Pulse+IT Magazine - February 2013

Australasia’s First and Only eHealth and Health IT Magazine

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ISSUE

18 FEBRUARY 2013

PATHOLOGY & RADIOLOGY

Pathology terms and units

Standardising pathology terms and units and the delivery of test results will improve interoperability.

Diagnostics and the PCEHR

Plans to deliver pathology results and radiology reports into the PCEHR are in a deadlock over funding.

Evolution not revolution the key to TestSafe How NZ’s TestSafe system has evolved from a way to present test results to one hospital’s clinicians into a true clinical data repository.

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Organisations please note: Based on an overwhelming response to the twice-weekly Pulse+IT eNewsletter service in 2012, this timely complement to Pulse+IT magazine is transitioning to a daily format. Each day is focused on a different part of the health sector, with aged care, allied health, medical practices and the acute sector all receiving dedicated coverage. Advertising opportunities have been released and are selling fast. To register your interest and obtain a media kit, email: enews@pulseitmagazine.com.au

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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 six edition for 2013 to be distributed for release in: • April 2013 - Secure Messaging & Electronic Prescribing • Mid-May 2013 - Medical Devices • July 2013 - PCEHR / HIC2013 Preview • Mid-August 2013 - Telehealth / HIMAA Conference Preview • October 2013 - New Zealand eHealth / HINZ Conference Preview • Mid-November 2013 - mHealth Submission guidelines and deadlines are available online: http://www.pulseitmagazine.com.au/editorial Pulse+IT acknowledges the support of the following organisations, each of whom supply copies of Pulse+IT to their members.

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

ISSN: 1835-1522 Contributors David Hansen, Simon James, Michael Lawley, Vincent McCauley, Kate McDonald, Matthew Nielsen, Anthony Nguyen and Louise Schaper.

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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COALITION PROMISES PCEHR STOCKTAKE

CT SCAN EDUCATION APP LAUNCHED

TRAINING BY REMOTE SIMULATION

Editorials

Features

News

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STARTUP

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PATHOLOGY AND THE PCEHR

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HISA

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EXCHANGING TEST RESULTS

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Editor Simon James introduces the 33rd edition of Pulse+IT and the results of our readership survey.

Louise Schaper predicts that the #epatient will be one of the trends of the digital health revolution.

We will see a convergence of the consumer, the technology, the science and the money.

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.

HL7 2.4 the standard for the electronic exchange of pathology and radiology orders and results.

SELECTED BITS & BYTES Coalition promises to do a stocktake on the PCEHR Hacked Gold Coast GP had data back-up but RDP suspected GP to patient video consults just part of the healthcare mix, according to Skype2doctor

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AUTOMATED RESULTS ANALYSIS

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EVOLUTION OF TESTSAFE

Online referral system closes the gap for specialists and GPs

NZ’s TestSafe lab and radiology results repository has evolved into what is close to an EHR.

App heralds official launch of the National Health Services Directory

MSIA Vincent McCauley explains the importance of the recent work being done on messaging standards and terminology standardisation to enable better information provision and interoperability.

A model has been designed to get pathology results into the PCEHR, but funding is the deadlock.

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CSIRO has developed new software that helps automate the analysis of pathology and radiology reports.

LIS MARKET LANDSCAPE The consolidation of laboratories means a changing market for laboratory information systems.

Federal privacy laws to have ramifications for data security

Hub allows GPs and radiologists to collaborate in real time AMA calls for a step-by-step toolkit for practices using the PCEHR

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PATHOLOGY UNITS AND TERMS

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SNAPPER FOR SNOMED CT

$10 million for prescription exchange interoperability

CSIRO’s Snapper software is available for converting legacy terminology into SNOMED CT.

Practitioners can assist patients to register for a PCEHR

The terms and units of measure for pathology requesting and reporting have been standardised.

PCEHR uploads are easy but registration needs streamlining

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Editorial

E-HEALTH PRACTICE INCENTIVES PROGRAM An IT consulting secondment to prepare a general practice for the latest eHealth Practice Incentives Program leaves Simon James pondering the hidden cost of the rollout of Australia’s eHealth foundations. In preparation for what is sure to be a very busy year for both the publication and the sector on which it reports, he takes the wrapping off the Pulse+IT iPad app, and gives away iPads to lucky respondants to the 2012 readership survey.

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

Welcome to the first edition of Pulse+IT for 2013!

While it already feels like a distant memory, the recent Christmas period afforded this editor an opportunity to spend some time returning to his IT consulting roots in rural general practice.

Like the majority of the general practices throughout Australia, the medical centre in question was hoping to use the festive season ‘quiet time’ to bring its IT systems up to date with the latest government directives as outlined under the eHealth Practice Incentives Program.

With Pulse+IT having invested considerable time covering the ePIP changes since they were first announced in the May 2012 federal budget, I was perhaps more cognisant of the magnitude of the task at hand than most practices, which is not to say things went smoothly.

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.

Having also been involved in this practice’s April 2009 ePIP compliance process, it’s been apparent for many months – at least to this editor – that the latest ePIP criteria were going to take far longer to comply with than the 15 minutes of paper work and basic computer configuration required to surpass the 2009 ePIP requirements.

As stated in the National E-Health Transition Authority’s (NEHTA) ePIP

implementation overview documents for the now-enacted 2013 ePIP, the new requirements for general practices seeking ongoing funding are: Requirement 1 - Integrating Healthcare Identifiers into Electronic Practice Records • Apply to Department of Human Services (DHS) to obtain a Healthcare Provider Identifier-Organisation (HPI-O) for the practice, and store the HPI-O in a compliant practice management and clinical software system; • Ensure that each general practitioner within the practice has a Healthcare Provider Identifier-Individual (HPI-I), stored in a compliant practice management and clinical software system; • Use a compliant clinical software system to access, retrieve and store verified Individual Healthcare Identifiers (IHI) for presenting patients.

Requirement 2 - Secure Messaging Capability The practice must have a standards compliant secure messaging capability to electronically transmit and receive clinical messages to and from other healthcare providers, use it where feasible, and have a written policy to encourage its use in place.

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Requirement 3 - Data Records and Clinical Coding Practices must ensure that where clinically relevant, they are working towards recording the majority of diagnoses for active patients electronically using a medical vocabulary that can be mapped against a nationally recognised disease classification or terminology system. Practices must provide a written policy to this effect to all GPs within the practice.

Requirement 4 - Electronic Transfer of Prescriptions The practice must ensure that the majority of their prescriptions are sent electronically to a prescription exchange service.

Requirement 5 - Personally Controlled Electronic Health (eHealth) Record System The practice must use compliant software for accessing the personally controlled electronic health record system, and creating and posting shared health summaries and when available, event summaries; and apply to participate in the eHealth record system upon obtaining a HPI-O. When presented succinctly, these criteria mask a number of caveats that soften the requirements in some areas, including differing deadlines for some criteria, with effective extensions added to others in reflection of the elongated Department of Human Services (DHS / Medicare) HPI-O and NASH certificate processing time frames.

However, also hidden from obvious view is the large amount of preparatory IT work that may need to be done before much, if anything, required in the ePIP criteria can be put into use in a general practice.

The practice to which I consulted first required a major update to its clinical software, which, while technically straight forward, consumed an entire weekend owing to the size of the database and the large number of workstations in the practice. Additional RAM then needed to be installed in each workstation to support the more resource-hungry requirements of the new version of the software.

This was followed up with the required commissioning of an ePrescribing solution, despite personal reservations about the veracity of the technology and its associated documentation, and more objectively the slim likelihood that the town’s sole local pharmacy will ever download any of the electronic scripts the practice generates.

While the practice had done a good job of applying for the various identifiers well before my arrival, outstanding work remains to be done; at the time of writing, the practice’s NASH certificate has not arrived, a pivotal piece of the jigsaw without which many of

the eHealth functions to be adopted by practices can not operate, let alone be configured in this case. And before the August secure messaging deadline, to achieve compatibility with the requisite SMD version of the practice’s existing secure messaging capability, the practice will require a major operating system update be rolled out across some 15 workstations, unavoidably followed by the re-installation of clinical software, additional proprietary messaging solutions, ePrescribing, digital certificates, along with a host of other software solutions typically used in modern computerised general practice.

Despite the considerable administrative burden and the potentially large IT support overheads practices will need to absorb, I note considerable efforts have been made to support practices along their ePIP journey. However there is a considerable body of anecdote that suggests the sheer number of organisations involved in the ePIP have further complicated what is already a significant parcel of work for general practices to undertake.

The Medicare website notes that the Practice Incentives Program is administered by the Department of Human Services on behalf of the Department of Health and Ageing (DoHA). The Australian Health Practitioner Regulation Agency allocates HPI-Is to practitioners, with NEHTA fulfilling the role of host of the ePIP Register, which lists the software products practices can select from to fulfil the various criteria. http://www.nehta.gov.au/pip The NEHTA website also provides practices with implementation guidelines and a range of other support material, albeit presented in a fairly ominous looking table with over 30 separate documents available to download. In combination with the documents provided by Medicare via an equally confronting list, this makes for a substantial amount of reading, a good deal of which is naturally redundant given the intent of their respective documentation is identical – assisting practices to comply with their ePIP requirements.

But as practices are now well aware, these government-provided resources represent just the tip of the documentation deluge, with the Australian Medical Association, the GP colleges, the Australian Association of Practice Managers, software vendors, and no doubt many other organisations all attempting to assist their respective memberships and customers. In combination with the additional resources being developed by Medicare Locals, it comes as no surprise to this editor that, one week before the February 1 deadline, DoHA reported to Pulse+IT that just 3300 of an estimated 7000 general practices had found an opportunity to register for their HPI-O. Unconfirmed reports as we went to print suggested a late rush of registrations occurred in the final days

of January, elevating the number of general practices that have registered for a HPI-O above 60 per cent.

Practices, their IT support personnel and the scores of people now occupying newly created ‘eHealth’ roles may well have been better served if they had a single ‘source of truth’ to refer to, to assist them to navigate the 2013 ePIP requirements, and a single government organisation with which to liaise when things become difficult.

The complexity of the interactions between practices and the various government help desks set up for eHealth purposes is best highlighted by one of NEHTA’s own support documents – the first one on its resources page – which lists no less than four different help desk numbers across just six different checkpoints in the document.

Readership survey recap

The lucky 100th, 200th, 300th and 400th respondents that completed the survey have each won themselves an iPad mini, which may come in handy for browsing the new Pulse+IT iOS app!

Pulse+IT for iPad One of the repeated requests made of Pulse+IT in the readership survey was for the magazine to be made available for tablet devices. In response to this demand, Pulse+IT has launched an app, which bears the not very imaginative name, ‘Pulse+IT.’ Unlike many of the 6800+ other titles available in Apple’s Newsstand, both the app and the magazines available within the app are available for free, a pricing arrangement I hope to be able to maintain indefinitely. In support of this initiative, I invite all readers with an iPhone, iPad or iPod touch to download the app and give it a test drive. The app, and the back issues contained within, are available from: http://appstore.com/pulseit

Concluding a year of strong growth, both in print and online, Pulse+IT launched a readership survey alongside the release of the November 2012 edition. Over 408 responses were collected via an online form with many people taking the time to leave substantive feedback and some great ideas to inform the future direction of the publication.

If you are interested in reviewing the results of our readership survey or would like to provide Pulse+IT with any additional feedback or ideas, visit us online here: http://bit.ly/pulseit2012results

The team at Pulse+IT are pleased with the first version of the app and are working with some talented local developers with a view to rolling out additional functionality in the weeks ahead. With this in mind I’d very much welcome any feedback that will assist us to evolve this offering.

Pulse+IT eNews now daily Launched in a twice-weekly format in 2012, the Pulse+IT eNewsletter service brings together recently published original articles from the Pulse+IT website, links to relevant third‑party articles, events, career and business opportunities. In January, we launched a weekly Aged Care edition (Wednesdays) and will be launching an Allied Health edition in late February (Thursdays), with a Singapore edition (Mondays) to follow in March. These new editions will complement our existing Practice (Tuesdays) and Acute (Friday) eNewsletters, and I look forward to the challenges and opportunities this daily news cycle will present in 2013.

Both existing and new eNewsletter subscribers are free to opt in and out of particular days/editions of the Pulse+IT eNewsletter to suit their interests. http://www.pulseitmagazine.com.au/enews To support these additional offerings, I’m pleased to announce that Sue Cartledge, former editor of Yaffa’s Hospital and AgedCare magazine has rejoined her former colleague Kate McDonald in the Pulse+IT news room. Sue will primarily focus on IT developments in aged care and allied health, broadening Pulse+IT’s reporting to cover the entire healthcare sector.

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News

Coalition promises to do a stocktake on the PCEHR if it wins election A Coalition government would do a “stocktake” on the PCEHR system should it win this year’s election to determine its level of functionality and what if anything should be done to improve it in future.

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Opposition spokesman for primary care, Andrew Southcott, said that while the Coalition agrees with eHealth in principle and voted to support the passage of legislation for the Individual Healthcare Identifiers and the PCEHR, it would wait until after the election to consider any changes, if necessary.

Dr Southcott said the Coalition had not considered any changes to the Practice Incentives Program, including the ePIP, but confirmed that if it wins government, it would not continue with the current structure of Medicare Locals. “[The PCEHR] is still a moving feast,” Dr Southcott

said. “Our plan is to do a stocktake when we come into government and determine what is the exact status of the project.

“Our position is that the government had a number of reports from Deloitte and Booz which identified a national eHealth strategy and recommended that the government focus on quick wins like electronic prescriptions and discharge summaries, and I strongly believe that this is what they should have done.

“The strategy that was outlined back in 2008 was for a gradual, staged approach and with ePrescriptions and discharge summaries you would have had something that clinicians would have found very useful and would have had a high take up.”

Dr Southcott repeated the claim that almost a billion dollars had been spent on the PCEHR, first made in The Australian last year.

The Minister for Health and Ageing, Tanya Plibersek, has disputed this figure in Parliament, saying the newspaper had doublecounted some of its figures.

Ms Plibersek told Parliament last year that the PCEHR allocation was $467 million over two years.

An extra $233 million over three years was allocated in the May 2012 budget, bringing the total to $700 million. NEHTA also receives additional funding that is separate to the PCEHR system.

Dr Southcott said the Coalition had established NEHTA and supported the principle of having a standards-setting body.

“If you look at the history in this area, we were able when we were last in government to get GPs to computerise very quickly, and we do have high rates of computerisation in general practice.

Specialists and allied health

less so, but we were able to do that in a space of a few years – get them to computerise.

“And what’s happened over the last decade is practice management software has become more sophisticated, it is really incorporated in the way the practice is run. That’s the pattern – if clinicians find it useful, they will take it up. I think the ePrescriptions and discharge summaries were obvious areas.

“The PCEHR ... we are close to a billion dollars spent on it, the registrations are well below what was even forecast in last year’s budget. The major speeches I have given on this with the IHI legislation and the PCEHR legislation outlined our general position, which is that we support eHealth in principle.

“We supported the IHI because that’s a good idea and is one of the building

blocks, and we do support eHealth in principle, but we do feel that with the PCEHR, the government has gone down a highrisk track and this is just another project which has been mismanaged.

“...with the PCEHR, the government has gone down a high-risk track and this is just another project that has been mismanaged...”

“Most of the money is already gone, so what we will do is a stocktake when we come into government to determine the functionality of the PCEHR.” Dr Southcott said he could not put any figure on potential eHealth investment, saying the

Coalition would wait until after the May budget to release its policies.

“It’s [early February] and the election is on the 14th of September, and we still have a budget between now and then, so this is not the final word on what our priorities will be in eHealth,” he said.

“Our policies are likely to be released after the May budget when we’ve got an appreciation of the overall financial position of the government.”

He said any changes to the Practice Incentives Program, including the ePIP, were not something that the Coalition had considered.

“I do know the RACGP and the Medicare Locals are doing a lot to make sure that their practices are aware of [the ePIP] and the new requirements, but it’s not something that we’ve considered.”

He also confirmed that Medicare Locals would be changed should the Coalition win the election.

Dr Andrew Southcott

Medical Director ready for ePIP and PCEHR Health Communication Network (HCN) has announced that users of its Medical Director and PracSoft software will qualify for the new eHealth Practice Incentives Program (ePIP) following its listing on NEHTA’s online product register as complying with the requirement for full interface with the PCEHR. Medical Director and PracSoft have been listed on the registers for HI Service integration for some months, along with electronic transfer of prescriptions capability for MD. HCN clients who use a Secure Message Delivery (SMD) compliant messaging service will also fulfil the secure messaging requirement.

An HCN spokesperson confirmed that Medical Director, the market-leading clinical software package, has officially been approved and is now on the PIP eHealth Product Register for PCEHR compliance.

“This is great news and testament to the dedication and effort put in by our employees over the Christmas and New Year period to achieve this milestone for our valued customers,” the HCN spokesperson said.

A general release of MD and PS versions 3.14d was available at the end of January, along with instructions on how to ensure ePIP compliance.

“We’ve said that we won’t continue with the structure of Medicare Locals but we do see the importance of a coordinating role in primary care,” he said.

Practices wishing to qualify for the new ePIP must have shown they are using compliant software for the first four requirements by February 1, with full PCEHR interface capability by May 1.

“It is something we are consulting on and we are seeking feedback from lots of different stakeholders.”

The HCN spokesperson said the company had also created a dedicated eHealth page to assist its customers with ePIP preparations.

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Bits & Bytes

50 per cent of general practices assigned HPI-O Slightly less than half of all of Australia’s general practices have applied for or been assigned a Healthcare Provider Identifier – Organisation (HPI-O), one of the requirements to be eligible for the eHealth Practice Incentives Program (ePIP).

According to recent figures from the Department of Health and Ageing, 2867 HPI-Os have been assigned to healthcare providers, with another 1400 applications being processed by the Department of Human Services.

A DoHA spokeswoman said that collectively, this amounts to 4267 healthcare provider organisations that have been or will be assigned an HPI-O number, and approximately 3300 of these are general practices.

It is estimated there are 7000 general practices in Australia, according to the most recent figures published by the Primary Health Care Research & Information Service (PHC RIS).

The spokeswoman also said that as of late January, 42,724 consumers have registered for a PCEHR, mostly online.

Medicare Locals are currently ramping up their efforts to assist practices to register patients, under the assisted registration regulations released late last year.

General practices must register for an HPI-O to be eligible for payments under the new ePIP, as well as apply for digital NASH certificates to access the PCEHR and use secure messaging.

The majority of software vendors have or are close to receiving certification that their product complies with the five requirements of the ePIP, with Communicare and Best Practice the latest companies to be registered on all of NEHTA’s ePIP product registries, fulfilling their GP desktop vendors panel contract.

Hacked Gold Coast GP had data back-up but RDP suspected as entry point The Gold Coast general practice that was hacked and held to ransom by suspected eastern European cyber criminals late last year had an external data back-up system in place and was able to recover most of its data, but the case provides a lesson in following security best practice, its IT consultant said.

Jason Fillmore of Essential IT Services said the Miami Family Medical Centre did regular back-ups through both its Windows 2003 Small Business Server Premium package and to DAT external tape drives, but the hackers had been able to disable all of those systems during the attack.

A staff member had taken one of the DAT tapes home the previous evening so that data was restored, but as it was only a data back-up and not a full system image back-up, it took time for the practice to get up and running again, he said.

to log in and tells them their data had been encrypted, but which also disables the start up of Safe Mode.

