Pulse+IT Magazine - November 2011

Australia’s First and Only Health IT Magazine

PULSE IT 

Issue

November

25 2011

Medication Management Improving S8 medication and patient management Phillip Shepherd argues improved S8 management can be achieved by leveraging Prescription Exchange Services.

Introducing MedView Roger Boot overviews the MedView project and the benefits delivered by Electronic Transfer of Prescriptions.

Australian Medicines Terminology update Bettina McMahon presents the National E-Health Transition Authority’s AMT adoption plan.

Increased ETP adoption is required Jane London encourages the uptake of Electronic Transfer of Prescriptions by general practitioners.

Medication management lessons learnt Joan Ostergaard shares experiences gained from medication management implementations.

A perspective from abroad Rachel de Sain offers insights into some medication management initiatives recently encountered in the US. Removing ETP road blocks Bryn Evans examines some of the challenges confronting the Electronic Transfer of Prescriptions sector.

www.pulseitmagazine.com.au

Kelvin’s eHealth Journey

1

3

Greeted by medical centre receptionist Lucy Black, the receptionist is logged into her computer and Kelvin is then added to the waiting list by Lucy.

Kelvin is on holiday in far North Queensland Kelvin lives in Croydon, Victoria with his wife Betty. He is reasonably healthy, only suffering from hypertension that is well controlled with medication. He has an allergy to Penicillin. Over a period of three weeks he develops cramps and pain in his abdomen when he eats fatty food.

Kelvin’s IHI number is retrieved from the HI service electronically and seamlessly added to the local practice record. Kelvin takes a seat in the waiting room.

He is under the care of Dr Adam Jones at his local GP Practice.

2

GP consultation

4

Dr Grant opens Kelvin’s medical record on his PC which now also includes his Healthcare Identifier. Kelvin complains to Dr Grant of cramps in his stomach, especially after eating pizza and fish and chips which he has suffered from for about three weeks.

Kelvin presents to a medical centre While on holidays his condition gets worse and he presents to a medical centre in the town he is staying.

National E-Health Transition Authority

Dr Grant performs an examination and makes a provisional diagnosis of gallstones. He then orders an ultrasound which confirms the presence of gallstones.

After discussing with Kelvin, Dr Grant refers to a General Surgeon: Dr James Brecker at Bay Hill Hospital. The referral is sent electronically via secure messaging.

Kelvin’s eHealth Journey is brought to you by the National E-Health Transition Authority (NEHTA).

NEHTA is the lead organisation supporting the national vision for eHealth in Australia.

7 5

Specialist consultation

Pharmacy Kelvin takes his prescription from Dr Brecker to a Community Pharmacy. The pharmacist scans the prescription barcode. The prescription is retrieved from the PES (Prescription Exchange Service) and dispensed.

8

Dr James Brecker receives the e-referral. Frank is booked in for an appointment by his GP’s staff.

Dr Brecker reviews Kelvin’s ultrasound, performs an examination and determines that Kelvin needs surgery to remove the gallstones.

6

Pathology As per the recommendations on Kelvin’s discharge summary, he has a follow-up blood test for liver function done on the day he is to return home from holiday. The GP has requested that the pathology test results be copied to Kelvin’s usual GP.

Admission to hospital for surgery Kelvin is admitted to the General Surgery ward.

Kelvin then undergoes surgery by Dr Brecker, and he makes an uneventful recovery. Kelvin is discharged three days later, much improved and is referred back to his GP for follow up. An e-discharge summary is sent to Dr Adam Jones, his local GP.

For more information about NEHTA visit www.nehta.gov.au For more information about eHealth including the Healthcare Identifier (HI) Service visit www.ehealthinfo.gov.au

9 Returns from holiday Kelvin goes home without receiving his results but on his return home he goes to his usual GP who has received the blood test results and a copy of the discharge summary.

After consultation with Kelvin, Dr Jones confirms that the blood tests are normal.

What a wonderful outcome!

PULSE IT +

Publisher Pulse Magazine ABN: 19 923 710 562 www.pulseitmagazine.com.au

Editor Simon James Australia: +61 2 8006 5185 New Zealand: +64 9 889 3185 simon.james@pulseitmagazine.com.au

Pages 12, 16, 26, 28, 32, 36, 38 Medication Management

Subscription Enquiries subscribe@pulseitmagazine.com.au

Advertising Enquiries ads@pulseitmagazine.com.au

About Pulse+IT Pulse+IT is Australia’s first and only Health IT magazine.

With an international distribution exceeding 37,000 copies, it is also one of the highest circulating health publications in Australasia. 32,000 copies of Pulse+IT are distributed to GPs, specialists, practice managers and the IT professionals that support them. In addition, over 5,000 copies of Pulse+IT are distributed to health information managers, health informaticians, and IT decision makers in hospitals, day surgeries and aged care facilities.

ISSN: 1835-1522

Looking ahead Editorial themes for all 2012 editions will be announced online at the Pulse+IT website by the start of December.

Pulse+IT invites suggestions from the readership to inform the selection of these themes.

Pulse+IT welcomes feature articles and guest editorial submissions relating to the nominated edition themes, as well as articles relating to eHealth more broadly.

Submission guidelines and deadlines are available online: http://www.pulseitmagazine.com.au/editorial

Contributors Roger Boot, Bryn Evans, Simon James, Jane London, Bettina McMahon, Joan Ostergaard, Chris Ryan, Rachel de Sain, Phillip Shepherd, Dr Geoffrey Sayer, and Alberto Tinazzi.

Disclaimer The views contained herein are not necessarily the views of Pulse 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 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, or the Kimberley Aboriginal Medical Services Council, all who produce publications that include the word “Pulse” in their titles.

Copyright 2011 Pulse Magazine 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.

Pulse+IT acknowledges the support of the following organisations, each of whom supply copies of Pulse+IT to their members.

Page 26 Australian Medicines Terminology

Page 40 Video Consultations

Page 48 Server Virtualisation

Editorials

Features

News

Page 6 STARTUP Editor Simon James introduces the 25th edition of Pulse+IT.

Page 32 FEATURE ARTICLE Joan Ostergaard shares some lessons learnt for organisations seeking to increase their utilisation of medication management technology.

Page 20 Zedmed releases version 17

Page 8 GUEST EDITORIAL Bryn Evans questions the planned opt-in model for the PCEHR. Page 12 GUEST EDITORIAL Phillip Shepherd argues improved S8 management can be achieved by leveraging Prescription Exchange Services.

Page 16 GUEST EDITORIAL Roger Boot overviews MedView and the benefits delivered by Electronic Transfer of Prescriptions.

Page 24 MSIA Dr Geoffrey Sayer reflects on his time as President of the MSIA. Page 26 NPS Jane London encourages the uptake of Electronic Transfer of Prescription technology by GPs. Page 28 NEHTA Bettina McMahon presents NEHTA’s AMT adoption plan.

Page 36 FEATURE ARTICLE Rachel de Sain offers insights into the medication management initiatives encountered recently in the United States.

Page 38 FEATURE ARTICLE Bryn Evans overviews some of the challenges confronting the Electronic Transfer of Prescriptions sector.

Off Topic Page 40 VIDEO CONSULTATIONS Chris Ryan presents a range of video consulting telehealth material including an overview of organisations now actively involved in the space.

Page 48 SERVER VIRTUALISATION Alberto Tinazzi introduces virtualisation technology and its application in medical practices.

APNA launches new online learning material for practice nurses Better monitoring of heart disease recognised Page 21 Better Health Channel releases iOS app Page 22 UWS to host Health Informatics Summer School in February I-MED releases iOS apps Page 23 Orion Health acquires Microsoft products, announces partnership

Resources Page 30 EVENTS CALENDAR Up and coming Health IT, Health, and IT events.

Page 53 MARKET PLACE The Pulse+IT Directory profiles Australasia’s most innovative and influential eHealth organisations.

EDITORIAL

Pulse+IT: 2011.5 Simon James

BIT, BComm Editor, Pulse+IT Phone (AU): +61 2 8006 5185 Phone (NZ): +64 9 889 3185 simon.james@pulseitmagazine.com.au

Welcome to the 25th edition of Pulse+IT, Australia’s

in a medical practice, with Chris Ryan delivering a

first and only Health IT magazine.

substantive and timely article canvassing a range of

video conference telehealth material, complete with a

Having taken a sector-wide view of this edition’s

‘medication

management’

theme,

Electronic

Transfer of Prescriptions (ETP) features prominently throughout the magazine, with representatives from

Acknowledgements

their respective cases for the rapid uptake of ETP

As our print production cycle draws to a close for

technology, particularly by general practice. The

2011, I would like to extend my thanks to all of this

NPS — contributing to Pulse+IT for the first time in an

year’s contributing writers, advertisers, subscribers,

organisational capacity — echoes their sentiments, and

and organisations that supply the publication to their

Bryn Evans canvasses some of the ways government

memberships. All of these individuals and organisations

might assist the sector to overcome current

play an ongoing and important role in making each

impediments to adoption.

edition of Pulse+IT a reality.

Joan Ostergaard shares some lessons learnt for

organisations looking to increase their utilisation of

Looking ahead

medication management technology, with Rachel de

In reflection of the increasing amount of eHealth

Sain offering insights into the medication management

activity occurring in the run up to the launch of the

initiatives she encountered during the recent Medicine

Personally Controlled Electronic Health Record in

2.0 and Health 2.0 conferences in the United States.

July 2012, Pulse+IT will resume publication of its print

editions earlier than previous years, with the first

Bettina McMahon of the National E-Health

Transition Authority overviews the organisation’s

magazine to reach the readership in February.

plan to accelerate uptake of the Australian Medicines

Terminology (AMT), and having recently concluded

editorial coverage we intend to deliver throughout

his term as President of the Medical Software Industry

2012, Pulse+IT will announce next year’s edition themes

Association, Dr Geoffrey Sayer shares some of his

on our website at the start of December. If you would

experiences and insights gained during his time in the

like to suggest a topic, have any suggestions for future

role.

articles, would like to contribute to an edition, or would

simply like to discuss your experiences with eHealth,

Alberto Tinazzi contributes a detailed overview

of virtualisation technology as it can be applied

Pulse+IT

to turn to for additional information and advice.

both eRx Script Exchange and MediSecure outlining

6

summary of the organisations that practices might like

For those interested in the scope of the feature

don’t hesitate to get in touch.

www.pulseitmagazine.com.au

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EDITORIAL

PCEHR and the ‘opt-in’ model – are we swimming against the tide?

The national Personally Controlled Electronic Health Record (PCEHR) project requires health consumers to register and ‘opt-in’ to the PCEHR system. This appears to be contrary to current practices and may be going against the prevailing trends in both Australia and overseas.

Bryn Evans

Director JEMS Consulting bryn.evans@ozemail.com.au

The youth lay on the floor, blood all over him,

in a PCEHR. Even for those consumers who do opt‑in,

half‑twisted onto his side. One arm was drawn over his

they will be allowed to restrict access to certain

face, his body motionless. Blood had pooled beside him,

information of their choice, and to restrict access to

and was splashed across the wash-basins, the walls

nominated clinicians. The result of this approach will

and floor. This was the scene which confronted me in

be that many patients will continue to be treated by

the toilets of a major public building. A man bent down

clinicians who are not fully informed of the patient’s

over the prone figure, which appeared unconscious and

medical history. The suppression of patient information

perhaps only a teenager, and began to turn him onto his

will inevitably disadvantage those who have not

back.

opted‑in and contribute to sub-optimal outcomes,

“Don’t move him,” I said, “I’ll call an ambulance.”

even the risk of avoidable deaths.

“I am a doctor,” said the man crouching down.”

Two airport employees appeared to assist the doctor,

illustrated at the start of this article, if the patient

and said an ambulance was on its way. As I stepped

has not registered, complex authorisation and access

away to give them room, I could see that the injured boy

controls stand in the way of the patient’s medical

had deep slashes in both wrists.

information, even though their life is on the line.

In an emergency, a trauma situation like the one

•••

The PCEHR’s Concept of Operations provides for

In the tragic case described above, immediate online

emergency access, but the necessary authorisation

access to the patient’s medical information — perhaps

procedures and access control threaten to be

in the near future on a smartphone or similar device

functionally difficult, bureaucratic and time-wasting.

— could mean the difference between life and death.

Concerns about the design and increased complexity

The Personally Controlled Electronic Health Record

of emergency access remain current and unresolved,

(PCEHR) could help — or could it?

so much so that the PCEHR’s emergency access model

The opt-in model

is stated as requiring further consultation.

Information on the patient’s medical history, such

The currently proposed opt-in model for the PCEHR

as blood type, allergies and medication history should

requires each consumer to register and give consent for

be available for instant access by clinicians. In such

their PCEHR to be established. Where a consumer has

situations, the principle ‘first do no harm’, has to be

not opted-in, no patient information will be available

paramount. Withholding a patient’s medical record information from clinicians, not only in emergency and

Author Info

trauma cases but in any provision of care, would surely Bryn Evans is a management consultant, with many years experience as a CIO in healthcare, and as chief executive of a clinical software supplier.

He writes extensively across a range of categories and genres, notably in the areas of management, information technology, sport, travel, history and fiction.

transgress this principle.

The overseas experience Evidence is accumulating from overseas experiences of the benefits that can accrue from Shared Electronic Health Records. But they appear to be predominantly

8

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based upon opt-out approaches. An EHR is

facility for treatment.

generated and made available to clinicians,

while the onus is put on the individual to

clinics, or GP practices (through electronic

father to an Emergency Department in

opt-out if they so choose.

discharge summaries from hospitals), and

the early hours of the morning, where he

Whether

in

hospitals,

medication?” out-patient

A few years ago I took my 93 years old

In the NHS in England, by March 2011

across geographical areas, patient medical

was asked what medication he had been

nearly six million Summary Care Records

information stored in EMRs is accessed

prescribed in the past. His medication

had been created. Around 30 million

by clinicians on the basis of providing

history would have read like a fair sized

people had been sent a letter with an

care, and without seeking the patient’s

formulary, so not surprisingly the doctor’s

opt‑out form to complete and return in a

prior consent. Within GP practices and

question was met with a blank stare.

pre-paid envelope if they wished to make

other healthcare organisations, patient

that choice. By the end of March 2011, only

medical information is accessed via EMR

have not opted-in, even in cases not at

1.16% had chosen to opt-out.1

systems purely in accordance to clinical

first deemed to be an emergency, will

need, unless a patient initiates a request to

sometimes be put at risk by the exclusion

a similar choice has been given to the

prevent such access.

of the PCEHR’s medical information.

consumer, in effect to opt-out in a variety

In emergency care a patient’s medical

of ways. The predominant theme is to

by the Health Consumers Council, who

information

create the EHR as a record of a patient’s

have stated publicly their preference for

is critical, and in a trauma case such

medical information for use by clinicians,

an opt-out approach. Over a number of

information in the first hour has been

and then leave it to the discretion of the

years in Australia and overseas, surveys

described as pure gold. A lack of a

consumer to access it if they wish, or

of the public have shown that health

PCEHR, even in routine treatments and

opt‑out.

consumers expect clinicians to be sharing

procedures, in a percentage of cases will

Elsewhere in Canada and Denmark,

The opt-in model is not even favoured

Clearly the lives of patients who

being

accessible

online

Singapore’s recently developed EHR

their medical information as a matter

lead to avoidable incidents.

functions as a national summary record of

of course, to provide the best health

each patient’s medical information for use

outcome. Typically, a common reaction by

should be available automatically for

by clinicians. It is not personally controlled,

health consumers is that they assume that

every health consumer by approved

and once a patient visits a hospital or

healthcare providers are already sharing

treating clinicians, just as it is within

doctor for a consultation, the principle of

patient information between appropriate

existing EMR systems. If not, the PCEHR

implied consent enables access to the EHR

treating clinicians to provide the best care

will lack credibility and adoption by both

by clinicians. Access by the consumer is not

for the patient.

patients and clinicians and be in danger of

yet planned.

The opt-out approach to the PCEHR

Some realities and conclusions

Patient information within a PCEHR

becoming a white elephant. And of course the opportunity for a consumer to opt-out, should be subject to a rigorous application

Placing the onus on the consumer to opt‑in

process, overseen and assessed against

the

and register for a PCEHR disadvantages

specified criteria by an independent

opt-in model should be given serious

and puts at risk those consumers who

quasi‑judicial body. To opt-out should not

reconsideration.

In Australia

the

alternative Under

an

to

would most benefit from a PCEHR.

be an easy option.

approach, this would automatically make

opt‑out

available in a PCEHR all appropriate

consumers will not register for a variety of

should adopt an opt-out model, and ensure

patient information that is held by

reasons such as: a lack of understanding;

we ‘first do no harm’. The PCEHR has

healthcare providers in their Electronic

cultural and language barriers; mental

the potential to provide patient medical

Medical Record (EMR) systems, unless a

incapacity; physical disability; too young

information any time, anywhere, for any

consumer specifically requests to opt‑out

an age to exercise the right; remote access;

health consumer, and assist the treating

of the PCEHR system. The extensive

negative advice; and many others reasons

clinician(s) at the point of care, wherever

implementations of EMR systems by NSW

including apathy and inertia.

that may be.

Health and other states and jurisdictions

have taken place based upon an implicit

confronted by a doctor saying: “We do not

References

opt-out model. That is, a patient’s consent

have access to your health record. When

1. http://www.dh.gov.uk/en/MediaCentre/

is implied when they attend a healthcare

did you last see a doctor? Are you taking

www.pulseitmagazine.com.au

Under an opt-in model, any number of

Those who are sick will not want to be

Once the PCEHR is available, we

Pressreleases/DH_125690

Pulse+IT

11

EDITORIAL

Effective S8 Management with Prescription Exchange Services Phillip Shepherd

Chief Executive Officer MediSecure phillip.shepherd@medisecure.com.au

“Doctors and pharmacists have backed calls from a

answer to the “how do I know?” question. The process

Victorian coroner for the introduction of a real-time

of prescribing and dispensing S8 medicines is used

prescription monitoring system in an effort to stamp out

every day by doctors and pharmacists across the

doctor-shopping.

country. Opioid medications have a legitimate and

Coroner John Olle called for the introduction of live

necessary role in treatment of pain in the community.

prescription monitoring within the year and asked for

But the process of managing these drugs of addiction

written submissions from relevant experts before he

and the patients who use them appears to be deficient,

makes final recommendations in relation to the death

particularly for timely feedback to both prescribers and

of a Melbourne man, 24, who overdosed on prescription

dispensers on the activity of an individual patient.

morphine and diazepam two years ago.”

1

Medical

Forum

WA

recently

addressed

S8

Medical Observer reported these Victorian Coroner

management and “compare[d] some results with our

findings on 9 August 2011. A tragic case of a young

2009 survey around narcotic prescribing. Since 2009,

man caught up in a deadly addiction to prescription

the profession has lost the Medicine Information Line

medicines and no safety net in place to prevent this

for doctor shopping on PBS scripts, a service that 17%

abuse of the national medicines system.

of our surveyed GPs found ‘very helpful’ and 31% found

‘sometimes helpful’ ...”2

How is this possible? With all the sophisticated

IT systems in the banking world that track customer

behaviour, with all the IT systems deployed in social

200‑300 scripts of concern each month” in the defined

In Western Australia, “there are approximately

media and the ability of advertisers to know what

high-risk groups. Letters are sent to the prescribers

any user is looking at and how they behave, how can

after the event. Further, “over 200 letters are sent

the medicines system, a fundamental plank of the

each month to prescribers who have prescribed for a

world‑class Australian health system, get it so wrong?

