need to be achievable in a matter of hours at most, or the timeliness of the backup will degrade to the point where unacceptable levels of data loss will occur in the event of deletion or corruption of the original data. As backups are performed, reports are generated, listing the files that were backed up and the length of time it took to perform the transfer. This log file should be monitored at frequent intervals to ensure that the backup is being performed reliably. As with all backup systems, frequent audits of the backed up data need to occur.

IS INTERNET BACKUP SECURE? Before transferring your practice data to a remote backup site, it is important that it is encrypted to prevent third parties intercepting the data whilst it is in transit. Encryption is a feature of all Internet backup solutions, however the sensitive nature of medical records dictates that practices need to ensure they are properly informed about the type of access the service provider themselves may have to such data — clearly this needs to be none! The privacy policies of the provider should be examined, as should the relevant laws of the country or countries in which the provider locates their data centres.

Considerations Despite the convenience of Internet backup technology, there are several factors that practices should consider before adopting such a solution: • Practices need to ensure their Internet Service Provider does not charge for uploads to avoid excess data charges or bandwidth throttling. • The time and possible Internet data charges associated with restoring a backup in the event of data loss should be calculated and assessed for viability. • The number of days of “roll back” provided by the Internet backup solution provider should allow the practice to restore a data “snap shot” from any period in history.

Conclusion The increasing availability of cheap, fast, reliable Internet access has made Internet backup solutions a viable prospect for many medical centres, and one that can provide enhance protection for patient data.

Introducing HealthLink’s Partner Systems

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

Tel 1800 125 036 enquiries@healthlink.net

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Could your Professional Standing survive a loss of patient information? What about... Computer Failure?

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

The Big Picture Does your clinical IT system exist in a bubble? Many health agency departments are keen to install the latest and greatest application to assist their clinicians with their highly specialised day-to-day work. However, without the right connectivity to the rest of your agency’s systems, you could be creating a bubble that prevents other experts from viewing the full patient record. Take this simple test to find out: Questions Q1: What sort of interface to the main Patient Administration System (PAS) does your system (let’s call it System X) have? A: Two-way interface (imports existing patient data into System X and exports new data back into the PAS). B: One-way interface (import or export of one of the above). C: No interface — stands alone. Q2: Which patient data is imported directly from the PAS into System X? A: Demographics, allergies, alerts, drug prescriptions, pathology reports, radiology reports. B: Demographics and one or two of the above C: Nothing, I already told you that. Q3: How easy is it for a clinician to get the relevant patient information whilst using System X? A: Pretty easy, they only have to have the one application open and they can switch between the tabs to get all the info they need. B: Not too bad, once they get all the windows open and don’t

Connectivity is the key As you will probably already know by now, connectivity is the key to a fully integrated electronic health record. Achieving this has been the dream — some might say nightmare — of health policy and strategy analysts for a very long time. It’s a worthwhile exercise to take a step back and create a connectivity map of all your IT systems: how, when and where they connect, what is connected and most importantly, why! Most health agencies will have a myriad of systems with databases of varying connectivity capability, due to software and hardware platforms and programming languages used. Having a connectivity map, which can help you to identify the gaps or weaknesses in your world of data capture, may assist you to eliminate the bubbles, or “silos”, of data and information that are hiding from your clinicians and decision makers. Often, it’s just a matter of putting in the work to get these bits and pieces connected — and finding the resources to do it, which is usually the more difficult of the two. Connectivity mapping is also going to go a long way in helping you make decisions about future additions to your stable of IT applications. Adding your proposed new system to the map will show you immediately where your system sits in the world that is your health agency — giving you the picture of what connectivity and interfacing is needed, right from the start. This will enable you to do the investigation work required to validate that these links can actually take place, especially if other proprietary systems are involved. Most IT managers have had the draining experience of implementing a new system, only to have its functionality hampered by a lack of connectivity. There are some packaged software systems available that will actually help you, rather than hinder, with connecting your data to one interface, where it can be made available on a permission-based structure to the relevant health professionals.

accidentally close any. C: Ok I think, except there was that fellow the other day who had a meltdown over the missing path reports...

Answers

Q4: How quickly does System X update the data?

Mostly As: You’re doing very well. Ready and waiting to connect most other systems, even possibly to the national electronic health record

A: Immediately — we pride ourselves on our real-time updates. The

— when it gets here. Give yourself a pat on the back!

patient information gets typed in during the consultation and treatment visit and it’s there for everyone with the right permission level to see.

Mostly Bs: Could be well on the way to full connectivity, as long as

B: Usually only a few hours, in the overnight batch process.

System X is flexible enough to achieve it.

C: Well, by the time the dictated audio file gets transcribed and the paper record gets taken over the scanning department to get attached

Mostly Cs: Some room for improvement, but hey, you’ve moved

to the electronic system, about a day or two.

beyond the paper and pen stage — almost...

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This is a good approach if your agency’s IT strategy team is at the point where it is ready to consider a large investment of this type. Otherwise, there are some lessons to be learned from the world of business.

