Pulse+IT Magazine - September 2009 by Pulse+IT Magazine

PULSE IT 

AUSTRALIA’S FIRST AND ONLY HEALTH IT MAGAZINE

ISSUE 14: SEPTEMBER 2009

SECURE MESSAGING

www.pulsemagazine.com.au

National E-Health Transition Authority www.nehta.gov.au

Shaping the future of healthcare The National E-Health Transition Authority (NEHTA) was established by the Australian Commonwealth, State and Territory governments on July 5th 2005 to develop better ways of electronically collecting and securely exchanging health information. We invite you to share our vision of a better healthcare environment for all Australians by joining a team of diversely qualified, talented people who draw on a wealth of experience to make e – health a reality. Working in one of Australia’s complex stakeholder environments with clinical, technical, business, political and consumer interests to manage and represent, every day brings new and interesting challenges as we pave the way for major health reform.

It’s an exciting time to join NEHTA so if you really want to make a difference, then we’d like to hear from you.

Recruitment:

Sydney • Business Analyst, Unique Healthcare Identifiers (UHI) x 3 Provide high-quality, professional business analysis services to the UHI Program.

• Clinical Terminology and Information (CTI) Lead the Customer and Quality team who manage customer relationships and support; and identify possible new products, services and projects.

• First & Second Level Customer Support Manager, UHI Responsible for Level 1 and 2 support and dealing with service queries.

• Senior Enterprise Architect, Architecture Services x 4 Guide and support the development of business, information and technical architectures for national e-health solutions based upon business requirements provided by domain experts.

• UAT Test Lead, UHI Develop test plans, define test types and report on test cases for the UHI Program.

Is Health Informatics your career choice? E-health will have a major impact on healthcare providers and the patients being treated. Apply your Health Informatics skills to health reform in Australia. Email your details to: careers@nehta.gov.au

Recruitment:

Brisbane • Business Analysis Tooling, Clinical Terminology and Information (CTI) Provide business requirements to the CTI teams working with internal and external stakeholders to capture and define the requirements for the Software Tooling.

• Business Analyst, Secure Messaging Identify problems, requirements and solutions in regards to the Secure Messaging project.

• Content Manager, CTI Lead the Content Development team who develop and maintain Australian terminology reference sets and extensions and develop and maintain selective terminology mappings.

• Project Manager, eMedication Management (eMM) Plan and coordinate the development requirements and process for the eMM package to support implementation processes.

• Solution Architect, Secure Messaging Facilitate delivery of solution architecture for service-based solutions within the e-health environment.

• Systems and Infrastructure Manager, CTI Lead the Systems and Infrastructure team who select, implement and develop terminology and structured information development tools and applications.

• Team Leader, Clinical Information Provide team leadership and apply Project Management disciplines to the coordination, management and support of the Clinical Information area.

Note that these opportunities were current as of August.

Up to date information on current opportunities is available from:

Enquiries and applications can be directed to:

www.nehta.gov.au

careers@nehta.gov.au

NEHTA is an Equal Opportunity Employer. Only people with the right to work in Australia may apply for these positions.

Pulse IT +

Publisher Pulse Magazine PO Box 7194 Yarralumla ACT 2600 ABN: 19 923 710 562 www.pulsemagazine.com.au

PAGE 36 SECURE MESSAGING Brendon Wickham delivers a comprehensive overview of secure clinical messaging and the underlying technical infrastructure required to support it.

Editor Simon James 0402 149 859 simon.james@pulsemagazine.com.au Editorial Enquiries editor@pulsemagazine.com.au Advertising Enquiries ads@pulsemagazine.com.au

PAGE 26 EVENTS CALENDAR Up and coming Australian and international Health, IT, and Health IT events.

About Pulse+IT Pulse+IT is Australia’s first and only Health IT magazine. With a national distribution exceeding 38,000 copies, Pulse+IT is also Australia’s highest circulating health publication of any kind. 28,000 copies of Pulse+IT are distributed to GPs, specialists, practice managers and the IT professionals that support them. In addition, over 10,000 copies of Pulse+IT are distributed to health information managers, health informaticians and IT decision makers in hospitals, day surgeries and aged care facilities. Contributors Simon James, Amanda Leong, Dr Paul Mara, Tim McIntyre, Robyn Peters, Philip Robinson, Brendon Wickham and Mark Worsman. 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, CMP Medica or the Kimberley Aboriginal Medical Services Council, all who produce publications that include the word “Pulse” in their titles. Copyright 2009 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. ISSN: 1835-1522 Subscription Rates Please visit our website for more information about subscribing to Pulse+IT.

PAGE 46 MARKET PLACE The Pulse+IT Directory profiles Australia’s most innovative and influential e-Health organisations.

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

HIMAA CONFERENCE PAGE 30

E-CONSULTATIONS PAGE 41

CONTINUITY OF CARE PAGE 42

RECRUITMENT PAGE 44

REGULAR Sections PAGE 06 STARTUP Editor Simon James introduces the fourth edition of Pulse+IT for 2009, edition number fourteen.

PAGE 10 BITS & BYTES Pulse+IT’s news section, delivering the latest e-Health developments from Australia and abroad.

PAGE 08 GUEST EDITORIAL Philip Robinson cautions both clinicians and market participants to be mindful of the importance of e-prescribing standards.

PAGE 26 EVENTS CALENDAR Up and coming Australian and international Health IT, Health, and IT events.

PAGE 29 NEHTA The National E-Health Transition Authority discusses the important role healthcare identifiers will play in a connected healthcare system. PAGE 46 MARKET PLACE The Pulse+IT Directory profiles Australia’s most innovative and influential e-health organisations.

FEATURE Articles PAGE 30 HIMAA CONFERENCE PREVIEW Pulse+IT discusses the Health Information Management Association of Australia’s forthcoming conference with convenor Natalie Sims. PAGE 36 SECURE MESSAGING Brendon Wickham delivers a comprehensive overview of secure clinical messaging and the underlying technical infrastructure required to support it.

PAGE 41 ONLINE CONSULTATIONS Mark Worsman and Amanda Leong outline some of the legal considerations associated with online consultations.

PAGE 44 RECRUITMENT Robyn Peters continues her series on practice management with a discussion about recruitment, staff retention, and staff termination.

PAGE 42 CONTINUITY OF CARE Dr Paul Mara details the importance of referral documents to patient continuity of care.

www.pulsemagazine.com.au

STARTUP Simon James BIT, BComm Editor, Pulse+IT simon.james@pulsemagazine.com.au

Pulse+IT: 2009.4 Welcome to the fourteenth edition of Pulse+IT, Australia’s first and only Health IT magazine. Once again, a hectic couple of months have transpired since the release of our last edition. The submission of the National Health and Hospital Reform Commission Final Report to Government was greeted with cautious optimism by many in the e-Health community, a sentiment that remained on display at the recently held Health-e-Nation and HIC’09 conferences. Capitalising on their Canberra locality, these events featured presentations from Nicola Roxon MP, Minister for Health and Ageing, and Senator Stephen Conroy, Minister for Broadband, Communications and the Digital Economy, both of whom pitched the take home message that “Government gets e-health”. While this revelation is reassuring, of more immediate significance to many of our readers will be the rapid and ongoing ascension of Electronic Prescribing (e-prescribing). During the past two months, all major clinical software developers operating in the GP/Specialist market have made public commitments to support one or both of the e-prescribing initiatives vying for market attention. Servicing the lion’s share of the GP clinical software market, the most significant of these announcements concerned HCN, which has committed to develop an interface to the “script hub” operated by eRx Script Exchange. Laying claim to 17,000 subscribers, the involvement of HCN will bring critical mass to e-prescribing in this country just a few short months after its tangible commencement, an impressive feat that one hopes will inspire a similar sense of urgency in other e-health quarters. While HCN has not ruled out enabling its software to work with the infrastructure of rival e-prescribing venture, MediSecure, HCN CEO, John Frost, has voiced concerns about MediSecure’s willingness to allow its secure messaging partners to extract data from Medical Director using technical methods not endorsed or supported by his company. Genie Solutions (with over 1,600 practices) and Zedmed (with over 800 practices) have both recently committed to update their clinical products to work with the script hubs of both eRx Script Exchange and MediSecure. These clinical software developers join Best Practice, who has already made similar commitments to both e-prescribing ventures. As has been the case with e-prescribing announcements all year, enthusiastic press releases have preceded tangible software

development, however the relatively modest programming requirements associated with such software updates should see e-prescribing technology available for use in the vast majority of general practices by the end of the year. Whether or not prescribers will warm to e-prescribing with the same enthusiasm as software developers remains to be seen, however eRx Script Exchange’s claim that 250,000 electronic scripts were sent and dispensed through its system in less than a month (July 23 - August 17) bodes well for the proponents of e-prescribing.

This edition In addition to further e-prescribing coverage by guest contributor, Philip Robinson, this edition of Pulse+IT features a detailed article on secure messaging written by Brendon Wickham. Crafted with secure messaging end users in mind, this article provides an overview of the underlying technical infrastructure that needs to be in place before a cohesive secure clinical messaging environment can flourish in Australia. Related stories detailing developments in the commercial secure messaging space are contained in the Bits and Bytes section of this magazine, with NEHTA supplying an article on their unique healthcare identifiers work program. Pulse+IT discusses the forthcoming Health Information Management Association of Australia (HIMAA) conference with event convenor Natalie Sims, and coverage of the forthcoming Australian Association of Practice Managers (AAPM) National Conference is also included. To be held in Melbourne, this event will allow attendees to meet with representatives from many general and specialist practice software developers, as well as representatives from Medicare Australia and the National E-Health Transition Authority (NEHTA). Dr Paul Mara continues his series on continuity of care with an instalment on referral documents, and Mark Worsman and Amanda Leong examine the medico-legal implications of online consultations. Robyn Peters concludes this edition with some advice for businesses looking to expand or contract their workforce. Simon James, Editor 0402 149 859 simon.james@pulsemagazine.com.au

Pulse+IT eNews & Twitter Service To receive the latest Australian Health IT news delivered free to your Email inbox or Twitter client, visit www.pulsemagazine.com.au 6

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GUEST EDITORIAL Philip Robinson Philip Robinson is a health informatics consultant with more than 25 years experience in health policy and health information systems including medication management. Philip spent several years in the Middle East where, most recently, he reviewed the Information Technology and Pharmacy Services for the Emirate of Dubai. Phil qualified as a Computer Scientist and is a Registered Pharmacist. philip@acsmail.net.au

Competing Standards for ePrescriptions – Holy Grail or a Prescription for Disaster? The benefits of Electronic Prescribing (ePrescribing) in hospitals, particularly within academic medical centres, have been well described in the literature for many years particularly by David Bates1 and his colleagues at the Brigham and Women’s Hospital in Boston, USA. Australia has had a number of pilot studies as instanced by the experience with Cerner in NSW as described at the recent HIC2009 Conference in Canberra2. However, few hospital wide implementations of ePrescribing have occurred with the exception, for example, of the experience of the Epworth Eastern hospital in Victoria3. Within a hospital, the electronic prescription is generally transmitted directly via an interface to the in-house hospital pharmacy system. In the primary care setting, ePrescribing was pioneered by Medical Director which, via its initial distribution and drug advertising-based revenue model, gained wide acceptance. The prescriber prints and signs the prescription form which the patient takes to their preferred pharmacy for dispensing. Recent work by eRX Script Exchange4 (endorsed by the Pharmacy Guild) and MediSecure5 (endorsed by the RACGP) has added the ability for electronic transmission of prescriptions between the prescriber and the dispensing pharmacist (via a broker or interchange site). This process will be referred to throughout this article as an ePrescription. Since the update on Electronic Prescribing [sic] provided by this publication earlier in the year [Pulse+IT, May 2009, pp1415], the competing ePrescription products have announced further expansion in the marketplace and various players have exchanged “pleasantries”. This article argues that the current market situation is confusing to the clinicians, not based on adequate adoption of Standards, and lacking in interoperability. The potential market for ePrescribing is huge with 171 Million PBS funded prescriptions for 2007/20086 which, at the quoted price of 25c per prescription, puts the ePrescription market at $40 million for PBS items alone or about $60 million when private and other prescriptions are included. During the author’s recent experience in the Middle East, one lesson learned was to “follow the money”. In other words, to determine who benefits from an initiative which may appear, on the surface, to be an altruistic act? In this case, as instanced by the recent presentation to the National Press Club by President Kos Sclavos, the Pharmacy Guild is heavily promoting its various ICT initiatives as it proceeds into negotiations with the Federal Government over the next Community Pharmacy Agreement (CPA). In their July newsletter, the Guild advised that 250,000 prescriptions (around 1% of the annual prescription volume) have been transmitted via eRX since April, with time savings estimated by some at up to 60 seconds per prescription.

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Whilst achieving time savings via eRX translates into increased efficiency for the Pharmaceutical Benefits Scheme, which can be traded in the CPA negotiations, the Guild is simultaneously protesting against the Award modernisation process of the Federal Government in an attempt, particularly in NSW, to keep employee wage costs down. One interpretation of linking these two issues is that the Guild, representing Pharmacy owners, aims to retain incomes via the next agreement while concurrently making staff savings as the complexity of dispensing is reduced via the widespread uptake of ePrescriptions. Bates takes this issue further with his prediction that “orders will be sent electronically to the pharmacy, where most will be filled by robots”. What then is in it for the RACGP? The MediSecure system, which came out of the Northern Territory ePrescription trial and claims to use HL7 and XML standards for transmission, is endorsed by the RACGP which is also associated with Medseed, distributor of the Clinical Support Desktop (MyGeneralPractice). The RACGP current policy is based on sound principles including that it: • “Supports secure electronic sharing of information; • Supports a standards-based approach; and • Supports an electronic patient record that conforms to coding, classification standards across Australia and the world”. However, like the Pharmacy Guild, the RACGP has a long history of attempting to pick winners on the Health IT racetrack. This author contends that the professional bodies, in particular, should ensure that they stand back from the marketplace and, without fear or favour, advise their members of software products that meet an agreed and published standard like those produced by the CCHIT Certification body in the USA. At the very least, any commercial relationship with software suppliers should be clearly declared as failure to do so leaves open the possibility of breaches of the Corporations Act. The Pharmacy Guild, while well-intentioned, should be recognised as the commercial body of pharmacy owners (i.e. a business association or type of trade union) and not the relevant professional body, which is the Pharmaceutical Society of Australia (PSA). At a recent public meeting in Victoria of the Health Informatics Society of Australia, Peter Fleming, CEO of NEHTA, endorsed the current competition between software providers in the ePrescription market. NEHTA is charged with development and compliance with eMedication Management standards which, according to their website, “will result in an improved use of medicines and a reduction of the number of adverse medication events”. It is assumed that Mr Fleming was supporting innovation and Mao’s principle of “let a hundred flowers bloom and a hundred schools of thought contend”. However, all participants in the ePrescription market will eventually need to comply with

the NEHTA-approved standards. As always, timing is everything and new products should be evaluated for compliance with Standards prior to endorsement by NEHTA. For the doctor and pharmacist users of these products, as usual, the devil is in the detail. In its August 2009 Newsletter, the Pharmacy Board of Victoria recommended that ePrescription procedures “should be used as a tool to enable pharmacists to spend more time considering the patient medication history, overall safety of the prescription, and provision of advice to the patient on the safe and effective use of the medication”. Certainly they ought not to be a recipe for a reduction in pharmacist numbers by Guild or Government. Doctors and Pharmacists should also be wary of signing up to these products without reading the fine print in the associated agreements. One agreement for pharmacists allows the supplier to “capture medicines usage data from its pharmacy dispensing software from time to time, and (the pharmacist) acknowledges and agrees that the supplier may use the data for Commercial Purposes...”. Subject to over-riding legislation, the agreement also attempts to limit liability for any situation such that a pharmacist would have minimal redress for a serious dispensing error caused by the software. This limitation on liability, which also applies to the physician’s agreement, survives termination of the contract. When based on agreed national standards of interoperability, the electronic transmission of prescriptions has the potential to eliminate transcription errors between doctors and pharmacists and provide feedback to the prescriber on patient compliance via notification of prescription receipt by the patient. With a truly national scheme, and subject to electronic signatures, ePrescriptions also have the potential to virtually eliminate the paper prescription. It is a pity that, in their rush to market, the current suppliers have not been able to agree on an interoperable standard that would prevent the current battle for valuable chunks of desktop computer memory in the physician’s consulting room or pharmacy. Further, incompatibility with eMedication Management Standards may mean that products currently being marketed may not ultimately comply once these standards have been finalised. As a consequence, confusion and cost may be experienced by clinicians who would expect and deserve a more certain environment. The Australian community also needs to be convinced that the prime motivator for these new systems is a safer and higher quality health system while improved financial benefits to clinicians and software providers should be secondary and consequential matters. In the meantime, prescribers and pharmacists should follow the principle of “Caveat Emptor”.