“How we got around it was we actually emailed the hacker because part of their message is ‘for us to prove that we can decrypt the files, send us a couple of files and we’ll decrypt them and send them back to show you we can do it’,” Mr Fillmore said.

“David Wood, the owner, said to them ‘how can we send this file if we can’t get in?’ So they sent us the unlock code that would take away that message. It was the trickiest bit of work I’ve ever seen. They were very thorough and had obviously given it a lot of thought.

They disabled a whole pile of services on the server.”

Miami Family Medical Centre uses the practiX practice management software and a SQL database, and everything had been locked down.

The hack is suspected of being a brute force attack via the practice’s Windows remote desktop protocol (RDP) connection. “Having an RDP port open is not really the best thing,” Mr Fillmore said.

“They encrypted the whole SQL database. In fact, they encrypted about 6500 files on the server – they went through and searched for every doc, xls, txt, pdf, mdb, mdf – all of the standard data files,” he said.

He believes the hackers used some sort of ransomware that brings up a message when users try

“They are not actually taking the data anywhere and it is not being uploaded or anything like that. They

just put this service in – the encryption – after they have disabled antivirus, disabled back-ups, disabled volume shadow copies. They did a whole pile of nastiness to the server.”

While the practice was fortunate it had followed the correct procedure of taking a back-up tape offsite, it did not have online back-up and had not done a full system image back-up, as the DAT tape holds only 70GB, Mr Fillmore said.

It is known that a number of medical practices in Queensland were similarly targeted, which Mr Fillmore believes is due to the perception that doctors not only need their data but that they can afford to pay the ransom. Since the attack, Mr Fillmore has disabled RDP access for a number of his clients.

“Unless they absolutely, entirely need to be remote desktopped directly to the server, I would recommend they don’t,” he said.

Practices can’t be cut off from the internet completely as they need access to Medicare and to receive pathology results, but he said unless practices really need RDP access direct to a server, then cut it off for the time being and instead use TeamViewer or LogMeIn or a similar remote system.

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Bits & Bytes

First steps in aged care gateway initiative

GP to patient video consults part of the medical mix – Skype2doctor

The federal government has issued a request for tender for contact centre services as the first step in its $198 million aged care gateway plan.

The aged care gateway aims to create a single entry point for the aged care system and enable timely and reliable information to be accessed by older people, their families and carers.

A key element of the gateway is a new My Aged Care website, which will consolidate information on ageing and aged care services. This will eventually include quality indicators and a rating system for aged care services.

Approved providers will be required to publish accommodation payment prices, to be charged from July 1 next year, in materials provided to prospective residents, on their own website and on the My Aged Care website from April 1, 2014.

A DoHA spokeswoman said the government’s current Aged Care Australia website will be decommissioned following the introduction of the My Aged Care website. The current national number for information on aged care, 1800 200 422, will be used by the aged care gateway’s national contact centre.

The gateway plan will also include the introduction of a central client record, which will be required to interoperate with existing government services and ICT systems.

DoHA plans for the central client record to contain personal and demographic information, carer and representative details, authority to share information, referral records and assessment history.

The contact centre and My Aged Care website will be managed by Healthdirect Australia and are due to go live on July 1.

The founder of the new Skype2doctor telehealth service has moved to allay fears that it will disrupt the traditional doctor-patient relationship, saying it will not detract from face-toface consultations but will be simply another way to deliver healthcare.

Dr James Freeman, who founded the GP2U telehealth service for specialist consultations that are currently subsidised under the government’s telehealth program, said Skype2doctor was an extension of this new mode of practice and would provide a mechanism for any GP to deliver telehealth care to any patient.

Skype2doctor plans to provide a platform for GPs working from home to offer paid video consultations to patients. All the GP

needs is a Skype account, a computer, a printer and PBS prescription paper.

The company has devised a fee schedule based on the Australian Medical Association’s recommended structure, although GPs are free to set their own fees. Patients simply pay by PayPal or credit card.

While the early details of the new service have come in for some criticism from the AMA and the RACGP, Dr Freeman said several organisations had called for the telehealth rebate to be extended to GPs providing care to people in aged care facilities and those at home with mobility issues, and this is exactly what Skype2doctor would enable, albeit as a paid service.

“If you look at a typical GP consult, 90 per cent of the

time you get reassurance, 70 per cent of the time you get a script written, 10 per cent of the time you get a medical certificate, 10 per cent of the time investigations, and five per cent of the time a referral – that’s the rough breakdown,” he said.

“A lot of GP work is psychology and psychiatry – 40 per cent of telehealth has been psychiatry and no one argues with that or that you can’t do a great job via telehealth. With GP counselling – again you can do a great job.

“That’s already 12 million consults a year in that category. There’s no doubt that you can’t do everything by telehealth but there certainly are areas that you can do and I think that’s a discussion for the profession and the public.”

Dr Freeman said the main logistical issue the new service had to overcome was the prescribing and dispensing of medications.

Skype2doctor has signed an agreement with Terry White Chemists to allow GPs to automatically fax a script to a local Terry White pharmacy or to deliver medications by courier through its online service.

Scripts can also be sent to the patient in the post.

The agreement is not limited to Terry White Chemists, as it was just the first large chain to sign up, and Dr Freeman said the company was currently in discussions with several other pharmacy groups to get them on board as well.

Under current prescribing and dispensing regulations, scripts must be written on PBS paper in order for the rebate to be refunded to pharmacists, so GPs taking part in the service will simply prescribe in the normal manner.

With prescriptions, patients are offered three distinct options, Dr Freeman said.

“They can elect for the doctor to post the script to their home, allowing the patient to choose any pharmacy to have it filled.

“They can select a nearby local pharmacy from a Google map and have the script immediately faxed through for pick up, or they can elect to have the

prescription fulfilled online by terrywhitechemists.com. au, who will arrange for it to be home-delivered. In all cases a paper PBS script, hand-signed by the treating doctor, is delivered to the necessary location.”

Under current dispensing regulations, both bricksand-mortar and online pharmacies are allowed to dispense drugs if they have a facsimile copy of the script, as long as the original is then posted.

“Because this is a premium service you have to offer better than what you can get and the advantage here for the pharmacy is that you can get the script before the patient is there and you can work at your usual rate,” Dr Freeman said.

“For the patient the service is tremendous because they can go in, grab the medication and off you go.

The third way is through an online pharmacy and they have the ability of delivering door to door.”

For the GP, one of the benefits of the Skype2doctor service is that it has already created an online patient management system that is used for its GP2U clients. The PMS looks and functions exactly like common GP desktop software like Best Practice, Dr Freeman said.

It has access to MIMS Online, patient notes, referral letter templates

and RACGP guidelines, and the only difference is that it’s hosted online.

Clinical notes are stored in a database behind a Defence Signals Directorate (DSD)-grade gateway, and while the service has sandbox access to the PCEHR, it is not likely that notes will be uploaded in the near future.

Skype2doctor is offering a full managed service to GPs, including the patient management system and online appointment bookings. When the GP lists their free appointments, it will also list the fees charged. “There is a recommended fee schedule which is $30 for five minutes, $50 for 10, $70 for 15 – that is $4 a minute plus a $10 flagfall,” he said.

“That is in line with the AMA’s recommended fee which is $71 for a standard consult and $130 if it is more than 20 minutes. We think that is a price point that is reasonable, but the GP sets their own fees and their own hours and they work in a way that fits in with their lifestyle.”

He believes routine repeat prescriptions for contraception, blood pressure and counselling for depression are obvious areas to explore, along with palliative care.

“It may not be a huge part of the market but it should be part of the mix,” he said.

HealthLink readies its users for ePIP and interoperability Secure messaging vendor HealthLink has been listed on NEHTA’s eHealth product register as conforming to the new requirements of the eHealth Practice Incentives Program (ePIP).

The secure messaging requirement ensures that listed products comply with the Secure Message Delivery (SMD) standard, which will help enable interoperability between messaging and clinical software vendors.

HealthLink has started automatically updating its more than 8000 clients to the SMD-compliant version of the software, HealthLink’s head of operations, Geoffrey Sayer, said.

“HealthLink has now undergone testing with the Australian Healthcare Messaging Laboratory and a second independent SMD laboratory,” Dr Sayer said. “As such HealthLink is well versed in dealing with the issues that will affect interoperability.”

Dr Sayer said HealthLink has already been actively testing a number of recently released clinical software products to confirm the integration with HealthLink, ensuring that users of those systems will meet the requirements for SMD. “HealthLink has been testing the interoperability of messages produced and consumed by several of the EMR systems to make sure that end-to-end systems actually work in the real world.

“Most importantly HealthLink can provide the practical day-to-day support required for GPs, specialists and healthcare organisations through this transition phase and assist them well into the future.”

HealthLink is also continuing work on the SMX partnership, which will shortly enable users of different messaging services to communicate with each other.

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Monet users to be eligible for ePIP and PCEHR General practice users of the Monet patient management and clinical software package will be eligible for the government’s new eHealth Practice Incentive Program (ePIP), with confirmation from the product’s vendor, Cloud9 Software, that it is close to achieving its compliance certificates.

Monet, first developed by Monet Technologies in the early 2000s and purchased by IBA Health in 2005, subsequently became part of iSOFT in 2009 and was then sold to Cloud9 in 2011.

It is used extensively within the IPN group of medical centres.

Monet has been listed on NEHTA’s ePIP product register for electronic transfer of prescriptions capability and the HI Service, Cloud9 business systems consultant Kylie Rose said. Monet would also be capable of full PCEHR access by May 1, she said.

Monet has been listed alongside Cloud9’s new offering, Clarity, which is being developed to replace the older architecture. Clarity has also been listed as ETP compliant.

“Clarity is based on the .NET framework and is a .NET development application that will ultimately become cloud-based,” Ms Rose said. “The architecture that Monet is built on is a bit redundant and our ability to expand functionality within that application is very difficult.

“Fundamentally the two applications are aligned to each other, but we are building the Clarity application as the next generation.”

She said that depending on IPN’s schedule, Cloud9 will begin transitioning most if not all Monet sites to Clarity over the next 12 months, starting with the patient management system in phase one and then the clinical suite.

Revision of privacy laws have wide ramifications for data security breaches The recent extortion attempts by hackers against general practices in Queensland have brought into focus the effect that the new privacy laws will have on the healthcare sector, with particular ramifications for breaches of data security.

The Privacy Amendment (Enhancing Privacy Protection) Bill 2012 passed both houses of Parliament late last year and will come into effect in March 2014.

The new privacy laws bring together the former Information Privacy Principles, which covered the public sector, and the National Privacy Principles, covering the private sector, into one group of 13 Australian Privacy Principles (APP).

The Australian Privacy Commissioner, Timothy Pilgrim, has urged all organisations, both public and private, to review the new principles and warned that his office will have substantially boosted powers to enforce the laws and exact penalties for any breaches.

“From the commencement of the new laws, I will be able to accept enforceable undertakings, seek civil penalties in the case of serious breaches of privacy, and conduct assessments of privacy performance for

both Australian government agencies and private sector organisations,” he said.

“While I will continue to work with agencies and businesses to help them comply with privacy laws, I will not shy away from using these powers in appropriate cases.”

It is expected an amendment to the new laws will be introduced next year to establish mandatory data breach notification rules, which the Office of the Australian Information Commissioner (OAIC) recommends follow the notification requirements of the PCEHR Act.

“These types of events along with [the new data breach notification laws] could actually close down businesses who don’t take this seriously.”

What this means for healthcare providers is that all organisations should review their privacy policies now, as they will be required to have a written statement. It also means they should look at boosting their IT security arrangements to ensure

a breach does not occur, security experts say.

While most of the new principles are similar to those that healthcare organisations have worked under for many years, it is the potential for unintended breaches of privacy through lax IT security processes that has many in the industry concerned.

Paul Waite, director of solutions and innovation at Obsecure, a Sydney-based company specialising in information security, said the Queensland hacking cases should be a warning sign to general practices in particular that they need to beef up their security.

Mr Waite said general practices are most vulnerable to data security lapses in the way they store and back up information.

He said extortion attempts such as those on the Gold Coast should also encourage practices to investigate taking out cyber security insurance.

The main problem, however, is in practice workflows and the transmission of patient information, especially by email, he said.

“GPs tend to use email for the movement of sensitive information and the privacy legislation pretty well forbids you from doing that

now,” he said. “Without going right down to saying you must not, it basically means that you need to take every precaution to protect information that is being transmitted, whether that be through email or FTP. You need to take a duty of care in regards to that health information.”

particular email. A lot of organisations, and even some of the larger corporates in Australia, don’t realise that if they are sending something of a personal nature internally using say a Microsoft environment, the Microsoft Exchange administrator can see every email that goes through the server.”

Mr Waite has a vested interest in the topic as Obsecure markets a software product that distributes sensitive patient data by providing a privacy-compliant, secure messaging platform for GPs which involves data encryption and strong two‑factor authentication.

While organisations may take this risk, it is only when a breach occurs that it really hits home, he said.

“If you haven’t had a breach you can take a risk, but the important thing is that under the old Privacy Act, you’d basically just get a rap over the knuckles.

However, he also believes that GPs and other healthcare providers are not adequately aware of what the new laws will mean.

“Now because of the civil penalties being introduced, that changes the whole way that you should consider doing things.

As with a new app being developed by Melbourne plastic surgeon David Hunter-Smith and colleagues to provide a secure way of sharing clinical photographs (see Pulse+IT November 2012), ubiquitous forms of data transmission such as email now need to be carefully looked at. Gmail, for example, is hosted in the cloud but Google’s servers are located throughout the world, not here in Australia.

“ We are working with a few industry bodies to put together privacy impact assessments (PIAs), so with those PIAs, coupled with security technology and cyber security insurance, that pretty well gives you good coverage ...”

And it is not just Gmail, Mr Waite said. “It’s any email system, because any administrator can see the contents of that

“The remediation means that for a period of time in the case of a breach of X number of personal records that could impact or form

He warned that an action plan in the event of a breach was essential, not just because of the cost of the breach itself, but the cost of remediating it.

an identity – the majority of healthcare providers would have sufficient detail there with Medicare numbers and date of birth and addresses, for example, that would be enough information to form an identity – you would have to monitor every credit agency for a period of time to ensure that the personal information stolen was not used in applying for credit.”

Mr Waite said this would mean that organisations that are responsible for a breach would need to purchase subscriptions to credit agencies like Veda or Dun and Bradstreet to check that credit has not been applied for using an individual’s details.

“The person responsible for monitoring those credit agencies is the person who let the information out,” he said. “When Sony had their 77 million PlayStation subscribers’ details leaked, they thought they were covered under public liability insurance and they are not. Now Sony has to monitor 77 million people over a period of time, so you can imagine the cost.”

Obsecure’s product, developed here in Australia, allows users to drag and drop any electronic records into an interface, which will then encrypt the file, wrap it securely before storing it in a secure location, either in a data centre or hosted in the user’s own environment, meaning it does not leave the office.

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Barwon ML moves into PCEHR registration Barwon Medicare Local in Victoria has been assisting general practices to sign up patients to the PCEHR system and hopes to have up to 10,000 consumer registrations by the end of the year.

It also aimed to have almost all of the general practices in the area prepared for the eHealth Practice Incentive Program.

Barwon ML, which has 336 GPs and 186 practice nurses in its catchment, is now acting as a ‘hub’ in DoHA’s eHealth cluster program, assisting four other Medicare Locals with their eHealth needs.

It started early on the PCEHR project, CEO Jason Trethowan said. “Our initial role was to take all of the information that is available from NEHTA and the Department of Health and Ageing, from software vendors and from Medicare, and to distil that into the regional level to make it a logical discussion for local healthcare professionals about what the PCEHR is.

“Now we are going into each of the practices to support them with signing up to the PCEHR. There is a lot of paperwork and typically general practices and more paperwork aren’t natural allies, so we support the practices with the administrative functions and the process, which is really important to get right.”

Barwon recently uploaded its first shared health summary directly from Medical Director to the PCEHR, following the roll out of MD’s PCEHR-compliant version in late January. Medical students have been hired on a casual basis as “eHealth consumer assistants” to gauge patient interest in signing up for the PCEHR at the practice level, he said.

Anecdotally, patients seem to be very interested in the project, Mr Trethowan said. “They seem to think these things should be done already.”

Online referral system helps close the gap for specialists and GPs A new online referral service has been launched allowing GPs to easily refer patients to the most appropriate specialist while allowing specialists to accept or reject a referral with the click of a button.

MEDrefer has been designed by a Queensland company to streamline the referral process, particularly for GPs new to an area who don’t have relationships with local specialists, and for young specialists starting out in their career.

MEDrefer is an online service but is also being integrated into Best Practice and Genie to streamline referrals even more, the company’s managing director, Brian Sullivan, said.

Mr Sullivan said the idea for MEDrefer came from a GP friend who was frustrated that he couldn’t keep track of whether a referral had been accepted or not and often had to chase up the patient, and who also had a drawer full of letters from young specialists looking for patients.

“Young specialists need to get the word out and established specialists often have full books and don’t want to receive any more referrals,” he said.

“We thought this was an opportunity and we looked

around the world and there is nobody who does what we do. There are lots of people doing online booking for GPs, but there wasn’t anyone doing anything online for specialists.”

MEDrefer is a free service for GPs, who are able to search a directory of consultants by their sub-specialties, location, availability and other factors like gender or languages spoken. They can book an appointment for the patient then and there, or provide the patient with a referral certificate listing five recommended specialists from which the patient can choose the most appropriate for their schedule and location.

The referral certificate has a code number printed on it, so when the patient contacts the specialist’s rooms, the receptionist can access the referral and decide whether to accept it.

The receptionist accepts the referral by putting the unique number into the MEDrefer website, and it becomes addressed to them specifically and is no longer available to the other recommended specialists.

MEDrefer then notifies the GP that the specialist has accepted the referral, along with the preferred method that the patient’s medical details can be transmitted.

If the specialist’s medical software doesn’t do patient reminders, MEDrefer can send an email or SMS reminder prior to the appointment. The system also sends an email to the specialist to see if the patient attended. If they did not, the GP is automatically notified so they can follow up with the patient.

For specialists, the service allows them to display their specific details and availability, along with whether they provide telehealth services and the like. If they use Genie, the system will automatically extract their schedule details and availability, meaning the receptionist doesn’t have to update two different systems.

MEDrefer also allows specialists to inform the GP of no-shows with the click of a button, automatically informs the GP if a referral has been accepted, and will transmit the report back to the GP for free.

Mr Sullivan and his team have created a directory of about 8000 medical specialists and 15,000 allied health professionals from publicly available information, but it does require those practitioners to register if they want to receive referrals.

The service costs $100 for 24 tokens or referrals.

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ACRRM hopes to share telehealth data with NHSD

App heralds official launch of national health services directory

The Australian College of Rural and Remote Medicine (ACRRM) has agreed in principle to work with the operators of the National Health Services Directory to consider a direct feed of provider information from the ACRRM Telehealth Provider Directory into the NHSD. While the details of the agreement are still being worked out, it is hoped that by sharing information, telehealth providers and Medicare Locals will not have to double up on their information, the college’s strategic programs manager for eHealth, Vicki Sheedy, said.

“It remains the first and most comprehensive non-commercial directory of telehealth services available in Australia,” Ms Sheedy said.

For a telehealth directory to work effectively, it needs more than just a listing of specialists, nurses, Aboriginal health workers, midwives or GPs who offer telehealth services, she said.

“Clinicians need to be able to find out what technology the other party is using to establish a telehealth connection.

Interoperability remains a major issue to the delivery of telehealth services.”