The Data Warehouse Contrary to how the name might sound, a data warehouse is not somewhere you put your data after you have finished with it, no longer need it and don’t want to look at it anymore. In fact, large to medium sized businesses have been using the data warehouse as their knowledge base for information management and decision making for many years. This is basically how it works: The data warehouse consists of a rather large database — or two, some automation and analytics tools, and a user interface. Of course, in reality it’s far more complicated than that, but that’s all the user really needs to know. Your data warehouse usually installs with a relational database, most likely the type you are used to using now. This is where you can “store” all of your data. I’m going to use oncology as an example for this. Let’s say you have five separate systems that hold the data for your oncology patients. The patient administration system that holds demographics, a surgery database, a radiation oncology database, a medical oncology database and a pharmacy database. Using the data warehousing system automation tools, you can set up a process to regularly copy all the relevant data from your five separate databases to the new database in the data warehouse. An overnight process is the most popular time for this. Now you can use this new database for viewing and analysis

of all your oncology patients data, along the way, turning the data into information. Depending on which data warehouse package you have purchased, you may also have installed a multi-dimensional database — often referred to as “The Cube”. Think about a Rubik’s Cube to understand how this works. You can identify multiple “dimensions” for your data and create a database “cube” based on these dimensions. For example, if you work in oncology, you may want to create dimensions of patient demographics, diagnosis, oncology surgery, medical oncology, radiation therapy and drug prescriptions. These “dimensions” are like the faces of the Rubik’s Cube. The cube will combine only the data you are interested in into one neat package. Now you can “manipulate” the dimensions with the analysis tools to get the big picture on what’s happening in oncology. As for the data warehouse user interface, it can consist of views of the data, pre-built custom reports, graphs and some query tools for the user, connecting directly to your relational and/or multi-dimensional database. An alternative to implementing the interface that comes with your particular brand of data warehouse is to build an in-house application — preferably web based — that can do all these things and more. Your custom built interface can also connect directly to the underlying databases and brilliantly connect everything your health professionals need to see to diagnose and treat their patients. With this type of solution from the business world, you will be ready to fully connect inside and outside of your health agency. National Electronic Health Record — here we come!

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FEATURE Robyn Peters Robyn Peters is the Managing Director of CONNECT DIRECT Pty Ltd, developers of Direct CONTROL a business management software solution for the health sector. robyn.peters@directcontrol.com.au

Payroll accounting with MYOB PAYG (Pay As You Go) tax is deducted from employee’s wages and paid to the ATO throughout the Australian Financial Year. It is an Australian Taxation Office requirement that details of wages paid be kept on record. They also require that the tax deducted from the employees pay be paid to the Australian Taxation Office by the 21st day of the following month. However, businesses can choose to pay this tax quarterly rather than monthly if the total annual PAYG is less than $25,000. If your annual PAYG withholding obligation is between $25,000 and $1 million you must report and pay monthly. Large withholders with PAYG withholding obligations of more than $1 million have special requirements for more frequent payment. On keeping these records manually, they would be recorded in the form of a wage book where each pay is dissected for each employee and then summarised at the end of each month. Figure 1 presents an example of a wage book where a cheque has been drawn for the total amount and the employees have been paid by cash. However, it is common today for wages to be kept electronically and many computer accounting packages include a payroll module.

• Pensions • Directors’ remuneration • Sickness and accident pay (not being insurance claims)

Necessary information In order to set up and process the payroll you need to: • Determine whether workers are contractors or employees. • Register for PAYG withholding. • Understand your obligations in regard to Employee Superannuation. • Assess if any Fringe Benefits Tax is applicable. • Have the latest employee awards. • Know the wage, allowance and deduction types. • Have employees complete tax declaration forms. • Have on hand current income tax instalments schedule. • Have current workers compensation insurance.

Setting up Payroll Categories MYOB has already setup for you the most common Payroll Categories. These are grouped into: • Wages • Superannuation • Entitlements • Deductions • Expenses • Taxes You can edit or delete this information as well as add new categories to meet your business needs. Refer to Figure 2 and Figure 3. Holiday Leave Loading is an annual leave bonus that may be paid under some awards. It is set at the rate of 17.5%. When this amount exceeds 320.00, only the amount over the 320.00 is subject to tax. However, the entire payment is still income and must be included in gross earnings on the group certificate. Most businesses today do not pay this loading.

GST and Salary and Wages Anything listed in the Income Tax Assessment Act as “salary and wages” is not subject to GST. This includes: • Commissions to employees • Bonuses • Eligible termination payments • Superannuation Figure 1 - A sample Wage Book.

Setting up the payroll Some businesses keep the payroll data file in a separate file from the other accounting procedures. This is recommended as it gives added security and more flexibility in backing up and restoring the payroll data and not impacting on other transactions (sales, purchases, bank reconciliations, etc) However, small businesses with only a few employees would generally record payroll manually or in MYOB in the one data file along with other transactions. Larger businesses would use a dedicated payroll system such as MYOB PowerPay, Attaché Business Partner Payroll, HR7. If you are using MYOB for recording pays, the easiest way to setup is to go to Setups > Easy Setup Assistant > Payroll and work through the steps. Ensure you have the correct payroll tax tables loaded and that you are working in the correct Payroll Year.