References 1 - Bates, David W; Using information technology to reduce rates of medication errors in hospitals; BMJ, Volume 320(7237), 18 March 2000, pp 788-791. 2 - Richman, R et al; High Returns Pharming COWS; In Sintchenko, V and Croll, P (Eds); Health Informatics Conference, August 2009. 3 - Robinson, P; Waiting for Nirvana - a review of the current status of ePrescribing; Presentation to VHA Rural Conference, May 2006. 4 - http://www.erx.com.au 5 - http://www.medisecure.com.au 6 - http://www.health.gov.au/internet/main/publishing.nsf/ Content/pbs-stats-pbexp-jun08

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BitS & BYTES New partnership boosts support for general practice managers The Royal Australian College of General Practitioners (RACGP) and the Australian Association of Practice Managers (AAPM) will work together to promote the speciality area of management in general practice. The three year partnership will focus on enhancing management in general practice to deliver better healthcare outcomes for patients. The agreement between the two organisations will see the RACGP and AAPM work together to support and promote accredited professional development training for practice managers. In addition, the agreement will foster research into practice management and build research capacity and resources for practice managers, opening opportunities to explore the many contributions practice managers make to the viability of general practice business models. “At a time of significant health system reform the RACGP is keen to work closely with our colleagues in the AAPM to develop funding submissions and position statements to take to the Australian Government. We are keen to work together to interact with government and other stakeholders as the future shape of our healthcare system comes together,” said RACGP President, Dr Chris Mitchell. “We are also keen to work collaboratively to develop further resources to assist practice managers in their day to day work. The RACGP proudly supports the role of practice managers as a critical part of our broader practice team. As general practice care becomes more complex, GPs are looking to members of our practice teams, led by our practice managers, to provide the support we need to ensure we can focus on doing what we do best; provide high quality care to our patients.” AAPM National President, Marina Fulcher said, “The AAPM is very excited about the signing of this agreement. While our two organisations have always been supportive of each other and worked collaboratively in the past, having an agreement that we will continue to develop our relationship and support each other’s organisation brings a new dimension.”

NPS and AGPN to collaborate on prescribing data project Divisions have shown significant interest in the “Prescribing Data in General Practice Demonstration” pilot project, with 37 Divisions applying to take part in the initiative. The quality improvement project is a collaboration between the National Prescribing Service (NPS) and the Australian General Practice Network (AGPN). It aims to help general practitioners review their prescribing practices and management of patients with chronic heart failure and hypertension, look at best practice guidelines, and discuss management with their own peers. David Butt, CEO of AGPN was delighted with the interest divisions have shown in the pilot project. “We were overwhelmed by the interest in this project. It indicates there is a genuine interest in general practice in piloting new and innovative approaches to quality use of medicines in Australia,” Mr Butt said. The project will utilise the latest version of the Canning Tool, a data extraction software utility that allows GPs to receive immediate feedback on their prescribing practices against clinical indicators. Feedback of aggregate results at general practice network and national levels can also be accessed. In a statement, NPS CEO, Dr Lynn Weekes, outlined the need to better

understand the prescribing habits of general practitioners in relation to heart failure and hypertension: “Chronic heart failure and hypertension have well‑established treatment guidelines but gaps have been identified in optimal treatment. “Studies show only half of newly diagnosed hypertensive patients with no co-morbidities, are receiving first‑line recommended therapy, while there is under-prescribing of the recommended drugs and dosage levels for some patients with chronic heart failure. The consequences of these prescribing practices include increased hospitalisation, higher mortality, greater symptom severity and increased costs to the healthcare system, which is why this project is so important,” Dr Weekes said. General practices participating in the project will be supported by their local division of general practice, who will be paid $6,000 for each practice enrolled in the initiative. General practices will not be directly paid for their involvement, however a $500 payment for data cleansing operations may be afforded to participating practices at the discretion of their division. The pilot project, which commences this month and will run for two years, will involve 20 divisions and as many as 180 general practices.

Below – A screen from the Canning Tool, showing the four chronic heart failure indicators.

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HISA launches interactive Health Hub web portal Buoyed by the success of the inaugural HealthBeyond Consumer e-Health conference, the Health Informatics Society of Australia (HISA) has launched a new website to foster the spirit of collaboration between different professional health associations with a pivotal role to play. Held in early May at Melbourne’s Etihad Stadium, the event was attended by 320 delegates and industry participants, facilitating interaction between the various segments of the health sector. HISA CEO, Dr Brendan Lovelock, was so impressed by the excitement generated at the conference that “The Health Hub“ (www.thehealthhub.org.au) website was launched in an effort to facilitate interaction all year round. “The HealthBeyond conference was a fantastic success,” says Dr Lovelock. “It got groups together that hadn’t been together before and the buzz was amazing...those on the therapy side, those in public health information...this was a major factor in the creation of the website. There is so much currently happening or about to happen in consumer e-Health that it is so important that we keep the buzz going.” The Health Hub website aims to bring communication to a broader audience than any single conference could provide. In its role as an open social networking platform, it remains association neutral, is

Below – A screenshot of the home page of The Health Hub web portal, which is designed to facilitate ongoing interaction between the various parts of the health sector.

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provided free of charge and is designed to meet the needs of all health associations. It also has the capacity to extend beyond consumer health into all health domains if the members wish to take it in that direction. “Social networking websites thrive on information anarchy,” states Dr Lovelock. “On The Health Hub website, associations can create and moderate their own secure groups, facilitate discussions, set up notifications to stay on top of current issues, participate in cross-association communication and browse the public profiles of professionals in other associations. They can take their own professional area of the Hub in any direction they wish.” Dr Lovelock believes that if consumer e-Health is to thrive, it is essential that professionals from different parts of the health sector are brought together and encouraged to talk among themselves. “The big e-health systems are now being deployed in acute, primary and community care settings, but consumers aren’t linked in to them,” he says. “Consumers need to be able to take advantage of readily available information if they are to progress from being a subject of their healthcare to being in control of their own healthcare. This transformation needs to be guided

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BitS & BYTES by the strong engagement of health professionals.” Dr Lovelock is pleased with the progress of the website, which went through several months of testing prior to launch. The website takes somewhat of a “come one, come all” approach designed to strengthen as many arms as possible in the Consumer e-Health space.

“We’re inviting participation from chronic disease associations, software developers, clinical communities, GPs, Allied Health workers, psychologists, pharmacists, physios and so many more... even top game developers to increase usability. Our objective is to bring all these groups together.” — Tim McIntyre

Orion Health and HealthLink deliver eReferrals in the ACT ACT Health is the first region in the country to implement a comprehensive electronic referral management (eReferrals) solution, which was developed in partnership by Orion Health and HealthLink. The eReferrals project has created significant interest amongst the clinical community because it provides GPs across the ACT with a more transparent process when referring patients to The Canberra Hospital (TCH) and creates efficiencies that benefit patients and healthcare providers. Some of the most common problems with paper-based referrals in hospitals occur as a result of legibility, duplication or data entry errors, or inadequate updates on the status of a referral. In some instances this can lead to problems with patient care and adverse patient outcomes. eReferrals help to eliminate the risks associated with manual processes and also allow staff at TCH to prioritise case loads to better serve patients. When a patient is in need of specialist care, a GP refers a patient to a specialist or other provider at TCH for treatment. Using the eReferrals system, the GP can electronically submit and manage the referral through to completion. The system enables GPs to track referral progress to ensure an appointment is booked in a timely manner and that the patient attended their appointment. It also provides automatic notifications of any change in the state of the referral. According to the companies involved in the project, initial reactions to the new system have been overwhelmingly positive. The pilot went live in early June, with more than 30 GPs across the ACT region using the system to refer to more than 60 specialists in TCH Outpatient Services. Plans are now underway to expand the system to encompass additional services at the hospital.

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The eReferrals solution was jointly developed and implemented as a HealthConnect project by ACT Health, Orion Health and HealthLink, and subsequently piloted with a group of General Practices using MedTech 32 clinical software. In the coming months, support for other clinical software will be added and several hundred General Practices within the ACT and nearby regions will be invited to utilise the service. Eventually, ACT Health expects the eReferrals solution, which tracks the transfer of care of a patient, to enable any healthcare provider within ACT and nearby regions to refer a patient to another healthcare provider. “We envisage this solution will enable electronic referrals throughout the ACT Health system. With the go live of this eReferrals solution, we’re on the way to making our vision of an eHealth future a reality”, said ACT Health CEO Mr Mark Cormack. The ACT eReferrals system builds upon the experiences of a similar project undertaken by Orion Health and Healthlink in Hutt Valley District Health Board in New Zealand. According to Orion Health’s Regional Manager Chris Stephens, following this particular deployment, urgent and semi-urgent referrals were processed faster (by three days) and productivity improved by 40%. “By replacing paper based systems we are able to improve patient access to care, ensure accurate and secure information transfer and increase productivity in handling and use of patient information. A trusted partner of ACT Health, HealthLink assists patients in their care as they move through the different parts of the healthcare system” says Geoffrey Sayer, General Manager for Healthlink Australia.

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BitS & BYTES Medicare COLLECTS OVER TWO million BANK ACCOUNTS Medicare Australia has collected the details of over two million bank accounts from Australians electing to have their Medicare rebates paid directly into their bank account. This figure represents a seven fold increase in the number of bank accounts recorded by Medicare since the start of 2008. According to Medicare Australia, the milestone is a sign that Australians are throwing their support behind electronic claiming systems and that increasing numbers of people would prefer to have their Medicare rebate processed on the spot at the point of service. Mr Chris Bowen, Minister for Human Services said, “Health care professionals are also coming on board with over one million transactions made electronically across Australia in the last month alone. “Recent Medicare Australia research found 80 per cent of people who pay to see their GP would like the choice of being able to claim their Medicare rebate on the spot at their GP. “For practices in metropolitan areas it is about offering patients a choice. Patients can use electronic claiming or they can take their bill to a Medicare office to claim their rebate if they want to. “Regional practices are also looking for other avenues to help their patients claim their Medicare rebate. They understand that it’s hard for some people to get to their nearest Medicare office.” An additional 4,244 practices across Australia are now offering electronic claiming compared to the same time last year and over one-third of GP patient claims are now transmitted electronically. By registering their bank account details with Medicare Australia, patients that are unable or unwilling to lodge their claim at the practice and instead lodge their claim by mail or at a Medicare office can have their rebate paid directly into their bank account. In an effort to spur further adoption of electronic claiming services by practices, patients who pay to see their GP are being encouraged by Medicare Australia to ask practice staff if they can claim their Medicare rebate electronically. This message has been reinforced by extensive direct mailouts and mass media advertising campaigns conducted over the past few months.

ReferralNet integrated into Medilink, deployed in Geelong In an effort to strengthen the secure messaging capabilities of their clinical software, Medilink has integrated Global Health’s ReferralNet technology into its practice management solution. For Medilink customers, the move will streamline the process of electronically sending and receiving referrals and specialist reports to other sites using ReferralNet. According to Stephen Lynch, Chief Operations Officer, Global Health, the ReferralNet program has steadily gained market acceptance during its seven year existence. “It is important to make the use of referrals and patient information as accessible as possible for specialists and GPs,” said Mr Lynch. “Medilink approached us and before too long had what they were looking for. It is integral to time management and reliability of information that you no longer have a GP filling out paperwork, which then goes to the front desk, on its way to another desk and finally to a specialist. That should be a thing of the past.” Bob Marsh, Medilink’s CEO, believes his company’s customers will welcome the development. “The end result has exceeded our

expectations in terms of customer service and value,” he said. In a related development, Global Health has collaborated with the General Practice Association of Geelong (GPAG) to deploy their secure messaging solution to both GPs and specialists throughout the region. The Geelong E-Communication Program is intended to enable specialists to send letters electronically to GPs, and allow GPs to send referrals to specialists. In the initial phase, which commenced in August, over 300 GPs have had ReferralNet set-up in their practices and have commenced secure electronic communications with 40 of their specialist and diagnostic services colleagues. The next phase of the Geelong E-Communication Program is planned to extend secure messaging to hospitals. CEO of the GP Association of Geelong, Jason Trethowan said, “The Division has allocated resources to make this implementation a reality. Almost 100% of GPs have been set up to receive electronic correspondence from Specialists and other providers. Our approach has been to work in the Specialist rooms and assist them in their change process to send their letters via ReferralNet.”

AAPM to host National Conference in Melbourne The Australian Association of Practice Managers (AAPM) will convene their National Conference in Melbourne, with the event to run from Tuesday, October 20, through to Friday, October 23. The AAPM has attracted an impressive contingent of keynote speakers to the event, including Jeff Kennett, former Premier of Victoria and current Chairman of the Beyond Blue depression initiative, Allan Pease aka “Mr Body Language”, a celebrated public speaker and author and an expert on sales and communication, Amanda Gore, a motivational speaker with expertise in managing change, effective leadership, innovation, and high performing team dynamics, and Steve Herzberg, Managing Director of leadership

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consulting firm, NRG. A long list of plenary and concurrent sessions will also be held, with speakers and facilitators covering practice management themes including e-health, accreditation, privacy, practice nursing, and medico-legal subject matter. Tickets to the four day event are available for $1160, which covers all conference sessions, the conference exhibition, and an array of social events. Members of the AAPM are entitled to a $100 discount off the cost of the full event registration. Single day tickets are also available for $320. More information about the event is available at the conference website: http://www.cdesign.com.au/aapm2009

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A report profiling the Australian Health Informatics workforce has been submitted to the Department of Health and Ageing. “A Review of the Australian Health Informatics Workforce” was developed by the Health Informatics Society of Australia (HISA), in consultation with Michael Legg and Associates, with funding for the project provided by the Department of Health and Ageing. The report consolidates the findings of a comprehensive workforce survey in addition to supporting data collected from focus groups, interviews, and a range of formal submissions solicited in response to preliminary versions of the report. While the total number of health informaticians in Australia remains unknown, the architects of the report have estimated the figure to be around 12,000 professionals. It may be some time before an accurate reading is feasible however, given that 41% of survey respondents did not self-identify as health informaticians despite closer analysis of the duties undertaken by these people indicating that they could rightly claim to be health informaticians. In an effort to combat this apparent lack of definitional awareness, HISA has proposed a new working definition

for the discipline, which reads: “Health informatics is the science and practice around information in health that leads to informed and assisted healthcare.” This proposed definition was released at the close of HISA’s recent Health Informatics Conference held in Canberra, however it is not yet a universally accepted descriptor. 1,279 people completed the workforce survey in the prescribed ten day survey period, which commenced on June 15. With an underlying assumption that the survey respondents were representative of the wider health informatics workforce, the report found health informaticians to be predominantly female (55%), a percentage that increases dramatically for many of the health informatics sub‑specialities analysed in the report. Most health informaticians work in large organisations that provide healthcare, with 56% of those surveyed being employed by organisations with over 1,000 staff. Only 109 people (9%) identified themselves as working for healthcare systems vendors, a figure that was surpassed by the 210 survey respondents that work for government departments. Just 10% of survey respondents were aged under 30 with an additional 19% more being aged 40 or under. 33% of

Figure 1 – The number of years survey respondents expect to continue to work in health informatics.

