Australasia’s First and Only eHealth and Health IT Magazine
29
ISSUE
2 JULY 2012
TELEHEALTH & HIC2012 PREVIEW
To Skype or not to Skype
Telehealth has been given a boost by the federal government’s ongoing incentive scheme, but which service is best for you?
Telehealth on a national scale
Michael Gill argues that the time for pilot projects is over: Australia now needs nationwide telehealth services.
The mobile consumer at HIC2012 The consumer-led healthcare system of the future is one of the main highlights of the upcoming Health Informatics Conference.
pulseitmagazine.com.au
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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
About Pulse+IT Pulse+IT is Australia’s first and only Health IT magazine. With an international distribution exceeding 34,500 copies, it is also one of the highest circulating health publications in Australasia. 32,000 copies of Pulse+IT are distributed to GPs, specialists, practice managers and the IT professionals that support them. In addition, over 5,000 copies of Pulse+IT are distributed to health information managers, health informaticians, and IT decision makers in hospitals, day surgeries and aged care facilities.
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.
ISSN: 1835-1522
Pulse+IT is produced in print seven times per year with the remaining three editions for 2012 to be distributed for release in:
Disclaimer The views contained herein are not necessarily the views of Pulse+IT Magazine or its staff. The content of any advertising or promotional material contained herein is not endorsed by the publisher. While care has been taken in the preparation of this magazine, the publisher cannot be held responsible for the accuracy of the information herein, or any consequences arising from it. Pulse+IT Magazine has no affiliation with any organisation, including, but not limited to Health Services Australia, Sony, Health Scope, UBM Medica, the New Zealand College of General Practitioners, the Rural Doctors Association of Australia, or the Kimberley Aboriginal Medical Services Council, all who produce publications that include the word “Pulse” in their titles.
• • •
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.
Contributors Bryn Evans, Michael Gill, Simon James, Kate McDonald and Louise Schaper.
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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PCEHR GP SOFTWARE ROLLOUT
CLINICAL IT SAFETY
WHEN HEALTH IT GOES WRONG
Editorials
Features
News
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STARTUP
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GUEST EDITORIAL
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Editor Simon James introduces the 29th edition of Pulse+IT.
Michael Gill argues that the current model for telehealth provision is unsustainable and a national strategy for telehealth is required.
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GUEST EDITORIAL Bryn Evans reports from the recent HIMSS Australia forum that there is a growing consensus that EMRs are essential to transform healthcare.
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HISA Louise Schaper announces the creation of a new health informatics certification program and gears up for this month’s HIC2012.
Resources
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EVENTS
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PULSE+IT DIRECTORY
Changes to the telehealth incentive scheme are aimed at boosting its uptake but there is still some debate about telehealth’s worth.
Skype is quick, easy and cheap, but many experts warn against its use in telehealth. Doctors, however, are voting with their feet.
PCEHR-enabled software to be rolled out to GPs in September South Australia pushes button on statewide electronic health record Clinical IT safety under inspection through TechWatch study Mobile is global but doctors aren’t too keen: PwC
TELEHEALTH FOR AGED CARE Specialists have been catered for but GPs will need real incentives to use telehealth in the sector that needs it most: aged care.
WHERE TO GO FOR TELEHELP
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MOBILE HEALTH AT HIC2012
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SELECTED BITS & BYTES
TO SKYPE OR NOT TO SKPE
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Up and coming eHealth, Health, and IT events.
The Pulse+IT Directory profiles Australasia’s most innovative and influential eHealth and Health IT organisations.
USE IT OR LOSE IT
Telehealth solutions are flooding the market so where do you go for advice on the best system to use?
PCEHR to save $11.5 billion over 15 years, Deloitte modelling shows Telehealth support officers up for grabs for Medicare Locals Who takes the rap for safety and liability under the PCEHR? Bundaberg GP launches patient assistance tool for chronic disease
The theme of a consumer or patient-led health system of the future is a highlight of the Health Informatics Conference 2012.
Secure message exchange market opens up
WHEN HEALTH IT GOES WRONG
NEHTA announces members of aged care software panel for PCEHR integration
Scot Silverstein has seen both sides of the health IT revolution, both as a medical informatician and as a relative of a patient harmed by IT.