The most popular technology used is still overwhelmingly Skype, but Ms Sheedy said it was becoming apparent that many organisations providing routine telehealth consultations were using Skype as well as more dedicated telehealth solutions.

“Even though 84 per cent of people on the directory are using Skype, they are not just using Skype,” she said.

“What we are finding is that Skype is a default solution, but those providing higher volumes of telehealth services are also using more dedicated telehealth health systems.

A free smartphone app to access the National Health Services Directory (NHSD) has been launched.

The app is suitable for both iPhone and Android devices and will enable consumers to enter a location into the directory to search for local health services such as GPs, emergency departments and pharmacies, with a Google map accompanying the search.

The $4.9 million NHSD went live in July and has been developed by the National Health Call Centre Network (NHCCN) with funding from COAG as a shared infrastructure project to provide one directory for consumers and healthcare providers looking for a wide range of health services.

It is hoped it will eventually also serve as a directory for endpoint location services

for secure messaging and as a national directory for telehealth providers.

It is just now being promoted to consumers as it has taken time to include as much information about primary healthcare services as possible.

The NHCCN has been working with Medicare Locals to add basic information such as location, contact information and opening hours offered by GPs and pharmacists as well as hospitals and their emergency departments.

NHCCN CIO Anton Donker said the plan was to add details for mental healthcare services, allied healthcare providers and state health services and to allow healthcare providers to update their own contact information, as well as

other kinds of practical detail such as whether they are able to see new patients or if parking was available.

While there is an important consumer element to the NHSD, it is also hoped that state health departments will use it for resources planning and to allow healthcare providers to find and refer to allied health practitioners like dietitians and podiatrists or social services such as Meals on Wheels, he said.

Federal Health Minister Tanya Plibersek said the directory contained some 14,000 service records, which have been checked for accuracy by Medicare Locals.

“This directory will be expanded over the next 12 months to include more detailed information and cover more types of health

services, such as allied health providers,” Ms Plibersek said.

Information such as languages spoken, bulk billing status and whether new patients are accepted and referral criteria will also be included.

Professor Donker said the national directory has been based on the successful Victorian Human Services Directory (HSD), created and maintained on behalf of

the Victorian Department of Health by DCA. The plan is that when the system is fully complete, it will enable links to other services such as the Healthcare Identifiers Service and the Australian Health Practitioner Regulation Agency (AHPRA) to ensure details are as up to date as possible.

There are also plans to use it as a national directory of endpoint location services

(ELS) for electronic messaging. The Victorian HSD already has this capability for users of the Argus secure messaging service.

Another logical step would be to create one national network of telehealth providers, including end points and related service information. Professor Donker said the NHCCN was working with the various telehealth groups to achieve this.

Princess Alexandra Hospital gets serious about telehealth provision A dedicated telehealth centre has been officially opened at Brisbane’s Princess Alexandra Hospital to provide telehealth services to patients in rural and remote Queensland.

The centre is part of the $5.1 million Princess Alexandra Hospital Online Outreach Services (PAH Online) project, which is jointly funded by the federal and state governments under the Digital Regions Initiative program.

The facility is already delivering specialist services in the areas of cardiology, endocrinology, dermatology and geriatrics, with plans to extend these services into orthopaedics, infectious diseases and oncology. It has the capacity to conduct at least five

thousand assessments annually.

Len Gray, a PAH geriatrician and director of the University of Queensland’s Centre for Online Health, which helped to design the new centre, said telehealth services for Queenslanders had been provided from Brisbane’s Royal Children’s Hospital for over a decade, but the new centre showed PAH was now getting serious about telehealth.

Professor Gray said the centre was situated in the middle of the hospital and had been outfitted with high quality sound, lighting and video conferencing technology to enable clinical telehealth provision.

Specialists will be able to conduct clinics for groups

of patients at one regional hospital or they could also see patients at several hospitals in one session.

“Ideally, for things that are not emergencies, it is better to organise it just like any doctor’s clinic,” Professor Gray said.

“When you start going to smaller communities, where there aren’t enough patients to fill a clinic session, the clinic could comprise consultations from several locations. It is important to have everyone organised, just like in any standard doctor’s clinic.”

He said the biggest challenge in expanding telehealth services was not so much technology, but rather more mundane issues like funding.

NPC passes quarter of a million milestone More than 250,000 medicines, medical devices and consumables have been allocated unique identifiers and loaded onto NEHTA’s National Product Catalogue (NPC), the organisation says.

The NPC has been developed by NEHTA and hosted on GS1 Australia’s GS1net data repository with the aim of providing standardised product and price data electronically to state health departments and private hospital providers.

All state and territory health departments are aligning their purchasing and tendering processes for healthcare products with the NPC. The ACT already achieved full NPC data integration for its master product catalogue and the other states are in various stages of aligning with the solution.

Earlier this year, Health Purchasing Victoria (HPV) released the first version of its Victorian Product Catalogue System (VPCS), which facilitates the automated receipt of supplier data loaded to the NPC. The VPCS will be progressively rolled out to all Victorian public hospitals and health services beginning this year.

St Vincent’s Healthcare Australia and Ramsay Healthcare are also adopting the NPC, and NEHTA is currently working with the New Zealand government to develop a trans-Tasman catalogue.

In addition to standardised product identification, the NPC also allows for standardised location identification, meaning products can be delivered to the correct operating theatre or pharmacy.

NEHTA has also developed an eProcurement solution using GS1’s global eMessaging standard GS1 XML for the exchange of electronic messages between the buyer and the supplier of goods. It is being rolled out with the NPC.

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Medical-Objects to roll out SMD-compliant Capricorn eHealth software vendor Medical-Objects has been listed on NEHTA’s product register for the secure messaging requirement of the eHealth Practice Incentives Program (ePIP) for its Capricorn secure messaging product.

Medical-Objects will transition its entire network infrastructure to the SMD standard – starting with the rollout of Capricorn v3.0 – this month.

The secure messaging requirement ensures that listed products comply with the Secure Message Delivery (SMD) standard, which will help enable interconnectivity between messaging and clinical software vendors.

Medical-Objects general manager Lynden Crawford said the company’s solutions are built on standards and it has been a leader in standards compliance, receiving the first HL7 accreditation in 2005.

“Medical-Objects Capricorn v3.0 conforms to all mandatory and optional Australian Technical Specification (ATS) 5822-2010 ‘E-health secure message delivery’ endpoint roles,” Mr Crawford said.

“SMD endpoint roles include both direct sender and receiver, as well as sending and receiving via intermediary services.”

Medical-Objects’ Capricorn can send and receive via intermediary services – analogous to sending a letter to a postbox to be retrieved by the recipient, which is also used by the other secure messaging providers – but it also includes the Secure Immediate Message Delivery (SIMD) mode, which allows users to send messages and receive responses in real time.

Mr Crawford said that SIMD was useful for directory look-ups, provider searches for referral and appointment system queries, amongst other applications.

Clinical hub allows GPs and radiologists to collaborate in real time Intelerad has launched a new clinical portal that will allow radiologists to communicate with referring doctors in real time.

InteleConnect Clinical Hub is an extension of Intelerad’s InteleConnect product, which was launched about two years ago to allow referring doctors to view images and reports without having to install local software.

The web-based system works on any browser on any device, including desktops, iPads and smartphones.

Gary Moss of local distributor Health Imaging Solutions said the Clinical Hub would now allow referring GPs to check for results online but also know when the patient booked an appointment and whether they attended or cancelled.

“Clinically that may be significant if there is a

significant pathology that should be investigated,” Mr Moss said. “It is helpful for the doctor to know whether the patient has elected not to proceed.”

The solution also allows GPs to have streamlined views of only their patients’ images and activity, and has new functionality that allows the radiologist to communicate with the referring doctor to discuss any abnormalities.

It also allows the GP to grant access to the patient’s report and images to a specialist. “It is all part of helping the doctors collaborate in the continuum of care,” he said.

“When the referring doctor is reading the report, the referrer can then engage the radiologist via a secure messaging service.

“If they have follow-up questions or they don’t understand something, they might be looking for advice on how to manage the patient. A radiologist is a clinical specialist and there is an opportunity for them to interact in real time.”

The service also operates on a radiologist to radiologist basis, so sole radiologists in private practice can get a second opinion from a colleague.

The solution is “zero‑footprint” and browser- and PACS agnostic so it can be used with third-party PACS. “We have a few public hospital clients that have bought PACS that don’t have referrer connectivity tools and we’ve been able to install our product in front of that,” Mr Moss said.

“Obviously we’d prefer that they use IntelePACS but it is standards-based at the back-end so we can run with other parties’ PACS.” And because it is zero‑footprint, hospital IT departments are usually happy as they don’t have to open special ports or give people permission to install the different applications.

Software does have to be installed at the radiologist’s end as Mr Moss said there is no substitute for high‑end imaging.

“While the GP is probably not interested in volume rendering, where you

generate a 3D image based on a CT scan, certain specialists are very interested in that sort of thing and they want to be able to perform those sorts of functions.”

“For these users fully functioned installable software is available.”

When the radiologist has a report ready, the referring doctor is notified using a secure messaging service.

Intelerad has developed an iOS app which will provides pop-up notifications on an iPad or iPhone. Users will have to download the free app, which is available from the iTunes App Store.

Otherwise, an email is sent to the referring doctor. “You get an email that says XYZ Radiology has a result for you or XYZ Radiology has an urgent result for you.

“Then the GP logs on and the browser session will authenticate them and then they have access to the report and can communicate with the radiologist if necessary.”

It will also allow closer collaboration between the referrer community, as GPs can allow individual specialists to log on to see their patient’s report and images before the consultation.

AMA calls for step-by-step toolkit for PCEHR The Australian Medical Association has called on the federal government to design a standardised, step-by-step toolkit to assist medical practices to participate in the PCEHR. In the AMA’s pre-budget submission, president Steve Hambleton said that while the organisation supported the PCEHR, the legal framework behind it had imposed additional red tape on practices.

“The government can alleviate this by assisting practices to navigate the complex pathways and requirements necessary

for them to participate,” Dr Hambleton said.

and information technology resources to meet these new requirements.”

The submission states that medical practitioners want to use the PCEHR to enhance clinical care.

“However, the PCEHR legislation and its participation requirements are complex and introduce new and significant obligations on medical practices,” it states.

It suggests that the government provide a single set of standardised template policies and protocols detailing what is required to participate in the PCEHR, which medical practices can adjust to suit their own practice arrangements.

“There are substantial penalties for non‑compliance with the complex legal requirements. Medical practices will have to devote substantial administrative

The AMA also called for government funding for an entity “that understands the clinical and administrative operations of medical practices to prepare these template documents”.

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Global Health launches cloud-based messaging Global Health, the Melbourne-based vendor of the ReferralNet secure messaging service, has launched a cloudbased secure messaging solution for specialists and allied health practitioners.

MasterCare connect includes a provider portal to deliver SMD-compliant secure messaging capability to specialists and allied health practitioners. It uses ReferralNet as the core solution underlying the cloud-hosted service.

It is the latest in the MasterCare suite of solutions, which also include electronic medical records for specialists and allied health practitioners, MasterCare MHAGIC (mental health case management) for psychiatrists, psychologists and allied health providers, and MasterCare ePAS for hospitals.

Global Health’s CEO, Mathew Cherian, said MasterCare Connect was a browser-based provider portal for managing referrals and recording patient information, accessible through any device with an Internet connection, including smartphones.

Using ReferralNet, non-GP healthcare professionals will be able to exchange documents with their colleagues using the SMD standard and be better equipped to transition to an electronic medical records system, Mr Cherian said.

MasterCare Connect is available in the cloud as a fully managed service, including back-up and security, server administration and licence, upgrade and maintenance requirements.

Its pricing structure is subscription-based, with a monthly or annual fee of $29 per month or $299 per year for an individual subscription, $64 per month or $649 per year for a multi-practitioner site of up to six users, with an extra $11 or $110 for each additional user.

Uploading to the PCEHR is easy but registration needs streamlining A general practice IT manager who has set his practice up to connect to the PCEHR has urged the system developers to streamline the registration process.

Luke Moloney, IT manager of the Samford Valley Medical Centre near Brisbane, which uploaded its first shared health summary and event summary using Genie’s PCEHR-compatible software recently, said sending documents to an individual’s PCEHR was very easy but getting set up to use the system in the first place was overly difficult.

Mr Moloney said the main issues were the multitude of confusing names and acronyms, the amount of paper forms that need to be filled out and a lack of easyto-follow guidelines to help practices register.

“Medicare really should think about some of the acronyms that they use,” he said. “There are ‘seed’ organisations and ‘network’ organisations and HPI-Os and HPI-Is and the HPD. Most people would think there are many seeds in the network – when I was reading it I thought presumably the network organisation is the key organisation and the seeds are the subsidiary ones.”

Mr Moloney estimates it took seven weeks from the time he first applied to take part to the time the practice was authorised.

There was a great deal of paperwork to go through and matters weren’t helped by the unfamiliarity of staff at both the HI Service and the PCEHR helpdesk with the system.

“We applied to get our HPI-O and the associated

HPI-Is but they wouldn’t process that until the PCEHR contract had been sent through,” he said. “It gets a bit overwhelming and the problem is that if you happen to accidentally say the wrong acronym to the person on the end of the line, that can cause all manner of problems.”

Mr Moloney did not receive any training in the system and attacked the job himself. He said training would be useful but that an easy-to-follow guide that translates some of the terms Medicare is using would be far more helpful.

“The amount of people who are going to be confused by the seed organisation and the network organisation is going to be massive. It is never clearly spelled out in the documents – it is only when you go to the NEHTA website. NEHTA puts out

probably the best material about it, but the problem is the Medicare forms that you have to fill in are pretty confusing in their terminology.

He said once it actually came to creating and uploading the summaries, it was a very straightforward process. Genie has designed its PCEHR interface with several preferences that the user can select.

“You can choose to always check and connect to the PCEHR when you go into a patient’s record,” he said.

“If they have one, then the PCEHR button will go green.

You can query if the patient has one but if you don’t open it, then it will turn white.

If they don’t have an IHI, it will turn black. It doesn’t interfere with anything or cause any delays.”

Many doctors will not want their full consultation notes uploaded, so the option is to copy and paste part of the note or to write a new summary, he said.

“For uploading the health summaries, it is a pretty simple process and it will take a bit of time, but it’s certainly not as laborious as it otherwise could have.”

He said the main issue was not whether doctors would use the system, but whether patients would take the time to register themselves. Again, he urged the system developers to

streamline the application process, perhaps by allowing an authorised person such as the GP to apply for a patient’s PCEHR through HPOS.

“He said the main issue was not whether doctors would use the system, but whether patients would take the time to register themselves.”

“I don’t think the issue will be with people uploading shared health summaries or event summaries,” he said. “It is going to be getting patients registered for their PCEHR. “We don’t know when any of the hospitals in our local area are going to come online. Even in the future when they do come online, the very sorts of people who will most benefit from this sort of system – mostly the elderly and people with severe health issues – the problem is that they, out of everyone, are the least likely to go through the registration process. That is a concern and I’m not sure how you address that.”

NEHTA and the Department of Health and Ageing are working on ‘assisted registration’, where a doctor in a general practice

or in the hospital setting encourages the patient to set up a PCEHR and assists them to do it there and then, but Mr Moloney doubted any doctor would have time to do assisted registration.

He also said doctors would rarely have the time to explain to patients what the PCEHR is and how to register. “I registered for mine over the phone and had a paper form to fill out.

The nurse or receptionist might help the patients to register but there should be some way that we could do it through the HPOS system, for example.

Stat and Charm named as digital champions Brisbane-based medical software vendors Stat Health Systems and Charmhealth have been named as “digital champions” for Brisbane in a recent survey.

The survey, carried out by Ernst & Young and the University of Queensland on behalf of Brisbane’s economic development agency Brisbane Marketing, audited over 500 small to medium enterprises and chose 25 of those who have helped to create a digital capability analysis for all Brisbane businesses as digital champions.

Stat Health Systems (SHS), Charmhealth and podiatry centre MyFootDr were among those 25. The companies will now act as advocates for the adoption of digital processes to their customers.

“They should reduce the proof that the patient needs to provide – doctors are asked to verify identity all the time so if the doctors could do it and then send it off through HPOS…

SHS CEO Carla Doolan said her company’s role as a digital champion was a huge honour. “We have embraced a digital approach to business – from recording and tracking support calls from our clients to identifying and developing new features for Stat,” Ms Doolan said.

“Another question is whether doctors will actually log in and look at it.

This is an issue that needs to be dealt with.”

In its role as digital champion, SHS will be advocating digital methods of customer communication and marketing, and using the latest technology for software design, development and release.

For practices, he said the most pressing concern was the lack of simple, step-bystep guidelines through the process.

Brisbane Marketing CEO John Aitken said the Brisbane digital audit ranged across 19 industries from single operators to companies of more than 5000 employees.

“NEHTA has a good flow chart with all the steps you have to go through, but unfortunately some of the hyperlinks in the PDFs don’t match. It can be annoying – they really need something that spells it out,” he said.

“The digital audit will provide valuable insights for the development of Brisbane’s digital strategy and in highlighting areas in which we can help businesses to grow.

“The digital strategy will encourage local businesses to harness digital technology to improve efficiencies, grow their businesses, encourage export and global reach and ultimately increase profitability.”

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HPI-O NASH tokens for secure messaging The digital HPI-O certificates sent to GPs to securely access the PCEHR system can now be used as authentication for secure messaging.

NEHTA recently announced that the National Authentication Service for Health (NASH) certificates devised and distributed

by Medicare Australia can also be used for secure message delivery (SMD) via compliant SMD products.

A list of SMD-compliants is available on NEHTA’s ePIP register, and includes HealthLink, Argus, Medical-Objects, ReferralNet and MMEx. The Department of Human Services stepped in to provide the interim NASH certificates for PCEHR access following IBM’s failure to get its NASH system off the ground. NEHTA terminated its $23.6 million contract with IBM last year, as IBM could not deliver its promised solution by its deadline of June 26.

Medicare began distributing the certificates to practices registered for a Healthcare Provider Identifier – Organisation (HPI-O) number in August last year.

NEHTA said practices that already have an HPI-O NASH digital certificate would receive a letter from DHS advising them that they can use this certificate as authentication for SMD. Those practices that do not yet have an HPI-O can start the registration process through the DHS website.

NEHTA said the certificate will enable GPs to access their patients’ PCEHRs and use SMD-compliant software. They are different from DHS’s location certificates, which GPs will still need to use to access the Healthcare Identifiers (HI) Service, Medicare claims and payments and ePrescribing solutions.

$10 million for prescription exchange interoperability Electronic prescription exchange vendors eRx and MediSecure will receive $660,000 each for technical work to ensure they are interoperable, as well as a share in more than $8.3 million in transaction fees. eRx and MediSecure have been working together for some months under a deal brokered by the Department of Health and Ageing (DoHA) to ensure both exchanges can interoperate.

At present, a prescription lodged with one of the exchanges can only be downloaded and dispensed by pharmacists using the same system.

According to a copy of the contract submitted to the Australian Competition and Consumer Commission (ACCC) by eRx, the government will contribute a total of $1,320,000, paid in three instalments, to the two exchanges as a capital investment to achieve interim interoperability.

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

the cost of delivering the service until interoperability is achieved. The volume of scrips is expected to increase substantially once the exchanges are interoperable, resulting in a reduction in the fee to 35c in the new year.

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

“Part of the work will include the standardisation of the format and positioning of the barcodes on the original prescriptions.”

