Pulse+IT Magazine - July 2013

Australasia’s First and Only eHealth and Health IT Magazine

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PCEHR & HIC 2013 PREVIEW

Plotting the PCEHR

From concept to launch to its current state, the personally controlled electronic health record has travelled a rocky road.

PCEHR a catalyst for change

Despite serious misgivings about the PCEHR, it has given impetus to real change in eHealth.

HIC 2013 preview The personal health journeys of two IT professionals will highlight how health IT is more than just technology at HIC 2013.

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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 three edition for 2013 to be distributed for release in: • Mid-August 2013 - Telehealth / HIMAA Conference Preview • October 2013 - Digital Practice / 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 Guest, Steve Hambleton, Simon James, Edwin Kruys, Kate McDonald, Brendon Wickham and Michael Wong.

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

Copyright 2013 Pulse+IT Magazine Pty Ltd No part of this publication may be reproduced, stored electronically or transmitted in any form by any means without the prior written permission of the Publisher.

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Editorials

Features

News

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STARTUP Editor Simon James introduces the 36th edition of Pulse+IT and reflects on the publication’s first hand experiences with the system thus far.

STEVE HAMBLETON The AMA supports the concept of the PCEHR and the ability to share information, but the PCEHR as it stands today is still proving overly complex for many practices.

BRENDON WICKHAM While teething problems continue, the PCEHR seems to be the impetus behind real change in eHealth, where progress has been glacial for decades.

DAVID GUEST After a decade of building the foundations of eHealth, medical record keeping is set to change as the PCEHR becomes embedded in the practice of medicine.

EDWIN KRUYS The PCEHR is far from ideal and many clinicians will not participate unless changes are made. The prime concerns are security, privacy, liability, and data mining.

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PCEHR ROAD LESS TRAVELLED In 2010, the government heralded the birth of the PCEHR, with a timeline from concept to launch of less than three years. One year after it went live, how has it fared?

POTHOLES FOR THE PCEHR New IT systems always comes with glitches and frustrations, but when it comes to a massive national infrastructure project like the PCEHR, they are often magnified.

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PCEHR registrations hit 250,000 as hospitals come online ICT complexity causes delay to opening of Fiona Stanley Hospital Canberra Hospital trials free wi-fi Aged care gateway on track for July launch Send a script by phone to the pharmacy

HIC 2013 PREVIEW Two IT specialists will recount their experiences with a cancer diagnosis and how they using IT on their own patient journeys at HISA’s Health Informatics Conference this year.

Resources

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EVENTS Up and coming eHealth, Health, and IT events.

Captivating software for visual education Calvary and CSC partner to use PCEHR for end of life care Child health app released as PCEHR registrations grow PCEHR release three features child development section HCN partners with Healthshare for MD sidebar app

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

Whole-of-life clinical repository through The Viewer SOS watch phone for the elderly

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Editorial

LEARNING FROM UNLEARNED LESSONS With the personally controlled eHealth system now having been operational – at least to some extent - for a full year, this edition of Pulse+IT features an expanded editorial section, presenting a range of views about the system as it now stands and its potential for the future. The first-hand experiences of Pulse+IT’s reporters with two different aspects of the PCEHR system are presented in this article.

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

For the past eight months the PCEHR and the government’s related eHealth initiatives have not been far from this editor’s mind, owing to what can only be described as a tortuous and elongated set‑up process in his family’s general practice.

been unable to resource themselves appropriately to competently manage the rollout of essential components like NASH certificates and HPI-O numbers, and process the voluminous paperwork that they themselves designed and mandated as the entry point to the system.

From a technical perspective, upgrading any of the popular GP clinical software packages that support the PCEHR is a relatively straightforward process.

However, what could conceivably be achieved in a matter of hours by most IT professionals blew out into a major undertaking thanks to an almost comical series of Medicare processing delays, lost paperwork and untimely technical outages with the core PCEHR infrastructure.

What is even harder to reconcile is the fact that the launch of the PCEHR followed over $100 million worth of expenditure on projects bundled under the controversial Wave 1 and 2 initiatives. Combined, this suite of projects was meant to inform not only the development of the current and future PCEHR technical infrastructure, but also the development of the processes, capacities and communication strategies required to enable healthcare organisations and consumers to adopt and make use of the national system.

About the author

Having commenced this journey in November, it is disappointing to report that the stop-start nature of the administrative side of establishing PCEHR functionality in the practice saw the process endure well into April, a six-month ordeal that will live long in the memory of many of the doctors and staff working in the medical centre.

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.

With the Department of Health and Ageing and the Department of Human Services (DHS) setting and administrating the deadlines and incentives for general practices to adopt the PCEHR, it is vexing that the same departments have

With my personal PCEHR experiences echoed by the stories of many IT professionals, tech-saavy doctors, practice managers and even Medicare Local eHealth officers, it is perhaps reasonable to ask what lessons have been carried forward from these projects, or alternatively, ponder just how dysfunctional the current system may have been if not for this preparatory investment.

By May, my indentured servitude to the PCEHR system was behind me, but this

“The administrative side of establishing PCEHR functionality developed into a six-month ordeal that will live long in the memory of many of the doctors and staff working in the medical centre.”

Simon James

month did not provide any PCEHR‑related respite for Pulse+IT, with journalist Kate McDonald finding herself at the centre of her own eHealth reporting.

More comprehensive articles outlining Kate’s recent experiences with her PCEHR can be found at the Pulse+IT website, however in a nutshell, Kate discovered two medications had been added to her PCEHR that she had never had dispensed to her by a pharmacist, much less prescribed to her by a doctor.

Kate’s own PCEHR adventure began with a fruitless phone call to the PCEHR helpdesk, with the telephone operator unable to establish Kate’s bona fides despite being provided with her full name, date of birth, address, Individual Healthcare Identifier (IHI), Medicare card number and expiry date, and the dates of her most recent visits to the GP, along with the name of her GP. The telephone call ended with Kate being told to visit her closest Medicare office with additional identification before any further action could be taken to rectify the erroneous and potentially dangerous medication information her PCEHR now contained.

In defence of the notion that the PCEHR is meant to assist the health sector to

operate more efficiently, no such visit ever took place. The DHS media team was contacted to request assistance in rectifying the problem. DHS promptly launched an investigation and Kate was ultimately advised of the details of the pharmacy in that had dispensed the drugs, useful information that was not available to her in her PCEHR. Having visited the pharmacy, it was revealed to Kate that two patients with the same name and Medicare number, but different addresses, existed in the pharmacy’s dispensing software. It was surmised that the drugs had been collected by another ‘Kate McDonald’ and had been dispensed under the incorrect record in their system.

The helpful pharmacist apologised for the oversight and corrected the data in his software, which automatically updated the records held by the PBS, and subsequently the representation of this information in Kate’s PCEHR.

years. She was advised by DHS to visit this second pharmacy, but decided to first make a trip to her usual medical centre to confirm the issue hadn’t originated upstream of the pharmacy sector, which it hadn’t.

A line was ultimately drawn under Kate’s game of PCEHR ping-pong with DHS contacting her to advise that they suspected a repeat script had caused the problem to re-emerge but they believed the number of repeats on the script had all been dispensed and the problem was unlikely to occur again.

When asked to reflect on Kate’s experiences by Senator Concetta Fierravanti-Wells in the June Senate Estimates hearings, Department of Health and Ageing officials deflected criticism away from the PCEHR by claiming that the system can assist by shining a light on problems with a patient’s medical record, implying that the experience is an example of the system doing its job.

But this argument is only valid to the extent that problems can be easily identified and rectified. As highlighted, this was not Kate’s experience and it is frankly inconceivable that many other healthcare consumers in the country would have the requisite resources at their disposal, the government connections, and of course the inclination to pursue a resolution.

The problem was therefore rectified to everyone’s satisfaction, or so we thought.

In the absence of ways for patients to easily identify and rectify issues, it is inevitable that the PCEHR will propagate and magnify any errors introduced via practice, pharmacy, hospital, aged care and other systems as they are progressively integrated with the PCEHR infrastructure.

On May 22, Kate was advised by DHS that the same drugs had again appeared on her PCEHR. They indicated the second round of dispensing had occurred at a pharmacy in in a suburb she had not visited for several

And without any specific incentives for healthcare providers in these organisations to prepare patient data for upload to the PCEHR, one wonders just how much data review and cleansing will ultimately occur.

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Guest Editorial

PCEHR PROMISE YET TO BE FULFILLED The Australian Medical Association (AMA) supports the concept of the PCEHR and the ability to share information with other healthcare providers. However, the PCEHR as it stands today is still proving overly complex for many practices. Targeted government support and more clinician involvement in the system would improve functionality and take-up by medical practitioners.

DR STEVE HAMBLETON MBBS FAMA President, Australian Medical Association president@ama.com.au

Twelve months on since the PCEHR’s introduction, it is now a good time to take stock and consider how we should move forward.

Let’s be clear at the outset. The AMA supports a system that provides reliable, key clinical information – the information that can enhance a clinician’s decision‑making about the healthcare the patient requires.

This is as true for the GP providing ongoing care to their regular patient as for an emergency doctor or anaesthetist providing care to an unconscious accident victim.

A system that allows multiple health practitioners to share clinical information about a patient is good for patients and good for the healthcare system.

About the author Steve Hambleton graduated from the University of Queensland in 1984 and commenced full-time general practice in Queensland in 1987. He has been working at the same general practice at Kedron in Brisbane since 1988. He was recently re-elected as president of the AMA for a third term.

As the PCEHR system has rolled out and clinical practice software has become more integrated, we are seeing significant constraints on the clinical usefulness and usability of the health record, flowing from its original design.

It is now up to the medical profession to drive improvements so the PCEHR system can achieve its purpose: to support patients and their doctors providing the best possible healthcare.

Clinician involvement The AMA recommends that a clinical advisory group that represents the views of practicing clinicians should immediately be established to oversee and advise the government on the practical implementation of the PCEHR and its use in clinical practice.

The clinical advisory group should also work with the System Operator on the technical adjustments that need to be made to the system, based on experience with its use in clinical practice.

As part of the PCEHR implementation, the government has pursued a range of activities to encourage uptake, including assisted registration schemes and recruitment squads targeting patients in healthcare organisations.

In a perfect world implementation support activities should have been coordinated so that as a patient registers for the PCEHR, their medical practice is also ready to provide them with PCEHR services, such as preparing and loading their shared health summary and viewing event summaries from other providers.

A patient who has been convinced to register for a PCEHR should not be confused and disappointed by discovering

“As the PCEHR system has rolled out and clinical practice software has become more integrated, we are seeing significant constraints on the clinical usefulness and usability of the health record, flowing from its original design.”

Dr Steve Hambleton

their medical practice is not ready to participate.

Unfortunately at this point it is difficult to know where patients are being registered and where practices are already providing PCEHR services, and to what extent the two align.

Lack of support Despite government funding of $50 million for PCEHR support through Medicare Locals, there is little quantitative information about what impact any funded services have made on practice readiness and PCEHR capacity.

Practices that have started using the PCEHR and providing services to their patients seem to have done so with very little support.

We should be aiming for the best possible match between registered patients and PCEHR-capable practices, ensuring the core relationship required for the PCEHR is built in from the start.

We also need to bed down the current system. We need to make using the system easier to get practices using the current system more confident in their processes and usage. There is a long way to go here.

Clearly it’s not the time to introduce non‑core functions that distract us from

the main task. Any changes to the PCEHR should be to increase the efficiency of medical care, and not clog it up with other information that is not directly relevant to clinical care.

implement specific support strategies to assist specialist practices to participate in the PCEHR.

How to improve the PCEHR

The eHealth PIP incentive also includes requirements for clinical coding and secure message delivery. The use of standardised clinical coding across medical care holds great promise for improved communication of medical information at all levels.

To make the complex legal framework and technology requirements easier for practices to navigate, we need to have a single, reliable source of information, accessible through a single website.

Government should also unravel the unnecessarily complex arrangements and paperwork currently required of medical practices to participate in the PCEHR. If Medicare Locals are funded to provide implementation support, they should be contacting and physically visiting all the practices in their catchments to ensure actual PCEHR readiness and capacity.

Government support to practices for PCEHR capacity through the Practice Incentives Program (PIP) eHealth incentive is very welcome. To truly get the ball rolling on clinical use, government should consider also incentivising PCEHR activity, for example, by paying practitioners an incentive to complete a certain number of PCEHR shared health records for patients.

Medical specialists are also critical to the long-term success of the PCEHR and eHealth more broadly. Government should

Other eHealth initiatives

Reliable and secure sending and receiving of electronic health information is also a critical building block to improved healthcare.

Both these elements highlight the need for other medical specialists to be fully engaged in eHealth, supported by specific government strategies and activities.

The PCEHR, together with these other key eHealth developments such as clinical coding and secure messaging, holds the promise of significant improvement to healthcare.

We should be mindful, however, that technology does not and should not drive clinical care. Where health technology is well designed and carefully implemented, it can greatly enhance the care provided by our clinical professionals.

That potential is closer today.

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Guest Editorial

PCEHR AS A CATALYST FOR CHANGE Many people had serious misgivings about the PCEHR when it was first announced, particularly in light of failures such as the UK’s National Programme for IT. And while there are still many teething problems, the system seems to be the impetus behind real change in eHealth, where progress has been glacial for decades.

BRENDON WICKHAM eHealth program officer, NPS MedicineWise brendon.wickham@gmail.com

At the opening plenary session of the Health Informatics Society of Australia’s HIC 2012 event, a couple of unusual things happened. Not long into the speaker’s talk, plenty of us in the audience had tears in our eyes: probably not something you’d expect at a conference about health informatics. And there was a standing ovation.

When the speaker finished, the packed auditorium clapped as one, and then everyone was standing. The clapping went on for a while. But it wasn’t an applause of celebration; it was an applause of shared understanding, support, and appreciation.

About the author Brendon Wickham is an eHealth program officer at NPS MedicineWise. He has a Masters of Health (eHealth) from the University of Tasmania and has been working in the eHealth domain for eight years.

The speaker was Regina Holliday. She is an artist and an advocate for consumer access to information generated by healthcare providers. In 2009, her husband succumbed to kidney cancer. The story of his illness and journey through the healthcare system is hard to hear. While they had some good doctors and nurses, there were others whose communication skills and esteem for holistic care was not up to par (in particular, an oncologist who thought so low of her plea for him to explain what was happening to her husband that he dismissed her as a “type A personality”). But while the humans were variable, the systems they encountered, both IT and organisational, were consistently inadequate.

Her struggle to get access to her husband’s medical record was a shameful battle. It wasn’t quite Orwellian, but it was bad enough. Each page cost 73 cents, and there was a 21-day wait. Ms Holliday and her husband were set adrift in an unfamiliar healthcare milieu, without any data lifeline.

She is now using her experience to encourage change, telling her story in her blog and joining with other patient advocates such as e-Patient Dave.

Recently, she represented consumers at hearings for the design of the Meaningful Use policy. And she created the Walking Gallery: painting pictures onto wearable jackets of concepts related to patient access to data.

Ms Holliday is an American and her trip to HIC 2012 was her first overseas. While I’ve seen a number of graphs showing how far behind ours the USA’s healthcare is overall, understanding the situation is much easier when a story is told by someone who experienced it personally.

Ms Holliday portrayed a country offering bleak prospects for those who find themselves cast into its healthcare system without substantial financial resources. That as an artist she found artistic inspiration from her experience reminded me, ominously, of how art and

innovation tends to flourish when people are oppressed.

Australia’s healthcare is measurably better than the USA’s, but the level of information sharing is arguably not. And Ms Holliday’s talk was a powerful reminder to the Australian eHealth community of why it’s important to address the problem.

Implications for PCEHR What does this imply for the PCEHR? The PCEHR had a painful birth. Should it have been so? How much fear and negative spin would we have avoided if people like Regina Holliday had been front and centre, telling their stories, and explaining the need? If the prominence given to

cranky curmudgeons and agenda-driven media, uncritical of their own criticism, was instead transferred to consumer advocates?

Partly, this might be because many critics seem to have failed to grasp what it actually is. There are multiple perspectives of the PCEHR and the system that hosts it, the national eHealth records system.

Hiccups and problems with the PCEHR have happened and will continue to happen. In the first week after it went live, those with a hyphenated name discovered they were blocked from registering.

And the PCEHR is not immune to errors made upstream, as Kate McDonald from this publication learned when she found records in her PBS feed that belonged to someone else.

But the core technological design doesn’t appear to have attracted much criticism.

One is that the system is an index of documents, built upon a web services infrastructure, an enterprise service bus, which can drive third-party innovation.

Even if the critics did understand this, I’m betting they’d be hard pressed to make a strong case for any fundamental flaws in this concept. It’s industry best practice.

But the PCEHR also appears to be a catalyst, a consolidating vision. Much recent progress is the result of millions of dollars of funding, but the fact that

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progress is being made – in a domain where progress has been glacial for decades – is exciting enough.

National specifications are now being used outside of pilot sites to enable interoperable information exchange. Adam McLeod, the project lead at one of the first Wave sites, said that he’s already seeing this happen. Soon, he said, the early adopter sites will have the capability to send discharge summaries, GP referral letters, and specialist letters (point-to-point and to the PCEHR).

This is a major step forward.

Misgivings about PCEHR According to the 2008 National E-Health Strategy, it wasn’t supposed to happen quite like this. The strategy’s ideal was the incremental development and refinement of robust standards that would improve information flow. Over time, distributed individual electronic health record (IEHR) systems would be built, and providers would start sending information to the IEHRs. Eventually, we would be able to bring together and summarise a patient’s IEHR records into a national consumer portal.

But standards development and adoption in a formidably fragmented environment aren’t straightforward tasks. Progress was achingly slow. In 2010 the National Health and Hospitals Reform Commission flagged a national eHealth records system as a priority. Funding for the PCEHR was subsequently announced.

I wasn’t the only one to have early misgivings about the PCEHR. It seemed too soon. We weren’t even close to technical interoperability, so how could we hope to achieve the holy grail of eHealth, a shared electronic health record?

And the sure signs of failure coming from the UK National Health Service’s National Programme for IT (NPfIT) – going the way of most big IT projects – didn’t assuage the unease. The PCEHR was more big IT. Doomed from the beginning.

But is it? Big, I mean.

Australia is far outweighed by the US, UK, and Canada in terms of its health IT spend, and the PCEHR is not a comprehensive bells and whistles thing (on day one it was an empty shell). It has a lot of room to grow.

If you take the above description – that the national system is an infrastructure platform upon which others can develop innovative solutions – then that seems relatively small in a conceptual sense. The big task the system takes on is the secure storing and serving of indexed data. The really big tasks in health IT – the recording, coordinating, and presentation of complex structured

and unstructured information, and particularly the point-topoint exchange of interoperable documents – is left for others to develop, based on the emerging standards the PCEHR seems to be driving, if not always in a straight path.

I’m still not sure if the PCEHR is big or small, but irrespective of the ‘PCEHR: folly or fab?’ debate, it seems that the visible progress is generating hope in the eHealth community. The early adopter sites had a lot of money and support, but the important point is that everything they’ve done is transferable. Other sufficiently resourced (and motivated) health services and vendors can create their own artefacts from the same pool of commonly shared specifications.

Significant benefits Another opening plenary speaker at HIC 2012 was the secretary of the Department of Health and Ageing, Jane Halton. In her speech she told some stories of her own. The Northern Territory has one of the biggest shared electronic health record systems (SEHR) in Australia. It started about five years ago, and use of it was initially quite low, but access has increased exponentially, particularly over the last two years.

Ms Halton related a couple of tales in which patients’ lives had been saved because of the SEHR, and she said many staff in the NT health system had seen beneficial outcomes because of it. If the NT experience is transferred to the national via the PCEHR, then we can expect significant benefits.

But it will take a while. Nigel Millar was at the conference to tell us of his experience implementing a nascent SEHR in the wake of the Christchurch earthquake. The experience proved to him the SEHR’s enormous benefits. He didn’t recommend having an earthquake, but he did recommend pretending we’ve had one. As long as we never stop asking patients how they are and what they need, Dr Millar said, we’ll ensure systems will be effective.

As Ms Holliday says, we are all patients in the end. We will need records to manage our care. And we will need to have some control over them – the reverse of the old, paternalistic paradigm of healthcare.

I don’t think health IT system development can always be easily definable. It’s usually not a purely rational exercise – it’s too complex, and there are too many competing interests and views.

We need to be open to the instinctive and the subjective. I think patients and clinicians who can tell compelling stories should be sought after and listened to. And who knows? Perhaps there’s even room for some artistry in the field of health informatics.

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Guest Editorial

TRUST ME, I’M A ... DATA MANAGER Computerisation has changed both the world and medicine in the last 40 years, but medical records have been surprisingly resistant to its advances. After close to a decade of building the foundations of eHealth, long-standing practices in medical record keeping are set to change as the PCEHR becomes embedded in the practice of medicine.

DR DAVID GUEST M.B., B.S. (Syd.) dguest@zeeclor.mine.nu

“Grete long cures note in folio/ shorter common cures that come or send in half side or quarto/ note visiting cuers in a manuell.” Thus wrote Dr Barker in early 17th century England, advising his colleagues on the way to record medical treatments. It was early days in Western medical data management and the routine recording of a patient’s clinical details was a long way off.