[registered drug addict] without prior authorisation. In

At the root of this young man’s problem was the

addition, ‘doctor shoppers’ ... (are) identified when they

process of prescribing and dispensing of medicines; in

present at one or more pharmacies with prescriptions

particular, the Schedule 8 (S8) or Drugs of Addiction

from more than one doctor ... One proposal ... is to

process. The management of S8 medicines is a state

write to identified patients, informing them that their

responsibility and each state has their own version of

behaviour has been noted ...”3

‘best practice’. As a general rule, the use of paper and

manual notifications is part of the S8 management

not possible to gather data and act promptly? The

process.

Western Australia S8 management process, like most

Doctors have long been concerned about the

other states, relies on paper collection of data, manual

‘doctor shopper’ and have for decades sought an

processing and manual follow up. Staff and resources

Is this a deficient process? Or is it just technically

Author Info

issues magnify the S8 problem.

Phillip Shepherd is CEO of MediSecure Pty Ltd. With over 30 years experience in manufacturing, technology and information strategy, Phillip previously worked with community pharmacies in e-commerce and supply chain and with general practice in practice management software, e-commerce supply chain and e-health programs. Phillip has a detailed understanding of the business drivers that are essential for success in e-health adoption in primary care.

According to Medical Forum WA: “The ... Education

and Health Standing Committee report on Changing Patterns in Illicit Drug Use in Western Australia ... echoed the idea of addiction to dangerous prescription drugs coming from long wait times to see a specialist and it said there was deficient tracking of opiate scripts due to a three-month delay before they appeared on

12 Pulse+IT

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the WA Health database.”2

Very simply, if every prescription for S8

of all S8 dispensing remains a continuing

medicines was transmitted to an AS4700.3

cost. Utilisation of an AS4700.3 compliant

system is a dinosaur.

Quite clearly, the S8 management

compliant Prescription Exchange Service

PES can automate the entire S8 process

Capacity to manage doctor-shoppers

(PES) — such as the MediSecure Script

with more timely reporting to state

with timely and focused intervention is

Vault — from the medical practitioners’

authorities, immediate flagging of patients

severely limited when the management

clinical software, then the Coroner’s

with multiple S8s and other non‑standard

process involves procedures like those in

recommendation for an (almost) real-time

S8 events.

Western Australia. Note that the primary

prescription monitoring system would be

data collection point in most state systems

in place. Monitoring of prescriptions would

two PES services, but unfortunately no

is at the pharmacy end of the process, that

not take place within the PES, but in a

interoperability at present. MediSecure is

is, at the point of dispensing.

third party service as defined by NEHTA in

committed to full interoperability. When

The Victorian Coroner called for a more

It is acknowledged that there are

the ETP Release 1.1 specifications.

this operates a doctor can choose to send

effective system, based on the prescribing

the S8 e-prescription to any approved PES

end. Did he have in mind a system that

the NEHTA Release 1.1 specifications

provider.

would identify the problem patient when

at an operational level. This includes a

they were sitting in front of a doctor, and

patient Individual Healthcare Identifier

Victorian Coroner’s call for S8 management

where positive intervention action could

field (IHI) in the e-prescription meta-data

can be implemented. Community harm

occur?

on the outside of the secure prescription

from S8s will be diminished; individual

MediSecure’s MDSv2.0 software meets

With a small change in thinking, the

There is a simple and effective answer

message. The IHI allows for individual

patient and doctor benefits will accrue with

for S8 management as outlined by the

medicines management, a key service for

no additional work, and pharmacy data

Victorian Coroner. Based on an existing

patients. With a medicines or S8 code in

reporting will be more accurate, timely and

e-health system that works and is

the meta-data, S8 and doctor shopping

automated.

deployed in many medical practices across

management can commence.

all states and territories, the system has

been developed, deployed and is operated

to receive a pop-up after they print the S8

1. O’Brien M. Wide support for real‑time

by the private sector under clear privacy,

prescription but before handing it to the

prescription monitoring call. http://

security and standards requirements.

patient to inform them of how many S8

www.medicalobserver.com.au/

Commonwealth and State Governments

scripts that patient had collected in the

news/wide-support-for-realtime-

have not spent taxpayers funds to deploy

past 90 days. The clinician could then make

prescription-monitoring-call

it, but they are the major beneficiary

an informed judgment: intervention; hand

2. McEvoy R. Stolen Scripts Just a

of the efficiencies, savings and benefits

over the S8 prescription; or refuse service.

Symptom? http://www.medicalhub.

generated by this e-health system.

com.au/wa-news/guest-opinion-

prescriptions

The

existing

Electronic

Transfer

Any prescribing clinician could elect

When all doctors send all their to

AS4700.3

Prescription

place and adding value for prescribing

simple,

clinicians.

economic

service can manage S8 patients. The

monitoring: pharmacists, patients and

advantage to participating pharmacies

necessary infrastructure is in place. The

prescribers. Medical Forum WA October

and can carry a secure e-version for every

frustration of doctor-shoppers and the

2011.

computer‑written prescription. By using

danger of the current S8 management

ETP, management of S8 prescriptions and

system can be relieved.

communications-in-practice/

doctor shopping can be addressed.

emedication-management

is

delivering

effective,

Services,

this

editorial/3680-stolen-scripts-just-a-

of Prescriptions (ETP) system is in It

Exchange

compliant

References

no-cost-for-clinicians

At the pharmacy end, manual reporting

symptom 3. Bangor‑Jones R, Keen N. Opiate

4. http://www.nehta.gov.au/e-

www.pulseitmagazine.com.au www.pulseitmagazine.com.au

Pulse+IT 15

EDITORIAL

Why bother with eScripts?

While the immediate benefits of eScripts can already be seen in some quarters, the true value of ETP (Electronic Transfer of Prescriptions) is not well understood by many.

ETP is a key enabler for Australia’s eHealth plans, and one from which we can expect to reap far-reaching benefits relatively soon.

The business case for our National eHealth Program is dependent on medication management, and to do this properly we need to include data from all relevant sources, including doctors, pharmacies, hospitals, and aged care settings. A Wave 2 project called MedView — which is built upon technology from eRx Script Exchange — does exactly this in a way that is efficient and effective.

Roger Boot

B.Agr.Ec. (Hons), Grad. Dip. IT, Masters Sci. Tech. Commercialisation eRx Script Exchange Vendor Manager roger.boot@erx.com.au

It is now two and a half years since the first

Medical Director, Stat Health or Zedmed in conjunction

Australia‑wide platform for eScripts, eRx Script

with eRx can now see whether their patients have

Exchange (eRx), was launched. Since May 2009, over

collected their medicine, as well as the trade name of

220 million scripts have been successfully downloaded

the drug dispensed. This is an optional feature which

and dispensed. 12,200 doctors and 3,200 pharmacies

the majority of doctors we speak to are keen to utilise.

have transmitted script information to and from the

exchange.

recognised. The RACGP “supports e-prescribing,

At the coal-face, Electronic Transfer of Prescriptions

which delivers considerable benefits to GPs and other

(ETP) has captured the attention and praise of the

medical practitioners”. The Pharmacy Guild sees it as “a

majority of pharmacists, but we need to continue our

vital piece of health infrastructure, creating immediate

efforts to demonstrate the benefits to doctors.

safety benefits for patients, as well as a better standard

The immediate benefits of eScripts

At an industry level, the value of eScripts is widely

of shared care between GPs and pharmacists”. And the AMA “supports the development of an ePrescribing

There are many benefits that flow from the

system as a fundamental building block for a national

introduction of eScripts. First, eScripts improve patient

electronic health system in Australia”.

safety by reducing the risk of transcribing errors during

dispensing. Second, eScripts improve the workflow

“building block”, as the AMA put it, is laid properly?

in the pharmacy, delivering efficiency benefits. Third,

Where do eScripts, or more accurately, a Prescription

patients have a better health care experience overall,

Exchange Service (PES), fit within Australia’s eHealth

as a result of improved coordination and management

plans?

of care between doctors and pharmacists. Fourth,

So how do we ensure that this fundamental

medical software platform, the doctor receives

The PCEHR Business Case relies on Medication Management

dispense history data delivered seamlessly into the

The Deloitte National eHealth Strategy of 2008

patient’s clinical record. Doctors using Best Practice,

emphasised the difficulty in accurately quantifying

when an eScript service is integrated fully with the

benefits from eHealth investments. However they did

Author Info

report hard numbers for medication management in Roger Boot is an eHealth consultant who has been involved with eRx Script Exchange since its predecessor ScriptX was announced in 2008.

Roger started his working life as a jackaroo on the Hay plain, and he holds three tertiary level degrees. He has led significant IT and change management projects in the primary industries, non-profit, and health sectors.

some sectors, including that 10% of hospital admissions are due to adverse drug events, and that preventable medication prescribing errors cost Australian taxpayers at least $380 million per year. While we are at it, let’s remember reports that indicate 25% of a clinician’s time is wasted seeking information about patients.

16 Pulse+IT

www.pulseitmagazine.com.au

Following the success of last year’s event, Best Practice Software is excited to announce that the next Best Practice Summit will be held in Bundaberg in March 2012. Register your interest in attending the conference and receiving further updates by emailing bpsummit@bpsoftware.com.au Workshops will include training sessions on various aspects of Best Practice Clinical and Management as well as future directions for Best Practice, integration with other packages and conversions, etc. Keep watching the Best Practice website: www.bpsummit.com.au in the coming months for further information. And if you haven’t yet tried Best Practice, send or call for the free DVD and experience these and other features for yourself – with your own practice data (from a back-up copy, of course):• We have MIMS – Australia’s most trusted drug database • Support professionals who are truly supportive • Speed and superior stability of 100% SQL performance • Converting your data from MD2, MD3 and MedTech32 virtually automatic • No ads, bolt ons or mixed file formats to compromise performance

• Great value – subscription $907.50 (per full time doctor) for both Clinical and Management • Discounts for practices larger than 4 GPs • Half price for part time practitioners – $453.75 • No downtime for updates or time-consuming maintenance • Unique, fully integrated whole-of-practice software.

eHealth sites across Australia All States and Territories are working on innovative eHealth initiatives. Keep up to date on the latest activities. http://www.ehealthinfo.gov.au/ehealth-sites www.ehealthinfo.gov.au is jointly brought to you by Australia’s Federal, State and Territory health authorities and the National E-Health Transition Authority (NEHTA) to help you explore the eHealth concept and stay in touch with the latest innovations as they unfold.

It is fair to say the business case for the Personally

MedView is a secure, highly available repository that can

Controlled Electronic Health Record (PCEHR) relies

grow to enjoy a national coverage.

heavily on medication management. So how do we

make sure we get it right? There are many factors that

brings together a team of industry leading partners and

we could talk about here, but let’s focus on just two for

software vendors in the community, hospital, and aged

now.

care sectors. Vendors include Best Practice Software,

Zedmed, Fred Health, Simple Retail, eRx Script

Firstly, we must include data from all relevant sources

and secondly, efficient and effective workflow is critical.

medicines

information

to

a

Exchange, BossNet, Pharmhos, and iCare. Industry partners include Barwon Health, Barwon Medicare Local,

Good Medication Management includes data from all relevant sectors Delivering

Lead by the Fred IT Group, the MedView project

and Monash University.

The MedView project is focussing on targeted

regions, with a primary focus on the region covered patient’s

by the Barwon Medicare Local and Barwon Health.

clinician(s) should include as complete a picture as

Additional focus regions are being identified. The

possible. Compiling all the scripts written by a patient’s

national reach of the partners in MedView will enable

various GPs is an important step, but it is only one

rapid scaling of the solution for all Australians, if there

piece of the puzzle we need to construct. We must

are subsequent program phases.

include data from all of the clinicians involved, and that

means doctors, pharmacists, and nurses in each of the

MedView, each time their MedView registered healthcare

community, hospital, and aged care settings.

team member prescribes or dispenses medications an

electronic record is automatically sent to the MedView

MedView is a Wave 2 PCEHR Lead Site which is

Once a patient has given consent to participate in

building exactly this capability. The Commonwealth

repository and securely stored.

Government has provided funding for the development

and implementation of MedView as part of the National

clinical systems to transfer prescribed and dispensed

eHealth Program.

data between healthcare providers, as well as to deliver

this clinically valuable information to the MedView

MedView will enable authorised clinicians to view

MedView uses eRx Script Exchange and hospital

data about their patients in an efficient and seamless

repository.

process. As with eRx — the technology platform

MedView is built upon — MedView will be tightly

of HL7 CDA (Clinical Document Architecture) in Australia.

integrated into existing clinical packages, and no new

All data is encrypted using Medicare PKI technologies,

hardware or software will be required at the doctor’s

with patients’ identified electronically using Individual

practice.

Health Identifier (IHI) via the Medicare Health Identifier

MedView Medicines Repository

MedView will be the first substantial implementation

Service.

The MedView project is building a national medicines

So why bother with eScripts?

repository which:

I like to think of eScripts as some essential “plumbing”

• Provides a combined list of both prescribed and

connecting doctors and pharmacists. Like all good

dispensed medications collected from community,

plumbing, the important point is that it just works

hospital, and aged care settings.

effectively and efficiently. Most of us shouldn’t have to

• Is accessible by clinicians from their existing desktop software.

think about it, and indeed we won’t, unless it breaks.

And while this “plumbing” (with an already extensive

• Is a key part of Australia’s national eHealth program.

reach) is useful and something that some of us can get

For the first time, Australian clinicians will be able

very excited over, it’s the services that can be built on top

to see a combined list of prescribed and dispensed

of that plumbing which are the really sexy bits with much

medications, regardless of how many different doctors

wider appeal.

and pharmacies the patient has attended.

MedView is a standards-based, consent-driven,

management in Australia, and medication management

conformant repository which provides comprehensive

is a key business driver for PCEHR. The link between

records of both prescribed and dispensed medications.

these is MedView.

www.pulseitmagazine.com.au

eScripts

is

the

key

enabler

for

medication

Pulse+IT 19

BITS & BYTES Better monitoring of heart disease recognised

Zedmed releases version 17

The Latitude Heart Failure External Sensors

Zedmed has released version 17 of its

sites, which are situated in Brisbane,

from Boston Scientific has won the 2011

clinical and practice management solution

Melbourne, and the Hunter Valley region

Kerrin Rennie Award for Excellence in

for general and specialist practice. The

of NSW.

Medical Technology. The industry award

software update — a six-monthly general

was presented as part of the Medical

release — will be distributed on disk

processes involved with registering to

Technology Association of Australia (MTAA)

to all Zedmed customers throughout

interact with the Healthcare Identifier

conference, MedTech 2011, in Sydney on 8

November.

Service, and to use HPI-I (provider

November.

Leveraging the work undertaken by

identifiers) in electronic communication,

To assist practices to navigate the

The Latitude Heart Failure External

Zedmed in its capacity as a member of

Zedmed has released a 5-step document

Sensors are used to remotely monitor

the Vendor Panel, the release includes

for its customers. The company has also

the status of a patient’s implanted

functionality that allows practices to

released comprehensive documentation

cardiac device, providing regular device

interact with the Healthcare Identifier

for practices wishing to start using Zedmed

measurements and medical alerts. The

Service.

to download patient healthcare identifiers

addition of weight scales and blood

(IHI) into their practice database.

pressure monitors allows for greater

to the Healthcare identifier Service were

monitoring capabilities. Data is wirelessly

made available by the company in its

of minor updates such as the addition of

transmitted from the patient’s home, and

version 16 release a few months ago,

new vaccines, improved address book

gives physicians up to date information

version 17 is the first release to be actively

searching, and additional Inbox sorting

allowing

distributed to Zedmed customers outside

options. The software now also allows

treatment.

of the Personally Controlled Electronic

users to generate electronic referrals and

Health Record Wave 1 lead implementation

specialist letters in HL7 format.

for

early

intervention

and

“The Latitute Heart Failure Sensors are

While many of the features relating

The release also includes a number

an example of how medical technology can be used to deliver care in the home rather than the hospital.”

“Through

remote

monitoring,

potential problems like heart failure can be diagnosed and treated earlier, preventing

APNA launches new online learning material for practice nurses

or minimising hospital stays. Earlier and

APNA, the peak professional association

practical

timely intervention means cost savings to

for nurses working in primary health

a palliative approach within a general

the health system,” said Anne Trimmer,

care, has announced the release of three

practice, and identifying where a palliative

CEO MTAA.

interactive learning modules designed for

approach fits within the Advanced Nursing

The Kerrin Rennie Award for Excellence

nurses working in general practice and

Competencies. The module runs for

in

Medical Technology

other primary health care settings.

two hours and attracts two Continuing

Quality of Life recognises the innovative

Launched in October, the additional

Professional Development (CPD) hours,

and extraordinary contribution of medical

courses bring to 10 the number of online

with APNA members able to participate

technology in improving health outcomes

learning modules currently offered by

for $24.

for Australian patients. Companies can

APNA. The organisation has recently

enter products used in the diagnosis,

migrated its online training resources to

participants with an understanding of the

prevention, treatment, or management of

a new technology platform, to allow it to

management of sexually transmissible

disease and disability in Australia.

provide more educational material at a

infections (STIs), and blood borne viruses

lower cost to participants.

such as HIV and viral hepatitis, raises

—

Improving

The Restore Sensor from Medtronic

strategies

for

implementing

The second new module provides

Australasia was noted as another finalist

online

awareness of the importance of STI

in the awards, with commendations given

learning module provides primary health

testing, contact tracing, and discussing

to Siemens, Device Technologies, Baxter

care nurses working in a general practice

safe sex and prevention with clients. The

Healthcare, and Medtronic Australasia for

setting with information and knowledge

module runs for approximately 1.5 hours

its Symplicity Catheter System.

in understanding a palliative approach,

and attracts CPD hours accordingly. Access

The

first

new

20 Pulse+IT

interactive

www.pulseitmagazine.com.au

BITS & BYTES Better Health Channel releases iOS app Launched by Victoria Minister for Health, David Davis, in late September, Better Health Victoria has released a free app for Apple iOS devices.

According

to

the

Minister,

the

‘Better Health’ app “extends the reach and access of the award-winning Better Health

Channel,

which

is

Australia’s

number one health and medical website featuring the most trusted, up-to-date and easy to understand health and medical information.

“iPhone and iPad users can search for

and locate an extensive range of health

Above - An image taken from the APNA Influenza Prevention interactive online learning module.

services

throughout Victoria

doctors,

dentists,

including

pharmacists

and

to the course material for APNA members

continuing

development

physiotherapists. The app also allows

costs $21.

events. In recognition of the particular

people to get quick access to hundreds of

A limited number of free places are

needs of this nursing workforce, APNA has

Better Health Channel medical conditions

available to nurses in NSW for both of

been providing online learning material

and treatments fact sheets, anywhere at

these online modules through education

since 2006, with some courses, such as a

anytime,” said Mr Davis.

grants supplied by GP NSW and NSW STI.

module on influenza prevention, having

professional

Shedding some light on current interest

been undertaken by over 1600 participants

levels in the app, Simon Blankenstein,

damage, prevention, and screening. This

since March this year.

Manager Digital Media, Department of

interactive online module is the first in a

Mr Webster indicated that most of

Health Victoria, said that over 33,000 unique

five-part series designed to provide nurses

the current online training modules in the

users have downloaded the app since its

with the necessary knowledge and skills

APNA library present between one and

launch in late September. These people

for managing patients who are susceptible

two hours worth of material. However

have collectively used the application

to solar damage and skin cancer. Nurses

more detailed training is also offered,

around 100,000 times, with a median

undertaking the module will learn how

including a diabetes management module

session length of around 1.5 minutes.

ultraviolet radiation affects the structures

which generally takes participants between

Blankenstein added that around 70% of the

and function of the skin, develop skills in

14-16 hours to complete. The online nature

users of the app were female.

identifying high-risk patients, and find out

of the course delivery allows attendees to

how to implement preventive strategies

work through the material at their own

services database interfaces with the

in

pace, as they are able pause and resume

comprehensive Victorian Human Services

sponsorship, this training module is free

course work at any time.

