Australasia’s First and Only eHealth and Health IT Magazine
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20 MAY 2013
MEDICAL DEVICES
Apps for health
What to look for when choosing apps for clinical use, and recommendations about great apps on the market.
Snoops out of mHealth
Standards and regulations are required to keep the snoops from limiting wider mHealth adoption.
Healthcare in the home Mobile technologies are being deployed to keep older people and the chronically ill out of hospital and at home.
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Inside
Publisher Pulse+IT Magazine Pty Ltd ABN: 34 045 658 171 www.pulseitmagazine.com.au Editor Simon James Australia: +61 2 8006 5185 New Zealand: +64 9 889 3185 simon.james@pulseitmagazine.com.au Advertising Enquiries ads@pulseitmagazine.com.au
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Looking Ahead Pulse+IT welcomes feature articles and guest editorial submissions relating to the nominated edition themes, as well as articles relating to eHealth and Health IT more broadly. Pulse+IT is produced in print seven times per year with the remaining four edition for 2013 to be distributed for release in: • July 2013 - PCEHR / HIC2013 Preview • Mid-August 2013 - Telehealth / HIMAA Conference Preview • October 2013 - New Zealand eHealth / HINZ Conference Preview • Mid-November 2013 - mHealth
Submission guidelines and deadlines are available online: http://www.pulseitmagazine.com.au/editorial Pulse+IT acknowledges the support of the following organisations, each of whom supply copies of Pulse+IT to their members.
About Pulse+IT Pulse+IT is Australia’s first and only Health IT magazine. With an international distribution exceeding 34,500 copies, it is also one of the highest circulating health publications in Australasia. 32,000 copies of Pulse+IT are distributed to GPs, specialists, practice managers and the IT professionals that support them. In addition, over 5,000 copies of Pulse+IT are distributed to health information managers, health informaticians, and IT decision makers in hospitals, day surgeries and aged care facilities. ISSN: 1835-1522 Contributors Dr Tessa Davis, Dr Juanita Fernando, Simon James, Kate McDonald, Anne Trimmer and Michael Wong. Disclaimer The views contained herein are not necessarily the views of Pulse+IT Magazine or its staff. The content of any advertising or promotional material contained herein is not endorsed by the publisher. While care has been taken in the preparation of this magazine, the publisher cannot be held responsible for the accuracy of the information herein, or any consequences arising from it. Pulse+IT Magazine has no affiliation with any organisation, including, but not limited to Health Services Australia, Sony, Health Scope, UBM Medica, the New Zealand College of General Practitioners, the Rural Doctors Association of Australia, or the Kimberley Aboriginal Medical Services Council, all who produce publications that include the word “Pulse” in their titles. Copyright 2013 Pulse+IT Magazine Pty Ltd No part of this publication may be reproduced, stored electronically or transmitted in any form by any means without the prior written permission of the Publisher. Subscription Rates Please visit our website for more information about subscribing to Pulse+IT.
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APP DEVELOPMENT
ST VINCENT’S NEW PAS
MEDICAL DEVICES
Editorials
Features
News
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SNOOPS OUT OF MHEALTH
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CHOOSING A GOOD HEALTH APP
NBN speeds key to telehealth growth and data sharing
How to sift through the less than useful medical apps to find the little gems for clinical use.
Easier, faster app development for phones, devices and desktops
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STARTUP Editor Simon James introduces the 35th edition of Pulse+IT, and speculates about whether the Department of Health and Ageing’s strategy to encourage consumer adoption of the PCEHR is the most effective way to achieve its July goal of 500,000 registrations.
MTAA MTAA’s Anne Trimmer argues that the use of medical devices in the home and for remote monitoring are proven technologies, but the barrier to wider use remains an economic one. Assistive technologies can be cost-effective by reducing the number of unnecessary hospitalisations.
Resources
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EVENTS
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PULSE+IT DIRECTORY
Up and coming eHealth, Health, and IT events.
The Pulse+IT Directory profiles Australasia’s most innovative and influential eHealth and Health IT organisations.
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A lack of knowledge about security, privacy and the proper use of mHealth is a threat to its potential.
APPS FOR HEALTHCARE A selection of some of the best apps on the market for teaching, learning and improving patient care.
SELECTED BITS & BYTES Pharmacies begin to link to national prescription repository
Allied health needs access to eHealth: NPHCP Privacy framework could help harness the power of big data
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MEDICAL DEVICES IN THE HOME New devices and apps are coming on the market for remote monitoring and telecare.
Emerging Systems to co-develop patient administration system with St Vincent’s Hospital
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HEALTHCARE OUT OF HOSPITAL
South Australia goes live with PCEHR in Aboriginal communities
Eric Dishman believes that care must occur at home as the default model, not in a hospital or clinic.
Stat, Profile and Monet now PCEHR and ePIP ready
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MEDICAL DEVICE INTEGRATION
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WEBRTC AND SHARED EHR
Formal recognition for health informaticians through CHIA
WebRTC, remote monitoring and shared EHR to be trialled for cystic fibrosis patients.
Argus and Medical-Objects demonstrate connectivity
How general practices can digitise and streamline the record keeping associated with medical devices.
Telehealth society calls for national telehealth strategy
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Editorial
MEDICAL DEVICES AND mHEALTH This edition of Pulse+IT profiles the use of medical devices throughout the healthcare sector, with feature writing and news coverage spanning general practice, aged care and home care settings. As healthcare costs continue to increase, a trend to provide as much care as possible at home using integrated medical devices and mobile applications is emerging.
SIMON JAMES BIT, BComm Editor: Pulse+IT simon.james@pulseitmagazine.com.au
Having revisited a topic that Pulse+IT investigated two years ago, it has been interesting to see how the theme of medical devices has evolved in such a short space of time. As this edition highlights, the definition of what constitutes a ‘medical device’ is now quite broad and the settings in which these devices are being used are many and varied. Accordingly, this edition covers the realm of smartphones and tablets, patient‑centric devices, apps for healthcare practitioners and how healthcare in the home is being delivered by a mixture of monitoring devices, apps and video conferencing. Anne Trimmer, CEO of the Medical Technology Association of Australia, discusses the gaps in current funding arrangements for patients using medical devices, while paediatric physician Tessa Davis looks at some of the smartphone apps she thinks are of real clinical use.
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.
The progress general practice clinical software developers have made with the integration of medical devices with their solutions is also covered, and we also look at some of the latest integrated medical devices on the market and how they are being used to help keep patients out of hospital and cared for in their home.
Looking ahead The next edition of Pulse+IT will feature detailed coverage about the personally controlled electronic health record (PCEHR). The magazine will be released in early July, timing in with the self-imposed deadline the Department of Health and Ageing set itself to have 500,000 patients registered to use the system. Despite the considerable human resources being deployed by the government in pursuit of this target, it seems highly unlikely that it will be achieved, with figures released in April showing that just 108,000 registrations had been processed and very low awareness by the general public that the system actually exists. Owing to the complexity and ongoing delays associated with the various PCEHR registration requirements, many general practices are still struggling to connect their clinical software to the system despite the passing of the relevant ePIP deadline earlier in the month. It seems inevitable that only a small number of Australians will have a PCEHR containing any clinician-generated content by the start of July, leading one to wonder whether clinicians – and not contractors with clipboards – may have been the most appropriate people for the government to engage to drive consumer adoption.
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News
Pharmacies begin to link to National Prescription and Dispense Repository Fred IT Group has released a PCEHR-enabled version of its Fred Dispense product to all of its pharmacy users that will also allow them to send dispense information through eRx Script Exchange to the National Prescription and Dispense Repository (NPDR), which recently went live. Scan this QR code to read and comment on the latest eHealth news online.
The NPDR is part of the PCEHR infrastructure, and is a repository of prescribed and dispensed medications that are sent through from eRx and, shortly, MediSecure. Consumers who have registered for a PCEHR will be able to view a history of their medications, which they can then share with their healthcare providers.
Scan this QR code to receive eHealth news delivered to your email inbox each week.
Doctors will also be able to open a view to the NPDR through their clinical software, with some GP desktop software providers now beginning work on reconfiguring their products to link to the NPDR.
Pharmacists using Fred Dispense or Simple Retail’s Aquarius are now able to send dispense information to the NPDR and to view their patients’ PCEHRs, with the patient’s consent. While the latest version of Fred Dispense has been released to all users, the national PCEHR system and the NPDR can not yet interact. A upgrade to the PCEHR, which will include the connection to the NPDR along with other new features such as a child and newborn health record, was due to go live as Pulse+IT went to print. Only those pharmacies that have registered for the PCEHR will begin to be activated to use the new functionality. Both Fred IT and Simple Retail are members of NEHTA’s pharmacy software vendors panel and have been working on PCEHR integration for several years. Aquarius is
still to be beta tested before it is rolled out to users, according to Simple Retail’s development pharmacist, Jerry Perkins. David Freemantle, general manager for enterprise solutions with Fred IT, said his company will begin switching on those pharmacies that participated in the MedView trial and have therefore received their HPI-O and HPI-I numbers, along with their NASH certificates. “There is still a technical activation component required, which is primarily about the [security] certificates,” Mr Freemantle said. “We can’t automate that. We then dial in to those 180 sites that did the MedView project and we’ll activate them first. We are working with DoHA on the deployment plan to get it rolled out more broadly.” Mr Freemantle said Fred IT rolls out updated versions of its software
automatically, with a dialin capability to manually activate the new version if required. “Our customers are always on the same version of Fred Dispense so the PCEHR/ NPDR-enabled version is now on every pharmacist’s desktop,” he said. The Medview project, which led to the development of the NPDR, involved a number of community pharmacies in the Barwon region of Victoria, south metro Brisbane, Tasmania and inner east Melbourne, as well as local GPs and Geelong Hospital. Simple Retail also took part in the project, as did the hospital pharmacy software vendor Pharmhos, which produces the Merlin software used by Geelong Hospital. Mr Perkins said Aquarius had passed all of the tests and the notices of connection required, but had not yet gone live in the real world. “That’s what we are waiting to do,” Mr Perkins said. “We are ready to roll it out once the Medicare Locals are happy with it. The first ones will probably be in the Medicare Local in the south Brisbane area that was involved in MedView.” Mr Freemantle said that for those Fred pharmacies not involved in MedView, the company will begin activating sites when they are signed up to the PCEHR,
which Medicare Locals are assisting with. “We’ll be activating sites based on Medicare Locals doing the registration work and getting them set up and ready, and we’ll dial in and do the technical activation,” Mr Freemantle said. That is also Simple Retail’s plan, Mr Perkins said. “It’s up to the Medicare Locals to get the pharmacies ready.”
“The PCEHR/ NPDR-enabled version is now on every pharmacist’s desktop.” Pharmacists using Fred Dispense will also be able to register consumers for their PCEHRs, as the company has included an integrated assisted registration function. “We’ve got a red flag showing they don’t have a PCEHR, so by clicking on that it will ask if you want to undertake the assisted registration process and up it comes,” Mr Freemantle said. Fred’s gateway to the NPDR is in the production system, but it will only be able to interact with the PCEHR when the new release became available. “At the moment the NPDR has got nothing to talk to.
The PCEHR release three contains the pieces that integrate to the NPDR. We’re ready to go as soon as the PCEHR is released, and at that point we start deploying initial sites.” Mr Perkins said he doubted there was much awareness amongst pharmacists about what the PCEHR was and how it will work, but that he sees value in it. “I don’t think it has been particularly well marketed, which is unfortunate as I think it’s a very valuable thing,” he said. “I had a country pharmacy for 15 years, a resort pharmacy, and it’s just terrific for people who can’t remember what their tablets are. “Every pharmacist has patients who come in asking about these ‘little white tablets’ that they take. We ask what they are for and they can’t remember that either, but that the doctor says I should take them.” He said an up to date medications history would also be useful when patients are discharged from hospital. “They get sent home at the end of the day and their medications have been changed and they don’t really know what they have to take. That happens pretty much every week to every pharmacy. We really want the hospitals to get on board.”
NBN speeds key to telehealth growth and data sharing The provision of high-speed broadband through the NBN is a key technology underpinning the expected growth in the use of IT for healthcare applications, according to a panel of IT vendors. High-speed broadband will enable further growth in the use of telehealth, cloudbased applications, network convergence and the ability to share data through electronic medical and electronic health records, with EMR and EHR use set to expand even further, according to research firm Frost & Sullivan. “IT offers a strategic way of achieving this, particularly with the NBN beginning to provide the necessary high-speed infrastructure,” Frost & Sullivan managing director Mark Dougan, who hosted the panel, said. “As the network expands its reach, technologies such as cloud services, big data analytics and advanced visualisation tools have the potential to revolutionise the health sector.” While the panel would not be drawn on whether the government’s or the opposition’s plans for the NBN were best, it did agree that high-speed broadband would improve the delivery of services, particularly for telehealth and cloud-based systems into rural and remote areas. ADSL2+ broadband was adequate for telehealth provision when it comes to video conferencing, but the full potential of telehealth in sharing data and images would require higher speeds, according to Gerry Forsythe, regional sales manager for telehealth vendor LifeSize Communications. “[Slower speeds] doesn’t have a big impact right now,” he said. “It will improve the way you share patient records though, as you do chew up a bit of bandwidth when you are doing that. Pulling the data up on the screen is the problem right now.”
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Governments should embrace big data: Carr Former human services minister Kim Carr opened the Health Informatics Society of Australia’s inaugural Big Data conference in Melbourne recently with an impassioned speech about freeing up public data, urging the nation not to “squander” the “great compact between government and researchers”. “I have taken the view that this should be an area in which there should be no controversy,” Senator Carr said. “After all, who could argue with the case that the Australian people are entitled to have information about themselves? Who is not a fan of evidence-based policy? This is a term that is used thousands of times a year in the Parliament of Australia, but you’ll find inreality quite few people are – and we need to look at what that’s about.” Senator Carr said he believed science and research had the power to solve most of the challenges facing society, and that government was in a unique position to harness that power. “But we can’t rely on guesswork. We can’t just trust our luck.”
Easier, faster app development for phones, devices and desktops US-based app and database development software provider Embarcadero has released an app development suite that promises to allow developers to build apps that can run on most devices and desktops as a native app. Called RAD Studio XE4, the software will allow developers to use one code base for all devices, including the iPhone, iPod touch, iPad, Windows Slates and Surface Pro tablets, along with Mac OS X and Windows PC applications, with support for Android coming soon.
“So long as we make the assumption that personal records have to remain confidential, we can take further steps to ensure confidence about that,” he said. “It should not be a blanket stopper to access to data.”
Embarcadero’s Sydneybased senior director for the Asia Pacific and Japan region, Malcolm Groves, said the software would help overcome a common problem in app development, in which developers have a choice of either tailoring the app for individual platforms as a native app and then having to rewrite the code completely for another platform, or compromising some performance by building a platformagnostic app using HTML5 or JavaScript.
The amount of data held by the department constituted “a map of human society, how life is actually lived”, he said. “The practical applications are staggering,” he said. “I can’t think of a limit on the opportunities here.”
“Everyone is thinking about mobile and as part of that they are faced with this choice: they can build an app as a native application, for example if you wanted to
Addressing perceptions that personal data could be misused or individuals’ privacy infringed, he said that while much of the fear was overblown, it was necessary for citizens and industry to hold government to account.
target iPhone and iPad, the options until now have been to use an Apple tool called Xcode,” Mr Groves said.
code, there’s no shared investment and you are essentially starting from scratch again.”
“That basically means that you build your application for iPhone and iPad and you’ve got full access to all of the capabilities of the platform – the cameras, GPS, all that sort of stuff. It also means that it performs really fantastically on that platform.
Queensland-based EHR and secure messaging provider Medical-Objects has been beta testing the new suite since last year, as much of its Windows applications have been built on the Delphi programming language.
“However, if you want to target more than just the iPhone and you want to target Android as well, or PC or Mac desktops, then you have a problem because doing that native design exactly for the platform means that when you come to do your Android app, you are totally rewriting it. There’s no shared
Medical-Objects’ CIO Jared Davison said RAD Studio XE4 would allow the company to use the Delphi programming language on other platforms such as Apple’s iOS, which wasn’t possible before. “We have existing mobile products operating out of the Medical-Objects cloud which use web technologies
and web browsers, but we have also built a lot of code over 10-plus years that is in Delphi and we now can actually reuse this investment within iOS,” he said. “Rather than having to redevelop everything, we can get some acceleration in our development by being able to use the same language that we’ve been using for years.” Mr Davison said that to date, Medical-Objects had released apps that allow clinicians to review pathology results or medical records, and had used web technologies to build those apps. However, many apps are simply running a web browser, and by putting more native gear in the apps, the developers can increase the performance and capabilities of these applications, he said. “With the existing apps, basically you connect your web browser on your device and the server provides web pages that are suitable for your device. When you are using 3G networks, which are not all that fast at times, the network can degrade performance of the app, so the less data you have going through the network the better the application performance is. “Having access to RAD Studio products provides us with something in which all the code can reside inside the memory of the device, and also data can be cached
for offline mode use, rather than loaded from a web server on the internet each time. By using RAD Studio we can provide much better work efficiency to our users, who need responsive applications to assist them as they work.”
“If you’re using Xcode to develop an iPhone application, you are pretty limited in the database you can use.” The technology will allow Medical-Objects to further develop apps for its secure messaging system and its EHR software for allied health professionals and specialists, both of which are built in Delphi and use HL7. Mr Davison said apps to access this software could now potentially run on different mobile devices without having to rewrite huge amounts of code. “We can reuse what we’ve already done,” he said. “We have more than 10 years’ worth of programming – we don’t want to be rewriting that – and a lot of it is really good stuff. Harnessing this, we will be able to offer our customers new innovative products for their mobile platforms.” Mr Groves said that one of the frustrations for clinicians is the inability to
access the many different clinical applications they use through mobile apps, simply because the app cannot access certain databases. “If you’re using Xcode to develop an iPhone application, you are pretty limited in the database you can use,” Mr Groves said. “For example, a database in a server in a hospital or a medical practice that you want to talk to from your device, you are constrained. “One of the things that has always been the strength of RAD Studio is that we provide access to a whole bunch of other systems out of the box. There is support for 12 or 13 different databases, including DB2, Sybase, SQL Server and Oracle, as well as support for web services and cloud services. A big part of this is that you can get at pretty much anything from it, and a lot of that strength comes across in the mobile suite.” For clinicians who these days use a desktop and a tablet during a consultation and an iPhone or smartphone while out and about, the development of apps that can perform like native apps on any of those devices will come as a relief. “The days of thinking you can have a system totally self-contained that doesn’t have to talk to the rest of the world are long gone,” Mr Groves said.
Zedmed plans assisted registration, link to NPDR Clinical and practice management software provider Zedmed has released version 22 of its product, featuring the integration of two online appointment booking services as well as the ability to add new secure messaging providers. Zedmed is also continuing its work on further integration with the PCEHR, including incorporating the facility to register patients’ PCEHRs directly through Zedmed and developing a view of the data in the National Prescription and Dispense Repository (NPDR). Zedmed has had full PCEHR functionality since September last year and to date, 82 per cent of clients are using the PCEHRcompatible version, Zedmed’s operations manager, Emily Elst, said. “This includes both specialists and general practice, and some of the general practice sites are in the process of finalising their registrations and PCEHR set-up now,” Ms Elst said. “Leading up to the first of May, we were getting a lot of inquiries through to support for help to get set up with the HI Service and to get the PCEHR running.” Zedmed business analyst Jane Blakeley said she had been working on the specifications to allow users to register patients, and she is also preparing to link to the NPDR. “We will be updating the information that we send to eRx so that the required consent for whether the prescription should be uploaded to the NPDR via eRx can be sent through,” Ms Blakeley said. “Once the NPDR is then online, those prescriptions will be able to be seen on the NPDR. The other part is creating a view so that you can actually see all of the prescription and dispense information for the patient that have been loaded to the NPDR.”
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Physiotherapists gear up for eHealth functionality Inner East Melbourne Medicare Local (IEMML) recently launched a pilot project to support 20 physiotherapy practices to trial electronic clinical software and other eHealth functionality. Working in partnership with the Australian Physiotherapy Association (APA), the trial forms part of IEMML’s new eHealth engagement with the allied health sector. “We’re working with two key groups: those with electronic clinical notation systems used during consultations, and those with paper-based or similar set-ups,” Sarah Lausberg, IEMML’s allied health eHealth liaison officer, said. “Our goal is to have the first group introduce eHealth systems such as secure messaging and online imaging while the second group will trial the use of clinical note-taking software during their patient consultations,” she said. “We know that moving to an electronic system is a big change for many practices so we’ve arranged a software vendor demonstration session … to introduce a range of software options. We’ll also use the opportunity to provide participating physiotherapists with information about the national eHealth record system as well as support for them to register.” Camberwell’s Back in Motion has been using and benefitting from electronic systems for some time. “Moving to an automated, electronic system has had a range of efficiency benefits for our practice,” physiotherapist and practice director Adrian Quinn said. “We now have easy access to client information from any computer, writing letters to GPs is much quicker thanks to auto-population of fields, and we can now far more easily communicate with particular subgroups of patients.”
Trying out telehealth – what the aged care sector wants from the technology Macedon Ranges and North Western Melbourne Medicare Local (MRNWMML) set up a telehealth program last year to link the area’s 40-odd residential aged care facilities and 130 general practices with out of area specialists. MRNWM-ML has been working with a number of general practices and RACFs who have since taken their first steps into telehealth, with many finding that the technology is easy to use with measurable benefits to patients. The Macedon Ranges and north-west Melbourne area includes a mixture of rural towns and outer metropolitan suburbs, and as such many of its GPs still qualify for the federal government’s telehealth incentive. All residential aged care facilities also qualify for the incentive when hosting a video conference with a specialist. Wendy Lacey, director of nursing at Reg Geary House in the suburb of Melton South, helped organise a day of telehealth consultations last December, involving six residents who were assessed by a mixture of several geriatricians, a dermatologist and a neurologist.
Reg Geary House is a 30-bed high care facility run by Western Health, but that does not mean the facility has easy access to specialists, Ms Lacey said. “We are as distant from hospitals as any others. We do have wound consultants and infection control consultants that we can source, but they are generally nurse consultants, not doctors. When it comes to medical specialists, we would be in the same boat as everyone else.”