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BitS & BYTES health informaticians indicated that they fall between the ages of 40 and 50, with 38% being 50 years or older. As highlighted in Figure 1, 73% of the health informatics workforce expect to be working in the field for at least another ten years, with 8% believing that they will exit the workforce in the coming five years. In health informatics it appears, with age comes tertiary qualifications. 79% of survey respondents are educated in multiple disciplines, with just over half of survey respondents indicating that their first training was undertaken in a health or health informatics discipline. Impressively, 11% have undertaken education or training in four or more distinct disciplines as highlighted in Figure 2. The review into the health informatics workforce concludes that there are many challenges ahead for the sector and for those that rely on the expertise provided by health informaticians. The report finds that there are too few health informaticians to meet the current demands being placed on the profession, a situation that is likely to worsen as the demand for improved e-health infrastructure intensifies. With the multiâ&#x20AC;&#x2018;disciplinary nature of health informatics implying a long lag time between the commencement of training and entry into the workforce as a suitably qualified professional, the authors recommend that the current health informatics workforce needs to be optimally deployed. Despite the strong demand from

employers for more qualified health informaticians, the report identifies market supply-side problems, noting that some universities offering health informatics qualifications are not attracting enough students to continue to operate these courses. These problems may be compounded by a related finding, which suggests that career pathways are not clearly defined, with no standardisation of job titles or descriptions, and no widely adopted set of professional competencies. The authors of the report believe that not enough is known about the current health informatics workforce, noting that the discipline is not being examined as part of any wider governmental health workforce strategy. The report also points to the relatively large number of peak bodies, colleges, standards organisations, and other groups representing health informaticians. Among others, these include the Health Informatics Society of Australia (HISA), the Health Information Management Association of Australia (HIMAA), the Medical Software Industry Association (MSIA), the Australian Information Industry Association (AIIA), the Australian College of Health Informaticians (ACHI), HL7 Australia, the Nurse Informatics Association (NIA), and Health Libraries Australia (HLA). A diagram highlighting the overlapping memberships of many of these groups is presented, however the report does not go as far as to suggest that representative consolidation is required.

Figure 2 â&#x20AC;&#x201C; The number of survey respondents with 1,2,3, and 4 or more qualifications.

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BitS & BYTES Improvement Foundation EXPANDS APCC Program More people with chronic diseases will benefit from the introduction of two new topics for the Australian Primary Care Collaboratives Program (APCC). The new topics, Chronic Obstructive Pulmonary Disease (COPD) and Lifestyle and Risk Modification (including Chronic Disease Self- Management) will be introduced to more than 90 General Practices through a national APCC Program wave beginning later this year. “To date, the APCC Program has led to key changes within Australian primary care and improved health outcomes for more than 236,000 Australians living with diabetes and coronary heart disease. We are delighted to be extending the scope of the APCC Program to include these two important new topic areas,” said Colin Frick, Chief Operating Officer, IFA. “Practices involved in the APCC Program have achieved significant improvements and due to the popularity and success of the Collaboratives, IFA are expecting high demand for places in the new national wave. Practices not directly involved in the national wave can still engage with the topics through the Program’s web portal,” said Mr Frick. For information about the APCC Program visit www.apcc.org.au

Local IT Firms Encouraged to look to asia FOR GROWTH Australian IT firms are looking more frequently abroad for opportunity as the Asia Pacific region continues to defy the world economic downturn. Recent studies have found that around 30 percent of companies in the Asia Pacific region intend to increase spending on software over the next 18 months, while only six percent will tighten the purse strings. David Twine, Austrade’s Regional Director for South East Asia, South Asia and the Pacific, believes Australian IT companies, particularly start-ups, should take note of opportunities close to home. “Asia Pacific businesses are well placed to navigate the downturn or recover faster due to the region’s robust economic growth over the past decade,” Mr Twine said in a statement. “Although IT spending in the Asia Pacific region is down from last year, it is still expected to grow by 5.8 percent to nearly US$196 billion this year.” — Tim McIntyre

Mater Health Services deploy Cognos workforce solution Brisbane’s Mater Health Services has finalised the deployment of IBM Cognos Workforce Planning Solution software, in a move designed to enable the organisation to meet staff and training demands through accurate long term workforce predictions. By analysing trends in staff attrition and highlighting the need for educational adaptation, the software aims to understand and combat the staffing shortcomings that hamper an industry that, according to Australian Health Workforce Committee Statistics, will face a nursing shortfall of 14,000 by 2010. “More so than ever now we are faced with the need for accurate long term workforce planning,” said Caroline Hudson, Executive Director of People and Learning, Mater Health Services. “With demand for health services being magnified by Australia’s aging population, it was important to implement a system that allowed us to look beyond 2015.” When Ms Hudson first came to Brisbane

from Western Australia in 2005, she took charge of systems that support a network of 7,000 staff across seven hospitals, which provided care for around 500,000 people each year. She found that like many other healthcare providers, Mater Health was using a multitude of decision-support tools and therefore could not measure attrition consistently. “With one of the largest maternity healthcare services in the Southern Hemisphere, consistency of information is of vital importance moving forward,” Ms Hudson said. “The IBM Cognos software enables us to start at a ward level and build to a global view of our services. We will be able to model data which will then assist in targeting the design of learning and development programs at Universities and enable the employment of suitably trained graduates at the right time, while at the same time looking at the impact of different attrition levels across many staff demographics.” — Tim McIntyre

MHAGIC mental health record receives ACHS recognition Global Health’s Mental Health Assessment Generation and Information Collection (MHAGIC) system has been recognised during the recent accreditation of Mental Health ACT by the Australian Council of Healthcare Standards (ACHS). The deployment of the solution by Mental Health ACT earned an Outstanding Achievement rating by ACHS, with Mental Health ACT also picking up seven Excellent Achievement ratings for other aspects of their operations. MHAGIC is a multidisciplinary, teambased Shared Electronic Medical Record and one of the first to be deployed in Australia. Having been initially rolled‑out in the ACT public sector in both community health and hospital settings, MHAGIC has subsequently gained market acceptance across the private sector, with over 70 private and government agencies now using the system. MHAGIC is the flagship module of

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Global Health’s MasterCare Shared EMR platform. MasterCare provides a secure, role-based view of clinical information, aggregated through a patient’s journey across multiple clinical interventions in the community and acute care facilities. To assist with the secure transfer of clinical information from MHAGIC across the team of care providers, Global Health has incorporated their ReferralNet clinical messaging platform within the MHAGIC module. Touting his company’s e-health offerings, Global Health CEO, Mathew Cherian said, “We are quite unique in the Australian market — offering a suite of market-leading solutions across multiple segments of the market. Inter-connectivity is the major impediment to e-health takeup and our unique presence across acute and primary care segment means we are well-placed to support the e-health momentum in Australia.”

Embracing people iSOFT is the largest healthcare information technology provider within Australia and New Zealand. In consultation with peak bodies developing the ehealth agenda across the region we are dedicated to supporting reforms that deliver a connected and personal health experience for providers and recipients of care. We are at the forefront of delivering national electronic health records that are improving outcomes across all care settings. Find out more about our world-leading technology at www.isofthealth.com

BitS & BYTES Orion Health APPOINTS REGIONAL MANAGER Orion Health has signalled plans for expansion with the appointment of Chris Stephens to the role of Regional Manager for Australia and South East Asia. Based in Sydney, Mr Stephens will be responsible for Orion’s operations in Australia, while directing business developments across South East Asia in preparation for the opening of a Singapore office. Orion Health’s growth comes as another successful year saw the company climb seven places to be ranked at number 63 in the Healthcare Informatics top 100 global healthcare IT list. Mr Stephens joined the company in 1998 and has held key roles including software development, project and product management, business development and sales. He holds a PhD in mathematics, and his understanding of the capabilities of Orion Health’s solutions combined with more than 10 years experience in International Healthcare IT markets positions him well to grow Orion Health’s business in Australia and Southeast Asia. Orion Health currently provides technology and services to over 1000 customers in 22 countries. — Tim McIntyre

Bently Health Service deploys Lasso mental health software Bentley Health Service, Mental Health (BHS,MH) has announced the deployment of a new software application, dubbed Lasso. Staff at Western Australia’s BHS,MH a public inpatient, outpatient and community mental health service for children, adolescents, adults and older people, recognised the need for an overhaul of the current patient admissions register and clinical audit system when it became apparent that the preparation of manual reports and limitations on data provision were hampering services. The decision was made to consult The Information Group (TiG), a company that provides applications and software development services specifically for the health care sector, resulting in the development of Lasso. Lasso enables staff to stay on top of data reporting, such as discharge workflow for bed occupancy planning and the identification of patients requiring follow up, by bringing information together across the entire spectrum of services provided by BHS,MH.

In a statement, Donald Cook, Director of Nursing, BHS,MH described his satisfaction at the speed and functionality of Lasso. “What used to take 10 hours of collation is now completed in less than two minutes. Our management team can access data more efficiently for reporting and decision making.” Lasso also provides a content management application that allows for the creation and editing of all reference codes, diagnosis codes, locations, findings, forms, documents and users, without programming. Staff use this feature to configure a detailed set of information about Bentley’s use of seclusion — the separation of a patient from others after an incident. “The use of Lasso for seclusion events exemplifies the importance of reliable data provision,” said Stephen Kalyniuk, a spokesman for TiG. “Lasso records information about why seclusion was used, who implemented it, how long it lasted and the outcomes. The ready information makes it easier to

Below – A Lasso Mental Health Admission entry screen.

DATA LOSS STILL PREVALENT In a worrying sign for businesses, IT managers may be underestimating the impact of data loss on revenue, according to a recent survey. The study, commissioned by Kroll Ontrack and conducted by StollzNow Research, collected information from 945 companies throughout Australia, Singapore and Hong Kong and found that just seven percent of respondent IT managers believed data loss has a significant impact on business. The report revealed that nearly half of the IT managers surveyed declared the loss of data in the past two years as a result of viruses, natural disasters, accidental deletion, system crashes, data corruption or hardware failures. Other areas for concern included the low frequency of backup system audits, a failure to keep pace with industry trends and management changes, and the low priority placed on the secure erasing of sensitive information. — Tim McIntyre

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BitS & BYTES monitor a seclusion event in accordance with the Mental Health Act and prevent claims of personality clashes or poor treatment of a patient by certain staff members.” Mr Kalyniuk said that TiG were happy

with the feedback so far, noting that BHS,MH have decided to train more staff than originally planned in the use of Lasso, which Mr Kalyniuk says is a testament to the usability of the solution. - Tim McIntyre

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one of the key technical resolutions of the Practice Incentive Program Working Group (PIP WG) that underscored this partnership has evolved, however Jared Davison, Senior Software Engineer, Medical-Objects, has indicated that this change will not affect the delivery of the infrastucture required to connect the two clinical messaging networks. In line with the current parameters established by the PIP WG, the venture partners are initially concentrating on the transport of clinical documents and not on the content of these messages. In its initial format therefore, the system will not, by itself, deliver the health sector a truly interoperable clinical messaging environment. For this to be achieved, Mr Davison believes clinical software developers — as opposed to messaging software developers — will need to improve the quality of their products’ HL7 message generation (export) and processing (import) ability, and ultimately, have their products certified by the Australian Healthcare Messaging Laboratory. Beyond the technical hurdles the partnership is seeking to overcome, commercial considerations have had to be traversed. The most notable outcome of these negotiations has yielded an arrangement whereby per message tolls will not be levied on users sending messages from one network to the other. Support costs will still apply for practices that wish to utilise the technical expertise of their messaging software provider for the installation, configuration or troubleshooting of their system of choice. In a related development, ArgusConnect has announced plans to cease offering free support to users of their software. Practices that do not sign up under an ArgusConnect support plan for $121 per practitioner will now be charged at a rate of $330 per hour for support.

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Medical‑Objects and ArgusConnect have announced plans to integrate their secure clinical communications and directory services, in what the companies have claimed is a major breakthrough for the secure electronic delivery of clinical information in Australia. In practical terms, the intent of the collaboration is to allow a practice with Medical-Objects installed to be able to send secure electronic correspondence to a practice using ArgusConnect. Similarly, it is intended that a practice using ArgusConnect will be able to send secure electronic correspondence to a practice with Medical-Objects installed. According to Glenn Stephens, CEO of Medical-Objects, his company’s partnership with ArgusConnect will extend the reach and usefulness of both companies’ software offerings. “This historic collaboration will significantly improve clinical communication between health professionals. It is a big step forward in developing a fully interoperable health message system in Australia. The bigger the network, the more powerful a tool it is for every user,” Mr Stephens said. The interconnected system will link the messaging delivery and directory services of both networks, working together to develop “interconnectivity”. In a statement, the companies have indicated that this work will “be based on the NEHTA specifications that currently exist where this can be reasonably done by both parties”. Originally slated to be operational by October 2009, the companies involved have indicated that the agreement will enable 20,000 health professionals around Australia to securely exchange clinical information using their Medicare PKI “location” certificates to perform message encryption. Since the collaboration and this delivery time frame was announced,

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Canning Tool updated to extract new APCC indicators Developers of the Canning Tool have extended its functionality to enable it to assist practices wishing to participate in the latest wave of the Australian Primary Care Collaboratives (APCC) program. Now at version 4.2, the utility is designed to extract a range of data elements from clinical software to allow practices, divisions and government to better understand the characteristics of patient cohorts. Originally designed to make it easier for Divisions to report on their National Performance Indicators, additional functionality has progressively been added to the utility over time. The latest version of the software can retrieve all the information required by the APCC, including data related to Coronary Heart Disease, Diabetes and Chronic Obstructive Pulmonary Disease. After a practice has used The Canning Tool to interrogate their clinical database, the relevant information can be displayed

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as aggregated indicators, in a patient list complete with clinical information, and as historical data on a per patient basis. The software facilitates the secure uploading of practice data to the APCC via their online web portal, and also allows practices to export patient information to an Excel spreadsheet. Containing patient address details, these exports can be mail merged for the purpose of conducting patient recalls. The Canning Tool can interface with Medical Director 2, Medical Director 3, Best Practice, Medical Spectrum, PractiX, and MedTech32, however currently APCC functionality is limited to MD2 and MD3 presently. Subsequent versions of the Canning Tool will support additional clinical packages in the coming months. The Canning Tool is sold on a per Division basis for a once off fee of $1,500. Currently, 80 out of 110 Divisions have purchased the tool for use by practices in their catchment.

Top – One of two colour-coded diabetes panels from the Canning Tool displaying the APCC diabetes indicators. Bottom – An extract from a CHD patient list showing the latest clinical information for each patient.

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MediSecure Pty Ltd, one of the two electronic prescribing initiatives vying for market attention, has announced the creation of the MediSecure Research Fund. According to a company statement outlining the initiative, “MediSecure believes that an effective way to improve health in the community is through investment in primary care and the purpose of the MediSecure Research Fund is to provide a mechanism for this necessary investment to be facilitated”. “We have taken this initiative because we believe that it is appropriate that some of the revenues generated by the emerging commercialisation of the e-health sector should be applied to medical research,” said Paul Montgomery, MediSecure Chairman. “This initiative is in keeping with our commitment to facilitate better health outcomes for individuals and the community, and our belief that the benefits of e-health should contribute. We are pleased that this initiative is actively supported by the Royal Australian College of General Practitioners and the Australian Association of Practice Managers.” The MediSecure Research Fund has been established as an independent charitable trust with a separate independent corporate trustee, MediSecure Research Limited, chaired by Mel Ward. Mr Ward is an experienced public company director and the current Chairman of Pro Medicus. Mel brings to the position professional experience from the telecommunications and information technology sectors, as well as an interest in and understanding of the health and health services sectors. Mr Ward said, “The company was established to promote medical research, in particular research connected with primary health and act as trustee of the MediSecure Research Fund, a charitable trust to support and fund medical research connected with primary health care. The MediSecure Research Fund welcomes contributions from participants in all areas of the e-health, medical and pharmaceutical markets. The fund is structured to allow tax deductable donations from any source, however the primary source of funds will be MediSecure Pty Ltd through ongoing revenues”.