Things changed little for centuries. The doctor’s diary was, like Samuel Pepys’, a personal record of his life. While it contained some clinical details, it was for private thoughts and memoirs and was not written with the patient in mind. The physician’s day book was more financial than clinical record and Dr Finlay’s Case Book was produced primarily for the edification of the audience.

About the author

Dr Joseph Bell, Conan Doyle’s inspiration for Sherlock Holmes, would have had little need for documentation. A brilliant mind and shrewd observation seemed to make both history taking and medical records superfluous.

David Guest is a general practitioner at the Goonellabah Medical Centre in Lismore, NSW. He has a long-standing interest in IT for general practice and is a member of the Improvement Foundation’s eCollaborative project.

By the early 20th century, science and medicine had changed. Early diagnostic testing added to the volume and complexity of the data that needed to be managed. More people were involved in an individual’s care.

In 1906, Dr Henry Plummer of the Mayo Clinic sparked a revolution in medical data management. The “unit record” contained all the patient’s data in one folder that accompanied the patient around the clinic.

Despite computerisation changing both the world and medicine in the last 40 years, medical records have been surprisingly resistant to its advances.

The vast majority of Australian hospitals still use paper records for patient management, but the business case for computerisation in general practice has been much stronger. Over the course of 10 years from the early nineties, electronic health records progressed from printing scripts, producing health summaries and generating letters to note taking, pathology and radiology processing and finally document handling. By the early 2000s, many practices were completely “digital”.

Glacial pace of change Form follows function, but function does not follow form. Cheap, near instantaneous communication has been a reality since the late nineties. Education, banking and the business supply chains have readily embraced it. It continues to make significant inroads into retail. Ten years ago it seemed inevitable that the medical IT marketplace would develop solutions for rapid, seamless, secure communication.

“When GP software is able to auto-populate a health record from a shared health summary, hundreds of thousands of hours of GPs’ and secretaries’ time will be saved.”

Dr David Guest

It didn’t happen. Clusters of proprietary medical data transport systems developed in pockets around the country, but the coverage was patchy at best. There was no incentive for competing companies to interoperate and many medical practitioners, after dabbling in electronic communication, returned to the lingua franca that paper provides.

In 2005, the government established the National E-Health Transition Authority (NEHTA) to break the impasse. To the outsider, the pace of change has been glacial. This is probably inevitable given the foundation work needed for developing the legal framework, medical IT standards and specifications, and for developing the authentication infrastructure for the Australian populace. These were major undertakings but made no change to a GP’s day to day medical practice.

This is about to change. Since May 1, 2013, all commonly used general practice software suites can interact with the personally controlled electronic health record (PCEHR). In the initial phase, the PCEHR is focusing on producing a shared health summary (SHS), a communication tool between the GP and the patient, summarising their significant health issues, medications, allergies and vaccinations.

While patient education and involvement in their clinical management is a crucial component of modern medical management, the cost of this new activity is borne by the general practitioner. Significant government incentives have been required to encourage GPs to engage with the process.

functionality for specialists and hospitals with electronic record systems.

Medication management may improve using the PCEHR system, although early implementation has been problematic due to the failure to incorporate patient Individual Health Identifiers (IHI) in the script submissions. This will change as the use of the national patient identifiers becomes more widespread. Once electronic records develop the tools to merge the differing medication lists that currently plague a GP’s working day, medication errors should decrease.

The handling of investigations and reports may also change.

Posting comments and instructions on significant pathology and radiology reports to the PCEHR may both speed and smooth the patient’s journey. How GPs will use these and the other new capabilities of the PCEHR is yet to unfold.

There has been much debate about the privacy of online records.

Almost daily breaches of medical record repositories are reported in the USA. While the PCEHR privacy controls are reasonable, there is no guarantee, or even likelihood, that any online record is 100 per cent secure.

Reaching the summit

In Western societies, healthcare is increasingly complex, invasive and costly. Sophisticated, technically advanced, diagnostic and therapeutic interventions require a similarly sophisticated system to handle the data that they produce. Dr Plummer’s paper chart is no longer fit for purpose. Information and communication technologies have the potential to make healthcare better and cheaper by reducing both the loss and duplication of medical data.

With the eHealth infrastructure in place we are now over the crest of the hill. The business case for GP involvement will be compelling. When GP software is able to auto-populate a health record from a shared health summary, hundreds of thousands of hours of GPs’ and secretaries’ time will be saved. eReferrals should come on stream from 1 August to provide similar

Patients can no longer rely on a Dr Finlay, or even a Dr Bell, to be all knowing about the best way to manage their case. To get the benefits of the system, patients will have to trust the system, accepting some loss of privacy in the process. For certain groups, particularly the elderly and the chronically ill, it will be a trade off that many will take.

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Guest Editorial

PCEHR: IT’S TIME FOR SOME BIG CHANGES Most clinicians would agree that eHealth records have lots of potential. Unfortunately, the current PCEHR is far from ideal and many clinicians will not participate unless changes are made. For those resisting taking part in the system, the prime concerns include security, privacy, medico-legal liability, and data mining.

DR EDWIN KRUYS MD, FRACGP, AdDipProjMgt edwinkruys@me.com

It seems like clinicians have been side‑lined during the development of the PCEHR. This became painfully clear when Dr Mukesh Haikerwal tried to connect his Melbourne practice to the PCEHR: the eHealth records database was not available, so he contacted the Department of Health and Ageing and said: “Hey guys, something is wrong with the PCEHR system!” The answer from the help desk was: “No there isn’t.” As Dr Haikerwal told the Sydney Morning Herald: “If the Qantas website was like this, you would say, ‘I will go to the travel agent instead’.”

Dr Haikerwal is a NEHTA clinical lead, and I would expect him to get the Rolls Royce treatment from the help desk (clinical leads are also supposed to promote the PCEHR among colleagues), but if this is the Rolls Royce treatment, then I have no hope whatsoever for other clinicians experiencing problems.

About the author Edwin Kruys is a GP practising in Geraldton, WA, with a special interest in travel medicine, project management and social media and health. He is a member of the International Society of Travel Medicine and the South Pacific Underwater Medicine Society. Dr Kruys blogs at http://doctorsbag.wordpress.com

The support from the help desk with regards to the sign-up process has caused frustrations with clinicians and managers. It was and still is chaos. There were technical glitches, crashes and even hacks, but I cannot recall the last time I received communication from the government regarding the PCEHR. The government has recently announced it is going to save on basic healthcare

like MBS fees and the safety net, which makes the PCEHR cost blow-out even more painful. Last year The Australian reported that NEHTA spent big money on “more than 731 functions for stakeholders, including lavish seafood dinners, after-dinner speakers, flights and accommodation in five-star hotels. The authority spent $871,000 on taxi fares in the past two financial years, $118,000 on business-class international airfares and $2.1m in total on travel.”

That was last year; I’m not sure I want to know the current figures.

Government officials are chasing up sick patients in hospitals and other healthcare facilities to sign them up. Medicare Local staff are offering people a chance to win iPads and tickets to the zoo when they sign up for a ‘free’ eHealth record. This raises questions regarding ethics.

Meanwhile the government has signalled it is considering data mining the patient information in the PCEHR. This would be the first time in history that government organisations have full access to patient information, and we’ve not been clearly warned about this.

Doctors are bound by the Hippocratic Oath, codes of conduct and other guidelines but this is clearly not applicable to government

organisations as they have consistently played down the risks associated with the PCEHR. We have been told the PCEHR will reduce medication errors, but recently a Pulse+IT reporter noticed that two medications she had never been prescribed had been uploaded to her record, possibly caused by a human error at a pharmacy. This case was important as it showed that the PCEHR is not immune to errors.

Incorrect medication information in the PCEHR will quickly be disseminated and can lead to disasters, for example because doctors often look at (past) medication lists to find out what medical problems someone has (had). It also raises the question of how many less IT-savvy people already have incorrect information in their eHealth records without knowing it. And removing incorrect information with the help desk will be a challenge.

Clinicians are expected to keep their own records as well as the PCEHR. This simply means extra work, especially for nominated healthcare providers. This work can probably not be delegated to non‑clinical staff.

Not being aware that information has been shielded by patients is another issue for many clinicians. We’ve arrived at the situation where the government has full access and control, and the clinician responsible and liable for the care may not. The PCEHR will be another record that needs to be carefully checked and verified to avoid medication and other errors.

We’ve got to get the balance right and make the system acceptable for all stakeholders. It’s easy to see that a collaborative approach will be more successful: patients together with their nominated health professional should be made responsible for shielding off undesired items from the PCEHR, without creating more liability for providers.

PIP incentive payments go to practices to reimburse the staggering amount of work required to get the organisation PCEHR‑ready, including IT upgrades. No doubt this incentive will disappear over time. Interestingly, there is no MBS item number for doctors updating the PCEHR. GPs have been told to either absorb the costs or charge for longer consultations so either the doctor or the patient will pay for the extra work.

The participation contract for healthcare organisations is one-sided. Clinicians lose control of all data once uploaded, and the government gains full control. After cancellation of the contract clinicians will not get their data back but they remain liable as certain clauses in the contract survive termination of the contract.

It would have been better if clinicians would have been able to download and remove their data, for example when the data is deemed insecure at any point in time.

The agreement increases liabilities for clinicians and organisations and specific PCEHR data breach fines are part of the contract.

Here are the risks as identified by my indemnity insurance provider: • Privacy breaches • Allegations of negligence for failing to detect critical patient information contained within the PCEHR • Loss or corruption of electronic documents or data • Intellectual property disputes • Fines and penalties.

My medical indemnity insurer MDA National states: “(…) before you opt in or decide to participate in the PCEHR, you should also consider that if your Practice (entity) is a party to the PCEHR contract, the entity itself along with your employees may be exposed. (...)

“Another possible exposure facing medical practitioners participating in the PCEHR are fines and penalties that relate particularly to the administration of the PCEHR. You should make sure you are aware of the obligations that apply to you and your staff before opting in.

“As with all contracts, if you have any doubts about what you are agreeing to, it may be worthwhile taking legal advice.

MDA National Insurance policies do not provide cover for fines and civil penalties.”

So it looks like I’m not completely covered.

Electronic record technology is not perfect yet, and the PCEHR is a work in progress.

But instead of starting from scratch, the government should have adopted one of the already fully functioning Australian eHealth record systems, like RecordPoint from Extensia.

Here are some advantages of RecordPoint’s shared health record system over the PCEHR: • Less complex • Community-based custodian model • No data access by government agencies • Less liability for health providers and practices • Needs and requirements can be customised to local preferences • No honey pot for hackers • Trialled and tested over many years.

The government seems to think that if they keep pushing the PCEHR, people will give in. But there is a problem with this power approach: health providers will lose interest in eHealth in general and will be hard-pressed to engage with future eHealth developments.

And if clinicians are not on board for 200 per cent, the project will fail. If we want to save the PCEHR, it’s time for some big changes.

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News

PCEHR registrations hit 250,000 as hospitals come online Consumer registrations for the PCEHR have reached a landmark figure of 250,000, with 10,000 people signing up in one day in June, according to the Department of Health and Ageing (DoHA).

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DoHA representatives told a Senate Estimates committee hearing in Canberra recently that while reaching the forecast figure of 500,000 by June 30 might be “a bit of a stretch”, the figure was still in sight as registrations began to grow rapidly.

The committee also heard that the four public hospitals in Tasmania – Royal Hobart, Launceston General, North West Regional and Mersey Community – would all be able to interact with the PCEHR by the end of June.

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DoHA deputy secretary Rosemary Huxtable told the committee that NEHTA was managing a rapid integration project

to support the states and territories to be able to upload discharge summaries to the PCEHR. “[Calvary Hospital] in the ACT and St Vincent’s Hospital in Sydney, they are able to upload discharge summaries, and in the next little while, the rest of the calendar year, most states and territories will be able to do that either across the whole state or from a number of hospitals,” Ms Huxtable said.

“[A] combination of all of those factors means we have begun to see growth now in registrations,” Ms Huxtable said. “Every day that is now growing, to the extent that [on one day] I think we had 10,000 registrations, the highest number we’ve had.”

NEHTA CEO Peter Fleming said that the four Tasmanian hospitals were on schedule to be on the PCEHR system, in terms of using the HI Service and uploading discharge summaries, by the end of the month.

Ms Huxtable said she believed that the 500,000 figure was still in sight. “If we go back to [2012-2013], we had an expectation that we would through the eHealth sites have people at a stage of readiness and awareness at that point, but the reality is that the development, the underpinning work we needed to do in a technical sense, took time, and the eHealth sites weren’t as far advanced as we expected.

Ms Huxtable said added functionality, enabling GP software to access the PCEHR and assisted registration had all helped to improve take-up of the system.

“The way we are going now, if you project through that 10,000 a day … while 500,000 might be a stretch in that regard, I think we are heading in the right direction.”

She said that as of midJune, 1928 shared health summaries had been uploaded, along with 446 discharge summaries.

Healthcare organisations registered for an HPI-O had reached 3636, while 4319 practitioners were authorised to access the system.

DoHA’s chief information and knowledge officer, Paul Madden, told the committee that in the aged care sector, work was continuing with aged care software vendors to get their systems connected.

“That will give us access to 75 per cent of aged care residents through the software they are using,” Mr Madden said.

Of the people currently registered, 4.6 per cent were over the age of 80 and 10.8 per cent were aged between 70 and 79, he said.

People aged between 60 and 69 were the largest age group registered, making up 15.7 per cent of all registrations.

Earlier, Ms Huxtable told the committee that funding arrangements for the PCEHR and for NEHTA beyond July 2014 were currently being discussed.

“We are currently working on a business case in respect of future eHealth funding with the states and territories,” she said.

“That business case is

being managed under the auspices of the Australian Health Ministers’ Advisory Council, to enable the government to consider funding arrangements from July 2014, both for the PCEHR and for [NEHTA].

“There will be ongoing costs associated with the PCEHR itself – the operation of the PCEHR system. As to additional costs, there has been work done in NEHTA around the development of specifications and standards, and the business case itself will work out all of the detailed elements for future funding.”

“Ms Huxtable told the committee that funding arrangements for the PCEHR and NEHTA were currently being discussed.”

Ms Huxtable confirmed that initial funding for the PCEHR in 2010 was $466 million, with a second tranche of $234 million over two years allocated in 2012, of which $161m was for operating the system.

This brings the total to $700 million, not $1 billion as has been claimed.

DOHA also confirmed that staff from health services organisation Aspen Medical have been deployed to

over 250 healthcare sites including hospital lobbies and outpatient clinics to conduct consumer awareness activities and assisted registration for the PCEHR. Aspen Medical has been subcontracted by the PCEHR national change and adoption partner, McKinsey & Co, to work in a number of different settings, including aged care, hospital outpatients, immunisation clinics and Aboriginal medical services.

Ms Huxtable said that while she would have to check the exact date of when the Aspen staff began to be deployed, they have been contracted until June 30.

Using Aspen Medical staff to sign up consumers was piloted at the Winnunga Nimmityjah Aboriginal Health Service in Canberra earlier this year, before the release of an electronic assisted registration tool (ART) in February.

However, Pulse+IT understands that the contract has angered some Medicare Locals, which have also been assisting healthcare facilities to raise consumer awareness.

Medicare Locals have been funded to carry out awareness among both practitioners and patients, and it is understood they have certain key performance indicators that they must reach.

$10m ad campaign for Medicare and PCEHR begins The federal government has launched its long-awaited advertising campaign for the PCEHR, airing new television commercials spruiking it as part of a “Medicare For All” promotion that also includes information on Medicare Locals and the after-hours GP helpline.

The existence of money for the campaign was revealed in the May budget, when $10 million was allocated over two years for a national communications campaign about the benefits of Medicare and healthrelated services. $6.5 million has been allocated for this financial year – of which there were three weeks left when the campain started – while another $3.5 million has been set aside for 2013-2014.

The ad directs viewers to a Medicare For All website, which features a series of four animated videos – one on Medicare itself, one on the eHealth record system, one on the after-hours GP helpline, and one on Medicare Locals.

Without mentioning the term PCEHR, the video explains the basics of an eHealth record and directs interested consumers to the www.ehealth.gov.au website, where they can sign up for a PCEHR. “Your record and the eHealth system will grow over time,” the ad says. “As the system develops, more of your health care information can be added by the doctors, nurses and other healthcare professionals you see, resulting in better connected and more efficient care for you.”

The site tells consumers that to register for an eHealth record, they will need their Medicare card, their address as recorded

by Medicare, details of their last visit to a doctor where they made a Medicare claim, and their bank account details if Medicare benefits go straight into the bank.

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RACGP calls for GP to patient telehealth on the MBS The Royal Australian College of General Practitioners (RACGP) has called for GP to patient video conferences to be introduced to the Medicare Benefits Schedule as an alternative to face to face consultations.

As part of its pre-election statement, the college said telehealth services are beneficial for many groups of patients, particularly those with chronic diseases who have difficulty accessing their GP due to transport, mobility and distance issues.

At present, GPs can only claim a telehealth consult on the MBS if the patient is present and the consult is with a specialist.

The RACGP is now calling for GPs to be able to claim a video conference just like an ordinary face to face consultation, saying it would be a cost-neutral exercise as it would be an alternative to in-person consults, not in addition to.

The college has also welcomed the extra $10 million in funding recently announced to upload advance care directives to the PCEHR, saying it would be a very valuable addition to the system.

RACGP president Liz Marles said she understood some of the funding would be used to develop a standardised template to upload to the PCEHR. Dr Marles said it was essential that advance care directives be an easy, standardised form. “For GPs to be able to do this, is has to fit well within our workflow,” Dr Marles said. “Form-filling and red tape are real bugbears.

“Having said that, working through with your patients their advance care directives is an important thing for the GPs to do. Having something that is clear, that is fairly standardised but is easily translatable for the patient is really important.”

ICT complexity causes delay to opening of Perth’s Fiona Stanley Hospital The planned opening of the $2 billion Fiona Stanley Hospital has been delayed by six months due to the complexity of its ICT system, according to the WA government.

WA Health Minister Kim Hames said the hospital will now open in October 2014, rather than April.

Dr Hames said construction work on the 783-bed hospital was more than 90 per cent complete, but the opening had been postponed “because of the scale and complexity of the project, particularly with the advanced ICT system”.

Delivering the technology has required 48km of communications cabling across five main buildings, covering 150,000 square metres, Dr Hames said.

“Fiona Stanley Hospital is the biggest and most complex public tertiary health facility ever to be built in Western Australia – it will be one of the most technologically advanced hospitals in the nation,” he said.

“It will deliver new levels of patient care and convenience through an extremely complex system that will manage administration, patient information, medical records, communication and patient entertainment.

“For doctors and nurses, that means everything they need to know about a patient can be called up bedside on a single screen – patient records, x-rays, scans, medication management and other vital medical information ...”

The bedside computers will also operate as the patient infotainment system, allowing patients to watch television and movies and access the internet.

“The October timeframe will give us additional time to ensure that every service is tested, trialled and bedded down when Fiona Stanley Hospital opens its doors for patients,” he said.

Facilities manager Serco is handling all procurement matters for the hospital on behalf of the WA government, and has been active recently in issuing several tenders for items like electronic medical devices and a prosthetics tracking system.

It has also issued tenders for a medications management system and

some specialist software services, but has yet to issue a tender for a clinical information system or electronic medical record.

The hospital is being designed with no traditional medical records facility and is aiming to eventually be completely paperless.

Serco has contracted BT Australasia to design and provide the full communications infrastructure for the Murdoch-based hospital.

BT is also in charge of systems integration across the building management and facility management systems and the hospital’s managed services, including unified communications, mobility and teleconferencing technologies.

BT is building a network infrastructure that will use cabled multi-protocol label switching (MPLS) technology on the campus for fast access, augmented by a Wi-Fi mesh network.

BT Australasia’s head of healthcare, Lisa Altman, told Pulse+IT last year that the company will install the WiFi mesh network to support a range of services, including real-time locating systems, robots and automatic guided vehicles for linen and meals.

The hospital is also designed to have full internal and external telehealth capabilities, Ms Altman said.

“We’ve got video and audio conferencing facilities throughout the hospital, so you can do things like

live streaming of surgical procedures to a number of lecture theatres within the hospital but also video transmission outside the hospital as well,” she said.

“The CSIRO is doing really interesting stuff in ophthalmology in WA using satellite ... but if you are getting to a dermatological consult you really need to see the fine grain so high definition video is needed.”

Dr Hames said the technology being used at Fiona Stanley was already in operation on a smaller scale at the $170 million Albany Health Campus, which opened in May. Full services at Fiona Stanley, including an emergency department, will not be operational until early 2015.

Canberra hospital trials free public Wi-Fi The Canberra Hospital has begun a trial of free public Wi-Fi for patients and families, beginning in paediatric and acute rehabilitation wards with a view to a wider roll-out.

ACT Chief Minister and Minister for Health, Katy Gallagher, said paediatrics was specifically chosen to be a part of the initial stages of the trial to make the stay of children and their families in hospital a little easier. The trial will expand to oncology, central

outpatients, the emergency department and renal services later in the year.

