Pulse+IT Magazine - November 2009

PULSE IT 

AUSTRALIA’S FIRST AND ONLY HEALTH IT MAGAZINE

ISSUE 15: NOVEMBER 2009

NEW HORIZONS

www.pulsemagazine.com.au

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

Leading the progression of e-health in Australia The National E-Health Transition Authority (NEHTA) was established by the Australian Commonwealth, State and Territory governments on July 5th 2005 to develop better ways of electronically collecting and securely exchanging health information.

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

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

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

Recruitment:

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

• Senior Engagement Analyst, Engagement Lead a team of Engagement Analysts and work on stakeholder management issues.

• Assistant Project Accountant, Finance Assist in the development and monitoring of budgets and forecasts and the maintenance of NEHTA’s financial systems.

Is Health Informatics your career choice?

E-health will have a major impact on healthcare providers and the patients being treated.

Apply your Health Informatics skills to health reform in Australia.

Email your details to: careers@nehta.gov.au

Recruitment:

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

• Systems and Infrastructure Manager, Clinical Terminology & Information (CTI) Lead the Systems and Infrastructure team.

• Content Manager, CTI Lead the Content Development team.

• eMM Project Manager, eMM (eMedication Management) Plan and coordinate the development requirements and process to support implementation processes including implementation guides.

• Risk and Issue Specialist, Project Management Officer (PMO)

Take the lead in ensuring that the NEHTA Program is managing risk and resolving issues effectively.

• Solution Architect, Secure Messaging

Responsible for facilitating delivery of solution architecture(s) for service-based solutions within the e-health environment.

• Business Analyst, Secure Messaging

Provide a mix of project management, business analysis and technical skills to the project and identify problems, requirements and solutions.

Note that these opportunities were current as of October.

Up to date information on current opportunities is available from:

Enquiries and applications can be directed to:

www.nehta.gov.au

careers@nehta.gov.au

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

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

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

Editor Simon James +61 (0) 402 149 859 simon.james@pulsemagazine.com.au Editorial Enquiries editor@pulsemagazine.com.au Advertising Enquiries ads@pulsemagazine.com.au About Pulse+IT Pulse+IT is Australia’s first and only Health IT magazine. With a national distribution exceeding 38,000 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 10,000 copies of Pulse+IT are distributed to health information managers, health informaticians and IT decision makers in hospitals, day surgeries and aged care facilities.

PAGE 27 READERSHIP SURVEY A readership survey that will contribute to the future editorial direction of Pulse+IT.

ISSN: 1835-1522 Contributors Jacques von Benecke, Janette Bennett, Kerryn Butler‑Henderson, Grahame Grieve, Simon James, Glenn Kennedy, Dr Michael Legg, Amanda Leong, Kyle Macdonald, Dr Andrew Pesce, Robyn Peters, Steve Quenette, Philip Robinson and Mark Worsman.

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

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.

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

PAGE 44 MARKET PLACE The Pulse+IT Directory profiles Australia’s most innovative and influential e-Health organisations.

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

SECURE MESSAGING PAGE 34 & 38

MEDICAL DEVICES PAGE 36

MANAGING RISK PAGE 40

INNOVATION PAGE 42

REGULAR Sections PAGE 06 STARTUP Editor Simon James introduces the fifth edition of Pulse+IT for 2009, edition number fifteen.

PAGE 12 GUEST EDITORIAL Dr Michael Legg details the key findings from the recent Health Informatics Workforce Review.

PAGE 18 BITS & BYTES Pulse+IT’s news section, delivering the latest e-Health developments from Australia and abroad.

PAGE 08 GUEST EDITORIAL Dr Andrew Pesce outlines the AMA’s stance on a range of e-Health issues, including electronic prescribing, personal health records and incentives to drive clinician adoption of e-Health technology.

PAGE 14 GUEST EDITORIAL Glenn Kennedy outlines the benefits of outsourcing the management of practice IT infrastructure.

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

PAGE 16 GUEST EDITORIAL Philip Robinson outlines the risks and benefits associated with undertaking health informatics work in the Middle East.

PAGE 29 NEHTA NEHTA overview its Compliance, Conformance and Accreditation Program.

PAGE 10 GUEST EDITORIAL Janette Bennett and Jacques von Benecke highlight some of the successes from the NHS National Programme for IT.

PAGE 44 MARKET PLACE The Pulse+IT Directory profiles Australia’s most innovative and influential e-health organisations.

FEATURE Articles PAGE 27 READERSHIP SURVEY A readership survey that will contribute to the future editorial direction of Pulse+IT. PAGE 34 SECURE MESSAGING Kyle Macdonald overviews the secure messaging capabilities of over thirty clinical software packages.

PAGE 36 MEDICAL DEVICES Mark Worsman and Amanda Leong outline the potential legal implications of the use of consumer technology in health.

PAGE 38 MESSAGING WITH CDA Grahame Grieve asks whether Australia should be looking to adopt CDA to improve clinical messaging.

PAGE 40 MANAGING RISK Robyn Peters encourages practices to better understand and manage risk.

PAGE 42 E-HEALTH INNOVATION Steve Quenette outlines some of the similarities shared by e-Health and other science and engineering fields.

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

Pulse+IT: 2009.5 Welcome to the fifteenth edition of Pulse+IT, Australia’s first and only Health IT magazine.

The last few months have seen increased levels of governmental e-health activity, with the National E-Health Transition Authority (NEHTA) releasing a 2009-2012 Strategic Plan and its 2008-2009 Annual Report. An updated Australian Medicines Terminology — and perhaps more significantly — draft technical documents outlining the organisation’s current view on electronic prescribing infrastructure were also released in late October.

Having doubled its membership numbers this year, the Medical Software Industry Association held a well-attended round table meeting in Sydney. The subsequent AGM saw Dr Geoffrey Sayer elected as the peak body’s new President, succeeding Dr Vincent McCauley who has transitioned to the role of Treasurer.

Utilising the extra capacity afforded to the organisation by the recent appointment of a CEO, the MSIA has flagged an intention to play an increasingly more hands on role in the provision of services to its members and the e-health sector more broadly.

The Health Informatics Society of Australia (HISA) has also experienced some personnel changes, with Dr Louise Schaper being appointed as the organisation’s new CEO, replacing Dr Brendan Lovelock who recently stood down from the position after more than three years with HISA.

THIS EDITION This edition of Pulse+IT features five guest editorials, including contributions from AMA President, Dr Andrew Pesce, and HISA President, Dr Michael Legg.

Philip Robinson returns with an article canvassing his observations and experiences as a health informatician working in the Middle East, and Glenn Kennedy outlines the benefits of outsourcing the management of practice IT infrastructure.

Janette Bennett and Jacques von Benecke commence a series that details their experiences and learnings from their work on the NHS National Programme for IT, an initiative that they assure the reader is progressing better than much of the

reporting by the local UK media would indicate.

Five feature articles are also included in this edition, two of which relate to the ever-topical subject of secure clinical messaging. Kyle McDonald presents the first of these, outlining the important role of clinical software in clinical messaging transactions. This article also provides an overview of the extent to which over thirty clinical software packages perform — correctly or otherwise — a range of common messaging functions.

Grahame Grieve, a recent recipient of HISA’s Don Walker Award for Effectiveness, contributes an article that introduces Clinical Document Architecture (CDA) to the readership, a technology that some believe may ultimately succeed HL7v2 for the purposes of clinical messaging.

Mark Worsman and Amanda Leong return with an article outlining the potential legal ramifications for the suppliers of mainstream consumer devices that have applications which may position them under the formal definition of a medical device.

Robyn Peters continues her practice management series with an article discussing IT-related risks that may arise in a typical medical practice, and Steve Quenette draws some parallels between the e-health domain and other science and engineering fields.

Finally, an expanded Pulse+IT Directory is included at the end of the magazine, with this section containing several new entrants that the reader may like to familiarise themselves with.

READERSHIP SURVEY Having been in circulation for just over three years and with fifteen editions now behind us, the Pulse+IT team are going to use the break afforded by the Christmas period to undertake some retrospection, introspection and forward planning. As part of this process, this edition of Pulse+IT contains a readership survey that I encourage you to complete.

While various third parties have collected information about the publication over the years, this survey constitutes the first quantitative research effort designed specifically to steer the

Pulse+IT Readership Survey Send us your feedback to enter the draw to win an Apple iPhone (RRP $879).

Turn to page 27 for more details.

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future direction of the publication’s editorial makeup. Most of the questions in the survey are multiple choice, and I expect that it should only take around five minutes to complete.

As indicated in the teaser advert on the adjacent page, respondents who complete the survey have a chance to win an Apple iPhone (RRP $879), which will be dispatched to the lucky winner in time for Christmas.

Looking to 2010

will be published under the selected edition theme, with the Bits and Bytes news section of the magazine remaining flexible to accommodate coverage of timely e-health developments. A selection of longer “out of theme” feature articles will also be published in an effort to broaden the appeal of each edition of the publication.

The Pulse+IT website will be refreshed in the lead up to Christmas, with work already underway to incorporate several modern web technologies into the site to allow content to be accessed in a variety of new ways.

Finally, we will be undertaking to refresh the design of the printed publication to provide us with the ability to accommodate a wider range of article styles going forward.

The rising profile of Pulse+IT and the ever increasing amount of e-health activity occurring in Australia has seen interest from companies looking to promote their products and services through the magazine steadily increase this year. While this certainly bodes well for the ongoing viability of the publication in what continues to be a testing time for media outlets, it has UNTIL NEXT YEAR become apparent that our typical edition size of 52 pages Thanks must go to all the writers and advertisers that have will need to grow to accommodate the increasing number of made this year’s editions of Pulse+IT possible. I’d also like to editorial opportunities that are presenting themselves. With this acknowledge the ongoing support of the Australian Medical in mind, the first edition for 2010 will see Pulse+IT’s page count Association, the Australian Association of Practice Managers, rise to a more significant 68 pages. On an annualised basis, the Health Information Management Association of Australia, this expansion will effectively double the amount of content and the Health Informatics Society of Australia, each of whom produced by Pulse+IT when compared with what was generated distribute copies of Pulse+IT to their respective memberships. in our inaugural year.

As always, if you would like to provide us with any feedback, Beyond simply providing us with an opportunity to offer up have any suggestions for future articles, or would simply like to more content, this page boost will allow us to “theme” each discuss your experiences with e-health, don’t hesitate to get in edition. While our past cover designs may suggest that this has touch. always been the intention, these designs were simply intended to highlight a more significant feature article contained within Simon James, Editor the edition. +61 (0) 402 149 859 HealthLink/Medinexus Halfsimon.james@pulsemagazine.com.au Page 180 x 120 Puse IT Mag It is anticipated that eight feature articles and guest editorials

connecting healthcare

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FEATURE Dr Andrew Pesce AMA President

AMA backs e-Health rollout Momentum for the implementation of e-health programs and services is growing, and the AMA is keen for the medical profession to embrace the new technology.

The AMA has a proud record of supporting the march towards a world-class e-health framework in Australia, and we have enthusiastically worked with the National E-Health Transition Authority (NEHTA) on its agenda.

We participate on a number of NEHTA committees and working groups.

We have lobbied the Government vigorously for funding for e-health infrastructure in hospitals, medical practices, aged care, pharmacy and other allied health practices.

The AMA fully supports the rollout of e-health initiatives in order to integrate systems, reduce fragmentation of care, streamline service delivery, reduce duplication of services, and improve quality and safety.

We believe the rollout should start with e-prescribing and medically-controlled sharing of essential patient health information between health care providers through electronic records.

Priority needs to go to funding and rolling out the infrastructure for e-health, especially electronic records, given that investment to date has mainly focused on development of standards and technical specifications.

The AMA believes that a vital part of the e-health revolution is to have remote communities wired for e-health service delivery through innovations such as telehealth and Internet consultations and advice. These were recommended by the National Health and Hospitals Reform Commission (NHHRC) in its Final Report to the Government in June this year.

Increasing the use of telemedicine generally has the capability to provide greater efficiencies for both doctors and patients — and improve health outcomes in the community. The AMA has urged the Government to include telemedicine in the Medicare Benefits Schedule.

The e-health rollout should include the electronic transfer of prescriptions early on.

In the absence of standards and specifications defined by NEHTA, at least two commercial vendors have commenced rollout of the e-prescribing products.

Doctors must be confident that the system they choose will be compliant with standards and specification, and that all products will be interoperable with existing practice software. Strong governance is required around the regulation of commercial software products to ensure this occurs.

While the recommendations from the NHHRC advocate the introduction of a “person-controlled” electronic health record, the AMA believes that far more consultation is required to define what the practical implications are for “person-controlled”.

The AMA encourages consumers to take an active role in

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managing their health, but an electronic health record (EHR) should be a “clinical” tool to assist doctors to access relevant summary clinical information about a patient whenever and wherever it is required.

Any EHR must balance health care safety and quality with privacy.

Protection of patient privacy will be the critical factor in gaining acceptance from consumers and the medical profession in the implementation of an electronic health record.

Improvements to the infrastructure in hospitals, medical practices, aged care, pharmacy and other allied health practices are required to enable e-health to happen — and happen in a timely fashion.

The provision of high speed broadband to rural and remote communities to enable e-health service delivery (such as telehealth and internet consultations) is a vital part of the e-health revolution. It is essential that governments provide sufficient training and support for all healthcare providers during the implementation phase.

E-Health needs doctors and doctors need e-health.

Many of our number know the term e-health, but many are yet to fully understand the practical benefits that will flow to the way they practise medicine and care for their patients.

Adopting e-health practices is a big move for many medical practitioners so it is important that all the right advice and assistance is made available to them.

For a successful e-health implementation, doctors and other users must have confidence in the available systems.

The Federal Government e-Health Practice Incentive Program initiative is a welcome program for general practice. However, specialist practices would benefit from similar incentives and support to ensure all the links in the e-health chain are in place.

The AMA is opposed to limiting the payment of patient benefits and rebates (such as Medicare and private health insurance) if providers are not “e-health-ready” by 2013. With adequate incentives through education, funding and support to encourage take up, punitive measures will be unnecessary.

The AMA broadly supports the introduction of Healthcare Identifiers and recognises they will facilitate the secure sharing of information between doctors and organisations.

However, governance supporting the implementation and privacy issues still needs to be clarified through the appropriate and necessary legislation.

And the AMA believes there should be no negative implications for patients, such as linking the payment of rebates or benefits to patients if their health provider is not e-health ready, as proposed by the NHHRC. Once these wrinkles are ironed out, the AMA and the medical profession stand ready to get behind e-health and make it the reality that the Australian health system needs.

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

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

The English National Programme for IT – Information Beyond the Sound Bites Healthcare in the United Kingdom is provided by a complex ecosystem of autonomous or semi-autonomous organisations, including hospitals, pharmacies, general practitioners and therapists with many still procuring and deploying their own IT systems. However under the strategic plans and contracts of the English National Programme for IT (NPfIT) it is no longer the case that each constituent finds it difficult or impossible to share and receive clinical information with other healthcare providers.

