Australasia’s First and Only eHealth and Health IT Magazine
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Issue
2 April 2012
Connected Care
eHealth CONNECTS CARE
Pulse+IT surveys the market for eHealth solutions being used to bridge divides throughout the healthcare sector.
Rolling the dice in Las Vegas
Bryn Evans reports back from the Las Vegas HIMSS conference, where he found a ‘desert storm’ of the latest healthcare technology.
All aboard the PCEHR train Dr Geoffrey Sayer argues that regardless of how the PCEHR unfolds, eHealth foundation pieces must not be lost in the process.
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Inside
Publisher Pulse+IT Magazine Pty Ltd ABN: 34 045 658 171 www.pulseitmagazine.com.au Editor Simon James Australia: +61 2 8006 5185 New Zealand: +64 9 889 3185 simon.james@pulseitmagazine.com.au Advertising Enquiries ads@pulseitmagazine.com.au
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Looking Ahead Pulse+IT welcomes feature articles and guest editorial submissions relating to the nominated edition themes outlined below, as well as articles relating to eHealth and Health IT more broadly. Pulse+IT is produced in print seven times per year with the remaining five editions for 2012 to be distributed for release in: • • • • •
Mid-May 2012 ~ Preparing for the PCEHR July 2012 ~ Telehealth / HIC2012 Preview Mid-August 2012 ~ PCEHR Analysis / HIMAA Conference Preview October 2012 ~ New Zealand eHealth / HINZ Conference Preview Mid-November 2012 ~ mHealth
Submission guidelines and deadlines are available online: http://www.pulseitmagazine.com.au/editorial
Pulse+IT acknowledges the support of the following organisations, each of whom supply copies of Pulse+IT to their members.
About Pulse+IT Pulse+IT is Australia’s first and only Health IT magazine. With an international distribution exceeding 37,000 copies, it is also one of the highest circulating health publications in Australasia. 32,000 copies of Pulse+IT are distributed to GPs, specialists, practice managers and the IT professionals that support them. In addition, over 5,000 copies of Pulse+IT are distributed to health information managers, health informaticians, and IT decision makers in hospitals, day surgeries and aged care facilities. ISSN: 1835-1522 Contributors Bryn Evans, David Grace, Simon James, Angela Mayhew, Kate McDonald, David Rowlands, Dr Geoffrey Sayer. Disclaimer The views contained herein are not necessarily the views of Pulse+IT Magazine or its staff. The content of any advertising or promotional material contained herein is not endorsed by the publisher. While care has been taken in the preparation of this magazine, the publisher cannot be held responsible for the accuracy of the information herein, or any consequences arising from it. Pulse+IT Magazine has no affiliation with any organisation, including any organisations producing publications that include the word “Pulse” in their titles. Copyright 2012 Pulse+IT Magazine Pty Ltd No part of this publication may be reproduced, stored electronically or transmitted in any form by any means without the prior written permission of the Publisher. Subscription Rates Please visit our website for more information about subscribing to Pulse+IT.
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HIMSS LAS VEGAS
BABYWATCH
REMOTE MONITORING
Editorials
Features
News
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STARTUP
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GUEST EDITORIAL
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Editor Simon James introduces the 27th edition of Pulse+IT.
Bryn Evans reports back from the Las Vegas HIMSS conference, which featured a ‘desert storm’ of the latest technology, information systems, trends and ideas for healthcare.
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GUEST EDITORIAL David Rowlands looks at how Australia can learn from eHealth and connected care in Hong Kong, where an electronic patient record sharing pilot project has been running since 2008.
MSIA Dr Geoffrey Sayer takes a journey on the PCEHR train and argues that whatever its final destination, the work done on the foundation pieces of eHealth must not be lost to the future.
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WOUND CARE GOES MOBILE The technology behind an innovative project for the remote management of chronic wounds has great potential in assisting the elderly and the chronically ill.
SELECTED BITS & BYTES Plibersek rejects PCEHR blow-out claims Sysmex releases Delphic update, mobile app
CDM NETS FUNDS FOR DIABETES CARE PROJECT
Argus achieves CCA for secure messaging
cdmNet is being used as the IT infrastructure partner for the federal government’s new diabetes care project.
Questions remain over functionality of PCEHR LRS Health launches anatomical pathology module
BABYWATCH KEEPS AN EYE ON THE PRIZE The team behind the Babywatch system has developed a web‑based solution to managing infant identification.
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WHY DID GOOGLE HEALTH FAIL?
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REMOTE MONITORING AND CONSULTATION
According to Microsoft’s David Dembo, Google Health did not fail, it was just closed too early.
HIMAA
Medtech Global is trialling of a
David Grace and Angela Mayhew explain how new patient queuing technology has helped the Melton Health super clinic in Victoria achieve efficiency gains.
video conferencing and remote monitoring system that allows the patient to see their doctor through their TV. It also allows specialists to join in the consultation.
Panel to discuss eHealth and broadband at ITAC Real-time access to controlled drugs data from July
Resources
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EVENTS
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PULSE+IT DIRECTORY
Up and coming eHealth, Health, and IT events.
The Pulse+IT Directory profiles Australasia’s most innovative and influential eHealth and Health IT organisations.
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Editorial
Connecting Care Produced at a time that might be considered the calm before the impending PCEHR storm, Pulse+IT has taken the opportunity to showcase a range of existing, readily available technologies that are helping to bridge the divides between various parts of the health sector, and in doing so, contributing to improvements in patient care. Simon James BIT, BComm Editor: Pulse+IT simon.james@pulseitmagazine.com.au
About the author Simon James is the editor of Pulse+IT, one of Australia’s highest circulating health publications of any kind. Prior to founding the publication in 2006 he worked in an IT support capacity for various medical practices, and subsequently for both clinical software and secure messaging developers.
This edition of Pulse+IT includes five feature articles and a several news stories showcasing a range of eHealth technologies deployed throughout various disparate healthcare settings. Many of these technologies are specifically designed to allow the sharing of healthcare information with a view to supporting collaboration between both healthcare providers and the patients in their care.
technology has helped the Melton Health super clinic achieve efficiency gains.
Having returned from the Health Information and Management Systems Society annual conference, Bryn Evans provides some insight into the global interest and development occurring in eHealth. David Rowlands also offers some international perspectives, this time from Hong Kong, where an established shared record system is being complemented by a more widely cast endeavour that encompasses patient involvement.
To be released in mid-May, the next edition of Pulse+IT will feature detailed coverage of the PCEHR, which will be launched just six weeks later. To assist practices and other healthcare organisations to prepare for the launch, the edition will include a series of practical, tutorial‑based articles detailing the steps practices and patients will need to undertake before they can interact with the shared health record system.
Writing on behalf of the Medical Software Industry Association, immediate past president Dr Geoffrey Sayer takes a journey on the ‘PCEHR train’ and argues that whatever its final destination, the work done on the foundation pieces of eHealth must not be lost to the future. The Health Information Management Association of Australia provides a report from David Grace and Angela Mayhew, who explain how automated patient queuing
Having leveraged our now-frequent online eHealth reporting, this edition’s Bits & Bytes news section is the largest and most diverse we’ve produced to date, spanning 20 pages and dozens of eHealth products, services and organisations.
Looking ahead
In the meantime, those interested in keeping abreast of the latest Australian and New Zealand eHealth developments are invited to visit us online at: www.pulseitmagazine.com.au As always, I welcome the input of our readers. If you have any suggestions for future articles, would like to contribute an edition, or would simply like to discuss your experiences with eHealth, don’t hesitate to get in touch.
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Guest Editorial
ROLLING THE DICE, AND LOOKING FOR A BIG CONNECTION AT THE
Las Vegas HIMSS Conference The Health Information Management Systems Society (HIMSS) annual conference and exhibition 2012 was held in Las Vegas from February 20 to 24. On display was a ‘desert storm’ of the latest technology, information systems, innovation, forecast trends and ideas for healthcare in the US and around the world.
BRYN EVANS Director: JEMS Consulting bryn.evans@ozemail.com.au
The lounging tourists in the gondola gazed in awe at the passing Renaissance architecture, while their gondolier sang ‘O Sole Mio’ silhouetted against an azure blue sky. The Venetian canal looked just as blue, and affluent diners at the waterside trattoria made the scene idyllic. But delightful as it seemed, the canal did not lead anywhere, the buildings were mere facades, and the blue sky only a painted ceiling. Welcome to the Venetian-Palazzo-Sands Casino and Expo Center in Las Vegas, host to HIMSS 2012. More than 36,500 attendees and in excess of 1100 exhibitors made it a truly overwhelming experience. More than 200 education sessions in 20 parallel streams presented delegates with a near impossible dilemma of choosing which ones to attend.
About the author Bryn Evans is a management consultant, with many years’ experience as a CIO in healthcare, and as chief executive of a clinical software supplier. He writes extensively across a range of categories and genres, notably in the areas of management, information technology, sport, travel, history and fiction.
In addition, there were a similar number of ‘learning events’ such as symposia, workshops, poster displays, roundtable meetings, synergy and e-sessions, specialty activities, networking and virtual sessions, the communities of profession meetings, the HIMSS Interoperability Showcase, the social media and knowledge centres, and the Intelligent Hospital Pavilion — a bewildering array of choice. On top of this, one’s senses were then assaulted by a parallel universe
of the exhibition’s 1100-plus healthcare vendors and service providers. Then there were the invitations to evening meetings, drinks receptions, informal and hosted dinners. The whole experience is best summed up by a delegate’s overhead remark around 8.00 am on day one: “Let the madness begin!”
Opening speeches – or were they tweets? From the start, the trend towards more and more deployments of eHealth into the community was evident. In her opening remarks, HIMSS chair Charlene Underwood foresaw a continuing and increasing growth in the demand for home care, which will be influenced by a parallel trend in demand for eHealth, telehealth and mobile health services. At the same time, Ms Underwood said, payers and funders, both private and government, will increasingly only pay for services that are evidenced on patient health outcomes. In his keynote opening address, Twitter co-founder Biz Stone spoke of how Twitter will assist in driving remote communications, sharing and empathy between patients, and better link healthcare providers and consumers. Mr Stone believes the power of Twitter’s open,
real-time information network will enable better analysis of sentiment and trends in people’s thinking. Although Twitter is still in a revolutionary stage, in time it should help to bring a greater personal responsibility to an individual’s healthcare, he said. From Involution Studios of Arlington, Massachusetts, and with his rich experience in designing Apple software, Juhan Sonin predicted that the impact of mobile phones and devices such as the iPhone and the iPad will have a huge impact on healthcare. The revolution in design of the user interface, using touch screen technology in mobile personal devices, is closely associated with two trends, he said. Healthcare information is rapidly becoming all digital, and through EHRs and other applications, personal healthcare information is being made available on mobile devices to health consumers. In a world containing seven billion people, where there are 5.5 billion mobile phones and a surging uptake of personal mobile devices, healthcare is being brought to the patient anywhere and anytime. A migration has begun from the traditional episodic‑based healthcare to continuous care. Mobile health, or mHealth, is aligned with the need to move more healthcare
“In a world containing seven billion people, where there are 5.5 billion mobile phones ... healthcare is being brought to the patient anywhere and anytime.” Bryn Evans
to the community, and preventative health. Health software systems must be re‑engineered for the new mobile technology, and the challenge is to bring health data to the consumer, where the population is increasingly experienced in using mobile devices. Following that is the need to use mobile technology with personal EHRs and new software applications to make faster and more accurate healthcare decisions.
Social media – how can health engage? The HIMSS Social Media Centre was an even larger drawcard than last year, providing education sessions, panel discussions with leading clinicians and healthcare IT bloggers, social media specialists, Internet kiosks, an attendees’ lounge, and large screens featuring conference highlights via Twitter. To visit the Social Media Centre was to see
not only the conference learning and networking, but even how healthcare communications worldwide have jumped into instant and new dimensions. Just one panel discussion at the centre, involving clinicians who participate in social media, provides a small taste of the challenging questions and thoughts: • Hospitals and their management do not have social media policies, and do not yet understand social media. • What are the consequences for medical advice using social media being inappropriate, and the risk of legal action? • Social media is not suitable for direct doctor-patient consultation, more for moderated advice and generic education. • Social media is extending networks of like-minded communities, and is a mimic of real life.
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“If social media is a mimic of real life, then perhaps within it there is a potential to enhance healthcare for everyone, anywhere and anytime.” Bryn Evans
If social media is indeed a mimic of real life, then perhaps within it there is a potential to enhance healthcare for everyone, anywhere and anytime.
Calling ‘Dr Watson’ IBM’s Watson, a natural language processing technology, made a big splash in the US when it beat all human contestants on the TV game show Jeopardy. Now, the ‘Dr Watson’ initiative, a collaboration between Nuance Communications, Wellpoint and IBM, heralds a transformation in medicine and healthcare which will bring a cultural shift for clinicians. No longer will there be a dependency on the knowledge in a doctor’s head, Nuance’s Dr Nick van Terheyden claimed. Dr Watson’s approach will introduce an accelerating move to computer-aided diagnosis and treatment, which will bring fundamental change over time to the philosophies and regimens of education and training in nursing and medical schools. Dr Watson combines the power of a super computer with the artificial intelligence of an evidence-based medical decision support system. A ‘Deep Q&A’ approach is used, which analyses, interprets and understands not only structured and unstructured data, but also natural language questions. Dr Watson can sift through a staggering 200 million pages in just three seconds. However, as no clinical trials have been conducted, Dr Watson’s immense potential remains an untested hypothesis. Questions surrounding easy clinical access, commercial feasibility and cost at the point-of-care also remain for the future.
Meaningful use Under the US government’s $24 billion program for ‘meaningful use’ of electronic medical records, more than $3 billion had been paid out by the end of 2011 to healthcare providers for compliance in stage 1 of the program.
Farzad Mostashari, the US federal national coordinator for health IT, spoke of how, with the increasing introduction of EMRs and EHRs, the sharing of information becomes transformational. Primary care physicians are beginning to realise that health records do not belong to them but to the patients, he said. As more and more patients ask complex questions about their condition, they surely have a right to access their EHR. The meaningful use program includes objectives such as the improvement of quality, efficiency and patient outcomes in healthcare. As an indication of the program’s scope and reach, 130,000 primary care providers are involved, and 90 per cent of pharmacies are now able to receive ePrescriptions.
‘To Err is Human’ – revisited In a presentation on adverse medical events reporting and the progress of US patient safety organisations, Stephen Earle, a project consultant at LifeSpan Health Systems and HIMSS fellow, reported that only 14 per cent of adverse events in healthcare are reported. “How can we learn from our mistakes, if we won’t share our experiences?” he asked. The To Err is Human report, published by the US Institute of Medicine in 1999, made a huge impact when it found that there were approximately 98,000 preventable deaths estimated to be occurring in the country’s healthcare system each year. It seems that was but the tip of the iceberg, with the report’s authors now believing that estimate was understated by a factor of 10. Supporting their view is that of all the autopsies performed in the US, which are a very small fraction of all deaths, five per cent of those autopsies reveal a fatal diagnostic error. “The single greatest impediment to the reduction of errors is that we punish people for making mistakes,” Mr Earle said. He argued that people fear the ‘whistleblower’ syndrome and are resistant to reporting adverse events. The culture must change to focus on improving the process. It is estimated that a person’s health and life expectancy is derived on average by only 20 per cent from hereditary genes. In his book Blue Zones, a National Geographic study of a number of communities around the world with the highest life expectancies, Dan Buettner spoke of common factors which had been identified as contributory to people’s health and longevity. The essence of these factors relate to well-recognised lifestyle practices such as regular low-intensity exercise, work and a purpose in life, reducing stress, not retiring completely and always doing some form of work, eating wisely by favouring a plant-based diet including beans and nuts, maintaining
relationships with family and loved ones, and connecting with a community. Mr Buettner’s message emphasised that the future for healthcare must be based more and more in the community, and be focused on monitoring and preventative measures in self care by the consumer.
Some concluding thoughts – or tweets? HIMSS 2012 was an energising marketplace of practitioners’ learnings, vendors’ promises, new ideas and displays of innovative software, wrapped up by future forecasts for healthcare information systems management and technology. The bottom-line question is, where should you bet your money? One theme does seem to predominate. The surging growth of mobile personal devices and social media in mHealth looks to be unstoppable. It must surely carry healthcare faster into the
community and drive health prevention technologies into the hands of the individual. Not surprisingly, the significant role played by mHealth at HIMSS 2012 will move on to the fourth HIMSS mHealth Summit in Washington later this year. Existing healthcare systems face an imminent future of re‑engineering or replacement to integrate with the needs and technology of mHealth. Health ICT must build the connections to smartphones, iPhones, iPads, tablets and the like. How is it to be done? Which technology, which vendor product, what software design, and which device? What healthcare processes must change? Who will pay? Somewhere at HIMSS 2012 were the answers to those questions, among sellers and buyers who will be winners and drive the future. But beware: sometimes blue sky is just a painted ceiling. Like the gamblers in the Venetian Casino, all you can do is roll the dice and make your call. The roulette wheel is spinning, so make your selections carefully.
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Guest Editorial
eHealth and
connected care in Hong Kong Connecting care across the array of participants that comprise our health systems is of vital concern everywhere, so it is important to look at developments in other parts of the world, such as Hong Kong, to consider the extent to which their successes are relevant and transferable.
David Rowlands B.Ec.(Hons), G.D.B.A., FACHI, AFACHSM Managing Director: Direkt Consulting david.rowlands@direkt.com.au
Hong Kong has a population of around seven million people, many living in areas with some of the highest population density in the world. Demographic trends would be familiar to Australians: while net growth in the general population from 2008 to 2016 is forecast at eight per cent, the corresponding increases for people aged 65 and over is expected to be 30 per cent. For people over 80, the increase is forecast at 43 per cent. The Hong Kong Government expects this imminent, rapid ageing of the population to result in a dramatic increase in the demand for healthcare services. The 10 conditions with the highest bed-day consumption in Hong Kong’s public hospitals are predominantly chronic diseases.
About the author David Rowlands is managing director of Direkt Consulting, a management consulting company with offices in Australia, Hong Kong and Singapore. He is heavily involved in health informatics in Australia and internationally. Thanks also to Dr C.P. Wong, Chairman of the Hong Kong Society of Medical Informatics Limited.
Around 90 per cent of the hospital beds in Hong Kong are provided by the Hong Kong Hospital Authority (HKHA) through 39 hospitals. HKHA also delivers around eight million specialist outpatient attendances per year and five million primary care clinic attendances, via 120-plus clinic sites. Primary care is mainly privately provided.
two decades. Today, integrated electronic patient records (EPRs) can be accessed in any of the HA’s hospitals, specialist or general clinics. Comprehensive electronic records (including images) exist for around 9.6 million patients, some spanning more than 10 years. The clinical system (CMS) has largely been designed, developed and implemented in-house at relatively modest cost by international standards. HKHA retains a high degree of expertise in clinical IT, and is currently developing the third generation of the CMS. Clinical IT outside the public hospital sector, however, is still quite limited.
Connecting care
Clinical IT in Hong Kong
Development of electronic health record sharing across the entire health sector was one of five streams of healthcare reform proposed by the Hong Kong Government in 2008. Realisation of this vision commenced with the Public-Private Interface — Electronic Patient Record Sharing Pilot Project (PPI-ePR), which allows authorised healthcare practitioners to access HKHA’s patients’ records with the patients’ consent.
The needs of its front-line clinicians have been targeted by the HKHA for nearly
By June 2011, the PPI-ePR pilot had enrolled over 153,000 patients and
2250 private healthcare professionals. Participating clinicians need a user ID, a password and a PKI token to access the patient records. When a patient’s record is viewed, the system sends an alert in SMS format to that patient’s mobile phone. A listing of participating private medical practitioners is publicly available via the HKHA website, not only enhancing accountability but also contributing to patient choice. While the current PPI-ePR system does not allow private providers to upload their patient records, a more comprehensive shared electronic health record (EHR) scheme is under development. The EHR will comprise sufficient content to support continuity of health care on transfer/ referral, improve the quality of health care and enhance health service efficiency.
Connected care Other key initiatives focusing on connected care include: • The Community Health Call Centre. This system supports continuity of care for more than 43,000 high-risk HA patients in the community – after discharge from hospital for follow-up care - with telephone support via a call centre. HKHA’s extensive clinical data sets have been mined to produce evidence-based markers for patients at risk of re-admission, and these feed the follow-up program. • Public Private Partnership (PPP) programs for patients with chronic diseases. HKHA has a number of on-going collaboration projects to work closely with private healthcare institutions and non-government organisations to support shared care for patients suffering from a targeted group of chronic diseases. Electronic sharing of patient records is crucial to the model of collaborative care and this work is paving the way towards a
“Participating clinicians need a user ID, a password and a PKI token to access the patient records. When a patient’s record is viewed, the system sends an alert in SMS format to that patient’s mobile phone.” David Rowlands
future patient care model leveraging the territory-wide EHR. • Closed loop communications. Pilot projects for supporting better clinical communication and for radiological image notification are under way. These projects aim to improve patient safety and work efficiency of healthcare providers by integrating information from a range of sources into the daily workflow of frontline colleagues.