Directory, which is believed to be in the

for all nurses.

has

process of being prepared for national

The third module deals with solar

their

practice.

Having

attracted

APNA has over 3000 members and

The

organisation

currently

The app’s integrated provider and

19 additional online learning courses

deployment. Such a development may,

estimates that around 60% of general

in

on

in turn, allow the Better Health app’s

practices now employ one or more nurses.

Immunisation,

Pharmacology,

developers to scale the software’s search

According to Steve Webster, General

IV Cannulation and General Practice

capabilities

Manager for Programs and Professional

scheduled to be released in the near

however the Department of Health would

Development at APNA, the vast majority

future.

not be drawn on its plans for the app’s

of practices employ nurses on a casual

Further information about APNA’s

future development, other than to say that

or part-time basis, which often makes

online learning is available via: http://www.

its library of content will be expanded in the

it difficult for nurses to travel to attend

apna.asn.au

coming months as part of a minor upgrade.

www.pulseitmagazine.com.au

development,

with

Basic

material

Pulse+IT 21

for

a

national

audience,

BITS & BYTES I-MED releases iOS apps The I-MED Network has released a pair of iOS diagnostic image apps for doctors that referring patients to the group’s practices in Queensland and Tasmania. I-MED are

University of Western Sydney to host Health Informatics Summer School in February

touting the ‘I-MED Online Queensland’ and ‘I-MED Online Regional Imaging’ apps

The University of Western Sydney (UWS)

professionals who are interested to get an

as the first of their kind in their respective

will host the 2nd Australian Health

overview of how ICT is used in the health

states, having previously deployed a similar

Informatics

(AHISS)

sector as a potential new application area

solution in Western Australia.

program in February 2012, following the

for their ICT skills. It also suits educators

Launching the Queensland app, I-MED

Summer

School

success of its inaugural summer courses,

or postgraduate students who want to

Network CEO Mark Masterson said, “We

which were held earlier this year.

get a quick briefing on health informatics

have invested significantly in this new

because they want to move into that

technology to help provide increased

steps through the basic concepts and

area.”

flexibility to doctors and we believe

principles of health informatics; health

the introduction of the I-MED Online

data coding and terminologies; clinical

many attendees, AHISS may serve as a

Queensland app will help them better

information systems; clinical decision

useful stepping-stone for further health

manage urgent patient cases and put

support and telehealth; and emerging and

informatics education and training.

treatment plans in place faster.”

future trends.

The apps are free to download from

Running over five days, the program

Professor Maeder added that for

“It is not intended to provide a

According to the organisers, each of

qualification or specific technical training,

the iTunes store, however login details

these short courses will be run as a full day

however after the week-long course

are required before any of the software’s

intensive mode classroom or workshop

participants will have the ability to become

functionality is made available to the user.

style session, delivered by a team of

involved in health informatics initiatives in

Once authenticated, doctors are able to

invited national experts and UWS Health

their workplace, and may wish to embark

access diagnostic images including MRI, CT,

Informatics staff. Morning sessions will

on further formal studies in specific topics

ultrasound and x-ray, along with a patient’s

be pitched at an introductory level, with

such as HL7, for example.”

imaging history.

the afternoon sessions providing more

detailed coverage of the subject matter.

School initiative is running again on the

The imaging group states that the

Professor Maeder, says the Summer

app will be particularly useful for referring

doctors who practice at a number of clinics,

participants to encourage interaction

program earlier this year.

and will also have applicability in scenarios

between presenters and attendees, with

where multiple doctors, potentially working

notes from the presentations to be made

a month prior to the event, and we

from multiple locations, wish to view

available to participants.

received very positive feedback in our

images simultaneously.

Anthony Maeder, Professor in Health

post-event evaluation, plus some advance

Manager

Informatics in the School of Computing

bookings for this year. We have since

Queensland, Justin Mottram, said, “Prior

Engineering and Mathematics, University

run several one‑day workshops using

to the introduction of this app, doctors had

of Western Sydney, said that AHISS will

selected educational material from AHISS

to be at their primary office or computer

be of interest to a range of people with

for organisations that wanted ‘in house’

terminal in order to receive and access

various expertise and interests.

delivery, including one overseas.”

patients’ diagnostic scans. If a doctor is on

call, out of the office, or moving between

such as doctors, nurses, or administrators

program will run from 6-10 February 2012.

facilities, they can now get instant access to

who may have some minor involvement

Prices for the course range from $150 for

new patient results and determine how and

with Information and Communications

students attending on a single-day basis,

when action needs to be taken. In critical or

Technology (ICT) in the workplace, but

through to $800 for the entire week for

urgent cases, this could help save lives.”

want to know more about the components

regular participants.

“We have ensured the app is extremely

of it that make up health informatics, and

secure with patient privacy maintained at

how these fit together within the health

including registration details is available

all times,” he added.

system environment. It wmay also suit ICT

from: http://bit.ly/uJb5Aj

I-MED

Network

General

Sessions

will

be

limited

to

30

“AHISS is aimed at health professionals

22 Pulse+IT

basis of the success of the inaugural “The first AHISS was fully subscribed

The Health Informatics Summer School

Further information about the course

www.pulseitmagazine.com.au

BITS & BYTES

Orion Health acquires Microsoft products, announces partnership Orion

the

Health having recently been selected as

acquisition of a suite of Microsoft health

Health

has

announced

a member of the National Infrastructure

software solutions marketed throughout

Partner consortium, which also includes

Southeast Asia under the brand names

Oracle and Accenture.

Amalga HIS (Hospital Information System)

and Amalga RIS/PACS.

acquisition

parties have signed a Memorandum of

The products, which were acquired

Complementing

the

product

arrangements,

Understanding

2007, were withdrawn from sale in 2010.

to co-market their health information

Microsoft has stated that their decision to

exchange (HIE) and data aggregation and

make the products available for acquisition

analysis products — Orion Health HIE and

by Orion Health was part of a move to shift

Microsoft Amalga Unified Intelligence

“resources to focus on the Amalga Unified

System (UIS) — to the public and private

Intelligence System in order to align with

HIE and integrated delivery network (IDN)

the company’s broader health IT strategy”.

markets.

hospital

information

system

their

two

from Global Care Solutions by Microsoft in

The

outlining

the

intent

Announcing the product acquisitions

is currently deployed in five hospitals

and partnership, Orion Health CEO, Ian

throughout Southeast Asia, one in each of

McCrae said the addition of Microsoft’s

Thailand, Malaysia, Vietnam, Singapore,

HIS assets “is a natural extension of Orion

and the Philippines. While not a large

Health’s portfolio of products that enable

footprint when compared with other

us to offer a complete solution to a wide

hospital information system deployments,

range of hospitals and health organisations

Wayne Oxenham, Vice President — Asia

in Asia Pacific.

and New Zealand, Orion Health, said that

under Microsoft stewardship, the product

Pacific countries is overdue to make the

had been completely overhauled, which

transformative leap to the next generation

could give its new owner a competitive

of systems which integrate the complete

advantage.

healthcare ecosystem, rather than siloing

information in individual organisations or

“Microsoft focused a lot on the

“The health sector in a number of Asia

technology, and brought it from an old VB

facilities.”

platform onto the latest .Net technology

stack. They spent three years doing this

Hospital Information System, Ian McCrae

development work, which is great for

indicated that Orion Health will integrate

Orion Health.”

a software development team of around

Orion Health indicated it will sell and

60 staff located in Thailand, providing

market the HIS and RIS/PACS software

the rapidly growing organisation with

as Orion Health HPM (Health Process

more engineering resources and a base

Management) suite. The software will

from which to expand its Southeast Asian

complement

operations.

the

company’s

existing

As part of the acquisition of Microsoft’s

range of clinical workflow and data

integration applications. Some of these

operation is absolutely world class and

products are to be used as part of the core

will be Orion Health’s fourth development

infrastructure for Australia’s Personally

centre,

Controlled Electronic Health Record, Orion

Christchurch and Canberra,” he said.

www.pulseitmagazine.com.au

“The

Thailand

the

others

HIS

development

being

Auckland,

Pulse+IT 23

MSIA

Things I should have said...

Dr Geoffrey Sayer

BSc(Psychol), MCH, PhD Immediate Past President, MSIA president@msia.com.au

I wish I had kept a diary for the past two years during

generally working under different political ethos. Given

my time as the Medical Software Industry Association

the public servants are stable over time, why can’t we

President (MSIA). The things I have seen, heard and

get sustainable change across different governments?

read have generated all sorts of emotional responses:

The focus seems, at certain levels in the hierarchy of

surprise;

frustration;

the public service, to be to stay out of the paper for

sadness; anger; and humility. Health at the best of

laughter;

disappointment;

the wrong reasons. I have come to the conclusion

times is a hot topic. Throw an “e” at the start of Health

that the public servants fear the media more than the

and all sorts of “emotional” responses are brought

politicians. It is the media that creates accountability

forward. Throughout this roller-coaster ride of ups and

in a transient way instead of instituted accountable

downs, where often you only have a narrow window to

processes as part of funding models or effective

get a point across, there are a number of things that,

political processes.

with the benefit of hindsight, I wish I had said.

The current politicians’ need both better advisors

processes. Two of these processes were the Senate

and to make public servants actually responsible

Enquiry and the Senate Estimates. The Senate

for their actions if they want to progress change.

Enquiry for the Health Identifiers legislation was a

The political process is a short-term cycle and the

new experience for me. The signing of the paperwork

objective seems to be simply to stay in power. We

before appearing was extremely serious as deliberate

should accept this as a fact of how politics works. It is

misrepresentation carries penalties, and rightfully so.

not as complicated as they would want us to believe.

At the time, industry was at logger-heads with anyone

More time (and money it seems), is spent on spin

who crossed our path, and we had profile regarding

doctoring rather than calling to account the people or

patient safety and the proposed implementation plans.

organisations that money is provided to.

In the political process there are accountability

On the way down to Canberra in the car with my

I was fortunate enough, I think, to meet senior

MSIA colleague we were being lobbied — the only way

politicians. It seems to me they are incredibly busy

I could describe it — by all sorts of people to be on our

and are incredibly nice when dealing with the punters.

best behaviour and present a positive industry position

I was told by a cynic they are paid to be nice and it is

at our representation. That was not hard to do as

not genuine, but I will give those I met the benefit

industry had a clear message — we wanted the Health

of the doubt. They are good at appearing genuinely

Identifiers, and it was the one thing that we all thought

concerned about your issues. But I have come to the

would be good for the eHealth agenda.

conclusion they really are being let down by the people

who are supposed to be implementing the policies

who were not very clear in their responses when

they announce. If one examines the senior ranks of the

they should have been. The accountability was also

public service, many have been there for many years.

inconsistent on the Senator’s side. A Senator lounged

They are career public servants. The same people

around in his chair asking each speaker their thoughts

What was strange was the performance of others

on benefits versus risk in a haphazard manner rather

Author Info

than one of meticulous consideration. It seemed he As well as being Immediate Past President of MSIA, Geoffrey is Head of Operations, HealthLink. He has spent the past 20 years working as an epidemiologist. For the past 10 years Geoffrey has occupied senior management positions in medical software companies.

wasn’t as learned as he made out, or at least was convincing us that he wasn’t, but was afforded the luxury of keeping account for this important piece of legislation. I thought that day I could make a great Senator. I could slouch around, duck in and out for apparently more important things and ask random,

24 Pulse+IT

www.pulseitmagazine.com.au

ill-formed questions as well as anyone.

politicians I have met in the past two years.

While there are things that I should have

Basically be difficult without being helpful.

In the world of business, if I was a share

said, I am sure there are things I should not

I wish I had said “Can I get paid for what

holder in a company and I contributed 50%

have. Despite the frenetic pace that the

you do too?”.

of the capital, I would take a vested interest

eHealth agenda is facing and its potential

Looking at the Senate Estimates

in how that money was being spent. I

derailment in many eyes, it is not too

process, the level of drilling down appears

would want know how that company was

late to look at what can be achieved if

limited, and the Senators appear to

going against the stated goals and the

we effectively work together to deliver

have different levels of performance

business plan of activities. I would want to

the building blocks of eHealth. It is still

depending on the level of briefing or

have my interests represented well in the

possible if we harness the good will and

advice they have been given. eHealth

form of directorship/s, and would also want

the money that has been allocated to the

can be complicated and detailed, but if

to have a big say in who the Chair of the

eHealth agenda. Industry can help if they

one is serious about $467 million, then

Board was as well. I would expect the board

are helped. It has to be a constructive and

one should make an effort to apply $467

would call to account management of the

effective action-generating outcomes. It is

million of accountability to the equation.

company in terms of their performance.

a hard task before us at best, so let us not

The fact that it commands so little time on

While the Chair and directors would need

make it harder than it already is. Simple,

the Senate Estimates agenda indicates to

to ensure they complied with appropriate

simple, simple steps is all that is needed.

this untrained eye that it is not really taken

board-type responsibilities through the

These steps will have lasting effects and

seriously, and there are more pressing

year, when it came to the AGM I would be

stimulate innovation and creativity in the

issues requiring accountability.

using my vote to show my appreciation

market place.

I find it odd that governments deal

by continued support or disdain by having

in millions and billions of dollars, but at

them removed, or asking why individuals

the $467 million that is not accounted

times really don’t seem to care about how

in the senior management in charge of

for?” Any simple calculation of announced

the money is being used when deciding

delivering the business objectives had

funding seems to have $10’s of millions, if

how that money will be spent. One of my

not been removed. I am perplexed why

not a lazy $100 million, unaccounted for.

business mentors taught me early to spend

that has not happened with companies

Why can’t that money be used to assist

money as if it is actually yours. The idea

regardless of whether they are ‘for profit’

industry broadly to get the foundation

is you value your own money more than

or ‘not for profit’. I am also perplexed by

pieces in place, like Health Identifiers,

someone else’s. While it did encourage

the adage that “people are working really

terminology

me to spend wisely, I actually feel more

hard” so I should be appreciative. I thought

across all sectors? This will deliver greater

responsibility when it is someone else’s

in any organisation it was about results —

benefits and improve the effectiveness and

money, and have tried to always be frugal

short term and sustainable asset growing

efficiency in health and healthcare delivery

and get the most out of money, whether it

activities. While I am sure shareholders

than a Personally Controlled Electronic

be research grants, budgetary figures, tax

like to hear people are working hard, they

Health Record (PCEHR) system alone.

payers, or company money.

actually like to know what results they

Furthermore, it will enhance the PCEHRs

In conclusion: “Where is the rest of

and

secure

messaging

I think we lose accountability when

are getting. It is what shareholder value

that are already in existence and support

we are not paying for clear outcomes. The

or outcomes have been delivered that

the uptake of existing ones. This will be a

accountability for public money is too much

matters. I wish I had a said to one Chair: “If

lost opportunity if this money is not wisely

after the fact with Auditor General reports.

Kerry Packer had given your organisation

spent with the broader industry to bring

Why isn’t there built-in accountability

$150 million, given the results, would you

them to the table to deliver change. If

as we go along with public money? Real

still be Chair of this organisation?” I could

we don’t engage the wider industry now,

‘lessons learnt’ as we go along. Why do

have followed up with: “Would the CEO

they will wander off and pursue things

governments try to distance themselves

still be the CEO?”

that really matter. eHealth dreams will be

from keeping a timely, closer, accountable

It is what happens next that really

remembered as lost opportunities, good

and transparent view of how public money

matters. We have all had experiences

money after bad again, like the ghosts of

is spent? I wish I had said that to the many

in our past that we would like to forget.

eHealth past.

www.pulseitmagazine.com.au

Pulse+IT 25

NPS

Electronic transfer of prescriptions: An important step for improving medication management Jane London

Senior eHealth Program Officer NPS: Better choices, Better health jlondon@nps.org.au

Since the release of two Electronic Transfer of

be interpreted and adopted by vendors. However, what

Prescription (ETP) solutions in early 2009, the general

potential does this open up in ETP? The first additional

practice community has looked on with interest. Both

benefit from ETP that we will see is the ability to view

vendors have similar offerings. Once a practice has

consolidated medication lists.

installed and configured one or both ETP solutions, the

software works in the background, sending prescription

information that they actually want ready access to,

information to the relevant prescription exchange

consolidated medications lists will enable consumers,

service, where it can be ‘drawn down’ by pharmacists

GPs, pharmacists and other relevant providers to view

into their dispensing system after a barcode on the

prescribed and dispensed medicines for a consenting

script has been scanned.

patient. This can assist in reducing doctor shopping,

Over the two years since their release, both services

improve the management of medicines, and assist

have matured. They are now more stable and work with

with medication reconciliation, especially at transitions

a greater number of prescribing systems. This progress

of care. There are also a range of health literacy

gives the eHealth and general practice communities

benefits that can be built in to help consumers better

an opportunity to look afresh at the products and

understand their medicines.

ask, “What do they currently offer, what changes are

vendors planning, and what will ETP products look like

prescriptions to be legally completed with e-signatures.

as they evolve?”

The removal of the need for a physical signature will

Often noted by clinicians as the shared health

NEHTA is working with jurisdictions to allow

The products as they currently stand offer some

allow potentially beneficial practice workflow changes.

benefits. An ETP system allows pharmacists to

For example, patients might collect prescriptions from

spend less time keying in data, potentially reducing

a central point, such as reception, or even have the

transcription errors and allowing more time for

script emailed to them. There will be more flexibility as

patient interactions. However, there seems to be little

patients will simply require a token (such as a barcode)

immediate benefit to the general practitioner: no

to have their medicine dispensed. This token may be

workflow savings and no financial incentives.

printed on something that looks like a prescription,

but could equally be populated with relevant health or

Enter the National E-Health Transition Authority

(NEHTA) and Standards Australia. The current focus

medicine information.

on eHealth has promoted considerable action in the

standards space. Only time will tell how ETP Australian

practice workflow efficiencies, but the future potential

Technical Specifications (due to be released soon) will

of ETP is exciting. Future developments are not that

The current world of ETP does not deliver GP or

far away. As ETP is accessible to the majority of GPs

Author Info

now, it is worthwhile for practices to investigate Jane London is a Senior e-Health Officer within the eHealth and Decision Support Team at NPS: Better choices, Better health. She is the project lead for an electronic transfer of prescriptions awareness raising activity that NPS is currently developing. Jane has extensive experience in working with general practice to develop and implement clinical and eHealth solutions.

available systems, and get actively involved in the eHealth medication management environment. Only with a critical mass of users will ETP systems continue to evolve, and begin to deliver additional benefits that will add value for consumers and streamline practice workflows.

26 Pulse+IT

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NEHTA

NEHTA and vendors plan for wider use of AMT Bettina McMahon

Policy and Information Services NEHTA bettina.mcmahon@nehta.gov.au

The National E-Health Transition Authority (NEHTA)

and a lack of guidance material on how to implement

has released a plan to accelerate uptake of the

AMT has inhibited more widespread adoption. Vendors

Australian Medicines Terminology (AMT). Developed

have also expressed concern about the lack of an AMT

with the software industry, the plan helps vendors to

roadmap, which would help them determine when to

make a decision about if and when they want to include

implement.