“I am hopeful that this trial will prove successful and provide patients and their visitors with another source of connection to their daily lives while in the care of our health care system,” Ms Gallagher said.

“Hospital stays can often be unexpected and require periods of waiting around for test results or procedures and this Wi-Fi

access will give people an opportunity to keep in touch with emails and social media as well as general internet browsing to help pass the time and keep in touch with their lives.”

During the trial period, ACT Health and Shared Services ICT will evaluate demand for the service, and will monitor Wi-Fi performance.

Internet access will be filtered for appropriateness, and access will be capped to avoid excessive cost.

HealthLink begins SMD commissioning process Secure messaging network provider HealthLink has begun the process of secure message delivery (SMD) commissioning in general practices.

Practices that have applied to take part in the eHealth Practice Incentives Program (ePIP) need to have SMD commissioned by August 1 to remain eligible for payments.

HealthLink’s national eHealth manager, Nikki Breslin, said SMD commissioning was a series of tasks that configures, tests and ensures the practice is ready for SMD. Practices need to have a number of prerequisites in place before commissioning can be done. These include being registered for an HPI-O, applying for and installing a NASH security certificate, and applying for a contracted service provider (CSP) link.

“The CSP link enables us to perform a query on the Healthcare Identifier Service for each and every secure message,” Ms Breslin said.

“It returns information from the endpoint location service (ELS) with regard to capabilities of the recipient site and which SMD network to deliver the message to.

“It is something that has to be in place to allow us to do that query on their behalf.”

Practices that have all of those requirements in place can then contact HealthLink to agree on a time and date for the commissioning process to begin. She estimated it would take about 30 minutes.

“It is quite a technically complex process with back-end changes on our end,” she said. “What they see on their end is a looptest type arrangement. They will send a message out, we will send a message in, and that’s part of the NEHTA checklist that proves they are operationally ready.”

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Bits & Bytes

Genie releases inbuilt assisted PCEHR registration Genie Solutions has released version 8.5.5 of its clinical software for GPs and specialists, featuring the ability to register patients for a PCEHR directly from within the system.

The new functionality will allow healthcare providers to send a request to register the patient to the PCEHR server from within the tools menu and receive a reply automatically.

Previously, patients had to fill out a paper form or providers could download the Java-based assisted registration tool (ART) following verification by the Department of Health and Ageing.

Genie Solutions’ software developer Matthieu Kluj said when users open the patient demographics or clinical window, they will find a new option in the tools menu called ‘Register a patient for PCEHR’.

“It’s a wizard, so you just follow the steps,” Mr Kluj said. “You fill in what needs to be filled in and then send a request to the PCEHR server, and you get a response automatically after that.

“If the request has succeeded, you can directly connect to the patient’s PCEHR and it’s instant. As soon as you register the patient, you are going to be able to interact with the patient’s PCEHR.” For the patient, an identity verification code (IVC) is generated to allow them to access their PCEHR through the consumer portal when they get home. Like the ART, the patient can choose to have the IVC sent directly through Genie and the doctor can print it out for them, or the patient can elect to receive it by email or text.

“They use this code on the PCEHR portal and access their PCEHR directly after that,” Mr Kluj said.

Aged Care Gateway, call centre and website on track for July launch The Department of Health and Ageing has delivered a progress report on its Aged Care Gateway project, confirming that it will go live on July 1 with an initial focus on providing general information while it builds capacity to ultimately deliver online assessments and referrals.

Craig Harris, assistant secretary of DoHA’s access reform branch, told the recent ITAC conference in Melbourne that the department is running at full clip to meet the July 1 launch of the gateway, its contact centre and the MyAgedCare website.

Mr Harris said the gateway’s rationale acknowledged the need to shift more power to the public with more information and less complexity.

“Information is not easily accessible or reliable; assessment processes are often repetitive and inconsistent across the country; [and] sources are quite wide and varied and often difficult to access and understand,” Mr Harris said. “It doesn’t help in making informed decisions.

“There’s a high demand for more choice and more control, and a bit of a lack of independence and transparency in our arrangements.”

Mr Harris said the gateway would play a significant part of the “Living Longer, Living Better” reforms’ goal of creating a flexible and seamless aged care system.

DoHA’s conception of the gateway is for an “identifiable entry-point” into the aged care system and “a single point of truth”, in which “you know full well you can come to the gateway and get accurate, consistent, reliable information”, he said.

“Information is not easily accessible or reliable; assessment processes are often repetitive and inconsistent across the country; [and] sources are quite wide and varied and often difficult to access and understand.”

The gateway’s national contact centre will also go live on July 1, and will be delivered through Healthdirect Australia and Stellar Call Centres, based in Box Hill, Victoria. It will operate from 8am to 8pm, Monday to Friday, and

10am to 2pm on Saturday.

Staff hiring started in May, and Mr Harris said that successful candidates will have high emotional intelligence, cultural sensitivity and knowledge of the aged care sector.

In the first phase, running into 2014, the contact centre will provide general information and referrals for assessment, and manage a waiting list.

Online assessment through the gateway is slated to begin in July 2015, though the contact centre will be able to provide assessments – via the nationally consistent assessment framework being trialled in four jurisdictions – next year.

There will be three levels of assessment in the national framework. Level three assessments will not be delivered by the contact centre or gateway, but information will be recorded on a central client record.

Central client records, around which there will be “significant security”, Mr Harris said, will be accessible by authorised providers as well as the contact centre.

Client records will integrate with the PCEHR, but Mr Harris parried a question trying to pin down a timeframe for integration.

A DoHA spokeswoman later told Pulse+IT the central client record “is being constructed with full recognition of the value of linking the central client record with the PCEHR. The timeframe for linking to the PCEHR will be determined by the development of the central client record and supporting systems.”

Mr Harris said ultimately the contact centre will identify to the government areas of unmet demand – “the heat spots for service provision” – and that this will be very beneficial to allocating resources.

The MyAgedCare website will eventually include tools for finding providers, selfassessment and estimating fees – the last of which Mr Harris said was a key component – but no delivery date has been made public for when they will begin operating.

is overseeing – a linking service for vulnerable older people and a carer support centre network.

The carer support centres, which will replace Commonwealth Respite and Carelink Centres (CRCCs), are scheduled to start operation in July next year.

No model has been devised on what form they will take, but evidence has been collected, he said.

Rejecting industry rumours that suggest the new centres were a cover for slashing services, Mr Harris said the “scuttlebutt” was incorrect. He said the centres would not be a “rebadging” of CRCCs, and intimated that existing services would be preserved.

Mr Harris said that the final support centre model will reflect demographic needs and projections.

Medical Association and National Rural Health Alliance – is working with DoHA on the design and implementation of the gateway. DoHA has also gathered the Department of Veterans’ Affairs, the states and territories, and NACA to convene a gateway consultation forum.

Part of its task is to devise a solution for a complex operating environment in which Victoria and Western Australia have not signed up to the Commonwealth Home and Community Care (HACC) program for funding services.

There will be a purchase– provider arrangement for HACC and aged care assessment team (ACAT) services. DoHA has not ruled out tenders for services, although Mr Harris gave the impression that such considerations were not yet a priority.

On confirmed timeframes for the gateway, Mr Harris said matching clients to providers will occur in the next 12 months, mapping availability of providers will occur in 2014/15, and real-time information that integrates the central client record with provider data will occur in 2015/16. Direct referral from the gateway to providers will start in July 2015.

On the linking service for vulnerable members of the community, Mr Harris said the department is currently looking at the evidence base for how it can best be delivered. The linking service is not part of the contact centre at this stage.

KPMG has developed four prospective models, which are under consultation through 18 workshops around the country.

DoHA’s spokeswoman subsequently confirmed that the purchase–provider arrangement will begin on July 1, 2014, and that model options are being explored.

Mr Harris also gave an overview of two of the gateway’s functions that the access reform branch

Meanwhile, the gateway advisory group – comprising the National Aged Care Alliance (NACA), Australian

The department is now urging all providers to update their contact details before July 1.

Mr Harris said PwC had delivered a report to DoHA on change management for establishing the gateway, but the DoHA spokeswoman said this was still under development.

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HSAGlobal signs Medicare Local for mental health plan South Eastern Sydney Medicare Local (SESML) has signed an agreement with New Zealand-based clinical software developer HSAGlobal to use its Collaborative Care Management Solution (CCMS) to manage two of its mental health programs.

CCMS is used in several of New Zealand eHealth projects, including as the software for the National Health IT Board’s shared care plan program and the Canterbury Collaborative Care Programme, an integrated primary, secondary and community care system designed to create shared care plans for patients with multiple chronic conditions.

In Australia, CCMS has been used to develop a client and clinical management system for Victorian-based early childhood and parenting centres QEC and Tweddle, as well as the Latrobe Community Health Service’s mobile wound care project.

SESML has signed up to use CCMS to manage its Access to Allied Psychological Services (ATAPS) and Partners in Recovery programs to deliver better coordinated care across the primary, acute and community healthcare sectors.

SESML recently received funding approval for the $549.8 million Partners in Recovery program. It aims to better support people with severe and persistent mental illness with complex needs.

SESML CEO Lynelle Hales said CCMS is designed to support integration, with multiple healthcare providers being able to share information about a client’s care and contribute to a shared plan.

“We see a real advantage to our clients in having all members of their care team working from the same plan and being able to communicate and collaborate securely and in real time,” she said.

Pharmacist launches mobile app to send a script by phone to the pharmacy A NSW pharmacist has developed an iPhone app that allows consumers to take a photo of their prescription and SMS it to their pharmacist, where it can be dispensed at a time convenient to both.

Part of a broader range of smartphone and web-based apps that Wollongong pharmacist Fabian McCann hopes to integrate within pharmacy, GP and nursing home software, the sek app is the first product to be released by his company, sekSystems.

In addition to the Send a Script consumer app, Mr McCann and his team have developed a web-based dashboard app for participating pharmacists that receives the consumer’s SMS and manages the dispensing process. When the medication is ready to be collected, it sends a notification back to the consumer.

The consumer app also contains an interactive allChemist database to help them locate a participating pharmacy. sekSystems is currently running a 30-day free trial for pharmacists, due to finish at the end of July.

After that, a monthly fee will be charged to use the system, although the app will be free to consumers.

sekSystems has developed a range of marketing materials such as window displays that it will provide to pharmacies to help promote the app to their customers.

Mr McCann, who has owned a number of pharmacies in his career and now runs a pharmacy in the Wollongong suburb of Kanahooka, said the development of the app was driven by the parlous state of the community pharmacy sector. He is using his pharmacy as a showcase for both the new app and other IT solutions he hopes to develop.

“I was doing it for myself but then I got the idea that everyone else might want to have it. It has turned from an idea within my own business to hopefully something that is going to be popular.”

Mr McCann said he discussed the development of an app with the vendors of his dispensary software, but no one was doing what he wanted to do, so he had a crack at it himself.

“I changed my brand to SocialChemist, which is the social media arm of it, and which will function as the portal,” he said. “That is a web application that will complement the app down the track.

“I was doing it for myself but then I got the idea that everyone else might want to have it. It has turned from an idea within my own business to hopefully something that is going to be popular.”

The consumer app is deliberately simple to use and involves a process of “tap, snap, select and send”. Consumers tap the app to open it, take a snap of the script, select their local pharmacy, and then send the message.

The simplicity of the app and its design, including bright colours and large buttons, is intended to encourage older people to use the system, he said.

“I know the younger generation is into it but we are trying to get an older demographic,” he said.

“Taking a pic is simpler than doing a scan or a QR code, so the simplest thing is to use an anti-shake camera phone. “ They can take an image, send it to the pharmacy, collect their medications,

and build up some confidence in technology.”

The first iteration of the app is very simple, but Mr McCann plans to add a large range of new functions while still retaining the four basic steps for non-tech users.

“Each time we do an update we’ll add a few more features and build up some confidence in it,” he said. “The next thing we are going to do is a script reminder and a medication management system, so it’s sort of like having your own Webster-pak with alarms and things inside the phone.

“The [alternatives] on the market that we have found, you need to be into mobile phones to understand them. They have six or eight taps. The one that we are

bringing out is going to be really simple and basic, just set a reminder for a tablet, and then as time goes on we’ll up the ante but only if takes the customer base with us.”

For pharmacists, the allChemist web app only requires them to have an internet connection.

The allChemist dashboard contains a number of screens through which the script is processed, including receipt of the new script, dispensing in progress, ‘not dispensed’ and dispensed screens.

If a particular medication is out of stock, for example, the pharmacist simply presses a ‘not dispensed’ button and is able to message the customer to tell them to call.

The release of the app is only the first step in Mr McCann’s broader plans, which are to integrate it into pharmacy, general practice and nursing home systems. He has applied for a NASH PKI certificate from Medicare and has developed an API to allow the system to work within other software systems.

The next version of the app will allow a GP to send a script to an inbox in the patient’s phone, but Mr McCann says that will be a longer-term exercise as GP software vendors wait for the allChemist system to achieve good market penetration.

An easier way for nursing homes to send orders is also on the cards, he said, and an Android version of the app is in development.

Emerging Systems to install EHS in St Vincent’s hospitals Clinical information system vendor Emerging Systems has been selected to install its EHS platform throughout the St Vincent’s Health Australia (SVHA) group.

SVHA operates four public hospitals, seven private hospitals and 10 aged care facilities in NSW, Queensland and Victoria, totalling over 2500 hospital beds and 1100 aged care places.

Emerging Systems has provided its EHS system to St Vincent’s public and private hospitals in Sydney for a number of years, improving on and expanding the system originally designed by clinicians at St Vincent’s Private.

The web-based solution provides functionality across all clinical areas from pre-admission through to post discharge.

It also provides electronic pathology and radiology ordering, results viewing, multidisciplinary progress notes and specialist referrals through to recording admission and discharge medications.

It was also the the first acute care system to link to the PCEHR, with clinicians at its hospitals in Sydney able to access patients’ PCEHRs and upload discharge summaries.

The roll out will be gradual over the next five or so years, with each site identifying what it needs from the system.

“Clinical staff will be able to electronically refer patients to other services and departments within the hospital reducing the time spent circulating and tracking paper,” SVHA CEO, Tracey Batten, said.

“Providing tracking of the referral process alone enables more efficient care delivery reducing a patient’s length of stay in hospital.”

It is understood Emerging Systems was selected over a large, US-based company.

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Medtech Global aims for the home healthcare market Medtech Global is working with the CSIRO and Victoria’s Peninsula Health to develop an effective, cost-efficient way of helping keep chronic heart disease patients at home and out of hospital.

As part of the Victorian government’s Health Market Validation Program (MVP), Medtech Global is conducting a feasibility study to see if a combination of its technologies as well as CSIRO’s research capabilities can better support chronic health disease patients in their home.

Medtech Global is leading a consortium with Victorian company Chakra Solutions and the CSIRO. Medtech’s chief technology officer, Rama Kumble, said the concept would bring together Medtech’s existing telehealth, online health record and analytical software, along with low-cost hardware and specific analytical skills.

Based on the Heart Cycle model of care for chronic heart failure patients, the project aims to reduce the amount of readmissions due to inadequate selfcare, but also to bring the patient’s GP and specialists together by sharing more targeted information.

Medtech Global’s plan is to provide a low-cost iPad or tablet that is loaded with its ManageMyHealth clinician and patient portal, which not only allows patients to view their medical records but also to add their own information and access health information. The technology will gather medical data using medical devices with almost no intervention by the patient.

The plan is to also use its telehealth software, VitelMed. “[An alert] could also go automatically to the call centre for the hospital, so they can triage and click on the button and see the patient,” Mr Kumble said. “The idea is that this could be applicable to other chronic disease patients very easily.”

Captivating software draws the eye to visual education for patients How much does the average person understand about their eyes? It’s probably safe to say, not a great deal.

Lack of information for eye patients can make testing and treatments a confusing and unnerving experience.

Tackling this problem has led eye-clinic group personalEYES to roll out Captiv8, a software program for patient education, across its network.

Anh Kieu, an orthoptist at personalEYES, said the video animations in the program are easy to understand and give patients proper information.

“It’s reliable and reviewed source from their health consultant,” Ms Kieu said.

“Patients are less likely to google their symptoms and diagnosis and arrive at misleading and incorrect information.” personalEYES introduced Captiv8 last year with an aim to give patients a “complete understanding” of their eyes before, during, and after consultation and treatment.

Every computer in the clinics has Captiv8, which is used by the ophthalmologist, optometrist or orthoptist to show patients a video relevant to their condition, and run through diagnosis and treatment options.

A Captiv8 iPad app can also be used by patients and

their family members in the waiting room before or after their consultation.

Videos can be shared via email for future reference or to pass on to family members who are not at the consultation.

“The advantage of using the program is that it provides both animation and simple explanation of often complicated diseases and treatments,” Ms Kieu said. “It’s an efficient method of delivering health information in basic language without technical jargon.”

Use of the iPad app is also a handy way to improve the quality of the consultation, since better-informed

patients are prompted to direct questions and concerns that have been raised by the video.

Ms Kieu said educating patients with the videos has led to better compliance for follow-up consultations and post-procedural instructions, such as the use of drops or wearing an eye shield.

A lot of personalEYES’ work is in laser eye correction surgery, and there is strong interest in the procedure from people sick of wearing glasses. However, because the surgery is not suitable for some patients, Captiv8 has been helpful in explaining why that is, and

explaining about alternative treatments such as implantable contact lenses.

If a patient elects to have that treatment, there is another animation on how the ICL is implanted and the expected results.

Captiv8 is used at personalEYES to explain the condition to patients diagnosed with age-related macular degeneration, other symptoms associated with it, the difference between the two types of macular degeneration, and risk factors.

In the time that they have been using Captiv8, Ms Kieu and her colleagues

have identified areas the developer needs to tackle for its next release of the software.

Some of these are macular hole, vitreo-retinal surgery, including retinal detachment surgery, central retinal vein and branch retinal vein occlusions and diabetic retinopathy.

“The software could be improved by better manipulation of the video during play,” Ms Kieu said.

“The clinician should be able to fast-forward or slide the video along to particular sections, rewind and pause.”

Extra money for health IT and eHealth in Queensland and South Australia budgets South Australia has eased concerns over the future of its planned enterprise pathology laboratory information system, allocating $11.4 million of the required $28.5 million to the project in its recent state budget.

Concerns had been raised within the industry that the project, which aims to provide a single enterprise pathology laboratory information system to support the delivery of pathology services across health, might be delayed due to budgetary constraints.

However, in addition to money for the pathology system, the SA government has also allocated $26.2 million of the total $101.3 million cost for its enterprise patient administration system, which will deliver a state-wide integrated electronic health record at all metropolitan hospitals, GP Plus centres and two country general hospitals.

Queensland has also allocated money in its budget to health IT, with $27.6 million to be spent on the continued statewide rollout of clinical and administrative support systems, including its integrated EMR, supplied

by Cerner, and systems for results reporting, order entry, medications management, clinical notes and discharge summaries.

That system is being provided by Allscripts and is currently being rolled out.

The winning bidder for the pathology system has not yet been announced.

It has also budgeted $107.5 million for ICT equipment, including for its asset replacement program and for unspecified systems to support its eHealth strategy.

Out of the box platform for mental health initiatives Software vendor Intrahealth has released a platform of integrated software products called com.unity to support mental health initiatives in Australia. com.unity combines Intrahealth’s Profile practice management system with Accession web portals for patients and external care providers and Profile iOS, a native mobile app for the iPad and iPhone.

Intrahealth general manager Craig Longstaff said the “out of the box” software solution had been designed to meet the needs of a number of the mental health initiatives including headspace, ATAPS and Partners in Recovery. “com.unity provides a case managementcentric approach that facilitates management of complex health needs through secure web access by patients, consumers and community care team providers,” Mr Longstaff said.

“The application is a secure shared medical record managed by the organisation while supporting the patient/ consumer consent process.”

The mobile application facilitates care management and planning activities for mobile healthcare providers so that they can manage patient care remotely. It supports both online and offline functions where mobile coverage may be varied.

While a number of Medicare Locals already utilise Intrahealth’s Profile to manage a number of their care delivery programs, com.unity extends on this by facilitating web-based central care management, Mr Longstaff said.

“Our web and mobile solutions are real time and enable secure sharing of information whether care providers are within the physical environment or part of the extended network of care,” he said.

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Electronic log book app for blood glucose levels Three University of Sydney IT students recently won the Microsoft Asian Cup Australia with their BlueClover mobile phone app designed to help diabetics manage their condition.

Andrew Chen, a final-year IT student and co-developer of the app, said he and fellow students Donald Zhang and Robin Huang designed BlueClover to replace the limited electronic solutions currently available to diabetics or the tedious logbook procedures they are encouraged to use to record their daily intake of food and drink.

“At the moment diabetes patients are required to manually record and calculate their levels,” Mr Chen said. “Our app focuses on a logbook that electronically records essential information needed for the management of the disorder such as blood glucose levels, amount of carbohydrates consumed for meals, and insulin levels.”

BlueClover has been designed with additional functionality such as object recognition and barcode scanning for automated input of food nutrient information into the users’ logbook.

Users can take a photo of the food product or barcode and the nutritional information will be retrieved from the app’s database.

“Instead of having to manually enter the information of the foods they eat, users can scan the barcodes of the products they consume,” he said.