“When it comes to medical specialists, we would be in the same boat as everyone else.” Ms Lacey said the experience was interesting and was valuable to the residents, but she said she believes that low care residents would benefit more from telehealth as they have a tendency to see more specialists. “I think it would be much more value added to a facility that has low care, not just high care, because often low care people have more appointments than high care,” she said. “Mind you, the high care people are harder to get to their
appointments, but low care have more of them. We had a look over the last 12 months to see how many people had appointments, and we would probably do about 10 or 12 a year. With low care it would be double.” That being said, the experience was a positive one for the residents and for their families. The dermatology consultation was particularly interesting, involving a lady with a skin cancer-like growth. “It is now quite large and has been there for a long time,” Ms Lacey said. “Because she is so frail and bed-ridden, the family didn’t want to put her through unnecessary treatments, but it looks unsightly on the top of her head.” Reg Geary House used a laptop equipped with a camera and teleconferencing software, which Ms Lacey said was very useful as most residents are bed-bound. The facility is too small to allocate a private room for consultations, so in this trial the laptop is taken straight to the bedside. “It was lovely for [the resident] because we were able to take the laptop over and show the specialist what the growth was. He was able to change the
treatment and also gave us a good understanding of whether she would have pain from it. The GP said he actually learned a lot and it was good for him to hear these things.” Another resident, who in the past had been capable of seeing his specialist at
hospital when transported in a wheelchair, was able to see a neurologist. “He is now beyond sitting in a wheelchair and his wife is having surgery so she is not able to manage taking him either, so they dropped off going to the appointments because it was too hard.”
MRNWM-ML’s liaison officer for telehealth, Sandra Dellios, said all residential aged care facilities and many GPs in the area had been contacted and a survey had been created to gather information about their needs and views on how telehealth could better assist them.
Data collection in aged care a breeze with intervention analysis wizard Like a business deal written on the back of a napkin during a long lunch, an application to crunch therapeutic-intervention data in aged care began as a sketch on a yellow pad. “TALogWiz” – which was recently named runner-up in the Best Implementation of the Year over 650 places at the 2013 Information Technology in Aged Care (ITAC) awards – is the brainchild of IT and therapy staff at WA-based aged care provider Bethanie Group. The application was inspired by a need to enter and interpret a large amount of accurate resident data for group and individual therapy in a timeefficient way, and thereby improve resident care and staff morale. There was no way to capture group data in the facilities’ clinical management software, which meant that every
single resident’s record needed updating for group session. There was also no way to track nonparticipation or refusal. “My passion is service to residents,” therapy services manager and TALogWiz co-creator Felicity Beaulieu said. “What are we doing? How do we know what we are doing is working? “The majority of residential aged care facilities struggle with this process of how we measure the leisure and lifestyle and therapeutic interventions for the clients we care for. I didn’t feel comfortable with, or confident in, the data we were collecting.” TALogWiz is used by occupational therapists, physiotherapists and therapy assistants across Bethanie’s 15 residential sites. TALogWiz’s front end is a Microsoft Excel spreadsheet, with a Microsoft Access database
at the back end. The data can be uploaded to iCareHealth’s clinical and care management software, or extracted from the software into TALogWiz, via a unique resident identifier. Approximately 50 Bethanie Group staff enter data in TALogWiz, and Ms Beaulieu generates monthly reports of resident participation from that data for uploading into the clinical management software. “Historically, those spreadsheets could take days to analyse, whereas now on average it takes a couple of hours,” Ms Beaulieu said. The reports are sent to each site, and staff can see what group and oneon-one therapy has taken place, and whether the interventions meet each resident’s care plan. The aim is a multidisciplinary approach, so that the reports are seen by all staff.
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Health Metrics looks to thirdparty gateway for PCEHR Aged and community care software vendor Health Metrics recently launched a medications management module incorporating MIMS Integrated, and is considering a third-party gateway approach to integrating with the PCEHR. Health Metrics, which was established more than four years ago, offers both cloud-based as well as locally installed versions of its eCase software for residential aged care and community care. eCase’s architecture was built to be cloud-enabled from the start, CEO Steven Strange said, and is completely deviceand browser-independent, meaning it can run on any device anywhere at any time. It also incorporates apps purpose-built for iPads and Android tablet devices. Last year, Health Metrics acquired aged care management software provider WeCare, which brought the total number of beds that Health Metrics services to around 15,000. This year, many aged care software vendors are beginning work on integrating PCEHR functionality directly into their products, but Mr Strange said he would probably take a different route. “The way we are probably going to support that is through a third-party gateway as they begin to appear on the market,” he said. “There are companies like HTR that are offering their gateway to the PCEHR on a transactional basis. Rather than try and reinvent all of those wheels, we will just conform to their gateway.” Health Metrics has also optimised the system for iPad and Android tablets to include charts, progress notes and work logs for nurses. The mobile platform contains an additional power-out feature that allow users to store data locally and re-synch with the server at a later point.
Allied health needs access to eHealth: National Primary Health Care Partnership The new chairman of the National Primary Health Care Partnership (NPHCP) has flagged a more activist role and sharper policy work for the organisation, citing a need to circle the wagons around primary care funding ahead of the election, improve ties with doctors, and level the playing field for eHealth support in the sector. Australasian Podiatry Council CEO Damian Mitsch – who was elected in early May to head the umbrella group of 23 peak health bodies – has a background in both IT and in aged care. He spent a decade at the Australian Physiotherapy Association before joining APodC and is also a director at Austin Health. “The professional bodies are vehicles of members,” Mr Mitsch said. “They are groups of members working on behalf of professions and, quite frankly, if the professional bodies aren’t there fighting to bring about positive change for the consumers of professional services, no one else will.” Mr Mitsch said that professional engagement would determine Australia’s future, and would act as a bulwark against “really bad decisions” being taken by governments. “I’d say to rank-and-file members that the next 20
years are some of the most crucial,” he said. “There are some of the largest changes and shifts in the health landscape and workforce landscape that we will have seen in several generations. It’s critically important that we’re in there driving the agenda, that they’re part of the grassroots movement to drive that.”
“The federal government has invested very, very heavily in getting doctors up to speed and out of the cottage industry that they were in 15 years ago in terms of technology.”
the gains other industries have made through an investment in general technology.” Mr Mitsch acknowledged that allied health was also behind general practice in eHealth adoption. “The great challenge, of course, is that if you look at the landscape, the federal government has invested very, very heavily in getting doctors up to speed and out of the cottage industry that they were in 15 years ago in terms of technology. “We’ve seen PIP flowing through the practices for quite some time now, and the doctors are getting to a point where technology is now part of what a GP does on a daily basis. That investment hasn’t been made outside of medical general practice.
“Healthcare in this country has not had the opportunity to take full advantage of an investment in technology,” he said.
“So one of the great barriers for the members of the partnership has been that even when there are new things announced, like the PCEHR, it’s almost like the first telephone ever invented: if the doctors have it but nobody else does, it’s going to make it very difficult to get the maximum benefit for the Australian population.”
“We have invested quite heavily in medical technology and devices, but we haven’t capitalised on
Mr Mitsch said the government could expand the sector’s access to eHealth in two ways.
Australia as a whole needed to catch up in the health sector, particularly when it comes to the use of information technology, Mr Mitsch said.
“Part of that would be to bring some of the practice software providers into the PCEHR discussion and to provide them some support to get linked into the PCEHR,” he said. “Some of that would be to invest in opening some of the opportunities that currently exist to medicos to participate.” Mr Mitsch said there was no reason why other professionals should not be part of the ePIP program. “It’s really about recognising that there are other players in the health IT space who can help to bring the benefits of these sorts of platforms to consumers, and to be prepared to let those people play in the space as part of a level playing field.” This in turn would improve patient participation, Mr Mitsch said. “We need to invest in giving patients better access to information, better access to their health engagement,” he said. “One of the things that has frustrated me for a long time is that patients are heavily invested in their own health, yet the information about an individual’s health is scattered around a variety of providers and often doesn’t come back to the patient. “It wasn’t that long ago where the privacy
legislation actually pried it out of people’s hands and gave the patient access to that information. “My view is that we need to allow consumers to own their health story than they do today, and technology is a great way to do that, but we’ve got to get the notion around people’s heads that the consumer has to be the central player in that.”
“We just can’t afford to keep pumping money into tertiary hospitals.” Asked to nominate something he wanted to achieve in his term as chairman, Mr Mitsch said he wanted doctors to be more engaged in the partnership. “If we could get the RACGP to join the partnership, we’d be very happy – we’d be thrilled to have them.” Another matter occupying his mind is the upcoming federal election. He said that while the NPHCP members might not always agree on everything, there were many common aims that the partnership wanted to put to the government and opposition before they announce their policies. “The number one message is that there needs to be a heavy investment in primary
care – much more so than has been in the past,” Mr Mitsch said. “While there’s a lot of contention about the future of Medicare Locals – and it would be fair to say that there are different views among the partnership around what Medicare Locals should be or are – one consistent thing you can take from the partnership is that there have to be mechanisms to invest in primary care to keep people out of unnecessary tertiary services. We just can’t afford to keep pumping money into tertiary hospitals.” Mr Mitsch had brickbats and bouquets for both parties. “Government is putting a lot of money into primary care through Medicare Locals,” he said. “We need to see results out of that. We’ve not seen the results yet. For sure, we need to be patient, but we need to keep that investment up. “On the Liberal side of the fence, there has been some speculation and some comments about the need to reduce bureaucracy and the need to eliminate unnecessary duplication. “Fine – we don’t have a strong opposition to that notion, as long as that isn’t seen as an opportunity to rip money out of primary care and to water down the investment.”
Comprehensive health services app for the ACT The ACT government has launched a free Find a Health Service app for consumers to search for healthcare services, practitioners and after-hours information on their mobile devices. An extension of the ACT’s Find a Health Service website, the app is available from Apple’s App Store for the iPhone and iPad and from Google Play for Android devices. Particularly targeted at after-hours healthcare availability, it also includes details for GPs, dental services, pathology, imaging, optometry, mental health, aged care, hospitals, specialists, pharmacies, community health, psychology and cancer services. While the ACT government is supporting the National Health Services Directory (NHSD), which also has released an app for GPs, hospitals, pharmacies and emergency departments, a spokesperson for ACT Health said the app and website provide far richer functionality as well as comprehensive descriptions about each service or practitioner. “The NHSD website or mobile app cannot provide the same level of functionality or service descriptions because the other contributing states have not yet populated their data to the same exact standards,” the spokesperson said. “It is difficult for larger jurisdictions to provide the ongoing updates that this level of information requires, in order to be effective for users.” “It is hoped the Find a Health Service mobile app will increase [people ‘s] confidence about finding and accessing after hours medical care in their local community, and importantly where the health service they need is available first,” ACT Chief Minister and minister for health, Katy Gallagher, said.
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Video outlines benefits of telehealth for doctors
Telstra and Seven West Media invest in HealthEngine booking service
Inner East Melbourne Medicare Local (IEMML) has released a new video aimed at encouraging general and specialist practitioners to consider telehealth for patients in aged care settings.
Telstra and Seven West Media have invested $10.4 million in online appointments booking service HealthEngine.
The video features interviews with medical practitioners, aged care staff and a resident who discuss their telehealth experience.
HealthEngine CEO Marcus Tan said the investment would enable the company to grow more quickly and enter new markets.
While the number of practitioners using telehealth in Australia is increasing, most focus on rural applications. With residents of aged care facilities facing similar or greater challenges in accessing specialist care, the IEMML telehealth team has worked to highlight the need for telehealth in aged care, IEMML’s director of strategy and eHealth, Adam McLeod, said. “We’ve been working on telehealth for aged care for some time now and one of the things we’ve noticed is that while practitioners are aware of telehealth for rural patients, they don’t necessarily realise the level of need for services that exists in the aged community,” he said. “Many in the medical community also don’t necessarily understand that telehealth can help them both as a way of addressing accessibility issues for their patients, and as an effective part of their practice.” The video covers a number of consultations, with feedback and information provided by the various people involved in the consultations. “One of the things we’ve found is that those practitioners that try out telehealth find it really beneficial, particularly in helping GPs and specialists better understand the care and treatment each is providing,” Mr McLeod said. The video is available on the IEMML website at www.iemml.org.au
“Our current customer focus is GPs and dentists and we have plans to expand into the allied
health and medical specialist sectors,” he said. Telstra and Seven West Media will each invest $5.2 million through a combination of cash and value-in-kind. HealthEngine says its appointment booking service Open Appointments has offered over 600,000 health appointments with more than 2000 practitioners at 400 health
practices across Australia. It has also released an app for patients to make a booking on their iPhone. Telstra media group managing director, Rick Ellis, said the HealthEngine investment aligned with Telstra’s capability in mHeath and eHealth. Telstra recently launched a new division called Telstra Health to target the healthcare market.
Privacy framework could help harness the power of big data Privacy considerations don’t necessarily need to be a barrier to the use of big data in healthcare and can be respected as long as a transparent framework is established and the onus for remedying data breaches is put on the collector rather than the subject, according to a privacy expert. Emma Hossack, CEO of shared electronic health record company Extensia and president of the International Association of Privacy Professionals Australia and New Zealand (iappANZ), told the HISA Big Data conference in Melbourne recently that the current consent model for the use of private data – particularly that relating
to health data – meant that the societal benefits of big data for medical research could not be fully realised. If more responsibility is placed on the data collector and data user to ensure appropriate and transparent frameworks, along with the introduction of mandatory date breach notifications such as those encapsulated in the PCEHR Act, then personal privacy can be respected and the benefits of big data harnessed, Ms Hossack said. “Because there is no certainty at the point of collection what data you really need to collect for your particular purpose, and because that purpose might in any event change
once you have analysed the data, it means that when you are seeking consent from the data subject, you cannot properly inform them of the purpose for which you are collecting the data,” Ms Hossack said. “Informed consent is one of the key processes in the current privacy structure – you must ensure that you tell the person whose data it is or who has the custodianship of the data, what you are going to do with it. Obviously that’s impossible with big data, so when you realise that you can’t actually get proper consent in the traditional manner, that means that one of the fundamental principles of privacy is turned on its head.
“It also means that the notice provisions, giving the party full notice and transparency about what their data will be used for, is also inappropriate with big data.” However, there is a way forward, she said. She agrees with the authors of the recent publication Big Data: A Revolution That Will Transform How We Live, Work And Think, Viktor Mayer-Schonberger and Kenneth Cukier, that industry should develop a transparent framework, in which the data subject is informed sufficiently to be able to make a decision about whether the benefits of sharing outweigh the risks, much like people do every day with loyalty plans and social media. Given that people often do not read or understand current consent models, they may even be in a better position if they are informed better, she said. In addition, the penalties such as those that will come into force in March next year with the new Privacy Amendment (Enhancing Privacy) Act 2012 will give people greater confidence that the data collectors will take care to secure it and match the security with the risk. Ms Hossack said many of the consent processes currently used to ensure that people are protected are often written in legalese and people don’t understand them, or they
feel they have no choice but to sign. This also has the danger of data collectors pointing to these consents as a means of abrogating their responsibility. “It’s a binary choice: either consent or don’t consent, but if you don’t consent you don’t get the service. In many cases, you can’t afford not to have the service, in which case it’s not really voluntary consent. “We should be looking at creating a framework whereby if the risks are high, and if there is damage as a result of data leaking out inappropriately and it becomes re-identified ... the party which is responsible for that breach should be heavily penalised.”
“Sometimes there will unfortunately be security breaches and data breaches, because that’s a fact of life.” Ms Hossack said public education and oversight through auditing and responding to complaints was essential. However, recent cuts to staffing and general low resourcing at the office of the Australian Privacy Commissioner meant that the organisation might not
be able to fulfil its role in educating the public and the private sector. “In Australia there are new fines coming in that will be in force on the 12th of March, 2014, but the problem we’ve got is that despite that, we have an under-resourced Privacy Commissioner.” She said that despite data breach notification not being compulsory at the moment in Australia except in respect of the PCEHR, a consensus is that it will become a feature of the law sooner rather than later. “It is a live issue and something should happen in that space next year. I think we need a transparent framework, which the public is aware of and they can then make the choice if they wish to participate in it and have their data used, but won’t have the responsibility and the onus of suing if there is a breach. “At the end of the day nothing is perfect … and sometimes there will unfortunately be security breaches and data breaches, because that’s a fact of life. “All this means that companies are going to have a heightened sense of the importance of privacy and their responsibilities to people in regards to their sensitive information, all of which is a really positive outcome.”
Electronic log book for blood glucose levels Three University of Sydney IT students have won the Microsoft Asian Cup with their BlueClover mobile phone app designed to help diabetics manage their condition. Andrew Chen, a final-year IT student and co-developer of the app, said he and fellow students Donald Zhang and Robin Huang designed BlueClover to replace the limited electronic solutions currently available to diabetics or the tedious logbook procedures they are required to use to record their daily intake of food and beverages. “At the moment diabetes patients are required to manually record and calculate their levels,” Chen said. “Our app focuses on a logbook that electronically records essential information needed for the management of the disorder such as blood glucose levels, amount of carbohydrates consumed for meals, and insulin levels.” BlueClover has been designed with additional functionality such as object recognition and barcode scanning for automated input of food nutrient information into the users’ logbook. “Instead of having to manually enter the information of the foods they eat, users can scan the barcodes of the products they consume,” he said. The logbook can also provide analysed information on the recorded data such as graphs and trends. The app has a built-in alarm system that reminds the patient to record their glucose and carbohydrate intake along with the amount of exercise they have done. The team’s mentor and supervisor, Jinman Kim, said the group spent a recent semester break developing and refining the app, adding capacity for it to collect and analyse more data.
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ComCare to develop mobile PCEHR assisted registration Despite a backlog in HPI-O applications that delayed ComCare’s PCEHR-ready version going live by three weeks, aged care software vendor EOS Technologies has embarked on a project with NEHTA to develop assisted registration functionality. EOS Technologies is a not-for-profit subsidiary of the Silver Chain community nursing group and a member of NEHTA’s aged care software vendors panel. Its PCEHR functionality has passed NEHTA’s compliance and conformance assessment, and its secure message delivery is being tested currently, EOS Technologies CEO Allan Turner said. “What we’re really encouraged by now is that we’ve engaged with NEHTA to do some additional work for assisted [PCEHR] registration,” Mr Turner said. “Because Silver Chain touches nearly 60,000 people every year, while we’re out there delivering care we can have this assisted registration on a tablet, we can help the client register for a PCEHR.” Mr Turner said in his opinion the PCEHR should have been an opt-out system, not opt-in, but “assisted registration is the best way to accelerate uptake, and we’re keen to be involved in that”. As well as the WA-based Silver Chain Group, ComCare users include RSL Care in Queensland and HammondCare in NSW. Mr Turner said assisted registration would be ready for ComCare’s July release, and a larger update of the software is scheduled for September. Some of the improvements include expanded clinical assessment features, a transport module to roster users’ travel, and multiple GPS maps display for mapping clients, services, visits and employee or team locations.
Emerging systems to co-develop patient administration system with St Vincent’s Sydney-based IT company Emerging Systems has announced it is codeveloping a new patient administration system (PAS) with long-time client St Vincent’s & Mater Health, Sydney (SV&MHS). Emerging Systems’ CEO Russel Duncan said the new PAS will integrate with its EHS clinical information system and will be built with a clinical rather than an administrative focus. EHS, known internally as deLacy, was initially developed by clinicians at St Vincent’s Private Hospital and has been used for over a decade throughout St Vincent’s public and private hospitals and facilities. Emerging Systems has since commercialised,
web-enabled and enhanced the system, and was the first acute care software provider to develop an interface to the PCEHR. It has also integrated with several GP software systems to allow electronic delivery and viewing of standardised discharge summaries, eReferrals, specialist letters and event summaries. SV&MHS CIO David Roffe said that having one connected system of patient administration and clinical management will provide significant benefits internally within the healthcare group. “Currently, we have issues surrounding disparate systems which hamper productivity and are costly
to maintain which we wish to resolve,” Mr Roffe said. “Most importantly, providing greater levels of integration between the new PAS and EHS clinical system will enhance patient management and clinical outcomes. “There will be multiple benefits, for example when patients are being prepared for discharge, the Patient Flow Manager will be able to view, monitor and coordinate available bed functions from a clinical perspective in real time.” Mr Roffe said that once integrated with the CIS, the new PAS will also be integrated into St Vincent’s clinical portal. Emerging Systems said the delivery of the new
PAS will be phased so that priority elements can be implemented while others are being developed. In the first phase, the existing HOSPAS patient administration and OPMS outpatient bookings systems will be replaced, along with medical records tracking (MRT) at St
Vincent’s Public Hospital. In the second phase, it will replace theatre management, internal PAS systems and MRT at St Vincent’s Private. The new system will provide enhanced functionality for referral management, waiting lists, coordinated bookings,
inpatient management, bed management, appointment scheduling, outpatient clinic management, clinical coding, clinical and administrative workflow and NSW Ministry of Health compliance reporting. It will also support activity-based costing at St Vincent’s.
Social robots on the agenda at ITAC The value to people with dementia of robotic assistants such as Matilda the social robot, Paro the robotic seal and Gerry the video-casting giraffe were a feature at the recent Information Technology in Aged Care (ITAC) conference in early May. Matilda’s caretaker Rajiv Khosla has been studying social robots at the Research Centre for Computers, Communication and Social Innovation at La Trobe University for a number of years. In February La Trobe launched a new trial to study how interaction with the robots affected the emotional wellbeing of people with mild dementia living in their own homes. Professor Khosla presented on how Matilda embodies lifestyle-centred care during a session discussing whether assistive devices are liberating or limiting.
Gerry’s researcher Wendy Moyle, director of the Centre for Health Practice Innovation (HPI) at Griffith University in Queensland, has also been studying how social robots may improve the symptoms of dementia for a number of years. She and her team have been working with Gerry, a telepresence robot developed by Stephen von Rump and his team at Giraff Technologies in Sweden, which is equipped with an in-built camera that can facilitate video calls between people with dementia and their families or carers. It is currently being trialled at an aged care facility. Professor Moyle is also hoping to conduct a largescale study of Paro the robotic seal, which can respond to touch, light, voice and temperature and has been classified by the US FDA as a medical device. Her team did a study
last year that found contact with the robot created positive benefits for people with dementia, including lowered anxiety and improvements in mood. The team is hoping to receive enough funding to conduct a study of 400 participants in 30 nursing homes. Her presentation explored social robots and their place in improving quality of life for people with dementia. Also on the ITAC agenda was Brian Prince, chief technology “evangelist” for cloud computing with Microsoft, who discussed how gamification can be used to create desired behaviours, and David Cox, managing director of Embleton Care – which was recently purchased by the Regis group – who discussed how clinical software can be better integrated into management process to improve care delivery.
HISA opens apps challenge, launches scholarship The Health Informatics Society of Australia (HISA) has opened its health apps challenge for 2013 and has launched a new scholarship to enable a student to attend the Health Informatics Conference (HIC) in Adelaide in July. The health apps challenge is the second staging of the competition, won last year by Alicia Cook and Nasser Dhim for their idea to develop an app using the principles of gamification for improving sexual health education for young women. This year, the challenge is open to anyone from the industry, not just students. Participants can enter an app that addresses any healthcare topic, although HISA is encouraging entrants to consider focusing on one of the four HIC 2013 themes of mental health, oncology, indigenous health and chronic disease management. Entrants do not have to design a full app but instead make a video pitch explaining the concept. Entries are open now and close on June 3. The winner will be announced at HIC 2013 on July 17. HISA has also launched a scholarship named in honour of Joan Edgecumbe, a founding member of HISA who served the society in various roles for over 20 years. The Joan Edgecumbe Continued Professional Development Scholarship will provide a student with full entry to HIC 2013, along with its networking reception and gala dinner. The scholarship is aimed at undergraduate, graduate certificate, diploma, masters and PhD students who demonstrate commitment and promise in the field of health informatics. Applications close on May 31, with the winner notified on June 18. Apply online at the HISA website.