However few people know the vast extent of the programme or that most areas are exceeding expectation and benefit realisation since implementation started in 2005. Good news often results in no media coverage. This article and a forthcoming series of articles focusing on lessons learnt from our experience in the UK, set out to rectify that situation.

NPFIT SERVICES In 2004/5, the National Health System (NHS) let contracts to four Prime Contractors in three major areas: • Integrated National services (“Spine”) • National broadband • Local Service Providers (LSP) of solutions and services for GPs, Secondary care, mental health and community care.

However as difficulties arose, some suppliers left the programme and as of 2008 there were only 2 LSPs left, one of which is BT. BT works with multiple vendor products and companies to deliver our services — as prime contractor we manage over 180 sub contractors. In England, the NPfIT include the following BT delivered integrated services: • A single sign on portal direct to local and national Spine services for all healthcare workers — over 700,000 staff.

• National Broadband Network — providing a secure infrastructure for transferring patient identifiable data of over 70 million patients between 32,000 connected sites. The network is also available to Wales and Scotland for secure messaging as patients travel across national boundaries for health care services.

• National Authentication Services: àà Master Patient Demographic database — containing demographic details of all patients. It includes many sub services resulting in over 100 exception reports daily, which identify potential duplicates and data anomalies. àà Demographic Data Quality GUI — Enabling the correction of patient details at a national level and updating local systems thus maintaining the integrity of the patient unique identifier. àà Identity Management — central directory services for all organisations and staff members who access records, part of a full Access Control Framework that also manages legitimate relationships — who can see what patient

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•

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•

•

•

•

•

•

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information where and when — and what information the patient has decided to seal from view.

Central Audit and Performance — for every single instance of a record being viewed, created, updated, and legitimate relationship established, there is a record of who did what to whom where and when. All of this data is stored and retained.

Message Handling Service — that accepts, validates, authenticates and authorise all message based interaction in NPfIT that uses the Spine backbone network to communicate with either regional or central services.

Summary Individual Patient Care records — a summarised view of key information enabling so that other agencies including emergency services can provide safer care.

Secondary Usage Service — a centralised data warehouse that through processes of encryption, anonymisation and pseudonymisation enables the NHS to undertake secondary use of patient data for multiple reasons such as cohort identification for treatment, research including patient based, epidemiological and pharmacological trials, provider payment and quality analysis. All in a legal, safe and secure manner.

Electronic Prescription Service — providing an end-toend solution from prescribing to dispensing, payment and updating of the patient local and summary record. Over 24 million messages have now been processed between 8,000 GPs and 10,000 pharmacy systems.

View Prescription Dispensed — a centralised GUI that allows for profiling prescribed and dispensed medicine and the correlation between the two. This aids the prevention of fraudulent prescribing, irregular use of dispensed medicines as well as highlighting usage patterns of medicine groups.

GP2GP — the complete transfer of a GP record between practices as the patient registers with a new GP. Over 750,000 records have been transferred between 5,000 practices, replacing a process that routinely took over six weeks.

NN4B — a service that is part of the Patient Demographics Service that issues unique numbers to babies at birth and links these records to the mother or a responsible guardian.

Child Protection Service — a service that exports records linked to dependant children in real time as they are accessed and updated to the central children database. This centralising service ensures that all agencies that have interactions with dependant children can see other agencies that are in contact with the same dependant child at all times.

TECHNOLOGY All Spine services utilise a gigantic Transaction Messaging Service (TMS), a central message infrastructure that allows messages to

flow from compliant systems to the central services, and from one approved end point of the network to another. The TMS also uses rules to manage responses to requested services and is capable of processing 436 messages a second, or 14 thousand million a year. As at September 2009, the Spine handles almost 100 million transactions a month. 20,000 system instances from more than 300 suppliers have been connected to the transaction and messaging spine. For all services, this technical solution uses: • A blend of COTS products and bespoke Java code through Java EE Technologies.

• Service Orientated Architecture (SOA).

• Web Services (SOAP).

• Health Language 7 Version 3 (HL7 v3) formatted message embedded in ebXML. • Both synchronous and asynchronous messaging patterns, facades and orchestrated patterns to deliver complex services to both internal and external services.

At a local level, the NPfIT services include the integration of all services between GP, acute, mental health, community, ambulance and departmental systems such as radiology, pharmacy and pathology solutions. The provision and installation of some end services solutions are also provided by BT such as Picture Archiving and Communication System (PACS). This has now been installed throughout NHS hospitals with plans now in progress for regional storage and national transfer.

BENEFITS The benefits that have been realised as a consequence of NPfIT include: • New ways of delivering care, enabling patients and clinicians to monitor the patient’s condition from within their own home and manage their chronic disease better, avoiding emergency admissions, reducing outpatient appointments and bed days.

• Financial savings — Independent analysts Ovum have estimated that £4.4 billion is being saved through central procurement of IT systems by NHS Connecting For Health compared with what could have been achieved by individual NHS organisations purchasing the same systems separately. Additionally, large sums have been saved

by migrating multiple disparate research databases and disease registries into a single data warehouse. Not only does this save money, it supports meta analysis across multiple diseases and co-morbidities. The EPS has also brought about significant savings in medication management.

• Improved patient outcomes have been achieved by delivering improved access to reliable information, on-line decision support tools, secure rules based messaging activating care pathways across organisational and care service boundaries.

• Reduction in the administrative burden of clinical staff with more time for care delivery.

ADDRESSING THE SOUND BITES There is much more to write about but hopefully this brief overview has given real information about the success of NPfIT. As for the accuracy of some of the news that does get published in the media you can judge for yourself by looking at http://www. connectingforhealth.nhs.uk/factsandfiction/mythbusters.

Why then the bad press sound bites? Health is a highly political environment in any country. It rightly matters to all of us and irrespective of whether an individual has to pay out of pocket or receives care free at the point of delivery, a large part of having any health service available still requires government funding and tax payers. There are two areas that have been delayed; hospital solutions and the patient summary care record. Both of these areas have required significant change in professional and organisational practice and policy and forced a real debate on subjects such as “who owns the patient record?” and “why shouldn’t a patient be able to chose their appointment time and hospital?”. It is not surprising then that there have been delays, and while this has produced bad news sound bites the debate has certainly been a good one and brought about significant change.

LOOKING AHEAD The next article in this series will examine one of the NPfIT services operating in the UK and consider lessons learnt that Australia could benefit from in achieving health reform supported by e-health services.

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GUEST EDITORIAL Dr Michael Legg PhD FAICD FAIM FACHI MACS(PCP) ARCPA, is Principal of Michael Legg and Associates, and President of the Health Informatics Society of Australia. michael_legg@optusnet.com.au

Health Informatics Workforce For more than five years the Health Informatics Society of Australia (HISA) and others have been telling Government that there are not enough skilled workers to undertake current health informatics projects. There is now the real possibility that this skills shortage will be a major barrier to the mooted health reforms that are the subject of Government consultation currently.

This same message has been put by the Health Information Managers Association Australia (HIMAA) and the Health Librarians Australia (HLA). HISA, HIMAA and HLA have all made various submissions including proposals to the Commonwealth Health Minister, the National Health and Hospital Reform Commission, to the Senate Enquiry on Health Workforce, the National E-Health & Information Principle Committee (NEHIPC) and to Treasury in Budget Submissions.

It is pleasing to see that there is finally some recognition that this as an issue with reference to the health informatics workforce in documents such as the National eHealth Strategy and the recently released National E-Health Transition Authority (NEHTA) Strategic Plan. The Commonwealth Department of Health and Ageing have also recently funded secretariat support for the establishment of an Australian Health Informatics Education Council and for a scoping paper reviewing the health informatics workforce.

The health informatics workforce review paper identified the following seven issues: 1. There are too few health informaticians for the current workload and unless addressed these workforce and skills shortages will be a major barrier to implementing the National E-Health Strategy and to health reform more generally.

2. Too little is known about the health informatics workforce — we know neither how many we have now, nor how many we need, and there is no indication that it is yet part of any national health workforce strategy or the remit of the National Health Workforce Agency.

3. There is a fundamental breakdown in the market between employers, education providers and potential workforce entrants — while there is a strong demand by employers for workers, there has been a failure to attract students leading to the closure of well-regarded university courses.

4. Because it is an emerging field, health informatics does not have wide recognition as a discipline in its own right; there is a poor general understanding of the knowledge domain in Australia; and many of the workers in clearly related jobs do not yet self-identify.

5. There is no career structure for health informaticians in Australia; there is no standardisation of job names or job descriptions and there is no widely adopted set of competencies.

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6. There will be a long lag time to produce new health informaticians because of the multi-disciplinary nature of the education and the complexity of the discipline — the workforce we do have must be used optimally.

7. A contributing factor to the lack of needed recognition and action on health informatics workforce issues is the fragmented representation of those in the discipline.

Mitigation of the first of the identified issues, the workforce shortage, is considered in the paper using the following framework to assemble the suggestions: • Increase the supply of workers by: àà Improving recruitment àà Increasing the opportunities for education and training àà Retaining the workforce longer àà Attracting re-entry of those who have exited àà Outsource internationally • Redistribute the workforce from areas of lower to higher priority.

• Improve the productivity of the workforce by: àà Standardisation àà The introduction of new technology including software and knowledge tooling àà Improved work environment àà Consolidation • Reduce the demand by: àà Design Going some way to addressing the fourth issue, recognition of the knowledge domain and self-identification by health informaticians, the review paper also includes a discussion on the definition and scope of health informatics and offers a new succinct definition of the domain, which is that “health informatics is the science and practice around information in health that leads to informed and assisted healthcare”.

The paper recommends that a workforce management plan be developed to prioritise the issues, tease out the opportunities against each issue, draw on international work that is underway and determine the resources required for its implementation so that a business case for funding can be developed if that is necessary.

Given the lag times involved this cannot be delayed or be a prolonged process. Developing and implementing Government policy in this area is seen to be of national significance.

FURTHER INFORMATION The full Health Informatics Workforce Review is available from a link on the home page of the HISA website www.hisa.org.au.

Feedback is welcome.

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GUEST EDITORIAL Glenn Kennedy Glenn Kennedy is CEO of Virtual Technology Services. glenn.kennedy@vtservices.com.au

Spread too thin? Consider outsourcing IT to specialists Codification of and adherence to “best practice” in a clinical sense is well entrenched within the medical profession. It has to be, both to optimise patient outcomes and protect practitioners from a whole host of ethical and legal risks.

EVOLUTION OF INFORMATION TECHNOLOGY BEST PRACTICE Requirement for best practice is not only confined to clinical activities. From a practice management perspective, the RACGP through its General Practice Computing Group (www.gpcg.org. au) has issued a comprehensive range of policies, procedures and checklists designed by, and for, the medical fraternity. These documents recognise that security of patient information and integrity of practice IT systems are critical for the proper ethical, legal and professional functioning of the practice.

Great strides forward have taken place since 1997, when the Department of Health and Family Services commissioned the IBM consulting group to deliver a functional requirements specification and supporting technical framework for the widespread adoption of computers in clinical and administrative general practice. At that time, Australia was held to be behind most western democracies in the levels of computerization of general practice. In 2007, the Australian General Practice Network (AGPN) noted that 90% of GPs had a computer on their desk, with 64% recording clinical information in the form of progress notes.

General Practice is now the most computerised and most connected part of the health system, with the largest amount of computerised health information residing in the computers of general practitioners. The pace of technological change and the associated benefits it will deliver to both patients and practitioners shows no sign of slowing. Whilst the benefits are significant and worthy of pursuit, the day to day realities of keeping pace with technological change and up-to-date with best practice IT management within a medical centre can be a burden, particularly for the majority of practices that operate as small businesses.

MORE THAN JUST A CHECK-BOX EXERCISE? Take a moment to revisit the GPCG guidelines, starting with the Computer Security Self-Assessment Guideline and Checklist. It covers several critical topic areas including the appointment of a Practice Computer Security Coordinator, IT security policies and procedures, access control, disaster recovery, backups, antivirus, firewalls, network maintenance, and secure electronic communication. Each of these topics has a range of key considerations attached to it, and each of them are mission critical. Ask yourself honestly: do you currently have the time to

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implement these fully in your practice? If the answer is yes, when is the last time you reviewed your IT management systems to ensure that guideline adherence is not just a “tick-box” exercise and that compliance has been achieved both on paper and functionally?

In the IT services industry, horror stories abound of clients who believed they were following proper protocol until the system was challenged. Take the medical receptionist who was diligently inserting back-up tapes on a daily basis. All was well until a system crash occurred and the data needed to be recovered, only there was hardly any data on the tapes. A trap for new players is that an email advising “Backup completed successfully” does not indicate the successful duplication of all files. In fact it may mean that only one has been copied! This problem would have been prevented by regular, random “testrestore” protocols. Backup is only as good as your last restore.

Take an even higher level impact aspect of IT management: disaster recovery. One element of best practice is to compile a thorough asset register, or “as-is” document, detailing a complete list of IT equipment, including a physical and virtual network diagram; switch, router, firewall and server configurations; and security/access policies. You may be surprised to know just how many people store this information on the very systems they are intended to be “recovering”.

SPECIALIST SUPPORT FOR MISSION CRITICAL IT So perhaps you have allocated the role of Practice Computer Coordinator to a member of your team and they are handling this in addition to their other responsibilities. Are you confident that they have the expertise to attend to these issues effectively? You refer patients to specialists for specialist diagnosis and treatment.

Why would you entrust IT and information management — mission critical aspects of your practice — to anyone less than IT specialists? If you think you can’t afford it, it’s worth considering the real cost of managing your own IT, in terms of both staff time and the potentially devastating consequences of getting it wrong. Can you afford not to enlist outside help?

Here again, there are decisions to be made. Do you enlist a “break-fix” consultant, who arrives when he can and charges like he knows you need him, or a managed technology services provider, who proactively monitors your environment and handles the day to day IT admin tasks with efficient remote access tools, but is still available onsite when you need him, with unlimited support? There are numerous advantages to the managed technology model. To start with, they have a vested financial interest in ensuring your system is trouble-free, and their ongoing remote monitoring helps to address risk factors before problems occur. Clinical and patient management software installs and

upgrades can be handled remotely, and some providers will even bundle the cost of hardware and software into a tailored monthly fee, so you never have to suffer alarming spikes in IT expenditure.

THE NEXT STEP – MANAGED IT ENVIRONMENTS Having taken the step to engage a managed technology service provider, you’re enjoying the benefits of hassle-free IT and can’t imagine how you used to manage in the old days. However you can still take it one step further to really maximize the benefits of your outsourcing decision by physically moving your server to an internationally rated storage facility, and connecting the server back to your own private network. There are numerous benefits to this model:

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1. Physical security You can have the best data protection protocols in the world, but if someone can walk into your practice and steal your hardware, your data is not safe. A managed IT environment provides the ultimate theft and disaster protection.

