Pulse+IT Magazine - April 2013

Australasia’s First and Only eHealth and Health IT Magazine

34

ISSUE

1 APRIL 2013

MESSAGING & E-PRESCRIBING

Secure Message Delivery

A collaboration between vendors is yielding results, but will it be enough to improve electronic communication?

Incentives drive eScripts

The ePIP gave a boost to electronic transfer of prescriptions, although a medications list is still in the future.

St Vincent’s discharges electronically St Vincent’s Hospital in Sydney can not only send electronic discharge summaries to the patient’s GP, but to their PCEHR as well.

pulseitmagazine.com.au

Organisations please note: The Pulse+IT eNewsletter service has expanded, with each day of the week now focused on a different part of the health sector. Aged care, allied health, medical practices and the acute sector all receive dedicated coverage, with targeted advertising opportunities now available. To register your interest and obtain a media kit, email: enews@pulseitmagazine.com.au

Want to keep your finger on the pulse?

Launched in 2012, Pulse+IT’s companion eNewsletter service is the sector’s most trusted source of timely eHealth and Health IT news. Pulse+IT eNewsletters bring together breaking news, events, career and business opportunities, and software training sessions, keeping readers informed and up to date.

Our rapidly growing list of almost 5000 subscribers enjoys:

1) 2) 3)

Reporting dedicated purely to eHealth in Australasia

Independent, timely and accurate journalism

No costs, logins, credit cards, paywalls or micropayments

www.pulseitmagazine.com.au/enews

PULSEITMAGAZINE.COM.AU

004

Inside

Publisher Pulse+IT Magazine Pty Ltd ABN: 34 045 658 171 www.pulseitmagazine.com.au Editor Simon James Australia: +61 2 8006 5185 New Zealand: +64 9 889 3185 simon.james@pulseitmagazine.com.au Advertising Enquiries ads@pulseitmagazine.com.au

040 | 045 | 048 | 050

Looking Ahead Pulse+IT welcomes feature articles and guest editorial submissions relating to the nominated edition themes, as well as articles relating to eHealth and Health IT more broadly. Pulse+IT is produced in print seven times per year with the remaining five edition for 2013 to be distributed for release in: • Mid-May 2013 - Medical Devices • July 2013 - PCEHR / HIC2013 Preview • Mid-August 2013 - Telehealth / HIMAA Conference Preview • October 2013 - New Zealand eHealth / HINZ Conference Preview • Mid-November 2013 - mHealth

Submission guidelines and deadlines are available online: http://www.pulseitmagazine.com.au/editorial Pulse+IT acknowledges the support of the following organisations, each of whom supply copies of Pulse+IT to their members.

About Pulse+IT Pulse+IT is Australia’s first and only Health IT magazine. With an international distribution exceeding 34,500 copies, it is also one of the highest circulating health publications in Australasia. 32,000 copies of Pulse+IT are distributed to GPs, specialists, practice managers and the IT professionals that support them. In addition, over 5,000 copies of Pulse+IT are distributed to health information managers, health informaticians, and IT decision makers in hospitals, day surgeries and aged care facilities.

ISSN: 1835-1522 Contributors Heather Grain, Leanne Holmes, Simon James, Kate McDonald, Louise Schaper, Peter Williams and Michael Wong.

Disclaimer The views contained herein are not necessarily the views of Pulse+IT 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+IT Magazine has no affiliation with any organisation, including, but not limited to Health Services Australia, Sony, Health Scope, UBM Medica, the New Zealand College of General Practitioners, the Rural Doctors Association of Australia, or the Kimberley Aboriginal Medical Services Council, all who produce publications that include the word “Pulse” in their titles.

Copyright 2013 Pulse+IT Magazine Pty Ltd 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.

028

058

053

TELEHEALTH SERVICES GO WEST

SATELLITES TO DELIVER TELEHEALTH

MICROSOFT TARGETS HEALTHCARE

Editorials

Features

News

006

040

E-DISCHARGE AT ST VINCENT’S

008

045

VENDORS COLLABORATE

Data modelling of patient flow for NEAT purposes

Six providers of secure messaging services have collaborated on an inter-connection project.

Half a million PCEHR registrations still achievable: DoHA

036

STARTUP Editor Simon James introduces the 34th edition of Pulse+IT and reminds general practice that while the first eHealth Practice Incentives Program deadline has passed, the deferred deadlines relating to the PCEHR and secure messaging are now on the horizon.

ACHI & HISA Peter Williams and Louise Schaper argue that the need for an eHealthand health informatics-literate workforce has never been greater, as has the need for more evaluation of eHealth projects. Together with HIMAA, HISA and ACHI are launching a certification program for health informatics in July.

Resources

034

EVENTS

061

PULSE+IT DIRECTORY

Up and coming eHealth, Health, and IT events.

The Pulse+IT Directory profiles Australasia’s most innovative and influential eHealth and Health IT organisations.

048

St Vincent’s Hospital is now able to send CDA discharge summaries to the patient’s GP and the PCEHR.

SECURE MESSAGING AND EPIP The deadline for the first ePIP payment has passed but additional updates are just around the corner.

050

ESCRIPTS SET TO TAKE OFF

053

MICROSOFT NOT ALL SURFACE

Initiatives like the ePIP and the new National Prescription and Dispense Repository are set to boost ETP.

Microsoft aims Lync, Skype, Office 365 and Surface tablet at the healthcare enterprise.

SELECTED BITS & BYTES Prescription exchanges disable dispense notifications

Hospitals and GPs can register patients for PCEHR HISA and ACHI collaborate on membership arrangements Home-Doctor device allows a true medical clinic in the home Healthcare practitioners do not register for PCEHR individually: DoHA Easy to use app launched for IBS patients on FODMAP diet

056

DIGITISING PAPER RECORDS

058

SATELLITES FOR TELEHEALTH

IDNT Online to transition into full CMS for dietitians

NBN Co has raised the speeds of its two long-term broadband satellites in a boost for telehealth.

Social robots heading into the home for mild dementia

Standards Australia has developed revised standards for digitising paper-based medical records.

Spintech wins $1.5m to expand automated ultrasound reporting

PULSEITMAGAZINE.COM.AU

005

PULSEITMAGAZINE.COM.AU

006

Editorial

SECURE MESSAGING AND E-PRESCRIBING While general practices breathed a collective sigh of relief with the passing of the February 1 deadline for the eHealth Practice Incentives Program, much hard work lies ahead for both these practices and the vendors that supply secure messaging products to the health sector.

SIMON JAMES BIT, BComm Editor: Pulse+IT simon.james@pulseitmagazine.com.au

For general practices at least, this edition’s dual themes of secure messaging and electronic prescribing will be familiar to readers, with both technologies a feature of the recently enacted eHealth Practice Incentives Program (ePIP).

The first deadline under the new ePIP requirements has passed and application forms need to be sent to Medicare in the coming weeks, however general practices are reminded that the deferred deadlines relating to the Personally Controlled Electronic Health Record (PCEHR) and secure messaging are now on the horizon.

With ongoing reports of HPI-O and NASH certificate processing delays and Healthcare Provider Directory (HPD) issues conspiring to undermine some organisations’ ability to progress their eHealth setups in a timely fashion, practices should not delay in tackling any outstanding work they need to undertake to maintain compliance with their ongoing ePIP commitments.

About the author Simon James is the editor of Pulse+IT, one of Australia’s highest circulating health publications of any kind. Prior to founding the publication in 2006 he worked in an IT support capacity for various medical practices, and subsequently for both clinical software and secure messaging developers.

To assist practices to better understand their ePIP secure messaging obligations, Pulse+IT has prepared an article examining this requirement, with the pertinent August 1, 2013 deadline not as far into the future as it may appear given the numerous steps some practices may need to undertake.

A separate article focused on the National E-Health Transition Authority’s SMD-POD project provides additional information and perspectives on the new messaging capability that all general practices in receipt of the ePIP are expected to have installed in just a few short months Many of the organisations noted in this particular article have positioned themselves as specialised providers of secure messaging services and naturally have a commercial imperative to maintain compliance with government eHealth initiatives. However it remains unclear what plans government has to bring the plethora of long-entrenched secure messaging solutions developed and maintained by pathology and radiology providers into the SMD fold, assuming of course a reduction in the number of messaging solutions a typical healthcare organisation has to maintain remains part of the over arching agenda.

With secure messaging and electronic transfer of prescriptions implying connectivity between disparate parts of the health sector, a detailed article on the work St Vincent’s Hospital has been undertaking with discharge summaries is also included in this edition, with an overview of the forthcoming National Prescription and Dispense Repository a featured theme.

Your operation just got easier.

At Genie Solutions, we know how precious your time is. With Genie, we help you streamline your practice management and make your life easier.

Genie integrates your appointments, billing and clinical needs in just one application. It runs on either Windows or Macintosh, with the ability to simply copy your data from one platform to another. It’s got everything you need as a procedural specialist.

for Australian specialists. Genie is a tried and tested solution proven to be invaluable to specialists throughout Australia.

If you’d like to find out more about what Genie can do for your practice, or would like a personal demonstration, just give us a call or visit our website to order a Demonstration CD online. We have offices or representatives in all states.

Genie Solutions Pty Ltd Phone: 07 3870 4085

Email: sales@geniesolutions.com.au

www.geniesolutions.com.au

www.dmwcreative.com.au GS00701

With 15 years experience and over 2000 sites, Genie Solutions is the market leader in medical software

PULSEITMAGAZINE.COM.AU

008

News

Prescription exchanges disable dispense notifications over duty of care fears Electronic prescription exchange vendors MediSecure and eRx have disabled the function that allows doctors to receive automatic notifications that a prescription has been dispensed, following concerns raised over duty of care by the RACGP.

Scan this QR code to read and comment on the latest eHealth news online.

Both MediSecure and competitor eRx attended a meeting with RACGP officials recently in which they were both requested to disable the function.

According to RACGP president Liz Marles, there were concerns over patient privacy and consent, and that the ability to receive automatic dispense notifications “may impact on a GP’s duty of care”.

Scan this QR code to receive eHealth news delivered to your email inbox each week.

Several sources told Pulse+IT the concerns relate to the recent case of a morbidly obese man who sued his GP, Emmanuel Varipatis, for failing to refer him to a weight-loss clinic or for bariatric surgery.

The patient, Luis Almario, has terminal liver cancer. In February, he was awarded $364,000 by the Supreme Court of NSW, which ruled that Dr Varipatis was legally responsible for the consequences of Mr Almario’s pre-existing liver disease progressing to cirrhosis, liver failure and liver cancer.

Dr Varipatis and his medical defence organisation, Avant, are appealing the decision.

Pulse+IT understands that the precedent set by the case has alarmed MDOs, as it could potentially mean that doctors will be expected to follow up every patient to ensure they are correctly following instructions. One source called it a “completely ludicrous” position but that a precedent had now been set and the bar for duty of care had been raised.

In the past, a doctor had no way of knowing if a prescription had been filled,

but with automatic dispense notification capability, GPs can easily find out, another source said.

“There is an argument that because a GP could credibly identify whether a patient did or didn’t pick up their pills, it could be argued by a patient’s lawyer that the GP should be held liable if the patient didn’t pick up pills and something happened as a result,” the source said.

“However, it’s a bit of a weak argument as just picking up pills doesn’t mean the patient actually takes them.”

RACGP spokesman on eHealth, Nathan Pinskier, said the recent case had added to concerns about duty of care, but it was in addition to the college’s concerns over automatic notifications. “[The case] certainly added to the concerns,” Dr Pinskier said. “It in itself is probably not the

prime driver but it is a complicating factor in the currently confused environment.”

Dr Pinskier said the vastly increased use of electronic transfer of prescriptions (ETP) precipitated by the introduction of the new eHealth Practice Incentives Program (ePIP) had brought to attention a change in the current model for prescribing and dispensing that needed further investigation.

“We’ve got three models of prescription issuance and dispense that are operating at the moment in the country,” he said. “The first model is the current state which is essentially for most prescribing and that’s the paper-based world.

“In the current state, I have no awareness as to which pharmacy you have gone to and whether or not it has been dispensed and consumed until such time as you choose to return to me and we have a discussion and you inform me one way or the other.”

Dr Pinskier said the introduction of electronic prescriptions would work on a similar model, only electronically.

“That works on a model of electronic prescriptions going up to a national system through a prescription exchange service but dispense notifications will not be

directly returned to the prescriber,” he said.

“There is no point-topoint dispense notification involved.”

However, the introduction of prescription exchange services has changed this model and information flow by sending information back to the prescriber, which raises the question of what the prescriber should then do about it.

“If the script hasn’t been dispensed, what is the GP’s duty of care to follow that up and make sure they actually take it?”

“The advice that we have been provided around the model is that in terms of upload [to a prescription exchange], no consent is required as it maintains the current state – whether it is by fax or you take it to the pharmacy, it doesn’t change the information flow.

“But the information coming back does change the current model in that I’ve got an obligation to notify the consumer.

“Does the general practitioner need that information, and what happens if they receive it and don’t act on it? If the script hasn’t been

dispensed, what is the GP’s duty of care to follow that up and make sure they actually take it?

“Are we a surveillance authority, the medications police? There are no academic or legal or best practice models to support that, but we think it is best done as an opt-in system.”

He said part of the issue would be resolved with the launch of the National Prescription and Dispense Repository, which will begin to roll out from May. Dr Pinskier said it was the RACGP’s view that the NPDR, as an opt-in service for consumers registered for a PCEHR, would provide a new model.

“Subject to the patient’s consent and their control, if they want to turn it on they will have dispense notifications going up to the PCEHR,” he said. “The consumer can opt in and they can elect to share that information.

“That is a better mechanism because it informs, it is considered and it’s controlled. I choose to share it and the provider chooses to look at it.”

MediSecure CEO Phillip Shepherd said that for those practices and clinicians who still wish to access dispense notification data, a new service will be created as a specific opt-in with a separate licence.

College of physicians would like a piece of the ePIP pie The Royal Australasian College of Physicians (RACP) is calling on the federal government to extend the eHealth Practice Incentives Program (ePIP) to medical specialists, saying it would encourage the use of eHealth technologies by physicians both in rural and metro settings.

In its 2013-2014 federal budget submission to the Department of Health and Ageing, the college recommends that a specialist incentive payment be made available to enhance the eHealth readiness of specialist doctors similar to that paid to GPs to encourage them to use eHealth technologies, including the PCEHR. The RACP also wants the government to introduce funding to allow specialists to upgrade their practice IT systems in order to access eHealth and telehealth technologies, and to clarify the position of telehealth within the activity-based funding (ABF) framework.

RACP president Associate Professor Leslie Bolitho said that for eHealth to be successful, all medical practitioners in Australia, including GPs and specialists, will need to adopt eHealth technologies.

He said that extending the PIP to specialist doctors will encourage the use of emerging eHealth technologies, enabling specialists to update online patient records as required.

Dr Bolitho said the college was not asking for the government to allocate additional funds. “[We] ask that a restructure of the PIP eligibility criteria be considered, so that it can be accessed by the multidisciplinary team,” he said.

“The RACP recommends that a Specialist Practice Incentive Payment be made available to enhance the eHealth readiness of specialist physicians and to encourage the uptake of technology.”

PULSEITMAGAZINE.COM.AU

09

PULSEITMAGAZINE.COM.AU

010

Bits & Bytes

Prescription exchanges achieve interoperability The two electronic prescription exchange services, eRx Script Exchange and MediSecure Script Vault, have achieved interoperability, meaning electronic prescriptions generated by one system can be read and dispensed by the other.

The developers of the two exchanges announced last year that they were working towards interoperability, and have been provided funding to the tune of $10m under the $15.4 billion Fifth Community Pharmacy Agreement (5CPA), including $660,000 each for technical work and $8.3 million in transaction fees. eRx’s general manager, David Freemantle, and MediSecure’s CEO Phillip Shepherd, said technical interoperability had been achieved last December, with the ability to scan eScripts from both exchanges rolled out through pharmacy dispense systems in January 2013.

Mr Freemantle said all pharmacies using market leader Fred Dispense, which is owned by eRx’s parent company Fred IT, can now scan MediSecure eScripts as well as eRx, the capability having been automatically included in Fred Dispense’s January update.

“Fred pharmacies were automatically enabled, so now they can all begin to scan MediSecure barcodes,” he said.

Both prescription exchanges saw a huge volume of enquiries in January as the deadline for the eHealth Practice Incentives Program (ePIP) neared.

“In 2012 we averaged about 70 practices signing on per month, but in January we had 343,” Mr Shepherd said. “We have also seen an increase of about 45 per cent in original prescription numbers.”

Both expect the volume of eScripts lodged in the exchanges to continue to grow.

Data modelling of patient flow for NEAT purposes The CSIRO has released a whitepaper outlining how evidence-based analytical and decision-support tools can help hospitals understand barriers to reducing emergency department waiting times and help them reach the four-hour target by 2015.

The whitepaper, “Evidence driven strategies for meeting hospital performance targets”, covers a number of tools and techniques that CSIRO has developed that allow hospitals to use data modelling to help improve bed management, patient flow, identify ‘frequent flyers’ and make evidencebased decisions on system reconfiguration.

With the introduction of the National Emergency Access Target (NEAT) – also known as the four-hour rule – in 2011, hospitals are now under pressure to reach the target of either admitting or discharging emergency department presentations within four hours by 2015.

Debate has raged for many years about what the solutions are to access block and ED overcrowding, and many clinicians fervently believe the answer is quite simple – more beds and more staff.

With budget limitations and cuts to health budgets now being instituted in NSW,

Victoria and Queensland in particular, that is not likely to happen any time soon.

CSIRO’s Sarah Dods said understanding the reasons for access block and ED overcrowding should always be based on evidence, which was now starting to appear.

Research Centre and now in use throughout the state.

The whitepaper states that contrary to conventional wisdom that emergency patient volumes are unpredictable, the number of admissions per day can be predicted with remarkable accuracy.

“There is also evidence that we can make better use of what we’ve got.”

PAPT uses historical data to provide an accurate prediction of not only the expected patient load but their medical urgency and specialty, and how many will be admitted and discharged.

On the question of whether or not more beds and more staff will ease access block, Dr Dods said data modelling and analysis can now provide evidence for those kinds of discussions.

“Queensland Health now runs the system on their servers, and the software is available in 27 hospitals in Queensland, which are at different stages of maturity in using it,” Dr Dods said.

“Perhaps you do need more beds, but there should be clear evidence,” she said.

“There is also evidence that we can make better use of what we’ve got. As hospitals move to electronic data systems and we are able to do more patient flow analysis, the discussion can move on from beliefs and assumptions...”

“It’s a really good example of how a research partnership working closely with clinicians can help to understand the right problems to solve and provide solutions that work for that market.

CSIRO is looking to roll out its patient admission prediction tool (PAPT), developed in association with the Queensland government through the Australian e-Health

“Overcrowding in hospitals is an international crisis and CSIRO hopes to commercialise the tool with an international partner.

“I think what we are also seeing is that the modelling patient admissions is just one part of modelling a very complex system.”

we are ePIP ready!

With Zedmed you can be confident that all your ePIP requirements are covered Integrated Healthcare Identifiers Secure clinical messaging HL7 & SMD Clinical coding- ICPC 2+ Electronic transfer of prescriptions PCEHR- shared health and event summaries

Contact us today to ensure your practice is ready

1300 933 000 zedmed.com.au

No. 1

for PCEHR

PULSEITMAGAZINE.COM.AU

012

Bits & Bytes

Secure messaging services trialling interoperability The three members of the Secure Message eXchange (SMX) consortium are trialling their interoperable capability in pilot sites.

The consortium, which includes Global Health, HealthLink and DCA, has been actively involved in testing message interoperability based on the Australian Secure Message Delivery (SMD) standard since last year.

The SMX vendors said they were committed to supporting general practices to qualify for the eHealth Practice Incentives Program (ePIP) and had commenced pilots in parallel.

“The pilots will confirm our assumptions of the operational model and cost structures of providing the service,” Mathew Cherian, CEO of Global Health, said.

Peter Young, general manager of DCA Health, which markets the Argus secure messaging service, said that under the ePIP, general practices are required to conduct an SMD commissioning process, which includes an interoperability test, HI conformance and other requirements. If practices pass the commissioning process they qualify for the ePIP, he said.

The consortium said that in practical terms, the volume of messages that can be exchanged via the SMD standard will take some time to build momentum and will be phased based on the payload type.

“Sites are encourage to carefully plan the transition, which needs care and time to ensure that existing services are not compromised and misadventure for patient information does not occur,” the partners said.

The SMX partners are also taking part in NEHTA’s SMD-POD project, which aims to assist vendors to demonstrate technical compliance to NEHTA specifications.

Half a million PCEHR registrations still achievable: Department of Health Over 75,000 individuals have registered for a PCEHR since its launch last July, according to the Department of Health and Ageing (DoHA).

DoHA representatives told a Senate Estimates committee hearing in Canberra recently that with 98 per cent of general practice software now PCEHR-compliant, it was expected that real growth in the numbers of individuals registering would begin.

Committee member Concetta FierravantiWells queried whether DoHA’s target of 500,000 registrations in the first year could be achieved.

“The targets in the 2012 budget were 500,000 sign-ups by 2013 – very ambitious I would have thought,” Senator Fierravanti-Wells said. “You are clearly not going to reach that target.”

DoHA deputy secretary Rosemary Huxtable said the 500,000 figure was the department’s expectation based on international evidence of what it could expect within the first full year of operation.

However, Ms Huxtable said that with PCEHRcompatible GP software now rolling out, she expected to see numbers of registrations increase.

“Getting that GP software in place is the time when the real value is in the record; this is the time that can really begin,” she said.

“The figure of 500,000 in the first year of operation, I think that is still achievable given that ... we are beginning to see the more comprehensive operation of the PCEHR system, not just registration but also clinical use.”

“The targets in the 2012 budget were 500,000 sign-ups by 2013 – very ambitious I would have thought. You are clearly not going to reach that target.”

Senator Fierravanti-Wells also asked how many healthcare providers had registered to use the system. Linda Powell, first assistant secretary for eHealth change and adoption in DoHA’s eHealth division, said 1171 healthcare organisations had been registered to use the PCEHR, with 1325 individual providers given authorisation links.

Individual practitioners do not have to register to use the PCEHR but

the organisations they work for do. Healthcare organisations are issued a Healthcare Provider Identifier – Organisation (HPI-O) number, which is allocated by the Department of Human Services (DHS).

To begin using the PCEHR, organisations must have registered for an HPI-O and stored it in the practice’s clinical software. They must also apply for a NASH PKI digital certificate to both access the PCEHR and use secure messaging.

In January, a DoHA spokeswoman told Pulse+IT that 2867 HPI-Os had been assigned to healthcare providers and another 1400 applications were being processed by DHS. Pulse+IT understands that a backlog in processing these applications, and in issuing NASH digital certificates, means that while many practices have the software to access the system, they cannot do so until their NASH certificate arrives.

It is also understood that in some GP software packages, practitioners’ HPI-Is cannot be stored in the software until the NASH certificate is installed.

Senator Fierravanti-Wells also asked how many shared health summaries had been uploaded to the

system, but Ms Huxtable said she could not give an exact figure.

“At this point there is a fairly low number of summaries because the GP software hasn’t had the capacity to upload a shared health summary,” she said.

“There is a fairly high number of consumerentered documents, so the records are populated with a variety of documents.

There are also Medicare documents. There is a very large number of documents in that regard.”

Asked how many practice management software packages were compatible, NEHTA CEO Peter Fleming said he estimated that 98 per cent of GP-specific software was PCEHRcompatible.

Mr Fleming said that in addition to two companion tools produced by HIE and Pen Computer Systems, which are plug-in tools that can allow software to access the PCEHR, there were seven practice management packages that are now compliant, which he said represented about 98 per cent of software on GP desktops.

“For example, I was in HCN’s offices [recently] and they are the major vendor in this space, and they represent something of the order of 50 per cent [of the market],” Mr Fleming said.

“They have updated their

systems like the others and in talking to them, they were able to tell me at the time that 1400 of their customers have taken the latest release.”

Asked why there was such a delay in the major practice management software vendors becoming compliant, considering the PCEHR launched on July 1, 2012, Mr Fleming said there were a number of steps required to roll out these systems.