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Stat, Profile and Monet now PCEHR and ePIP ready Stat Health Systems has passed its testing for PCEHR integration and released its PCEHR-enabled version before the May 1 deadline for the eHealth Practice Incentives Program (ePIP). Stat Health CEO Carla Doolan said the upgrades began in late April and the product was listed on NEHTA’s ePIP product register. It has since been joined by Intrahealth with its Profile product, along with Monet, which is used widely in the IPN network of medical centres. Ms Doolan said her team had been liaising with clients throughout the process to ensure they are aware of what they need to register for the ePIP incentives, as well as making information available to them as to where they can seek help with the process. The company had also organised tailormade tutorials through GoToMeeting, using Stat’s test environment to show how the PCEHR system works in the product. “We are really delighted with how it looks in the program and believe we have made it as quick and easy for the clinicians as possible.” she said. With the PCEHR work now finalised, Stat is planning further development of new functionality including integration of the DocAppointments online booking system and integrating voice dictation into the software, she said. Smaller players such as Abaki’s Practice 2000 and the Practice Management Software Company’s GPComplete have also been listed on the register as PCEHRcompliant. They have also been listed as compliant with electronic transfer of prescriptions requirements. The vast majority of clinical software systems for general and specialist practices can now access the PCEHR.
South Australia goes live with PCEHR in Aboriginal communities The Pangula Mannamurna Health Service in Mt Gambier recently went live with the eHealth record system, allowing healthcare practitioners to upload shared health summaries to clients’ PCEHRs.
“I would have to say remoteness is the least important difficulty,” Dr Ahmed said. “The largest obstacle has been confusion about processes because of all the different bodies that need to be involved.
Pangula is one of 10 Aboriginal community controlled health services and two substance misuse services in SA and is a member of the Aboriginal Health Council of South Australia (AHCSA), which is co-ordinating the roll out of the PCEHR to the clinics serving Aboriginal people in the state.
“The HI Service, the PCEHR branch, the PKI eHealth business branch in [the Department of Human Services] – they don’t really understand that little health services do not have people dedicated to doing this, and the amount of phone calls, cross communication, paperwork and follow up that needs to be done from the health service end is phenomenal.
AHCSA’s eHealth program manager, Sarah Ahmed, said nearly all of AHCSA’s member health services and the 30-odd clinics they run have applied to take part in the PCEHR, with six of the health services completing full registration so far. All of the health services use Communicare’s clinical information system, which is now PCEHR-compliant. However, while Dr Ahmed said the idea of the PCEHR was an attractive one to many Aboriginal people and the health services that care for them, the process of actually applying to take part has been fraught with difficulty, and it’s not just the usual challenge of remoteness that has caused most of these problems.
“Aboriginal people absolutely get the benefit of eHealth. It is so obvious.” “The people doing the PCEHR stuff are also doing the clinical work in a health service. So, given a choice between a sick and screaming child or being on the phone to Medicare’s eHealth division…” Dr Ahmed said the recent introduction of assisted registration for the PCEHR was the “best thing since sliced bread”, but that it had taken a lot of time and effort to co-ordinate the
multitude of application forms for the different health services, many of which operate in difficult circumstances. Of the 12 health and substance misuse services in SA, only two are located in Adelaide. The remaining services are spread across rural and remote SA from Mt Gambier in the south east, to Ceduna, Yalata and Oak Valley in the west, rural centres in Port Lincoln, Port Augusta and Whyalla, Coober Pedy in the north and up to the very remote areas across the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands in central Australia, which overlap SA, Western Australia and the NT. As many health services had already registered for Healthcare Provider Identifier – Organisation (HPI-O) numbers following AHCSA’s work on the Wave 2 project managed by the NT Department of Health, it was hoped that the transition to the PCEHR last year would be reasonably straightforward. It didn’t actually turn out that way. “We spent the next six months – July to December 2012 – figuring out how to apply for the PCEHR,” Dr Ahmed said. “We developed a few materials and PCEHR application packs and all of that, and we’ve really done a lot of hand-holding to help
people step through the application process.
will tell you what has been happening.”
“All but two of our member health services and clinics have applied for a PCEHR and we have six confirmed applications and another four are in the process. We have five or six NASH certificates now and the rest are en route and we are negotiating with Communicare to get all of the right versions of the software and all of the background configuration.”
AHCSA took the step of appointing an eHealth strategic solutions architect, Dan Kyr, to help work through the technical difficulties, which Dr Ahmed said has made a big difference to the team.
January and February this year were extremely difficult months, she said, as a huge amount of time had to be spent on ensuring all of the paperwork was completed correctly, sent off and received. Dr Ahmed is certainly not afraid to criticise what she sees as an overly complex practice registration system that did not take into account remoteness or lack of resources, or even lack of a regular postal service.
“He has had the time and know-how to go in and sort out the certificates and test them and see what works and what doesn’t and all of that kind of stuff, so that both we and our vendor have information that we can disseminate to our services with some degree of confidence.” Dr Ahmed also believes the initial process for helping individuals to register for a PCEHR was too onerous. “We actively pushed for assisted registration and many phone calls and hours later, it was finally approved.
“Some places only have a plane leaving once a week, and then it has to get to Kalgoorlie and then a couple of days to post off to wherever,” she said. “There was an expectation during the whole ePIP thing that things would just be posted off, but it’s not that simple.
“At the moment [we are working on] all of the policies and procedures around using the ART and training them, but they have been utilising the tool for about a month now and they are sending quite a few registrations to the PCEHR using the ART from South Australia.”
“There is a real lack of communication back to services from DHS and DoHA, and when sending things off we try to call to follow things up, but no one
The least of the problems was explaining the PCEHR to the community, despite various bureaucracies’ efforts to make the job difficult, she said.
“Aboriginal people absolutely get the benefit of eHealth. It is so obvious. They all travel, they all have family and they have multiple health issues and they struggle to remember and keep track of them. “The only point that people were concerned about was the consent issue – how much of this is in my control – and it was clearly outlined for them that it is completely voluntary and completely free, you give consent, you can ask for information to be deleted or hidden on your record.” The real value of the PCEHR for Aboriginal people in remote areas will come when not just clinics and general practices are PCEHR-capable, but hospitals as well, particularly for uploading discharge summaries. Dr Ahmed said South Australia Health is fairly well advanced in developing electronic discharge summary functionality, which will tie in with the state’s new EPAS system and be gradually rolled out over the next year or so. While AHCSA digests the lessons of the go-live at Mt Gambier, it is continuing with its registration campaign. “Assisted registration is probably the easiest way to go, and that is what we are doing. We are targeting the 3000+ we already have … and then everybody else as well.”
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Practice nurses as the telehealth change agent The Australian Practice Nurses Association (APNA) has released the first three of nine online learning modules to assist nurses and midwives to understand and establish telehealth services in their practice setting. The online education package has been designed by the Nursing and Midwifery Telehealth Consortia, a Commonwealthfunded group comprising of APNA, the Australian Nursing Federation, the remote health organisation CRANAplus, the Australian College of Nurse Practitioners and the Australian College of Midwives. APNA’s project manager, Shoshana Silverman, said the modules are being released progressively over the next month. “At the moment we have modules one, two and three live on the APNA website and the idea is that by the end of May, the whole education package will be hosted on all the consortia partner websites,” Ms Silverman said. Ms Silverman said the main objective of the project is to raise awareness and knowledge around the use of telehealth consultations but also to increase the uptake of telehealth in general practices and healthcare settings using nurses and midwives as the change agent. “These are the people who are going to come in and make it happen,” she said. Ms Silverman said some of the modules are quite short and would only take five or six minutes, with a longer technology module estimated to take a person new to telehealth about half an hour to complete. “It talks about some of the technical requirements like testing the bandwidth speed and what kind of equipment you can use, whether Skype is a good option for you or whether you need a dedicated video conferencing suite.”
Teamwork drives triage by telehealth between hospitals and remote GPs A consultant physician from Tasmania is using telehealth to in effect triage patients during video consultations with their general practitioners, having conducted well over 80 such video consults since he began using the technology.
“It doesn’t replace my normal practice – the patients are going to be seen by me on a personal basis – but the telehealth works as a triage and I can anticipate investigations and give directions to the GP of what to do before I see them in person.”
Jorge do Campo, an acute medicine specialist at Launceston General Hospital, first discussed using telehealth with a GP at the Devonport GP Superclinic in late 2011. Dr do Campo provides visiting services once a month to Devonport, an hour’s drive from Launceston, and to Scottsdale, which is about 70km to the north-east.
If he judges that the patient should come into hospital soon he can arrange the transfer without having to wait for a letter of referral, or he can recommend that the patient remain under the GP’s supervision. If the patient needs to see another specialist, he can write the referral himself.
While triage is not the aim of the consult itself, it does tend to happen spontaneously, Dr do Campo said. “If you are seeing the patient for the first time and the GP has requested a consult as soon as possible, depending on the information you have you can see whether the patient needs to come to hospital,” Dr do Campo said. “I use it as a tool to triage patients that the GPs think is necessary or as follow-up for patients that I already know or have seen before when I visit the practice or when they have been inpatients under us.
“We can start moving investigations in the same day, in real time.” “We can start moving investigations in the same day, in real time,” he said. “In the interview, the GP takes notes on directions and they can start the investigations. Sometimes I see that the patient needs to be referred on so I do the letter of referral. “It doesn’t matter if I haven’t seen the patient yet – I have enough information to refer them to another specialist so I generate the
letter of referral from the telehealth consult.” Dr do Campo and the GPs he works with all use Skype for the video consultation, which he conducts through his iPad in his consulting rooms. He uses his desktop PC to access the hospital’s portals to pathology or radiology results and his email system. The time of the consult is booked by phone, and the GP emails Dr do Campo the patient’s details, medications and area of concern, he said. “In general I try to use mobile devices, so I use my iPad or my iPhone and I can Skype with any of them. I combine the use of my iPad for [visual] contact with the GP and the patient and the laptop to check email and the information the GP has sent to me.” Technical problems do occur, such as the time that he was consulting with a GP through Skype and the audio link died. Video was still working so Dr do Campo waved his mobile at the GP and they finished the consult on the phone. “You can always have technical issues and technical problems, but it’s more important to create the network itself for teamwork,” he said. “When you really need an image,
you can ask the GP to take some photos and email them. You can still use the standard technology and do things around it that will help you be effective.” Teamwork is one of the great benefits of telehealth, he believes. While the initial motivation to begin providing telehealth consults was to reduce the amount of travel patients needed to do, the improved collaboration between the specialist and the GP is one of the great benefits of the technology, he said. Dr do Campo claims the MBS telehealth item number through his private practice and the GP does the same. “The motivation was to try to use the new system to avoid people having to travel and at the same time
… they didn’t have to pay for the consult as we have Medicare support to do it,” he said.
teamwork and you can incorporate more people in your network by utilising this sort of technology.
“We also abbreviate the time needed to have input from the specialist when the GP needs the consult.”
“The important thing is time waiting for a consult and getting sicker – that’s a benefit to the patient. For the GP, it’s a very new way of practising.
He believes almost any discipline can use telehealth to improve patient care, including patients in aged care facilities and at home. “I haven’t done [aged care consults] so far, but I can see telehealth as a tool for communication in any discipline and from any environment,” he said. “Nursing homes, home care, hospital in the home – any system you want to organise the telehealth consult with is ideal. It reinforces the concept of
“[We] are together looking after the patient and interacting with the patient. The patient is in an environment they are comfortable with – their regular GP – so they are friendlier. “On that basis I think we are supporting the GP in a nice way. I am representing the Launceston General Hospital when I go out to see patients, and this way we are telling the GP that the hospital is here with you taking care of the patient.”
App encourages parents to save the date to vaccinate NSW Health has launched an app for the iPhone and Android devices to help parents remember their child’s vaccination schedule and book a GP appointment straight from the app. As part of NSW Health’s new ‘Save the Date to Vaccinate’ campaign, the new app allows parents to enter their child’s name and birth date, as well as their GP’s contact details, into the app. The app will then calculate the next immunisation due date and send a series of reminders to prompt the parent to call their GP to schedule an appointment for each immunisation. Parents can make the call straight from the app. NSW Health director of health protection, Jeremy McAnulty, said the campaign aims to remind parents about the importance of vaccinating children on time, and provides a range of tools and resources to make it easier. Parents can use the app on their phone or add the child’s birth date, name and postcode through the website to create a printable vaccination schedule. The immunisation website also contains a series of downloadable brochures on the facts about vaccination, dispelling many of the myths promulgated by anti-vaccination campaigners. All children under seven and enrolled in Medicare are automatically included in the national Australian Childhood Immunisation Register. A vaccination history statement is sent to parents when the child turns 18 months and again at five. This information is also automatically linked to the child’s PCEHR. NSW Health’s mobile BlueBook app is also available on the App Store, but it can only be used by parents who are taking part in the trial of the technology through the NSW HealtheNet service in Sydney.
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Financial support the missing link for aged care eHealth The Aged Care Industry Information Technology Council (ACIITC) has urged policy-makers to consider financial incentives for providers to become PCEHRready, and said that the absence of key software functionalities has played a large part in the sector’s slow pace of change. ACIITC chair Suri Ramanathan said measures such as electronic discharge summaries would be a boost to wider uptake of eHealth in the aged care sector, but financial support was also needed. “Facilities operate on a paper-thin margin, so for them to adopt change, they need a little bit of a hand – for the same reasons that exist for pharmacies and GPs,” Mr Ramanathan said. “We believe that once the discharge summaries are seamlessly integrated with aged care clinical management software, our people will move. But they need a clear signal that there’s financial support for the change to take place. “That’s the missing link. The second part of it is that the industry has to sign off on what is being delivered. There’s no point in having modifications that no one needs.” He said HI Service integration, CDA document uploads and downloads and shared health summaries were all working well, and there now needed to be a focus on eReferrals, discharge summaries, integration with the National Prescription and Dispense Repository (NPDR) and secure messaging. He estimated that work would take another year to finish, and that ACIITC viewed the industry’s successful integration with the PCEHR system as being a five- to 10-year process. ACIITC has prepared an IT roadmap for the industry, to be released in September.
Pitfalls and problems of PCEHR go-live in a rural community The Pangula Mannamurna Aboriginal health service that went live recently with the PCEHR found the experience extremely complex, with a lack of information and a number of technical difficulties to overcome. Pangula Mannamurna, a not-for-profit Aboriginal community-controlled health service that provides free healthcare to the lower south-east region of South Australia, acted as a testing ground for the first go-live of the system for users of the Communicare software package in SA. Pangula is based in Mt Gambier and runs monthly outreach clinics in Bordertown, Kingston, Millicent and Naracoorte. It has four part-time GPs and a GP registrar on staff, along with two nurses, two Aboriginal Health Workers and a number of specialists who attend weekly or monthly, including a respiratory nurse, an endocrinologist and a mental health service.
organisation for the eHealth system and enabling the clinicians to use it, along with assisting clients to register for PCEHRs and helping to work through the technical issues that all general practices and health services will face if they decide to take part. And technical issues were aplenty, Ms Birkholz said. “There were a lot of teething problems. It took us over a week of constant phone calls between all of the IT specialists – our personal ones, Dan Kyr from AHCSA, Communicare’s top IT people – they were working on it 24/7 for a week to try to work out why we were having issues. “For example, we installed the NASH certificate and it should have automatically been there and that wasn’t the case. It took them a long time to work out the issues. We got there in the end, but it literally was a week of constant phone calls and ping-ponging backwards and forwards.
Stefanie Birkholz joined Pangula in October last year as a personal assistant and administration officer, but she quickly found herself assigned to cover all things eHealth.
“Hopefully, because we were the first ones with Communicare to go live with it, they now know exactly what the issue is so it won’t be a problem for anyone else.”
Ms Birkholz has been involved in getting Pangula registered as a seed
Ms Birkholz emphasised that she sees the benefits of the PCEHR for Pangula’s
clients, but acknowledged that the implementation of the system has not been made easy. The paperwork involved is “expansive”, she said. “There is paperwork in every single area with registering the organisation, the doctors, the RO and OMO – there is ongoing paperwork that comes in and there’s all of the time delays as well. “That’s why they put me into that role in order to have somebody who had the time to read through the paperwork and find out what information they need and getting it in on time.” Some of the service’s GPs were initially reluctant to take part in the system, mainly because there was a dearth of information, but they are more keen now, Ms Birkholz said. Communicare has also made the actual process of compiling a shared health summary and uploading it very easy. “[The GPs] have realised now that it’s not something that is going to be timeconsuming to them,” she said. “Communicare communicates with [the national system], so when they write a health summary in Communicare, they can click on a button to make a shared health summary and they can
edit it. They can remove anything they don’t want to go into the consumer’s health record, and they then just have to click upload. Ms Birkholz recommends that other practices and clinics appoint one administrative officer or the practice manager to take charge of getting the system up and running. “I just don’t see how an individual, practising doctor is going to have time to get their head around it.” The service’s clinicians will be requested to ask patients if they have a PCEHR each time they see them, and Communicare has put an icon on the patient file screen to allow doctors to upload a shared health summary or access a PCEHR. “That’s is what we are prompting doctors to do
– ask them if they have a record and then if they don’t they can be referred to me to assist them with signing up and the education about what it means,” she said.
“I just don’t see how an individual, practising doctor is going to have time to get their head around it.” Despite the many teething problems and difficulties, Ms Birkholz said there were a lot of benefits to the system, particularly for transient clients and those with complex medical conditions and needs. One client in particular, Howard Nicholls, speaks eloquently about how he
sees the system benefiting his healthcare. In an email to Ms Birkholz which Mr Nicholls has agreed to make public, he writes of how he hopes the PCEHR will improve his interaction with health services.
ATHS calls for national telehealth strategy
“This PCEHR program is a welcome one to me, due to the many complex health issues I have,” Mr Nicholls wrote.
Written by Colin Carati from Flinders University and health informatician George Margelis, the discussion paper is based on input from a multi-sectoral roundtable workshop of 50 participants held at the Global Telehealth 2012 conference in Sydney last November.
“I get very anxious when I have to change doctors, when this program gets underway, I will most certainly welcome it. “When I change doctors, my health takes a huge step backwards due to the new doctor not being familiar to my health issues and they change all of my medication because they feel I do not need to be on some of the medication that I currently am on. “My last report organised by [Pangula GP] Dr Kavanagh proved that my current treatment is working perfectly and my report on my current health was an excellent one. “If all doctors are able to have access and are able to view this information at any time they keyed into my program on their computer, then gee that leaves me with a sigh of relief, because I then would not have to cart huge amounts of Dr’s reports, scans and notes with me each time I change doctors.”
The Australasian Telehealth Society (ATHS) has released a discussion paper on the development of a national strategy for telehealth, outlining three key directions it thinks should be followed.
The discussion paper suggests that the proposed strategy should focus on national priority groups, such as the elderly and people with chronic disease; apply fit for purpose models of telehealth services and delivery; and choose areas of implementation for optimal effect, particularly regional and outer metropolitan areas. The strategies are underpinned in the paper by a series of operational plan proposals. These include encouraging the Department of Health and Ageing to sponsor a meeting of funded pilot projects in chronic, aged and palliative care and to publish the outcomes. It also recommends establishing a link to DoHA to lobby for greater MBS recognition of telehealth services, and incrementally remove the requirement for a “physical presence” to claim a telehealth consult under the MBS. ATHS president Anthony Maeder said the document is differentiated by its orientation towards a national approach which is “targeted, purposeful and efficient” in nature, as opposed to suggestions of developing centralised and nationally controlled schemes. The discussion paper is available from the ATHS website at www.aths.org.au
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Ballarat prepares for better health information exchange Ballarat Health Services (BHS) in Victoria has deployed Orion Health’s Rhapsody integration engine to better manage the increasing amount of electronic information exchanged and link up the health service’s various clinical, patient and administrative systems. BHS provides acute and sub-acute care to the Ballarat and Grampians region, along with residential aged and community care, and psychiatric and rehabilitation services. It is also building an integrated cancer centre and will soon install an electronic oncology system. The organisation is anticipating the growth in message exchange will be 30 per cent every six months, and its previous message platform, which used the Java Composite Application Platform Suite (JCAPS), was not thought capable of handling the capacity. BHS’s IT manager, Cameron Allen, said that while JCAPS is fairly standard throughout Victoria, it requires a lot of detailed Java-specific programming that has proved quite burdensome. BHS is predominantly using Rhapsody to manage its information exchange requirements at the moment, but there is the potential to expand it further. BHS director of information management, Kate Nolan, said there was a lot of potential with new system, particularly in ensuring a single medical record is maintained. BHS introduced a scanned medical record three years ago, using Core Medical Solutions’ BOSSnet system, which provides a fully indexed electronic replica of a patient’s historical medical record. Mr Allen said Rhapsody would also enable the health service to connect to the PCEHR in the future. “It will become the core of our information exchange,” he said.
Creating a Tapestry to connect seniors to family through mobile and web apps The makers of a socialnetworking app that can help reduce social isolation in older Australians will travel to Silicon Valley later this month thanks to a government grant to promote innovation. The Tapestry app gives seniors a simple interface for browsing the web and sharing photos and messages with their families and friends. “Research has shown that even just a connection to the internet can reduce depression by 20 per cent, so we had an inkling that social media with a particular focus on seniors could have even greater results,” Tapestry CEO Andrew Dowling said. “We’re seeing that people from all over the place are searching us out.”
Some aged care residents who took part in the company’s development trials were wary of using an app, so Tapestry started off small, recruiting 10 residents from Wesley Mission’s Alan Walker Village in Sydney. However, it was so popular with the users that the company decided to launch it on the market earlier than planned. Tapestry has been awarded a grant from Commercialisation Australia to build community care features into the app, and Mr Dowling said the company was canvassing the aged care industry to decide what their residents’ greatest needs were. A couple of ideas in development are intra-
facility “noticeboards” that would allow residents to communicate with each other remotely, and links to community services. Testing of the community care features is expected to take place in several facilities, each involving 40 to 50 users. “One of the very interesting things to come out of the pilot was that a hundred per cent of the users in the trial said that [the availability of] Tapestry, combined with the internet, would influence their choice of retirement village,” Mr Dowling said. “That’s obviously a big thing in an industry looking to differentiate itself.” One of the trial participants was 84-year-old retired stenographer Ruth Moore. Mrs Moore’s family lives
in Tasmania, and she only sees them twice a year. She said the impetus for her joining the trial was that geographical separation, in particular with her busy granddaughter, who has just graduated in medicine and is hard to contact. “It has been very successful,” Mrs Moore said. “She now thinks I’m very up-to-date with technology.”
She browses the internet to research topics of interest to her, and is also a keen user of Tapestry’s weather and community functions. Mrs Moore said the instant nature of the communication has made her happier and feel more settled about living far away from her family, as that distance from her family had previously given her “a bit of worry”.