The logbook can also provide analysed information on the recorded data such as graphs and trends.

The user friendly app has a built-in alarm system that reminds the patient to record their glucose and carbohydrate intake along with the amount of exercise they have done.

Calvary and CSC partner to use PCEHR for better management of end of life care Healthcare provider Little Company of Mary Health Care and software provider CSC are working together to develop new ways of sharing essential information to better manage end of life care for patients in the Calvary network of hospitals and palliative, aged, community and home care services.

The plan is to develop an electronic solution using CSC’s i.PM patient management system, which is installed throughout the Calvary public and private hospital network and in over 300 other hospitals in Australia and New Zealand.

The solution is underpinned

by CSC’s Health Information Exchange and is designed to enable much of the NEHTA-specified eHealth infrastructure, including the use of the PCEHR from within CSC products, to share information with external healthcare providers.

Mark Doran, CEO of Little Company of Mary Health Care, said patients approaching the end of life use health services at a higher rate than at any other time in their lives.

“To meet the needs of these patients, we must coordinate care across multiple care episodes,” Mr Doran said. “eHealth technologies that allow

us to share information internally and externally are vital to achieving this kind of care continuity.”

to redesign their care to achieve outcomes that are closer to their goals and preferences,” she said.

Little Company of Mary Health Care’s national director of clinical services, Sue Hanson, said it was nationally recognised that clinicians often had difficulty recognising that a person was approaching the end of their life, leading to difficulties providing appropriate care that was in accordance with their wishes.

“As a healthcare system we are not very good at that, and even if an individual clinician does recognise that a person is approaching the end of their life, we have a limited capacity to communicate that to other clinicians or to other services that might also be involved in that person’s care.”

“The plan is to develop an electronic solution using CSC’s i.PM patient management system, which is installed throughout the Calvary public and private hospital network and in over 300 other hospitals in Australia and New Zealand.”

“Recognising that a person is in the last year or so of their life does not mean that they are dying, but it does signal a time when we should be starting

Little Company of Mary Health Care is planning to embed a screening tool within its clinical practice in emergency departments, medical wards and residential aged care facilities that will help clinicians identify when somebody has moved into that last year of their life.

The organisation has developed an end of life care toolkit that includes the paper-based screening tool along with appropriate assessment tools and goals of care records.

The idea is to digitise this toolkit, and to use both i.PM and the PCEHR to alert other clinicians and service providers that a person is at risk of experiencing problems or receiving inappropriate care in that last year of their life. “We use screening tools that are based on evidence that has

come out of places like the Centre to Advance Palliative Care (CAPC) in the US, where they are widely used, and we have developed a toolkit that is relevant to the Australian context,” Ms Hanson said.

“The missing link and why this project is exciting is that all of these tools can currently be used within a single episode of care.

But we know that people move between healthcare services. Currently there are manual processes in place for attaching records to patients and sending records along, but they often don’t work.

“So this is an ideal way, using two tools: the i.PM system, which is used widely across public and private health services, and then the PCEHR, which is an opportunity to connect with people who aren’t linked to the i.PM system to share this information between care providers.”

CSC’s healthcare solutions director, Byron Phillips, said the project would involve two streams of work: the first to enable the Calvary network to use what he calls some of “the NEHTA essentials”, such as Individual Healthcare Identifiers, organisational identifiers, secure messaging, a view into the PCEHR and assisted registration.

“All those things are enablers of doing what Sue

ultimately wants to do and it will obviously open the door to many other care coordination opportunities,” Mr Phillips said.

The second stream of work is the specific end of life care project, which will involve CSC making some modifications to i.PM to allow better triaging of patients entering the last stage of their life.

“The more patient-related information we can place in the PCEHR that directly improves patient and carer experience and workflow, the more we will encourage its use.”

“There are a lot of people who can be identified for more appropriate care far earlier than we realise,” Mr Phillips said.

“Early triaging is some of the work that we are doing in i.PM to be able to record that and put them on the path of better management in the right care setting, which in future may not always be a hospital.”

Mr Phillips said that some of the work Ms Hanson and her team have done

on screening will be stored within i.PM for broader clinician access. “These details will be further complemented by the i.PM PCEHR viewer and with notifications in the PCEHR originating from previous patient episodes to identify screened patients to other clinicians, irrespective of the care setting.”

He said the project will provide a significant opportunity for any of CSC’s patient management customers to leverage their existing software to provide real healthcare benefits as a result of the new national eHealth enablers.

“The more patient-related information we can place in the PCEHR that directly improves patient and carer experience and workflow, the more we will encourage its use,” he said.

“We have tried to make the introduction of the first phase very simple and low impact, with the introduction of the patient health identifiers into i.PM, for example, being achieved without the need to upgrade the core i.PM product. This is pretty significant for some of our customers with extremely large numbers of hospitals using i.PM.” “It provides an opportunity for a lot of customers to begin to place rich content in the PCEHR, content that we believe absolutely key to drawing more people into using it.”

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Putting a pen to the pulse to measure central BP Researchers from the University of Queensland are using technology developed by Australian company AtCor Medical in a study looking at whether lowering central blood pressure can reduce cardiovascular disease risk in people with hypertension.

The technology, called SphygmoCor, uses a digital pen-like device to measure central blood pressure at the wrist, rather than the traditional brachial measurement using a cuff on the upper arm.

It is being used in a number of clinical trials around the world, including the UQ research, which recently won an NHMRC grant worth $1.4 million.

Principal investigators Jim Sharman and Michael Stowasser from the UQ School of Medicine are currently running the Targeted LOWering of Central Blood Pressure (LOW CBP) randomised controlled trial, which is looking at whether targeted lowering of central blood pressure will improve CVD risk above and beyond conventional brachial blood pressure.

The researchers say that even in populations with normal brachial blood pressure, there is still considerable risk for CVD, which their research has found is often due to persistently elevated central blood pressure.

To test whether targeting central blood pressure can reduce CVD risk, they are using AtCor’s SphygmoCor technology, a non-invasive way of accurately measuring central blood pressure.

“Preliminary studies have indicated that the standard inflated arm cuff, a crude method that is over 100 years old, may not necessarily be the best way to measure blood pressure on those who have hypertension,” Dr Sharman said.

Child health app released as PCEHR registrations grow The federal government has released the first app that can interact with the PCEHR as registrations for the system climbed past 215,000.

The new My Child’s eHealth Record app is based on the app designed by Deloitte and NSW Health as part of the Greater Western Sydney Wave 2 site, which has also created an electronic version of the paper-based Blue Book for newborns.

Available for iPhones and Android smartphones, the app allows parents to enter information such as immunisations,

growth parameters and developmental milestones.

It is only available for NSW users at the moment, as is the new Child Development section added recently to each PCEHR.

way for parents to keep track of their family’s key health information, and adds to the clinical and personal information the eHealth record system can already hold for an individual,” she said.

Health Minister Tanya Plibersek said the app does not replace the Blue Book or its equivalents, “but if a parent is asked by a childcare centre about their child’s immunisation status, they are very likely to have their mobile with them even if they are not carrying the blue book”.

The app includes realtime growth charts, immunisation records and reminders, health checkrelated questionnaires and answers, personal notes including developmental milestones, useful contacts and health information resources.

“The My Child’s eHealth Record app is yet another

“While a baby’s measurements should

be taken by a trained healthcare professional, parents can add this information directly to their child’s eHealth record via the app,” Ms Plibersek said.

Before downloading and using the app, parents must have registered their child or children for a PCEHR. Parents can sign up online or by phone if the child

is listed on the family’s Medicare card, but if not, applications must be made in person at a Medicare office or by writing.

Parents can give healthcare professionals access to the child’s PCEHR, and those with the compliant software can also upload documents.

Healthcare professionals have not been given access

to the parent’s personally entered notes.

IDNT Online goes on the dietitians’ menu

The app requires users to log into the my.gov. au website, which has replaced the australia.gov. au website and has a vastly improved user interface.

Users are also required to enter a personally chosen pin number to access the PCEHR through the app.

The IDNT Online documentation system for dietitians created by start-up company FC Dietetic Software Solutionshas been released as a full clinical management solution.

PCEHR release three features child development section The latest release of the PCEHR includes a new section for parents to add details of their children’s health, growth and development, mainly aimed at parents of newborns and younger children.

Based in part on the electronic Blue Book developed by NSW Health from its HealtheNet project, the Child Development section allows parents to enter measurements for head circumference, height and weight that can then generate a growth chart.

The section allows parents to keep their own achievement diary and add personal observations, and it also includes a list of the National Immunisation Childhood Schedule for reference.

Most of the functionality is only suitable for NSW parents at the moment,

as each jurisdiction has different schedules. The section includes a child health check schedule with questionnaires to fill out prior to the child’s appointment with a healthcare provider, but this is limited to the NSW Health Check Assessment Schedule at present.

A spokeswoman for the Department of Health and Ageing (DoHA) said it was not a new record, but rather new functionality that forms a part of a person’s existing eHealth record.

“The Child Development function has been provided as a tool for parents (and authorised representatives) to view and add information to their children’s eHealth record,” a spokeswoman for the Department of Health and Ageing (DoHA) said.

“This will help parents keep even better track of their

children’s early health, growth and development information. This is in addition to the information, both personal and clinical, that a child’s eHealth record can record.”

DoHA said that like the NSW electronic Blue Book project, the plan is for healthcare professionals to also add information directly to the record. “[It] it is anticipated that in future releases healthcare professionals will also be able to add clinical information, including a birth record and child health check assessment results.”

NSW Health also recently recently released a Save the Date to Vaccinate app to help parents remember their child’s vaccination schedule and book a GP appointment straight from the app.

Designed by clinical dietitian Claire Nichols and software engineer Felix Jorkowski, IDNT Online allows dietitians to write electronic client reports using the International Dietetic and Nutrition Terminology (IDNT), a standardised language used to support the international Nutrition Care Process (NCP) model.

The company has been has been developing the system for a year, and launched a beta version in September 2012. Based on Microsoft’s Azure cloud platform, it can be run on tablets and mobile devices. There is also a quick reference app for iOS, Android devices and Windows phones that allows users to search for IDNT terms.

Features include appointment scheduling and calendars, multiple user accounts, client management, referral and waiting list management, contacts management and electronic documentation. The team is currently working on adding invoicing and payments capability along with SMS and text-to-voice appointment notification.

Pricing has been set at $30 per month per full-time user, which Ms Nichols said could consist of two part-time staff. “If there are two part-time staff members they still count as one full-time user,” she said.

“We’d be looking at a cut-off of 40 hours of appointments a week equalling one fulltime user.”

Dietitians can trial the product for free for another month, as there are a few more features the team is going to add before the payment system is implemented.

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MMRGlobal bringing patent fight with NEHTA down under The US company that is claiming the National E-Health Transition Authority (NEHTA) may have infringed on its patents for personal electronic health records is planning a trip to Australia, announcing it had retained a legal firm here.

MMRGlobal has launched legal action against a number of companies in the US, including pharmacy giant Walgreens, popular health information website WebMD, diagnostic testing service Quest Diagnostics and most recently against Jardogs, a subsidiary of global electronic medical record vendor Allscripts.

In February, MMRGlobal announced it was investigating an alleged infringement of two of its patents by the Australian federal and state governments, through NEHTA, in the creation of the PCEHR. A spokesperson for NEHTA told Pulse+IT that “as a result of the allegation made by MMRGlobal in the press in early February this year that NEHTA may be infringing upon two of MMRGlobal’s Australian patents, NEHTA undertook a thorough investigation of the relevant patents”.

“That investigation has revealed, as expected, that there is and has been no infringement by NEHTA. NEHTA now intends to put this claim behind it and move on with implementing the national eHealth agenda.”

MMRGlobal has also managed to recruit pop singer Guy Sebastian to its campaign, promising him donations for a charitable foundation he is setting up from proceeds of any revenue the company makes from licensing its patents.

Asked whether he was planning the trip for meetings with NEHTA, Mr Lorsch told Pulse+IT that he “would prefer not to comment at this time until travel plans are firmed up”.

HCN partners with Healthshare for Medical Director sidebar app Health Communication Network (HCN) has demonstrated the first iteration of its new sidebar functionality for Medical Director, partnering with Healthshare to develop a patient education application to assist doctors with explaining to patients the options and outcomes of health problems once a diagnosis has been made.

HCN’s MD Sidebar, first announced in August last year, is an integration platform that allows thirdparty app developers to add apps and widgets to MD’s Widget Store. Users can then download the apps they need to the MD Sidebar, which sits on the right-hand side of the screen and can be minimised or maximised as needed.

HCN has developed an API framework to allow the apps to fully integrate with MD, allowing them to access information from patient files but also allowing the apps to write back to MD. In addition to the Healthshare app, HCN has also partnered with app developer Health v2 to add an image capture and sharing app to the Widget Store, along with an app to write medical reports for life insurance purposes and submit them automatically to UHG.

HCN’s medical director, Andrew Magennis, said the development of the MD Sidebar had also allowed the company to improve MD’s user experience by moving the prompts functionality to the sidebar.

calculators. There is also a patient waiting room app that HCN has developed that lets doctors see who their next patients are so they can bring up the patient’s file before the consult.

“Someone comes in with a bleeding nose and you open up their patient file, it will often prompt you to do things like update their vaccines, but you don’t want to be doing that right then,” Dr Magennis said. “We have moved these prompts to the sidebar so they can be viewed at any time during the consult.”

Campbell McAuley, director of Health v2, said the Image Safe app his company has developed runs on any iOS and Android mobile device and allows users to take a photo of an area of concern on the skin such as a mole that has changed shape.

“We have moved these prompts to the sidebar so they can be viewed at any time during the consult.”

The image is then directly sent to Image Safe’s server in the cloud and then directly integrated into the patient’s file within MD. “Patients can also upload their own photos so they can be monitored over time,” Mr McAuley said.

HCN’s commercial manager, Hong Nguyen, said that by taking API approach, the company could allow a secure and supported interface to app developers.

The Healthshare app will allow doctors to easily share patient education by searching its database of over 200 topics and finding fact sheets, videos or medication information leaflets that can then be printed out or emailed directly to the patient.

Mr Nguyen said that in addition to the UHG, Healthshare and Image Safe apps, a number of others are in the pipeline and HCN had developed some of its own, including some clinical tools and

Healthshare has worked with over 70 of Australia’s health organisations including beyondblue, Diabetes Australia and the Heart Foundation, to provide patient information and education on its site.

Dr Magennis said there are over 200 topics in the app and more are being added.

“We made sure it was well populated before adding it to the Widget Store and that the information is written by authoritative authors.”

in data from MD and filling out the form for you, which you can then just submit to UHG automatically,” he said. “You can also click off any box if the patient wants you to withhold that information.”

He said the UHG app would save a great deal of time in writing medical reports for life insurance. “The app prepares a PDF by dragging

Mr Nguyen said the new functionality was the first iteration of what is planned for MD Sidebar, which will continue to be populated

with both free and paid apps.

“We will focus on what we do well, clinical software, and have allowed app developers to come up with innovative ways to help doctors and practices deliver better patient care,” he said.

“We are also happy to speak with app developers.”

Queensland’s The Viewer to link to the PCEHR for discharge summaries In the two years since the release of Queensland Health’s The Viewer portal, which accesses the state’s clinical data repository (CDR), it has been taken up by 235 facilities state-wide.

Administratively, Mr Carroll said The Viewer comes in handy to find patients in the system, or to analyse reports, which can now take place in a matter of hours instead of days.

In the next six months, radiology department reports from six more hospitals will be added to the ranks of the 98 hospitals already in the portal.

The Viewer gives clinicians access to patient details, encounters, procedures and ED information, medication summaries, pathology and radiology reports, adverse reactions and discharge summary information,

“Where previously locating a paper chart could take time, The Viewer means doctors have some key patient information at their fingertips on one screen,” he said.

By the end of October, as part of the national eHealth strategy, Queensland will be uploading discharge summaries to the PCEHR.

“It’s the foundation of a shared electronic medical record for patients in Queensland’s public hospitals,” Paul Carroll, senior director at Queensland’s Health Services Information Agency, said. “The success of the system is evidenced by its adoption rate and you have something like an average of 64,000 views per month now.”

Downtime is minimal, principal project manager (technical) Paul McKee said. “It’s available on every desktop 24/7,” he said.

“It’s designed around the most recent .Net Framework. It’s flexible – the user interface is ours so we can modify it to add more things to it.”

New systems are also coming into The Viewer.

“We’re also going to expose the PCEHR to Queensland Health doctors through The Viewer,” Mr Carroll said.

“So if you are navigating a patient in The Viewer, you’ll hit the PCEHR button, and it will then go in and search the PCEHR. If there’s any information on that patient, it will then bring it up to the Queensland Health doctor.”

The plan is to have PCEHR linked to The Viewer by the end of this year.

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16

15

JULY

AUGUST

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19

15

JULY

GENIE: SEARCHES AND QUICK REPORTS Brisbane, QLD p: + 61 7 3870 4085 w: www.geniesolutions.com.au

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

AUGUST

16

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AUGUST

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16

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21

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

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22-23 JULY

22-23 AUGUST

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September 12

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22

13

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SEPTEMBER

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16-17 SEPTEMBER

19

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17-18 SEPTEMBER

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GENIE: APPOINTMENT BOOK AND BASIC BILLING Brisbane, QLD p: + 61 7 3870 4085 w: www.geniesolutions.com.au

18

26-27 SEPTEMBER

SEPTEMBER

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18

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14

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OCTOBER

BEST PRACTICE: USING BEST PRACTICE MANAGEMENT Darwin, NT p: + 61 7 4155 8888 w: www.bpsoftware.com.au

19

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17

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16

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October

BEST PRACTICE: CLINICAL MODULE FOR EXISTING USERS Darwin, NT p: + 61 7 4155 8888 w: www.bpsoftware.com.au

SEPTEMBER

OCTOBER

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18

17

16

OCTOBER

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17

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

November 12

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13

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Kinect for home monitoring and tablet for Parkinson’s

Sending out an SOS by watch phone an emergency beacon for the elderly

Two Edith Cowan University student projects have been nominated as finalists in the 2013 WA Information Technology and Telecommunications Awards (WaiTTA), one for the development of an app for people with Parkinson’s disease and the other for using Kinect for Xbox for in-home monitoring.

Sydney-based personal care technology company mCareWatch has released a mobile personal device for the elderly that is part wristwatch, part mobile phone, part emergency beacon.

ECU computer science honours student Laurence Da Luz has developed software that uses the infra-red camera and movement sensor within an Xbox Kinect to track a person’s movements in their home and learn their daily routine.

Aimed at the elderly living in their own homes as well as the independent living and residential aged care sectors, the SOS Mobile Watch looks like and actually is a watch, but it also functions as a mobile phone, a GPS tracking device and a medical alert system.

According to ECU, it can identify when an individual’s activity is out of the ordinary, for example if they miss a meal or don’t get out of bed, and it has the potential to contact a family member through an SMS or email.

Mr Da Luz has designed the software so it can be set up easily and quickly. In addition to sending alerts, the system also provides an early warning function.

The other project involved developing an app to track the progression of Parkinson’s disease. Called the Parkinson iTest and designed by ECU computer and security sciences student Jose Alvarado, the app allows Parkinson’s sufferers to use their tablet to perform tests on muscle rigidity and tremors, the results of which can be sent straight to the patients’ doctors.

The tests include tapping and spiral exercises which demand co-ordination and control over motor movements. The results are saved and can be reviewed by the user to track their own progress as well as informing doctors.

“Our main goal is to ensure that patients communicate and share their results with their doctors between each appointment,” Mr Alvarado said.

mCareWatch is a new company founded by Australian brothers Peter Apostolopoulos and Paul Apostolis, which specialises in using technology to support carers, the elderly and chronically ill. The

SOS Mobile Watch is the company’s first product and has been in development over the last two years.

Mr Apostolopoulos has a long history in health IT, having worked for NSW Health and Queensland Health before heading to Singapore to work for telecommunications giant SingTel, while his brother – who changed the spelling of his surname many years ago – is a sales and marketing specialist.

Mr Apostolopoulos said that in addition to his background in health IT and eHealth, there was a personal reason for setting up the new company and aiming at the assisted living and personal care market.

The brothers’ father suffered a stroke while

driving, which prompted them to start looking at wearable devices that allowed people to alert carers or family members in an emergency. There are a number of personal alarms and pendant-style products on the market, but many of those require the wearer to stay within distance of a base station.

They can also be quite obtrusive and limit the independence of the wearer, whereas a device that looks like and actually is a watch, but which can also function as a mobile phone and even allow the user to set medications reminders, would be more palatable, Mr Apostolopoulos said.

“We are working with a manufacturer who has developed a watch phone

before, but we needed to make sure that it could be tailored and made into a personal emergency response device,” he said.

“We also wanted to also allow individuals – family members or friends – to be able to get in contact on a daily basis, to address all of those social isolation issues as well.

“People can call the watch as much as they want.

All the wearer has to do, whether they are elderly or disabled, is press the orange button to answer calls. When they are in an emergency situation, they press the SOS button and it goes to a predefined list of carers and tries to get in contact with them. If they are unsure of where they are, the family member or carer can locate them via Google Maps on their smart phones using GPS technology built into the SOS Mobile Watch.”

mCareWatch has partnered with KORE Wireless to manage and deploy the device and it will use the Optus mobile digital network. It can be rented on a monthly data plan just like any mobile phone, and can also be purchased outright.