What Australia can learn Two of the major reasons for the success of clinical IT in the HKHA are strong clinical systems governance with deep engagement of clinicians, and a stable team of health informatics and IT colleagues who continue to work hand in hand with their clinical colleagues to ensure the system genuinely delivers clinical functionalities and benefits. Hong Kong has an extensive clinical governance system. Its network of advisory committees has 160 doctors and 100 other health workers regularly participating in the design and ongoing development of the system. Hong Kong’s Society of Medical Informatics was established in 1987, and provides active, powerful and targeted leadership. Hong Kong has also long recognised health informatics capacity-building as a fundamental enabler of health reform. This has been belated in
Australia, although Health Workforce Australia’s willingness to investigate health informatics requirements now demonstrates forward thinking. We can also learn from Hong Kong’s pragmatism: when private hospitals receive patients from public hospitals (when capacity is stretched) private doctors must enter these patients into a sharable electronic record if they are to be reimbursed. For example, 20,000 patients annually are sent to private hospitals for cataract surgery. Each operation costs HKD7000 (US$900). To receive this money, private doctors have to use the system. Likewise, most of the private radiological facilities absorbing the workload of public system MRI and CT scans have bidirectional sharing of images. This latter group does not receive imbursement, but recognises the value of enhanced chance of referral. We can also learn from Hong Kong’s sustained, coherent and convergent leadership. Messages are continually and mutually reinforced (e.g. branding such as “eHealth Record — Continuity of Care for You”), eHealth is continuously cited as one of a very small number of tenets for health system improvement, and planning is refreshed appropriately such that it can lead eHealth activity — Australia’s National e-Health Strategy was produced in 2008 and is arguably overdue for refreshment, given huge changes in the Australian healthcare landscape.
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News
Plibersek rejects PCEHR blow-out claims Minister for Health Tanya Plibersek has rejected claims in The Australian newspaper that the budget for the PCEHR had blown out by almost $300 million.
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Ms Plibersek said the newspaper seemed to have double counted some of the sources of funding for the PCEHR and the National E-Health Transition Authority (NEHTA). The Australian analysed statutory records from the Department of Health and Ageing, AusTender, the Senate Community Affairs committee and the Council of Australian Governments (COAG). “COAG allocated $218m in base funding for NEHTA for a three-year period from July 2009 until the PCEHR’s promised operational start on July 1 this year,” it reported.
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“The Health Department gave NEHTA another $136m to develop specifications
for the infrastructure and related software and systems, from July 09-12.”
contributing 50 per cent of the funding for NEHTA, equalling $109 million.
The Australian listed a number of other grants, mainly awarded to NEHTA.
“The Commonwealth’s portion of this funding is used for eHealth-related activities other than the personally controlled electronic health records system, such as healthcare identifiers, e-prescribing, standards and specifications, and the National Authentication Service for Health (NASH),” Ms Plibersek said.
However, Ms Plibersek said the two main sources of funding for the eHealth agenda are the PCEHR and the COAG approved funding. “Both of these sources of funding are within budget,” she said. “The personally controlled electronic health records allocation is $467 million over two years. This allocation goes towards NEHTA, Medicare support, the 12 eHealth pilot sites and the national infrastructure partner — that is, not NEHTA alone. “NEHTA also receives funding announced by COAG. Currently, that funding is $218 million over three years.” Ms Plibersek said the federal government is
“The $760 million figure cited in The Australian cannot be reconciled with either the personally controlled electronic health records system or the COAG funding allocations. It seems to have been reached by making significant errors in calculation, including the double counting of funds. “They seem to have been simply added together and, in many cases, double counted.”
iPad updated with integrated dictation, high resolution screen Apple’s latest iPad supports a new dictation function, allowing users to dictate messages and notes and convert them immediately to text, as well as a much higher resolution display that will make the viewing of clinical images easier. The new iPad, which was released in Australia on March 16, features Apple’s new Retina display, which it says delivers four times the number of pixels included in the iPad 2 display. In a statement, Apple said the 3.1 million pixels in the Retina display are more than one million more pixels than an HD TV and the display has increased its colour saturation by 44 per cent. Movies are now capable of playing at full 1080p HD resolution. With the new dictation function, Apple said that instead of typing, users can
tap the microphone icon on the keyboard and the new iPad will record your message. When you tap “done”, it will convert your words into text. “You can use dictation to write messages, take notes, search the web and more,” Apple said. “Dictation also works with third-party apps, so you can update your Facebook status, tweet, or write Instagram captions.” Although Apple has been reserved in marketing the iPad directly to clinicians for medical use, it is known that doctors have taken to the device with great enthusiasm. According to recent research, 26 per cent of European doctors own an iPad and 40 per cent of those that don’t are planning to purchase one
in the next six months. European doctors who own an iPad spend 27 per cent of their professional online time on the device. A report in American Medical News said numbers are not available for iPad sales specific to healthcare, but it found that major institutions such as Stanford University School of Medicine in California are handing it out to medical students. The report also found that at a healthcare district in California, more than 60 doctors are using iPads to look at x-rays and electrocardiograms, while residents and attending physicians at the orthopaedic surgery and rehabilitation department at Loyola University Medical Center in Illinois are using iPads to access drug reference guides and electronic medical records. Surgeons are using them in the operating room to access reference tools and an aged care provider has deployed iPads throughout its system for use at the point of care. The new iPad retails from $A539 for a 16GB Wi-Fi model with prices caping out at $A899 for a 64GB device with both Wi-FI and mobile broadband capacity.
Lopez to head international health metrics board Prominent Queensland-based academic Alan Lopez has been elected chair of the executive board of the Health Metrics Network (HMN), a World Health Organisation-hosted body designed to improve health information in poorer countries. Professor Lopez, head of the School of Population Health and a professor of medical statistics at the University of Queensland, will chair the HMN board for three years. The HMN was founded in 2005 and is based at WHO headquarters in Geneva. It works with low and middle income countries to strengthen health information systems that can then provide the reliable, complete and timely information about public health. “This is a crucial point in global health when we have the opportunity to consolidate and accelerate some great progress with disease control programs over the past decade, particularly for key global health concerns such as HIV/ AIDS, malaria and vaccine-preventable conditions such as measles,“ Professor Lopez said. “Consolidating these gains and further improving progress towards the Millennium Development Goals will depend on accurate, relevant and timely health information systems.” The HMN has developed a framework for health systems that is already in place in more than 80 countries around the world. Members are working to develop standards and tools that facilitate recording, reporting and analysis of health data and recently released a first draft of a set of standards for minimal data requirements in relation to pregnancies, births and deaths using mobile phones.
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Bits & Bytes
Oracle updates healthcare analytics platform Oracle has released an updated version of Oracle Enterprise Healthcare Analytics, a business intelligence and performance management solution aimed at helping healthcare organisations make informed decisions that improve financial performance, care quality and outcomes. The new version has added modules to support the mobile workforce through functionality for the iPad and iPhone, including the ability to initiate actions and workflows directly from mobile devices. An Oracle spokesperson said the update would address a growing demand across the healthcare industry for mobile, easy‑to-use and rapidly deployable analytical applications. The product includes Oracle Healthcare Analytics Data Integration, which consolidates, integrates, validates and loads source data from clinical, financial, administrative and research systems into Oracle’s healthcare data model. The new component tackles one of the most complex and time-intensive aspects of analytics and data management, the spokesperson said. It also includes components to allow organisations to map staffing requirements to patient scheduling and optimise the use of critical resources such as operating rooms through its Healthcare Operating Room Analytics. It also contains new attributes that support comparative effectiveness research and formulary modelling. The total solution includes Oracle Healthcare Analytics Data Integration, Oracle Health Sciences Cohort Explorer, Oracle Healthcare Operating Room Analytics and Oracle Healthcare Provider Supply Chain Analytics.
Sysmex releases Delphic update, mobile app Auckland-based clinical laboratory specialist Sysmex has released the latest version of its Delphic laboratory information system (LIS) as well as a new mobile application for its Eclair clinical data repository. Delphic v8.5 comes with a new graphical user interface called Delphic Explorer, which provides a seamless front‑end for Delphic LIS. It also includes a number of other features with advanced functionality such as new worksheet features, simplified request number formats with new templates, functionality revamp for tracker-storage module, smarter interfacing and an electronic orders interface. Late last year, Sysmex launched a new mobile application called Eclair
Touch, which enables secure mobile access to patient records held in central Eclair repositories within healthcare organisations. The app is for touch-screen mobile devices such as iPhone, iPad, iPod touch or any Android tablet or smartphone. Sysmex said it developed Eclair Touch to meet the growing need for mobility within healthcare, with an estimated 30 per cent of clinicians now using touch‑screen mobile devices or similar tablet technology. Rob Ticehurst, principal pharmacist for medication safety at Auckland Hospital, said the app offered potential benefits to hospital pharmacists. “When a patient is admitted to Auckland City Hospital,
the pharmacist uses Eclair (TestSafe) to check the medications that have been dispensed to the patient from community pharmacies,” Mr Ticehurst said. “As part of the medicines reconciliation process, the pharmacist prints the medication list from Eclair, and uses this as a source of information when talking to the patient. “Although it is excellent having a summary of the dispensing information in Eclair, printing out the paper report to take to the bedside creates one more task for the team. With Eclair Touch, we could eliminate this step and access the medication details we need directly from the mobile device.” Sysmex’s chief architect Graeme Hibbert said Eclair Touch was connected to a secure mobile website platform. “There’s no patient information stored on the device except a temporary cache,” Mr Hibbert said. “User access is authenticated in the same way as it is to the core Eclair web system. A full audit trail of all access and actions is also recorded.”
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TrakCare updated with new web interface InterSystems has launched a new version of its TrakCare unified health information system, featuring improved medication management functionality and a new web interface. The update offers electronic medication management functionality across electronic prescribing, dispensing and medication administration, with all data relevant to medication management residing in a single repository. This unified, closed loop approach helps reduce medication errors and makes it easier to achieve time and cost savings through reductions in data entry, unnecessary communications, and stock wastage, the company said. The new release also includes significant enhancements in workflow, configurable medication charts, additional alert capabilities, and a new method of displaying alerts to reduce “alert fatigue” and make it easier for care providers to take immediate action. Enhanced clinical functionality in TrakCare includes new clinical summaries, alerts and “break-the-glass” capabilities, improved care planning and review worklists, and grids and planners for appointments, bed bookings, and operating theatre bookings. These are combined with a new web interface with easier navigation to different functions and the ability to personalise information via Surgical Preferences, My Patient Lists and Clinical Summary Templates. TrakCare also now includes a patented technology called iKnow, which analyses and indexes unstructured data to unlock the value of important information held in clinical notes or any other type of free text, regardless of its source. iKnow automatically indicates the most meaningful elements in the data without needing any input from the user.
Argus achieves CCA for secure messaging Database Consultants Australia’s (DCA) Argus version 6.0 secure messaging product has passed the Conformance, Compliance and Accreditation (CCA) assessment process for secure messaging delivery (SMD) implementation. It was evaluated by two independent assessors in January and received its formal documentation of compliance from KJ Ross & Associates on February 15. Argus’ general manager Ross Davey said the team had been early adopters of the CCA initiative because it believed a common approach to clinical messaging will eventually lead to better capabilities for health professionals. He said delivery of a SMD product capable of passing CCA testing was not only important to Argus, but also to its vendor collaborators Best Practice, Zedmed, Medtech Global and Communicare, which have chosen Argus to be their messaging partners for achieving SMD capability under their National E-Health Transition Authority (NEHTA) vendor panel contract. “The sophistication of the Argus implementation and changes to its architecture
are far more complex than anything put through the NEHTA CCA process to date, meaning that this achievement is all the more impressive,” Mr Davey said. “Argus not only has to provide full new SMD functionality but also has had to retain the capability for continuing to exchange messages with older versions of Argus so that transition of all clients to the newer SMD technology can be seamless and painless.”
“Argus not only has to provide full new SMD functionality but also has had to retain the capability for continuing to exchange messages with older versions of Argus so that transition of all clients to the newer SMD technology can be seamless and painless.” Argus v.6.0 has the capability to communicate via SMD with other
messaging providers. Mr Davey said the new architecture can give all sending applications the ability to detect what the receiving capabilities are of all recipients prior to sending a document; rather than the error-prone method that is current standard practice across most messaging systems of sending a document and hoping for the best. “SMD conformance now also opens the possibility for reliable messaging provider interconnectivity,” he said. Another DCA product, Connectingcare, a web‑based directory of health and community services integrated with a secure messaging and referral system, has also received its CCA certificate. Connectingcare has been used across Victoria by primary care partnerships since 1998 and enables member agencies to securely send referrals and other secure messages. Connectingcare was acquired by DCA in July 2010 to complement its existing systems for a range of health and community services. More than 23,000 Victorian services are listed at
Connectingcare’s online service directory, which is based on the Victorian Department of Health’s Human Services Directory (HSD) data model. Argus v.6.0 will use DCA’s endpoint location services (ELS), which has been implemented in conjunction with the HSD, Argus’ operations manager, Chris Crawley, said. “This endpoint location service is also available to vendors for the future purposes of interconnectivity under an agreement with DCA.”
“This ELS is also available to vendors for the future purposes of interconnectivity under an agreement with DCA.” The initial release and deployment of Argus v.6.0 will be limited to Wave 1 PCEHR project participants with a view to providing SMD capability in-line with their project
objectives. The company is working with Best Practice, Zedmed and Medtech Global in the Wave 1 and 2 lead implementation site projects. Mr Davey said once DCA’s contractual commitments have been met with NEHTA the company will focus on a broad public deployment of an enhanced release of version 6 to provide some added features to Argus for its entire user base. “This is expected to be ready for public release in the second quarter of this year,” he said.
MBS Prompts gives oxygen to PrimaryCare Sidebar RACGP Oxygen has added MBS Prompts to its PrimaryCare Sidebar tool. MBS Prompts allows general practice teams to instantly identify what Medicare Benefits Schedule (MBS) chronic disease management items are claimable for their patients. MBS Prompts is now available to Medical Director version 3 users with Pracsoft 3 as their billing system. It will be available to GPs who use Best Practice in the coming weeks. The PrimaryCare Sidebar, designed by Pen Computer
Systems, is an eHealth resource that works alongside the clinical desktop and is compatible with leading practice software packages. The MBS Prompts tool simultaneously reads the clinical system and the billing system and assesses the MBS items for which the patient is eligible against what has been claimed through the practice. The new feature’s ‘traffic light system’ guides users in this task. RACGP Oxygen spokesman Nathan Pinskier said identifying the most suitable MBS chronic
disease management items can often be both time‑consuming and challenging for GPs and their practice teams. Additional features will be added to the PrimaryCare Sidebar in the coming weeks, Dr Pinskier said. Free 30-minute webinars are being held on Tuesdays from 1pm to 1.30pm and Thursdays from 3pm to 3.30pm AEDT. There is also one evening session per month for users who prefer a later time. For dates and login details, see www.racgp.org.au/ primarycaresidebar.
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GE-Microsoft JV changes the Caradigm The joint venture company established recently by GE Healthcare and Microsoft is to be called ‘Caradigm’, and will develop software to increase adherence to protocols aimed at avoiding hospital‑acquired infections. Speaking at the Health Information Management and Systems Society (HIMSS) congress in Las Vegas recently, the CEOdesignate of Caradigm, Michael Simpson, said the software will also allow hospitals to monitor discharged patients in order to reduce readmissions. Caradigm will be based on Microsoft’s open platform technology to facilitate healthcare management and bring patient data from different IT systems onto one comprehensive system. GE Healthcare applications will assist health professionals in exchanging clinical data and care information to enable them to offer the patient tailor-made healthcare that takes into account the care they are receiving from other sources. “The problems of cost, access and quality are universal,” Mr Simpson said. “Caradigm’s goal will be to give value by delivering a healthcare performance management package that will deliver on the promise of healthcare information technology and improve patient, system and population outcomes everywhere. “We have an exciting opportunity to transform healthcare globally with an established open platform and a new generation of applications focused on population health.” The new company will launch in the first half of 2012 and will be headquartered near the Microsoft campus in Redmond, Washington, with significant presence in Salt Lake City, Utah and additional cities around the world.
Questions remain over functionality of PCEHR components Serious questions remain about a number of aspects of the legislation underpinning the PCEHR, despite its passage through Parliament, according to several experts. At a hearing in Canberra recently, a Senate committee inquiring into the legislation heard that there were serious concerns about the governance arrangements for the PCEHR, privacy and consumer access, software glitches and functionality issues, and in particular, concerns over the short time frame before the PCEHR is meant to be up and running. The Australian Privacy Foundation (APF) made perhaps the strongest criticisms on governance, calling for the legislation to be completely rewritten to ensure an orthodox governance arrangement was put in place. The Consumers eHealth Alliance also raised these concerns. Dr Eric Browne, a member of the alliance’s steering committee who appeared at the hearing, said the main issue from his group’s perspective was governance. “We need a better governance arrangement whereby the parties that
have an interest in the PCEHR — the consumers, the healthcare providers, the software developers and vendors and the policy makers — all need to come together rather than being just a top-down, [Department of Health and Ageing (DoHA)/National E-Health Transition Authority (NEHTA)]-driven system,” Dr Browne said. “The claims are made and are part of the NEHTA and DoHA submissions that consultation has been widespread, and they cite a number of meetings and roundtables, but the agendas are always controlled by NEHTA or DoHA. NEHTA sees it as a vehicle for getting answers to specific questions rather than a two-way consultation and engagement process.”
In addition to his role with the Consumers eHealth Alliance, Dr Browne is also a health IT specialist of many years’ standing and a well-informed commentator on the topic of eHealth. In a post on his blog in January, Dr Browne found some serious problems with the underlying architecture of the PCEHR, especially concerning the Clinical Document Architecture (CDA) specifications. “Having studied both the HL7 specifications in detail as well as dozens, if not hundreds of examples of CDA documents from around the world over the past 5 years, I have come to the conclusion that there are significant safety and quality risks associated with relying on the structured clinical data
in many of these electronic documents,” he wrote. “So concerned am I by this issue that I am notifying key stakeholders and urging all individuals and organisations who take safety and quality of clinical data seriously, to investigate this issue thoroughly before committing to any further involvement with the PCEHR system being rushed through by the federal Department of Health and Ageing.” Dr Browne said that while it was test data that he used, it stood as an example of what could possibly go wrong with one of the core components of the PCEHR. “I think it would be very hard, given the architecture of the CDA and what I know about the implementation guides that NEHTA has introduced, I think it is going to be very hard to introduce a compliance, conformance and accreditation framework to validate these things in the time frame that has been laid out.” The deep concerns of the Medical Software Industry Association (MSIA) are also on record, particularly regarding what it says are threats to patient safety. Jon Hughes, president of the MSIA and CEO of Smart Health Solutions, which is taking part in two of the
Wave 2 trials, called for an immediate 12-month extension to the PCEHR roll out and for a simplified record to be made available by the deadline of July 1. The government has long said that the July 1 deadline was when consumers will be able to register for their PCEHR, not that all of the components will be ready by then.
“If it is going to cost more to provide all of the data further down the track and to set up these CCA regimes, then who is going to pay for it?” “If all they can do is sign up to an empty folder then it is a waste of $470 million,” Dr Browne said. “If it is going to cost more to provide all of the data further down the track and to set up these CCA regimes, then who is going to pay for it? “We don’t know who is going to pay for it, we don’t know what obligations are going to be passed on to the states or the software vendors — I think the software vendors have been put in a very difficult position with regards to all this because they have got to sign up to contracts
when maybe they don’t have all of the information at the moment. That is very problematic.” The MSIA and Dr Browne raised concerns about the Australian Medicines Terminology (AMT), which both the MSIA’s Dr Vincent McCauley and Dr Browne have been involved with for many years. Dr Browne said he was aware of some exercises where the medicines terminologies in some of the existing GP software have tried to be mapped to the AMT, and believes that also has safety implications. “In the time frame it is doubtful that is going to happen so if the vendors are going to make an investment in changing their systems then they have to have some certainty into the future about when these promised or foreshadows improvements of AMT are going to occur,” he said. As to whether the legislation should be rewritten or delayed, Dr Browne said the Consumers eHealth Alliance view was to get the governance right first and then make a decision, whether it is delaying it or reviewing it. “Otherwise we risk repeating the same unsatisfactory outcomes that have been common overseas,” he said.