The contract appears to have necessitated an application to the ACCC for authorisation as the agreement to share equally in the transaction fees could be considered anticompetitive.

According to supporting arguments submitted

by DoHA, the public benefits which will derive from interoperability would outweigh any anti‑competitive effect.

The $10m is not new money but is a budgeted part

of the $15.4 billion Fifth Community Pharmacy Agreement (5CPA), which also established a payment of 15 cents per electronic script to pharmacies. The market price charged by the exchanges has since settled in a way that the service is in effect free to pharmacies.

In the supporting documents accompanying eRx’s application, the federal government said that while electronic transfer of prescriptions is a priority under the 5CPA, the number of eligible electronic prescriptions for 2011-12 was less than expected.

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

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

Under the contract signed by both eRx and MediSecure, the two exchanges must work together and share all information necessary to create interoperability

between their systems.

Pulse+IT understands that while the technical hurdles are not difficult, it will require the exchanges to add an adaptor to each system in every client pharmacy system.

Part of the work will include the standardisation of the format and positioning of the barcodes on the original prescriptions and a mechanism to facilitate the inter-PES transaction fee.

Interoperability will still be considered interim, as the Australian technical

specifications for electronic transfer of prescriptions (ETP) are not yet ready. The technical specifications are currently being considered by a Standards Australia eHealth subcommittee.

The contract states that full PES interoperability, conforming to those specifications and a resulting Australian Standard, will follow the completion of the project.

The amount of money on offer is far superior to the amount being paid by NEHTA to the

secure messaging service vendors, some of which have also been working on interoperability.

Moving to Best Practice is as easy as

NEHTA announced recently that it would pay the fees for having secure messaging services tested at a NATA-approved laboratory, if the services pass their conformance test for the secure message delivery (SMD) standard.

They will also receive payments of $15,000 to each vendor that can prove it has achieved interoperability with at least two other vendors.

Practitioners can assist patients to register for a PCEHR The federal government has published the rules under which healthcare providers can assist their patients to register for a PCEHR. The rules are aimed at encouraging vulnerable consumers such as the elderly and those with chronic illnesses to register for a PCEHR and share their healthcare information with a range of providers.

Consumers can currently register online, by telephone or in person, but according to explanatory notes published by the government, the assisted registration process will encourage target demographics such as people in aged care who

are more likely to apply to register with the support of their healthcare provider.

written consent for three years or send it to DoHA for retention.

Nurses and employees of authorised organisations will be able to assist their patients through the registration process as well as the patient’s doctor, as long as they are employed by a registered healthcare provider organisation.

The explanatory notes say electronic and paper forms are being designed for the assisted registration process.

The healthcare provider will need to find the patient’s individual healthcare identifier (IHI) and verify the patient’s identity.

They must also record the patient’s written consent to have a PCEHR created and documents uploaded to it, and either store that

Organisations that provide assisted registration must also implement a policy that includes a framework for identifying whether a patient is a “known customer”. If they are known customers, their registration can be streamlined.

DoHA is preparing guidance on identifying consumers to inform this policy, which will be published online.

Like eating brussels sprouts – you know that changing your clinical software will be good for you – but not something you want to face. Best Practice is different. Best Practice makes the changeover so easy you can try it out with all your practice data (the back-up version of course) without committing. Converting your data from MD2, MD3 and MedTech32 is virtually automatic. Sweet!

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Tel: (07) 4155 8800 www. bpsoftware.com.au

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MDI Radiology goes live with COMRAD information system Radiology group MDI has installed the COMRAD radiology information system (RIS) throughout its 12 imaging centres in Melbourne.

The new RIS is aimed at streamlining business management and diagnostic processes, including reporting and the transfer of patient images in conjunction with MDI Radiology’s AGFA PACS. The new RIS will allow referring doctors who use Mac computers to view linked images, a capability not available in the original RIS/PACS combination.

COMRAD, which was developed in New Zealand and has approximately 90 per cent of market share there, is making inroads into the Australian market and has now established its headquarters here while still maintaining its support and development teams in Christchurch.

COMRAD’s CEO, Elizabeth Delahunty, estimates it has 34 per cent of the Australian market, mainly in private practices but also in some hospitals.

COMRAD only deals with RIS solutions and does not provide a PACS system, but has developed interfaces to the majority of third-party solutions, including multinational giants like Siemens, Carestream, Fuji and AGFA. “We have a lot of interaction with the multi-nationals because they are seeing there is a barrier to entering the Australian market because RIS workflow is different in Australia to other parts of the world,” she said. “You need to have a billing engine – which is complex in its interface to Medicare and our private health funds” The company is working with MDI Radiology to allow referring doctors to access linked reports and images on iOS, Windows and Android platforms.

Direct CONTROL and HTR team up for eHealth compliance Billing and business management software vendor and service provider Direct CONTROL and cloudbased clinical management software vendor HTR Business and Technology Services have joined forces to offer a solution to healthcare professionals and organisations looking to become eHealth compliant.

The partnership is not just aimed at general practices wanting to qualify for the ePIP incentives, but at all healthcare sectors and disciplines such as hospitals, surgeons, anaesthetists, pathologists, radiologists, allied health practitioners and pharmacy.

While the package is available to GPs who need both a clinical and billing solution so they can be ePIP-ready, Direct CONTROL integrates with a number of other clinical applications that will be able, through HTR, to interact with the new eHealth initiatives such as the HI Service, secure messaging and the PCEHR. For GPs, Direct CONTROL can provide the billing and scheduling services, while HTR provides its HTR Telhealth clinical management system, which has completed all five eHealth compliance requirements, HTR’s project manager for eHealth, Adrienn Volcz, said.

“What we are doing is combining our two applications to create a package,” Ms Volcz said. “DC does all of the billing across all medical disciplines as well as scheduling, and because HTR is ePIP-compliant we do the clinical information system, the secure messaging, HI Service, electronic transfer of prescriptions and access to the PCEHR. “When you have Direct CONTROL and HTR solutions together, medical centres don’t have to shop around and try to find out how to put the bits and pieces together.”

For clinicians other than GPs, Direct CONTROL’s integration with many clinical applications means that clients can also begin to use one or any of the five eHealth services, DC’s Robyn Peters said.

“DC and HTR can both be hosted in the cloud,” Ms Peters said. “However, many of our clients choose not to be hosted for many reasons – they want their data local. We give them that choice. They can still have their data local if they use DC and launch their clinical notes to the PCEHR via HTR.” Direct CONTROL integrates with many accounting applications, including

MYOB and QuickBooks, along with Technology One and others. It also has notices of integration (NOIs) with Medicare Australia and integrates with Microsoft Office, including the Direct CONTROL Outlook Add-in for synchronisation and sharing of calendars.

“Direct CONTROL provides a central hub where if inputting data via the appointment, it is entered once and is pushed to the accounting application, or if entering data in the third party applications, it is pushed to DC for verification and billing,” Ms Peters said. “Accounting integration can be to one accounting application or to each provider in a group practice who has their own accounting application.

“Each provider can generate the necessary detail such as their ABN if they are running their own business under another umbrella, and it is then integrated with their accounting application such as MYOB or Technology One. With our partnership with HTR, we now act as a hub for all third-party applications that integrate with Direct CONTROL to access the PCEHR as well as the other eHealth compliance requirements like secure messaging, Health Identifiers, ePrescriptions and clinical notes and coding.”

Direct CONTROL is the billing engine for clinical applications such as Medical-Objects, Charm Health, Carestream Health and others spanning radiology, pathology, urgent care and audiology software. The company is currently working on an integration with Episoft and can interface with Medical Director or Best Practice should that be the GP’s requirement.

“For general practitioners, aged care providers and specialists who don’t want to deal with software installations, both packages can be hosted in the cloud,” Ms Volcz said.

“Most clinical information systems are running on the desktop and it can be very convoluted to get integrated. Because HTR runs in the cloud, you don’t need to worry about it. We do everything for them.

“We have the servers and data centres and we can host Direct CONTROL in our servers, so basically they are both in the cloud. This is how we can integrate both applications, and from a user’s point of view, it won’t make any difference and they don’t need to worry about installing anything.”

Ms Peters said one of the problems facing global laboratory information system (LIS) and radiology information system (RIS) vendors and others in working in the Australian market is accommodating the medical billing.

“Medical billing in Australia is extremely complex,” she said. “Direct CONTROL automatically applies the necessary ‘billing rules’ for each discipline be it an in hospital or in room service and the correct fees for direct billing to Medicare (bulk bill or DVA),

health funds (ECLIPSE), WorkCover, CTP, TAC or private billing.

“A number of organisations have developed their own LIS or RIS but do not include billing, so they can bolt on DC and have the complete solution.”

Carestream Health, for example, is a supplier of imaging and information solutions to the global radiology market, the company’s territory general manager for Australia and New Zealand, Melissa Wood, said. Direct CONTROL is the billing engine for Carestream’s RIS using HL7 messaging.

“Since Carestream’s product is one global product, we require integration with a local billing organisation to provide radiology with the billing services and provisions they require,” Ms Wood said.

Some vendors use DC as a stand-alone app to push data to the LIS or RIS/ PACS, or use the LIS or RIS/PACS and push data to DC using HL7, Ms Peters said. In that circumstance, DC automatically reads in all necessary detail and generates the invoice. Web services can also be used.

“DC allows the developers of clinical applications to get on with what they do best as the DC team is totally focused on the billing and reporting.”

Touch-optimised support for Trakcare on mobile devices InterSystems has released a new version of its TrakCare unified healthcare information system, with clinical enhancements including support for family care and intravenous prescribing, and touch-optimised support for iOS and Android smartphones and tablets.

TrakCare’s touch-optimised support now enables gesture scrolling, pagination and change-of-device orientation on mobile devices. The system can automatically detect device types to deliver a range of views to the user, including a search and ward list view and a range of mobile electronic patient record views such as clinical notes, diagnosis, vital signs, orders, images and results.

TrakCare chief operating officer at InterSystems, Christine Chapman, said healthcare organisations need to deliver the benefits of an electronic patient record in any care setting, on any device available to clinicians.

“The benefit to our mobile approach – using a single software application supporting common Internet standards – is that we can offer a common user interface across all platforms that autodetects mobile devices to optimise specific functionality like touch,” she said.

TrakCare’s Internet-based architecture enables healthcare organisations to support new platforms and devices at the point of care without additional software or apps.

It has also added new functionality to its closed loop medications management module, with extended support for more complex prescribing to help ensure that a patient’s full medications history is captured in the electronic patient record, along with providing a full view of allergies and drug interactions at the time of prescription.

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Totalcare replaces Homer at Western Health outpatients Medical management software vendor Equipoise (International) has completed the rollout of its Totalcare billing solution in several outpatient departments at Victoria’s Western Health, having at the same time decommissioned the old Homer system used for patient management and outpatient billing for many years.

Homer has been gradually replaced by iSOFT’s iPM patient management system in a number of Victorian area health services for admissions and billing, but until recently Homer was still commonly used for outpatient services.

Western Health has instituted a workflow automation strategy in recent years to deliver financial efficiencies and wanted to upgrade Homer to a new system to improve billing practices, Equipoise’s managing director, Nat Wong, said.

It also replaced its radiology information system some years ago with a FujiFilm system, which uses Totalcare’s enterprise billing system as part of its radiology solution.

“A core part of that tender was the capability to do enterprise billing as well as the RIS,” Mr Wong said. “That project rolled out some time ago and it was deemed to be very successful.

“That was the catalyst to get them to look at other departments. They did the next one with cardiology and that was deemed to be successful too so then we had a rapid rollout to other outpatient departments like respiratory, neurophysiology, audiology and sleep disorders – anything that was using Homer at that time.”

Mr Wong said Western Health will also install Medicare’s ECLIPSE online claiming solution, which offers a secure connection between hospitals, Medicare, the DVA and health funds.

Getting to grips with trauma by remote simulation Training medical and nursing students using high-fidelity manikins is nothing new, but an innovative NSW program is now offering emergency departments procedural training using lifelike simulators operated remotely.

Under the Emergency Department Hub and Spoke Distributed Simulation using the Education by Web-based Innovative Simulation and E learning model (EdWISE) project, hospitals in NSW are being offered the opportunity to train medical and nursing students and new graduates in trauma, cardiac, airways and paediatric emergencies in the hospital itself.

Training simulators are freighted to the hospital, where local trainers provide hands-on skills development and the simulators are operated remotely from the Sydney Clinical Skills and Simulation Centre (SCSSC) at Royal North Shore Hospital.

Technical staff at the SCSSC operate the simulators over the Internet using remote desktop software, while teachers at the centre can also provide instruction via video conferencing.

Sessions are available to any NSW public hospital or university that is interested.

SCSSC director, Clinical Associate Professor Leonie Watterson, said simulation training has been slow to develop in many hospitals for a variety of reasons, with access to teachers and equipment the two major constraints. By sending the equipment to the hospital and operating it remotely, the project aims to overcome these barriers, Dr Watterson said.

“This approach has only been described once as a proof of concept so it’s

a great achievement for an Australian group to be delivering a largescale program using this method,” she said.

The project is led by the SCSSC in partnership with the Clinical Education and Training Institute (CETI), which coordinates the education and training for NSW Health staff, the University of Sydney and Royal Prince Alfred Hospital. It is funded by Health Workforce Australia as part of a program

Keep your finger on the pulse of your business. aimed at increasing training capacity for health students, especially in the rural sector.

Dr Watterson said the centre will send equipment packs to the hospital that include a variety of robotic simulators and any of the ancillary equipment needed such as portable ventilators and defibrillators. The local team then assembles the equipment and local teachers come in to provide some of the training. They communicate with the centre by video conferencing.

“We use remote desktop protocols, and that’s over broadband, to control the robots,” Dr Watterson said.

“When it comes to the interaction between the teachers and the students, we looked at a few IT options. One is to do it over the web using something like Skype.

“People have reported doing that, including a Japanese group that has done a pilot and one in the US that did a very small pilot as well. They both used Skype but we looked into it and we didn’t feel we’d get good enough quality, so we are using standard video conferencing on the NSW system.

“We use video conferencing codecs and we also felt it was important to get it working not just on the NSW Health network but also on the university

AARNet network. We’ve got it working on that so if people want to set up the training in their university clinical schools rather than in the emergency department, they can do that as well.”

“We use remote desktop protocols, and that’s over broadband, to control the robots.”

There are a range of simulators used, including baby, adult and mother models like Laerdal’s SimMan, SimBaby and SimMom. The focus of this particular project is on training in emergency departments, with four themed modules including trauma, cardiac, paediatrics and airways, although the centre is planning to introduce another module using Sophie and her Mum, a full birth obstetric model.

A surgical module is also in the planning using the bench-top models predominantly used in surgical simulation training.

“That technology is focused on haptic-based virtual reality and screen-based simulation,” Dr Watterson said. “The manikin simulators haven’t got a great deal of functionality

[for surgery training], although we have been doing some work on improving that for surgical emergencies.

“There are quite a few bench-top models that are very relevant, particularly for students and more junior staff for suturing and plastering.”

The project also includes an E Learning site, a repository of learning materials designed to complement the on-site simulation program or be used for independent learning.

Topics target all levels of experience, from students and new graduates to more experienced postgraduate emergency nurses, residents and junior registrars.

Topics include how to take a 12 lead ECG, how to defibrillate and how to perform transcutaneous pacing, cervical immobilisation, pelvic splinting or the log roll.

The EdWise training project is fully funded until June 30, 2013 – with hopes that funding will be extended – so hospitals can participate for free until then. Dr Watterson said that so far, 13 hospitals have taken part involving 500 student hours.

The SCSSC is also currently developing the capacity to do recording and local playback so students can review their session.

Direct CONTROL is suitable for all medical disciplines to include Pathologists and Radiologists applying necessary billing rules (coning / DIR & Bulk Bill incentives).

• In Hospital and In room Services • Direct Bill Medicare / DVA / Health Funds – ECLIPSE • WorkCover / Third Parties • Integrate with your LIS or RIS • Integrate with your Accounting Application • eHealth Compliant with HTR

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Transition to PharmCIS held up December PBS updates Doctors and pharmacists were forced to manually check changes to the December 2012 PBS schedule for several weeks as the rollout of the government’s new PharmCIS system held up the regular PBS schedule updates from prescribing and dispensing software.

The Department of Health and Ageing is introducing PharmCIS to streamline the collection of data that goes into the monthly updates of the PBS, amongst other benefits. DoHA planned to roll out PharmCIS in December and did not provide a November update in order to prepare for the new system. The October schedule remained current for the month of November.

However, the transition to the full PharmCIS system meant that the updates to the December schedule did not reach software vendors in time for them to prepare their automatic updates by December 1.

Users had to download or print the updated schedule from the PBS website to check for changes such as new prices, brand name changes or newly listed or delisted products. The schedule was available in text or XML file format.

MIMS national business manager Margaret Gehrig said the company needs the PBS data by the middle of the preceding month in order to incorporate it into its system, which is then sent to the software vendors that use MIMS as its drugs reference solution.

A spokeswoman for the Department of Health and Ageing said PharmCIS has been introduced to replace over 40 existing data systems, some of which had been in use for nearly 20 years.

The February 2013 schedules were updated without the same problem.

iPad app launched to assist in learning CT scan interpretation The developers of the CritIQ critical care education website have launched a new iPad app that replicates a training session for medical students, registrars and consultants to learn the art of CT interpretation.

really a three-dimensional structure viewed as twodimensional images, you need the ability to scroll up and down to get a 3D appreciation. So it occurred to me that the iPad was the ideal platform.”

The CT scanning in critical and emergency care app contains 70 fully scrollable CT scans along with audible radiology reports and allows students to study common pathologies, listen to a radiologist discussing them and zoom in on abnormalities. Users are then able to click on a tutorial about the pathology.

Dr Fraser, along with radiologist Craig Maskiell and registrar Renee Battson, worked with Geelong-based custom app and software design firm JNH Software to create the app, which replicates a normal teaching environment in which a trainee sits next to a radiologist and reviews scans one on one.

Todd Fraser, an intensivist at the Nambour General Hospital and Noosa Hospital in Queensland, first developed the Crit-IQ resource with co-founder Neil Orford, director of intensive care at Geelong Hospital in Victoria.

Dr Fraser said the app was designed for its ability to give trainees a 3D appreciation of CT scans, something not really achievable either in a textbook or a website.

“We have been trying to put CT onto our website, as we have a section called data interpretation that includes questions about things like ECGs and blood gases,” Dr Fraser said.

“We tried to put CT on there, but because CT is

On an iPad, there is the ability to scroll through a full series of images, and to view them in multiple planes, such as in crosssection or longitudinally.

“Then when you’ve decided what you think is the abnormality, you can put your headphones in, hit the play button and you can listen to a radiologist reporting the film in front of you,” Dr Fraser said.

“Rather than just have a static report, the radiology report will say an abnormality is best seen for example in slide 56 at A3, and you can pause it,

and navigate to slide 56 and then zoom on to A3 on the grid. Then you can press play again and continue the report. Once you get to the end of that, you can click on a tutorial that reviews the abnormality that was the subject of the case.”

The app is very well priced at about $10 from the iTunes store, far cheaper than a traditional textbook.

“And a textbook doesn’t give you anywhere near the utility that this does because they have static images, and that’s not how CT is viewed,” Dr Fraser said. “For something that gives you a similar level of information you’d be looking at $100 to $200 for a textbook.”

Further updates are planned, as are versions for paediatric CT interpretation and MRI. The team is also adding new functionality to Crit-IQ this year, offering critical care departmentbased memberships to allow departments to use the resources for their own internal education.

