Pulse+IT Magazine - August 2013

Australasia’s First and Only eHealth and Health IT Magazine

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ISSUE

19 AUGUST 2013

TELEHEALTH & HIMAA 2013 PREVIEW

Telehealth in the outback

Telehealth is a boon for remote clinicians and patients, but the practical barriers can be extreme.

Telehealth by web and wave

New and old technologies, including WebRTC and microwave broadband, can be harnessed for telehealth.

Clinical coding and ABF The national inpatient clinical classification system upgrade will be high on the agenda at this year’s HIMAA conference.

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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

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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 two editions for 2013 to be distributed for release in: • October 2013 - Digital Practice / HINZ Conference Preview • Mid-November 2013 - mHealth Proposed edition themes for 2014 will be announced in November.

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 Tessa Davis, Bryn Evans, Joanne Grey, Jeremy Hamlyn, Terry Hannan, Simon James, George Margelis, Fiona McCaul, Kate McDonald, Vicki Sheedy and Victoria Wade.

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.

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TELEHEALTH IN THE OUTBACK

TELEHEALTH FOR CHILDREN

TELEHEALTH OVER MICROWAVE

Editorials

Features

News

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STARTUP

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TERRY HANNAN

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Editor Simon James reflects on the government’s approach to eHealth communication.

Healthcare needs to support clinical decision making and clinical information management.

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ATHS George Margelis explains the practical steps towards a national, workable telehealth system.

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RACGP Tori Wade and Jeremy Hamlyn detail the benefits of video consults between GPs, patients and beyond.

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ACRRM

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BRYN EVANS

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HIMAA

Vicki Sheedy outlines how clinicians in rural and remote areas are supported through telehealth.

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Activity-based funding was a bit of a non-event at HIC 2013, despite its huge implications for eHealth.

The upgrade to the inpatient clinical classification system will be high on the HIMAA conference agenda.

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TELEHEALTH IN THE OUTBACK The Kimberley-Pilbara Medicare Local (KPML) has secured a satellite link to support eHealth and telehealth in very remotest areas.

SELECTED BITS & BYTES $8m for pathology on the PCEHR but private sector has concerns Doctors’ views on patient EHR access need to evolve

TELEHEALTH FOR THE KIDS The Royal Children’s Hospital has devised a three-year plan for its telehealth service, including consults with kids at home.

NEHTA aims to make PCEHR more useful to clinicians NSW to link hospital and community care clinicians to PCEHR

TELEHEALTH FOR ALL AGES UQ’s Centre for Online Health is developing clinically appropriate and sustainable telehealth services from paediatrics to aged care.

NSW Health considering FirstNet ‘Lite’ for small EDs

TELEHEATH BY MICROWAVE

Medications app aims to make pharma easy for families

The fibre, fixed wireless and satellite services envisaged by the NBN are not the only technologies available for telehealth provision.

TELEHEALTH BY BROWSER The real time communications standard WebRTC will allow telehealth to be conducted from within your browser.

THE FOAM REVOLUTION Have you heard of FOAM? Tessa Davis explains what FOAM is, what it can do and how to learn to love it.

Decision support reduces errors

Resources

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EVENTS

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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.

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Editorial

BETTER COMMUNICATION CRUCIAL TO SUCCESS OF E-HEALTH INITIATIVES

While telehealth and eHealth initiatives generally seek to improve the ability for patients and healthcare providers to communicate more effectively, a lack of detailed, cohesive communication from the government is likely to undermine its own eHealth ambitions.

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

During the recent HIC2013 event in Adelaide, Tanya Plibersek announced that “patients will soon be able to have pathology and diagnostic imaging results uploaded to their eHealth records thanks to an $8 million Federal Government investment.”

With the PCEHR’s potential to reduce duplicate investigations often touted as one of the system’s primary benefits, the announcement came as no surprise to many of the health informaticians in the audience. However, in the absence of any technical or even high level operational details, it did raise many questions.

Will patients have access to pathology results via their PCEHR before they have been reviewed by the referring clinician?

Will electronic pathology ordering from GP systems need to be established first? What exactly will the $8 million fund, and if there is a shortfall, how will this be addressed?

At what point might we expect to have diagnostic images available?

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.

Despite the passing of several weeks since the conference, no additional details that answer any of these questions have been released, with Pulse+IT investigations revealing that senior representatives of both the pathology sector and software industry remain at a loss as to how the minister’s vision will be realised.

During her address to the conference, the minister recounted a previous announcement from May 9 concerning the addition of advance care directives to the PCEHR. In this prior announcement the government allocated $10 million to this piece of functionality, however the intervening months since the original funding allocation have not yielded any details about how or when the system will be upgraded to support the sharing of patients’ end of life plans.

A lack of publicly available information supporting ministerial announcements for initiatives that won’t commence for some undefined time period is arguably defensible, however ongoing dysfunctional communications about existing eHealth initiatives may only serve to undermine the government’s own eHealth ambitions.

Take for example the recent decision by the Department of Health and Ageing (DoHA) to extend the deadline for a component of the eHealth Practice Incentives Program (ePIP). Amongst other things, general practices seeking to maintain their eligibility for ongoing ePIP funding were required to have a secure messaging solution commissioned before August 1. The ‘commissioning’ process refers to a series of technical and administrative steps that practices – usually with the help of their secure

messaging provider – need to undertake to ensure their messaging software is configured in such a way as to allow it to interconnect with other healthcare organisations using the SMD protocol.

Over the past few months, numerous sources involved with the deployment of SMD have expressed concerns about the preparedness of many general practices to commence the SMD commissioning process, with many unable to produce their NASH certificate or associated password despite their role in other ePIP requirements. Others have reported difficulty updating their listings in the Healthcare Provider Directory, with recent changes to Health Professional Online Services (HPOS) relating to contracted service providers also causing confusion.

In what can only be described as a belated reaction to the difficulties being faced by many practices, on Friday, July 26 – three business days before the original deadline – DoHA, in consultation with NEHTA, the Australian Medicare Local Alliance and the Department of Human Services granted practices an 11th hour reprieve, sliding

the SMD commissioning deadline by three months to October 31.

Unfortunately this shift in policy came so late in proceedings that on Monday, July 29 – two business days before the original deadline – the Medicare Australia website had not been updated and staff operating the organisation’s PIP enquiry line had no knowledge of the revised arrangements, remaining steadfast in their view that nothing had changed.

By the same date, NEHTA, which maintains the PIP eHealth Product Register which lists software relevant to the various ePIP requirements, had amended the pertinent information on its website. However with the authority failing to include any ePIP details on the ‘NEHTA Billboard’ on the home page of its website, it is reasonable to assume that a practice would need to have prior knowledge about both the change and the layout of the NEHTA website to have any chance of finding the relevant information.

Medicare Locals, which have been actively involved in the government’s

eHealth rollout, were also enlisted by DoHA to help communicate the revised ePIP arrangements, with some taking advantage of their weekly newsletters to inform practices in their catchment of the extended deadlines. Unfortunately given the time frames, such notice was not universal across the network of Medicare Locals, and it is understood that a great deal of telephone leg work was required to placate practices concerned about their inability to meet the original deadline.

While few would claim that the rollout of eHealth programs on a national scale is a simple proposition, it is somewhat ironic that efforts to improve the appropriate dissemination and communication of patient information throughout the health sector are not supported by comprehensive communications about these initiatives.

With meaningful use by clinicians of both the PCEHR and the SMD protocol at an embryonic stage, it is now more important than ever that the multiple government departments and agencies involved in Australia’s eHealth landscape communicate in a timely, effective and cohesive fashion.

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Guest Editorial

CLINICAL DECISION MAKING AT THE HEART OF E-HEALTH

Rather than spend many millions on poorly designed eHealth systems like the PCEHR, the healthcare industry and the government that funds it should look at the evidence for what works and design systems with clinical decision making and clinical information management taking a central role.

A/PROF TERRY HANNAN MBBS FRACP FACHI FACMI Consultant physician terry.hannan@dhhs.tas.gov.au

As the federal election in September approaches like an express train, it would seem worthwhile to take a look at where eHealth now fits on the national agenda.

It would appear that the government has put eHealth on the unpalatable ‘burnt toast’ ledger as it is not perceived as a vote‑winner.

Reading what is available from the federal opposition, it would seem that it does not have eHealth on its agenda either, possibly because it does not deem it as very significant.

Having tried to establish a functioning PCEHR and underachieved in that area, it can be said that the government of whatever persuasion after September 2013 will need some significant reform to health policy. Why?

About the author Dr Terry Hannan is a Clinical Associate Professor at the School of Human Health Sciences in the Department of Medicine, University of Tasmania. He is a consultant physician at Launceston General Hospital and has a deep knowledge of eHealth and health IT. He blogs at www.austemrs.com.au

The answer to this question is very clear.

Health is unaffordable. This is not only an Australian phenomenon but a worldwide one. It means that the established ‘systems’ of healthcare are wrong and health expenditures have been focused upon the wrong mechanisms of healthcare delivery.

OECD progressive evaluations show Australia sits within the top one-third of nations in terms of health costs as a percentage of GDP, but all of these nations

are seeing this ratio rising in parallel.

Australia has health costs running at approximately 9.1 per cent of GDP (i.e. ~$US3670 per person compared with per capita GDP of $US40,300) and on current linear models this will reach 16 to 20 per cent by 2045.

In an attempt to present a different image of healthcare functionality and funding models, it is worthwhile addressing healthcare delivery from the ‘clinical’ perspective i.e. direct patient care and the complex decision-making processes that are involved.

Clinical information management The dynamics of clinical decision-making (CDM) and information management (IM) are regularly not addressed when eHealth projects are undertaken, yet they are critical to any eHealth implementation.

The critical nature to healthcare improvement of these two processes can be seen within the definitions of healthcare delivery by expert organisations. For example, the World Health Organisation (WHO) defines healthcare in its charter as follows: “There is no health without management, and there is no management without information”.

So what does this mean for day to day patient care? Here is a description of what clinicians – physicians, nurses, pharmacists and physiotherapists, and in the current era, patients – do as information managers. We also have documentation of the outcomes of this information management with inadequate clinical decision support tools. These rules apply to the stages of acute, intermediate and chronic care.

Even though clinicians are seen as providing services, their primary role is the management of information. But what does this actually mean? In routine care, clinicians collect data such as patient history, physical examination, create reports, access laboratory data, read x-rays results then record this data (through the production of notes, operative reports, prescriptions and diagnostic test results).

This data is transmitted through various means such as telephone, paper documents, electronic charts and email. Finally, they process this information to arrive at a diagnosis or deduce a

hierarchy of possible diagnoses and initiate treatment(s).

This process becomes an iterative cycle of data and information management so that care can be monitored, adjusted and measured.

This understanding of clinical information management, based upon physician clinical decision making, was shown by Bruce Blum in his book Clinical Information Systems more than four decades ago and was reaffirmed more recently by Australia’s Enrico Coiera in the third edition of his text, Guide to Health Informatics.

Decision-making overload We also know that modern health technologies have created a situation of intolerable information and knowledge overload in the absence of an increase in human cognitive capacity to manage it. Therefore we need tools to assist the unaided human mind to affect the poor outcomes of care such as underuse, overuse and

HealthLink/Medinexus Half Page 180 x 120 Puse IT Mag

connecting healthcare

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“Having tried to establish a functioning PCEHR and underachieved in that area, it can be said that the government of whatever persuasion after September 2013 will need some significant reform to health policy.”

Dr Terry Hannan

inappropriate use of health resources and the perpetuation of inadequate quality of care. (See Lucian Leape’s report, ‘Five Years after To Err Is Human. What have we Learned?’)

Across health systems globally, we have actual measures of poor health outcomes that have resulted from clinical decision-making overload.

In Canada, it was shown in 2005 that five per cent of chronic kidney disease patients unnecessarily occupied 19 per cent of in-hospital bed days and consumed 25 per cent of duplicate unnecessary tests that each cost $C4.50. This represented $C4.55m in a 12-month period.

Similar results were found for CT scans, MRIs and prescriptions in the Canadian health system between 2005 and 2009.

In the UK, in an evaluation of resource utilisation based on clinical decision-making during after-hours in a UK emergency department, it was found that 87 per cent of the tests were unnecessary.

The reasons for this were diagnostic uncertainty, medico-legal protection, avoiding leaving work for colleagues, prevention of criticism from staff (especially consultants), to lessen anxiety and reduce stress levels. As shown as far back as 1975, these are the processes that lead to further information overload and impaired clinical decision-making.

Additional measures of impaired clinical decision making include clinicians’ inability to detect and reduce preventable adverse drug events, with this being closely correlated with medical indemnity premiums.

The health system’s dependency on poorly designed communication tools like our PCEHR between hospitals, primary care and patients exacerbates poor care outcomes.

The list of adverse health care measures is extensive, so can any eHealth processes – including clinical decision support and information management tools – improve care delivery? The answer is yes.

From the 1980s, we know well-designed, clinically appropriate, e-summary records improve care communication and quality of care.

The use of standardised alerts and reminders leads not only to health cost reductions, but to more appropriate resource utilisation and better bed utilisation in hospitals. The costs saving alone can be measured in billions of dollars.

For example, using computerised antibiotic guidelines in Intermountain Health Care hospitals in the US, major cost, quality and access outcomes have been achieved.

In addition, the use of these large clinical databases and direct clinical data capture has allowed researchers to measure how current funding models of more beds, more doctors and nurses do not produce better healthcare.

Inefficient widgets The emphatic messages we need to understand and to address within our unaffordable healthcare systems involve politics, economic and social change.

We must remove ourselves from unscientific, non-data-driven ‘personal recommendations’ for care and move the care delivery system away from the costly and inefficient ‘widgets’ model of care based on a pre-determined ‘appointment system’ involving healthcare encounters.

Care needs to be directed at patient self-management by giving them the HIT tools to manage their own health.

Sunshine Summit 2014 Sunshine Summit 2014 Sunshine Summit 2014 Sunshine Summit 2014 Sunshine Summit 2014 T: (07) 4155 8888, E: bpsummit@bpsoftware.com.au, www.bpsoftware.com.au

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Guest Editorial

TIME TO FOCUS ON

THE NATIONAL TELEHEALTH STRATEGY Last year, the Australasian Telehealth Society (ATHS) held a workshop to gather ideas for a national strategy for telehealth in Australia. From this, a white paper was developed that outlines practical steps towards a national, workable telehealth system that benefits all. The vision is for a transformative change in healthcare delivery to meet many of the challenges facing healthcare.

DR GEORGE MARGELIS MBBS M.Optom GCEBus National Committee Member, Australiasian Telehealth Society george@georgemargelis.com

Telehealth has huge potential to improve the quality and safety of healthcare whilst also improving its cost effectiveness.

Numerous studies have shown that when well implemented it provides an effective tool for better healthcare delivery.

However, its potential has been constrained in Australia by a number of barriers imposed by regulatory, reimbursement and cultural restrictions.

As a result Australian clinicians, patients and payers have not been able to take advantage of the potential benefits it can provide.

About the author Dr George Margelis is a medical doctor and health informatician. He was recently appointed Adjunct Associate Professor at the TeleHealth Research & Innovation Laboratory (THRIL) at the University of Western Sydney.

It is my belief that one of the main reasons for this is the lack of a cohesive and coherent national strategy on the development and implementation of telehealth in Australia. To date it has been entwined as a subset of a number of strategy discussions, but its full potential cannot be reached until it is recognised as the substantive tool for healthcare transformation that it is. We need to provide the required technical, clinical, cultural and financial research and development to allow it to flourish.

National telehealth strategy In late 2012, the Australasian Telehealth Society (ATHS) held a workshop at its annual conference in Sydney to gather

feedback from members of the healthcare and technology community on “national strategic directions in telehealth”. I was privileged to co-chair that meeting with Professor Colin Carati from Flinders University. From that workshop we developed a white paper, which is available at the ATHS website at www.aths.org.au.

For the purpose of the paper we used the definition of telehealth as “enabling healthcare services and related processes delivered over distance, using information and communication technologies”. This was designed to not be too prescriptive so as to allow for innovation in the development of telehealth solutions as the technology improved.

The vision was for a transformative change in healthcare delivery to meet the challenges of a rapidly ageing population, financial and workforce constraints, and the expectation of high quality healthcare delivered in a timely manner for the Australian population.

Focus and implementation Three broad themes developed from the discussion. The first was a focus on national priority groups and to target initially key groups identified in the National Health Reform Agenda who have to most to gain from telehealth as

“The goal is to embed telehealth as a valuable tool within the healthcare delivery system, and not have it as a sidelined research project of interest only to the technologists.”

to develop evidence-based models that were effective and sustainable. It was deemed essential that this research move on from the small pilot phase that has characterised telehealth research in Australia to larger scale projects with entrenched evaluation mechanisms that would inform the national debate.

Discussion to action Dr George Margelis

they provide the bulk of the burden of healthcare needs today. This includes the aged, those who are poorly mobile and disabled, and those in outer metropolitan rural and remote locations.

These sectors already have significant financial support from various levels of government and private payers, so there in no need for extra funding, but rather the making available of funding that is currently spent in these sectors to providers who use telehealth without the current restrictions.

An example is the exclusion of general practice services from the current reimbursement model. We are in agreement with the RACGP that primary care should be eligible for telehealth reimbursement as it is the most likely to interact with the various priority groups.

The second priority area was the application of ‘fit for purpose’ models – to develop technical, business and financial models that support clinical change that are sustainable and scalable, and work across multiple providers, funders and jurisdictions as required to deliver the requisite high quality care to the patient.

Such systems are deemed to be ‘fit for purpose’ for patient-centred healthcare with outcomes that are clinically relevant

at an individual as well as at a population level. The goal is to embed telehealth as a valuable tool within the healthcare delivery system, and not have it as a sidelined research project of interest only to the technologists.

The third focus is to optimise the locus for implementation. The current healthcare system is fragmented and driven by many ‘masters’ which makes change, including the implementation of telehealth, complex. However, the bulk of healthcare is delivered locally, and with a patientcentred model of healthcare delivery the focus should be on delivering relevant services and inherent value at a relatively local level, and aggregating this up to a national level.