2. Problem resolution times If an issue can’t be resolved remotely, you would usually have to wait for an engineer to arrive onsite. In a managed IT environment, engineers have ready access to your server in their central storage location. If, for example, your server blew up, this problem could be addressed more rapidly than if the equipment were housed at your practice.

3. Back-up and recovery In a managed IT environment, your data is housed on a server within a bank of servers. Backups are performed to both onsite and remote locations. If a server dies, backups can simply be replicated onto a new server within the rack.

4. Cost PCs and typical servers need to be replaced on average every three to four years. However practices that have outsourced the hosting of their server may benefit from using more robust “thin client” devices, which typically last several years longer than PCs, are less prone to failure, and consume less power.

As mentioned previously, more progressive service providers will be able to incorporate ongoing hardware costs into your monthly fees, eliminating unplanned spikes in spending.

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Houston VIP.net for Day Surgery includes:

If you do decide to engage a managed IT service provider, seek to deal with an organisation that has: • People who talk in terms of real business benefits, not technobabble.

• Access to a range of IT specialists, but through a dedicated Account Manager who understands your practice.

• Scalable solutions that can change or grow with your practice.

• Full disclosure of the fee structure, with no hidden costs.

• Relationships with reputable vendors for integration of telecommunications and security surveillance solutions from a single source supplier.

If you suspect your IT is not currently operating to best practice standards, or that staff time devoted to IT management could be better spent elsewhere, it might be time to review your approach to IT management in your practice.

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GUEST EDITORIAL Philip Robinson Philip Robinson is a health informatics consultant with more than 25 years experience in health policy and health information systems including medication management. Philip spent several years in the Middle East where, most recently, he reviewed the Information Technology and Pharmacy Services for the Emirate of Dubai. Philip qualified as a Computer Scientist and is a Registered Pharmacist. philip@acsmail.net.au

Middle East – The Sands of Time Beckon?

In the May edition of Pulse+IT, Dianne Pelletier wrote a tribute to experienced Australian health informatics specialists heading to the Middle East. This author has recently returned from several years in the Middle East and provides the following observations on the risks and benefits for any Australian health informaticians or clinicians looking at working in these health systems.

The most common jurisdictions in the Middle East are Saudi Arabia, Qatar, Bahrain, Oman and the United Arab Emirates (UAE) which together make up the Arabian Peninsula along with Yemen, which is not recommended to expatriates except for weekends in the historic centre of Sana’a. Super courageous expatriates could also consider Iraq or Afghanistan where re-construction is either happening or contemplated.

All countries are experiencing a rapid growth in health care services and according to the latest Arab Health newsletter, the health care market is growing at an annual rate of 16% and is currently worth approximately US$80 Billion. According to Pelletier, the interest for Australian IT specialists is the availability of greenfield sites, tax-free salaries and travel opportunities including to Europe and Asia. This author concurs with that view but there are pitfalls that need to be recognised.

The UAE has recently invested heavily in new hospitals, both public and private, with one of the major sites being the University Hospital in Dubai, which is affiliated with the Harvard Postgraduate Medical Foundation. Unfortunately, building has been delayed due to the impact of the Global Financial Crisis on Dubai, which has meant a major scaling back in the organisation of the new service and project staff being laid off.

This outcome would have been unthinkable when the project was created. However, other initiatives are still underway and the Emirate of Abu Dhabi and Qatar are two notable locations for well financed growth. Qatar boasts the prestigious Sidra project (www.sidra.org), where a number of Australians are working in the large project team creating this amazing teaching hospital in association with Cornell University.

The Health Authority for Abu Dhabi (HAAD) has outsourced hospital management to four separate international groups being Johns Hopkins (USA), Cleveland Clinic (USA), Bumrungrad (Thailand) and Vamed (Austria) e.g. at Sheikh Khalifa Medical Centre (www.skmc.gov.ae). However the federal Ministry of Health and the Dubai Health Authority are locally managed which creates difficulties for Western expatriate workers used to a high degree of management autonomy and relative freedom from bureaucracy.

Salaries within the Middle East are tax-free but, as there is no taxation treaty with Australia, salaries are subject to Australian taxation for Australian residents. Prospective expatriates should take detailed tax advice before undertaking an overseas posting. For example, while some approved projects are subject to tax exempt status (under Section 23AF) which provides for tax

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benefits in Australia, most do not have such useful status.

Conditions of employment in the Middle East should include employer-provided housing of a high standard, air-conditioning and a swimming pool being essential commodities given the climate. In Saudi Arabia, accommodation is likely to be in a compound associated with the hospital, which will include shopping facilities and movie houses while housing in UAE and Qatar tends to be in clusters of villas or apartments.

The Middle East, and Abu Dhabi, Dubai and Qatar in particular, have excellent air services to Europe and Asia such that it is possible to fly to, say, Cyprus or Turkey for a long weekend or to France or Italy for an annual holiday. There are a number of opportunities for the Aussie-style long-weekend due to national and religious holidays. Locally, four-wheel driving into the desert is a common getaway.

Support for alcohol consumption varies around the region from zero-tolerance in Saudi Arabia to availability in tourist hotels in Dubai. A few bottle shops are available to those with an appropriate alcohol licence. However, being intoxicated in a public place is frowned upon and could lead to severe consequences. Certainly, a respectful approach to alcohol and indeed all matters of cultural significance needs to be taken.

The quality of health services is reasonable by international standards with the more prestigious hospitals insisting on Western qualifications. Many senior clinicians of Arabic origin have trained in the USA or Europe and the UAE’s University of Sharjah is just starting to graduate students using the curricula from Monash University for its courses in Medicine and Pharmacy. However, Nursing is not well-regarded as a profession by local students and ward nurses tend to be from Malaysia, the Philippines or the subcontinent, with Western nurses tending to work at the Nurse Manager or Associate Director of Nursing level.

As shown by the recent survey by the Health Informatics Society of Australia (HISA), Australia has a shortage of health informaticians. However, while Australian governments continue to dawdle with the implementation of e-health and roll-out of Electronic Medical Records, health informaticians might like to consider employment in the Middle East. The opportunities for travel and professionally rewarding posts are attractive and there is no doubting the charm of many aspects of the Middle Eastern experience. However, survival within the general environment requires patience, persistence and tolerance as governance systems are not democratic and one should not expect the rule of law to be identical to the system that we enjoy in Australia.

Aspiring health informaticians or clinicians looking to the Middle East for a career break would also do well to take a crash course in Arabic, as, while English is widely spoken as the language of business, a few Arabic phrases go a long way towards breaking the ice (or perhaps smoothing the sand) with many Arabic speakers. Ma’salama!

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Record numbers attend the HIMAA conference in Perth The annual conference for the Health Information Management Association of Australia (HIMAA) was held in Perth in mid-October. Appropriately titled “Health Information Management: a Strategic Asset”, papers presented examined the Health Information Managers strategic contribution to innovation, leveraging assets, connecting the business and risk management.

The HIMAA conference was preceded by a one day IFHRO SEAR (The International Federation of Health Records South East Asia Region) conference at which a number of papers from partner countries, including Australasia, the Middle East and the United States of America, were presented on the theme “Health Information Networks: learning from one another”.

The HIMAA conference was opened

by Dr Simon Towler, Chief Medical Officer for the Department of Health, Western Australia. Highlights of the keynote speakers and presented papers included an innovative model of cancer data collection being used in the Barwon South Western region of Victoria, two thought provoking presentations that stimulated discussions about the current health and education environment and where Health Information Managers stand amongst this, and an excellent example of organisational inter-professional practice within the Auckland District Health Board.

The winners of the iSOFT Best Presentation award, Alexandra Toth and Grant Duffill, presented an entertaining

paper examining the drivers behind, and innovations in, the changes to health information management in Queensland since Dr Jayant Patel hit the headlines in 2005.

Four workshops were conducted on the Thursday afternoon, including a very informative session for Managers on working with newly trained coders, an enlightening workshop on writing proposals, an amusing yet useful session on emotional intelligence and the fourth workshop was about memory improvement.

Socially, the cocktail party Welcome Reception held the Tuesday night provided attendee’s with an opportunity to network with other guests and visit the exhibition booths before the conference began. The Conference Dinner at the Perth Zoo was the highlight of the week, with excellent food, wonderful company, many prizes and dancing that went well into the night.

The conference ended with site visits to the Mount Hospital and Royal Perth Hospital, with participants given the opportunity to offer positive experiences and recommendations for others interested in participating next year.

The conference enjoyed the largest delegate turnout since HIMAA’s 2003 conference in Sydney, with over 200 people attending the event over the three days. The 2010 HIMAA conference will be held in Sydney over three days from October 27.

— Kerryn Butler-Henderson

Houston deploys software for diabetic eye screening in Fiji The fight against diabetes induced eye disease in the Pacific has been boosted by the installation of new retinal diabetic screening software in Fiji’s Lautoka and Suva Hospitals.

The World Health Organization (WHO) estimates that almost 12% of Fijians and 20% of Indofijians have diabetes.

Although there are no official figures on the prevalence of diabetic retinopathy, according to one report it is the second most common cause of vision loss, after

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cataract, in one hospital in Fiji.

This advance in the prevention of blindness has been funded with the support of the Fred Hollows Foundation and the Reddy Lions Vision Group as part of the Retinal Diabetes Screening (RDS) program. This initiative has developed over a period of more than 10 years under the guidance of Auckland University’s Associate Professor Gillian Clover (now retired), in association with the Lions District 202A New Zealand, Lions International

BitS & BYTES SightFirst program, and local Lions Clubs in Lautoka and Ba, and supported throughout by Hamilton-based software developer, Houston Medical.

Developed by Houston, VIP.net Vision, is a practice management solution that the company claims provides much improved functionality and usability for practitioners in hospitals and allows for more efficient use of specialists’ time.

Speaking to the software’s impact in the Fijian deployment, Associate Professor Glover said: “Houston’s software has made a huge contribution to consistency of care for persons with diabetes eye disease in Fiji. It enables patient ophthalmic records to be available no matter where the patient presents — whether it be at base hospital or outreach mobile services to peripheral hospitals. Patient information can be retained and reviewed as they

progress through appointments for screening, ophthalmic examination and laser treatments.”

However, despite the deployment of the software in the Fijian hospitals, local Internet infrastructure constraints required that additional development be undertaken by Houston Medical’s software team to allow copies of the data — including high-resolution photographic images — to be stored on a laptop for later synchronisation with the hospital’s main database.

Following the success of their software deployments in Fiji, Houston Medical is now working on similar services for hospitals in Tonga, Samoa and the Solomon Islands.

The company has also been contracted by the Canterbury District Health Board in New Zealand to provide similar retinal diabetic screening services.

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HealthEasy prepares online practice software for release By consolidating the storage of patient information, the company claims that authorised third-party health professionals can be provided with access to patient records via a web browser, without the need for this data to be packaged and transmitted in other formats. Entire patient records will also be able to be easily transferred to other practices using the HealthEasy solution. The software will also include functionality dubbed “Rx-Sure” that will allow pharmacies to verify whether or not a prescription is valid online.

According to the company, no initial training will be needed by either the doctors or other staff, with ongoing support to be offered via video tutorials and an integrated live chat solution.

As a web-based application, the solution from HealthEasy will be compatible with a wide range of operating systems, including Microsoft Windows, MacOS X and Linux.

The company has not yet formalised its pricing model, however they have indicated that the cost to practices will be in the order of $99 a month per full time GP. The expected official launch date for the HealthEasy solution is July 2010, however interested parties will be able to view a functioning demonstration version of the software several months earlier as part of an “Early-Experience Program”.

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HealthEasy Pty Ltd, a Queensland-based Health IT startup company, is preparing to demonstrate a beta version of its webbased practice software solution in early 2010.

Developed with input from a group of health professionals led by GP Dr Ross Evans, the software will include functionality for clinical notes, prescribing, pathology and radiology, appointments, billing, reporting, and Medicare claims.

According to Mr Shayne Micchia, the company’s Senior Software Architect, the HealthEasy product will utilise the Software as a Service delivery model, negating the need for practices to install their software on either their practice server or the doctors’ individual workstations. Instead, users of the system will utilise their existing web browser to access the system across the Internet.

In contrast to how the majority of Australian practices currently host their clinical data, the solution from HealthEasy will centrally manage all patient information in an off-site hosting facility.

The company has indicated that this architecture will allow them to manage software updates and backups on behalf of their clients, however practices that wish to extract data for local backups or other purposes will be able to do so in a variety of formats, including XML, SQL and ASCII text.

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BitS & BYTES ERX SCRIPT EXCHANGE RECEIVES MICROSOFT ACCOLADE eRx Script Exchange and parent company Fred Health have been acknowledged as Microsoft’s Health Partner of the year.

Dr David Dembo, Leader - Health and Human Services, Microsoft Australia, said, “eRx won this award for both the innovation they and their partners showed in moving the Australian Health reform agenda forward, as well as their intelligent use of commoditised IT building blocks to ensure IT played a role in reducing the risk of the overall project.”

By the start of November, more than 2.5 million electronic scripts had been sent to the eRx script hub, with over 500,000 of these scripts dispensed by pharmacies using the technology.

RACGP UPGRADES PRACTICE RESOURCE PORTALS The RACGP has discontinued support for its MyGeneral Practice and MyPracticeTeam portals, closing both services at the start of October.

The portals, which required a proprietary software application be installed on each computer to function, has been superseded by a new website that consolidates patient handouts, calculators and dermatology resources, popular evidence based clinical resources, and links to other relevant information under a single website: www. mygeneralpractice.org.au Unlike the technology it replaces, the website is accessible by visitors using Macintosh and Linux operating systems, in addition to Microsoft Windows.

NINTENDO UPDATES WII FIT In October, Nintendo released an updated version of its popular Wii Fit fitness video game. When used in combination with the accompanying Wii Balance Board, the original software allowed users to perform a range of stretches and exercises under the guidance of a virtual fitness instructor.

Over 700,000 units of the original Wii Fit have been sold in Australia.

The updated software allows users to customise and design their own work out, perform a wider range of exercises, and receive an indication of the number of calories burnt during their workout. Other features with arguably less practical utility — such as the ability to calculate the weight of your dog, cat or baby — are also included in the new software.

Medilink releases integrated Medicare Easyclaim solution Medilink has released Integrated Medicare Easyclaim functionality in its flagship practice management software, Medilink ESI. In contrast to the much maligned stand alone version of Easyclaim — which requires the practice receptionist to enter a string of information into an EFTPOS terminal manually — Integrated Easyclaim solutions provide a link between the practice’s billing software and their EFTPOS terminal, streamlining the billing and claiming process considerably.

While the Medilink software already featured a range of billing and claiming options — including Medicare Online and ECLIPSE — Bob Marsh, software developer and owner of Medilink, believes Easyclaim eliminates many of the problems associated with these channels.