AMT in their software.

Ultimately, NEHTA’s long term goal is semantic

Implementation Group discussed the level of adoption

interoperability. The plan works towards this goal while

of the AMT in Australian health software. With

acknowledging the different approaches vendors can

representatives from the Department of Health and

adopt, and being realistic about what steps vendors are

Ageing, NEHTA, Medicare Australia, the Medical

willing to take at this stage in our progress.

Software Industry Association, Australian Information

In

mid-2011,

the

eHealth

ICT

Industry

A standard clinical language is essential for

Industry Association, Australian Association of Practice

a distributed eHealth system to work. We need

Managers, and Aged Care IT Vendor Association,

consistent clinical terminology in the healthcare

this group meets monthly to discuss eHealth

systems across Australia, which are communicating

implementation.

with each other and connecting with the PCEHR.

of AMT by addressing the barriers to uptake, and

The AMT is a national terminology of medicines,

which

assists

interoperability

between

clinical

The group wanted to accelerate the adoption

asked NEHTA to work with the group to develop an

information systems. A derivative of the international

implementation plan.

terminology SNOMED CT, it includes concepts,

identifiers, and descriptions. It provides a standard

Implementation Plan is an important step in addressing

national approach to the identification and naming of

the barriers to adoption identified by vendors. It puts

medicines.

AMT in the context of other activity by vendors and

Initially released in December 2007, the AMT

governments, and includes a number of commitments

has been implemented in some systems — most

by NEHTA to release products to support the

notably across the Department of Health Victoria in 12

increased adoption of AMT. These include a guide to

hospitals. Other implementations underway include

implementation, a list of reference implementations,

The Department of Health and Ageing’s Pharbiz

mapping guidelines and a governance model. The

Pharmaceutical Benefits Scheme system, and the

mapping guidelines have now been published1 and

Personally Controlled Electronic Health Record lead

the implementation guide is on track for external peer

site implementations.

review in November, with publication in December.

However, limited drivers for vendors to adopt AMT,

Released

in

September

2011,

the

AMT

The plan takes a staged approach with phase

one concluding in June 2012. The first phase builds

Author Info

on work currently being undertaken by vendors to Bettina McMahon leads the Policy and Information Services area at NEHTA, incorporating the policy and privacy functions, national product catalogue and supply chain, clinical terminology and information and Healthcare Identifier (HI) Service operations. Bettina has been with NEHTA since September 2009 and was initially NEHTA’s Head of Policy and Privacy.

map AMT to their proprietary medicines databases.

While this step doesn’t result in benefits like improved decision support in systems, it is required for communication of medication information between different clinical systems and is necessary for lead PCEHR implementations. Future steps will include

28 Pulse+IT

www.pulseitmagazine.com.au

Proposed AMT Implementation Maturity

Required Direction of Travel

Extent of AMT implementation

Phase 3

Native AMT

Extemporaneous Prescribing

Phase 2 Advanced Decision Support

Hospital (Pack and Dose Based) Prescribing

Mapping (Full AMT coverage) Phase 1

Basic Decision Support

Primary Care (Pack based) Prescribing

Mapping (preliminary coverage)

AMT used in e-health Summaries

Single Virtual Med Record (Incomplete)

ETP Primary care Allergies and ADRs

ETP Outpatients

Extract from Compliance and Basic drug doubling and multiple sources concordance contraindication checking with EHR integration

Computable Dose Integration with EHR events

Complete single medication record Regime Critique

Capabilities Supported & Facilitated

support for vendors moving away from mapping to an

unambiguous

implementation of the terminology and information

across different healthcare settings will not only create

models within their systems.

efficiencies in medications management, it is a critical

piece in the solution to reduce adverse drug events,

Further to the detailed activities to June 2012, the

plan describes the development of an AMT roadmap, which we will derive from consultation with a wider

communication

and

interpretation

which could save thousands of lives every year.

group of vendors, implementers and stakeholders. This

Further Information

roadmap will, for the first time, give vendors a level

NEHTA has been tasked by the governments of

of surety of deliverables, enabling them to factor in

Australia to develop better ways of electronically

new enhancements and features of the AMT into their

collecting and securely exchanging health information,

product development life cycles.

and is the lead organisation supporting the national

vision for eHealth in Australia. For further information

This work will begin shortly so that the next phase

will be able to begin on schedule in July 2012. NEHTA

on NEHTA’s work, visit: http://www.nehta.gov.au

will work with industry to identify and prioritise missing

elements of AMT that could be identified as barriers

terminologies@nehta.gov.au

to use. These may include areas of technical delivery,

For specific information about AMT, please email:

additional use cases, clinical safety, and possible links

References

to other systems.

1. https://nehta.org.au/aht

The plan is available online and will be updated

2. http://www.nehta.gov.au/connecting-australia/

periodically to reflect new information to increase

terminology-and-information/clinical-terminology/

the use, and ultimately the benefits, of AMT. Enabling

australian-medicines-terminology

2

www.pulseitmagazine.com.au

Pulse+IT 29

EVENTS

NOVEMBER ACAA National Congress 6 November - 8 November Broadbeach, QLD P: +61 7 3725 5555 W: www.acaa.com.au EHI Live 2011 Conference 7 November - 8 November Birmingham, UK W: www.ehi.co.uk Medical Technology Association of Australia Medtech Conference 8 November Sydney, NSW W: www.mtaa.org.au Society of Hospital Pharmacists of Australia National Conference 10 November - 13 November Hobart, TAS W: cpd.shpa.org.au GPCE Melbourne 11 November - 13 November Melbourne, VIC P: +61 2 9422 2700 W: www.gpce.com.au RMIT E-Health Symposium 12 November Melbourne, VIC P: 03 9426 6666 W: www.epworth.org.au 3rd Australian Rural and Remote Mental Health Symposium 14 November - 16 November Ballarat, VIC W: anzmh.asn.au

Australian College of Emergency Medicine ASM2011 20 November - 24 November Sydney, NSW P: +61 2 9213 4000 W: www.acem2011.com

The Inaugural Forum For Suicide Prevention Policy in Australia 2011 5 December - 6 December Melbourne, VIC P: +61 2 9080 4119 W: www.informa.com.au

4th ICST International Conference on eHealth 21 November - 23 November Malaga, Spain W: www.electronic-health.org

Health Services and Policy Research Conference 5 December - 7 December Adelaide, SA P: +61 8 8379 8222 W: www.hsraanz.org

HINZ Conference and Exhibition 2011 23 November - 25 November Auckland, NZ W: www.hinz.org.nz/page/conference HL7 Identification and Coding Implementation Workshop 24 November Melbourne, VIC W: www.hl7.org.au 1st Australian eHealth Research Forum 25 November Melbourne, VIC W: www.achi.org.au 2nd Annual Healthcare Complaints Management Conference 28 November - 29 November Melbourne, VIC P: +61 2 9080 4300 W: www.iir.com.au International Conference on Education, Informatics, and Cybernetics 29 November - 2 December Orlando, Florida, USA W: www.2011conferences.org/iceic

DECEMBER

Australian General Practice Network National Forum 2011 16 November - 19 November Melbourne, VIC P: +61 2 6228 0800 W: www.gpnetworkforum.com.au

Successes and Failures in Telehealth 1 December - 2 December Brisbane, QLD P: +61 7 3876 4988 W: www.icebergevents.com/sft11

HIMSS Europe Health IT Leadership Summit 20 November - 22 November Geneva, Switzerland W: www.hitleadershipsummit.eu

Dental Healthcare Policy Forum 1 December - 2 December Melbourne, VIC P: +61 2 9080 4300 W: www.informa.com.au

30 Pulse+IT

mHealth Summit 5 December - 7 December Washington, DC, USA P: +1 301 402 5311 W: www.mhealthsummit.org Australasian Society for Psychiatric Research Conference 5 December - 8 December Dunedin, NZ P: +61 2 9368 1200 W: www.iceaustralia.com/aspr2011/ 3rd Annual Reducing Medication Errors Conference 7 December - 8 December Melbourne, VIC P: +61 2 9080 4300 W: www.iir.com.au

JANUARY IT @ Networking Awards 18 January - 19 January Brussels, Belgium W: www.itandnetworking.org Certificate IV in Practice Management Brisbane, QLD 21 January (commencement) P: 1800 288 622 W: www.practicemanagement.edu.au

FEBRUARY Certificate IV in Practice Management 4 February (commencement) Sydney, NSW P: 1800 288 622 W: www.practicemanagement.edu.au

www.pulseitmagazine.com.au

EVENTS

3rd Annual Clinical Documentation, Coding & Analysis Conference 20 February - 22 February Melbourne, VIC W: www.iir.com.au/clinicalcoding 3rd Annual Technology in Healthcare Summit 2012 27 February - 28 February Sydney, NSW P: +61 2 8908 8555 W: www.acevents.com.au

MARCH Best Practice Summit 2012 8 March - 10 March Bundaberg, QLD P: 07 4155 8800 W: www.bpsummit.com.au Certificate IV in Practice Management 10 March (commencement) Melbourne, VIC P: 1800 288 622 W: www.practicemanagement.edu.au Diploma in Practice Management 10 March (commencement) Brisbane, QLD P: 1800 288 622 W: www.practicemanagement.edu.au

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Australian Healthcare Summit 2012 13 March - 14 March Sydney, NSW P: +61 2 9008 1101 W: www.activebusinesscommunications. com/health

Diploma in Practice Management Melbourne, VIC 14 April (commencement) P: 1800 288 622 W: www.practicemanagement.edu.au

4th Annual National Telemedicine Summit 22 March - 23 March Sydney, NSW P: +61 2 9080 4300 W: www.iir.com.au

MAY

Data Governance 2012 29 March - 30 March Melbourne, VIC P: +61 3 9326 3311 W: www.hisa.org.au/DG2012

APRIL Oral Health Meets e-Health Symposium April (TBC) Melbourne, VIC P: +61 3 9341 1558 W: www.oralhealthcrc.org.au Certificate IV in Practice Management 14 April (commencement) Adelaide, SA P: 1800 288 622 W: www.practicemanagement.edu.au

Diploma in Practice Management Adelaide, SA 5 May (commencement) P: 1800 288 622 W: www.practicemanagement.edu.au Certificate IV in Practice Management 19 May (commencement) Perth, WA P: 1800 288 622 W: www.practicemanagement.edu.au

JUNE Diploma in Practice Management 2 June (commencement) Sydney, NSW P: 1800 288 622 W: www.practicemanagement.edu.au

Online Calendar

To view a comprehensive list of Health IT, Health, and IT events, visit the Pulse+IT website: http://bit.ly/gFr0Vk

Pulse+IT 31

FEATURE

Lessons learned in Electronic Medication Management Joan Ostergaard

Strategic Product Manager InterSystems TrakCare Joan.Ostergaard@InterSystems.com

Electronic medication management systems offer

allergy and drug interaction incidents, as well as

the promise of significant benefits, including reduced

savings through better inventory control and support

medical errors, better compliance, time savings, cost

for pharmaceutical substitution.

savings, and better drug safety.

However, early adopters have described a number

involving many functional areas within a healthcare

of limitations and clinical risks associated with first

organisation. Having a functioning electronic system

generation systems. These range from making wrong

in itself — even a state-of-the-art one — does not

drug selections from electronic pick lists, irrelevant

guarantee good practice, or that all the expected

alerts which reduce productivity, to the duplication of

benefits will be achieved.

data entry across different departments.

Despite

these

problems,

the

adoption

But medication management is a complex area

It is better to implement a system meeting a

of

limited set of objectives — and limited issues to resolve

medication management systems continues to gather

— to demonstrate clear benefits at the end of the day.

pace. Few, if any, organisations have pulled the plug

This provides a solid platform to achieve additional

on new electronic medication management systems.

objectives and benefits over time, as opposed to a

While not always documented in the same detail, the

large implementation — with a promise of ‘everything

benefits of these systems still outweigh the negatives.

for everyone all at once’ — that remains mired in

The reduction of medication errors is particularly

unresolved issues.

difficult to measure because institutions do not have

reliable statistics. This does not mean that serious

In some healthcare jurisdictions there are incentive

medication errors do not occur, as pointed out in the

payments for electronic prescribing, and an initial

seminal work ‘To Err is Human’ by the Institute of

objective is simply accurate reporting to be able to

Medicine.1

receive these payments. Many hospitals want to better

Initial objectives will vary between organisations.

That said, it is important not to ignore the pain that

manage scheduled or dangerous drugs to increase

early adopters have experienced. So, what are some of

safety, comply with regulations, and prevent losses

the important lessons that we have learned so far?

through theft. This may not be a priority for a small day

Set clear objectives Almost all of our clients are currently implementing

surgery, but it may be for a hospital with a large and complex case mix.

or have plans to implement electronic medication

Close the loop

management capabilities, if they have not already

The term “electronic medication management”

done so. Among early adopters of InterSystems

describes

TrakCare, hospitals have reported reduced adverse

prescribing, dispensing, and medication administration.

a

system

which

includes

electronic

Author Info

This reflects the current trend for healthcare Joan Ostergaard is a Product Manager at InterSystems, focused on the strategic product direction of InterSystems TrakCare™. Her role includes market, business and technology analysis, and vendor relationship management. Previously she has worked at Kodak in positions including Clinical Consulting and Education Director for Asia Pacific, and Applications Manager across multiple geographies. She is a qualified Radiation Therapist and holds an Advanced Certificate in Management.

organisations to seek benefits that are most easily achieved using a “closed loop” approach.

Medication errors are one of the biggest sources of

preventable errors for most healthcare organisations.

Electronic medication management systems can reduce errors associated with illegible handwriting or ambiguous nomenclature, uncertainty about drug

32 Pulse+IT

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At we’d rather catch you than catch you out

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Not letting you fall. Ever.

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Support and guide our clients through every step of the process.

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When your Practice is ready, GPA ACCREDITATION plus will liaise with you to organise a survey visit conducted by experienced surveyors. “GPA ACCREDITATION plus surveyors were very helpful, which made everything run smoothly on the final stage of accreditation – there were no surprises!!” If that sounds different to the way you’ve been used to, call GPA ACCREDITATION plus and let’s get started. call us now on: 1800 188 088 or log on to: www.gpa.net.au

dosing, and interactions between drugs.

pharmacy system? If they decide to integrate, should

But systems which are not connected hold less

they plan to phase out their legacy systems at a later

promise of reducing medication errors. An ePrescribing

stage? What are the trade-offs in terms of increased

system may provide a care provider with access to a

complexity with an interfaced or even integrated

drug database and decision support system, but not

system, versus the capacity of users to adapt to a

connect with a pharmacy system. So the prescription

completely new system?

may need to be printed, taken to the pharmacy and

re-entered when it gets there, duplicating data entry

will have its own objectives, necessitating their own

and introducing the risk of transcription errors.

individual adoption plans. And, since staff can only

Even if the ePrescribing and pharmacy systems

cope with so much change at once, these adoption

are connected through interfacing, they may not

plans need to be staged and ongoing, and acknowledge

use the same information sources. The prescribed

that systems and requirements will continue to change

drug may have different names, or be listed by brand

over time.

rather than generic description, multiplying the risk of access to the same electronic patient record. While

Involve stakeholders and communicate benefits

the prescribing doctor knows all about the patient,

In healthcare organisations, resistance to change

the same clinical information may not be visible to or

is almost inevitable. Clinicians may be reluctant to

even available to the pharmacist. Both systems may

migrate away from a standalone system they are loyal

generate contraindication alerts, but in one system

to, or resent the effort involved in data entry with a

the reason for over-riding the alert is visible, and in the

new system.

other it is not. This may necessitate a phone call from

the pharmacist to the prescribing doctor, wasting time.

from the early stages. With a flexible and configurable

And the whole scenario may be repeated again when

platform, organisations can create solutions which

it is time for the nurses to administer the drug to the

are easier to use, more functional, and with access to

patient.

far more information than the legacy systems that

picking errors. In addition, the pharmacy may not have

Reducing medical errors, achieving time savings

through

reduced

data

entry

and

That is why it is important to involve stakeholders

clinicians are familiar with. Organisations also need

unnecessary

to invest in training. The system may be easy to use,

communications, and cost savings through better stock

but clinicians are busy and usually respond best to

control and reduced wastage are all easier to achieve

task‑based and incremental learning opportunities.

with a unified healthcare information system, which

includes medication management functionality, with

environment, they will also become open over time

all data residing in a single repository.

to valuing the benefits achieved by upstream and

Plan for adoption

34 Pulse+IT

To complicate matters further, every organisation

While users will initially focus on their own

downstream users. Additional data entry may be required. But if it is seen as benefiting others by driving

Most healthcare organisations — particularly in

additional functionality elsewhere in the cycle, users

advanced countries like Australia — face barriers in

will be more accepting of the changes involved.

implementing electronic medication management.

Most already use a number of specialised systems with

measuring the benefits achieved and regularly

loyal clinical user bases, many of which have a role

communicating them with stakeholders. Rather

in medication management. Standalone pharmacy

than initiating this after implementation, measuring

systems are widely deployed, and ePrescribing and

benefits against objectives should be planned from

nursing systems also exist in various forms.

the outset so that they can be demonstrated as early

Organisations can accelerate this process by

Organisations going down the closed loop path

as possible. Healthcare information systems with

have some difficult decisions to make. Should they

embedded analytics make it easier to automate the

replace existing systems with a single healthcare

measurement of benefits and report against KPIs. That

information system? Or should they integrate a

way, users of the system can see their own roles as

new system with, say, their existing ePrescribing or

part of the overall effort of delivering improvements in

www.pulseitmagazine.com.au

medication management, rather than working within

from clinical users of early systems. Alerts about

isolated units.

contraindicated medications, for example, are a

Maintain good practice

powerful tool that can cut down on medication errors.

But clinicians have complained that they are constantly

Modern healthcare information systems contain

having to deal with more alerts than they need to do

an ever‑expanding array of sophisticated clinical

their jobs.

functionality designed to make life easier for care

givers. So it is understandable that users expect to be

and this may need to go beyond a user’s specific role

able to rely upon the support of electronic medication

to also take into account their level of experience

management systems.

or seniority. Recent InterSystems’ development

Systems need to have the capacity to filter alerts,

The problem is that systems are not a replacement

provides the prescriber with a unified view of alerts

for clinical knowledge or clinician engagement with

and a friendly way to action them. The display of

patients. Implementing a good system does not excuse

alerts and the need to record an override reason can

organisations from doing the hard work of determining

be constrained by severity of the risk. This important

exactly how that system should maintain and improve

information provided by the prescriber is available to

upon existing good practice.

the dispensing pharmacist and administering nurse, so

Most systems come with a pre‑configured set

they are fully informed and assured that any changes

of rules that users need to modify to suit their own

to the patient condition between prescription and

requirements. This may include determining the

administration time are taken into account.

minimum information to be collected by the system,

configuring the kinds of alerts that different users

part of InterSystems’ current development efforts, with

will receive, management of the formulary and

advancements planned in the areas of workflow, user

standardisation of measurement units, and enabling

interfaces, medication charts, and the management of

appropriate security for users.

alerts.

Often organisations need to implement more

Medication management represents a significant

Clinical users are standing on the doorstep of the

complex rules to, for example, reflect the clinical

potential for information overload, which has long

pathway for a certain condition, such as diabetes.

been a part of other work environments. Improved

In addition to decision support systems based on

visibility of clinical information also creates the capacity

standard drug databases, this may rely on data held in

for increased stress. One of the challenges for systems

the patient record about age, weight and test results.

developers is to effectively filter information to include

Building these rules is much simpler in a unified

just the parts that clinical users need to work efficiently

environment based on common data sources.

and safely.