Superannuation, Deductions and Expenses These amounts are deducted from the employees’ pays and recorded in suspense accounts in the general ledger until payment is made to the relevant body. The accounts are: • Group tax payable account • Superannuation payable account Setting up employee details Employees’ records need to be kept as up-to-date as possible, with employees being encouraged to notify you of any changes,

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such as change of address. Employee Payroll Details is where you setup the Individual Employee Pays. Refer to Figures 4 and 5 on page 42. Superannuation Employers pay 9% of an employee’s gross wages earned (as long as this gross wage is more than $450 in a month) to the Employee’s nominated Superannuation Fund. Standard Pay Once the employee’s details are entered, you can record a Standard Pay to use for Processing Pays. Processing pays When all is setup, pays are processed from The Command Centre by clicking on Process Pays. If necessary, you can change the details of a standard pay at this time. Employee Resignations or Terminations A business is only as good as its worst employee! Should you terminate an employee or they choose to leave, you need to complete the following: • Calculate Holiday Pay due. • Complete a group certificate. • Complete an employment separation certificate. • Enter the date of Termination in the Termination Date Field in the Employee’s Payroll Details - Personal Details. Figure 3 (Top) and Figure 4 (Bottom) - Payroll Linked Accounts and Payroll Categories.

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• Select File > Start a new year > Start a new Payroll year. o Stock oAppointments: Stock Control o Stock Control o Control Stock Control o Appointments: Stock o Stock Control for Appointments: Outlook Outlook Outlook for Outlook Appointments:  Utilise  for Utilise  for Utilise Control Utilise for MYOB allows you to commence a new payroll year without Appointments: Outlook Appointments: Outlook Outlook Appointments: Appointments:  Utilise Outlook  for Utilise  for Utilise  Utilisefor having to commence nts: : Outlook Outlook for Appointments: for Appointments:  Utilise  Utilise o Scheduling / Sharing o Scheduling / PDAs / Sharing o Scheduling / PDAs o / Scheduling Sharing / PDAs / Sharing / PDAs a new fiscal year. This gives time for final Appointments: Outlook Appointments: Outlook Outlook Appointments: for Appointments:  Utilise Outlook  for Utilise  for Utilise  Utilisefor o Scheduling / Sharing o Scheduling / PDAs / Sharing o Scheduling / PDAso / Scheduling Sharing / PDAs / Sharing / to PDAs adjustments be made in the financial year just ending whilst o Unlimited Appointment o o Unlimited Types Appointment o Unlimited Types oAppointment Unlimited Appointment Types Types to continue into the new financial year. o Scheduling Scheduling / Sharing / / Sharing PDAs / PDAs allowing transactions o Scheduling / Sharing o Scheduling / PDAs / Sharing o Scheduling / PDAs o / Scheduling Sharing / PDAs / Sharing / PDAs Unlimited Appointment Unlimited TypesAppointment Unlimited TypesAppointment Unlimited Appointment Types Types Hard copy of your payroll details should always be printed,  with: Integrates with:  Integrates Types with: Integrates with:Appointment es Integrates o  Unlimited o Unlimited Unlimited Appointment Appointment Types Types o Unlimited Appointment o Types Appointment o Unlimited o Appointment Unlimited Types Types  Integrates with: Integrates with:  Integrates  with: Integrates with:because if these records are ever needed as evidence in court,

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FEATURE Mark Worsman and Vanessa Hoban Mark Worsman is a Senior Associate and Vanessa Hoban is a Legal Clerk at DLA Phillips Fox. DLA Phillips Fox has around 800 lawyers across 8 offices in Australia and New Zealand. It has an exclusive alliance with DLA Piper, one of the largest legal services organisations in the world, with lawyers in 28 countries. mark.worsman@dlaphillipsfox.com ~ vanessa.hoban@dlaphillipsfox.com

Cloud computing – more rain than shine? INTRODUCTION Cloud computing refers to a method of software delivery whereby Internet infrastructure is used to host software applications and the data that these applications interact with. This approach to the provision of software can be contrasted with traditional software deployment methods, whereby applications are installed and run locally on the users own computer hardware, independent of a connection to the Internet. The potential issues related to cloud computing have received considerable attention in the IT and legal sectors recently. With the increasing focus on “green” IT and the global trend towards the commoditisation of IT services, it is likely that this focus will continue to grow in the coming years.

Access issues Service levels Due to the Internet’s multi-tenant architecture, multiple users may need to access data simultaneously. To ensure that there is no dispute about the capacity of the service offered by a provider utilising a cloud computing solution, it is often in the interests of both a service provider and a user to state the service levels to which the service must conform. This would typically contemplate minimum access and data capacity. Restrictions on use, copying and communications A service provider using a cloud computing model will typically store and replicate its client’s data across various geographical locations. Therefore, it is important that the cloud provider only be granted a limited license to use a client’s data to the extent necessary to provide the service. The limited licence conferred upon the service provider should ideally prohibit any unnecessary or unwarranted reproduction or communication of a client’s data to ensure that the client’s copyright is not infringed by a company trading in other jurisdictions.

Off-shore issues Unauthorised access Access and security will also be an issue for providers and users where data is stored by a service provider in an off-shore jurisdiction that does not have the same legal protections for data that we may be accustomed to in Australia. A user will need to think twice about using a service where data may pass through a country where protections are not robust. This is especially the case with health information where more stringent requirements are imposed in an Australian context. For example, a breach of a law in Australia may not constitute a breach of a law in another country.