Mrs Moore and her granddaughter are both Dr Who fans and exchange emails after each episode.
Tapestry is looking at conducting more rigorous research into the positive health effects from using social media.
Easy access to email has also allowed Mrs Moore to re-connect with her sisterin-law, whom she had not spoken to for a long time.
The company hopes to explore collaborations with the University of Sydney’s School of Health Informatics and Statistics
and the University of NSW Centre for Healthy Brain Ageing, both of which study IT and ageing. “We’re keen on bringing in the research ... because depression in seniors is a really big issue,” Mr Dowling said. Half of Tapestry’s users are Americans, and the app’s growing international popularity will also be boosted by its selection in the federal government’s Advance Innovation Program, which subsidises start-ups’ entry into Silicon Valley to meet investors and develop strategy. Mr Dowling said the next big release will be iPad and iPhone versions of the Android app.
Sysmex develops single-click image viewer for Delphic version 9 Sysmex has released a major upgrade of its Delphic laboratory information system (LIS), featuring a new Image Viewer module that will allow labs to associate images such as request forms and clinical images with a patient request. When a lab user accesses the patient record in Delphic 9, all available images can be accessed in a single click. Sysmex said the new module will reduce the paper trail in
the lab and provide detailed reference information for patient request. A third-party solution is used to handle the scanning and storage. Delphic 9 also has a Call Centre module to provide a central point to respond to requests for test results, test amendments, facing reports and sending reports to additional doctors. It has also utilised its HL7 capabilities to ensure
a completely accurate electronic loop from request to testing to report distribution to clinical and practice management systems, the company said. Delphic 9 also now fully supports the sending of PDF reports and images in HL7 messages. It also has a Test Referral Manager module to enable improved management for the transfer of specimens within and across different laboratory regions.
Formal recognition for health informaticians through CHIA Three leading health informatics associations will launch a new health informatician certification program at the Health Informatics Conference (HIC2013) in Adelaide in July. Developed by the Health Informatics Society of Australia (HISA) in collaboration with the Australasian College of Health Informatics (ACHI) and the Health Information Management Association of Australia (HIMAA), the program is aimed at addressing the lack of formal recognition for health informatics skills in the Australian health workforce. Participation in the program will be via directed self-learning, leading to a Certified Health Informatician Australasia (CHIA) award after successfully passing an examination. Candidates must have an undergraduate degree plus experience in health informatics and associated health fields such as administration/management, clinical information systems, eHealth or information systems. HISA CEO Louise Schaper said engaging clinicians and health informaticians early in the business case, design, implementation and evaluation of eHealth initiatives had proven positive outcomes, yet too often these initiatives were treated as “IT projects” that don’t have health informatician involvement. The certification program has been developed by a committee composed of representatives from HISA, HIMAA and ACHI, and the core competencies tested in the exam have been developed with reference to similar programs by the American Medical Informatics Association and the International Medical Informatics Association, and build on the previous work done by the Australian Health Informatics Education Council.
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Best Practice releases PCEHR-enabled version Best Practice Software has released its new version, 1.8.3.595, which will allow users to access and upload documents to the PCEHR. The latest version is available for download from the Best Practice website, along with instructions and tutorials to help with installation and setting up for PCEHR requirements. Once installed, users will now notice a PCEHR menu item and a PCEHR button in the patient’s clinical record window. A coloured border on the PCEHR button will change colour depending on whether the patient is known to have a PCEHR or not. If the patient’s PCEHR has never been validated, it will be orange, but if it has been successfully accessed through Best Practice, it will be green. Pulse+IT understands that now that the PCEHR version of Best Practice is available, the federal government is set to begin its long-awaited marketing campaign for the PCEHR to consumers. All of the other members of NEHTA’s GP desktop software vendors panel have also released PCEHR-enabled versions of their software, including Zedmed and Genie, which released their versions last year. However, users were unable to access the PCEHR itself until they had applied for a NASH certificate, which was only made available in December.
Australia to move fast in electronic health record adoption over the next five years Australia is expected to be the fastest growing market for electronic medical records and electronic health records in the Asia Pacific region in the next five years, according to IT research firm Frost & Sullivan.
professionals hinder market development, she said. Robust EMR or EHR equipment are expensive, curbing investments from healthcare providers in the region who are already reeling under the pressures of declining margins.
Frost & Sullivan valued the the Australian healthcare IT market as a whole at $783 million in 2012 and expects it to reach $1.4 billion in 2018, with a compound annual growth of 10.3 per cent a year.
In Australia, the government is actively promoting electronic exchange of health information as part of the National E-Health Strategy. “However, while the market is fast progressing towards sophisticated EMR solutions, healthcare providers find it difficult to obtain budget approvals,” she said.
For the Asia Pacific region, the company said revenues from the EMR and EHR market were $US1.2 billion in 2012, predicting it would reach $US2.2 billion in five years’ time. Siemens, Cerner, Allscripts and InterSystems all held over 15 per cent share of the market each, with NEC, Fujitsu, MediTech, CSC Healthcare and others making up the rest.
HCN, which produces market leader Medical Director, was not part of the vendors panel but also released a PCEHRenabled version in January.
Frost & Sullivan healthcare research analyst Natasha Gulati said government initiatives to establish standards, regulations and infrastructure will further encourage healthcare providers to adopt EMR and EHR technology.
An HCN spokesperson said that to date, more than 75 per cent of customers had upgraded to the latest version, MD3.14d, which enables them to qualify for the ePIP.
However, challenges around interoperability and the lack of technical skills among medical
“Healthcare providers find it difficult to obtain budget approvals.” “EMR penetration in 2012 was estimated at 66.1 per cent for both hospital and ambulatory systems segments combined.” At a Frost & Sullivan forum held in Sydney recently, Chris Stevens, chief technology officer with New Zealand-based Orion Health, said EHR and EMR adoption and their ability to reduce healthcare costs were reliant on three major trends that he predicts will
affect healthcare delivery in the next five years. These trends are the change in the patientprovider relationship, the increased use of homebased monitoring systems and the trend towards wellness applications. “Most people have identified that one of the expensive parts of healthcare costs is treating people in hospital,” Mr Stevens said. “Remote care for chronic care – it works really well because when you look at technologies like Skype, patients today are far more comfortable with those technologies and they are starting to expect that type of technology. “We are expecting to see in the future; rather than drive 100km for my appointment, I want to do it by video conference. We will see more and more demand from patients for that kind of technology.” He said the use of home medical devices would improve ealthcare delivery, and the amount of data generated would be a boon to big data analytics. However, he said that in order to leverage that data, “you have to ensure that the information is shared appropriately. I have my normal patient
record, which can be shared regardless of where I am getting the care, I have home-based devices which are now effectively monitored … and information from my wellness devices can also be made available. “What all of these three trends share with each other is that it’s a lot more convenient for the patient and the provider. It has the double benefit of not only reducing healthcare costs but also improving outcomes.”
On the PCEHR, which Orion Health has been involved in building, he said one of the reasons he believes there has not been higher uptake is its opt-in model. “The problem with an opt-in model is that you are asking people to do something proactively, which creates a lot of resistance,” he said. “The key to that is to figure out what motivates people to sign up. My son has a chronic disease so if I was in Australia I’d sign him up as he goes to hospital
every three months for his checks. For me, however, I probably wouldn’t.” He said the target for the uptake of the PCEHR should not be all 23 million citizens of the country. “Because it’s an electronic medical records system, it is really about those people who are going to get value out of it,” he said. “For a lot of people, for the first 20 or 30 years of their life, they are just not going to get that value.”
Social media cheap as chips as a training tool for allied health practitioners Using social media to train healthcare staff and for educating the public is “cheap as chips” and should be adopted more widely, a Melbourne-based dietitian says. Emma Rippon, an accredited practising dietitian and managing director of Eat Well Nutrition, started the company’s social media program, which comprises Facebook, Twitter and YouTube, late last year.
tool for the public and to publicise industry news and events, and YouTube has proved a cost-effective way to deliver training on nutrition to staff at private hospitals and aged care facilities, industries where pressure on budgets meant reducing costs was a key concern, she said.
Ms Rippon told the ITAC 2013 conference recently that the business uses the different channels for specific purposes.
“It came out of our need to educate [client] staff better and more effectively. Our main goal was just to make sure that this nutrition evidence and best practice was out there in the industry, so that we could feel more comfortable that people were getting the right information.
Facebook and Twitter are used as an education
“It has got a lot of social good behind it.”
For example, training has been delivered via YouTube to 40 staff at an aged care facility in regional Western Australia that otherwise would not have been able to undertake it. Feedback from managers and care co-ordinators had been positive, and Ms Rippon said there were plans to establish a user feedback group to guide the program’s development. Ms Rippon said getting the YouTube channel up and running with videos had taken three months, but that the time and money taken to shoot a video and upload it to YouTube presents a better ROI than does creating a CD or licensing software.
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IT Integrity wins big at ITAC 2013 awards IT consulting firm IT Integrity was named ICT Company of the Year at last night’s Information Technology in Aged Care (ITAC) awards, held in Melbourne. IT Integrity has experience in the provision of infrastructure and support services for aged care following its merger with aged care specialist Datacare in 2011. The company was awarded for the consulting and project management work it has been doing with Star Gardens, the well-known aged care facility in Queensland that has been nominated for numerous awards for its IT implementations. IT Integrity managing director Scott Lawton said his company had been working closely with Star Gardens CEO Nigel Faull to help integrate a host of different technologies. “Those (technologies) prove there are some clear financial rewards as well as cultural ones,” Mr Lawton said. “Nigel has been able to quantify those quite well, and today at ITAC he is speaking right after me about some of those financial benefits.” Mr Lawton said IT Integrity had helped Star Gardens with the evaluation of different technologies and then performed the integration. “It was a consulting, project management and implementation role,” he said. “Even now we are working on understanding from a business point of view what it is that he wants to achieve, and making sure that the technology platform and the foundation that he’s got is able to scale with whatever he is doing, and then as new things come along, to deal with the vendors and make sure that the integration will work.” Aged care apps specialist e-Tools Software was the runner-up in the ICT Company of the Year category.
Argus and Medical-Objects demonstrate connectivity Secure messaging service companies Argus and Medical-Objects have announced what they claim is the first live demonstration of interconnectivity under the NEHTA SMD Proof of Interconnectivity Demonstration (POD) project. Part of the project requires vendors to demonstrate inter-connectivity of their messaging products between two or more sites, ensuring they connect with a minimum of two other deployed and conformant SMD products. Argus general manager Ross Davey and MedicalObjects general manager Lynden Crawford said in a joint statement that Argus had deployed software in the Ararat Medical Centre in Victoria, and successfully interchanged HL7 messages with the North Rise Medical Centre in Queensland, which uses Medical-Objects. According to NEHTA, the SMD-POD initiative was established in November 2012 to “provide proof that standards-based secure messaging can be deployed in a scalable way”, using national infrastructure services, and to also demonstrate that different secure messaging products are capable of interconnecting within the Australian primary
care sector and with other healthcare providers. While a range of secure messaging solutions have been utilised in healthcare organisations for well over a decade, NEHTA’s work on the SMD technical specifications was intended to improve secure messaging compatibility across the health sector, principally by allowing messaging solutions created by different vendors to talk to each other, or ‘inter-connect’. SMD has had a prolonged gestation period with little evidence of deployment or meaningful use in the market despite some early momentum, which culminated in an IHE Connectathon in April 2010. While NEHTA did not respond to requests for information about the vendors participating in the SMD-POD project or the project more broadly, Pulse+IT understands that of the nine organisations listed on the NEHTA eHealth PIP product register, six are involved in the project. These include Database Consultants Australia (Argus), Global Health (ReferralNet), HealthLink, LRS Health, MedicalObjects and the University of Western Australia with its MMEx product.
Secure messaging vendors participating in SMD-POD are required to meet four project milestones, in addition to undertaking to periodically disclose the status of their SMD deployment to NEHTA. By January 31, vendors were required to have been assessed by a National Association of Testing Authorities (NATA) accredited testing facility, demonstrating conformance to the Standards Australia technical specifications for SMD ATS 5822-2010. Secondly, by February 15, vendors were required to complete inter-connectivity testing with NEHTA’s test environment and with at least two other products (i.e. those of competing vendors) that had also passed the first requirement. Thirdly, building on the second requirement, by April 30, vendors need to deploy their messaging solutions in at least 25 general practices and a minimum of five other healthcare organisations, excluding hospitals. It is understood that specialist practices are the likely environment that most vendors have selected to complement their general practice sites. Fourthly, and by the same deadline of April
30, vendors are required to demonstrate interconnectivity between two or more of these sites, ensuring they connect with a minimum of two other deployed and conformant SMD products. The Argus/MedicalObjects interconnectivity demonstration in Victoria and Queensland forms part of this fourth requirement for the two companies. “This is a great achievement between Medical-Objects and Argus,” Mr Crawford said. “Working towards implementing interconnectivity in a standardsbased way can only benefit healthcare delivery. “The NEHTA SMD-POD project has played an active role in creating stronger business relationships and communication between the
participating vendors and therefore these milestones are able to be achieved. “Medical-Objects strongly encourage interconnectivity between vendors and view this achievement as a commitment to providing our customers with innovative products...”
“Working towards implementing inter-connectivity in a standardsbased way can only benefit healthcare delivery.” Mr Davey said the SMD-POD project had accelerated the effort
already being undertaken to improve interconnectivity between some of the messaging vendors operating in the sector. “POD has just been consistent with what we are already doing with respect to implementing SMD and then collaborating with other vendors to enable message interchange,” Mr Davey said. “Achieving significant milestones such as this has been an important demonstration to our clients of our intent to be inter-connectable and commitment industry standards.” Medical-Objects also demonstrated connectivity with ReferralNet, linking a Medical-Objects’ site in Queensland with a Global Health site in Victoria.
General practice dataset a MAGNET for researchers Monash University and Inner East Melbourne Medicare Local (IEMML] have launched the Melbourne East MonAsh GeNeral PracticE DaTabase (MAGNET) research platform, a database of clinical and practice information that will enable researchers to follow changes in general practice and policy over time. The dataset has been created from information extracted from GP practice management software, including clinical data, patient demographics, the nature of the practice and billing information from Medicare. The scientific director of MAGNET, Danielle Mazza, head of the Department of General Practice at Monash University, said the aim of the program was to establish a database of information emerging from general practice for research and evaluation purposes. The MAGNET dataset is based on practices that use Medical Director or Best Practice, and is extracted using the Pen Clinical Audit Tool (CAT), she said. “[This] dataset has clinical information that the GP is entering into their medical software, but it also has information about the practice where that patient is being seen. For example, information about the GPs, the nature of the practice, if there are practice nurses, the socio-demographic area they are practising in, and we also have billing data about use of Medicare. “We are getting a much more comprehensive picture, because it’s combining clinical data with the practice characteristics and the demographics and the interaction with Medicare.” She said the MAGNET dataset would also create the ability for researchers to evaluate changes in clinical practice and in public health policy over time.
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Bits & Bytes
QPS Benchmarking and Leecare integration on track Aged care software vendor Leecare Solutions and benchmarking products provider QPS Benchmarking have developed collaborative software capabilities to streamline the capture and reporting of data between both systems. The initial phase of the collaboration allows users to capture data directly via Leecare’s Platinum 5.0 interface. The web browser-based software ensures that data is collected according to QPS Benchmarking’s criteria and definitions, which will assist users in maintaining data integrity directly at the point of capture. Once specified data periods have ended, simple data output is performed by Platinum 5.0, allowing users to report on the QPS Benchmarking KPIs. “Dataflow automation for aged care applications has been growing in importance for residential aged care operators, primarily due to their increased responsibility for efficiency, compliance, quality and tracking, as well as knowledge capture,” Adam Holcroft of QPS Benchmarking said. He said users can access, analyse and report on this data, enabling them to implement corrective actions and allow managed responses to data exceptions across the organisation. “[A] single dataflow will help organisations to identify and respond to abnormal events, reduce the work involved in data collation, thereby significantly increasing compliance, knowledge capture and in turn productivity.” Leecare Solutions CEO Caroline Lee said that bringing together the technologies “will not only benefit aged care providers, but the industry as a whole, as providers endeavour to improve risk management practices and ... overall quality of care.”
BloodNet web system keeps track of precious supplies It’s not every day that a new IT system receives a 100 per cent approval rating from end-users, but this is exactly the score that the National Blood Authority’s BloodNet system received when it was trialled in public hospitals in 2010. Two years later and now in use by all hospitals in the country, BloodNet is a web-based system that allows hospital laboratories to order blood supplies from the Red Cross Blood Service, keep track of their inventory and better manage receipting and wastage. Designed and managed by the National Blood Authority (NBA), BloodNet is one of a number of systems that the authority will now oversee from
its new Blood Systems Operations Centre, which was officially opened in Canberra in March. The centre will allow the authority to monitor in real time the operations of the entire national blood supply chain and to intervene in case of shortages or emergencies.
“That’s worth over half a billion dollars, and the total budget for all blood and blood products is about $1.1 billion.” In addition to BloodNet, the centre will also help coordinate the other online
networks the authority manages, including the Australian Bleeding Disorders Registry and the Blood Chat forum for those working in the blood sector to discuss pertinent issues. The NBA has also established a Blood Portal through which registered users can access a range of systems that the NBA manages, all secured by single sign-on. The NBA’s general manager, Leigh McJames, admits that the authority has had a low profile since its establishment in 2003. When the collection of blood moved from hospitals to state-based Red Cross groups and now to the nationally coordinated Red Cross Blood Service, the NBA was set up to manage
the blood supply on a national scale. “Our role is to be responsible for managing the supply of blood and blood products to Australia and we have a contract with the Red Cross to provide the fresh blood,” Mr McJames said. “That’s worth over half a billion dollars, and the total budget for all blood and blood products is about $1.1 billion.” Mr McJames said the blood products sector is divided into three sources: fresh blood collected by the Red Cross Blood Service; plasma, which is also collected by the Red Cross and used in a range of products such as intravenous immunoglobulin and albumin, which are manufactured in Victoria by CSL; and specialty blood products that are generally imported. Supplies of IVIg are also imported as Australia generally doesn’t collect enough plasma for the demand. When the NBA was first established, orders from hospitals were generally phoned or faxed to the blood service and dispatched from its regional collection centres. Inventory management was generally done using manual entry on spreadsheets, as was reporting. In 2008, however, the work done by Queensland Health on its Ordering
and Receipting of Blood System (ORBS) impressed the NBA with the system’s ability to increase efficiency and the management of inventory, but also its ability to make clear the transport challenges and cold chain management issues that a country the size of Australia faces.
“Would you like to go back to your faxing and manual ordering process?” The NBA’s chief information officer, Nathan Kruger, said the NBA then developed BloodNet based on modifications to ORBS, which was put through a successful proof-ofconcept trial before a roll out to South Australia and Tasmania. “We then did an assessment and a survey of those sites and one of the questions was, ‘would you like to go back to your faxing and manual ordering process?’ and they categorically said no,” Mr Kruger said. “100 per cent said no.” Mr McJames said the wide user acceptance of BloodNet system is very unusual in his experience, having worked in the past in a regional health service and having seen IT systems come and go. Since the roll-out of BloodNet began, additional functionality
has been added, including a fate module that allows hospitals to record transfers and discards and make inventory management decisions based on evidence. Mr Kruger said about 80 to 85 per cent of hospitals are now using this module, and the organisation was also moving into using video conferencing and remote desktop functionality to do remote training on how to use the system. Also on the drawing board is designing interfaces with commonly used laboratory information systems. The NBA is currently trialling an interface with WA’s PathWest service, and this month will begin interfacing with the Hunter New England eBlood system, Mr Kruger said. Mr McJames said the new operational centre in Canberra will have a range of benefits, not only for the NBA itself but for the blood supply as a whole. “Because it’s real time, we can monitor that the distribution system is actually working as it’s supposed to and that blood is being delivered within the required timeframe. “It provides jurisdictions a direct look at hospitals in the way they are using blood and to ensure they are using it as efficiently and effectively as they should.”
Claydata aims to fill the gaps with private eHealth network Sydney-based eHealth systems vendor Claydata is gearing up to tackle the aged care, allied health and medical specialists markets with its modular, cloud-based offering, which it calls the “intelligent cousin of the PCEHR”. Claydata recently signed implementation agreements with two large aged care providers in Australia and its Putty system is also being used by a number of medical specialists and allied health practitioners. The company has developed a full range of eHealth platforms, applications and gateways based on the Linux operating system, from which it has developed its own programming language. Claydata has been active in the US for a number of years and is planning an IPO later this year, but in the meantime has turned its attention to the Australian market, where it has been refining its platforms in action with the North Shore Medical Group in St Leonards, where company co-founder and inventor, vascular specialist Dr Joseph Grace, practises as a phlebologist. In development since 2005, the Putty system contains a full EHR package, a communications package for crossplatform communications and secure messaging, a front-desk package for administrative and financial transactions, and a document management package, which was the first package developed. Underlying these packages are a range of platforms that drive the Putty product range, including an enterprise management system, a contact and social networking engine, a PuttyConnect platform for telemedicine, alerts, messages, VoIP, chat, file transfer and video conferencing; and PuttyShare, an HL7-compliant secure sharing solution. All All platforms can be hosted in the cloud.