BitS & BYTES Advantech CONDUCTS SOFTWARE IMAGE ROADSHOW Advantech Australia in conjunction with Microsoft’s Embedded Systems Division and ROK Technology have been running a series of ‘How To Build An Image’ Training Seminars, which began in Sydney in July and will conclude in Perth on the 15th and 16th of September. The training seminars are pitched at businesses looking to build and deploy customised operating systems and application suites for specific — and typically embedded — purposes. The first day of the course entails a theory presentation, lab sessions and a Q&A session. It encompasses the Windows Embedded Standard 2009 curriculum, presented as a minicourse, with a certificate available on completion. The second day involves a practical session, which gives participants the chance to put what they have learned on the previous day into practice. An informal, instructor-led session, day two allows people to build a deployable image for their own hardware solution. The course is presented by Jason Tolley, a Microsoft Certified Trainer and founder of ROK Technology Pty Ltd. Jason believed the July Sydney sessions to be a success. “One of the most rewarding things was that by the end of the second day in Sydney, everyone had their own images built on their own hardware,” he said. “If someone had have told me that was a realistic outcome 12 months ago, I would have told them they were crazy.” The Sydney seminars drew attendees from a diverse range of sectors, including surveillance, industrial, audiovisual technologies, visual signage and Government organisations. “Our target audience is anyone building a device that needs a robust embedded operating system,” says Tolley. “We are hoping to attract participants from the medical field to future sessions as we believe they will benefit substantially.” “Day two of the Sydney session was really fun. People bantered with each other, shared ideas and walked out of the place with a smile on their faces. It was very interactive. If one person struck problems I showed everyone else in the class the steps to take to resolve the issue. I think that’s the best way to learn.” — Tim McIntyre

Panasonic releases CF-H1 Mobile Clinical Assistant Panasonic has launched a new portable computer designed specifically for clinical settings. Dubbed the CF-H1 Toughbook, the device has been built upon Intel’s “Mobile Clinical Assistant” (MCA) reference design, which specifies the types of hardware functionality that can be leveraged in healthcare environments. According to a spokesman for the company, the construction of the device draws on Panasonic’s learnings from its long running Toughbook line of laptops, which have traditionally been deployed by companies operating in demanding environments, such as mining and construction sites. It is also apparent that Panasonic has benefited from their “fast follower” status in the MCA market, with the device exhibiting some simple usability refinements yet to be incorporated into other MCAs on the market. Among these are the positioning of the stylus pen dock on the front of the device, the inclusion of a prominent hand strap on the rear of the CF-H1 to improve the user’s grip on the device when in use, and the incorporation of several shortcut buttons positioned next to the screen. John Wood, Toughbook Group Manager in Australia, said, “Panasonic considered every need and feature requirement when designing the Toughbook H1, incorporating feedback from experienced healthcare professionals. The result is a durable, lightweight solution that is fully-featured, advanced and intuitive to operate. Panasonic has a long and proud heritage in building rugged mobile computing solutions for a wide range of industries. Panasonic now brings its expertise to the healthcare market, and has developed a solution in conjunction with medical professionals that will really assist the industry and overcome many challenges.” As with other devices in the Toughbook range, the CF-H1 sports a ruggedised construction, a quality that was on display at the official Australian launch of the device in Melbourne when — either accidently or for the purposes of the demonstration — the device was dropped from chest height to the floor and continued to function without any problems. The crash resistance of the device is tested to military standard

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MIL‑STD810F, which requires that it be capable of withstanding a drop of 90cm while operational, a height that is said to be similar to that of a patient’s bed. Unlike many tablet PCs that include a keyboard to allow for laptop-like operation, users of the CF-H1 would typically interact with the device via its 10.4 inch dual touch screen using either a stylus pen or their finger. This screen is designed to be clearly visible, even in direct sunlight. The device weighs around 1.5kg and sports an integrated handle for easy transportability. The CF-H1 is powered by two batteries, both of which can be swapped out of the device without it having to be shut down or put in hibernate mode. With its fanless construction and the low power requirements of its Intel Atom processor (running at 1.86GHz), Panasonic claim the device is capable of operating for 6 hours before a recharge or battery swap is required. The device has been designed and built from materials that make it conducive for disinfection to medically acceptable standards using typical disinfection solutions already found in clinical settings. To assist the user to do a thorough job of disinfecting the device, a packaged software application can be run on the CF-H1 that works in conjunction with its touch sensitive screen to visually demonstrate which parts of the screen have been wiped down, and more importantly, the areas that haven’t. Software can also remind the healthcare facility’s staff to disinfect the device at regular intervals. The CF-H1 integrates both a finger print reader and a contactless smart card reader, both of which can be used to authenticate healthcare professionals to clinical systems and desktop environments that support such access controls. Also included in the CF-H1 is RFID technology for wireless interaction with compatible tags, a technology increasingly being used for both patient record management, and management of patients themselves. The device can be configured with an optional 2D barcode reader, making it suitable for the majority of Australian healthcare facilities that have not yet widely deployed RFID systems.

BitS & BYTES As with most modern computers, the CF-H1 includes Bluetooth technology for wireless communication with nearby devices, and wireless network technology to allow users to remain connected to their healthcare facility’s network whilst moving between patients and administration areas. Wireless 3G broadband technology can also be integrated into the device, allowing healthcare professionals to achieve Internet connectivity anywhere mobile phone reception is available. The device can also be configured with an integrated GPS unit, which can be used, for example, to assist the user when conducting home visits, or to allow healthcare facilities to dynamically track the location of their MCAs. To give healthcare professionals the opportunity to quickly take photos and include them in patient records, the device features an integrated camera and two LED lights to maximise picture quality. However along with many of the CF-H1’s other value added features, the ability for photos to be seamlessly integrated into a patients record will be dependent on the ability of the organisation’s clinical software to integrate with MCAs. In its default configuration, the CF-H1 ships with 1GB RAM and an 80GB 1.8 inch hard drive, however the device can be customised to include solid state hard drive technology to improve performance and add further robustness to the MCA. Below – The Panasonic CF-H1 Toughbook Mobile Clinical Assistant. One of two battery docks is visible on the left of the device, with the finger print reader and function shortcut buttons shown on the right.

In Australia, the CF-H1 will be distributed by both DH Technology and Multimedia Technology. According to Mark Deere‑Jones, Panasonic Australia’s Director of Business Systems, DH Technology is well placed to promote the device by leveraging its existing presence in the health sector. “DH Technology has a dedicated healthcare sales and support team with specialised knowledge of the industry and an existing portfolio of healthcare products to complement the CF-H1.” Sold individually, the CF-H1 is priced to retail for $4,999, however bulk purchasing arrangements would typically apply, lowering the per unit price point. Despite having only been recently launched in Australia, Panasonic has already seen its new MCA deployed by the Dubbo RSL Aged Care Association at its facilities in both Dubbo and Wellington. Built in 1989, the Aged Care Facility has grown from a 40 bed hostel facility to a 187 hostel facility and high care unit across two sites, with 148 self care units and a total of 250 staff. In 2008, the facility embarked on a resource and information management review aimed at improving administrative processes. The review found that nursing staff were spending a considerable amount of time documenting patient care and performing medical administration duties, findings that lead to the deployment of software from iCare Solutions. In an effort to better mobilise its workforce, the organisation subsequently rolled out one CF-H1 for every two nurses on duty, for a total of 28 MCAs. According to Damian Moore, Dubbo RSL Aged Care Association, Nurses will primarily use the CF-H1 to document a patient’s progress in real time. Mr Moore said, “The Panasonic Toughbook H1 enables staff to document a patient’s progress in real time and administer medication safely at the bedside. Previously, nursing staff would write patient notes at the end of their shift, so some points may have been forgotten or changed. Now information can be recorded as it is happening, improving speed and accuracy. Staff are extremely excited about the new system. During training they have already seen the benefits and impact these new products are going to have — from increased time spent with patients to the improved safety and accuracy of patient care.”

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EVENTS CALENDAR eHealth 2009 September 23 - September 25 Istanbul, Turkey W: www.electronic-health.org Australian Health Congress 2009 September 29 - September 30 Sydney, NSW P: 02 8908 8555 W: www.acevents.com.au/health2009/

AUGUST GP Super Clinics Conference August 26 - August 27 Sydney, NSW P: 02 9080 4307 W: www.informa.com.au Medical Informatics Europe (MIE2009) Sarajevo, Bosnia and Herzegovina August 30 - September 2 P: +387 33 655 346 W: www.mie2009.org

SEPTEMBER International Surgical Week 2009 September 6 - September 10 Adelaide, SA P: 08 8274 6055 W: www.sapmea.asn.au 26th International Records Management Association of Australasia Convention Adelaide, SA September 20 - September 23 P: 1800 242 611 W: www.rmaa.com.au/natcon2009 Royal Australasian College of Medical Administrators Conference 2009 September 21 - September 23 Sydney, NSW P: 02 9213 4055 W: www.racma.edu.au Hospital Management and Information Innovation 2009 Nanjing, China September 22 - September 23 P: +86 21 5273 0733 W: www.hmii2009.com 12th Annual Health Facilities Planning & Design September 22 - September 23 Sydney, NSW P: 02 9080 4307 W: www.informa.com.au

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Integrated Primary Health Care 2009 September 30 - October 1 Melbourne, VIC P: 1300 316 882 W: www.integratedprimaryhealth.com HINZ Conference and Exhibition September 30 - October 2 Rotorua, New Zealand W: www.hinz.org.nz

OCTOBER Royal Australian College of General Practitioners GP’09 Conference October 1 - October 4 Perth, WA P: 08 9389 1488 W: www.gpconference.com.au

Higher Education IT Summit October 28 - October 29 Sydney, NSW P: 02 9080 4307 W: www.informa.com.au

NOVEMBER eHealth: The Modern Age Healthcare November 4 - November 5 Sydney, NSW P: 03 2723 6736 W: www.marcusevans.com AGPN Forum 2009 November 4 - November 7 Sydney, NSW P: 02 6228 0835 W: www.gpnetworkforum.com.au The Future of Medicare Forum November 5 - November 6 Sydney, NSW P: 02 9080 4307 W: www.informa.com.au GPCE November 13 - November 15 Melbourne, VIC P: 1800 358 879 W: www.gpce.com.au/melbourne

Australian Healthcare and Hospitals Association 2009 Congress October 7 - October 9 Hobart, TAS P: 08 8274 6050 W: www.sapmea.asn.au/ahha2009

ACAA National Congress 2009 November 15 - November 17 Melbourne, VIC P: 03 9805 9400 W: www.agedcareassociation.com.au

HIMAA National Conference 2009 October 14 - October 16 Perth, WA P: 02 9887 5001 W: www.himaa.org.au

Technology in Healthcare Summit November 16 - November 17 Melbourne, VIC P: 02 8908 8555 W: www.acevents.com.au

Pharmacy Australia Congress October 15 - October 18 Sydney, NSW P: 08 9389 1488 W: www.pac2009.com.au

Asia Pacific Association for Medical Informatics Conference 2009 November 22 - November 24 Hiroshima, Japan F: +81 82 257 5081 W: www.tinyurl.com/d4hfdg

Australian Association of Practice Managers National Conference October 20 - October 23 Melbourne, VIC P: 03 6231 2999 W: www.cdesign.com.au/aapm2009

Reforming Australia’s Health Workforce November 23 - November 24 Sydney, NSW P: 02 9080 4307 W: www.informa.com.au

To view more Health, IT, and Health IT events, please visit the Pulse+IT website. Events can be submitted for consideration via the calendar on the website, or via email to: editor@pulsemagazine.com.au

AAPM2009 National Conference ‘The Edge of Practice Management’ The Biggest Party in Melbourne in October 20 – 23 October 2009 Melbourne Convention and Exhibition Centre

th i s t s e t 3 a r 0 b e l Birth e c M day AAP AAPM’ s 3 0 th B i r t h d a y

Come along and celebrate AAPM’s 30th Birthday at the AAPM 2009 National Conference ‘The Edge of Practice Management’ from Tuesday 20 until Friday 23 October 2009 at the Melbourne Convention and Exhibition Centre. Hosted by AAPM Victoria, the program for AAPM 09 has been designed to showcase the best of what health care has to offer. Celebrate this milestone with champagne and birthday cake at the Happy Hour on Wednesday 21 October in the Exhibition Area.

Key Industry Leaders Forum

Check the website www.cdesign.com.au/aapm2009 for the latest program updates and full descriptions of social events, including a visit to the Melbourne Aquarium on Thursday 22 October.

The key industry leaders forum brings together representatives from government, employers, stakeholders and most important the practice management profession.

Optional workshops • Myers-Briggs Type Indicator® Wednesday 21 October, 1200 – 1300 (Register by Friday 25 September) The Myers-Briggs Type Indicator ® (or MBTI) is a fun and easy way to understand and develop your skills and knowledge, of how you and the practice team approach their roles and the practice’s function. Several million people world-wide undertake the questionnaire each year. • Expedition Friday 23 October, 0830 – 1230 Expedition is an innovative and competitive simulation where participants scale the highest mountain in the Americas. It challenges groups to become high-performing teams.

Thursday 22 October, 0900 – 1030 The Big Issues. The Big Players ... the industry leaders What’s happening in Practice Management? An opportunity for practice managers to be heard, and participate in a keen debate on issues that matter in practice management.

Whether it’s industrial relations, medical indemnity, e-health and healthcare reforms, the key industry leaders forum will address these issues, and a whole lot more! So don’t miss the biggest event at AAPM09 ... in fact the biggest event in 2009! Conference Design Pty Ltd 228 Liverpool St Hobart Tasmania 7000 w www.cdesign.com.au e info@cdesign.com.au p 03 6231 2999 f 03 6231 1522

www.cdesign.com.au/aapm2009

Visit www.carestreamhealth.com/info-mgt to ďŹ nd out more or contact liana.ansell@carestreamhealth.com

NEHTA

Setting foundations for e-health with healthcare identifiers Communication of health information is a vital part of effective healthcare. The accurate identification of individuals and healthcare providers is critical in all health communication. Healthcare identifiers for individuals, providers and healthcare organisations, will reduce the likelihood of medical mix-ups and avoid information being assigned to the wrong patient or sent to the wrong service. At present, communication within, between and across the myriad of private and government healthcare providers and systems has no single method of accurately and reliably identifying all participants. NEHTA, a joint initiative of the national, state and territory governments, is tasked with leading the design of e-health initiatives, including identifiers for individuals and healthcare providers.

The IHI will enable a person’s health information to be linked uniquely to them, and continue to be linked, no matter how many different healthcare providers they see and how many times they change address or other details. People may ask why a person’s existing Medicare number will not be used as a unique identifier. One reason is a person can be associated with more than one Medicare card. The unique identifier, however, will ‘uniquely identify’ that person regardless of what Medicare number is used. Authorised healthcare providers, healthcare centres and organisations will also be provided with unique identifier numbers. These will provide enough detail to clearly identify the individual provider, centre or organisation, including the provider’s business contact details if requested, and also operational information, such as the types of services provided.

Individual Healthcare Identifiers

Immediate benefits

In March 2009 the Australian Health Ministers, through the Australian Health Ministers’ Advisory Council (AHMAC), announced that all Australians will be allocated an Individual Healthcare Identifier (IHI) number for healthcare purposes. An IHI is a unique 16 digit identifier that will be assigned to all Australian residents and others accessing healthcare in Australia. Each number will apply to only one person and will be used in health information records alongside the person’s name and date of birth. It is a simple, yet robust, indexing system. Access to an IHI will be restricted to authorised healthcare providers or workers who can only use it to accurately identify an individual or health information that relates to the individual. No other clinical or health related information is stored with the IHI. NEHTA has contracted Medicare Australia to develop a new service to provide unique identifiers for patients and healthcare providers. The IHI is specifically designed to improve information management in the storage, retrieval and transfer of patient information across the health sector. Using an IHI will ensure that healthcare providers are able to clearly identify the person they are treating. The IHIs will enable important health information about a patient to be more readily and securely linked with other information about that patient. This is particularly important for people who may have many healthcare providers involved in their care, for example, the elderly. Healthcare providers may include an IHI in a person’s health records, along with name and current identifying information. If any healthcare information needs to be delivered to another healthcare provider, the IHI will provide clear identification of the patient, the referring provider and the healthcare service receiving patient information.