Choice of laws Because data can be stored nearly anywhere, the terms on which a cloud computing service is provided should include a choice of law provision. This means that if a dispute arises between a provider and a user, it is clear where the dispute will be heard (e.g. New South Wales, rather than Harris County, Texas). It also is important to state that, for example, the laws of NSW will apply, even if the service provider may be located outside of NSW. Privacy Many cloud computing service providers may store and use services from servers located in offshore locations. Many such locations do not have privacy protections that are the same or even similar to those that exist in Australia, including for example China and India. This has implications for individuals, users of services and providers of services that utilise cloud computing. The difference between what is prohibited in Australia and permissible elsewhere may be quite large, and this is especially likely to be the case with health information. This means that health service providers and users of a service that utilises cloud computing may inadvertently breach privacy laws simply by using a service that utilises cloud computing. Security If a data leak occurs in another country, both the service provider and the client concerned will face the reality of seeking to enforce its rights in that foreign country against the persons responsible for the breach. This may be difficult or impossible in many countries or, if possible, very expensive. Government intervention Also, as stated above, certain countries do not have strong data protection laws. In addition, in some countries, government entities are permitted to review data, including potentially a client’s data with relative impunity. For instance in the United States, the Patriot Act enables the FBI to obtain records from third parties, regardless of whether the information concerns US citizens.

Conclusion By offering customers a low cost alternative to buying and maintaining in-house computer infrastructure and a “greener” solution, cloud computing is likely to be utilised by increasing numbers of services providers and their clients. Given the inherent sensitivity of health information, there are a number of issues that need to be considered before committing such information to a cloud computing solution.

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FEATURE Dr Paul Mara MBBS, FRACGP, FACRRM, DRACOG, is a rural doctor practising in Gundagai and the Managing Director of GPA Accreditation Plus.

Continuity of care – do electronic health records matter? Introduction

Definition

Continuity of care is one of the key definitional domains of general practice1. Yet defining continuity of care itself is not so easy. There is an expansive academic literature on continuity of care, which covers areas such as longitudinality of care, improving access to providers, case management, role of nurses and other health providers, enhanced management of specific illness, and post operative care. The imperative for improved continuity is based on the ageing of the population with a consequent increase in chronic illness coupled with more complex (and sometimes potentially harmful) management options for these conditions, a greater focus on prevention, a more assertive and better educated population, growing concerns about cost of care, poly-pharmacy, and larger practices with multiple GPs and other practitioners. Clearly there is a professional and policy expectation that electronic medical records and improved communication systems will enhance continuity, but this expectation has not been reliably tested. Patients still nominate having their own their doctor as of primary importance. In Australia, use of computers in general practice was initially restricted to practice billing applications. Recognition of the benefits of having electronic prescribing — and a business model linked to pharmaceutical advertising that facilitated the supply of these packages at minimal cost — provided an entrée into clinical software and development of more comprehensive practice-based electronic records, which include health summaries, progress notes, recall and reminder systems, patient information, and referral templates next became standard Recent advances in digital radiology, standards for downloading of pathology and other investigation results, improved data extraction tools to identify patients at risk and monitor chronic illness are not universally applied. The reality remains that the use of any record is only as good as the quality of the data. And there still exists significant disconnects between providers and between different levels of the health system. Ask any GP about hospital discharge summaries and the eyes will roll and the amount of mail such as specialist reports received in any practice that have to be scanned into the patients record is a significant burden on staff productivity. This and future articles seek to define continuity of care, briefly discuss the role of electronic medical records in the context of the breadth of continuity in general practice, and identify specific issues with the use of current electronic records in general practice that have been identified in over 3000 practice accreditation visits conducted by GPA Accreditation Plus.

Continuity of care refers to how an individual’s health care is connected over time2. It should not be confused with access — access may be one element of continuity but concentrating on access can be at the expense of continuity. Three key dimensions of continuity have been described; namely informational continuity, management continuity and relationship continuity. Informational continuity relates to information that is collected and held both formally and informally. The latter is dependent on the strength of the relationship between health care providers and patients as much of this information is not recorded. Management continuity refers to the application of various protocols or management plans, how these are formulated and applied in individual patients and how these plans are communicated to other practitioners where necessary. Management continuity also includes the extent to which recorded information can be manipulated and accessed for health promotion, illness prevention, improved management and research. Programs such as the Australian Primary Care Collaboratives and NPS prescribing audits support and encourage practices to identify and manage patients with particular illnesses using accepted guidelines. Informational continuity and management continuity are only as good as the collection, recording and maintenance of the information captured and the underlying clinical processes that lead to the recording of the data. The systems surrounding the transfer of information or access other providers may have to this data are also important. Relationship continuity covers the interpersonal relationships that doctors develop over time with their patients and the position of trust that exists. Notwithstanding advances in electronic medical records systems, patients still value access and a longitudinal relationship with “their” doctor. Many of the elements of relationship continuity are not easily recorded but play a significant role in the therapeutic relationship. It is relationship continuity and a knowledge of the personal, family and social context that permits GPs to work more effectively with patients. For one doctor, a patient may be simply seen in the context of a presenting symptom or diagnosis. For another with a stronger relationship continuity, the whole management of the patient may be different because of a knowledge of individual circumstances. While improved record systems have an important role to play in informational and management continuity, one of the key mistakes made — particularly by policy makers — is to

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underestimate the importance of relationship continuity and the complexity of issues relating to continuity of care in general. Not only does strengthening relationship continuity have benefits for patients, it also provides professional and personal satisfaction for practitioners. Relationship continuity is one of the key factors that sets general practice apart from other perhaps more technologically based specialties and is one of the major satisfactions (and sometimes frustrations) for general practitioners.

