Australasia’s First and Only eHealth and Health IT Magazine
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7 JULY 2014
ACUTE CARE ICT & E-HEALTH A problem like Fiona
Overhyped and poorly planned, problems with clinical and other IT systems have dogged the development of Perth’s Fiona Stanley Hospital.
Medication misadventure
Implementing electronic medications management systems in acute care is a difficult but worthwhile challenge for improving patient safety.
Bugs and drugs Building an internal system for antimicrobial stewardship has worked for clinicians and management alike.
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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 Please visit our website for more information about advertising in Pulse+IT magazines, eNewsletters and website.
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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. In addition to our daily eNewsletter service, Pulse+IT is produced in print seven times per year with the remaining three editions for 2014 to be distributed for release in:
• Mid-August 2014 - Practices • October 2014 - New Zealand • Mid-November 2014 - mHealth and devices
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 35,000 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 Dr Chris Bain, Dr Karen Day, Mark Fahey, Simon James, Lindsay Kiley, Kate McDonald and Ganesh Ramanathan. 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, 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 2014 Pulse+IT Magazine Pty Ltd No part of this publication may be reproduced, stored electronically or transmitted in any form by any means without the prior written permission of the Publisher. Subscription Rates Please visit our website for more information about subscribing to Pulse+IT.
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NSW RURAL HEALTH PLAN
DIABETES MONITORING PLATFORM
HEALTH INFORMATICS CONFERENCE
Editorials
Features
News
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STARTUP
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PROBLEMS WITH FIONA
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GANESH RAMANATHAN
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BUGS AND DRUGS
Update to Medical Director with PCEHR enhancements
Electronic antimicrobial stewardship software provides decision support on drug dosing.
Hospital doctors’ views on using iPads at the bedside
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Simon James reflects on the release of the review into the PCEHR.
Royal Darwin Hospital’s first renal telehealth registrar reflects on his experiences providing telehealth in the Top End.
LINDSAY KILEY The new HIMSS continuity of care maturity model provides a way to benchmark progress and capabilities for hospitals.
MSIA Standard terminology to describe medications and standards-based medicines formularies are key to future eHealth systems.
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The construction and planned opening of Perth’s landmark Fiona Stanley Hospital has been plagued by problems with ICT complexity.
SCANNED MEDICAL RECORDS Digital medical records with eForms, EMM and results viewing can function as a full EMR.
SELECTED BITS & BYTES NEHTA’s future in the hands of COAG as Hambleton takes on chairman’s role
Dutton looking for quick feedback on an opt-out model for the PCEHR “Sleepwalking into catastrophe” with myGov website and the PCEHR
ELECTRONIC DRUG CHART How to implement electronic medications management in public and private hospitals.
Resources
HIMAA
PicSafe Medi adds barcode and notification functions eHealth at the centre of five-year plan for rural health in NSW Inner-city Melbourne hooks up to health pathways for referral options
HIMAA has teamed up with the University of Sydney’s National Centre for Classification in Health (NCCH) for its national conference.
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EVENTS Up and coming eHealth, Health, and IT events.
GP2U partners with SkinByDerms for teledermatology referrals
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PULSE+IT DIRECTORY
HealthEngine releases practicespecific appointment booking app
A picture is emerging on the design and use of personal health records (PHRs), the next big thing after electronic health records.
The Pulse+IT Directory profiles Australasia’s most innovative and influential eHealth and Health IT organisations.
PCEHR future, e-Patient Dave and YouTube wunderkind at HIC 2014
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Editorial
NEW BEGINNINGS FOR PCEHR AND NEHTA After what felt like six months of aimless waiting – for no other reason than that’s what it was for many working in Australia’s health IT sector – Health Minister Peter Dutton finally released the review of the personally controlled electronic health record (PCEHR) in late May.
SIMON JAMES BIT, BComm Editor: Pulse+IT simon.james@pulseitmagazine.com.au
Submitted by the review panel to Mr Dutton in December 2013, the document contains 38 recommendations covering both the PCEHR system itself, and the broader eHealth landscape in which it is intended to operate. Significant recommendations include that the National E-Health Transition Authority (NEHTA) be dissolved and replaced with an Australian Commission for Electronic Health (ACeH) reporting directly to the Standing Council on Health (SCoH). The panel recommended that a range of advisory committees be established to report to ACeH, and that the Independent Advisory Council (IAC) be retained, but with a direct line of reporting to the federal Minister for Health. Beyond the changes to eHealth governance structures, the panel recommended that the PCEHR be renamed My Health Record (MyHR), with all the personal controls that exist in the PCEHR to be retained.
About the author Simon James is the editor of Pulse+IT, one of Australia’s highest circulating health publications of any kind. Prior to founding the publication in 2006 he worked in an IT support capacity for various medical practices, and subsequently for both clinical software and secure messaging developers.
More significantly – and as widely expected – the system is to transition from one where consumers have to proactively opt‑in and register to set up a health record, to a system where they have to actively opt-out if they do not want ‘their’ My Health Record to exist in the government’s health record database.
The panel also recommended a review into the function and roles in the eHealth section of the Department of Health, Department of Human Services (DHS) and NEHTA to assess duplication, with the system operation of the MyHR to be handled by DHS under contract from ACeH. Judging by Mr Dutton’s public statements since the release of the review, it is apparent that the current government has seen value in engaging high profile clinicians – or at least one high profile clinician – to advise them on eHealth matters. Indeed, for immediate past president of the AMA, Dr Steve Hambleton, a GP and the only clinician on the three-man team that reviewed the PCEHR for the minister, his responsibilities in the eHealth arena are just beginning, following his appointment as chairman of NEHTA. In the run up to launching the PCEHR, NEHTA built a voluminous clinical leads group headed by another former AMA president, Mukesh Haikerwal. However, following the mass exodus of clinicians from NEHTA’s payroll last year, it has emerged that many of these clinicians felt that they were simply being engaged to sell a pre-determined system to their colleagues, with little ability to
meaningfully influence the design or implementation of the system. Against this backdrop, it would surprise few that adoption of the system by clinicians has been underwhelming to date, notwithstanding the development of some eHealth infrastructure that will be built upon as demand for the system rises. To this author, the appointment of Dr Hambleton at the pinnacle of the NEHTA organisational structure – ironically the same organisation that the review he was involved in recommended be dissolved – represents a significant shift in government thinking about what is required to achieve success in eHealth.
Dr Hambleton replaces lawyer and businessman David Gonski, who has occupied the NEHTA board chair since 2008 and recently completed the maximum six-year term permitted. Despite his imposing reputation in business circles and recently inflated public profile on the back of the former government’s proposed education reform, very little is known publicly about his contribution to eHealth in Australia during his time at the head of the NEHTA board. In fact, NEHTA’s own farewell press release offered few clues in this regard, other than to say Mr Gonski was “responsible for revitalising the board and galvanising cooperation between the governments
of Australia to deliver urgently needed infrastructure and standards for health information.” With many of the systems NEHTA has played a role in developing now in the public domain, it is apparent that Dr Hambleton intends to play an active role in reforming both NEHTA and the broader eHealth landscape. Whether he is able to play that active role and achieve real change, or whether he is sucked into the miasma that seems to envelop many who venture into eHealth policy and systems reform, is something we can only speculate on. We wish him the best of luck in his new endeavours.
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Guest Editorial
RENAL TELEMEDICINE: A REGISTRAR’S EXPERIENCE Earlier this year, the Northern Territory’s specialist training program funded a new service providing renal telemedicine consultations by registrars from Royal Darwin Hospital. The service’s registrar reflects on the benefits of the service as well as the unique challenges that have to be overcome in the Top End.
DR GANESH RAMANATHAN MBBS CHIA Registrar, Royal Darwin Hospital ganesh_sgi@hotmail.com
About the author Dr Ganesh Ramanathan is a firstyear renal advanced trainee who is currently working in the Northern Territory. He was the first renal telemedicine registrar at Royal Darwin Hospital and is currently undertaking a rotation at Alice Springs Hospital as the inpatient registrar.
In the Top End, we face unique challenges in terms of delivering renal services to our population, which is spread out into small communities. The burden of kidney disease is relatively high and we have established a successful outreach program, but despite 98 visits a year to different communities by four full-time nephrologists, there was still room for improvement.
Given there was a dedicated registrar, we were able to provide up to three telehealth clinics a week in the form of providerto-patient and also provider-to-provider tele-consults. One of these clinics is run by both the chronic kidney disease nurse and the telemedicine registrar. We do not have any restrictions in terms of the characteristics of patients to be reviewed through telemedicine.
From February this year, the specialist training program funded a renal advanced trainee position dedicated to telemedicine. Four registrars would rotate into this position in 2014, and I was the first renal telemedicine registrar at Royal Darwin Hospital. So far, we have yet to encounter other sites with a similar role, but we believe creating similar positions would be beneficial for the hospital’s telemedicine program and its patients, as well as providing unique learning opportunities for the registrars.
Challenges at Royal Darwin
Having a dedicated telemedicine medical professional is useful when setting up and running telehealth clinics. As the first telemedicine registrar, I helped to design the telemedicine program with the careful guidance of my consultants. We were able to set up specialised telehealth areas in our organisation and dedicated a consulting room in the dialysis unit to telehealth.
From Royal Darwin Hospital’s point of view, we are fairly well equipped to meet our needs. We have two rooms with Polycom HDX4500 equipment and multiple other areas with webcams with Polycom software with no issues in terms of accessibility.
Telehealth in the Northern Territory is funded by the state and coordinated by our telehealth coordinator. The entire state uses Polycom as the main video-conferencing software and most communities in the Top End use the Primary Care Information System (PCIS) as their clinical software. The nephrologists have access to PCIS and communication breakdown has not been a major issue thus far.
Some of our remote communities are less fortunate and do not have uniform
access to the technology for a number reasons. Certain communities are unable to participate in our program although they are really keen to do so. In order to tackle this problem, we have a telehealth helpdesk and a webpage to provide guidance. Recently, more staff have been appointed to assist our telehealth coordinator and we are planning to do an online training video to assist staff to familiarise themselves with the technology. Interruption to workflow is another major issue. A remote medical practitioner might only go to a community once a week, and sometimes participating in a telehealth consult can put an additional burden on these doctors. Thus, currently we are reviewing patients with either a doctor or a nurse present. Given we are new to telemedicine, we do not feel it is safe enough to review our patients without a healthcare professional present or directly to their homes. Provider-to-provider consults are useful in tackling this problem as they avoid the need to coordinate between the remote practitioner, patient and the specialist.
Benefits to the patients We have noticed some unique benefits of telemedicine to our patients besides the convenience and cost effectiveness that has been extensively described in the literature. Compared with face-to-face consults in Darwin, we are able to review patients in their community and in the presence of their family, which is important in certain cultures. In our centre, we noticed the provider-toprovider service is particularly popular. Whilst it is not as difficult to arrange as provider-to-patient services, it provides our rural general practitioners the opportunity to ask non-urgent questions about the
“... we were able to provide up to three telehealth clinics a week in the form of provider‑to‑patient and also provider‑to‑provider tele-consults.” Dr Ganesh Ramanathan
patient. This promotes understanding of renal diseases among rural GPs as well. We are also able to triage our patients. Previously, we received a referral letter but we only got part of the picture from the piece of paper when trying to decide when and where to see the patient. After that, we would see them in the outpatient clinic and then ask them to return after specialised investigations. This inevitably causes delay in diagnosing and treating the patient. After a clinic visit, we would write a letter to the GP, who again would only get part of the overall picture. However, with the aid of telemedicine, we are able to get a complete picture from the GPs and decide if we need to see the patient face to face in the first place. If required, then we are able to order all the specialised tests that are required prior to the face-to-face visit in order to prevent multiple visits. Ultimately, both the GPs and the specialists would be clear on the plan.
Benefits to the registrar Personally, I see it as an eye-opening experience. In the process of setting up the telemedicine program, I got to know the way the hospital system works, what a business model means and have a better understanding of health informatics. I think besides core medical knowledge, junior doctors need to understand these aspects in order to be able to deliver better care.
Moreover, tele-consults provide unique learning opportunities. I am able to learn from the general practitioners about the patient, community and health services that are available. Instead of sitting in an ivory tower and expecting care to be delivered according to the book, I am able to customise the care according to the needs of the patient and what is available in the community. If more dedicated positions for telemedicine are created, we could potentially establish a tele-consult network. For instance, if a smaller centre in the Top End hired a registrar or a RMO to run telehealth clinics, then we would be able to provide regular tele-consult services to that area. One has to bear in mind that hiring an additional healthcare professional to perform telehealth duties comes at a cost. However, in our organisation, besides tele-consults, the telemedicine registrar also has other roles such as attending three outpatient clinics, providing medical support to the dialysis units, handling outside calls and removing tunnelled central venous catheters. Although we are still facing problems given the program is relatively new, we have been able to develop a more extensive telemedicine program with the creation of a specialised position. I would encourage other organisations to consider creating similar positions.
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Guest Editorial
HIMSS ANALYTICS REVEALS
NEW CONTINUITY OF CARE MATURITY MODEL The Health Information Management Systems Society’s (HIMSS) analytics division unveiled a new maturity model for healthcare organisations in February that goes beyond the highest level of its EMR adoption model. For Australian healthcare organisations, the new continuity of care maturity model provides a way to benchmark progress and capabilities in interconnectedness and continuity of care against other organisations on a global scale. LINDSAY KILEY BA, MBA Marketing director, Asia-Pacific, InterSystems lindsay.kiley@intersystems.com
The HIMSS Analytics electronic medical record adoption model (EMRAM) has been hugely influential in guiding organisations around the world in their implementation of electronic health records, but EMRAM was never designed to address the sort of national, regional or community-based technology issues that governments and healthcare organisations are grappling with as they share electronic health records. So when the new HIMSS Analytics continuity of care maturity model (CCMM) was unveiled at the HIMSS14 Conference and Exhibition in the US in February, a number of healthcare organisations and technology providers, InterSystems amongst them, voiced their support. With seven stages that build on EMRAM, CCMM is a global model for healthcare providers that focuses on information exchange, care coordination, interoperability, patient engagement and analytics, with the ultimate goal of holistic individual and population health management.
About the author Lindsay Kiley is marketing director for the Asia Pacific region at InterSystems, a provider of software for connected healthcare. She joined the healthcare information technology industry 15 years ago with a passionate belief in the potential for IT to change the way healthcare is delivered.
In a presentation at HIMSS14, the executive vice president of HIMSS Analytics, John Hoyt, detailed the seven stages and associated criteria of the new model and how it can drive transformation in individual and regional health systems globally. “This is the direction the market is headed and we are happy to provide
a tool healthcare delivery organisations and governments can use to gauge their progress towards a more efficient care delivery approach,” Mr Hoyt said.
Seven stages of enlightenment To many in the healthcare industry, the highest level of the new continuity of care maturity model, Stage 7: ‘Knowledgedriven engagement for a dynamic, multi-vendor and multi-organisational interconnected healthcare delivery model’, may seem like nirvana, a seemingly unattainable level of enlightenment. Moving down through the levels, however, the language more recognisably describes what Australian healthcare organisations are working towards. Stage 6: ‘Closed loop care coordination across care team members’, might be used to describe a long-term goal of regional healthcare networks such as the South West Alliance of Rural Health in Victoria. Stage 5: ‘Community-wide patient record using applied information with a patient engagement focus’, on the other hand, sounds like something that the PCEHR may one day deliver. The most advanced healthcare providers in Australia in terms of their healthcare
information exchange capabilities, such as the Mater Health Services group of hospitals in Queensland, may want to have a close look at Stage 4: ‘Care coordination based on actionable data using a semantic interoperable patient record’. The vast majority of healthcare organisations, however, may find themselves contemplating where they might sit on the lower to middle levels: Stage 1: ‘Basic peer-to-peer data exchange’; Stage 2: ‘Patient-centred clinical data using basic system-to-system exchange’; or Stage 3: ‘Normalised patient record using structural interoperability’.
Models of connected care The beauty of a maturity model like CCMM, particularly when it finishes the pilot stage and becomes finalised, is how organisations can use it to benchmark themselves against what others have achieved, both here and overseas. This is useful both in terms of understanding the technological capabilities required to support more advanced connected care models, but also as a tool to attract the financial investment needed to participate in national or regional shared EHR initiatives such as the PCEHR. Like EMRAM, as more organisations move through the various stages and seek recognition from HIMSS Analytics for achieving the higher levels, a shared body of knowledge will be built up that will reduce the risk of going it alone, as pioneering organisations such as the UK National Health Service have had to do. One of the most valuable aspects of a formalised continuity of care maturity model is in providing a roadmap to all participants in the healthcare industry for the impending changes in how care is delivered. This means that medical equipment vendors, for example, for whom EMRAM may not have been relevant,
“As more organisations move through the various stages and seek recognition from HIMSS Analytics for achieving the higher levels, a shared body of knowledge will be built up that will reduce the risk of going it alone.” Lindsay Kiley
can better understand how they can interoperate with and add value to shared electronic health records. One of InterSystems’ customers, Ricoh Americas Corporation, maker of the Ricoh healthcare camera, was one of the technology providers that voiced their support for CCMM at HIMSS14. Patrick Braun, Ricoh’s healthcare vertical vice president, said information gaps are a major problem in healthcare. “The ability to dynamically capture data at the point of care, and intelligently structure this information for secure sharing among caregivers, delivers vital insight across the entire patient care continuum,” Mr Braun said. “The HIMSS continuity of care maturity model will provide a blueprint for providers that are on path to eliminate information silos, streamline workflows, and make information a vital tool in improving health outcomes.”
Information systems agenda Ricoh is a good example of the diverse range of healthcare organisations that are needed to participate in connected care delivery and that understand the value of contributing data to a shared EHR. With this latest initiative, it can now benchmark its capabilities against
a well-accepted, authoritative maturity model. An organisation like Australia’s largest provider of home nursing, Royal District Nursing Service (RDNS), which has also invested in a strategic healthcare informatics platform to exchange information with both shared EHRs and home monitoring equipment, could also benchmark itself to assess and improve the maturity of its interoperability capabilities. InterSystems is working to provide healthcare interoperability platforms to a number of other medical systems, equipment and service providers, both internationally and in Australia, who would all stand to benefit from the new CCMM. 3M Health Information Systems, which has integrated multiple coding, clinical documentation improvement and performance monitoring processes, is another good example of an organisation that is enabling care providers to achieve increased continuity of care. Whether CCMM becomes as influential as EMRAM in setting the information systems agenda for healthcare organisations of all kinds, not just acute care providers, remains to be seen. But by focusing on the ultimate goal of individual and population health management, HIMSS Analytics has made a good start.
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News
NEHTA’s future in the hands of COAG as Hambleton takes on chairman’s role
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Former AMA president Steve Hambleton intends to play an active role in improving clinical input into eHealth and in influencing the direction of the National E-Health Transition Authority (NEHTA) despite the recommendation of the federal government’s review panel, of which he was a member, that the organisation be dissolved. Dr Hambleton, who was appointed chairman of NEHTA late last month, said he stood by the recommendations of the review but that the final decision on NEHTA’s future was in the hands of the federal and state health ministers. NEHTA is owned and funded through the Council of Australian Governments (COAG).
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The review into the PCEHR, belatedly released by Health Minister Peter Dutton just after the May budget, recommended that the name of the PCEHR system be changed and that
NEHTA be dissolved, with responsibility for eHealth and the PCEHR moved to a new agency called the Australian Commission for Electronic Health (ACeH), to report directly to the Standing Council on Health (SCoH).
directions, the strategic direction of eHealth in this country,” Dr Hambleton said. “I think there is an enormous opportunity for us to do something. How and what body that is done in is the governments’ decision.”
Dr Hambleton said that as a member of the three-man review team he supported all of its recommendations, but the final say was in the hands of Mr Dutton and his state and territory counterparts.
He said he took on the role of chairman to be in a position to help implement future plans for eHealth.
Mr Dutton has stated publicly that he supports much of the review’s recommendations, but would take his time to consider the government’s official response. Some of the changes recommended for the PCEHR will require new legislation, and COAG will be required to agree on the dissolution of NEHTA. “COAG together with the federal health minister need to decide about future
“I think there’s a huge amount of investment that has gone into IT in this country, and I think there is a real opportunity to make sure we leverage off the investment we’ve made so far and get outcomes that are meaningful,” he said. “There is an opportunity for structural reform in the health system supported by good communications.” While former chairman David Gonski played a low-key role at NEHTA, Dr Hambleton said the chairman’s position and the board itself had a great
deal of influence over the direction of the company. “Obviously the governance body is the one that interprets the direction that the company should go in and the management needs to deliver on that, but you do have an enormous amount of influence together with the other board members, and that’s the exciting part. “We have very intelligent, motivated and engaged people but as we said at the AMA, as we said in the review, we need to make sure that we engage and deliver what the profession needs.” It is no secret that NEHTA has come in for a great deal of criticism, particularly from the medical software industry
and from clinicians, who have been critical of its lack of engagement in the implementation of the PCEHR. This was starkly illustrated last year when the entire clinical leads team resigned. Dr Hambleton said he accepted there had been criticism of NEHTA’s past performance but that he was confident it could be changed. “The answer is absolutely we can change it,” he said. “There is no doubt that there has been criticism levelled, governments have been concerned, software groups have been concerned, the profession has been concerned, but if you don’t get in and do something you can’t change it. If you get in there and do something, and recognise
there are issues, you can. I’m very confident that we can take up the challenge.” He also said he was confident that he could improve clinical input and governance and that NEHTA was already moving to engage clinicians more in product development. “My role early on is to find out where the clinical engagement in that sits and to make sure that we have sufficient to progress what NEHTA’s tasks are.” A number of foundational products had been delivered, such as Individual Health Identifiers, secure messaging, the Australian Medicines Terminology and SNOMED-CT AU, which in effect had created a national ‘rail gauge’ on which to build. “We’ve got that, we’ve just got to start using it,” he said. “Having been to places like Canada where there is no standard rail gauge, at least NEHTA has decided what the gauge is. “Part of the challenge is how NEHTA participates in the future, but much of the rest of the challenge is how we engage with what we’ve already got. There are some really good things about the PCEHR, the basics are there, and we’ve just got to start using them. It is not all because of NEHTA, but NEHTA has played a significant role in setting up the frameworks.”