Recent reforms including the development of the Medicare Locals as a locus for better primary care is an opportunity to also localise the delivery of telehealth services to enable sufficient scale for good implementation models, whilst avoiding the unnecessary overhead of largescale national programs. This will also foster innovation as the various groups develop models suitable for their loci of implementation that can be built upon by other groups.

Across all these themes a need for research and innovation was required

Now is the time for robust discussion about the National Strategy for Telehealth for Australia. However, we need to move rapidly from discussion to action. This is not a ‘set in concrete’ strategy, but rather a framework for the development of a new set of tools to be used in the delivery of healthcare. The goals are improved quality, safety and cost effectiveness of healthcare delivery for all Australians.

Technology can play an important role in delivering on those goals, but it needs to be embraced by the healthcare community as an enabling tool, not a threatening diversion from mainstream healthcare delivery. To do this requires collaboration across the gamut of stakeholders, healthcare providers, technology providers, regulators, funders and most importantly patients. They all need the opportunity to develop sustainable and scalable models of care that utilise the technology to enhance healthcare delivery.

There will be stumbles along the way, as there has been for all medical innovation over the centuries. However, if we keep our focus on the goal, ensure collaboration across all parties, and maintain an open frank and robust discussion along the way Australia has the opportunity to become a world leader in telehealth.

This can provide not only healthcare benefits to all Australians, but also potentially a lucrative export market for Australian healthcare and technology providers into the Asia Pacific region and the rest of the world.

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Guest Editorial

TELEHEALTH AND MEDICARE

WHERE SHOULD WE BE GOING? Telehealth has been shown to be an effective way to deliver healthcare to those in need and the introduction of MBS rebates was a welcome move. Opening up the MBS to allow GPs to consult directly with patients has great merit for the future of telehealth consultations.

DR VICTORIA WADE BSc, DipAppPsych, MPsych, BMBS, FRACGP JEREMY HAMLYN BEng, MfSci, MIEEE, PE

It has now been just over two years since Medicare introduced rebates for real time video telehealth in Australia and since then, over 50,000 video consultations have been completed through the MBS. While this might sound like a lot, crunching the statistics from the Medicare website indicates that video consultations are approximately 0.1 per cent of total equivalent consultations, although this figure rises to the dizzying heights of 0.5 per cent for psychiatry.

viable; when the numbers were raised to a (still modest) amount of around 20 consultations a month, additional income for the practice was generated.

When outer urban areas were no longer deemed eligible to participate in telehealth at the beginning of 2013, there was a drop of approximately 30 per cent in the number of service episodes, but the figure is increasing again now.

We would argue that this is not the ideal model for two reasons: the larger the number of different providers that become involved in patient care the more fragmented the care becomes with a higher rate of adverse events, and secondly, if the patient does need to be seen in person then an out-of-area specialist with no existing relationship to the practice cannot effectively advance the patient’s care. Telehealth should be part of a tool kit for delivering healthcare, not a replacement for existing services.

From a clinical point of view, rural patients have undoubtedly benefited from telehealth initiatives. Our practice operates a rural telepsychiatry and telepsychology service and has seen hospital admissions avoided, leading to grateful patients and satisfied GPs.

About the author Dr Victoria Wade and Jeremy Hamlyn are both research fellows in telehealth at the University of Adelaide. Dr Wade is clinical director and Mr Hamlyn operations director of the Telehealth Unit of Adelaide Unicare, which manages a group of general practices and a women’s health centre.

Most GPs’ current experience is that conducting telehealth is, at best, costneutral. Dr Wade developed a model of the financial viability of telehealth in rural practice that indicates the most important factor is volume: at three or four video consultations a month telehealth is not

Often neglected in debates about telehealth are referral pathways.

Telehealth increases referral options, allowing a wider range of specialists available to patients, with some telehealth organisations offering a ‘bank’ of specialists to the whole of Australia.

Minimum distance requirement Removing the outer urban areas from telehealth eligibility, and adding the 15km minimum distance requirement to MBS telehealth rebates, threw the baby out with the bathwater. Prior to this, our

practice was operating a service delivering specialist psychiatry and pain management to the outer northern suburbs of Adelaide; both services that were very much needed in this underserviced area, and both patients and GPs alike were disappointed when the service was removed.

In August 2012, the RACGP provided feedback to the federal government that the 15km distance requirement prevents many patients, who have clinically justifiable reasons for a video consultation, from receiving timely healthcare. This is particularly the case for patients with limited physical mobility and patients who have restricted access to transportation.

consultations. There are four specific situations where this would be particularly valuable: 1. GP to patients in residential aged care Due to increased pressure of work in general practice, it has become harder for GPs to leave their practice for ad hoc visits to aged care facilities. Our practice tested the value of telehealth in this setting four years ago, for situations from skin conditions to behvioural issues. We found that telehealth was useful, particularly for residents who were anxious about health issues, accepted by patients, and valued by the aged care staff.

Telehealth in practice

2. GP to patients with a disability People living with a disability are having their needs better recognised by government and it seems obvious that telehealth options should be available to better serve this group. A patient’s carer will also be able to benefit from having telehealth as an accessible option.

Opening up the MBS to allow GPs to consult directly with patients has great merit for the future of telehealth

3. GP to nurses in remote areas Rural GPs serve large areas and many provide medical back-up to small

The 15km minimum distance rule means that the provision of healthcare via video conference is based on an arbitrary kilometre criterion rather than clinical appropriateness.

healthcare facilities staffed by remote nurses. Rebating telehealth for this circumstance would deliver valuable assistance to very remote health services and benefit patients with poorer than average health outcomes.

4. GP to children in schools and childcare This is an issue which has not received a great deal of attention, but research from the US indicates that implementing telehealth to childcare centres can reduce children’s attendance at EDs and is costeffective for the entire healthcare system.

Telehealth can deal with minor injuries on the spot, expedite care for more serious matters, or provide reassurance to staff who are unsure about whether the child should be sent home or not.

The purpose of telehealth and video consultations is to offer a possible solution to transcend the conventional boundaries of distance, time and institutional structures. There is a great need for more research and evaluation, shifting the focus from activity and satisfaction to demonstrating positive effects on patient outcomes without restrictions.

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Guest Editorial

RURAL MEDICINE AND TELEHEALTH THE APPROACH OF ACRRM

The Australian College of Rural and Remote Medicine (ACRRM) is responsible for setting professional medical standards for training, assessment, certification and continuing professional development relevant to rural generalist medicine. The use of telehealth in accordance with ACRRM standards is seen by the College as an essential component of effective rural and remote practice.

VICKI SHEEDY Strategic Programs Manager - eHealth Australian College of Rural and Remote Medicine v.sheedy@acrrm.org.au

ACRRM is committed to supporting the delivery of sustainable, high-quality health services to rural and remote communities by providing quality education programs, and innovative support to doctors who serve those communities.

ACRRM recognises that quality rural medical practice is characterised by the provision of a broad range of services, including those facilitated by technology.

It is our commitment to quality health services for rural and underserved communities that resulted in ACRRM designating telehealth skills as requisite for doctors training towards its Fellowship in Rural Medicine.

It also drives ACRRM’s telehealth support and educational programs, which have been operational since 2004, when ACRRM’s store and forward telehealth services – Telederm, Teleradiology and Tele-toxinology – began.

About the author Vicki Sheedy is the strategic programs manager for eHealth with ACRRM and is responsible for the establishment and management of the ACRRM telehealth program. Vicki has over 25 years’ experience initiating and managing medical education and quality improvement programs.

In July 2011, the federal government recognised the provision of telehealth services within the MBS, providing Medicare rebates to patients and financial incentives to clinicians for online consultations across a range of medical specialties under the Modernising Medicare by Providing Rebates for Online Consultations initiative.

In addition to funding direct private consultations between patients and specialists, this initiative provided an MBS item number and incentives for GPs, nurses and Aboriginal health workers at the patient end to conduct a consultation via telehealth.

This initiative expanded the range of telehealth MBS item numbers beyond psychiatry and, for the first time, provided financial compensation for the involvement of the patient-end rural doctor who is responsible for the enduring care of rural people in their local communities.

This MBS rebate and financial incentive removed one of the major barriers enabling video telehealth consultations to become part of routine private rural medical practice. ACRRM strongly supported this initiative and its potential to improve health outcomes and improved models of care.

ACRRM president Professor Richard Murray expresses ACRRM’s position: “Telehealth brings the specialist and the general practitioner together in the shared care of patients. Done well, the shared interaction between referring doctor, the ‘consultant’ specialist and the patient delivers better medical care, strengthened professional relationships and enhanced insights and knowledge for all.

“DoHA emphasised that the decision to use, or not to use, telehealth together with the choice of particular hardware or software methods for consultation should rest with the clinician.”

“This type of symbiotic interaction between GP and specialist has been more typical of how rural doctors and the specialist consultant colleagues work together.

Telehealth affords an opportunity to strengthen that in the bush and to extend the collaborative model more broadly.”

Flexibility for clinicians The government did not establish a monolithic, closed national telehealth system for this initiative, as defined by some state government telehealth systems which have operated for over 10 years.

A reliance on existing standards and industry-enabled competition, innovation and flexibility has also put the onus on the professions and practices to work to establish telehealth relationships as part of referral arrangements for the benefit of patients. DoHA emphasised that the decision to use, or not to use, telehealth

These standards, resources, directories and telehealth virtual network are publicly available on www.ehealth.acrrm.org.au

Virtual community The website is the shop front for ACRRM telehealth activity. It provides:

Vicki Sheedy

“The GP, who may have been inclined to routinely refer away the patient with type 2 diabetes for initiation of insulin therapy, builds skills and confidence. The patient has the benefit of a triangulated and consistent communication for understanding and self-care. The consultant is able to apply their vertical expertise to the really challenging problems.

explored the clinical, contextual and technical considerations relevant to conducting telehealth consultations.

together with the choice of particular hardware or software methods for consultation should rest with the clinician.

In making their choices, clinicians should consider any legal (privacy and security), safety and clinical effectiveness implications.

ACRRM, amongst other organisations, was funded to develop guidelines, education and support arrangements to assist in the uptake of this opportunity to improve access to healthcare for patients who would benefit from telehealth services.

However, for rural doctors, finding the right specialist prepared to provide video consultations, at the right time, using compatible technology was problematic. A practical response was required.

ACRRM collaborated with other national bodies including specialist medical colleges, nursing colleges and peak bodies such as the National Aboriginal Community Controlled Health Organisation (NACCHO), the Royal Flying Doctor Service, industry and standards organisations like the Australasian Telehealth Society (ATHS) to develop support arrangements for clinicians.

These resources were developed according to an endorsed Framework for Telehealth standards developed by ACRRM, which

• Access to a Telehealth Technology Directory, with information about telehealth products and equipment mapped to existing relevant telehealth standards • Access to a Telehealth Provider Directory, with information about clinicians providing telehealth consultations • Access to telehealth discussion forums to connect with other clinicians experienced in the use of the technology in a variety of disciplines, to discuss telehealth solutions with other clinicians and technology providers • Access to telehealth guidelines according to the Telehealth Standards Framework • Access to telehealth education modules for rural doctors, GP practice staff, surgeons, physicians and ACCHS staff • Access to telehealth resources, templates consent forms, business models, implementation guides, requirements analysis etc.

Over 25,000 clinicians access this virtual community, with the most popular resources being the Telehealth Provider Directory and the telehealth technology databases.

The ACRRM Telehealth Provider Directory is the original non-commercial national database of telehealth-enabled doctors available in Australia. The directory is endorsed by the members of the ACRRM

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“The government did not establish a monolithic, closed national telehealth system for this initiative, as opposed to some state government telehealth systems which have operated for over 10 years.�

Telehealth Advisory Committee (ATHAC), which includes specialist colleges across Australia.

ACRRM has developed an information guide to mitigating risk when using Skype for clinical consultations.

The directory, which has been operational since 2012, aims to assist GPs and other patient-end clinicians to obtain relevant information regarding specialists providing telehealth services and vice versa.

As of July 15, 2013, a total of 997 health services have indicated that they are current providers of telehealth services.

This represents almost 2000 practitioners, making the ACRRM directory the largest telehealth directory operating in Australia.

ACRRM validates the registration status of providers against AHPRA data. GP, nursing, Aboriginal health and specialist colleagues are invited to promote their telehealth services in the directory.

Analysis of the data on the directory reveals that many clinicians use more than one technology, with Skype being the default option. Most popular technologies used in order of popularity are Skype, Vidyo, GoToMeeting, Jabber and FaceTime.

ACRRM has recommended that clinicians investing in a telehealth solution use a standards-based product, but we also recognise that issues of quality and potential security risk can be trumped by clinical need in certain circumstances.

Specialists and generalists who provide such services will be invited to register.

ACRRM believes this will improve both access to care as well as the continuity of care for these rural patients.

ACRRM is also working with Heathdirect Australia to further improve access to information regarding telehealth services availability.

Vicki Sheedy

Information includes how to make a telehealth booking, the interests of the clinicians and what technologies they are using.

with specialists visiting rural communities under the Rural Health Outreach Fund to augment these services by providing telehealth consultations in between visits.

Fifty-eight per cent of entries represent patient-end practitioners and 42 per cent are specialist-end practitioners. Rural GP practices are the most represented followed by surgeons, psychiatrists, endocrinology, paediatrics and cardiology.

Over 25 disciplines are represented.

Unmet demand However, there is still an unmet demand for additional services and information about those services.

Of the GPs contacting ACRRM for assistance to contact specialists offering a telehealth service, most requests indicated an interest in contacting a psychiatrist (31 per cent), dermatologist (17 per cent), and/ or a geriatrician (14 per cent).

The directory is expected to expand, as ACRRM has been funded by DoHA to work

Healthdirect Australia has agreed to collaborate with the ACRRM to add telehealth information to the National Health Services Directory (NHSD).

The NHSD is an initiative of all Australian governments to provide a shared, comprehensive and consolidated national directory of health service and provider information.

The NHSD has a search widget that will also be located on ACRRM websites, enabling users of to search the entire directory for a broad range of information, as well as to filter for services that offer access via telehealth.

This approach has been undertaken by the two organisations to support the work being done on the ground by practitioners.

Healthdirect Australia will continue to work collaboratively with ACRRM to increase the accuracy of the NHSD in relation to telehealth and other rural health services.

ACRRM will continue to work with other partners, including the RDAA, medical colleges, Medicare Locals and rural workforce and health service agencies to register providers on the directory and promote telehealth services for rural, remote and underserved communities.

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Guest Editorial

ACTIVITY-BASED FUNDING

THE ELEPHANT IN THE ROOM At the 2013 Health Informatics Conference, held from July 15 to 18 in Adelaide, the dominant themes were digital service delivery and eHealth, with discussion revolving around the revolutionary benefits to be gained through the adoption of digital service delivery applications and eHealth. Yet there was no recognition of the introduction in 2013-14 of activity-based funding (ABF) and its implications.

BRYN EVANS Director, JEMS Consulting bryn.evans@ozemail.com.au

The Commonwealth government’s hospital and health reforms are not working because of socio-economic factors outside of the health sector. That is the view of Martin Laverty, CEO of Catholic Healthcare Australia, who in his opening keynote speech at HIC 2013 argued that socioeconomic factors are the main drivers leading to health outcomes.

Mr Laverty quoted research by the World Health Organisation from its report on social determinants of health, which has shown that the most disadvantaged groupings in education, employment and income suffer the highest incidence of poor nutrition, chronic disease, and lowest life expectancy. The adoption of eHealth and digital service delivery can break down traditional barriers, and reach into underprivileged and remote sectors of the population.

About the author Bryn Evans is a management consultant with many years’ experience as a CIO in healthcare, and as chief executive of a clinical software supplier. He writes extensively across a range of categories and genres, notably in the areas of management, information technology, sport, travel, history and fiction.

From Kaiser Permanente in the US, Jamie Ferguson showed how a teambased care approach is being combined with the provision of mobile and remote device technology. It gives consumers greater access to healthcare services and information, to deliver better healthcare in the community at a lower cost. Through its eHealth (Social Mobile) program, in recent years Kaiser Permanente has seen the fastest growth in its home and virtual care delivery streams. These mobile

personalised health applications include care tracking, monitoring, diagnosis, testing, EKG, ultrasound, electronic and video consulting, and online chat.

Penny Dash from McKinsey & Co in the UK also sees the power of better consumer access and transparency powering an evolution in healthcare delivery. However, Dr Dash believes that the traditional and established institutions of health are obstacles to providing the personalised care of eHealth more effectively, along with constraining costs.

She sees a consumer revolution building, using the example of recent social media pressure which forced the UK government to mandate the publication of death rates of all NHS surgeons. The UK public is increasingly demanding that one should be able to make an appointment online, and communicate by email with a GP. In the Q&A Panel discussion, ABC presenter Tony Jones put forward the very likely scenario that whoever wins the forthcoming election will be seeking budget cuts across all government departments including health. So under such pressure can investment in eHealth be sustained?

Greater use of eHealth and digital service delivery enables increased patient care

and prevention outside of hospitals. By its nature eHealth promotes personalised care remotely, drives efficiency and quality, and assists with better outcomes. Digital service delivery can be used to constrain ever increasing health costs, and by its ubiquitous reach help to alleviate growing staff shortages.

“ABF is the single most important new development for sustaining and exploiting the benefits of eHealth and mobile technology.”

ABF – the unseen elephant in the room?

Bryn Evans

One major initiative that was not discussed in any of HIC’s keynote or plenary sessions was the introduction of activity-based funding (ABF), which is currently being implemented with effect from July 1. Yet ABF is the single most important new development for sustaining and exploiting the benefits of eHealth and mobile technology.

From 2013-14 onwards, healthcare will be funded based upon the data that is reported under the new ABF reporting regime. Many health services are having difficulty in establishing their reporting systems for patient care activity, particularly for non-admitted patients, which has grown rapidly in recent years.