Harvard computer-aided surgery expert joins UWA An expert in the use of computer graphics in the operating theatre will join the University of Western Australia later this year. Ron Kikinis is the director of biomedical informatics and founding director of the surgical planning laboratory at Harvard University in the US. Professor Kikinis will work at UWA with Karol Miller, head of the university’s Intelligent Systems for Medicine Laboratory, the world’s most cited laboratory working in the field of brain biomechanics. Their work at UWA involves finding ways to better remove brain tumours by using computers to more accurately measure changes in the brain during surgery. “Recent developments in the understanding of soft tissues — once an area neglected in favour of load-bearing tissues such as bones, ligaments, muscles and lungs — are about to revolutionise surgery and improve patient outcomes,” Professor Miller said. “Biomechanics and computer science will transform risky soft-tissue surgery such as operations to remove brain tumours.” He said his lab’s work provides a patient-specific, cost-effective, fast and sophisticated intra-operatic guide that surgeons use while they are operating. “Thanks to our algorithms working perfectly on graphics processing units, within 10 seconds one can get an accurate picture of the complexity of deformations from a basic computer,” he said. “This means that neurosurgeons are more likely to feel confident cutting more of the tumour out, knowing they are leaving the healthy tissue behind.”
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Secure power for operating theatres Schneider Electric has released a secure power distribution and monitoring solution for hospital operating theatres. The company said the solution delivers almost 100 per cent electric power availability to help ensure patient safety while increasing the efficiency of medical and maintenance personnel. The solution comprises a tightly integrated and pretested electrical switchboard, uninterruptible power supply, and a monitoring system compliant with all applicable regulations and standards. A large, touch panel screen in each operating theatre presents environmental conditions, the status of medical gases, and visual and audible alarms on the occurrence of an insulation or electrical fault, enabling fast decisions by doctors and nurses regarding whether to proceed. Maintenance personnel are simultaneously alerted by mobile phone or pager to enable them to respond quickly and correct the problem. Supervisory personnel benefit from real-time views of conditions across all operating theatres and recording of all electrical events and environmental parameters for 100 per cent traceability and reporting in support of accountability for patient safety. Schneider Electric has also announced the latest version of its automated Emergency Power Supply System test solution to help hospitals ensure their back-up power systems are compliant with all maintenance and testing regulations. The Emergency Power Supply System can also feature as part of a larger monitoring system that can verify utility costs and look at power quality from the utility service entrance right through final distribution to critical equipment, like MRI or CAT scan machines.
LRS Health launches anatomical pathology module Victorian-based laboratory information management specialist LRS Health is shortly to launch a new version of its MediPATH AP system for anatomical pathology. MediPATH AP can be added to LRS Health’s core MediPATH platform or installed as a stand‑alone system to run an anatomical laboratory. MediPATH has been installed at Monash Medical Centre for almost a year after it was selected by Southern Health to be rolled out throughout its hospitals in 2010. Designed and built in Australia, one of the product’s points of difference is that it has an Australian-specific billing system, MediBILL, embedded into it, LRS Health’s product manager Yvonne Sherlock said. MediBILL automates claims and receipts to and from e-enabled healthcare funds and is also a Medicare‑accredited invoice and debt management suite that simplifies hospital billing by consolidating all charges relating to a visit into a single invoice. It has also been accredited by Medicare Australia to process medical claims
through ECLIPSE, the electronic claim lodgement and information processing service environment. MediBILL is also being used as a stand-alone billing system throughout Barwon Health in Victoria and at The Alfred Hospital. Ms Sherlock said the new AP module includes the latest technology such as touchscreens and 2D barcodes. “The emphasis is to keep it safe — patient safety errors are catastrophic in this area — and our catchcry is ‘workflow made safer’,” Ms Sherlock said.
“The emphasis is to keep it safe — patient safety errors are catastrophic in this area — and our catchcry is ‘workflow made safer’ ... ” Features include improved image management, with the ability to easily capture and incorporate images into reports. There are a range of options for generating and delivering patient reports, including by autofaxing,
electronic reports in either HL7 or PIT format and a remote web-based results service as standard. Printing can be configured to print on specified printers anywhere on a network. Special stains and immunohistochemistry can be easily ordered via hotkey access during case review, with orders transmitted immediately to interfaced instruments. These orders then appear immediately on worklists for laboratory staff to action. MediPATH AP also includes speech recognition and audio recording, which is also available from within G-Edit, the inbuilt text editor. Patient results can be accessed securely through the internet, with results delivered in either an HL7 or PIT format via LRS Health’s AllTALK secure, automated messaging service. There is also an embedded SNOMED CT database to allow for accurate coding of anatomical pathology cases. MediPATH AP is also able to support the importation of legacy data, with imported reports able to be accessed during case review.
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Senate committee supports PCEHR bill The Senate committee investigating the legislation underpinning the PCEHR has recommended it be passed. The Labor-dominated committee split as expected on party lines, with the two Coalition senators issuing a dissenting report and the two Greens senators recommending minor amendments. The committee did agree that there were problems with governance and the ‘opt‑in’ model, recommending that when the government reviews the operation of the act after two years, it look at the appropriateness of the Department of Health and Ageing (DoHA) having responsibility as the system operator, as well as alternative governance structures.
The committee also noted the critical submissions made by a number of groups, such as the Medical Software Industry Association (MSIA) and the Consumer eHealth Alliance, about the design of the PCEHR and what they thought were inherent flaws and dangers. The report states that while the committee notes these concerns, it also noted the advice and explanations from DoHA and NEHTA. “The committee considers that the information it received throughout the inquiry suggests there is a level of confusion among stakeholders,” it said. “The committee appreciates the information that it has received to clarify these issues throughout its inquiry, and recommends that the Commonwealth and NEHTA ensure that this information is fully available to stakeholders.”
Credit: Tess Flynn
It also recommended that the review also consider the opt-in design of the system and whether it could move to an opt-out system, as recommended by consumer health groups and the Australian Medical Association (AMA).
Panel to discuss eHealth and broadband at ITAC A panel of experts will discuss how the National Broadband Network and initiatives such as the Personally Controlled Electronic Health Record (PCEHR) can assist in delivering better aged care at the 5th annual Information Technology in Aged Care (ITAC) conference, being held in Melbourne on April 19-20.
is the theme of the conference, which is aimed at understanding the importance of IT in establishing a sustainable, quality-focused aged care environment, with an emphasis on the fields of community care, medication management, assistive technologies and offsite information systems delivery.
“Smart technology for modern aged care”
Day two is of particular relevance as it covers the
promise both the National Broadband Network (NBN) and the personally controlled electronic health record (PCEHR) hold for the aged care sector. Speakers in the NBN/ PCEHR session include: • Sean Casey, broadband applications advisor with NBN Co, who will speak about building broadband for better care.
• Brett Harrison, head of technology delivery at Australian Unity Retirement Living, who will discuss how his company got more fibre in its communication diet through the NBN. • Sharon McCarter, assistant secretary of the eHealth systems branch with the Department of Health and Ageing (DoHA), who will discuss the government’s health reform agenda. • Leigh Donoghue, senior executive for health and the public sector with the PCEHR’s infrastructure partner Accenture, who will describe how Accenture is delivering the PCEHR infrastructure. • Rod Young, CEO of Aged Care Association Australia (ACAA), who will outline an aged care PCEHR project, and
• Caroline Lee, chair of the Aged Care Industry Vendors Association (ACIVA), who will discuss aged care vendor enablement in the PCEHR. Greg Tegart of the Australian Academy of Technological Sciences And Engineering (ATSE) will discuss how technology enables ageing-in-place; and Tracey Kennair of PricewaterhouseCoopers (PwC) will outline PwC’s view of the key challenges, opportunities and critical factors in developing a robust IT strategy for aged care. Other speakers include the Minister for Broadband, Communications and the Digital Economy, Stephen Conroy, and the director of the Centre for Health Systems and Safety Research at UNSW’s
Australian Institute of Health Innovation, Johanna Westbrook. Len Gray, the director of the Centre for Research in Geriatric Medicine at the University of Queensland, will discuss telehealth and smart technologies. Delegates will also be able to meet Charles and Sophie, two new aged care robots who have joined Matilda and Jack at La Trobe University’s Research Centre for Computers, Communication and Social Innovation (RECCSI). Streams at ITAC 2012 include smart technology case studies from providers, the adoption of smart technology in Australia, assistive technology uses for community and rural service provision, and telehealth and smart technology.
Clinical coding and activity-based funding explained The NSW branch of the Health Informatics Society of Australia (HISA) is holding an activity-based funding and clinical coding educational session in Sydney on April 19. Ric Marshall, executive director of ABF systems with the Independent Hospital Pricing Authority (IHPA) and former manager
of the casemix unit at NSW Health, will describe the basics of ABF, which was introduced as part of the government’s national health reform agreement. Under the system, the Australian refined diagnosis-related groups classification will be used to define and count acute admitted patient ‘activity’.
Digital ink makes an impression US company Bottomline Technologies recently purchased the assets of mobile documentation software firm Logical Progression and is now bringing its Logical Ink technology to the healthcare sector in Australia. Logical Ink is a mobile documentation solution that uses digital ink and a pen‑based interface to enable tablet‑based data capture and form completion for healthcare organisations. It allows validation of data in real time at the point of care, accessibility to patient records, mobility, security, and the creation of intelligent, interactive forms, with no duplicate data entry or scanning required. “Our software solution lets you build mobile applications from a paper document,” Logical Progression’s founder Chris Joyce said. “Because it‘s pen‑based, it’s a very natural interface for the clinician. It presents very much like the existing paper forms — you can complete form fields and write in margins, annotate diagrams and can sign documents with your biometric signature.
Other ABF classifications are being developed by the IHPA for the purposes of classifying other activities.
“We complement the EMR by integrating through standards like HL7. We are not replacing the primary record system, but we’re sitting alongside those hospital systems and giving both clinicians and other supporting staff a document portal that is pretty much like the paper clipboard they had before, only under glass.”
Cassandra Jordan, health information manager with the Jewish Wolper Hospital in Woollahra, will discuss the basics and benefits of using DRG codes and ICD-10-AM – in health informatics.
Mr Joyce said one of the main catalysts for the uptake of these systems is the ability of Windows-based tablet PCs to support handwriting recognition. The Windows operating system now comes with this inbuilt capability, which has evolved from its early years and no longer needs to be ‘trained’ for individual users.
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Virtual clinic for mental health The federal government has invited mental health organisations to apply for funding for a new virtual mental health clinic to provide telephone and web-based cognitive behavioural therapy. The government has made $20 million available over three years for the virtual clinic, which will be hosted on a new $12 million mental health portal, due to be up and running in July this year. The virtual clinic and portal are two of three related projects announced last year as part of the government’s mental health reform package. The other project is a central support centre to provide advice on the most effective therapies in the online environment and the governance of the portal, as well as to promote the portal to primary care providers. The portal will provide a single gateway for users to existing teleweb services and provide a platform for new programs as they are developed. In its invitation to apply (ITA) document, the Department of Health and Ageing (DoHA) said development of the portal is being progressed with advice from the department’s e-Mental Health Expert Advisory Committee and is expected to commence operations on July 1. The winning applicant will be expected to comply with DoHA’s Quality Framework for Telephone Counselling and Internetbased Support Services and undertake an external IT security audit. “Development of the portal will continue beyond that date and will include new functionality, programs and information,” the department said. The portal is being built by the National Health Call Centre Network (NHCCN), which will also host the portal when it goes live.
Electronic pathology ordering takes flight HealthLink has launched its eLab electronic pathology ordering system for the Australian market. eLab was originally developed as part of an international collaboration between HealthLink and Danish company DMDD (Danish Medical Data Distribution). It has been up and running in Denmark for six years and is now used by all community-based practices and some hospitals to initiate more than 600,000 orders per month. A trial is currently under way in New Zealand, where Wellington pathology laboratory Aotea Pathology has installed the system at its own cost and is rolling it out to its referring doctors. Since the trial started in November last year, the system has been rolled out to more than 40 practices, 460 doctors and 260 nurses. “The numbers of orders is now increasing sharply, with 11,790 electronic orders received by Aotea Pathology laboratory in February 2012,” HealthLink’s eLab product manager, Colin Simmons, said. He said the key benefits of electronic ordering
are easy, fast lab-lab/ procedure ordering, improved data quality with reduced cost of data input, and improved efficiency across the board; greater ease and efficiency for doctor, laboratory, patient and funder. “eLab is welcomed by busy GPs as it provides them key information which is inserted back into their local practice systems as the laboratory order is generated,” Mr Simmons said. “This automatic feedback reduces the GP’s workload and therefore provides a good incentive to use this service.” He said the laboratory gains by much-improved data quality and key information related to tests ordered. “The ordering GP supplies this critical health information as a natural by-product of placing the order from his local desktop computer. “The patient gains by always having the correct specimens taken for every test ordered and a much more efficient testing process, reducing the need for multiple doctor visits. All these gains are well documented in Denmark where the system has been
in use for more than six years.” Mr Simmons said eLab has achieved many of these objectives by adhering to standards. The system is designed in a way that allows all parties to progress naturally from their current local status to the desired regional or state and national status as and when this is promoted by health authorities. “This is exactly how implementation proceeded in Denmark, a country which has been recognised internationally as a leader in eHealth.” At the official launch of Aotea Laboratories’ eLab system last year, the company said the system would allow doctors to enter information directly into an online form that Aotea’s laboratory systems can read and instantly make available to all its staff. “Direct data entry into our systems greatly reduces the risk of human error from manual data entry,” a spokesperson said. “The tool also lets doctors access relevant test information from Aotea Pathology. “If ever required, the data can also easily be used by
other service providers such as other laboratories. This is a planned fit with the government’s move to by 2014 have patients’ medical information available in a standardised data set that can be used in a range
of electronic systems — wherever a patient needs to access it. “Over time, we think the majority of laboratory requests from primary care will be made using
electronic ordering workflows.” The spokesperson said future plans for eLab include making it available for specialist referrals and for interlab referrals.
NEC was endorsed as the industry partner for cloud computing by the two main aged care associations — Aged Care Association Australia (ACAA) and Aged & Community Services Australia (ACSA) — in July 2010. It offers a sector-specific cloud computing solution for aged care providers, involving a number of software packages from different vendors hosted on NEC’s cloud platform. Vendors include AutumnCare, ion.my.care, iCare, Leecare, Gold Care, Health Metrics and Clintel. NEC is now broadening what it offers to the industry through the cloud besides software applications. One of the company’s big
interests is telehealth, and with funding from the government for telehealth in aged care facilities as an area of need, it is considered a quickly developing field. NEC Australia’s head of health and aged care solutions, David Cooke, said there was much interest in VoIP services as well as telehealth. “For smaller facilities, telecoms costs are possibly not that significant, but what I think is happening is we are hitting a change between the type of PABX they might have traditionally had on‑premise and what operators might need to interconnect to expanded multi-location facilities,:” Mr Cooke said. “They may have had PABX in for maybe 12 years or so and it’s time for a refresh, so they are considering do we go IP; do we go on‑premise; do we go unified communication; and finally do we look to put it in
AIIA & ACIVA pre s e n t s
for
NEC to promote VoIP, telehealth to aged care Global giant NEC will promote its cloud-based voice, video and telehealth solutions at the upcoming Information Technology in Aged Care (ITAC) conference, being held in Melbourne this month.
in co nj unction wit h
the cloud. The trend that’s emerging is the upside from all these productivity gains in terms of higher, faster, quicker, more accurate, more responsive systems.” Mr Cooke said cloud-based offerings had been slow to kick off globally, but the trend got a boost when Microsoft began delivering its product over the cloud and Google apps started getting traction in the commercial market. “I think there has been a building of confidence in cloud-delivered services over the past two years which perhaps wasn’t there when we first launched this,” he said. He said several of the software vendors who have provided their product to NEC’s cloud offering had already started adapting their products to be cloud‑enabled, including Leecare and Clintel, and most now offer their clinical systems in some form of cloud or hosted system.
The one event you cannot miss this year AMT, NIP ,NASH, ELS, SMD, BEP, NCAP, HL7, IHE, CDA and any other acronym you can think of.
On the Booths Over 50 key government and government agency experts and others available for you to meet with and question.
The Panel Masterclasses: • HI Service • PCEHR Implementation for non Wave vendors • Desktop vendors – Implementing CDA specifications • Secure messaging and ELS • Current HL7 issues in the Australian context • Telehealth-state of the nation, standards and software • Pharmacy – issues for prescribers and dispensers • AMT – Current view points
SYDNEY: Tuesday 24th April 2012 from 9am MSIA members free – contact for registration link.
AIIA and ACIVA
contact your association for registration link and details.
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Operational blueprint for PCEHR in final draft An operational blueprint that will set out how the PCEHR will be managed after the system is launched on July 1 is in its final draft, according to the Department of Health and Ageing (DoHA). In a response to questions put on notice during a Senate committee hearing into the PCEHR in February, DoHA said the operational blueprint was being developed by administrative design company ThinkPlace. ThinkPlace is a member of the national infrastructure partner consortium and has been engaged on that basis, DoHA said. Committee member Sue Boyce had asked the department a number of questions regarding the operational blueprint, including when the development began, when it would be ready for use and if it would require staff training to use it. DoHA said formal discussions and workshops had been held between November 2011 and February 2012 to develop the blueprint. “The operational blueprint is at the final draft stage, subject to incorporating feedback from the PCEHR program control group. It provides a framework for the operational implementation of the PCEHR system and is now being used to guide development of the detailed processes and procedures to establish the PCEHR functions. Implementation activities for the operational blueprint have commenced.”
AGPN calls for PCEHR practice incentives The Australian General Practice Network (AGPN) has urged the federal government to consider paying incentives to general practices that use the personally controlled electronic health record (PCEHR). The AGPN’s official position on the PCEHR stipulates that general practices must be provided with an eHealth practice incentive payment to support the necessary infrastructure to establish the PCEHR. It is also demanding that individual GPs receive a financial incentive to compensate them for the extra time taken to encourage patient confidence and to get their consent to participate in the system and to upload information into a shared portal.
DoHA said the functions to be delivered within the framework, such as procedures to support registration and enquiries, are subject to separate training packages being built by each relevant agency.
AGPN chair Emil Djakic said in addition to the incentive payments, the Medicare Locals network must also be appropriately resourced to support GPs and practice managers to build the foundations and infrastructure needed to get the PCEHR up and running by and beyond July 2012.
“These training packages will ensure staff involved in delivery of each function receive training on the detailed polices and procedures,” it said.
“Medicare Locals are perfectly positioned to support the general practice sector to establish
the PCEHR if funded to provide eHealth support officers, who can educate and support general practice to adopt and integrate the system,” Dr Djakic said. “These are the minimum requirements to support PCEHR uptake. With the right levels of flexible funding, Medicare Locals are also well placed to promote community awareness and build change-readiness among allied health, nursing and pharmacy professionals around the benefits a PCEHR.” When questioned about practice incentives at a Senate committee hearing into the PCEHR in Canberra on February 6, Rosemary Huxtable, deputy secretary of the Department of Health and Ageing (DoHA), said the system was being designed to be as easy to use as possible so that accessing the PCEHR was streamlined into normal clinical workflows. “One of the important things is what exactly is the requirement on providers in a practical sense,” she said. “In terms of the design of the infrastructure, what we are seeking to achieve is ease of use as far as possible and having the
software within practice management systems that enable a very easy upload and download of information so that it is not at all an onerous task and in fact is probably no different from what occurs now in the recording of notes etcetera. “The second thing is that there is a range of investments that are already made into general practice. I think there is capacity to see them in the context of changing the healthcare delivery environment, including eHealth. Clearly, there has been a lot of investment already in computerisation, particularly of GPs.” She said the department had established an eHealth payment within the practice incentive payments (PIP) system some time ago. “If you exceed certain thresholds, you can access the eHealth PIP and the payments are up to $50,000 per year for a practice,” she said. “We are in active discussion with the sector now about how those requirements may change in the future to take account of the PCEHR. The PIP becomes a potential financing flow‑in for practices around eHealth.”
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NPS to release e-Audit for respiratory tract infections NPS is preparing a new clinical e-Audit for the management of specific respiratory tract infections, to be available in June. Clinical e-Audits are free electronic versions of NPS’ quality improvement activities for GPs, using the audit‑feedback-review cycle. The clinical e-Audit process involves participating GPs completing electronic data collection for 10 to 20 patients and securely submitting de-identified data online. The process allows GPs to receive immediate patient-specific feedback to assist implementation of changes to practice and to review individual and peer feedback results based on best practice clinical indicators. The web-based system is designed to operate in all common browsers. For the respiratory tract infections e-audit, the program requires GPs to recruit 10 or more patients with acute bacterial rhinosinusitis, acute sore throat pharyngitis/tonsillitis, acute otitis media, the common cold or non-specific upper respiratory tract infection, or acute bronchitis. NPS is also running clinical e-Audits for CVD risk and lipid-modifying therapy, management of hypertension, review of proton pump inhibitor (PPI) prescribing, and optimising management of type 2 diabetes.