Enhanced continuity of care leads to improved care for patients, more cost effective care for funders, and greater professional satisfaction for providers. Even with the growing recognition of the role of other health providers in providing primary care, expanding practices and the changing role of the general practitioner, GPs remain in a central position to continue to meet the challenge to collect, maintain and manage important information about patients. In fact the future of general practice may rest on GPs meeting this challenge.

Continuity of Care and the Patient Health Summary

References

Just because a practice has an electronic health record system, it does not necessarily mean that continuity of care is optimal. Information in the patient health summary includes contact and demographic data, current and previous medical history, current medications, family and social history (including smoking, drugs and alcohol history), allergies and alerts. This information is often used in templates for referrals to other specialists and health care providers and development of care plan templates for aged care and chronic illness management. Content standards for health summaries are defined by the RACGP in Criterion 1.7.2 of the Standards for general practices, 3rd edition3. Experience gained through accreditation visits has shown that this information is not always adequately maintained or current. While some electronic health record systems provide greater emphasis and ease of use in recording health summary information, a fundamental issue is practices and providers taking individual responsibility for the accuracy and currency of information kept. This responsibility lies at all levels of the practice, from ensuring that administrative systems maintain current contact information to ensuring that summary clinical information is up-to-date. Depending on the patient, reviewing and updating information can be a time consuming task, particularly given increased patient demands, the inadequate fee schedule, and general practitioner workforce shortage. A systematic approach is required. Key questions in relation to the patient health summary are shown in the adjacent table — practices may choose to conduct an audit of their health summaries against these requirements on a regular basis.

1 - http://www.racgp.org.au/whatisgeneralpractice (accessed April 2009). 2 - Haggerty JL, Reid RJ, Freeman GK, Starfield B, Adair CE, 1 McKendry R. Continuity of care: a multidisciplinary review. BMJ 2003;327:1219-21. 3 - http://www.racgp.org.au/standards/172 (accessed April 2009). Health Summary Content Requirements derived from Criterion 1.7.2 RACGP Standards for general practices, 3rd edition Do 90% of records include allergies? Are all adverse medicines events recorded? Does the medication list only include current medicines? Are all current health problems and management plans included? Is the past health history comprehensive? Are risk factors clearly identified? Is the immunisation status up to date? Is relevant family history and social history including smoking, alcohol and drug use entered?

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Computer Initiatives P: 1300 39 85 85 (VIC) P: 1300 39 85 39 (QLD) F: 03 9768 9058 E: tim@cinet.com.au W: www.cinet.com.au

AHML AAPM

P: 1800 196 000 or 03 8414 8225 F: 03 9685 7599 E: national@aapm.org.au W: www.aapm.org.au The Australian Association of Practice Managers (AAPM) represents Practice Managers and the profession of Practice Management. Founded in 1979, AAPM is a non-profit, national association recognised as the professional body dedicated to supporting effective Practice Management in the healthcare profession. The Australian Association of Practice Managers: • Represents and unites practice managers and the profession of Practice Management throughout the healthcare industry. • Promotes professional development and the code of ethics through leadership and education. • Provides specialised services and networks to support quality Practice Management.

P: 03 5327 9142 F: 03 5327 9289 E: info@ahml.com.au W: www.ahml.com.au AHML is a globally accredited online testing laboratory for the technical evaluation and certification of conformance to standards in healthcare technologies. AHML is a nonaligned, not-for-profit organisation with over 450 users from 36 countries, whose mission is to facilitate the conformant usage of healthcare standards. AHML’s services include online testing and certification against International and National Standards and implementation of client specifications for testing. AHML is accredited by the National Association of Testing Authorities (NATA) to ISO/IEC 17025 2005 in the field of Information Technology and with NATA’s mutual recognition arrangement with the International Laboratory Accreditation Cooperation (ILAC) their accreditation is recognised by 47 countries.

ArgusConnect Advantech Australia P: 1300 308 531 F: 03 9797 0199 E: info@advantech.net.au W: www.advantech.net.au

Advantech’s medical computing platforms are designed to enhance the quality and efficiency of healthcare for patients and users alike. All products match the performance of commercial PCs and tough medical safety ratings like UL606011 and EN60601-1; adding to this they are all IPX1 certified dust resistant and come with water drip-proof enclosures. Advantech offers long term support and a proven track record of reliability. The medical range extends through: • Point-of-Care Terminals. • Mini-PC and Medical Imaging Displays. • Mobile Medical Tablets. • Patient Infotainment Terminals. Advantech is also an official distributor of Microsoft Windows Embedded software across Australia & New Zealand.