NEHTA is working on four key areas where immediate benefits will be derived through the use of IHIs: • Discharge summaries — patients’ ongoing care needs can be effectively communicated to their healthcare provider(s) when they leave hospital. • Pathology Tests — patients will be accurately linked to their test results and their care provider. • Prescriptions — pharmacists can clearly identify the range of medications a patient may be receiving, allowing better monitoring for possible contra medications, as well as safely filling electronically lodged prescriptions. • Referrals — patient records and case history can be communicated safely to and from the referring healthcare provider and the required service or specialist.

Privacy Privacy is paramount in the development of legislation governing healthcare identifiers. Specific Commonwealth legislation is being drafted to detail the governance, privacy and approved uses for the IHI. Access to the IHI and the limited information it contains, is protected by state and national privacy laws.

Consultation AND TIMEFRAME IHIs will be available from mid 2010. Consultations with key healthcare and consumer stakeholders will contribute to making the legislation robust and effective — balancing the privacy of personal information with the healthcare benefits that can be gained through better sharing of health information. The Department of Health and Ageing conducted a public consultation process seeking comments and submissions: http://tinyurl.com/nrrufp

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CONFERENCE PREVIEW: HIMAA CONFERENCE 2009

Health Information Management – A Strategic Asset To be held in Perth from 14-16 October, this year’s HIMAA Conference will bring together health professionals from many different fields to share their ideas and experiences and broaden their professional horizons. Pulse+IT discusses the event with conference convenor, Natalie Sims. Pulse+IT: Why is “Health Information Management – A Strategic Asset” a relevant topic for this year’s conference? This year’s conference theme acknowledges that health information is a key driver in the Australian health system. There is growing appreciation of the value of good health information in the achievement of strategic goals for organisations and for patient wellbeing. To acknowledge the changes in Health Information over the last 10 years the Health Information Management Association of Australia has undergone a rebranding to better represent our evolving community of practitioners. The new logo with the bi-line “A Strategic Asset” indicates the profession’s role in the changing healthcare landscape. Health information in hospitals has moved out of the medical records department to embrace a broader community of health professionals. The broad topic of the conference addresses the ways in which health information professionals can contribute to the achievement of organisations’ strategic goals. Other topics which fall within this theme include: • Innovation: Originality and advancement in health information technologies. Innovative projects in health information management. • Leveraging Assets: Experiences and challenges in ensuring finances, human resources, asset management and legislation enable a functioning health information system at all levels. • Connecting the Business: Experiences and challenges in moving from organisational silos to enterprise wide engagement and use of health information.

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• Managing Risk: Real life experiences. Planning for, managing, measuring and mitigating risks. Business contingency planning and crisis management. Pulse+IT: Which speakers are presenting at the event? We have invited a number of keynote speakers to present at the conference this year. They include Dr Simon Towler, Chief Medical Officer for WA Health who will be opening the conference, Peter Fleming, CEO of the National E-Health Transition Authority (NEHTA), Richard McFadden, CIO of the Western Australia Health Information Network, Louise Schaper, President of HISA WA, Robyn Lawrence, Executive Director for Innovation, WA Health, Sandra Miller Director of Safety and Quality, and Lorraine Nicholson, President of The International Federation of Health Records Organisations (IFHRO). The plenary sessions feature a number of selected papers from health information professionals from around Australia and some overseas. Topics covered by this year’s speakers include cancer data collections, electronic health records, enterprise information environments, inter-professional education, workforce issues, business planning, information management strategies and documentation issues. Pulse+IT: What other educational opportunities will be provided at the event? The conference is not only focused on health and we take the opportunity to assist professionals to develop their skills in other areas. A number of workshops scheduled to be held on the second

day include developing emotional intelligence, memory improvement to increase productivity, clinical coding, and writing skills. Two site visits have also been organised to showcase health information systems in practise and promote the work being done in Western Australian hospitals. The two facilities available to tour are Royal Perth Hospital, WA’s major teaching hospital, five minutes walk from the conference venue and Mercy hospital, a smaller private hospital located in Mount Lawley. The site visits will be held after lunch on Friday 16th October. Pulse+IT: What social events are being held in conjunction with the conference? A welcome reception is being held at the Sheraton Hotel on the evening of Tuesday 13th October. This coincides with the official opening of the exhibition area and gives delegates an opportunity to meet our exhibitors and network with attendees of the IFHRO South East Asia Region (SEAR) day as well as those arriving for the HIMAA conference. On Wednesday 14th October the Conference dinner will be held at the Perth Zoo. A great menu that showcases Western Australian produce has been organised for the evening. Pulse+IT: How is the IFHRO SEAR day affiliated with the HIM conference? The International Federation of Health Records Organisations (IFHRO) supports national associations and health record professionals to implement and improve health records and the systems that support them. Last year IFHRO SEAR held their first conference in Bali. In recognition

of the success of that event, HIMAA is supporting our regional colleagues by co-hosting the second IFHRO SEAR conference in conjunction with the HIMAA conference. Despite the differences between health systems and the practices of health information managers, both organisations stand to learn a great deal from each other. The IFHRO SEAR day on Tuesday 13th October will include speakers from UK, Indonesia, USA, Maldives, Sri Lanka, Thailand, Nepal and Saudi Arabia. Pulse+IT: Who should attend the 2009 HIMAA conference? The conference is relevant to anyone who has an interest in health information. This includes health informaticians, health information managers, clinical coders, public health specialists, project managers, researchers, data managers, students and many other professionals. Our conferences are also very useful to users of health information. Pulse+IT: How have the conferences evolved? This year is the 27th HIMAA Conference. Over the years the conferences have evolved from a focus on the Medical Record Department. The 2009 conference acknowledges the change in the professional scope of the

graduates and changes to Information Management and Information Technology. The conferences now cover topics from clinical trials, health informatics, clinical information systems, clinical classifications, business planning, safety and quality, as well as the basics of managing health information. This demonstrates the diversity of areas in which Health Information professions are now participating. Over the past few years we have begun a routine of alternating conferences with symposiums. The symposiums are traditionally smaller events that cater more to vendor/delegate networking and demonstrations, whereas the conferences still provide an opportunity for larger forums and more formal papers from our colleagues in the health information profession. Pulse+IT: Who is supporting the 2009 Conference? Our major sponsors this year include Core Medical Solution and Iron Mountain who we thank for their ongoing support of HIMAA. We also have a full exhibition officially opening on Tuesday night, which includes 3M, Lanier voice, Wacom, the National Centre for Classification in Health, Infomedix, Frontline, Rolls, and Curtin University. Like the presentations and workshops, the exhibition provides

an opportunity to learn about what is happening and what is new in the industry. Delegates have an opportunity to talk directly with experts with practical, in depth knowledge of their products. This year we will also have a best speaker award supported by iSoft and five $100 book vouchers have been provided by Elsevier as lucky door prizes. Pulse+IT: Are there plans for a 2010 conference? We have already started planning for the 2010 conference, which will be held in Melbourne. The provisional conference theme of “Health Information — the golden thread of healthcare reform” will open the conference to papers from a variety of backgrounds. Submissions for papers will open toward the end of 2009. Pulse+IT: How can people register to attend the HIMAA Conference? You can find all the details about the 2009 HIMAA Conference from the HIMAA website. From the website you can register online or download the registration form. The website also includes helpful information about the conference venues and nearby accommodation. HIMAA Conference 2009 www.himaa.org.au

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National E-Health Transition Authority www.nehta.gov.au

E-health: Transforming the patient experience E-health will have a major impact on healthcare providers and the patients being treated. As a healthcare provider you sometimes have to deal with incomplete and fragmented information and end up wasting your time collecting information and duplicating treatment activities. Not having access to the required health information and having to manually coordinate care with other providers can lead to information being exchanged in an ad hoc and incomplete manner.

That’s one of the reasons why the National E-Health Transition Authority (NEHTA) was established - to develop better ways of electronically collecting and securely exchanging health information. Thinking about the current Australian health landscape, Australia is facing a growing demand for healthcare reform driven by an ageing population, an increase in the prevalence of chronic diseases, better informed health consumers, and a demand for improvements in the quality and safety of healthcare.

E-health is already in use across Australia. But so that we have a truly national e-health environment operating to the highest standards of safety and security, NEHTA’s work is to develop the specifications or foundations of a national e-health system. An area of focus is e-solutions (for the most commonly exchanged health information). This covers: • e-Diagnostics (incorporating both Pathology and Diagnostic Imaging) • e-Continuity of Care (incorporating both Discharge Summary and Referrals) • e-Medications management In a national e-health environment diagnostic imaging would electronically transmit requests for service as well as images and reports to those who are required to review or act upon the information. Pathology requests and laboratory results will be electronically transmitted with the ability to disaggregate the information for more informed use. Discharge summaries will be sent directly from the hospital to the doctor or other healthcare provider. Referrals will be sent electronically by the healthcare provider and through electronic medication management, prescriptions will be accurately and securely transmitted from the doctor’s desktop to the pharmacy.

One of the main requirements for safe and secure e-health is the ability to uniquely identify everyone involved in the healthcare environment.

This includes the person receiving healthcare, the person administering healthcare, and the place where the healthcare occurs. NEHTA has contracted Medicare Australia to scope, design, build and test a healthcare identifiers service to provide this function. In March this year the Australian Health Ministers, through the Australian Health Ministers’ Advisory Council (AHMAC), announced that all Australians will be allocated an Individual Healthcare Identifier (IHI) number for healthcare purposes. This work is well underway. An IHI is a unique 16-digit identifier that will be assigned to all Australian residents and others accessing healthcare in Australia. Each number will apply to only one person and will be used in health information records alongside the person’s name and date of birth. Using an IHI will ensure that healthcare providers are able to clearly identify the person they are treating.

The IHIs will enable important health information about a patient to be more readily and securely linked with other information about that patient. It is expected that IHIs will be available for use midway through next year. IHIs will benefit elderly patients who may have multiple healthcare providers. It will enable health information about a patient to be more readily and securely linked with other health information. This has the potential to improve the safety and efficiency of the care they receive.

e-solutions For a better health system

e-diagnostics

e-discharge e-referral

e-medication

Towards seamless transactions

Summaries and e-Referrals improving continuity

Management better transparency

National E-Health Transition Authority www.nehta.gov.au

A patient journey – Part 1

To understand the benefits of e-health, follow the path of Frank Harding and his wife Daphne (both aged 65) who live in Croydon, Victoria. Frank is a retired school teacher and he and Daphne decide to head up north for a holiday. Frank has a number of health conditions.

Port Douglas Cairns

Coffs Harbour

• Non – insulin Dependent Diabetes • Moderate Depression • Ex Smoker (30 per day)

Croydon

• Drug Reactions: Penicillin, Prozac • 179cm, 98 kg, BMI of 32

National E-Health Transition Authority www.nehta.gov.au

A patient journey – Part 2 Frank and Daphne drive to Cairns where they stay at a beach side caravan park. However while walking on the beach Frank falls and injures his ankle. Daphne does her best to get him back to the caravan park, where they call an ambulance to get his injuries looked at the Cairns Hospital. Frank is attended to in the emergency department. At this time Frank describes his health status to the doctors looking after him making it clear that he is allergic to penicillin. He quickly mentions his diabetes, but doesn’t disclose his depression. The doctors arrange some

x-rays and some pathology testing to see what’s going on with his diabetes.

off with his new prescription to the local pharmacy to get his medications.

The results come back and luckily he has only sprained his ankle, however his blood sugar level is quite low. The doctor explains that this may have been the cause of the fall and arranges a change to his medication level to try to stop this happening again.

Following their stay in Port Douglas the couple head off to Port Macquarie. Daphne decides that she wants to play some tennis but as Frank doesn’t feel up to it, he is unable to partner her. This tips Franks depression a little and they have an argument. Frank decides to see a doctor about his depression whilst there. Again things improve and the couple head home.

After their stay in Cairns they head off to explore Port Douglas. While there Frank decides to go to a GP to get an updated script for his diabetes medications. The doctor there again organises a blood glucose test and HBA1C to monitor Frank’s diabetes. Things seem to be progressing along okay, and Frank heads

Port Douglas: GP Cairns: Hospital Nth Qld Pathology

Weeks later back in Victoria Frank goes back to his GP. Frank provides relevant information about his healthcare adventure and his GP again assumes responsibility for Franks medications and health.

“Healthcare providers will be able to work far more efficiently with e-health due to greater access to information, compared to paper records. The natural flow-on effect of this will be a safer and higher quality system for the patients.” Dr Christopher Pearce, General Practitioner, Melbourne.

Coffs Harbour

Melbourne Diagnostics VML Pathology Regional GP EHR Repository

Croydon

• 6 Weeks • 10 Health Care providers • 6 Repositories of information One patient …

Towards safer more effective healthcare As NEHTAs work is adopted, Frank's journey will be very different.

Now

Cairns ED, Port Douglas GP & Croydon GP • Worked with incomplete and fragmented information. • Wasted time collecting information and duplicating treatment activities. • Did not have access to discharge summary, medication list, x-rays and other health information. • Manually coordinated care with other providers.

Frank • Reliant on individual health care providers for access to reliable information. • Repeated same information to multiple health care providers. • Received duplicate treatment activities. • Limited security of personal health information or ability to control access. • Received limited help with adherence to referral instructions, medication regimes, or care plans.

Future Cairns ED, Port Douglas GP & Croydon GP • Would have the ability to see an integrated and complete view of Frank’s health information including discharge summary, medication list, x-rays and other health information. • Would be able to share information electronically in a timely and secure manner across the health sector. • Could electronically interact with Frank regardless of his geographic location.

Your Privacy

Frank • Will have access to his health information. Can control access to personal health information. • His health information will be managed securely and confidentially. • Will have the ability to better manage his health through access to reliable sources of health information. • Can confidently rely on the health system to effectively coordinate his care regimes and treatment.

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Everyone like Frank who seeks healthcare expects that their personal health information is handled properly and transparently. In developing the foundations for the national e-health environment NEHTA is working hard to ensure that this will always be the case. New privacy laws are coming into operation to support national e-health and provide a structure and proactive approach to privacy. People

like Frank will have greater confidence in how their health information is stored, retrieved and used, and have more control over their healthcare experience. There will be common arrangements nationally for privacy, meaning more clarity in the protection of information.

FEATURE Brendon Wickham eHealth Support Officer, General Practice Victoria. b.wickham@gpv.org.au

The e-Health journey: a long and winding road Why is e-Health so difficult? The history of e-Health in Australia seems littered with false starts and endless trials. In an age of Internet banking and advanced business-to-business communication, the health sector seems to lag far behind. The goal of e-Health is to enable the secure, authorised sharing of health information between consumers, clinicians, health agencies and government. In other words, a transmittable Electronic Health Record (EHR). A record that is sufficiently understood by humans and computers alike according to their particular requirements. Getting this electronic record off the ground is proving more difficult than it might sound. The advantages of an EHR have been spruiked pretty much since the advent of business computing, but we are still a long way away from realising even a 1960s vision, let alone what we now know is possible in the current world of cloud computing, online banking and Internet video chatting. Health is complex There is probably no sector more complex. The combination of human biology, sophisticated science, cultural and language differences, education, professional allegiances, organisational structures and political boundaries all contribute to make the management of health information very difficult indeed. Unlike those of most other sectors, health IT systems can, and do, have a direct impact on human physical health. Many studies have shown they have the potential to dramatically improve healthcare and patient outcomes (i.e. save lives), but progress must be done cautiously, involve multiple collaborating partners and employ strict oversight.

Interoperability is impossible unless different systems use the same methods of communication between them, irrespective of the aforementioned variation in requirements. Hence developers of e-Health systems must agree to standards. The vast majority of the technological systems in place are “siloed”, unable to share information between each other. This is why a patient must repeat their details ad nauseum during their journey through the health system, and why clinicians are unable to find out critical information about their patients from other health providers. Interoperable standards are the only way to tear down these silos. Enter the National E-Health Transition Authority (NEHTA), which is charged with developing Australian standards for e-Health. NEHTA, Standards Australia and the National e-Health Strategy are the three prongs of a concerted effort by government to progress e-Health. It is a huge challenge that requires not only technical expertise, but the ability to foster change by engaging disparate stakeholders and winning hearts and minds. One of NEHTA’s first tangible deliverables will need to be workable secure messaging specifications. This is mandatory because the e-Health eco-system cannot exist without secure messaging to connect it all together. NEHTA proposes that the solution to secure messaging is for one computer program to communicate with another over the Internet using a relatively recent technology called web services. This article aims to explain why NEHTA has decided web services is the way to go and roughly what direction NEHTA is taking with their web services proposal.