“Why didn’t [DoHA] wait until you were sure the practice management software was ready for the 1 July launch?”

“Provider software is one of the last steps,” he said. “In perspective, they needed to make changes to their systems … there is a huge amount of changes that needed to be made to those systems, and they needed to be tested, both in the environment we set up and in the local environments before they go out on a larger scale.”

Senator Fierravanti-Wells asked Mr Fleming why NEHTA and DoHA didn’t wait to launch the PCEHR until practice management software was ready. “That would have been a more

prudent approach, would it not?” she said.

Stat partners up as mobile specialists head to the cloud

Mr Fleming said there were many steps in the program.

“The reality is this is one of the final steps, we are getting registrations, so the infrastructure is in place.”

Stat Health Systems has partnered with managed IT services provider Precision IT and virtual practice administration service Virtual Medical Office (VMO) to offer a complete clinical and practice management solution hosted in the cloud.

Ms Huxtable said that in addition to the PCEHR, there were many other dimensions to eHealth that have been worked on for some years and are now bearing fruit.

The solution is aimed particularly at specialists who value mobility and want to be able to access their systems from any device as well as have their secretarial and administrative requirements outsourced.

“These are complex issues: one is the HI Service, which as we know is a fundamental precondition for the PCEHR, but equally is required for secure messaging to work appropriately,” she said.

“We are seeing many of the features that have been worked on for some time, not just in the PCEHR space but more broadly … we are at the point where we see that coming to fruition now and we can see the benefits coming out of that.”

She said the department was pleased with the amount of general practices that had applied to take part in the ePIP. “What we know is that there has been a quite high takeup of the ePIP, which was required from 1 February ... given that our focus is really around general practice, we are very encouraged by the rate of take up within general practice.”

Stat software provides customised report writing, SMS appointment reminders, inhospital billing and ECLIPSE functionality as well as appointment management tools.

It also provides integrated clinical functionality such as script writing, eRx integration, access to the MIMS drug database and clinical tools.

The partnership with Precision IT means practices have the option to access Stat and other programs in a hosted environment, Stat’s CEO, Carla Doolan, said. The data is stored securely on an Australian-based server and can be accessed from any computer or tablet.

Ms Doolan said she was seeing many of her customers interested in moving to the cloud. Specialists in particular are keen to be as mobile as possible.

Stat has now partnered with VMO to provide specialists using Stat and the Precision IT cloud solution with VMO’s virtual practice secretarial and management services.

Ms Doolan said she expected to see more specialists, including some of her current clients, transfer from locally hosted software to the cloud. Stat also has a number of GPs using the system, with one large practice in Sydney the company’s first cloud client, she said.

PULSEITMAGAZINE.COM.AU

013

PULSEITMAGAZINE.COM.AU

014

Bits & Bytes

VEHN to hold a pitch panel for commercialisation

Hospitals and GPs can register patients for PCEHR at the bedside or in practice

The Victorian eHealth Network (VeHN) held a breakfast meeting recently with Commercialisation Australia specifically for companies working in the local health IT industry, which will be followed by a members-only pitch panel to pitch their commercialisation proposal to a panel of case managers.

St Vincent’s & Mater Health Sydney has been using assisted registration tools to sign up both inpatients and outpatients to the PCEHR since December, with an estimated 2000 patients registered so far.

Commercialisation Australia is a government agency that provides a competitive assistance program of funding and resources to help Australian companies, entrepreneurs, researchers and inventors looking to commercialise innovative intellectual property.

St Vincent’s Public Hospital has been trialling the Department of Health and Ageing’s assisted registration tool (ART), developed by Accenture and recently released for general practice use.

VeHN president Chris Gray said members will have the opportunity to pitch their proposal to a panel of Commercialisation Australia’s case managers, and to obtain valuable feedback.

The breakfast is one of a number of events planned this year by VeHN, which is one of Victoria’s ICT Industry Clusters of Excellence. Late last year, the VeHN held a showcase of 20 local vendors, both large and small, and holds regular monthly functions to bring disparate individuals and organisations together.

VeHN is also planning to conduct a twilight tour of Melbourne’s Centre for Health Innovation, which features the latest technologies and how their use in health.

“In the second half of the year we’ll do a regional event about eHealth in Bendigo or Ballarat and we certainly want to be able to do an update on the eHealth program, Mr Gray said.

VeHN will also hold a showcase of its members, in which companies do a fiveminute presentation of their capabilities and to network with industry, researchers and government, similar to the showcase it held last year.

The software allows “known customers” of the hospital or practice to bypass the requirement for the patient to register online or by phone. An explanation of the assisted registration process and a downloadable ART are available from the ehealth.gov.au website.

Practices can now either assert the identity of the patient as a known customer of the organisation, or they can run a 100-point documentary identity check, and use the ART to submit patient’s details directly to the PCEHR. “If successful, the patient will be registered almost immediately and you can upload clinical information to their record straight away,” the website states.

“You can offer assisted registration to a person who is 14 years or older.

“You cannot offer assisted registration to any adult who does not have capacity or who is acting on behalf of an adult in their care.”

The software will allow the practice to connect directly to the System Operator to register the patient. It will also send a message back to the practice that the registration has been successful. An identity verification code (IVC) is then either SMSed or emailed to the patient or sent to the practice for it to print out.

“We have medical students and a recruitment officer who roam the campus talking to patients, explaining how the system works and signing them up.”

Rachel Byrne, national eHealth record system project manager at St Vincents & Mater Health Sydney, said the hospital now has around 15 patients with a PCEHR coming in each week, with most of them having documents uploaded to their PCEHR, including electronic discharge summaries.

Ms Byrne said part of the trial included using different registration techniques depending on whether the individual is an inpatient or outpatient.

“In the outpatient clinics, we pull out the list of patient appointments and identify what the busy times are,” Ms Byrne said. “We then have our team members go up to those clinics. We have medical students and a recruitment officer who roam the campus talking to patients, explaining how the system works and signing them up.”

A spokeswoman for the Department of Health and Ageing said software vendors will be building this function into their products over the next few months.

St Vincent’s is targeting some clinics in particular, including its diabetes clinic, heart-lung clinic, immunology clinic, dialysis, geriatrics and aged care, and also the Kinghorn Cancer Centre.

St Vincent’s Hospital will also be doing assisted registration through the hospital’s clinical information system, Emerging Systems’ EHS.

For inpatients, St Vincent’s uses a report that lists patients coming in under certain specialties, including elderly patients as well as readmissions,

to identify those who might benefit from a PCEHR. Team members then attend the ward to speak to the patient. The approach is also underway at St Vincent’s Private, she said.

St Vincent’s is also using printed information about the eHealth records system on the patients’ meal trays.

“We have a meal tray card, which is a small business card folded over that sits on the tray, and that has a pager number for our team,” Ms Byrne said. “The patient asks the nurse to page the recruitment team and the team will go up to the patient’s bedside and register the patient.”

Adrian Verryt, internal change and adoption manager at St Vincent’s, said the team ensures that staff members are informed about assisted registration and how this can be incorporated in their work.

“We want administrative and clinical staff to have the confidence to have a conversation about what PCEHR is, so we have a one-page fact sheet which broadly outlines what we are doing, why we are doing it and what the benefits are to signing up,” he said.

“That is information both to the patient and information to the staff member, so that at any point in time, whether we are handing it out to the patient on the ward or a staff member, we

are getting the same key messages across to them.”

Ms Byrne said the Accenture ART is simply a downloadable executable which sets up an application on the desktop.

“Once you put in your HPI-O and your credential information, it sets up a connection to the PCEHR, and that is just to create the record,” she said. “That’s really all it is doing – you don’t see any data, you are just creating the record.

“It is all integrated with the administration systems they use every day and does not require double entry of patient information whereas the outpatients areas might want to use the ART.” “The tool is essentially a one-page form and then the desktop application. The patients fill in the form and they sign it; it is very simple and quick to fill in. That information is entered into the tool and the record is created instantly.”

Emerging Systems has also designed an integrated tool within its software – which

has been PCEHR-compliant since last year – and which enables staff to create a PCEHR for the patient from within the clinical system.

DoHA plans that GP software will also have an integrated tool in the coming months, which Emerging Systems’ CEO, Russel Duncan, and his team have pioneered.

“Emerging Systems will be the first vendor to do it – consumer assisted registration within the clinical system,” Ms Byrne said.

“Part of [Mr Verryt’s] work now is looking at which areas of the hospital want to use that functionality and which ones want to use the assisted registration tool.”

“It makes sense in areas like bookings, admissions and preadmission clinic that they use Emerging Systems’ solution,” Mr Verryt said.

“It is all integrated with the administration systems they use every day and does not require double entry of patient information whereas the outpatients areas might want to use the ART.” Ms Byrne said numbers of patients with a PCEHR had been increasing week to week since the trial began in December of last year.

“Now that we are seeing more patients coming in with eHealth records, we are looking forward to the GPs connecting.”

PULSEITMAGAZINE.COM.AU

016

Bits & Bytes

Plan to roll out advance care repository for aged care Funding to extend the deployment of electronic advance care directives being piloted in four aged care facilities in Tasmania will begin to flow from July, with the development of an implementation plan to upload the documents to the PCEHR currently underway.

Advance care planning functionality has been developed by the Cradle Coast eHealth, one of the Wave 2 projects for the implementation of the PCEHR. Cradle Coast has developed a repository to store the advance care directives that is accessible to aged care facilities and healthcare providers, and NEHTA is currently working on developing specifications to enable copies to be posted to the PCEHR. Department of Health and Ageing representatives said funding to deploy the advance care directives to other aged care facilities throughout the state would be available in July, although an implementation plan is still being negotiated with the Tasmanian government.

The funding is part of the $325 million Tasmanian Health Assistance Package, announced by federal Health Minister Tanya Plibersek last June.

Of the $36.8 million allocated in the bail-out to eHealth initiatives over four years, $11m has been provided to expand the Cradle Coast eHealth site to support improved palliative care service delivery Funding is also available to provide training for up to 91 residential aged care facilities across Tasmania.

NEHTA has been funded to develop a national specification for advance care planning and for vendor support for upgrades of aged care and GP software to create and receive advance care plans and upload them to a PCEHR repository.

HISA and ACHI collaborate on combined membership offering The Health Informatics Society of Australia (HISA) and the Australasian College of Health Informatics (ACHI) have signed an agreement to offer combined membership of both organisations to the health informatics community.

Fellows and members of ACHI will receive membership of HISA as part of the agreement, with HISA membership alone

still offered to anyone with an interest in eHealth and health informatics.

Full-time students will be offered student membership of both organisations.

HISA chair Katerina Andronis said the four membership tiers were reflective of expertise and contributions to the field of health informatics and recognised professional achievements.

Ms Andronis encouraged HISA members to consider upgrading to one of the top two tiers, which includes membership of ACHI. “It is important to note that constitutionally, both organisations will remain autonomous and that a review will occur in 12 months so that we can make any adjustments to operationalising this agreement if necessary,” Ms Andronis said.

Home-Doctor device allows a true medical clinic in the home NSW-based distributor of telemedicine solutions TeleMedicine Australia (TMA) has released what it says is the world’s first VoIP-based touch screen home-care device to the Australian market.

Originally developed in South Korea, the HomeDoctor device has builtin video conferencing technology along with the ability to connect to any wireless, USB or Bluetoothenabled medical device, including glucometers and otoscopes. It also has a built-in blood pressure cuff.

TMA CEO Ash Collins, who is also a practising GP in the NSW town of Temora, said in addition to the Home-Doctor device,

the solution includes a practitioners’ portal which has been modified to suit Australia’s medical system.

The portal allows healthcare practitioners to view measurements collected by the device over time in a graph, table or calendar. It also allows the clinician to send text messages directly to the device to communicate with the patient.

A button on the device turns green to tell the patient they have a message, and as the device is touch screen and there is a video phone included, the patient can click on the video phone and a dial pad is opened, through which they can dial the number for the doctor.

“The actual device was developed in Korea as part of a government project in 2009, but the portal has been developed by myself and a team of software developers based on Australian guidelines on diabetes and heart disease from Diabetes Australia and the Heart Foundation,” Dr Collins said.

The Home-Doctor device can be purchased by patients and kept in their homes but it is also suitable for aged care facilities, Dr Collins said. Each household only needs one device as you can add a number of patients to each.

It includes functionality to set alarms to remind patients at home to take

their medicine or have a meal, but it also has the capability to do a number of tests at home, with the results collected without the patient needing to type any data in.

The results are hosted in the portal for later viewing by the clinician, but with the video conferencing capability built in, the results can also be seen on the practitioners’ screen while they are doing a live video conference.

“In terms of the medical examination, the device collects information from peripherals and medical devices,” Dr Collins said.

“They include blood pressure through the built-in blood pressure cuff, there is oxygen saturation, temperature and also a general exam camera can

be connected to the device and record images if there is a wound, for example, or a dermatoscope can be connected to capture skin lesions or moles.

see the results at the same time they are talking to the patient, a feature that Dr Collins said makes it different to any other device on the market.

“It can also connect to an otoscope so a patient would be able to show the ear drum to the practitioner at the other end, and you can also attach a stethoscope, an ECG and a spirometer.

“At the time of the video consultation, the doctor can ask the patient to check their blood pressure through the blood pressure cuff. The patient measures the blood pressure and the blood pressure reading will appear on the doctor’s screen,” he said.

“In terms of the pathology investigation, the device is able to record and register readings from blood sugar devices, cholesterol, general or full blood count, urine analysis – all of the general tests but also some more specific ones.”

The solution also includes a medical-grade video conferencing system that comes with an application that allows the doctor to

“It’s the same for any of the measurements with medical devices or any examination with the camera – at the time of consultation, those results will appear on the video conferencing application.”

He believes there are a number of markets for the device, particularly for rural people living far from medical centres, the aged care sector and the booming mining sector.

“The device allows you to do a full medical history remotely, but also to listen to the sounds of the heart or the lung in real time, have a look inside the patient’s ears, examine the skin moles, have a look at the retina, they can check blood sugar levels.

“It enables the initial medical consultation, investigations, monitoring and diagnosis – it’s like having a full medical clinic in the home.”

Austco combines with Sedco for nurse call systems The owner of Australian nurse call system manufacturer Austco Communications has acquired the assets of rival Sedco, which went into voluntary administration in November 2012.

Sedco manufactured nurse call systems and paging systems and had offices in Australia and New Zealand. Its customer base and manufacturing facilities have now been taken over by Austco, which markets the Tacera internet protocolbased nurse call range.

Sedco is understood to have over 2000 installations throughout Australia. It specialised in the acute and aged care sectors, where it also marketed a range of dementia management tools using visual and audible alarms such as when a resident gets out of bed.

Robert Grey, chairman of Austco’s parent company Azure Healthcare, said Austco would consolidate Sedco’s manufacturing facility into its own and would continue to support Sedco’s customers.

Austco has also recently signed a large agreement with Honeywell Canada to supply and install the Tacera nurse call system at the new Oakville Hospital in Ontario.

The $2 billion hospital has commenced construction and is expected to be completed by 2015. It will include realtime patient telemetry, real-time location systems, patient flow, digital signage and Cisco wireless phones.

Tacera is an IP solution in which all system components are fully IP-configurable and have their own unique address for system management. It enables alerts such as tachycardia, bradycardia, arrhythmia, respiratory alerts and blood oxygen saturation alerts to be dispatched to mobile staff.

PULSEITMAGAZINE.COM.AU

017

PULSEITMAGAZINE.COM.AU

018

Bits & Bytes

HL7 file import, RemoteApp capability for eClaims Advanced Computer Software Supplies (ACSS) has released a major update for its eClaims practice management software, which now allows users to import patient demographic information in HL7 format directly from third-party clinical information systems.

ACSS is also shortly to deploy Microsoft’s RemoteApp functionality for clients using eClaims in the cloud, and will then begin work on interfacing with the Healthcare Identifiers Service and the PCEHR, along with secure messaging capability.

The company has also released a major update of its SimDay patient administration system for day hospitals, which includes a new GST report to display invoices, deposits and journals that include GST, and both eClaims and SimDay have a direct portal to Medicare Online.

ACSS’s application and web systems developer Hugo de Castro said eClaims is now capable of importing patient demographics in HL7 file format from external third party applications like Best Practice.

“The HL7 stuff is pretty simple, so any particular HL7 format that conforms to the standard within Australia can now be transferred across to eClaims,” Mr de Castro said. “Irrespective of what system, provided it follows that standard we can import it.”

Mr de Castro said the company’s pathology clients had requested the functionality in particular, mainly so they don’t have to enter data manually. Next in the pipeline for both eClaims and SimDay is integrating the new eHealth functionality.

“We are going to do some integration with the HI Service and we also need to do the PCEHR and secure messaging as well.

That will be available in both applications.”

Healthcare practitioners do not register for PCEHR individually: DoHA The Department of Health and Ageing has clarified the exact number of healthcare organisations that have registered for the PCEHR, emphasising that healthcare practitioners do not have to sign up individually to the system.

A DoHA spokeswoman said that as of midnight on February 17, 1233 healthcare organisations had registered for the PCEHR. The department does not keep figures on how many practitioners actually work for those organisations.

The federal opposition has been tying practitioner participation numbers to the amount of practitioners registered with the Australian Healthcare Practitioner Regulation Agency (AHPRA).

Opposition spokesman on primary care Andrew Southcott criticised the number of practitioner “registrations” in Fairfax and News Ltd publications recently, saying that less than one per cent of the 560,000 AHPRA registered practitioners have signed up to the PCEHR. “Individual healthcare providers do not have to register for PCEHR,” the DoHA spokeswoman said.

“They are covered by their healthcare organisation registration.

“To register for the PCEHR a healthcare organisation must first register with the HI Service. There are currently 3205 healthcare organisations registered with the HI service.”

Organisations must also apply for a Healthcare Provider Identifier – Organisation (HPI-O) to take part in the system.

“Individual healthcare providers do not have to register for PCEHR. They are covered by their healthcare organisation registration.”

The spokeswoman said that at February 1, the Department of Human Services (DHS) had received 5400 HPI-O applications across all practice types.

issued NASH certificates, but no figures are kept on whether these are from general practice or other provider organisations.

“NASH applications do not require the practice type to be included on the application. Therefore, we are unable to provide the number of applications from a general practice for a NASH certificate.”

Sources have told Pulse+IT that processing times for HPI-O and NASH certificate applications have been slow, with many practices yet to receive responses.

The spokeswoman said applications are processed as they are received.

“However, some of the applications received do not contain all the required information,” she said.

“As at 8 February 2013, DHS has assigned 3857 HPI-Os with a major proportion of these being general practices,” she said.

“DHS staff phone the applicants to request the information required, therefore the expected timeframe to process applications is dependent on receiving the necessary information from the applicant in a timely manner.”

Healthcare organisations must also have a National Authentication Service for Health (NASH) security certificate to access the system once registered. The spokeswoman said 1205 organisations have been

An industry source who received his NASH certificate a month after applying for one said that “if the registration process wasn’t so complex, the paperwork may well have been completed properly”.

Your waiting room just became productive!

Best Practice is proud to integrate PAT – Patient Assistance Tool – a new approach to the ongoing headache for General Practice of Chronic Disease Management – CDM that actually works. Instead of an ancient magazine your patient picks up a simple-to-use touch screen tablet* from your Practice Nurse as soon as their measurements are taken. They will provide the key information that will shape their GPMP, as well as receiving initial patient education. It saves you and your staff, it motivates your patient. These are just the first in a series of logical ‘why-didn’t-I-think-of-that’ steps in the software program developed

by Bundaberg GP and RACGP 2010 GP of the Year, Dr Pat Byrnes, in collaboration with Australia’s fastest growing GP software, Best Practice. *In practice almost all patients, including seniors, are competent after being coached through the first 4 screens.

Why wait? Find out the full story, including the low annual fee (no fee per plan) and the FREE trial offer now.

For more information contact us: T: (07) 4155 8888, E: sales@bpsoftware.com.au or www.patsoftware.com.au

PULSEITMAGAZINE.COM.AU

020

Bits & Bytes

Houston prepares for PCEHR, NZ palliative care standards New Zealand-headquartered clinical information system vendor Houston Medical is completing functionality for its VIP.net product to allow Australian users to access the PCEHR. Houston Medical CEO Derek Gower said that while mostly used by specialists in Australia, Houston Medical also has a small following in general practice.

The company is now actively engaged in integrating the requirements of the eHealth Practice Incentive Program (ePIP) for GP users, he said. “ePrescribing with eRx Script Exchange is completing testing, with Health Identifiers and SMD messaging to follow shortly after,” Mr Gower said.

“Houston Medical is the leading supplier of software to ophthalmologists in both New Zealand and Australia and having now just completed installs in two major sports medicine clinics, with orthopaedic surgeons and allied health users, access to the PCEHR will be essential.”

In New Zealand, Houston Medical has recently completed work with the Arohanui Hospice in Palmerston North to upgrade its older Houston Medical software to VIP. net. Changes to data reporting standards for palliative care are being introduced, so the company has been working closely with the hospice as a pilot site.

Houston Medical designed the new database tables to store the information required by NZ’s Ministry of Health. Each episode of care now has to be recorded, and within each episode each contact with the patient, family, carers and any medical providers is captured.

Mr Gower said he expects that the work done with standards as the official pilot site will also be of interest to palliative and aged care providers in Australia.

Easy to use app launched for IBS patients on FODMAP diet Monash University has launched an app for the iPad and iPhone that helps patients with irritable bowel syndrome (IBS) to accurately judge foods that are high in nutrients known to be poorly absorbed by the digestive tract.

Monash University’s Department of Gastroenterology has led the world in research into a family of carbohydrates called FODMAPs – fermentable, oligosaccharides, disaccharides, monosaccharides and polyols – that seem to trigger IBS symptoms.

The university has over the years created a formidable database of knowledge on FODMAP content of foods and has also created a special diet for patients with IBS to help them reduce or avoid foods high in these sugars, called the Monash University Low FODMAP Diet.

While the database is a wonderful resource for researchers, consumers and health professionals don’t have easy access to the information. Now, the FODMAP research team – led by Monash’s director of gastroenterology, Peter Gibson, and Jane Muir,

head of translational nutrition science – has developed an easy to use app to help consumers and healthcare professionals to monitor food intake.

Monash dietitian Jaci Barrett said the team had published papers over the years listing the levels of FODMAPs, but they aren’t very accessible to the general public.

“Health professionals also don’t know where to look for them,” she said. “We were looking for another way to get the information out there and share it in a user friendly manner.

“That’s when we started thinking about some sort of electronic way of sharing the information, leading to the iPhone app.”

FODMAPs are predominantly found in certain fruits and some vegetables, particularly onions and garlic, and in wheat and rye products.

Monash University has its own laboratory to test different foods for their FODMAP levels, which Dr Barrett said was not undertaken elsewhere.

“There are international researchers and dietitians who have been interested in our work who send us food from their country to analyse, so there is a lot of interest out there,” she said. “We are gradually expanding our understanding of the levels of these carbohydrates in foods around the world.”

The app uses a traffic light system to show which foods – and how much of it – are high in FODMAPs. Health professionals can also use it if they are caring for an IBS patient on the diet.

“Instead of giving people the actual quantity of FODMAPs in foods we’ve adapted it into a low (green), moderate (orange) and high (red) traffic light system so people can easily glance at the foods on the list and know whether they are suitable or not. We’ve given a bit more detail because previous food lists

have said ‘these foods are high and must be avoided’, but we’ve incorporated a lot more detail into the app.

and know what their sensitivities are, they can filter the settings on the food list,” she said.

“A certain food might be high in FODMAPs, but if they actually eat a small serve of it, they may get away with it without significant IBS symptoms.

The app was created by James Eunson, a Monash computer science graduate who is currently working on an Android version.

“For example, a food may be labelled red if you eat a whole serve, but it’s orange if you only have a third.

“There are international researchers and dietitians who send us food from their country to analyse, so there is a lot of interest out there.”

“Therefore if you love that food, you can try a small amount and it may not cause you symptoms.”

Dr Barrett has also recently launched an online tool for researchers and dietitians to measure food frequency and adequacy. Renamed the Comprehensive Nutrition Assessment Questionnaire (CNAQ), the tool is a series of questions that can be given to patients or research participants.