With the emphasis on enhancing preventative care in the community, and the adoption and advocacy of eHealth and mobile technology devices, non-admitted patient (NAP) care is the area which is widely supported to continue to grow faster than in institutionalised care facilities.

Comprehensive and accurate ABF reporting of NAP care is critically essential to support the continued growth of eHealth, to enable increased innovation in personalised healthcare outside of hospitals.

ABF reporting systems, in their entirety but especially for NAP activity, can: • Ensure the effectiveness and maintenance of efficient clinical costing

• •

•

•

•

•

systems, and the appropriate funding of healthcare services, particularly for those which are providing care for nonadmitted patients Identify where NAP activity is inefficient, and not appropriate Inform the cost benefit analysis of the use of eHealth and digital service delivery, where NAP services can be grown to replace or avoid hospital inpatient care Drive the rationalisation and standardisation of many small ‘orphan’ information systems used for NAP care services, which are unable to collect the required NAP data for ABF reporting Encourage the introduction of improved clinical information systems so that effective clinical information systems can capture NAP data to feed into ABF reporting Create a re-energised demand for strategic eHealth planning. All information systems should become compliant with requirements for data extraction, and integration with ABF reporting.

Provide seamless access to patient activity information across the patient journey.

Where NAP information systems are unable to effectively integrate with ABF reporting, or where NAP data is missing, or not captured, there will be the following consequences:

• NAP clinical activity will not be accurately reported, and as a consequence will lose funding • If a NAP clinical service cannot be effectively measured and reported, it cannot be properly managed, and any justification for the service’s continuation will be questioned • New and innovative clinical services, which introduce eHealth and digital service delivery to enable NAP activity, will be unable to cost justify such a new eHealth approach, and be discontinued.

Some conclusions The introduction of ABF reporting of NAP activity is an opportunity not yet recognised to drive the uptake of eHealth and digital service delivery. Where it can be demonstrated that new ways of delivering healthcare to the individual outside of hospital can produce better outcomes and at a lower cost, eHealth and its effective applications will be increasingly adopted.

Those eHealth projects that embrace the need to capture NAP data to feed into ABF reporting, and show improved quality outcomes and lower costs, can only gain. Both appropriate ABF funding and widespread acceptance of digital service delivery will ensue.

Simply put, ABF funding and reporting has the potential to be eHealth’s greatest supporter.

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News

$8m for pathology on the PCEHR but private sector has serious concerns Federal Minister for Health Tanya Plibersek recently announced that the government will spend $8 million to enable pathology results and diagnostic reports to be added to the national PCEHR system, with diagnostic images to come online in future.

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Speaking at the Health Informatics Conference (HIC 2013) in Adelaide in July, Ms Plibersek said the money would go towards configuring desktop software and developing specifications to allow pathology and radiology practices to send results and reports to the patient’s PCEHR as well as their GP. However, the private pathology sector has raised serious concerns with the announcement, saying it was not consulted beforehand and that it continued to have serious concerns about the consequences for patient safety of the government’s proposed method.

Katherine McGrath, CEO of Pathology Australia, said the $8m announcement was part of a “pre-election rush” and that the model the government seemed to be pursuing will be a “disaster”.

Some of Professor McGrath’s concerns were echoed by the Royal College of Pathologists of Australasia (RCPA), which opposes a proposed method of allowing GPs to in effect cut and paste results from pathology tests and upload them to the PCEHR. Professor McGrath said Pathology Australia, which represents large private providers such as Healthscope Pathology and Sonic Healthcare, was “deeply concerned” about the approach the government was taking. “[Ms Plibersek’s] announcement was made without any prior consultation,” she said. “We have since had a meeting

but we have had very little information about what the intention is, and some of the options that they are canvassing we believe have very serious consequences for patient safety.”

Ms Plibersek said the $8 million would be used for alterations to desktop and other software, as well as for the development of specifications. “[It] will be for software providers, vendors and others to change the software to make this possible, and to ensure that all of the software is interoperable and consistent,” she said.

The private pathology industry has worked with NEHTA to develop specifications to allow reports generated by pathology practices to be sent to the PCEHR, with the important rider that cumulative reports would also be able to be integrated into the system.

However, a standstill over funding eventuated last year when Pathology Australia held out for cost recovery for the work that would now be required.

Recently, however, the association dropped those demands for funding.

Professor McGrath said the sector was willing to participate, but that the preferred models had been “dismissed out of hand”.

“This is a very serious problem,” she said. “We have always cooperated with the government on this issue and have tried to work with them. Our attempts to cooperate have been effectively dismissed out of hand, even though in recent times we’ve offered to work with them, to do it for nothing.

“We previously asked for appropriate funding but we’ve made an offer to them to get it up and going at no cost, but we were still dismissed out of hand.

We believe that the rush to get information into the PCEHR is being done now without regard to the consequences.”

RCPA president Yee Khong said the college also held fears for the safety aspects of what was being planned.

Professor Khong said the main concern was the model he understood is currently being considered

by DoHA, in which a GP would be able to take certain parts of a test

result and send that to the patient’s PCEHR. “There is a great deal of danger in that approach,” he said. “The college believes the report should be looked at in its entirety and the pathologist’s interpretation included.”

“We believe that the rush to get information into the PCEHR is being done now without regard to the consequences.”

He also raised serious concerns about the different interpretations pathology practices had due to differences in equipment calibration, but predominantly in the units of measurement they use for different tests.

For example, some pathologists might measure blood glucose in units of millimoles while others use milligrams per decilitre.

Simply cutting and pasting a numerical value would be meaningless – and very unsafe – if the units of measurement are not standardised, he said.

The college has recently completed a standardisation project for pathology units and terminologies, but it is not yet in widespread use.

He said the safest thing to do would be to send pathology reports to the PCEHR as PDFs. Professor McGrath said the sector had no real concerns with a model in which test results were first seen by the patient’s GP and then uploaded by the GP, but that it disagreed with the ability to directly upload data from desktop systems.

“The risk then is of maintaining reliability and accuracy. Who is accountable for making sure the latest result and amended results are up there? The GP or the pathology provider?”

A DoHA spokesperson rejected the claims that the sector was not consulted about Ms Plibersek’s announcement. “The Department of Health and Ageing is in fact discussing with key stakeholders, including Pathology Australia and we have assured everyone that we wish to engage them and on the design for pathology and PCEHR,” the spokesperson said.

ePIP deadline for SMD commissioning extended General practices taking part in the eHealth Practice Incentives Program (ePIP) have been given an 11thhour reprieve after the deadline for commissioning a secure messaging service was extended by three months.

Originally slated for August 1, the deadline was extended on July 26, with a DoHA spokesperson confirming it had issued an amendment to the ePIP secure messaging capability requirements in consultation with NEHTA, the Australian Medicare Local Alliance (AMLA) and the Department of Human Services (DHS).

Over the past few months, numerous sources have expressed concerns to Pulse+IT about the preparedness of many general practices to commence the SMD commissioning process, with many unable to produce their NASH certificate or associated password.

Others have reported difficulty updating their listings in the Healthcare Provider Directory, with recent changes to Health Professional Online Services (HPOS) relating to contracted service providers also causing confusion.

Pulse+IT obtained a copy of a document issued to certain groups on July 26, which confirmed that general practices would be provided with additional time to commission a compliant secure messaging product.

“We will be consulting with all key stakeholders, again including Pathology Australia, on the proposed model for including pathology reports in the PCEHR.

The document said practices will be considered to comply with requirement two of the ePIP if by August 1 “they have booked, arranged or registered for a compliant secure messaging product to be commissioned”.

“Of course, patient safety will be a priority, just as it is for all other aspects of the eHealth record.”

A DoHA spokeswoman said any practice that doesn’t meet the amended secure messaging capability requirements should advise DHS by October 31.

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Bits & Bytes

Indigenous healthcare resources at the point of care The team behind the Indigenous HealthInfoNet web resource has recently launched ClinicalInfoNet, a web portal aimed at clinicians to assist them in the prevention and management of chronic disease among indigenous people.

The resource is available for all primary and allied healthcare clinicians online or from within the PrimaryCareSidebar tool in Medical Director and Best Practice. The resources cover cancer, cardiovascular disease, diabetes, kidney disease and chronic respiratory disease.

ClinicalInfoNet project manager Kathy Ride said it was targeted mainly at GPs and primary healthcare workers, practice nurses, indigenous healthcare workers and allied health professionals and is designed to be used at the point of care, such as during a patient consultation.

Clinicians can freely access evidencebased clinical guidelines, tools and patient education resources during consultations, all from one website and in real time.

The site allows clinicians to do an easy search for types of publications and treatment pathways depending on the chronic disease. All of the publications and tools are evidence-based and have been approved by an external panel of experts in indigenous health or chronic disease.

Ms Ride said more publications would be added to the site over time, and that options were being explored to broaden access through clinician software.

“The PrimaryCareSidebar is currently compatible with Best Practice and Medical Director, but we are fully aware that Communicare and MMEx are two other systems that are widely used in indigenous health and we are already in the process of looking at upgrading the Sidebar to have connectivity to those two,” she said.

NEHTA aims for meaningful use of PCEHR through clinical usability program NEHTA has established a clinical usability steering committee to oversee potential improvements to the PCEHR to make it more useful and usable for clinicians.

was being designed and before it was launched, Dr Haikerwal quoted Francis Urquhart of House of Cards fame, saying “you may say that but I couldn’t possibly comment”.

A steering group for NEHTA’s clinical usability program (CUP) met for the first time recently to provide strategic oversight of the CUP and as an “escalation point” for issues affecting the safe and meaningful use of the PCEHR in the clinical setting.

The first issue being tackled is GP desktop software and the interfaces to the PCEHR that have been designed by the different vendors within their clinical systems. Each software product is different in the way users build shared health summaries, for example.

The steering committee will be chaired by NEHTA’s head of clinical leadership, safety and stakeholder management, Mukesh Haikerwal, who has been the driving force in establishing the group.

“Each package and the way they display data and documents is different

Dr Haikerwal said the idea was to assess problems with the usability and usefulness of the PCEHR and find ways to fix them.

“The idea is that something has been delivered, it has got some great potential but it needs to be made more useful, usable and safe,” Dr Haikerwal said. ‘ “This is to call out the various parts of the current build to try and address the problems of usefulness, usability and utility.”

Asked if this should have been done while the PCEHR

and it would be potentially confusing if there was not some coming together in the way in which that is done,” Dr Haikerwal said.

“When I look at doing a shared health summary, there are bits on there that make little sense and need to be reviewed, for example the date order in which we put up the shared records.

It doesn’t put the most recent one on the top – it puts the most recent one on the bottom.

“They also pull out of the list what they consider from the desktop system a procedure. I’ve just done

one today, and it didn’t pull out surgery to carcinoma of the colon as a procedure.

Luckily it did pull out the coronary bypass graft as a procedure.

licence to create its own look when designing its interface to the PCEHR, as long as it followed the technical specifications created by NEHTA.

“You can see that it could be so good if it could be improved. We are not dealing with a blank sheet – we are dealing with a significant build so we have something to tweak.”

Another issue the steering group may consider is the matter of incorrect data being uploaded to the PCEHR, as happened to a Pulse+IT reporter several months ago when incorrect PBS data was unintentionally added.

Pulse+IT understands that any changes to the software suggested by the CUP are not mandatory, and that most of the issues are thought to be minor. Each software vendor was given

“That is a perfect example,” Dr Haikerwal said.

“Medicare made [PBS data] a clinical tool by joining it to the eHealth

record. I personally use the information on there to verify medications with my patients.”

Dr Haikerwal estimates he has created about 60 shared health summaries. “I’ve also done a large number of event summaries and they too have clunky bits in them that we need to work through.

“The number one issue we are looking at is the user interface and the next one is on the actual utility. Nobody expects perfection, but we expect it to be admitted if there are problems because then you can fix them.”

Photos and email added to AutumnCare Aged care software vendor AutumnCare has released version 4.4 of its enterprise-grade product, adding enhanced camera support technology that allows photos to be embedded within the resident’s file and a oneclick email or messaging function complete with a full audit trail.

AutumnCare managing director Stuart Hope said his team has redesigned the software so that it cannot only talk to Intel’s medical-grade tablet PC architecture but to any Windows-based device that has cameras, and which allows photos to be taken and embedded directly to the patient record.

The camera feature provides a way to take a photo using any Windowsbased device that allows the photo to be added to the patient’s record, including photos of wounds that can be directly embedded into the wound management assessment form.

AutumnCare has also added the ability to send full emails from within the software, which the company has avoided allowing in the past due to privacy reasons.

“It’s a problematic area because once you send an

email out you lose control, so we’ve devised a number of methods to do this,” Mr Hope said.

“We allow our clients to define authorised email addresses that can be sent to, such as GPs or pharmacists, or they can configure it to send to anyone. We can also track the return emails so you can have emailing from within AutumnCare but with an audit trail.”

Users can also send a message to other staff directly from a case note, aimed at streamlining communication and improving productivity.

DCA buys residential and community aged care suite Database Consultants Australia (DCA) has acquired the residential and community services division from CSC, including client contracts, staff and intellectual property.

DCA has an established footprint in residential and community aged care with its The Care Manager (tcm) solution and a growing footprint in community care following last year’s acquisition of Aboriginal healthcare specialist Communicare.

Peter Dannock, divisional general manager for The Care Manager at DCA, said the company had effectively acquired what was known as the aged and community care (ACC) business of CSC. “That suite was previously known as KCS and was part of iSOFT and before that IBA Health’s community and residential offerings in the past,” Mr Dannock said.

“What we have acquired is their software for residential aged care and community aged care, and there is also a component involving the finance aspects of that sector.”

A spokesperson for CSC said the aged care management software products were originally acquired when CSC purchased iSOFT in 2011. CSC has sold the suite as part of its strategy to rebalance its portfolio of services and focus on its core strength in next-generation technology solutions and services, she said.

DCA is a member of NEHTA’s aged care software vendors panel with tcm, and the primary care vendor panel with Communicare. Both have passed notice of connection and conformance, compliance and accreditation testing to interface with the PCEHR. In addition, DCA’s Argus secure messaging product has passed conformance and compliance accreditation for secure message delivery.

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MediSecure to hook up to the prescription respository Prescription exchange service MediSecure has announced it has signed a commercial agreement with NEHTA to integrate with the National Prescription and Dispense Repository (NPDR).

The move will mean that both prescription exchange vendors, MediSecure and eRx, will now be able to link to the repository, which has been built as part of the national PCEHR infrastructure.

When fully rolled out, the NPDR will provide a comprehensive list of prescribed and dispensed medications for each individual, irrespective of who they were prescribed or dispensed by.

Consumers have a view within their PCEHR of data sent to the NPDR, although the actual repository has only recently gone live. Certain pharmacies and general practices that were involved in the MedView project are currently able to access it through their software.

Pharmacies involved in the trial that have registered for the PCEHR and are using Fred Dispense or Simple Retail’s Aquarius dispensing software can now send patient data to the NPDR with the patient’s consent.

Some general practice software vendors are currently working on integrating the functionality within their products, with Genie and Aboriginal healthcare specialist Communicare already having completed the integration.

NPDR integration will gradually be rolled out throughout the primary healthcare, community pharmacy, hospital pharmacy, acute care and aged care sectors.

MediSecure CEO Phillip Shepherd said the next step is to have full engagement from all clinical and dispense software vendors to add data to the NPDR and PCEHR.

NSW to link hospital and community care clinicians to the PCEHR in August NSW Health plans to allow clinicians in its public hospitals and community health services to view clinical documents and images held in statewide repositories and the national PCEHR through a new portal.

The portal will be integrated into the Cerner acute care EMR system and the CHIME community care solution by the end of August.

NSW Health also plans to begin a wider rollout of electronic discharge summaries from hospitals to GPs, with the ability to upload them to the PCEHR also due by August 31.

Pulse+IT understands that this is part of NEHTA’s rapid integration project (RIP), which aims to have discharge summaries sent to the PCEHR from most public hospitals by the end of the year.

NSW clinical repository business architect and acute care physician Will Reedy told the Health Informatics Conference (HIC 2013) in Adelaide recently that the Orion Health-built portal would enable hospital clinicians using Cerner, and community care clinicians using CHIME, to view documents held in the patient’s PCEHR and in NSW Health’s clinical repositories.

Those health services using Orion’s EMR, including the Hunter New England Local Health District (LHD), will also be part of the roll out.

In addition to the national PCEHR, the portal will allow authorised clinicians to view diagnostic images and reports contained in the NSW enterprise imaging repository (EIR), which went live in February 2012.

“[We] will provide a clinical provider portal which we are building into Cerner or Orion that essentially tells the clinicians that the patient has a PCEHR...”

All of this is enabled by the state’s enterprise patient registry, which is able to link the different identifiers used by hospitals and health services and the national Healthcare Identifiers (HI) Service.

The repositories and the portal are part of the HealtheNet program, first developed by the Greater Western Sydney Wave 2 site for the PCEHR. “With HealtheNet, we will provide a clinical provider portal which we are building into Cerner or Orion

that essentially tells the clinicians that the patient has a PCEHR and that there is information from outside the organisation,” Dr Reedy said.

“They can see information from the PCEHR, diagnostic images (from the clinical repository) and some community information.

“There is a single click that opens up a separate browser window and it logs the clinician in within the patient context ... and it provides access to all of the state and national repositories.”

Dr Reedy showed an example of the portal in the Cerner EMR, demonstrating how for a particular patient, a simple link will show clinicians that there is information contained within the state repositories and in the PCEHR, with a menu on the left showing what that information is.

In the link to the PCEHR, for example, it shows what shared health summaries have been uploaded as well as medicines prescribed and dispensed through the National Prescription and Dispense Repository (NPDR). The menu mirrors the clinical information contained on the patient’s individual record.