Update to Medical Director with PCEHR enhancements Health Communication Network (HCN) has released a cumulative update to Medical Director and PracSoft, including the assisted registration tool for the PCEHR, a view of the National Prescription and Dispense Repository and clinical usability improvements. Update 3.15.2 builds on the full 3.15 release from last December and also includes improvements to the National Inpatient Medication Chart (NIMC) and pathology requesting, as well as quicker access to its Sidebar tool. The update includes the work that HCN has been doing as part of NEHTA’s clinical usability program (CUP) to improve clinical interactions with the PCEHR. PCEHR documents now reside on a new tab called PCEHR View, which allows users to filter documents, show Medicare records and retrieve prescription and dispense records from the NPDR. Medical Director now automatically checks a patient’s PCEHR status upon opening their record, and there is also the new assisted registration tool, which allows users to register patients for a PCEHR electronically while they are in the practice. Other non-PCEHR enhancements include adding the MD Sidebar to the top menu on the front screen instead of in the Tools menu. The most recent updates to the three widgets that come with the Sidebar are also included. The NIMC has been improved to allow doctors to select more than eight regular and seven PRN medications to generate multiple charts. Pathology request performance has also been improved, with the form now loading more quickly, HCN says. Both MD and PracSoft also come with new ethnicity and country of birth field that adhere to RACGP requirements.
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Bits & Bytes
Hospital doctors’ views on using iPads at the bedside A small study of a group of doctors who used iPads on ward rounds shows that while they like the device and used it to access clinical data, they still preferred to share information verbally with their patients. The study, conducted at St Vincent’s Hospital in Sydney by a team from the University of NSW’s Australian Institute of Health Innovation (AIHI), followed 10 doctors on their ward rounds and studied their interaction with patients while equipped with an iPad. The iPads allowed the doctors read-only access to the hospital’s MediWeb results reporting system and the MedChart medications management program, as well as a number of patient education apps that they were free to use. The idea was to see whether senior doctors would use the iPad to share information such as test results with their patients during ward rounds, and to explore both patients’ and doctors’ experiences of information sharing. Seven of the participating doctors were interviewed, and while they said sharing information with patients was important, they preferrred to talk their patients through results rather than show them. “I didn’t really use it as much interacting with the patient, because with my patient population I prefer to talk to them,” one doctor said. “I predominantly use the rounds as a chance to talk to the patient,” another said. “[T]here is so little time, so when you see patient, you don’t want to waste time waiting for something to load or reading through it.” The study was published in the Internal Medicine Journal.
PCEHR review panel recommends opt-out model, NEHTA to be abolished The Royle review into the PCEHR, released in May, recommended that the name of the system be changed, that NEHTA be ‘dissolved’ and the system move to an opt-out model, and that improvements be made to clinical usability.
and that the National E-Health Transition Authority (NEHTA) be dissolved and replaced by an Australian Commission for Electronic Health (ACeH), to report directly to the Standing Council on Health (SCoH).
Health Minister Peter Dutton released the review at the HIMSS conference in Sydney but said the government’s response to its recommendations was still several months away. Mr Dutton said he strongly agreed with the recommendation that the system be opt-out for consumers, rather than the current opt-in model.
To get clinicians using the system, the panel recommended that in addition to usability issues, the government “incent” GPs by changing the eHealth practice incentive payment (ePIP) to link ongoing ePIP funding to actual usage of the MyHR system.
The review, conducted by Uniting Care Queensland executive director Richard Royle, former AMA president Steve Hambleton and Australia Post CIO Andrew Walduck, found that there was “overwhelming support” for continuing the path of implementing an electronic health record for all Australians. However, it made 38 recommendations on how to improve the system, the most controversial being a recommendation to transition to an opt-out model from next January. The panel also recommended changing the name of the system to the My Health Record (MyHR),
“There was ‘overwhelming support’ for continuing the path of implementing an electronic health record for all Australians.” Operation of the system should be moved from the Department of Health to the Department of Human Services (DHS), under contract from ACeH, the panel recommended. It also wants to see an expansion of the National Prescription and Dispense Repository (NPDR), which Mr Dutton praised as a worthwhile endeavour in his speech.
The review panel also wants to establish a number of advisory committees to the proposed ACeH, including a clinical and technical committee, a jurisdictional committee, a consumer advisory committee and a privacy and security committee. Technical changes to make the system more attractive to consumers include a single sign-on capability and a notification system that tells the consumer by SMS when their MyHR is opened or used. From January 1 next year, the panel wants the system to include a minimum composite of records that would include demographics, current medications and adverse events, discharge summaries and clinical measurements. This, in addition to an opt-out model, would dramatically improve the value proposition for clinicians, the panel said. It recommended that work proceed on implementing diagnostic imaging and pathology into the system, and also to implement a standardised secure messaging platform. It also wants the secure messaging strategy to include secure communication between the medical industry and consumers themselves.
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MedicineInsight spotting gaps in prescribing practice Two hundred general practices are now taking part in NPS MedicineWise’s MedicineInsight program, which is gathering de-identified data from general practice clinical software to evaluate and improve prescribing practices. Launched in March last year, MedicineInsight is a four-year program that ultimately aims to sign up 500 general practices to look at data from two million patient episodes. It is using a data extraction tool developed with the University of Melbourne that captures data from the coded fields in software such as diagnosis, prescriptions, referrals, and pathology results. The data from each practice is used to give a tailored analysis of prescribing and clinical activity, with each practice receiving a meaningful report every six months as part of quality improvement processes, NPS program manager Nancy Huang said. Early results in the first year have concentrated on type 2 diabetes, with the data showing that participating practices are predominantly prescribing metformin as first-line therapy, Dr Huang said. Around 90 per cent of patients with type 2 diabetes are having their smoking status recorded by practices, and, where recorded, the percentage of patients reaching HbA1c targets has increased over the last five years. It also shows that 90 per cent of GPs are able to identify potential gaps in prescrbing practice and 70 per cent would take future actions such as improving their data quality and reviewing and recalling patients. The program is live in Victoria, NSW, Queensland, SA and Tasmania.
Dutton looking for quick feedback on an opt-out model for the PCEHR The federal government will take the next few months to assess the recommendations of the Royle review into the PCEHR and wants to gauge community support for a transfer to an opt-out model, Health Minister Peter Dutton said. The review recommended the system become opt-out from January 1 next year. Mr Dutton said he supported the recommendation, but that he wanted to take the time to assess community views for the controversial move before making a decision. “The review recommended moving to an opt-out arrangement and I strongly support this view,” he said. “The system in its current form ... restricts the uptake by patients and limits its use by doctors and other health workers. “Moving to an opt-out system means clinicians would then have a situation where every one of the patients they see would have a record. This will increase the value of the system for clinicians and provide better health outcomes for our country.” Mr Dutton said he agreed with most of the recommendations generally, particularly the opt-out arrangements, which he said he thought
were necessary. “I need to see whether there is community support for opt-out arrangements, and I sense that there is, and I think from there we can provide a response fairly quickly.” Change to a an opt-out model would require a change to legislation, namely the PCEHR Act. Both the Consumers Health Forum (CHF) and the Australian Medical Association (AMA) support the opt-out model and recommended it in their respective submissions to the review panel. Mr Dutton said the allocation of $140 million in the federal budget to the continuing operation
of the system for another 12 months would give the government time to make necessary changes. However, he also admitted that there were contractual obligations that the Commonwealth was still under which meant there would be a cost to ceasing funding. “We’ve got some contractual arrangements in place that would have seen a cost to the Commonwealth had we not proceeded,” he said. “[The $140m] is providing certainty around the funding arrangements now and then we will allocate money in a contingency reserve and look at next year’s budget to see if the funding will be ongoing.
“We have allowed ourselves this financial year with the additional funding because there are recommendations around structural change
in relation to NEHTA and to other aspects of the governance arrangements… “I’m hoping that from there we can respond quickly and
in the next few months ... have a better map going forward in terms of what we have accepted by way of the recommendations.”
NEHTA continues PCEHR development despite cloud over its future The National E-Health Transition Authority (NEHTA) is continuing with plans to improve and add functionality to the PCEHR, despite a recommendation in the Royle review that the agency be dissolved and its role transferred to a new statutory authority. Internal communications seen by Pulse+IT show that NEHTA plans to create a new PCEHR landing page in clinical information systems that would improve the current document list and enhance clinicians’ view of pertinent information. A meeting of NEHTA’s clinical usability program (CUP) steering group is also planned for this month to discuss how to develop a communication strategy to create greater engagement for eHealth and the PCEHR and develop educational strategies to address what it says are misconceptions about the uncertain future of the PCEHR, the usability of software, medico-legal and liability issues, and who to call for assistance. NEHTA’s future has been under a cloud since the
release of the Royle review in May, which recommended that the organisation’s current overarching role be dissolved and that a new Australian Commission for Electronic Health (ACeH) be established with a board that includes representatives who are actively using the PCEHR system.
“A strong theme of constraints being imposed on the industry due to the centralist approach taken with the PCEHR has been shared.” The review repeated criticisms from the medical software industry, medical associations and clinical groups that there was a lack of transparency in the decision-making process for the PCEHR within NEHTA, and that NEHTA’s governance structure does not have the confidence of the industry.
“The review has heard from multiple medical industry associations and software providers,” the review panel said. “A strong theme of constraints being imposed on the industry due to the centralist approach taken with the PCEHR has been shared. “A perceived centralist approach, led by NEHTA and the federal Department of Health has been identified as reducing confidence of the private sector to invest in product development and evolution, reducing the willingness to collaborate given multiple comments that information was often shared with NEHTA with little received in return.” Improvements that NEHTA is looking at include adjusting the document list to highlight documents added since the last shared health summary (SHS) was written. It would also include options for the SHS to function as the landing page and to enhance the PCEHR’s viewing ability to ensure all documents are able to be viewed easily including pathology and diagnostic imaging.
Desktop version of eMIMS follows cloud release MIMS has released the desktop version of its eMIMS drug reference product, joining the cloud-based version it launched in September last year. MIMS has developed eMIMSDesktop for those users of MIMS who prefer the software to be locally installed. It can be downloaded onto the desktop from a DVD or via the internet. Like eMIMSCloud, it contains current Australian product and consumer medicine information, up-to-date PBS restrictions and pricing and a drug interactions database. It also has additional links to TGA safety bulletins, NPS RADAR and NPS medicines update articles, and will be updated automatically on the first of each month. Both eMIMS products feature improved pill identification and the optional IMgateway drug/herb/food interactions module. Another feature is new search capability so users can choose by brand, generic name, indication or therapeutic class. Users can search for an abbreviated PI or the full PI or CMI, and the chosen medication can be added to the interactions checker from this view. The abbreviated PI provides rapid access to the most commonly used information about any product, including the PBS and authority information and nurse practitioner prescribing rights. The full PI includes the TGA-approved product information for specific brands. MIMS has also been providing a map to the Australian Medicines Terminology (AMT) within the data provided to its software partners for several months. MIMS maps the AMT codes to the generics and branded medicines currently on the market in Australia.
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Image app for the pathologically inclined The University of NSW’s Department of Pathology and its Museum of Human Disease have come together to design an interactive educational app for medical students and practitioners that catalogues thousands of images of diseased tissue stored by the museum. The Images of Disease app is intended to promote education about disease processes and their effects on human tissues and organs. It includes views of gross pathology and histopathology, with selected images appended by diagnostic imaging investigations and clinical and autopsy images. Images can be searched by disease name, organ system or pathological process, with hundreds of diseases covered. A number of interactive ‘hotspotted’ images are available to enable in-depth exploration of the features of common diseases. When a specimen name is highlighted in red, this indicates that there are hotspots on the image that will display a text description and red outline. The app also includes a ruler icon to measure the actual size of the specimen or features within it. Department of Pathology head Gary Velan said students can look up a particular disease, see what it looks like, read about its typical clinical features and see other diagnostic imaging investigations such as an MRI scan or x-ray that would normally accompany the condition. The app is optimised for iPhone 5 and is only available for iOS-based devices for the time being. It costs $17.99 through iTunes but is free to UNSW medical students. “We are hoping that through app sales we will be able to fund the development of the app for Android and Windows devices so all students will be able to access it,” Associate Professor Velan said.
“Sleepwalking into catastrophe” with myGov website and the PCEHR eHealth security experts have reacted with dismay to revelations in the Sydney Morning Herald about a basic security flaw in the myGov website that potentially opened up sensitive personal information, including health information held on the PCEHR, to malicious attacks. myGov is a single sign-on gateway for consumers to access a number of online federal services, including Medicare, Child Support and the PCEHR, and is soon to also be used by the Australian Taxation Office to file electronic tax returns.
site scripting flaw that allowed him to easily gain access to another person’s myGov account and from that to access other linked accounts. Trish Williams, an associate professor and eHealth research group leader at Edith Cowan University’s School of Computer and Security Science, said cross-site scripting was a very common method that works by capturing information from cookies or other web session information.
SMH journalist Ben Grubb has written several stories about potential weaknesses on the site, prompting Wollongong security researcher Nik Cubrilovic to take a closer look.
“Cross-site scripting code uses known vulnerabilities in web-based applications,” Dr Williams says. “A cookie is just a text file so it doesn’t do anything on its own. However, crossscripting allows malicious content to capture and use this information.”
What Mr Cubrilovic found was a very common cross-
Dr Williams said crosssite scripting was not
an individually targeted method but was more an opportunistic way to potentially hack a site. The problem with it affecting single sign-on sites like myGov is that you then have access to a whole range of other sites. “If I can get into myGov and use that, it automatically authenticates to the other sites,” she said. “That is the beauty of having single sign-on: from the user’s point of view you don’t have to remember all of your other passwords. But this vulnerability gives you access to a whole range of things.” Mr Cubrilovic said the flaw now seems to have been fixed, but both Dr Williams and security expert Steve Wilson, principal analyst at Constellation Research, say that this just shows the site wasn’t built using good security protocols in the first place.
“This is a common problem because security is seen as an add-on, whereas if it had a better quality process in development, those issues would not have been in there in the first place,” Dr Williams said. Mr Wilson said the situation was appalling. “This is supposed to be a government single sign-on
solution to accessing what are your most important and sensitive government dealings, and it is not fit for purpose,” he said. “It shows no sign of the careful design that should go into the master key for all of your government digital assets. There are four or five points at which this sort of thing should
have been headed off at the pass, and it was not.
PicSafe Medi adds barcode and notification functions
“We are just sleepwalking into catastrophe with myGov and the PCEHR. You have to assume that security is imperfect and you make policy based on that, but you can’t make eHealth policy based on blind faith that the security is okay because there’s no room for error.”
The team behind the PicSafe Medi patient-consented clinical image capture system has added new functionality to the software, including a safe offline mode, an in-built barcode reader and generator and a notification function for urgent cases.
Federal budget provides lifeline for PCEHR, spells end of Medicare Locals While most of the attention following the release of the May federal budget was on the widely opposed GP co-pay and cuts to national partnership agreements with the states, the federal government provided a lifeline to the PCEHR, extending its operation for another year through an allocation of $140.6 million. Part of the budget money will go towards supporting NEHTA for another year, but the government appeared to have accepted John Horvath’s report into the function of Medicare Locals in full, which recommended they be abolished. Medicare Locals are set to be renamed Primary Health Networks (PHNs) from July next year, the budget papers say, with funding to come from the existing resources of the Department of Health.
The department itself will undergo a “capability review” from June “to ensure it has the processes, systems and expertise in place to deliver the government’s policies and achieve results for the Australian public”.
“There will be fewer, but larger, PHNs in the new network that will replace Medicare Locals.” On the PCEHR, the papers say that the government will fund the system to the tune of $140.6m – $118.8m for the Department of Health, $20.8m for the Department of Human Services and $100,000 for the Department of Veterans Affairs, along with $1m to DHS in “related capital”.
“There will be fewer, but larger, PHNs in the new network that will replace Medicare Locals,” the budget papers say. The eHealth Practice Incentives Payment (ePIP) program will continue, and the planned evaluation of the Telehealth Pilots Program will also be conducted, with the pilots concluding at the end of September 2014. The government will continue to support Healthdirect Australia and its nurse triage and after-hours GP helplines, and the National Health Services Directory (NHSD). Healthdirect’s plan to add secure messaging and telehealth addresses to the NHSD will go ahead. Funding for NEHTA for another year is part of the total PCEHR allocation.
PicSafe Medi was launched in March last year as a way to overcome legal and privacy issues while at the same time making it easier for clinicians to take and share medical images. It consists of an app for iOS and Android that allows a photo to be taken and sent to a secure cloud repository, where authorised users can view the photos for a limited time, as well as the ability to record written and spoken consent from the patient. Photos are automatically removed from the device and can be attached to the patient’s record within the hospital setting through the UR number. It is secured by iWebGate, which offers a virtual network “demilitarised zone” between the user and the public internet. There is a new offline mode that is aimed at overcoming connectivity problems for medics out in the field. Normally the photo is immediately sent to the PicSafe Medi servers and removed from the phone, but if the user is unable to connect wirelessly, the new function will encrypt the photo and keep it on the device until connectivity is restored. There is also a new notification function that lets users know when the recipient of the photo has viewed it. If it is an urgent case, this allows the user to send it to an alternative contact if the intended recipient is not available. PicSafe Medi now also comes with a built-in barcode reader, so institutional users can scan the barcode to bring up the patient’s details and they no longer need to type in the UR number.
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HCN signs on as local arm for Map of Medicine
eHealth at the centre of five-year plan for rural health in NSW
Clinical and practice management software vendor Health Communication Network (HCN) has signed an agreement with UK-based Map of Medicine to act as the Australian contact for the clinical pathway solution.
NSW Health has released a draft of its rural health plan for the next five years, highlighting improvements in eHealth as one of its three main strategies.
Map of Medicine, which was developed in 2001 by two doctors in association with University College London and the Royal Free Hampstead NHS Trust, is an evidence-based system that is designed to produce local clinical pathways to improve patient care between the primary and acute sectors.
The plan has been informed by a number of other NSW Health plans, including the Blueprint for eHealth in NSW and the eHealth strategy for rural and remote NSW.
Originally developed to improve referrals to hospitals, it is also used to provide guidance to GPs in referring to local healthcare organisations and to create local care maps. It was introduced to Australia last year by the Metro North Brisbane Medicare Local and the Metro North Hospital and Health Service. HCN CEO Phil Offer said the partnership would be two-fold, with HCN taking on a sales and marketing role and acting as the local presence, and it will also involve some integration with HCN’s flagship product, Medical Director. The system will be promoted primarily to Medicare Locals, with several currently trialling Map of Medicine. Map of Medicine’s managing director of commercial operations, Darren Nichols, recently toured Australian sites with HCN’s knowledge solutions manager, Allison Hart, to showcase the product and how it can be applied to Australian healthcare. “With over 260 clinical topics immediately available to healthcare professionals, the application of proven clinical pathways is fast and even in these early stages, the results in Australia speak for themselves,” Mr Nichols said.
The draft plan is built around three “directions” – healthy rural communities, improved rural patient experience and rural health services – and has three strategies, focusing on the rural health workforce, rural health infrastructure and improvements in rural eHealth. NSW Health has taken on board recommendations
from last year’s eHealth strategy for rural and remote NSW in encouraging the six rural Local Health Districts (LHDs) to work with the eHealth NSW agency to collaborate on implementing eHealth solutions.
set up a direct connection for all rural LHD sites into the core statewide network.
This includes building greater connectivity across the service network, and group investment where appropriate.
A Statewide Infrastructure Program (SWIS) will include a consistent identity for all rural NSW Health employees, single sign-on to support mobility, and a consistent desktop management and application delivery tool called the System Centre Configuration Manager (SCCM).
A Rural eHealth Governance Group, comprising of the chief executives of the six LHDs and senior executives from eHealth NSW, has been established to develop a governance structure for rural eHealth. The recommendation to implement a Health Wide Area Network (HWAN) has been agreed to, which will
The 25 existing NSW Health internet gateways will be consolidated into three and overall capacity boosted from 1.2Gbps to 30Gbps.
Other core infrastructure improvements include allowing rural LHDs to connect to existing telehealth systems across the state, and providing
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access to booking and scheduling systems and support for high definition mobile video clients. Desktop and mobile conferencing solutions will be integrated into telehealth services. The plan also commits to the roll-out of HealtheNet, a PCEHR project. HealtheNet aims to deliver a patient’s clinical information, including access to their PCEHR, in a consolidated view through hospital and community care software systems Cerner and CHIME. The further implementation of Cerner throughout NSW hospitals will continue under the electronic
medical record phase 2 (EMR 2) project. It also commits to Community Health and Outpatient Care (CHOC), a clinical information system to support community and outpatient care for Aboriginal health, aged and chronic care, allied health, child and family, community home nursing, drugs and alcohol, mental health and sexual health. Electronic medications management will be implemented throughout the rural LHDs, in line with the NSW government’s $170 million, 10-year investment in EMM systems, and a Hospital Pharmacy
Product List (HPPL) will also deliver a single list of pharmaceutical products with standardised descriptions. There will be a statewide approval system for antimicrobial stewardship. The plan commits to supporting patient access and self-management by raising awareness of the PCEHR and moves to register patients for it through assisted registration tools. It also includes some nonclinical IT improvements, including an upgrade from the existing financial management system to Oracle.