Both payment options cover the watch and charger along with emergency calls, SMS and data charges.

It also works like a newfangled walkie talkie, allowing carers to open up two-way communication in an emergency. If the wearer is incapacitated and can’t answer the phone, authorised carers can send an SMS command to the watch, which automatically opens a two-way voice call without the watch wearer having to press a button.

“If a family member doesn’t respond to a normal call – you ring it as you would ring a mobile phone – and

they don’t respond, you can send a command to it which opens a twoway communication,” Mr Apostolopoulos said. “That’s good if they have had a fall and can’t press the button.

You can open up that twoway communication and say, ‘Mum, Dad, are you okay?’”

ConTac to deliver rehab services for aged care

The device can be preprogrammed with up to three auto speed-dial SOS numbers and all the wearer has to do is press a button.

If the first contact doesn’t answer, it will automatically call the next number. It also features an alarm clock that can be used for medication or meal reminders.

The project will combine telehealth work currently being carried out in aged care facilities through UQ’s Centre for Online Health (COH) and Centre for Research in Geriatric Medicine (CRGM), along with the use of telerehabilitation software first developed by UQ’s Telerehabilitation Research Unit (TRU).

The company is targeting consumers initially, offering older people living in their own homes the ability to remain independent but in touch, but it has also had discussions with aged care providers, particularly those that provide independent living accommodation.

“The first steps for us was to get it up and running for the consumer channel – people can purchase it online – but at the same time we have also received a lot of interest from the industry and service providers,” he said.

“We have a number of aged care providers that we are talking to right now, who want to make it available to their residents in aged care facilities but also independent living.”

The University of Queensland is one of the successful bidders for the $20 million NBN-enabled telehealth program with its ConTAC project, which aims to deliver much-needed medical and allied health services to 650 older Queenslanders living in residential aged care facilities and in the community.

TRU’s co-director and ConTAC chief investigator, Deborah Theodoros, said the home care aspect of the project would use eHAB software, developed by TRU’s codirector, physiotherapist Trevor Russell.

The software provides a ‘virtual clinic’ delivered on a tablet computer to offer a variety of health services including physiotherapy, speech pathology, occupational therapy and audiology remotely.

The software has been trialled extensively

by TRU along with service providers such as Blue Care, Queensland Health and the Hear and Say Centre, and has proved effective for physiotherapy after a knee reconstruction, for example, as well as in speech pathology.

“Most of what we do in speech pathology is audio-visual in nature, so when we are face to face with the individual, we are listening to them and watching what they do,” Professor Theodoros said.

“We provide them with strategies and techniques to improve their speech, language, voice or swallowing, and this can be readily done across the internet.”

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Workshops on implementing social media in healthcare eHealth & HL7 Education Partners has developed a day-long social media workshop that it is taking around the country, aimed at people involved in designing, implementing and managing a social media presence in their healthcare organisation.

Trainer Klaus Veil, an adjunct associate professor at the University of Western Sydney and well-known eHealth expert, said despite mainly concentrating on the more technical aspects of eHealth such as standards, he also saw an increasing need for comprehensive education offerings on wider issues, including social media.

While some might consider social media relatively simple to use, Mr Veil said from a healthcare organisation perspective, that was not necessarily so.

“Social media is very much a two-edged sword – the reason why social media is so popular and has such broad reach is because anybody, including seniors, can actually operate it and do increasingly use it,” he said. “So people think that it’s easy but it’s not - because social media from a healthcare organisation point of view needs to be integrated into their overall organisational PR and communications strategy. If you have a Facebook page or a Twitter stream with the last update in November 2012, that is not effectual.”

CSIRO to demonstrate evidence for telehealth under NBN project The federal government has revealed the winning bidders for the $20.3 million grants program to evaluate NBN-enabled telehealth pilot projects, including the CSIRO, which is planning the first large-scale use of patient-collected data uploaded to the PCEHR. The Minister for Broadband, Communications and the Digital Economy, Stephen Conroy, said the nine projects will help demonstrate how important high-speed broadband is to the future of healthcare.

“We now live in a world where … healthcare doesn’t only happen in a hospital, and aged care doesn’t always mean having to go into a nursing home,” Senator Conroy said.

Mr Veil said the workshop covers what social media channels are suitable to communicate with which target audience and how an organisation decides whether to become active with only a few channels or many.

The projects will cover around 2500 patients in 50 NBN communities, and comprise successful bids from the CSIRO, the Royal District Nursing Service and Flinders University. Feros Care, Silver Chain Group, Illawarra Retirement Trust and UniQuest will deliver aged care programs, while the Hunter New England Health District in NSW will look at cancer patients.

“People are quite committed to their favourite social media channels, so if you are a larger organisation you really need to have a presence on all of them, otherwise you are missing part of your social media audience,” he said.

The CSIRO has received two grants totalling $5 million, with $3m awarded to a project examining home monitoring of chronic disease for aged care,

and $2m to extend its Remote-I indigenous eye care program to evaluate telehealth over satellite broadband.

The eye care project, which is being run in conjunction with WA Health and the Australian Society of Ophthalmologists, recognises that indigenous Australians are at much greater risk of poor eye health, particularly in remote communities.

“We now live in a world where … healthcare doesn’t only happen in a hospital, and aged care doesn’t always mean having to go into a nursing home.”

Using the Remote-I telemedicine platform, 900 patients will be involved across three sites in Queensland and Western Australia. Technical assessment will also be carried out to determine satellite broadband’s efficacy in delivering telehealth.

For the randomised-control trial evaluating home monitoring of patients

with chronic disease, six sites have been chosen, comprising 450 patients who will be tracked over a year. Participants will be drawn from patients with a history of chronic disease, or those hospitalised twice in the preceding 12 months.

The study will assess all of the major chronic diseases, but patients with any chronic condition meeting the criteria are eligible candidates.

TeleMedCare will provide the telehealth platform and iiNet will contribute the fibre and fixed-wireless NBN connections.

Data collected at home by the patient – such as blood pressure and ECG readings, spirometry, pulse oximetry, weight and temperature – will be fed into the PCEHR. Sites have been chosen to give a cross-section of hospital and community care models, and the project will also evaluate usability for patients and clinicians, organisational change-management, business-flow processes, and workplace cultures.

“We’re trying to work out how to scale up telehealth nationally, and to do that we need to learn a lot about how these particular sites are adopting telehealth,” CSIRO ICT Centre chief scientist, Branko Celler,

said. “We’re hoping to produce a resource package for anyone that wishes to deploy telehealth.

“But further, we want to provide the data that will go to government and Treasury and policy-makers and funding agencies to confirm to them or otherwise that telehealth has a very good cost–benefit, and has improved healthcare outcomes.”

The CSIRO will also interpret the data collected to analyse “risk stratification”, which classifies whether patients are sick but stable, showing signs of improvement or acuity, or pending hospitalisation.

“If we can do that effectively, we can then orchestrate the best response – from the GPs,

from the community nurses, from the health services that are around the patient – to stop them going to hospital,” he said.

“There is very good evidence that telehealth in the right setting can reduce hospitalisation by anything between 10 and 40 per cent, depending on what the baseline circumstances are. It reduces GP visits and improves patient selfmanagement – there are some really positive aspects to telehealth.”

Professor Celler said that while this had been demonstrated internationally, there was not enough broadbased evidence from Australia. “It’s the most comprehensive and the most carefully controlled study that I know of – and one of the biggest.

“Fundamentally, we want to demonstrate the impact telehealth has in improving the management of chronic disease – quite low cost and better outcomes – and deliver sufficient information to government and healthcare providers to scale this up nationally,” Professor Celler said.

“That’s what’s happening worldwide, and we need the evidence for Australia.

“Our healthcare costs keep increasing. Telehealth methods in the home are increasingly shown to be cost-effective, to have a really big impact on reducing the burden of patients in hospitals.

Core measurements in the project will be completed

by July next year, and the report handed down by the end of September, 2014.

ePrescribing reduces errors but not time with patients New research has shown that the use of ePrescribing systems in the acute care setting can prevent more errors than they cause and have a negligible effect on time spent on patient care.

Two papers published recently in the Journal of the American Medical Informatics Association (JAMIA) by University of NSW researchers add to the weight of published research on ePrescribing and eMedications management in the acute care setting.

Led by Joanna Westbrook, director of the Centre for Health Systems and Safety Research at UNSW’s Australian Institute of Health Innovation, the first paper, The safety of electronic prescribing: manifestations, mechanisms, and rates of system-related errors associated with two commercial systems in hospitals, builds on research published last year which showed that the introduction of commercial ePrescribing systems can reduce prescribing errors by up to 66 per cent.

That research found that while prescribing errors were reduced, new types of system or computer-related errors can occur. The new research looks at what exactly those new errors are, and how this research can be used by vendors to tweak their systems for better safety.

The other paper, Impact of an electronic medication management system on hospital doctors’ and nurses’ work, looks at the hotly debated issue of whether the introduction of computerised physician order entry (CPOE) can mean that clinicians spend more time on the computer and less time on patient care.

The research finds that there was little difference in time spent on patient care by doctors or nurses after the introduction of an eMM system, although that time seemed to be spent in different ways.

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Leecare PCEHR-compliant as aged care hooks up Aged care software vendor Leecare Solutions has been certified as PCEHRcompliant and granted production access to the national system.

Leecare Solutions CEO Caroline Lee said users of the most recent version of its Platinum 5.0 software can now access residents’ PCEHRs, upload documents and download any existing documents in the system.

Dr Lee said the company began installing the recent upgrade in client facilities recently and would soon begin trialling PCEHR access at RSL LifeCare in NSW. Kooweerup Regional Health Services in Victoria would follow soon after, she said.

“Medicare Locals for both of them have been really active in assisting with the process,” Dr Lee said. “Plans have already commenced for the improvement of assisted registration in aged care programs also. As the PCEHR is an opt in system for all Australians, registration and authority from each resident of an aged care facility is required to gain the benefits of a single shared health record.”

Dr Lee said the roll out of the PCEHR in aged care was a huge step for the system.

“People in aged care – they are the most vulnerable, they’re the ones we will need the information from quickest, and the information on the PCEHR will be the most valuable for them, particularly for transfers and discharges,” she said.

The creation of a transfer document has been discussed among members of NEHTA’s aged care software vendors panel but had not been approved as yet, she said.

“At the moment what is also being discussed to be included is assisted registration and the prescribing and dispensing records,” she said.

Medications view added to PCEHR as prescripions repository goes live Fred IT and Genie Solutions recetly uploaded the first records to the National Prescription and Dispense Repository (NPDR), with a new view of the repository added to both of the clinical software packages and to all consumer PCEHRs. A Genie user was able to create a script which was dispensed through Fred, with the information sent to the NPDR and subsequently viewed in the patient’s PCEHR, Fred IT’s general manager for enterprise solutions, David Freemantle, said.

“We have undertaken BVT – business verification testing – where a doctor using Genie created a script which was then dispensed in a Fred Dispense pharmacy,” he said. “These transactions were then viewed in the patient’s PCEHR and via the rendered view in Fred Dispense.

“We are in the process now of working through some final issues. But the NPDR is in production and we will soon commence deployment.”

A new Prescription and Dispense View has also been added to everyone’s PCEHR, a DoHA spokeswoman confirmed. “The new view will show in greater detail the medications that are

prescribed and dispensed to a person, including the brand and generic name, the dose of the medication and directions for consumption,” she said.

“The new prescribe and dispense information provided with the recent system upgrade is in addition to the pharmaceutical benefits scheme (PBS) medication information that may already be available in a patient’s eHealth record.

“This new feature will provide a better view of the medications that are prescribed and dispensed over time, and will support better clinical decision making.”

“For consumers as well as healthcare providers, this new feature will provide a better view of the medications that are prescribed and dispensed over time, and will support better clinical decision making.”

The spokeswoman said that while the new functions have been enabled with release 3 of the PCEHR, which went live in June,

“the benefits will be realised over time”.

Fred IT, Simple Aquarius and their partners in the MedView project are gradually rolling out the functionality to pharmacies and general practices involved in the trial. As most pharmacies have yet to register for the PCEHR system, it is expected to be some time before use becomes widespread.

Genie Solutions software developer Matthieu Kluj said users will see the new functionality in the PCEHR tab of the software, under the document list.

“You can choose ‘prescription and dispense view’ and you can enter a date or order the results by PBS item or drug name – there are different filtering options,” Mr Kluj said.

Only users of Genie’s Windows version can use the functionality at the moment, as the NPDR currently accepts only eRx as the electronic transfer of prescriptions (ETP) service, and eRx is only available on the Windows platform.

Mr Freemantle said his team was currently in the process of building a Mac client for eRx. Phillip Shepherd, CEO of the other player in the ETP market, MediSecure,

said he had been in negotiations with NEHTA and DoHA about connecting MedSecure to the NPDR. Mr Shepherd said he believed MediSecure could be contributing to the NPDR within eight weeks, but that was reliant on the negotiations.

Communicare users can also access the NPDR if

they are using version 13.1 or higher. Users can access the NPDR information through the View Medications button in the PCEHR window or from the Medication Summary tab in the clinical record.

The Prescription and Dispense View window will be displayed and allows users to filter by a specified

date range all prescription and dispense records that have been written to the patient’s PCEHR. Users can choose to group medications by prescription, brand name, generic name or PBS item number by selecting an option from the drop-down menu.

Users can also print out a prescription record.

Investment in IT can lead to improved resident care in aged care facilities IT consulting and integration firm IT Integrity recently picked up the top award as the IT company of the year at the 2013 Information Technology in Aged Care (ITAC) conference for its work with Queensland aged care facility Star Gardens.

Star Gardens is a small aged care facility located in Beaudesert, near Brisbane, but it has big plans. When CEO Nigel Faull joined the company in 2007, Star Gardens wanted to increase the number of beds from 53 to 78, and the number of staff from 85 to 110.

However, its financial situation was not in great shape. So in 2008, Star Gardens undertook a review of its strategic plan and organisational structure, and as part of that identified IT as one way of improving things. At the time, Mr Faull said, the only IT system

the facility used was its accounting package.

For Star Gardens, the plan was to invest in a number of technologies over three years, including full clinical documentation, medications management, communications and HR and payroll. In 2010, however, the facility’s budget was looking bleak. so rather than the planned three-year implementation, Mr Faull decided to implement it over 12 months, at an estimated cost of $400,000.

Working with IT Integrity Star Gardens installed a number of new systems, including iCareHealth’s clinical documentation and medication management systems; Vocera’s handsfree communication system which is integrated with a nurse call system; and Simavita’s incontinence management system.

It also installed a smart card-based staff ID and mobile log-in system, which allows users to log in once to a computer and use the swipe card to return to the screen they were working on if called away for nursing duties.

The local pharmacy is better integrated as iCare’s medication module can interact with the pharmacy’s system, and Star Gardens has also installed Medical Director so the facility can connect to local GPs. Since then, there have been some noticeable improvements, Mr Faull said, including better staff morale and recruitment.

For residents, the combination of IT and more motivated staff has seen improvements in resident behaviour and clinical indicators. “How do you put a dollar on that?” he said.

Govt to consider patient to GP telehealth on MBS The federal government has committed to considering an expansion of the Medicare Benefits Schedule for telehealth items this year, and has also promised to implement video consults for the after-hours GP Helpline and the Pregnancy, Birth and Baby Helpline.

As part of an update to its national digital economy strategy, the government said it plans to undertake a review this year to determine the costs and benefits of an expanded range of MBS telehealth items to include patients participating in videobased consultations with their GP. The RACGP recently called for GP to patient video conferences to be introduced to the MBS as an alternative to face-toface consultations in its pre-election statement, arguing that telehealth services are beneficial particularly for patients with chronic diseases who have difficulty seeing their GP due to transport, mobility and distance issues.

The RACGP argued it would be a costneutral exercise as it would be an alternative to in-person consults, not in addition to them.

The government’s strategy document states that DoHA and the Department of Veterans’ Affairs (DVA) will lead a review to determine the costs and benefits of expanding the range of MBS telehealth items to include GP to patient video consultations.

The government will also implement video consultations for the after-hours GP Helpline and the 24-hour Pregnancy, Birth and Baby Helpline in the second half of 2013. The baby helpline is run by Healthdirect Australia on behalf of DoHA, as is the after-hours GP Helpline, which is triaged by nurses. Healthdirect Australia is funded by the Commonwealth and the states and territories.

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Bits & Bytes

CSC wins national rollout contract for MedChart in NZ CSC has won a five-year contract worth $NZ17 million to roll out its medication management solution MedChart to all 20 District Health Boards (DHBs) across the country.

It has also won a second contract, valued at $NZ2.6 million over five years, for the implementation of its ePharmacy solution in New Zealand’s Midland region. CSC will implement a hosted version of its in-hospital dispensing software across six DHBs. The use of MedChart has been pioneered at Dunedin Hospital in the South Island, and is being rolled out throughout the Southern DHB. The NZ Ministry of Health has set a target of having an electronic medications management (eMM) system in place in every hospital by 2014.

The decision to award the contract to CSC was not unexpected, with NZ National Health IT Board director Graeme Osborne telling Pulse+IT last year that the board had endorsed MedChart as the national standard it was aiming for under its eMedicines program.

Sponsored jointly by the National Health IT Board and the Health Quality and Safety Commission, the eMedicines program aims to improve patient health through the use of eMM systems.

“This work supports our clinical colleagues in improving patient safety in the hospital environment,” Mr Osborne said. “It’s a priority for New Zealanders to have access to a list of their medicines wherever they are in the health journey.

CSC’s industry general manager for healthcare in the Asia-Pacific region, James Rice, said the implementation of eMM systems around the world had shown significant improvements in medication safety.

App for anxiety aims to relieve anxiousness on the go Melbourne-based clinical psychologist Mark Grant has developed a mobile app for people with stress anxiety that aims to help reduce levels of anxiety when they occur.

The Anxiety Release app is based on non-verbal bilateral stimulation, an element of Eye Movement Desensitisation and Reprocessing (EMDR), a therapy used for people with post-traumatic stress disorder.

Bilateral stimulation involves focusing on alternating visual and/ or auditory stimuli, and when paired with focused

attention, produces decreased physical and mental tension. This process seems to have not only a calming effect on anxious people but also triggers new learning pathways in the brain.

The experience of feeling better also often leads to long-term changes in the individual’s perception of their ability to control their anxiety, Mr Grant said.

Bilateral stimulation is a promising alternative to anxiolytics and common methods for managing prolonged anxiety, like mediation or cognitive behavioural therapy (CBT).

“What it is activating is the sensory part of your brain and it is deactivating the thinking part of your brain, which is the opposite of what CBT does,” Mr Grant said.

“When you are anxious about giving that public speech, your brain is flooded with negative thoughts and your heart is pumping.

“When you activate the app you are confronted with alternating white lights, set against a background of brain imagery. At the same time your brain is being stimulated by alternating tones, in time to the lights.

“What is happening is your brain is being flooded with sensory input but it is neutral sensory input ... your brain is more wired to pay attention to sensory input than it is to internal input.”

The app is not suitable for people with epilepsy, acquired brain injury or severe or complex forms of PTSD, but mainly at those people with prolonged anxiety who dislike taking medication or who find meditation or CBT tiresome and impractical.

“We know that over 50 per cent of sufferers never seek help,” Mr Grant said.

“Of those that do seek treatment, up to 50 per cent drop out prematurely. It’s

clear that anxiety sufferers need a tool to enable them to deal effectively with stress and anxiety where and when it is taking place.”

The app consists of five audio sessions, beginning with a brain training session which introduces users to the process of changing their feelings though brain stimulation. This is followed by three anxietymanagement sessions consisting of a blend of guided focused attention and bilateral stimulation.

The fifth and final session is a “safe place” exercise to help the large proportion of anxiety sufferers who have safety issues.

Mr Grant is also looking at whether bilateral

stimulation and EMDR can be helpful in managing pain, as it seems to change affect. “It changes not only people’s emotions and thoughts but also the feeling in the body,” he said.

Future releases of the app will allow users to consent to sending information back to Mr Grant for research purposes. “I want to collect some statistical data on people’s uses and responses to it and create some research to support the process,” he said.

The app is currently available for iOS users from the iTunes store and costs $4.99. Mr Grant is also working on an Android version, due for release in the next few months.

eRx to launch QR code scanning app for pharmacy eRx Script Exchange will launch its first smart phone app to connect consumers with its national eScripts network in October. The eRx Express app will allow consumers to scan and pre-order their medicines from their regular pharmacy or other pharmacy of choice.

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

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

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

“Our primary concern has been in ensuring that we provide this flexibility whilst also ensuring that this and any future apps integrate with and uphold the security and privacy standards of other pharmacy and health applications, including integrating with pharmacy dispensing systems,” Mr Naismith said.

Because the app will use individual QR codes which replicate the eRx barcode information on each script, script requests sent via eRx Express will integrate directly into the pharmacy dispensing system, with no re-keying of data.

The app also has the potential to improve dispensing workflow, Mr Naismith said.