Joe Hughes, the architect of the enterprise imaging

repository, said the portal would allow clinicians to view diagnostic images and reports contained by internal and external public health organisations, including DICOM and HL7 integration. “If you are a radiologist and you are doing a report on the patient, the images from the EIR will appear as a prior study,� Mr Hughes said.

He said that while the private diagnostic imaging and pathology sectors were not part of the scope of HealtheNet program, the 11 different PACS/RIS systems, nine EMRs and nine PAS systems used in public healthcare organisations across the state will all be integrated in time.

The foundation of the whole HealtheNet program is the

enterprise patient registry, which is able to match identities from multiple jurisdictions across the state as well as the HI Service, Mr Hughes said.

Dr Reedy said HealtheNet was also building assisted PCEHR registration within its systems, with a project recently launched at Blacktown Hospital.

He said 80 per cent of people approached in an outpatients clinic had signed up to a PCEHR. HealtheNet, which included the building of the enterprise imaging repository, the enterprise patient registry, an enterprise service bus to allow NSW Health to share information with private providers like GPs, and the electronic blue book for newborns, which has since been adapted for

the PCEHR nationally, is expected to be rolled out statewide.

Some of these elements are also due to go live in August in the Western NSW Local Health District, which takes in regional population centres such as Bathurst, Orange and Dubbo.

Mr Hughes said the enterprise imaging repository, which was built with the assistance of Fujitsu, TeraMedica and Oracle, was live in western Sydney and western NSW, with plans for the rest of the state to have access by the end of the year.

Dr Reedy said NSW Health also planned to use its repository infrastructure to support other eHealth innovations such as mobile apps for consumers and providers.

GS1 to launch healthcare Recallnet Not-for-profit standards and barcoding organisation GS1 Australia will launch a healthcare industry version of its Recallnet system for product recall and withdrawal notifications for therapeutic goods in September.

GS1 Recallnet Healthcare has been developed over three years by GS1 Australia in association with NEHTA, the Therapeutic Goods Administration

(TGA), state and territory health departments and the industry.

It will provide an electronic product recall notification system for the Australian healthcare sector to improve the speed, efficiency and accuracy of the recall process for therapeutic goods.

A similar service was launched for the food industry in 2011, with

grocery, food and liquor products able to be withdrawn or recalled quickly and easily.

It will allow users to create recall and non-recall notifications following the uniform recall procedure for therapeutic goods guidelines and to submit recall notifications to the TGA for review and approval. The service will officially launched by GS1 next month.

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eRx to launch QR code scanning app for pharmacy eRx Script Exchange will launch its first smart phone app to connect consumers with its national eScripts network in October.

The eRx Express app will allow consumers to scan and pre-order their medicines from their regular pharmacy or other pharmacy of choice.

The app works by scanning the QR code that will begin to appear on prescriptions, replicating the eRx barcode information on each script.

Customers can then collect their medicine at a convenient date and time. They hand over their paper script at the same time that they collect, ensuring that all PBS requirements are met.

Paul Naismith, CEO of eRx parent company Fred IT Group, said the app was a bridge between the convenience of the mobile world and the privacy and security of the national eRx network.

“With the explosion in the use of mobile apps over recent years, we are pleased to be launching applications that provide consumers with the mobility and convenience that they want,” he said.

Because the app will use individual QR codes that replicate the eRx barcode on each script, script requests sent via eRx Express will integrate directly into the pharmacy dispensing system, saving time as there is no re-keying of data, he said.

“Innovations such as eRx Express also have real potential to help smooth out the peaks and troughs of the dispensing workload,” he said. “Ultimately, apps such as these can reduce queue times in pharmacies, which benefits our customers and staff, and frees up pharmacy to spend more time helping customers with their healthcare needs.”

Doctors’ views on patient access to EHRs will “need to evolve”: Accenture While most Australian doctors want patients to actively participate in their own healthcare, there is still a great deal of reluctance about allowing patients full access and input into their electronic health records, a view that will need to evolve as patient expectations change, according to technology services company Accenture.

Leigh Donoghue, managing director of Accenture’s health business in Australia and New Zealand, said more needs to be done to enable consumers to play an active role in their own care, including overcoming the cultural issues that suggest Australian doctors may be more resistant to change in this area than doctors in comparable countries.

A recent survey by Accenture found that the majority of Australian doctors say sharing health records electronically has a positive effect on reducing medical errors and improving the quality of diagnostic and treatment decisions, but that they were not in favour of allowing patients to have full access to those records.

The global survey was taken late last year and involved 3700 doctors in eight countries, including 500 from Australia. The

survey found that 83 per cent of Australian doctors said they were actively using electronic medical records and roughly 70 per cent reported improved quality of diagnostic and treatment decisions as a result of their use of shared electronic health records.

In terms of patient access to records, the survey found that 83 per cent want patients to actively participate in their own healthcare by updating their electronic health records.

However, the majority believe that patients should only have limited access to this record, a view shared across the eight countries.

The survey found broad agreement among Australian doctors that patients should be able to update standard information in their health records, including demographics (87 per cent) and family medical history (78 per cent).

However, a significant proportion of doctors were opposed to patients providing updates in areas such as medications (29 per cent), medication side effects (28 per cent), allergic episodes (26 per cent) and lab test results (59 per cent).

The level of opposition to such patient input was notably higher than most

other countries, the survey found.

“That is the thing that stood out for me when I look at Australia and the other countries surveyed,” Mr Donoghue said. “There was commonality across countries, and a growing interest reported, in the benefits of increased use [of EHRs and EMRs], but it was around patient access and the patient’s ability to contribute to the record that we saw some notable differences.”

Mr Donoghue said some of this is likely to reflect cultural differences but there were economic reasons as well. In the US system, for instance, patients have more choice in healthcare provision, which Mr Donoghue said adds a competitive element not apparent here.

“You see countries at one end of the continuum like the US where it seems that clinicians’ attitudes are that not only should patients have access to much of the record, but they should be able to play an active role as a co-contributor,” he said.

“Australia is towards the other end of the continuum with countries like Germany, where doctors are more reluctant. I think there are some pretty legitimate reasons why they may feel uncomfortable

with some of this; for instance, the ability of patients to contribute to the interpretation of their pathology results.

“Most doctors would feel uncomfortable with that, but again it’s the comparison across countries that points to a more deep-seated cultural issue around perceptions of the patient and the role that the patients play and should play in the management of their own care.

“I think some of it is a lack of familiarity with models of care where the patient is actively involved and plays a useful role. In the US, because the patient has more choice arguably, there’s a competitive dimension to put more emphasis on the patient experience.”

The survey found that less than a quarter of Australian doctors (18 per cent) believe that a patient should have full access to their own

record, 65 per cent believe patients should have limited access and 16 per cent say they should have no access.

Australia ranked second highest of the eight countries surveyed in the proportion of doctors that say patients should have no access to their record.

Mr Donoghue believes this will have to change as patients become more accustomed to having easy electronic access to their own information.

“It is going to have to change,” he said. “That is what we are seeing in other industries. One of the big differences is the uptake of mobile devices and the consumer having information and the ability to transact at their fingertips. If I can do that in banking and with telecommunications and I can do it with many of the services that I receive, why can’t I do that with healthcare?

“It is the road to the digital citizen and the digital citizen doesn’t take a different approach to healthcare. That’s why I think these cultural issues and their implications for how we provide health services are going to have to be tackled.”

Mr Donoghue said the combination of smartphones, faster broadband, mobile access to the PCEHR system, and a growing array of mobile health applications will trigger fresh demands from consumers for more active participation in managing their own care.

“There are obviously some things that have to be done and which are happening now,” he said.

He said some deepseated education and cultural issues will need to be overcome to improve information sharing, which will have a flow-on effect on models of care.

RACGP releases revised security guidelines The Royal Australian College of General Practitioners (RACGP) has released its revised computer and information security standards (CISS) guidelines, which provide general practices with information and recommendations about contemporary security issues and help protect against potential loss of sensitive data.

The intent of the second edition CISS is to provide a framework, accompanied by practical templates and a workbook, to protect electronic business and clinical information within a healthcare setting.

The new edition incorporates participation and legislative requirements for the PCEHR, a compliance indicator checklist, and a compliance indicator matrix and explanatory notes for each of the 12 computer and information security standards.

John Bennett, chair of the RACGP’s national standards committee for eHealth, said it was essential that GPs and their practice teams implement computer security measures to protect business and clinical information.

“Computer and information security is not optional; it is an essential professional and legal requirement for using computer systems in the delivery of safe quality healthcare,” Dr Bennett said.

“By securing content held in practice information systems, the practice not only maintains professional responsibilities to patients and ensures practice information remains accessible and accurate, it lessens the risk of greater security breaches and the negative effects these create.”

The CISS provides a record of the 12 basic computer and information securities that should be undertaken across all general practices.

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Quality improvement site for Medicare Locals The Improvement Foundation (IF) has launched a new site on its qiConnect web portal aimed at helping Medicare Locals to use healthcare data to enhance quality improvement within their regions.

IF, which runs the Australian Primary Care Collaboratives (APCC) program and the eCollaborative, which aims to support general practices and health services to be ready to use the PCEHR, is a not-for-profit organisation that uses the collaborative methodology to help bring about quality improvements.

The qiConnect portal contains a large amount of data submitted by general practices and health services and allows users to access hundreds of case studies and tested ideas.

The Medicare Local quality improvement (QI) sites on qiConnect can supply realtime, local data that can be used to support quality improvement initiatives and facilitate reporting by Medicare Locals.

Within the new QI sites, Medicare Locals can create their own resource library, reports, discussion boards and projectspecific pages, as well as participating in the broader qiCommunity, which links them to other MLs and organisations in the primary healthcare sector.

Kevin Arlett, chair of Townsville-Mackay Medicare Local, which has worked closely with IF to develop its own QI site, said qiConnect will bring the management and utilisation of practice data into the 21st century with data collection capabilities for a standard suite of measures.

“This system simplifies retrieval and analysis of data for general practices, so they can be proactive in their service delivery,” Dr Arlett said. “We look forward to launching qiConnect across our 240,000 square kilometre territory.”

NSW Health considering FirstNet ‘Lite’ for small emergency departments The NSW Ministry of Health is currently reviewing a simplified version of the Cerner FirstNet emergency department clinical information system to see whether it would be suitable to install in smaller EDs throughout the state.

Julie Roberts, director of the electronic medical records (EMR) program at HealthShare NSW, told the Health Informatics Conference (HIC) in Adelaide recently that as part of the ongoing adoption of the EMR statewide, the needs of EDs in smaller hospitals were being examined.

“We have built a FirstNet ‘Lite’, which is the Cerner ED solution, and we’ve made it simpler to use,” Ms Roberts said.

“It is currently being reviewed by the Ministry to see if it could meet the needs [of smaller EDs].”

FirstNet has been plagued by reports of poor performance for a number of years, leading the NSW government to commission Deloitte to do an independent review of the system in 2011.

Deloitte recommended the establishment of a remediation program to fix some of the problems, which is now underway.

The remediation program aims to improve usability, performance and work processes and some functionality in FirstNet. Ms Roberts told the conference that HealthShare NSW has been

working with Cerner on a number of enhancements, saying “there are 30-plus enhancements that are on their way”.

NSW Health is also beginning to roll out the Dragon speech recognition software in EDs across the state following a number of pilots. Pioneered by ED staff at Manly Hospital in Sydney, the Dragon system can be used to assist in completing clinical documentation within FirstNet. NSW Health is also further rolling out its electronic Between the Flags (BTF) program for ED nurses.

BTF is aimed at helping ED staff to identify when a patient is deteriorating and involves nurses recording five vital signs within the

EMR, which graphs the information in three bands of white, yellow and red.

Red signifies an emergency response is required.

According to a NSW Health video shown at the conference, the department plans to roll BTF out across the state and beyond the ED to the wards, where it is planned to become core clinical practice.

Part of Ms Roberts’ team’s work involves standardising commonly used clinical documentation such as progress notes, treatment plans, patient histories, clinical assessments, risk assessments, checklists and discharge summaries.

Electronic discharge summaries are being designed to be CDAcompliant, and the plan is to roll them out to all local

health districts (LHDs), Ms Roberts said.

She also discussed moves to create a centralised patient summary page that can draw information from within the EMR but also link to external clinical repositories and the patient’s PCEHR. This patient summary portal was demonstrated by acute care physician Will Reedy, who said NSW Health plans to allow clinicians to use it to view clinical documents held externally and in the PCEHR by the end of August.

Ms Roberts said the department was looking at several concepts to try to bring “the maze of data” together.

She is also working on the Community Health and

Outpatient Care (CHOC) program, which aims to provide IT solutions for mental health, allied health, child and family health, chronic care, aged care, sexual health, Aboriginal health and community health.

These solutions will include a mixture of CHIME – a bespoke system for the NSW community health sector designed many years ago that has since been replatformed by Fujitsu – and the Cerner EMR, depending on what each LHD requires, Ms Roberts said.

NSW Health went out to tender earlier this month for a mobile forms solution that will enable community health workers to complete forms electronically when they are with the patient and upload the data directly to the EMR.

Best Practice prepares for 2014 summit Clinical software vendor Best Practice will hold its annual summit in Coolum on Queensland’s Sunshine Coast in March next year.

Best Practice decided not to hold a summit in 2013 as resources were stretched working on PCEHR integration, but chief commercial officer Craig Hodges said the company was preparing some new ideas for next year’s event, to be held in March.

“The Bp summit seems to enjoy a strong following amongst our customers and users, and it already holds iconic status as a major medical software event,” Mr Hodges said. “In fact, in my seven months here the question I’m asked most is ‘when is the next Bp summit?’”

He said strategic decisions about the format, intent and location of the event had now been finalised.

Best Practice users can register their interest by emailing bpsummit@ bpsoftware.com.au. Online registrations for the summit will open later this year.

Best Practice has also released version 1.8.3.602 of its software, featuring changes reflecting the update to the National Immunisation Program Schedule, including the addition of varicella to the MMR combination vaccine.

Medibank to integrate Arezzo clinical decision support Medibank Health Solutions has signed a contract with UK-based InferMed to integrate its Arezzo clinical decision support software into Medibank’s platforms.

The Arezzo clinical decision support technology enables the design and creation of clinical pathways, guidelines and patient care protocols and is used in extensively in general practices in New Zealand.

InferMed also signed a deal in June last year with the Northern Territory Department of Health to use its Arezzo optimal pathways application (OPA) to develop a care pathway for antenatal care, which is also being extended to implement a second guideline for hearing health in Aboriginal populations.

The OPA is also expected be linked to the NT’s My eHealth Record (MEHR) for remote populations.

Arezzo powers England’s popular NHS Direct online health and symptom checker website, which also has an accompanying mobile app.

For Medibank Health Solutions, Arezzo will first be used as part of an integrated solution for Medibank’s workplace health business, which provides injury prevention and health management services to employers. It will then be extended to its call centre offerings.

The ultimate goal is to provide an end-toend service, allowing a patient to begin their interaction with Medibank Health Solutions through a self-diagnostic and treatment website, passing through to a nurse-based call centre if necessary, providing services for chronic disease management and workplace health checks, and interfacing with the patient’s clinical records, all using Arezzo.

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NSW and NT prepare for advance care planning The NSW government has released a fiveyear plan outlining moves towards better end of life care by using advance care planning, which will see changes made to aged care, hospital admissions, clinical reviews and discharge procedures as well as the incorporation of advance care plans in all electronic health records.

The government’s plan is aimed at normalising advance care planning and improving end of life care by integrating patients’ wishes into and throughout the management of life-limiting illnesses.

As part of the strategy, NSW Health will work with Medicare Locals, local health districts (LHDs), aged care services and with the Commonwealth, particularly in relation to incorporating advance care planning into the national PCEHR and enhancing its uptake in residential aged care facilities.

The strategy will see LHDs work on developing admission procedures that routinely include identification of prior advance care planning. They will also work with shared services division HealthShare NSW to ensure advance care directives, advance care plans and acute resuscitation plans are flagged in patient data systems and electronic medical records.

The Northern Territory government is also working on what it is calling advance personal planning, releasing an issues paper and draft legislation to allow adults to make decisions about their future needs in advance, in case they lose the capacity to make their own decisions.

The legislation will be essential to allowing NT residents to upload advance care directives to the PCEHR, as there is no current legal standing in the Territory for advance care planning or a person’s representative should that person no longer be able to make decisions.

Phone a lifesaver with emergency ID app Medical jewellery distributor Emergency ID Australia has released an app for Android and iOS that shows critical medical details as wallpaper on the locked screen of their mobile phones.

The app allows users to display urgent information such as allergies and emergency contact details on the screen for easy access by paramedics and emergency professionals.

Many people with health issues store their ‘in case of emergency’ (ICE) details

on their phones, but these are not much use when the phone is password protected and the user is unconscious.

Emergency ID Australia’s founder and director, former police officer Nicole Graham, said her own health history had highlighted the need to share critical information.

Ms Graham set up the company to develop and distribute medical jewellery and accompanying products after suffering complications from

an undiagnosed heart condition. The jewellery, which includes bracelets and pendants for adults and children, is aimed at those with an existing medical condition such as diabetes, epilepsy, allergies and dementia. The app is also targeting these groups.

“As someone who has undergone major surgery and had numerous doctors, procedures and medications to keep track of, I understand how difficult it can be to recall everything, particularly when you are ill, injured,

shocked or flustered – and obviously impossible if you are unconscious,” Ms Graham said.

“It allows you to store and save more detailed medical information inside the app for your own records, and to share them with your

doctors and healthcare professionals.”

In addition to displaying an emergency contact or medical condition alert on the screen, users can store information on their current medical conditions, allergies and reactions,

history of procedures, doctor’s details, where records are kept, insurance, medications and dosages, and emergency contact details within the app.

The app is available from the Apple App Store and Google Play for $3.

DoHA to provide medicines dosage data with brand name on PBS schedule The Department of Health and Ageing (DoHA) will provide the strength of ingredients for several multi-active drugs as part of their brand name in the PBS schedule, a move it says will help overcome problems that have arisen after a change in the way medicines are listed.