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Work restarts on pathology and imaging for PCEHR The Department of Health has issued invitations to expert groups to take part in workshops to finalise the design and integration of pathology and diagnostic imaging reports into the PCEHR. It appears likely that pathology and imaging reports will be uploaded as “immutable” or unmodifiable PDFs. Diagnostic images themselves will not be uploaded, but work is continuing on how to add information to the report about where the image can be located. Pathology reports were originally planned to be included in the PCEHR release five in May, but there were serious disagreements over how they would be rendered and who would upload them. Uncertainty over the continuing operation of the system following the delayed release of the Royle review commissioned by Health Minister Peter Dutton also impeded progress. The review panel recommended that work should proceed on integrating pathology and diagnostic imaging despite a submission from the RACGP calling for an plans for extra functionality to be immediately suspended until the basic clinical usability of the system was addressed. Still undecided from discussions held last year is how to handle the withdrawal of consent, how to handle the follow up of reports, and authority to post (ATP) message handling. It is understood that the preferred method is for pathology reports to be sent to the referring GP as usual, and that the GP and patient decide together what is uploaded to the PCEHR. The GP would then send an ATP through messaging software to the pathology practice, which would then upload the report as a PDF.
Medtech gears up for 9.2.0 release with patient portal push Medtech Global is gearing up for the release of the latest version of its Medtech32 clinical and practice management software with an increased focus on the capabilities of its ManageMyHealth patient portal. The company is currently in beta testing for version 9.2.0 with a view to a general release shortly. The new version will include a number of improvements to the software’s PCEHR capability following Medtech’s work on NEHTA’s clinical usability program (CUP), including the development of a wizard to speed up eHealth document creation and uploading. Medtech Global’s CTO Rama Kumble said the company was also making a big push with its ManageMyHealth patient portal. Launched
in Australia in 2012 and in widespread use in New Zealand, ManageMyHealth allows practices to offer online appointment bookings, repeat script request functionality, recall reminders for pap smears and immunisations and the ability for patients to view their medical records or lab results. It also allows practices to communicate electronically with patients. ManageMyHealth is integrated with Medtech32, and according to Mr Kumble, offers practices the ability to conduct more chronic disease management programs while increasing the efficiency of the front desk. “One difference between our online booking and some of the others on the
market is that it is very tightly integrated into the practice management system,” Mr Kumble said. “It manages all of the communications that happen between the practice and the patient, and allows the front desk staff to manage incoming online appointment requests from within the Medtech32 application. Mr Kumble said the software was in use at the East Brunswick Medical Centre in Melbourne, which commenced patient registration in June last year and averages 185 registrations per month. “They found that patients are happy with the flexibility offered in relation to being able to access booking appointments at the times that suit them,” Mr Kumble said.
“The reception staff are also happy to be able to offer an alternative to patients who find calling the surgery by phone sometimes difficult when staff are busy taking other calls.” In New Zealand, ManageMyHealth is used for a number of national
programs, including Beating the Blues, an online cognitive behavioural therapy-based program for mild to medium depression. It is also used to bridge the gap between the primary and secondary care sectors, as some hospital clinicians can access the system.
Medtech has also worked with medical emergency information and identification service MedicAlert to allow hospital doctors and emergency personnel to “break the glass” and access a patient’s medical history through ManageMyHealth in case of emergency.
Government to institute Horvath recommendations for Medicare Locals Further funding to Medicare Locals for their eHealth programs was a notable absence in the May federal budget as the government appears to have accepted the majority of the recommendations made by John Horvath in his review of the organisations. The Medicare Local eHealth program was funded for two years under the Labor government to help general and allied health practices, community pharmacies and aged care facilities to get ‘eHealth ready’. This included registering for and using the HI Service and the PCEHR as well as secure messaging and electronic transmission of prescriptions. A spokeswoman for the Department of Health said the two-year Medicare Local eHealth contracts were due to cease on June 30 and would not be extended.
“While there will be no further funding forthcoming from this current program other funds may become available throughout the year for primary health organisations,” the spokeswoman said.
“The twoyear Medicare Local eHealth contracts were due to cease on June 30 and would not be extended.” In April, funding for other programs managed by Medicare Locals was promised for one more year, including managing GP after-hours services, access to allied psychological services (ATAPS) and Close the Gap. However, eHealth was the only contract that was excluded.
The government announced in May that Medicare Locals will be abolished in June next year, to be replaced by Primary Health Networks (PHNs), following the recommendations of the review by Professor Horvath. The new networks will be health service purchasers rather than health service providers, and GPs will lead clinical councils that will advise them. When Medicare Locals were established they were given a wider mandate than the former divisions of general practice, with an objective to also include nurses, community pharmacists, allied health professionals and aged care facilities in localised decision making. In his review, Professor Horvath recommended that the new PHNs continue to provide support to assist general practice with the adoption of electronic health records.
Cutting Edge offers free version for DVA claims Electronic claiming specialist Cutting Edge Software is offering a free version to allied health practices that do low volumes of claims to Medicare and the Department of Veterans’ Affairs (DVA). Cutting Edge’s web-based system normally comes in two versions: a Standard version for allied health practitioners that is suitable for billing electronically to Medicare or the DVA, and an ECLIPSE version that includes claims to private health funds as well. Cutting Edge managing director Tony Stewart said the free offer is aimed at allied health practitioners who do a small volume of DVA claims but want to do it electronically rather than send in forms. Electronic payments usually take one ot three days compared to four to five weeks for paper claims. The Micro version is the same software as the Standard version, but is limited to five electronic claims per month. It does not allow for batch invoicing functions. “We thought for those providers we’d introduce this free tier,” Dr Stewart said. “It’s the same software that everyone else would use. “It’s web-based software so they just need to register with us and be registered for Medicare to submit online claims. We streamline that process, so people who want to do DVA claiming or just a small number of bulk bill claims can get that. “If their billing volume increases, then they can graduate up to the paid version.” Dr Stewart said web-based software has the advantage that patient details are stored online and the response back from the DVA is easily traceable. It runs on iPads, laptops and desktops so is suitable for practitioners who run a mobile office.
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Community AF screening feasible and cost effective A Sydney research team that has been trialling the use of the AliveCor heart monitor and iPhone ECG device in both community pharmacies and general practice has found that it is both a feasible and a cost-effective way to better screen older people for atrial fibrillation (AF), one of the leading causes of stroke. The AliveCor device is a single-lead ECG built into an iPhone case that has an accompanying app that can analyse the readings and display them on the phone’s screen. The readings are sent to a secure website, where an algorithm can predict AF with 97 per cent accuracy. Last year, the team published encouraging results from its Screening Education And Recognition in Community pHarmacies of Atrial Fibrillation (SEARCH-AF) stroke prevention study, which involved 10 pharmacies where screening was offered to all customers over the age of 65. Now, the team has published the results of its analysis of the feasibility of using the device on a greater scale in community pharmacies and how much it would cost to do so. The team found that the incremental cost-effectiveness ratio (ICER), based on 55 per cent warfarin prescription adherence, would be $30,481 for preventing one stroke. The costs include $20 per iECG screen, $252 for diagnostic assessment of AF (GP consult, specialist consult and 12-lead ECG) and $803 per annum for warfarin treatment, INR monitoring, three GP visits and one specialist visit. The app is available for iPhone and Android. Consumers are provided with secure storage and sharing functionality, while healthcare providers are equipped with a free web app that acts as a dashboard to help review their patient’s ECG data.
Inner-city Melbourne hooks up to health pathways for better referral options HealthPathways Melbourne, a web-based system that provides GPs with clinical guidance on specific health conditions and referral options to local heath services from one portal, was officially launched in late May. HealthPathways are an increasingly popular method being used in Australia and New Zealand to help GPs manage common conditions, to easily refer to local specialists and allied health professionals, and to link up with hospital-based services. They have been used in the Hunter New England region since 2011 and in western Sydney for the last year. Other areas introducing similar systems include Victoria’s Barwon region and the NSW central coast. Based on a system first developed in New Zealand’s Canterbury district and to a lesser extent the UK’s Map of Medicine, they are designed to provide GPs with condition-specific specialist advice that may assist in developing more accurate pre-referral workups. Each pathway contains clinical information and referral information designed for the local health system. The establishment of HealthPathways Melbourne
has been co-ordinated by Inner East Melbourne Medicare Local (IEMML) and Inner North West Melbourne Medicare Local (INWMML), with local GPs acting as clinical editors for each pathway. Pathways have been designed for diabetes, hepatitis B, hepatitis C, fatty liver disease, coeliac disease in adults and in children, and back pain, with further work planned for this year for cardiovascular, dermatology, COPD and mental health.
“Victoria has 86 different hospital networks with a large number of different referral points ...” According to Brunswick West GP and INWMML HealthPathways clinical editor Debra Wilson, the pathways had been developed for the local system by working with GPs, specialists and other health providers in the region, all of whom have expertise around managing a particular health condition. “The resulting pathway condenses not only clinical guidance but also a range of detailed local information
that ensures the GP can find the best service or referral point across the whole local health system,” Dr Wilson said. “Just as importantly, HealthPathways Melbourne has been designed to allow any health professional that uses the system to provide feedback and suggestions. That means we can continually improve and update individual pathways over time.” INWMML CEO Christopher Carter said the portal would also help GPs to link up to the 150 or so outpatient clinics in the region. “Victoria has 86 different hospital networks with a large number of different referral points covering a range of specialist hospital departments,” Associate Professor Carter said. “The feedback we get from hospitals and from GPs is that by reducing unnecessary referrals and ensuring the right tests and investigations are done beforehand we can cut down on delays in people getting appropriate and well-targeted specialist support. “The pathways also include guidance information for patients so that they can be better informed about what they can do to better manage their health.”
Queensland holds parliamentary inquiry into telehealth services A Queensland parliamentary committee is holding an inquiry into the telehealth services managed by Queensland Health with a view to ensuring telehealth services are, in the words of the inquiry’s chair, “on the right track”. The inquiry’s terms of reference include examining the implementation of telehealth by the Department of Health and hospital and health services in trials, as well as the new Rural Telehealth Service that was announced in the state government’s Blueprint for better healthcare in Queensland in February last year. The committee intends to visit some rural and regional telehealth sites
and hold public hearings in Brisbane and other locations. It invited submissions on telehealth from interested parties, which are available on the inquiry’s website. In its submission, the Australian College of Rural and Remote Medicine (ACRRM), which has developed a number of telehealth resources over the years and coordinates the well-regarded Telederm service, argued that telehealth arrangements should complement existing specialist services. They should also build on rural referral patterns to avoid further service fragmentation, and address the practicalities of coordination, scheduling and support from the
patient’s perspective, ACRRM said. The University of Queensland’s Centre for Online Health urged the inquiry to look beyond video conferencing as the only technology for telehealth. Store and forward and telemonitoring are other technologies that need to be harnessed, it said. The Australasian Telehealth Society (ATHS) argued that simply expanding the current Queensland Health videoconference network was not enough. “If telehealth development is treated as an IT project, the end result is the ‘dust cover effect’, whereby unused video conferencing machines are found in cupboards, or not found at all,” the society said.
PICS roll-out starts to gather momentum in South Island A team from New Zealand’s South Island Alliance and vendor partner Orion Health will be touring South Island District Health Boards (DHBs) in the coming months to demonstrate the new Patient Information Care System (PICS) that is due to be implemented throughout the region. PICS is being built by Orion Health as a single system to manage patient information from all hospitals in the South Island, with plans to extend it into primary care to allow the capture of patient information at the point of care. It promises to streamline the patient journey and help to coordinate care between different hospitals and providers around the South Island and standardise patient flow across DHBs. It will include data on patient demographics, appointments, clinical records, in-patient admissions, discharges and scheduling. All five DHBs have endorsed the implementation and it recently received approval from Health Minister Tony Ryall for government investment. The new system is expected to first be implemented at the new Burwood Health Campus in Christchurch in March next year, where construction is underway on a purpose-built sub-acute facility for the elderly and rehabilitation services. Canterbury DHB CEO David Meates said PICS will replace the HOMER system currently used for patient demographics, admissions, transfers and discharges as well as the SAP system for older persons’ health and mental health. “This isn‘t about replacing our current system with a similar one,” Mr Meates said. “SI PICS will help future-proof our systems; it has new functions we can build on to positively change the way healthcare is provided over the next 20 years.”
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GP2GP sets records for medical record transfers NZ’s Patients First is getting ready to release an updated version of its GP2GP patient file transfer system, featuring an increase to the file size limit and some back-end fixes that promise to make the system run more smoothly. GP2GP has been operating in New Zealand for over two years to allow general practices to easily transfer medical data when a patient moves out of an area or to a new practice. In May, it set a record of 32,689 transfers for the month. Patients First’s CEO, Jayden MacRae, said the main new feature was an increase in message size from 5MB to 20MB. “It has been limited to 5MB in the past, which for most patients is more than sufficient, but you do have some people with quite a lot of information in their medical records so we are now supporting 20MB transfers,” Mr MacRae said. “That’s a four-fold increase and should cover the vast majority of the population.” Mr MacRae said that since its introduction, 968 practices have used GP2GP to either send or receive messages, and 826 practices have sent more than 10 patient files each, which he said illustrates consistent and regular use. GP2GP is a completely voluntary system with no financial incentives to use it, and yet Patients First’s outgoing CEO, Andrew Terris, estimates that it has seen upwards of 95 per cent adoption across the general practice community. Mr Terris said adoption had been “stellar” due to the utility practices found with the system. The main incentive for practices was the time saved by staff on printing, photocopying and licking envelopes. On the importing side, it also saves time for the receiving practice in that they don’t have to re-enter patient data.
Peninsula Health and Medtech get the goahead for CHF home monitoring A proposal by technology vendor Medtech Global and Peninsula Health in association with the CSIRO to trial remote monitoring of patients with chronic heart failure in their homes has been selected to receive full funding as part of the Victorian government’s Health Market Validation Program (Health MVP). The chronic heart failure model of care project will involve 300 patients, half of whom will receive standard care and the other half using Medtech’s VitelMed software on their mobile phones or devices to automatically track their weight and activity levels. Weight measurements are collected from a Bluetoothenabled scale and sent to Medtech’s cloudbased ManageMyHealth portal, to which clinicians
have access. The trial is also using Medtech’s MD Analyze software to analyse the clinical data and improve treatment pathways. The software includes prompts for the patients if they do not weigh themselves, and the ability for healthcare staff to contact them through VitelMed if they need to speak to the patient. The project will use Peninsula Health’s existing MEPACS personal alarm emergency response service if the patients are not weighing themselves to enhance compliance and improve adoption of the technology. Peninsula Health CEO David Anderson (pictured right with Medtech’s Rama Kumble) said the trial would
involve the existing chronic heart failure clinic, which is serviced by a team of cardiologists and cardiac nurses. “The idea is that we will do a trial between the existing group and the existing services with the proposed service, which includes the scales, the daily measurements, the feedback back to the patient that says you’ve forgotten your measurements, as well as the clinical protocol,” Mr Anderson said.“It is a clinical trial of around 18 months to hopefully identify both better outcomes and reduce costs using the technology.” He said the project team consulted with cardiologists on what measurements to track using the technology, and weight was the prime indicator.
HealthLink
Secure MessagingTransforming Healthcare HealthLink delivers on the promise of ehealth reform through standards compliance and nationwide secure messaging. “A key part of the feasibility stage was for the cardiologists to say whether they wanted to collect a large number of data and it was concluded that the change in weight and
activity were really the two key signs,” he said. Medtech is also working on the capability to add data from wearable devices such as Fitbits.
The video capability of mobile devices can also be used to better provide educational resources to patients in the months between scheduled visits to the cardiac clinic.
Queensland’s paediatric telehealth service racks up a major milestone The Queensland Telepaediatric Service (QTS) has reached a milestone of 20,000 remote consultations since it began operating in November 2000 and is now one of the largest paediatric telehealth services in the world. QTS connects medical specialists from its base at Brisbane’s Royal Children’s Hospital with over 100 regional and remote hospitals throughout Queensland.
Dr McBride does a fourweekly telehealth clinic on a Thursday morning, and says the other consultants tend to do the same. His burns patients are generally seen first, followed by paediatric surgical patients.
“It can be a little more difficult if the person at the other end can’t confidently act as our hands.”
Established and operated by the University of Queensland’s Centre for Online Health, it has a dedicated telepaediatric coordinator and uses a mixture of phone, email and video conference, with about 90 per cent of all referrals resulting in a consultation by video.
Burns consultations are conducted with an occupational therapist while Dr McBride does the paediatric surgery ones on his own. “We book the patients into clinic review just as we normally would, only it’s telehealth rather than in the same room.”
RCH paediatric surgeon and burns specialist Craig McBride regularly uses QTS to link him with regional patients and with a network of scar management therapists throughout the state.
The types of paediatric surgery cases that are suitable for telehealth vary, but usually consist of the more common conditions such as hernia, hydrocele and undescended testes, he said. “We have also
used it for follow-up of patients with more complex conditions that live a long way out of Brisbane.” Pre-operative consultations as well as post are conducted, although for surgery patients, preoperative checks mean the team in Brisbane is more dependant on the clinician at the other end of the consultation to demonstrate problem areas, he said. “It can be a little more difficult if the person at the other end can’t confidently act as our hands. In those situations we’ll generally book the patient for theatre in Brisbane, but see and examine them ourselves prior to surgery.”
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For his burns patients, Dr McBride can both inspect the surgical site during the consult and view clinical photos that have been emailed previously. “Photos are a good way of documenting progression of healing, and form a standard part of the record for us to refer back to.”
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Challenge winner launches clinical translation app The winning entry in NZ’s 2011 Clinicians’ Challenge has been officially released after several years of development, resulting in an app that can be used by patients with speech difficulties or English as a second language to communicate with clinicians, and vice versa. Listen Please was first put forward in the 2011 competition, which is organised by Health Informatics NZ, the New Zealand Health IT Cluster and the National Health IT Board, and has since been refined by inventor Janet Liang. Dr Liang, an intensive care specialist at North Shore Hospital in Takapuna, developed the app for use in medical emergencies and at the bedside. It is primarily aimed at patients who can’t speak at all due to airway restrictions or for patients who don’t speak English. It can translate Mandarin, Cantonese, Korean, Samoan and Tongan through printed and audio translations and uses pictures and photos to help understanding. The idea is to use the app in emergency situations when a human translator is not available. “Clinical translators do a fantastic job, but it sometimes isn’t practical to have one around all day, or sometimes they cannot be available quickly enough,”she said. Dr Liang has devised a series of questions that clinicians would need to ask in an emergency as well as those that can be asked during everyday care. The questions are worded to suggest Yes (tick)/ No (cross)/ Don’t Know (question mark) answers so that clinicians don’t need to translate the patient’s reply. There is also a patient talks mode to allow patients to communicate common needs such as wanting to speak to family or to go to the toilet.
GP2U partners with SkinByDerms for teledermatology referrals Telehealth provider GP2U has partnered with teledermatology service SkinByDerms to allow patients and GPs to securely upload clinical photos to GP2U’s platform directly from a mobile phone to be reviewed by specialist dermatologists. While SkinByDerms also offers a bulk-billed specialist dermatology service on its platform, the new partnership allows GPs to write a referral to a dermatologist and attach clinical photos through the GP2U app. The images are also attached to the patient’s file and stored for future viewing. The app now contains a QR code that users scan with their device to allow photo uploads. It includes a default setting that means
clinical images are not saved locally but removed from the device after they are uploaded, overcoming common privacy concerns. GP2U founder James Freeman said the new functionality would allow GPs to conduct the referral process completely online, including booking an appointment with a SkinByDerms consultant. As part of the referral process, they will also be able to add standard questionnaires to the referral, send the referral through securely and then add the clinical images using the app. “The GP can grab the phone, take a digital image, and send it up to the patient’s file for viewing by the dermatologist using QR code scanning,” Dr
Freeman said. “When you scan the QR code, it gives you a security token and patient ID and slips straight to the application for photo uploading.” Patients can also upload their own photos by going to the GP2U homepage and logging in, he said. “You see a QR code at the end of the booking process,” he said. “With your smart device, you open our app, click on the barcode scanner and scan the QR code. That will take you into the photo upload widget, and you upload your picture. “Then if you go to the main site and have a look at your file, you find that it’s there. The doctors can then open the patient account and see the picture.”
Medee aims to build digital health technology community The medical device commercialisation specialists behind digital health company uHealth have launched a new service to provide information on emerging medical technologies to consumers. They have also signed a distribution agreement with the makers of the AliveCor heart monitoring device.
Will Knox and Jeff Reid set up uHealth last year to develop a portfolio of quality, medically validated digital technologies, including the AirSonea asthma device, the WiTouch Pro wireless transcutaneous electrical nerve stimulation (TENS) device and the LUMOback posture sensor and mobile app.
They have since added the AliveCor health monitor for iPhone device to their roster. AliveCor is a singlelead ECG device built into an iPhone case that has an accompanying app that can analyse the readings and display them on the phone’s screen. It has been approved by the Therapeutic Goods
Administration (TGA) and validated in several studies, including for use in community pharmacy to screen for atrial fibrillation, by a team from the University of Sydney led by cardiologist Ben Freedman. uHealth has also added a new smartphone-based endoscope technology called endoscope-i that it is marketing to ENT specialists, as well as a product developed by UK company Sensium Healthcare that consists of a wireless, disposable patch that monitors vital signs every two minutes and sends an alert to the nurse should the patient deteriorate. It is also awaiting TGA approval for Dario (pictured), an all-in-one glucose meter that plugs into a smartphone and can both measure blood
glucose levels and link to a cloud-based diabetes management platform on the user’s smartphone. As the portfolio of products expands, uHealth has also launched Medee (pronounced Medi and a play on the words ‘medical’ and ‘community’), which Mr Knox describes as a free subscription-based platform that aims to provide health information and news about existing and emerging technologies for common chronic conditions such as diabetes and asthma. It also plans to target the booming aged care market, both in terms of institutional aged care and devices that will help elderly people stay at home for longer. Mr Knox said Medee is basically an email database
of interested consumers and health and technology information that will allow the company to tailor “infomail” packages that can be sent to subscribers. It will be structured around monthly packages on a particular health issue or chronic disease, with an infomail sent out once a week for three weeks containing information about the chronic disease state itself, how it is traditionally managed, and how particular technologies might fit into a new way of managing those conditions. The final email will contain obligation-free offers on the technologies at discount prices. All of the technologies featured will be regulated products that are TGA approved and clinically validated, with a team of health experts advising on their quality.