“The major flaws and frustrations with the outdated Medicare Online Patient Claiming is the three-day delayed rebate with risks and inefficiencies associated with keying errors or changes to the claimant’s BSB and Bank account numbers,” said Mr Marsh.

Mr Marsh went on to suggest that beyond meeting the needs of practices, Easyclaim is a solution that patients are increasingly aware of and interested in utilising.

“Now more than ever, consumers are better educated, far more assertive and money conscious particularly with the state of the economy.

“The debate about Patient Private Billing versus Medicare Bulk Billing continues, however we have all moved on considerably since it was instigated.

Electronic claiming of Bulk Billing with the old Medclaims product died a natural death in June last year. EFTPOS terminals became the way to go for Patient Private Billing many years ago, and together with the availability of sophisticated Practice Management software, most Practices have been brought out of their caves,” said Mr Marsh.

Medilink is undertaking a series of workshops to demonstrate the new functionality in its product. Registration details are available from the company website: www.medilink.com.au

NEHTA unveils Strategic Plan The National E-Health Transition Authority (NEHTA) has released a Strategic Plan to guide its operations for the remainder of 2009 through until 2012.

According to NEHTA CEO, Mr Peter Flemming, the strategic plan represents an attempt by the organisation to align itself with the National E-Health Strategy, which was submitted to Government in September 2008 and released in a summarised form a few months later.

“NEHTA has considered its future work program based on the National Strategy and other important work completed this year including the National Health and Hospital Reform Commission recommendations.

“As a result we have produced our Strategic Plan to clearly show our stakeholders across the health sector the directions we are taking to drive the adoption of e-health.

“The Strategy outlines four strategic priorities that define our role in adoption and implementation,” Mr Fleming said.

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The strategic priorities referred to by Mr Fleming include the need to urgently develop the essential foundations required to enable e-health, including Healthcare Identifiers, secure messaging and authentication capabilities, and clinical terminology.

Secondly, NEHTA is to coordinate the progression of priority e-health domains including referrals and discharge, pathology and diagnostic imaging and medications management.

Thirdly, NEHTA will undertake to accelerate the adoption of e-health by increasing the awareness and uptake of e-health initiatives by the various stakeholder groups, through collaboration and communication programs, incentives and implementation support.

Finally, NEHTA will attempt to position itself to lead the direction of current and future e-health initiatives and the impacts on privacy and policy.

The plan is available from the NEHTA website: www.nehta.gov.au

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MSIA hosts round table meeting, elects new executive In early October, the Medical Software Industry Association (MSIA) held a round table meeting in Sydney.

The meeting was convened at what is a pivotal time for e-health in Australia, with several recently released governmentendorsed or government-commissioned reports set to impact on the way e-health solutions are developed, deployed, and funded in Australia.

The event was attended by over 80 MSIA members and invited representatives from various government organisations.

Around a dozen NEHTA representatives were in attendance, with the organisation’s CEO, Mr Peter Flemming, delivering a presentation on NEHTA’s recently released Strategic Plan.

Representatives from Medicare Australia and the Department of Health and Ageing were also in attendance, as was Mr Adam Powick, the chief architect of the 2008 Deloitte National E-Health Strategy.

Following lunch, a series of short presentations detailing specific areas of MSIA representation and engagement were conducted, covering a range of diverse topics including NEHTA’s Australian Medicines Terminology project, the RACGP clinical guidelines, electronic PBS initiatives, Medicare Electronic Claiming, various National Prescribing Service (NPS) projects, Standards Australia IT-014, Health Informatics Workforce issues, the PIP Secure Messaging working group, the Medicare Stakeholder Reference Forum, and a GP Interoperability project designed to facilitate the transfer of patient records between different clinical software packages.

A small group workshop devoted to Conformance, Compliance and Accreditation was also held, with the event concluding with a presentation by Dr Stuart Smith on “Games and Health”.

The MSIA’s AGM followed the round table meeting, with a new executive committee being elected. After three years of service to the MSIA as President, Dr Vincent McCauley (McCauley Software) will now serve as Treasurer, with Dr Geoffrey Sayer (PhD) (HealthLink) being elected as President. Jenny O’Neill (Epi-Soft) was elected as the new MSIA Secretary, succeeding Dr Andrew Magennis who

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stood down after nine years of service on the MSIA Committee.

Andrew’s long running commitment to the peak body was formally recognised with the inauguration of the “The Andrew Magennis Award” for outstanding service and leadership in the health software industry. This award will be presented annually to an individual selected by the MSIA membership.

Dr Magennis’ involvement with e-health stretches back to 1993, when he partnered with the developers of Medical Director to incorporate his A-Z DEX medicinal information into the thenfledgling prescribing software package.

Prior to this collaboration, A-Z DEX was available only in a printed format.

Nearly 20 years on since founding A-Z DEX, Dr Magennis remains involved with the product in his capacity as Medical Director of HCN. Speaking after the event, Dr Magennis said: “I depart from the MSIA executive knowing that I leave it in good hands and that its growing membership will all gain benefit from the efforts of their CEO Bridget Kirkham and the new committee under the leadership of Geoffrey Sayer.

The voice of the MSIA Executive is very experienced and should be listened to.

“I pass on my special thanks to all of the committee members and office bearers with whom I have worked over the past nine years. Without them, I doubt that my visions could have amounted to much more than a dream.

“As for the MSIA Andrew Magennis Award for leadership and service in the health software industry, I can only say that I was very humbled when I became the inaugural recipient of this award.

“When you are passionate about something and you enjoy what you do, and in particular, when you sincerely believe that what you are doing is making a difference, it is not hard to turn up to work each day. I am very honoured that my colleagues have seen fit to create this award in my name and I truly hope that in the not too distant future, many of the exciting ‘end points’ that we have all being hearing about for some years now become a reality.

“These are exciting times and we are only limited by our imaginations and

BitS & BYTES maybe a little bit of bureaucracy from time to time.”

In his capacity as new MSIA President, Dr Sayer outlined some of the roles and responsibilities the MSIA will be seeking to undertake going forward.

“Many of the MSIA membership are heartfelt in their desires to deliver improved patient outcomes, increase efficiencies in healthcare while maintaining the necessary privacy and confidentiality requirements associated with health information. While some may think there is a light at the end of the tunnel, it appears to be flickering with the danger of being snuffed out with different pressures being placed on government agencies to deliver long overdue outcomes with ‘quick fixes’. There are also growing competitive market forces in a tight environment for scarce resources in the commercial sector given the government’s reluctance to appropriately recognise industry’s role in delivering e-health initiatives.

“The MSIA role is to assist in advocating for a sustainable industry through improved understanding by funders of the economies in the market place. This will ensure that government initiatives in e-Health are also aimed at increasing the economic viability of the industry through competitive and sustainable initiatives that supports ongoing innovation and servicing of customers beyond project money. We are not after handouts rather we are after sustainable business opportunities that reward innovation and improved efficiencies and encourage competition Below: Dr Andrew Magennis holding the award inaugurated in his name at the recently held Medical Software Industry Association AGM.

in the market place. Like healthcare, e-Health does not come for free and it is not a cheap commodity despite several government attempts to make it so,” said Dr Sayer.

When asked about the MSIA’s view on the e-Health component of the Practice Incentive Program — a recurring theme during the round table discussions — Dr Sayer indicated that industry needs to be involved earlier in the formulation of future criteria to ensure optimal results for all stake holders.

“It is important that MSIA has a clear, consistent and loud voice for progression of the e-Health agenda. While many of us support the recognition of GPs through the e-Health PIP initiative, I think there is universal agreement that there was a lost opportunity for a stimulus package for the sector with the recent rounds of funding.

An industry considered option would have achieved greater leaps forward in interoperability, improved patient outcomes and increased efficiencies while building economic viability, innovation and competition in the market place. We are keen to ensure these sort of opportunities are not lost again,” said Dr Sayer.

Having received a capacity boost from the appointment of inaugural CEO, Ms Bridget Kirkham, earlier in the year, and with the MSIA now representing 90 member organisations, the MSIA has signalled an intention to undertake a more hands-on role in the provision of services to its members and the broader health sector going forward.

Dr Sayer said: “I am particularly keen to see the MSIA take a leadership role in best practices, from the escrowing of software, ensuring appropriate access to patient data, respect of intellectual property, providing quality levels of servicing and leading initiatives in the areas of Conformance, Compliance and Accreditation (CCA) of software and services. These activities will lead to an increase in the local market’s trust and confidence in MSIA member’s products and services.

“The MSIA membership contains the largest body of e-health experts in the country and brings to bear the most innovative and practical experiences of delivering sustainable IT and IM solutions.

It is the MSIA role to harness the MSIA members’ knowledge and enthusiasm to achieve better outcomes for the MSIA member companies and their customers in serving the Australian people.”

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BitS & BYTES NEW EDITION OF EJHI RELEASED The Electronic Journal of Health Informatics has published its latest issue at http://www.ejhi.net The issue, Volume 4 Number 1, is a special issue featuring five papers from the Australian Health Informatics Conference (HIC 2008), in addition to four original papers.

Guest edited by Heather Grain, the papers presented in the issue traverse a range of informatics subject matter under the following titles: “Videophone Delivery of Medication Management in community Nursing”; “An In-depth Look at an Informal Carer’s Information Needs: A Case Study of a Carer of a Diabetic Child”; “A Model Driven Approach to Care Planning Systems for Consumer Engagement in Chronic Disease Management”; “The I-CAN: Using e-Health to get People the Support they Need”; “‘Qualities’ not ‘Quality’ — Text Analysis Methods to Classify Consumer Health Websites”; “Incorporating Privacy Support into Clinical Data Warehouses”, “The Drugulator — A New Method for Performing Dosage Calculations”; “A Bi-directional Interface linking a Dialysis Network with a Clinical Information Network”; and “Telenursing In Home Care Services: Experiences of Registered Nurses”.

LYMPHOMA EDUCATION DEBUTS IN SECOND LIFE Roche Australia, Lymphoma Australia and the Leukaemia Foundation have collaborated to deliver an interactive education resource in Second Life, a virtual reality environment that allows participants to interact with each other and explore and create a virtual world.

Dubbed the Roche Integrated Support Entourage Unique & Personal (RISE UP), the area within Second Life is designed to assist in addressing the low levels of awareness of lymphoma in the broader community, where research indicates that 80% of Australians are not able to list a common symptom of lymphoma.

After installing free software from Second Life (www.secondlife.com), users can search for “RISE UP” to teleport to the virtual education centre. Here, users can view Node Man, a gigantic structure that demonstrates the position of lymph nodes in the body as well as the common symptoms of lymphoma. Other interactive resources are also available.

InterSystems completes VIC TrackCare deployment In September, InterSystems announced that it had completed the deployment of its TrakCare information system to 22 community health agencies in Victoria.

The rollout of the web-based solution was undertaken as part of the Victorian Government’s $360 million HealthSMART program.

The first community health agencies went live with the TrakCare system in early 2007, with InterSystems committing to complete the initial implementation at the remaining agencies by the end of this year.

According to InterSystems, agencies that have implemented the solution stand to benefit from efficiency gains, improved client experience and better resource allocation. Other touted benefits include improved healthcare outcomes through preventative health initiatives, and the ability to perform limited information sharing across the Victorian health system.

Specific features of the TrakCare solution, such as Electronic Referral (e-Referral), will in future enable the 3,600

users across the community health agency workforce to exchange and share client and patient information across Victoria, a capacity that is expected to improve the quality of care and deliver better outcomes.

“Victorian community health workers can now access central electronic health records and a client master index to book client appointments. They can also manage clinicians’ diaries, refer clients and accept referred clients,” said Darren Jones, InterSystems Director for Worldwide Markets, TrakCare.

“For the first time, hundreds of community health staff in each of the 22 agencies are able to manage their clients using a central case management system that removes duplication, enhances efficiency and removes the need for both staff and clients to repeatedly enter and supply their demographic information and past clinical history,” said Mr Jones.

In addition, the software will allow agencies to establish care plans, develop and monitor preventative health services and introduce event management.

Best Practice integrates myDr patient education resources Best Practice has partnered with the developers of the myDr.com.au website to deliver patient education resources to doctors using Best Practice’s clinical software.

According to the companies involved, the initiative was driven by research with GPs that revealed their frustration with not having efficient access to high quality, Australian patient education during the consultation.

Over 500 patient education sheets are now accessible from within the Best Practice clinical software solution, covering all common disease states and common medical tests and investigations.

The resources are written by a team of experienced Australian medical writers and then reviewed and approved by practicing Australian clinicians.

Dr Frank Pyefinch, Managing Director of Best Practice indicated that

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streamlining access to patient information was the primary motivation behind the collaboration.

“I wanted to ensure that the general practitioners who use Best Practice have access to accurate, up-to-date patient information that is relevant to Australian clinical practice,” said Dr Pyefinch.

Frances Westwick, Managing Editor of the myDr website believes the initiative will improve patient access to credible health information, both during the consultation and subsequently from home.

“By being able to quickly and easily access the myDr patient education sheets in Best Practice, it means GPs are able to better counsel and support their patients during the consultation, all with the reassurance that once the patient gets home, they can access further information on the myDr.com.au website,” said Ms Westwick.