Medical and pharmacy groups had written to DoHA to demand it reverse a change to the listing of generic descriptors for multi-active medicines on the PBS, saying the change was causing problems with medical software and was potentially a safety issue.

Representatives from the Australian Medical Association, the Pharmacy Guild, the Pharmaceutical Society of Australia, Pharmaceutical Defence Ltd and the Medical Software Industry Association wrote to DoHA about the issue, saying the main cause for concern was the potential to prescribe or dispense

multi-active drugs in the wrong strength.

The organisations say the change was made to the PBS to make it consistent with the Australian Medicines Terminology (AMT), but it is now conflicting with the packaging and product description of medicines approved by the Therapeutic Goods Administration (TGA).

They use the example of Coveram, which is prescribed for patients with hypertension. Coveram has two main active ingredients – perindopril and amlodipine – and comes in different dosage strengths. One is Coveram 5mg/10mg, which has 5mg of perindopril and 10mg of amlodipine.

Coveram has always had perindopril listed first since it was approved for the PBS in 2010, and this is the way it appears on product packaging, as approved by the TGA. In prescribing

and dispensing software, it was formerly listed as perindopril/amlodipine tablets 5mg/10mg.

Now, however, due to a change in listing the generic description alphabetically, it appears on the PBS as amlodipine 10mg + perindopril 5mg, which is being shown in medical software as amlodipine/ perindopril tablets 5mg/10mg.

The problem is also possible with other multiactive drugs identified, including an ointment for psoriasis, a brand of eye drops and the painkiller Panadeine Forte.

The introduction of AMT descriptors in PBS data began with the release of the department’s PharmCIS system last November. Mapping to NEHTA’s AMT codes is necessary for implementing developments such as the electronic transfer of prescriptions (ETP).

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Web-based resources provide pathways to healthcare Western Sydney is introducing a HealthPathways program for local healthcare providers, based on the system pioneered by the Canterbury Initiative in New Zealand and also up and running in the Hunter New England region of NSW. HealthPathways is a web-based information portal for a range of common conditions that is tailored for local healthcare practitioners based on the resources available in the area.

Decision support during trauma treatment sees major reduction in errors The introduction of a computerised decisionsupport tool for treating trauma patients in the emergency department of Melbourne’s The Alfred Hospital has seen the rate of clinical errors reduce by 21 per cent.

It has been used since 2011 in the Hunter New England region, and is now being introduced to the Barwon region in Victoria, the NSW central coast and in western Sydney, where it is being championed by the Western Sydney Local Health District (WSLHD) and the Western Sydney Medicare Local (WSML).

The system, known as Trauma Reception and Resuscitation (TRR), was devised by the head of The Alfred’s Trauma Centre, Professor Mark Fitzgerald, with the software designed by a team led by Kon Mouzakis, head of the Software R&D Group at Swinburne University.

Tim Usherwood, a professor of general practice at the University of Sydney and deputy chairman of WSML, said the idea had been around in hospitals for a long time to map the care of conditions and hence to standardise them. “This is a similar model for the community,” he said.

TRR has been trialled over almost three years in two of The Alfred’s trauma bays, and in that time errors have reduced markedly, as has the amount of blood used in treating trauma patients.

For type 2 diabetes, for example, the HealthPathway would include information on local dietetic or podiatry services, but also locally agreed guidelines for referring retinal abnormalities.

“Another example is chronic kidney disease,” Professor Usherwood said. “A nephrology clinic is likely to prefer to see only people with more advanced disease or with particular complications.

TRR is a real-time computer-aided decision and action support tool that is designed to be used in the first 30 minutes of trauma management. It involves a scribe – usually the trauma nurse leader – entering patient data such as diagnosis and treatment via a touchscreen.

“With HealthPathways, you can have a local conversation about the referral criteria, what things might be required before referral and then write those things into the local pathway. There is a national standard of care, which is evidence-based, but this tailors it to local needs.”

Vital sign data is captured from monitors and all of this information is displayed overhead on a large LCD screen. At the heart of the system is a series of medical algorithms that

takes the data and prompts the trauma team in real time to confirm the state of the patient, perform certain procedures and administer drugs. If the level of oxygen or heart rate goes below the threshold of the algorithm, for instance, alerts appear on the screen.

“We thought a significant reduction [in errors] would be about five per cent but it came to about 21 per cent.”

Mr Mouzakis said trauma doctors know what they are doing and the system in no way replaces their expertise. However, analysis of the data collected over the trial has shown that in first 20 or so minutes after a trauma patient arrives, a clinical decision has to be made every 72 seconds.

“Things do get missed,” he said. “This system is designed to prompt you and to ask if you have checked X or have you checked Y.” Mr Mouzakis said the system was trialled in two of the four trauma bays at The Alfred, but due to its success in reducing errors it is now used in all four.

“In the study the patients were assigned to a trauma bay randomly, and they collected quite a substantial number of patient data over 30-odd months.

“There was an independent review done on the data – we provided the information and a video auditing tool – and there was a substantial reduction in human error.

“We thought a significant reduction would be about five per cent but it came to about 21 per cent.”

There was also a huge reduction of upwards of 80 per cent in the amount of blood administered to patients, he said.

“Administering blood into trauma patients was very common, whereas this walks you through it to make sure everything is on the right path. The reduction in blood came out of left field.”

Mr Mouzakis and his team have installed a version of the software on a Windows 8 tablet device that will enable it to be used in the field, he said. They are also keen to see it in use in regional hospitals that don’t have trauma teams.

“A lot of cases of severe trauma happen on country roads, so to be able to get to a facility and use the technology would be great.”

HISA board and award winners announced at HIC 2013 The Health Informatics Society of Australia (HISA) announced the new members of its board and its award winners at the Health Informatics Conference (HIC 2013) in Adelaide recently.

The current members of the board are chair Katerina Andronis, Jen BichelFindlay, Tam Shepherd and David Hansen.

This year, Phil Robinson and Nick Buckmaster have been re-elected to the board, and new members are Siaw-Teng Liaw and Cathy Campbell.

The winners of the Don Walker Awards were Chuck Parker of Continua Health Alliance, Helen Delimitros of Alfred Health and Leon

Heffer of BioGrid Australia.

Helen Almond from the University of Tasmania is the inaugural winner of the Joan Edgecumbe Scholarship.

Martin Seneviratne (pictured) beat 44 other entries in the HISA App challenge, worth $8000, with his iResident, a tablet-based app for junior medical officers that acts as a to-do list and which he hopes can be integrated with electronic medical records.

Research into the effect of an electronic medical record on the quality of laboratory test orders won the Branko Cesnik award for best scientific paper.

The study, led by Andrew Georgiou of the Centre for

Health Systems & Safety Research at the University of NSW, assessed the type and frequency of preanalytical laboratory test order errors that were associated with the EMR across three hospitals and one pathology service.

The best student paper was won by Alison Craswell of the University of Wollongong for her paper on the computerisation of perinatal data entry. The paper presented findings from doctoral research into issues of concern identified by midwives about the accuracy of computerised perinatal data records, which are mandated at a federal level.

Kate McDonald of Pulse+IT won the media award.

Sysmex releases new version of Delphic, updates Eclair New Zealand-based clinical and laboratory information systems specialist Sysmex has released a new version of its Delphic LIS, featuring a swathe of new features including an imaging module, results search and a test referral manager.

Sysmex has also recently released an update of its Eclair clinical information system and announced that two more district health boards in NZ’s North Island will install the Delphic LIS by the end of the year.

Sysmex marketing manager Deborah Steele said the new Image Viewer module had been developed to replace an existing image viewer, with the new system now more dynamic and featuring the ability to zoom in on images.

“It basically stores images against any patient request as a whole library of any clinical image or request form that has been scanned in for a patient or a request,” Ms Steele said. “It is associated with that specific patient record in the laboratory information system.”

The new Image Viewer can handle pretty much every file format, including TIFs, JPGs and PDFs, Ms Steele said.

There is also a test referral manager that streamlines the transfer of specimens within the laboratory, between laboratories in the same organisation or with external laboratories by using HL7 messaging, she said.

Sysmex has also updated its Eclair web-based clinical information system.

New features include an updated patient details section in the patient record, which when first accessed displays all pertinent information including demographics, current active encounters, orders pending and in progress, and diagnoses, allergies and alerts.

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Bits & Bytes

DocAppointments launches check-in app for patient flow Online appointment booking service DocApppointments.com.au has released a new check-in app for Android tablets that aims to streamline patient flow in general practice and free up receptionists’ time.

The app is a simple one that can be downloaded onto an Android device that is attached by a mount to the wall.

When the patient arrives at the surgery, they can by‑pass reception and check in themselves, much like at an airport self‑check-in booth.

DocAppointments founder Calin Pava, a GP at the Devonport GP Superclinic in Tasmania, said DocAppointments itself is now fully integrated into Zedmed and Practice 2000 as well as Best Practice and HCN’s PracSoft, and is currently in the process of being integrated into Stat.

The check-in app is available only with Best Practice and PracSoft at the moment, but it will also be integrated into Stat.

“We chose to do it on Android [devices] because they are cheaper for practices to buy than an iPad,” he said.

“Basically, when the patient comes into the practice, if the receptionist is busy then rather than clogging the entrance they just go to the wall, put in their name and the doctor that they have the appointment with, and the software checks that they have an appointment within an hour of the time they arrive. If the software finds an appointment, it ‘arrives’ them.”

The patient’s status appears within the practice management software just as if a receptionist had done it manually. Dr Pava said many people would simply by-pass reception and go straight to the tablet as they are so familiar these days with self‑check-in systems.

Medications app aims to make pharma easy for families A new pharmacy-focused app has been launched aimed at helping parents to manage both the prescription and nonprescription medications of the whole family.

The PharmaEasy app for the iPhone and iPad has been designed by Albert Thammavong to allow users to enter the names of all of the family members and link them with their current medications.

Users can enter medication details such as medication name, expiry date, dosage and cost, and to take a photo of the packet for easy identification. It

also features an alert to tell users when they are running low, with the ability to send an email to the pharmacist to order a repeat.

“There are some smarts behind the app,” Mr Thammavong said. “You enter the quantity and how long you have to take it, and it works out where you are up to.

“When it is two or three days before you run out, it flags it in a red colour and prompts you to renew it.”

Mr Thammavong said the main idea was to help families manage their

multiple medications, both prescription and non-prescription. The app also features a handy effectiveness graph so users can enter their observations on how well the drugs are working.

“At the moment there is nothing that records the history of effectiveness,” he said.

“This gives you your own report so you can talk to the pharmacist about how the medication is going, any improvements, and the pharmacist can give you advice on how to improve or better manage your medication regime.”

Federal and state governments agree to develop business case for eHealth The federal, state and territory governments have signed a memorandum of understanding (MOU) committing them to developing a nationally agreed business case for funding for eHealth beyond July next year.

Current funding for eHealth initiatives such as the PCEHR, provided by the federal government, and for NEHTA, which is jointly funded, runs out on June 30, 2014.

Queensland, SA and the ACT signed the MOU late last year, with WA signing off in February, NSW in May, and Victoria and Tasmania in June. Federal Health Minister Tanya Plibersek gave official sanction on June 25.

The governments have also committed to building a business case and migration plan for the transition of each jurisdiction to the National Health Services Directory (NHSD), which will be devised by the National Health Call Centre Network, also jointly funded by the Commonwealth and the states.

The national eHealth business case will be led by the Department of Health and Ageing’s E-Health Working Group (EHWG), which reports to the Ministerial Council on

health, now known as the Standing Council on Health.

The federal Minister for Health will also this year appoint an individual to review the operation of the PCEHR Act and its regulations, and to prepare a report on the review by December 29, 2014.

“The parties reaffirm their commitment to the implementation of national eHealth capabilities.”

“The outcomes of the independent reviews will complement the nationally agreed eHealth business case to inform governments’ consideration of long-term governance arrangements for the national eHealth system,” the MOU states.

“The parties reaffirm their commitment to the implementation of national eHealth capabilities and agree to maintain the momentum created from investments to date and to continue a coordinated approach to implementation.”

The MOU also contains a long-term vision statement,

which commits the jurisdictions to achieving for Australia an effective eHealth capability.

It will do this by streamlining clinical processes such as access to diagnostic results and ePrescribing, delivering core elements of enabling national eHealth infrastructure, and building a long-term national eHealth capability.

They promise to do this in an “incremental and pragmatic manner, focusing initial investment in those areas that deliver the greatest benefits for consumers, healthcare providers and healthcare managers”.

In the interim, the federal government has committed to rolling out and operating national specifications, standards and infrastructure such as the PCEHR. In return, the states and territories have committed to continuing to work on implementing IT in public hospitals such as discharge summaries to be uploaded to the PCEHR, medications management systems, diagnostic testing systems, patient administration and scheduling systems, master indexes and implementing healthcare identifiers into public hospital and healthcare services.

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iMIMS for Android phones and devices in development MIMS is developing a version of its iMIMS app for Android smartphones and tablets and has also added the ability to purchase and renew the medicines information platform from directly within the app.

MIMS has recently moved the app from its previous developer account following the sale of UBM Medica Data Services, of which MIMS Australia is a part, to Electra Partners in April.

MIMS said it was soon to release version 1.3.0 of the app, which will include some minor bug fixes and some improvements in the handling of special text characters for medicines and information containing superscript and subscript characters.

The major new feature is the ability for independent subscribers to purchase and renew iMIMS from directly within the app using Apple’s In-App Purchasing mechanism.

“This feature has been a popular request from our users and will make the iMIMS purchasing experience simpler by allowing you to tap a simple button, enter your Apple password, and Apple will take care of the billing and invoicing through your Apple iTunes account,” the company said.

“There is no need for you to go to the MIMS or iMIMS website and enter your credit card details anymore.”

MIMS has also added the add-on Pill Identifier module to the cost of the overall subscription, saying most users have opted to purchase the module anyway.

The new price of iMIMS with the Pill ID included will be $179.99.

Institutional users of the app are not affected, as the subscription is generally paid for by the employer. While there is no firm date, iMIMS for Android should be available later this year or early the next.

Expert committee for HISA aged care special interest group The Health Informatics Society of Australia’s (HISA) aged care special interest group elected a new committee at the Health Informatics Conference (HIC) in Adelaide recently.

Andrew Georgiou (pictured) an associate professor at the Centre for Health Systems & Safety Research at the University of NSW and last year’s SIG chairman, was re-elected to the committee.

Dr Georgiou said the new committee had a good mix of industry experts, academics, aged care providers and technologists.

The other members are: • Jennifer Dunn of St Vincent’s & Mater Health Sydney eHealth • Ralph La Tella from the Health Information Management Association of Australia (HIMAA) • Damien Malone of SomerCare • Sean O’Donnell from Calvary Aged Care & Retirement Services • Llyr Otto of The Whiddon Group • Larissa Popowski from South Eastern Melbourne Medicare Local • Jeffrey Soar of the University of Southern Queensland • Ping Yu of the University of Wollongong.

The aged care informatics conference was held as part of the full HIC conference this year.

One of the highlights of the aged care stream was Martin Laverty, CEO of Australia’s largest nongovernment network of residential and community aged care services, Catholic Health Australia.

Mr Laverty, who also gave a keynote address at the conference, said aged care services of the future will need to be different to those offered today.

“Aged care has been slow to tak up technology but it is starting to move along now.”

“Demand for services will grow, availability of staff will be scarce, and consumer expectations will differ from those of consumers of today,” Mr Laverty said.

He quoted a Productivity Commission forecast that government spending on aged care will increase from 0.7 per cent of GDP in 2006-07 to 1.9 per cent by 2046-47.

This will largely be due to increasing expenditure on residential aged care.

Technology has a large role to play in meeting the challenges of providing quality aged care in the years ahead, he said.

Dr Georgiou agreed, saying aged care was an area where technology could make a big difference.

“Aged care has been slow to take up technology but it is starting to move along now,” Dr Georgiou said.

“However, it is a different arena from primary care and particularly acute care, which is based on episodes of care. The challenge for IT is to devise systems that are suitable for aged care needs.”

Dr Georgiou was also named as the winner of the Branko Cesnik award for best scientific paper at the HIC 2013 for a study he led on the effect of an electronic medical record on the quality of laboratory test orders.

This research is part of an ongoing research project carried out by the Centre for Health Systems & Safety Research (CHSSR), which is part of the University of NSW’s Australian Institute of Health Innovation.

The research began with an ARC Linkage grant some years ago, when the CHSSR began work with NSW Health to evaluate

the introduction of large IT systems in healthcare settings.

The research has since been funded by an ARC Linkage grant with the then-South West Sydney Area Health Service and more recently by the federal Department of Health and Ageing’s Quality Use of Pathology Program, which Dr Georgiou said was keen to get evidence about how IT systems are working for pathology services.

The recent paper looked at the errors that were caused by the introduction of electronic test ordering.

“The pathology service that we were looking at had an error log, which is quite unique,” Dr Georgiou said.

“We analysed it and as it turned out, for the traditional errors that occur in path labs – a mismatched specimen or a mislabelled specimen, things that can have an effect on patient safety – the EMR was better when compared to a paper system.”

Errors did occur, however, mainly due to the fact the laboratory studied had a hybrid system of both paper and electronic test orders.

Errors on the paper orders

were logged as electronic order entry problems, which is why there was a noticeable rise in errors after the introduction of the EMR. “Our conclusion was that the way the system gets put in is important, the way it integrates with other systems is important.

“Evaluating and maintaining an evidence base about what’s happening is crucial, because these things can go on and on and you wonder why you are getting more errors.”

Much of the CHSSR’s bestknown work involves this sort of evaluation, which can be used by both health systems and by software vendors to improve the systems they are using and developing.

The centre’s director, Johanna Westbrook, is well known for her work on electronic medication management systems, and also participated in the pathology study.

“We are also doing research on work innovation, because one of the big issues is that when an IT system comes in, it transforms things,” Dr Georgiou said.

“But if things are going wrong, the IT will just make things go wrong faster. IT can’t just be put in there and it will work fine; it really has to be understood in the context of clinical care.”