“Innovations such as eRx Express also have real potential to help smooth out the peaks and troughs of the dispensing workload, distributing the dispensing workload across the day,” he said.

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Bits & Bytes

Flawed data overestimates GP-type patients in ED

Tele-Derm service for rural doctors receives future funding

The method used to calculate how many patients presenting to emergency departments may have been better off seeing a general practitioner consistently overestimates the proportion and should no longer be used for policy decisions, according to a new study.

The federal government has committed to ongoing funding for the muchloved and used Tele-Derm service, which was under threat recently after nine years in operation.

A team led by University of WA professor of emergency medicine and Fremantle Hospital ED physician Yusuf Nagree compared four methods for calculating low acuity or general practice-type patients who presented to ED.

A group of rural doctors who use the Tele-Derm dermatology service set up a petition to lobby the government to continue funding the service, which provides specialist advice and education on dermatology to rural GPs.

One method is used by the Australian Institute of Health and Welfare (AIHW), which evaluates ED attendees by looking at where ED staff placed them on the Australasian Triage Scale (ATS).

Professor Nagree and his team found that the AIHW method, which they say is relied upon by governments and other organisations to inform health policy decisions, overestimated general practice-type patient workload in EDs and should no longer be used to guide policy decisions.

They found that the other three methods all showed that 10 to 12 per cent of patients attending tertiary EDs might be GP-type patients. The AIHW method showed that GP-type patients accounted for about 25 per cent of attendances.

The study was based on three years’ worth of data on over 500,000 ED attendances at three tertiary hospitals in Perth, extracted from WA’s Emergency Department Information System (EDIS).

“While general practice-type patients may add to waiting room numbers, they do not cause ED overcrowding or ambulance diversion and have little effect on ED workload or waiting times,” the researchers found.

Established by the Australian College of Rural and Remote Medicine (ACRRM) and hosted on its Rural and Remote Medical Education Online (RRMEO) online learning platform, Tele-Derm uses store and forward technology to provide specialist advice from a Brisbane-based dermatologist, Jim Muir, usually within 24 hours.

It also has a large educational component, allowing rural GPs and registrars to read through case studies and submit their own cases for discussion, diagnosis and advice on follow-up treatment.

First established in 2004, potential threat to the service infuriated doctors.

Gerry Considine, a GP registrar based in the Adelaide Hills who has

used the service both as a medical student and registrar since 2009, said the service was invaluable to him.

“The beauty of it is that not only is it for GPs who want a bit of a hand with diagnosing something, but it’s also for students and registrars who are still learning to get some experience and to see what other experts are saying,” Dr Considine said.

“There’s no other specialty where you can get that feedback in that time. It’s so quick.

“The one thing I don’t see that the government can ignore is that it’s just so cost effective, more than faceto-face or video conference. The way that TeleDerm works is just amazing.”

“The one thing I don’t see that the government can ignore is that it’s just so cost effective, more than face-to-face or video conference,” Dr Considine said. “The way that Tele-Derm works is just amazing.”

Ewen McPhee, a GP based in Emerald in Queensland, said Tele-Derm is a very responsive service that is extremely valuable for patients.

“It is fascinating, very powerful and highly valued by rural doctors because it saves people so much money on travel,” Dr McPhee said.

“Jim Muir basically provides professional consulting services 24/7 via the internet. The process is just store and forward. You take photos, you put the history in and you send it off.

Sometimes within an hour Jim has got back to you.

“There is that aspect of it – store and forward consultations – but he’s got over 1000 different dermatological cases where you can read cases online.

It’s almost like an online encyclopaedia.”

Dr Muir, a consultant dermatologist at Mater Hospital in Brisbane who also has a private practice in the suburb of Carindale, generally does the consultation work in the early morning and later at night. “Because it’s store and forward, it doesn’t interfere with my face-toface job,” he said.

“If I was doing video consulting, I wouldn’t be able to do my face-to-face

job. You don’t need video conferencing – store and forward works better for dermatology.”

Tele-Derm was initially funded as part of the Medical Specialist Outreach Assistance Program, now known as the Rural Health Outreach Fund.

As it is difficult to recruit dermatologists to visit rural areas in person, ACRRM decided to develop a virtual program instead, Vicki Sheedy, ACRRM’s strategic programs manager for eHealth, said.

“Each year the funding has been extended, and we’ve delivered and they were happy,” Ms Sheedy said.

“Since then, two things have happened that have made us nervous. One is the fact that there is now an MBS telehealth item number, but store and forward is ineligible.

“Store and forward is much better for dermatology as long as the specialist can rely on the GP to take a proper history, to do the appropriate tests and procedures, including ordering pathology or doing a biopsy, and to do the follow-up, including relevant procedures, monitoring and prescribing.

“It’s almost like a virtual shared care arrangement.

It’s got that educational component, the upskilling component and

the specialist advice component. It’s a complete package.”

Dr Muir said he first became interested in remote consultations when he was working at the Royal Brisbane Hospital in 1992 and a doctor from north Queensland with a difficult case decided to send him photos in the post.

“If you do the maths, it’s a third of the price of MBS telehealth initiatives.”

“I knew what it was from the photo so I rang him up,” he said. “The patient had a thing called warfarin necrosis. Then when the internet came along people would send me photos in an email saying Jim, can you help me with this thing.”

He later provided a visiting service to rural Queensland, but saw the need to fill the gaps in the three months or so between visits.

“I thought that with the help of the internet, we should be able to provide a good service,” he said.

“There was no point in giving doctors advice if they couldn’t carry out that advice, so there is online education in how to use dermatological medicaments, how to do procedures like excisions

and biopsies and things like that. Then it has hundreds and hundreds of cases that they can do blinded, and they are all based on a Q&A. “They get a photo, they get a clinical history and they get questions like ‘describe what you can see, what is your differential diagnosis, what else would you like to know or tests to order’, and then they get the answers.

“Alternatively, they are all coded under their condition so if they see a case of seborrhoeic dermatitis or psoriasis and they want to look up similar cases, they just click on the diagnostic icon, and other cases they can look at will come up.

“And because they go into very detailed advice and treatment, I’m hoping they can adapt the treatment from that case to their own case.”

If the doctor has a particular case that needs specialist advice, they are able to log on to the website, upload photos and a clinical history, and a text message is sent to Dr Muir.

Telehealth at Royal Childrens Hospital is business as usual Melbourne’s Royal Children’s Hospital has devised a three-year roll-out plan for its telehealth service with the aim of making video consultations “business as usual” throughout the hospital.

RCH began offering telehealth services over 18 months ago, starting in neurology, respiratory, nephrology and allergy, and has since opened it up to a number of different medical disciplines.

Consultations can involve the patient’s GP or local paediatrician, or are conducted directly with the child in their own home.

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

RCH uses GoToMeeting and has set up a web page that patients simply need to click on to take part in the consultation.

Ms Jury said bookings for video consults were integrated within the normal hospital booking system and coordinated in the same way.

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

“I then look at it and send them out an answer, with turnaround in 95 per cent of cases within 24 hours,” he said.

“It can basically run from any room in the hospital,” Ms Jury said. “We don’t want people to use a special room because we want it to be part of the natural flow of the hospital.

Tele-Derm is free to ACRRM members and RRMEO subscribers, and to GPs working in defined rural and remote areas of Australia.

“If they are in their administrative offices they can do it there, or if they are in outpatients they can do it there. The moment we start making people change their normal work, that’s just another barrier.”

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Feature

THERE AND BACK AGAIN: A PCEHR TALE In 2010, the Australia government decided to take a road less travelled when it announced it would establish a national system for the sharing of health information by establishing a personally controlled electronic health record available to every citizen who wanted one. The timeline from concept to launch would be less than three years. One year after it went live, Pulse+IT traces the rocky road of the PCEHR.

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

The idea of an electronic health record that a number of different healthcare providers could access in consultation with their patients is certainly not a new one, but the idea of a national, personally controlled EHR for every Australian must have come as a surprise to the authors of the 2008 national eHealth strategy, upon which the PCEHR is thought by some to be based.

That is not necessarily correct, but the landmark eHealth strategy, commissioned from Deloitte by the new Rudd government in 2007, did discuss in some detail the potential for individual electronic health records (IEHRs), which Deloitte recommended be developed through a distributed approach with practical outcomes.

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.

a distributed manner across the health system. Vendors would have a clearly defined and stable set of national eHealth standards on which to base product development, the strategy stated.

It also floated the idea of a national consumer portal and a national clinical portal, along with the establishment of a “National E-Health entity” separate from but working with a national eHealth governing board and a national eHealth regulation function.

The Deloitte strategy stated that the first step in a journey towards building a national IEHR capability was “to connect care providers across the Australian health system so that they can effectively access and share consumer health information”.

The next step, it said, “should be to enable the flow of priority sets of information between care providers to provide a base of comprehensive and reliable information on which IEHRs can be built.”

The implementation of the eHealth strategy and its principal recommendations would probably take a decade and should be done in a gradual and incremental manner, the strategy said.

However, in 2009, the National Health and Hospitals Reform Commission (NHHRC), also set up by the Rudd government to investigate and make recommendations on a complete restructure of the healthcare sector, handed down yet another landmark report. In addition to such massive structural changes as the introduction of activity-based funding, the commission also recommended that the government pursue the introduction of a system of individual electronic health records.

Once this began to happen, secure repositories could then be developed in

The difference was, the NHHRC recommended it happen in a hurry, saying

“The Deloitte strategy stated that the first step in a journey towards building a national IEHR capability was ‘to connect care providers across the Australian health system so that they can effectively access and share consumer health information’.”

Kate McDonald

a national system should be in place by 2012. This the government took to heart, and despite quite furious debate within the industry and the wider health sector about whether the concept was even possible let alone probable, $466.7 million was set aside in the 2010 budget towards the development of what was now being called a personally controlled electronic health record (PCEHR).

The government then got to work deciding on what this new system would actually look like, releasing a draft concept of operations document in April 2011. Yet again, this set off furious debate, most notably concerning the opt-in rather than opt-out nature decided upon, as well as some very deep concerns, expressed in particular by the Australian Privacy Foundation, over the security of the system and its implications for privacy.

The draft concept of operations, known as the Con Ops, was opened up for public consultation in April, and a final version released in September, 2011. Perhaps the most extraordinary aspect of the whole affair was that the government insisted the system, which no other country had ever built and which was still pretty much an idea, must go live by the following July.

Foundation elements A number of the foundation elements that would be required to build the new system were already in train, so it was not like everything would need to be built from scratch within eight months.

In 2006, the Howard government and the state health ministers, through COAG, had commissioned NEHTA to begin developing specifications for what would be the most important foundational element – a national healthcare identifier service – legislation for which was introduced to Parliament and passed with bipartisan support in 2010.

The new Healthcare Identifiers (HI) Service began operating on July 1 of that year.

It allowed for the allocation of a 16-digit number – called an Individual Healthcare Identifier (IHI) – for every Australian, along with identifiers for healthcare providers (HPI-I) and the organisations they work for (HPI-Os). The responsibility for the operation of the HI Service was passed to the Department of Human Services (DHS).

NEHTA also worked on developing specifications for a National Authentication Service for Health (NASH), electronic transfer of prescriptions (ETP), and for the

architecture underlying clinical documents such as eDischarge summaries and eReferrals that would allow them to be read by both people and machines.

Some of these projects were failures – for example, IBM was drafted by NEHTA to build the NASH but ultimately failed to do so, with a solution eventually developed

by DHS – and the ETP specification, first devised in 2009, has still not made its way through the Standards Australia process four years later. Some projects were successful, such as the implementation of the HL7 clinical document architecture (CDA) standard for healthcare information.

The secure messaging industry also worked together to develop a secure message delivery (SMD) standard to facilitate information flow.

As to the information to be included within the PCEHR itself, how it would be rolled out to consumers, healthcare professionals, private industry and state health jurisdictions, and what could potentially be included in future, this was all to be tested through specific implementation sites, held in two waves.

Wave 1 involved three general practicebased sites in Melbourne, Brisbane and the NSW Hunter Valley, with each funded as part of a $14.8 million package that also involved a number of software companies.

These sites were responsible for testing a number of elements in the field, including the development of GP clinical software capable of recording IHIs, the secure sending and receipt of documents such as referrals, specialist letters and discharge summaries, and also for developing strategies for consumer and practitioner engagement.

The second wave of sites was announced in March 2011 and involved nine different consortia looking at a range of eHealth initiatives, from the development of a consolidated medications view through the MedView project to implementing an

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“In February 2011, NEHTA announced it had put together a panel of general practice software vendors that would begin the work of integrating new specifications and developing an interface to the PCEHR system.”

could be ready for a consumer launch on July 1, 2012, without anything having been built.

Kate McDonald

The glitch was resolved in February, but not before setting off a storm of controversy at that month’s Senate hearings into the government’s proposed legislation to enact the PCEHR.

electronic Blue Book in Greater Western Sydney and an advance care directives repository in the Cradle Coast region of Tasmania.

In February 2011, NEHTA announced it had put together a panel of general practice software vendors that would begin the work of integrating new specifications and developing an interface to the PCEHR system. The primary care sector was rightly chosen as the most important sphere for getting the system off the ground, with acute care, aged care, pathology and diagnostics, community pharmacy and allied health to follow.

National infrastructure In August 2011, a consortium led by Accenture was announced as the national infrastructure partner which would build the new system. The consortium, also including Orion Health and Oracle, would build new portals through which consumers could view their information, control access to it and enter their own notes.

It would also build a portal to allow healthcare providers to view and update a patient’s record, develop an audit trail to show when and by whom a person’s record was accessed, and provide a reporting capability for critical information about the PCEHR system itself, including performance and usage.

However, the release of the final Con Ops a month later not only set off more debate amongst consumer and privacy groups, and especially within the eHealth sector itself. The Medical Software Industry Association (MSIA), for example, was pretty scathing in its response to the draft Con Ops, ridiculing the idea that the industry

The Australian Medical Association (AMA) sincerely doubted many clinicians would have anything to do with the system as it stood, a view it continued to iterate through most of 2011 and 2012, while the RACGP shared its concerns over medico-legal liability and the burden the system would place on practitioners at the coal face.

Concerns over what many considered the rushed nature of the implementation were emphasised in early January 2012, when NEHTA called its infamous “pause” in the implementation of specifications in GP software, issuing a statement saying internal checks had detected issues in the version of its specifications released the previous November.

The MSIA called for a 12-month delay before the system was rolled out, while medical, consumer and privacy groups continued to voice a range of concerns.

However, the legislation enabling the PCEHR made its way through Parliament – again with bipartisan support – in June 2012, less than two weeks before the planned launch. Consumers would be able to register for a PCEHR on July 1, by phone, mail or attending a Medicare office. Notably for an eHealth record, there was no facility in place on the launch date to register online.

In addition, there would not actually be anything in the record when it was created, and planned promotional activities involving the Minister for Health signing up for a record on the first day had to be called off, but the deadline was set and, with a few wobbles, met.

Go live While the evidence is anecdotal, the actual first day of the new system going live – July 2, in reality, as July 1 was a Sunday – was an interesting experience for some. Pulse+IT tried to register by phone at nine o’clock in the morning, but the hotline remained engaged until very late in the afternoon. When we did manage to make contact, we were put on hold for 10 minutes before being disconnected.

We tried the next day, but again had no luck, so despite no official announcement that online registration was available, we tried anyway, and succeeded. In the first week of operation of the new national system, 803 people were able to register.

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“Online registration proved to be a difficult task, with the stringent security and identity validation measures put in place proving a barrier.”

Kate McDonald

Online registration proved to be a difficult task, with the stringent security and identity validation measures put in place proving a barrier. There was a great deal of embarrassment over the revelation by Medical Observer reporter Mark O’Brien that people with an apostrophe or hyphen in their surnames were unable to sign up at all, and the difficulties and slow uptake were only really resolved the following year, when a form of assisted registration was introduced.

the other major player in the market, Best Practice, until April 2013, just before the deadline.

Meanwhile, healthcare providers still had no access to the system until later in August, when the provider portal went live. They still couldn’t upload any documents as the GP software vendors were still working on integrating the PCEHR into their systems, but when the migration of information from the MBS, PBS, organ donor register and childhood vaccination records began in late August, the Department of Health and Ageing felt confident enough to announce that “the complete national infrastructure for PCEHR has now been implemented”.

However, two initiatives have worked to boost numbers and awareness, such that registrations reached the half-way mark of the target of 500,000 consumers in late May. Those initiatives were the general practice eHealth Practice Incentives Program (ePIP), and the release of an assisted registration tool (ART).

Software vendors were still struggling to get their clinical software ready for the PCEHR, so two add-on tools that could provide an interface between clinical software and the national system were released, one by Health Industry Exchange with its HIE Companion and one by Pen Computer Systems through its PrimaryCareSidebar.

The first clinical document was uploaded to the PCEHR in early September using the HIE Companion in conjunction with Best Practice software by Brisbane GP Suzanne Williams. It wasn’t until the following month that the first document was uploaded directly from within clinical software, this time by Bernard Shiu using Zedmed, the first of the GP vendor panel members to release PCEHR-compliant software.

Genie Solutions followed shortly afterwards, but it wasn’t until Health Communication Network released its PCEHR-compliant version of Medical Director in January 2013 that a critical mass of GP users were able to have full of use the system. It would take

This meant that registrations for the system remained low, with little consumer marketing undertaken. That in turn caused immense pressure on both the government and the Department of Health and Ageing to justify the system, which so few people seemed to be using.

ePIP and ART Health Minister Tanya Plibersek first gave a hint that the new requirements for the ePIP, to come into effect in February 2013, would be far more stringent than in the past when she released brief details of the requirements as part of the May 2012 federal budget.

It became clear that general practices would have to use software that could access the HI Service and retrieve IHIs, use clinical coding of diagnosis, have secure messaging and electronic transfer of prescriptions capability, and have an interface to upload and download documents from the PCEHR. These requirements were initially due to be met by February 2012, but under pressure from the medical associations and software vendors – some of whom doubted their systems would be PCEHRcompliant by then – the final requirement for PCEHR access was pushed back to May. Meanwhile, the software vendors themselves were understandably angry when told that ETP capability would be required of their systems, and then would not, and then would be again. Doctors

themselves were understandably angry when Ms Plibersek remained resolute in her opposition to any sort of extra payment for the time taken to curate a record for patients. She later relented and agreed that GPs could claim the longer C-level consultation item for working on a record.

The release of the assisted registration tool (ART) in February 2013 was a welcome development. As “known customers” of a practice or healthcare organisation, it made far more sense for patients to be introduced to the PCEHR and registered at the point of care.

The difficulties of registration for the system, for consumers, healthcare organisations and practitioners alike, have been an ongoing drama this year. Medicare Locals have been drafted in to help practices with their paperwork, but complaints about the onerous nature of the application forms, the different security certificates and the lack of easily digestible information on how to register in the first place are continuing today.

Since the ART’s release, registrations have improved immeasurably, helped by teams of Medicare Local and Aspen Medical staff who have been deployed in recent months to approach patients in a range of settings, both clinical and public.

Anecdotal evidence pointing to a backlog of application forms being processed by Medicare in the lead up to the first ePIP deadline of February 1 was rejected by DHS, which said applications were being processed as received.

Assisted registration is now being integrated into clinical software, a method pioneered by Emerging Systems at St Vincent’s Hospital in Sydney, where it has been used since before Christmas. St Vincent’s, a lead participant in one of the Wave 2 trials, has been able to access the PCEHR since last year, and has since begun uploading discharge summaries to patients’ PCEHRs as well as sending them to their GP.

australia’s premier e-health conference

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hisa.org.au/hic2013

Ministerial address, 9.30am Wednesday 17 July 2013 HIC2013_PulseIT_halfpage_JUNE.indd 1

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“Release three of the PCEHR contained new functionality, including a section for parents to add their child’s development milestones and measurements...”

Kate McDonald

New functionality Release three of the PCEHR in May this year contained some new functionality, including a section for parents to add their child’s development milestones and measurements, which has since been joined by a mobile app allowing parents direct access to their child’s PCEHR on their phones.

There is also a new prescription and dispense view, which when fully rolled out will allow consumers to see a consolidated view of their prescriptions and the accompanying instructions. This is different from the PBS information that was loaded last year, and is one of the biggest selling points for the system, particularly for the aged and chronically ill who have trouble remember all of the meds they are on.

Both of these new functions were developed directly from the Wave 2 projects: the child development section and app designed and tested by the Greater Western Sydney site, and the prescription and dispense view by the MedView project, which has since morphed into the National Prescriptions and Dispense Repository (NPDR). This is set to draw in a wider range of healthcare organisations and practitioners, such as hospital and community pharmacists.

The Cradle Coast site in Tasmania, which developed a clinical repository for advance care directives, has also been involved in working out how to use the PCEHR to link up primary care with aged care and acute care.

At present, the name of the custodian of a person’s advance care directive can be added to the PCEHR, and while Ms Plibersek announced to great fanfare in May that the government had

awarded $20 million to the project to develop a way of uploading actual advance care directive documents to the PCEHR, the method by which this will be done is still uncertain.

Players and stayers As the one year anniversary of the launch of the PCEHR approaches, it is timely to take a look at where the various players – including consumers, healthcare practitioners, the organisations they work for and the software developers – are now situated.