Current approaches to secure messaging

A first step: secure messaging

There are two broad approaches to send a message from one computer to another: store and forward and point to point.

An environment that supports a transmittable EHR will share characteristics of an eco-system; individuals and communities interacting with each other and growing and mutating to adapt to changing requirements. This level of interaction requires cooperation, and that means information generated by electronic systems needs to be mutually understandable. In other words, we need electronic health systems to be interoperable. The health sector has many functions, and many of those rely on electronic systems. These functions often have different purposes, which means that those who develop the systems (e.g. health IT vendors, health organisations and governments) often have competing priorities, and usually very different business models and even philosophies.

Store and forward Email is an example of a store and forward system. The sending computer packages up the information (e.g. addressee and message) into a format that is then transmitted to the receiver’s computer by using an array of “middle-men” computers. It is important to note that the message is not “pushed” directly into the receiver’s computer — the receiver checks to see if another computer (its email “server”) has messages stored and waiting for it to download. Hence the term store and forward. Note that the store and forward approach is not restricted to email. There is a range of options for information to be transmitted (usually over the Internet). Some vendors pick one

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of these standards to send a message that is then stored in their database and waits for the receiver to check for unread messages by using the same communication method. It is very similar to email, but usually allows for more functionality (e.g. the acknowledgement to the sender that a message has been received, or not – something not possible with standard email and very important in the health context). Point to point The other approach is for two computers to connect directly to each other and transmit the message between them directly (i.e. no middle man). This is known as point to point. Security In health, as in banking, security is an important consideration. E-Health systems need to ensure that information being transmitted can not read by any unauthorised party. They must also safeguard against one computer reading the information on another computer, even when they’re both enclosed within a “circle of trust” such as a Virtual Private Network (VPN). A VPN, or analogous solution, cannot guarantee that health messages are not being intercepted by someone other than the authorised practitioner (or indeed, by anyone other than those to whom the patient has consented). Using complicated security policies, it is possible to have some control over user access, but it requires more overheads in administration of the system.

The challenge Health secure messaging already exists across Australia, enabled by a number of different products and solutions using one or the other of the approaches described above. Some of these cover the whole of Australia, some are localised. Some can even talk to each other, but there are none that can communicate to all (or even most). The majority of these messaging products are limited to the sending and receiving of a message. But in the course of their normal activity, health systems go beyond this narrow scope. They require a range of access options and a variety of functions. These functions are sometimes referred to as services. Examples of services are: the sending of pathology reports, transmission of

prescriptions, referring of patients, looking up of contact details, updating of a centralised health record etc. NEHTA’s challenge, therefore, is to select and define a method for interoperating, access-controlled and services-driven e-health systems. This method must include: • A directory: àà To find a current and authorised organisation or individual. àà To obtain their electronic address. àà To obtain their electronic security credentials. • A secure connection to transmit information in such a way that no third party can intercept, read and understand it. • The ability for the sending/initiating computer to “know” what services the other computer is capable of. • An ability to audit messages so that we know they: àà Were sent by the individual or organisation who claimed to send it. àà Cannot be refuted by the individual or organisation who actually sent it. àà Were delivered successfully to the correct recipient (and, if not, the sender was notified of the failure). àà Have not been tampered with en route. The method must be: • Capable of scaling to cope with different levels of demand and sophistication, and not impede future innovation. • Capable of including all organisations that deliver healthcare. NEHTA’s secure messaging specification does not need to be concerned with the structure of the message content, nor what the organisation does with the information once it has been successfully transferred (though, for some clinical functions such as medications and pathology, NEHTA has tightly described specifications). Email and methods of point-to-point can resolve some but not all of the above requirements for interoperability.

The solution NEHTA’s solution to the challenge of secure messaging in Australia is multi-layered and non-centralised. NEHTA has determined that a combination of web services

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and Public Key Infrastructure (PKI) will meet the core need of being able to securely send a message between identified, authorised parties. Web services When we connect one computer to another we “tell” it to “ask” the other for something. This request and response scenario isn’t necessarily kicked off by direct user command. Many computers are programmed to automatically connect to others and get or send information when specified events occur. When computers connect to each other they are networked. There are many ways of networking computers, and the most successful network (in terms of scalability, reliability, geographical coverage and sheer weight of numbers) is the Internet. The Internet is so successful because it is based on a very simple set of rules that any computer (no matter how weak it is or what operating system it uses) can easily implement. This simplicity comes with a price, but it also comes with many advantages and those advantages are slowly being worked out and exploited. The most important example is, of course, the World Wide Web. Just like the simple rules underlying the Internet, the web has its own set of very simple rules for computers networked to the Internet to transmit and store information. Web services is the term given to a collection of data formatting and Internet standards that together enable computers on the Internet to interact with each other (i.e. independent of direct human input). Some of these standards have been around for 20 years or more, some for only 10 years. Only this century has web services started to make an impact on the computing world, and increasingly it’s becoming an unstoppable force for solving data sharing problems. It has succeeded where other methods have failed. The web service standards aren’t all that mysterious. In fact, you probably use them every day. When you browse a web page, your computer is using an address (i.e. “http://

something.something.something/something_else) to connect to a computer somewhere and ask it for the information that it has stored at that address (i.e. a web page). Pretty much the same thing happens with web services. The address follows the same pattern (once again, it starts with “http://”). Only instead of a web page with text and images, the computer that is requesting information will receive text structured in a special way that it can “understand” and act upon. Some mock-up web services code is shown in Figure 1. NEHTA has chosen web services because it enables the interoperability that is so essential for e-Health. Moreover, it is flexible enough to cope with our current situation, an interim stage, and the final push towards full interoperability. NEHTA’s ultimate vision is for every health provider (from GP or specialist clinic to a large regional health service) to be able to directly connect with each other and exchange information. Health providers only need an Internet connection and NEHTA compliant software.

PKI Secure messaging systems need to establish a user’s credentials (for identification and authorisation) and be able to audit the message. Web services technology by itself cannot perform these functions, and this is where PKI enters the picture. PKI works by providing all participating users a public and a private key to authenticate details. A full explanation of PKI is beyond the scope of this article, suffice to say that PKI requires a central body — currently Medicare Australia — to manage the issuing of public and private keys and for users to secure their private key and keep their details current. NEHTA have selected PKI for their solution because it is the only method in existence that can both prove identity and guarantee the integrity and provenance of a message. NEHTA is currently working with Medicare Australia to develop a certification body and structure (called NASH - National

Figure 1 - A mockup of how a computer service might request another service and receive a response using web services.

REQUEST <?xml version=”1.0”?> <SOAP-ENV:Envelope SOAP-ENV:encodingStyle=”http://schemas.xmlsoap.org/soap/encoding/” xmlns:SOAP-ENC=”http://schemas.xmlsoap.org/soap/encoding/” xmlns:SOAP-ENV=”http://schemas.xmlsoap.org/soap/envelope/” xmlns:xsd=”http://www.w3.org/1999/XMLSchema” xmlns:xsi=”http://www.w3.org/1999/XMLSchema-instance”> <SOAP-ENV:Body> <m:getProviderName xmlns:m=”http://uhi.gov.au/”> <param1 xsi:type=”xsd:int”>4485115822654889</param1> </m:getProviderName> </SOAP-ENV:Body> </SOAP-ENV:Envelope> RESPONSE <?xml version=”1.0”?> <SOAP-ENV:Envelope SOAP-ENV:encodingStyle=”http://schemas.xmlsoap.org/soap/encoding/” xmlns:SOAP-ENC=”http://schemas.xmlsoap.org/soap/encoding/” xmlns:SOAP-ENV=”http://schemas.xmlsoap.org/soap/envelope/” xmlns:xsd=”http://www.w3.org/1999/XMLSchema” xmlns:xsi=”http://www.w3.org/1999/XMLSchema-instance”> <SOAP-ENV:Body> <getProviderNameResponse> <Result xsi:type=”xsd:string”>Metro Hospital</Result> </getProviderNameResponse> </SOAP-ENV:Body> </SOAP-ENV:Envelope>

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Authentication Service for Health) to manage PKI and its related requirements. Directories As described above, we also require the ability to lookup an individual or organisation and obtain the necessary details. NEHTA is currently working with Medicare on the structure and functionality of an Australian directory (dubbed the UHI, or Unique Healthcare Identifier) that will make it a lot easier for clinicians and health providers to find each other and to obtain vital patient information on time. The directory is due to be functional by the end of 2009, though there are legislative and operational hurdles to be overcome before it is fully populated and integrated. In addition to the UHI we require another type of directory. A system knit together by web services cannot function unless there is a central directory to which organisations publish the services they have made available. Examples of services are: search for a provider’s details, get a pathology result, receive a referral. NEHTA’s term for this directory is the Endpoint Location Service (ELS). The ELS is of little relevance to healthcare workers but it is critical for software developers. The ELS and the web services specifications have moved to a mature stage, but the final push requires detailed consultation and feedback with software vendors and state governments (who, because of their eReferral objectives, also develop secure messaging software).

An intricate task The establishment of NEHTA represents a large investment by Australian governments. It is tasked with what no one could pretend is an easy assignment. The dream of full interoperability (i.e. where clinical information can be safely exchanged even when communicating across medical specialities and between different spoken languages) is a goal that is theoretically possible but considered almost unattainable. But it is a challenge that must, for the sake of improved healthcare, be tackled with commitment from all involved. The cutting edge nature of the technology creates ambiguity. Its flexibility and openness means there is no right answer. NEHTA cannot refer to a manual to see how well they’re doing. Beyond generic international standards there is no roadmap they can follow. On the other hand, they must ensure that the decisions they make are based on best-practice, or are evidence-based, wherever possible. NEHTA is not operating in a computer science vacuum. Almost everything they are tasked to do has been done before, they just need to find the most appropriate way to go about it. One of the most prominent thinkers and educators in the computing world is Bruce Eckel, and he encapsulates what should be the key goal for NEHTA: “A standards body should formalise existing practice, rather than inventing new practice without experience.” After all, how can it be a standard if no-one previously used it in some way? By adopting web services, NEHTA has chosen the right path (indeed, there was no other choice). While web services isn’t quite established practice in health, it is increasingly embedded within many other sectors. Inevitably there will be some disagreement between NEHTA and those IT developers who are not entirely convinced by their

direction. NEHTA must establish its authority by earning the trust of the community it serves at the same time as recognising that it cannot do the job on its own. At the same time, software vendors running a tight bottom line cannot afford to experiment. IT development costs a lot of money, so before committing to development, vendors need to be satisfied that they are not risking their (very) precious time. NEHTA will not be able to foster interoperability unless it can persuade more than one early adopter to come on board and start implementing their standards. NEHTA is fully aware of this predicament and made mention of it in their document titled “Towards a secure messaging environment, 2006”: “In some ways [developing an interoperable secure messaging standard] represents a standard chicken-and-egg dilemma — it is hard to understand the need to be enabled to utilise web services when there are few existing services to consume and conversely there is no market to develop web services when there are few consumers enabled.” NEHTA’s task, then, is to consult with secure messaging vendors to form standards that are usable in the real world, and to convince them that they will not suffer if they adopt the standards. And this is exactly what is happening. In March this year, the Department of Health and Ageing (DoHA) announced a new Practice Incentive Payment for eHealth (the ePIP). A key requirement to qualify for the ePIP is for general practices to have a working secure messaging product that is compliant with NEHTA’s specifications. In what is possibly a world first, NEHTA and software vendors are currently sitting around a table and hammering out the finer details of the proposed standard. This approach is a quite a diversion from the norm, where a government department prepares a specification and tenders the work out to a developer. NEHTA has laid much of the groundwork, but the final push towards a working system will ultimately be shaped by those who have to code it into their existing systems. There is probably no better way of doing this. It is a realistic mix of top-down and bottom-up approaches (bearing in mind that, in this case, the end-user is the developer themselves, not the clinicians who will use the system. Adoption of the standards is unlikely to change the user-interface in the short-term). As John Lilly, the CEO of Mozilla (the organisation that produces the Firefox web browser), said recently when commenting about a new version of the core technology that forms web pages: “…I think no-one actually knows what the perfect standardsbased world looks like. There’s no really great way to do this; it’s this balance between a lot of things.” The outcome of this collaborative approach will become apparent very soon. Next March (2010), in collaboration with DoHA and Integrating the Healthcare Enterprise (IHE), secure messaging developers will get a chance to publicly demonstrate their compliance with the new standards in a “connectathon”. Compliance will be independently verified by the Australian Healthcare Messaging Laboratory (AHML). We are closer now than we have ever been before to an interoperable environment. With web service specifications and the UHI we are heading towards an exciting next few years in health.

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8th 8thANNUAL ANNUALCONFERENCE CONFERENCE and andEXHIBITION EXHIBITION

PERSON PERSONCENTRED CENTRED HEALTHCARE: HEALTHCARE: eHealth eHealthasasan anenabler enabler

www.hinz.org.nz www.hinz.org.nz

Wednesday Wednesday 30th 30th September September - Friday - Friday 2nd 2nd October October 2009 2009

Energy Energy Events Events Centre, Centre, Rotorua, Rotorua, NZ NZ

FEATURE Mark Worsman and Amanda Leong Mark Worsman is a Senior Associate and Amanda Leong is a Solicitor at DLA Phillips Fox. DLA Phillips Fox has around 800 lawyers across eight offices in Australia and New Zealand. It has an exclusive alliance with DLA Piper, one of the largest legal services organisations in the world, with lawyers in 28 countries. mark.worsman@dlaphillipsfox.com ~ amanda.leong@dlaphillipsfox.com

Online Health Consultations: the legal issues Overview The Internet provides healthcare professionals (HCPs) and online healthcare service providers (HCS Providers) with opportunities and alternative platforms to offer health services to patients. However, HCPs and HCS Providers need to be mindful of the legal issues that may arise in providing healthcare services online.

The difficulties with online consultation Some websites in Australia now offer online health services including online consultations, prescription renewals and the ability to request pathology test results. One of the issues for HCS Providers and participating HCPs is the fact that the HCP has only limited information available at the time of the online consultation due to the patient not being physically present. This means that assessment of the patient and diagnosis will inevitably be more difficult than is the case with traditional consultations. Accordingly, HCPs need to be very cautious in diagnosing patients online given the disadvantage of relying on the patient’s account and the inability of the HCP to question, test or use other diagnostic techniques on the patient. There will be situations where diagnosis or generating a prescription is not appropriate at all. If an inappropriate or incorrect diagnosis is made by a HCP, it is likely to expose the HCP and the HCS Provider to liability. HCPs will also need to be alert to patients who have language or other communication disadvantages to avoid miscommunications resulting in incorrect diagnosis as the HCP or HCS Provider will likely be liable for any resultant inappropriate or incorrect diagnosis. The legal implications of an inappropriate or incorrect diagnosis potentially differ to those arising from a face to face consultation. For example, it is unclear how the Courts will approach the standard of care required for online consultations, given the uncertainty about: • what a patient could reasonably expect from an online consultation; and • how much information a doctor should elicit from a patient before making a diagnosis.

Interstate consultation Regulation of registered HCPs is often delegated to State and Territory based registration boards. Because online consultation presents HCPs with the potential to consult patients outside of the jurisdiction in which that HCP is registered to advise, HCPs could potentially risk contravention of the relevant professional registration scheme. To address this potential problem HCPs and HCS Providers should ensure that the online system only allows patients of a

jurisdiction in which the HCP is licensed to practice to be treated by a HCP in that jurisdiction. We note in passing that an exposure draft of the Health Practitioner Regulation (Administrative Arrangements) National Law Bill 2008 has been released and could, if implemented, overcome these problems by potentially introducing a national registration and accreditation system for certain HCPs. This interstate issue may also be a problem where a dispute arises involving a patient who is registered or residing in one State and receives advice in an online consultation when interstate. Or, it could be an issue where a HCP is registered, for example, in NSW but consults with a patient residing outside of NSW. It is not clear in these circumstances where a complaint would be heard.