“We can analyse it and it gives us a snapshot of their normal dietary habits and their adequacy – whether they get enough energy, proteins and vitamins etc – and we obviously put FODMAPs into it, because that was our particular interest,” she said.

The app also includes a number of recipes and menus, created by a research chef who works with the university.

“We set each new user up with an account with a secure username and password that is emailed to them and they can go in and set up their participation, whether it is for research or just fill in the questionnaire themselves.”

Dr Barrett said an extra feature had been added for consumers who have a particularly good understanding of what their level of tolerance is with their diet. “If they have worked with a dietitian

The team has built in the database of FODMAPs and all other nutrients so it automatically calculates the nutrient profile from the answers, and then exports the results immediately into an Excel spreadsheet.

PPMP integrates with 1stAvailable Practice management software vendor Professional Practice Management Program (PPMP) has signed an agreement to integrate the 1stAvailable appointment booking site into its product, used predominantly by physiotherapists, allied health practitioners and medical specialists.

The integration means that both new and existing patients can search for and book available appointments with their preferred clinician at 1stAvailable.com.au.

Each booking gets automatically uploaded into the practice’s internal booking system, with real-time synchronisation functionality precluding double bookings or manual synchronisation of the online portal with the existing internal appointment book.

For PPMP, the idea is to reduce the practice’s administration load and help to attract new patients.

David Britten, CEO of PPMP, said the benefit of 1stavailable is its ability to bring new patients to practices.

“If you are an existing patient of a practice, you can go on to its website and make an appointment with your favourite doctor or dentist or physio, whereas 1stAvailable has more of a search-type focus,” Mr Britten said.

“Existing patients can go to their favourite provider and book in and make an appointment, but if you are simply new in town you can search for a physio and postcode and go into an appointment book of a given practice and see if someone can see you at the time.”

PPMP is offering the integration as a value-add for its application, but practices wanting to use the service must pay 1stAvailable’s monthly subscription fee.

PULSEITMAGAZINE.COM.AU

021

PULSEITMAGAZINE.COM.AU

022

Bits & Bytes

PicSafe Medi app for secure clinical photos goes live Melbourne-based app development company ProjectProject has officially released its PicSafe Medi mobile photography app, which has been designed in conjunction with clinicians to comply with electronic health record and patient privacy legislation.

PicSafe Medi allows a registered user to quickly take a consented medical photo on a smartphone and share the image with another colleague in a secure and legally compliant mobile imaging system.

As reported in the November issue of Pulse+IT, the idea behind the app came from Melbourne plastic surgeon David Hunter Smith and dermatologist Ted Carner, along with burns specialist Heather Cleland.

PicSafe Medi allows clinicians to obtain full patient consent – either signed or audio-recorded – for the photo, which is then encrypted and sent to a securely hosted server, called PicSafe Cloud Bank.

Once stored, a short URL can be generated and sent to registered PicSafe users nominated by the photographer.

This recipient can then log into the app or website and view the URL-tagged image for a maximum of five minutes, after which the URL is inactivated and further access denied. It comes with functionality for an auditable trail for all data transactions, including geo, time, and device ID tagging.

According to Dr Hunter-Smith, the PicSafe Medi system can be seamlessly integrated into any hospital’s existing IT system. His team has been talking to a number of public and private hospitals in Victoria about rolling out the product.

PicSafe Medi is available on the Apple App Store and on Google Play for Android. The app is free for the first month, after which a monthly subscription costs $19.99.

IDNT Online to transition into a full CMS for dietitians Start-up Tasmanian software developer FC Dietetic Software Solutions is working to transform its IDNT Online documentation system into a full clinical management solution for dietitians.

Established in May last year by clinical dietitian Claire Nichols and software engineer Felix Jorkowski, FC Dietetic Software Solutions launched a beta version of IDNT Online last September, and has also recently released an app that works as a quick and easy reference tool to search for terms used in the International Dietetic and Nutrition Terminology (IDNT).

Now, the team has plans to build a complete clinical management solution that will be web-based and specific to the needs of dietitians.

Mr Jorkowski said he would begin by developing patient file functionality, before working on integration with Medicare Online and the national eHealth system, including an interface with the PCEHR. Currently, IDNT Online allows dietitians to write electronic client reports using the IDNT, a standardised language used to support the international Nutrition Care Process (NCP) model.

Ms Nichols said there wasn’t any current software that used the IDNT in this way, so there was a gap in the market, particularly for dietitians working in the private sector who she said were under-serviced with software options.

“Dietitians are either using GP software or psychology software,” she said. “There are a couple of systems out there for allied health but they are more general and there’s nothing specific to the needs of the dietitian.

With IDNT, there isn’t really any software that uses it the way we do.”

IDNT Online is completely web-based, using Microsoft’s Azure cloud platform, and can be run on tablets and mobile devices.

It is currently in beta testing so is free to use by dietitians for the time being, although once it becomes a full-service CMS, it will be a licensed package, Mr Jorkowski said.

Ms Nichols said IDNT is similar to terminology sets such as SNOMED or ICD-10 but is specifically for dietetics, although there are plans to include it in SNOMED in future.

“Why dietitians need their own standardised language is because our assessment is based very much on people’s oral intake and they are parameters that other health professionals don’t look at,” she said.

The app was developed as a quick reference tool to allow dietitians to search for IDNT terms. Ms Nichols said the company had received multiple requests from other dietitians for an IDNT app.

“It’s a way of standardising the language the way that SNOMED does to make sure that everyone, when they write anything as a chart entry, it means the same thing. It’s the same as in medicine – different words can be interpreted in different ways.

“The increased use of tablets and smart phones in a clinical setting as a method of accessing information is another reason why there was a desire for the option of an app,” she said.

“The aim is to have software that is able to be used by people that aren’t very familiar with the terminology, so it lets you search for terms. The terms are then added to a report and they can be entered into a patient’s record and used for letters, for example.”

The team also plans in future to add the capability to do evaluation and monitoring, so the software can be used to monitor changes in a patient’s condition over time. “There are outcome indicators and it can be used to show whether nutritional care is helping to improve their health,” Ms Nichols said.

“That’s why we chose to use IDNT rather than just do it in a more generalised way. We are in the process of changing the software into more of a clinical management system so there will be patient files.”

“Our assessment is based very much on people’s oral intake and they are parameters that other health professionals don’t look at.”

Mr Jorkowski has developed the app for iOS phones and devices, Android devices and Windows phones.

or medical records that the hospital has, but we were aiming that our software would integrate with their EMRs, so the dietitian writes the notes on our software. We have moved away from that because there is more interest in the private area.”

Mr Jorkowski said that he hoped that when more functionality has been built in to IDNT Online, the team might have a better crack at the public-sector market.

One way of doing that is to develop an evidence base, which Ms Nichols hopes to achieve through a randomised controlled trial through one of the several universities she is curently talking to.

“Once we have that done and there is some evidence that doing notes in this way and reporting outcomes does have advantages, I think the uptake will be a lot greater.”

Ms Nichols said the original intention was to build the software for public-sector dietitians such as herself, but that has proved a bit difficult than for private dietitians.

The team is also looking at export markets, particularly in the US and Canada where IDNT is also used. IDNT has already been translated into different languages, and Ms Nichols said she had received some interest in the software from Malaysia, Thailand and Singapore.

“At the moment it varies in what software area health services use and I’ve worked at a few in my career. At the moment, they use the electronic health

The team hopes to launch the full CMS at the Dietitians Association of Australia’s national conference, being held in Canberra in May.

Stroke researchers launch Wiicycling program Researchers are asking gamers who have recently upgraded to the new Nintendo Wii U to donate their old Wii consoles to a stroke rehabilitation project.

The Wii U was released in Australia last November and features high-definition graphics and a new wireless control panel.

Original Wii consoles are still in demand, however, particularly by a research group from Neuroscience Research Australia (NeuRA) that is studying the use of the Wii to help stroke survivors restore movement to their limbs.

The research group, led by neurophysiologist Penelope McNulty, has pioneered Wii-Based Movement Therapy, an intensive training program using the Wii that improves the way stroke patients are able to use their arms and legs.

Dr McNulty is asking gamers who have upgraded to Wii U to help out stroke survivors who need the machines for rehabilitation but can’t afford them.

A trial of the therapy that can be delivered online has recently begun in Armidale in NSW, conducted at the Armidale Broadband Smart Home, set up to demonstrate the potential applications of the NBN including home automation, remote health monitoring, video conferencing, rehabilitation, education and sensor monitoring.

One-hour formal therapy sessions are being held for 10 consecutive weekdays using Wii Sports tennis, golf, boxing, bowling and baseball, with added homework.

Patients are using the Wii remote in their more affected hand to control play and augment their formal therapy, with daily home practice that progressively builds towards three hours per day over the program, Dr McNulty said.

PULSEITMAGAZINE.COM.AU

023

PULSEITMAGAZINE.COM.AU

024

Bits & Bytes

Serving up the PCEHR at Eastern Health Inner East Melbourne Medicare Local (IEMML) and Eastern Health will shortly begin a trial at Box Hill Hospital to provide a bedside registration option for patients wanting a PCEHR. For the duration of the month-long trial, all lunch trays for patients will include a tray liner with information about the national eHealth record system, Adam McLeod, director of strategy and eHealth at IEMML, said.

“Box Hill Hospital serves over 7000 lunches to patients each month and this trial means that every one of those patients will be able to learn more about the advantages of an eHealth record,”Mr McLeod said.

“We think it makes a lot of sense to give Eastern Health patients this option at a time when they are focused on their health and the next stages of their treatment and recovery.”

While tray liners have been used as a promotional tool by Calvary Hospital in the ACT and in other sectors, this trial adds the option of assisted registration. Assisted registration has been designed to simplify the process of setting up a PCEHR, requiring only some basic demographic information and a Medicare number.

Any patient who decides they want to register for an eHealth record will be able to complete a form and have it processed on-site, meaning their eHealth record can be set up before they even leave the hospital, Mr McLeod said.

IEMML also recently started working with general practices in the region to offer assisted registration in practices.

Mr McLeod said early feedback had been positive, particularly from smaller practices and those providing services to migrant communities.

Spintech wins $1.5m to expand automated ultrasound reporting software Melbourne company Spintech Oceania has won a Commercialisation Australia grant worth $1.5 million to further develop its MIDAS software, which automates diagnostic ultrasound reports and is customisable for individual medical specialists.

The patented software provides automated interpretive written report generation from the measurements and observations taken by sonographers and can be integrated into any brand of ultrasound system that uses DICOM structured reporting.

Spintech Oceania’s founder and managing director, Phil Spinks, said part of the grant money would be used to further develop the MIDAS software, which currently runs on Windows, to be able to work on any device or platform, and to work across an unlimited number of sites with an unlimited number of users.

Mr Spinks said there was no other software available in the world that can automate ultrasound reporting while not interfering with specialists’ workflows.

He said the conventional process of doing an ultrasound scan and then having that scan reported by a doctor had not changed much in the last 40 or 50

years. The only change in that time had been the introduction of voice recognition software, which is prone to error.

What Spintech has achieved is the creation of software using a programmable rules engine invented by Christine Mingins, a former professor of IT at Monash University. The rules are able to be programmed with whatever specialist knowledge is required for whatever domain is being worked in, he said.

“The practice still keeps using the RIS/PACS in the way that they did, but the reports just pop up in the RIS for the doctor to verify and no one has to type it.”

Few real solutions have been devised to improve this workflow except for some software from the major equipment manufacturers like GE, which markets a reporting package that uses preset word templates into which the measurements are inserted.

However, Mr Spinks said this type of software was inflexible and forced doctors

to alter their workflow to suit the program, whereas MIDAS can be customised to suit the individual.

The spark that set off the development of a truly customisable automated reporting system was a fortuitous meeting with Professor Mingins, Mr Spinks said.

“Christine had invented a piece of software called a programmable rules engine. You can program the rules with whatever specialist knowledge you want to for whatever domain you work in, and then you tell it whatever you want it to produce.

“I said my background is predominantly ultrasound, so if we took measurements from an ultrasound scan and we took observations from the sonographer, could the rules engine generate a written report the same way as if a doctor had dictated it? She said yes.”

Four years of development later, and Spintech has developed two parts of the software, he said. “The first part is what we call the rules, so we have been working with a variety of very high-profile specialists in Australia to develop the rules around the way that they do their reporting, for obstetrics, for vascular, for echocardiography, for phlebology and for a range

of other things. The second part is the GUI that goes around the rules engine to make it simple to use.”

The development of the DICOM structured reporting standard has been hugely important, as it is now universally used by the equipment manufacturers, whether that be GE, Siemens, Philips, Toshiba or any other. The output from DICOM structured reporting from the ultrasound machine provides the measurements from the study, the images from the study and the patient demographics.

“They all come into our software automatically at the end of the study, so they no longer have to have a piece of paper that they write this stuff down on or colour in pictures,” Mr Spinks said.

“Then the sonographer looks at the measurement screen in MIDAS and they make their observations with a few drop-downs that are on there. Then they click a tick, and that tick button runs all of those measurements and observations through the rules engine that has been written for that specific exam, and up pops a written report.”

MIDAS software is able to interpret each individual measurement that comes from the study and put an associated statement against that

measurement that the reporting specialist would use themselves. However, individual specialists use different terminology, and there can be hundreds of measurements from the scan that the doctor would look at in conjunction.

“In say a vascular study, you could have 300 measurements and you could have 300 associated statements, but that’s not the way it works. The specialist would look at three things in conjunction with each other and make one statement about three things. Our rules do the same thing.”

The rules themselves can also draw conclusions because they are outputting information based on certain criteria that is individual to that particular doctor, and the rules can be programmed to do that as well, he said.

“Then you take it one step further. If you have a group of doctors who own a group of radiology practices, and you have 20 doctors and 10 of them say ‘50 per cent stenosis is mild’ but the other 10 say ‘50 per cent stenosis is moderate’, we can make one little change in one single rule and based on the doctor’s log-in, it will always use the correct wording for that individual doctor for that study.

“It is all in the rules, but the customers never see those rules – it is all part of the

engine of this system. All they see is the GUI and the report that is generated.”

Mr Spinks said the Commercialisation Australia grant would allow the company will begin to develop a universal product called MIDAS Enterprise.

“MIDAS Professional is a Windows-based software product with some limitations when you start putting it across a large number of practices with a large number of users.

“What MIDAS Enterprise will do is work on any device – an iPhone, an iPad, an Android phone, laptop, whatever – and it’s going to have a whole lot of inbuilt features and security mechanisms that allow us to work across an unlimited number of sites with an unlimited number of users.”

MIDAS can also integrate into any radiology information system/ picture archiving and communication system (RIS/PACS) as it uses HL7.

“The practice still keeps using the RIS/PACS in the way that they did, but the reports just pop up in the RIS for the doctor to verify and no one has to type it. That’s the other part of this process: making sure that what we have created is something that can integrate into another platform that they run their whole business on.”

PULSEITMAGAZINE.COM.AU

026

Bits & Bytes

Bra app aims to support good exercise habits The University of Wollongong has launched a new app to help women choose the correct fitting sports bra, with the aim of encouraging healthier lifestyles, avoiding neck and back pain and reducing the need for breast reduction surgery.

The new app, called Sports Bra and available from the App Store for the iPhone and iPad, has been designed using evidence-based research by Breast Research Australia (BRA), a research centre at the University of Wollongong’s Biomechanics Research Laboratory.

Led by sports physiotherapist Deirdre McGhee and professor of biomechanics Julie Steele, BRA studies the biomechanics of breast health and bra design. “Our research has found that we can’t just solve this problem by saying go and get yourself fitted properly,” Dr McGhee said.

“Of the adolescents we’ve tested, 75 per cent of them had never been fitted and don’t want to be, and with adult women we found that 66 per cent usually buy a new bra without the assistance of a professional bra fitter.”

For large-breasted women, minimising breast bounce is “a no-brainer” due to their mass, Dr McGhee said.

“What women tend to do is brace – it’s like their brain instinctively tries to limit the breast movement and so they will contract their pec muscles. In bracing, the women tend to round their shoulders and limit the swing of their arms. It’s not a good running style. Women are freer in their arm and trunk movements when their breasts are supported better.”

For GPs with patients with back pain or who need to get more exercise, Dr McGhee recommends that they look at breast support as part of their treatment plan.

Social robots head into the home for people with mild dementia La Trobe University’s famous aged care robots are heading out of the residential sector and into the homes of people living with mild dementia.

Part of La Trobe’s Research Centre for Computers, Communication and Social Innovation (RECCSI) research into social robots, a trial got underway recently in Melbourne to study how interaction with the robots affected the emotional wellbeing of people with mild dementia.

A robot is being placed in the home of a person with dementia for two weeks, with the emotional wellbeing of each participant measured by their responses.

“These assistive robots are expected to improve the emotional wellbeing of mild dementia sufferers through engagement and sensory enrichment,” the study’s lead researcher, Rajiv Khosla, said.

The trial will also study the effect on the quality of life of carers involved in supporting the people with dementia. It is funded by a $40,000 Alzheimer’s Australia Dementia Research Foundation grant.

The robots – named Matilda, Jack, Charles and Sophie – are provided

by NEC and have been designed by Professor Khosla’s team for service and social innovation in healthcare.

The robots have previously been used in trials in aged care facilities in Melbourne and Queensland. They have been trained to read human emotions by analysing facial features and body language and are wirelessly programmed to notify nurses if a patient is distressed, injured or requires help.

For the non-residential care study, however, they will use their social abilities.

“They can talk, sing, dance, play games, tell the weather and read the newspaper,” Professor Khosla said. “They are unique, the first of their kind to be used therapeutically for mild dementia sufferers.

“They include innovative services like reminiscing with dementia suffers, sending mood-based emails and supporting care-givers to remotely manage activities of dementia sufferers.

with the social robots using their voice or a touch panel with large buttons. The touch panel allows remote communication with the robot at home.”

“The social robots can also make phone calls and remind patients to take their medicine.

Professor Khosla said they will interact with participants and measure their social response by detecting changes in their emotional state.

“Senior citizens with mild dementia can communicate

“We believe these robots will help the dementia

sufferers to gain confidence in daily life and reduce feelings of uselessness.

“They could revolutionise the way we look after older people with dementia.

“The social robots are already breaking technology barriers and are set to provide more sophisticated and emotionally engaging services to help our senior citizens become more independent and resilient.”

DocAppointments fully integrated with Zedmed Online appointments service DocAppointments is now fully integrated with Zedmed’s practice management software solution, in addition to Best Practice and PracSoft.

receptionist has to put the appointments online and then transfer them to the practice management system, but with DocAppointments it is done automatically.”

Dr Pava said practices can choose where they have their portal as some have closed books and don’t want to accept new patients, or to be listed on a directory.

The service is also now fully automatic, so individual doctor’s appointments are automatically made available online as well as in the practice management system, DocAppointment’s founder, Calin Pava, said.

The length of each individual doctor’s appointments can also be made available automatically, he said.

“Even within the practice, the practice manager can decide if one individual doctor takes new patients or not. If you have an older doctor who doesn’t take new patients, you just click one box in admin and automatically that one doctor is allocated a code that he gives only to his own patients.

“You have one click of a button in your admin screen and you can make all the appointments that are blank in your practice management system for each individual doctor become available automatically online – you don’t have to do anything else,” Dr Pava said.

“In some systems the

“We have adapted the software so it mimics whatever you have set up in the practice management software. Once you have it installed and you have clicked all of those boxes, you don’t need to touch anything after that.”

Patients can make appointments either through DocAppointments. com.au or through the practice’s own website.

“If you have a new doctor in the practice, you leave it open and it allows you to channel all of the new patients to the new doctor, but you still allow all patients of the practice to make appointments online.”

iCareHealth to concentrate on aged and community care Aged care software vendor iCare Solutions has rebranded as iCareHealth to reflect its move into the broader aged care sector, encompassing community care. iCareHealth acquired UK community care software company h.e.t software in August last year and is developing a product suite for its aged care provider customers, many of whom provide community care services as well.

“Most of the aged care providers in Australia, if they are in the not-forprofit sector, will have community care packages, so we are working with our customers at the moment to understand what their needs are really going to be,” iCareHealth CEO Chris Gray said.

“In Australia, the number of people receiving aged care services continues to increase. In line with the preference of recipients to remain in their own home, the federal government has increased the number of community care packages.

“With community care software now part of our portfolio in Australia, we have begun the process of integrating this functionality with our clinical, care and medication management software to cater for these changes in the aged care industry.” iCareHealth is currently working on the release of v3.0, which will incorporate the eHealth standards being undertaken as part of NEHTA’s aged care software vendor panel, which has been created to drive the uptake of the PCEHR in both residential and community aged care settings.

According to NEHTA, all members of the aged care software vendor panel have achieved their notice of connection (NOC) testing to enable access to the Healthcare Identifier Service and the PCEHR, and are at various stages of conformance testing for the balance of the functionality.

PULSEITMAGAZINE.COM.AU

027

PULSEITMAGAZINE.COM.AU

028

Bits & Bytes

App for prostate cancer patients on hormone therapy Australian Prostate Cancer Research has released a free iPhone app to help men better manage the difficult process of undergoing androgen deprivation therapy (ADT) for advanced prostate cancer.

Developed by a team led by urologist Jim Duthie, the adt app is designed to provide timely information and reminders about health checks and blood tests throughout the lengthy treatment, and is also aimed at helping general practitioners caring for men with advanced prostate cancer to understand and help better manage the disease and its side-effects.

Australian Prostate Cancer Research CEO James Garland said the app was designed specifically as an information and support mechanism. It includes prompts throughout the therapy timeline to remind men to have blood tests or other health checks, explaining why they need to.

It also includes information on sideeffects such as sexual dysfunction and incontinence and the emotional problems that accompany them. “The key to having an app working with men over the age of 60 and having advanced prostate cancer, is that it needs to be extremely simple to use,” Mr Garland said.

He said the app would be particularly useful for men living in rural areas who don’t have regular access to a urologist.

It is also designed to be helpful to GPs, who according to research are quite open about the fact that they are not confident in dealing with the side-effects.

A survey of GPs found that 88 per cent were not confident in managing sexual rehabilitation post-treatment, and 80 per cent are not confident dealing with continence problems post-treatment.

The adt app is available for free from the Apple App Store.

Telehealth services go west to the Darling Downs The University of Queensland’s Centre for Online Health (COH) has received funding from natural gas company QGC to develop and implement whole-of-community telehealth services in several towns in the Darling Downs region of southern Queensland.

Three nursing homes in the region will have access to telehealth services, as will the public hospitals in Toowoomba and Dalby. The project will also investigate mechanisms which support the delivery of telehealth services into general practice.

Associate Professor Anthony Smith, deputy director of the COH, said QGC initially provided funding for a scoping study in 2012 that will now be

implemented in Dalby, Chinchilla and Miles in the Western Downs region.

The service models will be designed to be sustainable.

While paediatrics, geriatrics and general medical specialist support were all in demand, Dr Smith said the plan was to establish the infrastructure and new processes that would potentially result in the delivery of a broad range of telehealth services where and as they are required.

“We are concentrating on a range of specialties for patients of all ages, and ensuring that any new telehealth services are introduced as a response to the health needs of patients in these communities,” Dr Smith said. “An important aspect of introducing telehealth services is

ensuring that we have the right mechanisms in place to facilitate consultations at a distance, and that the appropriate support is made available to the clinicians involved in the service.

“Our aim is to build a whole-of-community telehealth service which will help deliver specialist services into selected hospitals, general practice medical centres and nursing homes.”

Part of the $1.3 million from QGC – which has set up a $150 million social impact management plan from its Curtis LNG project – will be used to build a dedicated telehealth room at Dalby Hospital, based on similar configurations established by the COH at the Royal Children’s

Hospital (RCH) and the Princess Alexandra Hospital (PAH) in Brisbane.

systems, situated in all hospitals and most health centres in the state.

To support patients in residential aged care facilities, the Centre will also be instituting the hightech approach developed by Dr Smith and Professor Len Gray, director of the COH, which involves bringing high-resolution video conferencing technology to the resident’s bedside.

“We will be working with Queensland Health with the intention of expanding telehealth services and this will require a range of operational and logistical

Dr Smith said that the underlying goal of the project is to ensure that any telehealth services are sustainable.