Make the system friendly and manage alerts

Systems developers, implementers, and healthcare

organisations all have a part to play in taking on board the feedback of early adopters of electronic medication

Making the system easy to use for all groups involved

management systems. If we get it right, not only

in medication management is a major focus for

will later adopters be spared from suffering from the

systems developers. Different users have different

same problems, but their success will pave the way for

functional requirements, and the system should allow

further advances in healthcare information systems

them to navigate across different areas without losing

involving clinical users.

track of the task at hand. Information in an electronic medication management system should be expressed

References

in a way that is appropriate to each person’s role, even

1. Linda T. Kohn, Janet M. Corrigan, and Molla S.

though the underlying data is identical.

Donaldson, Editors, Committee on Quality of

Health Care in America, Institute of Medicine.

The management of safety alerts is probably

the number one ease-of-use issue within medication

To Err Is Human: Building a Safer Health System

management systems. Distracting and unnecessary

(2000). National Academy Press, available from:

alerts have been the subject of numerous complaints

http://www.nap.edu/catalog.php?record_id=9728

www.pulseitmagazine.com.au

Pulse+IT 35

FEATURE

Medication Management – insights from the medicine 2.0 and health 2.0 conferences Having recently travelled to the United States to attend both the Medicine 2.0 and Health 2.0 conferences, Rachel de Sain shares her observations about the range of medication management initiatives she encountered.

Rachel de Sain

Director Flaxworks rdesain@flaxworks.com.au

At the recent Medicine 2.0 and Health2.0 conferences

came across was at Kaiser Permanente’s brilliant Sidney

a number of technology solutions intended to improve

R Garfield Centre for Innovation2 in San Leandro. In

medication management were presented. Most were

their mock environments they had the Maya system

software, rather than hardware solutions, however

from MedMinder3, a pill box that lights up the pills you

there was a growing interest, and clearly commercial

need to take and then turns off once they have been

demand, for both.

taken. It can also send messages to a person’s mobile

Most of the hardware solutions I encountered

or landline phone if they haven’t taken their pills within

appeared quite clunky and unappealing — big, bulky

a specified period of time, and can also escalate the

devices that are a constant reminder something is

alerts by informing the care team.

wrong, rather than a beautiful, useful device you are

happy to have out on show.

abstracts presented at Medicine 2.0, one in particular

Medication adherence was the topic of a number of

The TabSafe medication management system

looking at the option of using mobile phones and SMS

reminds, dispenses, and alerts the user. It also posts

for medication reminders. Vineet Singal presented

information on medication compliance, inventory,

an abstract based on his experience at Anjna Patient

and other health information accessible from any

Education.4 It is the first not-for-profit organisation

Internet‑capable device.

of its kind to implement sustainable health education

programs at free clinics.

1

Some will argue that older users — the primary

market for these sorts of devices — do not care about

design, but in my experience, particularly when

patients often do not follow the prescribed drug

considering the next generation of elderly, I would

regimen

have to disagree. The marriage of form and function,

This problem is nowhere more apparent than at

designing products that are not only useful but also

Schuman‑Liles, a mental health clinic in Oakland,

beautiful, is sadly lacking in a lot of medical devices, not

California, which serves over 1,000 patients monthly.

just for medication management. I believe rectifying

The clinical effectiveness of drug therapies for

this shortcoming will lead to improved adherence by

mental health at the clinic is limited by inadequate

the user.

patient adherence to the recommended protocol,

with a reported 50-70% of mentally ill patients at

Probably the most interesting hardware solution I

Even with the best in-clinic educational experience, or

educational

intervention

program.

Schuman‑Liles not following the prescribed regimen,

Author Info

regularly filling prescriptions, or attending follow up Rachel consultants on digital strategy, is part of the clinical leads & consumer reference forum at NEHTA, is a board member for HISA (Health Informatics Society of Australia), and previously held positions on the board at AIMIA Victoria and Vic ICT for Women.

appointments.5

Successful proofs of concept for mobile-based

interventions can be seen through Delaware’s Medicaid program and the CDC’s HEALTH-87000 program, the former utilising text-messaging outreach to increase the number of patients who adhered to

36 Pulse+IT

www.pulseitmagazine.com.au

Diabetes self‑management from 52.3% to 70.5% over a

increase adoption and adherence of Health IT services.

six‑month period.

The RXPact service provides incentives such as a photo

With only a laptop and a cell phone, the

of a grandchild that is unveiled when the user takes

Schuman‑Liles clinic is able to provide periodic text

their pills, providing a fun way to help people adhere to

and/or voice alerts to patients, reminding them to

their medication regimes.8

take medication or to attend follow-up appointments,

and to send educational messages about disease or

older adults with cognitive issues. Many unplanned

treatment tailored to physician recommendations.

pregnancies have occurred from lack of adherence

Additionally, patients can call or text a free number to

to taking the contraceptive pill, and to this end,

receive follow up support from health professionals

design gurus IDEO were tasked with developing a

(medical students, doctors or nurse practitioners), a

multi‑platform campaign to reach women aged 24-34.

crucial source of support for mentally ill patients. Based

They developed a series of witty and engaging calls

on health strategies discussed in the clinic, automated

to action that led to an interactive website named

reminders will be sent via text on a weekly basis to

Besider9. This platform allows the user to talk openly

patients who agree to participate in the program. At a

and learn from experts about the issues associated

rate of four texts per month, the texting program costs

with not remembering to take the pill and other forms

less than $1 per patient for six months.

of contraception. The website features a brilliant mix

4

4

Medication adherence is not just an issue for

Mobile reminders have been in use for a number

of humour and fact, with a culturally relevant twist

of years and as mobile phones get smarter, so do

to improve awareness, and in turn, develop a more

the applications for medication management and

proactive engaged patient more likely to adhere to

integration with devices such as glucose monitors.

their medication requirements.

In fact diabetes adherence has been a key area for

research to better understand how technology can

that technology can be used to improve medication

be used to support patients to adhere to medication

management, from simple reminders to integrated

regimes.

devices with alert systems. However the real success

There is significant research and evidence to prove

Tulane University has been researching the

will come when we not only use these new tools, but

use of SMS reminders for diabetics, developed by

develop them in a way that addresses the ability and

MedAdherence , and so far early results are promising

motivation of the patient to adhere to the required

with related studies showing 90% of a patient’s

routine.

6

diabetes outcome is related to self management.

7

Developing cost effective tools for medication

References

adherence was a hot topic at the Health 2.0 conference

1. http://www.tabsafe.com

with the winners of the Novartis Code-a-thon looking

2. http://xnet.kp.org/innovationcenter

to meet the growing need for services in this area.

3. http://www.medminder.com/Solutions

Health 2.0’s Code-a-Thons are live events, which occur

4. Singal V. Utilizing the Power of Text-messaging

over the course of one or more days, bringing together

(SMS) Technology to Increase Patient Compliance

developers, designers, innovators and entrepreneurs to

with Medication and Adherence to Physician

build exciting new applications and tools for improved

Recommendations and Educational Interventions

health care. These short and focused events result in

in Free Clinics. http://www.medicine20congress.

the rapid development of interesting concepts and

com/ocs/index.php/med/med2011/paper/view/711

working prototype applications that can be developed

5. http://www.schuman-liles.org/

further by the participating teams.

6. http://www.medadherence.com/solutions.html

7. Brannon K. Can Texting Improve Diabetes Care?

RXPact won first place in the event and $3000 for

their website, which records personal information and

http://tulane.edu/news/newwave/071811_diabetes.

employs social rewards and gaming to help patients

cfm

take their medications. There is a growing trend of

8. http://bit.ly/pS5OIT

using gamification, or game design theory, to help

9. http://bedsider.org

www.pulseitmagazine.com.au

Pulse+IT 37

FEATURE

A unique equation that can make eHealth a reality: PCEHR + ETP = MedView?

Bryn Evans

Director JEMS Consulting bryn.evans@ozemail.com.au

It has been widely recognised for a number of

medication history, particularly within the first 24 hours

years

that

of discharge from hospital, or treatment by another

using

electronic

improved

medication

prescribing,

management transfer

clinician. For the first time ever, MedView will provide

of prescriptions, streamlined processes and the

electronic

that, together with past history, regardless of how

consequent reduction of medication errors, can make

many different doctors and pharmacies the patient has

a major contribution to improving patient safety. Much

attended.

research has shown that medication errors of various types, are regularly found to be the largest single cause

Teething problems or stagnation?

of avoidable incidents in hospitals.

The information exchange engine which will drive

The MedView Project

MedView is Fred IT’s eRx Script Exchange (eRx) service.

The eRx service, and its competitor MediSecure, receive

One of the lead implementation sites in the Personally

indirect funding from the Commonwealth Government

Controlled Electronic Health Record (PCEHR) project,

through its agreement with the Pharmacy Guild. As

is perhaps the most important of all, MedView. This

well as backing by the Department of Health and

is a joint initiative by Fred IT Group with its eRx Script

Ageing and the National E-Health Transition Authority,

Exchange (eRx) service, Geelong Division of General

through the PCEHR project for the Electronic Transfer

Practice, and Barwon Health in Victoria. Best Practice

of Prescriptions (ETP), the National Prescribing Service

Software, Zedmed, Fred Health, Simple Retail,

(NPS) is also actively supporting and promoting the use

BossNet, Pharmhos, iCare, and Monash University are

of ETP by doctors and pharmacists.

also participating.

Yet despite so much enthusiasm and the boost

MedView will provide a web-based repository

of the PCEHR MedView initiative, ETP is at risk of

of patients’ prescribed and dispensed medications,

stagnating with an uncertain future. Many general

collected from GPs, medical centres, acute care

practitioners are not adopting ETP despite NPS

hospitals, aged care facilities, and pharmacies in the

exhorting doctors to do so. Around 80% of pharmacies

Barwon region. Doctors and pharmacists will be able

have registered with the ETP services. Pharmacy

to access MedView seamlessly from their own practice

software suppliers — even though they receive a small

systems, and see the patient’s latest medication

percentage of the transaction fee once their customers

history, regardless of where the patient has previously

are using the service — claim they are out of pocket.

visited a pharmacy and/or a doctor.

It is also understood from reliable sources, that both

of the ETP services, eRx and MediSecure, are yet to

MedView offers a solution to a long-held goal of

clinicians. Right at the top of most doctors’ wish-list is

achieve profitability.

the desire to see for a presenting patient an up‑to‑date

Why are some GPs not taking up ETP? Probably

the usual factors in varying incidence and degree, are

Author Info

to blame: incomplete understanding of the new ETP Bryn Evans is a management consultant, with many years experience as a CIO in healthcare, and as chief executive of a clinical software supplier.

He writes extensively across a range of categories and genres, notably in the areas of management, information technology, sport, travel, history and fiction.

services, resistance to change in working practices, the priority of patient care on a doctor’s time demands, and the lack of a meaningful financial incentive, in order to motivate doctors to put the time and effort into change and adoption. The Royal Australian College of General Practitioners has called for GPs to be paid

38 Pulse+IT

www.pulseitmagazine.com.au

compensation, in recognition of the extra workload of

inclusions such as non-PBS items, seems to be of some

the PCEHR and eHealth generally.

urgency.

What is the barrier for pharmacies? No doubt

Pharmacy software suppliers can probably be

similar factors to those suggested above for GPs may

allowed to reach their own commercial arrangements

be relevant. Indeed those pharmacies which have

with their clients.

enrolled in an ETP service are claimed to be making no

financial gain from providing the service.

some improved financial incentive to participate,

together with a timeframe, at the end of which is a

For the eRx and MediSecure services, a significant

Pharmacies may also need to be considered for

number of prescription transactions — comprising

penalty if not enrolled.

those generated by doctors and pharmacies not yet

using ETP (and therefore not processed) — and certain

companies, which have initiated the two ETP services,

transactions, such as non-PBS items are not recognised

have taken a risk to invest in these two ventures. If they

as eligible, and so are not generating revenue fees

do not achieve a positive return within a reasonable

from the Government. The result is low coverage of

timeframe, they will not reinvest, and these services

total prescription transactions by ETP processing, and

will be unsustainable.

consequent constrained fee revenue for the eRx and

MediSecure services.

MedView project by pharmacists and doctors, the

The critical issue is that the eRx and MediSecure

To drive universal uptake of ETP, and the PCEHR

Government should perhaps look at a legislated

The way forward

framework for participation, as has been used in the

To gain universal engagement by GPs and other

USA, which provides for both financial incentives and

doctors, some appropriate level of financial incentive

penalties over a specified period of time.

will almost certainly be necessary. But payment would

need to be subject to compliance and performance

PCEHR project can provide the infrastructure, and

criteria,

evidence of benefits, which could be the foundation

improved

patient

outcomes,

email

The successful implementation of the MedView

communication with consumers, care plans etc.

for such a regime of ‘carrots and sticks’ in appropriate

An accelerated and more comprehensive take‑up

Government regulation. Perhaps more than anything,

by doctors, is essential to achieve the profitability

the PCEHR MedView lead site project could make

of eRx and MediSecure, but time is the enemy. A

eHealth a reality.

review of the financial arrangements for prescription

transactions, and consideration of more extensive

health consumers.

And then the real benefits would be enjoyed by

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Pulse+IT 39

OFF TOPIC

Video consulting telehealth – from hospitals to the home and everywhere in between Video consulting is a big subject, within a big subject

Chris Ryan

Principal Telehealth Consultant Attend Anywhere chris.ryan@attendanywhere.com

• How are multiple players and components

(Telehealth), within a big subject (eHealth). Articulating what is involved can be like articulating the health

orchestrated?

• How do people know where, when, how, and with

system itself — not an easy task. This is because video consulting is just normal consulting with another travel

what to connect to their appointment?

• How are consumers reassured about security,

option. The trouble is that most people’s horizons only

privacy, and the credentials of the clinicians?

extend to considering the ‘transport’ components

• How do practitioners manage medico-legal issues?

(video conferencing), rather than all the end‑to‑end

• How do you leverage emerging eHealth systems

management and logistics that we take for granted under normal circumstances, and more besides.

For people who want do more than just hold a

rebates?

Skype video conference twice a year, comprehending

• Where do people go for local support?

the opportunities and issues involved is like watching

• How is end-to-end quality assured?

stars come out — you see the one or two that most

• How are reporting, audit, and evaluation managed?

closely relate to your perspective, then a few more, and

then you realise the sky is full of them. For example:

travel option, and to think about the answers to these

• How do practices easily get set up with the most

questions in terms of extending current paradigms

suitable technology for their needs?

• How do we make it really simple to bring others in without them needing to be ‘set up’?

The trick is to view video consulting as just another

where possible and then filling the gaps.

The current Australian investment in video

consulting is around $620 million, matching our current

• How do people find services and each other and

investments in eHealth projects. Yet there is very little

connect to the right place at the right time using

in the way of central building blocks, services, and

the right technology, without being in a dozen

governance by comparison. This is understandable

‘directories’?

given the history of the new MBS items — and the lack

• How do you create unique, individual video appointments for people?

• How are sessions integrated from within existing systems and workflows?

• How do you assess the practical capability of patients to do this from home?

• What policies and procedures need amending?

Author Info

and services?

• How are private fees managed in excess of

Chris Ryan is the principal telehealth consultant at Attend Anywhere, an Australian company with a long history of facilitating the sustainable inter-organisational use of people’s own video conferencing technology to exchange health services. Coming from a rural health background, Chris has played a key role in the adoption of video conference telehealth since arriving in Australia in 1995.

of bureaucracy is a good thing — however the ongoing predilection to simply invest in component parts of telehealth and not the ‘whole’ is of concern. There is no question that the current scatter-gun approach and the ‘retro-fitting’ of enabling components and information is making it difficult for people at the pointy end to decipher what is going on.

The problem with conventional operational experience A senior figure in the eHealth sector said this year “if Australia can’t lead the world in telehealth, then we should give up”. Yes, Australia has a long history of telehealth within the public hospital sector, and yes, the clinical experience gained is invaluable, and yes

40 Pulse+IT

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AAPM NATIONAL CONFERENCE

18

–

21

OCTOBER

2011

Burswood Entertainment Complex Perth Western Australia

SPONSORS

AAPM Victoria

AAPM New South Wales

AAPM Queensland

EXHIBITORS

Thank you to our sponsors and exhibitors!

AAPM and the Perth organising committee would like to thank all our sponsors and exhibitors for their ongoing support.

we have a great opportunity to leverage

an extra dimension within existing and

all of this in the face of competition from

emerging information systems and other

that virtually no one giving advice from

overseas. Operationally though, this is a

telehealth modalities. This is a green

government,

double edged sword. Conventional video

field opportunity where we can leverage

the health sector actually uses video

consulting experience at an operational

our clinical experience but build new

conferencing in the way that they are

level has predominately been within single

operational frameworks unencumbered

asking others to — i.e. daily in their own

organisational and technical infrastructures

by the restrictions of old world technology

offices to talk with lots of different people

using conventional video conferencing

and thinking.

in

architectures that date back some time, such as those used by Queensland Health.

The ‘business to business’ (B2B) or

This is new ground from an operational perspective

However it is the author’s observation

different

academia,

industry

organisations,

or

including

on an ad-hoc basis. This is indicative of

the

human,

organisational,

and

technical issues involved — it’s not as

consumer (B2C) nature of the primary

There are many experienced people in the

straightforward as people think. If people

health, home, and specialist environment

telehealth community, in the telehealth

do use video conferencing at work, it is

is very different to this. As well as the

industry, and in the video conferencing

most likely conventional technology and

inter-system and distributed nature of the

industry who have shared a passion for

usually within their own or ‘joined up’

challenge, the market is more likely to be

the value of video consulting over the

organisational networks — not what is

informed by experiences with consumer

past 10-15 years. The financial ‘rains’

needed. It is no wonder that sometimes

video conferencing than they are with

have sprouted a raft of instant video

it appears to be a case of the partially-

conventional technologies, and the former

consulting experts and advice across the

sighted leading the blind.

make more sense. The players are different

health system and the video conferencing

and need to integrate video consulting as

industry.

Health and Ageing have earmarked a

Going forward, the Department of

Below - Multiple Inter-dependent components are required for success — the technology is only one.

Information and Facilitation Coherent and cohesive source of credible information and streamlined provisioning

Communication and Change Management Value of video and the WIIFM factor

Consumer Confidence Security, privacy and credentials

Overarching Management Scheduling, billing, admin audit and evaluation

Enabled Participants People locate services, each other, know where, when, how to connect

Health Provider and Local Venue Directories What services are available and places that people can access them

Workflow Integration Sessionmanagement, information and eHealth systems, etc

Distributed Support and Training Get help from the right local places

Coordination Orchestrating multiple parties and stakeholders

42 Pulse+IT

Legal Consent, accreditation providers, indemnity insurance

End-to-End Quality Assurance Quality gates to provide services, active reporting and resolution of quality issues

Infrastructure

Support all valid technologies, broadband, people not in VC directories

www.pulseitmagazine.com.au

further $47 million for telehealth training

as Skype, but which has more specific

and adoption projects. How is this money

functionality like scheduling and services

Enabled clinical service providers are the key

going to be spent? What are we going to

directories. It would exist separately from

People who live and work outside metro

advise people, and how do we know that

the infrastructure layer so people could use

areas don’t need convincing of the

what we are telling them is right? In the

their own video conference technology,

benefits derived from video consulting.

author’s opinion it seems a little premature

and it would not require participants to

Unlike isolated patients or healthcare

to be providing advice to others given the

have an account.

professionals however, the benefits are

general lack of insight and cohesion that

not as obvious to the mostly metropolitan

currently exists, and without the required

The Victorian experience

central building blocks and services in

In Victoria, the public hospitals are

people with already full schedules, the

place. Whatever happens, this work needs

divided into multiple networks with

convenience, ease of use and effectiveness

to be coordinated nationally and deliver a

separate organisational and technical

of the video consultation process is at least

consistent message.

infrastructures, and there is no central

as important as the financial incentives.