Dr Fraser said there are currently about 35 member departments across Australia, New Zealand, Hong Kong, the Netherlands, the UK, Ireland, Fiji and Israel.

“Departments like it because they can use it for controlling the online and self-directed learning for their junior staff and provide

a consistent framework for how they develop their skills,” he said.

Specifically for senior consultants is the Journal Club, in which Dr Orford chooses and reviews the major papers that have been published that he believes will make a difference in practice.

“We also have a series of podcasts with interviews with interesting people in intensive care,” Dr Fraser said. “I’ve also spoken to medical ethicists about end of life care for intensive care patients. They are all boiled down to a 20-minute interview that you can listen to in your car or while you are exercising. They have proven very popular.”

There are a number of learning modules covering different areas from basic topics like chest x-ray interpretation in ICU and blood gas analysis to tracheostomy insertion, along with an extensive echocardiograph database.

There is also a similar service for critical care nurses, called Crit-Nurse, which uses some of the resources from Crit-IQ as well as nursing-specific programs developed by two experienced nurse educators. “Australasian intensive care is regarded as one of the best platforms for training in the world and we feel that what we can offer is those principles and deliver them.”

Best Practice aims for top spot in 2014, survives flood Best Practice Software has appointed Craig Hodges to the new position of general manager, charging him with a mission to become the leading medical software vendor by 2014.

Best Practice says it has captured more than 30 per cent of the general practice market since it was established eight years ago. The company’s founders, Lorraine and Frank Pyefinch, said he will take a leadership role in the organisation, which is based in their home town of Bundaberg, hit hard by the January floods.

Mr Hodges said the company had received numerous messages of good will from customers. “Bundaberg has been through a lot – the second major flood in two years and we were hit by tornadoes,” he said.

“It’s a terrible sight.

Three team members were stranded at home and one had to stay in an evacuation centre. Dr and Mrs Pyefinch, a former Bundaberg mayor, were also stranded in their home, but helped neighbours out by cooking for those who had lost power.

“A lot of surgeries have emailed and said they hope everything is all right and we’ll try not to bother you,” Dr Pyefinch said.

The company provided free copies of its clinical software and computers for use in local disaster clinics for volunteer doctors treating evacuees and those people who were displaced by the floods.

The Wide Bay Medicare Local set up two emergency clinics staffed by volunteer doctors to treat evacuees. Mr Hodges said the software and computers would be used to keep an accurate record of all consultations which can be forwarded at a later date to people’s regular GPs. You can donate to the Queensland Floods Appeal through the Australian Red Cross.

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Events February

April

18-19 FEBRUARY

12-13 MARCH

17

4TH ANNUAL CLINICAL DOCUMENTATION, CODING & ANALYSIS CONFERENCE Melbourne, VIC p: +61 2 9080 4300 w: www.healthcareconferences.com.au

4TH ANNUAL NATIONAL DISABILITY SUMMIT Melbourne, VIC p: +61 2 9080 4090 w: www.healthcareconferences.com.au

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

21-22 FEBRUARY NATIONAL FORENSIC NURSING CONFERENCE Sydney, NSW p: +61 2 9080 4300 w: www.healthcareconferences.com.au

20-21 MARCH 5TH ANNUAL NATIONAL TELEMEDICINE SUMMIT Sydney, NSW p: +61 2 9080 4090 w: www.healthcareconferences.com.au

18

APRIL

APRIL

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

May

21-22 MARCH 3RD ANNUAL DEVELOPING THE ROLE OF THE NURSE PRACTITIONER CONFERENCE Melbourne, VIC p: +61 2 9080 4090 w: www.healthcareconferences.com.au

1-2

MAY

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

21-22 MARCH 3RD ANNUAL HOSPITAL PATIENT COSTING CONFERENCE Brisbane, QLD p: +61 2 9080 4090 w: www.healthcareconferences.com.au

21-22 MARCH 21

FEBRUARY

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

25-26 FEBRUARY 6TH ANNUAL HOSPITAL BED MANAGEMENT & PATIENT FLOW CONFERENCE Melbourne, VIC p: +61 2 9080 4300 w: www.iir.com.au

25-27 FEBRUARY AUSTRALIAN HEALTHCARE WEEK 2013 Sydney, NSW p: +61 02 9229 1000 w: www.austhealthweek.com.au

March 6-7

MARCH

3RD ANNUAL E-LEARNING SUMMIT 2013 Melbourne, VIC p: +61 2 9080 4307 w: www.informa.com.au

22ND ANNUAL MEDICO LEGAL CONGRESS Sydney, NSW p: +61 2 9080 4300 w: www.healthcareconferences.com.au

12-13 MARCH 4TH ANNUAL NATIONAL DISABILITY SUMMIT Melbourne, VIC p: +61 2 9080 4090 w: www.healthcareconferences.com.au

25-26 MARCH 2ND ANNUAL ELECTRONIC MEDICATION MANAGEMENT CONFERENCE Melbourne, VIC p: + 61 2 9080 4090 w: www.healthcareconferences.com.au

25-26 MARCH 4TH ANNUAL MENTAL HEALTH UNITS CONFERENCE Melbourne, VIC p: + 61 2 9080 4090 w: www.healthcareconferences.com.au

27

MARCH

2013 AUSTRALIAN E-HEALTH RESEARCH COLLOQUIUM Brisbane, QLD w: aehrc.eventbrite.com.au

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

16

MAY

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

16-17 MAY 3RD BIENNIAL NATIONAL FALLS PREVENTION SUMMIT Brisbane, QLD p: +61 2 9080 4090 w: www.healthcareconferences.com.au

Save the dates 23-24 MAY

20-21 JUNE

20

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

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

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

27-28 MAY

15

MAY

AUGUST

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

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

17

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

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

2ND ANNUAL PREPARING FOR PERSONALLY CONTROLLED EHEALTH RECORDS Sydney, NSW p: + 61 2 9080 4090 w: www.healthcareconferences.com.au

31

JUNE

20

JUNE

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

OCTOBER

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

21-23 OCTOBER HIMAA 2013 NATIONAL CONFERENCE Adeliade, SA p: +61 2 9887 5001 w: www.himaa2.org.au/conference

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

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HISA

BRINGING YOU

THE DIGITAL HEALTH REVOLUTION IN 2013 The consumer, big data, personalised medicine and the convergence of science, technology and much-needed funds are set to be the big issues of 2013, and the Health Informatics Society of Australia (HISA) is set to play its part in this digital health revolution. The rise of the #epatient is one of the big trends we will see this year, and many of these topics will be covered at HISA’s Big Data and HIC2013 conferences.

DR LOUISE SCHAPER BSc(OT)HONS, PhD CEO: HISA ceo@hisa.org.au

The start of 2013 saw a plethora of articles and blog posts proclaiming, in various forms, that 2013 is “The Year of Digital Health”1 and predicting digital health and big data technologies and systems will transform healthcare.

Consumer technologies such as the internet, social media and self-tracking devices are empowering patients with information like never before. #epatients are leading the change and healthcare professionals need to adapt.

HISA has been championing the transformational role of technology and information in the business of healthcare for 21 years. In 2013, we are delivering three national conferences that will bring together national and international experts and enthusiasts on eHealth, health informatics, big data and telehealth.

One example is crowdsourcing a cure for brain cancer. Consider the case of Salvatore Iaconesi.2 His response to his brain cancer diagnosis is turning the ‘medical establishment’ on its head. He digitised his health record and put it online in various formats to seek advice and information from everyone and anyone.

His website The Cure3 has had hundreds of thousands of visits and his treatment plan combines multiple contributions, across multiple disciplines. Mr Iaconesi will be a keynote speaker at HIC2013 and promises a not-to-be-missed presentation.

Here is my summary of some of the key trends that are reshaping healthcare and which you will be hearing more about in 2013 and beyond.

1. The consumer

About the author Dr Louise Schaper is CEO of the Health Informatics Society of Australia, Australia’s health informatics organisation. Louise has over 10 years of experience in eHealth and health informatics, a degree in occupational therapy and a PhD on technology acceptance in healthcare.

It wasn’t so long ago that conversations about the role of consumers or patients focused on how baby-boomers wouldn’t be prepared to settle for what their parents and grandparents did and would change healthcare delivery through their sheer numbers and their raised expectations.

Now, the conversation has radically shifted. Thanks to technology, connectivity and information ubiquity, consumers of all ages and backgrounds are changing the nature of healthcare delivery.

2. Big data and using small data better Healthcare is an information-intensive industry. Healthcare providers are increasingly finding themselves needing to analyse the data they capture in order to produce the intelligence that determines the effectiveness of their interventions.

Government and other funders’ needs for data will intensify as they determine where to invest their healthcare budgets. We need to use the small, localised datasets better,

but the demand for data intelligence from increasingly larger datasets will continue to reshape healthcare.

Big data is big business. Projections are that, come 2016, half of hospitals in the US will be using advanced analytics software.4 HISA’s Big Data conference is Australia’s first conference to focus exclusively on the issues surrounding big data and healthcare. Big data starts with small data, so speakers will address the issues of both small and big data in healthcare as they pertain to personalised medicine, biomedical informatics, health 2.0 and participatory health, data governance and data analytics. Of course, the raison d’être of this field is the use of data to produce healthier outcomes – on both a personal and population scale – and the potential of this will also be explored at Big Data 2013.

3. Personalised medicine Personalised medicine won’t just transform healthcare, it will transform how we live. Personalised medicine allows the medical care an individual receives to be

tailored specifically for them. This includes advances in genomics and pharmaceuticals so that the pill you take for condition X will work better for you than for others with a different genetic makeup. An example of this is the discovery of blood biomarkers that could make personalised drug treatments for depression a real possibility.

Whole genome sequencing – something we have heard very little about in Australia – is now available to anyone. Companies such as 23andme are leading the charge and 2013 will see the cost of having your genome sequenced become an affordable service for many.

Wearable sensors in our clothes, sheets and shoes will also increasingly become available. Microchips barely detectable by the human eye will ride through your body using an ingested pill as their vehicle of choice. Sensors that monitor our biological processes from within our bodies and on our skin will soon become a given. A US company that manufactures ‘stretchable electronics’ that can stick on your skin and measure heart rate, brain activity, body

temperature and hydration levels has just raised $10m in venture capital to bring these technologies to market.5 Personalised medicine will be a focus of both HISA’s Big Data and HIC 2013 conference offerings.

4. Convergence of great minds, technology and money All great revolutions are precipitated by convergence, a convergence of forces that serve to make a time in history remarkable through the change it heralds.

In healthcare this convergence comes in the form of the rapid advancement in technological innovation that captures data produced by #epatients, by the healthcare system and by our own genome, and enables that data to be transformed into information, then knowledge, and then to use and share that information for the benefit of human health and wellness.

This convergence is aptly shown in the infographic on page 38, which is based

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The future of digital healthcare. Reprinted with the permission of @Paul_Sonnier.

on the work of Eric Topol’s Creative Destruction of Medicine. The excitement is palpable and now is the time that those with brilliant minds – scientists, researchers, geneticists, technologists, engineers, informaticians, healthcare professionals, designers and others – team up to radically transform healthcare.

The sandpit of health IT innovation is attracting a lot of companies, from larger, established organisations to small startups. It is also attracting investment dollars.

Almost $US3 million is up for grabs for developers to design innovations that meet healthcare challenges and needs.6 Included are games and apps that create data to improve quality of care and health outcomes. In a nod to health IT ‘going

mainstream’, the $US10m Tricorder X Prize was announced last year at the Consumer Electronics Show. The prize challenges innovators to devise a Star Trek-like device that can measure key health metrics and diagnose a set of 15 diseases.

As always, HISA will continue to do what we do, to help you lead and shape our digital health future. We believe it’s going to be an awesome year.

It may not be Star Trek or $10m, but HISA’s Healthcare App competition proved to be very popular last year. We will be doing this again in 2013 and I invite you to contact Amanda Barbone at HISA if you have suggestions on how we can focus the competition this year to meet needs or challenges you are facing.

1. www.forbes.com/sites/ johnnosta/2013/01/02/2013-the-yearof-digital-health/2/ 2. http://edition.cnn.com/2012/11/25/ opinion/iaconesi-cure-open-source/ index.html?hpt=hp_c1 3. www.artisopensource.net/cure/ 4. www.frost.com/c/10046/sublib/displayreport.do?id=NA03-01-00-00-00 5. http://bits.blogs.nytimes. com/2012/09/07/big-data-in-yourblood/ 6. www.health2con.com/devchallenge/

Many conferences and events globally are held which attract health innovators and investors. Some of these are listed at www. wirelesshealthstrategies.com/events.html

References

MSIA

RECENT PROGRESS IN E-HEALTH PATHOLOGY Some of the essential steps that need to be taken to further enable interoperability and better decision making in the diagnostics field have been achieved over the last year. One is the standardisation of terms and units of measure for pathology, another is the revision of the Australian Standard for secure messaging of pathology results, and the third is work on developing secondary clinical repositories for PCEHR data.

DR VINCENT MCCAULEY MB BS, Ph.D MSIA National eHealth Implementation Coordinator implementation@msia.com.au

Over the last 12 months there have been a number of new initiatives and significant updates to existing eHealth diagnostics (pathology and radiology) standards that will improve interoperability and enhance the ability to exchange more complex clinical data using the HL7 V2 Standard, which is widely implemented in Australia and world-wide. In addition, work has progressed significantly in standardising pathology eHealth terminology and measurement units and these have contributed to the ongoing development of electronic pathology data representation and exchange.

Pathology Units and Terminology Standardisation (PUTS) project

About the author Dr Vincent McCauley is an acknowledged national and international expert in eHealth standards. He leads MSIA’s team assisting its membership of more than 120 leading eHealth software vendors and the wider vendor community in creating a richly interconnected, semantically interoperable eHealth environment.

The PUTS project involved a partnership between the Royal College of Pathologists of Australasia (RCPA), related specialist colleges and associations in the areas of haematology, microbiology, biochemistry and serology as well as cancer organisations, major pathology laboratories and the Medical Software Industry Association (MSIA).

Additional funding has been provided by the Department of Health and Ageing (DoHA) and the project has been led by Michael Legg, who is co-chair of the Standards Australia diagnostic messaging

committee, with able assistance by Christiaan Swanepoel. The PUTS project is the initial step in the National Pathology Terminology and Information Standardisation plan and will be finalised at the end of this month.

The four objectives of the PUTS project were to: • Develop and approve revised standard units of measure that can be represented electronically; • Develop and approve agreed Australian Pathology Terminology • Develop a fully specified terminology for the reporting of ‘common’ biochemistry items used in clinical decision support including advice on usage.

• Review the protocols for cancer reporting and ensure the terminology available is consistent and able to be used in electronic decision support, including advice for their use.

It was decided early in the project that there would be no attempt to use a “one terminology fits all” approach, either across the project or within a specific domain. Instead the most mature terminologies would be selected in domains, and these would be mixed and matched as appropriate. This contrasted sharply with previous unsuccessful

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approaches that attempted to use a single terminology across all pathology domains, both for requesting tests and reporting results. It was also decided to concentrate on standardised terms that would span at least 80 per cent of use cases rather than attempt a comprehensive ontology.

Modern eHealth systems deal seamlessly and transparently with this approach and such an approach ensures that previous standardisation work can be leveraged directly, thus effectively minimising the need to develop new terms.

Following a survey of the terminology and coding systems currently being used in the pathology domain, specific PUTS working groups were formed under the auspices

of the appropriate clinical college or association with each group having industry members from the appropriate “coal-face” as well as a health informatician resource.

For example, the Australian Association of Clinical Biochemists (AACB) auspiced the biochemical terminology work and agreed to be involved in on-going maintenance of the completed set of terms.

“cell counts per field”. There is an agreed set of computable units of measure – the Unified Code for Units of Measure (UCUM) – which allows automated conversion between units, and this formed the framework for a comprehensive approach to an agreed set of pathology units of measure that are able to be used effectively in electronic decision support systems.

The work on units of measurement was notable. Those outside of pathology probably are unaware that despite the widespread introduction of the International System of Units (SI units), there is still a significant amount of variation in what units are used to report results as well a number of tests that cannot be reported in SI units, for example

The reports from all working groups have completed their final public comment phase and will be published shortly by the RCPA. SNOMED (Systematized Nomenclature Of Medicine Clinical Terms) codes have been largely agreed for requesting pathology and LOINC (Logical Observation Identifiers Names) Codes for reporting results.

Australia’s first Big Data in medicine and healthcare conference

18 - 19 APRIL

melbourne

010100001000100100101000010100001001000010 in health and biomedicine biomedical informatics 1100001010000100010010 100010100100010100001010000100010010100010 personalised medicine 0001010000100010010 00100010100001010000100010010100010 addressing the challenges health 2.0 / participatory health 00010100 of the data deluge in health 100010100100010100001010000100010010100010 data governance 0001010000100010010 s 100010100001010000101000010100001000100111 se o l data analytics 010001001001010000101000010 c 001010000101000010001001001010000101000010 i rd rc h !

B healthier outcomes 10101000010000101000010 r ly M a HISA: leading the conversation and direction 010100001000100100101000010100001001000010 2 Ea

for big data in healthcare in Australia.

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Be part of this inaugural event! hisa.org.au/bigdata2013

health-mic

“Such a process could lead to pathology and other diagnostic information becoming available online very rapidly and there appear to be few technical barriers.”

Vincent McCauley

Completion of this project within budget and on-time marks a significant milestone in eHealth diagnostics and it is worth noting the factors that contributed: auspicing by the clinical colleges and associations in partnership with industry, effective stakeholder engagement and early involvement of industry and standards communities, sector-knowledgeable health informatics leadership, parallel eHealth standards development leveraging existing standards, an open process with regular, cross-sector communication via newsletters and workshops, and clear agreed target benefits for both clinicians and industry.

New versions of 4700.2-2012 and HB262‑2012 The Standards Australia HL7 V2 Diagnostic Messaging Standard (4700.2) is the most widely implemented eHealth standard in Australia. A few months ago, a revised version 4700.2-2012 was completed and published. This replaced the version published in 2007 and is based on HL7 V2.4.

In addition, the associated Diagnostics Messaging Handbook was updated and published as HB262-2012, which is the first revision since 2002. Both these publications are available for free download from www.e-health.standards.org.au/ Home/Publications.aspx New and improved areas include: • Usage of National eHealth identifiers for patients (IHI), providers (HPI-I) and

healthcare organisations (HPI-O) as recommended by the Australian Health Messaging Laboratory (AHML) • Recommendations from the Medical Software Industry Association HL7 Interoperability Working Group to improve semantic interoperability, including receiver addressing, standardisation of terminology representation, improvements in usage of display segments and usage recommendations for Rich Text • Clarification of representation and usage of terminology and units for ordering and reporting to reflect the outputs from the PUTS project • Inclusion of many more examples in the handbook and practical implementation issues and solutions.

A project which has recently commenced at Standards Australia and which is leveraging the previous work is looking at how to represent the complex and detailed cancer reporting formats in electronic messages for the majority of common cancers that have been developed and published by RCPA over the last two years.

to have one centralised repository of information. This is the first step towards realisation of that concept, which is encapsulated in the IHE Cross-Enterprise Document Sharing (XDS) Standard that is at the core of the Australian PCEHR implementation.

For large pathology companies, exposing their huge volumes of data as a secondary repository linked transparently to the national PCEHR common document index is an attractive proposition compared with uploading to the PCEHR central repository.