“Our research will investigate a range of factors including technical feasibility and costeffectiveness,” he said. “The funding provided by QGC will act as an important driver to encourage the development of new services which deliver benefits for patients living in these towns.

“We have an excellent opportunity to help advance the use of telemedicine in general practice.

Whilst there are some commercially operated telemedicine services on the market, we are interested in exploring ways in which GPs can be more engaged with services available through Queensland Health.”

Queensland Health has an extensive network of Cisco Tandberg video conference

“Whilst there are some commercially operated telemedicine services on the market, we are interested in exploring ways in which GPs can be more engageed with services available through Queensland Health.” processes to be put into place,” Dr Smith said.

“The mechanisms for referring a patient, scheduling a consultation, managing clinical information and records, sharing correspondence and funding specific services all needs to be carefully managed.”

Dr Smith said the advantage of working with several towns in the Western Downs is that they all are unique in terms of their demographics and service requirements.

“There tends to be a large proportion of the population who are over 65 years of age or under 14. Although there is a paediatric population that needs to be supported, it is principally an older population where adult and geriatric services will also be very important.

“We anticipate that a range of services may be appropriately delivered from the hospital in Toowoomba; the telepaediatric service at the RCH; and the PA Online telehealth centre at the PAH in Brisbane.”

Depending on the types of services being offered in the region, the COH expects to use a range of techniques including video conferencing and webbased clinical support.

“Some approaches may be better suited to lower cost communication methods such as email, as is the case with dermatology and wound care where valuable advice may be provided by a specialist with access to a good quality digital photograph and relevant case history.”

Dr Smith said the team expected to learn valuable lessons about the configuration of telehealth services in a range of different settings. “We expect that these new services will have a lasting benefit for people living in these communities ... [and] in other rural and remote communities.”

Edisse falls-detection device raises investor interest The recent design launch of Sydney startup Edisse’s falls-detecting wristwatch has garnered interest from potential backers, with two-phase technical trials slated to begin next month.

“We had some really good feedback and a couple of investors are interested,” Edisse’s Nick Tong said of the February 27 launch at the University of Sydney.

Edisse’s watch – which logs data in real time from a SIM card to a cloud-based reporting system, and is accessed by smartphone, tablet or PC – will be worn by 350 test subjects during the two fourmonth trials. It is hoped the product will be commercialised by mid-2014.

The watch’s genesis came from the team’s interest in disability and aged care – cofounder Angela Mariani works as a carer – and Mr Tong’s personal experience when his grandfather had a fall.

The project has run at a hectic pace, and it took the team only three months from inception to the prototype launch. Edisse expects the technical testing – which will take place in aged care facilities, hospitals and with individuals in the broader community – to throw up another two versions of the watch.

The expected cost of the system, at around $30 a month per unit, compares favourably with other products in the market. Mr Tong said Edisse had benefited from a certain amount of serendipity that many local start-ups struggle to attain. “[We’re] very specialised and we’ve found some very specialised investors who are keen to invest in health.”

However, it’s the residents, patients and the community – along with workers in nursing, allied health and aged care – who Mr Tong said will determine Edisse’s final success or failure.

PULSEITMAGAZINE.COM.AU

029

PULSEITMAGAZINE.COM.AU

030

Bits & Bytes

Physiotherapists gear up for eHealth functionality Inner East Melbourne Medicare Local (IEMML) recently launched a pilot project to support 20 physiotherapy practices to trial electronic clinical software and other eHealth functionality.

Working in partnership with the Australian Physiotherapy Association (APA), the trial forms part of IEMML’s new eHealth engagement with the allied health sector.

“We’re working with two key groups: those with electronic clinical notation systems used during consultations, and those with paper-based or similar set-ups,” Sarah Lausberg, IEMML’s allied health eHealth liaison officer, said.

“Our goal is to have the first group introduce eHealth systems such as secure messaging and online imaging while the second group will trial the use of clinical note-taking software during their patient consultations,” she said.

“We know that moving to an electronic system is a big change for many practices so we’ve arranged a software vendor demonstration session … to introduce a range of software options. We’ll also use the opportunity to provide participating physiotherapists with information about the national eHealth record system as well as support for them to register.”

Camberwell’s Back in Motion has been using and benefitting from electronic systems for some time. “Moving to an automated, electronic system has had a range of efficiency benefits for our practice,” physiotherapist and practice director Adrian Quinn said.

“We now have easy access to client information from any computer, writing letters to GPs is much quicker thanks to auto-population of fields, and we can now far more easily communicate with particular subgroups of patients.”

Real-time entering and editing of clinical notes at the bedside CSC’s Healthcare Group recently won the vendors’ award in the Clinicians’ Challenge competition at the Health Informatics New Zealand (HINZ) conference in Rotorua with a readymade answer to one clinician’s needs: design a system that would allow several users to access and edit a ward round or admission note in real time, preferably using open HTML5 technology on a mobile device.

The challenge, set by Hutt Valley District Health Board registrar Angus Turnbull, was aimed at allowing clinicians to create and edit patient notes at the bedside. Dr Turnbull, now on rotation at Wellington Hospital, wanted to use the ability of mobile devices and operational transformation technologies like Google Wave and Etherpad to make note-taking during ward rounds much more agile.

At the moment, ward notes are still being done with pen and paper in a folder, Dr Turnbull said. “For some emergency department patients, a laptop on a mobile trolley is used by one team member who often struggles to keep up.”

In his challenge submission, Dr Turnbull wrote that while many hospitals now use EMRs for admissions and will in future likely integrate these with ward round notes through mobile devices, this still posed problems.

“We have taken a more social media approach to recording the notes, just like a person logs onto Facebook.”

It was predominantly for efficiency that Dr Turnbull made the challenge, he said. “Creating notes at the bedside is a time-limited process when you may only see each patient for one or two minutes.

“This process can result in delays as one team member must type the whole note via a portable keyboard or touch screen and impair team efficiency, and a better approach is needed given that numerous medical staff may be present,” he wrote.

“As you often have multiple team members present, allowing collaborative document editing via mobile devices can significantly improve the utility of EMR technology.”

What he wanted to see was a system that allowed several users to simultaneously edit a ward round or admission note in real time, such as one recording the history

while another records examination findings and a third corrects errors.

While CSC’s Mobility Suite isn’t specifically what he envisioned, it does have much of the functionality Dr Turnbull was looking for. Brian Ackland, CSC’s software engineer behind the development of the solution, said it was an HTML-based application that currently runs on iPhones and iPads – with Android and other platforms on the drawing board – and allows clinicians to create notes, look up results and record observations while they are on the move.

Dr Turnbull was looking at open platforms like Google Wave or Etherpad as they allow collaborative editing, and while Mobility Suite doesn’t use these technologies, part of the challenge for the vendors was to look at the wider context for healthcare, Mr Ackland said.

Part of the collaborative editing element, in which errors can be rectified, was not available in Mobility Suite for several reasons, Mr Ackland said.

“We have taken a more social media approach to recording the notes, just like a person logs onto Facebook,” he said. “You hit the comments area and you save it, and it automatically

records the date and time and who you are and shows how long ago a note was recorded.

“Multiple people can be adding notes at the same time, or you could have one doctor recording observations while another is reporting some progress notes. We do have an

editing function but that just means crossing it out. For audit purposes we like to keep what somebody has written in its original state.

Just like a pen and paper, if someone wants to cross it out that’s fine but it’s still on the system.”

The Mobility Suite has been designed with

CSC’s webPAS patient administration system in mind, but as it has been built on HTML, the company is looking at how it can be redesigned to fit in with other vendors’ EMRs, Mr Ackland said.

CSC will also design a nonApple application when the demand is there, he said.

Study of hospital EMR shows how good IT can become bad IT in healthcare Three papers in a recent issue of the Medical Journal of Australia have highlighted the ongoing complexities of integrating large health IT systems with clinical practice, particularly in the acute care sector.

In a retrospective study of the introduction of Cerner’s FirstNet emergency department electronic medical record system at the Nepean Hospital ED in Sydney in 2009, researchers found that when the new system was introduced, there was a significant increase in the waiting time for all patients compared to the control period.

They also found an increase in the waiting time, treatment time and total time for discharged patients after the introduction of the system, along with an increase in did not waits (DNW). The researchers found that overall, the

implementation of the EMR was associated with a deterioration in ED key performance indicators.

In an accompanying commentary, University of Sydney professor of language technology Jon Patrick and emergency physician Sue Ieraci wrote that while the study was limited and could only show correlation with ED waiting times, not causation, the study delivers an important message. “[The] work required to use the information system was perceived by the ED staff to directly conflict with time spent with patients,” Professor Patrick and Dr Ieraci wrote.

While an EMR system may be ‘good’ health information technology (HIT) in some environments, it can easily turn into ‘bad’ HIT, they wrote. “Unless this is

corrected, HIT efforts will overuse precious health care resources, will be unlikely to achieve claimed benefits for many years to come, and may actually cause harm.”

Enrico Coiera, director of the Centre for Health Informatics at the University of NSW, discussed why eHealth is so hard. Professor Coiera pointed to a “long list of disappointments and failures, locally and internationally … that is hard to ignore”.

“The very first rule of informatics tells us to start with the clinical problem we want solved rather than the technology we want to build,” he wrote.

“Yet, too often, large-scale e-health projects break this most basic rule, focusing on technology rather than compelling clinical problems.”

Your waiting room has just become productive!

Instead of an ancient magazine your patients pick up a simple-to-use touch screen tablet from your Practice Nurse as soon as their measurements are taken. They will provide the key information that will shape their GPMP. It saves you and your staff, it motivates your patients.

Just the first in a series of logical ‘why-didn’t-I-think-of-that’ steps in the software program PAT – Patient Assistance Tool developed by RACGP 2010 GP of the Year, Dr Pat Byrnes, in collaboration with Australia’s fastest growing GP software, Best Practice.

Why wait? Find out the full story, including the low annual fee (no fee per plan) and the FREE trial offer now.

For more information contact us: T: (07) 4155 8888 E: sales@bpsoftware.com.au or www.patsoftware.com.au

PULSEITMAGAZINE.COM.AU

032

Bits & Bytes

Preventative health mobile platform for aged care

IPTV a viable health literacy channel for chronic disease education

Saving Australia $1.2 billion a year in hospital admissions is an ambitious task, but that’s the ultimate goal forStayWell Health Solutions, a Sydney app development company that has emerged from the apps4NSW competition.

Australia is sitting on a diabetic time-bomb: every day, 280 Australians become diabetic, and the cost to our health system is at least $12.4 billion a year.

While still in its infancy, StayWell has some big plans for the future, including rolling out a preventative health mobile platform for aged care by 2015. It is hoped that such a platform has the potential to prevent one to two days of hospital admissions per user every year.

One of the ways to lower the rate of diabetes – and the cost of treating and managing it – is by increasing health literacy in the community.

StayWell Health Solutions was recently formed by the team behind the Grey Book app concept, which won first place in the empowering consumers and people’s choice categories in the apps4NSW competition. The developers hope it will provide a stepping stone in developing that aged care mobile platform.

The app aims to give older citizens greater control over their health by giving them easy access to their medical records and better contact with primary care providers.

StayWell is a collaboration between health informatics researcher Joanne Curry of the University of Western Sydney, health IT executive Frank Dorrian and data warehousing and visualisation specialist Murray Cooper.

The company is in negotiations with NSW Health, the Clinical Excellence Commission (CEC) and a number of private companies to develop and commercialise its apps, according to Dr Curry.

She also said talks are being planned with NEHTA about PCEHR integration. “There should be no reason why you shouldn’t be able to upload information to your PCEHR, but making sure that message is sent over the network securely, in the right format, is the issue,” she said.

A recent trial to improve health literacy using internet protocol television (IPTV) has given a glimpse of the possibilities from this novel approach.

The trial – a collaboration between the University of Melbourne’s Institute for a Broadband Enabled Society (IBES), Diabetes Australia - Vic, telecommunications giant Ericsson Australia and advanced social networking technology

provider SeeCare – sought to improve access to highquality, trusted information.

“You can Google anything and get any answer you like; particularly in times of crisis, such as when people are diagnosed with cancer or diabetes, the first thing people tend to do is reach for Google,” project manager Ken Clarke said.

“But it’s not that great an experience, and you just can’t trust what people are telling you. The health literacy project is all about delivering material to people so they can rely on it, but also in a way that’s good for people who typically don’t have access to a PC, or the skills to use one.”

Mr Clarke, a senior research fellow at IBES, said the TV becomes a user-friendly portal

for those sectors of the community, such as seniors, Aborigines and Torres Strait Islanders, and migrants with English as a second language.

In the trial, 20 volunteers were assessed by four diabetes nurse educators.

The nurses logged in to the system – which was an Ericsson customisation of SeeCare’s home care application – to allocate relevant content to the volunteers’ IPTV accounts, which was then available for them when they logged in at home. “The ability to adapt and integrate different technologies and different care and support processes was key to the novelty of the approach,” SeeCare director Gil Tidhar said.

“The demand for relevant and reliable information is significant. Being able to

provide such information remotely by educators who interact with people in need and their carers – and who are able to personalise the information and distribute it, especially to remote and regional areas – is a significant step forward.”

SeeCare is now planning to explore the incorporation of IPTV into its telecare offering,” Dr Tidhar said. “From SeeCare’s perspective, it’s clear that a quality health education system has to be a combination of technology and human support. You need both to provide appropriate care.”

At the trial’s public launch, Eric and Evelyn Weston (pictured) shared their experiences with the audience. Mrs Weston, 73, volunteered for the project because she wanted to help others, having seen the effects of the condition on her family. Mr Weston, 79, is pre-diabetic, and has been managing his condition for 11 years. Mrs Weston and her son have lived with diabetes for more than three decades.

Although Mrs Weston had a relatively high level of health literacy, she and Mr Weston were candidates for the pilot because of their unfamiliarity with computers. “I don’t have one, and wouldn’t know how to use it if I did.”

The value of the IPTV content is clear to Mrs

Weston. “I’m pretty good at managing my diabetes, but I have a friend whose husband is diabetic and he doesn’t have a clue – and isn’t interested, either.

“There are a lot of people who have diabetes and think, ‘I’ll just take my medication and I’ll be right’ – and eat anything and everything. But you have to be very careful with your diet.”

Mr and Mrs Weston also provided feedback about the content. Mr Weston thought that there should have been information to show people with diabetes that they can lead a full and active life and still manage their condition, while Mrs Weston thought there should be material on complications from diabetes.

“We can target anything you care to mention,” IBES’s Mr Clarke said, “but content is king, and you’ve got to have a good bank of material to send out to people’s homes.”

IBES will now lobby the Victorian and federal governments for funding to bring the service out into the community, and to areas beyond diabetes education.

“Now we need that bigger dollop of cash,” Mr Clarke said. “We’ve done this on the smell of an oily rag.”

Ericsson Australia strategic product manager Colin Goodwin said the use of

IPTV for health education had been shown to work by the trial. “With the roll-out of the NBN, the majority of Australians are likely to have IPTV, so what we’re looking at is a very common technology environment,” Mr Goodwin said.

“What was not clear before proof-of-concept was whether people would relate well to having healthcare education provided on a TV, rather than having to go to a computer or a tablet, for example. For many [clients], a computer is quite intimidating, whereas a TV is a lot more everyday.

“We saw with the people Diabetes Australia brought in – perhaps a little to our surprise – that they seemed to be very comfortable relating to it, even with things like authenticating themselves with user name and password with a keyboard and a TV didn’t really faze them.”

The future of IPTV in health literacy will depend on policymakers creating the right environment for it to flourish, Mr Goodwin said.

“It’s an area which looks promising ... [but] these are not applications which easily pay for themselves.

They need to be considered as one of hundreds of applications that could be available on your TV – and then the model will become possible to support them commercially.”

Cyber insurance package aimed at general practice The recent increase in sophisticated hacks aimed at capturing personal data such as those that targeted medical practices in Queensland last year, along with the expectation that a mandatory data breach notification law will be introduced shortly, has led to the development of a cyber insurance package aimed at medical and allied health practices.

Last year, the Privacy Amendment (Enhancing Privacy Protection) Bill 2012 was passed by Parliament and will come into effect in March 2014. It‘s expected to be accompanied by mandatory data breach notification rules, and will include significant penalties for failure to report.

In the event of a breach, it is expected that companies will have to pay for credit reference files to be maintained and monitored for a period of time to ensure that no one has taken individual identities.

Paul Waite, director of solutions and innovation at obsecure, a Sydney-based company specialising in information security, and his colleagues have decided to offer a package that includes insurance as well as tools and guidelines to help practices avoid a breach in the first place.

Called Cyber Plus, the package will include a bundle of technologies to protect computers and servers from viruses, threats and dangerous websites.

Cyber Plus also includes a privacy and breach notification toolkit to allow practices to identify where potential risks and threats lie, as well as privacy impact assessments and breach response plans and notifications.

Data is secured by obsecure’s software, which encrypts all data using industrygrade encryption standards and strong authentication methods, including twoand multi-factor authentication.

PULSEITMAGAZINE.COM.AU

033

PULSEITMAGAZINE.COM.AU

034

Events April 11

16-17 MAY

20-21 JUNE

HISA VIC GETS VOCAL ABOUT MEDICARE LOCALS Melbourne, VIC p: +61 3 9326 3311 w: www.hisa.org.au/events

3RD BIENNIAL NATIONAL FALLS PREVENTION SUMMIT Brisbane, QLD p: +61 2 9080 4090 w: www.healthcareconferences.com.au

5TH ANNUAL OBSTETRIC MALPRACTICE CONFERENCE Sydney, NSW p: + 61 2 9080 4090 w: www.healthcareconferences.com.au

17

23-24 MAY

20

13TH ANNUAL HOSPITAL IN THE HOME CONFERENCE Melbourne, VIC p: +61 2 9080 4090 w: www.healthcareconferences.com.au

LET DR JOANNE CURRY TAKE YOU ON A PATIENT JOURNEY WITH ESSOMENIC Sydney, NSW p: +61 3 9326 3311 w: www.hisa.org.au/events

APRIL

APRIL

FUTURE HEALTH FORUM AUSTRALIA Sydney, NSW w: www.futuregov.asia

18

APRIL

HISA NSW - TALES OF TELEHEALTH Sydney, NSW p: +61 3 9326 3311 w: www.hisa.org.au/events

May 1-2

MAY

INFORMATION TECHNOLOGY IN AGED CARE Melbourne, VIC p: +61 2 9080 4300 w: www.itac2013.com.au

9

MAY

HISA WA - SYNOPSIS OF BIG DATA & AGM Perth, WA p: +61 3 9326 3311 w: www.hisa.org.au/events

27

MAY

2ND ANNUAL PCEHR: THE JOURNEY TOWARDS NATIONAL EHEALTH ADOPTION Sydney, NSW p: + 61 2 9080 4090 w: www.healthcareconferences.com.au

31

MAY

6TH ANNUAL PHARMACEUTICAL LAW CONFERENCE Sydney, NSW p: + 61 2 9080 4090 w: www.healthcareconferences.com.au

30-31 MAY 2ND ANNUAL TRANSITION CARE: IMPROVING OUTCOMES FOR OLDER PEOPLE Sydney, NSW p: + 61 2 9080 4090 w: www.healthcareconferences.com.au

31

MAY

6TH ANNUAL PHARMACEUTICAL LAW CONFERENCE Sydney, NSW p: + 61 2 9080 4090 w: www.healthcareconferences.com.au

June 18-19 JUNE 15-16 MAY HIMSS FORUM AUSTRALIA & NEW ZEALAND Sydney, NSW p: +65 6664 1189 w: www.himssasiapac.org/anz13/

16

MAY

HISA NSW - QUALITY AND SAFETY Sydney, NSW p: +61 3 9326 3311 w: www.hisa.org.au/events

JUNE

2ND ANNUAL YOUNGER PEOPLE WITH VERY HIGH & COMPLEX CARE NEEDS CONFERENCE Melbourne, VIC p: + 61 2 9080 4090 w: www.healthcareconferences.com.au

19

JUNE

HISA VIC - QUALITY AND SAFETY Melbourne, VIC p: +61 3 9326 3311 w: www.hisa.org.au/events

20

JUNE

HISA NSW AGM Sydney, NSW p: +61 3 9326 3311 w: www.hisa.org.au/events

July 22-23 JULY 3RD ANNUAL NATIONAL HOSPITAL PROCUREMENT CONFERENCE Melbourne, VIC p: + 61 2 9080 4090 w: www.healthcareconferences.com.au

22-23 JULY 5TH ANNUAL EMERGENCY DEPARTMENT MANAGEMENT CONFERENCE Melbourne, VIC p: + 61 2 9080 4090 w: www.healthcareconferences.com.au

25-26 JULY 4TH ANNUAL REDUCING HOSPITAL READMISSIONS & DISCHARGE PLANNING CONFERENCE Melbourne, VIC p: + 61 2 9080 4090 w: www.healthcareconferences.com.au

Save the dates 15

AUGUST

HISA NSW - 2ND YOUNG TALENT TIME Sydney, NSW p: +61 3 9326 3311 w: www.hisa.org.au/events

15

AUGUST

17-18 SEPTEMBER

17

2ND ANNUAL REDUCING AVOIDABLE PRESSURE INJURIES CONFERENCE Melbourne, VIC p: + 61 2 9080 4090 w: www.healthcareconferences.com.au

HISA NSW - PATHOLOGY INFORMATICS & RESEARCH INITIATIVES Sydney, NSW p: +61 3 9326 3311 w: www.hisa.org.au/events

OCTOBER

21-23 OCTOBER

HISA WA GETS VOCAL ABOUT MEDICARE LOCALS Perth, WA p: +61 3 9326 3311 w: www.hisa.org.au/events

HIMAA 2013 NATIONAL CONFERENCE Adeliade, SA p: +61 2 9887 5001 w: www.himaa2.org.au/conference

22-23 AUGUST

20

5TH ANNUAL OPERATING THEATRE MANAGEMENT CONFERENCE Melbourne, VIC w: www.healthcareconferences.com.au

HISA VIC GETS MOBILE Melbourne, VIC p: +61 3 9326 3311 w: www.hisa.org.au/events

29-30 AUGUST 4TH ANNUAL CORRECTIONAL SERVICES HEALTHCARE SUMMIT Melbourne, VIC w: www.healthcareconferences.com.au

29-30 AUGUST 2ND ANNUAL ASSISTANTS IN NURSING CONFERENCE Sydney, NSW p: + 61 2 9080 4090 w: www.healthcareconferences.com.au

28 18

SEPTEMBER

HISA VIC SHOWS OFF THE LATEST HEALTH INFORMATICS RESEARCH Melbourne, VIC p: +61 3 9326 3311 w: www.hisa.org.au/events

NOVEMBER

NOVEMBER

HISA NSW - CHRONIC DISEASE MANAGMENT Sydney, NSW p: +61 3 9326 3311 w: www.hisa.org.au/events

Online Calendar: To view a comprehensive list of eHealth, Health, and IT events, visit: http://www.pulseitmagazine.com.au/events

PULSEITMAGAZINE.COM.AU

035

PULSEITMAGAZINE.COM.AU

036

ACHI & HISA

A COMPLEX INTERVENTION IN A COMPLEX SYSTEM WHY WE MUST INVEST NOW IN AUSTRALIA’S HEALTH INFORMATICS WORKFORCE

The increasing complexity of eHealth and health IT implementations was highlighted recently in two articles in the Medical Journal of Australia. A lack of published research into the impact of eHealth initiatives allied to a lack of investment in Australia’s health informatics workforce needs to be overcome to further progress eHealth for better clinical outcomes.

PETER WILLIAMS B.Bus MPP FACHI CPA PRESIDENT: ACHI peter.e.williams@health.vic.gov.au DR LOUISE SCHAPER BSc(OT)HONS, PhD, FACHI CEO: HISA ceo@hisa.org.au

Articles published recently in the Medical Journal of Australia by Australasian College of Health Informatics fellows Enrico Coiera and Jon Patrick highlight important issues that are inhibiting the progress of eHealth in Australia.

Professor Coiera makes the point that the “first rule of health informatics”, which says to start with the clinical problem to be solved rather than the technology we want to build, is often ignored to the peril of successful eHealth project outcomes.