Almost all of the software companies that offer clinical information systems to the primary care sector are PCEHRcompliant, including the big two of Medical Director and Best Practice, the smaller players such as practiX, Genie, Zedmed, Medtech Global and Monet, along with more specialist companies like Stat Health, Intrahealth, HTR Telhealth and Abaki.

Communicare, which is widely used in Aboriginal health and community care, has been at the forefront of integrating the new standards and specifications as a member of NEHTA’s GP desktop software vendors panel, and has had almost all of its requirements in place since last year.

Aged care has been the next target, with an aged care-specific vendors panel established in June last year. The aged care software sector has not had the incentive – or threat – of an ePIP hanging over its head, but it has also made progress. The panel – which includes market leaders iCareHealth, Autumncare, Leecare and DCA, along with WA-based EOS Technologies – has been working on implementing the specifications and capabilities within their products. Leecare announced in June that its Platinum 5.0 system was PCEHR-compliant.

Pharmacy has been a more difficult road to travel. NEHTA has attempted to set up a pharmacy software vendors panel but it only contains two companies – market leader Fred IT and Simple Retail, which makes the Aquarius dispensing software. These two companies have worked with acute care pharmacy software vendors Pharmhos and Core Medical Solutions, which market the Merlin and BOSSnet hospital pharmacy systems respectively, in the MedView/NPDR project and both are now able to access the NPDR and the PCEHR. However, other players, such as the Symbion-owned Minfos, which is used in many Chemmart and Terry White chemists, is understood to have decided not to take part in the PCEHR at this stage.

Acute care is even more difficult. Emerging Systems and CSC, through its i.PM patient administration system, are the only two acute care specialists that are able to interface to the PCEHR at present. However, NEHTA and DoHA are currently undertaking

a big push to allow discharge summaries to be uploaded to the PCEHR throughout the country this year, with Tasmania the first expected to come online as a whole. Pulse+IT is currently investigating progress on a state-by-state basis, and will publish an overview in a future issue of the magazine.

The vast allied health sector and many community nursing organisations have yet to become involved, and the private pathology sector is still in a stalemate with DoHA about funding for its involvement.

Numbers game As of mid-June, over 250,000 consumers had registered for a PCEHR, and a consumer marketing campaign involving TV advertisements began to be aired. The number of healthcare organisations registered for an HPI-O had reached 3636, with 4319 practitioners were authorised to access the system, the majority of them GPs. 1928 shared health summaries had been uploaded, along with 446 discharge summaries.

The total cost of the system to date is roughly $700 million, although ongoing funds for the operation of the PCEHR and its wider roll out will be required in the future. Funding has been allocated to keep the system operational, and NEHTA in business, until June 30, 2014. Beyond that, the situation is unclear. With the Gillard government expected to be unseated in the September federal election, it remains to be see what if anything an Abbott

government will do with the PCEHR. It is highly unlikely it will be discarded, but what changes a conservative government will make is unclear.

The opposition spokesman on primary care and eHealth, Andrew Southcott, told Pulse+IT earlier this year that his colleagues planned to do a “stocktake” on the PCEHR to determine its level of functionality and what if anything should be done to improve it in future.

Dr Southcott said that while the Coalition agrees with eHealth in principle and voted to support the passage of the IHI legislation and the PCEHR, it would wait until after the election to consider any changes, if necessary. “[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.”

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PCEHR: WHY IS IT ALL SO HARD? The introduction of a new IT system always comes with its glitches and frustrations, but when it comes to a massive infrastructure project like the PCEHR – being built and rolled out under the harsh glare of an extraordinarily polarised body politic and beady eyes of the media – those glitches and frustrations are often magnified. While the consumer registration process has improved, the frustrations of clinicians and practice managers have not abated.

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

While there are no hard numbers available, there are plenty of people in the healthcare industry who are committed to trying to ensure the PCEHR is a success and that it will bring the promised benefits of increased information sharing, better patient engagement with their healthcare and ultimately better patient care overall.

One of the prime demographic groups being targeted for early uptake of the PCEHR are Aboriginal and Torres Strait Islander people. There is no need to detail to a healthcare audience the appalling facts of indigenous disadvantage in health and wellbeing, infant mortality, chronic illness and lack of access to care.

The PCEHR cannot in itself do much to change those facts in the short term, but some of the obvious benefits to indigenous people are the promise of a mobile health record that can be accessed by numerous healthcare providers, easily obtainable and up to date list of medications, and better dialogue between healthcare providers over the individual’s care.

So it makes sense that numerous Aboriginal healthcare organisations are keen to take part in the PCEHR, hoping it will mirror such examples as the Northern Territory’s My eHealth Record and the University of WA’s project in the Kimberley.

Sarah Ahmed, the eHealth program manager for the Aboriginal Health Council of South Australia (AHCSA), is co-ordinating the roll out of the PCEHR to the clinics serving Aboriginal people in the state. Dr Ahmed helped to steer AHCSA’s involvement in the NT Department of Health-led Wave 2 project, and has since been overseeing the change to the national system.

“Aboriginal people absolutely get the benefit of eHealth,” Dr Ahmed says. “It is so obvious. They all travel, they all have family and they have multiple health issues and they struggle to remember and keep track of them.”

As part of the Wave 2 project, Aboriginal AHCSA staff visited consumers in rural and remote areas of the state to talk about electronic health records and how they could improve healthcare provision.

“They’d go out and sit down and start talking about how there is this thing called a My eHealth Record, and it means that you don’t have to keep repeating your information and remembering details about your health when you travel, and at that point most people would stop them and ask to where to sign,” Dr Ahmed said.

This is an experience also shared amongst Aboriginal people in a different setting.

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“Aboriginal people absolutely get the benefit of eHealth. It is so obvious. They all travel, they all have family and they have multiple health issues and they struggle to remember and keep track of them.”

Sarah Ahmed

Julie Tongs is the CEO of the Winnunga Nimmityjah Aboriginal Health Service in Canberra, and while many would think residents of the national capital would have good access to healthcare, that is not necessarily so.

“People don’t understand that while we are here in Canberra, we have a lot of challenges,” Ms Tongs says. “They might be different challenges, but the profile of people’s health is much the same.”

Ms Tongs is a great fan of the concept of the PCEHR and her health service has been involved from the start. All of the members of the board have signed up for their own record, and her staff have been active in applying to register for a HPI-O and HPI-Is for the services healthcare workers, which include GPs, nurses, Aboriginal health workers and midwives.

Queensland’s Stamford Valley. Mr Moloney’s practice was one of the first in the country to be fully signed up and actually using the PCEHR system last year, but even for a person with patience and an IT background, the rigmarole of the registration process was incredibly frustrating.

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

He 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.

“Because the majority of our clients are vulnerable, I believe it is really important for us to be able to the sign up into the PCEHR,” Ms Tongs says. “A lot of clients are mobile and we have homeless clients – we have a big mix of clients. It’s important because these are the clients who will end up accessing an emergency department or another service.

Actually uploading a document to the PCEHR itself was easy and took no time at all, he says, allaying one of the fears of general practitioners that the process would take too long in a consultation. It wasn’t the upload itself – it was the horror stretch trying to get there.

“We’ve had incidents where people have come down from the Northern Territory and they haven’t bought their medication. You are ringing around trying to find out but the clinic is closed, so ... it is so important for our people to know and understand this.”

This is echoed by Thinus van Rensberg, a Canberra-based GP with a long interest in IT. He is reluctantly taking part in the PCEHR – he remains deeply sceptical of its worth, but is taking part to be able to see what the practical implications of the system are.

Mind-boggling bureaucracy

Dr van Rensberg has given vent to his frustrations about the bureaucracy in several forums, and has written scathing letters to the eHealth Team at the Department of Human Services (DHS) detailing what seems like remarkable incompetence on the part of the people who are supposed to be helping practices with the system. He talks of long delays between applying for and receiving his NASH certificate, the lack of knowledge of the staff on the PCEHR helpdesk, of sending 30-page forms by fax only to have

While the promised benefits are obvious, one of the major drawbacks of taking part in the system is, as one GP put it, the “mind-boggling” bureaucracy that participants must go through to register. This is a complaint heard time and again by Pulse+IT over the last year or so, beginning with a series of frank comments from Luke Moloney, then the IT manager for a general practice in

them rejected because one was out of order, of being informed his paperwork seems to have been misplaced, and of what he says are a constant stream of shifting goalposts and changes, all of which have been confirmed by his software vendors and his Medicare Local.

AHCSA’s Dr Ahmed agrees. She says the process of applying to take part in the system has been fraught with difficulty, and it’s not just the usual challenge of remoteness that has caused most of these problems.

“I would have to say remoteness is the least important difficulty,” Dr Ahmed says. “The largest obstacle has been confusion about processes because of all the different bodies that need to be involved.

“The HI Service, the PCEHR branch, the PKI eHealth business branch in DHS – they don’t really understand that little health services do not have people dedicated to doing this, and the amount of phone calls, cross communication, paperwork and follow-up that needs to be done from the health service end is phenomenal.

“The people doing the PCEHR stuff are also doing the clinical work in a health service. So, given a choice between a sick and screaming child or being on the phone to Medicare’s eHealth division…”

This has been Winnunga’s experience as well. When Pulse+IT reported on the experience of one of AHCSA’s clinics, Pangula Mannamurna Health Service in Mt Gambier, Winnunga’s IT expert contacted us to say she too had gone through the same drama.

“It has been challenging, but our clients are challenging too,” her CEO, Ms Tongs, says. “We are used to challenges here.”

Teething problems There seems to be no doubt that assisted registration has very much helped to sign up consumers and reduce the paperwork for those practice – and some hospitals – that are involved in recruiting patients, but for the practices themselves, there doesn’t seem to be much light on the horizon.

Even the software vendors have voiced frustration. Most who are involved in one of NEHTA’s panels are reluctant to talk on the record, but some have spoken up.

Communicare explained on its website that there had been much confusion last year over whether clinical software would have to be able to use electronic transfer of prescriptions (ETP), with the

vendors being told no and then months later it was back on their list of work.

Allan Turner, CEO of aged care software vendor EOS Technologies, said in April that there seemed to be a standard 10-week wait for an HPI-O, and that his company had not been issued with its HPI-O 13 weeks after that initial 10-week period.

Pulse+IT has written about a backlog in processing of HPI-O registrations and of NASH certificates, based on the anecdotal evidence we have received both on and off the record, but the Department of Human Services has rejected this accusation.

“There is no backlog in the processing of HPI-O registrations, and claims of a “standard 10 week wait” are incorrect,” a DHS spokesperson told us. “Applications are processed in date order as received. As at 19 April there were over 5600 HPI-Os registered in the HI Service.

“As at 19 April, there were only 275 HPI-O applications on hand, of which 107 are incomplete and the organisations have been followed up at least once by a Customer Service Officer seeking the relevant information. The remaining 168 applications are currently being assessed and processed.”

The spokeswoman said that since January 2013, the HI Service had received on average 800 HPI-O applications per month.

“Whilst we can’t discuss individual applications for privacy reasons claims can generally be processed quickly if organisations provide a complete application with all required information and documentation. Where an incomplete application is provided, a Customer Service Officer must then contact the organisation concerned for the missing information, which increases the time taken to finalise the claim.

“If the organisation does not provide the information the Department makes a second call and if information is not sent after a second call a letter is sent to the organisation. Once the claim has been finalised, organisations are informed of the result in writing.”

Despite the teething problems, many people remain committed to the process, saying the end result will be worth it. “Regardless of what happens, eHealth is here to stay,” Ms Tongs said. “We talk about cost savings; how much will this save? What about the intensive resources that you use trying to track down somebody’s medical history?

“It’s when you get to the acute end of the system, that is where this stuff really kicks in.”

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PERSONAL STORIES IN

THE JOURNEY TO PERSONALISED MEDICINE Most who attended would agree that the highlight of last year’s Health Informatics Conference (HIC) was Regina Holliday, the US artist who gave a keynote speech on her personal story of her family’s interaction with the healthcare system, and how it led to her becoming an advocate for patients and for health IT. This year, two IT specialists will recount their experiences with a cancer diagnosis and how they using IT on their own patient journeys.

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

Patient perspectives about their interaction with the healthcare system are abundant these days due to the numerous blogs and online support groups available, but of increasing interest is patient perspectives about their interaction with their healthcare information.

Department of Health and Ageing Diabetes Care Project. It is designed to work for any chronic disease, and is being offered to general practices, primary care networks and Medicare Locals to improve team care for chronic disease.

One reason why Ms Holliday’s presentation at HIC 2012 resonated so strongly was the emphasis it placed on patient access to their information and how empowering it can be. At this year’s HIC, being held in Adelaide in July, the personal experiences of IT specialists themselves will be told.

While it has been used to create care plans for women with breast cancer, there has not been a cancer-specific plan developed before. Mr Hilton, however, is changing all of that by developing a cthe cureare plan in association with his medical and allied health team as he goes through treatment for cancer himself.

Jon Hilton, well-known in the local health IT community as HISA’s vice president and in his day job as programs manager at Precedence Health Care, will bring a very personal view to how Precedence’s cdmNet chronic disease management system is being used.

In January this year, Mr Hilton had exploratory surgery that found a growth between his bile duct and gall bladder. The growth was cancerous, but an operation to remove it and the affected organs was unsuccessful, so he is now on a six-month course of chemotherapy.

cdmNet is a GP-led software system designed to facilitate the team care arrangements required for patients with chronic illnesses, and which also allows patients to participate fully in the management of their own care.

He has created a diary of the treatment on his personal blog, but has also been successful in getting his GP, oncologist, and surgeon to use cdmNet and add clinical notes to his own care plan.

It was recently validated in a Victorian trial for type 2 diabetes, and is providing the care coordination and IT support for the

“I’m off to see a exercise physiologist so I’m hoping to get them into the picture, and I’ve been talking to my pharmacist,” Mr Hilton says. “It’s just a matter of

“We need to pay attention to some of the more mundane but fundamental issues around how we administer healthcare and how we make it more effective.”

Jon Hilton

getting the time to sit down with them and go through it. Everybody’s keen and it’s working well.”

On his blog, he writes that cdmNet is working very well – “the oncologist has put in a note, which impressed the practice nurse and GP no end”.

“So far I have a good collection of input from myself (of course) the GP, practice nurse, surgeon, oncologist and dentist.

I have a good relationship with the pharmacist, so they will be next.”

He also writes about how the experience is showing that Precedence and Medicare Locals will need to ensure that all clinicians who come to use the system, particularly allied health professionals, will need to be fully engaged to get the most out of it.

Oncology patient journey While not many people have used cdmNet for cancer before, it is flexible enough to allow GPs to create their own plans, which is what Mr Hilton has done for his care.

“What I did was sit down and look at my case, and tried to keep it general,” he said.

“Given that I was in a unique position here, I have enough knowledge about cdmNet to understand how to make a plan so that it could be generalised.

“So that’s what I did – I took the opportunity to build a plan that I thought could be generalised, ran that by the oncologist, who understood it and agreed that it was reasonable. I’m now in the process of engaging with the RACGP to put a working group together to assist with the clinical governance of these plans.”

This is what Mr Hilton will be discussing in his presentation at HIC as part of the oncology patient journey stream being held on Wednesday, July 17. “There are roughly three parts to my story: in hospital, being discharged from hospital and a bit of bouncing backwards and forwards, and living in primary care managing my condition,” he says.

“I’ll be telling a story that goes through those three elements with a major focus

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“I see a cure as a dynamic process, in which multiple doctors, professionals, artists, scientists and others join as a society – to converse, support each other, be open to various contributions and shape solutions that merge humanity, technology, technique, philosophy and art.”

Salvatore Iaconesi

on the primary care stuff. I’ll be using screenshots from my care plan – I have no privacy concerns here and I don’t care who knows what about me.”

What he also wants to get across to the audience is his view that the real wins in health IT are to be gained from cleaning up administrative processes to make it easier to administer healthcare.

“While telemedicine and video and wonderful high-tech stuff are necessary and important and useful, we still need to pay attention to some of the more mundane but fundamental issues around how we administer healthcare and how we make it more effective,” he says. “That’s what cdmNet is squarely aimed at.”

Cracking the cure Another personal story will be told by Salvatore Iaconesi, an interaction designer, engineer and artist from Rome who will talk via video about his experience with a cancer diagnosis and how he managed to hack his own medical records.

Mr Iaconesi was diagnosed with a brain tumour last year. He asked to get a digital copy of his medical records so he could show them to other doctors, but as some were written using Windows software – he is a Linux and OSX user – and his MRI scans were stored as DICOM files, he was

unable to open the records or share them with anyone else.

researchers who offered information and support.

“Sadly they were in a closed, proprietary format and, thus, I could not open them using my computer, or send them in this format to all the people who could have saved my life,” he writes.

“The geneticist and TED fellow Jimmy Lin has offered to sequence the genome of my tumor after surgery – in an opensource platform, of course. And the Italian parliament has been debating a motion to make all patients’ medical records more open and accessible, which would be amazing progress in my country.”

So he cracked them. Mr Iaconesi has since designed an open source reader for DICOM images that is free to download and use, and he has also published all of the information on his website.

“I opened them and converted the contents into open formats, so that I could share them with everyone ... I have been able to share the data about my health condition (about my brain cancer) with 3 doctors. 2 of them already replied.

“I have been able to do it because the data used open, accessible formats: they have been able to open the files using their computers, their tablets.”

As he said in a TED talk earlier this year, the response to his project was incredible.

“More than 200,000 people have visited the site and many have provided videos, poems, medical opinions, suggestions of alternative cures or lifestyles, personal stories of success or, sadly, failures – and simply the statement, “I am here.” Among them were more than 90 doctors and

Mr Iaconesi has since had surgery and the tumour was removed, but he has not forgotten what it felt like to be diagnosed in the first place. “Being “diseased” is like a state of suspended life,” he said.

“When you are declared “diseased,” you become a set of medical records, therapy, dosages, exam dates. It’s as if you disappear, replaced by your disease.

“I see a cure as a dynamic process, in which multiple doctors, professionals, artists, scientists and others join as a society – to converse, support each other, be open to various contributions and shape solutions that merge humanity, technology, technique, philosophy and art.”

HIC 2013 will be held at the Adelaide Convention Centre from July 15 to 18. The primary theme is ‘Digital Health Service Delivery – The Future Is Now’. For more information, see www.hisa.org.au

Advantech

3M Health Information Systems P: 1800 029 706 F: +61 2 9498 9375 E: tjconnell@mmm.com W: www.3M.com.au/HIS 3M Health Information Systems is a leading provider of software solutions to help healthcare organisations capture, classify, and utilise data — accurately and efficiently.

With more than 28 years of experience in health information management, 3M offers integrated solutions for: • Coding, Grouping and Reimbursement • Document Management and Scanned Medical Records, providing: ◊ Access anytime to complete patient history ◊ Intuitive, customisable document viewing ◊ Automated worklists ◊ Electronic signature • Dictation and Transcription, providing: ◊ Reduced dictation time ◊ Increased accuracy ◊ Lower transcription turn‑around‑time ◊ Seamless integration with PAS and EHR systems

ACIVA E: secretary@aciva.org.au W: www.aciva.org.au The Aged Care IT Vendors Association (ACIVA) was formed in early 2010, a not-for-profit organisation, incorporated in NSW. ACIVA represents the residential aged and community care sectors and vendors at various national forums regarding strategic developments and eHealth. ACIVA members are residential aged and community care software vendors, industry benchmarking software, financial software, call-bell, hardware, networking, infrastructure and industry partners.

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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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Best Practice P: +61 7 4155 8888 F: +61 7 4153 2093 E: sales@bpsoftware.com.au W: www.bpsoftware.com.au Best Practice sets the standard for GP clinical software in Australia offering a flexible suite of products designed for the busy GP practice, including: • Best Practice Clinical (“drop-in” replacement for MD) • Integrated Best Practice (Clinical/ Management) • Best Practice Automatic SMS reminders Visit us at the following conferences throughout the year: • • • • •

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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.

The Australian Association of Practice Managers: • Represents practice managers and the profession of practice management throughout the healthcare industry.

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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.

Argus is the messaging solution chosen by many Medicare Locals through the ARGUS AFFINITY program delivering eHealth strategies across Australia. With over 17,000 users Argus continues to grow in popularity by delivering highly secure messages, a reliable product, backed by outstanding customer service all at the lowest cost possible.

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

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

• See cdm.net.au/evidence

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CONNECT DIRECT Pty Ltd

Cerner Corporation Pty Limited P: +61 2 9900 4800 F: +61 2 9900 4990 E: AsiaPacific@cerner.com W: www.cerner.com.au Cerner is one of the leading global suppliers of health care information technology solutions. Cerner’s mission is to contribute to the systematic improvement of health care delivery and the health of communities.

Our vision of proactive health care management drives innovation in the development of effective solutions for today’s health care challenges, while creating a foundation for tomorrow’s health populations. Working with more than 4000 clients worldwide, Cerner is solving health care’s many challenges making sure the right people have the right information at the right time.

Our innovative leadership is allowing us to push boundaries by: • Leveraging clinical and pharmaceutical data in Condition Management and Personalised Medicine • Connecting the community with personal and community health records

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Clintel provides systems to Specialist and Day Surgeries nationally. Powerful, highly configurable and easy to use, our systems mirror the needs and workflow of your practice and individual specialty.