Real-time access to controlled drugs data from July The federal government will launch an electronic recording and reporting of controlled drugs system on July 1. It will be based on an existing system designed by Hobart’s XVT Solutions under contract to the Tasmanian Department of Health and Human Services (DHHS). XVT Solutions was contracted to develop a suite of applications that collectively record, monitor and provide real-time reporting on controlled drugs dispensed from pharmacies and health facilities. The company has developed three applications for the system, including Real Time Reporting (RTR), an integrated set of web applications that record, monitor, analyse and report on pharmacy dispensing in real time.
other registered health professionals with information on patients receiving controlled drugs. A DHHS spokesperson said DORA gives prescribers appropriate information to support their decision to prescribe a controlled drug in real-time. The information only relates to the patient being treated, not third party information.
“Dispensing creates a report that shows patient name, drug, strength, prescriber, date and pharmacy. This action does not involve any further action on part of the dispensing pharmacist.”
These audits must be completed before April 30 to be recognised in the Quality Prescribing Initiative (QPI) year, part of the Practice Incentives Program (PIP).
The company also designed a Drugs and Poisons Information System (DAPIS) that is linked to RTR and which manages all patient, drug, prescriber, practice, and pharmacy information, including authority management and poisons licensing.
The spokesperson said the system dates back to 2008 when DHHS received funding from the Commonwealth’s Health Connect program to develop and introduce a real-time reporting system.
The clinical e-Audit has been developed in-house by NPS and is a stand-alone application that is not integrated with clinical prescribing systems.
Linked to this is DAPIS Online Remote Access (DORA), a web application that provides GPs and
“Reporting of dispensing is initiated in real-time — when dispensing occurs,” the spokesperson said.
“Dispensing creates a report that shows patient name, drug, strength, prescriber, date and pharmacy. This action does not involve any further action on part of the dispensing pharmacist. “Patients are not registered — dispensing the medication must be reported under poisons regulations and the patient dispensing history results from that reporting.” It is understood that the new reporting system will not be linked to other eHealth initiatives such as the PCEHR, as patients do not and will not have access to the information. Pulse+IT understands that while the Tasmanian system is currently being rolled out to some community pharmacies, it is predominantly hospital pharmacists who are using it at the moment. Lawrence Howson, managing director of XVT Solutions, said the system has been designed around a secure website, but more work will need to be done by the Department of Health and Ageing (DoHA) to determine how it will be rolled out nationally. It is understood that all of the components will
be made available to the states and territories for implementation on July 1. As Schedule 8 drugs are controlled by state and health territory health departments, it will be up to each jurisdiction to begin implementation. It is also understood that no extra software will be required by pharmacists or doctors and the system will interface with existing systems such as Medicare and the PBS. Mr Howson said the system would only be accessible by authorised users using existing capability such as Medicare’s Public Key Infrastructure (PKI) procedures and infrastructure. “It is also secured by a specific IP addresses as well,” he said. “There are multiple levels of security.”
Currently, prescriptions of Schedule 8 drugs must be registered on a controlled drugs register (or dangerous drugs registers, known as “DD Books”) in each state and territory, which includes the quantity, strength and balance of each controlled drug, the patient name and address and prescriber details as well as date of supply and prescription number.
“The best time for intervention is when a prescriber is about to write a prescription or a pharmacist is about to dispense a controlled drug.”
The system was promised as part of the Fifth Community Pharmacy Agreement, enacted in July 2010, with a tender opened in April 2011 for the hosting and development of the system. Tasmania’s system was subsequently chosen and the federal government has now licensed it.
These registers are manually recorded and maintained within the pharmacy and, in most jurisdictions, copies of the prescriptions are sent to state and territory health departments at regular intervals. The registers must be available for inspection by health departments and the police.
The Fifth Agreement included $5 million to develop a system to collect and report data relating to controlled or Schedule 8 drugs to address the problems of forgery, abuse and doctor shopping.
At the moment, this is done manually and faxed or posted to the relevant health authorities. According to a consultation paper on the new system published in March last year, when data is
analysed up to six to eight weeks after an event, as may currently occur in some jurisdictions, the clinical significance of the intervention is compromised. “The best time for intervention is when a prescriber is about to write a prescription or a pharmacist is about to dispense a controlled drug,” the paper stated. “Wherever possible this system will be designed to interface with any existing state or territory health department monitoring and reporting systems. “The system will enable real-time, secure reporting of controlled drugs within each jurisdiction … Currently it is a legislative requirement to record all stock movements for controlled drugs (including receipt from supplier), balances and reconciliation of controlled drugs including in section 90 (community) and section 94 (public hospital and private hospital) pharmacies.” “In those states and territories that do not yet have an electronic register, the system will provide this, assisting pharmacists to more easily meet their statutory obligations to maintain records of controlled drugs. The electronic register will also assist in identifying errors or omissions,” the report said.
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UGPA calls for implementation support The heads of the major general practice associations have called on the federal government to properly fund and support GPs to assist in the smooth implementation of the PCEHR. At a meeting in Canberra recently, United General Practice Australia (UGPA) expressed concern about the lack of preparation for the practical implementation at practice level of the PCEHR, which is due to be introduced on July 1. UGPA comprises the Royal Australian College of General Practitioners, the Australian Medical Association, the Australian General Practice Network, General Practice Registrars Australia, the Australian College of Rural and Remote Medicine and the Rural Doctors Association of Australia. In a statement, UGPA said its members have been working tirelessly with the government and agencies for some time to ensure the PCEHR becomes a reality. “The PCEHR is a great opportunity for patients and the community, but it is in danger of being lost or impaired unless there is coordinated action to meet the deadline for implementation,” the statement read. UGPA called for the introduction of a mechanism to encourage GPs and patients to quickly sign up to the PCEHR. It said general practice can assist in this process, but must be properly supported. In its submission to the Senate committee hearing into the PCEHR, held on February 6, the AMA said it was essential that provision was included in the legislation for nominated healthcare providers, who will be charged with creating and maintaining a consumer’s shared health summary, be remunerated for this work.
ISN looks to the cloud for private practice Medical network specialist ISN Solutions has launched a cloud-based service specifically for the private practice and private hospital sector. The service brings together a number of partners, including wide area network provider M2 Communications, part of the Commander Group, and VMware provider ZettaGrid. The service also offers integrated digital dictation or voice recognition from Speech Solutions, while another vendor, VConsult, has partnered with ISN to offer back-end functions to private practices and young doctors, such as managing appointments and calls, through to promoting the practice to potential referrers. “It’s a high grade, high availability and affordable solution that is tailored to the medical industry,” ISN Solutions managing director Rafic Habib said. “Our solution is hosted in a data centre, one of the most secure in the world.” Mr Habib said cloud solutions are perfect for the medical industry, for a number of reasons. “Traditionally a medical practice wanting to run a
medical application needs to purchase at least a server, a back-up system and an uninterrupted power supply (UPS) to run the medical application,” he said. “The capital expenditure involved with this purchase can vary from $10,000 to tens of thousands, depending on what is needed, the size of the practice and its requirements.”
“... expenditure involved with this purchase can vary from $10,000 to tens of thousands, depending on what is needed, the size of the practice and its requirements.” He said hosted solutions are able to provide all of the required functions without the high cost of desktop-based traditional computing. “M2 Communications specialises in delivering wide area networks, which are ideal for connecting the practice or multiple practices to the data centre,” he said.
“Speech Solutions, in partnership with a number of medical software applications, offers an integrated and doctor‑friendly voice recognition technology that is medical industry‑specific and returns letters transcribed and attached to the patient file. “And VConsult (virtual consulting) offers a unique value proposition ideal for roaming or young doctors that want an alternative to hiring staff and the administrative burden and costs associated. They offer back-end functions, including making and managing appointments, promoting the practice to potential referrers, managing calls and managing relationships with third party organisations.” Mr Habib said that when designing this solution, it was important to keep in mind that IT fundamentals of medical practice computing do not change, even if you reallocate your practice to the cloud. “Your pathology results, dictations, scanning, multi‑tray printing are critical to your practice and other IT back-office functions such as back-up and maintenance of servers must still happen.”
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Events March 22
May 27-29 March
CLINICAL GOVERNANCE WORKSHOP Sydney, NSW p: +61 2 6228 0846 w: www.agpn.com.au
CHIK’s HEALTH-E-NATION 2012 Gold Coast, QLD p: +61 2 8060 8398 w: www.health-e-nation.com.au
22-23 March
29-30 March
DEVELOPING EMERGENCY MEDICINE CONFERENCE 2012 Sydney, NSW p: +61 2 9431 8699 w: www.developingem.com
4TH ANNUAL NATIONAL TELEMEDICINE SUMMIT Sydney, NSW p: +61 2 9080 4090 w: www.iir.com.au
2ND ANNUAL HOSPITAL PATIENT COSTING CONFERENCE Brisbane, QLD p: +61 2 9080 4300 w: www.iir.com.au
23-24 March
29-30 March
5TH ANNUAL HOSPITAL BED MANAGEMENT & PATIENT FLOW Melbourne, VIC p: +61 2 9080 4300 w: www.iir.com.au
DATA GOVERNANCE CONFERENCE 2012 Melbourne, VIC p: +61 3 9326 3311 w: www.hisa.org.au
24
March
March
MENTAL HEALTH SEMINAR Melbourne, VIC p: +61 2 9422 2666 w: www.australiandoctor.com.au
28-29 March PATIENT CENTRED DESIGN FORUM Sydney, NSW p: +61 2 9238 8888 w: www.informa.com.au
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OPEN SOURCE CHEF Sydney, NSW p: +61 2 8296 4459 w: www.acs.org.au
12-13 April 9TH ANNUAL FUTURE OF THE PHARMACEUTICAL BENEFITS SCHEME SUMMIT Sydney, NSW p: 61 2 9080 4036 w: www.informa.com.au
April
19-20 April
27-29 March DATA QUALITY ASIA PACIFIC CONGRESS Sydney, NSW p: 1300 550 662 w: www.dqasiapacific.com
May
APNA National Conference Melbourne, VIC p: +61 3 9645 9858 w: www.apna.asn.au
April
CONFORMANCE AND CERTIFICATION IN HL7 CDA AND V2.X Brisbane, QLD p: +61 (0)410 549 396 w: www.hl7.org.au
IHT2 HEALTH IT SUMMIT San Francisco, USA p: +1 561 748 6281 w: www.ihealthtran.com
3-5
May
April
18
27-28 March
1
INFORMATION TECHNOLOGY IN AGED CARE Melbourne, VIC p: +61 3 9670 5900 w: www.agedcare.org.au
24-25 April IHT2 HEALTH IT SUMMIT Atlanta, USA p: +1 561 748 6281 w: www.ihealthtran.com
7-9
May
EHEALTH WEEK Copenhagen, Denmark p: +32 2 793 76 36 w: www.worldofhealthit.org
20-21 May HIMSS MIDDLE EAST Abu Dhabi, UAE p: +65 6664 1189 w: www.himssme.org
22-24 May CEBIT AUSTRALIA 2012 Sydney, NSW p: 61 2 9280 3400 w: www.cebit.com.au
24-25 May NATIONAL MEDICINES SYMPOSIUM Sydney, NSW p: +61 7 3848 2100 w: www.nps.org.au
25-27 May AMA NATIONAL CONFERENCE Melbourne, VIC p: +61 2 6270 5400 w: www.ama.com.au
June
Save the dates
21-22 June
30
Electronic Medication Management Melbourne, VIC p: +61 2 9080 4042 w: www.iir.com.au
HIC2012 Sydney, NSW P: +61 3 9326 3311 w: www.hisa.org.au
AAPM NATIONAL CONFERENCE Brisbane, QLD p: +61 3 6231 2999 w: www.cdesign.com.au/aapm2012
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14-16 September
29-31 October
THE GENERAL PRACTITIONER CONFERENCE & EXHIBITION - Brisbane Brisbane, QLD p: +61 2 9422 2007 w: www.gpce.com.au
HIMAA 2012 NATIONAL CONFERENCE Surfers Paradise, QLD p: +61 2 9887 5001 w: www.himaa.org.au/2012
June
PRESENTATIONS FROM INNOVATION: PUTTING EVIDENCE TO WORK Auckland, NZ p: +64 4 389 8981 w: www.hinz.org.nz
July
7-10 November AGPN NATIONAL FORUM Adelaide, SA p: +61 2 6228 0846 w: www.agpn.com.au
19-20 July PRIMARY HEALTH CARE RESEARCH CONFERENCE Canberra, ACT p: +61 2 6281 6624 w: www.phcris.org.au
7-9
November
HINZ 2012 Rotorua, NZ p: +64 4 389 8981 w: www.hinz.org.nz
26-27 July 4TH ANNUAL EMERGENCY DEPARTMENT MANAGEMENT CONFERENCE Melbourne, VIC p: +61 2 9080 4042 w: www.iir.com.au
16-20 October
July – 2 August
17-19 September HIMSS ASIAPACIFIC 2012 Singapore p: +65 9299 0802 w: www.himssasiapac.org
16-18 November THE GENERAL PRACTITIONER CONFERENCE & EXHIBITION - Melbourne Melbourne, VIC p: +61 2 9422 2007 w: www.gpce.com.au
Online Calendar: To view a comprehensive list of eHealth, Health, and IT events, visit: http://www.pulseitmagazine.com.au/events
29 - 31 October 2012
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MSIA
There and back again an ehealth journey
As the journey to the PCEHR begins its approach to the station, is the end result going to be a smooth disembarkation or an absolute train wreck? The answer may lie somewhere in between, but whatever occurs, it is important that the work already done on standards, terminologies and the foundation pieces of eHealth are not lost for the future. Dr GEOFFREY SAYER BSc(Psychol), MCH, PhD Immediate Past President: MSIA geoff.sayer@healthlink.net
With apologies to the Bard, this has been a summer of malcontent. In Sydney it feels that we have missed out on summer altogether due to the constant wet weather. No one can remember having a sunny day at all and yet you can feel the eHealth debate getting hotter and hotter as we get closer to the infamous July 1, 2012 deadline. Let’s recap what we are actually going to get delivered — the ability to register for a Personally Controlled Electronic Health Record (PCEHR). We will be reminded of that with greater frequency as we close in on that date, and as ambition is tempered by reality. There is a palpable sense that there is a push to deliver a working system so that the ambition and opportunity is not lost before political attention and interest is diverted elsewhere.
About the author As well as being Immediate Past President of MSIA, Geoffrey is Head of Operations, HealthLink. He has spent the past 20 years working as an epidemiologist. For the past 10 years Geoffrey has occupied senior management positions in medical software companies.
Rolling out a national system for the sharing of patient information with the necessary provisions from a technical, legal and social perspective is not something that happens quickly. It is also something that has never been done before anywhere in the world within the timeframe on offer here. We have also been told it is possible to align 12 different projects with different vendors, stakeholders and ambitions into a common single thread of interoperability.
In the likely event of there not being a nationally available PCEHR, there will be plenty of people saying ‘I told you so’, but what can we expect to see on the eHealth journey as we get to the finish line? Browsing the Web, it is now possible to get an opinion or answer on anything. I have always been bemused by the bloggers and anonymous posters who have rampaged through the eHealth debate in Australia. Reputations are sullied, innuendo is everywhere and Dr Spin is not as qualified with the same rigour as the medical fraternity. There is clearly emotion in eHealth. At one end of the spectrum we hear calls of an impending train wreck and at the other end we hear “trust us, we know what we are doing”. I always think what I am actually hearing is “trust us, we’re from the government — we’re here to help”. (Not to be confused of course with “trust me, I’m a doctor”.) Let’s look at the train wreck analogy that is being used to describe the eHealth agenda in this country. If you have heard any speaker on eHealth, the train gauge analogy is trotted out time and time again. That is, if you allow the states to work independently they will come up with different systems that won’t allow you to move things across borders. There won’t be
a common gauge and the track work won’t meet up. This occurs because different specifications and standards would be employed, or more likely different interpretations of specifications and standards would result. Unfortunately, this is already part and parcel of healthcare, with variations in its delivery across geographies because of different interpretations of what is best practice, the best funding models and what is the art of clinical practice. When you think about a train wreck, this will occur when a train on one rail gauge encounters rail that is of a different gauge or alignment. The train will jump off the track and it is likely carnage follows, or at the very least nothing else can move down that track until a clean-up operation has been undertaken. We have already seen the Wave 1 sites delayed when it was discovered that different groups were working on different specifications. While there is considerable work being undertaken to get things back on track, it is fair to say in the current eHealth
Health Informatics Society of Australia
“While there is considerable work being undertaken to get things back on track, it is fair to say in the current eHealth environment, we have specifications and use of standards out of sync.” Dr Geoffrey Sayer
environment, we have specifications and use of standards out of sync.
Based on the many submissions to the Senate committee, we seem to have:
Is a realignment needed?
• • • • •
Have we averted a train wreck by finding out that some standards are out of alignment and getting them lined up again? Or have we just delayed the wreck as there are other things that can cause it? Most failures in transport are due to wider system failures or issues that when lined up cause things to go horribly wrong. In eHealth, the evidence from the Senate review would suggest that there are other things out of alignment as well.
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That sure is a lot of things gone a bit wonky. And these are reasons for serious concern for anything wanting to travel down the eHealth track to a PCEHR anytime soon. Whenever there is pressure to deliver on ambitious promises in eHealth, there is a risk of short cuts with standards that could
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end up causing longer term problems or take us to dead ends with no discernible improvement. We seem to have forgotten the lessons from the earlier Health Connect trials a decade ago. It appears that we have also lost the original intentions behind the Wave 1 and Wave 2 sites. We are yet to learn the lessons from early initiatives and yet there are already cycles of redevelopment being asked of vendors taking part in the Wave 1 activities because of specifications changes. What happens when it goes live to field? Will there be more iterations of software coding? It would be naïve to suggest no. Remember, an iteration of software code comes with extra burdens of quality assurance and testing. There will also be pressure on project teams and vendors to take short cuts or cut back on functionality to meet a deadline. We have already experienced a misalignment because of the pressure to deliver. We will be doing that again unless we reduce the task at hand to a manageable level, recalibrate the timelines and reset the expectations. The functionality we leave on the side of the tracks may be important ones that give us the early wins for a longer term success and push us to the tipping point. It is easy to predict that terminologies will most likely fall by the wayside and be left behind on the PCEHR track. Terminologies are a significant part of the eHealth rail gauge — a critical foundation piece for all exchanges of health-related data whether they have anything to do with a PCEHR or not. It would mean a lost opportunity to actually get terminologies working, to get these delivered into clinical systems. Granted, it is not an easy thing to do and has been a work in progress for over a decade. In recent time considerable efforts have been made to get it back on track to a usable system, but the crucial step of actual deployment may be lost due to expediency.
“We seem to have forgotten the lessons from the earlier Health Connect trials a decade ago.” Dr Geoffrey Sayer
It is easy to predict that data quality issues will not be addressed. There are the camps that say that GPs are required by RACGP Standards of Care to ensure that patients have an accurate and up to date health summary. This would mean that it is not an additional workload to provide such summaries. However, don’t think that consenting and change processes will not place a burden and additional workloads on GPs and other healthcare workers. We also have to be mindful that health summaries for a GP’s practice are not always the same health summary you would want to have for a PCEHR. It is also possible that final legislation supporting the PCEHR may not be passed on time. While the initial bill has passed through the lower house, the opposition has reserved its right to amend it following the Senate committee review. Will we trust that the final legislation will deliver the necessary amendments from the submission and review processes? Will it be too late to test the models that the new legislation will support and the rules and regulations around the legislation?
Preparing for failure? What will be the new models for eHealth if the models proposed fail? It is most likely to be a regression to the pre-PCEHR-ambition status quo. The enthusiasm may be lost for improvements unless there are sustainable benefits that are demonstrated from the Wave 1 and Wave 2 sites for the foundation pieces. The positioning of the PCEHR as equivalent to landing a man on the moon is a nice ideal
but what we saw out of that ambition was significant improvements in technologies and approaches to computers, engineering and science that are now used whether you want to go to the moon or not. These have sustainable uses beyond the moon landing program and stimulated innovation. In contrast, the current approach to the PCEHR has no alignment with the business cases that will attract all vendor participation and there are no sustainable business models for the ongoing participation of vendors to operate in an innovative and competitive environment. It seems also that the tipping point argument we were told would diffuse the new technology across the landscape seems to have fallen by the wayside. Now nothing happens unless the public chequebook is pulled out. We have to be passionate that the foundation pieces of Health Identifiers for patients, providers and healthcare organisations, along with secure message delivery (SMD), authentication (NASH) and terminologies (AMT and SNOMED CT) are not lost due to any failure or pause for consideration of the PCEHR. They have to be the real focus of the remaining time. Money will be found to help get political will over the line so it can be seen to have delivered the promise of “registration”, but let’s make sure that we are using that money to leave a lasting legacy through the foundation pieces, so that no matter what happens, there are pieces to pick up if a train wreck occurs. Otherwise we are back where we started when we first went on this eHealth journey.