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EVENTS CALENDAR AGPN Forum 2009 November 4 - November 7 Sydney, NSW P: 02 6228 0835 W: www.gpnetworkforum.com.au Hospital in the Home 2009 November 5 - November 6 Sydney, NSW P: 02 8644 2302 W: www.archi.net.au/events/upcoming

OCTOBER Australian Association of Practice Managers National Conference October 20 - October 23 Melbourne, VIC P: 03 6231 2999 W: www.cdesign.com.au/aapm2009 4th Annual Occupational Health & Wellbeing Conference 27 - 28 October 2009 Sydney, NSW P: 02 9080 4300 www.iir.com.au SQC Conference October 28 - October 29 Melbourne, VIC P: 1300 854 063 W: www.sqc-au-conference.com.au Higher Education IT Summit October 28 - October 29 Sydney, NSW P: 02 9080 4307 W: www.informa.com.au National Broadband Network October 28 - October 29 Adelaide, SA P: 02 9080 4307 W: www.informa.com.au 2nd Annual Hospital & Healthcare Security & Safety Conference October 29 - October 30 Brisbane, QLD P: 02 9080 4300 www.iir.com.au

NOVEMBER eHealth: The Modern Age Healthcare November 4 - November 5 Sydney, NSW P: 03 2723 6736 W: www.marcusevans.com

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The Future of Medicare Forum November 5 - November 6 Sydney, NSW P: 02 9080 4307 W: www.informa.com.au GPRA Future Series 2009 November 6 Sydney, NSW P: 1300 131 198 W: www.gpra.org.au Medicines Management 2009 November 5 - November 8 Perth, WA P: 03 9645 6311 W: www.shpamm2009.com Successes and Failures in Telehealth 2009 November 10 - November 11 Brisbane, QLD P: 07 3876 4988 W: www.sftconference.com National Broadband Network November 10 - November 11 Brisbane, QLD P: 02 9080 4307 W: www.informa.com.au GPCE November 13 - November 15 Melbourne, VIC P: 1800 358 879 W: www.gpce.com.au/melbourne ACAA National Congress 2009 November 15 - November 17 Melbourne, VIC P: 03 9805 9400 W: www.agedcareassociation.com.au Technology in Healthcare Summit 2009 November 16 - November 17 Melbourne, VIC P: 02 8908 8555 W: www.acevents.com.au

Asia Pacific Association for Medical Informatics Conference 2009 November 22 - November 24 Hiroshima, Japan F: +81 82 257 5081 W: www.tinyurl.com/d4hfdg Reforming Australiaâ&#x20AC;&#x2122;s Health Workforce November 23 - November 24 Sydney, NSW P: 02 9080 4307 W: www.informa.com.au Obstetric Malpractice November 24 - November 25 Sydney, NSW P: 02 9080 4043 www.iir.com.au

DECEMBER National MediTech Summit 2009 December 1 - December 2 Sydney, NSW P: 02 9818 6566 W: www.chillimarketing.com.au Telecoms Regulations December 7 Sydney, NSW P: 02 9080 4307 W: www.informa.com.au/telecoms National Broadband Network Summit December 8 Sydney, NSW P: 02 9080 4307 W: www.informa.com.au/telecoms Integrated Cancer Centres Symposium December 9 - December 10 Melbourne, VIC P: 02 9080 4307 W: www.informa.com.au Hospital Performance Measurement Summit December 10 - December 11 Sydney, NSW P: 02 9080 4307 W: www.informa.com.au 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

READERSHIP SURVEY: 2009

Win an Apple iPhone!

Online:

www.pulsemagazine.com.au

In preparation for the new year, Pulse+IT is seeking feedback from its readers to assist with the development of its editorial framework for 2010 and beyond.

Fax:

02 9475 0029

The Pulse+IT Readership Survey can be completed online at www.pulsemagazine.com.au/survey2009, or by filling out both sides of this page and returning it by mail or fax.

Mail:

All respondents who complete this survey online before 15th December 2009 will enter a draw to win the latest 16GB Apple iPhone 3GS (RRP $879).

1. What type of organisation do you principally work for?

Pulse Magazine PO Box 7194 Yarralumla ACT 2600

5. Briefly describe the types of articles you would like to see in future editions of Pulse+IT?

2. What is your role at this organisation?

3. From a Health IT perspective, what parts of the health sector would you most like to see covered in future editions of Pulse+IT (rank 1 to 6)?

 Aged Care  Allied Health  General Practice  Pharmacy  Public and Private Hospital  Specialist Practice

6. Do you review the Pulse+IT calendar (see page 26)?

4. Each edition of Pulse+IT features the following types of articles. Please rank these in order of importance and interest to you (rank 1 to 3):

9. How long does it usually take you to read each edition of Pulse+IT?

 Yes



No

7. Do you review the vendor listings in the Pulse+IT Directory (see pages 44-50)?

 Yes



No

8. Do you retain copies of Pulse+IT after reading?

 Yes



No

 A week or less.  Guest editorials and opinion pieces (see pages 8-16).  Longer than a week but less than a fortnight.  Health IT news as presented in the Bits & Bytes section of the magazine (see pages 18-24).  Longer than a fortnight but less than a month.  Longer feature articles of a more technical or  A month or longer. instructional nature (see pages 34-35).

Please continue survey overleaf PULSE + IT

27

From previous page 10. How many people do you expect will read your copy of the November edition of Pulse+IT?

 Just me  2  3  4  5+

 Yes



AMA

 HIMAA 

HISA

12. Are you a member of a professional body not listed above whose membership would benefit from receiving copies of Pulse+IT?

 Yes



No

please specify

13. Do you read Pulse+IT online at the Pulse Magazine website (www.pulsemagazine.com.au)?

 Yes



No

14. Would you prefer to read Pulse+IT online or in print?

 Online



Print



No



N/A



No

 Less than 1 month  2-3 months  4-6 months  7-12 months  A longer time period  Question not applicable to my organisation 19. Which secure messaging vendors provide software to your organisation (tick all that apply):

 2Hippo (www.2hippo.com.au)  ArgusConnect (www.argusconnect.com.au)  eClinic (www.eclinic.com.au)  Healthlink (www.healthlink.net)  Medical-Objects (www.medical-objects.com.au)  Global Health (www.global-health.com.au)  Other 1  Other 2 please specify

16. If you were to contact a company advertising in Pulse+IT or an organisation referred to in a Pulse+IT article, is it likely that you would mention the publication in your initial discussion with the organisation?

 Yes

No

please specify

15. Would you be interested in writing articles for Pulse+IT?

 Yes



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

11. In addition to other channels, Pulse+IT is distributed to the memberships of the following organisations. Are you a member of any of these organisations? (tick all that apply):

 AAPM

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



Unsure

 Other 3 please specify

 Question not applicable to my organisation

OPTIONAL: If you would like to be contacted by Pulse+IT to discuss any aspect of the publication, please record your contact details below: Name:

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Email address / Phone:

NEHTA

Compliance, Conformance and Accreditation E-health is already in use across Australia. But so that we have a truly national e-health environment, the National E-Health Transition Authority (NEHTA) is developing the specifications or foundations of a national e-health system.

A critical part of this work is agreeing how the IT systems deployed within the health sector by vendors and healthcare providers will be compliant with national e-health requirements.

NEHTA’s Compliance, Conformance and Accreditation (CCA) Program is working to provide a framework that supports system interoperability, security and safety. When healthcare providers invest in e-health products, they should be able to readily determine the products’ capacity to communicate securely and safely with the rest of Australia’s e-health network.

The CCA Program is working towards a nationally accepted certification that would confirm that e-health systems or products meet key standards that support these requirements.

National standardisation As a general principle, compliance activities are designed to ensure consistency in the use of e-health specifications and standards by individuals and organisations.

Aligned with specification development, NEHTA is developing criteria and test specifications that will allow determination of whether products conform to national e-health requirements.

NEHTA’s strategy for developing conformance testing is incremental and industry-driven, so that the range of tests, the types of testing and the providers of conformance testing services can evolve and expand over time. Conformance testing will provide an objective measure of progress in the uptake of

CCA Definitions A national certification capability is an essential foundation for safe, secure and interoperable e-health solutions in Australia. It will enhance procurement procedures, reduce risks associated with implementation, and help systems meet important safety requirements. Compliance, conformance and accreditation are three important concepts that underpin certification. In combination, they offer a high level of assurance concerning quality and interoperability.

• Compliance ensures consistency among e-health specifications and leads to the correct re-use of mature and relevant international standards. Compliance also relates to the adherence of an individual or organisation to regulatory requirements and standards.

• Conformance relates to how software products and services accurately implement e-health specifications.

• Accreditation specifies third-party attestation related to a conformity assessment body conveying formal demonstration of its competence to carry out specific conformity assessment tasks [ISO 17000].

e-health standards nationally.

As specifications are taken through Standards Australia, NEHTA will seek to attach test specifications to them so that implementers will know clearly how to demonstrate conformance.

NEHTA’s approach to Certification is based on the ISO/ IEC international and Australian Standards addressing the area of Conformity Assessment, which includes Accreditation, Certification and Conformance Testing. The ISO/IEC 17000 series and related standards collectively specify the requirements around bodies operating in the Conformance, Accreditation and Certification spaces.

The CCA program also aims to establish a simple certification process that potential purchasers of systems can understand and trust.

Collaboration NEHTA is consulting with key stakeholders to understand the expectations and capabilities of the sector, to best suit requirements of a national and standardised e-health system.

There will be a consultation process both for conformance test specifications, and for the form and operation of any certification function that will administer the publication of test results and any certification ‘ticks’ associated with them.

Benefits The CCA Program delivers a number of benefits to the healthcare community.

To achieve the full potential of e-health, a national approach to Certification is necessary to address the differences in information between transacting parties. These differences create increased transaction costs and increase the risks of poor performance of an acquired product. A national approach to the certification of e-health products and services (including rigorous testing processes) promises to minimise the number and frequency of failed expectations.

Healthcare providers will have improved confidence in the systems they are using. Vendors will benefit from having a common process for facilitating improvements in specifications as the process uncovers ambiguities, errors or incompleteness in standards and specifications. Organisations purchasing systems have a trusted method of distinguishing products which meet national requirements from those that don’t. Consumers will have improved confidence in the healthcare system as a standards based interface with healthcare systems has the potential to improve efficiencies and reduce errors.

Further Information For further information on NEHTA’s work visit www.nehta.gov.au or contact David Manfield, Manager Compliance Conformance and Accreditation on david.manfield@nehta.gov.au

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

Leading the progression of e-health in Australia Interested stakeholders would have read the National E-Health Transition Authority (NEHTA) Strategic Plan (2009-2012) released in early October 2009. Here NEHTA CEO Peter Fleming explains aspects of the strategy further.

What does the NEHTA strategy mean for the development of e-health in Australia?

The strategy positions NEHTA as the lead organisation supporting the vision for e-health. This is an important point because for a national e-health infrastructure to exist in Australia, one organisation needs to have a clear mandate to deliver key components of the National E-Health Strategy. There has been enormous effort across both the public and private health sectors in e-health innovation but we cannot continue with an ad-hoc approach, which is of course where national specifications come in. Over the years there has been confusion in the health sector over NEHTAâ&#x20AC;&#x2122;s role. This plan provides much needed clarity and will help facilitate progress in making e-health a reality in Australia.

Vision:

How does NEHTAâ&#x20AC;&#x2122;s work align to the National E-Health Strategy?

The National E-Health Strategy released in December 2008 outlined four major strategic streams of activity: foundations, e-health solutions, change and adoption, and governance. NEHTA has considered its future work program based on the National Strategy and other public reports describing the current state of e-health in Australia including the National Health and Hospitals Reform Commission (NHHRC) recommendations. The Governments of Australia have identified the need to move to an Individual Electronic Health Record (IEHR) and have progressed this by endorsing the National E-Health Strategy. NEHTA is not responsible for delivering all aspects of the National E-Health Strategy but it is critical that the NEHTA plan shows alignment particularly in the areas of national infrastructure and adoption support.

To enhance healthcare by enabling access to the right information, for the right person, at the right time and place.

What do the four strategic priorities mean for the healthcare sector?

Vision / Mission

The four strategic priority areas for NEHTA support the vision for e-health.

These priorities are closely linked to the work streams outlined in the National E-Health Strategy.

01 02 03 04

NEHTA’s first priority is to develop the essential foundations required to enable e-health - essential e-health services such as healthcare identifiers, secure messaging, authentication, and clinical terminologies that will form the backbone of Australia’s e-health system.

Secondly, we are progressing priority e-health solutions and processes that will have a high impact in the sector and can be made available early. We want to enable improved continuity and co-ordination of care, safer and improved medication management and improved access to and use of diagnostic information. These solutions have been identified to maximise clinical and social benefits through improvements in healthcare delivery.

Our third priority is to enhance engagement and collaboration across clinical settings. We’re focusing on understanding and articulating how health processes should change with the implementation of the priority e-health solutions, and facilitating a co-ordinated national approach.

Finally, we recognise that NEHTA is in a unique position to lead the e-health agenda in Australia. As the key organisation developing the solutions and driving adoption amongst the stakeholder groups NEHTA has an overarching sense of the landscape of e-health, both nationally and internationally, at any one time. We see our role as being able to articulate the technical application of e-health across Australia’s health sector. We will identify and evaluate the outcomes delivered by the priority e-health solutions, inform the development of legislation, regulation and policy relating to e-health.

Strategic Priorities

Strategic Initiatives

Strategic Roadmap

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

What are the challenges facing NEHTA? Delivering the ‘foundations’ or building blocks for a national e-health infrastructure is essential, but by nature people are eager to see a ‘finished product’. So we have to be very clear with our stakeholders so they can understand how our work program fits together.

The challenge for NEHTA is that it takes time to develop the foundations to enable a national system for e-health.

NEHTA’s

Mission: NEHTA is the lead organisation supporting the national vision for e-health in Australia; working openly, constructively and collaboratively with consumers, providers, funders, policy makers and the broader healthcare industry; to enable safer, higher quality, accessible, equitable, efficient and sustainable healthcare.

This has required government funders to remain committed before we get to a tipping point. We have to maintain the interest around our work program and to demonstrate local e-health capabilities as they come to fruition, so that everyone understands how the broader national implementation will work.

NEHTA has been in operation since 2005. How do you respond to critics that say NEHTA has been slow to deliver?

Like any new organisation operating in a complex environment, NEHTA has had to find its place in the healthcare sector and it is fair to say that we have done some things very well and, in hindsight, there are things we could have done differently.

We have welcomed feedback on our performance and are determined to meet the expectations of the sector and our stakeholders.

The Deloitte paper did comment that NEHTA has brought significant focus and increased the profile of e-health in Australia since 2005 and has progressed the development of national e-health foundation elements such as standards, identifiers and terminologies.

From NEHTA’s inception, we’ve focused on building the foundations and basic infrastructure required for a national e-health environment.

There is strong international evidence that nations such as New Zealand, England, Scotland, Denmark and Canada have only made significant e-health progress at a national level once they have established appropriate e-health foundations.

So we remain focused and committed in ensuring that we get the foundation work completed. What drives us to succeed is that e-health has the potential to significantly improve patient care.

We need to urgently deliver on the priorities and tasks we have set ourselves so these improvements can be realised within the healthcare sector.

What does the next 12 months hold for NEHTA? We will be undertaking a number of collaboration projects and these will most likely trial secure messaging, discharge summaries and referrals.

When we talk about collaborations we are referring to existing e-health work that is presently being undertaken in the sector. Our goal is to work with suitable projects such as these and trial our specifications in them. This involves identifying them, assessing the viability and what area of our work is most suitable to trial. This inherently requires the projects to be at a reasonably mature stage of development. All of this said, we are in the process of evaluating suitable projects with a view to kicking off two collaborations in the near future.

One of our key targets is the development of Healthcare Identifiers in time to use these live by June 2010.

NEHTA has contracted Medicare Australia to develop the service to provide identifiers for patients and healthcare providers and we are on schedule for delivery. There has been a period of public consultation by the government around identifiers and while we can’t trial identifiers without supporting legislation we are confident the government is going to be on track with its passage through parliament.

In addition, over the next two years the sector will be supported in taking up a common approach to secure online connectivity based on Internet standards and secure authentication.

Vendors can be certified, so providers can buy software with confidence.

Incentives are provided to help GPs with the burden of upgrading.