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P: 03 5335 2220 F: 03 5335 2211 E: argus@argusconnect.com.au W: www.argusconnect.com.au ArgusConnect provides and supports Argus secure messaging software that enables doctors and healthcare organisations to exchange clinical documents securely and reliably. Argus can be used to send specialist reports to referring doctors but it can also exchange pathology and radiology reports, hospital discharge summaries and notification between healthcare providers. Healthcare practitioners can use any of the popular clinical software packages to send reports and other clinical correspondence via Argus. Argus is the messaging solution chosen by nearly 50% of all Divisions of General Practice across Australia through the ARGUS AFFINITY DIVISIONS program. Keep a watch out for the AFFINITY DIVISIONS ‘Buddy Practice Initiative’, a program promoting the adoption of Argus by specialists and allied health practitioners.

Best Practice

P: 07 4155 8800 F: 07 4153 2093 E: sales@bpsoftware.com.au W: www.bpsoftware.com.au Best Practice sets the standard for GP clinical software in Australia offering a flexible suite of products designed for the busy GP practice, including: • Best Practice Clinical (“drop-in” replacement for MD2) • Integrated Best Practice (clinical/management) • Top Pocket (PDA companion software for Pocket PC)

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

Cerner is a leading supplier of healthcare information systems and our Millennium suite of solutions has been successfully installed in over 1200 sites across the globe. Cerner’s technology has been designed so that it can be adapted to meet the needs of the very different healthcare delivery systems that exist, with a universal framework which allows clinician workflow to seamlessly span role and venue. Our innovative leadership is allowing us to push boundaries by: • Leveraging clinical and pharmaceutical data for new discoveries in Condition Management and Personalised Medicine • Connecting the community with personal and community health records • Seamlessly connecting the patient record across the continuum of care

Computer Initiatives has been supporting the medical profession for over 15 years. Providing IT consultancy services, quality hardware, professional support with qualified engineers to our large customer base in Melbourne and now in Brisbane and the Gold Coast. Recommended and preferred by a number of Divisions of General Practice and specialist software providers we are well versed in providing the following services to the professions: • Supply and install of hardware/ software and peripherals • Disaster recovery and replication plans to minimise downtime to a number of minutes • Remote monitoring and diagnosis of crucial information systems • Advanced networking deployment and support • Prompt and competitive on site support • Internet configurations and content filtering services • Security audits, configurations and monitoring • Regular maintenance services We pride ourselves in our accreditations and levels of certification. We are a Microsoft Gold Partner – the highest level of MS certification and a Microsoft Small Business Specialist.

200,000:

The number of copies of Pulse+IT that are produced each year.

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DIRECT CONTROL

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

DOCSTOCK

P: 02 8883 4425 F: 02 8883 4426 E: info@docstock.com.au W: www.docstock.com.au 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!

“Innovative Document Management”

Emerging Health Solutions

“Innovative RFID Tracking”

P: 02 8853 4700 CMY F: 02 9659 9366 E: Arthur.Harris@emerging.com.au K W: www.emerginghealthsolutions. com.au Emerging Health Solutions (EHS) provides next generation electronic health records. A Clinical Information System that is patientcentric & web-based that captures and provides appropriate, timely, clinical information in a secure and auditable environment to assist clinicians deliver effective, quality care. EHS is currently live in Australian hospitals and has been assisting the Australian health industry for over a decade. Emerging is a specialist I.T. health provider acutely aware of the privacy and security issues that rightfully exist when dealing with patient records. Emerging’s core clients include St. Vincent’s, Mater Health service, and the South Australian Government Department of Health.

“Innovative Data Storage”

FILE PTY LTD

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

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

Equipoise International

P: 07 3252 2425 F: 07 3252 2410 E: sales@totalcare.net.au W: www.totalcare.net.au Equipoise International Pty Ltd (EQI) is the developer and supplier of the ‘Totalcare’ clinical health and management information system. Used by health care facilities across Australia, clients include GP’s, specialist practices, day surgery facilities and hospitals. A fully integrated suite of software modules, Totalcare has been developed in close working relationships with clinical specialists, healthcare administrators and hospitals and has been designed to suit and follow the particular needs and processes of healthcare providers. Totalcare is a complete clinical, front office, financial & management solution designed to give you everything you need to run your specialist practice, day surgery and hospital.

GPA

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

GENIE solutions

P: 07 3870 4085 F: 07 3870 4462 E: info@geniesolutions.com.au W: www.geniesolutions.com.au Genie is a fully integrated appointments, billing and clinical management package for Specialists and GPs. Genie runs on both Windows and Mac OS X, or a combination of both. With over 1500 sites, it is now the number one choice of Australian specialists.

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

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HEALTH SOLVE Health Communication Network - HCN

HEALTHENGINE

P: 02 9906 6633 F: 02 9906 8910 E: hcn@hcn.com.au W: www.hcn.com.au

P: 0419 091 170 F: 08 9467 6150 E: info@HealthEngine.com.au W: www.HealthEngine.com.au

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

HealthEngine.com.au is a comprehensive online directory of GP’s and Specialists, offering free doctor and practice listings to any Medical Practitioner registered in Australia.