The Model Healthcare Community
NEHTA’s Model Healthcare Community – showcasing Australia’s eHealth programs – is touring Australia For more details visit:
www.nehta.gov.au This national eHealth roadshow is proudly sponsored by the National E-Health Transition Authority (NEHTA) on behalf of the Governments of Australia.
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HIMAA
Automated Queue Management IN A HEALTHCARE SETTING
Melton Health is one of three Super Clinics funded by the Victorian government to provide same-day hospital and ambulatory care services in the outer-western metropolitan area of Melbourne. The clinic provides over 90,000 episodes of care per annum and has successfully implemented “world first” queuing technology deliver a range of efficiency benefits to both patients and the healthcare facility.
David Grace PSM Dip of App Sc (Nursing), BA of Hlth Sc (Nursing), MHon (Nursing), RN DavidG@djhs.org.au Angela Mayhew BA Sc (Health Information Management) AngelaM@djhs.org.au
About the authors David Grace is a registered nurse and the deputy chief executive of Djerriwarrh Health Services. In 2000 he was awarded the Public Service Medal for his contribution to health management. Angela Mayhew is the manager of the Health Information Department of Djerriwarrh Health Services.
Background Melton Health is part of Djerriwarrh Health Services, a provider of public health care services to the Melton and Moorabool shires, located approximately 45km to the west of Melbourne. Djerriwarrh Health Services’ mission is to help people in our community to better health and well-being. It does this by providing an integrated range of health services including primary, ambulatory, acute and aged care. Services are provided from five main campuses; Melton Community Health Centre (primary care), Melton East Community Health Centre (primary care), Melton Health (ambulatory care), Bacchus Marsh & Melton Regional Hospital (acute care) and Grant Lodge (aged care). The organisation employs over 650 staff and has a total organisational budget of over $40m. Melton Health opened in February 2006 and is a purpose-built Victorian government-funded Super Clinic providing same-day hospital and ambulatory care services to the rapidly expanding communities in the Melton and Moorabool shires. One of the key objectives of Super Clinics was to utilise new and innovative technology to deliver services in a more efficient and effective manner. The Melton Health implementation team believed that
improving the time and way people were queued was an important contributor to patient satisfaction. The implementation team identified an opportunity to use an automated queuing system to reduce the number of reception counters and waiting areas required, reducing capital and recurrent operating costs. While automated queuing systems were becoming more widely used throughout a wide range of client service industries, it became evident that no one had previously attempted to integrate the technology with a health service’s patient administration system (PAS).
Objectives The objectives of installing an automated queuing system integrated with the health services’ patient management system were to: • reduce the need for patients to wait in queues at reception counters; • provide instruction to patients on which waiting area to attend and how to get there, using technology; • allow clinicians to see the names and length of wait of each patient waiting for their clinic from the computer screen located in their consultation room; • provide a mechanism for clinicians
within their consulting room to “call up” patients from the waiting room; • automate the collection of arrival times, consultation commencement times and consultation completion times without having to manually enter the data into the PAS; • alert managers when waiting times exceed predetermined thresholds; and • allow monitoring of performance targets against performance indicators.
Methods Planning for the integrated automated queuing system was overseen by an information technology committee, established as part of the implementation team of the three Super Clinics. A local information technology team was also established for Melton Health, focusing on the technical integration of the queuing system and patient management system using the information technology infrastructure in place at Djerriwarrh Health Services. Initially, the efforts of the team focused on ensuring that the integration was technically possible and then scoping the project. As part of scoping the project, a realistic Gantt chart of activities was developed as well as flow charts outlining the expected patient flow throughout the various services. Upon acceptance of the project scope and budget by the information technology committee, the project was then implemented by the local information technology team. In order to achieve the project’s objectives, Qmatic was selected as the automated queuing system and was integrated with iSoft’s iPM patient management system using HL7 messaging through third-party HL7 messaging software called HL7 Connect. The integration and implementation of the project was achieved within the prescribed timelines and prior to the clinic opening.
Service improvement and innovation From a patient’s perspective, the implementation of the automated queuing system means that upon entering the clinic, the patient scans a barcode at the top of their appointment notification letter at one of two self-service kiosks located near the front door. As the patient scans the letter their name is added to a list of patients waiting on the clinician’s computer screen in their consulting room. The patient is also automatically recorded as “arrived” in the patient management system. The kiosk issues an appointment number ticket and provides information on which waiting area — designated by a colour coding system — to attend. When the clinician is ready to see the patient, they click a button on their computer screen which initiates both an audible and visual call up of the patient’s ticket number over the speaker system and waiting room television. The call up includes information on what entry door to use to enter the consulting area. The call up of the patient by the clinician also automatically initiates recording of the consultation commencement time. Calling up the next patient by the clinician initiates recording of the conclusion time of the consultation for the previous patient in the patient management system. The implementation of the automated queuing system has reduced the need for patients having to use reception services, freeing up the reception for general inquiries and other customer service matters. Clinicians are able to monitor the number and length of wait of patients. Managers are automatically alerted of the need to problem-solve any excessive wait issues, against predefined thresholds, as they occur in real time. While other healthcare organisations may use a “deli” system to call up patients,
a fully integrated queuing system in the patient management system provides much more capacity to automate a complex array of clinic services (sometimes over 40 individual clinics running at once) and utilise the technology for record-keeping purposes as well as monitoring waiting times.
Outcomes While there is no pre-implementation statistical information to compare the impact of the automated queuing system, post-implementation data collected confirms that: • less than one in 10 patients need to use the reception services and • the average wait time from the time of scanning the letter at the self-service kiosk to the time that the clinician calls up the patient from the waiting area is no greater than 10 minutes. A patient survey confirms that 72 per cent of patients perceived that they did not have to wait at all for their service while 98 per cent perceived that they waited less than 15 minutes. A survey of staff also suggests that staff perceived the computerised systems at Melton Health as a major strength in the model of care provided. In relation to the design of the building, the automated queuing system reduced the number of reception counters required from four to three, as well as reducing the waiting area floor space by approximately 25per cent. It is estimated that the initiative reduced the building cost by about $800,000 (at 2006 building rates). Keeping abreast of technological advances can be challenging, particularly when the technology is new. The outcome of implementing an automated queuing system at Melton Health has been positive both from the health service’s point of view as well as the patients’.
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Feature
Wound Care goes mobile Late last year, an innovative project for the remote management of chronic wounds made the news when it won a Victorian Healthcare Association (VHA) award. The technology behind the project is simple yet elegant, and has much potential in assisting the elderly and the chronically ill to stay in their own homes.
Kate McDonald Journalist: Pulse+IT kate.mcdonald@pulseitmagazine.com.au
The Latrobe Community Health Service’s (LCHS) mobile wound care project has been running since April 2010 and in its first year, 12,775 assessments were performed on 824 clients presenting with 1227 wounds. It has enabled one specialist wound consultant to assess and give advice to community nurses across the Gippsland region of Victoria, which covers 42,538 square kilometres. It has also enabled a large array of data to be captured, including clinical wound aetiologies, the cost of individual episodes of care and treatments, and data on the cost of wound product consumables, healing time and healing rates.
About the author Kate McDonald is a senior staff journalist for Pulse+IT. Formerly the editor of Australian Life Scientist magazine, she has also edited industry titles Hospital & AgedCare and Nursing Review. Her interests cover health ICT, biotechnology and translational research.
So successful was the trial in its first year that a grant was provided by the Victorian Department of Health to continue it for another. One of the project partners, Monash University’s Department of Rural and Indigenous Health, is evaluating the data and it is hoped that funding will be forthcoming for the project to continue for another year, by which time a great deal of significant trend data will be available. Either way, the project is an excellent illustration of how technology can assist in finding ways to keep people out of hospital and aged care facilities and in their own homes. While some of the patients involved
in the trial had acute wounds, many were living with chronic wounds such as leg ulcers, pressure ulcers and skin tears that as often as not see sufferers repeatedly present for medical care at a general practice or a hospital, and others forced to move out of their homes and communities and into residential aged care. The trial, a joint project between LCHS, the Department of Health, Monash and four different healthcare agencies in Gippsland, also includes software provider HSAGlobal and Fujitsu, which initially hosted the software and provides Infrastructure as a Service (IaaS). In the Latrobe project, a centralised clinical nurse consultant called Marianne Cullen acts as a regional wound consultant for community nurses throughout the region. Ms Cullen is based at LCHS’s Traralgon site and has remote access to every patient file, so once the community nurse enters new data on the patient’s wound and needs some advice on the best way to proceed, Ms Cullen can view the file and the photographs and recommend the best treatment for the current situation. Matt Hector-Taylor, CEO of HSAGlobal, which is providing its Mobile Wound Care product for the trial, says the best part of the technology is the way it supports the
model of care. Nurses are able to photograph and track wounds and deliver care at the point of care, which is in the home. “They can say they are a bit worried about the way a wound is tracking and ask for advice, and Marianne can remotely look into the wound and support the homecare nurse to manage the case,” he says. “There is literally a workforce in the community with the specialist support needed to keep the patient at home. “What is important here is not just that there is a central wound consultant based in Latrobe but that all of the community and home providers of care in the Gippsland region are working in the same way and with the same information as she is. Her ability to make a difference across the whole region is significantly enhanced.” As part of the research project, a good deal of baseline data was recorded about the types of wound, and the numbers, length of stay and cost per wound, divided into different types of wound. In the second year, the clinical leaders of the project — Ms Cullen and LCHS’ executive director of ambulatory services Nicole
Steers — have been systematically addressing opportunities to improve care and outcomes identified from the first year’s data, Mr Hector‑Taylor says. “After that second year of focused improvement initiatives such as standardised pathway introduction for specific wound-types, I believe they are seeing early signs that those initiatives are starting to bear fruit, in terms of both quality and cost.” LCHS is negotiating for funding to extend the research project for another year, and “it will be quite special if they are successful with keeping the research going, because at the end of year three there should be some great quantitative evidence supporting the introduction of new models of care supported by technology and the improvement process that follows”, he says.
Shared care for New Zealand The Mobile Wound Care product is available in both stand-alone and integrated options, allowing users to operate the application
HealthLink/Medinexus Half Page 180 x 120 Puse IT Mag
connecting healthcare
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independent of any other, or with an interface into HSAGlobal’s Collaborative Care Management Solution (CCMS). HSAGlobal is using CCMS to work with three district health boards (DHBs) in Auckland, New Zealand, testing new ways of managing the care of people with chronic illness. The DHBs have launched three pilot projects involving selected GP clinics, community pharmacies and hospitals across Auckland, Counties Manukau and Waitemata, part of a National Shared Care Plan program sponsored by the NZ Ministry of Health’s National Health IT Board. The pilots initially involved eight GP practices in greater Auckland, several hospital speciality services including heart failure, gout and acute intervention respiratory services (AIRS), pharmacists and community care services. Additional GP practices and secondary services, including renal, pulmonary rehab and diabetes have joined the project over time. Patients taking part in the pilots have a shared care plan developed for them, which includes a summary of personal health information, their health goals and the treatment and follow-up care they receive. They can access the plan electronically, as can the doctors, nurses and other health professionals caring for them. “What the three Auckland DHBs are looking to do is put a platform in place to enable shared care management and planning between primary, secondary and community care for patients with long‑term conditions that would also involve the patient in their own care,” Mr Hector-Taylor says. “Patients are selected from primary care who have a long-term condition like heart failure or COPD or diabetes or renal patients — patients who are heavy users of healthcare — are enrolled from primary care and then a kind of virtual team is created around the patient. A plan is prepared and there is proactive care across the continuum of healthcare.” Similar to Precedence Health Care’s cdmNet project under Australia’s new Diabetes Care Plan, this project involves an electronic patient record coupled with a workflow management solution. “One of the key differentiators here is that the National Shared Care Plan project is patient-centric rather than disease-centric,” Mr Hector-Taylor says. “The patient’s record — their medications, their diagnosis, their measurements, their results — are brought to all of the parties wherever they are. “But also you have a care plan and assessments and a variety of notification and communications mechanisms that mean the
whole team is working with the person’s single integrated plan. CCMS integrates with the different practice management systems and those at hospitals and pharmacies so that people still work in their own systems but the data they are working with is also visible to the other members of the care team as well.” The shared care plan involves bidirectional data that is kept in sync, he says. “It is a quite a complex challenge to provide the level of integration needed in a region where there are multiple providers and multiple district health boards and multiple primary care organisations. And now we are onto phase 2 and the program team is growing the number of GP practices and the number of patients and the number of other providers to come on board. The priority is using the technology to enable some of the strategic priorities across the region, including improved primary-based management of patients at risk of an acute admission.” HSAGlobal’s CCMS is a purpose-built shared care management product. It is web-based, highly configurable, designed to integrate and built using industry standards. It has been developed using standard Microsoft interfaces to provide rich functionality and a familiar look and feel for users. CCMS is also being used as part of the collaborative care platform for Project Chain in Canterbury, an integrated primary, secondary and community care program that was given special impetus by last year’s earthquake. “Because of the earthquake the Canterbury region lost a number of acute care beds and residential aged care beds so they have a real shortage of capacity,” Mr Hector-Taylor says. “Project Chain is a group of targeted initiatives, all enabled by CCMS to help maintain the health of high needs patients in the community. “The initiatives include CREST, a program of supported early discharge for selected over 65s; a medications management service for high needs patients with complex medications requirements, and a variety of other “frequent flier” type initiatives. Most importantly, Project Chain is looking to introduce long-term funding models to support integrated care, as well the technology enabler (CCMS) and new service delivery models.” Project Chain and the National Shared Care Plan project are exciting whole of system initiatives that may well shape the direction of health service delivery over the coming years, particularly for patients with long-term conditions, he says. “HSAGlobal’s goal is to provide an off the shelf technology solution and implementation approach for integrated care internationally, so we are very pleased to be a part of these leading-edge projects in New Zealand.”
At we’d rather catch you than catch you out
At GPA they’re called Quality Accreditation Managers (QAM) QAM Job description:
Not letting you fall. Ever. Work in the interest of our clients from first contact to reaching accreditation. Support and guide our clients through every step of the process. GPA AccrEditAtion plus does things differently.
Accreditation doesn’t have to be the daunting process. As so many of GPA ACCREDITATION plus clients are happy to repeat “GPA’s process has changed what we thought was going to be a hardship into a rewarding experience.” From the beginning your own personal QAM steers you through the entire accreditation process at your own pace. The flexible GPA ACCREDITATION plus modular programs (online or paper-based) are designed to be user friendly, ensuring practices confidently prepare to meet the RACGP standards. We report back to you step by step, giving you the opportunity to make improvements along the way. “I was very happy with the modules – it allowed me to work slowly and consistently through the requirements and I felt supported at the same time.” When your Practice is ready, GPA ACCREDITATION plus will liaise with you to organise a survey visit conducted by experienced surveyors. “GPA ACCREDITATION plus surveyors were very helpful, which made everything run smoothly on the final stage of accreditation – there were no surprises!!” If that sounds different to the way you’ve been used to, call GPA ACCREDITATION plus and let’s get started. call us now on: 1800 188 088 or log on to: www.gpa.net.au
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Feature
cdm nets funds for diabetes care project Since its early days as a collaborative care project, cdmNet has been rolled out across the country and is now RACGP Oxygen’s preferred IT solution for managing chronic illness. It is also being used as the IT infrastructure partner for the federal government’s new diabetes care project, and is looking to add many more allied health professionals to its list of users.
Kate McDonald Journalist: Pulse+IT kate.mcdonald@pulseitmagazine.com.au
Figures from the Australian Institute of Health and Welfare show that chronic disease affects over seven million Australians and costs the health system about $70 billion a year. Added to that is the effect chronic disease has on productivity, with the Productivity Commission estimating losses of about $12 billion a year.
point is that the practicalities of following up a care plan are sometimes too big a hurdle. Trying to collaborate regularly by email or phone with several disparate team members can be extremely difficult and time-consuming, as is the administrative burden placed on general practice when attempting to keep up with Medicare’s requirements.
The statistics are well known and many organisations are trying to tackle this burden, including from the preventative care side, but the management of chronic illness is a massive problem for the health sector. The evidence suggests that the best way to treat chronic illness is to plan longitudinal care utilising a team that includes general practitioners, specialists, nurses and allied health professionals.
These are long-standing issues, which prompted Michael Georgeff, a computer scientist and professor in the Faculty of Medicine, Nursing and Health Sciences at Monash University, to found Precedence Health Care in 2008 and subsequently develop an online tool to assist healthcare professionals in better managing chronic illness.
The development of care plans such as GP Management Plans (GPMPs) are subsidised through the Medicare Benefits Schedule (MBS) and there are a number of practice and nurse incentives available, but even so, it is thought that only one quarter of all people who should be on a care plan are on one, and even worse, that only one in five of those plans are regularly followed up and reviewed. While GPMPs and the incentives received are all well and good, the major sticking
Dubbed cdmNet, the tool has since been adopted by RACGP Oxygen, the eHealth arm of the Royal Australian College of General Practitioners, as its preferred IT solution for managing chronic illness. cdmNet is also being supported by the government’s Digital Regions Initiative to bring chronic disease management to rural and remote areas using the National Broadband Network (NBN), and recently became involved in the federally funded Diabetes Care Project, a two-and-a-half year trial being led by McKinsey and Co
to develop a new model of healthcare delivery to improve care for people with diabetes.
How it works For Professor Georgeff, the development of cdmNet was guided by two ideals: the first was to provide the ability to share care plans with the whole care team and with the patient.
“... there really was a step‑change in the way that chronic illness was managed.” Prof Michael Georgeff
“The second point and probably the more important one was to automate as many of the processes and workflows involved in collaborative care that we could,” Professor Georgeff says.
doubling of GP practice productivity, a five-fold increase in the number of reviews that were done, and a five-fold increase in home medicines reviews, he says.
“That means we automate all of the Medicare processes, we would create, electronically sign and then distribute all of the documentation that was required, we would send reminders to patients to make appointments, and we would automate all of the workflows involved in GP management plans.”
“In other words, there really was a step-change in the way that chronic illness was managed and fundamentally, just because we worked in an electronic medium, it wasn’t simply the sharing of the data, it was the automation of those workflows that was the key.”
Precedence contracted researchers from Monash and Deakin universities to conduct reviews of the product and they found a
cdmNet currently includes treatment guidelines for diabetes, osteoarthritis, coronary heart disease, chronic heart failure,
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stroke, chronic kidney disease, asthma, chronic lower back pain, chronic obstructive pulmonary disease, and depression as a co‑morbidity. cdmNet also allows a GP or practice nurse to create customised care plans for other conditions or particular patient needs. According to Precedence, based on the outcomes of the trials of cdmNet, total net earnings per GP per year for chronic disease management increase from $15,000 prior to the use of cdmNet to $45,000 using cdmNet. cdmNet is a web-based system that allows authorised users to register and log in with a password. From the general practice side, users download a component that sits on the desktop and does two things: it alerts the GP to activities relating to chronic disease management, such as a review being due, or that a patient should be considered for a care plan. For new patients, with their consent, a click of the button automatically uploads their medical record into the online site. From there, an electronic health record is created and smart rules are used to generate a draft care plan based on the appropriate guidelines. From Professor Georgeff’s perspective, the real key is that it has been designed for collaboration so allied health professionals
also register, log in and are then able to enter their appointments and progress notes. “In fact, that’s what makes it work,” he says. “Allied health have adopted it very enthusiastically, primarily because it lets them really engage in the shared care.” Patients also get a user name and password and can log in, and they receive reminders to make appointments. “At the moment we leave it to the GP to tell the patient and in many cases they don’t!” Professor Georgeff says. “We haven’t focused on the patient engagement because most patients leave it to the GP. They like their reminders but other than that …” Precedence recently added a telehealth component to the solution, working in partnership with Cisco, which has provided its WebEx web-based video conferencing product. The idea is to enable GPs and allied health professionals to access different technologies with the click of one button. “cdmNet shares the data only with the care team members, so it is a restricted setting and we do that mainly for privacy reasons, but often there’s a need for a telehealth consult,” he says. “It could be because of depression or it could involve an emergency where someone with diabetes burns their foot or wants to quickly contact the doctor.