Such a process could lead to pathology and other diagnostic information becoming available online very rapidly and there appear to be few technical barriers.

However, it remains to be seen whether the privacy and governance challenges and obstacles that are inherent in this approach can be overcome as easily.

PCEHR secondary pathology repositories

Implementation of the outputs from the PUTS project and the updated messaging Standards is currently underway. This will result in richer information, improved interoperability and be an enabler for the current generation of electronic decision support systems.

Following repeated representations from MSIA, the initial workshop to map out the landscape for “conformant repositories” as described in the PCEHR concept of operations, took place recently. In the initial announcement of the PCEHR work program, the then federal Minister for Health stated it was not the intention

Like much of eHealth, if it has been done well and is as successful as hoped, it will be mostly “invisible” and only noticeable by clinicians as richer, more consistent clinical data automatically appearing in their electronic notes and smart, seamless electronic diagnostic ordering systems integrated into the clinical workflow.

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Feature

PATHOLOGY, RADIOLOGY AND THE PCEHR The integration of pathology and radiology results and reports into the PCEHR has long been heralded as one of the most important drivers for wider clinician acceptance of the system, but while much work has been done on designing a safe way of delivering those results, negotiations as to when this will be achieved are at a standstill, and there is no word yet on when it will begin.

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

While the PCEHR system has been designed to provide patients with control over their healthcare information, advocates behind the project have long touted the wider benefits of better information sharing between clinicians, and nowhere is this seen as more important than in pathology.

The ability of general practitioners and acute care clinicians to have access to a full history of a patient’s healthcare, including their most recent test results and a cumulative view of these results over time, should surely provide a better and safer basis for clinical decision-making.

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

Equally important is the ability of specialist physicians to provide advice to their colleagues based on a full history – for example, a pathologist evaluating an abnormal test result in the full knowledge of a patient’s history of chronic disease, armed with previous test results from a different provider and with a current summary of the patient’s health status, would be better able to provide advice in consultation with the patient’s GP. The huge importance of delivering diagnostic test results to the PCEHR is in some minds the make or break of the system. A record of a patient’s sniffles and incomplete lists of medications are not

going to be of much value and clinicians will quite rightly ignore them. Easy access to diagnostic test results, on the other hand, would be of great value.

This is why the public and private pathology and radiology sectors were important parts of the different reference groups set up by NEHTA when it began the planning and design of the system.

NEHTA’s diagnostic services reference group includes the Australian Association of Pathology Practices (AAPP), the Australian Diagnostic Imaging Association (ADIA), the National Coalition of Public Pathology (NCOPP), the Royal College of Pathologists of Australia (RCPA) and the Royal Australian and New Zealand College of Radiologists (RANZCR) among others.

The plan was to have results from private pathology delivered to the PCEHR system

by June this year, with the public sector to follow a year later. Diagnostic imaging was to come at a later date due to the complexity of delivering images to the PCEHR, even if this was desirable or not.

There were a number of issues to work through, but NEHTA and the pathology sector have devised a way that up-to-date and cumulative reports can be delivered to the PCEHR. What is holding it back from happening is a standstill over funding.

Professor Katherine McGrath, CEO of the AAPP, the national peak body for private pathology in Australia, says the private pathology sector has participated in the reference group very willingly, and was keen to become part of the PCEHR system. She also believes that requesting doctors are keen to see pathology results integrated into the system.

However, there are some special needs in the pathology, she says. “The pathology sector, particularly the private pathology sector, is very computerised. One of the absolutely critical factors in any system that delivers pathology results into a computer process, is that if there are any changes to the results, pathologists must be able to refresh those results automatically.

“In some tests, for example, you give an initial result and then a follow-up result further down the track, when you might realise for various reasons that that result is not the correct one. So it is redone and a new result is sent out. The current systems that are set up in private pathology are able to refresh doctors’ systems with the up-todate results.

“One of our concerns has been that in terms of building a system to deliver pathology results into the PCEHR, there is still that ownership of the results by the pathology provider so they can keep the report refreshed with up-to-date knowledge. One of our concerns has been that a pathology result may have been taken off a requesting doctor’s desktop and that may not be the most up-to-date result. A patient might be mistreated or treated wrongly if the result is not the most recent one.”

Professor McGrath says it is critical that the ownership of the result and the responsibility for keeping it up to date lies with the pathology provider, and that the system needed to be designed to allow this. A solution has been worked out to allow this, she says. “That system is designed, it has been tested and it

“...the manual handling of the individual healthcare identifier and the work around validating the IHI would be prohibitively expensive. So we need electronic ordering from the GPs to be able to implement this system.”

Katherine McGrath

is capable of being delivered. But our problem is that of course there is a cost in delivering that. Our sensitivity in this space is that we are ready, willing and able, but the federal government has not shown really any interest in having pathology in the PCEHR, which is a surprise to us.

“Basically, we have knocked on their door and said this system is designed and with appropriate cost recovery, we are ready to do this, but their response to us has been really showing very little interest in getting that up and running.”

Funding deadlock One of the barriers may be the national pathology funding agreement 2011-2016, which provides $12 billion over five years for pathology services. The government is keen to ensure that costs don’t blow out, and while the agreement states that the pathology sector “will use its best endeavours” to enable results to be sent to the PCEHR, there is no cost structure within that agreement to cover the PCEHR. There is a clause in the agreement that states that the government recognises that pathology participation in the PCEHR will include exploration of possible incentive payments, but eHealth is an addition to, rather than a part, of the agreement.“The computer systems and the way they are

structured in pathology providers at the moment need to be modified,” Professor McGrath says. “You need to keep a different database because pathology practices batch a lot of their results and this is not conducive to the immediate availability required by the PCEHR. They have to redesign and develop new systems for delivering these results in real time, whenever they are requested.

“That takes a redesign, and we do need electronic ordering from the GPs to be able to do this. Because our systems are so automated, the manual handling of the individual healthcare identifier and the work around validating the IHI would be prohibitively expensive. So we need electronic ordering from the GPs to be able to implement this system.

“Another problem is that while we have some doctors referring on paper and some electronically, our people have to maintain dual systems, so whilst over the long term there are savings for the pathology sector if everyone goes to electronic requesting, it won’t be until everybody goes that you can do away with paper. Otherwise you have to keep the two systems going. There are some issues to be sorted out.”

The Department of Health and Ageing has not replied to Pulse+IT’s requests for information on its plans for pathology

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and the PCEHR, so for the time being the situation is deadlocked. Professor McGrath says she is surprised at DoHA’s response.

“We see pathology as an important part of the PCEHR and it would be a reason for many doctors to start using it more if pathology was in there, so we can’t quite understand their reluctance,” she says.

“We are ready and the ball is in their court, because we believe that we have done everything that we need to, working with NEHTA and the government, to get this up and running.”

Diagnostic imaging While the delivery of pathology results to the PCEHR has been agreed to and is just waiting on DoHA to give the go ahead, the diagnostic imaging sector is not quite at that level yet. Diagnostic imaging is a very complex field, as it includes textual reports accompanied by images that cannot be sent to a PCEHR by HL7.

The RANZCR’s representative on the diagnostic services reference group, Dr Nick Ferris, says a lot of work still needs to be done on developing a model that can be adapted for diagnostic imaging. While there are some similarities between the two sectors in terms of developing standards for electronic referrals, radiology has a number of challenges that it will have to be faced differently, Dr Ferris says.

The ADIA’s spokesman, Scott Ferrero, has in the past urged the federal government not to conflate radiology with pathology when formulating specifications for their involvement in the PCEHR simply because they both focus on diagnosis. The idea that what works for pathology will work for radiology is not true, he says.

“Specimens and patients are very different beings,” Mr Ferrero says. “We’ve suggested pretty strongly that they shouldn’t be using pathology templates for diagnostic imaging.”

At this stage attention is focused on uploading radiological reports to an individual’s PCEHR, while the future management of the accompanying images is unclear. Dr Ferris says he understands that pathology reports would be uploaded in a PDF format following the development of an HL7 CDA template.

For diagnostic imaging, however, it is rather more complex. “The PCEHR has been developed very much from the perspective of general practice and the people in the hospital sphere mainly have to deal with hospital IT systems and state health department arrangements, which vary across each state,” Dr Ferris says.

“I think the main role in the PCEHR will be provision of reports of outpatient studies, and some inpatient studies after discharge.

Some of this information may also be referred to in discharge summaries written by other hospital staff.”

Differing state practices would also be a challenge, he says. While NSW has set up a centralised repository for diagnostic images and reports for use by both the acute and primary healthcare sectors, and there are similar arrangements planned for some other states, Victoria is not likely to go down this path.

“And an important point for discussion is that these repositories are explicitly only for the public system,” Dr Ferris says.

For radiology practices, what would greatly assist would be to have all referrals sent electronically and conformant with a NEHTA specification. “That would facilitate the smooth uptake of the healthcare identifiers. There would need to be a similar template or specification for reports, and NEHTA has developed some general specification for referrals.

“The college has released some guidelines on what should be in a report. All of this will then need to be sent as a secure

message, and it’s not really known what proportion of practices are able to send HL7 messages with the secure messaging protocols that NEHTA and Standards Australia have developed.”

For private radiology providers, Mr Ferrero says there were a number of challenges that have to be overcome, but some of the foundation technologies that are being developed, such as the national Healthcare Provider Directory, would be “godsends”.

The construction of large imaging repositories that private providers would be expected to populate was not an answer, and a centralised index was a better choice, Mr Ferrero says.

“There is a whole host of problems with these massive imaging repositories, one of which is cost, and the other one is synchronisation. If you don’t know who has pushed your data around, and where they have pushed it to, trying to keep control of that through downstream systems is impossible. The only way you can do it is by being the publisher of your information.

“There is technology called XDS-I which Integrating the Healthcare Exchange (IHE) has developed and we are big advocates of that. You can store the data once and have indexes to that data and that is the intelligent way of doing it. XDS-I specifically does that.”

The costs of working on the project and integration with workflows also need to be taken into account, Mr Ferrero says.

“There are no national orderable catalogues in Australia and terminologies are different between states and from practice to practice. And there are image storage costs. There is no legislation for agreement at the moment around image storing. It differs between states and even between state jurisdictions. We need to decide a policy on how we are going to store images and reports.”

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REVISED STANDARD FOR ELECTRONIC

EXCHANGE OF PATHOLOGY AND RADIOLOGY RESULTS Standards Australia has published a revised standard for the electronic exchange of pathology and diagnostic imaging orders and results using the Health Level Seven (HL7) version 2.4 protocol, the NEHTA preferred specification. The revised standard includes the use of the Healthcare Identifiers Service, which has been designed to allow better identification of patients in test orders and results.

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

Australian Standard 4700.2 2012 is a revision of the existing standard for the electronic exchange of pathology orders and results, and provides requirements and guidance for the implementation of electronic messages using HL7 v2.4. It will help ensure that patients and providers can be identified using the HI Service in both test orders and results.

It is expected that this will help improve positive identification of the subject, the requester and the report recipients.

Co-chair of the Standards Australia subcommittee for diagnostics messaging, Professor Michael Legg, says that while there are no big changes to the standard, the revision will provide greater clarity around how to send diagnostic reports, and will also show how to use the new identifiers by reference.

“We have also firmed up guidelines on the rendering of the report so a proper message from a pathology practice should, in addition to the atomic results, send a rendering of the report as they would expect the viewer to see it,” Professor Legg says. “This is to address the risk of of receiving systems losing or changing meaning by displaying data in a different format. It is a safety issue around receiving systems – not putting data through ‘the digital shredder’, as one of my colleagues

described it, where you take results and display it out of context and so lose some of its meaning. Most medical imaging reports are already shown in the way they would on paper so it is less of an issue.”

Most general practice software has been tweaked over time to receive a number of different message report formats, including the old pathology information transfer (PIT) format that has been used for more than 15 years. Professor Legg says the revised standard now deprecates the use of PIT and requires the use of alternative display formats such as XHTML. While all private pathology practices are able to send HL7 messages, the receiving systems were often a reason for variation, he says.

“What they have done is often shoehorn stuff in to fit the receiving systems and so you end up with variations,” he says.

“What we at the Standards Australia working group have worked toward is a standardised message that conveys all of the information accurately and in a form that can be used by the receiving system for things like alerts and other decision support. Depending on how the receiving systems deal with the pathology reports, the intention is to provide the capacity to still see the report in the way that the laboratory would show the results.”

Cumulative reports The working group is also now revising its HB 262 handbook for messaging between diagnostics providers and health service providers to reflect the changes in the standard. “The handbook is a detailed how-to guide,” Professor Legg says. “With changes to both terminology and the identifiers, we are going to go back to the handbook and update that. That is on our work program and we expect that will be finished by the end of June 2013.”

Standards Australia is also looking at how clinicians can ask for results from a pathology laboratory before seeing the patient in a clinic, and also how to put complex structured reports such as those

recommended by the Royal College of Pathologists of Australasia for cancer into a pathology message. Both of those projects will all be completed by June 30.

Another future project will look at standardising how cumulative reports are shown, he says. “Where you get into strife is where it is passed on from the primary report recipient to another – a copy report.

That certainly can lead to confusion so we are going to address that issue. We are also going to address the issue of how you show results with alerts associated in a consistent way.”

Another project that is in its scoping phase at the moment is a joint project between the RCPA and the RACGP looking at

decision support in requesting. This will concentrate on five particular conditions with the intention to align the advice given by both colleges and to devise a practical way of putting that into electronic systems.

“The detailed clinical models are being worked on with NEHTA, there is the standard on safety-related aspects of pathology report rendering, and the last of that is looking at the rendering of messages to registries. There are around 200 registries and almost all of them are served by pathology. They are at international, national, state and local levels – the big ones being cancer and the public health network for infectious diseases. That is another place we are looking to standardise.”

HealthLink/Medinexus Half Page 180 x 120 Puse IT Mag

connecting healthcare

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SMART SOFTWARE TO AUTOMATE THE

ANALYSIS OF PATHOLOGY AND RADIOLOGY REPORTS Reading and processing narrative-based clinical reports is a time-consuming process. To ease the workload of clinical staff and aid the computer processing of these reports, CSIRO is developing smart clinical decision support software called Medtex. The software is aimed at extracting free text data to aid decision support and take the weight off clinical staff.

ANTHONY NGUYEN BEng (Hons 1), PhD anthony.nguyen@csiro.au GUIDO ZUCCON BEng, MEng, PhD guido.zuccon@csiro.au

Medtex is able to process clinical records such as pathology and radiology reports that contain a lot of valuable medical information that is often buried in text which may be unstructured, ungrammatical or fragmented.

An example is determining the stage of a cancer patient. Determining the stage that a cancer is at involves drawing information from a number of sources such as radiology, pathology and surgical reports. This is usually a time-consuming task requiring the expertise of more than one person.

A simple way of easily and consistently collecting clinical data could improve health outcomes for patients, boost the efficiency of the health system and provide a rich data set for further research.

About the authors Dr Anthony Nguyen is a Research Team Leader and Dr Guido Zuccon is a Post Doctoral Fellow from the Australian e-Health Research Centre. Anthony and Guido develop medical text analysis capabilities to unlock information in electronic health records for supporting clinical decision making.

Medtex works by “learning� what statements to look for and uses SNOMED CT, the internationally defined set of clinical terms, to unify language across information sources. The more reports the software processes, the smarter it gets.

Virtual cancer registry The medical text analysis software performs cancer registry tasks such as the notification of cancer reports and the coding of notifications data.

The system automatically scans HL7 messages and analyses the free-text reports for terms and concepts relevant to cancer. Classification of pathology reports that are notifiable cancers can be achieved with sensitivities of 98 per cent and specificities of 96 per cent.

The coding of specific cancer notification items such as basis of diagnosis, histological type and grade, primary site and laterality can be extracted with overall accuracies of 80 per cent.

In the case of lung cancer staging, positive results were achieved after a formal trial on lung cancer cases comparing the stages it assigned with those given by expert pathologists. Medtex also allows for detailed tumour stream synoptic reporting.

This software has been developed in conjunction with the Queensland Cancer Control Analysis Team, Queensland Health.

Computer software to read limb X-ray reports The checking of X-ray reports to ensure limb fractures are not missed and that patients receive appropriate follow-up once discharged from the emergency department is essential but can often be a laborious task.

“Medtex works by “learning” what statements to look for and uses SNOMED CT, the internationally defined set of clinical terms, to unify language across information sources.”

Anthony Nguyen

In partnership with the Royal Brisbane and Women’s Hospital and the Gold Coast Hospital emergency medicine department, Medtex has been trained to reliably identify limb fractures documented in radiology reports. The next stage of the research involves linking the fractures identified in the radiology reports with patients’ disposition recorded in an emergency department information system to provide decision support to the checking process, which is currently done manually.

Current research The Medtex software is being used in a range of other research projects to streamline the processing of reports and improve the ability of computers to offer clinical decision support. These projects

include the classification of cancerrelated cause of deaths codes from death certificates, extracting information from documents which are scanned then processed using OCR, and automatically populating structured reports from natural language speech.

CSIRO works closely with healthcare practitioners from cancer registries, and hospital pathology and emergency medicine departments in Queensland and NSW. Working with key health industry stakeholders allows Medtex to provide organisations with informed clinical decision support by extracting greater value from their clinical narrative reports.

Automating the collation, analysis, summarisation and classification of patient data means reduced dependence on

busy expert staff. Automated processing also means more – and better – data is available in real time for populationlevel studies, comparative analyses, benchmarking and even reporting of health data.

Medtex has been developed at the Australian e-Health Research Centre, a joint venture between CSIRO and the Queensland government through Queensland Health.

Further information Technical details on CSIRO’s Medical Free Text Processing Medtex software are available at: http://aehrc.com/research/ health-data-management-and-semantics/ medical-free-text-processing

Figure 1. The Medtex software automatically processes pathology reports and produces a structured report.

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EVOLUTION NOT

REVOLUTION KEY TO TESTSAFE The TestSafe system first pioneered in Auckland has gradually expanded over the last decade to become a clinical data repository for lab results, diagnostic images and medications, and is now moving on to include clinical documents and electronic orders. Patient access is on the cards in a project that Australia could have learned a lot from in how to develop a true electronic health record.

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

It is a truth almost universally acknowledged that laboratory information systems were probably the first widespread application of IT in the acute care environment. The automation of lab equipment and the electronic collection and distribution of results has pioneered the growth of health IT worldwide.

New Zealand company Sysmex has been manufacturing an LIS since the 1980s and still does to this day, but it is the additional applications it has developed alongside the LIS that has seen it gradually develop what could pragmatically be considered a national electronic health record that rivals anything else on offer.

Sysmex provides the backbone to the regional clinical data repository now known as TestSafe through its Eclair technology. Eclair was developed simply as a way to allow treating physicians to view lab results electronically in the hospital context, but since then has become the regional repository for a number of different clinical datasets, including pathology, radiology and pharmacy, both in the acute and the primary care sectors.

TestSafe first began at Auckland’s Middlemore Hospital, where a forwardthinking CEO was keen to investigate how to use IT to improve clinical

information sharing. Middlemore installed Sysmex’s LIS a number of years ago to help automate laboratory services, but according to Colin McKenzie, Sysmex’s national sales manager, once ward-based doctors heard about it, they wanted a piece of the action too.

“The doctors on the wards became aware that the laboratory was computerised and they wanted access to the results,” Mr McKenzie says. “Even though paper reports were sent up to the wards, doctors more and more said ‘why can’t we just log in and look at the results?’