Pages 46-47 of this article list the

ownership or control over any of the

current activities being undertaken by

infrastructure. There has also been no

business models from a practical as well

various stakeholder groups.

Government

department

as financial perspective. The technology

telehealth

has to be accessible in the same place as

and

Before and after the consultation

little

telehealth funding

management

over

for the

years.

based clinical service providers. For these

The solutions must include sustainable

From

the service provider, and the appointment

inception, state-wide video conference

must be as easy to agree to and as

Successful integration of video consulting

event management has been forced to

rewarding to participate in as a physical

is first and foremost a management,

facilitate inter‑organisational participation

encounter. When a clinician notes their

facilitation and work flow integration

using peoples’ own video conference

next appointment is via video it must be a

challenge,

infrastructure and be sustainable from an

single click to join it — as simple as calling

achieved at a technical level alone,

which

simply

cannot

be

operational and financial perspective.

in the next patient listed in their electronic

no matter what the vendor brochure

appointment book.

might say. As I have said, buying a video

became both national and international, an

conference system does not equate to

‘open’ management model was developed

successful healthcare appointments any

that identified 12 local and central ‘roles’,

Infrastructure and practice set up advice

more than buying a car does.

and provided context based information

The Royal Australian College of General

What happens ‘before’ and ‘after’ the

As volumes of participation grew and

and functionality to these geographically

Practitioners

consult is just as critical as what happens

dispersed people.

Guidelines for Video Consultations In

during it, and this is why Skype works

providing

General Practice Version 2 are as good a

so well. The main attraction of Skype —

overarching central building blocks and

place to start as any for practical advice.

quite apart from the low cost — is that it

services closely matches the challenges

These are an evolving set of practical

is easy to get going, easy to find people,

that Australia now faces more broadly,

guidelines, which have now had quite a

and only takes a single click to connect

although it has gone under the radar

bit of input. Combined with the newly

to the right place. Although Skype seems

because the programs are not part of a

released Standards for General Practices

unquestionably here to stay, it is currently

single publicly funded project.

Offering Video Consultations, which is

not scalable for many applications for a

Key lessons have included the need for

an addendum to RACGP Standards for

range of practical and privacy reasons,

a core business focus on overall outcomes

general practices (4th edition), there is a

including the reasons highlighted by

and independence from the component

lot of useful guidance, although arguably

business-grade

vendors.

parts. Also important is separating the

there is too much information to be easily

The fact that everyone needs to have an

user interface and business management

absorbed, and a more suitable delivery

account and will forever be in your ‘buddy

functions from the infrastructure layer.

medium such as a web video or an online

list’ is an issue in itself.

This means multiple video conference

course could be considered.

technologies

technology

In any case, one system is not going

This

experience

can

be

of

accommodated,

The

(RACGP)

guidelines

Implementation

categorise

the

to fit all. What we need is a common

and users get a consistent experience as

technologies as per below, and give an

Skype‑like management platform for

the underlying technologies get easier,

indication or the pros and cons of each.

healthcare that is as easy to provision

cheaper and become ubiquitous.

Note this list is roughly in order of price,

www.pulseitmagazine.com.au

Pulse+IT 43

access, and convenience, not quality

and quality with higher upload speeds, the

are forced to communicate at the lowest

or functionality. The often used term

download speeds are often slower than

common denominator.

‘high end’ has become a misnomer, as

available with consumer offerings.

software‑only

the same high definition quality and

organisations where advice about Internet

Interoperability and interconnectivity are not factors in many scenarios

functionality

connectivity options may be sought.

There are many scenarios where this is a

solutions that

now

would

deliver

have

been

referred to in this way:

Pages 46-47 of this article list several

non issue, for example, where all parties

• Computer software video conferencing

Technology, interoperability and interconnectivity

• Tablet app video conferencing

Everyone

and

forthcoming Medibank Health Solutions

• Desktop video conference appliance

challenges, and it is important to be clear

Online Care (American Well), Skype, Lync,

where interoperability (different systems

or a public hospital network.

being compatible like fax machines), and

interconnectivity (different systems being

as part of the call initiation, it is quick and

• Immersive video conference solution

able to connect to one another across

easy to download the video conference

They also give practical guidance on

networks), are important and where they

program or ‘app’ that the originating party

areas such as bandwidth, which is another

are not. For example this is an important

wants to use if it doesn’t already exist, e.g.

misunderstood topic that means different

consideration for public hospitals where

WebEx, GoToMeeting HD Faces, Vidyo

things to different people and is steeped in

there is a lot of existing video conferencing

or Lifesize. It is already commonplace

wisdom that is past its ‘used by’ date.

equipment and a need to communicate

to have multiple video conferencing

• Web browser video conferencing

(dedicated unit) • Video conference room appliance (dedicated unit)

In

a

pre-NBN

world,

bandwidth

has

different

needs

are working within a single management and

technical

platform,

e.g.

the

Similarly, in many environments and

across the rest of the health system.

software products on a computer or tablet.

challenges relate as much to access as

The current interoperability problems

Getting people together then is more of a

they do to capacity, and the capacity

with Secure Message Delivery (SMD) are

management challenge than a technical

debate is as much to do with the volume

not a good yard stick for video consulting.

one. Of course this doesn’t work as well

of concurrent usage as it is the demands

Like email, a secure message can arrive

if the people need to create an account in

of a single video conference, even a high

at any time without notice and you might

the video conference system to connect.

definition one. Smaller practices have

receive messages from multiple disparate

different needs in this regard to larger or

systems at once. Standards are important

conference systems can connect via

multi–location practices.

to avoid the need to have multiple

the Internet today, although this often

People using standards based video

The upload speed of a connection is

systems and monitoring each of them for

requires a level of user knowledge, and

just as important as the download speed

a message. Video consulting is not like

some conventional technologies don’t

for video conferencing, as this affects

that — you only need to be in one video

handle the Internet very well. In the future,

the quality of what you send as well as

conference at a time and there is a level of

technologies will deliver the required video

what you receive. Thanks to modern

prior arrangement, even if it is only a few

quality using only Internet access and a

video conference technologies, dedicated

minutes.

web browser. Flash based solutions and

links are arguably not required in many

Standards are important however and

services like Google Chat can do this now,

situations, however the type of Internet

exist in commercial grade technologies,

but arguably without the video quality, and

link and service quality remain important

although native calling between these

people still need an account.

factors. In some areas and for some

and FaceTime or Skype seems a long way

practitioners

connection

off. This challenge is being worked on

The exchange approach

provides good enough quality and thus

feverishly worldwide and arguably what

The exchange approach lets people

no new service is required, although it is a

we do in telehealth in Australia is not going

connect using a diverse range of standards

good idea to check that your practice has

to speed this up.

and non standards-based technologies

a suitable data plan to avoid excess data

In the mean time there are multiple

over different networks. Everyone dials in

charges. There are limited options available

scenarios and approaches which are listed

to a central ‘exchange’ which has links to

above ADSL2+ or cable. The pricing gap

below. In some of these we need to be

all of the networks and houses all of the

between

commercial

careful not to achieve interconnectivity

technologies. The exchange then acts like

services can be significant and while the

at the cost of overall quality and limited

a central, multilingual interpreter so that

latter tend to offer much better reliability

functionality because the technologies

everyone can see and hear each other.

an

ADSL2+

consumer

44 Pulse+IT

and

www.pulseitmagazine.com.au

cross-jurisdictional

to this approach and it is the basis of a

Peer to peer over the Internet in the future

National Telehealth Infrastructure Service

soon to be released telehealth offering

Right now, standalone, standards-based

(led by the NT Department of Health),

from Telstra.

video conference systems can interoperate

Examples include the proposed state

health

department

BlueJeansNetwork,

and

the

companies are engaged in activity relating

Vantage

with each other assuming there are no

The business layer management approach

connectivity issues.

sense in some scenarios as an interim

When Australia had different rail gauges,

technologies like Skype or FaceTime may

solution

interoperability

Queensland bananas still somehow made

be able to natively interoperate taking

remains an issue, although they are

it by train to Victoria. This was a triumph

advantage of the substantial bandwidth

expensive to deploy.

of

management

that will be available. We seem a long way

Network Operations Centre.

Video conferencing exchanges make while

native

end-to-end

logistics

In

the

future,

software-based

rather than native connectivity. Today,

off this happening seamlessly in a B2B and

The telephony approach

every Thursday night, 80 different video

B2C environment although Microsoft’s

The aim of the telephony approach is to

conference systems on different networks

recent purchase of Skype may influence

achieve the same level of reliability, quality,

located in hospitals all over Australia are

this.

device independence and interconnectivity

connected to a single video conference

that we expect from the telephone

event. This is achieved by keeping a record

network. Today, this approach suits people

at the business management layer about

Government and health sector activity

who want end-to-end quality assurance

who has access to what technologies, plus

There is some great telehealth work

and service level agreements within a

information about each technology and

going on but you would be forgiven for

business grade environment. Right now

how to connect to it. The management

being confused or for questioning the

as a stand alone solution this only works

layer then passes information to the

amount of duplication, given the size

using dedicated network connections

relevant people and technologies about

of our population and the overall lack

from a single carrier, so interconnectivity

when and what they need to do to

of experience of actually achieving the

and open access remains a problem. In the

connect.

outcomes we seek. There are at least five

future, people will be able to call between

For example, a specialist at the

health sector or government organisations

different carriers using a common dialling

Alfred using Vidyo can click on a video

offering similar practical advice, including

plan and standards like SIP and E.164

appointment with a specialist in Townsville

the Department of Health and Ageing

numbers. This does seem some way off

hospital using a Tandberg system. The fact

itself.

as the technical and financial peering

that this travels through five technologies

agreements between carriers are yet to

over three IP networks is transparent to

source of up-to-date, coherent, consistent,

be worked out. Most telecommunication

the participants.

and

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Pulse+IT 45

everyone agrees on, and that health

by founding members RACGP Oxygen and

seems to be on the right track. Considering

service

in

representatives from the video conference

its objectives, the Guidance paper actually

multiple levels of detail. It needs to be

providers

industry. The scope of the AMTIA appears

falls a long way short, in the opinion of the

democratically editable but moderated,

to be growing beyond its original focus on

author.

and

information

technical solutions and interoperability,

about available vendor solutions matched

and the organisation is expected to release

Health Informatics Society of Australia

against standards and guidance. People

more details soon.

HISA ran the Rural and Remote Telehealth

deliver

can

categorised

consume

need to see the information in a snapshot,

conference in Cairns in July this year, and

are interested. The information needs

Australian Health Practitioner Regulation Agency

to be endorsed by all stakeholders as

AHPRA has released Draft Guidelines for

an objective assessment rather than

Technology Based Consultations that

Medicare Locals

individual opinion or a regurgitation of the

represent guiding principles rather than

Medicare Locals are slated to play a key

vendor’s marketing. The Australian College

operational advice.

role in providing local support and training

and then drill down in more detail if they

included a telehealth event as part of HIC2011 in partnership with the ATHS.

of Rural and Remote Medicine (ACRRM)

for video consulting.

are working on a product inventory that

Australasian Telehealth Society

seems like it might head in this direction.

ATHS

and

A brief synopsis of telehealth activity

the author is aware of is outlined below:

is

a

public

which

academic

National E-Health Transition Authority

based

society

NEHTA is in the process of scoping what

telehealth

predominantly hospitals

policy

its involvement in video consulting should

recommendations, advice, and advocacy.

provides

be. They reportedly have received an

Australian College of Rural and Remote Medicine National Telehealth Advisory Group

Their second annual meeting will be held

estimated $1 million additional funding

1-2 December, alongside the Queensland

for this purpose, and to provide input into

University Centre

related DOHA projects.

The Government has funded ACRRM to

‘Successes and Failures in Telehealth’

develop a TeleHealth Standards Framework

conference.

NEHTA gets to grips with the entire

for Online

Health

and a range of support materials to assist

In the opinion of the author, once

breadth and depth of the video consulting

medical practitioners, patients, and health

Department of Health and Ageing

space (as opposed to simply the video

facilities to understand and appropriately

DOHA are funding a range of initiatives

conferencing part), it will recognise

utilise video-based telehealth services for

and projects, some of which are mentioned

a great opportunity to leverage its

rural and remote communities.

throughout this article. DOHA has also set

existing workplan for the benefit of video

ACRRM has partnered with specialist

aside $47m for video consulting training

consulting

and nursing colleges, peak Aboriginal,

and support, but the details of what the

wheels.

rural health, and telehealth associations,

training will cover, and how it will be

and the Royal Flying Doctors Service, and

managed, are yet to be released.

their work includes a telehealth product

inventory and an advisory service.

consists of representatives from across

GP Victoria provides a good summary of

The DOHA Telehealth Advisory Group

without

re-inventing

any

National and state based general practice networks

the heath sector. The MBS Online website

telehealth on its website, and GP NSW

Australian Information Industry Association

contains very comprehensive and well

has published two presentations providing

presented information about the MBS

information and practical advice.

AIIA are founding members of the

item numbers and related matters.

Australian Medical Telehealth Industry

Alliance (AMTIA), and have a health

comment

guidance

National Health Call Centre Network / Health Direct

task‑force that includes many of the

documents which appear to have been

In partnership with key stakeholders,

leading infrastructure suppliers in this

written by different people. The content

NHCCN are developing a National Health

space.

of the Guidance on Security, Privacy and

Services Directory to support eHealth in

Technical Specifications for Clinicians

general, and this is expected to include

Australian Medical Telehealth Industry Alliance

document displays a remarkable disparity

video consulting and contain details of

in experience compared with the Telehealth

providers of services that offer access in

AMTIA has been brought together recently

Technical Standards Position Paper, which

this way.

46 Pulse+IT

DOHA also recently released for two

practical

www.pulseitmagazine.com.au

Royal Australian College of General Practitioners

challenge does not work.

RACGP Implementation Guidelines for

and that of leading telehealth programs

Video Consultations in General Practice

such as the Ontario Telehealth Network,

Version 2 are an evolving set of practical

that operational solutions must include an

guidelines that have received quite a

overarching management component with

bit of input. This, combined with the

an independent core business focus on

Standards General Practices Offering Video

overall outcomes rather than component

Consultations, which is an addendum to

parts. To put this multifaceted jigsaw

RACGP Standards for general practices

together, you must know what you are

(4th edition), provide some sensible and

doing, and you can’t be one of its parts.

practical advice as a starting point. RACGP

We know from our own experience,

also provides an advisory service via a call

Declaration of interest

centre.

Chris Ryan is the principal telehealth

Conclusion

consultant

at Attend Anywhere,

Australian

company

with

a

an long

There is a lot happening in this space

history of facilitating the sustainable

and rightly so — the enormous health

inter‑organisational

outcome, economic, and social potential

own video conferencing technology to

is well documented. Telehealth in general

exchange health services.

has been touted as the ‘get out of jail free’

card that can address rising health care

independent consulting focused on the

costs and the challenge of the ‘ageing

people, process, technology, and service

tsunami’. It’s also pretty convenient and

integration issues involved, as well as

popular with consumers.

a range of central building blocks and

services.

The government has done a good

use

of

people’s

Attend Anywhere provides technology

job in providing the raw materials for the

health system to work with, and should be

video

congratulated for its vision. There is a lot

does have an overarching management

to do, however, both practically and from

platform based on the Victorian distributed

a communication perspective. ‘I see what

management model. The platform lets

you are saying’ has a whole new meaning

people find services and each other

in a video conference but people need to

and attend on-demand or scheduled

experience for themselves the massively

appointments and events, using the

increased value that visual communication

technology available to them.

delivers compared to the telephone.

organisations,

There seems general agreement that

Attend Anywhere does not supply conferencing

Chris

also

technology,

consults

to

including

but

many Monash

overarching national building blocks and

University, the RACGP (where he worked

services are needed which bring together

on the RACGP Implementation Guidelines

the business layer, the governance, the

for

health information and workflow systems,

Practice), and is a member of AIIA, ATHS,

and the video conference infrastructures

MSIA, HISA and the AMTIA.

from an operational perspective.

The question is how long will it

Video

Consultations

in

General

References

take us to get this right, and how much

Due to page space restrictions, links to all

more money will we waste viewing the

organisations and documents referenced

component parts of this jigsaw in isolation

in this article have been made available

to each other? Simply seeking technical

online at the Pulse+IT magazine website:

solutions to what is a management

http://bit.ly/uEcj3X

www.pulseitmagazine.com.au

PULSE+IT

47

Following the success of last year’s event, Best Practice Software is excited to announce that the next Best Practice Summit will be held in Bundaberg in March 2012. Register your interest in attending the conference and receiving further updates by emailing bpsummit@bpsoftware.com.au Workshops will include training sessions on various aspects of Best Practice Clinical and Management as well as future directions for Best Practice, integration with other packages and conversions, etc.

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If you haven’t yet tried Best Practice, go to www.bpsoftware.com.au or call: (07) 4155 8800 to order the FREE DVD and experience these and other features for yourself – with your own practice data (from a back-up copy, of course).

OFF TOPIC

Improving disaster recovery and business continuity with server virtualisation Alberto Tinazzi

IT Security Consultant eHealth Security Services atinazzi@ehealthsecurity.com.au

What is virtualisation?

Windows. Similarly, a Macintosh computer can use

Virtualisation is a technique that allows the user to run

Parallels Desktop to run Windows on top of Mac OS X.

multiple instances of an operating system on a single

physical computer. Physical resources such as CPU

computer arrangements across an organisation,

cores, memory, and storage of the single computer are

which can help to simplify management and increase

subdivided amongst multiple ‘virtual’ machines.

security. This is called Virtual Desktop Infrastructure,

Virtualisation also allows for standardised desktop

A common error is to confuse virtualisation with

and it consists of replacing all desktop PCs with thin

emulation. An emulator mimics the behaviour of

clients connected through the local network to a

different hardware, for example, a computer with a

large server running virtual instances of the desktop

typical Intel x86 CPU can emulate a PDA or a mobile

operating system and applications. Applications,

phone based on an ARM CPU. Virtualisation instead

drivers and updates can be installed just once, lowering

relies on a piece of software called a hypervisor (or

the time required for the IT department to manage the

Virtual Machine Manager) which is responsible for

infrastructure. Additional benefits introduced by this

allocating resources provided by a physical machine

technology include:

to a number of virtual machines compatible with the

• Increased security, as all data is centralised.

same type of hardware architecture.

• A consistent user experience, as the user will have

Many also confuse virtualisation with cloud

the same desktop view from any location in the

computing; however, while virtualisation is an enabling technology for many cloud computing platforms, cloud computing is concerned with providing computing

organisation, including when connecting remotely.

• Reduced total cost of ownership.

resources as a service, in a timely, flexible and

Server virtualisation

automated fashion.