Wesley goes mobile with clinical systems in the cloud Wesley Mission Brisbane (WMB) has embarked on a mobility strategy for its 12 residential aged care communities, equipping care staff with mobile devices to provide real-time access to Leecare’s cloud-based Platinum 5.0 clinical information system. WMB is currently rolling out Platinum 5.0 to all of its aged care communities, with its three largest sites now complete and a fourth in the process. It has installed WiFi in all sites to support the mobile devices, which are a mixture of the Samsung Galaxy Tab 3 and the Note 10.1. Selina Beauchamp, WMB’s business systems group manager, said all staff members on every shift had access to a device. “Clinical staff such as registered and enrolled nurses and allied health professionals are given the device, and care staff are using kiosk devices, which are stored in a lockable cabinet and signed in and out at each shift,” she said. WMB is hosting Platinum 5.0 locally and provides access based on roles for clinical and care staff, and full access to the system for visiting GPs. The organisation also plans to roll out Leecare’s medications management module once the core clinical system is fully implemented. Wesley has also taken advantage of the software’s capabilities to create pictorial care plans to give care staff information on the personal needs of residents. Many care staff have English as a second language, so the pictorial care plan provides essential information at a glance. It has also modified the tea trolleys that deliver drinks to the residents to fit the tablets, doing away with the need for paper lists of the personal likes of each resident.
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Waterproof version of SOS Mobile Watch set for launch The company behind the three-in-one personal alarm device SOS Mobile Watch are getting ready to launch a waterproof version, having also added new locationfinding functionality and found new and unexpected markets for the technology. Sydney-based mCareWatch launched its first generation SOS Mobile Watch last year, targeting older people living at home with a device that acts as a watch, a mobile phone with GPS tracking and a personal alarm. The idea was to have an alternative to traditional pendant alarms that are worn around the neck, but also to allow older people the freedom to go about their daily activities without forcing them to stay close to a base station. Since then, the company has also launched a software platform called ConnectiveCare for residential aged care facilities that allows care staff to monitor residents and detect whether they are leaving designated areas through its Geo-Fence capability. Devices are also being used by hospitals when discharging elderly patients into transitional care and for those recovering from stroke. The company will release an IP67classified water-resistant device called the SMW14 shortly. It is also working on an advanced smart mobile watch that will include a gyroscope to detect falls as well as Bluetooth functionality to allow the wearer and their carers to pair it to blood pressure monitors or other wireless devices for chronic disease management. The SOS Mobile Watch has an emergency button in case of falls, can be opened up for two-way communication at the touch of a button and also works as a good oldfashioned watch. Carers can also configure medication and appointment reminders through mobile apps and a web portal, and the device can be linked to the family or carer’s smartphone through mobile apps.
HealthEngine releases practice-specific appointment booking app Online appointment booking and directory service HealthEngine has developed a practicespecific appointment booking app and is promoting its practice management system integration as part of the plans to double the number of practices using its services. The Perth-based company, which last year signed a $10 million partnership with Telstra and Seven West Media, is also planning a new round of capital raising to build a war chest as part of its plan to double its volume of 3000 practitioners at 1000 health practices in the next year. HealthEngine CEO Marcus Tan said the company has enough cash on hand to fund its growth plans, but was looking at taking advantage of a buoyant market that has a large appetite for technology stocks. While there are no definite plans, growth through acquisitions is a possibility. HealthEngine recently launched an Android version of its patientfocused app, which lets patients search for and book appointments with GPs and allied health practitioners in the local area. It has also launched a free practice-specific app called Get Better
that practices can give to existing patients to let them book appointments on their smartphones. “The HealthEngine app is the marketplace app that is basically for patients to find practices, but we also have a practice-specific app that they can promote to their individual private patients,” Dr Tan said.
on promoting the benefits of full integration with practice management software. HealthEngine has always had this capability and is integrated with Best Practice, PracSoft, Zedmed, Genie and Practice 2000, but many practices still prefer to use the pay-perappointment model and offer appointments through the HealthEngine website.
“It’s powered by the HealthEngine system and is for practices to be able to promote to their patients as a home app that is specific to that practice. It’s a nice addition to the stable.”
Others see the advantages of full integration so HealthEngine has a subscription model available with a set fee per month based on the number of practitioners.
Dr Tan said the company was also concentrating
“We started off with a solution that a lot of
practices are still very happy using but we are at a point where they see it’s much easier to integrate,” Dr Tan said. “A lot of practices are being given options and are seeing the value in integration.
The company offers a plugin that practices can add to their websites to allow for online bookings and can also build a simple webpage hosted on the HealthEngine site for practices that don’t have their own website.
“We try to be as flexible as possible and for those practices that don’t want integration, we still offer a very good service.”
It has a customisation service for the Get Better app but the basic model is free for subscribing practices to use.
The company is also offering a subsidy to practices in areas of the country where patients are searching online for appointments but none are available. It is offering a limited number of access grants to practices in those areas that would like to use online bookings but are still hesitant.
OzeScribe named a preferred provider for Queensland Health for outpatient notes Medical transcription service OzeScribe has been appointed as a preferred provider for Queensland Health, joining a panel of five providers. OzeScribe, which was established in Melbourne in 1999 and now works with an estimated 98 per cent of public hospitals in Victoria, is integrated with most general practice and medical specialist practice management software, including Medical Director, Best Practice, Genie, Shexie, Zedmed, Houston Medical and The Specialist. Its platform also allows transcripts to be securely sent directly to hospital electronic medical record systems such as Cerner and InfoMedix, as well as an individual portal for each user, where files can be securely stored and managed.
OzeScribe director and co-founder Lyndie Arkell said the preferred provider status meant Queensland hospitals can use the service for outpatient and clinic notes and to reduce transcription backlogs. Once the backlog is cleared, OzeScribe can create a co-source arrangement to work with in-house teams to ensure hospitals don’t get behind again. For Queensland hospitals, transcriptions are delivered directly into their software in the format they require, as well as to the referring GP’s system if desired. OzeScribe is compatible with all of the major secure messaging services including Argus, HealthLink, ReferralNet and Medical-Objects. Ms Arkell said OzeScribe had established a flexible
platform that enables specialists to use a service that suits them best, including an app that allows doctors to dictate straight into their mobile phone and then securely send the recording to OzeScribe. They can also use voice recognition software such as Nuance’s DragonDictate but with the back-up of a human transcriber if they so wish. “If you’re using one of our apps, you can get Nuance and use that to dictate,” she said. “Then you will get a draft of [the dictation] and see it on your phone and you can accept the draft, saving you lots of money, or if you don’t like it you can then send it off to get transcribed. “We believe the popularity of our service is the ability to reject it and get it typed if you want.”
Apotex enters the automatic refill app market with NPS Generic pharmaceuticals company Apotex has partnered with NPS MedicineWise to add new functionality to the NPS MedicineList+ smartphone app, including the ability to download data on medicines directly from pharmacy dispensing software. NPS launched the new version of MedicineList+ earlier this year, adding extra functions such as the ability to scan in barcodes to add data straight into the app, to email the medicines list to family or healthcare providers, and a reminder function. It is now available for both iOS and Android. NPS has now partnered with Apotex to build an enhanced version that will interface with dispensary software to directly download details of prescription, over the counter and complementary medicines to the smartphone. There are also plans to add the ability to order a refill for repeat scripts. Apotex’s marketing manager, Paul Chang, said the system would use Intellipharm’s middleware product, already used in many pharmacies, which will extract certain data from the dispensing system, including medication history and current medications, and send it to the app. “Patients can then see a list of everything that has been dispensed, including over the counter and complementary medicines,” Mr Chang said. While its main market is generic drugs, Mr Chang said Apotex also offered a number of technology platforms for the retail pharmacy business, including ApoWealth for financial analysis and APO-Dispensary, a dispensary data analysis tool. The company has also worked with the Pharmacy Guild’s Guildlink service to add QR codes to its packaging.
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Sharing health information and the privacy paradox
PCEHR future, e-Patient Dave and YouTube wunderkind at HIC 2014
A survey of consumer willingness to trade digital privacy for greater convenience has found that while Australians and New Zealanders have confidence that governments and organisations will keep their data safe, they are yet to be convinced to give up their online privacy.
A government-sponsored PCEHR consultation event is expected to generate widespread interest at the annual Health Informatics Conference (HIC 2014), the organisers say.
The Privacy Index study, conducted by IDC on behalf of data storage firm EMC, surveyed 15,000 consumers in 15 countries, including 1000 in Australia and New Zealand, to gauge their digital privacy beliefs in six different areas of online activity: consumer, employee, social, medical, financial and citizen.
More than 1000 delegates will attend the four-day event in Melbourne from August 11 to 14.
It asked them the extent to which they would be willing to trade in privacy for greater convenience, what level of confidence they had in institutional ethics and transparency when protecting individual privacy, their confidence in those institutions’ skills and abilities to protect privacy, and their confidence in their level of future privacy. What the survey found was a number of paradoxes. Consumers want the convenience of technology but are unwilling to sacrifice personal privacy to get those benefits. Globally, the willingness to trade privacy for benefit was highest when it came to medical and government information, as was the confidence level that governments and businesses had the ethics and skills to protect privacy. Australia and New Zealand shared this confidence but otherwise ranked quite low – 11 out of the 15 countries surveyed – in the privacy index overall. When it comes to medical information, 41 per cent were willing to trade in privacy compared to 47 per cent globally, despite 74 per cent saying they would value easier access to medical records.
Scheduled for the last day of HIC, and with details yet to be finalised at the time of going to press, the Health Informatics Society of Australia (HISA) is looking for input from Australia’s eHealth and health informatics experts to plan the PCEHR event. Software vendors with PCEHR capability will be
demonstrating the system, so visitors can meet the key vendors and see firsthand how electronic health records can work, HISA CEO Louise Schaper said.
affected the acceptance of the PCEHR in Australia including privacy, security, patient controls and sharing of medical data are on the agenda for HIC this year.
“As a result of the recent PCEHR review, we know the government wants more consultation around getting this important health infrastructure working successfully,” Dr Schaper said.
HIC will be preceded by four one-day satellite conferences, including the regular Digital Healthcare Design, Nursing Informatics and Indigenous Informatics conferences, as well as a new Participatory Health conference.
“Our members are Australia’s eHealth leaders who have the expertise and knowledge we need to tap into to make it happen.” Health consumer rights are increasingly prominent in social media and many of the issues that have
This new conference will feature patient advocate Dave deBronkart, better known as e-Patient Dave, who will discuss how engaged patients are changing healthcare. A session on active and
independent ageing will also be held to discuss how to use ubiquitously connected technology to engage patients in healthy behaviours and will feature former Tasmanian premier David Bartlett, who had a career in IT and was CIO of the Tasmanian Department of Health and Human Services before entering politics. e-Patient Dave will also address the main HIC conference in tandem with Danny Sands, cofounder of the US Society of Participatory Medicine. They will discuss the power of ‘e’ in the patientphysician relationship. Another patient advocate for improved health technology speaking at the conference is Regina Holliday, who made a big impression in her keynote speech at HIC in 2012. She will address HIC 2014 on the second day, along with Stephen Damiani, a Melbourne-based risk management specialist who has set up a foundation to raise funds to investigate rare genetic disorders called the Mission Massimo Foundation, named after a young son who has a form of genetic leukoencephalopathy. HIC 2014 will also feature social media expert Bertalan Mesko, a Hungarian medical futurist who founded a site called webicina.com to curate
medical and health-related social media resources for patients and medical professionals. Budding US scientist Jack Andraka will also speak on the second day. Still in high school in the US, Jack won a $75,000 award at the Intel International Science and Engineering Fair in 2012 for inventing a prototype dipstick-like rapid diagnostic test for cancer. The Maryland high school student was only 15 when he created the novel paper sensor, which claims to detect pancreatic, ovarian and lung cancer in five minutes at the cost of a few cents. He has since given several TED talks, gone viral on YouTube in a video showing his ecstatic reaction to the Intel win, and will discuss innovation and open data at HIC. He will also take part in a Q&A session on the digital future of medicine with Dr Mesko. Local EHR speakers include Paul Carroll, senior director of Queensland Health’s Health Services Information Agency, and Ernst and Young’s Sari McKinnon, former director of solutions and architecture for the Ministry of Health in Singapore, where a national electronic health record was delivered in 2011. HIC 2014 chairman and secretary of the Victorian Department of Health,
Pradeep Philip, said that with the calibre of speakers and participants attending, HIC promises to be a thought-provoking, engaging, and meaningful event for patient advocates, clinicians, health administrators, academics, and public policy experts. “That health informatics and eHealth will shape the health system of the future is not in question,” Dr Philip said. “How it does so is in your hands. That’s why I encourage you to actively participate in this year’s conference, to play your part and lead change in Australia’s health system.” The always-popular Q&A panel hosted by Tony Jones will include Department of Health CIO Paul Madden and HISA board member Michael Gill. The conference will also be addressed by Victorian Health Minister David Davis and federal Minister for Human Services, Senator Marise Payne. The annual Innovation Expo will feature the finalists in the annual Health Apps Challenge, where budding programmers pitch their mobile health app creations. This year’s challenge involves four categories: aged care, medication management, the quantified self and clinician productivity. See www.hisa.org.au for more information.
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Events July 1-2
26-27 JULY
16
HOSPITAL EFFICIENCY 2014 Sydney, NSW p: +61 2 9229 1000 w: www.hospitalefficiency.com.au
TASMANIAN HEALTH CONFERENCE Hobart, TAS p: +61 3 6234 7844 w: www.tasmanianhealthconference.org.au
22-23 JULY
28-29 JULY
ANNUAL WOMEN’S AND CHILDREN’S HEALTH UPDATE Perth, WA p: +61 1300 797 794 w: www.healthed.com.au
ITAC 2014 Hobart, TAS p: +61 8 8981 5119 w: www.itac2014.com.au
6TH ANNUAL EMERGENCY DEPARTMENT MANAGEMENT CONFERENCE 2014 Melbourne, VIC p: +61 2 9080 4090 w: www.healthcareconferences.com.au
JULY
28-29 JULY 13TH ANNUAL HEALTH INSURANCE SUMMIT Sydney, NSW p: +61 2 9080 4307 w: www.informa.com.au
29-30 JULY AUSTRALASIAN LONG-TERM CONDITIONS CONFERENCE 2014 Auckland, NZ p: +64 7 838 1098 w: www.healthnavigator.org.nz
August 24-25 JULY REDUCING HOSPITAL READMISSIONS & DISCHARGE PLANNING CONFERENCE Melbourne, VIC p: +61 2 9080 4090 w: www.healthcareconferences.com.au
24-25 JULY 4TH ANNUAL NATIONAL HOSPITAL PROCUREMENT CONFERENCE Sydney, NSW p: +61 2 9080 4090 w: www.healthcareconferences.com.au
11
AUGUST
NURSING INFORMATICS AUSTRALIA CONFERENCE Melbourne, VIC p: +61 3 9326 3311 w: www.hisa.org.au/hic2014nia
11TH GUIDELINES INTERNATIONAL NETWORK CONFERENCE Melbourne, VIC p: +61 3 9682 0500 w: www.gin2014.com.au
21
AUGUST
NZHITC WELLINGTON NETWORKING EVENT Wellington, NZ p: +64 4 815 8177 w: www.healthit.org.nz/events
23
AUGUST
GENERAL PRACTICE EDUCATION DAY Sydney, NSW p: +61 1300 797 794 w: www.healthed.com.au
25-26 AUGUST 4TH ANNUAL CLINICAL AUDIT IMPROVEMENT CONFERENCE Sydney, NSW p: +61 2 9080 4090 w: www.healthcareconferences.com.au
HIC 2014 Melbourne, VIC p: +61 3 9326 3311 w: www.hisa.org.au/hic2014
13-14 AUGUST
CONFERENCE FOR GENERAL PRACTICE 2014 Christchurch, NZ p: +64 9 525 2464 w: www.generalpractice2014.org.nz
THE FUTURE OF MEDICARE CONFERENCE Sydney, NSW p: +61 2 9080 4090 w: www.healthcareconferences.com.au
RADAIM 2014 Gold Coast, QLD p: +61 7 3851 4298 w: www.phoenixconf.com
20-23 AUGUST
11-14 AUGUST
24-27 JULY
25-27 JULY
AUGUST
15
AUGUST
HEALTHSHARE NSW & E-HEALTH NSW EXPO Sydney, NSW p: +61 2 8644 2074 w: www.hssevents.health.nsw.gov.au
25-27 AUGUST 15TH INTERNATIONAL MENTAL HEALTH CONFERENCE Gold Coast, QLD p: +61 7 5502 2068 w: www.anzmh.asn.au/conference
28
7-10 SEPTEMBER
20-22 OCTOBER
HISA NSW MEETING Sydney, NSW p: +61 3 9326 3311 w: www.hisa.org.au/events
ACSA NATIONAL CONFERENCE Adelaide, SA p: +61 8 8981 5119 w: www.acsaconference.org.au
LASA NATIONAL CONGRESS 2014 Adelaide, SA p: +61 2 6230 1676 w: www.lasacongress.asn.au
28-29 AUGUST
22-23 SEPTEMBER
21-24 OCTOBER
6TH ANNUAL OPERATING THEATRE MANAGEMENT CONFERENCE Sydney, NSW p: +61 2 9080 4090 w: www.healthcareconferences.com.au
MANAGING THE DETERIORATING PATIENT CONFERENCE Melbourne, VIC p: +61 2 9080 4090 w: www.healthcareconferences.com.au
AAPM 2014 CONFERENCE Adelaide, SA p: +61 3 6231 2999 w: www.aapmconference.com.au
AUGUST
26
SEPTEMBER
4TH ANNUAL HEALTHCARE COMPLAINTS MANAGEMENT CONFERENCE Sydney, NSW p: +61 2 9080 4090 w: www.healthcareconferences.com.au
29-30 SEPTEMBER 3RD ANNUAL REDUCING AVOIDABLE PRESSURE INJURIES CONFERENCE Melbourne, VIC p: +61 2 9080 4090 w: www.healthcareconferences.com.au
23
OCTOBER
HISA NSW - AGED CARE Sydney, NSW p: +61 3 9326 3311 w: www.hisa.org.au/events
29
OCTOBER
NZHITC CHRISTCHURCH NETWORKING EVENT Christchurch, NZ p: +64 4 815 8177 w: www.healthit.org.nz/events
October 28-29 AUGUST 6TH ANNUAL CORRECTIONAL SERVICES HEALTHCARE SUMMIT 2014 Melbourne, VIC p: +61 2 9080 4090 w: www.healthcareconferences.com.au
September
4
SEPTEMBER
RACGP NSW & ACT FACULTY’S MEDICAL RECEPTIONIST COURSE Sydney, NSW p: +61 1800 626 901 w: www.australiandoctor.com.au/events/ medical-receptionist
4-7
SEPTEMBER
RANZCR COMBINED SCIENTIFIC MEETING Melbourne, VIC p: +61 1800 193 405 w: www.csm2014.com
7-9
OCTOBER
HIMAA AND NCCH 2014 NATIONAL CONFERENCE Darwin, NT p: +61 2 9887 5001 w: www.himaa2.org.au/conference
8
OCTOBER
HISA VIC - PCEHR Melbourne, VIC p: +61 3 9326 3311 w: www.hisa.org.au/events
9-11 OCTOBER THE RACGP CONFERENCE FOR GENERAL PRACTICE Adelaide, SA p: 1800 472 247 w: www.gpconference.com.au
15
OCTOBER
NZ AGED CARE ASSOCIATION CONFERENCE Wellington, NZ p: +64 4 473 3159 w: conference.nzaca.org.nz
28-29 OCTOBER EHEALTH INTEROPERABILITY CONFERENCE Sydney, NSW p: +61 2 9080 4090 w: www.healthcareconferences.com.au
30
OCTOBER
RURAL MEDICINE AUSTRALIA 2014 (RMA2014) Sydney, NSW p: +61 7 3105 8200 w: www.acrrm.com.au
Online Calendar: To view a comprehensive list of eHealth, Health, and IT events, visit: http://www.pulseitmagazine.com.au/events
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MSIA
STANDARD TERMINOLOGY FOR
ELECTRONIC MANAGEMENT OF MEDICATIONS Public health strategies are now being implemented in all states to streamline the supply and economic management of medications in their hospitals, strategies that may also significantly reduce the risk of medication errors for patients. Standard terminology to describe medications and standards-based medicines formularies are key components of Australia’s future eHealth systems.
MARK FAHEY Business development manager, MIMS mark.fahey@mims.com.au
As readers of Pulse+IT would be well aware, the Australian health system is looking to eHealth solutions to improve the quality of outcomes for patients as well as achieve operational efficiencies to ensure that the health system is affordable and sustainable. One of the most significant financial costs to the Australian public health system is the supply of medications. Australian and global studies have shown that strategies to reduce medication business process inefficiencies can also significantly reduce the risk of medication errors for patients.
About the author
Each state health system now acknowledges that effective management of medications through purchasing, prescribing, dispensing, administration and reconciliation processes will reduce the overall cost of the provision of needed medications to patients. The fundamentals are now in place that allow a state health system to effectively manage the business of supplying medications and also reap the benefits to patients and clinicians that follow.
Mark Fahey is the acute care business development manager for MIMS Australia. He has designed solutions that leverage acute care patient monitoring and automatic patient data capture together with eHealth solutions to deliver paperless and closed-loop medication management systems.
In recent years electronic prescribing and administration initiatives in hospitals have helped reduce the frequency of medication errors. Medical record and medication chart legibility errors are typically the first problems to be addressed by introducing
clinical software solutions. Significant progress has also been made in reducing medication administration and pharmacy dispensing errors by the use of software tools. However, the full realisation of achieving a true closed-loop medication management system by seamlessly integrating every aspect of giving and receiving a medication safely across the care continuum is still rare to see in practice. A stumbling block has been a lack of standardisation that is needed to describe branded and generically equivalent medicines and their components, and standard naming conventions and terminology. At the moment a hospital clinician may ePrescribe a medication in a clinical software application that uses a medications list and reference that is different to the medicines reference and drug formulary used by the hospital pharmacy to dispense the medication. Then typically the administration of the medication is recorded in a noninteroperable medical record system. Each step usually requires some degree of “human mapping” of the medication process and this lack of standardisation increases the risk of a medication error occurring and also results in inefficiencies in the economical supply of drugs.