Is your insurance adequate? HCPs may also need to confirm whether their insurance will cover online consultations and if their insurance would cover a complaint about online advice provided outside of the State or Territory in which the HCP is registered. HCPs should also check whether the HCS Provider’s insurance will cover such online activity to ensure that even if the HCP’s insurance is not applicable, the HCS Provider’s insurance will cover the HCP.

Information security There are only limited ways of verifying the identity of the patient in an online consultation. This may be a problem if, for example, a patient’s access credentials to the website are stolen. In this example, an unauthorised user could cause an inappropriate prescription to be made for the patient, potentially exposing the HCP and the HCS Provider to liability. Health information collected by HCPs is subject to the Privacy Act 1988 (Cth). If the patient’s access credentials are stolen or lost, unauthorised access to the patient’s online information could also expose the HCP and HCS Provider to liability for breach of their respective obligations under the Privacy Act. For example, if a HCP accesses a patient’s health information on a mobile device and the device is accessed by another person (because it is, for example, lost or stolen) the HCP may be liable for any resultant breach of privacy, not to mention any unauthorised use of the HCP’s account.

Conclusion HCPs and HCS Providers must be alert to the legal liability risks related to diagnosing patients online, privacy, security, patient identification, professional registration and accreditation and insurance.

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FEATURE Dr Paul Mara MBBS, FRACGP, FACRRM, DRACOG, is a rural doctor practising in Gundagai and the Managing Director of GPA Accreditation Plus.

Continuity of care – referral documents I have a thing about referral letters. It was possible in the past that a patient’s medical record would be accessed and viewed by only one doctor. This has now become unlikely with increased scrutiny of medical records through accreditation, Medicare Australia audits, management by a diverse range of health providers, more emphasis on chronic care management and growing pressure for patient held records. I typically tell my students and registrars that how we are perceived by our colleagues will be dependent to a large part on the content and quality of our referrals. If patient health summaries provide a snapshot of a patient’s health and consultation notes record each patient encounter, then referrals should be more than just a regulatory process that allows a patient to claim Medicare rebates for a referred service or practices to claim Enhanced Primary Care items. Referral documents can be seen at many levels. These include referrals to specialist colleagues for either complex acute or chronic conditions, referrals for ongoing problems that are well known to the specialist, referrals to other providers such as physiotherapists or diabetic educators, or referrals for investigations. The nature and complexity of the documentation should reflect individual circumstances and there is an ongoing challenge to ensure that neither too little nor too much information is provided through these referrals.

Standards requirements for referrals The RACGP defines requirements for referral documents in Criterion 1.6.2. This mandates that “referral documents to other health providers should contain sufficient information to facilitate optimal patient care”. The key requirements are that referral documents are legible and on practice stationery, that sufficient information is provided, that there is patient consent for transfer of information, and that copies are kept in the patient’s record for clinical and medicolegal reasons. Information provided should include (where appropriate) the purpose of the referral, relevant history, findings on examination and current management, In computerised practices most referrals are now typed and many practices use templates that automatically print health summary information including current problems, medication lists, allergies, past health, family history and social history. Frankly I find these cold and often inaccurate or irrelevant. The issue is more than just one of style. Inaccurate or incomplete information in the medical record has the potential for serious risk to the patient and as a consequence medico-legal implications for practitioners.

Pitfalls In my opinion referral letters should reflect not just a compilation of information but tell a story about the patient. They provide

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an opportunity to reflect on a problem, to review the patient’s history and management including investigations summary. Unfortunately some referrals, particularly those reliant on templates, tell more about the quality of the record keeping and referring doctor’s clinical process than they do about the patient and the current problem. A referral to a cardiologist, for example, for onset of chest pain should provide more than the statement: “Please review this patient with chest pain” followed by an incomplete health summary, out of date medication list and scanty encounter notes. In general the following recommendations should be considered: • use a new referral as an opportunity to review a patient’s history in detail and reflect on the underlying problem, history, examination findings and previous investigations and management; • referral documents should reflect the main aim of the referral. If the problem is new and complex, more information should be provided; • ensure that medical records are accurate, up to date and complete; • as far as possible use the power of the computer to eliminate the plethora of paper forms for investigations and other simple referrals; • if templates are used ensure that information included is accurate and up to date; and • if referral documents are transferred electronically ensure that this is undertaken using secure transfer protocols.

Handling feedback from referrals So the referral has been written and the patient has visited the other practitioner or had the investigation ordered — in itself an increasing issue of medico-legal concern — but it doesn’t end there. Practices are now required to have formal written procedures in place for following up and handling of this feedback or results. This issue is discussed in detail in the RACGP Standards Criterion 1.5.4. To preserve continuity ideally all results should be reviewed by the referring practitioner. Where this is not possible — where the referring practitioner is away for example — practices should have a formal mechanism in place for handing over responsibility for reviewing investigations and feedback from referrals.

Summary For most practitioners, general practice is about the people. We see patients as people with social and environmental relationships as well as a medical problem. One of the key definitional domains of general practice is the continuity of care. Continuity itself has many expressions. Patients attending one practice and developing an ongoing relationship with one doctor; improved information management and flows.

Electronic medical records can only be as good as the underlying information management systems that support appropriate collection, storage and dissemination of information. Relationship continuity will never be replaced by electronic medical records, no matter how complex the systems or whether patient information is stored at the practice level, held in central databanks or by the patient (or a combination of all three). Providing comprehensive referrals is a time consuming activity, one that is not adequately reflected in the current fee schedule, but increasingly as information flows become important and valuable in the health system, GPs will need to position themselves to appropriately collect and maintain patient health information and have the systems available to transfer this information as the patient navigates their way through the health system.

Standard 1.6: Coordination of Care Criterion 1.6.2: Referral documents

Our referral documents to other health care providers contain sufficient information to facilitate optimal patient care.

Indicators

A) Our practice can demonstrate that referral letters are legible and where appropriate: • include the purpose of the referral • include relevant history, examination findings and current management • include a list of allergies and current medicines • are on appropriate practice stationary • are documented in patients’ health records.

Standard 1.5: Continuity of Care Criterion 1.5.4: System for follow up of tests and results

Our practice has a system for the follow up and review of tests and results.

Indicators

A) Our patient health records contain evidence that pathology results, imaging reports, investigation reports and clinical correspondence received by our practice have been: • reviewed by a GP • initialled, and • where appropriate, acted upon in a timely manner. B) Our GP(s) and staff can describe the system by which pathology results, imaging reports, investigation reports, and clinical correspondence received by our practice are: • reviewed • signed or initialled (or the electronic equivalent) • acted on in a timely manner, and • incorporated into the patient health record. C) Our practice has a written policy describing the review and management of pathology results, imaging reports, investigation reports and clinical correspondence received by our practice. D) Our GP(s) and staff can describe how patients are advised of the process for the follow up of results. E) Our GP(s) and staff can describe the procedure for follow up and recall of patients with clinical significant tests and results. F) Our practice has a system to recall patients with clinically significant tests and results. G) Our practice has a written policy to follow up and recall patients with clinically significant tests and results.

HealthLink/Medinexus Half Page 180 x 120 Puse IT Mag

connecting healthcare

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FEATURE Robyn Peters Robyn Peters is the Managing Director of CONNECT DIRECT Pty Ltd, developers of Direct CONTROL a medical billing and scheduling software solution for the health sector. robyn.peters@directcontrol.com.au

Managing people in, retaining, and managing people out Managing people into your workplace, retaining good staff, and managing non-performing staff out can be the most time consuming aspect of the business if you have not got this right. Investment in people is one of the major costs of your business. Get this right and you will be able to focus on what you do best: patient care. The challenge is to create a work environment that everyone wants to be a part of. You and they need to want to enter the workplace each day. If you or they do not, then find another job. You are not doing yourself or your work any favours. The one good thought to hold on to is that “Like attracts Like” and this should give you some comfort in finding the right people. Over the years we have been privileged to work with many like-minded people. The problem is that it is the 1% who are not like-minded that we will still be talking about when we are 99 years of age! You have to accept that people you employ, contract or work with lead their own lives and as such that is their priority as it is yours to focus on yours. Whether you are working in the Public Service or a large private practice and relying on others or if you are in sole practice and needing good staff to assist your business workflow there appears to be no difference apart from fact that the cost is not out of your immediate pocket and in private practice it is. Many practitioners in private practice have their partners working with them on the business and this is good as you are both working toward a common goal. However, as you grow and/or your personal life circumstances take your partner away from your business you need to employ people. It is no different if you are a single practitioner in business or a multi-national corporation. Retaining good staff is not easy. You want staff to be loyal and committed. You want people who will work as hard as you do, with your work ethic and passion, and when you think you have found them, giving them “enough rope” to achieve. Should they then leave by their own choice, or

Tips for Hiring Before you can ask others to work with you, you have to: • Know the business thoroughly and be willing to share your knowledge and dreams and passion. • When you find the people you think will help you grow, you have to let them do it! This is the hard bit! And knowing when they are not doing it right. • Ensure they (and you) know what you require of them and why. • Implement systems and procedures to help them do their job. • You and they want to “step-in” to your “workplace” each morning … if they or you do not want to go there? Get another job! You are not doing the business any favours nor yourself.

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yours, the business must carry on regardless. The Business comes first. Others who work with you must feel as though they are “self-employed” and part of the business. If the business fails, they do not have a job. If the business succeeds they are rewarded for their efforts as part of the ownership.

WHERE TO FIND GOOD STAFF Word-of-mouth is often the best. Spreading the word that you are looking for staff is recommended as usually only those who want to work with you or your discipline will apply. Pathology “collection” people can be good for this as they go from Practice to Practice and often know who might be looking for work and what positions are available. Advertising usually results in an inundation of applications and the time and effort to work through them can be immense. If you do advertise, have in place a process where you can quickly sort the suitable applicants from those that are not suitable. Recruitment agencies are an option but are mainly used by large organisations with high staff turnover. Assessing Applications With today’s computerised document production it is very easy for anyone to generate an impressive CV, however you can still get a good feeling about the applicant from this document. Note the presentation and watch for any careless errors (e.g. “I am very proffesional”). Qualifications are good but it is ultimately the emotional intelligence you need to look for. Should an applicant not be skilled in certain areas, they may be quick to learn. Know the essential and desirable criteria and be open to other skills they may have. Have a check list and work through each application. Use a scale from 1 to 10 referencing your essential and desirable criteria. You may choose to call referees prior to the interview or after the interview. Take care however, as it has been known that some who do not want staff often give them a glowing reference that is not reflective of their actual ability. There is only one question you need to ask a referee and that is: “Would you employ them again?”. Of course, applicants will only list “good references”. I have personally had a referee tell me how good a past employee was, only for me to call back later after experiencing difficulty with the staff member to be told that they had provided a good reference to assist in moving the staff member on from their organisation! The Interview No one is comfortable with interviews. Do not offer peppermints! Choose a comfortable environment. Maybe outside of your

workplace or if in your workplace, offer them a “walk through” prior to the interview. Should you be sourcing someone for a senior position you may have to conduct more than one interview.

Tips for Interviewing •

• • • • •

Prepare a list of questions / scenarios. Ensure your questions include reference to specific job requirements: àà Staff work shifts from 7am to 7pm. Is there any reason you cannot work within these hours? Should after employment they tell you they cannot work the hours, then you have reason to suggest that they find other employment. àà We sell product and these need to be unpacked and placed on shelves. Do you have any difficulty carrying 10kg packages. Should after employment they tell you they have a bad back and can’t perform the work, you have reason to suggest that they find other employment. Have a minimum of three on the selection panel, with at least one independent member. Rate 1 to 5 Be objective (then be subjective). Discuss salary (Award? / Contract? / Workplace agreement?). Encourage the applicant to ask questions. End interview and “chat”. This is your opportunity to be social and informal and get to know them.

Some have applicants complete personality tests (e.g. Myers Briggs). I have noted with interest over the years results here where a Practice Manager is not a Business Manager nor is a Secretary a Nurse. Documentation Documentation is necessary. Each staff member should have a record of letter of offer, assessment, training, appraisal reports and any warnings. The must haves are: • A Letter of Offer. • An induction process covering OH&S and job-specific training. • Policies and procedures for direction. • Job descriptions for guidance. • A Confidentiality Agreement outlining grounds for immediate dismissal. • A Non-Disclosure Agreement if your IP is of importance. • Terms of their probationary period.

HOW TO KEEP THEM When did you last take a holiday? A good manager is one who can be done without! Employ the right people in the first place. Keeping them? So many factors to manage: their personal life choices, your environment, other staff reactions. Communication is the key from both parties. As long as everyone in your business is earning a living doing what they enjoy most will stay around. Be open and supportive. Offer career development, job security and reward for effort.

IF PAIN PERSISTS, SEE YOUR MEDICAL IT SPECIALISTS.

Because we don’t just take away your IT Pain, we enhance the quality of the way you do business.

HOW TO LOSE THEM Do not miss an opportunity. The majority who are not comfortable will leave without any issues. If the working relationship is not happening, offer them encouragement and support in finding another position. If they resign, accept immediately. Handle it well as you never know where this person might be tomorrow. But hold on to the thought that if they did not do well for you, what makes it any different for future employers.

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45 P 1300 300 471 | E info@isnsolutions.com.au | W www.isnsolutions.com.au

CH2 (CLIFFORD HALLAM HEALTHCARE) P: 1300 720 274 F: 1300 364 008 E: marketing@ch2.net.au W: www.ch2.net.au

AHML AAPM

P: 1800 196 000 or 03 8414 8225 F: 03 9685 7599 E: national@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 association recognised as the professional body dedicated to supporting effective Practice Management in the healthcare profession. The Australian Association of Practice Managers: • Represents and unites 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: 0409 279 514 E: info@ahml.com.au W: www.ahml.com.au AHML is a globally accredited online testing laboratory for the technical evaluation and certification of conformance to standards in healthcare technologies. AHML is a nonaligned, not-for-profit organisation with over 450 users from 36 countries, whose mission is to facilitate the conformant usage of healthcare standards. AHML’s services include online testing and certification against International and National Standards and implementation of client specifications for testing. AHML is accredited by the National Association of Testing Authorities (NATA) to ISO/IEC 17025 2005 in the field of Information Technology and with NATA’s mutual recognition arrangement with the International Laboratory Accreditation Cooperation (ILAC) their accreditation is recognised by 47 countries.

ArgusConnect Advantech Australia P: 1300 308 531 F: 03 9797 0199 E: info@advantech.net.au W: www.advantech.net.au

Advantech’s medical computing platforms are designed to enhance the quality and efficiency of healthcare for patients and users alike. All products match the performance of commercial PCs and tough medical safety ratings like UL606011 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.

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P: 03 5335 2220 F: 03 5335 2211 E: argus@argusconnect.com.au W: www.argusconnect.com.au ArgusConnect provides and supports Argus secure messaging software that enables doctors and healthcare organisations to exchange clinical documents securely and reliably. Argus can be used to send specialist reports to referring doctors but it can also exchange pathology and radiology reports, hospital discharge summaries and notification between healthcare providers. Healthcare practitioners can use any of the popular clinical software packages to send reports and other clinical correspondence via Argus. Argus is the messaging solution chosen by over 50% of all Divisions of General Practice across Australia through the ARGUS AFFINITY DIVISIONS program. Keep a watch out for the AFFINITY DIVISIONS ‘Buddy Practice Initiative’, a program promoting the adoption of Argus by specialists and allied health practitioners.

Best Practice

P: 07 4155 8800 F: 07 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) • Top Pocket (PDA companion software for Pocket PC)

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

Cerner is 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 which 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

Clifford Hallam Healthcare (CH2) is today Australia’s largest Pharmaceutical and Medical Healthcare service provider with over 5,000 customers and a catalogue of over 15,000 products. 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 Transportation 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 throughout Australia.