The most widely-cast virtualisation technique, and

Virtualisation technology can be used on a

probably the one that provides more immediate

standard desktop computer when a user requires

benefits from a business perspective, is server

the ability to run multiple operating systems on

virtualisation. The rationale behind server virtualisation

a single desktop. In this scenario, virtualisation

leverages the fact that a typical server CPU generally

allows the user to run multiple operating systems

operates at between 5% and 15% of its capacity,

conveniently, simultaneously, and without the need

meaning the server is more often than not heavily

to set up complex disk partitioning and dual booting

underutilised.1

arrangements. For example, a Windows computer with

VMware Workstation installed can run Linux on top of

of virtualisation, and have for many years been

Large organisations have been early adopters

Author Info

consolidating their server resources. Accordingly, Alberto Tinazzi is a Certified Information Systems Security Professional (CISSP). He works as an independent information security consultant specialised in the healthcare sector. He has 16 years experience as an IT professional, specialised in information management and security. He has spent the last 10 years working within the health sector covering a number of different roles within the Division of General Practice Network.

despite the increasing computerisation of many organisations, the number of physical servers within organisations is reducing. A consolidation ratio of 4:1 means that four physical servers can be virtualised to run on one physical server, but there are cases where this ratio can be as high as 12:1. This provides a number of immediate tangible economical benefits, such as

48 Pulse+IT

www.pulseitmagazine.com.au

Large organisations saw immediately the advantage of virtualisation and started consolidating their server farms by massively reducing the number of physical servers. A consolidation ratio of 4:1 means that 4 physical servers can be virtualised to run from 1 physical server, but there are cases where this ratio can be as high as 12:1.

Above - A traditional computing architecture is shown on the left, which is contrasted with a virtualised environment on the right. Two virtual machines are running independently within the Hypervisor environment sharing the hardware resources of a single computer.

This provides a number of immediate tangible economical benefits such as the reduction of capital the reduction of expenses evident, whatofare the advantages may want to with adoptpower new technologies expenses tocapital acquire the required hardware,clearly the reduction operational costsitassociated and to purchase the hardware, reduction of for small and medium sized organisations? aiming to provide better service delivery cooling, and smaller data centres. operational costs associated with power

A typical general or specialist practice

to its patients, such as online booking and

and cooling, and smaller data centres.

will probably rely on one or two physical

the delivery of educational material and

physical servers, raising server utilisation

business functions, the availability of

an absolute minimum.

An interesting case study carried out by vmware, on a regional healthcare organisation in the US 2, An interesting case study conducted servers, therefore server consolidation resources. shows that by virtualising their infrastructure they have been able to consolidate 62 servers into 6

by VMware on a regional healthcare is unlikely to be a high priority. However, Because all these business functions physical servers raising server utilisation from 5 to 80%.

This has also theon recovery time organisation in the US, shows that by because most of these businesses rely on willreduced likely depend the practice server, from 12 to 1 hour and improved the time required for provisioning a new server from 24 to 2-3 virtualising their infrastructure they have a limited number of physical servers which its availability becomes of even greater hours a TCO reduction of679% their capex and ofall43% on their opex. with downtime to be kept to been ablewith to consolidate 62 servers into areon responsible for running essential importance, from 5% to 80%. has also reduced According to aThis study carried out the recovery time from 12 hours to one

server/s becomes of paramount With just in operation bytheSpringboard Research in 2010, Australia is one theserver leading countrythe

importance from a business continuity downtime is very high. A hardware in the Asia Pacific Region for the adoption of virtualisation technologyriskbyof87%, followed by Japan point of view. malfunction, a system resource conflict, or 82% . vmware also claims that their virtualisation products are used by 94% of the ASX 100 and provisioning a new server from 24 hours to Let us consider the scenario of a typical a malware infection may make the server 4 96% theThis Fortune by to two threeof hours. has led to1000 a total . practice with a single server responsible for unusable and cause quite prolonged and hour, and 3 improved the time required for

cost of ownership reduction of 79% on

running essential business functions, such

unplanned outages.

their capital availability expenditure, andissues a reduction as clinical records, patient appointments Rebuilding a server scratch, System affecting business-continuity in SME (Simon, I am notfrom sure howand 2 of on their expenditure. to43% title thisoperating section... please

accounting, andappropriate recovering fell and freebilling, to change it aspathology you feel

information from backups

According to another study carried out

radiology downloads, receiving admission

by Springboard Research in 2010, Australia

and discharge notifications from hospitals,

may take many hours or possibly days,

products are used by 94% of the ASX100

outsourced to a third party. And over the

damaged caused to the system. In most

and by 96% of the Fortune 1000.

next few years it may decide to adopt new

cases, the only way to recover from a

technologies, such as Electronic Transfer of

malware infection is to rebuild the entire

depending on the availability of spare parts While benefits for larger businesses are so evident, what are the advantages for SME? A typical is the leading country in the Asia Pacific transmission of referrals to specialists, file which may need to be sourced. medical or specialist practice will probably rely on 1 or 2 physical servers, therefore, server Region for the adoption of virtualisation sharing, printing and data backups.

If the server becomes infected with consolidation in this case is surely not a need.

However, because most of these businesses rely on technology with 87% penetration, followed In a near future, the practice may malware, a good antivirus may be able 3 a Japan single physical server responsible for running essential availability of by with 82% penetration. decide to handleallthe hosting business of its tofunctions, remove the the source of the infection, server of paramount importance from a business-continuity point of view. such VMware also becomes claims their virtualisation emails and website, which are currently but it will be unable to recover from the 4

2 vmware - Reducing Server Total Cost of Ownership with VMware Virtualization Software – http://www.vmware.com/pdf/TCO.pdf What about SMEs? Prescriptions and shared electronic health system from scratch and recover all data 3 Cloud computing adoption accelerates in Asia Pacific - November 2, 2010 the benefits provided by records, introduce the use of an Intranet from the most recent backup. This clearly http://www.vmware.com/ap/company/news/releases/11022010-cloud-computing-adoption.html virtualisation to larger businesses are or a document management system, and translates into prolonged downtime, 4 Customers Trust VMware - http://www.vmware.com/company/customers/

While

www.pulseitmagazine.com.au

Pulse+IT 49

during which the practice may not be able

may run the clinical database; yet another

be allowed access to the system running

to operate.

server may be responsible for downloading

the clinical record. Likewise, a nurse

In order to improve continuity of

pathology and radiology reports; another

may require access to the clinical system

operation and gain the ability to recover

one may run the Intranet or website; and

but may not be allowed access to the

quickly from all malfunctions, the practice

so on.

accounting system.

requires a system that is resilient. Such a

system should be designed in a way that

software product that might conflict with

Improving disaster recovery

avoids single points of failure wherever

other software installed on the system

When using virtualisation architecture,

possible. It should therefore be redundant

would impact only on a specific business

the recovery process is quite efficient as it

in all its parts. Business functions should

function, and would not affect other

consists of simply copying across the latest

be compartmentalised in such a way that

functions. Likewise, if for example the

snapshot of the affected virtual server. A

a malfunction affecting a specific business

accounting system becomes infected

‘snapshot’ is an exact copy of the virtual

function does not affect all other functions.

with malware and needs to be rebuilt, the

server that can be taken at any point in

Finally, the system should also allow for

downtime caused will be affecting only

time, with only minimal downtime. The

speedy recovery from failure.

the accounting function while all other

system may be set to take snapshots of

systems will still be operational.

each virtual server every night. Snapshots

Dividing business functions

In this way, the introduction of a new

Compartmentalisation

of

business

should be treated the same as other

Virtualisation allows the organisation to

functions provides better security, as

backups and stored offsite.

split the functions performed by a single

staff will only be provided access to

physical server across multiple virtual

the servers running business functions

or the presence of malware makes the

servers. For instance, a virtual server may

pertinent to their job function. For

clinical system unusable, it is possible to

be responsible for user authentication,

instance, an accountant requires access to

revert to the latest snapshot in just a few

file and printer sharing; another server

the accounting system but should never

minutes. Likewise, if the server is stolen

If the installation of a software update

or itIntranet has been severely le for downloading pathology and radiology reports, another one may run the or or water, recovery will Below A compartmentalised virtual machine arrangement designed to provide separation nd so on. between key server functions.

damaged by fire take only a few

minutes once a new physical server is made available.

Flexible infrastructure Yet

another

advantage

of

server

virtualisation is that it enables the practice to respond more rapidly to dynamic business

conditions,

whether

driven

by growth or unanticipated resource availability. A new virtual server can be deployed in a few minutes, and if more capacity is required, a new physical server can be added quite easily.

Installing a new server is typically

a very time-consuming process which can lead to quite extensive downtime and frustration when things do not go as planned. Virtualisation nullifies this onerous task.

High availability Clustering is a technique that allows virtual machines to run across multiple physical servers called nodes. This allows for the

50 Pulse+IT

www.pulseitmagazine.com.au

workload to be evenly distributed across

This can be organised in different

that a number of considerations are made

a pool of physical servers, and also allows

ways. The externally hosted virtual servers

to identify a suitable service provider and

for live migration of a virtual machine from

could be always-on, in which case data

to establish adequate security measures.

one physical server to another in the event

synchronisation will happen continuously,

that a physical server requires hardware

making the practice infrastructure readily

computing in the healthcare sector can be

maintenance.

available in case of a disaster. Another

found in Pulse+IT [Issue 22, May 2011, page

In order to recover quickly from disasters,

be identified to host the practice’s virtual

your business is on the information system,

it is possible to combine a practice’s

server in case of a local disaster. In this

and how robust and efficient your existing

Private Network (VPN). This approach

disaster recovery, one should also be

contingency measures which allow a

would allow the organisation to resume

aware of the issues and security risks

business to continue, or quickly resume

Further

information

about

cloud

Flexible infrastructure A virtualisation cluster could be arrangement involves having the hosted 38].

Yet another advantage of server virtualisation is that it enables the practice to respond more configured to automatically recover from virtual servers on for a small amount of rapidlyfailure to dynamic business whether driven by—growth unanticipatedfor resource hardware by restarting all affected conditions, time — generally in off-peak hours to Isorvirtualisation you? virtual servers on other available nodes.serversynchronise the practice in servers.

As and every business operates quiteis availability.

A new virtual can be deployed a fewFinally, minutes in case more capacity as part of the business’ disaster recovery differently, there is no easy answer to this required a new physical server can be added quite easily, as well as more physical memory and Off-site disaster recovery plan, one or more cloud providers should question. It all depends on how dependant storage can be added at any time with no disruption.

Installing a new server with typically is athe very timemust consuming that produces local virtual server infrastructure an case provider be suppliedprocess, with data recovery processesquite are. an extensive external hostingand service.

The practice’s the most do recent snapshot the practice’sVirtualisation All organisations, how downtime frustration when things not go asofplanned. nullifiesno thismatter onerous virtual servers replicate themselvesoftothe virtual server/s. smallacross they areand should have a disaster task.

Thecan latest snapshot virtual server can be simply copied executed on the a public cloud through a dedicated Virtual While cloud computing is great for recovery plan. The plan should establish new hardware in no time.

High Availability operation in no time, should a major introduced by this type of solution. As its regular operations, in the event of a disaster affect theis area where the business cloud computing involves externalising disaster or catastrophic event.servers Clustering a technique that allows virtual machines to runtheacross multiple physical is (called located. nodes). This allows for the business IT infrastructure, it is essential Inacross case of prolonged downtime, workload to be evenly distributed a poolsystem of physical servers, but it also allows for live migration of a virtual machine from a physical server to another in Below - In the event of a hardware problem occurring with the left physical server shown in this example, the Server 1 and Server 2 virtual the event that to a the physical server requires hardware maintenance, with no downtime at all. machines are migrated still-functioning physical server shown on the right, allowing these virtual servers to remain available.

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Pulse+IT 51

to remain operational a practice should be

selected.

able to switch back to manual operation.

products are available for free, but

This means, for example, reverting to

your organisation may require larger

patient paper records, being able to order

servers with fully redundant hardware.

Suggested further reading

and receive pathology manually, being

Implementing

1. http://en.wikipedia.org/wiki/

able to consult paper-based referential

non‑fault‑tolerant hardware may greatly

material such as drug prescribing guides

reduce the advantages introduced by the

and other relevant publications, being able

technology.

to write prescriptions and referral letters

manually, and being able to bill patients for

level of compartmentalisation desired.

References

the services provided, which includes the

Each virtual server will require allocation

1. Learn About Virtualization. http://www.

capability of manually looking up relevant

of physical resources, such as memory

visualnetworksystems.com/learn-

billable items.

and storage, and may attract additional

about-virtualization

software licensing costs.

Downtime can be greatly reduced

Many

basic

virtualisation

virtualisation

on

may attract higher fees than what you are used to pay for traditional IT services.

Virtualization 2. http://www.riskythinking.com/glossary/ maximum_tolerable_downtime.php

Another variable is introduced by the

2. Reducing Server Total Cost of

depending on the virtualisation solution in

place. It can go from a few hours in the case

self-recovering system, then you would

of the most basic virtualisation solution, to

probably require a virtualisation cluster

seconds in case of a fault‑tolerant cluster

and/or an hybrid cloud solution. In this

or a hybrid cloud solution.

case, you will have to account for the

accelerates in Asia Pacific. http://www.

cost of the extra cluster nodes and for the

vmware.com/ap/company/news/

subscription fee to the cloud service.

releases/11022010-cloud-computing-

adoption.html

How much does server virtualisation cost?

It depends on the level of redundancy

If you are considering a fully resilient,

Implementing a virtualisation solution

is not a lengthy task, but it requires specific

HealthLink/Medinexus Half and Page 180 120 required and on the virtualisation solution professional knowledge a skill setxthat

Ownership with VMware Virtualization Software. http://www.vmware.com/ pdf/TCO.pdf 3. Cloud computing adoption

4. VMware Customers. http://www.

Pusevmware.com/company/customers/ IT Mag

connecting healthcare

52 Pulse+IT

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Argus ACSS AAPM

P: 1800 196 000 / +61 3 9095 8712 F: +61 3 9329 2524 E: headoffice@aapm.org.au W: www.aapm.org.au The Australian Association of Practice Managers (AAPM) represents Practice Managers and the profession of Practice Management. Founded in 1979, AAPM is a non-profit, national peak association recognised as the professional body dedicated to supporting effective Practice Management in the healthcare profession.

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 and networks to support quality Practice Management.

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 General Practitioners, Allied Health, Specialists, Radiologists, Pathologists, Private and Public Hospitals. eClaims — Comprehensive and robust appointment and billing systems with digital/voice recognition capabilities, electronic reporting transmissions and HL7 PACS system integration.

SimDay — Proven PAS (Patient Administration System) specifically designed for day surgeries and private hospitals — Now with ECLIPSE integration.

SimDay Express — A lite version of our Patient Administration System designed as a cost effective method of delivering PHDB, HCP, State Health & Cancer Register data extractions.

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 pathology, radiology and specialist reports, hospital discharge summaries, referrals and clinical data securely and reliably.

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 65 Divisions of General Practice through the ARGUS AFFINITY program. With over 12,800 users Argus continues to grow in popularity by delivering a highly secure message, reliable product, backed by outstanding customer service all at the lowest cost possible.

Advantech

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

Advantech’s medical computing platforms are designed to enhance the quality and efficiency of healthcare for patients and users alike. All products match the performance of commercial PCs and tough medical safety ratings like UL60601-1 and EN60601-1; adding to this they are all IPX1 certified dust resistant and come with water drip‑proof enclosures.

Advantech offers long term support and a proven track record of reliability.

The medical range extends through: • Point-of-Care Terminals.

• Mini-PC and Medical Imaging Displays.

• Mobile Medical Tablets.

• Patient Infotainment Terminals.

Advantech is also an official distributor of Microsoft Windows Embedded software across Australia & New Zealand.

Join the ACHI Info email list at: www.ACHI.org.au/List

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T: +61 3 9023 0800 F: +61 3 9614 2650 E: info@precedencehealthcare.com W: www.precedencehealthcare.com cdmNet is an online service specially designed to manage the entire life cycle of a patient’s chronic disease. cdmNet delivers best practice chronic disease management, including creation of GPMPs, TCAs and Reviews.

In addition, collaboration with your care team is quick, easy and ongoing. cdmNet minimises the bureaucracy, eliminates the paperwork, and ensures compliance with Medicare requirements for chronic disease management. cdmNet optimises patient care, simplifies care team collaboration and minimises administration & paper work.

Find out more about how cdmNet can assist you and your practice by typing cdm.net.au/info into your browser address bar. cdmNet: Chronic Disease Management just got a whole lot easier.

Cerner Corporation Pty Limited

P: 1300 308 531 F: +61 3 9797 0199 E: info@advantech.net.au W: www.advantech.net.au

Australasian College of Health Informatics

cdmNet

P: +61 2 9900 4800 F: +61 2 9900 4990 E: AsiaPacific@cerner.com W: www.cerner.com.au

Best Practice

P: +61 7 4155 8800 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) ANNOUNCING:The 2012 Best Practice Summit Following the success of last year’s event, The Best Practice Summit will be held at CQ University in Bundaberg from March 8-10. www.bpsummit.com.au

Cerner is a leading supplier of healthcare information systems and our Millennium suite of solutions has been successfully installed in over 1200 sites across the globe. Cerner’s technology has been designed so that it can be adapted to meet the needs of the very different healthcare delivery systems that exist, with a universal framework that allows clinician workflow to seamlessly span role and venue.

Our innovative leadership is allowing us to push boundaries by: • Leveraging clinical and pharmaceutical data for new discoveries in Condition Management and Personalised Medicine • Connecting the community with personal and community health records • Seamlessly connecting the patient record across the continuum of care

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Direct Control

CH2 (Clifford Hallam Healthcare) P: 1300 720 274 F: 1300 364 008 E: marketing@ch2.net.au W: www.ch2.net.au

Clifford Hallam Healthcare (CH2) is today Australia’s largest pharmaceutical and medical healthcare service provider with a catalogue of over 30,000 products servicing metro, regional and rural customers across Australia.

Supported by a National Network, CH2 utilises local knowledge and local people to provide pharmaceuticals, medical consumables and equipment products to the healthcare market.

CH2 is represented by a National Sales Force as well as a local Customer Service team in each state.

CH2 understands the value of quality data and are committed to implementing the GS1 system throughout our business and with our partners. The use of EANCOM standard messages, Global Trade Item Numbers (GTIN) for product identification, Global Location Numbers (GLN) for location information and Serial Shipping Container Code (SSCC) labels are paramount to our industry moving forward. CH2 are passionate supporters of these philosophies and believe the uplift in quality systems will result in improved patient safety.

CH2 are currently working with partners to implement the National E-Health Transition Authority (NEHTA) National Product Catalogue. “Our aim is to be a great company to do business with. The right product, at the right price, at the right time.”

WardBox® is CH2’s direct to ward distribution system. It is a just in time replenishment system where orders are created in a theatre or ward area and then transmitted electronically to one of CH2’s warehouses using SOS or an EDI interface. The service incorporates barcode scanning technology, direct delivery to individual wards or departments, monthly invoicing and comprehensive reporting. WardBox® is designed to assist our customers in reducing purchasing and supply operating costs. This valuable service increases supply chain efficiencies, improves service delivery models and assists in achieving economies of scale.

WardBox® distribution is used for pharmaceuticals, medical, surgical and general supplies at numerous healthcare facilities.

CH2 recently won the “SAP Best Business Intelligence with Channel Partner” award at the SAP Customer Awards of Excellence 2011. CH2 also sponsored the 2011 Victorian SCLAA awards.

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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”.

dbMotion

P: +61 2 8011 4885 E: info-aus@dbmotion.com W: www.dbmotion.com dbMotion’s connected healthcare solutions for shared electronic health records (Shared EHRs) and health information exchange (HIE) transform healthcare, empowering physicians and revolutionizing patient care for healthcare organisations. The service oriented architecture (SOA) based dbMotion™ Solution gives caregivers and information systems secure access to an integrated patient record composed from the patient’s medical data maintained at facilities that are otherwise unconnected or have no common technology through which to share data, without replacement of existing information systems.