“The LIS was never developed for that functionality, so we decided that we needed a better presentation platform to present the lab results to non-lab people, to clinicians on the wards. So we built Eclair, and we transported the results when they were ready to a secondary database and in the 1990s developed a database presenting the results in the way clinicians wanted it.”

Originally, Eclair was just built for Middlemore Hospital as a database to collect and present lab results, including haematology, biochemistry and microbiology, to its ward doctors. However, as a teaching hospital, Middlemore would often see a turnover of new registrars

every six months, and it was when these doctors moved on to other hospitals in their rotation that things began to develop.

“When they would move over to Auckland City Hospital, for example, they would say, ‘where’s the Eclair? Middlemore has this really neat system where we can look up all of the lab results on a computer.’

Auckland City Hospital said they would look at it in the future but clinician pressure said they wanted to have it now. It was really clinician-driven.

“So we hooked up the Auckland City Hospital LIS to publish results to exactly the same database as Middlemore. We didn’t build a new database – we just used the same database and they began to share hospital laboratory results across multiple facilities in the city.”

These days, the Auckland, Counties Manukau and Waitemata District Health Boards (DHBs) are all using the system

and more recently the Northland DHB has come on board. TestSafe is operated by healthAlliance, the shared services organisation for the DHBs in the northern region, which covers a population of about 1.7 million people. The database is still hosted by Middlemore Hospital.

Once lab results were easily uploaded and shared, clinicians began to push for community laboratory-generated results to also be included, Mr McKenzie says.

“So we put a project together and got the private providers around the table, and they were more than happy to publish a copy of the results to the clinical repository as long as the funder had requested them to do so and it was part of the contract.

“We got all of the community lab results in. Community laboratories aren’t paid any more for it as it was just made part of the contractual obligation. They produce the result anyway and they send an electronic result to the GP and most of the GPs have

A view of pathology results sent to TestSafe from both hospital and community laboratories.

desktop systems that receive electronic information. We knew that they were compliant using HL7, so all we did was make a copy of it and redirect it back at the CDR, and the funder just made it part of the contract that they required a copy of all the results that were funded by the DHB be delivered to the CDR.”

Radiology and pharmacy The next step then was obviously radiology.

Sysmex devised a similar method to pathology in allowing the transmission and storage of radiology reports, with the addition of attaching a small URL to the report to allow access to the image.

Diagnostic images are far too large to send through HL7, so a URL was attached to the report that redirected the clinician back to where the image was stored, namely the originating picture archiving and communication system.

“When they send the radiology report, which is more textual, they put in a URL of where the image is kept,” Mr McKenzie says.

“When a doctor reads the report in Eclair, there is a little icon there which when clicked takes them back across the network to find the PACS image. They are big DICOM images so they can’t be sent down HL7.

We link them back to the PACS server and display it through the web browser.”

Imaging information took the same road as the lab results, Mr McKenzie says, with all of the hospitals then wanting the same functionality, and then primary care radiology was brought on board. “The funder said if we outsource any of our radiology services to a private provider, then part of the contract is to put the result back into the regional repository. So now we have lab results and radiology results from across the continuum of primary and secondary care, all in one place.”

After that, pharmacy was the obvious next step. Hospital-dispensed medications were easy enough, but the community sector

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“We didn’t build a new database – we just used the same database and they began to share hospital laboratory results across multiple facilities in the city.“ Colin McKenzie

is where most dispensing occurs, so the clinicians were keen to get this information into the system as well.

“They said if we can look at the lab results from here and from primary care and the radiology as well, if we could see the dispensing information and see exactly what the medications had currently been dispensed – the brand, the drug, the dose, the instructions – this would be fantastic.

“We completed that a couple of years ago and 300 community pharmacies in the Auckland region are now publishing dispensing information. That is almost 100 per cent of all community pharmacies.”

Opting out One of the major differences between the TestSafe system and things like Australia’s PCEHR is its opt-out nature. TestSafe is clinically driven and clinician-controlled, and patients are informed that their lab results, radiology reports and dispensed medications will be sent to a central repository where their physicians can access the information with their consent.

It is explained to them that it is for their own and their clinicians’ benefit, but that if they do not want that information shared, they can opt-out of the system through a website or ringing an 0800 number.

“By default it’s an opt-in,” Mr McKenzie says. “We know that if we went the other way and asked people to ring up and opt in, people don’t do it. Then you don’t get huge

coverage or the benefits to patients’ health, doctors’ time and the ongoing reduction in duplication of effort and getting patients out of hospital more quickly.”

The TestSafe concept has spread its wings further, with the Canterbury District Health Board following its lead and setting up TestSafe South, using Eclair and hosted at Christchurch Hospital. South Canterbury and the West Coast DHBs have now joined in, with the Southern DHB about to begin.

TestSafe South will be the one central system for the whole of the South Island.

Under the NZ National Health IT Board plan for country, the other two regions will follow this lead as well. This means that if a patient moves from Christchurch to Auckland, for example, a patient’s new doctor will still be able to access their old information. The prescient decision to assign all New Zealanders with a National Health Identifier (NHI) 18 years ago has helped immensely in this regard, Mr McKenzie says.

For general practitioners wanting to access a patient’s information within the repository, they apply to TestSafe to be able to do so based on their provider numbers gathered by their Primary Healthcare Organisation (PHO) and whether the individual patient is enrolled in that PHO. “We’ve done some integration so when they have patient in context within the practice management system – the patient is sitting in front of them and they’ve got

their local records up – then we put an icon on the desktop so if they want to see any other information that is in the clinical data repository they push that button and we fire them a secure URL and it exposes the CDR so they can review it.

“When they do that, as it hits the hospital, what they do is there one piece of extra security – here in the Auckland region, when they hit the hospital network, we know who the clinician is and we look at who is the patient they are enquiring on.

“If the patient is enrolled with the PHO that doctor belongs to, that allows them in. If they are trying to look at a patient who is not enrolled in their PHO, then a window opens and tells them that, and says ‘you are enquiring on a patient who currently doesn’t belong to your PHO, do you want to continue as you’ll be double audited?’ If they press yes, then they go through but a message is written to the log that they have done this and there is a proactive audit in the background looking for anybody who might be trying to scan the database inappropriately.”

GP integration Allowing primary care practitioners access to the information has been relatively straightforward, as the majority of GPs in the Auckland region uses the Medtech practice management system. HealthLink is also the main secure messaging provider. The TestSafe team is working on getting the 20-odd per cent of GPs not

using Medtech to be able to interface with the system, but is also rolling out wider functionality. Automatic electronic orders is the next step, Mr McKenzie says.

“Because we have all the lab, radiology and dispensing information, now we are overlaying electronic orders over the top of that. If the doctor is trying to order a lab test we can interact because we’ve got the information and we can throw back messages such as ‘are you aware that this patient had this done only a week ago?’ We are telling them at the point of order; there is minimum reorder interval logic in there.

We’ve done a lot of work in the Central region, at Palmerston North, where they have rolled out electronic orders through the same GP mechanism.”

And more information is on the cards. The TestSafe team has just finished a program of work to allow clinical documents to be stored in the database, sent in any format such as PDF or Word. These will be the key clinical documents that GPs need and that hospital clinicians believe would be useful to share with their primary care colleagues. “The hospital network in Auckland is now publishing what they call

a select set of regional clinical documents in the repository. The key ones to start with are discharge summaries, which is key to share with primary care, and then on the other side, referrals.

“And on our program of work now, we have identified that patient alerts and allergies need to go in. Once we complete that, we have pretty much completed most of what clinicians are asking for at the moment.”

As the system is clinician-driven, all requests to add extra information go to a clinical review board to decide whether it is worthwhile. One doctor has mentioned to Mr McKenzie, for instance, that it might be useful to store part and batch numbers for medical devices such as hip or knee replacements to improve recalls.

Then comes patient access to the information. This is still very much in the planning stage, with a recent trial undertaken by clinicians at Middlemore who already have access and knowledge of Eclair to see if they can view the data from home. The big issue is how to present the data to patients to make it understandable and so it doesn’t alarm them.

“A lot of studies have shown that there have been some problems with people having access to results and then they go on the internet and they self-diagnose,” Mr McKenzie says. “There have even been incidents of self-harm” Patient access is on Mr McKenzie’s roadmap, but a big question is exactly how many patients will be interested in the first place. The information displayed may be limited, as will access to it. “Talking to the general public, they generally want the results to be available to their clinicians when they are being treated in hospital or primary care,” he says. “When you ask them candidly if they would log on if they had access, would they review their results or update anything, a lot of the responses are ‘no, not really’.

“There is not a huge public push for this.

There are certain people like athletes who want to take charge of their information, but the general feeling from the public is that as long as the results are available to their doctors when they are there, and they can control access by opting off if they want to, then maybe eventually they might like to log on and have a look but basically they don’t see it as a top priority for themselves.”

Diagnostic images are kept in the original PACS, with a URL attached to the TestSafe report.

Mr McKenzie believes that the key behind the success of TestSafe has been its evolutionary approach and the fact that it is clinically driven.

“As we put each further piece of information in and made it available, they kept on asking for more, and what they were asking for was relative to what they were doing rather than trying to design it on paper before starting to implement it. And now with completing the loop with electronic orders going in, that is taking the next step. It has been evolutionary. It started just with lab results at Middlemore and has slowly evolved. There wasn’t any big bang theory. We always think about evolution, not revolution.”

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CHANGING LANDSCAPE OF THE

LABORATORY INFORMATION SYSTEMS MARKET Big changes are underway in the laboratory information systems (LIS) market in Australia, particularly due to regional consolidation of laboratories in several states. Consolidation is just one of the trends that are affecting what funders and users are looking for in an LIS.

MATT NIELSEN BSc MT (AIMS) (ASCP) Project Manager: InterSystems Corporation matthew.nielsen@intersystems.com

There are currently some very big changes occurring in the laboratory information systems sector in Australia.

The well-known product implemented in several state-wide public pathology services and several national private pathology laboratories has been abruptly discontinued, which is causing many pathology providers to shop for a new LIS. The tenders that have been produced so far by these buyers have confirmed some known global trends in the LIS sector and have brought to light some new ones.

About the author Matt Nielsen is a qualified medical lab scientist and has worked for many years in the laboratory in the USA and Australia. He has worked on health IT implementations that have ranged from single sites to entire states in Australia, Japan and the USA and has served on both the client and vendor sides.

it fuels client demands as evidenced in the requirements of recent tenders.

The large and complex laboratory service networks are typically looking for large, stable LIS vendors with a globally proven track record of success in delivering large-scale LIS implementations. The justification for an in-house IT department at a public facility to create its own LIS customisations is in question, with the readily available supply of robust and tested COTS LIS functionality and cuts in government spending.

The typical LIS implementation has a life cycle of five to 10 years or longer due to the costs of implementation and the ‘pain’ of change. And an LIS is clearly no longer considered a bespoke product.

The days of creating your own LIS from scratch for anything but a small lab service are probably all but over.

There are a large number of vendors who now offer commercial off the shelf (COTS) functionality that is marketed to the mainstream clinical laboratory. This trend can be seen with the 25 LIS vendors currently scheduled to exhibit at HIMSS in the US this year.

The trend of regional consolidation of lab services is continuing, as observed in the public sector with the subsistence of QLD Pathology; Path West, created in WA in 2005, which put all labs under one entity; the final consolidation of the last few SA stand-alone labs into SA Pathology/IMVS; and the recent consolidation of Pacific area Medical Lab Service (PaLMS) and Hunter Area Pathology Service (HAPS) in NSW.

Proactive vendors are providing regularly scheduled product enhancements that meet changing market demands as part of standard product maintenance on an annual basis. The average LIS has become extremely complex and the more functionality the vendors supply, the more

Regional consolidation

This aligns with the consolidation in the public health sector as a whole. For labs in particular this is driven by decreases in government reimbursement on some

“The days of creating your own LIS from scratch for anything but a small lab service are probably all but over.”

more akin to a system-to-system interface than a historical simple instrument interface.

Automation is growing with the emergence of instrumentation in departments that were historically very labour-intensive, particularly in sample processing, genetics, histopathology, microbiology, and transfusion. The list of pre-developed instrument interfaces from a LIS vendor is consistently a key selection criterion as it is an indicator of flexibility and experience.

Matt Nielsen

tests, an increase in the number of tests ordered per patient per encounter, increased costs, government budget cuts, and MBS rate cuts. Labs are aiming to achieve economies of scale and reduce overheads and increase efficiencies by merging and centralising services.

LISs are no exception. A centralised lab service requires a centralised LIS that is highly scalable and can support a large number of concurrent users, several hundred concurrent instrument interfaces, and workflow support to all major lab departments. It also needs to run efficiently on a simple and affordable hardware platform.

Increases in efficiency are progressively sought through automation of manual tasks. An LIS is now expected to have built-in, user-friendly rules engines to automatically apply business logic to the workflow, consequently removing the human factor, increasing efficiency and improving consistency and quality.

Lab instrument vendors such as bioMerieux, Roche and Beckman Coulter are providing highly integrated instrument clusters. This is driving added demand on the LIS to be more responsive to interfacing and support increasingly complex instrument interfaces that are

New instrument interface development by the vendor increases implementation costs. US-based vendors often find themselves behind this game as the Food and Drug Administration in the US delays the release of new instrumentation due to its lengthy certification process.

Reimbursement and results reporting Being able to efficiently and accurately generate an invoice for lab services is an ever-present demand in the LIS market in Australia. This is unfortunately true even in the public sector as providers have learned to survive by seeking reimbursement for services from Medicare and private health funds wherever possible.

This has created a new demand on LISs to support electronic billing such as Medicare Online claiming, DVA Paperless, and Electronic Claim Lodgement and Information Processing Service Environment (ECLIPSE).

Non-Australian vendors can struggle to understand the local billing rules and often partner with a local health billing specialist, increasing the bid complexity and cost, or sometimes they simply don’t enter the market all.

Larger lab services are looking for an LIS vendor that can provide strong functionality across all departments through a unified

system with a single data repository to reduce complexity and clinical risk. They are also looking for strong integration capabilities to third-party systems.

The “best of breed approach” – selecting multiple lab department-specific IT systems that are considered the best available for each department – proves to be costly in implementation, hardware, maintenance and staffing as it lacks economies of scale. It also creates duplication of common workflow across departments, makes patient collections difficult to manage, and makes “all of lab” business intelligence (BI) reporting next to impossible.

Embedded analytics is now an essential component of an LIS, enabling labs to be more commercially competitive. The next generation of analytics will be able to access unstructured data, a previously untapped resource where a huge amount of valuable data resides.

The delivery of results is trending away from paper and even further away from faxes and increasingly toward secure messaging directly into the ordering doctor’s practice information system.

Electronic orders are now expected as standard within a health service to close the loop with doctors.

Some labs are even taking the next step to close the loop with patients by requiring their LIS to link to the PCEHR. Some may wonder how an e-order is going to find its way from a medical practice information system into the correct LIS, given that the patient can choose their pathology provider, and what role the PCEHR will play in this.

And we are all questioning what the next wave of requirements for a LIS are and how the LIS of the future will support portable devices, radio frequency identification (RFID) of specimens, courier logistics and the cloud.

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STANDARDISING PATHOLOGY UNITS AND TERMINOLOGY

After over 18 months of detailed work, the Royal College of Pathologists of Australasia (RCPA) recently released draft reference sets of terminology for pathology requesting and reporting, and preferred units of measurement for results. These reference sets will be integrated into clinical software.

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

Part of the RCPA’s Pathology Units and Terminology Standardisation (PUTS) project, the draft will lead to a revised policy for the units of measurement used in pathology reporting as well as a series of reference sets of terminology for requesting and reporting by the various disciplines, including biochemistry, haematology, microbiology, immunopathology, genetic pathology, anatomical pathology and cytopathology.

Public comment on the draft reference sets were invited last December, and closed in late January. A new RCPA policy is expected to be endorsed after the public comment, which will describe the rules around standardised units, terminology and the naming of tests. One of the key aims of the project is to standardise units of measure so they can be read by clinical software and be represented in electronic messaging.

Chair of the PUTS steering committee and Fellow of the RCPA, Michael Legg, says the project had been running for just over 18 months and involved some 80 pathologists, scientists and informaticians divided into 10 working groups. One developed the units, one worked on requesting terminology, and the others worked on terminology for reports for each of the pathology disciplines.

Professor Legg says work on standardising measurements and terminologies in pathology was nothing new, but it had not been done before in such a comprehensive and coordinated way.

The steering committee had representatives from the RCPA, the Australian Association of Pathology Practices, the Department of Health and Ageing (the sponsor of the project), NEHTA, the Medical Software Industry Association and the leaders of each of the working groups.

“The RCPA started with the standardisation of units in the early ‘70s but in practice there is significant variation of what is actually reported,” Professor Legg says. “Not only that, it is the kind of variation that may lead to serious harm as pathology reports are shared more widely.

So people are keen to fix it, and we are well down the track to getting that done.”

The policy will also include an indication of where it is appropriate to combine the results of tests from different laboratories either in cumulative reports or in graphs, and where it is dangerous to do so.

The steering committee chose two clinical terminologies: SNOMED for requesting pathology and Logical Observation

Identifiers Names and Codes (LOINC) for reporting the results. LOINC has been developed by the US-based notfor-profit Regenstrief Institute, which has also developed a unified code for units of measure (UCUM), which sets out one logical way of describing units that can then be machine-read and used for electronic messaging.

A recent agreement between Regenstrief and the International Health Terminology Standards Development Organisation (IHTSDO), which owns SNOMED, will see LOINC incorporated into SNOMED in due course, Professor Legg says.

Orderable test codes The requesting terminology group led by Dr Lawrie Bott aimed to standardise the names of tests that general practitioners and specialists order while allowing for common synonyms to find them.

By using SNOMED for requesting, the PUTS project is selecting a list of orderable test codes for Australia, which are planned to be integrated into general practice clinical software.

The orderable test codes will cover over 95 per cent of the tests by volume ordered by general practitioners. Doctors will still request pathology by the name of the test, but they will be accompanied by standard codes that will facilitate better and safer electronic ordering.

“The point of doing most of this is to start to get something to help doctors do what is a very hard job,” he says.

pathology reports the opportunity to make better and safer use of results, Professor Legg says.

“The intention is that you can show results in comparison but also use electronic decision support. The data that is provided by the pathology laboratory is incorporated in most risk assessments for example, and the College has been very active in establishing structured reports for cancer.

There is further work to be done, however.

The next phase of the PUTS project is called the Pathology Information Terminology and Units Standardisation (PITUS) project, which will look at implementing the requesting terminology, structured requesting, and developing the information models for reporting pathology, drawing on the work that NEHTA has done.

“The structured reports for cancer project led by Dr David Ellis has been a really important one It draws on not just histology, which is the principal technique for telling someone whether they have cancer or not, but for the rest of the laboratory results which are often important in treatment, prognosis and monitoring.”

The terminology reference sets and RCPA standards and guidelines will be submitted to the next meeting of the RCPA Council in late February. Professor Legg says that all going well, it should be the policy of the College by March.

Once endorsed, these terminology reference sets and units will in turn be available for referencing by the Australian Standard for Pathology Messaging, AS4700.2 (see pages 46-47).

What this all means in practice is that it will help pathologists provide the best advice and allow those who receive

“One of the standout results of the PUTS project has been an agreement amongst geneticists on a common format for reports from both cytogeneticists – the people that look at chromosomes – and the molecular biologists – the people that look at the sequence of the genome ,” he says. “’Omics’ is certainly a focus area for the College and its informatics advisory committee. This new medicine is being called ‘predictive, preventive and personalised’ medicine in Europe and with the inclusion of ‘participation’, P4 medicine in the US. “We are seeing the biological and information revolutions coming together in this new approach. It gives every prospect of significant scientific advancement in our understanding of disease and to change the way that healthcare is done for the better.”