“It will send emails to the participants saying we want to set a time for this teleconference, it proposes a time and then at the time of the conference it will send a reminder to everyone that it is coming up ...” Prof Michael Georgeff
“The telehealth component is really a single button — when you are logged into cdmNet there is a single button and when you press it, it quickly brings up the whole care team and says, there is your care team, who do you want to communicate with, the GP, the specialist or whatever — and from that point on it automates the process. “It will send emails to the participants saying we want to set a time for this teleconference, it proposes a time and then at the time of the conference it will send a reminder to everyone that it is coming up. [As cdmNet] has all of the information about the care team, we can send them all the details so the user doesn’t have to enter all of that information in.” Cisco is also a partner with Precedence in the Australian Collaborative Care Cluster (ACCC), a project first established by the Victorian government in 2009 to tackle the management of chronic disease. Precedence heads the web-based IT side of the cluster, while other partners include the Baker IDI Heart and Diabetes Institute, the CSIRO, Monash University, the RACGP, Southern Health, the Royal District Nursing Service, DandenongCasey General Practice Association, Diabetes Australia – Victoria, Fred Health and Bupa. Professor Georgeff says the ACCC is based on the idea that any one part is not going to work by itself. “This brings together various other organisations who have got part of the solution with the aim that if we all work together, we’ll have something that actually might help solve the problem.” One example is the work Precedence is doing with Fred Health, the pharmacy dispensing software specialists. In this project, barcodes are attached to the patient’s care plan so when they
go to any pharmacist that uses Fred, it will read the barcode and show the care plan to the pharmacist, so he or she can then become more engaged in the patient’s care.
Diabetes Care Project More recently, Precedence Health Care was named as the key IT infrastructure component for the government’s Diabetes Care Project (DCP). The DCP is trialling a new model of healthcare delivery designed to improve care for people with diabetes. A consortium, led by global management consultancy McKinsey, has been appointed to deliver the project for the Department of Health and Ageing. The project is hoping to involve approximately 150 general practices in Queensland, Victoria and South Australia, and up to 10,000 patients. It will compare results between two intervention groups and a control group to enable a rigorous evaluation of the outcomes. The control group will have no change to their care, and for these patients nothing will change for the care team. Participants in intervention group 1 will receive access to cdmNet along with education and training. They are invited to use cdmNet to help integrate with the rest of the care team and provide greater visibility of the patient health record and care history. For intervention group 2, participants will receive access to cdmNet, education and training, along with a new funding model and support from a care facilitator. It is expected that a much greater variety of interactions with allied healthcare professionals will be available to patients in this group. A further aim of the trial is to inform future policy and funding for diabetes in the primary care space, to see if chronic disease can be managed better. The Australian Medical Association, which opposed the government’s previous attempts to change the funding structure for diabetes, helped shape the design of this pilot in its role with the Diabetes Advisory Group, which also includes representatives from Diabetes Australia. cdmNet is also involved in two of the Wave 2 trials of the PCEHR — St Vincent’s & Mater Health and Calvary Healthcare ACT. “The main aim of those projects as far as cdmNet is concerned is to make sure that we are conformant in any developments in the PCEHR,” Professor Georgeff says. “The reality is that it is only when you have applications such as cdmNet that the PCEHR will really be taken up.”
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Feature
babywatch keeps an eye on the prize The team behind the Babywatch infant identification system has signed its first contract with Sunnybank Private Hospital in Brisbane. This elegant web-based solution to managing infant identification is also about to be installed at in a neo‑natal special care nursery in a major public hospital in Sydney.
Kate McDonald Journalist: Pulse+IT kate.mcdonald@pulseitmagazine.com.au
As a midwife, Natasha Oglesby has seen her fair share of mix-ups in the hospital setting. Human error is largely to blame, mainly due to overstretched staff and the hectic nature of most maternity units.
and a file number. A file number belongs to the baby, not to the mother, so when you think about it looks like we are doing something but in actual fact we are not really doing a great deal.”
It was after one particularly fraught episode, when she was working a 12-hour shift in the isolation room in a neo-natal intensive care unit and the midwives were so busy she could rarely find someone to do the necessary double checks, that Ms Oglesby decided she’d had enough.
She thought that clinicians should be able to uniquely identify the mother and the baby as a couple, not just from a surname. “And if you don’t have the baby’s chart with you, you can’t even check if you have the right baby,” she says. “You can already see these massive holes unfolding. There are flaws in the system that are so silly.”
She had previously been on shift when a baby had been administered the wrong medication — or more correctly, medication was administered to the wrong baby — and over 20 years as a midwife had often encountered problems with misidentification. “At the end of shifts like that, you know something has to change, just because of the sheer frustration of constant misidentification issue with regards to labels,” Ms Oglesby says. “As a midwife, we are responsible and when we go to do a transfer, say from the birth suite to the ward, we are supposed to check with another midwife to then double check the identification of that baby. But what I found really frustrating is that the identification is only being checked against a surname
So, rather than suffer in silence, she decided to do something about it. In 2009, Ms Oglesby began designing the Babywatch system, which in December last year successfully completed a trial in the maternity ward at Sunnybank Private Hospital in Brisbane, part of the HealthScope hospitals group. Sunnybank has signed a contract for the system and another hospital in Sydney is about to try out it as well.
How it works Not having software development experience herself, Ms Oglesby worked with CMO Global, a software developer specialising in compliance, document management and action and issue
tracking. Together, Ms Oglesby and CMO Global developed a software package that enables users to track, verify, monitor and log all actions and procedures involving newborns during their stay in hospital, from birth to discharge or transfer to another hospital. Babywatch is a wristband barcode system that works in conjunction with hand-held PDA scanners, and at the back-end logs that an action has occurred and charts the information. It enables real-time documentation and comprehensive records management of information, data collection and verification, as well as synchronisation of information between hospital departments and sites when transfer is required. Babywatch is a web-based solution that can be hosted or can sit on a dedicated server. It can also be used in evacuations to ensure identification is correct. “The main component is the identification,” Ms Oglesby says. “Everything that we are doing to the baby, whether we are giving them medication, immunisations, IV fluids, whether we are moving or returning the baby, transferring the baby — before we do anything we do an identification check, which is done from the hand-held. “Once we have done an identification check, which we call the match, we are then able to do transfers etc. We are logging within the system where the baby is going to, whether the baby is removed from the mother and if it is removed from the mother, why.
Natasha Oglesby
unique to that container of milk. All of the information about that milk — who it belongs to, when it was expressed, where it is being stored and when it should be used by — is recorded through the system.
“If a baby is born in theatre, some hospitals take that baby to special care regardless. So, you would then check the identification before you leave theatre, tell the system ‘transfer to special care’, ‘removed from mother’ and where it says ‘why’ you’d put ‘post-section’ and this is provided by drop-down menus. Then you press save and that will then log the user so it would be traced to the person who is using the hand-held.”
“When you admit the milk in, when you tell the system it is going to be stored at room temperature, automatically the system will only allow you to scan that for the next four hours. If you scan it past that allocated time, then it will tell you it has expired and must be disposed of.
The key to the system is its dual tracking — both the mother and the baby are matched. The mother is given a wristband upon admission, and when the baby is born, the mother’s wristband is scanned along with the one created for the baby. Only when there is a match is the wristband attached to the newborn.
“So we are not only checking that we are not giving the wrong milk but also we are verifying all of the details with regard to where it was stored and when it was expressed so we are not giving out of date milk. The system also provides stock control — it is telling us how much milk is still available, where it is located and all of that can be pulled up on the hand-held at the bedside so you don’t have to go down the corridor to the fridge.”
“The identification checks start before the baby is even labelled. It then maintains the identification through every step that we do with that baby.” The barcoding system is also used for milk management. If a mother has to express milk it is labelled and given a barcode
If the mother is not in the hospital and is bringing milk in for the baby, the system can alert her via SMS if stocks are running low. The system also allows for a report to be produced that can be electronically sent to a general practitioner once the mother and baby leave the hospital.
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“We had 28 days in theory to reach that target but we actually met the requirement within seven days, so we just continued it.”
their IT requirements so we went into the site on November 6, and the trial ran until the 21st of December.”
Natasha Oglesby
The other modules in the system are medication management, immunisation management, pathology management and care management.
Sunnybank Private trial Babywatch has been a couple of years in the making and in that time Ms Oglesby and her company have developed partnerships with a few close suppliers. These include Peacock Bros of Melbourne, a hardware supplier which has set up a healthcare‑specific branch of its business to supply consumables such as barcoders, scanners and hand-held devices predominantly to hospitals. Babywatch has also partnered with Motorola, a leading manufacturer of hand-held devices, although the software is device-agnostic that has been designed to run on any Windows platform. It can also run on the iOS platform so can be used with iPod Touch, iPhone and iPad devices. If hospitals wish to use Apple products, Babywatch has partnered with an Apple specialist to customise the software. The software at present is a stand-alone product but can be integrated with hospital systems if required, and it has been designed with a view to eventual integration into the PCEHR. “It has been designed so that the back-end is available for integration, but at this stage it is not integrated and is just a stand-alone system,” she says. “We would certainly anticipate integration to medical records at some stage, but I believe that our system would prove more beneficial in risk management system integration as it ensures all actions, procedures on or to the newborn are correct, therefore reducing risk and liability to the hospital.” For the Sunnybank Private trial, Ms Oglesby was first contacted in May last year, she says. “They dropped me an email saying they had seen the information on our website and could I come and present it to them. They knew that no else had tried it at that time and they were prepared to be the first. The contract to do a trial was signed in two weeks, but obviously they needed to finalise
The trial involved 12 hand-helds, both Motorola and Apple, and 11 trial midwives. The hospital wanted to test four modules within the system: basic identification to track removal and return of the baby to the mother, milk management as described before, and documentation for the hepatitis B vaccination and the administration of vitamin K.
“We had 28 days in theory to reach that target but we actually met the requirement within seven days, so we just continued it,” Ms Oglesby says. “Every night I printed off a report of all actions that were happening during the day from the server and after about nine or 10 days I would print them off and laugh because I could see them finding all of the other modules too.” The equipment was pulled out over Christmas and due to the holiday period Ms Oglesby had to wait for confirmation, but the midwives were so keen to have it back that the contract was signed quite quickly. The Babywatch licence is per bed, so at Sunnybank there are 27 licences and eight hand-helds in use, which is the maximum number of staff per shift, she says.
Expansion plans With the first contract signed and under way, Ms Oglesby is now hoping to roll it out to other hospitals, including a tertiary hospital’s neo-natal intensive unit in Sydney, the name of which she is unable to reveal at present. Then, the sky’s the limit. Ms Oglesby sees a number of other departments where an identification system like this would be useful, particularly paediatrics. “All we would need to do is change a couple of wordings, like ‘baby’ to ‘patient’. I’m very keen to expand into paediatrics because again these are areas where the mothers are often not present and these children can’t really identify themselves necessarily, so they are another area that need to be protected.” She is also shortly to launch MaternIT, a mobile application for midwives designed for the iPad. The idea is to allow midwives to provide Medicare-funded services to women throughout the pregnancy, birth and post-birth periods. It will include patient demographic data, access to lab and scan results, record prescriptions and handle the many reporting requirements for Medicare and for midwife standards reviews.
Save the Date
NATIONAL CONFERENCE Brisbane Convention & Exhibition Centre
Tuesday 16 – Friday 19 October 2012
www.cdesign.com.au/aapm2012
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Feature
Why did GOOGLE HEalth FAIL? It didn’t – Google just pulled the service too early, according to Microsoft’s David Dembo. He believes that consumers, like healthcare professionals, need to be convinced that the use of online tools will significantly improve their health and that body of evidence is only now emerging.
Kate McDonald Journalist: Pulse+IT kate.mcdonald@pulseitmagazine.com.au
When Google announced in June last year that it was dropping its Google Health online personal health record (PHR) platform, there was much debate as to exactly why the offering failed so publicly. Many reasons were given for the failure, including consumer apathy, concern over security and privacy and the fact that no one really knew what to do with it. In a much discussed article in US magazine Information Week earlier this year, reporter Paul Cerrato rejected the analysis of Colin Evans, the former CEO of personal health record provider Dossia, who claimed that the problem was the unwillingness of healthcare providers to give consumers control over their medical data. Instead, Cerrato wrote, the main reason the public doesn’t sign up for online personal health records in significant numbers is they don’t really care that much about their health. “Yes, concerns about security and privacy and the reluctance of providers to share patient information slow things down, but at its core this is about apathy,” he wrote. “As I’ve said before, most Americans care more about their cars than their health.” The current CEO of Dossia, Mike Critelli, told Information Week that Google Health
failed because it required consumers to do too much of the work in getting data downloaded. Jessica Ryan Ohlin, an analyst with Frost & Sullivan, described Google Health leaving the market as “sobering”. “Google didn’t fully commit to this, they didn’t build enough relationships with health IT vendors, payers, providers and other healthcare stakeholders that would leverage the value chain across healthcare, and they relied on consumers — many of whom don’t see the need for a PHR,” Ms Ohlin said. Not everyone agrees with this way of thinking, however. Kenneth Mandl, the co-founder of the open-source PHR project Indivo, which is said to have inspired the creation of Google Health, recently told US National Public Radio that there were a number of reasons the service didn’t take off. It didn’t have enough apps and it didn’t open itself up to the developer community, something that companies like Apple do so well, he said. Google also didn’t put much effort into establishing a trust model, Dr Mandl said. “What would Google do with your health data once they had it? And do I trust a company to manage my health that does not even have a customer service number?
“Is search and advertising the revenue model I am looking for in my health records company?” David Dembo, a clinician and Asia Pacific business development executive for Microsoft’s Health Solutions Group here in Australia, has a different theory. He believes that Google dropped the service too early and should have waited for critical mass to build. “I actually don’t think that Google Health was a failure,” Dr Dembo says. “I think the only failure was their early withdrawal. They didn’t wait for the body of evidence or for the patients to be convinced. What they appeared to do was make their judgement all around the test base and scale and they thought that would come.”
Body of evidence Microsoft is convinced that scale will come, but it will take time, Dr Dembo says. “It is a real pity that Google Health did withdraw because that would have been another investment by a big, talented multinational to help build on that body of evidence.”
A body of evidence is critical to the success of any PHR venture, he believes, and technology companies must realise that both clinicians and consumers alike must be convinced something will work and will be of benefit before they take it up wholeheartedly. “This is an interesting conversation to be had in that it ties in with the case for the PCEHR,” he says. “As a collective, we get distracted by technology and really this is a change management issue. This is a human issue and is about changing the way we behave, changing the way clinicians prescribe and consumers consume. “The pivot here remains the doctor. That is still the first person that the consumer goes to for advice — that is their gatekeeper, so to speak. And there’s very few industries that have done a good job of clinician behaviour change management.” Dr Dembo points to the pharmaceutical industry as one sector that has been “masterful” at changing clinician behaviour. He says the pharmaceutical
industry understands that to get clinicians to change what they are currently doing to what it would like them to do, it is essential to study the factors that motivate them in the first place. “The first thing is [clinicians] have to be convinced that changes are in the best interest of the patient,” he says. “Second of all, because we are scientifically trained, we must have robust data to support the change that is being made, and a subtle but critical component of getting clinicians to change is it has to be positioned as mainstream and not too far from the fringe. The first principle of medicine is do no harm, so you tend to practice medicine that is well accepted. “And that is exactly what the pharmaceutical companies do — they gather a robust data set that allows them to make claims about what they’d like you to do rather than what you are currently doing. The body of evidence for the use of online tools is only beginning to emerge and unless the evidence becomes robust enough to convince clinicians to change the way they practice, there will be sluggish adoption by patients. “We still need to convince our medical colleagues that not using technology to augment the doctor-patient relationship leaves both the doctor and the patient exposed to poor health outcomes. Intuitively we all seem to know that consumer technology has massive potential in health, but change in health relies on evidence and that is what all stakeholders should be focusing on now.”
Case study: HealthSpace Despite the relative success of Microsoft’s PHR offering HealthVault and of Dossia, with the demise of Google Health it is still pertinent to ask whether other consumermanaged systems will go the distance. The UK, as always, provides a salutary lesson in what not to do.
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“We still need to convince our medical colleagues that not using technology to augment the doctor-patient relationship leaves both the doctor and the patient exposed to poor health outcomes.” Dr David Dembo
Prominent researcher Professor Trisha Greenhalgh, head of the healthcare innovation and policy unit within the Centre for Primary Care and Public Health at Barts and the London Medical School, has extensively researched and written about eHealth in the primary care setting. She published an article in the British Medical Journal in 2010 about the uptake — or lack thereof — of HealthSpace, an Internet accessible personal electronic health record that was introduced by the UK’s National Health Service in 2007. HealthSpace was inspired by the success of Kaiser Permanente’s My Health Manager in the US, which offers a customisable portal through which members may access parts of their centrally held record. “By mid-2008, 2.4 million of Kaiser’s 8.7 million members had registered for My Health Manager, most commonly for repeat prescriptions,” Professor Greenhalgh wrote.
one per cent opening an advanced account, which offered increased functionality and was aimed at the chronically ill. “Overall, patients perceived HealthSpace as neither useful nor easy to use and its functionality aligned poorly with their expectations and self management practices,” she wrote. “Those who used email-style messaging were positive about its benefits, but enthusiasm beyond three early adopter clinicians was low, and fewer than 100 of 30,000 patients expressed interest [in messaging]. “Policy makers’ hopes that “deploying” HealthSpace would lead to empowered patients, personalised care, lower NHS costs, better data quality, and improved health literacy were not realised over the three-year evaluation period.”
Healthbook and HealthVault
“Use of the system was associated with up to 10 per cent fewer visits to the physician and a significant reduction in telephone calls. A survey of members who were actively using this technology showed that most perceived it as useful and easy to use.”
Perhaps one reason why Kaiser’s My Health Manager has succeeded where HealthSpace and Google Health have not is that in the latter two cases, there seems to have been little effort put into developing relationships with consumers and other vendors. And, to repeat Dr Dembo’s point, the body of evidence is not yet there.
Not so HealthSpace. As Professor Greenhalgh reported, between 2007 and October 2010, 172,950 people opened a basic HealthSpace account, with less than
So where does that leave projects such as Healthbook, the consumer portal being developed by Medibank as one of the Wave 2 PCEHR projects in Australia?
Healthbook is planned to be more like a health diary than an full service like HealthVault, but one reason why Medibank believes it will be successful is that it will be offered initially only to Medibank customers, and it will come with the resources of 100 nurses to provide advice and guidance. According to Isabel Frederick, general manager for eHealth at Medibank, Healthbook will be different from other consumer health portals in that the initial users of the product will already have established relationships with Medibank, “so it will be an extension of that healthcare relationship”, Ms Frederick says. An existing relationship might be the reason why other offerings such as Dossia are successful. Dossia was launched in 2006 by a consortium of employers to offer a PHR to employees as a way of helping to control spiralling healthcare costs. Members include Intel, AT&T, WalMart and BP, who between them employ over two million people. Dossia has now launched a Health Manager extension, which integrates game and social networking dynamics and messaging to improve user engagement and behaviour change, Dossia’s CEO told Information Week recently. In its new version, Dossia is certainly trying to build relationships with vendors and consumers, and will now be able to aggregate data from multiple sources, including from users’ health plans, healthcare providers and wellness and medical devices. This is something that Microsoft’s HealthVault already does, according to Dr Dembo. “We built HealthVault to be that bridge between the consumer world and the health system world,” he says. “And that is what has happened in the US. It is available to organisations that are convinced that consumers need to be a participant in their care, to have a much stronger relationship with consumers, that
face to face is augmented with online. They can use HealthVault to do that. “We have over 200 organisations that are doing it; there are around 300 applications that are live on HealthVault and over 80 consumer devices. We are already beginning to see the evidence of its impact, the kind of evidence that gives us confidence that a greater body of evidence will come. It garners confidence in enabling consumers to participate more in their care. That kind of cascade happens and people become bullish about consumer control.” However, HealthVault is not likely to be introduced into Australia in the short term for lack of a sustainable local market to fuel its growth. Also, if Australia continues down the path towards data sovereignty, in which legislation would predicate that all health data resides here and is not to leave our borders, the Australian health system will not be able to access HealthVault in other countries. “For there to be a business case for HealthVault in Australia, the role that the consumer plays in eHealth needs to go further than the role that it has been given in the PCEHR,” he says. “The way I would differentiate between what HealthVault offers and what the PCEHR is going to offer, is that PCEHR enables Australian consumers to have transparency on their data and it provides them with the ability to consent for their information to be shared within the health system. It is kind of a portal in to the health system, rather than the other way around. “HealthVault is more about a portal out of the health system that enables a health system to see what is happening in the community and it provides the consumer with much more empowerment to be participants in their care rather than simply recipients of care. With the PCEHR, the consumer still remains a recipient of
care, while HealthVault enables people to become a participant. When we see the market move towards genuine consumer empowerment, then there will be a strong case for HealthVault in Australia.”
devices and online tools. A gap, however, exists between what the services consumers seek and what the health system can provide, so consumers have to go outside the system to find help.
eHealth future
“There are some great articles I have read around consumer devices and the gamification of health and how a large chunk of society is already moving towards the online self-help world and generating a large dataset of health and wellness data. There is recent research showing that there are over 200 million mobile health apps that are in circulation — about a third of Americans track their health data online but don’t share it with anyone else.