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Events May 1-2
MAY
INFORMATION TECHNOLOGY IN AGED CARE Melbourne, VIC p: +61 2 9080 4300 w: www.itac2013.com.au
9
MAY
HISA WA - SYNOPSIS OF BIG DATA & AGM Perth, WA p: +61 3 9326 3311 w: www.hisa.org.au/events
15-16 MAY HIMSS FORUM AUSTRALIA & NEW ZEALAND Sydney, NSW p: +65 6664 1189 w: www.himssasiapac.org/anz13/
16
MAY
HISA NSW - QUALITY AND SAFETY Sydney, NSW p: +61 3 9326 3311 w: www.hisa.org.au/events
16-17 MAY 3RD BIENNIAL NATIONAL FALLS PREVENTION SUMMIT Brisbane, QLD p: +61 2 9080 4090 w: www.healthcareconferences.com.au
27
MAY
2ND ANNUAL PCEHR: THE JOURNEY TOWARDS NATIONAL EHEALTH ADOPTION Sydney, NSW p: + 61 2 9080 4090 w: www.healthcareconferences.com.au
31
MAY
6TH ANNUAL PHARMACEUTICAL LAW CONFERENCE Sydney, NSW p: + 61 2 9080 4090 w: www.healthcareconferences.com.au
20
June
4
JUNE
HISA QLD - AGM & WORKFORCE/EDUCATION EVENT Brisbane, QLD p: +61 3 9326 3311 w: www.hisa.org.au/events
JUNE
17-18 JUNE 2ND ANNUAL YOUNGER PEOPLE WITH VERY HIGH & COMPLEX CARE NEEDS CONFERENCE Melbourne, VIC p: + 61 2 9080 4090 w: www.healthcareconferences.com.au
19 HISA SA - TECHNOLOGY TO SUPPORT PATIENT CARE & AGM Adelaide, SA p: +61 3 9326 3311 w: www.hisa.org.au/events
23-24 MAY 13TH ANNUAL HOSPITAL IN THE HOME CONFERENCE Melbourne, VIC p: +61 2 9080 4090 w: www.healthcareconferences.com.au
LET DR JOANNE CURRY TAKE YOU ON A PATIENT JOURNEY WITH ESSOMENIC Sydney, NSW p: +61 3 9326 3311 w: www.hisa.org.au/events
2ND ANNUAL TRANSITION CARE: IMPROVING OUTCOMES FOR OLDER PEOPLE Sydney, NSW p: + 61 2 9080 4090 w: www.healthcareconferences.com.au
HISA ACT - AGM & EVENT Canberra, ACT p: +61 3 9326 3311 w: www.hisa.org.au/events
MAY
JUNE
30-31 MAY
13
23
20
JUNE
HISA VIC - MIND THE GAP - QUALITY AND SAFETY Melbourne, VIC p: +61 3 9326 3311 w: www.hisa.org.au/events
20-21 JUNE 5TH ANNUAL OBSTETRIC MALPRACTICE CONFERENCE Sydney, NSW p: + 61 2 9080 4090 w: www.healthcareconferences.com.au
JUNE
HISA NSW AGM Sydney, NSW p: +61 3 9326 3311 w: www.hisa.org.au/events
July 15
JULY
HIC2013 Adelaide, SA p: +61 3 9326 3311 w: www.hisa.org.au/events
22-23 JULY 3RD ANNUAL NATIONAL HOSPITAL PROCUREMENT CONFERENCE Melbourne, VIC p: + 61 2 9080 4090 w: www.healthcareconferences.com.au
22-23 JULY 5TH ANNUAL EMERGENCY DEPARTMENT MANAGEMENT CONFERENCE Melbourne, VIC p: + 61 2 9080 4090 w: www.healthcareconferences.com.au
25-26 JULY 4TH ANNUAL REDUCING HOSPITAL READMISSIONS & DISCHARGE PLANNING CONFERENCE Melbourne, VIC p: + 61 2 9080 4090 w: www.healthcareconferences.com.au
Save the dates 15
AUGUST
HISA NSW - 2ND YOUNG TALENT TIME Sydney, NSW p: +61 3 9326 3311 w: www.hisa.org.au/events
15
AUGUST
16-17 SEPTEMBER
26-27 SEPTEMBER
2ND ANNUAL REDUCING AVOIDABLE PRESSURE INJURIES CONFERENCE Melbourne, VIC p: + 61 2 9080 4090 w: www.healthcareconferences.com.au
4TH ANNUAL HEALTHCARE COMPLAINTS MANAGEMENT CONFERENCE Sydney, NSW p: + 61 2 9080 4090 w: www.healthcareconferences.com.au
17
HISA WA - MEDICARE LOCALS Perth, WA p: +61 3 9326 3311 w: www.hisa.org.au/events
HISA NSW - PATHOLOGY INFORMATICS & RESEARCH INITIATIVES Sydney, NSW p: +61 3 9326 3311 w: www.hisa.org.au/events
22-23 AUGUST
21-23 OCTOBER
5TH ANNUAL OPERATING THEATRE MANAGEMENT CONFERENCE Melbourne, VIC p: + 61 2 9080 4090 w: www.healthcareconferences.com.au
HIMAA 2013 NATIONAL CONFERENCE Adeliade, SA p: +61 2 9887 5001 w: www.himaa2.org.au/conference
29-30 AUGUST 4TH ANNUAL CORRECTIONAL SERVICES HEALTHCARE SUMMIT Melbourne, VIC p: + 61 2 9080 4090 w: www.healthcareconferences.com.au
29-30 AUGUST 2ND ANNUAL ASSISTANTS IN NURSING CONFERENCE Sydney, NSW w: www.healthcareconferences.com.au
OCTOBER
20 18
SEPTEMBER
HISA VIC SHOWS OFF THE LATEST HEALTH INFORMATICS RESEARCH Melbourne, VIC p: +61 3 9326 3311 w: www.hisa.org.au/events
NOVEMBER
HISA VIC GETS MOBILE Melbourne, VIC p: +61 3 9326 3311 w: www.hisa.org.au/events
28
NOVEMBER
HISA NSW - CHRONIC DISEASE MANAGEMENT Sydney, NSW w: www.hisa.org.au/events
Online Calendar: To view a comprehensive list of eHealth, Health, and IT events, visit: http://www.pulseitmagazine.com.au/events
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Feature
mHEALTH – SNOOPS OUT! mHealth is a powerful and increasingly pervasive tool for healthcare professionals, but a lack of knowledge about security, privacy and the proper use of the technologies involved is a serious threat to the wider potential of mHealth for clinical care. Information systems, standards and regulatory processes, supported by full legislative backing, are urgently required to keep out the snoops.
DR JUANITA FERNANDO FACHI, PhD, MA, BA, Grad Cert Bus Sys juanita.fernando@med.monash.edu.au
Emerging evidence shows breaches of private mHealth information occur across a range of clinical professions. For example, the BBC-News of the World phone hacking scandal in 2006-07 saw a myriad of health information across the globe compromised; in at least one case, the UK High Court awarded an affected litigant ÂŁ600,000.1 mHealth breaches are not limited to hacking though. Other threats, often inadvertent, manifest as medical photography or film files stored on a personal mobile device (PMD), images and text posted on social media websites or loss of a mobile device storing patient data.2, 3, 4 The impact of these events sometimes creates scandals that trigger community doubt about mHealth, damaging an ostensibly useful eHealth practice tool. Clinicians and their patients must be able to protect themselves against snooping, whether deliberate or inadvertent.
About the author Dr Juanita Fernando is the academic convenor of the BMedSC(Hons) with the Faculty of Medicine, Nursing & Health Sciences at Monash University and the chair of the health privacy sub-committee of the Australian Privacy Foundation (APF).
A recent World Health Organisation (WHO) survey showed that mHealth applications can assist clinicians in a variety of ways, including the facilitation of access to health support services even when the patient is located in geographically distant or remote areas with a lack of
infrastructure.5 Other plausible benefits of mHealth include SMS alerts and monitoring systems, recruitment for clinical trials and other research, store and forward patient care data and mobile access to evidence-based practice tools. mHealth is an important adjunct to patient diagnosis and management processes. mHealth tools are not simply pervasive across contemporary clinical care; many graduating clinicians also plan to use them for practice.6 Yet many researchers and clinicians claim the tools are not subject to scrutiny or assessment in the same way as other areas of health practice. Rigorous evaluation of mobile applications for diagnosis or access to evidence-based practice remains scarce as very few high quality studies are published in this domain and a legislative vacuum seems to exist in Australia. However, the Therapeutic Goods Administration (TGA) is reported to have claimed medical device software for therapeutic purposes is already regulated in Australia, and smartphone applications fall within this framework.7 While I am unable to locate any publicly available evidence in support of the claim, clearly there is consensus about the need for regulatory support of therapeutic mHealth applications.
“Clinicians and their patients must be able to protect themselves against snooping, whether deliberate or inadvertent.� Juanita Fernando
Security and privacy Despite the TGA claim, personal accounts from clinicians indicate that local information system managers do not permit mobile devices, especially PMDs, to be connected to a hospital network, which is at least partly due to their inability to control the devices, fostering potential exposure to medico-legal claims of privacy breach. Medical indemnity insurers and the Australian Computer Emergency Response Team (AusCERT) have also warned clinicians about participation in mHealth systems for similar reasons.
information through access to wireless services and organisational intranets. They can be mislaid, lost or stolen, thereby exposing data to unauthorised people. Yet basic password protections are often unused by clinicians so information stored on a mobile device is available to anyone who possesses it.4 The lack of clinicians with a conceptual understanding of mHealth security and privacy tools exacerbates medico-legal threats, risking further scandals and limitations to the potential benefits mHealth tools offer for patient care.11
The Australian Medical Association (AMA), as with other professional organisations, has published a guide to support clinical confidence about professional behaviours in mHealth.8 Professional medico-legal and advisory services frequently direct concerned physicians to Royal Australian College of General Practitioners (RACGP) and other guidelines on privacy and security standards.9 Belief that mHealth initiatives are just technology projects demonstrates a limited conceptual understanding of the matter.10
Regulations and standards
Many mobile devices already offer basic and easily used password software applications to protect the privacy of stored information. Basic password protection on mobile devices is a security-related issue underpinning privacy. Mobile device passwords are vital because over time, the devices tend to accrue sensitive
Both the business and health sectors can come together to address medico-legal and privacy concerns that currently limit physician and patient confidence in mobile devices globally.
Regulation and guidelines about privacyenhanced use of PMDs and other mobile devices in the health workplace can usefully mirror those applied to the business sector. A recent submission by the Medical Technology Association of Australia (MTAA) recommends the regulation of medical applications on PMDs and other mobile devices that are intended by the developer to cure, treat, monitor or diagnose a medical condition.12
Preliminary analysis of the evidence suggests that clinicians generally overlook
or are unaware of support resources provided by professional associations and other organisations. For instance, a medical application evaluation site on the internet offers peer review of many applications for clinicians.13 Emerging peer-reviewed publications also offer practical support for clinicians.4-5, 8, 14 Other work is taking place to enable configurations that disassociate personal data from work data.15 However, this mosaic of resources is scattered and not easily located by time-poor clinicians. A unified list of these resources, supported by hypertext links, could be a useful way to begin protecting clinicians and their patients from the consequences of mHealth privacy breach. Evidence shows breaches of private mHealth information regularly occur across a range of devices. The pace of snooping scandals reported in the mass media and through health regulatory boards has increased as mHealth tools become entrenched in everyday practice. Various health privacy scandals trigger considerable doubt about the ability of clinicians to self-regulate the use of mHealth tools in a way that protects themselves or the public. The impact of these scandals is likely to dampen community confidence in the application of digitised clinical records and so hampering enrolments in the local PCEHR for patient care. Mobile device information systems, standards and regulatory processes, supported by full legislative backing, are urgently required to ensure snoops cannot threaten the application of these devices in support of patient care.
References All references are available through the online version of this article at the Pulse+IT website.
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Feature
HOW TO CHOOSE A GOOD HEALTHCARE APP There are tens of thousands of healthcare apps out there and they seem to proliferate by the day. The majority are aimed at consumers, but for healthcare professionals, medical apps can be a wonderful resource. How, though, do you sift through the less than useful apps to find those gems?
DR TESSA DAVIS BSc(Hons), MBChB, MA, MRCPCH tessardavis@me.com
With thousands of medical apps to choose from for your mobile, it’s very easy to get lost browsing the app stores. But really, we have to choose, because apps offer an easy way to improve healthcare and health education. If we don’t use them, we’re missing out on an exciting new movement in medicine. So what makes a good healthcare app? I have asked myself this many times as I developed my own apps and reviewed many more. Deciding whether an app is good or not is nearly impossible to do before you buy it, but reading app reviews and word of mouth from colleagues can be a pretty reliable way of helping you pick. Generally when I look at an app or develop one, I consider a few main areas that make apps great: content, design, price, and added value.
About the author Tessa Davis is a paediatric emergency trainee at Sydney Children's Hospital. She has an interest in health innovation, patient safety and IT. Tessa created www.guidelinesforme.com, www.learnmed.com.au, and www.iclinicalapps.com
To state the obvious, without the content being useful to you, the app is worthless. The quality of the content is important, so looking at who the authors/developers are will give you an idea of their clinical expertise. Although the concept of healthcare apps receiving a special seal of approval is starting to emerge, most apps don’t have this. As with any time you browse for healthcare information on the internet, you need to consider the reliability of the source.
It’s also important to have a think about whether you will actually use the app – the content might seem fun, but will that just be as a one-off and then languish in a folder on your mobile for all eternity? If you’re paying for an app you should find it useful regularly. And do you have the content in another app already? As my list of medical apps on my phone has grown, I have started to realise that many apps are overlapping in content. I have at least six apps that calculate fluid requirements in children. In actual fact, there’s only one that I use regularly, so rationalising your apps is a good idea to avoid phone overload.
The difference with design Design is my biggest bugbear with apps – just because an app only costs 99c doesn’t mean we should be grateful for what we receive. It really doesn’t take much effort from developers to get someone to design some nice app graphics, and it makes a world of a difference to the user. You should feel happy using the app and not like you are trudging through an uninspiring textbook. It should be easy to find your way around the app – if it needs you to watch a 20-minute explanatory video before you start using it, then that’s
“When I look at an app or develop one, I consider a few main areas that make apps great: content, design, price and added value.” Tessa Davis
a clue that the design and user interface haven’t been well thought-out. And crucially, an app should never crash. There is nothing more irritating that a screen freezing and having to reset it – a good developer will have ironed out any major issues before release. Unfortunately you won’t know most of this until you’ve made the purchase, but the screenshots on the app stores will give you an idea of whether or not effort has gone into the design. Price is probably going to be the thing that makes you decide whether or not to buy the app in the first place. Developers can get very excited about all the time, effort and money they’ve put into building their app and therefore inflate the price. Always look around the app stores to see what else is available as there may be a good competitor. If an app costs more than another in the same area, then it needs to be clearly offering something extra to the user. Most apps will be less than $10. If you’re paying more than this then it needs to be something pretty special.
Added value As apps have become so widely used, many people who would not previously have considered app developing are jumping on the bandwagon. Often health education material is released in app form where it might not be the most appropriate forum. So I always like to consider – what is the
added value of this being a mobile app rather than a web app or ebook? For me, textbooks fall into shaky territory. The best format for a textbook is either to read the hard copy, or if you prefer, read it as an ebook. However, there are many textbooks in app-format – this often restricts their readability (ebooks are designed to maximize your reading comfort, mobile apps are generally not) thus making it less useful. The other option for many healthcare apps (e.g. calculators, reference apps) would be to have it as a website or web app. Users can save this to their mobile home screen and access in the same way as a mobile app. Web apps can be easier to develop and less restricted, particularly when dealing with iTunes where you are limited by Apple’s user interface guidelines. The draw to develop apps as mobile apps is because it’s easy to access your target market through the app stores, and users usually don’t need internet access to use the apps, which can be an issue in hospitals. Choosing a quality app is not easy when there is so much choice available, but if you stick to these principles you will be able to choose a good product. There are many excellent examples of well-planned, nicely-designed, useful and reasonably priced apps out there. It just needs a bit of careful sifting to find them.
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Feature
APPS FOR HEALTHCARE PROFESSIONALS The world of healthcare apps is opening up amazing opportunities for teaching, learning and improving patient care. As mobile technology becomes integrated into our day-to-day practice, new ideas for how to use mobile apps are emerging. Here are some of the best apps on the market.
DR TESSA DAVIS BSc(Hons), MBChB, MA, MRCPCH tessardavis@me.com
It’s not just a case of using your mobile to Google an eponymous syndrome that you’ve never come across before; apps are finding creative and innovative ways to make healthcare more effective and more efficient. In this article, I’ll look at some of the areas where apps can offer us the best use of mobile technology in patient care.
Apps that store patient data on your phone It’s just too tempting to have mobile phones in clinical practice and not be able to use them to store patient info – most crucially taking photos of patients and being able to share them with colleagues for management plans or tracking progress of lesions. While this throws up all sorts of problems with patient security, the reality is that it happens. Many institutions turn a blind eye (although this will change) and clinicians keep patient photos on their phone. But some apps are starting to emerge that solve this problem. PicSafe Medi (pictured on page 38) on iPhone and Android stores patient consent, data and photos securely on a cloud-based server and allows you to share the images with colleagues. This is a beautifully designed app, but at the moment it prices individual users out of the market. At $19.99 per month, it’s too steep to be
worthwhile but it is a great starting point for this type of technology. WoundSmart is another aesthetically lovely app that you can use to track healing of wounds or ulcers on your patient and know that it’s stored securely. At $20.99, it’s not cheap either, but both of these are the beginning of what will surely be an emerging trend of apps that offer high security of patient information.
Apps that empower patients One of the biggest benefits of mobile apps is that can they can increase patient engagement and transparency of care. Apps can empower patients to take control of their own chronic health conditions. A multitude of diabetes apps can help patients track their sugar levels and manage their medications. Glucose Buddy (available for free on iOS and Android) is the complete package. Patients can input their BSLs, keep track of their insulin doses and set reminders. They can then print off their logbook for the doctor to see. These type of apps improve patient motivation and education around their own condition. MyChart by Epic takes things one step further – it allows patients access to
much of their own medical records. They can view and book appointments, refill prescriptions, and update medications and allergies. There are several large companies like this that integrate an electronic medical record management system with direct patient and physician engagement. As healthcare evolves to acknowledge the benefits of increased transparency and patient involvement in their own care, these kinds of apps will become every day life for patients and physicians.
Reference apps Although textbooks are not always the most inspiring way to learn about good patient care, they are a necessity of life as a healthcare professional. Mobile apps can make this process easier and more pleasant. Epocrates (free on iOS and Android) is a wonderful example of an all-encompassing reference app. For no cost at all, you can look up drugs and see detailed information of their indications, side effects, dosing and drug interactions. There are also a massive number of calculators and reference tables. PalmEM ($36.99 on iOS and $28.66 on Android) is a quick reference app for emergency care that is specifically designed for mobile use. You can quickly look up drug doses, treatment plans and guidelines. It’s perfect for those moments where you don’t have time to search a textbook but need some brief management refreshers. I’m not entirely convinced of the benefits of having actual textbooks on your phone. Oxford University Press, for example,
has many of its handbooks in mobile app format. They are rather expensive and you are best to consider how often you would use this. I prefer it where it is clear that having the product in an app format actually offers added value to the user. Sometimes there is no substitute for actually flicking through a book.
Learning through gamification Mobile apps have a wealth of opportunity to educate doctors and what better way to that than through gamification. Gamification is the use of games (and game theory) in a non-game environment, for example using simulation and point-scoring to learn about patient management. Resuscitation! (free on iOS with in-app purchase to buy more scenarios) is a fun way to practice management of sick patients. You play through a real patient scenario: take a history, examine, order investigation, and essentially try not kill the patient. Points are awarded depending on how good your management is. It is extremely good fun, educational and good for those of use who are rather competitive. Learning procedures through simulation is also possible through mobile apps. Medrills has a whole series of iOS and Android apps that teach you how to manage particular situations, for example cricothyroidotomy, airway management or IV access. The graphics in these apps are simply stunning. And there you have it. Apps are continuing to revolutionise professional education and also patient care. We should all be a part of the revolution.
The WoundSmart and Resuscitation! apps.
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Feature
HEALTHCARE IN THE HOME
USING TECHNOLOGY TO DELIVER HEALTHCARE The use of medical devices in the home and for remote monitoring are proven technologies, but the barrier to wider use remains an economic one. Some devices are publicly funded but many aren’t, contributing to inequality in access to care. However, wider use of assistive technologies in the home can be cost-effective by reducing the number of expensive, unnecessary hospitalisations.
ANNE TRIMMER BA/LLB CEO: Medical Technology Association of Australia
The Australian health system is facing serious challenges. We have an ageing population and a high prevalence of chronic disease. Over $121 billion was spent on health in 2009-10 and this cost is expected to skyrocket over the next decades. A large proportion of health expenditure is spent on chronic disease management in the hospital setting. Older Australians wish to remain in their own homes as long as possible. Many are technologically savvy and willing to embrace assistive medical technologies. There has been a rapid adaptation of existing medical devices for the home health market. Almost any medical device can be wirelessly enabled to assist with healthcare delivery in the home. Technologies underlying telehealth and home healthcare such as interoperability and wireless solutions have led to major innovations in other industries (e.g., the smart phone industry).
About the author Anne Trimmer is the Chief Executive Officer of the Medical Technology Association of Australia. Prior to joining MTAA, Anne had an extensive career in the legal profession, practising law as a commercial partner of a major Australian law firm.
There are a range of assistive medical technologies that can be used to monitor and manage healthcare in the home. The conditions that are most suited for home care and remote monitoring include those that are prevalent with age such as heart disease and diabetes. Examples of assistive medical technologies are shown in Table 1.
The challenge is not in the development of new technology: the technology is there. The challenge is making the existing range of assistive technologies accessible to all Australians regardless of age, income or geographic location. Medicare Benefit Schedule (MBS) item numbers for telehealth were introduced in 2011. Telehealth item numbers cover only videoconference consultations that involve a patient, general practitioner and a specialist. The uptake of items has not been high and recent geographic restrictions have further reduced eligibility. Individuals who wish to access telehealth (vital signs monitoring) or assistive technologies must do so in an adhoc way. Funding might be accessed through state and territory pilots, aids and appliances schemes, or eligibility via the Department of Veterans’ Affairs (DVA). In some cases, a device (e.g., a pacemaker) might be available to privately insured individuals via the Prostheses List. However, the service component (remote monitoring) is not funded. Under the current system a person is only funded to have their condition monitored and their device checked if they attend a clinic. In many cases, the technology
“The challenge is not in the development of new technology: the technology is there.” Anne Trimmer
has been available for some time, but the barrier is appropriate reimbursement (e.g., remote monitoring of implantable devices). Recent reforms such as the Productivity Commission’s “Caring for Older Australians” and the 2012 “Living Longer Living Better” reforms package have recognised the role of assistive technologies in caring for older Australians. However, to date there has
been no concrete plan about how to remove barriers to adoption and no pool of money set aside. Table 2 (see page 44) lists ways that assistive technologies might be funded in Australia. Home health solutions have the potential to achieve either cost equivalence in expenditure or cost savings as a result of avoiding clinic visits and hospitalisations. MTAA has calculated that cost savings
Table 1: Assistive medical technologies used to manage healthcare in the home Technology / purpose
Examples
Wellness and prevention
• •
Smart phone health apps Self-management programs
Assistive technologies/ageing at home
• • • •
Smart phone medical apps Medical sensors Medication management Medical smart homes
Assessment/diagnostic
• • •
Smart incontinence management Sleep apnea management Home-based diagnostics
Emergency care
• • • • •
Alarms/medical alerts Emergency pendants Wearable sensors including GPS Movement/pressure sensors Smoke, gas, flood and temperature sensors
Chronic disease management (vital signs monitoring)
• • • • • • • •
Pulse oximeters Spirometers Heart rate monitors Blood pressure meters Drug delivery/infusion pumps Electrocardiogram (ECG) Home haemodialysis monitors Glucose monitoring
• • •
Cardiac devices Continuous glucose monitors Cochlear implants
Implantable medical devices with remote monitoring capabilities
of around $3.1 billion per annum could be achieved if care was provided in the home. As an example, remote monitoring of medical devices can be established as a publicly funded service in Australia with neutral or positive federal budget impact. MTAA has calculated that cost savings to the Commonwealth of $3 million per annum can be achieved for remote monitoring of implantable cardiac devices alone. Access Economics has reported that introducing a telehealth intervention into existing veterans’ care programs in Australia would lead to significant cost savings. The main benefit would be enabling up to a quarter of participants to remain in their own homes for a year or two longer, rather than transitioning into a nursing home. The provision of medical technologies and home healthcare does not necessarily represent an additional cost to government. Rather, costs may be shifted and in many cases cost savings will be achieved. For many Australians, the opportunity to use assistive medical technologies and remote monitoring will provide more practical, reliable and affordable access to medical care, without the time and expense involved in travelling to major cities. The time is right for Australia to develop policy that incorporates reimbursement for a wide range of technologies that fall under the home health umbrella, to deliver healthcare in a structured, innovative and cost-effective way, as an alternative to resource-intensive and expensive hospitalisation.