Healthcare organisations using dbMotion have realised benefits in a wide variety of areas, ranging from patient safety, quality, efficacy, and IT agility.

P: 1300 557 550 F: +61 7 5478 5520 E: support@directcontrol.com.au W: www.directcontrol.com.au

Digital Medical Systems P: 1300 865 977 F: +61 3 9753 3049 E: inform@dgs.com.au W: www.dgs.com.au

Easier ICT is a technology partnership with DMS — we make I.T. work for you.

DIGITAL MEDICAL SYSTEMS has provided ICT solutions and services to medical practice clients across Australia since 1990. We have specialist expertise and experience in the installation and support of leading medical software applications.

DMS is a Business Partner for IBM, Lenovo, HP and Microsoft. Other leading ICT brands include Trend Micro, Symantec, CA, Cisco, Toshiba, Canon, Epson, Kyocera, Fujitsu and Brother.

Accreditation is easier with the customised DMS IT Systems Documentation. Ensure your practice has the best quality IT policy, security and maintenance program that meets and exceeds the standards guidelines from the RACGP and AGPAL and GPA. World leading DTech provides 24x7 near Real-Time Monitoring and Management that alerts and enables our engineers to quickly troubleshoot and solve problems of security, network, Internet, Server and software remotely on almost any client computer system or device.

Medical IT systems are automatically maintained by DTech to the most highly available status to minimize downtime by preventing problems from occurring or reducing their impact.

Proactive, Flexible, Consistent, Reliable, Audited, and Affordable — for even the smallest practice.

Call DMS for: • Systems Analysis & Consulting • Solutions Design • Procurement & supply of hardware, software, network and peripheral products • Installation & Configuration • Support Services inc Help Desk • DTech Monitoring, Maintenance & Management • Disaster Recovery solutions • Fully managed & automated Online Backup customised for clinical data

Direct CONTROL is an affordable, intuitive and educational Medical Billing and Scheduling application for Practitioners of all Disciplines.

Seamless integration with Outlook, MYOB or Quickbooks. Direct CONTROL’s Clinical Module manages Episodes of Care and includes State, Federal and Health Fund Statistical Reporting for Day Surgeries/Hospitals.

Direct CONTROL facilitates Medical Billing Australia-wide and overseas.

Included is all Medicare, DVA, Work Cover, Private Health Insurance fee schedules 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.

Direct CONTROL supports ALL your Business needs letting you and your staff get on with earning a living doing what you enjoy most … Patient Care.

eHealth Security Services

P: 1300 399 116 / +61 2 9016 5378 F: +61 2 9016 5379 E: info@ehealthsecurity.com.au W: www.ehealthsecurity.com.au eHealth Security Services (eHSS) specialises in the provision of security as a service and offers an extensive range of Managed IT Services including IT Support for small to medium businesses in the health sector. eHSS’ MediAccess® service provides comprehensive and cost-effective managed security and remote access solutions. eHSS has thorough knowledge and understanding of IT matters in the health industry and its regulatory aspects. eHSS has extensive experience reviewing and assisting with organisational policies and procedures and technical implementations against applicable standards.

Easier IT — we make I.T. work for you.

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Emerging Systems

P: +61 2 8853 4700 F: +61 2 9659 9366 E: sales@emerging.com.au W: www.emerging.com.au/ehealth 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 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.

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 developed within Australia and operating successfully in St Vincent’s & Mater Health, Sydney and Government of South Australia, Department of Health Hospitals.

Equipoise (International) Pty Ltd Totalcare

GPA

P: 1800 188 088 F: 1800 644 807 E: info@gpa.net.au W: www.gpa.net.au

P: +61 7 3252 2425 F: +61 7 3252 2410 S: skype.totalcare.net.au E: sales@totalcare.net.au W: www.totalcare.net.au

Equipoise International Pty Ltd (EQI) is the developer and supplier of the ‘Totalcare’ clinical and office management system. Used since 1995 by health care facilities across Australia including General and Specialist practice, Radiology, Day Surgery and Hospitals.

Totalcare is a fully integrated Clinical, Office and Management software suite. Totalcare is stable, scalable, customisable and easy to learn and use. From a small practice to a distributed, multi site, multi disciplinary corporate entity or hospital, Totalcare can provide a solution for your needs.

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.

Pre-Admission Patient History Orders & Results Clinical Care Guides Assessments Progress Notes Referrals Labour & Birth Medications Reconciliation Clinical and Non‑Clinical Messaging Diets Discharge Planning Appointments Rostering Allocations Resource Calculation Clinical Dashboard and more

EHS has integrated Sabacare’s Clinical Care Classification (CCC) System, a diagnosis framework integrated in SNOMED CT. EHS’ 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.

Choose GPA for more support, improved service and greater choice.

Genie runs on both Windows and Mac OS X, or a combination of both. With over 2200 sites, it is now the number one choice of Australian specialists.

Health Communication Network P: +61 2 9906 6633 F: +61 2 9906 8910 E: hcn@hcn.com.au W: www.hcn.com.au

EHS provides: • • • • • • • • • • • • • • • • •

GPA ACCREDITATION plus has given general practices a reliable alternative in accreditation. GPA is committed to offering a flexible accreditation program that understands the needs of busy GPs and practice staff. GPA assigns all practices an individual quality accreditation manager to support practices with their accreditation.

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.

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Global Health

P: 1300 723 938 F: +61 3 9675 0699 E: marketing@global-health.com W: www.global-health.com Global Health is a leading provider of e-health solutions that connect clinicians and consumers across the healthcare industry. Global Health’s portfolio consists of: • ReferralNet - a cloud-based secure message delivery system for the exchange of information between healthcare providers.

• MasterCare® - a suite of health information systems that provides tools to collect, manage and access clinical and patient information at the point of care.

• LifeCard® - a personal health management system for keeping all your important medical information in ONE secure location.

With LifeCard® you can maintain a personal health record, access emergency health information and be rewarded for looking after your health.

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

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Health Informatics Society of Australia P: +61 3 9326 3311 F: +61 3 8610 0006 E: hisa@hisa.org.au W: www.hisa.org.au

The Health Informatics Society of Australia is a membership based not-for-profit organisation which has been supporting and representing Australia’s health informatics and e-health community for almost 20 years. HISA aims to improve healthcare through the use of technology and information. We: • Provide a national focus for e-health, health informatics, its practitioners, industry and a broad range of stakeholders • Support, promote and advocate • Provide opportunities for networking, learning and professional development • Are effective champions for the value of health informatics HISA members are part of a national network of people and organisations building a healthcare future enabled by e-health. Join the growing community of organisations and individuals who are committed to, and passionate about, health reform enabled by e-health.

Health Information Management Association Australia P: +61 2 9887 5001 F: +61 2 9887 5895 E: himaa@himaa.org.au W: www.himaa.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.

HealthLink

P: 1800 125 036 (AU) P: 0800 288 887 (NZ) E: enquiries@healthlink.net W: www.healthlink.net Australia’s and New Zealand’s largest effective secure communication network.

• Referrals, Reports, Forms, Discharge Summaries, Diagnostic Order and Reporting • Provider of Secure Messaging Delivery (SMD) services • Fully integrated with leading GP and Specialist clinical systems • Robust; Reliable and Fully Supported Join the network that more than 70 percent of GPs use for diagnostic, specialist and hospital communications.

MEDITECH Australia

P: +61 2 9901 6400 F: +61 2 9439 6331 E: sales@meditech.com.au W: www.meditech.com.au

ISN Solutions

P: +61 2 9280 2660 F: +61 2 9280 2665 E: info@isnsolutions.com.au W: www.isnsolutions.com.au

A Worldwide Leader in Health Care Information Systems

ISN Solutions is a Medical IT company that specialises in the design, setup and maintenance of computer networks for medical practices and private hospitals.

We manage IT services, we are dedicated to the medical industry.

We know that if you are consulting then you need a quick response.

Our support model is designed to minimise the interruptions to the doctor specially. We are familiar with most medical software applications in Australia. We have strong industry references.

Some of our solutions include, but are not limited to:

InterSystems

P: +61 2 9380 7111 F: +61 2 9380 7121 E: anz.query@InterSystems.com W: www.InterSystems.com InterSystems Corporation is the worldwide leader in breakthrough solutions for connected care, with headquarters in Cambridge, Massachusetts, and offices in 23 countries. InterSystems TrakCare™ is a Web-based healthcare information system that rapidly delivers the benefits of an Electronic Patient Record. InterSystems Ensemble® is a seamless platform for integration and the development of connectable applications. InterSystems HealthShare™ is a strategic platform for healthcare informatics, providing capabilities for sharing of clinical information, comprehensive advanced analytics, building clinician and patient Web-based communities, and quickly filling informational and functional cross-system “gaps.”

InterSystems DeepSee™ is software that makes it possible to embed real‑time business intelligence capabilities in transactional applications. InterSystems CACHÉ® is a high performance object database that makes applications faster and more scalable.

• Cloud based computing tailored to medical industry • Medical voice recognition • Capped cost medical support and maintenance plan • Ability to consult remotely • Medical application support

iSOFT

P: +61 2 8251 6700 F: +61 2 8251 6801 E: company_enquiry@isofthealth.com W: www.isofthealth.com iSOFT is one of the world’s largest providers of healthcare IT solutions.

We work with healthcare professionals to design, develop and implement healthcare solutions that deliver administrative, clinical and diagnostic services to ensure continuity of care across all care settings. iSOFT provides flexible and interoperable solutions to the whole spectrum of providers, from single physician practices through to integrated national solutions supporting thousands of concurrent users.

Our capacity to embrace change and keep abreast of emerging new directions in healthcare has allowed our clients to explore the exciting potential of new technologies while securing their existing investments.

MEDITECH today stands at the forefront of the health care information systems industry. Our products serve well over 2,300 health care organisations around the world. Large health care enterprises, multi‑hospital alliances, teaching hospitals, community hospitals, rehabilitation and psychiatric chains, long-term care organisations, physicians’ offices, and home care and hospice agencies all use our Health Care Information System to bring integrated care to the populations they serve. Our experience, along with our financial and product stability, assures our customers of a long-term information systems partner to help them achieve their goals.

Medtech Global Ltd

P: 1800 148 165 E: sales@medtechglobal.com W: www.medtechglobal.com For over 27 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.

HIMAA is also a Registered Training Organisation conducting, by distance education, “industry standard” training courses in Medical Terminology and ICD-10-AM, ACHI and ACS clinical coding.

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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.

Pen Computer Systems

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 17 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.

Nuance Communications

P: 1300 550 716 F: +61 2 9434 2301 E: Vicki.Rigg@nuance.com W: australia.nuance.com W: newzealand.nuance.com Nuance (NASDAQ: NUAN) is a leading provider of speech and imaging solutions for businesses and consumers around the world.

Its technologies, applications and services make the user experience more compelling by transforming the way people interact with information and how they create, share and use documents.

Every day, millions of users and thousands of businesses utilise Nuance’s proven range of productivity applications which include Dragon NaturallySpeaking (speech recognition), OmniPage (OCR), PaperPort (document management) and PDF Converter Professional (PDF creation and conversion).

Feature Rich. Dynamic. Innovative.

P: +61 2 9635 8955 F: +61 2 9635 8966 E: enquiries@pencs.com.au W: www.pencs.com.au Established in 1993, Pen Computer Systems (PCS) specialises in developing information solutions for National and State eHealth initiatives in Primary Health that deliver better Chronic Disease outcomes.

PCS expertise extends to: • Chronic Disease Prevention and Management • Population Health Status, Reporting and Enhanced Outcomes • Decision-Support tools delivered LIVE into the clinical consult • Web-based Electronic Health Records (EHRs) • SNOMED-CT and HL7 Standards Frameworks Our Clinical Audit Tool (CAT) for example delivers an intuitive population reporting and patient identification extension to the leading GP systems in Australia. CAT delivers enhanced data quality and patient outcomes in general practice.

Orion Health NEHTA

P: +61 2 8298 2600 F: +61 2 8298 2666 E: admin@nehta.gov.au W: www.nehta.gov.au

MITS:Health

P: 1300 700 300 E: info@mitshealth.com.au W: www.mitshealth.com.au Managed IT Services for the Health Industry

The National E-Health Transition Authority was established by the Australian, State and Territory governments to develop better ways of electronically collecting and securely exchanging health information. NEHTA is the lead organisation supporting the national vision for eHealth in Australia.

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

P: +61 2 8096 0000 / +64 9 638 0600 F: +61 2 8096 0001 / +64 9 638 0699 E: enquiries@orionhealth.com W: www.orionhealth.com Orion Health is a world leader in the e-health industry. We specialise in electronic health record (EHR) solutions, disease management, clinical decision support, and hospital administration tools. More than 300,000 clinicians in 30 countries use Orion Health products.

Our EHR solutions have been widely adopted across Canada, Europe and the USA to enable secure crossorganisational and regional sharing of patient information, resulting in improved patient care.

Our Rhapsody Integration Engine, a healthcare dedicated and standards based Integration hub, is used by customers to easily create interoperability between existing healthcare information systems.

Our solutions are designed to support emerging health IT trends and standards, we work closely with our customers, clinicians, government bodies and other industry leaders to deliver intuitive solutions to meet your current and future needs.

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Medilink

from Practice Services P/L

P: +61 3 9819 0700 F: +61 3 9819 0705 E: Sales@practiceservices.com.au W: www.practiceservices.com.au Medilink Practice Management Software • 21 years young, large user base • Medilink = Intuitive ease of use • Solo Drs up to Hospitals in size • Claiming via integrated EFTPOS àà and/or integrated HICAPS àà and/or Medicare Online àà 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

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Spellex

P: +61 2 8014 4573 E: info@spellex.com.au W: www.spellex.com.au Spellex has been the leading provider of comprehensive medical dictionary enhancement software to thousands of the world’s most prominent healthcare companies for 21 years.

Our easy-to-use Australian medical spell checking software integrates fully with all Microsoft programmes, Web-based applications, and popular platforms.

Spellex Medical is available for end-users to ensure the medical accuracy of documents and to enhance their productivity. Spellex software development kits can also be integrated with developer’s custom programmes and Web sites. Whether you’re an individual transcriptionist or you need to provide greater medical documentation accuracy across an entire hospital or campus, Spellex has a solution that’s right for you.

For a free trial of Spellex software, go to spellex.com.au and click the Free Trial tab.

Sysmex New Zealand

Therapeutic Guidelines Ltd

P: +64 9 630 3554 F: +64 9 630 8135 E: info@sysmex.co.nz W: www.sysmex.co.nz

P: 1800 061 260 E: sales@tg.org.au W: www.tg.org.au

Sysmex New Zealand is a market leader in the development and implementation of health IT products and services for clinical laboratories, hospitals and healthcare organisations.

We offer the following health IT solutions: • Delphic LIS – a market-leading laboratory information system for hospital and community laboratories with a strength in providing multi-lab solutions.

Specialised modules manage workflows in the anatomical pathology, haematology and microbiology work areas.

• Eclair – an advanced clinical data repository (CDR) which stores patient data from a range of systems including laboratory, radiology, pharmacy and clinical document sources to create a secure patient-centric record.

Eclair provides complete electronic ordering functionality.

Real Outcomes Real Productivity Minimising Waste

Stat Health Systems (Aust)

P: +61 7 3121 6550 F: +61 7 3219 7510 E: carla.doolan@stathealth.com.au W: www.stathealth.com.au Stat Health Systems (Aust) has built a progressive and resilient system that introduces a new level of stability and flexibility to the medical software market. Stat is an integrated clinical and practice management application which has embraced the latest Microsoft technology to build a new generation solution.

Fully scalable and the only medical software application to incorporate a multi-functional intuitive interface, Stat is at the forefront of computing technology.

Stat Health provide a premium support service, clinical data conversion from existing software and tailor made installation and training plans for your practice.

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Trend Care Systems

P: +61 7 3390 5399 F: +61 7 3390 7599 E: support@trendcare.com.au W: www.trendcare.com.au A national and international award winning solution recognised for its ability to provide real benefits in the acute and sub-acute health care settings.

TrendCare is an international leader for e-health solutions excelling in all of the following: • Patient dependency and nursing intensity measures.

• Projecting patient throughput and workforce requirements.

• Rostering and work allocation.

• Efficiency, productivity and HRM reporting.

• Discharge analysis, bed management and clinical handovers.

• Allied health registers with extensive reporting.

• Clinical pathways with variance reporting.

• Patient assessments and risk analysis.

• Diet ordering and reporting.

• Staff health tracking and reporting.

Vensa Health

Therapeutic Guidelines Limited is an independent not-for-profit organisation dedicated to deriving guidelines for therapy from the latest world literature, interpreted and distilled by Australia’s most eminent and respected experts.

These experts, with many years of clinical experience, work with skilled medical editors to sift and sort through research data, systematic reviews, local protocols and other sources of information, to ensure that the clear and practical recommendations developed are based on the best available evidence. eTG complete Incorporates all topics from the Therapeutic Guidelines series in a searchable electronic product, and is the ultimate resource for the essence of current available evidence.

It provides access to over 3000 clinical topics, relevant PBS, pregnancy and breastfeeding information, key references, and other independent information such as Australian Prescriber (including Medicines Safety Update), NPS Radar, NPS News and Cochrane Reviews. eTG complete is available in a range of convenient formats – online access, online download, CD, and intranet access for hospitals. Multi-user licences, ideal for a practice or clinic, are also available.

It is widely used by practitioners and pharmacists in community and hospital settings in all Australian states and territories.

Updated three times per year, eTG complete meets the criteria for ‘key electronic clinical resources’ in the Practice Incentives Program (PIP) eHealth Incentive.

The November 2011 release of eTG complete includes new topics on Diagnostic approach to fatigue in primary care and Ulcer and wound management. miniTG The mobile version of eTG complete is miniTG, offering the convenience of having vital information at the point of care and designed for health professionals who practise and consult on the move. It is supported on a wide range of mobile devices, including Apple®, Pocket PC®, and selected Blackberry® devices.

P: +64 9 522 9522 F: +64 9 522 9523 E: website@vensahealth.com W: www.vensahealth.com The next time you receive a text message mobile reminder or an alert from your doctor, hospital or physio you now know its done by Vensa.

Vensa Health is a mobile health (mHealth) provider in the health care sector offering eHealth integrated mobile solutions, enabling text-messaging for patient communications for applications such as appointment reminders, medication reminders, test results alerts, recalls for screenings such as mamograms, immunisations and more.

Vensa has invested substantially into developing products and services that offer communication solutions to better content providers with patients, including mobile text-messaging, voice, mobile sites and Telehealth services delivery.

Zedmed

P: +61 3 9284 3300 F: +61 3 9284 3399 E: sales@zedmed.com.au W: www.zedmed.com.au Owned by Doctors who understand the challenges facing the medical profession everyday and backed by nearly 30 years of experience in medical software programming, Zedmed provides innovative, full featured and sophisticated practice management and clinical records software solutions.

Zedmed would also like to introduce to you Medical Record eXchange – a free, simple solution allowing Doctors to send patient’s medical information to insurance companies electronically.

Using the latest in data extraction technology and fully encrypted, this is a secure, time-saving solution to one of the most dreaded requests Doctors receive on an almost daily basis.

For more information please visit: www.medicalrecordexchange.com.au

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Want to know more about eHealth?

www.ehealthinfo.gov.au www.nehta.gov.au

The National E-Health Transition Authority is jointly funded by the Australian Government and all State and Territory Governments.