So, progress in consumer-managed online health records will be slow. However, Dr Dembo certainly believes it is the way of the future, with a few provisos. “There is a hell of a lot of risk in the approach that I see to eHealth projects, in that we focus too much on the technology and not the human element. The other risk that I see is that we tend to — by we I mean healthcare stakeholders — is that we do get distracted overly by the stereotypical chronic disease management patient that may have many pathologies, that may be a little recalcitrant or perhaps not well educated, and that is a bias away from the majority of society of healthcare consumers. “In the main, we have a well educated population. They are concerned about their health and are motivated to take a more active role in remaining healthy. It is in this area of wellness that significant momentum already exists for consumer
“The community surrounded by smart devices and smart portals is digitising in advance of the health system and if the health system wants to leverage such a potentially powerful data set, it will have to start building a stronger connection between the consumer and itself. Consumers, whether from frustration or aspiration seem convinced that technology is a pillar of wellness and they are embracing it in droves. It is now up to us healthcare stakeholders to prove that traditional health services can extend beyond bricks and mortar into the online world.”
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Feature
Remote monitoring and consultation through your TV
Last year, Medtech Global aquired the rights to a video conferencing and remote monitoring system that allows the patient to see their doctor through their television. It also allows third parties such as specialists to join in the consultation. Aimed at chronic disease management, the system is also being tried out in a Melbourne aged care facility.
Kate McDonald Journalist: Pulse+IT kate.mcdonald@pulseitmagazine.com.au
Video conferencing for healthcare is such an obvious benefit in a country as large as Australia that the federal government has introduced an MBS rebate for specialists offering the service to areas of need. One area of need is aged care, where despite round the clock nursing care, it is often difficult to find doctors willing to attend a nursing home both during and after business hours. To get a specialist to visit a nursing home is nigh on impossible, so video conferencing makes a lot of sense. However, the aged care sector has historically been reluctant to invest in the technology for a number of reasons. Cost is the main one, but the dearth of specialists willing to use the technology is another. And with no substantive incentives for GPs, they too have yet to really embrace the potential. One GP who is happy to take the plunge is Dr Igor Jakubowicz, who regularly provides medical care to the residents of the Martin Luther Homes aged care facility in The Basin in outer suburban Melbourne. He has joined with software provider Medtech Global to run a trial of its new VitelMed telehealth system, which has a few added extras besides two-way video conferencing. Although this trial is taking place at a nursing home, the real potential
of the system is in keeping patients in their own homes for longer. One component of the VitelMed system is a set-top box that people in the home simply attach to their television, through which they can see and interact with their doctor. The doctor and specialist use a PC‑based program to consult while using their electronic medical record system to record the consulting notes and collect data from the remote medical device connected to the set-top box. The VitelMed system also allows the doctor to remotely control the camera at the patient end with pan-tilt-zoom capability. A call log displays all call activities, with incoming calls, calls during absence and dialled calls clearly marked with distinctive colours. The call log menu is easily accessible by the patient and the doctor through a simple remote control with four navigation keys. As soon as the patient receives a new message, the VitelMed unit will continuously flash until the patient opens the menu and the new message will pop up. This tool is often used as a reminder or alert function. A unique feature of the system is the single RED button which, when pressed by
“The MBS item number is for patients seeing a specialist — the aged care facility is considered an area of need but it only applies to specialists, so GPs don’t actually see those benefits as they have to physically attend the nursing home anyway.” Dr Igor Jakubowicz
the patient, results in a video call to the triaging centre. The call can be answered by the front-desk operator and transferred to a doctor anywhere in Australia. Other parties such as specialists and family members can just as easily be conferenced in to establish a multi-party session. Patients can chose to connect to a healthcare provider of their choice using the directory on their television. Family members can also join in the conversation remotely over the Internet, as can specialists from their consulting rooms. Users of the family software can send text messages to each other and to the unit in the patient’s home.
The system is also set up to connect via Bluetooth to off the shelf medical devices such as blood pressure monitors, blood glucose monitors, ECGs, pulse oximeters and spirometers. The system transmits this data to the care provider, which can help identify early escalation of developing problems and allows early intervention to avoid a potential hospitalisation. The VitelMed service also allows a doctor to access a patient’s records and complete medical files in real time to gain a clear picture of the history and requirements of the patient. Fully integrated with Medtech Global’s patient portal, called ManageMyHealth, and its practice management system
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like to see the patient in person initially, the potential is more in providing quick and easy follow‑up care. “If they are looking at a specific skin lesion, you can take a high resolution photo and can send it in advance through the system,” Dr Jakubowicz says. “If you have a good webcam, you can do a close up and it’s high quality.” At the aged care facility, the system is set up in a consulting room and a nurse attends with the patient. The GP or the specialist can manage the consultation, with the specialist accessing it over the Internet. The same situation could apply in the home, with a carer attending the consult, although Medtech Global has added software to allow family members not at home to sit in as well.
Medtech32, the VitelMed solution is intended to provide an integrated clinical solution to GPs and specialists looking to take advantage of the government’s telehealth incentive and extend their patient service offering. Rama Kumble, general manager and CTO for VitelMed with Medtech Global, says the system can be used with any GP software, not just Medtech32, and, as the company is on NEHTA’s GP Software Vendor Panel, it will be conformant with the requirements of the PCEHR.
Incentives for GPs The provision of in-home care is the long-term goal, but in the meantime the trial is taking place at Martin Luther Homes to see if it useful for the aged care sector. Medtech is promoting the system to GPs and specialists under the one-off $6000 Medicare incentive for investing in telehealth, which scales back from July. The incentive is one thing, but ongoing incentives for GPs to use telehealth is another, Dr Jakubowicz says. “I would use this whenever I can but I’m not paid for it,” he says. “The MBS item number is for patients seeing a specialist — the aged care facility is considered an area of need but it only applies to specialists, so GPs don’t actually see those benefits as they have to physically attend the nursing home anyway.” Still, Dr Jakubowicz is more than happy to take part in the trial as he sees enormous benefits, particularly for aged care and in-home care. He and a local dermatologist, Doug Czarnecki, have got together to provide general and specialist care to elderly residents at Martin Luther Homes. He admits that it is hard to find a specialist who wants to give it a go, but as Dr Czarnecki is semiretired, this works perfectly for him. While most specialists would
“We think the people who would like to use it are particularly long-term patients,” Mr Kumble says. “They are quite happy to have a consult in the evening. It will also be good for people who are non-English speakers if they have family members with them.” While many GPs and specialists would prefer not to work out of hours, some like Dr Czarnecki are more than happy to do so. According to Dr Jakubowicz, he has offered his services to areas of need such as northern Tasmania, where there are few dermatologists to be found. The uptake hasn’t been great, perhaps because GPs not in district of workforce shortage (DWS) areas are not remunerated, which is why both he and Medtech Global are keen for doctors to take advantage of the one-off incentive to at least get the infrastructure in place. “When we have finished the trial and we have the clinical evidence then we will go out to everyone with a view to its use in aged care and we are confident they won’t be out of pocket,” Mr Kumble says. “We will also be starting a trial in New Zealand although there is no incentive scheme there, but they want to go ahead anyway because it saves them on travel and access to doctors. “We are truly excited about the possibility of providing equitable care to rural and remote patients using a technology that uses your home television. We will be embarking on pilots in other countries such as India, where an integrated telehealth solution from Australia can deliver high quality medical services to rural populations.” In the meantime, Medtech Global is further developing the system for use in remote regions of the country, and Dr Jakubowicz strongly suggests the government consider an MBS item number for GPs, which he says will vastly improve the uptake of the technology and at the same time make it far easier for carers, patients and their families.
Cerner Corporation Pty Limited
Advantech AAPM P: 1800 196 000 / +61 3 9095 8712 F: +61 3 9329 2524 E: headoffice@aapm.org.au W: www.aapm.org.au The Australian Association of Practice Managers (AAPM) represents Practice Managers and the profession of Practice Management. Founded in 1979, AAPM is a non-profit, national peak association recognised as the professional body dedicated to supporting effective Practice Management in the healthcare profession. The Australian Association of Practice Managers: • Represents Practice Managers and the profession of Practice Management throughout the healthcare industry. • Promotes professional development and the code of ethics through leadership and education. • Provides specialised services and networks to support quality Practice Management.
P: 1300 308 531 F: +61 3 9797 0199 E: info@advantech.net.au W: www.advantech.net.au Advantech’s medical computing platforms are designed to enhance the quality and efficiency of healthcare for patients and users alike. All products match the performance of commercial PCs and tough medical safety ratings like UL60601-1 and EN60601-1; adding to this they are all IPX1 certified dust resistant and come with water drip‑proof enclosures. Advantech offers long term support and a proven track record of reliability. The medical range extends through: • Point-of-Care Terminals. • Mini-PC and Medical Imaging Displays. • Mobile Medical Tablets. • Patient Infotainment Terminals. Advantech is also an official distributor of Microsoft Windows Embedded software across Australia & New Zealand.
P: +61 2 9900 4800 F: +61 2 9900 4990 E: AsiaPacific@cerner.com W: www.cerner.com.au
Best Practice P: +61 7 4155 8800 F: +61 7 4153 2093 E: sales@bpsoftware.com.au W: www.bpsoftware.com.au Best Practice sets the standard for GP clinical software in Australia offering a flexible suite of products designed for the busy GP practice, including: • Best Practice Clinical (“drop-in” replacement for MD) • Integrated Best Practice (clinical/ management) Visit us at the following conferences throughout the year: • GPCE Sydney, 18 - 20 May • RDAQ Gold Coast, 8 - 10 June • GPET Melbourne, 5 - 6 September • GPCE Brisbane, 14 - 16 September • AAPM National Conference Brisbane, 23 - 26 October • ACRRM Fremantle, 25 - 28 October • AGPN Adelaide, 10 - 14 November • GPCE Melbourne, 16 - 18 November
Cerner is a leading supplier of healthcare information systems and our Millennium suite of solutions has been successfully installed in over 1200 sites across the globe. Cerner’s technology has been designed so that it can be adapted to meet the needs of the very different healthcare delivery systems that exist, with a universal framework that allows clinician workflow to seamlessly span role and venue. Our innovative leadership is allowing us to push boundaries by: • Leveraging clinical and pharmaceutical data for new discoveries in Condition Management and Personalised Medicine • Connecting the community with personal and community health records • Seamlessly connecting the patient record across the continuum of care
Argus
ACSS P: 1300 788 005 / +61 2 9632 0026 F: +61 2 9632 0096 E: sales@acsshealth.com W: www.acsshealth.com ACSS provides innovative and customisable patient management software streamlining day-to-day operations for GPs, Allied Health, Specialists, Radiologists, Pathologists, Private and Public Hospitals. eClaims® — Comprehensive and robust appointment and billing system with digital/voice recognition capabilities, electronic reporting transmissions and HL7 PACS system integration. eClaims® Hybrid — A solution tailored to Hospitals and other health service providers including billing agents who lack online capabilities. eClaims® Hybrid is the interface solution for connecting you to Medicare and health funds through ECLIPSE. SimDay® — Proven PAS (Patient Administration System) specifically designed for day surgeries and private hospitals – Now with ECLIPSE integration.
P: +61 3 5335 2220 F: +61 3 5335 2211 E: argus@argusconnect.com.au W: www.argusdca.com.au Argus provides and supports Argus secure messaging software; a popular electronic solution that enables healthcare practitioners to exchange pathology, radiology and specialist reports, hospital discharge summaries, referrals and clinical data securely and reliably. Argus interfaces with most clinical software applications sending directly from within your letter writing facility or word processor and runs virtually invisibly in the background. Documents sent using Argus can be automatically added to electronic patient records; thus avoiding the need to scan or manually file them. Argus is the messaging solution chosen by 65 Divisions of General Practice through the ARGUS AFFINITY program. With over 12,800 users Argus continues to grow in popularity by delivering a highly secure message, reliable product, backed by outstanding customer service all at the lowest cost possible.
cdmNet P: +61 3 9023 0800 F: +61 3 9614 2650 E: info@precedencehealthcare.com W: www.precedencehealthcare.com cdmNet is an online service specially designed to manage the entire life cycle of a patient’s chronic disease. cdmNet delivers best practice chronic disease management, including creation of GPMPs, TCAs and Reviews. In addition, collaboration with your care team is quick, easy and ongoing. cdmNet minimises the bureaucracy, eliminates the paperwork, and ensures compliance with Medicare requirements for chronic disease management. cdmNet optimises patient care, simplifies care team collaboration and minimises administration & paper work. Find out more about how cdmNet can assist you and your practice by typing cdm.net.au/info into your browser address bar.
Clintel Systems P: +61 8 8203 0555 E: info@clintel.com.au W: www.clintel.com.au The Specialist: A complete solution for your Appointments, Billing including Online Claiming and Clinical requirements in an intuitive scalable solution. Clintel provides systems to Specialist and Day Surgeries nationally. Powerful, highly configurable and easy to use, our systems mirror the needs and workflow of your practice and individual specialty. Our industry standard SQL database enables a true “paperless” practice. Our leading edge architecture is future proof, it is designed to meet changing requirements and offers first class reporting and analysis of clinical and business data. Standalone or networked multi-site installation which runs on both Mac OSX and Windows operating systems. Our support is first class, our philosophy is “whatever it takes”.
cdmNet: Chronic Disease Management just got a whole lot easier.
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Direct Control
CH2 (Clifford Hallam Healthcare) P: 1300 720 274 F: 1300 364 008 E: marketing@ch2.net.au W: www.ch2.net.au Clifford Hallam Healthcare (CH2) is today Australia’s largest pharmaceutical and medical healthcare service provider with a catalogue of over 30,000 products servicing metro, regional and rural customers across Australia. Supported by a National Network, CH2 utilises local knowledge and local people to provide pharmaceuticals, medical consumables and equipment products to the healthcare market. CH2 is represented by a National Sales Force as well as a local Customer Service team in each state. CH2 understands the value of quality data and are committed to implementing the GS1 system throughout our business and with our partners. The use of EANCOM standard messages, Global Trade Item Numbers (GTIN) for product identification, Global Location Numbers (GLN) for location information and Serial Shipping Container Code (SSCC) labels are paramount to our industry moving forward. CH2 are passionate supporters of these philosophies and believe the uplift in quality systems will result in improved patient safety. CH2 are currently working with partners to implement the National E-Health Transition Authority (NEHTA) National Product Catalogue. “Our aim is to be a great company to do business with. The right product, at the right price, at the right time.” WardBox® is CH2’s direct to ward distribution system. It is a just in time replenishment system where orders are created in a theatre or ward area and then transmitted electronically to one of CH2’s warehouses using SOS™ or an EDI interface. The service incorporates barcode scanning technology, direct delivery to individual wards or departments, monthly invoicing and comprehensive reporting. WardBox® is designed to assist our customers in reducing purchasing and supply operating costs. This valuable service increases supply chain efficiencies, improves service delivery models and assists in achieving economies of scale. WardBox® distribution is used for pharmaceuticals, medical, surgical and general supplies at numerous healthcare facilities. CH2 has recently released version 1.4 of CH2 Direct®, their simple, intuitive and fast, online ordering system. There is no installation required so simply contact their national customer service to obtain a login. 062
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Digital Medical Systems P: 1300 865 977 F: +61 3 9753 3049 E: inform@dgs.com.au W: www.dgs.com.au Easier ICT is a technology partnership with DMS — we make I.T. work for you. DIGITAL MEDICAL SYSTEMS has provided ICT solutions and services to medical practice clients across Australia since 1990. We have specialist expertise and experience in the installation and support of leading medical software applications. DMS is a Business Partner for IBM, Lenovo, HP and Microsoft. Other leading ICT brands include Trend Micro, Symantec, CA, Cisco, Toshiba, Canon, Epson, Kyocera, Fujitsu and Brother. Accreditation is easier with the customised DMS IT Systems Documentation. Ensure your practice has the best quality IT policy, security and maintenance program that meets and exceeds the standards guidelines from the RACGP and AGPAL and GPA. World leading DTech provides 24x7 near Real-Time Monitoring and Management that alerts and enables our engineers to quickly troubleshoot and solve problems of security, network, Internet, Server and software remotely on almost any client computer system or device. Medical IT systems are automatically maintained by DTech to the most highly available status to minimize downtime by preventing problems from occurring or reducing their impact. Proactive, Flexible, Consistent, Reliable, Audited, and Affordable — for even the smallest practice. Call DMS for: • Systems Analysis & Consulting • Solutions Design • Procurement & supply of hardware, software, network and peripheral products • Installation & Configuration • Support Services inc Help Desk • DTech Monitoring, Maintenance & Management • Disaster Recovery solutions • Fully managed & automated Online Backup customised for clinical data Easier IT — we make I.T. work for you.
P: 1300 557 550 F: +61 7 5478 5520 E: support@directcontrol.com.au W: www.directcontrol.com.au Direct CONTROL is an affordable, intuitive and educational Medical Billing and Scheduling application for Practitioners of all Disciplines. Seamless integration with Outlook, MYOB or Quickbooks. Direct CONTROL’s Clinical Module manages Episodes of Care and includes State, Federal and Health Fund Statistical Reporting for Day Surgeries/Hospitals. Direct CONTROL facilitates Medical Billing Australia-wide and overseas. Included is all Medicare, DVA, Work Cover, Private Health Insurance fee schedules with built in rules relevant to each medical discipline (allied health, general practice, surgeons, physicians, anaesthetists, pathologists, radiologists, day surgeries/hospitals). Ideal for the single practitioner or the multidisciplinary Practice. Direct CONTROL supports ALL your Business needs letting you and your staff get on with earning a living doing what you enjoy most … Patient Care.
eHealth Security Services P: 1300 399 116 / +61 2 9016 5378 F: +61 2 9016 5379 E: info@ehealthsecurity.com.au W: www.ehealthsecurity.com.au eHealth Security Services (eHSS) specialises in the provision of security as a service and offers an extensive range of Managed IT Services including IT Support for small to medium businesses in the health sector. eHSS’ MediAccess® service provides comprehensive and cost-effective managed security and remote access solutions. eHSS has thorough knowledge and understanding of IT matters in the health industry and its regulatory aspects. eHSS has extensive experience reviewing and assisting with organisational policies and procedures and technical implementations against applicable standards.
Emerging Systems P: +61 2 8853 4700 F: +61 2 9659 9366 E: sales@emerging.com.au W: www.emerging.com.au/ehealth Emerging Systems EHS web-based Clinical Information System records the clinical care delivered to a patient from pre-admission through to discharge. EHS interfaces with the hospital PAS system, capturing and providing all of the information Clinicians require during a patient stay to support the delivery of effective, appropriate, quality care outcomes in a secure and auditable environment. Importantly, EHS links Clinical Care with Workforce Rostering and Staff Allocation allowing for predictive Resource Allocation based on the care required, enabling valuable productivity improvements. EHS is a proven and highly useable electronic medical record developed within Australia and operating successfully in St Vincent’s & Mater Health, Sydney and Government of South Australia, Department of Health Hospitals. EHS provides: • Pre-Admission • Patient History • Orders & Results • Clinical Care Guides • Assessments • Progress Notes • Referrals • Labour & Birth • Medications Reconciliation • Clinical and Non‑Clinical Messaging • Diets • Discharge Planning • Appointments • Rostering • Allocations • Resource Calculation • Clinical Dashboard and more EHS has integrated Sabacare’s Clinical Care Classification (CCC) System, a diagnosis framework integrated in SNOMED CT. EHS’ extensive list of modules work seamlessly with other systems via our integrated interface engine which accepts HL7 and other accepted Health IT standard protocols complying with the Australian Technical Specification: ATS 5822:2010 eHealth Secure Message Delivery. Accessibility: EHS is accessible on a range of devices according to user preference including our latest iPad / iPhone application.