Our industry standard SQL database enables a true “paperless” practice.

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

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

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P: 1300 557 550 / +61 7 5478 5510 F: +61 7 5478 5520 E: support@directcontrol.com.au W: www.directcontrol.com.au Direct CONTROL is an affordable, intuitive and educational Practice Management System for providers of all disciplines with seamless integration with Outlook, MYOB or QuickBooks and Medicare Online.

The Clinical Module manages Episodes of Care including State, Federal and Health Fund Statistical Reporting for Day Surgeries/Hospitals.

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• Streamline your workflow.

• 3000 current users.

• Several research projects based on DCP. • Try it today.

EpiSoft Cutting Edge Software P: 1300 237 638 E: enquiries@cesoft.com.au W: www.cesoft.com.au Cutting Edge produces affordable, intuitive billing solutions for Mac, Windows, Linux and iPad. Cutting Edge is ideal for practitioners who prefer to maintain control of their own billing from a number of sites.

Cutting Edge Software is approved by Medicare Australia to manage your electronic: • Verification of Medicare and Fund membership • Bulk Bill and Medicare claims • DVA paperless claims • Inpatient claims to Health Funds

P: +61 2 8985 6688 / 1300 799 904 E: enquiries@episoft.com.au W: www.episoft.com.au EpiSoft’s web based platforms deliver dual purpose systems that work as comprehensive clinical and practice management platforms together with clinical trials software facilitating multi-centre investigator initiated trials. EpiSoft has developed platforms for: • Mental Health • Cancer management & surveillance • Inflammatory Bowel Disease • Hepatitis • Indigenous chronic disease management • Asthma shared care • Specialised surgery • Pre-admissions patient portal

We have solutions tailor-made for: • Anaesthetists • Surgeons/Surgical Assistants • Physicians • GPs • Allied Health

Affordable and scalable, EpiSoft is used in health organisations ranging from small clinics to large hospital groups across Australia, New Zealand and Singapore.

The software comes with up-to-date schedules for MBS/Rebate, Gap Cover (all registered health funds), Workers’ Compensation, Transport Accident authorities and DVA.

Create multidisciplinary teams, collaborate effortlessly and streamline workflows with our intuitive cloud software. With the highest level of security, redundancy and reliability your data will be accessible anytime and anywhere.

Emerging Systems P: +61 2 8853 4700 F: +61 2 9659 9366 E: sales@emerging.com.au W: www.emerging.com.au/ehealth Emerging Systems EHS web-based Clinical Information System records the clinical care delivered to a patient from pre-admission through to discharge. EHS interfaces with the hospital’s PAS system, capturing and providing all of the information Clinicians require during a patient stay to support the delivery of effective, appropriate, quality care outcomes in a secure and auditable environment.

Information is displayed in a user friendly single pageview for easy access by to information by clinicians.

Importantly, EHS links Clinical Care with Workforce Rostering and Staff Allocation allowing for predictive Resource Allocation based on the care required, enabling valuable productivity improvements.

EHS is a proven and highly useable electronic medical record (EMR) developed within Australia and operating successfully in St Vincents & Mater Health, Sydney and Government of South Australia, Department of Health Hospitals.

EHS provides:• Pre-Admission • Patient History • Orders & Results • Clinical Care Guides • Assessments • Progress Notes • Referrals • Labour & Birth • Medications Reconciliation • Clinical and Non Clinical Messaging • Discharge Summaries • Appointments • Rostering & Allocation • GP Connect • Workforce Resource Calculation • Document Management System • Clinical Dashboard and more EHS supports interactions with the health identifier service and PCEHR. The extensive list of modules work seamlessly with other systems via our integrated interface engine which accepts HL7 and other accepted Health IT standard protocols complying with the Australian Technical Specification: ATS 5822:2010 eHealth Secure Message Delivery.

Accessibility: EHS is accessible on a range of devices according to user preference including our latest iPad application.

Extensia P: +61 7 3292 0222 F: +61 7 3292 0221 E: enquiries@extensia.com.au W: www.extensia.com.au Extensia links healthcare providers, consumers and their communities for better and more efficient health care.

The products used to do this can be custom branded for all Organisations and include: • RecordPoint – a proven Shared Electronic Health Record that links all clinical systems, hospital settings, care plan tools and any other sources of information available. It provides a secure means of sharing critical patient data in a privacy compliant and logical structure.

• EPRX – an Electronic Patient Referral Exchange and Directory. It streamlines the process of selecting a provider and completing a referral.

Patient information is transferred seamlessly from clinical software. The most relevant providers, services and products are presented instantly and referral documents are generated and sent electronically.

Genie Solutions P: +61 7 3870 4085 F: +61 7 3870 4462 E: info@geniesolutions.com.au W: www.geniesolutions.com.au Genie is a fully integrated appointments, billing and clinical management package for Specialists and GPs. Genie runs on both Windows and Mac OS X, or a combination of both. With over 2500 sites, it is now the number one choice of Australian specialists.

GPA P: 1800 188 088 F: 1800 644 807 E: info@gpa.net.au W: www.gpa.net.au GPA ACCREDITATION plus (GPA) is the only independent accreditation program for general practice in Australia.

Established in 1998 and run by a team of committed general practitioners, business leaders and experienced administrators, GPA has developed a program that continuously evolves in order to set new standards in general practice accreditation, while offering full support to practices to make accreditation both achievable and rewarding.

GPA is committed to providing an accreditation program, which is flexible and understands the needs of busy GPs and practice support staff. Whilst accreditation gives practices access to the Practice Incentive Program (PIP), GPA believes it should offer benefits that go well beyond the PIP. Our program provides practices with a pathway to enhanced patient care, continuous professional satisfaction, improved practice efficiency and superior risk management. GPA ACCREDITATION plus certificates and signage remind patients that their practice has achieved a level of care and service above and beyond essential general practice standards.

GPA provides a system designed to accommodate busy general practices.

Among our services, we offer practices the opportunity to use technologicallyadvanced, environmentally-friendly online programs, allowing staff to upload documentation at their own pace; individually assigned client managers, supporting practices through accreditation from start to success and beyond; highly-trained and sensitive surveyors, with extensive experience in all facets of general practice; and interactive training seminars, bringing practices the latest information in standards and innovation.

At GPA, we believe that accreditation should be an accomplishment, not a test, and we uphold that belief in our approach and service. For an accreditation program that will offer you assistance, support, information and satisfaction…the choice is yours.

Health Communication Network P: +61 2 9906 6633 F: +61 2 9906 8910 E: hcn@hcn.com.au W: www.hcn.com.au Health Communication Network (HCN) is the leading provider of clinical and practice management software for Australian GPs and Specialists and supplies Australia’s major hospitals with online Knowledge resources.

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

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

Health Informatics New Zealand E: admin@hinz.org.nz W: www.hinz.org.nz Health Informatics New Zealand (HINZ) is a national, not-forprofit organisation with a focus on collaboration, education and advocacy for the use of IT in the health sector. HINZ enables professional collaboration through conferences, seminars and an interactive online portal, bringing together clinicians, administrators, allied health professionals and many others with an interest in health IT and the advances it can enable. HINZ provides a platform to share information about the Health Informatics industry - leveraging best practice from New Zealand and overseas, as well as facilitating networking activities to bring industry experts and interested parties together to collaborate. Membership is for anyone with an interest in Health Informatics.

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Health Informatics Society of Australia P: +61 3 9326 3311 F: +61 3 8610 0006 E: hisa@hisa.org.au W: www.hisa.org.au HISA is Australia’s health informatics organisation. We have been supporting and representing Australia’s health informatics and e-health community for almost 20 years. HISA aims to improve healthcare through the use of technology and information. We: • Provide a national focus for e-health, health informatics, its practitioners, industry and a broad range of stakeholders • Support, promote and advocate • Provide opportunities for networking, learning and professional development • Are effective champions for the value of health informatics HISA members are part of a national network of people and organisations building a healthcare future enabled by e-health. Join the growing community who are committed to, and passionate about, health reform enabled by e-health.

HealthLink P: 1800 125 036 (AU) P: 0800 288 887 (NZ) E: enquiries@healthlink.net W: www.healthlink.net Australia and New Zealand’s most effective secure communications service. Transforming healthcare by connecting healthcare providers.

• Provider of compliant Secure Messaging Delivery (SMD) services • Standards compliance delivering certainty in care • Fully integrated with leading GP and Specialist clinical systems • Referrals, Reports, Forms, Discharge Summaries, Specialist Diagnostic Orders and Reporting • Affords all healthcare providers efficiencies in reducing paper based handling • Robust; Reliable and Fully Supported • New online services including Care Insight - distributed search for clinical information • Expert partnerships with Healthcare organisations, State and National Health Services Join HealthLink and be connected with more than 85 % of Australian GPs and 99% of NZ GPs who are already part of the HealthLink community.

InterSystems P: +61 2 9380 7111 F: +61 2 9380 7121 E: anz.query@InterSystems.com W: www.InterSystems.com InterSystems Corporation provides the premier platform for software for connected healthcare, with headquarters in Cambridge, Massachusetts and offices in 25 countries. InterSystems TrakCare™ is an Internet-based unified healthcare information system that rapidly delivers the benefits of an Electronic Patient Record. InterSystems HealthShare® is a strategic platform for healthcare informatics. It enables organizations to capture and share all patient data, and provides real-time active analytics that drive informed action across a hospital network, community, region, or nation.

HealthShare facilitates strategic interoperability, coordination of care, population health management, and community engagement. InterSystems Ensemble® is a platform for rapid integration and the development of connectable applications. InterSystems CACHÉ® is the world’s most widely used database system in clinical applications.

MEDITECH Australia P: +61 2 9901 6400 F: +61 2 9439 6331 E: sales@meditech.com.au W: www.meditech.com.au A Worldwide Leader in Health Care Information Systems MEDITECH today stands at the forefront of the health care information systems industry. Our products serve well over 2,300 health care organisations around the world. Large health care enterprises, multi‑hospital alliances, teaching hospitals, community hospitals, rehabilitation and psychiatric chains, long-term care organisations, physicians’ offices, and home care and hospice agencies all use our Health Care Information System to bring integrated care to the populations they serve. Our experience, along with our financial and product stability, assures our customers of a long-term information systems partner to help them achieve their goals.

Medtech Global Ltd P: 1800 148 165 E: salesau@medtechglobal.com W: www.medtechglobal.com

Houston Medical

For over 30 years, Medtech Global has been a leading provider of health management solutions to the healthcare industry enabling the comprehensive management of patient information throughout all aspects of the healthcare environment.

P: 1800 420 066 (AU) P: 0800 401 111 (NZ) E: info@houstonmedical.net W: www.houstonmedical.net

Health Information Management Association Australia P: +61 2 9887 5001 F: +61 2 9887 5895 E: himaa@himaa.org.au W: www.himaa2.org.au The Health Information Management Association of Australia (HIMAA) is the peak professional body of Health Information Managers in Australia.

HIMAA aims to support and promote the profession of health information management.

HIMAA is also a Registered Training Organisation conducting, by distance education, “industry standard” training courses in Medical Terminology and ICD-10-AM, ACHI and ACS clinical coding.

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“We provide time to health professionals through efficient practice management software” Our multidiscipline software provides interfaces to every major manufacturer, enabling many clinics to save space by becoming completely paperless!

We are a progressive medical software company and take pride in working with our health care clients to deliver tailored EMR and PMS packages based on each unique situation and practice requirements. We’re focused on helping to make their businesses more efficient and productive as well as delivering measurable improvements in customer satisfaction and market share.

You can arrange a free demonstration of our software by visiting: www.HoustonMedical.net

Leecare Solutions P: +61 3 9339 6888 F: +61 3 9339 6899 E: enquiries@leecare.com.au W: www.leecare.com.au Leecare Solutions, with their products Platinum 5 & P5 Exec, are the aged care industry’s leading web browser based clinical and management software system. Since 2000, Leecare has provided relevant, contemporary software solutions for Australian and New Zealand aged care organisations.

Leecare’s mission and products provide outstanding clinical decision making support, and management support tools that use any device, can be installed on multiple platform types and in any location. Used in over 30,000 aged care places, it is the solution used by quality providers, proven through thousands of accreditation, validation and other regulatory visits, as it is based on professional clinical and lifestyle provision concepts.

Medtech’s Medtech32 and Evolution solutions improve practice management and ensure best practice for electronic health records management and reporting.

Clinical Audit Tool integrates with Medtech32 and Evolution providing fast, efficient and secure analysis of patient data enabling practices to identify and deliver services, which address health care priorities across their population.

Medtech’s ManageMyHealth patient and clinical portal enables individuals to access their health information online and engage with their healthcare provider to support healthy lifestyle changes.

MIMS Australia P: +61 2 9902 7700 F: +61 2 9902 7701 E: info@mims.com.au W: www.mims.com.au MIMS Australia is built on a heritage of local expertise, credibility and adaptation to changing healthcare provider needs. Our information gathering, analysis and coding systems are proven and robust.

MIMS information is backed by MIMS trusted, rigorous editorial process and constantly updated from a variety of sources including primary research literature. Our database and decision support modules are locally relevant, clinically reviewed and updated monthly and compatible with a host of clinical software packages. Indeed, the majority of Australian prescribing packages and many dispensing applications are supported by the MIMS medicines data base.

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

OzeScribe Mouse Soft Australia Pty Ltd P: +61 3 9888 2555 F: +61 3 9888 1752 E: sales@medicalwizard.com.au W: www.medicalwizard.com.au Medical Wizard saves time and money through greater efficiency and comprehensive integration.

Throughout its 19 year history, Medical Wizard has led the way with innovative solutions. We are constantly evolving Medical Wizard to meet the challenges of the medical profession for today and tomorrow.

A software of choice for discerning Specialist practices, notably Gastroenterologists, Cosmetic Surgeons, Ophthalmologists, General Surgeons, IVF Centres and Day Hospitals amongst others.

All aspects of practice management from appointments, billing, clinical, theatre management and compliance reporting are covered and backed by a dedicated local support team.

P: 1300 727 423 F: 1300 300 174 E: sales@ozescribe.com.au W: www.ozescribe.com.au

Professional Transcription Solutions

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.

P: 1300 768 476 E: marketing@etranscriptions.com.au W: www.etranscriptions.com.au

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.

Australia’s Most Trusted Teaching Hospital and Private Practice Transcription Provider • Web-based - Dictate and receive reports anywhere • Double-edited with over 99.5% accuracy • Fast turn-around in 2 - 48 hours, as required • All medical and surgical specialities covered in Australia’s largest teaching hospitals • Rapid documentation of recorded HR interviews, Research and Expert Reports • Guaranteed cost savings • Data held securely at a State Government owned data centre • Call our friendly staff anytime for your overflow, backlog or all of your typing or data entry requirements • Call us now for an obligation free trial

Precision IT

Orion Health P: +61 2 8096 0000 / +64 9 638 0600 E: enquiries@orionhealth.com W: www.orionhealth.com

MITS:Health P: 1300 700 300 E: info@mitshealth.com.au W: www.mitshealth.com.au Managed IT Services for the Health Industry MITS:Health provides a full range of IT services specifically tailored for medical centres, GPs and specialists across Melbourne.

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Equipment supply and installation Remote monitoring and support Data backups Networking Internet Website Development

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: 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!

Shexie Medical System P: 1300 743 943 F: 1300 792 943 E: info@shexie.com.au W: www.shexie.com.au Shexie is an Australian owned business which has been developing software for medical practices for over 15 years.

Our industry and technical knowledge allows us to provide the ultimate ‘easy to use’, ‘fully functioned’ and ‘robust’ product on the market.

Shexie Medical System clinical and practice management software is ideal for surgical or specialist practices of any size. Many fully integrated features including Paperless Office, SMS, full Paperless Electronic Claiming including Eclipse, MIMS Integrated, statistical analysis, security, synchronize appointments with Outlook/PDAs, transcription interface, diagnostic equipment interface, automated MBS/Fund rates updates.

Soon to be released Shexie Platinum version also contains eHealth - Health Identifiers, PCEHR and Secure Messaging.

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Stat Health Systems (Aust) P: +61 7 3121 6550 F: +61 7 3219 7510 E: carla.doolan@stathealth.com.au W: www.stathealth.com.au

P: 1800 061 260 E: sales@tg.org.au W: www.tg.org.au

Stat Health Systems (Aust) has built a progressive and resilient system that introduces a new level of stability and flexibility to the medical software market.

Therapeutic Guidelines Limited is an independent not-for-profit organisation dedicated to deriving guidelines for therapy from the latest world literature, interpreted and distilled

by Australia’s most eminent and respected experts.

Stat is an integrated clinical and practice management application which has embraced the latest Microsoft technology to build a new generation solution. Fully scalable and the only medical software application to incorporate a multi-functional intuitive interface, Stat is at the forefront of computing technology. Stat incorporates all eHealth requirements as per the NEHTA specification.

These experts, with many years of clinical experience, work with skilled medical editors to sift and sort through research data, systematic reviews, local protocols and other sources of information, to ensure that the clear and practical recommendations developed are based on the best available evidence.

Stat Health provide a premium support service, clinical data conversion from existing software and tailor made installation and training plans for your practice.

Facebook: facebook.com/StatHealth Twitter: @NotifyStat

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.

P: +61 3 9013 4445 E: info@sysmex.com.au W: www.sysmex.com.au

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.

Sysmex is dedicated solely to helping your healthcare organisation achieve more in less time, with fewer errors and better patient outcomes.

It is widely used by practitioners and pharmacists in community and hospital settings in all Australian states and territories.

Sysmex lead the way in eDiagnostics: • Providing an essential building block for the electronic medical record with the Eclair Clinical Information System • Enabling sharing of key patient information across regions through the Eclair Clinical Data Repository • Completing the electronic loop with laboratory and radiology order request management (CPOE) • Streamlining all areas of the anatomical pathology laboratory workflow from request to report with Delphic AP • Improving reporting times and reducing costs through an enterprise Delphic LIS, shared across multiple laboratories

Updated three times per year, eTG complete meets the criteria for ‘key electronic clinical resources’ in the Practice Incentives Program (PIP) eHealth Incentive.

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The March 2013 release of eTG complete includes updates of selected Psychotropic topics. The online version of eTG complete has now been optimised for use on smart phones and tablet devices. miniTG The mobile version of eTG complete is miniTG, offering the convenience of having vital information at the point of care and designed for health professionals who practise and consult on the move. It is supported on a wide range of mobile devices, including Apple®, Pocket PC®, and selected Blackberry® devices.

VIRTUAL CONSULTING ROOMS

Totalcare

VConsult

P: +61 7 3252 2425 F: +61 7 3252 2410 E: sales@totalcare.net.au W: www.totalcare.net.au Totalcare is a fully integrated Clinical, Office and Management software suite designed to suit the particular needs and processes of healthcare providers. Used since 1995 by health care facilities across Australia including General and Specialist practice, Radiology, Day Surgery and Hospitals, Totalcare is stable, scalable, customisable and easy to learn and use. From a small practice to a multisite, multi-disciplinary corporate entity or hospital, Totalcare can provide solutions for your needs.

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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

TrendCare

P: 1300 82 66 78 F: 1300 66 10 66 E: admin@vconsult.com.au W: www.vconsult.com.au VConsult offers outsourced practice management solutions for medical and allied health practitioners allowing the focus to be on your professional practice and patient care. VConsult provides a seamless “behind the scenes” service by professionally managing your telephone calls, reception, invoicing and medical transcription requirements.

VConsult is perfect for your practice if you are: • Setting up, already established or winding down in Private Practice • Working in a public appointment and want to portray a professional image • Looking to minimise your overhead costs • Requiring your patient calls to be answered by a professional and experienced medical receptionist.

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Trend Care Systems P: +61 7 3390 5399 F: +61 7 3390 7599 E: support@trendcare.com.au W: www.trendcare.com.au

A national and international award winning solution recognised for its ability to provide real benefits in the acute and sub-acute health care settings.

TrendCare is an international leader for e-health solutions excelling in all of the following: • Patient dependency and nursing intensity measures.

• Projecting patient throughput and workforce requirements.

• Rostering and work allocation.

• Efficiency, productivity and HRM reporting.

• Discharge analysis, bed management and clinical handovers.

• Allied health registers with extensive reporting.

• Clinical pathways with variance reporting.

• Patient assessments and risk analysis.

• Diet ordering and reporting.

• Staff health tracking and reporting.

P: 1300 933 000 F: +61 3 9284 3399 E: sales@zedmed.com.au W: www.zedmed.com.au Zedmed is an innovative provider of business solutions to the medical and financial services industries. Our practice and clinical management solution is designed to be simple, intuitive and seamlessly integrated.

With personalised training, installation and data conversions from almost all software packages, changing software has never been so easy.

Zedmed would also like to introduce to you Medical Record Exchange – a free, simple solution allowing Doctors to send patient’s medical information to insurance companies electronically.

Using the latest in data extraction technology and fully encrypted, this is a secure, time-saving solution to one of the most dreaded requests Doctors receive on an almost daily basis.

For more information about Medical Record Exchange, please contact us: Phone: 1300 933 833 www.medicalrecordexchange.com.au