Professor Patrick differentiates “good health IT” from “bad health IT” and reminds us that – like a good clinician – good HIT does no harm to patients or staff.

There is an urgent need to have more evaluation of the impact of eHealth initiatives on patient outcomes and service efficiency, for these to be published in peer-reviewed journals and for the results to be made widely accessible for all. This is starting to happen overseas but there are very few Australian examples.

About the authors Peter Williams is an advisor on eHealth policy and engagement in the office of the chief information officer at Victoria’s Department of Health, and president of ACHI. Dr Louise Schaper is CEO of the Health Informatics Society of Australia and has a PhD on technology acceptance in healthcare.

In all other areas of clinical practice, whenever new or innovative approaches are introduced they are soon subjected to review and assessment to show both what has worked and what has not, in order to advance clinical knowledge and understanding. In evaluating ICT in healthcare, we first need to ensure that

the technology either melds well with or improves clinical processes, the patient experience and the patient outcome.

Evaluation is also important because ICT can appear to present a high opportunity cost for a health system under increasing fiscal stress. Governments remain wary of investing in ICT unless its value to the community can be demonstrated.

This is particularly the case in healthcare because, as demonstrated in comprehensive analyses such as the RAND study in the US, the investment may deliver the macroeconomic benefit of a healthier community but health costs may still continue to rise due to the nature of the industry.

ICT should be expected to help bend the cost curve down and it is this economic argument for investment in health IT that led to the ‘meaningful use’ reforms that have taken centre stage in the US.

Health informatics specialists Why has there been such a lack of evaluation of eHealth projects in Australia?

Surely funders want to know their investment has been worthwhile?

One reason for the paucity of good evaluation data can be attributed to the issue raised by Professor Coiera. There

are not enough clinicians or ICT specialists with a strong grasp of health informatics, with the necessary depth of understanding of healthcare processes and the socio-technical nature of our complex healthcare system. Without this knowledge, ignorance can flourish and the sharing of wisdom and lessons learned is amputated.

We know that engaging with clinicians and health informaticians early in the process will improve the likelihood of delivering positive impacts of eHealth initiatives, yet we continue to see project managers treating eHeath initiatives as “IT projects”, often devoid of significant input by clinicians and health informaticians who can help steer initiatives away from failure.

The investment in an eHealth- and heath informatics-literate healthcare workforce and investing in creating positions for specialist health informaticians is vitally needed. As Professor Coiera states, billions have been spent on eHealth but “barely a dollar” has been invested in developing the health informatics

“Project managers who see eHealth initiatives as being ‘IT projects’ are destined for failure.”

Peter Williams and Louise Schaper

skills and knowledge needed to successfully deliver a good return on that investment.

The shortfall in health informatics specialists is not a new issue.

The 2008 National E-Health Strategy recognised that establishing a professional health informatics workforce and informaticsaware clinicians was essential to deliver planned benefits. Five

Australia’s first Big Data in medicine and healthcare conference

18 - 19 APRIL 2013

melbourne

010100001000100100101000010100001001000010 in health and biomedicine biomedical informatics 1100001010000100010010 100010100100010100001010000100010010100010 personalised medicine 0001010000100010010 00100010100001010000100010010100010 addressing the challenges health 2.0 / participatory health 00010100 of the data deluge in health 100010100100010100001010000100010010100010 data governance 0001010000100010010 b le 100010100001010000101000010100001000100111 ila a data analytics 010001001001010000101000010 13 av 20 w 001010000101000010001001001010000101000010 no ata d m healthier outcomes 10101000010000101000010 big ra u/ HISA: leading the conversation and direction og 010100001000100100101000010100001001000010 g. a Pr r for big data in healthcare in Australia. a.o his

Be part of this inaugural event! health-mic

PULSEITMAGAZINE.COM.AU

037

PULSEITMAGAZINE.COM.AU

038

“Evaluation of the impact of eHealth should be a staple of all eHeath initiatives. Anecdotal evidence of its impact doesn’t cut it with clinicians, healthcare administrators or funders and nor should it – we should be demanding high quality evaluation studies as part of all large-scale eHealth initiatives.”

Peter Williams and Louise Schaper

years later and we are no further progressed in having a funded, long-term strategic response to what is clearly a growing need.

Our international counterparts are making significant progress in this and we need to catch up. Positions for ‘chief health informatics officers’ in the UK, Canada and US are common and medical informatics is now a recognised clinical speciality in the US. These countries and others are giving health informatics the necessary recognition. Australia’s already ‘immature’ workforce is shrinking as our talent follows the high-paying and numerous careers prospects on offer internationally.

Health informatics certification program

After 21 years of leadership in the sector, workforce is a key component of HISA’s redevelopment of its strategic plan. Together with HIMAA, HISA and ACHI are launching a certification program for health informatics in July this year.

Professor Coiera points out that eHealth is hard. The health information environment is complex. Funders have a legitimate role in understanding how well their programs are meeting their objectives for service quality.

Clinicians need to be able to provide their care in the most effective and safe manner. Consumers need to have access to the best information on which to base their choices for maintaining good health.

The recently announced collaboration between ACHI and HISA was partly in response to the need for better recognition of the importance of health informatics, defined at its simplest as the application of ICT to improving healthcare. Health needs to move beyond the transactional use of ICT and realise the transformational benefits already experienced in many other industries, particularly in supporting the more integrated and personalised models of care expected in the future.

It is not easy reconciling all of these demands. Typically it is not the particular technology that determines the best outcome (there are “good” and “bad” examples of implementing identical software applications) but rather the extent that there has been appropriate integration with clinical workflow and an appreciation of the interoperability challenges of engaging with the wider eHealth environment.

ACHI and HISA are positioned to play a leading role in helping that transformation happen but funders of both health and education also need to recognise that the outcomes they are seeking for ICT to mitigate the increasing demand on healthcare services will not be delivered unless there is a concerted and coordinated national effort to address this issue.

Health informatics plays a crucial role in both design and evaluation. It is not about whether the application worked but did it support improved outcomes for the patient and the health system? Better insight into how those outcomes can be realised will come from clinicians and ICT specialists with capability in health informatics. We just need more of them!

ACHI has recently established a program evaluation subcommittee, which includes an objective to collate, promulgate and report on evidence of major health informatics or eHealth initiatives in Australasia. In undertaking this role it is liaising with our international colleagues in the American Medical Informatics Association and the European Federation of Medical Informatics, who have a similar aim.

References 1. Coiera, E. (2013) Why e-health is so hard. We need to respect the basic rules of informatics and invest in e-health expertise.

Med J Aust 198(4): 178-179. doi: 10.5694/mja13.10101 2. Patrick, J.D. & Ieraci, S. (2013) Good HIT and bad HIT. Med J Aust, 198(4): 205. doi: 10.5694/mja12.11350

PROVEN MEDICATION ERROR REDUCTION MEDICATION MANAGEMENT MedChart

Proven to reduce medication error1, our e-prescribing solution CSC MedChart is used by leading hospitals in the United Kingdom, New Zealand and Australia. Fully web based, MedChart supports complex infusions, integrated antibiotic stewardship and medicines reconciliation. For continuity across primary and secondary care, MedChart generates take home medication lists to support and enable electronic discharge summaries.

Pulse IT April 2013

To learn more, visit CSC.CoM/EMM or email healthsolutions@csc.com REFERENCES:

CSC MedChart Prescribing Medication Chart

1. Effects of Two Commercial Electronic Prescribing Systems on Prescribing Error Rates in Hospital In-Patients: A Before and After Study. Westbrook JI, Reckmann M, Li L , Runciman WB, Burke R, et al. 2012.

PLoS Med 9(1): e1001164. doi:10.1371/journal.pmed.1001164

PULSEITMAGAZINE.COM.AU

040

Feature

ST VINCENT’S HOSPITAL

ELECTRONIC DISCHARGE SUMMARIES Sydney’s St Vincent’s & Mater Health introduced electronic discharge summaries in January last year.

Nothing new, you might say, but the difference with St Vincent’s is that it is the testing ground for delivering high quality discharge information in a standardised format that all GP software systems can read, and which can be uploaded to the patient’s PCEHR at the push of a button.

KATE MCDONALD Journalist: Pulse+IT kate.mcdonald@pulseitmagazine.com.au

When St Vincent’s Hospital in Sydney began work on introducing electronic discharge summary functionality in 2011, it did so with two clear objectives in mind: to add value to the information sent to a patient’s GP, and to ensure safe clinical handover.

As part of its work with the Eastern Sydney Connect Wave 2 project, however, it was also tasked with developing some elements of electronic discharge summaries that have not faced other hospitals or health systems that have instituted the practice, including creating and rendering the summaries as CDA documents, ensuring they can be received and viewed in the correct GP’s desktop system, and at the same time developing the ability to upload the summary to the patient’s PCEHR.

About the author Kate McDonald is a senior staff journalist for Pulse+IT. Formerly the editor of Australian Life Scientist magazine, she has also edited industry titles Hospital & AgedCare and Nursing Review. Her interests cover health ICT, biotechnology and translational research.

Those extra elements have been difficult to institute, and the work is far from over, but as of 2012, the vast majority of patients discharged from St Vincent’s are provided with a detailed, clinically useful discharge summary that can be sent to the patient’s GP and be uploaded to the PCEHR. St Vincent’s is the first hospital in Australia to achieve this feat, and its clinical information system provider, Emerging Systems, is the first vendor to integrate the functionality within its installed product.

Now, St Vincent’s is able to send and receive four types of CDA documents – discharge summaries, eReferrals, specialist letters and events summaries – to and from GPs, and also send them up to the PCEHR through EHS. The module of functionality within EHS that links the GPs to the hospital is called GP Connect, and the module that links the hospital to the PCEHR is called PCEHR Connect.

It has taken a lot of human hours and quite a lot of money, but the team that has developed the new functionality believes that the end result – real information sharing between GP, hospital and patient, as well as improved clinical handover – is a worthwhile objective.

Today, St Vincent’s consistently achieves 82 per cent of patients leaving hospital with a discharge summary. That summary contains a great deal of valuable information that is drawn from a number of different systems, including Emerging Systems’ EHS clinical information system and CSC’s MedChart electronic medications management system, to provide a clinically useful document.

According to Adrian Verryt, St Vincent’s internal change and adoption manager for the PCEHR, the system has been designed so that the junior doctors tasked with

creating the discharge summary need only focus on the clinical content to be included, as the interface with the PCEHR all occurs in the background with minimal input for the clinician.

“There is a clinical synopsis, a summary of the stay, list of discharge medication from our MedChart eMM system, any results outstanding or pending and then follow-up appointments or risks or alerts,” Mr Verryt says. “In terms of filling it out, it’s a sequence of tabs that doctors work through and once completed they can finalise the discharge summary.”

The hospital has the patient’s GP’s details in its database, including the GP’s Healthcare Provider Identifier – Individual (HPI-I) and HealthLink electronic data interchange (EDI) address.Using EHS, the doctor simply has to finalise the discharge summary and press the button. And then?

Then, according to St Vincent’s CIO David Roffe, “a miracle happens”.

Complexity in practice That miracle – the creation, transmission and receipt of a meaningful clinical document – sounds simple in theory but has been enormously complex to achieve in practice. However, while the technical issues are being worked through, the major challenge has been in ensuring the new system fits in with the workflow of not just the clinicians but other hospital staff.

“There have been technical difficulties and workplace difficulties in implementing discharge summaries completely,” Emerging Systems’ CEO Russel Duncan says. “Our EHS clinical information system has been able to capture all of the clinical details associated with a patient’s discharge summary and has done for probably two or three years now.

The complexity often lies in the process or workflow to produce a meaningful discharge summary.

“To date we have consistently got over 82 per cent of patients leaving hospital with a discharge summary, and the remainder are those that we don’t actually need to do them.”

David Roffe

“For example, take the process of documenting the discharge medications, which in itself can be a quite complicated process to complete electronically. What often happens around discharge time is that the doctors complete the discharge summary but something may occur or change such as the patient’s condition and they have to review and re-finalise the discharge medications and then update the discharge summary. This has caused some complication in the workflow surrounding this process from a user perspective.

“Furthermore, when we got to the exchange of messages and how it’s sent to the outside world, one of the issues we discovered was that the general practice systems all accepted slightly different variations [of message formats], and some of them are quite extreme. ‘Yes, we accept PDFs, no we don’t accept PDFs, we accept RTFs, no we don’t accept plain text.’ One of the big things for the hospital was that when we actually did some of the plain text messages, they essentially turned up unreadable in the GP desktop software.”

Mr Roffe says it was not his intention to send plain text to a GP anyway. “I wanted to add value to the information provided to GPs and the formatting was important,” he says. “When we went and spoke to GPs, the only thing that would work was plain text and we wanted to set the bar higher. We also wanted to place the document into the practice management folder where it made

sense to the GP, not just where it fell into their system by default.”

Mr Duncan says the team created a standardised document which all GP systems could read, based on the CDA specification, and one that the hospital executive found acceptable.

“Where humanly possible, we attempted to send that document format out to the GP systems but there are some other nightmarish things about undertaking this exercise,” Mr Duncan says. “You have to know the version of the software that the GPs are using and it has to be something that is supported by the hospital and also be consumable by the GP at the other end.”

Each practice management software system has a different process for receiving messages and storing them in a useful place. Typically, a message will go into the software’s letters section, which is often handled by the receptionists.

However, a discharge summary is a clinically relevant document and doctors often prefer to view it immediately.

“Depending on what software you have,” Mr Verryt says, “your discharge summary will come directly into your inbox, but we have to make sure that we have the right details in our GP database which is aligning with the name of the doctor in their GP database to make sure that it drops into the right folder for that doctor.”

PULSEITMAGAZINE.COM.AU

041

PULSEITMAGAZINE.COM.AU

042

As part of the Wave 2 project, technical staff worked with five different practice management system vendors to test the templates for eDischarge summaries, including Medical Director, Best Practice, Zedmed, MedTech32 and Genie, and in what turned out to be a laborious process the team had to hand-craft each of the outbound HL7 streams to work with each of those systems, Mr Roffe says.

“We got a copy of each of them, we stuck them on PCs and hammered them with different combinations of HL7 streams and then we hand-crafted them,” he says. “Why did we do that? To provide a good user experience for the GP. Otherwise it would just be plain text. It was a big piece of work to be done but once we tweaked it, it was easy to replicate.”

Implementation As part of the project, St Vincent’s decided to bring in a new policy from January 21, 2012, when a new rotation of junior doctors started, to ensure that every patient would be discharged from hospital with a discharge summary. “That was the rule,” Mr Roffe says. “Training was involved in getting the doctors to complete those discharge summaries, and to date we have consistently achieved 82 per cent of patients leaving hospital with a discharge summary. It was a hard job – six manmonths, so it was huge – but what we delivered in the end was a thing of value.”

While most patients discharged from St Vincent’s leave with a discharge summary, that does not mean the summary gets to the same proportion of GPs. Not all patients have a regular GP, some who have been previously admitted have changed their GP, and of course many GPs are not known to the hospital.

For secure messaging, it depends on whether the GP has an EDI account, and that EDI is known to the hospital, Mr Roffe says. At present, St Vincent’s only supports

HealthLink as a messaging service, although there is some hope that with the major providers now committed to using the SMD standard and interoperability, that issue will eventually be solved.

“When the patient comes into the hospital we ask them for their GP’s details,” Mr Roffe says. “If the GP is known to us and we know their EDI address, it is matched up and that’s how it gets to the GP. If we don’t know the GP, it doesn’t go anywhere electronically so we just give a hardcopy to the patient.

“If we know the general practice but it does not have an EDI address, then we fax a copy. The issue here is that not all GPs have an EDI address and another problem is that if they have an EDI address with a secure messaging vendor that we don’t

currently support, then we can’t send it at this point in time.”

Mr Verryt says St Vincent’s has had to reconfigure its database of GPs and reconfigure some admissions centre work practices to ensure all of the right information is captured. “The critical workflow is to capture the GP’s name upon the patient’s arrival and to get the patient’s consent to send the discharge summary to them,” he says.

CDA documents The standardised CDA documents are also causing a bit of a problem, as the format settled on mandates that the GP’s HPI-I is used. Several organisations Pulse+IT has spoken to have confirmed suspicions that there is a reasonable percentage

of GPs who are unwilling to find out what their HPI-Is is and reveal it to their practice, as the HPI-I is closely linked to the functioning of the PCEHR and many doctors remain unconvinced of the national system’s worth and will not take part.

“These are quite solid specifications from NEHTA but all of the workflow issues still desperately need some work.”

The Healthcare Provider Directory (HPD) is supposed to overcome many of these problems – storing and making it easy to find GPs’ HPI-Is and EDIs – but it’s not really functional as yet. Amid the mountain of paperwork that general practices must complete to apply for the ePIP, the PCEHR has a consent form to add the practice GPs’ to the HPD. At present, however, the directory is sparsely populated.

Russel Duncan

“One of the things that really need to be addressed is the workflow element,” Mr Duncan says. “What NEHTA have done is they have come along with CDA documents and settled on the formatting standard.

The key thing they haven’t done, however, is support the workflow element. That has to be addressed. The workflow starts in the hospital and finishes on the GP’s desktop, but there’s a whole pile of things that happen in the middle. “[The hospital] has to capture the right practice and the right GP to make sure it’s delivered to the right place. And if it is re-finalised and changed, it has to go back through a similar process. If it gets updated after the patient has gone home … there is a whole pile of workflow issues that you must work through.

“We’ve had to introduce some software that hasn’t been part of the original specification but we are working to those latest specifications now. These are quite solid specifications from NEHTA but all of the workflow issues still desperately need some work. St Vincent’s is suffering the brunt of it internally.”

Then there is the human element, Mr Verryt says. At the admissions end, St Vincent’s system does not yet have

the ability to carry over the name of the GP from one episode to the next, so admissions staff still have to ask the patient the name of their GP on readmission. Some patients aren’t in a position to answer these questions, so they have to be followed up later.

And from the discharge end, the doctors often have to revise the discharge summary after it has been finalised.

“Doctors don’t want to have to go back into a discharge summary and refinalise something they have already done, but we have to remind them that they must refinalise in order for the revised version to be sent to the GP,” Mr Verryt says.

“We are working through a new process involving a scheduled task running in the background that will resend the discharge summary to recipients provided the discharge summary has been finalised once by the authoring doctor – that is not something that is happening at the moment. The subsequent version that has been created after it has been finalised is not being sent to the GP, so there is some tidying up that we need to do.”

PCEHR functionality Then there is the PCEHR element itself, something that other hospitals in Australia that do electronic discharge summaries – such as the many hospitals in Queensland that now have the ability – have not yet had to face. In October last year, St Vincent’s Hospital became the first hospital in Australia to connect to the PCEHR, at the

same time uploading its first electronic discharge summary to the system.

Through EHS, clinicians are alerted that the patient has a PCEHR by a green tick icon in the patient file. Patients are asked if they have a PCEHR at admission, when a verification check through the HI Service is done using the patient’s Individual Healthcare Identifier (IHI).

Clinicians can then view the record if they so wish. Mr Roffe said at the time that the design of the alert was deliberate: the team wanted to make it as easy for the clinicians as possible and to integrate it with their workflow.

“The question is, will the clinician actually go and look [for a PCEHR]?” Mr Roffe says.

“The answer is possibly no. However, if there is a screen that says there is one, they will probably go and have a look. We don’t want our clinicians to have to search the system – it does it in the background so you know when there is a PCEHR.” As it is personally controlled, patients decide whether they wish to apply access restrictions to health provider organisations allowing access to their record – a ‘lock’ icon has had to be designed to show where a patient has elected to restrict access to their PCEHR or to certain documents in it – and they are also given the ability to withdraw consent for a document to be uploaded.

Using EHS, it is a reasonably simple process to upload the discharge summary

PULSEITMAGAZINE.COM.AU

043

PULSEITMAGAZINE.COM.AU

044

“Underpinning all of this is safe clinical handover – that’s the whole reason why we have been doing this.”

Adrian Verryt

to the patient’s PCEHR, Mr Verryt says.

“Again it’s a background thing; the system recognises the patient has a PCEHR. It has gone off in the background, validated the patient’s IHI, and provided the patient has not withdrawn consent to upload to their PCHER, at the point of discharge the scheduler will run upload the discharge summary to the PCEHR.” If all of the background processes work and the ability to send a discharge summary to a GP seems like a “miracle”, so is the work that has gone into managing the consent model, Mr Duncan says.

“It’s part of the discharge summary creation – it’s part of the screens when they are creating it,” he says. “Patients can withdraw consent if they don’t want it uploaded. The other problem is the system needs the HPI-I of the author and the admitting doctor. HPI-I acquisition has been a major challenge for us. You have to get the doctor to give their consent to have their details published in the HPD and then you have to retrieve them, or you have to go to AHPRA and get the number from them.

These types of problem are common.”

eDischarge and eReferral Despite the challenges, there have also been some pluses. The hospital’s medical records department is easily able to retrieve a discharge summary if the GP hasn’t received it and send it to them electronically without having to print it out and fax it. And if the doctor wasn’t the first recipient of the summary, their names

can be added to the system and it can be sent to their software. And in return for St Vincent’s agreeing to send eDischarge summaries to GPs, the GPs have agreed to send their referrals to both the public and the private hospital electronically.

“We wanted to try and get eReferrals in from GPs and to distribute them into our specialist clinics,” Mr Roffe says. “It enhances the experience of the GP – he or she doesn’t want to have this process to work with a public hospital and another process to work with a private hospital and yet another process to work with a specialist and and the other five different specialists who do it five different ways.

“The proposition we went with to our GPs in our catchment area was, ‘If you refer electronically to us, we’ll make sure it gets to the specialist at the other end’. That is a very challenging thing to do and has failed quite a number of times. But we also told them it was a learning process and a journey. We wanted to entrench the care value chain and that is a team effort.”

St Vincent’s has also streamlined the sending of specialist letters from outpatients, which in the past could take up to six weeks. The hospital has been able to reduce this to an average of 14 hours, with all letters stored in a central repository, accessible through EHS. That is not to say that enabling private specialists is easy either. Specialists are private businesspeople who have honed workflows and they are often uninterested in changing those workflows merely for a

few patients or referring GPs who like to do things differently.

“The private specialists are still an issue but I think the tipping point will come as more GPs and more vendors of practice management systems become e-enabled,” he says. “They will start talking to specialists and say, ‘unless you accept my electronic referral I will refer to someone else’. That will be the tipping point.”

And the tipping point for GP acceptance of the considerable hurdles that have to be overcome before the whole system works smoothly? It will probably come when GPs realise that if they want to improve clinical information sharing and therefore improve patient care, they will in some way have to take part in the national system, he says.

Asked what GPs will do when confronted with a patient who has a functioning PCEHR, including a recent discharge summary, which the GP knows nothing about, Mr Roffe says they will have to “join the program”, at least in some small way.

“Underpinning all of this is safe clinical handover – that’s the whole reason why we have been doing this,” Mr Verryt says. “It’s not just getting GPs connected – it’s about effective sharing of healthcare information to achieve a safe clinical handover.”

Mr Verryt says that taking a micro view, St Vincent’s would like to engage electronically with as many GPs as possible, not just the 500 or so in the two Medicare Locals it works with. “If someone has an EDI and a software system, we’d like to communicate with them too.”

And taking a macro view, Mr Duncan says the idea is to improve clinical handover. “It is about improving the quality of patient care,” he says. “The payoff may not be today and it may not be theoretically attributable to systems alone, but the overarching idea is to improve patient care – more people getting better quicker.”

Feature

VENDORS COLLABORATE ON SECURE MESSAGING Six providers of secure messaging services have collaborated on a project to enable their software to inter-connect with the solutions offered by other market participants. The initiative is yielding results with project milestones being achieved against aggressive time frames, however much work remains to be done before the promise of ubiquitous and reliable secure messaging is realised.

SIMON JAMES BIT, BComm Editor: Pulse+IT simon.james@pulseitmagazine.com.au

In November 2012, the National E-Health Transition Authority (NEHTA) invited secure messaging software developers to participate in the Secure Message Delivery – Proof of Inter-connectivity and Deployment (SMD-POD) project. According to NEHTA, the initiative was established to “provide proof that standards-based secure messaging can be deployed in a scalable way, utilising National Infrastructure Services, and to also demonstrate that different conformant Secure Messaging Vendor products are capable of interconnecting within the Australian Primary Care sector and with other healthcare providers”.