References 1. Telehealth for veterans. Report by Access Economics for the Department of Broadband, Communications and the Digital Economy. 30 November 2010.
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Table 2: Potential means of funding assistive technologies in Australia Federal Government
Department of Health and Ageing (DoHA) Medicare Benefits Schedule (MBS)
Current Funding
Gap
• •
•
MBS items for telehealth were introduced in 2011 MBS only reimburses for video consultations that involve a GP and a specialist
• Department of Health and Ageing: Aged Care Division. Community Care Packages
Packages include: • • • • • •
ommunity Aged Care Packages C Home and Community Care Program Extended Aged Care at Home (Dementia) Consumer Directed Care Transition Care Program National Disability Scheme
Department of Veterans’ Affairs (DVA) Rehabilitation Appliances Program (RAP) Hospital in the Home (HITH) Programs
•
The RAP provides aids and appliances (e.g., personal alarms) to eligible veterans to help them maintain their independence at home
• •
•
There is significant potential for new models of support service delivery to patients in the community if consultations were available to clients at home Vital signs and remote monitoring of devices need funding Most packages do not include home monitoring and assistive technologies Current program guidelines and service specifications lists should include home monitoring and healthcare technologies as a standard option available to all community care clients he RAP could be expanded to include a T range of assistive technologies, in particular peripherals such as vital signs monitors
State Government Current Funding
Gap
Hospital in the Home (HITH) Programs
•
HITH patients are regarded as hospital inpatients and receive the same level of care they would in a hospital
•
A wide range of services could be provided as part of HITH services, e.g., continuous monitoring of vital signs, wound care, and home-based diagnostic services
State and Territory Health Services
•
Each State and Territory Government has a program to fund sub-acute medical items and assistive devices (e.g., wheelchairs, continence aids)
•
There are no specific schemes that fund innovative home health care services such as remote monitoring These schemes could be expanded to include assistive and home monitoring technologies
•
Other Current Funding
Gap
Private Health insurance
•
Some providers are beginning to offer services, including vital signs monitoring and disease management programs over the telephone
•
It is expected that private health insurance providers will adopt innovative home health solutions as they compete for customers and to provide cost-effective solutions to keep people out of hospitals
Patient co-payment
•
A number of companies are offering fee-for-service telehealth solutions from as little as $10 per day
•
Many individuals need in-home care but cannot access government-subsidised programs Some level of patient co-pay is to be expected
• Public-private partnership agreements
•
Internationally, information technology companies and smart phone manufacturers are beginning to invest in the remote monitoring area through public-private partnership agreements
•
•
In the future telecommunications companies will enter the home health space by offering managed, customised, pay as you go services (e.g., telecare and home monitoring) An alternative to upfront procurement is a system where items are paid for via a monthly contract (similar to how an iPhone is purchased)
Feature
MEDICAL DEVICES FOR
CHRONIC DISEASE AND AGED CARE IN THE HOME The use of in-home medical devices is nothing new, but the devices and apps that are increasingly coming on to the market are also being integrated with clinician-run telehealth services to provide real-life remote monitoring, telemedicine and telecare. This article takes a look at some of the most recent developments in Australia.
KATE MCDONALD Journalist: Pulse+IT kate.mcdonald@pulseitmagazine.com.au MICHAEL WONG Journalist: Pulse+IT michael.wong@pulseitmagazine.com.au
The use of new technologies to provide remote monitoring of healthcare status in the home, particularly for the elderly and those with chronic illness, has been an active cottage industry for almost two decades. Probably the best known researcher in Australia is Professor Branko Celler, now the chief scientist of the CSIRO ICT Centre, who did pioneering work with his team at the Biomedical Systems Laboratory at the University of NSW from the mid 90s. These days, everyone is getting in the act, although it seems the main barrier to wider use is ongoing funding. Here, we take a look at some of the new devices and applications being used in the real world.
The device has built-in video conferencing technology along with the ability to connect to any wireless, USB or Bluetooth-enabled medical device, including glucometers, otoscopes and dermatoscopes. It also has a built-in blood pressure cuff. TMA CEO Ash Collins, who is also a practising GP in the Riverina town of Temora, says that in addition to the HomeDoctor device, the solution includes a practitioners’ portal that allows healthcare practitioners to view measurements collected by the device over time in a graph, table or calendar.
NSW-based distributor of telemedicine solutions TeleMedicine Australia (TMA) has released what it says is the world’s first VoIP-based touch screen home-care device to Australia.
It also allows the clinician to send text messages directly to the device to communicate with the patient. A button on the device turns green to tell the patient they have a message, and as the device is touch screen and there is a video phone included, the patient can click on the video phone and a dial pad is opened, through which they can dial the number for the doctor or nurse.
First developed as part of South Korea’s $29 million Smart Care project, the Home-Doctor device has been customised for English-speaking users and contains Australian medical guidelines for diabetes and heart disease.
The Home-Doctor device can be purchased by patients and kept in their homes but it is also suitable for aged care facilities, Dr Collins says. Each household only needs one device as you can add a number of patients to each. It includes functionality to
Home-care devices
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set alarms to remind patients at home to take their medicine or to have a meal, but it also has full capability to do any number of tests at home, with the results collected without any data input from the patient. The results are hosted in the portal for later viewing by the clinician, but with the video conferencing capability built in, the results can also be seen on the practitioners’ screen while they are doing a live video conference with the patient. The device collects information from a number of peripherals and medical devices, Dr Collins says. “They include blood pressure through the built-in blood pressure cuff, there is oxygen saturation, temperature and also a general exam camera can be connected to the device and record images if there is a wound, or a dermatoscope can be connected to capture skin lesions or moles. “In terms of the pathology investigation, the device is able to record and register readings from blood sugar devices, cholesterol, general or full blood count, urine analysis.” Dr Collins has designed a number of purchasing options for the overall solution, which is called the Hi Care Home-Doctor solution. For aged care facilities, his team
TeleMedicine Australia's Home-Doctor device.
will provide the device and set up a portal that is accessible to regular healthcare providers and to the patient. Dr Collins says each device costs about $4000, with discounts for bulk orders, and there is a fee for the use of the portal, which amounts to about 50c a day for the patient and the healthcare provider.
Monitoring for medication Intel’s Home Guide remote monitoring device, which includes an in-built camera and is capable of taking remote measurements through peripheral medical devices, is being used in an innovative project by the Royal District Nursing Service (RDNS) in Victoria. The project involves nurse-led video conferencing with clients in their own home from the RDNS customer service centre (CSC) in Melbourne, which has been providing 24/7 telephone nursing assistance for several years. The calls are made directly to the Intel device at appointed times each day, RDNS’s Stelvio Vido says. “The device is placed in the client’s home and is connected through the internet, and we make a connection in the cloud from our end. Our nurse at the CSC has the same set-up as all the other nurses there but there’s a camera attached. “The appointments are made at an agreed time with the client and at the predetermined time the nurse at the customer service centre will effectively ring the device. It rings like a phone and the client answers. It tends to happen right on the dot so for the client there is a great deal of certainty about when the appointment is going to occur.” At the moment, RDNS is mainly using the device to visit the client virtually and observe them taking their medications, but the device also has a diary element. It asks
the clients certain questions, which are answered by a push-button on the screen. Depending on what the answer is, the device can prompt or trigger a response. The device is also capable of taking regular measurements through peripheral devices, and RDNS is planning to expand the trial to do remote monitoring of chronically ill clients, Mr Vido says. “We are using the video conferencing dimension at the moment but it’s also capable of collecting data for remote monitoring through Bluetooth and it also has a feature of being able to provide eLearning, so videos can be played. Typically we would do seven visits per week, one every day, but with the video conferencing it means that we do six by video conferencing and the seventh one in person, because we believe people should always be seen in person.” RDNS received grant funding from the Victorian Department of State Development, Business and Innovation under the Broadband Enabled Innovation Program (BEIP) to set up the trial, and now the organisation is looking at how it can transition to a regular, sustainable service. Clients who are eligible for the federal government’s Home and Community Care (HACC) program may be able to be subsidised in future, and RDNS’s private clients might also be happy to pay for the technology themselves.
Monitoring for movement One of the newest vendors on the market is the UK-based wireless monitoring specialist Just Checking, which has launched an Australian arm following a successful trial with Alzheimer’s Australia WA and the Silver Chain nursing service. The Just Checking system uses radiobased, battery-operated passive infrared sensors placed in each room with a velcro patch, and a two-part magnet and radiotransmitter door contact.
Management Advisory Service, were fitted with the professional model sensor kits. For the professional model, two to four weeks is usually sufficient to analyse the data charts and work up a care plan around it, she says. For the family model – which will be launched in Australia in July – users often wish to keep the sensors in place for longer than a month, to feel greater connectedness and to help them make an informed decision on changing care requirements.
Telehealth by telephone
A nurse at the RDNS call centre teleconferences with the Intel device.
A controller is plugged into the home or facility power supply and sends data to the password-protected website every four minutes, via the GPRS network. The company is currently working on an update that will have logging of, and access to, data in real time. Just Checking operations manager Ellen Bragger is an occupational therapist and says much of her work with people with dementia is in trying to minimise the impact of the memory impairment. This is usually done through a combination of modifications to the physical environment and education for family and carers. However, in the case of Elsie – a real person with dementia receiving home care whose family has given permission for her case to be discussed – Just Checking’s round-the-clock wireless monitoring system was used to investigate how she was using her space. To her family and carers, Elsie appears to be sleeping all day and awake at night, and they were also worried that she was
refusing meals. Fitting of the sensors showed very quickly that, contrary to the impression of her family and carers, she did sleep through the night. Elsie was also logged at the kitchen three times a day, at mealtimes, but the data also provided new information showing that she had stopped showering, which has now been acted upon. “It’s very simple data that’s actually very powerful,” Ms Bragger says. Just Checking was developed in the UK a decade ago, and has since been taken up by more than three-quarters of local health authorities. Ms Bragger had worked for Just Checking in the UK, and has been examining the feasibility of introducing it to the Australian market since mid-2011. Last year, Just Checking teamed up with Alzheimer’s Australia WA and Silver Chain Group to deliver a pilot program in Albany, Geraldton and Perth. In the trial, 15 homes using community or respite care services, or working with the Dementia Behaviour
Telehealth doesn’t necessarily need to use the latest technology – most of it in Australia is still done by telephone after all. However, using traditional technologies for new purposes seems to be taking off. One example is Monash University’s Telephone-Linked Care (TLC) Diabetes program, which is based on technology first developed by Robert Friedman, a professor of medicine and public health at Boston University, more than 15 years ago. The TLC system is an interactive computer-assisted telephone system that has proven successful in several trials, particularly for improving physical activity, nutrition and medication adherence. It has since been adapted by the Monash team to test whether it would be useful for assisting people with type 2 diabetes with better self-management. The TLC diabetes program uses a mobile phone to send participants’ blood glucose results from an Accu-Chek glucometer to the computerised telephone system. Users then phone the system to receive feedback on their blood glucose results, along with feedback and advice on diet, medications and daily exercise. Last year, the TLC team published the results of a randomised-control trial of the technology in people with type 2 diabetes, which found that there was a statistically
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significant decrease in blood glucose levels as well as an increase in mental healthrelated quality of life. TLC Diabetes project manager Dominique Bird, a research fellow with the International Public Health Unit in the Department of Epidemiology and Preventive Medicine at Monash, said the team first did a pilot study of the TLC system in Australia in 2004 and 2006. The TLC system is quite easy for the patient to use, Dr Bird says. “We provided people with a kit – a meter, a Bluetooth device and a mobile phone. The app on the mobile was designed to send what we needed to our database, and that was the time, the serial number of the meter and the value. People did that from home as a single press of a button. “In the TLC server, we had entered at the beginning of the trial – and that could be updated in the trial – the recommended range for that person and that was given to us by the GP or sometimes the endocrinologist. That allowed the TLC system, in the phone call that followed that uploading, to give feedback.”
The phone call goes to an automated system that is able to take the measurements for the past week and compare them with the previous four weeks. It also asks a number of questions about other parameters and provides feedback. As the serial number of the device is sent to the system, it can identify the patient and opens their individual file. It will also ask preliminary questions such as whether the person is currently in hospital and under medical care, thereby negating the need for the feedback. “The most crucial feedback is the percentage of this week’s blood glucose levels compared to the previous four weeks,” Dr Bird says. “For example, it will say ‘this week you only have 20 per cent in the range but in the previous four weeks you were over 75 per cent in the range, so something must has happened’. “Obviously it can’t figure out why, so it asks them if they know why. ‘Hopefully it is only temporary and it’s easy to fix it, but if you don’t know why, I would suggest you speak with your health professional’. It doesn’t take over the GP or diabetes educator’s role. It is meant to reinforce it.”
Eric and Evelyn Weston receive diabetes education through IPTV.
After providing feedback on blood glucose levels, the system will then ask questions about medication adherence, physical activity and healthy eating.
Telehealth by television Even the humble old television can be used to deliver certain health services, albeit using new technologies like internet protocol television (IPTV). A recent trial has been looking at how to improve health literacy in the community, particularly for chronic conditions like type 2 diabetes. The trial – a collaboration between the University of Melbourne’s Institute for a Broadband Enabled Society (IBES), Diabetes Australia Vic, telecommunications giant Ericsson Australia and advanced social networking technology provider SeeCare – sought to improve access to high-quality, trusted information. “You can Google anything and get any answer you like; particularly in times of crisis, such as when people are diagnosed with cancer or diabetes, the first thing people tend to do is reach for Google,” project manager Ken Clarke says. “But it’s not that great an experience, and you just can’t trust what people are telling you. The health literacy project is all about delivering material to people so they can rely on it, but also in a way that’s good for people who typically don’t have access to a PC, or the skills to use one.” Mr Clarke, a senior research fellow at IBES, says the TV can be used as a user-friendly portal for sectors of the community such as seniors, Aborigines and Torres Strait Islanders, and people with English as a second language. In the trial, 20 volunteers were assessed by four diabetes nurse educators. The nurses logged in to the system – an Ericsson customisation of SeeCare’s home care application – to allocate relevant content to the volunteers’ IPTV accounts, which was
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then available for them when they logged in at home. SeeCare is now planning to explore the incorporation of IPTV into its telecare offering. “From SeeCare’s perspective, it’s clear that a quality health education system has to be a combination of technology and human support,” SeeCare director Gil Tidhar says. “You need both to provide appropriate care.” At the trial’s public launch recently, Eric and Evelyn Weston were there to share their experiences with the audience. Mrs Weston, 73, volunteered for the project because she wanted to help others, having seen the effects of the condition on her
family. Mr Weston, 79, is pre-diabetic, and has been managing his condition for 11 years. Mrs Weston and her son have lived with diabetes for more than three decades.
and think, ‘I’ll just take my medication and I’ll be right’ – and eat anything and everything. But you have to be very careful with your diet.”
Although Mrs Weston has a relatively high level of health literacy, she and Mr Weston were candidates for the pilot because of their unfamiliarity with computers. “I don’t have one, and wouldn’t know how to use it if I did,” she says.
Mr and Mrs Weston also provided feedback about the content. Mr Weston thought there should have been information to show people with diabetes that they can lead a full and active life and still manage their condition, while Mrs Weston thought there should be material on complications.
The value of the IPTV content is clear to Mrs Weston. “I’m pretty good at managing my diabetes, but I have a friend whose husband is diabetic and he doesn’t have a clue – and isn’t interested, either. There are a lot of people who have diabetes
Ericsson Australia strategic product manager Colin Goodwin says the use of IPTV for health education had been shown to work by the trial. “With the roll-out of the NBN, the majority of Australians
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are likely to have IPTV, so what we’re looking at is a very common technology environment,” Mr Goodwin says.
Consumer devices for wellbeing Consumer gaming devices like the Xbox, Wii and Kinect are also being investigated for their potential, not so much to provide telecare but to assist older people and those with chronic illnesses to better manage their conditions and maintain their wellbeing. For example, a new project based in Victoria called the Ageing Well at Home with Broadband project is seeking to test the feasibility and acceptability of delivering a virtual exercise program using Microsoft Kinect for Xbox 360. The goal is to allow participants to do something at home to preserve their function and mobility and stay relatively active. The technology is currently being tested with residents in the suburb of Brunswick, which was Victoria’s first site in the NBN roll-out. Residents participating in the trial received a broadband connection and an Xbox, and are able to exercise alone or in a virtual group of four, plus an instructor, via the Xbox’s Avatar Connect software. The Kinect’s infra-red sensor tracks users’ movements during exercises, and Avatar Connect captures users’ facial expressions on their avatar, giving the group sessions a stronger sense of having a real-time conversation. In the group sessions, the instructor was based at Merri Community Health Services headquarters, and participants were at home. Elizabeth Cyarto, a research fellow at the University of Melbourne’s National Ageing Research Institute (NARI), says the group sessions gave participants the feeling of being in a traditional exercise class, the confidence of following an
A trial participant exercises using Kinect through her Xbox.
instructor and, importantly, a feeling of community and “getting out there”.
“The Wii is inexpensive, easy to use and, very importantly, fun,” Dr McNulty says.
Dr Cyarto says the researchers were pleasantly surprised at how quickly the participants had learnt how to log in to the program and accept invitations to join the classes. However, there are some hurdles to get over. As Avatar Connect only tracks upper-body movement, exercises had to be tailored to the upper body. Users also need to keep in mind not to wear clothing that is very baggy, which can confuse the sensors.
A trial of the therapy that can be delivered online recently began in at the Armidale Broadband Smart Home in NSW, which was set up to demonstrate the potential applications of the NBN including home automation, remote health monitoring, video conferencing, rehabilitation, education and sensor monitoring.
Nintendo’s Wii is also being used for wellbeing and rehabilitation, in one case for people recovering from a stroke. A research group from Neuroscience Research Australia (NeuRA) led by neurophysiologist Penelope McNulty is studying the use of the Wii to help stroke survivors restore movement to their limbs,
One-hour formal therapy sessions are being held for 10 consecutive weekdays using Wii Sports tennis, golf, boxing, bowling and baseball, with added homework. Patients are using the Wii remote in their more affected hand to control play and augment their formal therapy, with daily home practice that progressively builds towards three hours per day over the program.
The research is based on Wii-based Movement Therapy, an intensive, 10day training program using the Wii that improves the way stroke patients are able to use their arms and legs.
“We are developing new ways of delivering therapy to patients in the comfort of their own homes, rather than asking people to travel to therapy, and Armidale is our first test site,” Dr McNulty says.
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Feature
HEALTHCARE IN THE HOME, NOT THE HOSPITAL Social scientist and general manager for healthcare at Intel, Eric Dishman, has some radical suggestions for the healthcare system. He wants to see 50 per cent of healthcare services taking place in the home by 2020, and believes that care must occur at home as the default model, not in a hospital or clinic. His argument is that independent living technologies can help us do it now.
KATE MCDONALD Journalist: Pulse+IT kate.mcdonald@pulseitmagazine.com.au
Eric Dishman can be very critical of the traditional healthcare model and may startle some traditionalists with his belief that the one-on-one doctorpatient relationship is “a relic of the past”. However, he has some pretty good evidence to back his claims up, evidence gathered from over 10 years of research into independent living and assistive technologies, studying both technological enhancements but also the sociology of healthcare. He also has some anecdotal evidence to back up his claims, with his own health problems and experiences providing a very personal story. And personal health is what he is all about. Mr Dishman talks regularly about what he calls the three pillars of personal healthcare: care anywhere, care networking and care customisation. At a TED talk in April, he demonstrated on stage how he sees these three pillars providing a new way to look at healthcare delivery, using himself as the example. When he was at university over 20 years ago, Mr Dishman had a series of fainting spells that led to a diagnosis of two rare kidney diseases. His team of doctors told him that he was not likely to live more than two or three years and that he would never be eligible for a kidney transplant. While he was attended to well by six different specialists over the course of
the diagnosis, each doctor was looking at a different aspect of his illness with no overall coordination. This caused further problems when he started having heart palpitations, and his doctors thought he had a heart problem as well. It took five weeks of tests before a nurse looked at the paper medicines list he took with him and noticed that three different specialists had prescribed three different versions of the same drug. “I did not have a heart problem,” he said. “I had an overdose problem. I had a care coordination problem. And this happens to millions of people every year. Eighty percent of medical errors are actually caused by communication and coordination problems amongst medical team members. It’s dependent on specialists who just look at parts of us. It’s dependent on guesswork of diagnoses and drug cocktails, and so something either works or you die. And it’s dependent on passive patients who just take it and don’t ask any questions.” Mr Dishman said he was one of those passive patients and had been prepared to accept the prognosis, but a friend encouraged him to take his healthcare into his own hands and he has done so ever since. Last year, he received the kidney transplant he was told he would never get.
“The most important point I want to make to you about this is the sacred and somewhat over-romanticised doctorpatient one-on-one is a relic of the past.” Eric Dishman
“These people making these proclamations to me were not bad people,” he said. “In fact, these professionals were miracle workers, but they’re working in a flawed, expensive system that’s set up the wrong way. It’s dependent on hospitals and clinics for our every care need.” Mr Dishman wants to do away with this system, saying it is unsustainable and unaffordable globally. “The future of personal health that I’m talking about says care must occur at home as the default model, not in a hospital or clinic.” On stage at TED, he demonstrated how this might happen. He showed how he could use a portable ultrasound machine that can be attached to a smartphone to scan his new kidney – which he has nicknamed Libby – and share it with his renal physician remotely by video conference, thus saving him the time it would take to drive to hospital unnecessarily. “Humans invented the idea of hospitals and clinics in the 1780s,” he said. “It is time to update our thinking. We have got to untether clinicians and patients from the notion of traveling to a special bricks-andmortar place for all of our care, because these places are often the wrong tool, and the most expensive tool, for the job. “Now, the smartphones that we’re already carrying can clearly have diagnostic devices like ultrasounds plugged into them, and a whole array of others, today,
and as sensing is built into these, we’ll be able to do vital signs monitoring and behavioural monitoring like we’ve never had before.” This is what he calls care anywhere. However, these devices now need feed into the second pillar, care networking. “[If] we’ve got all these networked devices that are helping us to do care anywhere, it stands to reason that we also need a team to be able to interact with all of that stuff. We have got to go beyond this paradigm of isolated specialists doing parts care to multidisciplinary teams doing person care. Uncoordinated care today is expensive at best, and it is deadly at worst. I want to use technology that we’re all working on and making happen to make healthcare a coordinated team sport. “The most important point ... is the sacred and somewhat over-romanticised doctorpatient one-on-one is a relic of the past. The future of healthcare is smart teams, and you’d better be on that team for yourself.” The third pillar, care customisation, is what others called personalised healthcare and which depends very much on genome sequencing and big data, which he says will remove some of the guesswork involved in healthcare. “Randomised controlled studies … and population studies that we’ve done have
created tons of miracle drugs that have saved millions of lives, but the problem is that healthcare is treating us as averages, not unique individuals ... That’s what’s leading to the guesswork. “The technologies that are coming – highperformance computing, analytics, big data that everyone’s talking about – will allow us to build predictive models for each of us as individual patients. And the magic here is, [you can] experiment on my avatar in software, not my body in suffering.”