HCN focuses on improving patient outcomes by providing evidence based software tools to health care professionals at the point of care. Market snapshot: • 17,000 medical professionals use Medical Director • 3,600 GP Practices use PracSoft • 800 Specialist Practices use Blue Chip and • 2,100 Specialists use Medical Director • Leading suppliers of Knowledge Resources to Australia’s major hospitals

Find a Doctor: Doctors can be searched Australia-wide by name, specialty, gender, and geographic location. Find a Service: GP and specialist medical practices, public and private hospitals, day surgeries and medical test centres across Australia.

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

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

For further information, please contact Mike: 0419 091 170

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HealthSolve RiGHTPEOPLE is our Staff Management system for any health organisation. Use in conjunction with the HealthSolve CMS or stand alone. HealthSolve solutions are industry standard, and readily interoperable with other systems.

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

Australia’s largest effective secure communication network.

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

Care Management Systems for: • Acute Care • Aged Care • Community Care

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

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

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

HEALTHLINK

HealthSolve provides solutions across the continuum of care with solutions for all sectors.

HISA

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

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

Visit our website to learn more about our complete offering which includes MDPlus advanced tools, GPRN data and iRIS for radiology practices.

P: 1800 803 118 F: 08 8203 0595 E: info@healthsolve.com.au W: www.healthsolve.com.au

HIMAA

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

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

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

Houston Medical

P: 1800 420 066 or +61 2 9669 1844 F: +61 2 9669 1791 E: houston@houstonmedical.net W: www.houstonmedical.net Houston Medical, formed 1988, leading supplier of software for Ophthalmology and Retinal Diabetic screening, installed in hospitals and practices of all types throughout New Zealand, Australia, Fiji, Dubai and Hong Kong. After a complete re-write, Houston VIP.NET using Security Groups with User Defined Forms, allows different specialities their own desktop and workspace on a common database. Billing, appointments TXT and RSD messaging, word processing, prescribing, operating lists all integrated but separate. Whether for day surgery, ophthalmology, cardiology, dermatology, urology, general practice, allied health, or any combination in a mixed practice, in once, out in a 1000 different ways, a truly unique concept for 2009!

iSOFT

NEHTA

P: +61 2 8251 6700 F: + 61 2 8251 6801 E: company_enquiry@isofthealth. com W: www.isofthealth.com iSOFT is one of the world’s largest providers of healthcare IT solutions. We design, build and deliver industry-leading software systems that serve the entire health sector, ranging from GP surgeries to specialist departments and across entire hospitals.

P: 02 8298 2600 F: 02 8298 2666 E: admin@nehta.gov.au W: www.nehta.gov.au

Medical-Objects

P: 07 5456 6000 F: 07 3221 0220 E: info@medical-objects.com.au W: www.medical-objects.com.au

Our solutions facilitate cooperation and communication between doctors, nurses, pharmacists and lab technicians by allowing unified patient management, electronic ordering, results reporting and transfer of data between different care settings.

Medical-Objects has provided secure messaging to over 10,500 health professionals with referrals, reports, letters and discharge summaries. Delivering directly into leading practice software, removing the need for scanning and faxing.

iSOFT aims to create virtual health networks that promote clinical and corporate governance, quality, efficiency and consent in healthcare, enhancing the experience for all participants.

Referrals are digitally signed and encrypted, moreover, compatible with Medicare’s requirements and in line with NEHTA’s eHealth PIP direction. Using Medicare supported PKI, you can trust that referrals are digitally signed with PKI and we are working with NEHTA as an eHealth PIP eligible secure messaging vendor.

INTERSYSTEMS

P: 02 9380 7111 F: 02 9380 7121 E: anz.query@InterSystems.com W: www.InterSystems.com InterSystems provides innovative software products that enable you to create, deploy, run, and connect healthcare applications faster. InterSystems Ensemble®, our rapid integration platform, can cut IT project times in half for enterprises that need to connect applications, processes, and people. Our health information exchange platform, InterSystems HealthShare™, enables the creation of electronic health records that share clinical data across multiple organisations on a regional or national level. InterSystems TrakCare™ is an advanced Web-based healthcare information system that rapidly delivers the benefits of an Electronic Patient Record. Ensemble, HealthShare, and TrakCare all leverage the lightning speed, massive scalability, robust reliability, and rapid development capabilities of InterSystems Caché®, the world’s fastest object database.

MIMS AUSTRALIA JAM SOFTWARE

P: 02 9799 1888 F: 02 9799 4042 E: enquiries@jamsoft.com.au W: www.jamsoft.com.au MED™4i (Medical Electronic Desktop™) streamlines Health Care with easy-to-use customisable interfaces, modular versatility & connectivity backed by friendly expert engineers. Comprehensive Patient database with multiple-format billing including electronic Online Patient Verifications & Claiming to Medicare, DVA & Health funds (paperless) MS Office integration, Orders, e-Results, Prescriptions (including MIMS) & Customisable databases including surgical audits. Your specific needs can be easily accommodated. Fully supported with on-going upgrades to meet the ever-changing health environment.