While a range of secure messaging solutions have been utilised in healthcare organisations for well over a decade, NEHTA’s work on the SMD technical specifications was intended to improve secure messaging compatibility across the health sector, principally by allowing messaging solutions created by different vendors to talk to each other, or ‘inter‑connect’.

One of the often stated benefits of such inter-connectivity is that – ignoring business model complexities – healthcare organisations may be in a position to rationalise the number of messaging solutions in their organisations, many of which were originally installed for the

electronic transmission of pathology and radiology results. Proponents of SMD argue that if organisations only have to install, pay for and support a single messaging solution that is compatible with the messaging solutions of the organisations they wish to communicate with electronically, the sector’s reliance on paper and faxed based communication will be reduced significantly.

SMD has, however, had a prolonged gestation period with little evidence of deployment or meaningful use in the market despite some early momentum, which culminated in an IHE Connectathon back in April 2010.

Two years later, the May 2012 federal budget flagged impeding changes to the eHealth Practice Incentives Program (ePIP) which put SMD back on the agenda for the messaging software vendor community. Since then, nine organisations have been listed on NEHTA’s eHealth PIP product register under the Secure Message Delivery category, with general practices required to have done some preparatory work pertaining to SMD by February 1, 2013 to qualify for the first ePIP incentive payment.

To meet the ePIP requirements on an ongoing basis, by August 1, 2013 practices must be able to verify that their

PULSEITMAGAZINE.COM.AU

045

PULSEITMAGAZINE.COM.AU

046

“Frankly none of us are doing it for the money. SMD-POD provides a coordinated way for us all to test. NEHTA have lent a hand in terms of setting up a reference platform and have assisted by fast tracking applications for NASH certificates. So it’s a useful way of focusing the effort.”

SMD-POD participant

compliant SMD product has been installed and configured in accordance with the Commissioning Requirements for SMD. Further information about the secure messaging requirements of the ePIP is available on pages 48-49.

SMD-POD participants NEHTA limited the invitation and associated funding to secure messaging vendors with more than 50 general practices in two or more geographic locations. They additionally required that the messaging vendors’ software was able to send and receive referrals to, and letters from, specialists, and that their software was capable of connecting to the Healthcare Identifiers Service.

While NEHTA did not respond to Pulse+IT’s requests for information about the vendors participating in the SMD-POD project or the project more broadly, this author understands that of the nine organisations listed on the NEHTA eHealth PIP product register, the following six are involved in the project: • • • • • •

Database Consultants Australia (Argus) Global Health HealthLink LRS Health Medical-Objects University of WA

Project requirements To qualify for the payments afforded by NEHTA to project participants, secure messaging vendors are required to meet five project milestones.

By January 31, vendors were required to have been assessed by a National Association of Testing Authorities accredited testing facility, demonstrating conformance to the Standards Australia technical specifications for SMD ATS 5822‑2010.

Secondly, by February 15, vendors were required to complete inter-connectivity testing with NEHTA’s test environment and with at least two other products (i.e. those of competing vendors) that had also passed the first requirement.

Thirdly, building on the second requirement, by April 30, vendors need to deploy their messaging solutions in at least twenty five general practices and a minimum of five other healthcare organisations, excluding hospitals. It is understood that specialist practices are the likely environment that most vendors have selected to complement their general practice sites.

Fourthly, and by the same deadline of April 30, vendors are required to demonstrate inter-connectivity between two or more

of these sites, ensuring they connect with a minimum of two other deployed and conformant SMD products.

The final requirement is designed to ensure SMD-POD participants provide ongoing reports back to NEHTA, disclosing the status of their SMD-capable software deployment throughout the health sector.

While these timelines have been described as very aggressive by several of the vendors participating in the SMD-POD project, the latter deadlines have in fact been extended by three months with NEHTA originally intending the project to complete by January 31, just over two months after the project was first announced.

Each secure messaging vendor that adheres to the revised milestones outline above is eligible for a payment of $15,000+GST. An early completion bonus payment of $8000+GST was afforded to vendors that completed the first four requirements by March 15.

When asked about the funding arrangements for the project, one of the SMD-POD participants described the money on offer as “paltry”, with another taking a slightly more diplomatic stance, saying, “Frankly none of us are doing it for the money. SMD-POD provides a coordinated way for us all to test. NEHTA

have lent a hand in terms of setting up a reference platform and have assisted by fast tracking applications for NASH certificates. So it’s a useful way of focusing the effort.”

Challenges While the SMD-POD project and the ePIP requirements are not directly related, vendors report encountering issues with many practices that have not yet setup some of the underlying eHealth services mandated by the ePIP. Some of these issues have been attributed to processing delays for HPI-O numbers and the allocation of NASH certificates, with other practices encountering problems when adding their organisations and providers to the Healthcare Provider Directory (HPD).

With each of these components a requirement for SMD-based secure messaging to work successfully, one vendor has raised concerns about the preparedness of many practices to start installing and using SMD capabilities without the intensive assistance of secure messaging vendors or other third parties.

“That’s where I have the question mark as to whether practices are going through all the [ePIP] steps. They get the HPI-O, they indicate that they want an entry on the Healthcare Provider Directory because it’s optional if you do or you don’t, they get their NASH certificate, and fourthly in the case for the vendors that need it, that the

practice has signed a Contracted Service Provider (CSP) authority for that vendor.

Having all those ducks in a row for every practice is a challenge. They are supposed to do it for ePIP but when we get to testing it, we’re betting there’s a big number that haven’t yet got over the line.”

The future challenge of deploying SMD functionality outside of general practices appears to be more acute, with a vendor noting that specialists and allied health providers have historically received less support to adopt eHealth initiatives than their counterparts in general practice.

“When you move to specialists and allied health people who are not being paid [for eHealth] and haven’t got a focal point like PIP to do it, then virtually no specialists have their NASH….there’s a lot of effort to go in there. We’re engaging with Medicare Locals because they are tasked with getting all this going with their eHealth staff but they can’t ignore specialists and allied health people. It’s one thing to get the GPs going with the assistance of PIP, but if the specialists and allied health people aren’t going it’s not a hell of a lot a use as the GPs won’t have anyone to communicate with.”

Other vendors have noted that SMD – which is described as a transport specification only – does not address the long running problem of the various clinical software products generating and interpreting electronic correspondence

differently. This variance can lead to inconsistences in the way messages are displayed, if indeed such messages are able to be reliably imported at all.

Despite these challenges and the ongoing work that will be required before the promise of ubiquitous and reliable secure messaging is realised, many of the secure messaging vendors that Pulse+IT spoke to about the SMD-POD project were optimistic about the work they were undertaking as part of the initiative, one vendor summarising the project thus: “I think this SMD-POD exercise has been good. They’ve had to shift the goal posts a number of times because they’ve found some of the deadlines haven’t been practical because of delays like getting NASH certificates sorted out, and also because of some of the practicalities of messaging vendors not being able to get ready because putting stuff in their own live sites is difficult. Getting a live site ready to change over and put a brand new messaging technology in there is not as simple for some as it is for others.

If someone is putting in a brand new messaging technology into a practice and perhaps have to rip it out afterwards to revert back to their existing infrastructure, it’s not an easy ask. Those sort of things have reared their head, but the POD people have tried to be flexible in order to cater for that. At the end of the day I believe it’s going to push things along a lot faster than if it had been left to happen by itself.”

PULSEITMAGAZINE.COM.AU

047

PULSEITMAGAZINE.COM.AU

048

Feature

SECURE MESSAGING AND THE E-HEALTH PIP The majority of general practices are already using one or more secure messaging solutions for electronic correspondence, principally to download pathology and radiology results. While the deadline to qualify for the first eHealth Practice Incentives Program payment has already passed, practices are likely to need to undertake additional work relating to secure messaging before August 1 to remain compliant with the ePIP requirements.

SIMON JAMES BIT, BComm Editor: Pulse+IT simon.james@pulseitmagazine.com.au

The May 2012 federal budget flagged changes to the eHealth Practice Incentives Program (ePIP), with many of the new requirements coming into effect on February 1, 2013. To qualify for the first quarterly payment under the new requirements, practices must: • Apply for a Healthcare Provider Identifier for their Organisation (HPI-O) and enter it into their practice software. The practice must also retrieve and store patients’ Individual Healthcare Identifiers (IHI) in their software; • Have a written policy to progress the use of clinical coding in the practice’s clinical software; and • Install and utilise an electronic transfer of prescriptions service.

These criteria were required to have been met by February 1, 2013, with the ePIP application form due to be submitted to Medicare before April 24, 2013.

Additionally, by May 1 the practice must configure their practice software to connect to the PCEHR and register their organisation to participate in the eHealth records system.

While general practices have long been utilising secure messaging services to receive pathology and radiology

results, the ePIP requirement for secure messaging is perhaps the most complex owing to the number of steps that must be undertaken to fulfil the requirement.

Firstly, the practice must apply for or obtain a National Authentication Service for Health (NASH) public key infrastructure (PKI) certificate for healthcare provider organisations, a process that can be performed within two weeks of receiving the practice’s HPI-O if Medicare has not yet allocated the practice this indentifier.

Secondly, within four weeks of receiving the NASH PKI certificate, the practice must obtain a secure messaging product listed on NEHTA’s eHealth PIP product register.

At the time of writing, the following nine organisations and their products (shown in brackets) were listed on this register: • Alcidion (Miya Platform v4.0) • CSC Healthcare Group (practiX v1.38.1) • Database Consultants Australia (Argus v6) • Global Health (ReferralNet Agent v4.0) • HealthLink (HMS v 6.6.3) • HTR Business and Technology Services (HTR Telhealth v1) • LRS Health (AllTALK v3.01) • Medical-Objects (Capricorn v3.0) • University of WA (MMEx v1.0)

“While the deadline to qualify for the first eHealth Practice Incentives Program quarterly payment has already passed, general practices are likely to need to undertake additional work relating to secure messaging before August 1 to remain compliant with the new ePIP requirements.”

Simon James

Owing to the substantial collective workload, secure messaging vendors will need to undertake to upgrade as many as 7000 general practices across the country, the requirement to obtain one of these solutions is softened somewhat, with Medicare permitting practices to simply obtain “written advice from a vendor listed on the PIP eHealth Product Register for Secure Messaging Delivery that a product will be available for installation and configuration by 1 August 2013”.

So while your practice may not currently have a secure messaging capability, or may have an older version of one of the products listed on the register, obtaining a letter from one of the vendors listed on the ePIP register is enough to ensure your practice meets this part of the criteria at this time. However, whether or not practices have already obtained or upgraded to a secure messaging solution listed on the register, the August 1 date is a significant ePIP deadline for all general practices as this is when a compliant secure messaging solution must not only be installed, but also “configured in line with the Commissioning Requirements for Secure Messaging Delivery”.

These commissioning requirements – outlined in a 20-page document on the NEHTA website – are technical in nature and best navigated with the assistance of

your IT support professional and selected secure messaging provider/s.

It is important to note that while practices may already be using secure messaging software quite successfully, these commissioning requirements are designed to ensure that the messaging software is configured in such a way as to allow it to utilise many of the government’s new eHealth services, including the Healthcare Identifiers Service and the National Authentication Service for Health. When these services are utilised by the secure messaging software, it is intended – though yet to be demonstrated outside of controlled testing scenarios – that these services will allow for secure messaging solutions to become more compatible with competing services, allowing healthcare organisations to communicate via electronic means more effectively.

The final component of the secure messaging criterion requires practices to have a written policy to encourage the use of secure messaging for both incoming and outgoing correspondence. According to Medicare, “The written policy on Secure Messaging should set an objective of increasing usage of secure electronic messages (sent and received) using compliant Secure Messaging products.

Practices may wish to keep a record of secure messaging use to measure and

assess progress against this policy. Most products are able to keep a record of messages sent and/or received and should be installed with this function activated.”

It is recommended that this policy be complemented with training for doctors in the practice to ensure they are familiar with the way their clinical software deals with incoming letters from specialists and discharge summaries from hospitals, which are likely to be handled differently by their clinical software when compared with the workflows associated with incoming electronic pathology and radiology results. Training to familiarise clinical staff with the outgoing electronic correspondence features of their software may also be beneficial, enabling them to send electronic referral letters to other healthcare providers where feasible.

Further information The eHealth PIP Product Register, implementation overview documents and further information about the secure messaging commissioning requirements are available at the NEHTA website: http:// www.nehta.gov.au/pip Further information about the work being undertaken to improve compatibility between different secure messaging services is available on pages 45-47.

PULSEITMAGAZINE.COM.AU

049

PULSEITMAGAZINE.COM.AU

050

Feature

ETP THE BASIS FOR

NATIONAL PRESCRIPTION AND DISPENSE REPOSITORY Despite the lack of an agreed standard underpinning the electronic transfer of prescriptions (ETP), developments in the technology have continued apace, in part driven by the requirement under the eHealth Practice Incentives Program (ePIP) for GPs to send eScripts to a prescription exchange, and the recent announcement that the two vendors are now interoperable. The launch of the new National Prescription and Dispense Repository (NPDR) is also imminent.

KATE MCDONALD Journalist: Pulse+IT kate.mcdonald@pulseitmagazine.com.au

The safety benefits of electronic transfer of prescriptions capability as part of an overall eMedications management program have long been heralded as one of the great benefits of eHealth, but ETP as a technical standard has had a chequered history in the last few years.

The first electronic prescription exchange service, eRx Script Exchange, was launched in April 2009 and now claims to have almost 14,000 doctors and 3491 pharmacies using the system. MediSecure Script Vault launched in the same month with commercial deployment in July of that year. There is no hiding the fact that the two vendors are intense rivals, but a recent agreement brokered by the Department of Health and Ageing to make the two systems interoperable will no doubt further the technology’s uptake.

of national specifications for ETP. “The draft is the culmination of 12 months of development and incorporates extensive feedback from clinicians, consumers and technology experts around the country,” NEHTA said. “It will now progress to Standards Australia, through (technical sub-committee IT-14), for ongoing consultation and refinement with the goal of updating existing Australian standards and developing new technical specifications by the end of 2010.”

No one is willing to say why exactly, but the draft technical specifications were withdrawn, and the revised versions – known collectively as ETP 1.2 – have yet to see the light of day.

While the uptake has been slow but steady in Australia, and it is simple enough for clinicians to use as it is integrated into the majority of both general practice and pharmacy IT systems, there have been a few stumbles along the way, not the least of which is the failure of governmental organisations to come to an agreement on the technical standards that underpin it.

Standards Australia is working on six technical specifications, which will form the basis for Australian Technical Specification (ATS) 4888 and will use the clinical document architecture (CDA) developed as part of HL7 v3. CDA will allow the development of a number of other functions, including electronic signatures.

According to Standards Australia’s work program for its eHealth sub-committee, most of the new specifications for ETP 1.2 are due to be released in June this year.

In a statement dated July 20, 2010, NEHTA announced it had released its latest draft

In the meantime, use of the technology has forged ahead, helped immeasurably by the

“In 2012 we averaged about 70 practices signing on per month, but in January we had 343.”

Phillip Shepherd

listing of ETP as one of the requirements of the ePIP. Even here, however, ETP has had a few problems, with NEHTA telling members of its GP software vendors panel that ETP functionality was part of their original contract in 2011, then later removing it, and then reinstating it again late last year for the purposes of the ePIP.

ETP and the ePIP The two electronic prescription exchanges, eRx and MediSecure, were listed as compliant with NEHTA’s requirements for the ePIP in October last year. To date, 15 general and specialist practice software vendors are ETP compliant, including the major players such as Medical Director, Best Practice, Genie, Zedmed, Medtech, Stat, Communicare, and practiX. A number of smaller vendors, such as MMEx and Houston Medical, are also working on integrating one or both of the exchanges.

On the pharmacy side, the majority of community pharmacy software vendors are using eRx, including FRED Dispense, Simple Retail’s Aquarius, Corum’s LOTS and Amfac Windows Dispense, minfos, PharmacyPro and DispenseIT, with ScriptPro and MountainTop Dispense working on the integration. DispenseIT is also integrated with MediSecure.

Both prescription exchanges saw a huge volume of enquiries in January as the deadline for the ePIP neared. “In 2012 we averaged about 70 practices signing on

per month, but in January we had 343,” MediSecure CEO Phillip Shepherd says.

“We have also seen an increase of about 45 per cent in original prescription numbers.” eRx general manager David Freemantle says eRx was also overwhelmed in January, and both expect the use of electronic prescribing systems and the volumes of eScripts lodged in the exchanges to continue growing rapidly.

The increase this year is in contrast to the slow uptake over the 2011-2012 period, according to DoHA. In documents submitted to the Australian Competition and Consumer Commission (ACCC) in November, DoHA admitted that while ETP was a priority under the Fifth Community Pharmacy Agreement (5CPA), the number of eligible electronic prescriptions for 2011-12 was less than expected.

“Early analysis has revealed that there are large numbers of electronic prescriptions being lodged to the [prescription exchange services] by prescribers (doctors), but the number being downloaded by dispensers (pharmacies) is quite low,” DoHA said.

“The main cause identified is that the patient presents to a pharmacy which is not connected to the particular [prescription exchange service] containing the relevant electronic prescription.”

Exchange interoperability Last year saw a massive breakthrough in eHealth in Australia when the two services

agreed to begin to work on interoperability.

The two organisations have long been fierce rivals, so it took several meetings with officials from DoHA, and a very tidy sum of money under the 5CPA, for the two to begin the work.

An agreement was achieved in June 2012, and the two began working on the technical aspects of interoperability under contract with DoHA. In November, eRx took the step of submitting the contract to the ACCC under legal advice, as it could be considered anti-competitive as the two organisations were agreeing to an equal share in revenue from ePrescribing.

DoHA submitted supporting arguments for the contract arguing that the public benefits which will derive from interoperability would outweigh any anticompetitive effect. It was given approval by the ACCC in March this year.

Under the contract, the government contributed a total of $1.32 million, paid in three instalments, to the two exchanges as a capital investment to achieve interim interoperability.

A prescription exchange service electronic prescription fee (PEPF) is also being paid on each transaction, with $8,361,460 available in total. The fee was set at 85c per transaction up to December 31, 2012, and reduced to 35c per transaction until June 30, 2013, or until the funds are fully expended.

If a prescription is collected by one exchange and dispensed by the other, the two have agreed to an interchange fee of 50 per cent share each.

Part of the work towards interoperability included the standardisation of the format and positioning of the barcodes on the original prescriptions and a mechanism for facilitating the inter-PES transaction fee. It also included the addition of an adaptor to each system in every client pharmacy.

PULSEITMAGAZINE.COM.AU

051

PULSEITMAGAZINE.COM.AU

052

“Technically, MedView did what we set out to do and showed that ETP is a viable source of data and a logical source of that data.”

David Freemantle

Once the ACCC had given its interim approval, the two exchanges were quickly able to achieve interoperability. Technical interoperability was achieved in December, with the ability to be able to scan eScripts from both exchanges rolled out through pharmacy dispense systems in January.

National repository With interoperability now being rolled out, the imminent launch of a national medications repository will become much easier. Part of the overall concept of operations of the PCEHR system, what is now being called the National Prescription and Dispense Repository (NPDR) will go live on May 6.

The NPDR will not only allow approved healthcare practitioners to view a person’s prescription and dispense history, but also allow consumers to have information on their prescribed and dispensed medications uploaded to their PCEHR. Part of the PCEHR national infrastructure, the NPDR has been designed and built for the Australian government by Fred IT Group and its partners following the MedView project, which centred around general practices, pharmacists, a hospital and an aged care facility in Geelong.

A DoHA spokeswoman says the information contained in the NPDR will become available as part of a consumer’s eHealth record, accessible by consumers

and healthcare providers involved in the consumer’s care.

“The functionality will be available through the PCEHR nationally, and will be provided to healthcare providers through upgrades to prescribing and dispensing software, which will be gradually rolled out in accordance with the software vendor’s release schedules,” she says.

“NEHTA is currently negotiating with other contracted software providers who were not involved in MedView to include … functionality in their software.”

DoHA says consumers will need to register for a PCEHR in order to have prescribed and dispensed information uploaded to their record utilising the PCEHR consent model. The department, as the PCEHR system operator, will be responsible for operating the new registry.

Mr Freemantle, who led the development of the MedView project, the precursor to the new system, says the NPDR will be different from MedView in that consumers will be able to have the information uploaded to their PCEHR. Consumers did not have online access to their information during the trial as it was about proving that connectivity between different types of software systems and the MedView repository itself was possible.

With MedView, GPs and pharmacists were able to open a view of the data through a

web portal. With the NPDR, however, the view will be directly integrated into their desktop software, and the information will be uploaded to the patient’s PCEHR, if they consent for it to do so.

“Technically, MedView did what we set out to do and showed that ETP is a viable source of data and a logical source of that data,” he says. “We had an extremely positive response to it. The transition to the NPDR and the national infrastructure is the next step in the project. We have taken what we have built with the Geelong trial and integrated it with the PCEHR.” The next steps involve integrating GP, pharmacy, hospital and aged care software to allow the new functionality. This will be achieved through the different software vendor panels that NEHTA has established The MedView team has also built a generic adaptor to allow other software systems to integrate with the NPDR, including MediSecure, which is currently in discussions with NEHTA as to when and how it will link to the NPDR. While the ETP 1.2 specification are still being considered by Standards Australia, Mr Freemantle says the repository has been built to be standards-compliant. “The system is built to the dispense and the prescribe records ETP 1.2 specification, so it is CDA-compliant and will be able to cater for these emerging standards in the future,” he says.

Plans for a roll-out beyond Geelong largely depend on the software vendors integrating their clinical systems to be able to use the new system and will be driven by the larger PCEHR change and adoption program, he says.

“At the moment the NPDR roll-out will be centred on the same sites that were involved in MedView, and then other vendors will come on board through the vendor panels and the process of deploying more widely can happen.”

Off Topic

MICROSOFT TARGETS THE HEALTHCARE ENTERPRISE WITH SURFACE TABLET

Microsoft has long had a dedicated division working behind the scenes with healthcare organisations and governments around the world, but with the increasing use of consumer devices in the healthcare environment, the global giant is also concentrating on developing applications for its Lync unified communications platform, Skype and its new Surface and Surface Pro mobile devices for healthcare.

KATE MCDONALD Journalist: Pulse+IT kate.mcdonald@pulseitmagazine.com.au

Apple may have started the mobile revolution when it launched the iPad and its devices still remain the product of choice for doctors in particular, but Microsoft is now snapping at its heels with the recent launch of the Surface tablet, which Microsoft is promoting as an enterprise-level device for users in the healthcare sector.

Microsoft’s senior director for worldwide health, Bill Crounse, was in Australia recently for one of his regular trips and was proudly wielding his Surface tablet, a lightweight and well-received device that he believes is one of the bevy of new technologies that, in his words, are going to be revolutionary as much as evolutionary in clinical medicine.

While Apple is still the king of consumer devices, Dr Crounse believes the fact that Microsoft dominates enterprise IT is one reason that the Surface – and the new Surface Pro, launched recently in the US but not yet available in Australia – will be a major player in the healthcare setting. “[Not] just Microsoft but what all of the OEMs are doing in this whole new generation of very mobile, very robust devices is ... they really begin to meet the needs of clinical end-users, but they also meet the needs of enterprise IT,” he says.

“This era of bring your own device has been marvellous in terms of pushing technology forward because it is a consumer-driven sort of thing, and clinicians are consumers. They’ve been coming in with these devices, presenting them to IT and saying ‘make it work, make it network’.

“It is very hard for the CIO sometimes to say no to that and so they’ve been trying to take these devices and trying to make them work, but what they are finding is many of things out there in the market were never intended for the enterprise, particularly in healthcare where you have to be concerned about data security and privacy and loss of devices and encryption.

“So we are finally having this new generation of devices that can both delight the end user, who has become accustomed to a certain standard in the kind of devices they want to use, be they smartphones or tablets, and the needs of IT being able to ensure they are encrypted by default, that they can be managed as they come into the enterprise.”