Mainframe healthcare In another TED talk in 2010, held in the midst of the US healthcare reform debate, Mr Dishman discussed how simple technologies can be used for preventative health measures, particularly for elderly people living at home. One of the easiest is the humble telephone, which can not only be used in association with sensors to monitor activity and behaviours in the home, but to predict changes in an individual’s health. Intel and its partners have been running a study of 600 elderly households – 300 in Ireland and 300 in the US – to look at how we can measure and monitor behaviour in a medically meaningful way. “[If] you think about the phone … it’s something that we can use ... to help people actually take the right medication at the right time,” he said. “We’re testing these kinds of simple sensor-network technologies in the home so that any phone that a senior is already comfortable with can help them deal with their medications.” He spoke about how the phone could be used for cognitive testing, measuring over time changes in the way older people answer it. For example, whether they recognise the caller can be looked at for changes in cognition that might be a pointer to the development of dementia,
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“Our goal as a country is to move 50 per cent of care out of institutions, clinics, hospitals and nursing homes, to the home, in 10 years.” Eric Dishman
and also how changes in the tone of voice can be a predictor of Parkinson’s disease. “We call these behavioural markers. There’s lots of others. Is the person going to the phone as quickly, when it rings, as they used to? Is it a hearing problem or is it a physicality problem? Has their voice gotten more quiet? “We’re doing a lot of work with people with Alzheimer’s and particularly with Parkinson’s, where that quiet voice that sometimes shows up with Parkinson’s patients may be the best early indicator of Parkinson’s five to 10 years before it shows up clinically. “Behavioural markers matter. How do we change behaviour? How do we measure changes in behaviour in a meaningful way that’s going to help us with prevention of disease, early onset of disease, and tracking the progression of disease over a long period of time?” He also discussed what he calls ‘Y2K + 10’ and ‘mainframe poisoning’, meaning the tsunami of baby boomers who are now eligible for retirement and how current approaches to healthcare are akin to holding on to mainframe computing when mobile devices are so powerful. “This mentality of traveling to and timesharing large, expensive healthcare systems actually began in 1787,” he said, showing an illustration of the first general hospital in Vienna.
“And actually the second general hospital in Vienna, in about 1850, was where we started to build out an entire curriculum for teaching med students specialties. And it’s a place in which we started developing architecture that literally divided the body, and divided care into departments and compartments. And it was reflected in our architecture, it was reflected in the way that we taught students, and this mainframe mentality persists today. “Now, I’m not anti-hospital. With my own healthcare problems, I’ve taken drug therapies, I’ve traveled to this hospital and others, many, many times. But we worship the high hospital on a hill. This is ‘mainframe’ healthcare. “And just as 30 years ago we couldn’t conceive that we would have the power of a mainframe computer that took up a room in our purses and on our belts, that we’re carrying around in our cell phone today, and suddenly, computing that used to be an expert-driven system, [is now] a personal system that we all owned as part of our daily lives. “That shift from mainframe to personal computing is what we have to do for healthcare. We have to shift from this mainframe mentality of healthcare to a personal model of healthcare.” He said health IT was still stuck in a discussion of how to get doctors to use electronic medical records within this mainframe, not about the shift from the
mainframe to the home. “This is a very reactive, crisis-driven system,” he said. “We’re doing 15-minute exams with patients. It’s population-based. We collect a bunch of biological information in this artificial setting, and we fix them up, like Humpty-Dumpty all over again, and send them home, and hope … that they do as asked and don’t come back into the mainframe. “And the problem is we can’t afford it today … we can’t afford mainframe healthcare today. Business as usual in healthcare is broken and we’ve got to do something different. We’ve got to focus on the home. We’ve got to focus on a personal healthcare paradigm that moves care to the home. “[US president Barack Obama] needs to stand up and say, at the end of a healthcare reform debate, ‘Our goal as a country is to move 50 per cent of care out of institutions, clinics, hospitals and nursing homes, to the home, in 10 years.’ “It’s achievable. We should do it economically, we should do it morally, and we should do it for quality of life. How do we be more proactive, prevention-driven? How do we collect vital signs and other kinds of information 24 by 7? How do we get a personal baseline about what’s going to work for you? How do we collect not just biological data but behavioural data, psychological data, relational data, in and on and around the home? “And how do we drive compliance to be a customised care plan that uses all this great technology that’s around us to change our behaviour? That’s what we need to do for our personal health model.” Eric Dishman’s TED talks can be found at www.ted.com/talks/eric_dishman_health_ care_should_be_a_team_sport.html and www.ted.com/talks/eric_dishman_take_ health_care_off_the_mainframe.html
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Feature
INTEGRATING MEDICAL DEVICES IN GENERAL PRACTICE
Electronic medical records, document scanning, email, secure messaging and computer-based faxing have all served to reduce the amount of paper modern medical practices have to handle on a day to day basis. However, while nearly all general practices are able to receive and process pathology reports sent from geographically distant laboratories using purely digital workflows, many practices still rely on paper as a means of viewing the data produced by medical devices situated in their own treatment rooms. SIMON JAMES BIT, BComm Editor: Pulse+IT simon.james@pulseitmagazine.com.au
For the majority of Australia’s general practices, including those running clinical software from Best Practice, HCN (Medical Director), Stat Health and Zedmed, the opportunity to connect a range of medical devices to their computers has existed for some time. This article outlines some of the options that are available to general practices, some of whom may already possess all the necessary hardware and software to digitise and streamline the record-keeping associated with medical device-related diagnostic tests.
Medical devices and clinical software The developers of the clinical software packages mentioned in this article have supplied Pulse+IT with the following information outlining their products’ current compatibility with various medical devices. Readers are advised to contact both their clinical software developer and the relevant medical device distributor before making a purchasing decision to ensure that any recent clinical software updates, operating system changes or hardware revisions have not resulted in a loss of compatibility.
Best Practice Best Practice has published an application programming interface (API) to allow device manufacturers to more easily interface their products with Best Practice’s clinical software. Rob Lister, manager of information technology at Best Practice, says: “We are working with a number of device manufacturers to integrate their products via the standardised interface, and that while early adopters like QRS already have spirometer, ECG and BP monitor interfaced, we are engaging with other organisations like Welch Allyn, MIR Solutions and Thormed while they develop their systems to use our API.” Medical Director Medical Director users can view a comprehensive list of compatible devices from within the HCN Maintenance Device List. As well as highlighting any currently installed devices, this area of the program contains the contact details of the relevant device vendors. Amongst the devices listed as compatible are the Norav PC-ECG, Biolog CV3000 ECG, Cube ECG, QRS Diagnostics’ devices, Welch Allyn’s CardioPerfect and Spot Vital Signs software, encompassing ECG, oximetry, pulse, blood pressure and spirometry devices, to name a few.
Stat Health Doctors using Stat Health are able to click on the ‘Devices’ button in the consulting screen, which displays a list of medical devices attached to their computer. From this list the user is able to trigger the device’s software interface, with the results of the test automatically imported into the patient’s record. CardioView and WinSpiro Pro products are supported currently, with Carla Doolan, CEO of Stat Health, indicating that the company is also working to interface with Office Medic, which supports both ECG and spriometry systems. Zedmed Zedmed users are able to connect their computers to Welch Allyn CardioPerfect and SpiroPerfect devices, the Norav PCECG, the Biolog 3000 ECG, the Easyone Spirometer, and the Micro Medical (now Care Fusion) MicroLoop Spirometer. If a Zedmed-compatible medical device is connected to the workstation, the user can select either the ECG or spirometer icon located in the patient’s file to launch the device manufacturer’s bundled software. Once the ECG or spirometer test has been performed, a link to the result will be automatically saved in the ‘Summary View’ of a patient’s Zedmed record.
Workflows and benefits As practices that are not using hardware and software combinations that permit seamless medical device integration would be well aware, the scanning of diagramatic data generated by ECGs and spirometry devices can be both time-consuming and problematic. The presence of coloured backing paper and the need to scan at high resolution to preserve the quality of graphs dramatically increases the scanned image size when compared to most other scanned documents. In addition, the non-A4 shaped paper sizes utilised by some ECG and spirometry devices can
“The old fashion paper-producing ECGs that generated a long roll of paper required secretaries to cut it up, paste it onto paper and photocopy it.” Dr Milton Sales
reduce scanning efficiency as extra human intervention is often required during the process to ensure acceptable results. Even when scanned, ECG and spirometry images cannot be manipulated or intelligently processed using specialised software in the ways that modern technology permits. Dr Milton Sales, a GP from Newcastle and Medical Director user, has had his clinical software configured to interface with his practice’s ECG and spirometry devices for some time – as many as 10 years for the ECG and around four years for the spirometer. His practice currently uses an ECG manufactured by Micro Medical and an Easyone Spirometer. Recalling the issues associated with the equipment that preceded his current ‘computer-connected’ medical devices, Dr Sales says: “We found particularly with ECGs, scanning them never gave a good picture. The ECG software allows you to make diagrams bigger or more spread out, and you can run filters on it. Depending on which version of the software you have you can also get the system to provide you with a suggested diagnosis. The old fashion paper-producing ECGs that generated a long roll of paper required secretaries to cut it up, paste it onto paper and photocopy it. The doctor would then report on it and finally it would be scanned. Even then it was stored in a different section of the notes meaning it wasn’t obvious that it was an ECG.”
Dr Sales describes his practice’s ECG as being “quite a small device, basically four to five inches in diameter and all the leads come off that”. Integration work undertaken by the developers of clinical software usually allows the user to trigger the device’s proprietary software from within a patient’s record, perform the necessary tests, and then import the information collected back into their clinical software. Elaborating on this process as it pertains to Medical Director, Dr Sales says: “For the ECG functions, there’s a toolbox within the individual patient’s Medical Director record. If you click on the ECG button, it then launches the bundled software for the ECG device. But it’s seamless; it’s like it’s happening within Medical Director with a new window displaying the ECG. If you close that window, you’re back into the medical record again where you would make your comments or report on the ECG. The image can be called up again in the ECG software, but this process is triggered from within Medical Director. “With the spirometry side of things, there’s a lung function module within Medical Director, and the numbers and a graph are populated from the spriometry device into the respiratory tab of the Medical Director notes. Again, the user doesn’t have to specifically go external to Medical Director; it’s populated from within the program via its integration with the software provided with the spirometry device.”
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CYSTIC FIBROSIS PROJECT TO TRIAL WEBRTC An innovative project currently underway in Victoria will see patients with cystic fibrosis living in regional areas provided with better, more coordinated access to specialist care. The project is using a range of technologies, including WebRTC - browser-based video conferencing and data sharing - a range of remote monitoring technologies and a shared electronic health record that the patient and clinicians can access through portals.
KATE MCDONALD Journalist: Pulse+IT kate.mcdonald@pulseitmagazine.com.au
The Victorian government is funding a new project to improve access to care for people with cystic fibrosis living in regional areas of the state, using a combination of technologies including WebRTC-enabled telehealth, remote monitoring devices and a shared electronic health record. The Regional Cystic Fibrosis e-Health & Telemonitoring Program is being funded by the Victorian government’s Broadband Enabled Innovation Program and the Victorian Department of Health, and will be undertaken by Monash University. The project is designed to remotely monitor patients at home and deliver more services online, with patients able to view care plans and radiology images from home and take part in video consultations. The video consults are expected to partly use of the browser-based WebRTC technology, an open-source approach currently being developed with implementation led by Google and Mozilla. Patients will also be able to access a portal to participate in their own treatment programs, with the measurements and data collected by the remote monitoring devices integrated into a shared EHR. The project is being led by John Wilson, the head of the Cystic Fibrosis Service at
Alfred Health and a professor in Monash University’s Faculty of Medicine, Nursing and Health Sciences. “Telemedicine is an opportunity to provided better access, improved monitoring and prolonged treatment courses for many patients who would otherwise be dependent on hospital care,” Professor Wilson says. “The cutting-edge of telemedicine lies in the ability to monitor many conditions in the home environment using highspeed broadband. The Monash team have accomplished this by providing healthcare solutions suitable for implementation within the Australian community.” The shared EHR, which will be enhanced to include a patient portal and to receive and store data from the home monitoring devices, is being provided by Smart Health Solutions, which has developed its technology to improve care for several chronic disease groups, including people living with cystic fibrosis. The WebRTC technology will be enabled through video consultation specialist Attend Anywhere’s management and integration capability. The provider of remote monitoring technology has yet to be decided.
Attend Anywhere managing director Chris Ryan said the development of WebRTC will be a major game-changer, not just for telehealth but for all real time communications. In addition to The Alfred, Mr Ryan said major clients such as Healthdirect Australia have already recognised the potential and are gearing up to take advantage of the technology across a number of services. WebRTC is generating great interest in the telehealth and telemedicine sectors. As opposed to proprietary video conferencing solutions or popular free services like Skype which require user accounts, WebRTC is a draft web standard for real time communications built into web browsers. It does not require any software or plug-ins to be installed, any central video servers or multi-point control unit infrastructure and is accessed through a simple Javascript API. The technology allows video or audio communications along with real-time data transfer between web browsers such as Chrome
“The technology works peer to peer between browsers so the only cost for the majority of calls is the user’s internet.” Chris Ryan
and Firefox. Microsoft is also taking part in the development of the technology for Internet Explorer, and Mr Ryan said it is already working on Android devices in beta mode. “This is a web standard for incredible quality, secure video conferencing that is highly scalable, resilient and interoperable between devices. The technology works peer to peer between
HealthLink/Medinexus Half Page 180 x 120 Puse IT Mag
connecting healthcare
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“Cystic fibrosis patients can record a lot of data in home monitoring systems – lung function results, blood glucose, oxygen saturation, weight and blood pressure – as well as health questionnaires.” Jon Hughes
browsers so the only cost for the majority of calls is the user’s internet. Central costs are tiny, even to support massive volume. “With no software downloads, the user experience is incredibly streamlined and there’s no echo, even using standard computer speakers. It’s safe to say we are pretty excited by it. You will also be able to make or accept calls through WebRTC to traditional SIP-based video and telephony systems, which is another part of the puzzle.” As part of the cystic fibrosis project, Attend Anywhere is developing a interface to the EHR and patient portal that will allow video or audio calls using WebRTC to go directly to the project’s landing page. “[Patients] either enter a scheduled [video consultation] appointment or you go in and you literally click on the service you want to access – it’s like walking through a surgery front door and taking a number,” Mr Ryan said. “The service knows people are waiting, can choose which ones to attend to first and callers can be transferred to other service queues if necessary.” One of the new capabilities that will be enabled by WebRTC is a secure data connection between the browsers. The ability to drag and drop images or files into the web browser during a video call is expected to much improve real-time collaboration. In a video consultation, for instance, a doctor can securely deliver an ePrescription barcode to a patient at the other end in real time or one doctor can drag and drop an x-ray or a note allowing another doctor to receive the file securely and immediately. Attend Anywhere provides telehealth advice and program management services to the Cystic Fibrosis Service at Alfred Health, which has also worked with Smart Health Solutions for many years. Smart Health’s director, Jon Hughes, said his company’s technology had been supporting the cystic fibrosis patient program in Australian centres for a decade.
“We have a shared electronic health record that has been around for about 13 years, and the market is finally catching up with us!” Mr Hughes said. “Our solution predates the PCEHR and is currently being enhanced to interoperate with it, including the use of NASH PKI, Australian Health Identifiers, and an interface to the PCEHR itself. “On our platform we have implemented support for a number of chronic disease management programs, the first of which was cystic fibrosis but which now also includes kidney disease, infectious diseases, cancer, homeless health and diabetes.” Mr Hughes said the new project will also provide an opportunity to investigate further integration of telehealth with eHealth records. “This project will integrate home monitoring systems into our EHR,” he said. “Cystic fibrosis patients can record a lot of data in home monitoring systems – lung function results, blood glucose, oxygen saturation, weight and blood pressure – as well as health questionnaires. “This project will integrate that data with the clinical data that we currently import from healthcare information systems such as hospital diagnostic services like pathology, lung function and diagnostic imaging, hospital patient administration systems and from private diagnostic services. “We want to ensure that all of this information can be made available to all of the members of the patient’s healthcare team, regardless of where they are physically located.” Professor Wilson said part of the funding would help pay for the development of the software and the interfaces but that it was also a full clinical trial. “It will look at what factors can help us better implement home monitoring,” he said. “It is a way to enhance the EHR and will test a number of different devices.”
Advantech
3M Health Information Systems P: 1800 029 706 F: +61 2 9498 9375 E: tjconnell@mmm.com W: www.3M.com.au/HIS 3M Health Information Systems is a leading provider of software solutions to help healthcare organisations capture, classify, and utilise data — accurately and efficiently. With more than 28 years of experience in health information management, 3M offers integrated solutions for: • Coding, Grouping and Reimbursement • Document Management and Scanned Medical Records, providing: ◊ Access anytime to complete patient history ◊ Intuitive, customisable document viewing ◊ Automated worklists ◊ Electronic signature • Dictation and Transcription, providing: ◊ Reduced dictation time ◊ Increased accuracy ◊ Lower transcription turn‑around‑time ◊ Seamless integration with PAS and EHR systems
ACIVA E: secretary@aciva.org.au W: www.aciva.org.au The Aged Care IT Vendors Association (ACIVA) was formed in early 2010, a not-for-profit organisation, incorporated in NSW. ACIVA represents the residential aged and community care sectors and vendors at various national forums regarding strategic developments and eHealth. ACIVA members are residential aged and community care software vendors, industry benchmarking software, financial software, call-bell, hardware, networking, infrastructure and industry partners. Members are committed to furthering the interests of residential aged and community care in national forums to ensure eHealth and access to the personally controlled health record (PCEHR) becomes a reality for the aged care industry in the very near future. Contact: Emma Pate emma.pate@eostech.com.au
P: 1300 308 531 F: +61 3 9797 0199 E: info@advantech.net.au W: www.advantech.net.au Advantech’s medical computing platforms are designed to enhance the quality and efficiency of healthcare for patients and users alike. All of Advantech’s medical PCs match the performance of commercial PCs but are medically rated to UL/EN 60601-1 third revision, IPX1 drip‑proof enclosures and are designed to suit ward and theatre based applications. Advantech offers long term availability and support plus a proven track record of reliability. The medical range extends through: • Point-of-Care Terminals. • Mini-PC and Medical Imaging Displays. • Mobile Medical Tablets. • Computerised Medical Carts. • Patient Infotainment Terminals. Advantech is also an official distributor of Microsoft Windows Embedded software across Australia & New Zealand.
Australasian College of Health Informatics P: +61 412 746 457 F: +61 3 9569 9449 E: Secretary@ACHI.org.au W: www.ACHI.org.au The Australasian College of Health Informatics is Australasia’s Health Informatics professional body, representing the interests of a broad range of clinical and non-clinical e-health professionals. ACHI is the community of Health Informatics thought-leaders in Australasia. ACHI is committed to quality, standards and ethical practice in the Health Informatics profession. More information is available at: www.ACHI.org.au Join the ACHI Info email list at: www.ACHI.org.au/List
Argus ACSS
AAPM P: 1800 196 000 / +61 3 9095 8712 F: +61 3 9329 2524 E: headoffice@aapm.org.au W: www.aapm.org.au The Australian Association of Practice Managers (AAPM) is a not for profit, national peak association founded in 1979, dedicated to supporting effective practice management in the healthcare sector. The Australian Association of Practice Managers: • Represents practice managers and the profession of practice management throughout the healthcare industry. • Promotes professional development and the code of ethics through leadership and education. • Provides specialised services to support quality practice management including advocacy, education, resources, networking, advice and assistance.
P: 1300 788 005 / +61 2 9632 0026 F: +61 2 9632 0096 E: sales@acsshealth.com W: www.acsshealth.com ACSS provides innovative and customisable patient management software streamlining day-to-day operations for GPs, Allied Health, Specialists, Radiologists, Pathologists, Private and Public Hospitals. eClaims® — Comprehensive and robust appointment and billing system with digital/voice recognition capabilities, electronic reporting transmissions and HL7 PACS system integration. eClaims® Hybrid — A solution tailored to Hospitals and other health service providers including billing agents who lack online capabilities. eClaims® Hybrid is the interface solution for connecting you to Medicare and health funds through ECLIPSE. SimDay® — Proven PAS (Patient Administration System) specifically designed for day surgeries and private hospitals – Now with ECLIPSE integration.
P: +61 3 5335 2220 F: +61 3 5335 2211 E: argus@argusconnect.com.au W: www.argusdca.com.au Argus provides and supports Argus secure messaging software; a popular electronic solution that enables healthcare practitioners to exchange many forms of patient related information securely and reliably and to Australian standards. Argus interfaces with most clinical software applications sending directly from within your letter writing facility or word processor and runs virtually invisibly in the background. Documents sent using Argus can be automatically added to electronic patient records; thus avoiding the need to scan or manually file them. Argus is the messaging solution chosen by many Medicare Locals through the ARGUS AFFINITY program delivering eHealth strategies across Australia. With over 17,000 users Argus continues to grow in popularity by delivering highly secure messages, a reliable product, backed by outstanding customer service all at the lowest cost possible.
Best Practice P: +61 7 4155 8888 F: +61 7 4153 2093 E: sales@bpsoftware.com.au W: www.bpsoftware.com.au Best Practice sets the standard for GP clinical software in Australia offering a flexible suite of products designed for the busy GP practice, including: • Best Practice Clinical (“drop-in” replacement for MD) • Integrated Best Practice (Clinical/ Management) • Best Practice Automatic SMS reminders Visit us at the following conferences throughout the year: • • • • •
GPCE Sydney, 17-19 May RDAQ Mackay, 7-9 June GPCE Brisbane, 20-22 September RACGP Darwin, 17-19 October GPCE Melbourne, 15-17 November
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cdmNet P: +61 3 9023 0800 F: +61 3 9614 2650 E: info@precedencehealthcare.com W: www.precedencehealthcare.com Chronic Disease Management just got a whole lot easier cdmNet simplifies team-based care for the estimated 30% of patients in general practice who qualify for MBS Chronic Disease Management Items. cdmNet minimises the bureaucracy, eliminates the paperwork and helps ensure compliance with Medicare requirements If you wish to use cdmNet to provide high quality care* for your chronic disease patients while increasing your revenues, contact us now. * See cdm.net.au/evidence
Cerner Corporation Pty Limited
Clintel Systems P: +61 8 8203 0555 E: info@clintel.com.au W: www.clintel.com.au The Specialist: A complete solution for your Appointments, Billing including Online Claiming and Clinical requirements in an intuitive scalable solution. Clintel provides systems to Specialist and Day Surgeries nationally. Powerful, highly configurable and easy to use, our systems mirror the needs and workflow of your practice and individual specialty. Our industry standard SQL database enables a true “paperless” practice. Our leading edge architecture is future proof, it is designed to meet changing requirements and offers first class reporting and analysis of clinical and business data. Standalone or networked multi-site installation which runs on both Mac OSX and Windows operating systems. Our support is first class, our philosophy is “whatever it takes”.