“One of the most significant financial costs to the Australian public health system is the supply of medications.” Mark Fahey
What is needed to streamline the process and further reduce the opportunity for medication error is a way of unambiguously identifying drugs available to the clinician in their health system and a common terminology to describe the medication which is needed to support interoperability of the medication recorded to other health professionals and health sectors. The Australian Medicines Terminology (AMT) is a NEHTA-developed set of specifications that standardise the identification, naming, and describing of medicine information. The introduction of AMT will reduce and perhaps in time totally eliminate the “human mapping” requirement that is today’s standard practice. It is expected that AMT will also help to reduce errors due to standardised terminology structure, the safer exchange of medicines information using common computer readable codes, and improved decision support. AMT can be implemented in clinical information systems that: • • • • • • •
Prescribe Record Review Issue – including dispense Administer Transfer information Record and analyse adverse events.
Just as standards-based communication via HL7 and the description of clinical conditions via SNOMED CT are considered
mandatory in contemporary electronic medical records systems, support of AMT is now considered mandatory to allow interoperability of drug and medicines concepts to other systems and clinical departments. Queensland Health has used a common drug catalogue for many years, but in other states typically the individual hospitals or regional health services have been responsible for deciding which drugs are purchased and stocked. In most states and territories there has not been an organisational approach to the supply and management of medications. This uncoordinated approach often results in inefficiencies such as wastage due to expiry date before use and over-stocking of medications in some hospital pharmacies, while others may be ordering the same medication from suppliers to overcome a shortage. State health organisations are now looking to establish systems that provide clinicians with a non-ambiguous medicines management system to support the clinical applications that prescribe, administer and dispense medications. The systems are early examples of real-world use of AMT for the unambiguous description of medicines approved and stocked for state supply. NSW Health’s Pharmacy Improvement Program (PIP) is enhancing hospital pharmacy systems and processes to support safer, more efficient and cost-
effective medication management and patient care in NSW public hospitals. One outcome of the program is a Hospital Pharmacy Product List (HPPL), which is a state-wide list of pharmaceutical products used by NSW public hospital pharmacies. This list will for the first time provide standardised naming and product descriptions across the state, which is essential to allow the state’s ambitious electronic medicines management and electronic medical record roll-outs to progress. Tasmania’s public health system is now supported by an electronic medicines formulary which is used by clinical staff and administrators across Tasmania’s four main hospitals and 17 rural and regional hospitals with measurable improvements being realised in quality, safety and efficacy, access and optimal use of medications across the health service. The formulary has also enabled meaningful medication information to be shared to and from the national PCEHR with the aim of more effectively managing the transition of medication as the patient transfers between hospital and community care. With the formulary now in place for just over 12 months, Tasmania’s Department of Health and Human Services has already saved over $500,000 on medication costs. The price tag of establishing the system was a minimal $80,000, so for all involved, the system has proven itself to deliver immediate clinical and economic benefits. The way drug and medicines information is recorded and shared by healthcare providers is vital to the economic delivery and success of Australia’s future eHealth system. A standardised approach to reduce medication business process inefficiencies is also fundamental to providing quality of data for eHealth, and it underpins the enabling of clinicians to exchange their traditional paper-based records for a modern, electronic system.
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HIMAA
HEALTH INFORMATION MANAGEMENT
DRIVING THE INFORMATION HIGHWAY HIMAA is heading to Darwin for its national conference in October, teaming up with the University of Sydney’s National Centre for Classification in Health (NCCH) to provide a wide-ranging event that highlights how health information managers and clinical coders are driving the information highway.
In an historic coalition, the Health Information Management Association of Australia (HIMAA) has this year teamed up with the University of Sydney’s National Centre for Classification in Health (NCCH) to present its annual national conference.
information foundation that support these important national initiatives, so we wanted to focus the conference program on insights, progress, challenges and lessons learnt faced by the health information management profession.”
HIMAA president Sallyanne Wissmann and NCCH director Richard Madden say that both the partnership and the conference theme were developed just after the change of federal government late last year, but they couldn’t have predicted then how appropriate the theme of Health Information Management: Driving the Information Highway would be.
HIMAA’s annual conference will be of relevance to health information managers, clinical coders, health informaticians, data analysts and a myriad of roles within the health sector that manage and use health information.
The aim in offering a combined conference program is to extend the learning and professional development opportunity for the organisations’ respective and related constituencies, they say. Ms Wissmann says health information is a fundamental component of the health system, with so many outcomes of the health system dependent on good quality, fit for purpose, patient, clinical and business information. “For the last couple of conferences we have focused on the emerging eHealth and health reform agenda,” she says. “By now, health information management professionals are well and truly embedded in implementing and managing the
The highlight of the conference is expected to be the rich and diverse networking opportunities that it provides delegates in the form of special interest groups that are open to all delegates to attend, interactive session forums and the conference social events. As one delegate put it last year: “Loved it … the experience, the presenters, vendors. The opportunity to meet and network in a national arena with likeminded professionals was impressive.” “There has never been a better time for health information professionals to come together to understand the strategic environment within which we operate and be inspired and motivated about shaping the future,” Ms Wissmann says. “The conference will certainly focus on our achievements, national and internationally.”
The clinical coding and classification stream will be of particular relevance to all public and private hospital delegates who perform and manage the clinical coding function. It is the premier event to attend for clinical coding updates, developments and networking opportunities. Classification experts from around the world, including Dr Bedirhan Ustun from the World Health Organisation (WHO) in Geneva and Dr Olafr Steinum from Sweden, will relate advances in international clinical classification. Associate Professor Graeme Miller and Julie Gordon from the University of Sydney’s Family Medicine Research Centre will present on the classification linkage between primary and tertiary care sectors. The NCCH team will comprehensively detail improvements for the next cycle of the national AR-DRG classification system which incorporates the ninth edition of ICD-10-AM/ACHI/ACS and AR-DRG version 8.0, for implementation in July 2015 and 2016 respectively, including an expanded
approach to coding additional diagnoses and the NCCH’s online education plans. Associate Professor Joanne Callen will give an opening keynote address on health information management advances in eHealth, while NEHTA’s Cathy Richardson will workshop SNOMED-CT, classification, terminology and analytics for HIMs. The Australasian Telehealth Society’s Dr Liam Caffey will present on telehealth and IP, while the Northern Territory’s own eHealthNT will highlight its pioneering My eHealth Record. NCCH’s Adjunct Professor Rick Marshall will compare casemix in the UK to Australia, while the Independent Hospital Pricing Authority’s (IHPA) James Downie will update delegates with the latest on the ABF in Australia. “We are also pleased to be focusing our two peer-reviewed journals, HIMJ and HIM-I, again this year, and to be welcoming a workshop on qualitative research for health information professionals from
Online registration for the HIMAA and NCCH annual NATIONAL CONFERENCE is open! Don’t miss the network event of the year for HIMs, Clinical Coders and other professionals associated with Health Information Management.
…Catch the early bird rates! “Health Information Management: Driving the Information Highway” 7- 9 October 2014 Double Tree by Hilton Esplanade Darwin, Northern Territory We look forward to welcoming you
Web: www.himaa2.org.au/conference Email: himaa@himaa.org.au Phone: 02 9887 5001
Associate Professor Callen and an associate editor with the journals, Dr Stella Rowlands,” Ms Wissmann says. “Joanne and Stella will show delegates just how easy it is to dip their professional toe into the stimulating waters of research. “All of this is in the context of our concurrent HIM and clinical coding streams, and a selection of papers, posters and practice bytes from the conference’s highest ever complement of abstract submissions.” Professor Richard Madden says the conference is one that health information professionals around Australia and overseas won’t want to miss. “And the opportunity to experience the tropical delights of the Top End in the mango season is a bonus,” he says. The HIMAA NCCH 2014 National Conference is at the DoubleTree by Hilton, Darwin, 7-9 October. For more information visit http://himaa2.org.au/conference/
Enrol now for
Comprehensive Medical Terminology Intake closes 22 May, course commences 5 June. 2014 intakes also in July and September.
HIMAA has delivered distance education in Medical Terminology and Clinical Coding for 16 years. Study at home in your own time. Personalised educator service.
Ever considered making a ‘C’ Change? Consider the opportunity to become a Clinical Coder. Ask about our Introductory to Advanced Courses. For more information please contact Education Services
Web: www.himaa2.org.au/education Email: education@himaa.org.au Phone: 02 9887 5898
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ACHI
OPENING MEDICAL RECORDS FOR PATIENTS A LIMITED LITERATURE REVIEW
Personal health records (PHRs) are the next big thing after electronic health records (EHRs), enabled by the uptake of electronic clinical notes and additional functionality. As part of the Australasian College of Health Informatics’ (ACHI) new biannual evidence review, we assessed 10 research articles on patient accessible records published in 2013 to see if a picture is emerging on the design and use of PHRs. DR KAREN DAY RN, PhD, FACHI DR CHRIS BAIN MBBS, Master Info Tech, MACS, FACHI
PHRs have begun to feature in health IT policy, such as the development of the PCEHR in Australia, and a New Zealand policy specifying that everyone will have access to the basics of their health information. What does this mean and how can we leverage PHRs to improve health outcomes? Is it safe for patients to use the functions, and what are some of the barriers to engaging in healthcare via PHRs? What is the potential for PHRs to improve access to care and how will services change? We have conducted a literature review of 10 articles about patient accessible records – a broader term to identify papers about PHRs, and the ‘state of accessibility’ – to assess the current state of play with PHR adoption. The articles were chosen from a broader group of articles suggested by ACHI members as being of particular importance or interest, as part of its newly instituted biannual evidence review1.
About the author Dr Karen Day is a senior lecturer in health informatics at the University of Auckland’s School of Population Health. Dr Chris Bain is a research fellow with the Faculty of IT at Monash University. They are members of ACHI’s program evaluation subcommittee (PES).
The objective of this process was not to produce a systematic review of the literature, but rather a contemporaneous snapshot of evidence around an issue – in this case the issue of patient accessible records – put forward by the members of a key relevant national professional body. The first step of our literature review was to invite ACHI Fellows to recommend articles for review for the year of 2013
on the topic of PHRs. There were 13 recommendations, and the authors also searched Medline, Google Scholar, PsychInfo and CINAHL databases to add to articles from the ACHI constituency to ensure good coverage on the topic. Articles were included if they presented research findings about patient accessible records (which were often PHRs) and/or patient portals. In total there were 33 articles, of which 10 were selected for more detailed analysis. Table 1 lists the selected articles. Once all the articles were identified for inclusion in the review process, we separately analysed the abstracts of candidate articles. We scored each abstract according to relevance to topic, academic rigour, novel or insightful nature of content, and real world applicability of findings or lessons. The scores were tallied and the 10 articles that scored highest were selected for full analysis and inclusion in this report. The draft report was reviewed by the members of the ACHI program evaluation subcommittee (PES) members and adjusted according to feedback received.
Findings The 10 articles reported on research in the USA and Australia. The three Australian articles by Lau and colleagues reported on two randomised controlled trials (RCTs) about how people used a ‘personally
controlled health management system’ (PCHMS) designed for research purposes, while the American articles reported on research ranging from how people actually used PHRs to what their concerns were about accessing medical information via a PHR; for example, privacy. The research methods matched the research questions as per Table 2. There were six RCTs: two by Lau et al were the same structure, while the rest were all different from one another. The RCTs were designed to measure the effect of PHRs, such as to improve blood pressure control, diabetes management outcomes, increase immunisation service utilisation, increase health service utilisation for physical and emotional wellbeing, and improve the safety of medication use.
their health information”2. The authors are not explicit about what form a PHR could or should take, and this is clear in the literature we found. Five articles reported on versions of PHRs. Lau et al created a ‘personally controlled health management system’ (PCHMS) signposting a person’s health journey as well as providing facilities for social
interaction and access to records kept by clinicians. Magid et al described the effect of a web-based disease specific selfmanagement tool for heart health, while Tang et al created a bespoke set of PHR functionalities to manage diabetes. Taha et al used a simulation of Epic’s MyChart PHR. Depending on the purpose of the PHR, the nature of the data being
Table 1 - List of selected articles Article
References
1
Chrischilles EA, Hourcade JP, Doucette W, Eichmann D, Gryzlak B, Lorentzen R, Wright K, Letuchy E, Mueller M, Farris K, Levy B. Personal health records: a randomized trial of effects on elder medication safety. JAMIA. 2013;0:1 - 8.
2
Christensen K, Sue VM. Viewing laboratory test results online: patients’ actions and reactions. Journal of Participatory Medicine. 2013;5:e38.
3
Lau AYS, Dunn AG, Mortimer N, Gallager A, Proudfoot J, Andrews A, Liaw ST, Crimmins J, Arguel A, Coiera E. Social and self-reflective use of a web-based personally controlled health management system. Journal of Medical Internet Research. 2013;15(9):e211.
4
Lau AYS, Proudfoot J, Andrews A, Liaw ST, Crimmins J, Arguel A, Coiera E. Which bundles of features in a web-based personally controlled health management system are associated with consumer help-seeking behaviors for physical and emotional well-being? Journal of Medical Internet Research. 2013;15(5):e79.
5
Lau AYS, Sintchenko V, Crimmins J, Magrabi F, Gallego B, Coiera E. Impact of a web-based personally controlled health management system on influenza vaccination and health services utilization rates: a randomized controlled trial. JAMIA. 2013;19:719 - 27.
6
Magid DJ, Olson KL, Billups SJ, Wagner NM, Lyons EE, Kroner BA. A pharmacist-led, American Health Association Heart360 web-enabled home blood pressure monitoring program. Circulation Cardiovascular Quality Outcomes. 2013;6:157 - 63.
7
Taha J, Czaja SJ, Sharit J, Morrow DG. Factors affecting usage of a personal health record (PHR) to manage health. Psychology and Ageing. 2013;28(4):1124.
8
Tang PC, Overhage JM, Chan AS, Brown NL, Aghighi B, Entwistle MP, et al. Online disease management of diabetes: Engaging and Motivating Patients Online with Enhanced Resources-Diabetes (EMPOWER-D), a randomized controlled trial. JAMIA. 2013;20:526 - 34.
A PHR is not ‘just a PHR’
9
Vodicka E, Mejilla R, Leveille SG, Ralston JD, Darer JD, Delbanco T, Walker J, Elmore JG. Online access to doctors’ notes: patient concerns about privacy. Journal of Medical Internet Research. 2013;15(9):e208.
The Markle Foundation defines a PHR as “an electronic application through which individuals can access, manage and share
10
Zarcadoolas C, Vaughon WL, Czaja SJ, Levy J, Rockoff ML. Consumers’ perceptions of patient-accessible electronic medical records. Journal of Medical Internet Research. 2013;15(8).
Taha et al used questionnaires and observations to measure the effect of age on cognitive functioning associated with health literacy and numeracy among older adults, and an email survey by Christensen and Sue was used to see how people respond to getting their laboratory results online. The nested cohort was based in the OpenNotes study in the US, and explored peoples’ attitudes about privacy of their PHR data. In the focus group, Zarcadoolas et al discussed with vulnerable people their expectations about a usable PHR. The study sizes ranged according to the research method, e.g. from 28 focus group participants (Zarcadoolas et al) to 3874 primary care patients (Vodicka et al). Participants ranged from university students to older adults, from insured people to those who are vulnerable (low income, education and of minority race).
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used, and the need to be connected to a specific healthcare provider, PHRs can be linked to the provider (Lau et al), an online website for disease management (Magid et al), have functionality focused on a single disease and be linked to a provider (Tang et al), or simply make clinical notes available to patients (Vodicka et al, and Christensen and Sue). Who uses PHRs? Anyone may be interested in using PHRs for self-care. Older people may find PHRs useful for self-care of long term conditions but literacy and numeracy capabilities decline as we age and may affect the utility and safety of PHRs (Taha et al). Educated, middle aged women of high income are most likely to use PHRs, but people of low income and education have indicated that they would use PHRs for appointment scheduling, laboratory results, and medication management if the user interface were straightforward and easy to use, like Facebook.
Concerns about equity and the ‘digital divide’ may be overcome by reducing medical jargon and creating value by facilitating patient actions such as the convenience of online appointment booking.
Two different perspectives on why people would use a PHR were found in the 10 articles: clinicians wanting to achieve better health outcomes for their patients, and patients wanting to improve their care.
Engaging patients in using PHRs is a puzzle yet to be solved because of its many facets. Lau et al found that providing social media (polls and forums) for mutual support and reflective tools like a diary increased service utilisation and therefore engaged people in health behaviours that otherwise would not have occurred. They also found that certain bundles of features of an online PCHMS work better for certain groups. This suggests that flexibility for consumers to mix and match features for their own needs and preferences is an important design feature.
Lau et al’s clinical perspective resulted in the use of PHRs as a form of intervention, e.g. to improve uptake of immunisations, or increase early treatment of physical and emotional health issues. Other clinicians aimed to improve diabetes control and blood pressure control, while others targeted medication safety to improve health outcomes.
Vodicka et al found that once people became aware of privacy as a possible issue in their PHR use, they changed the way they thought about privacy. However, this did not change the overall sense of concern, which is not considerable enough to stop people from using their PHRs. The online web-based PHR for blood pressure control engaged participants successfully
Why would people use a PHR?
Table 2 - Research questions and methods Article
Research question/objective
Method
1
Impact of a PHR on the safety of medication use among older adults
Single centre open-label parallel-group study (RCT), 3:1 ratio
2
Investigate patients’ emotional responses to viewing test results online, and determine what follow up actions occur.
Email survey
3
Analyse how consumers used the social (forum and poll) and self-reflective (diary and personal health record (PHR)) features of a PCHMS
Single group pre/post-test online prospective study
4
Identify features in a PCHMS that are associated with consumer utilization of primary care and counselling services, and help-seeking rates
One-group pre/post-test online prospective study
5
Assess the impact of a PCHMS on the uptake of seasonal influenza vaccine and primary care service utilization
Two-group parallel RCT six month waitlist control vs PCHMS
6
Determine whether a pharmacist-led, web-enabled, home blood pressure monitoring intervention improves blood pressure control
Pragmatic RCT in 10 clinics
7
Evaluated the ability of older adults to use a simulated PHR to perform 15 common health management tasks
Questionnaires, observation
8
Evaluated an online disease management system supporting patients with uncontrolled type 2 diabetes
Parallel randomized controlled trial
9
Identified patients’ attitudes toward privacy when given electronic access to their medical records
Nested cohort study
10
Identified vulnerable consumers’ response to patient portals, perceived utility and value, and reactions to specific portal functions
Focus groups
because of the link between their actions, their data collection, and their subsequent health outcomes. However, the burden of data entry should be addressed to increase future engagement. The vulnerable consumers in Zarcadoolas et al’s study drive home the point that if a user interface is easy to use, seems familiar (like Facebook), does not have medical jargon, and makes it easy and convenient to access health services, then PHRs will be used. Having said all this, as we age our cognitive abilities to process the graphs, percentages and other statistical ideas that are commonplace in health information reduces, and PHRs should be adjusted for older people in addition to the well-known health literacy concerns.
There is widespread concern about patient engagement in terms of health literacy, with more focus on literacy and jargon than on numeracy. As researchers, practitioners and vendors work on reducing the effect of medical jargon on patients’ access to health services, the additional issue of graphically and statistically representing risk, population context and variance in health outcomes needs attention. This raises the question: do all people require a one-size-fits-all PHR? Should PHRs be created to fit a purpose, such as the online web-based blood pressure management tool examined by Magid et al? How can the clinical use of PHRs be expanded from the doctor-patient dyad to include other clinical professionals, e.g. pharmacists and nurses?
What does all this mean?
PCEHR and patient portals
In 2008, Kaelbar et al3 wrote an article outlining a ‘research agenda’ for PHRs, saying that “patients, policymakers, providers, payers, employers, and others have increasing interest in using personal health records (PHRs) to improve healthcare costs, quality, and efficiency”. In our review of the 10 more recent articles, we found research mostly about providers and patients, and the improvement of healthcare quality and efficiency.
If people are comfortable about reading their own laboratory results, have their medical information presented to them in convenient and easy to use formats, and they have the cognitive abilities to read, comprehend and act on the information and features contained in their PHRs, how should policy about PHRs be constructed?
Six articles examined PHRs as a clinical intervention, while four explored patient engagement issues such as privacy, usability and the kinds of people best suited to use PHRs. While the OpenNotes project has revealed that clinical workload will not rise, Lau et al, with their PCHMS, propose that clinical workload and its nature can be changed to accommodate a more preventive and early diagnostic approach. Privacy is a concern for clinicians, policymakers and patients alike. The concern shifts in its nature as awareness rises, meaning that privacy as a barrier to engagement needs to be addressed.
The PCEHR is controversial in its structure, user uptake, functions and delivery: it is a policy construct that appears to have used the one-size-fits-all (eventually) approach with the patient in control. A similar criticism applies to New Zealand’s National Health IT Plan’s vision that all people should have access to their basic health information. The literature in our review is understandably about targeted groups of people and targeted functions of PHRs; that’s what researchers do. However, there may be value in examining the tensions between a PHR-for-all as a policy and the development of targeted features in flexible combinations accessed on a justin-time basis for patients and clinicians to
use together and separately to meet both episodic and long term needs. The slow uptake of the PCEHR could be explained as a result of lack of perceived need. The reasons and patterns of this uptake deserve the attention of researchers. The effects of use, and the barriers to uptake, were the focus of our literature review, and should be explored further in our own clinical practice as patients are invited to use the available PHRs or demand to see and use what they can. If the electronic health record is still a puzzle for us to unravel, with its years of development, research and application, then the PHR doesn’t pose immediate total solutions to the clinical imperative to intervene and improve people’s health. A PHR is not just a PHR. In other words, the PHR is a multifaceted, possible, partial solution that requires clinician leadership and accommodation, and patient engagement and adoption. In terms of the ‘research agenda’ proposed by Kaelbar et al, we still have much work to do to fill the gaps of cost-effectiveness, refining policy, and examining how PHR features (and combinations of features) can be used to improve the health of our people.