MOOCs draw in the crowds to iTunes of higher education The University of NSW and the University of Western Australia have announced they have partnered with US-based education company Coursera, the largest provider of massive open online courses (MOOCs), joining the University of Melbourne.

Described by the dean of the Australian School of Business at UNSW Geoffrey Garrett as like the “iTunes of academe”, MOOCs are high-quality online courses provided by top universities for free over the internet.

In July, the University of Tasmania went live with its first MOOC, an online dementia education course that so far has 6500 registrants from around the world, with 2500 logging on to start the course within 24 hours of going live at 9am.

The MOOC, Understanding Dementia, has been developed by the Wicking Dementia Research and Education Centre, based in UTAS’s Faculty of Health Science.

Co-director of the Wicking Centre, James Vickers, said the goal was to improve the quality of life for people with dementia, their families and carers.

“Understanding Dementia has been structured as a complete and comprehensive course of 11 weeks duration, with the goal of providing quality evidence-based information about dementia,” Professor Vickers said.

UTAS is not yet part of the Coursera platform, which involves 85 universities from around the world in offering MOOCs. The courses are not designed for an academic credit but they can assist students preparing for university or professionals wanting to extend their knowledge.

Courses range from basic anatomy to big data to safety in healthcare.

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HIMAA

HIMAA SEEKS LEADERSHIP FROM CONFERENCE The upgrade of the national inpatient clinical classification system to ICD-10-AM 8th edition will be high on the agenda at this year’s Health Information Management Association of Australia (HIMAA) national conference. A Q&A on eHealth and the PCEHR is also certain to provoke a lively debate.

If ‘Transforming Health Information: The Past, Present and Future’ is the theme of this year’s National Health Information Management Association of Australia (HIMAA) Conference in Adelaide in October, the program is certainly structured to encourage transformational leadership, HIMAA’s president, Sallyanne Wissmann, says.

“Health information managers, clinical coders, and other health information management professions have long been considered as providing valuable services to the collection and management of patient health information within the Australian healthcare system,” she says.

The history of the health information management profession in Australia has its origins in the 1940s, and since this time the requirements relating to health information management have grown and matured to being a fundamental requirement of defining, measuring and assessing the efficacy and effectiveness of Australia’s healthcare system.

The national HIMAA Conference is the leading event for people working in health information management, Sallyanne says.

“The 2013 HIMAA National Conference will provide attendees with a valuable, thought‑provoking and engaging conference experience that will enhance

networking and information sharing opportunities between health information management professionals,” she says.

This year’s conference will be opened by His Excellency Rear Admiral Kevin Scarce, Governor of South Australia, with the opening keynote presentation to be given

by Professor Johanna Westbrook, director of the Centre for Health Systems and Safety Research (CHSSR) at the Australian Institute of Health Innovation (AIHI).

“Professor Westbrook has comprehensive research and academic experience in HIM matters, from clinician use of online decision support, computerised pathology ordering systems, and medication safety to IT use in aged care, and the communication patterns of health professionals,” Sallyanne says.

“Johanna’s presentation will promote the value and importance of best practice health information management enabling better health outcomes for patients.”

Past and present Professor Phyllis Watson, one of HIMAA’s most senior members and historians whose book Health Information Management: The First Fifty Years was launched in March of this year, will present on the ‘past’ element of this year’s conference theme.

In response to the breadth of expertise represented by the health information management profession, the conference program for 2013 will again focus on two program streams: present and future challenges and developments in relation to health information management, and in clinical coding and classification.

The opening keynote presentation for the health information management stream will be by Rita Scichilone, senior advisor on global standards with the American Health Information Management Association.

Ms Scichilone will explore how the health information management profession is making its mark by embracing new views of the role of health information managers.

“Rita is involved with many standards development organisations including WHO-FIC, HL7, IHTSDO, and ISO TC 215 Health Informatics,” Sallyanne says. “Her presentation will address the current environment and expectations of the HIM profession combined with a lively discussion about transforming health information into health intelligence.”

Neville Board, information strategy manager with the Australian Commission on Safety and Quality in Health Care, will outline implementation experiences with the National Safety and Quality Health Service Standards, with a focus on their implications for HIM professionals.

“Presentations will be supplemented by a lively panel discussion on eHealth, which has featured significantly in the health information management landscape during the past 12 months due to the implementation of the national eHealth record system,” Sallyanne says.

“The panel is sure to explore considerations for health information management professionals in the eHealth world of sharing and accessing patient health information.

“The panel is sure to explore considerations for health information management professionals in the eHealth world.”

Sallyanne Wissmann

“For attendees interested in taking away practical skills and knowledge and maximising the professional development opportunities offered during the conference, a project management workshop will be run for attendees wanting to know how to manage a successful project in health.”

The coding stream The clinical coding and classification stream of the program will commence with an opening address by Tony Sherbon, CEO, of the Independent Hospital Pricing Authority (IHPA). As clinical coded hospital data continues to be an underpinning requirement of the inpatient activity-based funding model by IHPA, Sallyanne believes this presentation will be of particular relevance to clinical coding professionals.

“In July this year, the national inpatient clinical classification system was upgraded to ICD-10-AM 8th edition.

The HIMAA national conference will be the first opportunity for clinical coding professionals from around the country to meet to share their experiences using it.

“The HIMAA Education Services team will present practical, hands-on workshops in ICD-10-AM 8th edition to support clinical updates from senior clinical specialists – always a popular combination within the conference program.”

Dorothy Rao of the Community Services and Health Industry Skills Council will

speak on the pathway to accreditation of a coder qualification, while Julie Brophy will present the Clinical Coder Capability Framework that the Victorian government is developing to support coder training in the state’s health system.

HIMAA is planning a landmark plenary at the conference to enable members to provide feedback to their professional association on the strategic direction of HIMAA for the next three to five years.

Discussions will build on a membership survey and series of focus groups conducted between May and September this year. HIMAA’s Strategic Plan for 20142016 will be launched in early 2014.

“At the leading edge of the profession, special interest groups (SIGs) in eHealth, health record scanning, paediatric hospitals, private hospitals, and regional HIM will meet at the conference, and a National Coding SIG will be launched along with a national HIMAA Coding Advisory Committee,” Sallyanne says.

“The conference will conclude with a lighthearted and entertaining debate about the evolution of the profession under the theme: Everything Old Is New.” The HIMAA National Conference 2013 will be held at the Hotel Grand Chancellor in Adelaide from October 21 to 23.

Further information and registration is now available at http://himaa2.org.au/ conference/

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Feature

SATELLITE INFRASTRUCTURE:

TELEHEALTH IN THE OUTBACK Earlier this year, the Kimberley-Pilbara Medicare Local (KPML) convened a summit of government bodies and healthcare providers from Western Australia, South Australia and the Northern Territory to discuss ways to streamline and enhance satellite-based internet connections for healthcare in very remote areas.

They have since secured a dedicated link to a satellite internet service for the next two years.

FIONA MCCAUL Director, The Marketing Pod fionamccaul@live.com.au

In March this year, senior health infrastructure teams from the tri-state region had the opportunity get together to identify the main challenges of healthcare provision in the Kimberley and Pilbara. In advance of the NBN Co’s planned launch of two long-term broadband satellites in 2015, the Satellite and Telehealth conference discussed how improvements could be made in the short-term, leading to a draft proposal for funding to be submitted to government.

For the first time, technologists, administrators and clinicians were able to brainstorm some of the technical issues of healthcare provision over satellite broadband and to share their different experiences in developing a replicable approach to satellite links in a region of over 4.8 million kilometres, or 62.3 per cent of Australia’s land mass.

About the author Fiona McCaul is a marketing consultant based in Darwin. She was contracted by the Kimberley-Pilbara Medicare Local to write a report on the conference, and has consulted for the Northern Territory Medicare Local (NTML) in the delivery of the My eHealth Record campaign in 2012.

other areas of Australia where internet connectivity is taken for granted. To put the location into perspective, the township of Newman is 1200km north-west of Perth. It has a population of 9088, according to the 2011 census, an increase of 105 per cent over its population five years previously.

PAMS’ chronic disease self-management co-ordinator, Megan Ewing, explained how despite the remoteness, the service has been active in telehealth and had rolled out commercial-grade satellite dishes and electronics in 2011. It has also installed the MMEx electronic health record developed by the University of Western Australia.

One of the groups represented at the conference was the Puntukurnu Aboriginal Medical Services (PAMS). PAMS has clinics in four remote central WA desert communities – Punmu, Jigalong, Parnngurr and Kunnawaritji – with a new clinic recently opening in the mining township of Newman.

In 2011, PAMS installed commercial grade satellite dishes and electronics to facilitate internet and eHealth. Each clinic had a satellite dish installed in arduous conditions by a small, dedicated team. The team faced challenges that most subcontractors wouldn’t dream of, including a desert environment with temperatures above 50°C in the shade, which made logistics challenging to say the least.

The installations are crude but effective, with satellites dishes attached to ground mounts that are anchored by bags of quick-set cement.

PAMS operates in a unique playing field, completely different to cities and many

The satellite dishes and satellite modem had to be fitted into tailor-made travel

remote health services in attendance at the Satellite and Telehealth Conference.

The three key eHealth groups represented were IT, health information and telecommunications strategists and implementers; clinicians; and advocates for national eHealth programs including telehealth.

KPML, which was the driving force behind the conference, organised it as a way to workshop the layers of technology currently being used in all regions.

Detailed analysis was conducted on the electronic communications used in medical health services.

The challenges identified as a united group at the conference were: Photos courtesy of the Puntukurnu Aboriginal Medical Services.

boxes to fit the required size limit for the regular mail flight that visits the communities. The boxes were designed this way so that when there were technical issues, the box could be easily unplugged and sent back to base on the mail flight, fixed, and then returned via the mail flight.

Despite these challenges, the satellite technology has been installed for over two and a half years and haven’t missed a beat, Ms Ewing said.

Healthcare anywhere PAMS uses Medibank’s Anywhere Healthcare service, which Ms Ewing said was perfect for the community as there is no cost due to bulk billing. It has also implemented the web-based MMEx platform for shared care, useful for the indigenous people living in the region, the Martu, who often travel between communities and to regional centres.

“Having an accessible health record facilitates cultural sensitivity for the Martu and without question is an eHealth risk

management safety factor in the delivery of safe informed healthcare,” Ms Ewing said.

She used the example of a Martu person from Jigalong who was visiting Kunawarritji on the Canning Stock Route who required medical treatment.

“The clinic nurse, who is usually a FIFO health professional, is able to access the patient’s health record and determine the patient’s medical history, the last event summary, their adverse and allergy status and the current medication list.

“The nurse is able to use the information to guide her clinical decision-making and consult the PAMS medical practitioner either in Newman or Jigalong if necessary.

The consultation is documented as an entry to the patient’s MMEx eHealth record.”

Climate challenges Puntukurnu’s experiences echoed the experiences and challenges of the other

• Patient access to faster more efficient healthcare in remote Australia • Telehealth and creating borderless eHealth solutions • Geographical magnitude – distance and access to hospitals, specialists and allied health providers • Climatic conditions and their effect on satellite and technical equipment – cyclones, harsh temperatures in the deserts, sandstorms and violent storms during the wet season • Cost of and speed of reliable connections to the internet via satellites.

The delegates acknowledged collectively that although they use various types of communications tools such as Skype, FaceTime, Lync and Scopia, the needs are all the same. They include: 1. Efficient and stable satellite communications for access to the internet. This means there is a need for increased speed and bandwidth to enable best practice and access in eHealth; and 2. More cost efficient satellite connection contracts. Currently most health

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services are paying in excess of $1200 per month for services that cost about $60 per month in the cities.

Satellite looks ROSIE Since the summit, KPML and some of its collaborators have been successful in obtaining an alternative to government funding. Following a meeting in late July, they have been able to announce that an agreement has been met with benefactors, including a supplier of corporate satellite communication links, to supply an interim measure in advance of the launch of the long-term NBN satellites.

The initiative is now being called Remote Outback Australia Satellite Infrastructure Enablement for eHealth (ROSIE-eH), and it has become an open collaboration bringing together a number of private, corporate and non-government primary, allied, mental health and aged care providers from the initial target region of WA, the NT and SA. The organisers say there is also

keen interest from central and northern Queensland and western New South Wales-based organisations.

According to KPML’s acting chief information officer Rob Starling, the consortium has successfully negotiated with the satellite link supplier, supported by mining and service companies, for a 75 per cent discount – worth $2 million – for two 2Mb managed, contended links and access to a 1Mb dedicated link over two years for ROSIE-eH participants.

Dr Starling said three remote and very remote Aboriginal community controlled health services have received funding from the National Aboriginal Community Controlled Health Organisation (NACCHO) and SA’s Country North Medicare Local for installation, commissioning and operating links through ROSIE for the next year.

“The Kimberley Aboriginal Medical Services Council (KAMSC) is using a 2/2Mb link to tune the ROSIE service delivery

The satellite dishes are attached to ground mounts that are anchored by bags of cement.

model with the satellite service provider,” Dr Starling says. “This initial work is across three very remote service delivery locations with six other sites also coming online. The work includes testing various codecs for tele-videohealth consultations and case conferences.

“This foundation work will have a cumulative benefit for new sites as they come online and contribute their own innovations in remote eHealth service delivery for their patients using ROSIE.” At the follow-up workshop in Alice Springs, the consortium was able to critique the proposed business model, service level agreements and operational processes for ROSIE and a strategy to engage further private financial assistance.

Assistance or engagement will be sought in operational support, on-site training

by GPs and specialists and promoting the inclusive ethic of the initiative.

Work was also outlined for seeking public funding for research and eHealth innovations using ROSIE for outback satellite internet-based eHealth, including video conferencing, focusing on meaningful use of the PCEHR system and national standards.

KPML’s efforts in remote eHealth and telehealth service delivery have been partially supported by the Australian Medicare Local Alliance (AMLA) and the Medicare Local Cluster Hub support program by the Department of Health and Ageing.

The organisations involved in getting ROSIE-eH from an idea to operational in just over three months have all carried their own costs. “They all appreciate this real commitment to making inclusive eHealth in outback Australia happen over the next two years to fill the gap until the NBN satellites are commissioned,” Dr Starling says.

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Feature

TELEHEALTH AT ROYAL CHILDREN’S HOSPITAL IS BUSINESS AS USUAL

Melbourne’s Royal Children’s Hospital has devised a three-year roll-out plan for its telehealth service with the aim of making video consultations ‘business as usual’ throughout the hospital. As opposed to the common centralised telehealth rooms, RCH encourages its clinicians to conduct video consults where and when they see the need. They are also able to video conference with kids in their own homes.

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

Royal Children’s Hospital began offering telehealth services over 18 months ago, starting in neurology, respiratory, nephrology and allergy, and has since opened it up to a number of different medical disciplines. Consultations can involve the patient’s GP or local paediatrician, or are conducted directly with the child in their own home.

people to use a special room because we want it to be part of the natural flow of the hospital. If they are in their administrative offices they can do it there, or if they are in outpatients they can do it there.

RCH’s telehealth program manager Susan Jury says telehealth consults are offered free to patients with some billable to Medicare. While the majority of patients are based in rural Victoria, certain patients from other states can also use the service.

Conferencing with kids

RCH uses GoToMeeting as its primary technology and has set up a web page that patients simply need to click on to take part in the consultation. Bookings for video consults are integrated within the normal hospital booking system and are coordinated in the same way, she says.

“We try to keep it as close as possible as day-to-day consultations.”

The hospital has not gone down the path of others and set up a specific video conferencing room, preferring instead to open it up to any clinician on any computer.

“It can basically run from any room in the hospital,” Ms Jury says. “We don’t want

“The moment we start making people change their normal work, that’s just another barrier.”

One of the earliest adopters of telehealth at RCH was Mandie Griffiths, a paediatric respiratory and sleep physician. Dr Griffiths now conducts a telehealthonly clinic for half a day every couple of months, usually from an office.

Dr Griffiths says there are few patients, or conditions, for which video consults would be completely unsuitable.

“There’s not too many patients that I’ve said no to for this sort of thing. I think it’s applicable to a broad range of patient groups and I don’t recall ever saying no because of a particular condition. I do like to alternate telehealth and clinical appointments most of the time.”

Dr Griffiths says telehealth works well for most of the common respiratory and sleep disorders, such as asthma, chronic

Mandie Griffiths. Photo courtesy of the Royal Children’s Hospital.

Griffiths’ long-term patients is a teenage boy from rural Victoria with a chronic respiratory disease and an underlying neuromuscular disorder. Travelling all the way to Melbourne upsets him and he tends to become more unwell when he has to travel, she said.

Dr Griffiths sees the boy every couple of months by telehealth, and he has not had to come to the hospital in person for a year, and then only when the family is coming anyway. In between, she corresponds with the family by email.

If she needs to prescribe a new medication or order a test, she posts the referral form or the script. “It’s all done on the day – they just don’t get it till a day or two later – and if there are any issues in the timing of the scripts, you can fax it to the chemist.”

cough, obstructive sleep apnoea and cystic fibrosis, as well as more complex conditions like restrictive lung disease in neuromuscular disorders. “It’s great for follow-up of sleep study results,” she says.

Deciding who to see through telehealth is a clinical decision. “If patients are acutely unwell, you will want to examine them.

You may elect to see them clinically, but telehealth provides an alternative if they can’t get to you. They can go to their GP who can examine them with your guidance in front of you through videoconference.

For follow-up where the examination is not as important, then you can do it from their own home.”

In fact, Dr Griffiths does most of her consults with the child from home. For complicated patients she tends to ask the GP or paediatrician to be involved, but for more straightforward scenarios, like children with sleep disorders, she prefers to talk to the child in their own surrounds.

And the children far prefer it that way, especially her teenaged patients. Most seem to very much enjoy talking to their doctor through their computer, she says.

“It’s a bit of novelty to start with but it depends on the age of the child as to what they think. For the younger kids, they start off on their mum and dad’s knee, but they will get a little bit bored if you are not talking directly to them all the time.