For more information on NEHTA’s work go to www.nehta.gov.au

For more information on NEHTA’s work go to: www.nehta.gov.au If you are interested in e-health and would like to keep across e-health developments, please go to: www.ehealthinfo.com.au

FEATURE Kyle Macdonald Dealing with approximately 100 clinical systems vendors across New Zealand and Australia, Kyle and his vendor integration team spend their days helping people across the sector to do fully integrated messaging. The companies Kyle works with provide the major information systems used by Australia’s hospitals, laboratories, general practices and allied healthcare providers. kyle.macdonald@healthlink.net

Secure Communication: Please don’t shoot the messenger AN INTRODUCTION TO CLINICAL SYSTEM INTEGRATION Fully integrated messaging involves standardisation of disparate systems to ensure messages are readable by the intended recipient without manipulating the message payload. Ensuring that messages are properly standardised is hard work but it is a safer approach than trying to modify messages as they move between systems.

In any electronic message transaction, there are several interested parties, including the sender, the sender’s clinical software vendor, the recipient’s clinical software vendor and the recipient. HealthLink has a team dedicated to testing processes to ensure that messaging continues to work after systems are updated, by providing feedback to the software developers about any necessary changes. Messaging testing occurs at many levels, from ensuring that outgoing messages meet the AS4700 Standard (Australian HL7 standard), to confirming that the information within the message can be properly integrated within the recipient‘s clinical software and displayed in a useful and relevant manner.

These testing processes are based on the assertion that the acknowledgment is vitally important and that the sender has a duty of care to ensure that it receives a conformant acknowledgement (positive or negative) and that if it receives a negative acknowledgement that it (the sender) corrects the relevant problem. It is a sad reflection on the maturity of the market that many senders, let alone the vendors suppling their software, fail to understand the importance of acknowledgments in the message interchange process.

HealthLink runs a test bed of clinical systems that currently contains 10 different products in both stand alone and network configurations.

THE RELEVANCE OF THE AS4700 STANDARDS Achieving robust messaging interoperability is crucial to health system automation. Detailed compliance with message standards is seldom attained without a lot of hard work.

Understandably, vendors usually implement the most frequently used aspects of a standard first. For example, many vendors do not validate HL7 fields against the validated values of the Standard. If this happens, how can the recipients’ system use the atomised information if the code is unique to each sender?

There is also a tendency to treat the message payload as an image or an unstructured “blob of data”. The benefit/ importance of atomising (or disaggregating) the message is that the “rich” data can be used powerfully by clever clinical systems to populate and inform treatment and care plans.

Currently many reports are typically text only letters, with no

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atomisation used. While there is currently a drive to present more human readable Rich Text Format (RTF) reports to make reports look better, this does not necessarily help achieve the long-term goal of populating the patient’s record with useful, reusable information. Ideally atomised data and “images” segments are both sent within a fully conformant message.

HERDING CATS: PERSUADING CLINICAL SYSTEM VENDORS TO ADHERE TO COMPLEX STANDARDS HealthLink is pushing clinical software vendors to “do the right thing”. This is not an easy task as these vendors have resource constraints, and their own set of customer expectations. These factors, combined with a general lack of messaging knowledge, means that messaging improvement is all too often put into the “too hard basket”. People, at all levels, compare messaging with general office email and thus they lack comprehension of the value that true “system to system” messaging can bring to patient care. At the same time they are in danger of overlooking the duty of care they have to their customers and their customers’ patients to ensure that the end-to-end message delivery process is completely robust.

By working closely and proactively with clinical software vendors, the quality of messaging is improving. In the tables on the adjacent page is a high level view of what various vendors can currently achieve by way of fully integrated messaging.

Working towards the goal of ensuring that every message sent is a high quality message, there are four sets of tests that regularly occur at HealthLink: Go Live Test reports A “Go Live” report is produced for every new party sending HL7 messages. This report checks the first messages from the site against the required test bed systems to ensure that all required fields are in place. HealthLink produces a report for the sender to help explain how the reports actually look when received by the referring GPs. Beta reports Updated versions of a clinical vendor’s software are checked against any outstanding issues, new features tested and regression testing carried out (against the AS4700 standard). The information from the report is fed back to the vendor organisation.

New message-type testing As messaging matures in Australia, vendors and referrers are starting to expect more and more from the information flow.

HealthLink works with all parties using its test bed to ensure that new and upgraded messages work as planned.

Troubleshooting In this complex electronic world, things sometimes do not work as expected. HealthLink investigates problems and using the Australian AS4700 Standard, follows up on the problem with the sender or recipient system’s supplier to advise of changes needed in their implementation of the Standard.

systems are also undertaken. Whereas AHML currently just checks a message’s structure, our extended testing ensures that the information contained in the message is readable and usable at the recipient’s end.

HealthLink’s testing scripts are used to adapt to changing circumstances. As the clinical software market matures and demand for more and more sophisticated messaging becomes evident, fields that were left out and ignored in early product versions are now being used. Testing mechanisms need to be updated to reflect this.

HealthLink is aware that its work to help vendors uphold standards benefits everyone in the messaging sphere, including our competitors. However, we firmly believe that getting message standards working correctly is the right thing to do.

THE IMPORTANCE OF AHML: THE AUSTRALIAN HEALTHCARE MESSAGING LABORATORY AHML provides a very useful message validation facility. It would be good if it was more widely used by vendors. HealthLink extends the testing provided by AHML by, for example, ensuring that the fields contained in the message are correctly displayed in the various clinical systems. End-to-end checks between

Below - A summary extract from HealthLink’s clinical software testing records. “PIT” refers to Pathology Information Transfer messages, “LAB” refers to HL7 pathology and radiology messages, “RSD” refers to HL7 Referral Status Discharge messages (includes specialist reports), “ACK” refers to HL7 acknowledgment messages designed to provided an end-to-end assurance that message delivery has occurred.

Legend

Under Development

Not Tested

Known Problems

Working

 

 

 

 

NT

Working or expected to work correctly

1

Fails to work correctly

2

1

3

2

3

Not applicable

NA1

NA2

NA3

Not tested

NT

NT

NT3

1

2

PIT Software

Version

Medical Director v2

2.96

Medical Director v3

3.10

Genie

7.6.5

Best Practice

1.6.3b490

MedTech32 AU

7.0.0b2526

Zedmed

11.0.513

IBA Practix

1.32 B1.49

IBA Classic

2.15 B4

IBA Monet

-

Profile v5 Aus

5.1.2.333

Profile v7 Aus

7.0.0.1321

VIP

9.07e

Mx Solutions

-

Incisive

242.2

Mediflex

-

Medinet

1.0

Shexie

6.0 r87

Software 4 Specialists

Audit 4 v2.29

Surgiware

-

DoctorWare

SmartRooms 13.1.6

Jam Software

MEDFormz 1.8

Communicare

7.5.200

Stat Health

-

Medical Wizard

-

Locum

3.14

GPComplete

10.12.4

Total Care

v5

MMeX

1.22

Clinical Computers

CCOS

Med Network

Remedy4

Health Trak

-

MediLink

MediLink ESI 2009 R2

Clintel

The Specialist v0910c

NA

HL7

Import PIT

Import LAB

Send LAB ACK

Import RSD

Send RSD ACK

                                

       

      

    

    



NA

NA

            

2

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

2 2

1 2 2

NA 1 2 2

Send RSD

Import RSD ACK

NA

NA

NA1

NA1















NA

NA

NA

NA

        

      

      

    

    

1

NT

NT

NA

NA

NA

NT

NT

NA

NA

NA

NA

NA

NA

NA

   

NT

2

NA1



 

NA1

1

NA

NA

NT

NT

NT

NA

NA

NA

NA

NT

2 2

1

1

NA NT

2 2 1 1

NA

1

NT

NA NT

2 2

NT

NA NT

2 2

NA

NT

NA NT

2 2

NA

NA1

NA1

NA1

NA1

NA1

NA1

    

    

NA

NA

NA

NA



NA

  

2 2 2 2

NA 2 2 2

NA



NA

NA

NA

NA









NA

NA

NA

NA

NA

NT

NT

NT

NT

NT

 

NT

NT

NT

NT

NA

NA

NA

NA

2

3

2

NA

2

NA

2

NA

2

NA

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FEATURE Mark Worsman and Amanda Leong Mark Worsman is a Senior Associate and Amanda Leong is a Solicitor at DLA Phillips Fox. DLA Phillips Fox has around 700 lawyers across eight 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 3,500 lawyers in 29 countries. mark.worsman@dlaphillipsfox.com ~ amanda.leong@dlaphillipsfox.com

Regulation of medical devices: video games and phone applications Video games and software applications for smart phones are increasingly being designed and marketed for their healthrelated benefits. If you supply in, or import into, Australia a medical device that is not properly listed on the Australian Register of Therapeutic Goods (ARTG), then you could potentially face imprisonment or fines of hundreds of thousands of dollars.

Typically, medical devices include products such as MRI scanners, artificial hips, syringes, blood pressure monitors and more. These products have a relatively clear-cut therapeutic purpose and it is readily apparent that they are medical devices for regulatory purposes. However, mainstream technologies are giving rise to new products with fitness and health related purposes. This new wave of products may also constitute medical devices for regulatory purposes. If so, they are subject to regulation by the Therapeutic Goods Administration (TGA) in the same way that traditional medical devices are.

Medical devices must be listed on the ARTG, which is a register of therapeutic goods approved by the TGA for supply in Australia. Generally, medical devices must be assessed by the TGA and included on the ARTG prior to their supply in, or importation into, Australia.

be used for fitness and for health related purposes.

For example, the Australian Physiotherapy Association has acknowledged that use of the Nintendo Wii may be of assistance in the treatment of injured athletes, recovering stroke victims, aged residential care facility residents and others. However the fact that the Nintendo Wii console can be used for such purposes does not make it a medical device. If, however, there is a specific ‘game’ that can be used for a health related purpose and, more importantly, for treatment or alleviation of a disease, then that game may well satisfy the legislative definition of what constitutes a medical device. If that is the case, the Nintendo Wii console might also constitute a medical device because it is an ‘accessory’ to the game, a term also defined in the Act. Likewise, if a mobile phone health application included a glucose monitor for diabetics, then that application could satisfy the definition of what amounts to a medical device since its intended purpose is to ‘monitor’ disease. Software applications that have specific design features for diagnosing, preventing, monitoring or treating mental disorders also are likely to satisfy the legislative definition and, if so, need to comply with the requirements of the TGA and the Act.

WHAT IS A MEDICAL DEVICE?

WHAT TO DO IF YOUR TECHNOLOGY MAY AMOUNT TO A MEDICAL DEVICE

According to the Therapeutic Goods Act 1989 (Cth) (Act), a medical device is an instrument, apparatus, appliance, material or other article (or an accessory to these items) used by human beings for the purpose of: • diagnosis, prevention, monitoring, treatment or alleviation of disease; • diagnosis, monitoring, treatment, alleviation of or compensation for an injury or handicap; • investigation, replacement or modification of the anatomy or of a physiological process; or • control of conception, and does not achieve this purpose by pharmacological, immunological or metabolic means.

PENALTIES FOR NON-COMPLIANCE There are hefty penalties for not complying with the Act and its regulations, including imprisonment and substantial fines of up to hundreds of thousands of dollars. In particular, the supply in Australia of a medical device that is not listed on the ARTG is a strict liability offence with severe financial penalties.

NEW TECHNOLOGIES Video game consoles, such as Nintendo’s Wii and software, such as iPhone Apps that allow users to download and manipulate medical images and test for certain vision problems, can clearly

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Many such devices may satisfy the definition of a medical device contained in the Act. It appears that the TGA is currently adopting a laissez-faire attitude towards enforcing the Act in respect of devices that are not considered mainstream medical devices. It may be the case that if the TGA was concerned about a particular device, it would allow an ‘after-the-event’ listing of the device on the ARTG and not enforce the sanctions in the Act, notwithstanding prior non-compliance (that is, even though the device was supplied in Australia, the TGA may not penalise this so long as the device is promptly listed on the ARTG after the TGA requests it).

Nevertheless, given the potential penalties that a supplier may face for supply or importation of a medical device that is not listed on the ARTG, it may be prudent for suppliers to list their ‘new wave’ medical devices on the ARTG. It may be the case that if a consumer was adversely affected by such a device, the TGA would be forced to impose the serious sanctions contained in the Act against the supplier.

Health practitioners that have concerns about the safety of a medical device can report their concerns to the TGA through the TGA’s incident reporting investigation scheme, which is generally used to report any deficiencies in medical devices such as defective components, performance failures and poor construction or design.

Panasonic recommends Windows Vista® Business.

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FEATURE Grahame Grieve Grahame Grieve, CTO, Kestral Computing Pty Ltd Co-chair, HL7 Structured Documents and Modeling & Methodology Work Groups grahame@kestral.com.au

Should we use CDA instead of HL7 v2 for sending Pathology & Radiology Reports?

INTRODUCTION One of the great success stories in e-Health is the wide spread adoption of electronic reporting from pathology and radiology practices to their clinical users: the vast majority of reports in Australia are now sent using HL7 v2 via commodity secure messaging software. The pathology industry now seems ready to call the task complete, and to focus on maintaining the status quo on the basis that this meets our needs in a satisfactory fashion.

I believe that this is premature. It is time for us to consider adopting CDA in place of HL7 v2 for pathology and radiology reports.

HL7 V2 Starting from 1993, pathology reports were communicated in the PIT format, a format defined by an informal industry group called the “Pathology Information Group”. PIT was a fairly simple text based format that was relatively easy to produce, and not overly complex to display to the clinician. A PIT report consists of a series of lines containing header information that identifies the patient, the report, the requesting doctor etc, and then the report as a series of text lines that may include some formatting such as font colours, bold, italic, etc. Since that time, the transmission of reports has migrated from physical delivery of encrypted diskettes, through modem based delivery, to Internet based delivery systems with full encryption.

In 1998, Standards Australia published an implementation guide for using the HL7 v2 standard to represent pathology reports. Since then, the industry has slowly migrated to using HL7 v2 in the place of the PIT format, based on updated versions of AS 4700.2. The HL7 format is a highly structured semi-text format where the content is divided into “segments” containing a series of data elements. There are a few header segments that generally match the functionality of the PIT header portion, and then a series of “observation” segments that may be either a full text representation of the report, or a data item with identification, value, units, reference ranges, and interpretation flags.

HL7 v2 offered several advantages over the PIT format: • it included the actual data items in an already accepted format suitable for decision support; • it had shared infrastructure and element definitions with other HL7 messages which are widely used (for instance, communicating patient identification messages); • it offered convergence between standards, private industry and the public healthcare systems; and • it was an international standard, which made it easier for overseas vendors to participate.

Of these, the most visible advantage to the end-consumer of HL7 v2 reports related to clinical decision support. Although

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clinical decision support is still very much in its infancy, even simple tasks like making graphs of reports were not really feasible using PIT. The introduction of HL7 v2 was not without its problems. The most noticeable, particularly for the end users, was that the text representation format that is included in HL7 (the “FT” format”) was primitive compared to the existing PIT capabilities (though many of these capabilities were implemented inconsistently across the industry). As a consequence, many HL7 v2 messages include the PIT content as one of the observations; this means that the clinician’s desktop application can at least display the report as it would have prior to the adoption of HL7 v2, and still process the data items as desired.