References 1. Bain C, Pearce C. Independent Technology Evaluation: A Pipe Dream or a Worthwhile Aim? Pulse+IT Magazine. Nov 2013;(39). 2. Tang PC, Ash JS, Bates DW, Overhage JM, Sands DZ. Personal health records: Definitions, benefits and strategies for overcoming barriers to adoption. Journal of the American Medical Informatics Association. 2006;13(2):121 - 6. 3. Kaelbar DC, Jha AK, Johnston D, Middleton B, Bates DW. A research agenda for personal health records (PHRs). Journal of the American Medical Informatics Association. 2008;15(6):729 - 36.
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HOW DO YOU SOLVE A PROBLEM LIKE FIONA? Faint murmurs about the problems being created by the incredible complexity of ICT operations planned for Perth’s Fiona Stanley Hospital were heard as far back as 2011, but it wasn’t until June last year that it was officially announced that the hospital’s opening would be delayed by six months. While FSH’s problems are now out in the open due to a parliamentary inquiry, many fear that the whole drama may have a negative effect on other health infrastructure in the state.
KATE MCDONALD Journalist: Pulse+IT kate.mcdonald@pulseitmagazine.com.au
When it was first announced back in 2009, it was billed as WA’s first paperless hospital, a technological and ecological marvel to behold, a new hospital for the digital age where information technology would seamlessly integrate with communications infrastructure to provide world’s best practice in health service provision near the gently flowing waters of the Swan. Most people with a distaste for spin would have seen these claims as the usual marketing gumpf, but at the time, it was not a stretch to accept that the new Fiona Stanley Hospital was going to be a pretty great facility. For the health IT industry, it was the chance to show off some of the best technology around in terms of wireless infrastructure, robotics and cutting-edge clinical software.
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.
That might still turn out to be true, but there is now no doubt that it is this super-duper ICT that has held up the opening of the hospital. In April, a bipartisan parliamentary committee made short shrift of the excuses of Health Minister Kim Hames and former WA Health director-general Kim Snowball in the More than Bricks and Mortar report into the commissioning of the hospital, revealing that it was obvious as far back as 2012 that there was no way FSH would open on schedule. The blame for the delay was placed on the complexity of the ICT.
“Over time, there was a litany of reports ... [showing that] this was falling behind significantly and there were delays in recognising and conceding we were never going to deliver a hospital, not in April 2014,” committee chairman and Liberal MP Graham Jacobs said. “It was never going to happen. If the recognition of the delays, backed up by early reports, was actually recognised, a lot of the costs could have been mitigated.” Dr Hames rejects the amount, but the parliamentary committee puts the cost of the delay in opening the hospital, including extra money for IT and staff wages, at an eye-watering $330 million. More money will be needed for IT – the government allocated an extra $40m in the May state budget – and that might not be the end of it. “We need to make sure the very complex and difficult IT system that is required to ensure Fiona Stanley Hospital works safely for patients who come through the door, is paid for,” Dr Hames told Parliament. “We will put up the funds for whatever is required.” Former WA under-treasurer Tim Marney probably put it best when he told the committee’s inquiry in February that the best of breed approach taken in kitting out FSH was probably the wrong one.
“You never build stuff that you can buy off the shelf,” Mr Marney, now the state’s mental health commissioner, told the committee. “You never build bespoke stuff that then has to be integrated with generic products. You change your business processes rather than changing the systems to suit the business processes. You never do big bang, because big bang goes boom.”
“If the recognition of the delays, backed up by early reports, was actually recognised, a lot of the costs could have been mitigated.” Dr Graham Jacobs
Best of breed It is possible to open a new hospital with best-of-breed clinical systems but what that means is enormous complexity, and very few hospitals are capable of the massive integration task. Richard Royle, executive director of UnitingCare in Queensland, which is building a fully digital hospital at Hervey Bay on a much smaller scale than the 783-bed FSH, recently said he had decided on the opposite approach, plumping for an integrated EMR from Cerner that has only five other clinical interfaces, including those to pathology and radiology. “My understanding from the minister (Kim Hames) is that there are 158 interfaces at Fiona Stanley,” Mr Royle says. “158. They have a best of breed model [but] history is showing that the more interfaces you have to build into a system, the more challenges you will have. So what we have done is the opposite.” The original plan for FSH was to have an EMR ready to go when the first patients were wheeled in, with interfaces to pathology, PACS/RIS, patient administration, pharmacy, clinical specialties, information management and reporting, identity management and data centres, all running off a wide area network built by BT. This is still the plan, but a big-bang EMR is not yet in sight. The hospital that was first announced as having no storage space for paper medical files is now going to have to find some, and the identity management system is
also in doubt, with the WA government announcing in late June that the $6 million it had spent trying to design a role-based, single sign-on smartcard for physical and computer access to the hospital was wasted because the solution doesn’t work. While the problems of Fiona Stanley Hospital can be overcome, for many working in the WA public health sector the real problem lies in the flow-on effects on other planned infrastructure, particularly the new Perth Children’s Hospital that is due to open in late 2015. Several sources have told Pulse+IT – and Mr Marney backed it up in his comments to the committee – that the EMR chosen for Fiona Stanley was to have influenced the choice for the new kids’ hospital. It is now highly likely that an off-theshelf system will be chosen with none of the integration hassles that FSH has to wrestle with. Two industry sources have told Pulse+IT that US EMR giant Epic is the favoured candidate for the kids’ hospital, but that the company might have second thoughts after the dramas FSH has experienced so publicly. Epic, which recently won the tender for Melbourne’s Royal Children’s Hospital, is used widely in paediatric care in the US but has not yet been implemented anywhere in Australia. Tendering for other elements of FSH has also been problematic. The planned closed-loop medications management system, which includes pharmacy robots,
automated guided vehicles and automated medication units as well as prescribing software and interfaces with the WebPAS patient administration system, the LIS and RIS systems and iPharmacy, is a huge undertaking that only the largest companies can handle, ruling out many smaller vendors that can offer quality software systems but not the whole hardware deal. The tender for that system is still open.
Pissed off public servants A lot of the problems seem to come back to poor planning. The full contract with Serco, which is in charge of building and operating the hospital on the government’s behalf, is worth $4.3 billion over 20 years, $2 billion of which is the actual build of the hospital. However, Mr Marney told the February committee inquiry that Treasury had only been given two weeks to review the contract before it went to cabinet, and that Treasury was quite rightly “pissed off” about it. Dr Hames rejected this in WA’s parliament, saying that a person contracted to Treasury was on the organising committee the whole time. “The under-treasurer was, to use his words, ‘pissed off’ in the end with the time he had to look at the final contract, but I can tell members that a few people in health might have been ‘pissed off’ with him as well, in terms of how a very detailed and complex contract was worked through with Treasury.”
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“You never do big bang, because big bang goes boom.”
at secure and seamless interoperability,” she said. “However, we are well aware that up until now what we felt was progressing comfortably and what we felt was locked down is still being resolved at different levels by different people.
Tim Marney
Former Health director-general Kim Snowball also defended his role in the contract negotiations and planning for the hospital. “Those being criticised are the same people who have worked incredibly hard to deliver for the state, including the Treasury, the biggest health infrastructure project of all time, on time and on budget in Fiona Stanley Hospital,” he said. “In fact all of the major projects under construction in health were on time and on budget at the time I left the role. This doesn’t happen by accident, but by good, solid and careful management.” While the reasons are unclear, it is pertinent to note that WA has not had a permanent director-general for Health since Mr Snowball resigned in December 2012, standing down officially the following March. Nor has there been a permanent appointment as CIO of Health Information Network (HIN), the WA Health agency that oversees clinical IT. Bill Leonard was appointed as acting CIO in January after Andy Robertson stood down from the role, also acting, after just over a year.
Lack of integration Not much of this should have come as a surprise to experts in the health IT field. In fact, Di Mantell, the hospital’s general manager for facilities management, is quite open about the huge complexity of the hospital build and operation. While she is not in charge of clinical IT, she does have intimate knowledge of the underlying ICT infrastructure behind the project. Ms Mantell told the eHealth Interoperability
Conference in September last year that the physical building would be ready by December 2013, but that the three-month transition to its planned official opening date of April 2014 was a stretch. “What will happen is the state rehabilitation service will close at Shenton Park and our service will open in October [2014],” Ms Mantell told the conference. “That will move about 110 patients to the new service. Then over the next three phases we will gradually build up the service until it is fully operational by April 2015. We have worn a lot of flack for it in the media – they are having a field day with us – but you get that. If the building is not ready then you shouldn’t open it. You only get one chance to do this properly and it’s better to delay than to find out when it’s open that something doesn’t work.” Ms Mantell detailed the extent of the ICT infrastructure at the hospital, both clinical and non-clinical, estimating that in addition to the big-name IT systems there were about 1600 other, smaller applications that clinicians and researchers – the West Australian Institute of Medical Research (WAIMR) is co-located on the Fiona Stanley campus – wanted to bring with them. “We do have a pervasive wireless technology network, we do have medical equipment that has information systems installed, we will have RTLS, we are working towards enabling electronic medical records, we will have telehealth that is available across a diverse number of sites in the building, and we’re looking
“We will have those things I just mentioned, but will we have a full digital record when we walk in? No, we won’t. Will we have a full closed-loop medication management system? No, we won’t. But are we finally on the journey because we’ve got everybody on the same page to get people there? Yes, we will.” A spokesperson for the hospital says it is currently finalising a range of clinical ICT applications for production, including some that have developed in-house and those which have been procured externally. These applications include: • A digital medical record provided by Core Medical Solutions. FSH say this will complement existing clinical information systems and will include a PCEHR viewer at a later stage. • CSC’s webPAS patient administration system, which is being rolled out statewide • CSC’s iCM system, which provides a common clinical record across metropolitan health services in WA • A Notifications and Clinical Summaries (NaCS) system, which has been designed in-house to send discharge summaries to GPs and to the PCEHR using secure message delivery • A closed loop medication management solution, which is still out for tender • Provision for an intensive care clinical information system. “FSH will utilise the existing ULTRA LIS and AGFA PACS/RIS systems that currently provide a common patient record across the metropolitan health services,” the spokesperson says. “General practitioner referrals will be processed through Central Referral Services.”
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DECISION SUPPORT FOR BUGS AND DRUGS An electronic antimicrobial stewardship approval and decision support software program known as eASY that was designed by clinicians from the Northern Sydney Local Health District (NSLHD) has undergone a revamp recently, with new functionality added that provides decision support on drug dosing and multi-site levels of restriction, in addition to existing tools such as guidelines on what antibiotics to use and real-time notifications of approval or refusal.
KATE MCDONALD Journalist: Pulse+IT kate.mcdonald@pulseitmagazine.com.au
eASY was developed by a team led by the director of pharmacy at Manly and Mona Vale hospitals, Noman Masood, and the director of operations at NSLHD, Andrew Montague, in association with a local vendor partner. Since its release in 2011, eASY has been implemented in hospitals throughout the district, including Mona Vale, Manly, Royal North Shore, Ryde and Hornsby hospitals, and discussions are underway to provide a free licence to use the product in any public hospital in NSW. An updated version of the program was developed earlier this year that features new functionality, including a tool that helps clinicians decide on the individualised dose of antibiotics based on kidney function. It also now comes with multi-site functionality so smaller hospitals within a local health district that might not have sufficient infectious disease specialists on staff can add extra layers of restrictions to the prescribing of antibiotics. There are also plans to provide bacteria-based decision support, which will allow doctors to perform a point-of-care check on the prevalence of antimicrobial resistance in different areas based on type of pathogen. Mr Masood says the impetus behind the development of the program was two-
fold. When the idea was first considered four or five years ago, it was becoming obvious that public hospitals would be mandated to manage and restrict access to antibiotics due to the emerging dangers of antimicrobial resistance. “One of the biggest challenges in the health industry right now is the issue of infection control,” Mr Masood says. “We are now seeing multi-resistant bacteria coming out not only in hospitals but also in the community. One of the challenges for us is to see how well we use our antibiotics and what kind of antibiotics we are using. “There are established guidelines about indications and what sort of antibiotics should be used for those indications, but adherence to those guidelines remains somewhat problematic. It is an ongoing challenge for us.” The second impetus for change at Mona Vale and Manly was its paper-based system, which Mr Masood says was unable to deal with the multiple clinicians who now need to be involved in antibiotic prescribing in a fast-moving and at times chaotic environment like a hospital. “There are communication issues,” he says. “For example, if there is a conversation between an infection control
senior consultant and an attending physician, how does the pharmacy know? At four o’clock on a Friday afternoon, you might get a request for an antibiotic that nobody knows about and that we don’t stock in the hospital, and then there’s a frantic rush to try and access from another site within the district.”
Complicated management One of the biggest issues facing antimicrobial stewardship is the fact that medication management in hospitals has become far too complicated, Mr Masood says, and the best approach to minimising this complexity is to have a multidisciplinary approach to medication prescribing through the use of electronic systems such as eASY. This would ensure optimal governance through a restricted process to accessing high-end antibiotics that are used for critical infections such as MRSA and VRE. “The issue with paper-based systems is that they are prone to breakdown and have multiple risks with respect to monitoring of utilisation,” he says. “The other obvious issue is that hospitals are frantic environments where discussions often happen in corridors or over the phone and quite often everybody who needs to know about those conversations don’t know about those conversations. “There is also a communication issue for the smaller or rural hospitals that sometimes rely on specialists who may not be on site. Those sorts of communication barriers are quite a bit of a challenge.” When first developing the concept of eASY, Mr Masood, Dr Montague and Royal North Shore clinical microbiologist and infectious diseases physician Bernie Hudson got together to see what could be done to improve antibiotic utilisation. A broad analysis on utilisation factors was undertaken, which showed that use of
“There are established guidelines about indications and what sort of antibiotics should be used for those indications, but adherence to those guidelines remains somewhat problematic. It is an ongoing challenge for us.” Noman Masood
high-end antibiotics was going up at twice the rate of low-end antibiotics. They began to look through the literature on electronic systems and at guidelines developed by the Australian Commission for Quality and Safety in Health Care (ACQSHC) on what was required for good antimicrobial stewardship. “First, we needed to have guidelines available for our doctors, which we already did,” Mr Masood says. “The second issue was that the prescribers needed to get a prospective feedback about their prescribing, so that feedback process meant that we needed to invent an electronic system. “The third was the monitoring of our resistance patterns of key pathogens in our hospital and to make that information available to our prescribers. Because we already had a very good infection control system in the hospital, if we were able to target these three things plus the communication side of things, then we’d actually be able to do it rather well.” Owing to the high cost of acquiring commercial systems that may not be tailored to local requirements, they decided that rather than spend money on buying a system, they would invent one themselves and use that money to invest in more staff.
They found a vendor that was happy to work on building the system at the right price, and then began to build the first version of what became eASY, which went live in March 2011. An antimicrobial stewardship program was developed across the two hospitals, led by clinicians from the departments of medicine, surgery and pharmacy, and the electronic system was built with actual users in mind. “We wanted to build something which was driven by people working at the coal face rather than the managers telling them how it should be done,” Mr Masood says. “Dr Montague went to all the medical staff, the infection control nurses went to the nurses, and the pharmacists went to the pharmacists, just to make sure everyone was on the same page. “We invested in human beings, so we appointed two part-time antimicrobial stewardship (AMS) pharmacists for each site, and we went through the whole iterative process and took about six months to actually make it happen.” Upon launch, things started happening rather quickly. The main issue the team was interested in initially was to see how the new system would affect the use of key antibiotics. Comparing the two hospitals’ use with others in Australia and around the world through the South Australian-
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“We wanted to build something which was driven by people working at the coal face rather than the managers telling them how it should be done.” Noman Masood
designed National Antimicrobial Utilisation Surveillance Program (NAUSP), Mona Vale and Manly found they were using up to three times higher levels of certain antibiotics than similar hospitals. “If you looked at countries like France, the differences were astronomical,” Mr Masood says. “Obviously the restriction process needed to improve. We started to see some changes within the first three months, and subsequent to that, on almost 90 per cent of antibiotics, we are now below the average.”
Decision support Infectious diseases specialists are all given access to the system, from whatever site they are based at. Using eASY, they are now able to quarantine time each day to action orders for high-end antibiotics. Prescribing doctors are able to log in and request an antibiotic. Based on the patient’s details and the indication that the doctor has selected, the system will highlight to the doctor the guidelines and recommendations for that indication. “Before they start going on their own path, we want them to have a look at what is the right path,” Mr Masood says. “It’s a way of prompting them that there is a guideline that they should probably consider. They have the option of going by the guidelinebased therapy or override it. Either option is available to them.
“As soon as they submit that request, it notifies the infectious diseases clinician as well as the AMS pharmacist, so the communication side of things can be sorted straight away. The pharmacists, in the majority of cases, are the first ones to enter into the system. They look at that request and they can provide the information to the prescriber on whether the dose is right or not, whether this is the right antibiotic for the indication or not, and they can highlight to the infectious diseases clinician if there are any concerns.
“Drug dosing, especially with antibiotics, becomes very important because not only do you need to give the antibiotics at the right time but also at the right dose,” Mr Masood says. “Hospitals see a lot of elderly patients who have impaired kidney or liver function. What our system is designed to do now is it will draw data from the EMR and calculate their kidney function and recommend antibiotic dosage. “That basically means decision support. In the past we were saying which antibiotic to use but not how much to use. Now we are trying for individualised therapies that say ‘this patient whose data suggests the kidney function is such should get this much antibiotic’. We can get the antibiotic dosing to the best possible level. “Not only does it give the dose but there are also key indications such as meningitis and endocarditis, which are potentially very dangerous infections, where antibiotic dosing tends to be extremely important and we want to make sure that they get that dosing right as well.”
“Then the infectious diseases clinician, hopefully within a few hours, will look at that request as well and then they can say they approve it or decline it and suggest a different therapy. If they have declined it, they’ll have to give a reason, and when they give that reason it automatically goes back to the doctor explaining it.
For those situations where antibiotic dosing is slightly higher than for other indications, the system is designed to recommend a dose according to the indication, not just to the guidelines. “It’s not a dumb system: we want to make it as smart as possible so that you can do those things,” he says.
“If they decline it the doctor knows straightaway because they are notified, and if it is approved the doctor knows that they have done the right thing”.
“The other thing that we also are building into the new system is that it will have multi-site functionality, which means that where you have a smaller hospital that may require broader restrictions as the expertise is not there compared to a big hospital, where the expertise is present, you need separate sets of approval restrictions.”
The system has been working smoothly for the last three years and has been instituted across the whole NSLHD, but it was obvious to all that there was a lot more potential. In the updated version, eASY 2.0, the developers have taken the clinical pathway module to a higher level by adding functionality for drug dosing and disease management.
Future functionality As Mr Masood puts it, there are hundreds of other functions that can be added to the
system, but time and cost are the hurdles. The development team also believes that clinical decision support is the most valuable function, which is why they have concentrated on that. They have left it up to the different hospitals to decide whether to provide access through smartphones or tablets – it is optimised for iPad and iPhone – but data security can be a challenge for some hospitals with a system that integrates remotely with the hospital’s main servers. “We are looking at those options, but the most important thing is the support system, so we are building an app so doctors can check what antibiotic to use and how much to use and to do that
calculation without having to add the data,” Mr Masood says. “That’s something we have in our wish list but obviously there is a cost implication. Also, what we’re looking at is to provide bacteria-based support as well so that when a doctor selects the bacteria, the system will tell them, based on the patient’s location, what resistance factors there are for that area. “There are hundreds of functionalities that we could add but it’s the highlevel decision support that is the most important.” The NDLHD team is currently working with NSW Health’s office of commercialisation
on further developing the product so it can be offered to other health districts. NSW eHealth has funded an independent evaluation of the system which validated eASY’s ability to fulfil ACQSHC criteria. Mr Masood says eASY is now one of the products on the eHealth list of antimicrobial stewardship programs available for local health districts across NSW. “We are marketing it on the basis of it not necessarily being a commercial product but more a patient care and safety product,” he says. “We are offering it to local health districts without any licensing fees as the idea is to make it available to hospitals so they can invest not in software but rather in people.”
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EPWORTH TAKES AN
INCREMENTAL APPROACH TO DIGITISATION Rolling out a full electronic medical record in the acute care setting is notoriously fraught with difficulty, an exercise that is hard, expensive and ripe for failure. An alternative measure that can provide excellent results is a scanned medical record accompanied by electronic forms and diagnostic results viewing. That is the path chosen by Epworth Healthcare in Melbourne as it implemented Core Medical Solutions’ BOSSnet DMR over the last year.