P: 02 9902 7700 F: 02 9902 7701 E: info@mims.com.au W: www.mims.com.au

MIMS is the premier supplier of medicine information to Australian healthcare professionals. To cope with the demands of delivering 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 information being current 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.

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.

NTS Transcription Services

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

PULSE + IT

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.

NUANCE COMMUNICATIONS

P: 1300 550 716 F: 02 9434 2301 E: Kerry.Young@nuance.com W: www.nuance.com/au Nuance (NASDAQ: NUAN) is a leading provider of speech and imaging solutions for businesses and consumers around the world. Its technologies, applications and services make the user experience more compelling by transforming the way people interact with information and how they create, share and use documents. Every day, millions of users and thousands of businesses utilise Nuance’s proven range of productivity applications which include Dragon NaturallySpeaking (speech recognition), OmniPage (OCR), PaperPort (document management) and PDF Converter Professional (PDF creation and conversion).

Pulse+IT is distributed to all corners of the health sector and is enjoyed by General Practitioners, Specialists, Practice Managers, Hospital and Aged Care decision makers, Health Informaticians, Health Information Managers and Health IT Industry participants Having grown rapidly from its launch circulation of 10,000 copies in August 2006, Pulse+IT’s current bi-monthly distribution of 40,000 printed copies ranks it as Australia’s highest circulating health publication of any kind.

THE SPECIALIST

P: 1800 803 118 E: info@healthsolve.com.au W: www.clintelsystems.com “The Specialist” is an intuitive and truly sophisticated tool that allows management of patients within: • specialist medical practices • private hospitals • day surgeries. The Specialist includes 5 modules: • Accounting • Correspondence • Time Manager • Medical Records • Mobile Data Facility “The Specialist” runs on both Macintosh™ and Windows™ platforms. Current installations range from single stand-alone computers to networks connected to either Macintosh™ or Windows™ file servers.

In addition to printed magazines, Pulse+IT offers a number of digital products including a weekly The Specialist is industry standard, eNewletter service, Twitter and RSS and readily14:50:20 interoperable with feeds, an online events calendar, 20/02/09 SR Logo_65x42mm.pdf other systems. and an interactive website.

STAT HEALTH SYSTEMS

PEN COMPUTER SYSTEMS P: 02 9635 8955 F: 02 9635 8966 E: enquiries@pencs.com.au W: www.pencs.com.au

P: 07 3121 6550 F: 07 3219 7510 E: carla.doolan@stathealth.com.au W: www.stathealth.com.au

SMARTROOMS BY DOCTORWARE

PCS expertise extends to: • Chronic Disease Prevention and Management • Population Health Status, Reporting and Enhanced Outcomes • Decision-Support tools delivered LIVE into the clinical consult • Web-based Electronic Health Records (EHRs) • SNOMED-CT and HL7 Standards Frameworks

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

Our Clinical Audit Tool (CAT) for example delivers an intuitive population reporting and patient identification extension to the leading GP systems in Australia. CAT delivers enhanced data quality and patient outcomes in general practice.

PULSE + IT

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

ZEDMED

P: 03 9284 3300 F: 03 9284 3399 E: sales@zedmed.com.au W: www.zedmed.com.au Owned by Doctors who understand the challenges facing the medical profession everyday and backed by nearly 30 years of experience in medical software programming, Zedmed provides innovative, full featured and sophisticated practice management and clinical records software solutions.

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

WACOM

P: 03 9499 4622 F: 03 94991397 E: sales@doctorware.com.au W: www.doctorware.com.au

Comprising both practice management and clinical software, our all-in-one patient record and superior after sales support provides the basis for a stable and time effective software solution for specialist practices of all sizes. SmartRooms is available in an appointments and billing only version for practices with uncomplicated software needs.

Stat is an integrated clinical and practice management application which has embraced the latest Microsoft technology to build a new generation solution. Stat Health Systems have formed partnerships with Ocean Informatics and First DataBank who will supply tools for clinical database management and the drug database respectively. Fully scalable and the only medical software application to incorporate a multi-functional intuitive interface, Stat is at the forefront of computing technology. The Stat roll-out has begun and we are able to convert data from all existing software. Stat also provides a premium support service and the Stat Online Claiming Solution (SOCS).

From a single Specialist to a multisite GP Practice, we are renowned for our superior customer service and products that provide stability, security and ease of use. We also provide comprehensive data conversions from most software packages on the market today. Zedmed is proud to be one of the longest serving Australian medical software solution providers, with clients nationwide.

SIGN IT‘S A

OF THE TIMES. PAPERLESS SIGNATURE CAPTURE As we move to the digital age we reduce the need for the use of paper. With the new Wacom SignPAD (STU-500) you can now capture all your patients signatures safey, securely and efficiently. So move with the times, Wacom SignPAD.

www.wacom.com.au/displays/stu-500

RRP $449

SignPAD • Capture patient signatures electronically (Work drectly with your existing practice software)

• Simple, safe, secure workflow or claims process (Streamline administration of claims vouchers)

• Reduced printing costs (file Medicare vouchers electronically)

• Reduce storage and filing. (save space & time - store created files electronically)

WHEN EVERY HANDOVER IS MISSION CRITICAL.

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

Tel 1800 125 036 enquiries@healthlink.net Integration

Standards