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Off Topic

SNAPPER SOFTWARE AVAILABLE FOR ADOPTION OF SNOMED CT

The CSIRO’s award-winning software tool, Snapper, is currently available as a free download to aid in the transition from legacy health terminologies to SNOMED CT.

DAVID HANSEN PhD BSc (Hons) MBA david.hansen@csiro.au MICHAEL LAWLEY PhD BSC (Hons) michael.lawley@csiro.au

The transition from legacy health terminologies to SNOMED CT is necessary since Australia is standardising on SNOMED CT as the preferred clinical terminology for use in electronic health and medical records, including PCEHRcompliant systems.

Existing electronic systems and the legacy terminologies and vocabularies they contain represent a substantial investment in health information collections in Australia.

Faced with the requirement to provide SNOMED CT coded data, vendors and health information managers can either convert systems to use SNOMED CT or convert the collected data to SNOMED CT in a post-processing step. In both cases an accurate map from the existing terminology to SNOMED CT is essential.

To aid the health IT community in the transition, the National eHealth Transition Authority (NEHTA) has licensed the Snapper SNOMED CT mapping tool, developed at the Australian e-Health

About the authors David is the CEO of the Australian e-Health Research Centre, an unincorporated joint venture between CSIRO and Qld Health.

Michael leads the Clinical Terminology research at the AEHRC and is Australia’s representative on the Technical Committee at the International Health Terminology Standards Development Organisation.

Research Centre, for all public and private companies in Australia.

The Snapper software is based on the CSIRO Snorocket classifier that is used to maintain SNOMED CT itself. Snapper makes the structure of SNOMED CT and the meaning of its concepts transparent, thus providing a user-friendly interface for creating mappings from an existing term-set to concepts in the SNOMED CT terminology.

The use of Snapper empowers users themselves to transition to SNOMED CT, adopt this standard clinical terminology, and preserve the value of their existing health information collections. In recognition of its significance, Snapper was the 2012 winner of the E-Health category of the Queensland iAwards.

Use case 1: Mapping AMT to monographs in the AMH Dr Jean-Pierre Calabretto, manager of quality, strategy and development for the Australian Medicines Handbook (AMH),

has used the tool to map medicine titles from the AMH monograph titles to the medicinal products in the Australian Medicines Terminology (AMT).

The first step was to use the automap function of Snapper, which identified about 80 per cent of the approximately 900 terms that existed in AMH. The remaining equivalent terms were then easily identified through the search and graphical browse capability of Snapper.

Completing the job took only a few days, compared to the significant investment of time using the initial approach of a webbased browser and a spreadsheet. “The Snapper tool is fantastic,” Dr Calabretto said. “I am able to approach this mapping work so much more easily and efficiently.”

Use case 2: Mapping large classifications to SNOMED CT The CSIRO has now used the tool to do a number of large consulting jobs for international organisations. A recent consulting project mapped over 9000 legacy terms, some derived from ICD coding systems, to SNOMED CT concepts.

“Snapper enabled us to do a large amount of the work automatically,” a clinical terminologist at the CSIRO, Donna Truran, said. “The drag and drop functionality of the tool then helped to easily complete a mapping once the correct term had been identified in the graphical representation of the SNOMED CT hierarchy.”

Figure 1. Part of the mapping between AMT substances and the substance hierarchy in SNOMED CT.

The team has also recently worked with the Royal Australian College of Surgeons to map over 2000 procedures in the RACS Surgical Log Book to SNOMED CT codes.

Use case 3: AMT and SNOMED CT AU The current version of Snapper available for download contains a version of SNOMED CT-AU with an integrated Australian Medicines Terminology (AMT).

This is the result of an initial mapping of the AMT substances to the Substances hierarchy in SNOMED CT, completed at NEHTA using Snapper.

This provides medicines in AMT with a full substance hierarchy, including drug class information that is currently not available in the stand-alone AMT.

Current research Amongst many current projects, CSIRO researchers at the Australian e-Health Research Centre are working with Queensland Health to develop a SNOMED CT reference set to capture diagnosis information in the web-based Enterprise Discharge Summary.

Snapper is being used to create the reference set from the existing set of free text entered in the diagnosis field. The CSIRO Terminology Server is then used to provide the content to the field in their web form – with auto-complete functionality to provide suggested concepts as the user types in the diagnosis.

You can download Snapper free of charge from: http://aehrc.com/snapper

Figure 2. The AMT paracetamol concept mapped to the SNOMED CT Acetaminophen concept, with inherited class concepts.

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Advantech

3M Health Information Systems P: +61 2 9498 9499 F: +61 2 9498 9377 E: gharris@mmm.com W: www.3m.com.au/his 3M Health Information Systems is a leading provider of software solutions to help healthcare organisations capture, classify, and utilise data — accurately and efficiently.

With more than 28 years of experience in health information management, 3M offers integrated solutions for: • Coding, Grouping and Reimbursement • Document Management and Scanned Medical Records, providing: ◊ Access anytime to complete patient history ◊ Intuitive, customisable document viewing ◊ Automated worklists ◊ Electronic signature • Dictation and Transcription, providing: ◊ Reduced dictation time ◊ Increased accuracy ◊ Lower transcription turn‑around‑time ◊ Seamless integration with PAS and EHR systems

ACIVA E: j.edgecumbe@ehe.edu.au W: www.aciva.org.au The Aged Care IT Vendors Association (ACIVA) was formed in early 2010, a not-for-profit organisation, incorporated in NSW. ACIVA represents the residential aged and community care sectors and vendors at various national forums regarding strategic developments and eHealth. ACIVA members are residential aged and community care software vendors, industry benchmarking software, financial software, call-bell, hardware, networking, infrastructure and industry partners.

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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.

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Australasian College of Health Informatics P: +61 412 746 457 F: +61 3 9569 9449 E: Secretary@ACHI.org.au W: www.ACHI.org.au The Australasian College of Health Informatics is Australasia’s Health Informatics professional body, representing the interests of a broad range of clinical and non-clinical e-health professionals. ACHI is the community of Health Informatics thought-leaders in Australasia.

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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.

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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.

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Cerner Corporation Pty Limited

Clintel Systems P: +61 8 8203 0555 E: info@clintel.com.au W: www.clintel.com.au The Specialist: A complete solution for your Appointments, Billing including Online Claiming and Clinical requirements in an intuitive scalable solution.

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CSC’s HealthCare Group P: +61 2 8035 6700 F: +61 2 8035 6801 E: healthsolutions@csc.com W: www.csc.com/healthsolutionsAPAC Healthcare is key part of CSC’s global business. It has a strong track record of delivering successful government health programs across Europe and in both the public and private healthcare sectors in the US. Focused on eHealth, CSC’s Healthcare Group provides an end-to-end service combining technology innovation, world-class consulting and system integration services with proven healthcare software.

In the Asia Pacific region, CSC provides localized solutions to improve: patient flow, access to clinical information, medication safety and pathology diagnostics. CSC participates in regional government health information exchange initiatives to connect care across care environments and to enable clients to leverage existing e-health investments. For more information, visit the Healthcare Group’s Asia Pacific website at www. csc.com/healthsolutionsAPAC

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.

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CONNECT DIRECT Pty Ltd P: 1300 557 550 / +61 7 5478 5510 F: +61 7 5478 5520 E: support@directcontrol.com.au W: www.directcontrol.com.au Direct CONTROL is an affordable, intuitive and educational Practice Management System for providers of all disciplines with seamless integration with Outlook, MYOB or QuickBooks.

Direct CONTROL’s Clinical Module with HTR is eHealth Compliant and manages Episodes of Care including State, Federal and Health Fund Statistical Reporting for day surgeries/ hospitals.

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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.

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Digital Medical Systems P: 1300 865 977 F: +61 3 9753 3049 E: inform@dgs.com.au W: www.dgs.com.au Easier ICT is a technology partnership with DMS — we make I.T. work for you.

DIGITAL MEDICAL SYSTEMS has provided ICT solutions and services to medical practice clients across Australia since 1990. We have specialist expertise and experience in the installation and support of leading medical software applications.

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The software comes with up-to-date schedules for MBS/Rebate, Gap Cover (all registered health funds), Workers’ Compensation, Transport Accident authorities and DVA. PULSEITMAGAZINE.COM.AU

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Emerging Systems P: +61 2 8853 4700 F: +61 2 9659 9366 E: sales@emerging.com.au W: www.emerging.com.au/ehealth

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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.

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Health Informatics New Zealand E: admin@hinz.org.nz W: www.hinz.org.nz Health Informatics New Zealand (HINZ) is a national, not-for-profit organisation whose focus is to facilitate improvements in business processes and patient care in the health sector through the application of appropriate information technologies. HINZ offers an online repository for the collection and dissemination of information about the Health Informatics industry - sharing best practice from New Zealand and overseas, as well as facilitating networking activities to bring industry experts and interested parties together to collaborate. The HINZ Executive Committee works to maintain its purpose for members with the goal of improved healthcare outcomes, through the dissemination and utilisation of information, knowledge and technology.

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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.

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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 eHealth community for almost 20 years. HISA aims to improve healthcare through the use of technology and information. We: • Provide a national focus for eHealth, health informatics, its practitioners, industry and a broad range of stakeholders • Support, promote and advocate • Provide opportunities for networking, learning and professional development • Are effective champions for the value of health informatics HISA members are part of a national network of people and organisations building a healthcare future enabled by eHealth. Join the growing community who are committed to, and passionate about, health reform enabled by eHealth.

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InterSystems 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.

P: +61 2 9380 7111 F: +61 2 9380 7121 E: anz.query@InterSystems.com W: www.InterSystems.com InterSystems Corporation is a global leader in software for connected care, 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 healthcare informatics platform for information exchange and analytics within a hospital network, and across a community, region or nation.

InterSystems CACHÉ® is the world’s most widely used database system in clinical applications. InterSystems Ensemble® is a platform for rapid integration and the development of connectable applications.

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Medtech Global Ltd ISN Solutions P: +61 2 9280 2660 F: +61 2 9280 2665 E: info@isnsolutions.com.au W: www.isnsolutions.com.au ISN Solutions is a Medical IT company that specialises in the design, setup and maintenance of computer networks for medical practices and private hospitals.

We manage IT services, we are dedicated to the medical industry.

We know that if you are consulting then you need a quick response.

Our support model is designed to minimise the interruptions to the doctor specially. We are familiar with most medical software applications in Australia. We have strong industry references.

Some of our solutions include, but are not limited to: • Cloud based computing tailored to medical industry • Medical voice recognition • Capped cost medical support and maintenance plan • Ability to consult remotely • Medical application support

Mouse Soft Australia Pty Ltd

For over 28 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.

MITS:Health

P: +61 3 9888 2555 F: +61 3 9888 1752 E: sales@medicalwizard.com.au W: www.medicalwizard.com.au

Medtech’s Medtech32 and Evolution solutions improve practice management and ensure best practice for electronic health records management and reporting.

P: 1300 700 300 E: info@mitshealth.com.au W: www.mitshealth.com.au

Medical Wizard saves time and money through greater efficiency and comprehensive integration.

Managed IT Services for the Health Industry

Throughout its 19 year history, Medical Wizard has led the way with innovative solutions. We are constantly evolving Medical Wizard to meet the challenges of the medical profession for today and tomorrow.

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 9901 6400 F: +61 2 9439 6331 E: sales@meditech.com.au W: www.meditech.com.au

P: +61 2 9902 7700 F: +61 2 9902 7701 E: info@mims.com.au W: www.mims.com.au

A Worldwide Leader in Health Care Information Systems

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.

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MITS:Health provides a full range of IT services specifically tailored for medical centres, GPs and specialists across Melbourne.

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Equipment supply and installation Remote monitoring and support Data backups Networking Internet Website Development

A software of choice for discerning Specialist practices, notably Gastroenterologists, Cosmetic Surgeons, Ophthalmologists, General Surgeons, IVF Centres and Day Hospitals amongst others.

All aspects of practice management from appointments, billing, clinical, theatre management and compliance reporting are covered and backed by a dedicated local support team.

Feature Rich. Dynamic. Innovative.

MEDITECH Australia

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.

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P: 1800 148 165 E: salesau@medtechglobal.com W: www.medtechglobal.com

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.

Medical Software Industry Association P: +61 427 844 645 E: ceo@msia.com.au E: president@msia.com.au W: www.msia.com.au With the increase in government e-health initiatives, the MSIA has become increasingly active in representing the interests of all healthcare software providers.

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

Join over 100 other companies across all areas of medical IT/IM so your voice can be heard.

NEHTA P: +61 2 8298 2600 F: +61 2 8298 2666 E: admin@nehta.gov.au W: www.nehta.gov.au The National E-Health Transition Authority was established by the Australian, State and Territory governments to develop better ways of electronically collecting and securely exchanging health information. NEHTA is the lead organisation supporting the national vision for eHealth in Australia.

New Zealand Health IT Cluster P: +64 4 815 8177 E: admin@healthit.org.nz W: www.healthit.org.nz The New Zealand Health IT Cluster is a vibrant alliance of organisations interested in health IT, comprising software and solution developers, consultants, health policy makers, health funders, infrastructure companies, healthcare providers, and academic institutions – who have agreed to work collaboratively.

• New Zealand industry is consistently well regarded in providing quality, relevant solutions domestically and in offshore markets.

• New Zealand has an internationally regarded model of partnership that fosters development of innovative solutions to healthcare challenges.

• In key and emerging markets the New Zealand health IT brand is strongly recognised. By 2015 sales growth is doubled from the 2010 baseline.

OzeScribe

Shexie Medical System

P: 1300 727 423 F: 1300 300 174 E: sales@ozescribe.com.au W: www.ozescribe.com.au

P: 1300 743 943 F: 1300 792 943 E: info@shexie.com.au W: www.shexie.com.au

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.

Medilink from Practice Services P: +61 3 9819 0700 F: +61 3 9819 0705 E: Sales@practiceservices.com.au W: www.practiceservices.com.au Medilink Practice Management Software • 21 years young, large user base • Medilink = Intuitive ease of use • Solo Drs up to Hospitals in size • Claiming via integrated EFTPOS ◊ and/or integrated HICAPS ◊ and/or Medicare Online ◊ and/or ECLIPSE • Many standard features • Many optional modules • Links to many third party packages and services • Cut debtors and boost cash flow • 17 years as an Authorised Medilink Dealer, selling, installing & training • Fixed Cost Support, Onsite or Remote

Shexie is an Australian owned business which has been developing software for medical practices for over 15 years.

Our industry and technical knowledge allows us to provide the ultimate ‘easy to use’, ‘fully functioned’ and ‘robust’ product on the market.

Shexie Medical System clinical and practice management software is ideal for surgical or specialist practices of any size. Many fully integrated features including Paperless Office, SMS, full Paperless Electronic Claiming including Eclipse, MIMS Integrated, statistical analysis, security, synchronize appointments with Outlook/PDAs, transcription interface, diagnostic equipment interface, automated MBS/Fund rates updates.

Soon to be released Shexie Platinum version also contains eHealth - Health Identifiers, PCEHR and Secure Messaging.

Pen Computer Systems 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.

P: +61 2 9506 3200 F: +61 2 9566 1186 E: enquiries@pencs.com.au W: www.pencs.com.au Established in 1993, Pen Computer Systems (PCS) specialises in developing information solutions for National and State eHealth initiatives in Primary Health that deliver better Chronic Disease outcomes.

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

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!

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 within the application.

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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Sysmex New Zealand P: +64 9 630 3554 F: +64 9 630 8135 E: info@sysmex.co.nz W: www.sysmex.co.nz Sysmex New Zealand is a market leader in the development and implementation of health IT products and services for clinical laboratories, hospitals and healthcare organisations.

We offer the following health IT solutions: • Delphic LIS – a market-leading laboratory information system for hospital and community laboratories with a strength in providing multi-lab solutions.

Specialised modules manage workflows in the anatomical pathology, haematology and microbiology work areas.

• Eclair – an advanced clinical data repository (CDR) which stores patient data from a range of systems including laboratory, radiology, pharmacy and clinical document sources to create a secure patient-centric record.

Eclair provides complete electronic ordering functionality.

Totalcare 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.

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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

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TrendCare

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Therapeutic Guidelines Ltd

Trend Care Systems

P: 1800 061 260 E: sales@tg.org.au W: www.tg.org.au

P: +61 7 3390 5399 F: +61 7 3390 7599 E: support@trendcare.com.au W: www.trendcare.com.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. eTG complete Incorporates all topics from the Therapeutic Guidelines series in a searchable electronic product, and is the ultimate resource for the essence of current available evidence.

It provides access to over 3000 clinical topics, relevant PBS, pregnancy and breastfeeding information, key references, and other independent information such as Australian Prescriber (including Medicines Safety Update), NPS Radar, NPS News and Cochrane Reviews. eTG complete is available in a range of convenient formats – online access, online download, CD, and intranet access for hospitals. Multi-user licences, ideal for a practice or clinic, are also available.

It is widely used by practitioners and pharmacists in community and hospital settings in all Australian states and territories.

Updated three times per year, eTG complete meets the criteria for ‘key electronic clinical resources’ in the Practice Incentives Program (PIP) eHealth Incentive.

The November 2012 release of eTG complete includes revised Analgesic and Cardiovascular topics. 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.

Vensa Health P: +64 9 522 9522 F: +64 9 522 9523 E: website@vensahealth.com W: www.vensahealth.com

A national and international award winning solution recognised for its ability to provide real benefits in the acute and sub-acute health care settings.

TrendCare is an international leader for e-health solutions excelling in all of the following: • Patient dependency and nursing intensity measures.

• Projecting patient throughput and workforce requirements.

• Rostering and work allocation.

• Efficiency, productivity and HRM reporting.

• Discharge analysis, bed management and clinical handovers.

• Allied health registers with extensive reporting.

• Clinical pathways with variance reporting.

• Patient assessments and risk analysis.

• Diet ordering and reporting.

• Staff health tracking and reporting.

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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.

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.

Vensa Health is the leading mHealth solutions provider focusing on delivering mobile health innovations worldwide. If you have received an SMSfrom your doctor, hospital or physio it is almost certain Vensa Health was responsible for its delivery.

At Vensa we are focused on offering solutions and innovations, which add value to our clients, this is the fundamental philosophy underpinning all of our services and technology offerings.

With nearly 80% adoption of mobile health in New Zealand and a solid customer base, Vensa Health is focusing on Australasia and Middle East regions in its expansion with a BHAG of closing the gap for 10% of earth’s population health.

Zedmed P: 1300 933 000 F: +61 3 9284 3399 E: sales@zedmed.com.au W: www.zedmed.com.au Owned by Doctors who understand the challenges facing the medical profession everyday and backed by nearly 30 years of experience in medical software programming, Zedmed provides innovative, full featured and sophisticated practice management and clinical records software solutions.

Zedmed would also like to introduce to you Medical Record Exchange – a free, simple solution allowing Doctors to send patient’s medical information to insurance companies electronically.

Using the latest in data extraction technology and fully encrypted, this is a secure, time-saving solution to one of the most dreaded requests Doctors receive on an almost daily basis.

For more information about Medical Record Exchange, please contact us: Phone: 1300 933 833 www.medicalrecordexchange.com.au