PCEHR legislation passes but soft launch expected
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Editorial
TELEHEALTH & HISA’S HIC2012 With the arrival of this edition to coincide with the consumer-facing launch of the Personally Controlled Electronic Health Record system, practices are reminded that July 1 also brings changes to Medicare Australia’s telehealth arrangements.
SIMON JAMES BIT, BComm Editor: Pulse+IT simon.james@pulseitmagazine.com.au
This edition of Pulse+IT features a series of articles related to telehealth, with a particular focus on video consultations as they pertain to specialists, general practitioners and those involved with aged care. The ramifications of recent changes to the MBS are also discussed, with a guest editorial by Michael Gill questioning the sustainability of Australia’s infatuation with telehealth pilot projects, particularly those mapped to limited geographic regions and healthcare silos. In the absence of definitive guidance from government and with a wide range of views on offer, this edition also includes a discussion about the suitability of the ubiquitous Skype service for GP to specialist video consultations.
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.
As one would expect so close to the launch of the controversial national health records system, there’s no hiding from PCEHR developments as much of the coverage provided in this edition’s Bits & Bytes news section highlights. In fact, the moving feast that is the PCEHR is likely to be the dominant theme of discussion amongst delegates at HISA’s preeminent eHealth event, HIC2012. To kick off in Sydney later this month, Kate McDonald profiles some of the event’s highlights in the latter pages of this edition, including a profile of outspoken international keynote speaker, Dr Scot Silverstein.
Looking ahead To be released in mid-August, the next edition of Pulse+IT will take a look at the post-launch state of the PCEHR. While much work remains to be undertaken and scepticism abounds, the weeks following the official launch of the service on July 1 are nevertheless likely to be eventful; several developers of general practice clinical software products are expected to unveil initial iterations of their PCEHR interfaces, with the transition arrangements for the Wave 1 and 2 eHealth pilot sites to commence. The edition will also feature significant pre-event coverage of the Health Information Management Association of Australia’s national conference, which is to be held on the Gold Coast over three days, starting on October 29. In the meantime, those interested in keeping abreast of the latest Australian and New Zealand eHealth developments are invited to sign up to our free eNewsletter service, or 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 to 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
QUESTIONING TELEHEALTH AND SUSTAINABILITY Australia has entered the telehealth arena with a number of pilot studies, many funded by government and looking at disparate aspects of the healthcare system. This, however, leads to fragmentation and no clearly defined plan for telehealth uptake. What is needed are large scale, focused services that bridge not only the urban-rural divide, but between the acute and primary care sectors, and primary care and allied health.
MICHAEL GILL Organisation Performance Consultants migill@organisationperformance.com.au
This short paper takes the clinical benefits of telehealth and remote monitoring as given1. The purpose here is to question the current lack of business thinking and consequent commercial sustainability of telehealth in this country. Telehealth in Australia is fragmented, too focused on endless pilots and is often devalued by the systems being used for administrative internal processes instead of clinical usage. Large-scale, focused national and regional telehealth services have the ability to make a difference2. The recent report3 by The Boston Consulting Group highlights the tremendous potential of the growing Internet economy. Focusing on the three or four national health priorities and redeveloping the care delivery model and clinical protocols4 specifically to allow and support health-at-a-distance, telehealth will positively impact service providers, families and patients.
About the author Michael Gill has considerable experience across the Australian health sector with special reference to telehealth opportunities associated with chronic care, aged care and mental health. He is the HISA Chair of the Australian Telehealth Conference being held in Melbourne at the end of August.
Where much good work has commenced, none of it appears to be linked to a national perspective or even to a national rollout. In this country we do not have a government position on telehealth deployments that are national, aligned with known health priorities and configured in such a way so as to maximise emerging resources like the NBN or major new hospital builds.
The private sector has been fragmented in its response to this issue until recently, when a cross section of health industry representatives released Australia’s first national telehealth strategy5. There is a myth which, crudely stated, is as follows: left to the market, telehealth services will emerge supported by a little public seed money. There needs to be national plan, national resources and a deliberate attempt to provide a set of national telehealth services if we in Australia are to effectively address our dwindling healthcare budget. Telehealth should be about delivering a targeted health service to large numbers of patients in order to reduce the pressure on the acute care system and to provide better care coverage at the primary level. Given that particular system benefit, the tactical benefit is to deliver a return on investment to those practitioners actively engaged in delivering the service6. From a GP or allied health perspective this implies a revenue increase. At an operational level, the primary benefit is in patient access to treatment and convenience. Simply encouraging a series of ad-hoc pilots and projects does not necessitate a defined benefit being achieved across all three levels, which is
“There needs to be a national plan, national resources and a deliberate attempt to provide a set of national telehealth services if we in Australia are to effectively address our dwindling healthcare budget.” Michael Gill
the key requirement if regional or national sustainability is to be achieved7.