Cutting Edge Software P: 1300 237 638 E: enquiries@cesoft.com.au W: www.cesoft.com.au Cutting Edge produces affordable, intuitive billing solutions for Mac, Windows, Linux and iPad. Cutting Edge is ideal for practitioners who prefer to maintain control of their own billing from a number of sites. Cutting Edge Software is approved by Medicare Australia to manage your electronic: • Verification of Medicare and Fund membership • Bulk Bill and Medicare claims • DVA paperless claims • Inpatient claims to Health Funds We have solutions tailor-made for: • Anaesthetists • Surgeons/Surgical Assistants • Physicians • GPs • Allied Health The software comes with up-to-date schedules for MBS/Rebate, Gap Cover (all registered health funds), Workers’ Compensation, Transport Accident authorities and DVA.
P: +61 2 9900 4800 F: +61 2 9900 4990 E: AsiaPacific@cerner.com W: www.cerner.com.au Cerner is one of the leading global suppliers of health care information technology solutions. Cerner’s mission is to contribute to the systematic improvement of health care delivery and the health of communities. Our vision of proactive health care management drives innovation in the development of effective solutions for today’s health care challenges, while creating a foundation for tomorrow’s health populations. Working with more than 4000 clients worldwide, Cerner is solving health care’s many challenges making sure the right people have the right information at the right time. Our innovative leadership is allowing us to push boundaries by: • Leveraging clinical and pharmaceutical data in Condition Management and Personalised Medicine • Connecting the community with personal and community health records
CONNECT DIRECT Pty Ltd P: 1300 557 550 / +61 7 5478 5510 F: +61 7 5478 5520 E: support@directcontrol.com.au W: www.directcontrol.com.au Direct CONTROL is an affordable, intuitive and educational Practice Management System for providers of all disciplines with seamless integration with Outlook, MYOB or QuickBooks. Direct CONTROL’s Clinical Module with HTR is eHealth Compliant and manages Episodes of Care including State, Federal and Health Fund Statistical Reporting for day surgeries/ hospitals. Included are all fee schedules (Medicare, DVA, Work Cover, TAC, CTP, Private Health Insurance) with built in rules relevant to each medical discipline (Allied Health, General Practice, Surgeons, Physicians, Anaesthetists, Pathologists, Radiologists, day surgeries/hospitals). Ideal for the single practitioner or the Multidisciplinary Practice. SQL .NET for interoperability and scalability
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Doctors Control Panel E: www.pracsoftutilities.com W: PSU_admin@pracsoftutilities.com • Download and trial DCP software for GP’s and health teams. • DCP is your digital PA and guidelines advisor. • DCP facilitates TCA, GPMP and MHCP creation and tracking. • Contains guidelines licenced from RACGP. • Low annual subscription. • The best preventive care add-on software in Australia. • Compatible with MD3 and BP. • Achieve new heights in preventive care performance. • Significant benefit for patients. • Increase your revenues. • Streamline your workflow. • 3000 current users. • Several research projects based on DCP. • Try it today.
Emerging Systems P: +61 2 8853 4700 F: +61 2 9659 9366 E: sales@emerging.com.au W: www.emerging.com.au/ehealth Emerging Systems EHS web-based Clinical Information System records the clinical care delivered to a patient from pre-admission through to discharge. EHS interfaces with the hospital’s PAS system, capturing and providing all of the information Clinicians require during a patient stay to support the delivery of effective, appropriate, quality care outcomes in a secure and auditable environment. Information is displayed in a user friendly single pageview for easy access by to information by clinicians. Importantly, EHS links Clinical Care with Workforce Rostering and Staff Allocation allowing for predictive Resource Allocation based on the care required, enabling valuable productivity improvements. EHS is a proven and highly useable electronic medical record (EMR) developed within Australia and operating successfully in St Vincents & Mater Health, Sydney and Government of South Australia, Department of Health Hospitals. EHS provides:• Pre-Admission • Patient History • Orders & Results • Clinical Care Guides • Assessments • Progress Notes • Referrals • Labour & Birth • Medications Reconciliation • Clinical and Non Clinical Messaging • Discharge Summaries • Appointments • Rostering & Allocation • GP Connect • Workforce Resource Calculation • Document Management System • Clinical Dashboard and more EHS supports interactions with the health identifier service and PCEHR. The extensive list of modules work seamlessly with other systems via our integrated interface engine which accepts HL7 and other accepted Health IT standard protocols complying with the Australian Technical Specification: ATS 5822:2010 eHealth Secure Message Delivery. Accessibility: EHS is accessible on a range of devices according to user preference including our latest iPad application.
Extensia P: +61 7 3292 0222 F: +61 7 3292 0221 E: enquiries@extensia.com.au W: www.extensia.com.au Extensia links healthcare providers, consumers and their communities for better and more efficient health care. The products used to do this can be custom branded for all Organisations and include: • RecordPoint – a proven Shared Electronic Health Record that links all clinical systems, hospital settings, care plan tools and any other sources of information available. It provides a secure means of sharing critical patient data in a privacy compliant and logical structure. • EPRX – an Electronic Patient Referral Exchange and Directory. It streamlines the process of selecting a provider and completing a referral. Patient information is transferred seamlessly from clinical software. The most relevant providers, services and products are presented instantly and referral documents are generated and sent electronically.
Genie Solutions P: +61 7 3870 4085 F: +61 7 3870 4462 E: info@geniesolutions.com.au W: www.geniesolutions.com.au Genie is a fully integrated appointments, billing and clinical management package for Specialists and GPs. Genie runs on both Windows and Mac OS X, or a combination of both. With over 2500 sites, it is now the number one choice of Australian specialists.
GPA P: 1800 188 088 F: 1800 644 807 E: info@gpa.net.au W: www.gpa.net.au GPA ACCREDITATION plus (GPA) is the only independent accreditation program for general practice in Australia. Established in 1998 and run by a team of committed general practitioners, business leaders and experienced administrators, GPA has developed a program that continuously evolves in order to set new standards in general practice accreditation, while offering full support to practices to make accreditation both achievable and rewarding. GPA is committed to providing an accreditation program, which is flexible and understands the needs of busy GPs and practice support staff. Whilst accreditation gives practices access to the Practice Incentive Program (PIP), GPA believes it should offer benefits that go well beyond the PIP. Our program provides practices with a pathway to enhanced patient care, continuous professional satisfaction, improved practice efficiency and superior risk management. GPA ACCREDITATION plus certificates and signage remind patients that their practice has achieved a level of care and service above and beyond essential general practice standards. GPA provides a system designed to accommodate busy general practices. Among our services, we offer practices the opportunity to use technologicallyadvanced, environmentally-friendly online programs, allowing staff to upload documentation at their own pace; individually assigned client managers, supporting practices through accreditation from start to success and beyond; highly-trained and sensitive surveyors, with extensive experience in all facets of general practice; and interactive training seminars, bringing practices the latest information in standards and innovation. At GPA, we believe that accreditation should be an accomplishment, not a test, and we uphold that belief in our approach and service. For an accreditation program that will offer you assistance, support, information and satisfaction…the choice is yours.
Healthbank Consult P: 1300 856 722 F: 08 8301 4001 E: support@healthbankconsult.com.au W: www.healthbankconsult.com.au Healthbank Consult is a telehealth system developed in Australia for Australian healthcare providers. Secure, fully encrypted and HD capable, Healthbank Consult is designed to be compatible with your clinical desktop for easy integration with your practice’s workflow and retains an audit trail for Medicare. Compliant with RACGP telehealth guidelines, Healthbank Consult will qualify Rural GPs, Specialists, Aged Care Facilities and Aboriginal Medical Services for a $4,800 Medicare telehealth rebate plus ongoing fees.
Health Informatics New Zealand E: admin@hinz.org.nz W: www.hinz.org.nz Health Informatics New Zealand (HINZ) is a national, not-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 Communication Network P: +61 2 9906 6633 F: +61 2 9906 8910 E: hcn@hcn.com.au W: www.hcn.com.au Health Communication Network (HCN) is the leading provider of clinical and practice management software for Australian GPs and Specialists and supplies Australia’s major hospitals with online Knowledge resources. HCN focuses on improving patient outcomes by providing evidence based software tools to health care professionals at the point of care. Market snapshot: • 17,000 medical professionals use Medical Director • 3,600 GP Practices use PracSoft • 800 Specialist Practices use Blue Chip and • 2,100 Specialists use Medical Director • Leading suppliers of Knowledge Resources to Australia’s major hospitals
Health Informatics Society of Australia P: +61 3 9326 3311 F: +61 3 8610 0006 E: hisa@hisa.org.au W: www.hisa.org.au HISA is Australia’s health informatics organisation. We have been supporting and representing Australia’s health informatics and eHealth community for almost 20 years. HISA aims to improve healthcare through the use of technology and information. We: • Provide a national focus for eHealth, health informatics, its practitioners, industry and a broad range of stakeholders • Support, promote and advocate • Provide opportunities for networking, learning and professional development • Are effective champions for the value of health informatics HISA members are part of a national network of people and organisations building a healthcare future enabled by eHealth. Join the growing community who are committed to, and passionate about, health reform enabled by eHealth.
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Medtech Global Ltd
Houston Medical
P: 1800 148 165 E: salesau@medtechglobal.com W: www.medtechglobal.com
P: 1800 420 066 (AU) P: 0800 401 111 (NZ) E: info@houstonmedical.net W: www.houstonmedical.net
Health Information Management Association Australia P: +61 2 9887 5001 F: +61 2 9887 5895 E: himaa@himaa.org.au W: www.himaa2.org.au The Health Information Management Association of Australia (HIMAA) is the peak professional body of Health Information Managers in Australia. HIMAA aims to support and promote the profession of health information management. HIMAA is also a Registered Training Organisation conducting, by distance education, “industry standard” training courses in Medical Terminology and ICD-10-AM, ACHI and ACS clinical coding.
HealthLink P: 1800 125 036 (AU) P: 0800 288 887 (NZ) E: enquiries@healthlink.net W: www.healthlink.net Australia and New Zealand’s most effective secure communications service. Transforming healthcare by connecting healthcare providers. • Provider of compliant Secure Messaging Delivery (SMD) services • Standards compliance delivering certainty in care • Fully integrated with leading GP and Specialist clinical systems • Referrals, Reports, Forms, Discharge Summaries, Specialist Diagnostic Orders and Reporting • Affords all healthcare providers efficiencies in reducing paper based handling • Robust; Reliable and Fully Supported • New online services including Care Insight - distributed search for clinical information • Expert partnerships with Healthcare organisations, State and National Health Services Join HealthLink and be connected with more than 85 % of Australian GPs and 99% of NZ GPs who are already part of the HealthLink community.
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“We provide time to health professionals through efficient practice management software” Our multidiscipline software provides interfaces to every major manufacturer, enabling many clinics to save space by becoming completely paperless! We are a progressive medical software company and take pride in working with our health care clients to deliver tailored EMR and PMS packages based on each unique situation and practice requirements. We’re focused on helping to make their businesses more efficient and productive as well as delivering measurable improvements in customer satisfaction and market share. You can arrange a free demonstration of our software by visiting: www.HoustonMedical.net
InterSystems P: +61 2 9380 7111 F: +61 2 9380 7121 E: anz.query@InterSystems.com W: www.InterSystems.com InterSystems Corporation provides the premier platform for software for connected healthcare, with headquarters in Cambridge, Massachusetts and offices in 25 countries. InterSystems TrakCare™ is an Internet-based unified healthcare information system that rapidly delivers the benefits of an Electronic Patient Record. InterSystems HealthShare® is a strategic platform for healthcare informatics. It enables organizations to capture and share all patient data, and provides real-time active analytics that drive informed action across a hospital network, community, region, or nation. HealthShare facilitates strategic interoperability, coordination of care, population health management, and community engagement. InterSystems Ensemble® is a platform for rapid integration and the development of connectable applications. InterSystems CACHÉ® is the world’s most widely used database system in clinical applications.
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.
MEDITECH Australia P: +61 2 9901 6400 F: +61 2 9439 6331 E: sales@meditech.com.au W: www.meditech.com.au A Worldwide Leader in Health Care Information Systems MEDITECH today stands at the forefront of the health care information systems industry. Our products serve well over 2,300 health care organisations around the world. Large health care enterprises, multi‑hospital alliances, teaching hospitals, community hospitals, rehabilitation and psychiatric chains, long-term care organisations, physicians’ offices, and home care and hospice agencies all use our Health Care Information System to bring integrated care to the populations they serve. Our experience, along with our financial and product stability, assures our customers of a long-term information systems partner to help them achieve their goals.
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.
MIMS Australia P: +61 2 9902 7700 F: +61 2 9902 7701 E: info@mims.com.au W: www.mims.com.au MIMS Australia is built on a heritage of local expertise, credibility and adaptation to changing healthcare provider needs. Our information gathering, analysis and coding systems are proven and robust. MIMS information is backed by MIMS trusted, rigorous editorial process and constantly updated from a variety of sources including primary research literature. Our database and decision support modules are locally relevant, clinically reviewed and updated monthly and compatible with a host of clinical software packages. Indeed, the majority of Australian prescribing packages and many dispensing applications are supported by the MIMS medicines data base. MIMS is delivered all the ways you need – print to electronic, on the move, to your patient’s bedside or your consulting room desk. Whatever the format, MIMS has the latest information you need.
Orion Health P: +61 2 8096 0000 / +64 9 638 0600 E: enquiries@orionhealth.com W: www.orionhealth.com
MITS:Health P: 1300 700 300 E: info@mitshealth.com.au W: www.mitshealth.com.au Managed IT Services for the Health Industry MITS:Health provides a full range of IT services specifically tailored for medical centres, GPs and specialists across Melbourne. • • • • • •
Equipment supply and installation Remote monitoring and support Data backups Networking Internet Website Development
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.
Professional Transcription Solutions
Medilink from Practice Services P: +61 3 9819 0700 F: +61 3 9819 0705 E: Sales@practiceservices.com.au W: www.practiceservices.com.au
P: 1300 768 476 E: marketing@etranscriptions.com.au W: www.etranscriptions.com.au Australia’s Most Trusted Teaching Hospital and Private Practice Transcription Provider
Medilink Practice Management Software • 21 years young, large user base • Medilink = Intuitive ease of use • Solo Drs up to Hospitals in size • Claiming via integrated EFTPOS ◊ and/or integrated HICAPS ◊ and/or Medicare Online ◊ and/or ECLIPSE • Many standard features • Many optional modules • Links to many third party packages and services • Cut debtors and boost cash flow • 17 years as an Authorised Medilink Dealer, selling, installing & training • Fixed Cost Support, Onsite or Remote
• Web-based - Dictate and receive reports anywhere • Double-edited with over 99.5% accuracy • Fast turn-around in 2 - 48 hours, as required • All medical and surgical specialities covered in Australia’s largest teaching hospitals • Rapid documentation of recorded HR interviews, Research and Expert Reports • Guaranteed cost savings • Data held securely at a State Government owned data centre • Call our friendly staff anytime for your overflow, backlog or all of your typing or data entry requirements • Call us now for an obligation free trial
Precision IT
Shexie Medical System
P: 1300 964 404 F: +61 2 8078 0257 E: info@precisionit.com.au W: www.precisionit.com.au
P: 1300 743 943 F: 1300 792 943 E: info@shexie.com.au W: www.shexie.com.au
• 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.
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.
Mouse Soft Australia Pty Ltd P: +61 3 9888 2555 F: +61 3 9888 1752 E: sales@medicalwizard.com.au W: www.medicalwizard.com.au Medical Wizard saves time and money through greater efficiency and comprehensive integration. Throughout its 19 year history, Medical Wizard has led the way with innovative solutions. We are constantly evolving Medical Wizard to meet the challenges of the medical profession for today and tomorrow. A software of choice for discerning Specialist practices, notably Gastroenterologists, Cosmetic Surgeons, Ophthalmologists, General Surgeons, IVF Centres and Day Hospitals amongst others. All aspects of practice management from appointments, billing, clinical, theatre management and compliance reporting are covered and backed by a dedicated local support team. Feature Rich. Dynamic. Innovative.
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 for most Australian university teaching hospitals and major private clinics. It really does make sound business sense to let OzeScribe worry about managing dictation, transcription and technology. We provide free electronic document delivery – OzePost – to your EMR and your associates’ EMR, saving you thousands of dollars in time, packing and postage. OzeScribe is the provider of the most advanced solutions available. • Run by doctors – for doctors. • Australian trained typists. • Manage dictation and transcription via computers, iPhone, iPad, android or smartphones. • Integrated M*Modal speech recognition technology on demand.
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.
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 3219 7510 E: carla.doolan@stathealth.com.au W: www.stathealth.com.au
P: 1800 061 260 E: sales@tg.org.au W: www.tg.org.au
Stat Health Systems (Aust) has built a progressive and resilient system that introduces a new level of stability and flexibility to the medical software market.
Therapeutic Guidelines Limited is an independent not-for-profit organisation dedicated to deriving guidelines for therapy from the latest world literature, interpreted and distilled by Australia’s most eminent and respected experts.
Stat is an integrated clinical and practice management application which has embraced the latest Microsoft technology to build a new generation solution. Fully scalable and the only medical software application to incorporate a multi-functional intuitive interface, Stat is at the forefront of computing technology. Stat incorporates all eHealth requirements as per the NEHTA specification.
These experts, with many years of clinical experience, work with skilled medical editors to sift and sort through research data, systematic reviews, local protocols and other sources of information, to ensure that the clear and practical recommendations developed are based on the best available evidence.
Stat Health provide a premium support service, clinical data conversion from existing software and tailor made installation and training plans for your practice. Facebook: facebook.com/StatHealth Twitter: @NotifyStat
eTG complete Incorporates all topics from the Therapeutic Guidelines series in a searchable electronic product, and is the ultimate resource for the essence of current available evidence. It provides access to over 3000 clinical topics, relevant PBS, pregnancy and breastfeeding information, key references, and other independent information such as Australian Prescriber (including Medicines Safety Update), NPS Radar, NPS News and Cochrane Reviews.
P: +61 3 9013 4445 E: info@sysmex.com.au W: www.sysmex.com.au
eTG complete is available in a range of convenient formats – online access, online download, CD, and intranet access for hospitals. Multi-user licences, ideal for a practice or clinic, are also available.
Sysmex is dedicated solely to helping your healthcare organisation achieve more in less time, with fewer errors and better patient outcomes.
It is widely used by practitioners and pharmacists in community and hospital settings in all Australian states and territories.
Sysmex lead the way in eDiagnostics: • Providing an essential building block for the electronic medical record with the Eclair Clinical Information System • Enabling sharing of key patient information across regions through the Eclair Clinical Data Repository • Completing the electronic loop with laboratory and radiology order request management (CPOE) • Streamlining all areas of the anatomical pathology laboratory workflow from request to report with Delphic AP • Improving reporting times and reducing costs through an enterprise Delphic LIS, shared across multiple laboratories
Updated three times per year, eTG complete meets the criteria for ‘key electronic clinical resources’ in the Practice Incentives Program (PIP) eHealth Incentive.
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The March 2013 release of eTG complete includes updates of selected Psychotropic topics. The online version of eTG complete has now been optimised for use on smart phones and tablet devices. miniTG The mobile version of eTG complete is miniTG, offering the convenience of having vital information at the point of care and designed for health professionals who practise and consult on the move. It is supported on a wide range of mobile devices, including Apple®, Pocket PC®, and selected Blackberry® devices.
VIRTUAL CONSULTING ROOMS
Totalcare
VConsult
P: +61 7 3252 2425 F: +61 7 3252 2410 E: sales@totalcare.net.au W: www.totalcare.net.au Totalcare is a fully integrated Clinical, Office and Management software suite designed to suit the particular needs and processes of healthcare providers. Used since 1995 by health care facilities across Australia including General and Specialist practice, Radiology, Day Surgery and Hospitals, Totalcare is stable, scalable, customisable and easy to learn and use. From a small practice to a multisite, multi-disciplinary corporate entity or hospital, Totalcare can provide solutions for your needs. • • • • • • • •
Admissions / Appointments Billing Statutory Reporting Integrated SMS Prescriptions Orders & Reports Clinical Notes Letter/Report Writing, Document and Image Management • Scanning and Barcode recognition • Video and Image Capture • HL7 Interfaces
TrendCare
P: 1300 82 66 78 F: 1300 66 10 66 E: admin@vconsult.com.au W: www.vconsult.com.au VConsult offers outsourced practice management solutions for medical and allied health practitioners allowing the focus to be on your professional practice and patient care. VConsult provides a seamless “behind the scenes” service by professionally managing your telephone calls, reception, invoicing and medical transcription requirements. VConsult is perfect for your practice if you are: • Setting up, already established or winding down in Private Practice • Working in a public appointment and want to portray a professional image • Looking to minimise your overhead costs • Requiring your patient calls to be answered by a professional and experienced medical receptionist.
Zedmed
R O
Trend Care Systems P: +61 7 3390 5399 F: +61 7 3390 7599 E: support@trendcare.com.au W: www.trendcare.com.au
A national and international award winning solution recognised for its ability to provide real benefits in the acute and sub-acute health care settings. TrendCare is an international leader for e-health solutions excelling in all of the following: • Patient dependency and nursing intensity measures. • Projecting patient throughput and workforce requirements. • Rostering and work allocation. • Efficiency, productivity and HRM reporting. • Discharge analysis, bed management and clinical handovers. • Allied health registers with extensive reporting. • Clinical pathways with variance reporting. • Patient assessments and risk analysis. • Diet ordering and reporting. • Staff health tracking and reporting.
P: 1300 933 000 F: +61 3 9284 3399 E: sales@zedmed.com.au W: www.zedmed.com.au Zedmed is an innovative provider of business solutions to the medical and financial services industries. Our practice and clinical management solution is designed to be simple, intuitive and seamlessly integrated. With personalised training, installation and data conversions from almost all software packages, changing software has never been so easy. Zedmed would also like to introduce to you Medical Record Exchange – a free, simple solution allowing Doctors to send patient’s medical information to insurance companies electronically. Using the latest in data extraction technology and fully encrypted, this is a secure, time-saving solution to one of the most dreaded requests Doctors receive on an almost daily basis. For more information about Medical Record Exchange, please contact us: Phone: 1300 933 833 www.medicalrecordexchange.com.au