The industry is now close to achieving plug-and-play interoperability with regard to pathology and radiology reports.

Increasingly I am hearing comments suggesting that the job is done, that we have met the industry needs, and that there is no need to consider further changes, at least for the time being.

I hear these comments at industry groups, standards meetings, and in discussions with our customers.

But the only thing that is constant in IT is change, and HL7 has published a new format called CDA. I believe that it is time for us to consider migrating to use CDA for radiology and pathology reports.

CDA CDA (“Clinical Document Architecture”) is an XML document format defined by HL7 that specifies the structure and semantics of “clinical documents” for the purpose of exchange. A CDA document has a header that contains the same general content as the PIT and HL7 v2 headers, and a body composed of a series of sections, each containing a human displayable representation of its content, along with structured data containing the actual data items of interest.

CDA offers a number of advantages over HL7 v2 as outlined in Table 1. These advantages are spread across the various participants: service providers, their clinical customers, vendors, and government programs.

While it is widely believed that HL7 V2 meets the current needs of the industry, this is only true if we limit what we need to what we can now do. This is my list of what we need: • fidelity of clinical reports, so that the reporting conventions that have built up in the last couple of generations can be carried over into the electronic world, while allowing for continuing development and growth; • ability to properly represent the structured data in a natural form with proper grouping/containment and a solid and computable underlying model for data element representation;

• ability to explicitly link between the structured data and the matching parts of the clinical report (this is not so important for the high volume reports, but much more relevant for Anatomical Pathology, Radiology, etc); • ability to use pictures and videos, and to integrate these directly and explicitly into the report in context, rather than handling them somewhat distantly as attachments that may be interesting and/or relevant; • reports should be easy to generate and process using industry standard tooling (parsers, visualisers, databases, query engines, code generators, etc); • there should be a clearly defined set of sender and receiver responsibilities that can be met with confidence, so that service providers and vendors can properly discuss legal liabilities on a foundation of a clear set of technical guidelines; and • ability to integrate the diagnostic service reporting process/ contents/workflow with the greater clinical equivalent that depends on it and flows from it (i.e. migrating content easily from one to the other, sharing transmission and storage infrastructure, etc).

For these reasons, CDA is clearly a better choice than HL7 v2, and for these reasons, the industry should start planning how to migrate from HL7 v2 messages to using CDA documents now.

BUT… There are several possible reasons to object to doing this. The first is a series of objections about the data representation inside CDA documents that is based on HL7’s Reference Information Model, which has been a source of controversy for many years.

While some of these objections have some validity, it is necessary to choose some approach, and all possible approaches have problems. These objections are becoming increasingly less relevant simply because of the worldwide take up of CDA documents.

Another common objection is that CDA documents are bigger than their HL7 v2 equivalents. An equivalent CDA document is perhaps several times as big (though it compresses to close to the same size). For diagnostic services that pay based on message size, this may be a problem (though hopefully this will be less of a factor in the future, particularly as NEHTA rolls out its Secure Messaging infrastructure). However as CDA documents enable richer data and foster multimedia, their size may become much larger indeed.

Another objection is that we currently have no particular skills around CDA in Australia. This is certainly true, but something that must change, if only to support the use of CDA reports in more purely clinical contexts. In fact, an investment in CDA training, capacity building, sample code, test suites, pilot implementations, and tools for visualisation, parsing, construction and validation by the vendors on both sides of the house in diagnostic service reporting may be regarded as an investment that could be leveraged in that wider context.

The most serious objection is about the change process — that even if CDA documents are a better approach, the improvement they offer doesn’t justify the cost of the change, particularly given that what we have does work now. There is no doubt that the change from PIT to HL7 v2 was costly and traumatic for some; change is always costly in its own right, though at least some of the challenges related to the short-comings of HL7 v2 when compared to CDA. In addition, part of the response to the challenges was the creation of industry consortiums such as

Integrating the Healthcare Enterprise (IHE), so we are now much better placed to consider further changes.

Even so, it is not clear whether the more uncertain cost of change will be justified by the less uncertain benefits of migrating to CDA, and this is no simple choice to make. It is possible that external pressures will drive the change; a liability decision in the courts could push the industry towards CDA quickly, for instance.

In the absence of this, it is inevitable that there will be gradual evolution towards CDA because of the capabilities it offers. We have a choice of whether to do it in an organised, proactive fashion, where the process and expectations are clearly set, or whether to just let it happen, with the chaos that would ensue.

SUMMARY While the industry has finally converged on HL7 v2, CDA offers several compelling advantages over HL7 v2 for the transmission of pathology and radiology reports. Rather than complacently accepting that HL7 v2 meets our current needs and is the best solution, I believe that we should rather, admit that CDA offers a number of compelling advantages for our current and near future needs, and instead ask the question: how could we best plan to migrate to CDA in an orderly manner, and when should we consider doing this?

Table 1: The Advantages of CDA over HL7 Version 2 Clinical Safety

The single most important advantage of CDA revolves around clinical safety. Part of the CDA standard is an XML transform that can be used to convert any CDA document to an XHTML representation suitable for display in any browser.

Every document author is obligated to ensure that the documents they produce display correctly using this transform. For the receiver, they must be able to display the outcome of this transform to the user; additional processing is useful but not required. Compared to the current situation with HL7 v2, this is much simpler and safer.

Document Management

CDA documents are expected to persist, and have appropriate features to support storage, persistence, and authentication of the report as a document separately to the transmission of the report as a message.

Presentation Content

HL7 v2 and PIT offers limited formatting facilities. CDA is based on XHTML, and offers extensive formatting choices (lists, tables, hyperlinks, styles, etc). In addition, CDA includes a coherent framework for the inclusion of multimedia content, including images and video. Though these are not currently a focus of the industry, it is widely believed that graphical representations will become ubiquitous in the future.

Expressivity

CDA provides much more expressivity for the data items. As well as providing a much better information base for measured data, codes and terminologies, CDA has structures for properly expressing grouping and containment of ideas. Though it is possible to represent this data in HL7 v2, it is clunky, which leads to a variety of home grown approaches to incorporating grouping and metadata complexity into the simple HL7 v2 messages; but these will not attract international interest or support.

CDA also provides functionality to cross-link the data items and the human representation; this will become more important and useful as structured or synoptic reports become a more common practice.

Alignment

CDA is widely recognised as the most appropriate format for clinical reports, general clinical referrals, discharge summaries, post-op notes, etc, and the rest of the world is rushing to adopt CDA for these kinds of uses. CDA is also the focus of NEHTA’s clinical report work.

Many of these reports will include portions of pathology and radiology reports, and this will put pressure to provide this information in a CDA ready form.

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

Appetite for risk Does your business have an appetite for risk? Establishing a Risk Appetite and ensuring that the culture of your business encourages staff to see risk as an opportunity and not as a threat is paramount to anticipating problems before they occur and managing them well if they do.

Planning for what might occur and how it will impact on your business, and what you can do should it occur minimises bad outcomes. The things you least expect will create the biggest challenges.

Planning to eliminate or at best reduce risk gives direction and a feeling of ownership and involvement for all. It reduces “management by crisis” and improves communication. You are looking after the future of the business, focusing on your objectives and the organisational structure to achieve those objectives and assessing costs that might be involved. You plan for success and manage risks along the way.

Avoid blame and take ownership to ensure risks are understood. Establish clear lines of authority and accountability and develop proper incentive structures and a code of ethics.

Ensure good reporting and anticipate problems. Link risk management to future business success.

These same management skills apply to Clinical Risk Management and Adverse Events.

THE MATRIX

THE WHISTLEBLOWER

• • • •

Encourage whistleblowing. If you do not know what is happening, how can you manage effectively?

A whistleblower is anyone (employee, director, related officer or contractor) who attempts to let you know (anonymously or otherwise) of some matter that may be suspected or anticipated that can impact negatively on the business.

Discuss openly your policy on whistleblowing and guarantee confidentiality and respect for both the informer and the alleged offender. Be fair in your assessment and provide an independent review.

Develop a risk matrix. All staff should have input into this process with no assumptions. List everything you can think of that might occur that could have negative impact on your business. Is it likely to happen? If it did how would it impact on the business? Is it a problem or a catastrophe? What should you do in the event that it does happen? Will there be a cost involved? How much?

What are the early warning signs? Reassess and visit regularly in a monthly Risk Management meeting. Get everyone out of their comfort zone and don’t hide behind what may be already documented. From this planning process, better policies and procedures are developed and implemented.

CHECKLIST • Policies are displayed, communicated to staff and implemented.

• Identify workplace hazards and take corrective action • Assist with incident investigations.

• Participate in induction and other regular training for employees.

• Respond to issues raised by staff.

• Keep a register of injuries as required by state law.

YOU ARE ULTIMATELY ACCOUNTABLE What did you know and when?

What did you do about it?

What could you have done about it?

Why did you ignore the early warnings?

FURTHER READING • • • • • •

AS 4360: Risk management ISO 9001: Quality systems management ISO 14001: Environmental management AS 4801: Safety management systems Australian Institute of Company Directors (AICD) http://www.riskmanagement.com.au

Below and upper adjacent page - Examples of risk that practices may encounter and suggestions on how to prepare for these occurrences.

Examples of Risk

Suggested Policy and Procedures for you to customise

You arrive at work and there is no power. Nobody has printed out the appointments for the day and the only record is on the computer. You have no idea who is scheduled for the day. The phone is already ringing for those wanting an appointment today.

Policy: Power Outage Actions - Appointments

The power is back on but the Internet is not connected, preventing electronic results from being downloaded. Patients are calling.

Policy: Internet Outage Actions - Results

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Procedure: Always print out the following day’s appointments each afternoon. This allows you to make appointments for that day and call back others who want an appointment in the future. Have a laptop (with a good battery) as a backup.

Procedure: Telephone the relevant laboratories to fax through urgent results.

Examples of Risk

Suggested Policy and Procedures for you to customise

The Internet is now connected, however a staff member is on Face Book instead of performing recalls.

Policy: Internet Access - Staff

You have just spent hours typing a report in Microsoft Word and on re-opening, the content is missing.

Policy: Training - Document Recovery

Your IT Support provider has logged in to assist, but can view sensitive patient information in your database. A relative of the IT provider is a patient.

Policy: Privacy Policy - Suppliers

Changing software providers.

Policy: Software Installations and Upgrades

Procedure: Policy and Procedures in place so that staff understand their duties and possible dismissal if they surf the net on work time.

Procedure: Staff are well trained in Microsoft Word and understand the need for saving, backing up, and steps to retrieve lost documents.

Procedure: Patient confidentiality documentation should cover external contractors as well as staff. If breached, instant dismissal should occur.

Procedure: Take control. Assess data migration options and perform a test transfer for assessment and training purposes. Only when staff are satisfied that no workflow disruptions will occur should “go live” happen.

Policy: Backing Up and Restoring Data

Restoring from your backup failed.

Procedure: Document backup procedures and ensure that backups are restored often for testing.

The image on a doctor’s monitor has turned upside down. I saw this happen! A Surgeon was about to consult and accidently pressed a combination of keys that caused the monitor view to rotate 180 degrees.

Policy: Training - Computer Support Procedure: Staff trained in all facets of computer support, including computer settings, network settings, and application support.

Obstetric Malpractice Preventing, Managing & Defending Claims Against Your Organisation 24 – 25 November 2009 | Crowne Plaza Darling Harbour This definitive industry event comprises key case studies and enlightening sessions that can be readily applied to facilitate further understanding of the prevention, management and defence of obstetric malpractice claims.

Don’t miss this fantastic opportunity to meet with industry colleagues to network and gain advice to prevent, manage and defend obstetric malpractice claims.

TO REGISTER CALL NOW! Bookings Hotline: (02) 9080 4090 eMAil: info@iir.com.au WeB: www.iir.com.au/obstetric/pit

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FEATURE Steve Quenette Steve Quenette is the Manager of both Health and Computational Geophysics initiatives at the Victorian Partnership for Advanced Computing (VPAC) Ltd1, and Project Director of the National Collaborative Research Infrastructure Strategy (NCRIS) funded research centre AuScope Simulation, Analysis and Modelling Victoria2. He is completing a PHD on software engineering for high performance computing in the School of Information Technology at Monash University. steve@vpac.org

A science and engineering view on health innovation There are many benefits to being a member of an organisation with initiatives in all prolific disciplines of sciences and engineering.

One such benefit is the opportunity to draw insightful analogies between these disciplines. For example, both geophysics and health suffer from the ‘egg shell’ problem. That is, we can only see the surface of the Earth, and ‘sense it’ to a shallow depth (i.e. the egg shell). Furthermore, one cannot fabricate an Earth in a lab.

As a result, the discipline of geophysics utilises well understood physical phenomena, framed against what we can see at or near the surface, to explain the evolution of the Earth. From this understanding many innovations are made in exploration and mining, but also in natural disaster prediction and management, and environmental management.

Whilst there are some obvious differences, in many ways health is similar. Because we cannot simply open up a body to look inside, we draw conclusions based on what we can sense (e.g. x-ray, radiology, pathology, etc) and theoretical outcomes.

Hence, there are still many facets of the human body we don’t understand. This is especially true in the context of improving health outcomes. On the other hand, many GP decisions are made from what they can sense by sight and touch from a patient. Once again, utilising observations on or near the surface in conjunction with some well understood phenomena, we achieve an understanding which is then applied to aid health outcomes.

Increasingly so, clinical decisions are being made with both human and scanning observations. Furthermore, clinical care is often delivered by more than one person or organisation. Here entails the challenge for innovation in health — the increasing need for health outcomes derived from very large and complex information, multi-faceted and multi-person care workflows, and care delivered across organisational boundaries.

This can be seen through the emerging trends in e-health activities as proposed and funded by Federal and State governments, as well as by innovators in health organisations themselves. Examples such as efforts around the personal health record, electronic referrals, cross-organisational care for niche disease states, and hospital and policy management.

In some cases, efforts span more than one of these areas.

Despite e-health being a facilitator of these activities, within an individual organisation such efforts are operationally seen as multi-disciplinary, and hence involve people and buy-in from care delivery, research and IT. From the IT perspective, there are some tangible concerns.

Computer systems in the e-health domain are expected to interoperate and be extensible. On one hand, health has been well served by HL7 for the purposes of asynchronous information

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transfer between computer systems (in much the same way as the SMS protocol has facilitated text messaging between friends). However until recently, the clinical information delivered in these messages, especially with respect to observations, has not been well standardised. To continue the analogy, if you SMS me in Swahili, I will be able to receive your message, but will not be able to understand you very well. On the other hand, the national promotion of SNOMED CT for terminology is arguably a significant step in achieving health information standards. And yet from an IT perspective, there is a need to have interoperable and sustainable systems right now. While there is no ubiquitous standard representation for the very rich ontology required for health there remains a fundamental concern for continued innovation over time.