Siloed approach limits access The current dialogue across health practitioner groups and policymakers is centered on addressing the urban-rural divide in terms of health service access. That is, extending diagnostic expertise from its metropolitan concentration out towards the rural areas. I argue that this view is too restricted. The main health divides in Australia are between acute (the hospital sector) and primary (GPs and specialists) and between primary and allied health. While rural access is certainly a major issue, it should not of itself be the redress target for online real time diagnostic video and data services. It is the siloed approach to healthcare delivery in Australia that encourages duplication, limits access and fails to address the need for team-based care arrangements, particularly for the chronically unwell. Focusing just on the rural-to-urban divide ignores the fact that key nodes within the system such as GPs and allied health professionals are also small to medium business. The development and deployment of a national set of telehealth services (for example post-operative wound management, physiotherapy for rheumatoid arthritis patients, maternity services and oncologist consultations for cancer sufferers) will require numerous design and technical features to be addressed8. Many of these are well known and addressable9. What has not been considered in detail across much of the literature is the need to achieve sustainability, or putting it another way, return on investment. Nationally, the use of business case development based on costbenefit analysis to support the deployment of telehealth diagnostic
video and its associated data transfer and display is decidedly rare10. In an Access Economics ‘Telehealth for Aged Care’ report dated November 2010, a cost-benefit analysis was provided around the introduction of telehealth intervention into existing aged care programs. Results demonstrated that over the course of the intervention (2012-2013/2013-2014), a benefit-cost ratio (BCR) of 1.61 to 1 (a 61 per cent return on investment) was possible. A recent paper dealing with tele-oncology consultation in rural Australia provides some financial insight (section 4.3)11.
Overcoming the practical barriers for GPs The motivation for general practitioners to maintain a subscription fee-based service is unlikely to be viable as the time to break even based on volume is too uncertain for any pilot approach. The need to buy outright or lease the technology is seriously limited by the practicalities associated with the “other end”, notably scheduling and booking. Consider this metaphor: selling a single wrench is much harder to do than to sell a box of tools that also contains a wrench. Global literature research reveals that much of all telehealth thinking has been either about the technology, a very specific innovation or about the clinical process to prove the health outcome. I argue that there is a requirement to add an additional service value to video-delivered diagnostic consultation from the perspective of the medical practitioner in order to move towards sustainability. Put simply, telehealth needs to have an additional attached service to make it financially appealing to frontline health professionals (GPs and allied health) who operate mainly in the private sector. Such a service add-on needs to either be fully integrated in a technical sense or have the ability to utilise the
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Internet carriage to actually deliver the service in parallel in real time. Some possible examples include linking pathology services, online dementia assessment tools and automated electronic prescriptions. Visualising the normal operational day for a GP practice in Australia involving up to four practitioners and associated support staff reveals the following. • • • • • • •
The practice seeks at least a 15 per cent return on investment Limits to this primarily relate to: A process design relatively unchanged for a century A paper flow process which consumes 20 per cent of a full-time equivalent administrative position Five or more pieces of paper for each simple consultation 15 per cent of administrative office space for storage Three pieces of paper for each allied health link
Field research and focus groups with GPs12 suggest that hosted ICT services like telehealth simplify office processes to provide a 12 per cent gain in clinician and administrative staff time. Doctors and support staff save 12 per cent and 25 per cent of time respectively on case management for chronically ill patients. For mobile doctors dealing with aged care visits and other home visits, telehealth and other mobility services offer a 12 per cent efficiency improvement.