Dr Crounse says one of the big strategies for Microsoft these days is its concentration on what it calls “the flexible work style”, which rather than a one-sizefits-all view now takes into account that

PULSEITMAGAZINE.COM.AU

053

PULSEITMAGAZINE.COM.AU

054

“With this device [the Surface] and a little bandwidth, I can be a global telemedicine provider and that’s the difference.”

Bill Crounse

end-users are choosing to use a number of different devices and platforms. “This new generation of devices, touch for Windows 8, apps, cloud – [that] is all about enabling this flexible work style,” he says.

Lync federation with Skype Of particular interest to the Australian telehealth sector is Microsoft’s plans for the integration of its Lync unified communications platform with Skype, which Microsoft purchased in 2011.

Microsoft recently announced that the “federation” of the two products would begin in June.

Dr Crounse could not divulge any more information, but he did say that “anyone who looks at it will realise there is going to be further integration” between the two.

Microsoft is also promoting Lync as an enterprise-grade platform, as opposed to the consumer-grade Skype, and Dr Crounse believes unified communications will also help revolutionise the healthcare sector, particularly in large networks like hospitals.

“Not only Lync but Skype as well are becoming fairly predominant platforms for what I call ‘commodity’ telemedicine and telehealth services,” he says. “It varies country by country ... but part of what we are seeing here in Australia is some amazing progress at an institutional level, with people understanding and mapping out where are their patients coming from and how far are they travelling.

“How can we leverage this technology to better serve that population, not only the clinicians who want to get out of trains, planes and automobiles and work more efficiently, but also patients who are being asked to travel three hours across town for a snippet of information or reassurance, when in fact this technology can be applied?

“What’s important at government levels is greater recognition that these telehealth services are not just about extreme distances or remote areas. The need is every bit as great within a metropolitan area – it can take three hours to get across Sydney in traffic, so why are we asking the frail, the elderly and the disabled to get in cars, with a huge carbon footprint, or huge expense in a taxi, not to mention discomfort and unpleasantness?”

Telemedicine of old At a healthcare enterprise level, Microsoft is marketing Lync not just for physician to patient communication, but for care team collaboration within single healthcare facilities or groups of facilities. And while Lync is a video conferencing solution, Dr Crounse sees functionality such as instant messaging and presence notifications as equally important.

“We are talking about creating vast federated networks with directories and presence so that if I’m a physician and I need help with something, I can go to a global directory and I can see who’s online and is available, what their speciality is, IM

them, voice call them, web conference with them – it can be a single party or multiparty conference.

“It’s really changing the way that we work and moving away from the really synchronous paper, phone and fax world to a world that is much more nimble. The value of both Lync and Skype is in the reliability of the platform and the ease of use. You can’t underestimate the ease of use, whether we are talking about consumers or clinicians. And with things like integrating scheduling, it just makes it easy.”

Many hospitals have invested vast sums in buying video conferencing equipment, particularly for clinician education and broadcasting live surgical procedures, but Dr Crounse believes that is actually “the telemedicine of old”.

“They are point to point,” he says. “They are big, bulky, expensive to use – that is telemedicine of old. The sort of telemedicine we are talking about here is unified communications for the masses.

Big television screens are all very good, but it doesn’t scale.

“With this device [the Surface] and a little bandwidth, I can be a global telemedicine provider and that’s the difference. I’m forecasting some fairly fundamental changes in lesser skilled people, armed with smart technology, being able to scale healthcare services in ways that we haven’t seen before.”

Microsoft Health Australia’s health industry solutions manager Simon Kos uses the example of the co-director of the Children’s Hospital Westmead endocrinology department, Professor Geoff Ambler, who is using a range of technologies to better connect with patients.

“He is using Lync on his PC, connecting in through a Polycom gateway, accessing the

NSW Health Tandberg network and now he has virtualised his paediatric diabetes clinic out to Orange and Bathurst,” Dr Kos says. “What he has found is that not only is it easy for him, as he’s not doing a 16-hour day of travel, but he can actually engage the local care team in a way that he never did. There’s good knowledge transfer, clinical education by peer to peer, and the kids love talking to the doctor on telly.”

Microsoft is also working to encourage app developers to combine a number of technologies in new apps to assist clinical workflow, including how to use Lync on the Surface to improve communications within hospitals, but also to create gateways into electronic medical records and health information systems like those developed

by Cerner and Epic.

Dr Crounse says Microsoft had long been working with the big EMR vendors,

but its main advantage was Microsoft’s dominance of the software market. “To a lesser or greater degree there is some Microsoft in all of their solutions,” he says.

“Back-end or front-end – somewhere in there, there is some of our stuff.”

“When we look at these kinds of devices, we ask is there a trusted platform module (TPM) chip in here, can this device be managed remotely, does it integrate and plug and play very nicely with the enterprise applications?

Consumer devices

“It can be a two-sided discussion – there is the IT viewpoint and the clinical viewpoint, and in defence of the clinicians, up until fairly recently there really hasn’t been an alternative to what the experience has been on the iPhone or the iPad.

While many vendors have already moved into developing apps for the iPad and iPhone that allow clinicians to access an EMR or receive results, Dr Crounse believes that Microsoft will be able to do a lot more due to its presence in every aspect of the enterprise. “I understand that iOS for consumer devices – there’s no question that there has been a lot of traction there,” he says. “The issue has always been how those devices plug and play in the enterprise environment.

Microsoft’s footprint is very clearly in the enterprise.

“They are brilliant, lovely devices, but they are lacking in some of the things you need, like data security, data input options, digital inking – things that doctors really want in devices. It is also about the experience of going from smartphone to tablet to laptop to desktop to the big screen in the living room. That’s what we are delivering.”

PULSEITMAGAZINE.COM.AU

055

PULSEITMAGAZINE.COM.AU

056

Off Topic

STANDARDS FOR

DIGITISING HEALTH RECORDS The Standards Australia Health Informatics sub-committee has worked on the development of revised and interim standards for digitising paper-based medical records technical requirements when developing a digitised health record system. The Standards documents also offer the first comprehensive definitions of the suite of terms used describe all types of health records, such as medical records, EHRs and personal health records.

HEATHER GRAIN A.dip HIM, Grad Dip IS, MHI, FACHI h.grain@ehe.edu.au LEANNE HOLMES Grad Dip Business, Assoc Dip MRA, CHIM lholmes@netspace.net.au

Today an increasing number of healthcare organisations are implementing different forms of digitised and electronic health record systems. The transmission and receipt of clinical documents, scanned and other forms of record information require a consistent and best practice approach to record handling. This requirement is particularly relevant to what is a common entry point, often referred to as a “medical record scanning solution”.

The national health informatics standards community of Standards Australia (IT-014 Health Informatics), with the support of the Department of Health and Ageing, recognised the need for best practice standards and for the introduction and operation of these systems. In mid‑2012, Standards Australia published standards for digitised health record systems.

This important standard is a two-part publication:

About the authors Leanne Holmes is currently undertaking an MBA at Deakin University and was the project leader within IT-014-2 for this project. Heather Grain is the co-chair of Standards Australia IT-014-2 Health Concept Representation, which developed this standard. Heather represents Consumers Australia at IT-014.

• AS 2828.1-2012 Health Records – Paper Based Health Records is an update of the AS 2828-1999; while • Int AS 2828.2-2012 Health Records – Digitized (scanned) health record system requirements is a separate document.

These documents define requirements for consistency between the development and design of paper forms and records

and compatibility for digitisation, whether through scanned systems, or other forms of digital creation. They also provide significant information for software vendors on processes for receipt of documents into their health record systems, whether digitised or otherwise.

These documents also offer the first comprehensive definitions of the suite of terms used describe all types of health records, such as medical records, EHRs and personal health records, including defining attributes of each. These definitions are robust, consistent and are harmonised with international definitions and standards. Readers are encouraged to become better acquainted with these terms.

Each of these documents has been established following detailed review by national experts and those seeking to implement and develop these systems.

The documents represent consensus and have been approved by the Standards community.

Paper based health records (AS 2828.12012) makes new recommendations to paper-based health records including the physical aspects of health forms i.e. quality, layout, colour and order of filing.

It also considers types of paper such as

non-carbon required (NCR) and introduces bar-coding to medical record forms.

The digitised health record document (AS 2828.2-2012) is an Interim Standard. This means that as a “Provisional Standard� it has a two-year life. It provides both a guide to the future direction in digitisation technologies as well as a mechanism to collect public feedback on the subject. This document is designed to inform the reader of the more technical requirements and specifications when developing a digitised health record system. It defines digitisation and discusses its relationship with clinical information systems. It also provides informative guidelines on document capture and considers scanning, data indexing and viewing features.

It discusses bar codes and OCR technologies and highlights metadata requirements, legal and retention principles, back-up and risk contingencies and the impact on staff and workflow.

Standards Australia is recognised by government as the peak, non-government standards body in Australia. Standards Australia is dedicated to setting benchmarks to meet growing expectations of the Australian community, industry and government.

In June 2014 the interim standard 2828.2 will be revised. An expression of interest is extended to all stakeholders, including software vendors and healthcare providers, to participate in the revision of this

interim standard with the IT-014-02 SubCommittee.

There are no pre-requisites to membership of this sub-committee. Participation is not only a public contribution but an opportunity to learn and understand the requirements and position of all sectors of healthcare to growing eHealth issues facing us all.

Further information To acquire a copy of these standards visit SAI Global: www.infostore.saiglobal.com To participate in the revision of AS2828 please email Daniel Henzi: daniel.henzi@standards.org.au

HealthLink/Medinexus Half Page 180 x 120 Puse IT Mag

connecting healthcare

PULSEITMAGAZINE.COM.AU

057

PULSEITMAGAZINE.COM.AU

058

Off Topic

SATELLITES TO BRING MORE TELEHEALTH TO THE BUSH

The two long-term satellites that the National Broadband Network Company (NBN Co) will launch in 2015 are designed to bring high-speed broadband to rural and remote parts of Australia where even fixed wireless is not possible. Telehealth provision is hoped to be one of the main beneficiaries, but there are limitations to the technology that healthcare providers need to take into account.

KATE MCDONALD Journalist: Pulse+IT kate.mcdonald@pulseitmagazine.com.au

The two long-term broadband satellites to be launched in 2015 will enable people living in rural and remote areas to access more video-based health services, according to NBN Co CEO Mike Quigley.

city and the bush. “It will give people in the outback, remote regions and Australia’s overseas territories access to economic and social opportunities that the rest of us take for granted,” he said.

Announcing the signing of a $300 million contract for the launch of the promised long-term satellites in 2015 with European satellite launch company Arianespace, Mr Quigley said the satellites “will allow access to fast internet to up to 200,000 homes, farms and businesses in remote parts of the country at speeds people in the city currently take for granted”.

“For instance, faster speeds will allow people in regional communities to work from home like they would from the office, access video-based health services and make high-quality video calls to family and friends.”

The long-term satellites were originally slated to deliver broadband upload speeds of one megabit per second and download speeds of 12Mb/s.

However, those speeds were recently revised by NBN Co with a higher speed tier of 25Mb/s download and 5Mb/s upload available, equal to the fixed wireless speeds that will be rolled out to some rural areas beginning in June.

NBN Co’s current interim satellite service, which is used by 25,000 homes in regional Australia, is capable of peak download speeds of up to 6Mb/s.

Mr Quigley said the NBN satellite service was key to bridging the divide between the

However, NBN Co adds a caveat to these claims, stating that end-user experience will depend on factors outside of its control, including equipment quality, software, broadband plans and how service providers design their networks.

Limitations of latency Last year, CSIRO issued a whitepaper on the potential for telehealth provision using satellite broadband, setting out some guidelines on what is achievable within the limitations of the technology.

Sarah Dods, health services research theme leader at CSIRO’s Digital Productivity and Services Flagship and lead author of the whitepaper, says that the differences between satellite communication and other kinds of broadband need to be taken into account

when considering the development of telehealth applications and the services they can deliver.

While not precluding the use of video conferencing for purposes like general medical consultations, the limitations of satellite – particularly the element of latency – could have an effect on the quality of the interactions and might restrict somewhat the services healthcare providers can offer.

CSIRO developed a graph showing what sort of telehealth services – from simple sensor monitoring to store and forward to low- and high-resolution video conferencing and remote operation – were probably achievable within the parameters

of download and upload speeds and the interaction timescale.

Dr Dods says that with the higher tier speeds now being introduced, the extra bandwidth would enable more services to be delivered, although latency or lag may still prove a problem, depending on the services envisioned.

“The fundamental latency of the satellite service is largely set by the altitude of the satellite, which sets the physical distance the signal has to travel,” Dr Dods says.

“The [NBN CO] announcement ... indicates that the new satellites will go into geostationary orbits, so this latency limitation will be unchanged.”

Dr Dods says the graph illustrates that bandwidth and interaction timescales, which partially depend on latency, work in different directions.

“The extra bandwidth moves across to a new rate on one axis, but won’t have much effect on the other. In terms of transport systems that we can relate to more easily, the bandwidth upgrade is like upgrading the highway between Melbourne and Sydney from a single-lane road to a fourlane highway. The signal has to travel the same distance, but the extra lanes will make the trip easier.

“The extra bandwidth may help move from standard resolution to real-time high resolution video for some telehealth

Space Systems/Loral staff fitting a propulsion tank into a satellite. Image courtesy of Space Systems/Loral (SSL)

PULSEITMAGAZINE.COM.AU

059

PULSEITMAGAZINE.COM.AU

060

“The fundamental latency of the satellite service is largely set by the altitude of the satellite, which sets the physical distance the signal has to travel.”

Sarah Dods

services, particularly the upstream increase from 1Mb/s to 5Mb/s.

For these signals, all the bits that make up a picture need to transmitted in a burst, travel along the physical link, and then get reconstructed at the destination.

“There are more bits in a high resolution picture, so the extra bandwidth will help transmit them faster and in a shorter burst.

The burst still has to travel the same distance, but the first and last bits of information will arrive closer together, so the picture also can be reconstructed faster.”

Whether this makes a significant difference for telehealth still depends on the clinical application, she says. “For example, real time clinician responses in an emotionally charged therapy session are likely to require lower latency for a satisfactory interaction than a general consultation.”

CSIRO is currently engaged in research to develop deeper understandings of these processes, she says.

Coalition criticism The Minister for Broadband, Communications and the Digital Economy, Stephen Conroy, says the satellite service will give Australians in rural and remote areas access to broadband that is superior to that which people living in cities can get through Telstra’s copper network, which will gradually be switched off under the government’s fibre to the home (FTTH) plan.

The two long-term satellites, currently being built by Space Systems/Loral in California, will be launched separately into geostationary orbit in 2015 from the Guiana Space Centre in French Guiana.

Last year, Opposition communications spokesman Malcolm Turnbull criticised the purchase of the two satellites, saying there was enough capacity on private satellites already in orbit or scheduled for launch for the NBN to deliver broadband to the 200,000 premises in remote Australia without building its own.

“When these two NBN satellites are launched, there will be huge spare capacity on them,” Mr Turnbull said. “Once again, the NBN is investing more than is needed to achieve its mission.

Once again, the incentive will be for this giant new government monopoly to intrude into other markets, and undermine existing private sector providers.

“At the expected cost of $1 billion to build, launch and operate two satellites built from scratch, NBN Co is spending over $10,000 for each of the 106,000 households its corporate plan says will be using satellite broadband in 2021. That does not even account for the other costs required for the satellite portion of the NBN, such as installing receivers at remote premises.”

However, Optus CEO Paul O’Sullivan defended NBN Co’s decision to build and launch its own satellites, telling the Sydney Morning Herald that his company would not be able to provide the same quality of broadband service on its existing commercial satellites.

Mr O’Sullivan said the two long-term satellites were being specifically built to carry broadband traffic, while the satellites his company and others use is mainly for television and video services.

The NBN satellites will use the Ka band, which is capable of carrying data at a higher radio spectrum frequency than broadcast-type satellites, which use the Ku band.

NBN Co says that instead of splitting capacity between a number of other tasks such as satellite telephony and broadcast television, or between a number of countries, the multiple high-capacity beams on NBN Co’s two Ka-band broadband satellites will be dedicated to the delivery of high-speed broadband to rural and remote Australia.

NBN Co is planning to build satellite ground stations across the country, including in Wolumla, Bourke and Broken Hill in NSW, Ceduna in SA, Geeveston in Tasmania, Roma in Queensland and Kalgoorlie, Geraldton, Carnarvon and Wagerup in WA.

Advantech

3M Health Information Systems P: 1800 029 706 F: +61 2 9498 9375 E: tjconnell@mmm.com W: www.3M.com.au/HIS 3M Health Information Systems is a leading provider of software solutions to help healthcare organisations capture, classify, and utilise data — accurately and efficiently.

With more than 28 years of experience in health information management, 3M offers integrated solutions for: • Coding, Grouping and Reimbursement • Document Management and Scanned Medical Records, providing: ◊ Access anytime to complete patient history ◊ Intuitive, customisable document viewing ◊ Automated worklists ◊ Electronic signature • Dictation and Transcription, providing: ◊ Reduced dictation time ◊ Increased accuracy ◊ Lower transcription turn‑around‑time ◊ Seamless integration with PAS and EHR systems

ACIVA E: j.edgecumbe@ehe.edu.au W: www.aciva.org.au The Aged Care IT Vendors Association (ACIVA) was formed in early 2010, a not-for-profit organisation, incorporated in NSW. ACIVA represents the residential aged and community care sectors and vendors at various national forums regarding strategic developments and eHealth. ACIVA members are residential aged and community care software vendors, industry benchmarking software, financial software, call-bell, hardware, networking, infrastructure and industry partners.

Members are committed to furthering the interests of residential aged and community care in national forums to ensure eHealth and access to the personally controlled health record (PCEHR) becomes a reality for the aged care industry in the very near future.

Contact: Secretariat Joan Edgecumbe j.edgecumbe@ehe.edu.au

P: 1300 308 531 F: +61 3 9797 0199 E: info@advantech.net.au W: www.advantech.net.au Advantech’s medical computing platforms are designed to enhance the quality and efficiency of healthcare for patients and users alike. All of Advantech’s medical PCs match the performance of commercial PCs but are medically rated to UL/EN 60601-1 third revision, IPX1 drip‑proof enclosures and are designed to suit ward and theatre based applications.

Advantech offers long term availability and support plus a proven track record of reliability.

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

• Mini-PC and Medical Imaging Displays.

• Mobile Medical Tablets.

• Computerised Medical Carts.

• Patient Infotainment Terminals.

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

Australasian College of Health Informatics P: +61 412 746 457 F: +61 3 9569 9449 E: Secretary@ACHI.org.au W: www.ACHI.org.au The Australasian College of Health Informatics is Australasia’s Health Informatics professional body, representing the interests of a broad range of clinical and non-clinical e-health professionals. ACHI is the community of Health Informatics thought-leaders in Australasia.

ACHI is committed to quality, standards and ethical practice in the Health Informatics profession.

More information is available at: www.ACHI.org.au Join the ACHI Info email list at: www.ACHI.org.au/List

Argus ACSS

AAPM P: 1800 196 000 / +61 3 9095 8712 F: +61 3 9329 2524 E: headoffice@aapm.org.au W: www.aapm.org.au The Australian Association of Practice Managers (AAPM) is a not for profit, national peak association founded in 1979, dedicated to supporting effective practice management in the healthcare sector.

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 to support quality practice management including advocacy, education, resources, networking, advice and assistance.

P: 1300 788 005 / +61 2 9632 0026 F: +61 2 9632 0096 E: sales@acsshealth.com W: www.acsshealth.com ACSS provides innovative and customisable patient management software streamlining day-to-day operations for GPs, Allied Health, Specialists, Radiologists, Pathologists, Private and Public Hospitals. eClaims® — Comprehensive and robust appointment and billing system with digital/voice recognition capabilities, electronic reporting transmissions and HL7 PACS system integration. eClaims® Hybrid — A solution tailored to Hospitals and other health service providers including billing agents who lack online capabilities. eClaims® Hybrid is the interface solution for connecting you to Medicare and health funds through ECLIPSE. SimDay® — Proven PAS (Patient Administration System) specifically designed for day surgeries and private hospitals – Now with ECLIPSE integration.

P: +61 3 5335 2220 F: +61 3 5335 2211 E: argus@argusconnect.com.au W: www.argusdca.com.au Argus provides and supports Argus secure messaging software; a popular electronic solution that enables healthcare practitioners to exchange many forms of patient related information securely and reliably and to Australian standards.

Argus interfaces with most clinical software applications sending directly from within your letter writing facility or word processor and runs virtually invisibly in the background. Documents sent using Argus can be automatically added to electronic patient records; thus avoiding the need to scan or manually file them.

Argus is the messaging solution chosen by many Medicare Locals through the ARGUS AFFINITY program delivering eHealth strategies across Australia. With over 17,000 users Argus continues to grow in popularity by delivering highly secure messages, a reliable product, backed by outstanding customer service all at the lowest cost possible.

Best Practice P: +61 7 4155 8888 F: +61 7 4153 2093 E: sales@bpsoftware.com.au W: www.bpsoftware.com.au Best Practice sets the standard for GP clinical software in Australia offering a flexible suite of products designed for the busy GP practice, including: • Best Practice Clinical (“drop-in” replacement for MD) • Integrated Best Practice (Clinical/ Management) • Best Practice Automatic SMS reminders Visit us at the following conferences throughout the year: • • • • •

GPCE Sydney, 17-19 May RDAQ Mackay, 7-9 June GPCE Brisbane, 20-22 September RACGP Darwin, 17-19 October GPCE Melbourne, 15-17 November

PULSEITMAGAZINE.COM.AU

061

cdmNet P: +61 3 9023 0800 F: +61 3 9614 2650 E: info@precedencehealthcare.com W: www.precedencehealthcare.com Chronic Disease Management just got a whole lot easier cdmNet simplifies team-based care for the estimated 30% of patients in general practice who qualify for MBS Chronic Disease Management Items. cdmNet minimises the bureaucracy, eliminates the paperwork and helps ensure compliance with Medicare requirements If you wish to use cdmNet to provide high quality care* for your chronic disease patients while increasing your revenues, contact us now. * See cdm.net.au/evidence

Cerner Corporation Pty Limited

Clintel Systems P: +61 8 8203 0555 E: info@clintel.com.au W: www.clintel.com.au The Specialist: A complete solution for your Appointments, Billing including Online Claiming and Clinical requirements in an intuitive scalable solution.

Clintel provides systems to Specialist and Day Surgeries nationally. Powerful, highly configurable and easy to use, our systems mirror the needs and workflow of your practice and individual specialty.

Our industry standard SQL database enables a true “paperless” practice.

Our leading edge architecture is future proof, it is designed to meet changing requirements and offers first class reporting and analysis of clinical and business data. Standalone or networked multi-site installation which runs on both Mac OSX and Windows operating systems.

Our support is first class, our philosophy is “whatever it takes”.

Cutting Edge Software P: 1300 237 638 E: enquiries@cesoft.com.au W: www.cesoft.com.au Cutting Edge produces affordable, intuitive billing solutions for Mac, Windows, Linux and iPad. Cutting Edge is ideal for practitioners who prefer to maintain control of their own billing from a number of sites.

Cutting Edge Software is approved by Medicare Australia to manage your electronic: • Verification of Medicare and Fund membership • Bulk Bill and Medicare claims • DVA paperless claims • Inpatient claims to Health Funds We have solutions tailor-made for: • Anaesthetists • Surgeons/Surgical Assistants • Physicians • GPs • Allied Health The software comes with up-to-date schedules for MBS/Rebate, Gap Cover (all registered health funds), Workers’ Compensation, Transport Accident authorities and DVA.

P: +61 2 9900 4800 F: +61 2 9900 4990 E: AsiaPacific@cerner.com W: www.cerner.com.au Cerner is one of the leading global suppliers of health care information technology solutions. Cerner’s mission is to contribute to the systematic improvement of health care delivery and the health of communities.

Our vision of proactive health care management drives innovation in the development of effective solutions for today’s health care challenges, while creating a foundation for tomorrow’s health populations. Working with more than 4000 clients worldwide, Cerner is solving health care’s many challenges making sure the right people have the right information at the right time.