It should be noted that the messaging paradigm (used by HL7) is used elsewhere. For example, DIS/HLA standards are used for defence war games and simulations. A similar methodology is used at the Australian Synchrotron in the EPIC protocol. However, they all essentially suffer from a lack of real data model standards in similar way.

From the IT perspective, constellations and federations of information across organisational boundaries introduces ethical, privacy, authentication and authorisation issues that are not present on sole-organisational initiatives. IT will have to deal with the imminent data deluge. Referrals will be autonomously generated, dispatched and received. Scanned information is increasing in fidelity and quantity. Simultaneously, more scanned information is being incorporated into clinical outcomes. For example, the Children’s Hospital of Philadelphia in their first year of digitally scanning clinical pathology, used over 30 terrabytes of disk storage. The long term storage, backup and affordable connectivity of such information is a significant issue. Whereas for our own personal photo library we are happy to go down to the local electronics goods store and buy a terabyte hard disk, to establish a scalable, sustainable, robust, backed-up, efficient and green petabyte storage infrastructure is still a non-trivial process.

For Chief Information Officers (CIOs) today’s scenario presents an opportunity. The infrastructure in place today will have to change, presenting an opportunity for CIOs to ‘own their data’.

That is, have control and access to the fine details of clinical knowledge in their systems. Innovative health outcomes will come from emergent uses of this new data. Furthermore, financial measurements will rely even more on clinical measurement.

There is an organisational need for data agility.

From this perspective, e-health is not alone. Our fellow ‘egg shellers’ in the geology industry have suffered from the same data

lock problem. However, organisations like GeoSciences Victoria have evolved to developing 3D geological reference models3.

These models are an intelligent composition of existing and new sub-models incorporating observational data and interpretation knowledge. Some data is relational, and others are no different to the raw MRI scanner data, and the reconstructions built from it. They have provided themselves the data agility to engage with various information providers and to provide information to various users. In turn, they are positioned to innovate.

With the emergence of digital pathology, the nature of multi-disciplinary teams meetings will change. In the automotive sector, this change was driven through the need for rapid time to market and the proliferation of computer aided design tools.

In turn, this requires large multi-disciplinary teams to efficiently work together. MIT’s Haystack4 initiative has inspired efforts like the AutoCRC’s IDE platform5. IDE is a tool that enables seamless workflows to be developed by collaborating engineers in their natural discussion room setting. Its goal is to enable the Obeya room method for cross-functional team communication. This method was made popular through the highly appraised Toyota Product Development System. The Haystack initiative aims to make it easier for people to collect, organise, find, visualize, and share their information. It appreciates that one of the biggest obstacles to such information management is the rigid, centrally-planned information models and user interfaces of existing applications and web sites. The data people use in the real world is rarely so well-formed, and this is especially true in e-health.

Here is a scenario that is not inconceivable in the near term.

What happens when multidisciplinary team meetings begin to use digital pathology, and that pathology is provided by an eReferral from an external pathology provider? At present there is insufficient network infrastructure to cheaply support this. Even in locations where there is physical infrastructure that can enable this to occur, the initiative won’t get past the CIO’s first Internet bill. We are seeing such blockers to innovation already with digital pathology federated at several hospitals in Victoria. There is an inability to exchange, let alone federate these images without physically transporting hard-disks. This is interesting, because as part of Australia’s bid for the Square Kilometre Array (SKA), a radio telescope with 10,000 times greater discovery potential than any of the world’s existing telescopes, a trans-continental 10 Gbps connection was demonstrated earlier this year. This demonstration was 500 times faster than consumer broadband speeds, and yet is still several hundred times below what is required to support the SKA. Moreover, as facilitated by AARNet on-net (Australia’s research and education network backbone), direct costs would not have been imposed on the researchers involved.

E-Health in Australia is well braced to move forward. There is an opportunity to lay the foundations for data-enabling innovations. The patterns of problems have been seen in other areas of science and engineering. Using this acquired expertise, we have the confidence of what the future looks like and some pointers of how to get there.

IF PAIN PERSISTS, SEE YOUR MEDICAL IT SPECIALISTS.

Because we don’t just take away your IT Pain, we enhance the quality of the way you do business.

References AND FURTHER READING 1 - http://www.vpac.org 2 - http://www.auscope.monash.edu.au 3 - http://www.3dvictoria.dpi.gov.au 4 - http://groups.csail.mit.edu/haystack/ 5 - http://www.autocrc.com

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43 P 1300 300 471 | E info@isnsolutions.com.au | W www.isnsolutions.com.au

CARBONELLE CONSULTING

AAPM

P: 02 9889 1311 F: 02 9889 1411 E: info@carbonelle.com.au W: www.carbonelle.com.au

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 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.

Adelaide ESQUARE

P: 08 8234 1600 F: 08 8234 6785 E: medilink@esquare.com.au W: www.esquare.com.au One stop shop IT Solutions Provider: • Official Medilink Dealer for sales and support in South Australia • Computer hardware and software sales, support and servicing • Computer Networking solutions and troubleshooting • Web Site design and development • Email solutions • Web Site Hosting • Domain Name Registration and Hosting • Friendly and highly responsive team

Brisbane, QLD SOFTWARE7

P: 0412 626 769 F: 07 3378 4163 E: enquiries@software7.com.au W: www.software7.com.au Business Information Technology Solutions Provider. Some of our services are: • Authorised Medilink Dealer for sales and support in Brisbane.

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

• Web site design, development and hosting services.

• Email solutions.

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

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

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

ArgusConnect

P: 03 5335 2220 F: 03 5335 2211 E: argus@argusconnect.com.au W: www.argusconnect.com.au

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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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 MD) • Integrated Best Practice (clinical/management) • Top Pocket (PDA companion software for Pocket PC)

ArgusConnect provides and supports Argus secure messaging software that enables doctors and healthcare organisations to exchange clinical documents securely and reliably.

Argus can be used to send specialist reports to referring doctors but it can also exchange pathology and radiology reports, hospital discharge summaries and notification between healthcare providers. Healthcare practitioners can use any of the popular clinical software packages to send reports and other clinical correspondence via Argus.

Argus is the messaging solution chosen by over 50% of all Divisions of General Practice across Australia through the ARGUS AFFINITY DIVISIONS program.

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

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

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

CH2 (CLIFFORD HALLAM HEALTHCARE) P: 1300 720 274 F: 1300 364 008 E: marketing@ch2.net.au W: www.ch2.net.au

Clifford Hallam Healthcare (CH2) is today Australia’s largest Pharmaceutical and Medical Healthcare service provider with over 5,000 customers and a catalogue of over 15,000 products.

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

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

CH2 understands the value of quality data and are committed to implementing the GS1 system throughout our business and with our partners. The use of EANCOM standard messages, Global Trade Item Numbers (GTIN) for product identification, Global Location Numbers (GLN) for location information and Serial Shipping Container Code (SSCC) labels are paramount to our industry moving forward. CH2 are passionate supporters of these philosophies and believe the uplift in quality systems will result in improved patient safety. CH2 are currently working with partners to implement the National E-Health Transition Authority (NEHTA) National Product Catalogue. Our aim is to be a great company to do business with. The right product, at the right price, at the right time.

WardBox™ is CH2’s direct to ward distribution system. It is a just in time replenishment system where orders are created in a theatre or ward area and then transmitted electronically to one of CH2’s warehouses using SOS or an EDI interface. The service incorporates barcode scanning technology, direct delivery to individual wards or departments, monthly invoicing and comprehensive reporting.

WardBox™ is designed to assist our customers in reducing purchasing and supply operating costs. This valuable service increases supply chain efficiencies, improves service delivery models and assists in achieving economies of scale.

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

Computer Initiatives COMMUNICARE Systems P: 08 9332 2433 F: 08 9310 1516 E: info@ccare.biz W: www.ccare.biz

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

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

COMPUTER CARE IT

P: 02 9410 0405 (NSW) P: 03 9646 0141 (VIC) P: 02 6282 2256 (ACT) E: sales@computercare.com.au W: www.computercare.com.au Computer Care works as a business partner with medical practices and other health organisations to accommodate all IT needs, covering: • Experience in all major practice management software (migration, upgrades, etc) • Computer systems & networks • Security • Hardware • Help Desk support • IT consulting • Technology trouble shooting

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

Computer Initiatives has been supporting the medical profession for over 15 years. Providing IT consultancy services, quality hardware, professional support with qualified engineers 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.

$900:

The cost of participating in the Pulse+IT Directory in all of these copies.

For more information about advertising in Australia’s first and only Health IT magazine, call Simon James on 0402 149 859

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.

Emerging Health Solutions

P: 02 8853 4700 F: 02 9659 9366 E: Arthur.Harris@emerging.com.au 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.

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GPA thinks a change would do you goodâ&#x20AC;Ś When it comes to accreditation, GPAâ&#x20AC;&#x2122;s new online program

A+

is guaranteed to change your life!

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

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

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

HEALTHLINK 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.

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

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

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

Health Communication Network - HCN

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.

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

Health Communication Network (HCN) is the leading provider of clinical and practice management software for Australian GPs and Specialists and supplies Australia¹s major hospitals with online Knowledge resources.

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

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

HEALTHENGINE

P: 0419 091 170 F: 08 9467 6150 E: info@HealthEngine.com.au W: www.HealthEngine.com.au HealthEngine.com.au is a comprehensive online directory of GP’s and Specialists, offering free doctor and practice listings to any Medical Practitioner registered in Australia.

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

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

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

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

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

P: 1800 125 036 F: 07 3870 7768 E: enquiries@healthlink.net W: www.healthlink.net Australia’s largest effective secure communication network.

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

HEALTH SOLVE

P: 1800 803 118 F: 08 8203 0595 E: info@healthsolve.com.au W: www.healthsolve.com.au HealthSolve provides solutions across the continuum of care with solutions for all sectors.

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

HealthEngine.com.au - Getting the Right Patient to the Right Doctor For further information, please contact Mike: 0419 091 170

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

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Houston Medical

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

HIMAA

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.

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

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

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.

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. 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.

JAM SOFTWARE HISA

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.

ISN SOLUTIONS PTY LTD

Hunter Valley ANYTIME COMPUTER SOLUTIONS P: 02 4934 8560 E: aldon@anytime.com.au W: www.anytime.com.au

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

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P: 1300 300 471 F: 02 9280 2665 E: info@isnsolutions.com.au W: www.isnsolutions.com.au

ISN Solutions is a medical IT company that specialises in the design, setup and maintenance of computer networks for medical practices.

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

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

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), Letters, Prescriptions (including MIMS), Orders, e-Results, MS Office integration & CustomDB including surgical & other audits.

Now with HL7 Secure Messaging.

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

NEHTA

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

MEDICAL SOFTWARE INDUSTRY ASSOCIATION P: +61 (0) 427 844 645 E: ceo@msia.com.au E: president@msia.com.au W: www.msia.com.au

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

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

MEDILINK

P: 1800 623 633 F: 07 3392 1108 E: support@medilink.com.au W: www.medilink.com.au Integrated best of breed solutions: • • • • • • • • • • •

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

20 years of caring for practices.

Join over 80 other companies across all areas of medical IT/IM so your voice can be heard.

MEDTECH GLOBAL

Melbourne & VIC PRACTICE SERVICES P/L

P: 03 9819 0700 F: 03 9819 0705 E: Sales@practiceservices.com.au W: practiceservices.com.au 15 years as Authorised Medilink Dealer selling, installing, training and supporting Medilink Practice Management Software • Fixed Cost Onsite and Remote Support • Medilink = Intuitive ease of use • Solo Drs up to Hospitals in size • Cut debtors and boost cash flow with Online Claiming via EFTPOS and/or Medicare Online for Funds, Patients, DVA & bulk billing • Many optional modules • Links to many third party packages and services Our Users are our best Salespeople

P: 03 9690 8666 F: 03 9690 8010 E: salesAU@medtechglobal.com W: www.medtechglobal.com

Medical-Objects

P: 07 5456 6000 F: 07 3221 0220 E: info@medical-objects.com.au W: www.medical-objects.com.au Medical-Objects has provided secure messaging to over 10,500 health professionals with referrals, reports, letters and discharge summaries. Delivering directly into leading practice software, removing the need for scanning and faxing.

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

For 25 years, Medtech Global has been enhancing the quality of patient care by working with healthcare professionals in developing and delivering award winning industry-proven technology products. Our technology solutions are both sophisticated and user-friendly, designed for the comprehensive management of patient information throughout all aspects of primary and secondary healthcare, mental health and corporate health.

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

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

NSW & NT CARBONELLE CONSULTING

P: 02 9889 1311 E: info@carbonelle.com.au W: www.carbonelle.com.au Carbonelle support over 600 clients with 21 Years of Experience.

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

MIMS Australia is built on a heritage of local expertise, credibility and adaptation to changing healthcare provider needs. Our information gathering, analysis and coding systems are proven and robust. MIMS information is backed

by MIMS trusted, rigorous editorial process and constantly updated from a variety of sources including primary research literature. Our database and decision support modules are locally relevant, clinically reviewed and updated monthly and compatible with a host of clinical software packages.

Indeed, the majority of Australian prescribing packages and many dispensing applications are supported by the MIMS medicines data base.

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

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

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

Whatever the format, MIMS has the latest information you need.

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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: Vicki.Rigg@nuance.com W: www.nuance.com/au

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

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

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

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.

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STAT HEALTH SYSTEMS

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

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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.

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

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

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PULSE + IT

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

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SMARTROOMS BY DOCTORWARE

P: 03 9499 4622 F: 03 9499 1397 E: sales@doctorware.com.au W: www.doctorware.com.au SmartRooms provides a comprehensive software solution for specialist practices for both Mac and Windows.

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

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

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

• Fast turn around and excellent quality.

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

• Victoria’s largest supplier to hospitals.

• References available on request.

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 readily interoperable with feeds, an online events calendar, 20/02/09 SR Logo_65x42mm.pdf 14:50:20 other systems. and an interactive website.

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Syber sCRIBE

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).

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.

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.

QIP and aGPaL Present tHe 5tH InternatIonaL ConferenCe In HeaLtH Care

Quality around the World

20 â&#x20AC;&#x201C; 22 May 2010 Melbourne australia registrations open noW!

The Quality Around the World program will focus on the key issues impacting the face of health care internationally â&#x20AC;&#x201C; safety and quality, health care reform, communication and e-health.

Quality Around the World offers valuable learning for all decision makers and health professionals from clinicians to practice managers in all areas from general practice to community health and hospitals.

Join the QIP and AGPAL teams, opinion leaders, national and international experts to learn more about the trend toward integrated primary health care, the latest on infection control, the rise of e-health, communicating in a multicultural practice, and more.

Register early as this conference will sell out!

QIP

www.qip.com.au/conference