“I ask the parents to set up some toys on the ground next to them and when I need to ask the child a question or talk to them, they can pop up back on mum’s knee and look into the camera. That works quite well because they are much more comfortable playing with their own toys in their environment than they are in the hospital.

“Some of the teenagers think it’s fantastic – I’ve got teenagers doing their VCE and they don’t want to miss school or homework time to travel down for an appointment, and they’ll just get on the computer and the parents will be in the background somewhere. They know how to work it out better than I do. It’s fantastic for them. The kids in between are all pretty good as well.”

Telehealth has even proved beneficial for some children’s wellbeing. One of Dr

Ms Jury says the attitude the hospital had taken after piloting telehealth and deciding to roll it out more widely was that any clinician who was interested in conducting video consults could do so.

“We don’t think it needs to be exclusive,” she says. “It can be a doctor, allied health, nurse and it could be any department.

Nephrology, neurology, plastics, oncology … our approch is “why can’t it be?”

Obviously clinical appropriateness is the first thing. It’s not going to be suitable for every patient or every consultation, but I think there is some scope in every discipline.”

Ms Jury describes the first year of the service as “dipping our toes in the water”, but since she was appointed as telehealth program manager last year, it has now become a day-to-day offering with the number clinicians involved increasing.

“I see my role is as supporting people to develop it as their own service. It will be part of what every department does. It’s just another way of providing a high-quality service for all.”

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Feature

TELEHEALTH BENEFITS PEOPLE OF ALL AGES The intense demand on established healthcare services in Queensland has prompted the introduction of an array of telehealth services throughout the state, which aim to provide a solution that is not only more efficient and effective but also to reduce travel time and improve clinical outcomes. The University of Queensland’s Centre for Online Health (COH) is one of the driving forces for researching and developing clinically appropriate and economically sustainable telehealth services.

JOANNE GREY Centre for Online Health j.grey@uq.edu.au

Part of the School of Medicine within the Faculty of Health Sciences at the University of Queensland, the COH is recognised internationally for its role in research, service delivery and education and training in the fields of telemedicine, telehealth and eHealth.

The centre’s keys areas of activity include clinically focused research; academic and vocational education and training; and the provision of clinical telemedicine services, including one of the world’s largest paediatric telemedicine services.

It also conducts ground-breaking research into telehealth services for residential aged care, and has been intimately involved in helping to develop sustainable telehealth services for people living in rural areas of the state.

The director of the COH, Professor Len Gray, believes telehealth is ideal for people living in Australia, particularly for rural and remote Queenslanders.

About the author Joanne Grey is the communications and media manager for the Centre for Online Health and the Centre for Research in Geriatric Medicine. She is responsible for the promotion of the two centres, as well as the proACT clinical telehealth programs, the Health-e-Regions project, RES-e-CARE and the ConTAC project.

“Telehealth allows patients to remain in their community with family support, save money usually spent on travel and have equal access to specialist care,” Professor Gray says. “Telehealth provides a valuable means of distributing a wide range of specialist services, irrespective of

location. Patients of all ages are provided with access to specialist services where typically they would be very limited or nonexistent.”

He says telehealth also fosters networking and collaboration between specialists at tertiary hospitals and regional clinicians, which in turn strengthens the capabilities of regional health services and helps ensure that patients can be treated as close to home as possible.

The COH focuses on clinical research with an emphasis on examining the feasibility, efficacy, clinical effectiveness and economics of telehealth in a variety of settings.

While it may constitute the more mundane aspects of healthcare provision, the development of sustainable services is essential, Professor Gray says.

He believes the biggest challenge in expanding telehealth services is now not so much technology, but rather issues like organisation and funding.

“Who is going to pay, can it be done through Medicare or is the hospital at the other end going to pay? Now that we’ve got the technology sorted out and the right environment, our challenge is

Professor Len Gray provides a teleconsult from the PAH’s Telehealth Centre.

to sort out protocols and administrative arrangements.”

Telepaediatrics Based at Brisbane’s Royal Children’s Hospital (RCH) and now at the Princess Alexandra Hospital (PAH), COH is one of the few academic centres where the delivery of telehealth services is critically appraised in a world-class research and teaching environment.

The centre has particular strengths in telepaediatrics and its work has been extensively reported in published literature. Over 16,000 telepaediatric consultations have been performed over the last 13 years under the telepaediatric service at the RCH. Consultation specialties include burns, endocrinology, neurology, psychiatry and surgery.

A purpose-built telehealth centre at the PAH connects via video-conference to regional centres such as Mt Isa, Warwick, Kingaroy, Roma and Dalby.

Specialists are able to conduct clinics for groups of patients at one regional hospital or they could also see patients at several hospitals in one session.

This makes enhanced treatment options, access to patient records and improved care coordination all possible.

Recently, the COH 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.

“The PA Telehealth Centre delivers specialist services in the areas of cardiology, endocrinology, dermatology and geriatrics, with plans to extend these services into orthopaedics, infectious diseases and oncology,” Professor Gray says. “It has the capacity to conduct at least five thousand assessments annually.”

The centre is equipped with high quality sound, lighting and video conferencing technology to enable clinical telehealth provision.

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, says the service models will be designed to be sustainable.

The plan is to establish the infrastructure

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and new processes that will 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 says.

“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.”

Telegeriatrics

travel and are offered a telehealth consultation instead of a faceto-face consultation with a geriatrician. Telegeriatrics provides a stress-free option for older people and their families.

The COH is conducting a randomised control trial that will see video conferencing technology deployed as a mobile wireless device at the resident’s bedside and operated by a geriatrician from a remote telehealth studio at UQ. The main aims of the study are to investigate the potential to reduce transfers to emergency departments and reduce transport costs, as well as improve access to specialists, prescribing practice and the quality of care for residents.

In the field of geriatric medicine, the COH is working closely with UQ’s Centre for Research in Geriatric Medicine (CRGM) to establish routine telegeriatric health services comprising video consultations with patients and a comprehensive web-based system for managing aged care assessments.

“The desire for telehealth is greater in residential aged care than in hospitals, where facilities are isolated and it’s often a struggle to get health professionals to visit,” Professor Gray says. “Although the technology is a bit more expensive, many residential care providers have indicated that the cost is not a major barrier to them in terms of affordability.

Currently, the COH and the CRGM provide regular video conferencing consultations to older people. Many people living in residential aged care facilities are spared the inconvenience of

“Telehealth needs to be performed often – and systematically – to ensure that it is affordable and effective. As usage increases, the cost will come down.”

Feature

MICROWAVE BROADBAND AN ALTERNATIVE TO FIBRE FOR TELEHEALTH

One of the big selling points for the federal government’s National Broadband Network (NBN) is its potential to open up new modes of healthcare delivery, including telehealth and telemedicine, to areas of Australia that experience barriers to access. However, the fibre, fixed wireless and satellite services envisaged by the NBN are not the only technologies available.

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

In November last year, a fire at Telstra’s exchange in Warrnambool in south-west Victoria brought home to many just how much we rely on telecommunications infrastructure in our daily lives. Not only were phones and internet cut off to the public, affecting tens of thousands of people, but things we take for granted like ATMs and EFTPOS were disabled for days, if not weeks. According to some reports, many businesses in the area were accepting paper IOUs as customers did not have access to their money.

For Warrnambool Base Hospital, on the other hand, it was business as usual. It was able to keep functioning and even offer assistance to Deakin University and Ambulance Victoria because it was not connected to the virtually monopoly Telstra service.

The hospital is part of the South West Alliance of Rural Health (SWARH), which for many years has been using a microwave broadband service to provide unified communications across a range of regional hospitals and clinics.

Microwave broadband is, as Andrew Findlay, managing director of microwave telecoms provider Vertel, puts it, certainly not new technology, as it is used to provide the backhaul for the majority of mobile

phone services, and nor is it suitable for every application. Microwave is a pointto-point technology that can provide extremely reliable, high-capacity wireless communications, with the limitation that it needs clear line of site (LOS).

“We have a transmitter and a receiver at both ends, for instance at a hospital and at a high site,” Mr Findlay says. “It might be on top of a mountain or a tall tower, and between those two points we get the right from the government to operate at a radio frequency and a path between those two points exclusively.”

As it is an exclusive, licensed frequency rather than an open frequency such as that used by mobile carriers, Mr Findlay says microwave is able to use a much higher frequency band to deliver high-speed data services.

“It is a very mature and reliable technology and if you engineer and design it well, it will give the same performance criteria as you get from fibre. The availability and the performance of our service matches and in some cases exceeds that of fibre optics.”

SWARH has been using microwave broadband for many years in one form or another. The technology has changed over time – Mr Findlay says the standard

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Clinicians can teleconference at Geelong Hospital over the SWARH’s WAN.

upon which it is built has moved away from a circuit base, which was quite hard to manage and share, to an Ethernet base that can be shared with anyone.

Wide area network SWARH’s CIO, Garry Druitt, says the organisation decided on microwave for very practical reasons. The alliance was established in 1997 and devised a strategy for what it required, at the heart of which was the development of a wide area network (WAN) that could be used by all participants so they could standardise and centralise the distribution of services, thereby lowering the unit cost.

In addition to determining what patient management applications and finance systems the alliance would agree to use, Mr Druitt says they also wanted to achieve some quick wins, including a restructure of telephony services by replacing all

PABXs with an Internet Protocol (IP) based system.

“We established in about 1999 or 2000 the first IP-based telephone system in health in the world,” he says. “We partnered with Cisco and what was known at that time as Com Tech and has now morphed into Dimension Data. From 2000 to 2004, we replaced all of the PABXs, and there were 16 of them, with a single call manager, or UC as they call it these days.

“That delivered telephony to everybody via a server and IP, and so we had low-cost calls and calls that were routed to each hospital were free. We had a 30 or 40 per cent reduction in call costs.”

At the time, the Victorian government had launched a scheme called Vicnet, which wanted to deliver internet connections to hospitals in association with Telstra and AAPT. Mr Druitt, however, worked out that

he could build a microwave network that would be 50 per cent cheaper with double the capacity.

“We replaced very low-speed, high-cost links with a wide area network based on microwave, and Ericsson and AAPT built it and leased it back to us. However, it reached a point where those vendors were moving out of that market and we needed to put greater investment into higher speed. It was also based on a serial microwave network but Vertel has moved it a generation forward to an Ethernet-based microwave network.

“We helped broker a deal between Vertel and AAPT to purchase that network and continue investment and move to doubling and tripling the speed of the link. We are starting to increase our multimedia services between clinicians in terms of telemedicine, and that is the direction we headed once we made that investment.”

“We helped broker a deal between Vertel and AAPT to purchase that network and continue investment and move to doubling and tripling the speed of the link.”

Virtualisation

Garry Druitt

These days, the network is capable of delivering up to 100 Mbps over licensed microwave into every SWARH facility, with 500 Mbps capacity across the network. In regional Australia, some small hospitals still exist on four or six Mbps, which makes telehealth and the sharing of medical images near impossible.

Alternatives to NBN Both Mr Findlay and Mr Druitt agree that if if there was unlimited money and time, everyone would choose to install fibre to the premises, as is planned for urban areas under the NBN. In the shorter term, and where limited funds are desperately needed for direct patient care, there are very workable alternatives.

“I think what the big limitation has been in telehealth is having some reasonable bandwidth so people can start,” Mr Findlay says. “Once you start experiencing what you can do with it, you can start building a business case to justify getting the NBN extended or getting an alternative.”

Mr Findlay has not been afraid to voice a different opinion to most in the telecommunications industry that Labor’s NBN plan is far superior to the Coalition’s alternative. “I think the majority see the benefit of the government spending money on a fantastic network everywhere, but I’m think getting useable broadband to everyone quickly is what the NBN should

all of its routing infrastructure, so we can plug into any carrier or any link if it is cost effective and saves money. Currently the Victorian government is running fibre between Warnambool and Geelong, so we’ll look at using that, and the microwave that is currently servicing that link would then become a redundant link.”

be about,” Mr Findlay says. “Then once that’s done and once people understand the benefits of how broadband can be applied to both business and personal life, that’s when we can add a reasonable discussion about what is the next phase of the technology.

“I’m of the view of getting useable broadband quickly, but the thing I really like about what the Coalition said was that they are not wedded to the definition of the problem of how to get fibre everywhere, they’re open to look at different technologies to get those services delivered.

“For SWARH, they have 50 locations that we have a dedicated micro link into. We do bring it back in some places on a fibre core, so we do use fibre when it’s available, but our wireless access means that we can install it really quickly and at a really good price point.”

For Mr Druitt, when the NBN does come to regional Victoria he will consider it, but he doesn’t believe that is likely for another four or five years. “Like all things that come to us, we evaluate things on a business case,” he says. “We will look at what the NBN is offering, but currently there won’t be an offering suitable for us.

“When it can compete in a business sense with our existing links, then we might switch to that carrier, but SWARH owns

SWARH is using its WAN to continue to develop more services for clinicians, including the roll out of thin client technology to replace traditional hospital workstations. Clinicians will be able to use Citrix’s Receiver technology, meaning they can use their own devices running on any operating system to connect to the SWARH network and access its applications.

It is also opening this capability to offsite clinicians, and is further developing its telehealth capabilities, Mr Druitt says.

“Our network has a lot of video cameras in emergency departments and for use in meeting rooms and evaluation rooms, and we do have GP clinics as customers of SWARH. Those that are connected to our network don’t have a problem, but for those that are not connected we do have telemedicine available.

“You can register with us and download one of our clients from the internet, and that means that you can use your workstation as a video unit for telemedicine to connect internally to any of our devices. That is currently available.

“We have also extended our teleconferencing to places like the Royal Eye and Ear Hospital and the Royal Children’s Hospital, where our emergency departments can contact them to do remote ophthalmology scans, for example.

We also have doctors connected at their home via 3G to the emergency department at Geelong. We are doing quite a lot of things with external people using 3G technology and our own network.”

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Feature

TELEHEALTH IN YOUR BROWSER The browser-based real time communications standard known as WebRTC is gaining a lot of interest around the world, backed as it is by heavyweights like Google and Mozilla. Its full maturity is also being eagerly awaited in the field of telehealth, as it promises to help develop new applications that will allow users to conduct video consults and exchange data and images from within any browser.

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

The developers of proprietary methods for enabling real time communications may not be too worried yet about the threat many think WebRTC poses, but there are a lot of people eagerly anticipating the formal ratification of an agreed standard for WebRTC, the browser-based platform for real time communications (RTC).

RTC is certainly nothing new, and video conferencing technology companies along with free services like Skype, FaceTime and Google Talk have all developed large markets. However, most of these applications require software to be downloaded and installed and are not designed to interoperate with rival solutions. What WebRTC promises to do is begin to move the world into browserbased real time communications.

WebRTC is referred to as a transport layer technology and is designed to be a native function of the browser. As Chris Ryan, managing director of telehealth consulting service Attend Anywhere describes it, WebRTC is an open source framework that works in a similar fashion to the framework that allows sharing of photos or videos in the browser today.

In this case, it enables secure real time audio, video and data sharing capability through simple Javascript application programming interfaces (APIs). The

development of new video conferencing devices and applications using WebRTC is considered a bit of a game-changer in the world of the web. “It’s now simple for developers to embed amazing quality, free, secure, multipoint, interoperable real time video, audio and data exchange within their applications,” Mr Ryan says.

“The technology will become a standard function of modern web browsers.”

As the developers of the standard put it, historically RTC has been corporate and complex, requiring expensive audio and video technologies to be licensed or developed. That all changed when Skype was developed in the early 2000s as a free, peer-to-peer VoIP service that reflected the philosophy of its developers. Skype has obviously since taken off and is now almost ubiquitous, with close to a billion users, a net worth of around $2.5 billion when Microsoft bought it in 2011, and approximately 35 per cent share of the international call market.

If Skype revolutionised RTC last decade, WebRTC promises do so in this. What has many people excited about WebRTC is not just its promised ease of use, but its potential. WebRTC’s network, audio and video components can be easily accessed by developers to implement their own RTC web apps.

“This is a draft web standard for incredible quality, secure video conferencing that is highly scalable, resilient and interoperable between devices.”

Chris Ryan

The API standard is soon to be ratified by the World Wide Web Consortium (W3C), the main international standards organisation for the web, and a protocol is being ratified by the Internet Engineering Task Force (IETF). The IETF met recently to discuss WebRTC, and it is understood members discussed some enhanced security aspects and have agreed to work as quickly as they can to get a ratified version 1.0 of the standard out sooner rather than later, even if this means reducing the scope a bit.

into the browser of the person you are conferencing with.

In a clinical consultation, for instance, a doctor could securely deliver an ePrescription to a patient at the other end in real time, or one doctor coudl drag and drop an x-ray or report, allowing another doctor to receive the file securely and immediately.

Mr Ryan is helping some of his clients to use WebRTC, including The Alfred Hospital as part of its new Regional Cystic Fibrosis e-Health & Telemonitoring Program. This project, being led by the head of the Cystic Fibrosis Service at Alfred Health, Professor John Wilson, is being funded by the Victorian government’s Broadband Enabled Innovation Program and the Victorian Department of Health.

WebRTC will allow specialists at The Alfred to conduct traditional one-on-one consults with patients but also facilitate the multidisciplinary consultations required for the ongoing management of chronic illnesses.

Attend Anywhere is also helping with plans to use WebRTC for video calls to Healthdirect Australia’s health advice line, after-hours GP helpline (AGPH) and Pregnancy, Birth and Baby counselling service.

Professor John Wilson conducts a video conference with a patient’s care team.

Giving it even more weight is its enthusiastic backing by Google, which bought the rights to many of the components used in RTC in 2011 and made them open source. In November 2012, Google launched WebRTC on its Chrome browser and it has since been implemented in Firefox and Opera, with a very streamlined plug-in for Internet Explorer.

In February, Google and Mozilla announced they had achieved interoperability between Chrome and Firefox.