Computer Initiatives P: 1300 85 39 39 (VIC) P: 1300 85 39 85 (QLD) F: 03 9768 9058 E: tim@cinet.com.au W: www.cinet.com.au

Computer Initiatives has been supporting the medical profession for over 15 years. Providing IT consultancy services, quality hardware, professional support with qualified engineers to our large customer base in Melbourne and now in Brisbane and the Gold Coast. Recommended and preferred by a number of Divisions of General Practice and specialist software providers we are well versed in providing the following services to the professions: • Supply and install of hardware/ software and peripherals • Disaster recovery and replication plans to minimise downtime to a number of minutes • Remote monitoring and diagnosis of crucial information systems • Advanced networking deployment and support • Prompt and competitive on site support • Internet configurations and content filtering services • Security audits, configurations and monitoring • Regular maintenance services We pride ourselves in our accreditations and levels of certification. We are a Microsoft Gold Partner – the highest level of MS certification and a Microsoft Small Business Specialist.

200,000:

The number of copies of Pulse+IT that are produced each year.

$900:

The cost of participating in the Pulse+IT Directory in all of these copies. For more information about advertising in Australia’s first and only Health IT magazine, call Simon James on 0402 149 859

DIRECT CONTROL

P: 1300 557 550 F: +61 7 5478 5520 E: support@directcontrol.com.au W: www.directcontrol.com.au Listening to what people want has resulted in the birth of a fully integrated business solution for Practitioners. The aim was to develop an affordable, intuitive, easy to use, educational business solution for Practitioners of all Disciplines that eliminates the need for double entry of data. This has been achieved with seamless integration with Outlook and MYOB. Direct CONTROL facilitates medical billing Australia wide and overseas. Included is all Medicare, DVA, WorkCover, Private Health Insurance and other billing with the latest rules and fees relevant to each medical discipline (general practice, surgeons, physicians, allied health, anaesthetists, pathologists, radiologists and day surgeries/hospitals). Ideal for both the single practitioner and the multi-disciplinary Practice.

GPA

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

GENIE solutions

P: 07 3870 4085 F: 07 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.

Health Communication Network - HCN

GLOBAL HEALTH

P: 03 9675 0600 F: 03 9675 0699 E: sales@global-health.com W: www.global-health.com

P: 02 8853 4700 F: 02 9659 9366 E: Arthur.Harris@emerging.com.au W: www.emerginghealthsolutions. com.au Emerging Health Solutions (EHS) provides next generation electronic health records. A Clinical Information System that is patientcentric & web-based that captures and provides appropriate, timely, clinical information in a secure and auditable environment to assist clinicians deliver effective, quality care. EHS is currently live in Australian hospitals and has been assisting the Australian health industry for over a decade. Emerging is a specialist I.T. health provider acutely aware of the privacy and security issues that rightfully exist when dealing with patient records. Emerging’s core clients include St. Vincent’s, Mater Health service, and the South Australian Government Department of Health.

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 1600 sites, it is now the number one choice of Australian specialists.

Direct CONTROL lets you get on with earning a living doing what you enjoy most … patient care.

Emerging Health Solutions

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.

Global Health is a premier provider of technology software solutions that connect clinicians and consumers across the healthcare industry. ReferralNet takes advantage of email and the Internet to provide a practical and secure infrastructure for delivering healthcare information efficiently to industry professionals. ReferralNet Claims offers real time submission of claims from practices, public and private hospitals and billing agents to Health Funds, Medicare and Department of Veterans’ Affairs. MHAGIC is the latest and most comprehensive Mental Health Assessment Generation and Information Collection system in Australia.

P: 02 9906 6633 F: 02 9906 8910 E: hcn@hcn.com.au W: www.hcn.com.au

Health Communication Network (HCN) is the leading provider of clinical and practice management software for Australian GPs and Specialists and supplies Australia¹s 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 Australia¹s major hospitals

Locum replaces traditional paper records with a robust electronic filing system that manages patient information and improves the efficiency of medical practice.

PULSE + IT

Houston Medical

HEALTHLINK HEALTHENGINE

P: 0419 091 170 F: 08 9467 6150 E: info@HealthEngine.com.au W: www.HealthEngine.com.au HealthEngine.com.au is a comprehensive online directory of GP’s and Specialists, offering free doctor and practice listings to any Medical Practitioner registered in Australia. Find a Doctor: Doctors can be searched Australia-wide by name, specialty, gender, and geographic location. Find a Service: GP and specialist medical practices, public and private hospitals, day surgeries and medical test centres across Australia. Find Information: seeks to demystify the maze of specialty qualifications, subspecialty interests, medical tests and procedures. We do not sell search position, and Sponsored Links are clearly labeled as such. Doctors or Practice Managers may enhance their doctor or service listing by purchasing a Custom Profile: • Display your photo or business logo • Showcase your areas of interest with specific, detailed information • Custom web address (URL): HealthEngine.com.au/dr/ YourName • Enhance your web presence: effectively a micro-website on HealthEngine.com.au benefitting from our pagerank and Search Engine Optimisation. Link to your own website, and increase traffic to your profile by sharing informative healthrelated articles. HealthEngine.com.au - Getting the Right Patient to the Right Doctor For further information, please contact Mike: 0419 091 170

P: 1800 420 066 or +61 2 9669 1844 F: +61 2 9669 1791 E: houston@houstonmedical.net W: www.houstonmedical.net

P: 1800 125 036 F: 07 3870 7768 E: enquiries@healthlink.net W: www.healthlink.net Australia’s largest effective secure communication network. • Fully integrated with leading GP and Specialist clinical systems • Robust; Reliable and Fully Supported Join the network that more than 60% of GPs use for diagnostic, specialist and hospital communications.

HIMAA

P: 02 9887 5001 F: 02 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.

HEALTH SOLVE

P: 1800 803 118 F: 08 8203 0595 E: info@healthsolve.com.au W: www.healthsolve.com.au HealthSolve provides solutions across the continuum of care with solutions for all sectors.

HIMAA aims to support and promote the profession of health information management. HIMAA also conducts, by distance education, "industry standard" training courses in Medical Terminology and ICD-10-AM, ACHI & ACS clinical coding.

Care Management Systems for: • Acute Care • Aged Care • Community Care HealthSolve RiGHTPEOPLE is our Staff Management system for any health organisation. Use in conjunction with the HealthSolve CMS or stand alone. HealthSolve solutions are industry standard, and readily interoperable with other systems.

Houston Medical, formed 1988, leading supplier of software for Ophthalmology and Retinal Diabetic screening, installed in hospitals and practices of all types throughout New Zealand, Australia, Fiji, Dubai and Hong Kong. After a complete re-write, Houston VIP.NET using Security Groups with User Defined Forms, allows different specialities their own desktop and workspace on a common database. Billing, appointments TXT and RSD messaging, word processing, prescribing, operating lists all integrated but separate. Whether for day surgery, ophthalmology, cardiology, dermatology, urology, general practice, allied health, or any combination in a mixed practice, in once, out in a 1000 different ways, a truly unique concept for 2009!

INTERSYSTEMS

P: 02 9380 7111 F: 02 9380 7121 E: anz.query@InterSystems.com W: www.InterSystems.com

HISA

P: 03 9388 0555 F: 03 9388 2086 E: hisa@hisa.org.au W: www.hisa.org.au The Health Informatics Society of Australia (HISA) aims to improve healthcare through health informatics. HISA: • Provides a national focus for health informatics, its practitioners, industry and users. • Advocates on behalf of its members. • Provides opportunities for learning and professional development in health informatics.

InterSystems provides innovative software products that enable you to create, deploy, run, and connect healthcare applications faster. InterSystems Ensemble®, our rapid integration platform, can cut IT project times in half for enterprises that need to connect applications, processes, and people. Our health information exchange platform, InterSystems HealthShare™, enables the creation of electronic health records that share clinical data across multiple organisations on a regional or national level. InterSystems TrakCare™ is an advanced Web-based healthcare information system that rapidly delivers the benefits of an Electronic Patient Record. Ensemble, HealthShare, and TrakCare all leverage the lightning speed, massive scalability, robust reliability, and rapid development capabilities of InterSystems Caché®, the world’s fastest object database.

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MEDTECH GLOBAL

P: 03 9690 8666 F: 03 9690 8010 E: salesAU@medtechglobal.com W: www.medtechglobal.com

ISN SOLUTIONS PTY LTD P: 1300 300 471 F: 02 9280 2665 E: info@isnsolutions.com.au W: www.isnsolutions.com.au

ISN Solutions is a medical IT company that specialises in the design, setup and maintenance of computer networks for medical practices. Our consultants and engineers are dedicated to the medical industry, understand your business needs and know what is required to run a practice. We strive to take away the pain from you, on managing the day to day IT issues regardless of which medical application you use. Our claim is supported by strong industry references. Some of our solutions include but are not limited to: • A paperless practice • Speech Recognition • Capped cost medical support & maintenance plan • Ability to consult remotely • Linking your imaging equipment to your network • Medical application Support

JAM SOFTWARE

P: 02 9799 1888 F: 02 9799 4042 E: enquiries@jamsoft.com.au W: www.jamsoft.com.au MED™4i (Medical Electronic Desktop™) streamlines Health Care with easy-to-use customisable interfaces, modular versatility & connectivity backed by friendly expert engineers. Comprehensive Patient database with multiple-format billing including electronic Online Patient Verifications & Claiming to Medicare, DVA & Health funds (paperless) MS Office integration, Orders, e-Results, Prescriptions (including MIMS) & Customisable databases including surgical audits. Your specific needs can be easily accommodated. Fully supported with on-going upgrades to meet the ever-changing health environment.

For 25 years, Medtech Global has been enhancing the quality of patient care by working with healthcare professionals in developing and delivering award winning industry-proven technology products. Our technology solutions are both sophisticated and user-friendly, designed for the comprehensive management of patient information throughout all aspects of primary and secondary healthcare, mental health and corporate health. Some of our products include: • Medtech32 and Medtech Evolution – practice management and clinical software packages • Manage My Health – an online patient portal that holds electronic health records • MDAnalyze – a surgical audit/ clinical outcomes software We are also able to provide training, data services and consultancy.

MIMS AUSTRALIA P: 02 9902 7700 F: 02 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.

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 design, build and deliver industry-leading software systems that serve the entire health sector, ranging from GP surgeries to specialist departments and across entire hospitals. Our solutions facilitate cooperation and communication between doctors, nurses, pharmacists and lab technicians by allowing unified patient management, electronic ordering, results reporting and transfer of data between different care settings. iSOFT aims to create virtual health networks that promote clinical and corporate governance, quality, efficiency and consent in healthcare, enhancing the experience for all participants.

NEHTA

P: 02 8298 2600 F: 02 8298 2666 E: admin@nehta.gov.au W: www.nehta.gov.au

MEDILINK

P: 1800 623 633 F: 07 3392 1108 E: support@medilink.com.au W: www.medilink.com.au Integrated best of breed solutions: • • • • • • • • • • •

Medicare Online DVA Paperless ECLIPSE Medicare Easyclaim SMS 2 way Reminders Secure eMessaging Clinical EMR Paperless Solutions Online training Support 24/7 Unbeatable value

20 years of caring for practices.

Medical-Objects

P: 07 5456 6000 F: 07 3221 0220 E: info@medical-objects.com.au W: www.medical-objects.com.au

The National E-Health Transition Authority identifies and fosters the development of the best technology necessary to deliver a e-health system for Australia. This includes national health IM and ICT standards and specifications.

Medical-Objects has provided secure messaging to over 10,500 health professionals with referrals, reports, letters and discharge summaries. Delivering directly into leading practice software, removing the need for scanning and faxing. Referrals are digitally signed and encrypted, moreover, compatible with Medicare’s requirements and in line with NEHTA’s eHealth PIP direction. Using Medicare supported PKI, you can trust that referrals are digitally signed with PKI and we are working with NEHTA as an eHealth PIP eligible secure messaging vendor.

PULSE + IT

Pulse+ IT PULSE MAGAZINE

P: 0402 149 859 F: 02 9475 0029 E: info@pulsemagazine.com.au W: www.pulsemagazine.com.au Pulse Magazine is the publisher of Pulse+IT, Australia’s first and only Health IT magazine.

NUANCE COMMUNICATIONS P: 1300 550 716 F: 02 9434 2301 E: Vicki.Rigg@nuance.com W: www.nuance.com/au

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).

Pulse+IT is distributed to all corners of the health sector and is enjoyed by General Practitioners, Specialists, Practice Managers, Hospital and Aged Care decision makers, Health Informaticians, Health Information Managers and Health IT industry participants Having grown rapidly from its launch circulation of 10,000 copies in August 2006, Pulse+IT’s current bi-monthly distribution of 40,000 printed copies ranks it as Australia’s highest circulating health publication of any kind.

THE SPECIALIST

P: 1800 803 118 E: info@healthsolve.com.au W: www.clintelsystems.com “The Specialist” is an intuitive and truly sophisticated tool that allows management of patients within: • specialist medical practices • private hospitals • day surgeries. The Specialist includes 5 modules: • Accounting • Correspondence • Time Manager • Medical Records • Mobile Data Facility “The Specialist” runs on both Macintosh™ and Windows™ platforms.

STAT HEALTH SYSTEMS

PEN COMPUTER SYSTEMS P: 02 9635 8955 F: 02 9635 8966 E: enquiries@pencs.com.au W: www.pencs.com.au

Established in 1993, Pen Computer CY Systems (PCS) specialises in developing information solutions CMY for National and State eHealth initiatives in Primary Health that K 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.

PULSE + IT

P: 07 3121 6550 F: 07 3219 7510 E: carla.doolan@stathealth.com.au W: www.stathealth.com.au

SMARTROOMS BY DOCTORWARE

P: 03 9499 4622 F: 03 9499 1397 E: sales@doctorware.com.au W: www.doctorware.com.au SmartRooms provides a comprehensive software solution for specialist practices for both Mac and Windows. Comprising both practice management and clinical software, our all-in-one patient record and superior after sales support provides the basis for a stable and time effective software solution for specialist practices of all sizes. SmartRooms is available in an appointments and billing only version for practices with uncomplicated software needs.

P: 03 9569 4890 / 1300 764 482 F: 03 9569 5543 E: sales@syberscribe.com.au W: www.syberscribe.com.au Syber Scribe provides Internet based medical typing services for hospitals and clinics. • Fast turn around and excellent quality. • Connection to most Patient Management Systems, possible for filing purposes. • Victoria’s largest supplier to hospitals. • References available on request.

Current installations range from single stand-alone computers to networks connected to either Macintosh™ or Windows™ file servers.

In addition to printed magazines, Pulse+IT offers a number of digital products including a weekly The Specialist is industry standard, eNewletter service, Twitter and RSS and readily interoperable with feeds, an online events calendar, 20/02/09 SR Logo_65x42mm.pdf 14:50:20 other systems. and an interactive website.

Syber sCRIBE

Stat is an integrated clinical and practice management application which has embraced the latest Microsoft technology to build a new generation solution. Stat Health Systems have formed partnerships with Ocean Informatics and First DataBank who will supply tools for clinical database management and the drug database respectively. Fully scalable and the only medical software application to incorporate a multi-functional intuitive interface, Stat is at the forefront of computing technology. The Stat roll-out has begun and we are able to convert data from all existing software. Stat also provides a premium support service and the Stat Online Claiming Solution (SOCS).

ZEDMED

P: 03 9284 3300 F: 03 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. From a single Specialist to a multisite GP Practice, we are renowned for our superior customer service and products that provide stability, security and ease of use. We also provide comprehensive data conversions from most software packages on the market today. Zedmed is proud to be one of the longest serving Australian medical software solution providers, with clients nationwide.

GPA thinks a change would do you goodâ&#x20AC;Ś When it comes to accreditation, GPAâ&#x20AC;&#x2122;s new online program

A+

is guaranteed to change your life!

We invite general practices to trial this latest advancement in accreditation. Call us today to find out more about A+ and the 7 day no-obligation free trial. 1800 188 088 or go online at www.gpa.net.au