Our innovative leadership is allowing us to push boundaries by: • Leveraging clinical and pharmaceutical data in Condition Management and Personalised Medicine • Connecting the community with personal and community health records

CONNECT DIRECT Pty Ltd P: 1300 557 550 / +61 7 5478 5510 F: +61 7 5478 5520 E: support@directcontrol.com.au W: www.directcontrol.com.au Direct CONTROL is an affordable, intuitive and educational Practice Management System for providers of all disciplines with seamless integration with Outlook, MYOB or QuickBooks.

Direct CONTROL’s Clinical Module with HTR is eHealth Compliant and manages Episodes of Care including State, Federal and Health Fund Statistical Reporting for day surgeries/ hospitals.

Included are all fee schedules (Medicare, DVA, Work Cover, TAC, CTP, Private Health Insurance) with built in rules relevant to each medical discipline (Allied Health, General Practice, Surgeons, Physicians, Anaesthetists, Pathologists, Radiologists, day surgeries/hospitals).

Ideal for the single practitioner or the Multidisciplinary Practice.

SQL .NET for interoperability and scalability

062

PULSEITMAGAZINE.COM.AU

Doctors Control Panel E: www.pracsoftutilities.com W: PSU_admin@pracsoftutilities.com • Download and trial DCP software for GP’s and health teams.

• DCP is your digital PA and guidelines advisor.

• DCP facilitates TCA, GPMP and MHCP creation and tracking.

• Contains guidelines licenced from RACGP. • Low annual subscription.

• The best preventive care add-on software in Australia.

• Compatible with MD3 and BP. • Achieve new heights in preventive care performance.

• Significant benefit for patients.

• Increase your revenues.

• Streamline your workflow.

• 3000 current users.

• Several research projects based on DCP. • Try it today.

Emerging Systems P: +61 2 8853 4700 F: +61 2 9659 9366 E: sales@emerging.com.au W: www.emerging.com.au/ehealth Emerging Systems EHS web-based Clinical Information System records the clinical care delivered to a patient from pre-admission through to discharge. EHS interfaces with the hospital’s PAS system, capturing and providing all of the information Clinicians require during a patient stay to support the delivery of effective, appropriate, quality care outcomes in a secure and auditable environment.

Information is displayed in a user friendly single pageview for easy access by to information by clinicians.

Importantly, EHS links Clinical Care with Workforce Rostering and Staff Allocation allowing for predictive Resource Allocation based on the care required, enabling valuable productivity improvements.

EHS is a proven and highly useable electronic medical record (EMR) developed within Australia and operating successfully in St Vincents & Mater Health, Sydney and Government of South Australia, Department of Health Hospitals.

EHS provides:• Pre-Admission • Patient History • Orders & Results • Clinical Care Guides • Assessments • Progress Notes • Referrals • Labour & Birth • Medications Reconciliation • Clinical and Non Clinical Messaging • Discharge Summaries • Appointments • Rostering & Allocation • GP Connect • Workforce Resource Calculation • Document Management System • Clinical Dashboard and more EHS supports interactions with the health identifier service and PCEHR. The extensive list of modules work seamlessly with other systems via our integrated interface engine which accepts HL7 and other accepted Health IT standard protocols complying with the Australian Technical Specification: ATS 5822:2010 eHealth Secure Message Delivery.

Accessibility: EHS is accessible on a range of devices according to user preference including our latest iPad application.

Extensia P: +61 7 3292 0222 F: +61 7 3292 0221 E: enquiries@extensia.com.au W: www.extensia.com.au Extensia links healthcare providers, consumers and their communities for better and more efficient health care.

The products used to do this can be custom branded for all Organisations and include: • RecordPoint – a proven Shared Electronic Health Record that links all clinical systems, hospital settings, care plan tools and any other sources of information available. It provides a secure means of sharing critical patient data in a privacy compliant and logical structure.

• EPRX – an Electronic Patient Referral Exchange and Directory. It streamlines the process of selecting a provider and completing a referral.

Patient information is transferred seamlessly from clinical software. The most relevant providers, services and products are presented instantly and referral documents are generated and sent electronically.

Genie Solutions P: +61 7 3870 4085 F: +61 7 3870 4462 E: info@geniesolutions.com.au W: www.geniesolutions.com.au Genie is a fully integrated appointments, billing and clinical management package for Specialists and GPs. Genie runs on both Windows and Mac OS X, or a combination of both. With over 2500 sites, it is now the number one choice of Australian specialists.

GPA P: 1800 188 088 F: 1800 644 807 E: info@gpa.net.au W: www.gpa.net.au GPA ACCREDITATION plus (GPA) is the only independent accreditation program for general practice in Australia.

Established in 1998 and run by a team of committed general practitioners, business leaders and experienced administrators, GPA has developed a program that continuously evolves in order to set new standards in general practice accreditation, while offering full support to practices to make accreditation both achievable and rewarding.

GPA is committed to providing an accreditation program, which is flexible and understands the needs of busy GPs and practice support staff. Whilst accreditation gives practices access to the Practice Incentive Program (PIP), GPA believes it should offer benefits that go well beyond the PIP. Our program provides practices with a pathway to enhanced patient care, continuous professional satisfaction, improved practice efficiency and superior risk management. GPA ACCREDITATION plus certificates and signage remind patients that their practice has achieved a level of care and service above and beyond essential general practice standards.

GPA provides a system designed to accommodate busy general practices.

Among our services, we offer practices the opportunity to use technologicallyadvanced, environmentally-friendly online programs, allowing staff to upload documentation at their own pace; individually assigned client managers, supporting practices through accreditation from start to success and beyond; highly-trained and sensitive surveyors, with extensive experience in all facets of general practice; and interactive training seminars, bringing practices the latest information in standards and innovation.

At GPA, we believe that accreditation should be an accomplishment, not a test, and we uphold that belief in our approach and service. For an accreditation program that will offer you assistance, support, information and satisfaction…the choice is yours.

Healthbank Consult P: 1300 856 722 F: 08 8301 4001 E: support@healthbankconsult.com.au W: www.healthbankconsult.com.au Healthbank Consult is a telehealth system developed in Australia for Australian healthcare providers.

Secure, fully encrypted and HD capable, Healthbank Consult is designed to be compatible with your clinical desktop for easy integration with your practice’s workflow and retains an audit trail for Medicare.

Compliant with RACGP telehealth guidelines, Healthbank Consult will qualify Rural GPs, Specialists, Aged Care Facilities and Aboriginal Medical Services for a $4,800 Medicare telehealth rebate plus ongoing fees.

Health Informatics New Zealand E: admin@hinz.org.nz W: www.hinz.org.nz Health Informatics New Zealand (HINZ) is a national, not-for-profit organisation whose focus is to facilitate improvements in business processes and patient care in the health sector through the application of appropriate information technologies. HINZ offers an online repository for the collection and dissemination of information about the Health Informatics industry - sharing best practice from New Zealand and overseas, as well as facilitating networking activities to bring industry experts and interested parties together to collaborate. The HINZ Executive Committee works to maintain its purpose for members with the goal of improved healthcare outcomes, through the dissemination and utilisation of information, knowledge and technology.

Membership is for anyone who has an interest in health informatics.

Health Communication Network P: +61 2 9906 6633 F: +61 2 9906 8910 E: hcn@hcn.com.au W: www.hcn.com.au Health Communication Network (HCN) is the leading provider of clinical and practice management software for Australian GPs and Specialists and supplies Australia’s major hospitals with online Knowledge resources.

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

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

Health Informatics Society of Australia P: +61 3 9326 3311 F: +61 3 8610 0006 E: hisa@hisa.org.au W: www.hisa.org.au HISA is Australia’s health informatics organisation. We have been supporting and representing Australia’s health informatics and eHealth community for almost 20 years. HISA aims to improve healthcare through the use of technology and information. We: • Provide a national focus for eHealth, health informatics, its practitioners, industry and a broad range of stakeholders • Support, promote and advocate • Provide opportunities for networking, learning and professional development • Are effective champions for the value of health informatics HISA members are part of a national network of people and organisations building a healthcare future enabled by eHealth. Join the growing community who are committed to, and passionate about, health reform enabled by eHealth.

PULSEITMAGAZINE.COM.AU

063

Medtech Global Ltd

Houston Medical P: 1800 420 066 (AU) P: 0800 401 111 (NZ) E: info@houstonmedical.net W: www.houstonmedical.net

Health Information Management Association Australia P: +61 2 9887 5001 F: +61 2 9887 5895 E: himaa@himaa.org.au W: www.himaa2.org.au The Health Information Management Association of Australia (HIMAA) is the peak professional body of Health Information Managers in Australia.

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

HIMAA is also a Registered Training Organisation conducting, by distance education, “industry standard” training courses in Medical Terminology and ICD-10-AM, ACHI and ACS clinical coding.

HealthLink P: 1800 125 036 (AU) P: 0800 288 887 (NZ) E: enquiries@healthlink.net W: www.healthlink.net Australia and New Zealand’s most effective secure communications service. Transforming healthcare by connecting healthcare providers.

• Provider of compliant Secure Messaging Delivery (SMD) services • Standards compliance delivering certainty in care • Fully integrated with leading GP and Specialist clinical systems • Referrals, Reports, Forms, Discharge Summaries, Specialist Diagnostic Orders and Reporting • Affords all healthcare providers efficiencies in reducing paper based handling • Robust; Reliable and Fully Supported • New online services including Care Insight - distributed search for clinical information • Expert partnerships with Healthcare organisations, State and National Health Services Join HealthLink and be connected with more than 85 % of Australian GPs and 99% of NZ GPs who are already part of the HealthLink community.

064

PULSEITMAGAZINE.COM.AU

“We provide time to health professionals through efficient practice management software” Our multidiscipline software provides interfaces to every major manufacturer, enabling many clinics to save space by becoming completely paperless!

We are a progressive medical software company and take pride in working with our health care clients to deliver tailored EMR and PMS packages based on each unique situation and practice requirements. We’re focused on helping to make their businesses more efficient and productive as well as delivering measurable improvements in customer satisfaction and market share.

You can arrange a free demonstration of our software by visiting:

Medical Software Industry Association

P: 1800 148 165 E: salesau@medtechglobal.com W: www.medtechglobal.com

P: +61 427 844 645 E: ceo@msia.com.au E: president@msia.com.au W: www.msia.com.au

For over 30 years, Medtech Global has been a leading provider of health management solutions to the healthcare industry enabling the comprehensive management of patient information throughout all aspects of the healthcare environment.

With the increase in government e-health initiatives, the MSIA has become increasingly active in representing the interests of all healthcare software providers.

Medtech’s Medtech32 and Evolution solutions improve practice management and ensure best practice for electronic health records management and reporting.

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.

Clinical Audit Tool integrates with Medtech32 and Evolution providing fast, efficient and secure analysis of patient data enabling practices to identify and deliver services, which address health care priorities across their population.

www.HoustonMedical.net

Join over 100 other companies across all areas of medical IT/IM so your voice can be heard.

InterSystems

MEDITECH Australia

P: +61 2 9380 7111 F: +61 2 9380 7121 E: anz.query@InterSystems.com W: www.InterSystems.com

P: +61 2 9901 6400 F: +61 2 9439 6331 E: sales@meditech.com.au W: www.meditech.com.au

InterSystems Corporation provides the premier platform for software for connected healthcare, with headquarters in Cambridge, Massachusetts and offices in 25 countries. InterSystems TrakCare™ is an Internet-based unified healthcare information system that rapidly delivers the benefits of an Electronic Patient Record. InterSystems HealthShare® is a strategic platform for healthcare informatics. It enables organizations to capture and share all patient data, and provides real-time active analytics that drive informed action across a hospital network, community, region, or nation.

HealthShare facilitates strategic interoperability, coordination of care, population health management, and community engagement. InterSystems Ensemble® is a platform for rapid integration and the development of connectable applications. InterSystems CACHÉ® is the world’s most widely used database system in clinical applications.

A Worldwide Leader in Health Care Information Systems MEDITECH today stands at the forefront of the health care information systems industry. Our products serve well over 2,300 health care organisations around the world. Large health care enterprises, multi‑hospital alliances, teaching hospitals, community hospitals, rehabilitation and psychiatric chains, long-term care organisations, physicians’ offices, and home care and hospice agencies all use our Health Care Information System to bring integrated care to the populations they serve. Our experience, along with our financial and product stability, assures our customers of a long-term information systems partner to help them achieve their goals.

Medtech’s ManageMyHealth patient and clinical portal enables individuals to access their health information online and engage with their healthcare provider to support healthy lifestyle changes.

MIMS Australia P: +61 2 9902 7700 F: +61 2 9902 7701 E: info@mims.com.au W: www.mims.com.au MIMS Australia is built on a heritage of local expertise, credibility and adaptation to changing healthcare provider needs. Our information gathering, analysis and coding systems are proven and robust.

MIMS information is backed by MIMS trusted, rigorous editorial process and constantly updated from a variety of sources including primary research literature. Our database and decision support modules are locally relevant, clinically reviewed and updated monthly and compatible with a host of clinical software packages. Indeed, the majority of Australian prescribing packages and many dispensing applications are supported by the MIMS medicines data base.

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

Precision IT Mouse Soft Australia Pty Ltd P: +61 3 9888 2555 F: +61 3 9888 1752 E: sales@medicalwizard.com.au W: www.medicalwizard.com.au Medical Wizard saves time and money through greater efficiency and comprehensive integration.

Throughout its 19 year history, Medical Wizard has led the way with innovative solutions. We are constantly evolving Medical Wizard to meet the challenges of the medical profession for today and tomorrow.

A software of choice for discerning Specialist practices, notably Gastroenterologists, Cosmetic Surgeons, Ophthalmologists, General Surgeons, IVF Centres and Day Hospitals amongst others.

All aspects of practice management from appointments, billing, clinical, theatre management and compliance reporting are covered and backed by a dedicated local support team.

Feature Rich. Dynamic. Innovative.

Orion Health

Pen Computer Systems

P: +61 2 8096 0000 / +64 9 638 0600 E: enquiries@orionhealth.com W: www.orionhealth.com

P: +61 2 9506 3200 F: +61 2 9566 1186 E: enquiries@pencs.com.au W: www.pencs.com.au

Orion Health is New Zealand’s largest privately owned software exporter and a global leader in eHealth technology.

Founded in 1993, by CEO Ian McCrae, Orion Health has grown from a specialist health integration vendor into a company that sells a comprehensive suite of eHealth solutions. Orion Health has extensive experience in the design and installation of complex systems within demanding healthcare environments.

Orion Health designers and engineers work right alongside in-house clinicians in order to develop elegant and intuitive products that encourage swift adoption with minimal disruption, allowing your clinicians to focus on patients.

Today, our products and solutions are currently implemented in more than 30 countries, used by hundreds of thousands of clinicians, and help facilitate the care for tens of millions of patients.

Established in 1993, Pen Computer Systems (PCS) specialises in developing information solutions for National and State eHealth initiatives in Primary Health that 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.

New Zealand Health IT Cluster P: +64 4 815 8177 E: admin@healthit.org.nz W: www.healthit.org.nz The New Zealand Health IT Cluster is a vibrant alliance of organisations interested in health IT, comprising software and solution developers, consultants, health policy makers, health funders, infrastructure companies, healthcare providers, and academic institutions – who have agreed to work collaboratively.

• New Zealand industry is consistently well regarded in providing quality, relevant solutions domestically and in offshore markets.

• New Zealand has an internationally regarded model of partnership that fosters development of innovative solutions to healthcare challenges.

• In key and emerging markets the New Zealand health IT brand is strongly recognised. By 2015 sales growth is doubled from the 2010 baseline.

OzeScribe is the dictation and transcription solution for most Australian university teaching hospitals and major private clinics. It really does make sound business sense to let OzeScribe worry about managing dictation, transcription and technology.

We provide free electronic document delivery – OzePost – to your EMR and your associates’ EMR, saving you thousands of dollars in time, packing and postage.

OzeScribe is the provider of the most advanced solutions available.

• Run by doctors – for doctors.

• Australian trained typists.

• Manage dictation and transcription via computers, iPhone, iPad, android or smartphones.

• Integrated M*Modal speech recognition technology on demand.

• Cloud Computing Specialists.

• Onsite Medical IT Support.

• VoIP Telephone Systems and Internet Connectivity.

• IT Equipment Procurement.

• Experience with all clinical & practice management software packages.

• Sydney, Brisbane, Gold Coast and Melbourne.

Precision IT is a highly competent and impeccably professional IT support firm with a primary focus on working with GPs and Specialists. Working with our clients, we develop reliable, robust and feature rich IT systems to meet the demands of the modern medical practice today and into the future.

Our Precision Cloud service is fast becoming the choice for new and established practices and covers all of the standard guidelines from the RACGP and AGPAL and GPA. Talk with us today about the future of your practice!

Shexie Medical System

OzeScribe P: 1300 727 423 F: 1300 300 174 E: sales@ozescribe.com.au W: www.ozescribe.com.au

P: 1300 964 404 F: +61 2 8078 0257 E: info@precisionit.com.au W: www.precisionit.com.au

P: 1300 743 943 F: 1300 792 943 E: info@shexie.com.au W: www.shexie.com.au

Medilink from Practice Services P: +61 3 9819 0700 F: +61 3 9819 0705 E: Sales@practiceservices.com.au W: www.practiceservices.com.au Medilink Practice Management Software • 21 years young, large user base • Medilink = Intuitive ease of use • Solo Drs up to Hospitals in size • Claiming via integrated EFTPOS ◊ and/or integrated HICAPS ◊ and/or Medicare Online ◊ and/or ECLIPSE • Many standard features • Many optional modules • Links to many third party packages and services • Cut debtors and boost cash flow • 17 years as an Authorised Medilink Dealer, selling, installing & training • Fixed Cost Support, Onsite or Remote

Shexie is an Australian owned business which has been developing software for medical practices for over 15 years.

Our industry and technical knowledge allows us to provide the ultimate ‘easy to use’, ‘fully functioned’ and ‘robust’ product on the market.

Shexie Medical System clinical and practice management software is ideal for surgical or specialist practices of any size. Many fully integrated features including Paperless Office, SMS, full Paperless Electronic Claiming including Eclipse, MIMS Integrated, statistical analysis, security, synchronize appointments with Outlook/PDAs, transcription interface, diagnostic equipment interface, automated MBS/Fund rates updates.

Soon to be released Shexie Platinum version also contains eHealth - Health Identifiers, PCEHR and Secure Messaging.

PULSEITMAGAZINE.COM.AU

065

™

Stat Health Systems (Aust) P: +61 7 3121 6550 F: +61 7 3219 7510 E: carla.doolan@stathealth.com.au W: www.stathealth.com.au

P: 1800 061 260 E: sales@tg.org.au W: www.tg.org.au

Stat Health Systems (Aust) has built a progressive and resilient system that introduces a new level of stability and flexibility to the medical software market.

Therapeutic Guidelines Limited is an independent not-for-profit organisation dedicated to deriving guidelines for therapy from the latest world literature, interpreted and distilled

by Australia’s most eminent and respected experts.

Stat is an integrated clinical and practice management application which has embraced the latest Microsoft technology to build a new generation solution. Fully scalable and the only medical software application to incorporate a multi-functional intuitive interface, Stat is at the forefront of computing technology. Stat incorporates all eHealth requirements as per the NEHTA specification.

These experts, with many years of clinical experience, work with skilled medical editors to sift and sort through research data, systematic reviews, local protocols and other sources of information, to ensure that the clear and practical recommendations developed are based on the best available evidence.

Stat Health provide a premium support service, clinical data conversion from existing software and tailor made installation and training plans for your practice.

Facebook: facebook.com/StatHealth Twitter: @NotifyStat

Sysmex New Zealand P: +64 9 630 3554 F: +64 9 630 8135 E: info@sysmex.co.nz W: www.sysmex.co.nz Sysmex New Zealand is a market leader in the development and implementation of health IT products and services for clinical laboratories, hospitals and healthcare organisations.

We offer the following health IT solutions: • Delphic LIS – a market-leading laboratory information system for hospital and community laboratories with a strength in providing multi-lab solutions.

Specialised modules manage workflows in the anatomical pathology, haematology and microbiology work areas.

• Eclair – an advanced clinical data repository (CDR) which stores patient data from a range of systems including laboratory, radiology, pharmacy and clinical document sources to create a secure patient-centric record.

Eclair provides complete electronic ordering functionality.

066

Therapeutic Guidelines Ltd

PULSEITMAGAZINE.COM.AU

eTG complete Incorporates all topics from the Therapeutic Guidelines series in a searchable electronic product, and is the ultimate resource for the essence of current available evidence.

It provides access to over 3000 clinical topics, relevant PBS, pregnancy and breastfeeding information, key references, and other independent information such as Australian Prescriber (including Medicines Safety Update), NPS Radar, NPS News and Cochrane Reviews. eTG complete is available in a range of convenient formats – online access, online download, CD, and intranet access for hospitals. Multi-user licences, ideal for a practice or clinic, are also available.

It is widely used by practitioners and pharmacists in community and hospital settings in all Australian states and territories.

Updated three times per year, eTG complete meets the criteria for ‘key electronic clinical resources’ in the Practice Incentives Program (PIP) eHealth Incentive.

The March 2013 release of eTG complete includes updates of selected Psychotropic topics. The online version of eTG complete has now been optimised for use on smart phones and tablet devices. miniTG The mobile version of eTG complete is miniTG, offering the convenience of having vital information at the point of care and designed for health professionals who practise and consult on the move. It is supported on a wide range of mobile devices, including Apple®, Pocket PC®, and selected Blackberry® devices.

VIRTUAL CONSULTING ROOMS

Totalcare

VConsult

P: +61 7 3252 2425 F: +61 7 3252 2410 E: sales@totalcare.net.au W: www.totalcare.net.au Totalcare is a fully integrated Clinical, Office and Management software suite designed to suit the particular needs and processes of healthcare providers. Used since 1995 by health care facilities across Australia including General and Specialist practice, Radiology, Day Surgery and Hospitals, Totalcare is stable, scalable, customisable and easy to learn and use. From a small practice to a multisite, multi-disciplinary corporate entity or hospital, Totalcare can provide solutions for your needs.

• • • • • • • •

Admissions / Appointments Billing Statutory Reporting Integrated SMS Prescriptions Orders & Reports Clinical Notes Letter/Report Writing, Document and Image Management • Scanning and Barcode recognition • Video and Image Capture • HL7 Interfaces

TrendCare

P: 1300 82 66 78 F: 1300 66 10 66 E: admin@vconsult.com.au W: www.vconsult.com.au VConsult offers outsourced practice management solutions for medical and allied health practitioners allowing the focus to be on your professional practice and patient care. VConsult provides a seamless “behind the scenes” service by professionally managing your telephone calls, reception, invoicing and medical transcription requirements.

VConsult is perfect for your practice if you are: • Setting up, already established or winding down in Private Practice • Working in a public appointment and want to portray a professional image • Looking to minimise your overhead costs • Requiring your patient calls to be answered by a professional and experienced medical receptionist.

Zedmed

R O

Trend Care Systems P: +61 7 3390 5399 F: +61 7 3390 7599 E: support@trendcare.com.au W: www.trendcare.com.au

A national and international award winning solution recognised for its ability to provide real benefits in the acute and sub-acute health care settings.

TrendCare is an international leader for e-health solutions excelling in all of the following: • Patient dependency and nursing intensity measures.

• Projecting patient throughput and workforce requirements.

• Rostering and work allocation.

• Efficiency, productivity and HRM reporting.

• Discharge analysis, bed management and clinical handovers.

• Allied health registers with extensive reporting.

• Clinical pathways with variance reporting.

• Patient assessments and risk analysis.

• Diet ordering and reporting.

• Staff health tracking and reporting.

P: 1300 933 000 F: +61 3 9284 3399 E: sales@zedmed.com.au W: www.zedmed.com.au Owned by Doctors who understand the challenges facing the medical profession everyday and backed by nearly 30 years of experience in medical software programming, Zedmed provides innovative, full featured and sophisticated practice management and clinical records software solutions.

Zedmed would also like to introduce to you Medical Record Exchange – a free, simple solution allowing Doctors to send patient’s medical information to insurance companies electronically.

Using the latest in data extraction technology and fully encrypted, this is a secure, time-saving solution to one of the most dreaded requests Doctors receive on an almost daily basis.

For more information about Medical Record Exchange, please contact us: Phone: 1300 933 833 www.medicalrecordexchange.com.au