WebRTC for consumers What this all means for telehealth is not yet clear, but many in the industry believe it will enable more people to be able to access telehealth, but also to enable telehealth to be done better. One of the new capabilities that will be enabled

by WebRTC is a secure data connection between the browsers that will give users the ability to drag and drop images or files

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Mr Ryan is a keen advocate for WebRTC as an attractive option in many clinical scenarios, particularly its benefits in needing no video software or plug-ins like Flash. “This is a draft web standard for incredible quality, secure video conferencing that is highly scalable, resilient and interoperable between devices,” he says.

healthcare is consumer-driven,” he says.

“In the physical world it is consumers who initiate the care – they choose when to go to a GP or a hospital and they choose the transport method to get there. They will want to do that with telehealth as well. The point is that consumers take responsibility for when and how they ‘arrive’, not the health system.

“The technology works peer to peer between browsers so the only cost for the majority of calls is the user’s internet.

Central costs are tiny, even to support massive concurrent volume. With no software downloads, the user experience is incredibly streamlined and there’s no echo, even using standard computer speakers.

It’s safe to say we are pretty excited by it.

You will also be able to make or accept calls through WebRTC to traditional SIPbased video and telephony systems, which is another part of the puzzle.”

WebRTC for providers

Mr Ryan says WebRTC will increasingly be adopted by consumers using everyday applications and they will want to use it to access healthcare. “One reason WebRTC will be so powerful for telehealth is that

For healthcare organisations offering telehealth services, Mr Ryan says it will allow them to do things faster, cheaper and better. “From a provider perspective, enabling secure video consulting access to their service via their web site will be as easy as embedding a YouTube video.”

WebRTC will also be able to be used in conjunction with the existing telecommunications-based systems used by many health services, including the Cisco-owned Tandberg, Vidyo, Lifesize and Polycom systems most commonly used in hospitals. Mr Ryan goes to great lengths to emphasise that, as with physical transport, there are different video technologies

suited to different circumstances.

“WebRTC is just one option that is particularly well suited to the consumer space and health professionals in their own practices or homes.”

He is also up front about its limitations, such as WebRTC being in its early stages, with some important parts of the picture still missing. “Although mainstream support in all browsers, support for mobiles and a more complete set of capabilities is expected to arrive in the next 12 months, we are not expecting this to be all smooth sailing until the standards and their implementations have stabilised.

“And while WebRTC promises to solve a range of issues relating to interoperability, access, and peer to peer secure data transfer, it in no way solves the domain issues of how consumers initiate planned or unplanned healthcare encounters, how they access services, how multiple healthcare providers are incorporated into the care and how people are moved through the system as they are today, except using video instead of physical transport.”

Off Topic

ONLINE MEDICAL EDUCATION

WELCOME TO THE FOAM REVOLUTION Have you heard medics talking about FOAM or #FOAMed? What does it mean and what exactly is it? Why are so many people giving up their free time to generate free online content? We explain exactly what it is that everyone’s getting so excited about in free online medical education.

DR TESSA DAVIS BSc(Hons), MBChB, MA, MRCPCH tessardavis@me.com

So what is FOAM? FOAM stands for Free Open Access Medical Education. It’s a collective term for all the online medical education resources that have become available over the last 10 years. The overall aim of FOAM is to maximise online free learning opportunities for health professionals.

As online technology has developed, more and more health professionals have been posting free content online. Eventually, it became difficult to keep track of what was available – FOAM is a term coined

by Perth-based emergency doctor Mike Cadogan that ties them all together under one name.

FOAM comes in many shapes and sizes – there are content, platform and presentation styles to suit everyone’s learning needs.

About the author Tessa Davis is a paediatric emergency trainee at Sydney Children’s Hospital. She created www.guidelinesforme.com, an online, crowd-sourced database of clinical guidelines; www.learnmed.com.au, a not-for-profit social enterprise; and www.iclinicalapps.com, a mobile app development company.

Blogs are popping up all over the place.

Individuals or groups with similar interests set up a blog or website where they publish regular posts. These can be specific educational posts where they discuss teaching on a particular topic, or they can be more general posts about a personal experience or learning point.

Sites like Life in the Fast Lane, EMCrit, St Emlyn’s and ALiEM are all examples of

great medical blogs. There are hundreds out there – all in the name of FOAM. Twitter is a great way to keep up to date with FOAM. Unlike blogging websites where the posts are relatively long, Twitter is an example of micro-blogging where people post 140-character FOAM snippets.

FOAM users put the hashtag #FOAMed in their Twitter posts so you can find them easily. These offer links to other FOAM content, interesting articles, or are short FOAM tidbits themselves.

FOAM content With so many FOAM resources available, there has been a move to start collating FOAM content. GoogleFoam (www. googlefoam.com) is a customised Google search engine set up by Todd Raine. So, if you’re looking for some FOAM information, GoogleFoam will search through preexisting FOAM content for you. For those searching for learning resources, this is great for easy access to FOAM; and if you’re a FOAM contributor it avoids you duplicating content that’s already there.

FOAMEM.com is an RSS feed that aggregates posts from all FOAM websites.

This means that instead of having to browse each FOAM site individually you can see all the latest posts in one feed.

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“All of these sites have emerged because of the huge volume of FOAM now being produced.”

The answer to this is to take everything in context, as you do with any other piece of communication. Look at the author and what their experience is; research further yourself if needed; and see what others are saying about the information too.

Dr Tessa Davis

In many ways it’s more peer-reviewed than a journal. One simple blog post can engage 10 people in a Twitter discussion within minutes – it’s instant feedback and debate.

SmartFOAM is a recently released free mobile app that collates FOAM content into feeds that are easily readable on your mobile. Again, this is simply a way of improving ease of access to FOAM while you are on the go. All of these sites have emerged because of the huge volume of FOAM now being produced. We need to keep it manageable.

Other resources provide frameworks for improving medical education and patient care. GMEP.org (Global Medical Education Project) provides a forum for hosting and uploading media (pictures, videos, text) and asking questions online.

GuidelinesForMe.com was started to create a crowd-sourced database of links to online clinical guidelines. At present, it has almost 3000 guidelines on it. Like much of FOAM, the people behind these sites recognised a problem and found a FOAM solution.

The Social Media and Critical Care Conference (SMACC) held in March 2013 was the first conference to really embrace FOAM and social media. FOAMites from all over the world joined together in a unique and innovative experience. It demonstrated that FOAM is more than just having conversations online.

Benefits of FOAM FOAM is not limited to one realm; it really is all-encompassing. What’s so special

about FOAM that motivates so many people to contribute? FOAM provides many benefits to its users and contributors. Its main use is in keeping clinicians up to date. It encourages regular learning by making education interesting and easy to access. FOAM has engaged thousands of health professionals in self-education.

It also encourages innovation in healthcare and medical education. New ideas are being generated all the time, not simply in terms of content, but with innovative ways of presenting that content so as to encourage engagement. Individuals can get their ideas off the ground quickly because there is a large FOAM community to support them.

For those producing FOAM, it improves writing and presenting skills by encouraging medics to think about how to present information concisely and appropriately to their audience. And it’s a great way of networking. Through Twitter, SMACC, LITFL and FOAM in general, you can meet health professionals with similar interests all over the world.

It can’t all be wonderful, some will say.

Indeed, there are many FOAM objectors, and FOAM is not perfect. Critics often cite the lack of peer review and potentially unreliable information with FOAM content.

After all, how do we know that what someone is telling us online is accurate?

Should we really change our practice simply because of a 400-word blog post?

Accreditation is a potential limitation.

Those of us contributing to FOAM spend a huge amount of time (and sometimes money) creating these free resources. The motivation is providing great education, but some people do feel it would be good to be able to formally recognise this in some way. Time will tell whether FOAM accreditation will develop – perhaps we will get CPD credits for taking part in a Twitter chat.

As yet, formal organisations don’t recognise or engage with FOAM and we need to be careful about creating a ‘them’ and ‘us’ scenario. Colleges, journals and organisations are what help us work for a living and we need to collaborate with them. This is starting to change. The paediatric journal Archives of Disease in Childhood recently started a Twitter journal club (#ADC_JC), which united FOAM with a well-respected and well-establish journal.

And it worked well.

Love the FOAM FOAM is wonderful, but it doesn’t replace clinical experience and it doesn’t replace reading textbooks or journal articles.

The key thing to remember is that it’s not intending to replace these. Its aim is to supplement our existing learning through innovative means and encourage all of us to get involved in teaching and learning to help make us better at our job.

Don’t be shy; just get on and do it. Love the FOAM!

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: secretary@aciva.org.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: Emma Pate emma.pate@eostech.com.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.

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

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.

cdmNet P: +61 3 9023 0800 F: +61 3 9614 2650 E: info@precedencehealthcare.com W: www.precedencehealthcare.com cdmNet is the gold standard for managing chronic disease in Australian GP clinics.

University trials show cdmNet results in improved quality of care and better patient outcomes.* cdmNet helps practices take a systematic approach to the management of their chronically ill population. It simplifies collaboration with the care team and ensures regular follow up and review. cdmNet eliminates paperwork and makes compliance with Medicare requirements easy. It increases the productivity of the entire practice and allows evidence-based care to be delivered to all chronically ill patients.

If you wish to use cdmNet to provide high quality care for all your chronically ill patients while increasing your revenues, contact us now.

• See cdm.net.au/evidence

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CONNECT DIRECT Pty Ltd

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

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”.

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Cloud9 Software P: 1300 875 297 F: +61 2 9715 6573 E: globalsales@c9s.com W: www.c9s.com At Cloud9 we understand the complexity of healthcare. We understand the importance of having the right information available when and where it’s needed.

So Cloud9 created an eco-system to connect healthcare providers that supports the availability of key information to improve outcomes for the patient, clinician and organisation alike.

An information infrastructure with real-time access across primary, community and acute setting benefits Clinicians trying to provide the best care for individuals as well as Researchers looking to improve safety and effectiveness of treatments.

Our e-Health infrastructure has been designed to fit in with your current systems, whilst Cloud9’s next generation administrative and clinical applications allow you to upgrade existing systems as your business grows.

Cloud9 Solutions: • Cloud9 Spine, Health Information Exchange • Synchronicity, Application Integration Suite.

• Clarity for GP’s and Specialists.

• Clarity Hospital Information System.

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 and Medicare Online.

The Clinical Module 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.

Accommodating the needs of nearing 2000.

SQL .NET for interoperability and scalability

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.

EpiSoft 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

P: +61 2 8985 6688 / 1300 799 904 E: enquiries@episoft.com.au W: www.episoft.com.au EpiSoft’s web based platforms deliver dual purpose systems that work as comprehensive clinical and practice management platforms together with clinical trials software facilitating multi-centre investigator initiated trials. EpiSoft has developed platforms for: • Mental Health • Cancer management & surveillance • Inflammatory Bowel Disease • Hepatitis • Indigenous chronic disease management • Asthma shared care • Specialised surgery • Pre-admissions patient portal

We have solutions tailor-made for: • Anaesthetists • Surgeons/Surgical Assistants • Physicians • GPs • Allied Health

Affordable and scalable, EpiSoft is used in health organisations ranging from small clinics to large hospital groups across Australia, New Zealand and Singapore.

The software comes with up-to-date schedules for MBS/Rebate, Gap Cover (all registered health funds), Workers’ Compensation, Transport Accident authorities and DVA.

Create multidisciplinary teams, collaborate effortlessly and streamline workflows with our intuitive cloud software. With the highest level of security, redundancy and reliability your data will be accessible anytime and anywhere.

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.

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 New Zealand E: admin@hinz.org.nz W: www.hinz.org.nz Health Informatics New Zealand (HINZ) is a national, not-forprofit organisation with a focus on collaboration, education and advocacy for the use of IT in the health sector. HINZ enables professional collaboration through conferences, seminars and an interactive online portal, bringing together clinicians, administrators, allied health professionals and many others with an interest in health IT and the advances it can enable. HINZ provides a platform to share information about the Health Informatics industry - leveraging best practice from New Zealand and overseas, as well as facilitating networking activities to bring industry experts and interested parties together to collaborate. Membership is for anyone with an interest in Health Informatics.

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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 e-health community for almost 20 years. HISA aims to improve healthcare through the use of technology and information. We: • Provide a national focus for e-health, 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 e-health. Join the growing community who are committed to, and passionate about, health reform enabled by e-health.

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.

InterSystems P: +61 2 9380 7111 F: +61 2 9380 7121 E: anz.query@InterSystems.com W: www.InterSystems.com 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.

MEDITECH Australia P: +61 2 9901 6400 F: +61 2 9439 6331 E: sales@meditech.com.au W: www.meditech.com.au 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 Global Ltd P: 1800 148 165 E: salesau@medtechglobal.com W: www.medtechglobal.com

Houston Medical

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.

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.

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“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: www.HoustonMedical.net

Leecare Solutions P: +61 3 9339 6888 F: +61 3 9339 6899 E: enquiries@leecare.com.au W: www.leecare.com.au Leecare Solutions, with their products Platinum 5 & P5 Exec, are the aged care industry’s leading web browser based clinical and management software system. Since 2000, Leecare has provided relevant, contemporary software solutions for Australian and New Zealand aged care organisations.

Leecare’s mission and products provide outstanding clinical decision making support, and management support tools that use any device, can be installed on multiple platform types and in any location. Used in over 30,000 aged care places, it is the solution used by quality providers, proven through thousands of accreditation, validation and other regulatory visits, as it is based on professional clinical and lifestyle provision concepts.

Medtech’s Medtech32 and Evolution solutions improve practice management and ensure best practice for electronic health records management and reporting.

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.

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.

Orion Health P: +61 2 8096 0000 / +64 9 638 0600 E: enquiries@orionhealth.com W: www.orionhealth.com 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.

OzeScribe P: 1300 727 423 F: 1300 300 174 E: sales@ozescribe.com.au W: www.ozescribe.com.au

MITS:Health P: 1300 700 300 E: info@mitshealth.com.au W: www.mitshealth.com.au Managed IT Services for the Health Industry MITS:Health provides a full range of IT services specifically tailored for medical centres, GPs and specialists across Melbourne.

• • • • • •

Equipment supply and installation Remote monitoring and support Data backups Networking Internet Website Development

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.

PicSafe Medi P: +61 3 9670 9339 E: ted@picsafe.com W: www.picsafe.com The Secure Mobile Medical Imaging System Designed by Australian and US Dermatologists and Plastic Surgeons to be used by a wide range of healthcare professionals working in a variety of clinical settings, PicSafe Medi (patent pending) is as simple as using the normal camera function on your mobile smart device except... your patient’s photo is completely secure and legally compliant in its consent, transmission, and storage when taken with PicSafe...

Both iOS and Android compatible, PicSafe Medi simultaneously suffices patient privacy and related government regulatory requirements (including new Federal APP’s, commencing 12th March, 2014) surrounding the capture, use, and storage of medical photographs.

Using PicSafe Medi, Healthcare professionals can now quickly connect and efficiently document a patient’s status pictorially, facilitating the medical referral process and, ultimately, improving patient outcomes and satisfaction.

Stored clinical photographs are fully patient-consented (including authorisation for specific usages of their photo), watermarked to assure authenticity, and managed in a highly secure, auditable, private server environment, accessible only to authenticated PicSafe users.

From the time you take a patient’s photo with a smart device, to the encrypted transmission and secure storage phases of photo handling, the process is seamless and non-intrusive to both photographer and patient.

• Increase your efficiency and improve your patients’ clinical outcomes • Remove the worry surrounding costly patient privacy breaches • Assure quick, efficient pictorial documentation of your patient’s status • Facilitate a streamlined medical referral process • Fully document your patient encounters for billing, auditing, and medical-legal purposes PicSafe-Medi is “the missing link” in compliant mobile clinical photography.

Precision IT P: 1300 964 404 F: +61 2 8078 0257 E: info@precisionit.com.au W: www.precisionit.com.au • 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!

Professional Transcription Solutions P: 1300 768 476 E: marketing@etranscriptions.com.au W: www.etranscriptions.com.au Australia’s Most Trusted Teaching Hospital and Private Practice Transcription Provider • Web-based - Dictate and receive reports anywhere • Double-edited with over 99.5% accuracy • Fast turn-around in 2 - 48 hours, as required • All medical and surgical specialities covered in Australia’s largest teaching hospitals • Rapid documentation of recorded HR interviews, Research and Expert Reports • Guaranteed cost savings • Data held securely at a State Government owned data centre • Call our friendly staff anytime for your overflow, backlog or all of your typing or data entry requirements • Call us now for an obligation free trial

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™

Shexie Medical System P: 1300 743 943 F: 1300 792 943 E: info@shexie.com.au W: www.shexie.com.au 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.

Sysmex P: +61 3 9013 4445 E: info@sysmex.com.au W: www.sysmex.com.au Sysmex is dedicated solely to helping your healthcare organisation achieve more in less time, with fewer errors and better patient outcomes.

Sysmex lead the way in eDiagnostics: • Providing an essential building block for the electronic medical record with the Eclair Clinical Information System • Enabling sharing of key patient information across regions through the Eclair Clinical Data Repository • Completing the electronic loop with laboratory and radiology order request management (CPOE) • Streamlining all areas of the anatomical pathology laboratory workflow from request to report with Delphic AP • Improving reporting times and reducing costs through an enterprise Delphic LIS, shared across multiple laboratories

Totalcare 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 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.

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.

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

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PULSEITMAGAZINE.COM.AU

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

Therapeutic Guidelines Ltd P: 1800 061 260 E: sales@tg.org.au W: www.tg.org.au 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.

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.

VIRTUAL CONSULTING ROOMS

VConsult 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.

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.

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.

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.

Zedmed

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.

P: 1300 933 000 F: +61 3 9284 3399 E: sales@zedmed.com.au W: www.zedmed.com.au Zedmed is an innovative provider of business solutions to the medical and financial services industries. Our practice and clinical management solution is designed to be simple, intuitive and seamlessly integrated.

With personalised training, installation and data conversions from almost all software packages, changing software has never been so easy.

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

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