Equipoise (International) Totalcare
GPA P: 1800 188 088 F: 1800 644 807 E: info@gpa.net.au W: www.gpa.net.au
P: +61 7 3252 2425 F: +61 7 3252 2410 S: skype.totalcare.net.au E: sales@totalcare.net.au W: www.totalcare.net.au Equipoise International Pty Ltd (EQI) is the developer and supplier of the ‘Totalcare’ clinical and office management system. Used since 1995 by health care facilities across Australia including General and Specialist practice, Radiology, Day Surgery and Hospitals. Totalcare is a fully integrated Clinical, Office and Management software suite. Totalcare is stable, scalable, customisable and easy to learn and use. From a small practice to a distributed, multi site, multi disciplinary corporate entity or hospital, Totalcare can provide a solution for your needs.
Genie Solutions P: +61 7 3870 4085 F: +61 7 3870 4462 E: info@geniesolutions.com.au W: www.geniesolutions.com.au Genie is a fully integrated appointments, billing and clinical management package for Specialists and GPs.
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. 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 2400 sites, it is now the number one choice of Australian specialists.
Healthbank Consult Extensia P: +61 7 3292 0222 F: +61 7 3292 0221 E: enquiries@extensia.com.au W: www.extensia.com.au Extensia links healthcare providers, consumers and their communities for better and more efficient health care. The products used to do this can be custom branded for all Organisations and include: • RecordPoint – a proven Shared Electronic Health Record that links all clinical systems, hospital settings, care plan tools and any other sources of information available. It provides a secure means of sharing critical patient data in a privacy compliant and logical structure. • EPRX – an Electronic Patient Referral Exchange and Directory. It streamlines the process of selecting a provider and completing a referral. Patient information is transferred seamlessly from clinical software. The most relevant providers, services and products are presented instantly and referral documents are generated and sent electronically.
Global Health P: 1300 723 938 F: +61 3 9675 0699 E: marketing@global-health.com W: www.global-health.com Global Health is a leading provider of e-health solutions that connect clinicians and consumers across the healthcare industry. Global Health’s portfolio consists of: • ReferralNet - a cloud-based secure message delivery system for the exchange of information between healthcare providers. • MasterCare® - a suite of health information systems that provides tools to collect, manage and access clinical and patient information at the point of care. • LifeCard® - a personal health management system for keeping all your important medical information in ONE secure location. With LifeCard® you can maintain a personal health record, access emergency health information and be rewarded for looking after your health.
Health Communication Network P: +61 2 9906 6633 F: +61 2 9906 8910 E: hcn@hcn.com.au W: www.hcn.com.au Health Communication Network (HCN) is the leading provider of clinical and practice management software for Australian GPs and Specialists and supplies Australia’s major hospitals with online Knowledge resources. HCN focuses on improving patient outcomes by providing evidence based software tools to health care professionals at the point of care. Market snapshot: • 17,000 medical professionals use Medical Director • 3,600 GP Practices use PracSoft • 800 Specialist Practices use Blue Chip and • 2,100 Specialists use Medical Director • Leading suppliers of Knowledge Resources to Australia’s major hospitals
P: 1300 856 722 F: 08 8301 4001 E: support@healthbankconsult.com.au W: www.healthbankconsult.com.au Healthbank Consult is a telehealth system developed in Australia for Australian healthcare providers. Secure, fully encrypted and HD capable, Healthbank Consult is designed to be compatible with your clinical desktop for easy integration with your practice’s workflow and retains an audit trail for Medicare. Compliant with RACGP telehealth guidelines, Healthbank Consult will qualify Rural GPs, Specialists, Aged Care Facilities and Aboriginal Medical Services for a $6,000 Medicare telehealth rebate plus ongoing fees.
Health Informatics Society of Australia P: +61 3 9326 3311 F: +61 3 8610 0006 E: hisa@hisa.org.au W: www.hisa.org.au HISA is Australia’s health informatics organisation. We have been supporting and representing Australia’s health informatics and e-health community for almost 20 years. HISA aims to improve healthcare through the use of technology and information. We: • Provide a national focus for e-health, health informatics, its practitioners, industry and a broad range of stakeholders • Support, promote and advocate • Provide opportunities for networking, learning and professional development • Are effective champions for the value of health informatics HISA members are part of a national network of people and organisations building a healthcare future enabled by e-health. Join the growing community who are committed to, and passionate about, health reform enabled by e-health.
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Health Information Management Association Australia P: +61 2 9887 5001 F: +61 2 9887 5895 E: himaa@himaa.org.au W: www.himaa.org.au The Health Information Management Association of Australia (HIMAA) is the peak professional body of Health Information Managers in Australia. HIMAA aims to support and promote the profession of health information management. HIMAA is also a Registered Training Organisation conducting, by distance education, “industry standard” training courses in Medical Terminology and ICD-10-AM, ACHI and ACS clinical coding.
InterSystems
iSOFT
P: +61 2 9380 7111 F: +61 2 9380 7121 E: anz.query@InterSystems.com W: www.InterSystems.com
P: +61 2 8251 6700 F: +61 2 8251 6801 E: company_enquiry@isofthealth.com W: www.isofthealth.com
InterSystems Corporation is a worldwide leader in breakthrough solutions for connected care with headquarters in Cambridge, Massachusetts, and offices in 23 countries. InterSystems TrakCare™ is a Web-based unified healthcare information system that rapidly provides the benefits of an Electronic Patient Record. InterSystems Ensemble® is a seamless platform for rapid integration and the development of connectable applications. InterSystems HealthShare™ is a strategic platform for healthcare informatics, and the creation of an Electronic Health Record on a regional or national scale. InterSystems DeepSee™ is software that makes it possible to embed real-time analytics capabilities in transactional applications. InterSystems CACHÉ® is the most widely-used database system in clinical applications.
iSOFT, a CSC company, is one of the world’s largest providers of healthcare IT solutions. We work with healthcare professionals to design, develop and implement healthcare solutions that deliver administrative, clinical and diagnostic services to ensure continuity of care across all care settings. iSOFT provides flexible and interoperable solutions to the whole spectrum of providers, from single physician practices through to integrated national solutions supporting thousands of concurrent users. Our capacity to embrace change and keep abreast of emerging new directions in healthcare has allowed our clients to explore the exciting potential of new technologies while securing their existing investments.
P: 1800 125 036 (AU) P: 0800 288 887 (NZ) E: enquiries@healthlink.net W: www.healthlink.net Australia’s and New Zealand’s largest effective secure communication network. • Referrals, Reports, Forms, Discharge Summaries, Diagnostic Order and Reporting • Provider of Secure Messaging Delivery (SMD) services • Fully integrated with leading GP and Specialist clinical systems • Robust; Reliable and Fully Supported Join the network that more than 70 percent of GPs use for diagnostic, specialist and hospital communications.
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P: +61 2 9901 6400 F: +61 2 9439 6331 E: sales@meditech.com.au W: www.meditech.com.au A Worldwide Leader in Health Care Information Systems MEDITECH today stands at the forefront of the health care information systems industry. Our products serve well over 2,300 health care organisations around the world. Large health care enterprises, multi‑hospital alliances, teaching hospitals, community hospitals, rehabilitation and psychiatric chains, long-term care organisations, physicians’ offices, and home care and hospice agencies all use our Health Care Information System to bring integrated care to the populations they serve. Our experience, along with our financial and product stability, assures our customers of a long-term information systems partner to help them achieve their goals.
Medtech Global Ltd P: 1800 148 165 E: salesau@medtechglobal.com W: www.medtechglobal.com
ISN Solutions HealthLink
MEDITECH Australia
P: +61 2 9280 2660 F: +61 2 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 and private hospitals. We manage IT services, we are dedicated to the medical industry. We know that if you are consulting then you need a quick response. Our support model is designed to minimise the interruptions to the doctor specially. We are familiar with most medical software applications in Australia. We have strong industry references. Some of our solutions include, but are not limited to: • Cloud based computing tailored to medical industry • Medical voice recognition • Capped cost medical support and maintenance plan • Ability to consult remotely • Medical application support
Medical Software Industry Association P: +61 427 844 645 E: ceo@msia.com.au E: president@msia.com.au W: www.msia.com.au With the increase in government e-health initiatives, the MSIA has become increasingly active in representing the interests of all healthcare software providers. The MSIA is represented on a range of forums, working groups and committees on behalf of its members, and has negotiated a range of important changes with government and other stakeholders to benefit industry and their customers. It has built a considerable profile with Government and is now acknowledged as the official ‘voice’ for the industry. Join over 100 other companies across all areas of medical IT/IM so your voice can be heard.
For over 28 years, Medtech Global has been a leading provider of health management solutions to the healthcare industry enabling the comprehensive management of patient information throughout all aspects of the healthcare environment. Medtech’s Medtech32 and Evolution solutions improve practice management and ensure best practice for electronic health records management and reporting. Clinical Audit Tool integrates with Medtech32 and Evolution providing fast, efficient and secure analysis of patient data enabling practices to identify and deliver services, which address health care priorities across their population. Medtech’s ManageMyHealth patient and clinical portal enables individuals to access their health information online and engage with their healthcare provider to support healthy lifestyle changes.
MIMS Australia P: +61 2 9902 7700 F: +61 2 9902 7701 E: info@mims.com.au W: www.mims.com.au MIMS Australia is built on a heritage of local expertise, credibility and adaptation to changing healthcare provider needs. Our information gathering, analysis and coding systems are proven and robust. MIMS information is backed by MIMS trusted, rigorous editorial process and constantly updated from a variety of sources including primary research literature. Our database and decision support modules are locally relevant, clinically reviewed and updated monthly and compatible with a host of clinical software packages. Indeed, the majority of Australian prescribing packages and many dispensing applications are supported by the MIMS medicines data base. MIMS is delivered all the ways you need – print to electronic, on the move, to your patient’s bedside or your consulting room desk. Whatever the format, MIMS has the latest information you need.
OzeScribe Mouse Soft Australia Pty Ltd P: +61 3 9888 2555 F: +61 3 9888 1752 E: sales@medicalwizard.com.au W: www.medicalwizard.com.au Medical Wizard saves time and money through greater efficiency and comprehensive integration. Throughout its 19 year history, Medical Wizard has led the way with innovative solutions. We are constantly evolving Medical Wizard to meet the challenges of the medical profession for today and tomorrow. A software of choice for discerning Specialist practices, notably Gastroenterologists, Cosmetic Surgeons, Ophthalmologists, General Surgeons, IVF Centres and Day Hospitals amongst others. All aspects of practice management from appointments, billing, clinical, theatre management and compliance reporting are covered and backed by a dedicated local support team.
Nuance Communications P: +61 2 9434 2300 F: +61 2 9929 0815 E: Vicki.Rigg@nuance.com W: australia.nuance.com W: newzealand.nuance.com Nuance (NASDAQ: NUAN) is a leading provider of speech and imaging solutions for businesses and consumers around the world. Its technologies, applications and services make the user experience more compelling by transforming the way people interact with information and how they create, share and use documents. Every day, millions of users and thousands of businesses utilise Nuance’s proven range of productivity applications which include Dragon NaturallySpeaking (speech recognition), OmniPage (OCR), PaperPort (document management) and PDF Converter Professional (PDF creation and conversion).
P: 1300 727 423 F: 1300 300 174 E: sales@ozescribe.com.au W: www.ozescribe.com.au OzeScribe is the dictation and transcription solution for 7/10 Australian university teaching hospitals and major private clinics. It really does make sound business sense to let OzeScribe worry about managing transcription, technology and staff, and show you how we can provide a free electronic document delivery service OzePost to your EMR and your associates’ EMR, saving you thousands of dollars in time, packing and postage. OzeScribe is the provider of the most advanced solutions available. • Australian trained typists. • Manage dictation and transcription via computers, iPhone, iPad, android or smartphones. • Integrated M*Modal speech recognition technology on demand.
Feature Rich. Dynamic. Innovative.
Pen Computer Systems Orion Health NEHTA P: +61 2 8298 2600 F: +61 2 8298 2666 E: admin@nehta.gov.au W: www.nehta.gov.au
MITS:Health P: 1300 700 300 E: info@mitshealth.com.au W: www.mitshealth.com.au Managed IT Services for the Health Industry MITS:Health provides a full range of IT services specifically tailored for medical centres, GPs and specialists across Melbourne. • • • • • •
Equipment supply and installation Remote monitoring and support Data backups Networking Internet Website Development
The National E-Health Transition Authority was established by the Australian, State and Territory governments to develop better ways of electronically collecting and securely exchanging health information. NEHTA is the lead organisation supporting the national vision for eHealth in Australia.
P: +61 2 8096 0000 / +64 9 638 0600 E: enquiries@orionhealth.com W: www.orionhealth.com Orion Health is a world leader in the e-health industry. We specialise in electronic health record (EHR) solutions, disease management, clinical decision support, and hospital administration tools. More than 300,000 clinicians in 30 countries use Orion Health products. Our EHR solutions have been widely adopted across Canada, Europe and the USA to enable secure crossorganisational and regional sharing of patient information, resulting in improved patient care. Our Rhapsody Integration Engine, a healthcare dedicated and standards based Integration hub, is used by customers to easily create interoperability between existing healthcare information systems. Our solutions are designed to support emerging health IT trends and standards, we work closely with our customers, clinicians, government bodies and other industry leaders to deliver intuitive solutions to meet your current and future needs.
P: +61 2 9635 8955 F: +61 2 9635 8966 E: enquiries@pencs.com.au W: www.pencs.com.au Established in 1993, Pen Computer Systems (PCS) specialises in developing information solutions for National and State eHealth initiatives in Primary Health that deliver better Chronic Disease outcomes. PCS expertise extends to: • Chronic Disease Prevention and Management • Population Health Status, Reporting and Enhanced Outcomes • Decision-Support tools delivered LIVE into the clinical consult • Web-based Electronic Health Records (EHRs) • SNOMED-CT and HL7 Standards Frameworks Our Clinical Audit Tool (CAT) for example delivers an intuitive population reporting and patient identification extension to the leading GP systems in Australia. CAT delivers enhanced data quality and patient outcomes in general practice.
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Sysmex New Zealand
Medilink
from Practice Services P: +61 3 9819 0700 F: +61 3 9819 0705 E: Sales@practiceservices.com.au W: www.practiceservices.com.au Medilink Practice Management Software • 21 years young, large user base • Medilink = Intuitive ease of use • Solo Drs up to Hospitals in size • Claiming via integrated EFTPOS ◊ and/or integrated HICAPS ◊ and/or Medicare Online ◊ and/or ECLIPSE • Many standard features • Many optional modules • Links to many third party packages and services • Cut debtors and boost cash flow • 17 years as an Authorised Medilink Dealer, selling, installing & training • Fixed Cost Support, Onsite or Remote
P: +64 9 630 3554 F: +64 9 630 8135 E: info@sysmex.co.nz W: www.sysmex.co.nz
P: 1800 061 260 E: sales@tg.org.au W: www.tg.org.au
Sysmex New Zealand is a market leader in the development and implementation of health IT products and services for clinical laboratories, hospitals and healthcare organisations. We offer the following health IT solutions: • Delphic LIS – a market-leading laboratory information system for hospital and community laboratories with a strength in providing multi-lab solutions. Specialised modules manage workflows in the anatomical pathology, haematology and microbiology work areas. • Eclair – an advanced clinical data repository (CDR) which stores patient data from a range of systems including laboratory, radiology, pharmacy and clinical document sources to create a secure patient-centric record. Eclair provides complete electronic ordering functionality.
Real Outcomes Real Productivity Minimising Waste
Trend Care Systems Stat Health Systems P: +61 7 3121 6550 F: +61 7 3219 7510 E: carla.doolan@stathealth.com.au W: www.stathealth.com.au Stat Health Systems (Aust) has built a progressive and resilient system that introduces a new level of stability and flexibility to the medical software market. Stat is an integrated clinical and practice management application which has embraced the latest Microsoft technology to build a new generation solution. Fully scalable and the only medical software application to incorporate a multi-functional intuitive interface, Stat is at the forefront of computing technology. Stat Health provide a premium support service, clinical data conversion from existing software and tailor made installation and training plans for your practice.
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Therapeutic Guidelines Ltd
P: +61 7 3390 5399 F: +61 7 3390 7599 E: support@trendcare.com.au W: www.trendcare.com.au A national and international award winning solution recognised for its ability to provide real benefits in the acute and sub-acute health care settings. TrendCare is an international leader for e-health solutions excelling in all of the following: • Patient dependency and nursing intensity measures. • Projecting patient throughput and workforce requirements. • Rostering and work allocation. • Efficiency, productivity and HRM reporting. • Discharge analysis, bed management and clinical handovers. • Allied health registers with extensive reporting. • Clinical pathways with variance reporting. • Patient assessments and risk analysis. • Diet ordering and reporting. • Staff health tracking and reporting.
Therapeutic Guidelines Limited is an independent not-for-profit organisation dedicated to deriving guidelines for therapy from the latest world literature, interpreted and distilled by Australia’s most eminent and respected experts. These experts, with many years of clinical experience, work with skilled medical editors to sift and sort through research data, systematic reviews, local protocols and other sources of information, to ensure that the clear and practical recommendations developed are based on the best available evidence. eTG complete Incorporates all topics from the Therapeutic Guidelines series in a searchable electronic product, and is the ultimate resource for the essence of current available evidence. It provides access to over 3000 clinical topics, relevant PBS, pregnancy and breastfeeding information, key references, and other independent information such as Australian Prescriber (including Medicines Safety Update), NPS Radar, NPS News and Cochrane Reviews. eTG complete is available in a range of convenient formats – online access, online download, CD, and intranet access for hospitals. Multi-user licences, ideal for a practice or clinic, are also available. It is widely used by practitioners and pharmacists in community and hospital settings in all Australian states and territories. Updated three times per year, eTG complete meets the criteria for ‘key electronic clinical resources’ in the Practice Incentives Program (PIP) eHealth Incentive. The March 2012 release of eTG complete includes updates of selected Cardiovascular topics and a complete revision of the Oral and Dental guidelines. miniTG The mobile version of eTG complete is miniTG, offering the convenience of having vital information at the point of care and designed for health professionals who practise and consult on the move. It is supported on a wide range of mobile devices, including Apple®, Pocket PC®, and selected Blackberry® devices.
Vensa Health P: +64 9 522 9522 F: +64 9 522 9523 E: website@vensahealth.com W: www.vensahealth.com The next time you receive a text message mobile reminder or an alert from your doctor, hospital or physio you now know its done by Vensa. Vensa Health is a mobile health (mHealth) provider in the health care sector offering eHealth integrated mobile solutions, enabling textmessaging for patient communications for applications such as appointment reminders, medication reminders, test results alerts, recalls for screenings such as mamograms, immunisations and more. Vensa has invested substantially into developing products and services that offer communication solutions to better content providers with patients, including mobile text-messaging, voice, mobile sites and Telehealth services delivery.
Zedmed P: +61 3 9284 3300 F: +61 3 9284 3399 E: sales@zedmed.com.au W: www.zedmed.com.au Owned by Doctors who understand the challenges facing the medical profession everyday and backed by nearly 30 years of experience in medical software programming, Zedmed provides innovative, full featured and sophisticated practice management and clinical records software solutions. Zedmed would also like to introduce to you Medical Record eXchange – a free, simple solution allowing Doctors to send patient’s medical information to insurance companies electronically. Using the latest in data extraction technology and fully encrypted, this is a secure, time-saving solution to one of the most dreaded requests Doctors receive on an almost daily basis. For more information please visit: www.medicalrecordexchange.com.au
eHealth: it’s happening now!
AAPM National eHealth Roadshow These workshops will cover: • What you need to know about eHealth • How your practice can be eHealth compliant • Why eHealth is important for every practice • How eHealth will change the future of healthcare delivery for everyone
• $60 AAPM members, $75 non-members • Attendance earns 4 CPD points • Numbers limited to 20 per session – book early to avoid disappointment
To register, or for more information, go to: www.aapm.org.au
This national eHealth roadshow is proudly sponsored by the National E-Health Transition Authority (NEHTA) on behalf of the Governments of Australia.
Better Communication, Better Care
Just what the Doctor ordered “Our Electronic Referrals initiative has been very well received by our GPs. At our recent strategic planning meeting, electronic referrals was raised as one of the best initiatives that we have undertaken in recent years.
This project is already making a difference for GPs and patient care and will open up huge opportunities for better communication and collaboration between our Primary Care and hospital clinicians.”
Better Communication, Better Care
The HealthLink eReferral system is currently being implemented across more than 60% of New Zealand’s hospitals and general practices. It is now ready for implementation in any Australian or New Zealand region. Call us today
Dr Adrian Gilliland, Clinical Advisor Primary Care, Capital and Coast District Health Board HealthLink serves 9,000 practices (75% of Australia’s general practices, 100% of New Zealand’s) and exchanges more than 65 million clinical transactions annually. HealthLink has seven offices across Australasia focusing on web services and online communications.
AUS: 1800 125 036 NZ: 0800 288 887 Email: info@healthlink.net www.healthlink.net
Better Communication, Better Care