KATE MCDONALD Journalist: Pulse+IT kate.mcdonald@pulseitmagazine.com.au
Scanned medical records are nothing new and many hospitals and healthcare organisations have implemented a solution in various forms over the last decade or so, but the technology behind scanning solutions has improved enormously over that time and it now provides a practical, cost-effective way to digitise the mountain of paperwork that still proliferates in almost every hospital in the country. Scanned medical records can act as a necessary tool to maintain historical records but with a few added extras, they can also be a step towards a full EMR. When joined with electronic forms, electronic ordering and results reviewing and an electronic medications management module, these pieces of technology can constitute what many regard as a full EMR, without the headaches of boxed solutions. Epworth Healthcare in Melbourne has this year completed the roll-out of Core Medical Solutions’ BOSSnet Digital Medical Record (DMR). First installed at Epworth Eastern in late 2010, it has now been implemented throughout the hospital group, with the last facilities going live in March this year. Epworth previously used a legacy, nonclinical scanning solution that needed to be replaced. Rohan Ward, CEO of Core
Medical Solutions, says there was no discussion about trying to do anything other than fix something that was broken, but there was an eye on what BOSSnet could provide in the future as well. “We were chosen because we had a product that could replace their legacy scanning solution but we also provided a logical and manageable system that can be used when you want to move to a paperless environment,” he says. “But the main thing was they had a system that was going to stop working and it had to be replaced.” BOSSnet DMR was initially implemented at Epworth Eastern in November 2010, and after a comprehensive tendering process in 2012, it was implemented across the remaining six facilities in 10 months. Greg Horvat, Epworth’s senior project manager for the implementation, says BOSSnet has all of the capabilities required for electronic scanning, but it can also receive electronic pathology and radiology results and reports, along with additional functions such as its eForms capability and electronic ordering of results. “BOSSnet gives us the opportunity of bringing in results from pathology and
radiology electronically and displaying them in BOSSnet, and we now have seven pathology providers and three radiology providers sending in results to BOSSnet,” Mr Horvat says. “It also gives us greater flexibility to do more things with the product down the track. They were probably the main reasons why it was chosen.” CMS’s eForms capability was also a plus. At their simplest, eForms simply mirror a paper form in their look and feel, but they also provide individual hospital departments with the flexibility to go digital when they are ready.
there are more than 260 paper forms in use. Mr Horvat says this has now been consolidated to 130 eForms, all of which can easily be populated and reviewed electronically at any time. Epworth Brighton was the first rehabilitation site to use eForms in BOSSnet last October,and since then more than 78,000 eForms have been populated across all sites.
Change management
In the outpatient rehabilitation setting, with its myriad forms for different disciplines, this can prove a godsend. “There is also a growing shared library of advanced eForms, which provide the ability to calculate, chart, and provide decision support,” Dr Ward says.
Dr Ward says a scanned medical record is a much simpler undertaking than a big-box EMR. While BOSSnet is used to its fullest capabilities at Barwon Health, where it is also connected to the PCEHR and is gearing up to generate discharge summaries for the national system, the change management required can be a big hurdle for many organisations to overcome.
Epworth estimates that across all four of its four outpatient rehab hospitals
“You can’t go to a full electronic medical record straight from paper,” Dr Ward says.
Implementing a scanning solution is also faster. Starting in October last year, Mr Horvat and his team rolled BOSSnet out at Epworth Brighton and then at Camberwell a week later. The hospitals at Hawthorn and Richmond were implemented six weeks after that. Richmond is Epworth’s largest facility with a mixture of inpatients and outpatients. “In November, while implementing Richmond, we also implemented Hawthorn,” Mr Horvat says. “Hawthorn is a smaller hospital with a large number of patient and staff movements between both sites. It made strategic sense to implement these two hospitals together. “And in March we repeated this approach by implementing Epworth Freemasons and Cliveden at the same time.” It all went reasonably well although getting the clinicians on board was the biggest challenge. As it is a private hospital group, all of the doctors are visiting medical officers, and along with the nursing staff
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“The doctors are not employees so it is a lot harder to engage them and change their processes.”
“That is not ideal because the way BOSSnet is primarily designed is as an application that is used with a keyboard and a mouse,” Mr Horvat says. “When you put that onto an iPad it is not ideal because the screen is halved in size and the buttons can be a little difficult to get to.
Greg Horvat
they were apprehensive of workflow changes. “The doctors are not employees like they are in a public hospital so it is a lot harder to engage and convince them to change their processes,” Mr Horvat says.
Infrastructure In the outpatient rehabilitation area, all forms are now electronic. “When staff consult a patient, they open up the eForms and they look just like the paper-based forms,” he says. “Some fields are pre-populated with previously collected data, like the patient label or another therapist’s note. “And once they click ‘submit’, the eForm is instantly added to the patient’s history for colleagues to use. Doctors and therapists can go back into the eForm and modify data where they need to and the system tracks every interaction. The doctors have responded well to this innovation and have found it assists their care for the patients. “And I know that on the allied health side, they think that the step to the electronic forms is fantastic. A lot of therapists are younger having recently come out of university, and their adoption of eForms was a lot easier. Acute nursing staff were also trained across all six hospitals. In addition to a training program, there was also a big
on any site through any of the devices the organisation has installed. They can also access the system in their rooms, and also on their mobile devices through Citrix.
push to roll out more devices to access the new system. Almost 100 laptops, 64 carts with laptops and 132 thin clients have been rolled out, along with the additional wired and wireless infrastructure that goes with these devices. Mr Horvat says that in the rehabilitation setting, a lot of investment was put into devices as much of their data entry is electronic, whereas in acute hospitals this wasn’t as big a requirement. “Acute staff are still completing paperbased notes and it’s only if they needed to look at the patient’s past history that they go into BOSSnet. “Alternatively, if they want to review current pathology and radiology results they can use BOSSnet. We still have paper reports being faxed to the wards and removing these will form another large change management piece of work in the near future. “Part of what we’ll be looking at in the next phase of rolling out BOSSnet will be to slowly get them used to the fact that you need to use BOSSnet more and more to do your job day to day. Our approach has been to take small snippets and small steps to getting there.”
Mobility The next step is to implement a full mobile solution for BOSSnet. At the moment, VMOs are given a log-in to access BOSSnet
“That is not a criticism of the product – it is just where the product is – but we are working now in the next phase of the project to get a full and proper mobile solution for BOSSnet. CMS already has one of those in Barwon so what we’re going to do is expand on that to fit our requirements.” The emergency department is next to use eForms with data entry transferring from the the existing patient administration system, iPM, to BOSSnet. “BOSSnet receives patient demographic details from iPM, so triage, clerical and billing functions will still be completed in iPM,” he says. “However clinical documentation will be completed in an eForm which is then automatically faxed to GPs via BOSSnet. The emergency department will then be able to better utilise future BOSSnet functionality.” Dr Ward says Epworth is moving towards a full EMR by using eForms, results review, results acknowledgement and scanning and reviewing patient documents postdischarge. “They are a long way ahead of most other hospitals in the country anyway, although they probably don’t think they are,” he says. “They’re not at full EMR yet because they have still got lots of paper forms, but they are well on their way.”
Australian Association of Practice Managers
The Art of Performance 2 0 1 4 N at i o N a l C o N f e r e N C e I A d e l A I d e Co n v e n T I o n C e n T r e I 21 – 24 oC Tober 2014
REGISTER NOW: www.AAPMconference.com.au The Australian Association of Practice Managers’ annual conference has a reputation as one of Australasia’s leading conferences for healthcare managers.
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practice managers practice team members practitioners from all specialities of healthcare
team leaders practice nurses policy makers government staff
healthcare managers
Delegates will be spoilt for choice with a program that incorporates ongoing professional development, up-to-date information relating to our profession, as well as a careful blending of very creative surprises to exceed expectations.
keynoTe sPeAkers
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Gillian Hicks Catherine Norton Khoa Do Hugh Kearns
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Dr Norman Swan Vinh Giang Justin Vaughan Daniel Lock
Visit the website for full program and registration details:
www.AAPMconference.com.au
do you have a project that was a success, a system your practice has implemented that has delivered real benefits or, perhaps, an idea to share and develop?
Ideas Forum
This conference is open to all who are involved in health care management and delivery:
At the 2014 conference we will be introducing the Ideas Forum for delegates to share projects and practices that have delivered positive outcomes within their practices. The format will be electronic posters (ePosters). ePosters will be prepared in PowerPoint and displayed during the conference on monitors in the exhibition and catering area. The posters will rotate automatically and each poster can have up to three slides. Delegates will be able to pause ePosters to view them in more detail. There will also be an index to allow delegates to find an individual ePoster. All topics will be considered, this is an opportunity to both share and receive feedback. The ePosters are not intended as commercial presentations.
Conference Design Pty Ltd mail@conferencedesign.com.au www.conferencedesign.com.au P: +61 3 6231 2999
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Feature
THE END OF THE PAPER DRUG CHART Implementing an electronic medications management system is a hugely complex and difficult project for the acute care sector, but one where the benefits are most quickly realised through reductions in medications misadventure. In these case studies, we look at how eMM has been rolled out at private not-for-profit Cabrini Health, tertiary facility Austin Health, metropolitan Peninsula Health, and the rural Portland Hospital.
KATE MCDONALD Journalist: Pulse+IT kate.mcdonald@pulseitmagazine.com.au
Acute care software specialist InterSystems recently conducted an ad hoc survey of 30 Australian hospitals that are currently deploying or are planning to implement electronic medication management (eMM) systems to see how they are faring. Most cited complexity and interoperability requirements as significant barriers to eMM implementations, with 26 public hospitals and four private hospitals reporting that while they all expected eMM to lead to increased patient safety, 60 per cent cited complexity or cost of interoperability as a significant barrier to deployment. When asked how many other systems eMM would need to interoperate with, 47 per cent of hospitals said five to 10 systems and 20 per cent said 15-20, with the average number around 12. Change management issues and difficulty in gaining clinical adoption were cited by about half of respondents as barriers, but most believed it was worth it. The benefits of eMM systems they said, were accurate, current medication lists, better drug/allergy interaction checking, convenient access to contextually relevant drug information, better medication reconciliation and improved dosage alerts.
Cabrini goes mobile with MedChart Melbourne’s Cabrini Health has very much been a pioneer in using mobile devices, having rolled out CSC’s Mobility Suite back in 2011. Through their own personal devices, Cabrini’s visiting specialists can check their patient lists and locate where their patients are, view a patient’s PACS image and result, and order and view pathology tests and results all via the webPAS patient administration system. The next stage is what could easily be described as the nirvana of hospital IT: the ability to prescribe and review medications through an iPad-optimised version of CSC’s MedChart medications management system. When radiology comes online, visiting specialists will have what is in effect a full electronic medical record in the palm of their hands. Cabrini first rolled MedChart out in its palliative care facility at Prahran and its two rehabilitation services in Elsternwick, with Brighton to go live in August and the 500-bed Malvern Hospital in November. Judith Day, Cabrini’s CFO/CIO, says the roll-out of MedChart will ultimately include integration with the hospitals’ iPharmacy system, and will in effect be a closed loop medication process.
“There are very few private hospitals that have implemented electronic medication management,” Ms Day says. “Once implemented the doctors will be able to launch MedChart from the clinical EMR system on their iPads and I don’t think that is possible anywhere else in the country.” In partnership with Cabrini’s eMM project director Peter Bennett, Cabrini and CSC have developed the mobile version of MedChart for doctors to use on their iPads as part of its BYOD policy and are getting ready to give nurses access on Motion F5 tablet PCs. That’s not to say it has been an easy process. “Medication management is one of those elements of an EMR that people steer away from because it is just so hard to implement, particularly in private [hospitals] where the doctors are not employed,” Ms Day says. “We don’t have registrars or interns, so it is the doctor being engaged or it’s nothing.” When Cabrini began the roll-out at Elsternwick and Prahran, a pharmacist was assigned to shadow the doctors on their ward rounds as they began to use MedChart. Mr Bennett says this allowed the pharmacist to observe what medications were most commonly prescribed by each doctor and she was then able to set up quick lists for those drugs, along with expanded protocols for commonly prescribed PRNs. Those facilities have also installed a ward overview screen for the nurses, so they can easily see when medications are due without even having to go into MedChart. Pharmacy services will also be redesigned when iPharmacy and MedChart are integrated so that pharmacists are more involved in reconciling medications on admission and enabling the drug chart to be created before the doctors arrive.
“The doctors will be able to launch MedChart from the clinical EMR system on their iPads and I don’t think that is possible anywhere else in the country.” Judith Day
They then simply have to launch MedChart from their iPad and prescribe from there. This will also remove the need for doctors to sign batches of paper scripts, now that Medicare is taking action to remove the necessity to send in paper forms for PBS claiming. “The doctors are very happy that they won’t have to sign prescriptions any more,” Ms Day says. “In the private sector, doctors complete the medication chart but then when we dispense the medications we have to print off a script, bundle them up and send them to the doctors’ rooms, where they have to sign them again. “It drives them crazy but as we are rolling out MedChart now we can stop that. That is one of the benefits of implementing the system.”
Portland Hospital aims for discharge prescriptions Earlier this year, Portland Hospital in Victoria’s south-west switched on medications management functionality through its TrakCare health information system from InterSystems in all wards of the hospital, the first facility in the South West Alliance of Rural Health (SWARH) to do so. While implementing EMM is a difficult process that requires a lot of change management, Portland has had the benefit of using TrakCare as its patient
administration and clinical information system for some time, meaning staff were familiar with its processes and confident in its capability. And as the medication management functionality is already built into TrakCare, the whole process has only cost $10,000, something that SWARH’s divisional manager for productivity and development, Katharina Redford, says raises a few eyebrows at other hospitals weighing up the high cost of going electronic. Portland began planning for the roll-out in mid-2013 and went live in September, converting each department and ward over to the system incrementally. While the roll-out has been reasonably smooth, as with all major changes there have been a few adjustments. Ms Redford says they were relatively minor and were more about developing a more nuanced understanding of the system and how it works. It is early days yet but in the months since it was fully rolled out, Ms Redford says the system has improved productivity by reducing the time it takes to write a medication chart and the time that pharmacists formerly spent walking through each ward. However, it still requires that nurses spend about the same amount of time on administration. And while the rate of errors has not yet changed, the errors are quite different to those that occurred in the past. “Instead
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“We can already produce discharge lists and we can put meds on the discharge summary, but what I’d like to do is to produce a PBS prescription so they can take that prescription to the community pharmacy.” Katharina Redford
of an error like ‘I can’t read what has been written’, it is more ‘that is out of line with our guidelines’,” she says. “These errors aren’t necessarily incidents: they are because more collaborative, intelligent questions are being asked.” Ms Redford says one of the benefits of having medications management integrated within the clinical information system rather than as a bolt-on is that information can readily be drawn from other functions, such as patient allergies and pathology results. “With a paper medication chart you have to rely on someone recording the allergies on every chart and every page on every chart,” she says. “On a paper chart you might just miss that note not to prescribe penicillin. That now gets recorded within TrakCare and it is always there, so if you order penicillin and the patient is allergic to penicillin, it won’t let you do it.” Portland has decided against equipping nurses with tablet computers to use the medications module for the time being and instead went with computers on wheels (COWs) for practical reasons. Like the other hospitals in the SWARH alliance, the hospital has very good wireless access so laptops on a trolley proved suitable, and the nurses also like
to keep their hands free and have a place to keep their thermometers, containers of Agarol or Mylanta and the like. In addition to mobile access, the next step for the implementation is to integrate TrakCare with iPharmacy and to produce PBS-compliant discharge prescriptions. “We can already produce discharge lists and we can put meds on the discharge summary, but what I’d like to do is to produce a PBS prescription so they can take that prescription to the community pharmacy,” she says.
Electronic prescribing shows quality results It is not often that Victoria’s HealthSmart roll-out receives good news, having been roundly eviscerated in a report by Victorian Auditor-General John Doyle in 2013. The report concentrated on four health services that had rolled out the Cerner electronic medical record, which one hospital has not installed, two have rolled out fully and the other is most of the way there. In his report, Mr Doyle makes particular reference to the complexity and difficulty of introducing electronic medications ordering and management, saying that there are significant difficulties in using the system to manage complex prescriptions.
While no one denies that the roll-out has been difficult, recent data seems to show that there have been major reductions in medication errors at two of the health services that introduced Cerner through the HealthSmart program, Austin Health and Peninsula Health. The introduction of Cerner to automate prescribing and drug administration, as well as radiology and pathology ordering and reporting, won the two health services a quality improvement award from the Australian Council of Healthcare Standards (ACHS) late last year in the clinical excellence and patient safety category. In their submission for the award, the clinical systems project teams from Peninsula Health and Austin Health cited a number of statistics to prove their point, including: • A 55 per cent decrease in medication errors in sub-acute care in the 12 months after the system went live compared to the previous 12 months • A decrease of 77 per cent in ISR rating three (moderate severity) incidents • A decrease of 37 per cent in ISR rating four (mild severity/near miss) • A reduction of 67 per cent in missed doses, 25 per cent in prescribing errors and 72 per cent in wrong drug errors • No medication errors were recorded due to legibility issues • 99.9 per cent accuracy in allergy status • No incidences of lost drug charts. Austin Health and Peninsula Health worked closely together on the project, although both developed their own communication and change management strategies. They split the roll-out into two phases: the first go-live, in June 2011, involved implementing the core software system with capability from electronic pathology and radiology orders, results, allergy and alerts management, discharge prescriptions, discharge summaries and electronic discharge prescribing.
The phase two go live, involving inpatient medication prescribing, dispensing and administration, went ahead in June 2012 and was completed across all sites and services (emergency, acute, sub-acute and mental health,) of both health services by August 2013. In preparation, a range of computers on wheels, tablets and mobile devices were deployed and IT infrastructure upgraded including installing new wireless systems. At Austin Health, executive director of acute operations Fiona Webster says her service is now in the position to be one of the best implemented medication systems in Australia. All medications ordered in the emergency department are
done through Cerner, with medications management now highly visible throughout all departments. “We can connect the whole drug chain,” Ms Webster says. “We all know exactly what drugs have been ordered, what drugs have been given to the patient, we know every dose of the drugs in the hospital. “With a paper system you would never have had that visibility. It’s giving you a much better sense of prescribing patterns and there is a lot of data that sits underneath it that we are just starting to understand.” While it is not unusual for doctors and nurses to be very suspicious of electronic systems, Ms Webster believes that as a lot
HealthLink now puts referrers in the picture
of the work in ordering and reviewing tests is done by junior doctors, they are a lot less resistant to change than more experienced clinicians. “They appreciate the visibility that the system brings,” she says. “They are not having to remember dose ranges and that sort of thing. “Now we know when drugs are not given on time and we know when antibiotics are ordered. A lot of medication errors are due to legibility but all of that is gone now. “Documentation of allergies has improved dramatically and clinicians can now see things on the system that they hadn’t been able to see previously.”
Referrers can now see images from the patient record HealthLink already delivers tens of thousands of diagnostic reports every day. Now in conjunction with Medinexus, referrers can access reports and images directly from their clinical system or via a web portal - no matter where they are. In association with
Tel: 1300 79 69 59 Email: help@ medinexus.com.au Suite 1102, 1 Newland Street, Bondi Junction NSW 2022
“We attract more referrers by delivering our reports and images via the HealthLink and Medinexus system” Radiologist, Liverpool NSW
“One of the great things with HealthLink and Medinexus is that when the radiologist calls me regarding an abnormal finding I already have the images and reports available on my screen ‘straight away’ so I can see exactly what he is referring to” Referrer, Pennant Hills NSW
“It’s so simple to use. There’s no longer any need for film or a hard copy report to be delivered to me. It’s also so convenient that I can access reports and images no matter where I am” Referrer, Sydney City
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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) was established in 1979 as the national peak association supporting effective practice management in the healthcare sector. The Australian Association of Practice Managers: • Provides education, resources, networking, advice and assistance to promote excellence in healthcare practice management. • Represents practice managers and the profession of practice management throughout the healthcare industry. • Promotes professional development and the code of ethics through leadership and education.
ACIVA E: secretary@aciva.org.au W: www.aciva.org.au The Aged Care IT Vendors Association (ACIVA) was formed in early 2010, a not-for-profit organisation, incorporated in NSW. ACIVA represents the residential aged and community care sectors and vendors at various national forums regarding strategic developments and eHealth. ACIVA members are residential aged and community care software vendors, industry benchmarking software, financial software, call-bell, hardware, networking, infrastructure and industry partners. Members are committed to furthering the interests of residential aged and community care in national forums to ensure eHealth and access to the personally controlled health record (PCEHR) becomes a reality for the aged care industry in the very near future. Contact: Emma Pate emma.pate@eostech.com.au
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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 9037 1000 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.
Best Practice
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.
Best Practice sets the standard for GP clinical software in Australia offering a flexible suite of products designed for the busy GP practice, including:
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.
Advantech’s medical computing platforms are designed to enhance the quality and efficiency of healthcare for patients and users alike. All of Advantech’s medical PCs match the performance of commercial PCs but are medically rated to UL/EN 60601-1 third revision, IPX1 drip‑proof enclosures and are designed to suit ward and theatre based applications. Advantech offers long term availability and support plus a proven track record of reliability. The medical range extends through: • Point-of-Care Terminals. • Mini-PC and Medical Imaging Displays. • Mobile Medical Tablets. • Computerised Medical Carts. • Patient Infotainment Terminals. Advantech is also an official distributor of Microsoft Windows Embedded software across Australia & New Zealand.
• Best Practice 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: • • • • •
BP Summit, 14-16 March GPCE Sydney, 23-25 May RDAQ Brisbane, 6-8 June GPCE Brisbane, 12-14 September RACGP Adelaide, 9-11 October
Cerner Corporation Pty Limited
Advantech P: 1300 308 531 F: +61 3 9797 0199 E: info@advantech.net.au W: www.advantech.net.au
P: +61 7 4155 8888 F: +61 7 4153 2093 E: sales@bpsoftware.com.au W: www.bpsoftware.com.au
Australasian College of Health Informatics E: Secretary@ACHI.org.au W: www.ACHI.org.au The Australasian College of Health Informatics is Australasia’s Health Informatics professional body, representing the interests of a broad range of clinical and non-clinical e-health professionals. ACHI is the community of Health Informatics thought-leaders in Australasia. ACHI is committed to quality, standards and ethical practice in the Health Informatics profession. More information is available at: www.ACHI.org.au Join the ACHI Info email list at: www.ACHI.org.au/List
P: +61 2 9900 4800 F: +61 2 9900 4990 E: AsiaPacific@cerner.com W: www.cerner.com.au Cerner is a leading global supplier of health care information technology solutions engaging across Australia for 24 years. We partner with health services ranging from tertiary referral academic hospitals to rural health facilities. Our vision of proactive health care management drives innovation to address today’s health care challenges, while creating a foundation for tomorrow. The best way to solve a challenge is through innovation as evidenced by our Forbes ranking as 13th most innovative company worldwide. Our focus for Australia is driven by realising improvement in clinical outcomes. Facilitating clinical transformation, while delivering capability to manage the overall health status of the population, contributes to better health and care.
CONNECT DIRECT Pty Ltd
cdmNet P: +61 3 9023 0800 F: +61 3 9614 2650 E: info@precedencehealthcare.com W: www.precedencehealthcare.com cdmNet is the gold standard for managing chronic disease in Australian GP clinics. University trials show cdmNet results in improved quality of care and better patient outcomes.* cdmNet helps practices take a systematic approach to the management of their chronically ill population. It simplifies collaboration with the care team and ensures regular follow up and review. cdmNet eliminates paperwork and makes compliance with Medicare requirements easy. It increases the productivity of the entire practice and allows evidence-based care to be delivered to all chronically ill patients. If you wish to use cdmNet to provide high quality care for all your chronically ill patients while increasing your revenues, contact us now. • See cdm.net.au/evidence
Cutting Edge Software P: 1300 237 638 E: enquiries@cesoft.com.au W: www.cesoft.com.au Cutting Edge produces affordable, intuitive billing solutions for Mac, Windows, Linux and iPad. Cutting Edge is ideal for practitioners who prefer to maintain control of their own billing from a number of sites. Cutting Edge Software is approved by Medicare Australia to manage your electronic: • Verification of Medicare and Fund membership • Bulk Bill and Medicare claims • DVA paperless claims • Inpatient claims to Health Funds We have solutions tailor-made for: • Anaesthetists • Surgeons/Surgical Assistants • Physicians • GPs • Allied Health The software comes with up-to-date schedules for MBS/Rebate, Gap Cover (all registered health funds), Workers’ Compensation, Transport Accident authorities and DVA.
Cloud9 Software P: 1300 875 297 F: +61 2 9715 6573 E: globalsales@c9s.com W: www.c9s.com At Cloud9 we understand the complexity of healthcare. We understand the importance of having the right information available when and where it’s needed. So Cloud9 created an eco-system to connect healthcare providers that supports the availability of key information to improve outcomes for the patient, clinician and organisation alike. An information infrastructure with real-time access across primary, community and acute setting benefits Clinicians trying to provide the best care for individuals as well as Researchers looking to improve safety and effectiveness of treatments. Our e-Health infrastructure has been designed to fit in with your current systems, whilst Cloud9’s next generation administrative and clinical applications allow you to upgrade existing systems as your business grows. Cloud9 Solutions: • Cloud9 Spine, Health Information Exchange • Synchronicity, Application Integration Suite. • Clarity for GP’s and Specialists. • Clarity Hospital Information System.
Digital Medical Systems P: 1300 865 977 F: +61 3 9753 3049 E: inform@dgs.com.au W: www.dgs.com.au EASIER MEDICAL IT is a technology partnership with DMS – we make IT work for you. DIGITAL MEDICAL SYSTEMS has provided ICT solutions and services to medical practice clients across Australia since 1990. We have specialist expertise and experience in the installation and support of all Australian leading medical software applications. DMS is a Business Partner for IBM, LENOVO, HP, CISCO and Microsoft. Other leading ICT brands include Webroot Secure Anywhere, StorageCraft, CA, Toshiba, Canon, Epson, Kyocera, Fujitsu and Brother. Accreditation is easier with the customised DMS IT Systems Policy and Procedures Documentation. This ensures your practice has the best IT policy, security and maintenance program that meets and exceeds the standards guidelines from the RACGP.
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 the innovative answer to administrative excellence integrating with Microsoft Office, accounting applications, the OOP, clinical applications and Medicare Online. Included are all fee schedules (Medicare, DVA, Work Cover, TAC, CTP, Private Health Insurance) with built in rules relevant to each medical discipline (Allied Health, General Practice, Surgeons, Physicians including Oncology, Anaesthetists, Pathologists, Radiologists, Day Surgeries/Hospitals). Manage Episodes of Care including State, Federal and Health Fund Statistical Reporting for Day Surgeries/ Hospitals. Restructuring work flow with Direct CONTROL guarantees to provide remarkable results, enabling you to grow your business and increase cash flow.
World leading DTech provides 24x7 near Real-Time Monitoring and Management technologies sends alerts and enables our engineers to quickly troubleshoot and remotely solve problems fast of security, network, Internet, server and software on almost any client computer system or device – most are fixed in minutes… Proactive, Flexible, Consistent, Reliable, Audited, and Affordable - for the smallest to the largest practice. Call DMS for: • Systems Analysis, Solutions Design & Consulting • IT Systems Documentation for Accreditation & Compliance • Procurement & supply of leading brand hardware, software, network and peripheral products • Full Installation & Configuration services • On-Site and Remote Technical IT Support • 24x7 IT support Help Desk with extensive medical software expertise • 24x7 DTech Monitoring, Maintenance & Management • Disaster Recovery solutions • Fully managed Online Backup customised for clinical data • Fully managed Internet and Web Security
Doctors Control Panel E: www.pracsoftutilities.com W: PSU_admin@pracsoftutilities.com • Download and trial DCP software for GP’s and health teams. • DCP is your digital PA and guidelines advisor. • DCP facilitates TCA, GPMP and MHCP creation and tracking. • Contains guidelines licenced from RACGP. • Low annual subscription. • The best preventive care add-on software in Australia. • Compatible with MD3 and BP. • Achieve new heights in preventive care performance. • Significant benefit for patients. • Increase your revenues. • Streamline your workflow. • 3000 current users. • Several research projects based on DCP. • Try it today.
EASIER MEDICAL IT – Call 1300 865 977
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Emerging Systems P: +61 2 8853 4700 E: sales@emerging.com.au W: www.emerging.com.au/ehealth Emerging Systems is a market leader of healthcare information and integration technology solutions. Our eHealth products and services have supported clinicians in leading Australian public and private hospitals for over a decade to deliver safe, quality healthcare. The award-winning EHS Clinical Information System is a modular, patient-centric system providing a wide range of clinical functionality to track, record and monitor patient care from pre-admission to discharge creating a multi-disciplinary EMR - improving clinical communication and patient flow while reducing patient risk. PCEHR Compliant. EHS Clinical Mobility Solution further enhances multi-disciplinary clinical communication. Emerging Systems provide clients with a full range of tailored IT services including Consultation and Managed IT Services.
Extensia
GE HCIT Solutions
P: +61 7 3292 0222 F: +61 7 3292 0221 E: enquiries@extensia.com.au W: www.extensia.com.au
P: +61 2 9846 4000 F: +61 2 9846 4001 E: GEHCinfo@ge.com W: www3.gehealthcare.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:
Connecting productivity with care
• 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.
P: +61 2 8985 6688 / 1300 799 904 E: enquiries@episoft.com.au W: www.episoft.com.au Accessible anytime, anywhere and on any device, Episoft deliver comprehensive clinical, practice and research management software in one seamless system that facilitates multicentre investigator initiated trials.
Affordable and scalable, EpiSoft is used by: • Private Hospitals • Medicare Locals • Public Hospital outpatient departments • Specialist clinics Create multidisciplinary teams, collaborate effortlessly and streamline workflows with our intuitive cloud based software.
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• Clinical solutions to drive improved patient outcomes • Robust clinical data at the point of care • Imaging solutions to drive productivity • Analytics to improve efficiencies and reduce cost • Interoperability with other systems. Centricity Perinatal integrates documentation and foetal monitoring. The Connect module integrates perinatal information in context with other clinical data, continuously and on one screen – enabling clinicians to see perinatal and enterprise EMR data at the same time. Remote access allows clinicians to view foetal strips while away from the hospital, providing continuous access to clinical expertise. Centricity Perioperative integrates and simplifies surgery management and anaesthesia workflows throughout the pre-op, intra-op and post-op care areas, helping to manage anaesthesia and nursing documentation, scheduling, operating theatre inventory and more.
EpiSoft
EpiSoft has developed platforms for chronic disease management for: • Cancer including surveillance and infusion medication management • Hepatitis treatment including GP shared care programs • Mental Health • Indigenous Health • Respiratory disease • Specialised surgery • Pre-admissions patient portal
GE Healthcare IT provides robust clinical and imaging solutions that help you do more with less.
Genie Solutions P: +61 7 3870 4085 F: +61 7 3870 4462 E: sales@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 3000 sites, it is now the number one choice of Australian specialists.
Centricity Imaging Solutions will help you simplify your workflows, access data, and collaborate efficiently. They provide radiologists and physicians with tools to collaboratively inform the patient treatment plan and enhance decision-making. Our portfolio includes: Picture Archiving System (PACS), Radiology Information System (RIS), Universal Viewer, Vendor Neutral Archive, and Image Exchange for departments, enterprises, and communities. GE Services can increase usability, enhance performance, and optimise a solution’s ROI. Our offering includes consulting, implementation, customisation, education, support, and enablement services.
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.
GPsupport P: +61 3 9999 1212 F: +61 3 8678 0607 E: admin@gpsupport.com.au W: www.gpsupport.com.au Information Systems for the health care industry. When associated with GPsupport all your technology needs are completely managed, freeing you to focus on patient care and clinical operations. Your I.T is for us to worry about. Since 2008, GPsupport has been dedicated to delivering I.T solutions to General Practice, Allied Health and Aged Care providers. • • • • • •
Healthcare Centric IT Support Private Cloud Services Equipment Supply and Installation Multi-site networks Disaster Recovery Planning Accreditation Compliance
Our private cloud service is fast becoming the preferred choice for healthcare providers to relieve the pain of maintaining in-house systems while adhering to accreditation standards and your future needs.
HealthLink P: 1800 125 036 (AU) P: 0800 288 887 (NZ) E: enquiries@healthlink.net W: www.healthlink.net Transforming healthcare by connecting healthcare providers. Australia and New Zealand’s most effective secure communications service. • NEHTA compliant Secure Messaging Delivery (SMD) services • Fully integrated with leading GP and Specialist clinical systems • Referrals, Reports, Forms, Discharge Summaries, Specialists, Diagnostic Orders and Reporting • Affords all healthcare providers efficiencies in reducing paper based handling • Expert partnerships with Healthcare organisations, State and National Health Services • HL Connect for Allied Health, Telehealth and Aged Care Providers • Working with Medicare Locals Australia-wide for eHealth delivery Join HealthLink and connect with more than 85 % of Australian GPs and 99% of NZ GPs who are already part of the HealthLink community.
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.
Houston Medical P: 1800 420 066 (AU) P: 0800 401 111 (NZ) E: info@houstonmedical.net W: www.houstonmedical.net “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
InterSystems Health Informatics New Zealand 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
P: +61 2 9380 7111 F: +61 2 9380 7121 E: anz.query@InterSystems.com W: www.InterSystems.com.au
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.
Health Information Management Association of 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.
InterSystems is a global leader in software for connected care, with headquarters in Cambridge, Massachusetts, and offices in 25 countries. InterSystems TrakCare® is an Internet-based unified healthcare information system that rapidly delivers the benefits of an electronic patient record. InterSystems HealthShare® is a strategic platform for healthcare informatics, enabling information exchange and active analytics across a hospital network, community, region or nation. InterSystems CACHÉ® is the world’s most widely used database system in clinical applications. InterSystems Ensemble® is a platform for rapid integration and the development of connectable applications. InterSystems’ products are used by thousands of hospitals and laboratories worldwide, including all of the top 15 hospitals on the Honor Roll of America’s Best Hospitals as rated by U.S. News and World Report. For more information, visit InterSystems.com
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Intrahealth P: +61 2 9956 3827 (AU) P: +64 9 480 7442 (NZ) E: enquiries@intrahealth.com W: www.Intrahealth.com Intrahealth is a global software and associated services company supplying solutions to the outpatient environment. Intrahealth provides a highly configurable integrated EMR (including case management), web access applications for real time patient, provider and external provider connectivityand a native application for the iPad and iPhone. Intrahealth solutions function across multiple community based practice types (Primary Care, Specialist Physician, Community Care, Home Care, Residential Care, etc). Intrahealth’s suite of products are used in: Individual community based clinics, Chains of clinics, Corporate medical environments & Large scale Government implementations.
Medical Software Industry Association E: ceo@msia.com.au E: president@msia.com.au W: www.msia.com.au With the increase in government e-health initiatives, the MSIA has become increasingly active in representing the interests of all healthcare software providers. The MSIA is represented on a range of forums, working groups and committees on behalf of its members, and has negotiated a range of important changes with government and other stakeholders to benefit industry and their customers. It has built a considerable profile with Government and is now acknowledged as the official ‘voice’ for the industry. Join over 100 other companies across all areas of medical IT/IM so your voice can be heard.
P: 1800 556 022 E: mail@medrefer.com.au W: www.medrefer.com.au MEDrefer is a secure online referral tool used by GPs, Specialists and Allied Health Professionals to manage the referral process for the benefit of patients. MEDrefer is a free service for GPs with an extensive search directory and profile of Specialists and Allied Health Professionals, a search reveals their listing in order of relevance and availability. MEDrefer provides an automatic tracking system for the GP to know if the patient attends their appointment, assisting duty of care. Now integrated with Best Practice and Genie software, as well as other systems, through the MEDrefer Manager. Join MEDrefer today to close the loop on your referral process.
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.
Medtech Global Ltd 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
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.
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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.
P: 1800 148 165 E: salesau@medtechglobal.com W: www.medtechglobal.com 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. 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.
New Zealand Health IT Cluster P: +64 4 815 8177 E: admin@healthit.org.nz W: www.healthit.org.nz The New Zealand Health IT Cluster is a vibrant alliance of organisations interested in health IT, comprising software and solution developers, consultants, health policy makers, health funders, infrastructure companies, healthcare providers, and academic institutions – who have agreed to work collaboratively. • New Zealand industry is consistently well regarded in providing quality, relevant solutions domestically and in offshore markets. • New Zealand has an internationally regarded model of partnership that fosters development of innovative solutions to healthcare challenges. • In key and emerging markets the New Zealand health IT brand is strongly recognised. By 2015 sales growth is doubled from the 2010 baseline.
OzeScribe P: 1300 727 423 F: 1300 300 174 E: sales@ozescribe.com.au W: www.ozescribe.com.au OzeScribe is the dictation and transcription solution chosen by most Australian university teaching hospitals and major private clinics. Our system is entirely flexible and can be tailored to your specific requirements, whether it be co-source or total outsource, for one doctor or a public hospital! We provide free electronic document delivery - via OzePost - to your EMR, your associate’s EMR, saving you thousands of dollars in time, packing and postage. OzeScribe is the provider of the most advanced solutions available, interfacing with most market leading PAS/Practice management solutions. OzeScribe is: • Run by doctors - for doctors. • Free NEHTA compliant electronic delivery to referring GPs etc via OzePost - powered by Argus. • Australian based and trained typists. • Superior accuracy via Quality Assurance (QA) transcription guaranteed. • Windows and Mac compatible web‑based dictation, transcription and document management portal. • Free app for iOS and Android devices. • Integrated M*Modal speech recognition technology on demand. With demonstrated time and cost saving benefits, it really does make sound business sense to let OzeScribe take care of managing your dictation, transcription and associated technology. To speak with a consultant call us now on 1300 727 423!
Orion Health P: +61 2 8096 0000 / +64 9 638 0600 E: enquiries@orionhealth.com W: www.orionhealth.com Orion Health is New Zealand’s largest privately owned software exporter and a global leader in eHealth technology. Founded in 1993, by CEO Ian McCrae, Orion Health has grown from a specialist health integration vendor into a company that sells a comprehensive suite of eHealth solutions. Orion Health has extensive experience in the design and installation of complex systems within demanding healthcare environments. Orion Health designers and engineers work right alongside in-house clinicians in order to develop elegant and intuitive products that encourage swift adoption with minimal disruption, allowing your clinicians to focus on patients. Today, our products and solutions are currently implemented in more than 30 countries, used by hundreds of thousands of clinicians, and help facilitate the care for tens of millions of patients.
Precision IT P: 1300 964 404 F: +61 2 8078 0257 E: info@precisionit.com.au W: www.precisionit.com.au • Cloud Computing Specialists. • Onsite Medical IT Support. • VoIP Telephone Systems and Internet Connectivity. • IT Equipment Procurement. • Experience with all clinical & practice management software packages. • Sydney, Brisbane, Gold Coast and Melbourne. Precision IT is a highly competent and impeccably professional IT support firm with a primary focus on working with GPs and Specialists. Working with our clients, we develop reliable, robust and feature rich IT systems to meet the demands of the modern medical practice today and into the future. Our Precision Cloud service is fast becoming the choice for new and established practices and covers all of the standard guidelines from the RACGP and AGPAL and GPA.
PicSafe Medi P: +61 419 572 222 E: kerri-anne@picsafe.com W: www.picsafe.com
Professional Transcription Solutions
The Secure Mobile Clinical Imaging System
P: 1300 768 476 E: marketing@etranscriptions.com.au W: www.etranscriptions.com.au
Designed by Australian and US Dermatologists and Plastic Surgeons to be used by a wide range of healthcare professionals working in a variety of clinical settings, the patented PicSafe Medi app is as simple as using the normal camera function on your mobile smart device except... your patient’s photo is completely secure and legally compliant in its consent, transmission, and storage when taken with PicSafe Medi. Both iOS and Android compatible, PicSafe Medi simultaneously suffices patient privacy and related government regulatory requirements (including new Federal APP’s, commencing 12th March, 2014) surrounding the capture, use, and storage of medical photographs. Using PicSafe Medi, healthcare professionals can now quickly connect and efficiently document a patient’s status pictorially, facilitating the medical referral process and, ultimately, improving patient outcomes and satisfaction. Stored clinical photographs are fully patient-consented (including authorisation for specific usages of their photo), watermarked to assure authenticity, and managed in a highly secure, auditable, private server environment, accessible only to authenticated PicSafe Medi users. From the time you take a patient’s photo with a smart device, to the encrypted transmission and secure storage phases of photo handling, the process is seamless and non-intrusive to both photographer and patient. • Increase your efficiency and improve your patients’ clinical outcomes • Remove the worry surrounding costly patient privacy breaches • Assure quick, efficient pictorial documentation of your patient’s status • Facilitate a streamlined medical referral process • Fully document your patient encounters for billing, auditing, and medical-legal purposes • PicSafe Medi is “the missing link” in compliant and secure mobile clinical photography. PicSafe Medi is “the missing link” in compliant and secure mobile clinical photography.
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 within 24 - 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 a no obligation free trial
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.
Talk with us today about the future of your practice!
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Stat Health Systems (Aust) P: +61 7 3121 6550 F: +61 7 3398 5064 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 leads 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
The July 2014 CD release of eTG complete contains an important update on the treatment of osteoporosis, to reflect new information published by the Therapeutic Goods Administration in April.
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No other changes to the content will be published at this time. Antibiotic Guidelines version 15 will be coming out in November in eTG complete and in print. miniTG The mobile version of eTG complete is miniTG, (in offline format), offering the convenience of vital information at the point of care 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.
Webstercare
Totalcare
P: 1800 244 358 F: 1800 626 739 E: info@webstercare.com.au W: www.webstercare.com.au
P: +61 7 3252 2425 F: +61 7 3252 2410 E: sales@totalcare.net.au W: www.totalcare.net.au Totalcare is a fully integrated Clinical, Office and Management software suite designed to suit the particular needs and processes of healthcare providers. Used since 1995 by health care facilities across Australia including General and Specialist practice, Radiology, Day Surgery and Hospitals, Totalcare is stable, scalable, customisable and easy to learn and use. From a small practice to a multisite, multi-disciplinary corporate entity or hospital, Totalcare can provide solutions for your needs. • • • • • • • •
Admissions / Appointments Billing Statutory Reporting Integrated SMS Prescriptions Orders & Reports Clinical Notes Letter/Report Writing, Document and Image Management • Scanning and Barcode recognition • Video and Image Capture • HL7 Interfaces
Webstercare is a world-leading medication management innovator and was recognised in 2013 by BRW as Australia’s sixth most innovative company. About 30 years ago, Webstercare developed Webster‑pak®, the world’s first medication dose administration aid, and today the majority of Australia’s community pharmacies use the Webster-pak system to help consumers maximise their medication use. Webstercare has since developed another 300 products and services– all developed to solve existing problems. These include MedsPro®, a system for maximising the efficiency of dispensing Webster-paks; MedsCom® Connect which connects pharmacies with aged care facilities and GPs; and MedSig® to streamline clinical medication administration processes.
Zedmed ™
VIRTUAL CONSULTING ROOMS
VConsult P: 1300 82 66 78 F: 1300 66 10 66 E: admin@vconsult.com.au W: www.vconsult.com.au VConsult offers outsourced practice management solutions for medical and allied health practitioners allowing the focus to be on your professional practice and patient care. VConsult provides a seamless “behind the scenes” service by professionally managing your telephone calls, reception, invoicing and medical transcription requirements. VConsult is perfect for your practice if you are: • Setting up, already established or winding down in Private Practice • Working in a public appointment and want to portray a professional image • Looking to minimise your overhead costs • Requiring your patient calls to be answered by a professional and experienced medical receptionist.
P: 1300 933 000 F: +61 3 9284 3399 E: sales@zedmed.com.au W: www.zedmed.com.au At Zedmed, we provide general practice, specialist and allied health clinics with turnkey software solutions for their most common practice needs. We’re committed to producing best in class products and services and are consistently striving to provide additional value-added products and services to help practices work more profitably and efficiently, so our customers can focus on delivering patient care. Zedmed - Focused Innovation.
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Scheduling care and telephone communications Home visits and after hours care Practice information Telephone techniques Reminders, recalls and results Diagnosis and management of health problems Continuity of care including clinical handover
HealthLink
Adding a whole new dimension to healthcare
At HealthLink we understand our products work best when they free up medical practitioners to concentrate on what they do best - personalised patient care - while giving them the accurate, timely and complete information to further enhance that care. Today’s complex, hurried healthcare environment demands patient information systems that are absolutely dependable. At HealthLink we work through every challenge to ensure our clients have nimble, fit -for- purpose systems that deliver peace of mind performance.
www.healthlink.net