Sustainability
known as a medical practice. Some other benefits across three tiers identified previously that will need to be captured, measured and realised are shown in the table at the bottom of this page. The table suggests the main elements needed to build a business case taking in to account the three levels of focus detailed previously. The weighting reflects what is important from a whole system perspective and will change depending upon specific clinic focus areas. While public acute care services can ‘load’ video in to their current budgets and exploit under-utilised infrastructure, the reach of the service to private GPs and specialists will be frustrated unless these groups obtain a positive cash flow.
Conclusion In the US, the home-enabled healthcare market should be thriving but only accounts for about three per cent of national health spending14. In Australia, a similar low rate of adoption is entirely likely unless the misalignment of incentives, the clinical value proposition, rate of patient adoption and a return on investment for providers are properly addressed via a detailed business plan. Just as importantly, pilot projects and funding need to be abandoned in favour of national or regional projects based on a staged but full rollout of agreed key clinical services. Adopting large-scale approaches enables the take-up volumes needed for financial sustainability.
References
These observations suggest two key ideas about building a sustainable service — value adding and saving and harvesting process time in a busy small to medium business otherwise
A comprehensive list of references is included in the online version of this article, which is available at the Pulse+IT website.
Possible Weighting13
Regional or National Telehealth System
GP Practice and Practice Nurse
Patient at Home
40%
Patient volumes being accessed via telehealth services
Additional income and incentives to justify expenditure together with space opportunity costs
Simple step connectivity and acceptable fee value
30%
Reduced hospital admissions for specific clinical groups
Rapid scheduling and billing control and adequate maintenance support
Reduced presentation at GP clinic or hospital over time for the condition
10%
Improved GP support for aged care residents
Adequate patient take-up rates over time
Reduced waiting times for clinical support, especially after hours
10%
Improved community nurse clinical support.
Population of specialist referral points in place
Ability to leave a message for the GP such as a request for script renewal
10%
Take-up of appropriate MBS items.
Population of allied health referral points in place
MBS or private insurance base fee coverage
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Guest Editorial
ELECTRONIC MEDICAL RECORDS CAN TRANSFORM HEALTHCARE
There is a growing international consensus that electronic medical records (EMRs) are essential to transform healthcare. The benchmarking of progress around the world in adopting EMRs suggests that Australia is dragging its heels. At the recent HIMSS Australia Forum 2012, international eHealth leaders showcased the evidence for the EMR.
BRYN EVANS Director: JEMS Consulting bryn.evans@ozemail.com.au
About the author Bryn Evans has many years’ experience as a chief executive of a clinical software supplier, and chief information officer in public hospitals. He is also an author, and writes extensively across a range of categories and genres, notably in the areas of sport, travel, history, information technology and eHealth.
The theme of the HIMSS Australia Forum 2012 was that healthcare delivery can be transformed through information technology, business intelligence, eHealth and the electronic medical record (EMR). More than 100 executive leaders from the health industry attended the conference in Sydney on May 10 and 11, with delegates from the Asia Pacific, North America and Europe exchanging their ideas and experiences on how to innovate and to build ICT integrated healthcare with EMRs and other eHealth systems for intelligent hospitals of the future.
where every patient is connected to their mobile personal device, whether smartphone, tablet, ultrabook, or whatever device that future technology may bring, Dr Chang said. In such a future Severance Hospital has a startling vision to achieve zero medical errors and adverse events. The transformation to quality care depends upon the correct identification of the right patient at the right place; the prescribed medication for the right patient in the right doses; a timely consultation with the right clinician; and patient care with smart monitoring and surveillance.
Medication management drives the future
In Singapore hospitals, a major success has been the implementation of electronic medication management. Robotised pharmacy departments dispense drugs in sealed bar-coded packs with unit doses, which are delivered to each patient, according to Dr Chong Yoke Sin, chief executive of integrated health information systems with the Singapore Ministry of Health.
Information technology is not an end in itself. An intelligent hospital must in the future deliver a personal, customised service to its patients, and provide the highest quality care both in the hospital and at home. To support accurate diagnosis and treatment, an electronic medical record (EMR) is essential, according to Dr Byung-Chul Chang, professor of surgery at Severance Hospital in South Korea. Dr Chang identified an urgent need to reduce adverse medication events and errors in hospitals. In a transformational journey towards being an intelligent hospital, Severance Hospital looks towards a global future
Singapore’s electronic medication management aims for the ‘Five Rights’ — the right drug with the right doses, via the right route at the right time, to the right patient. Some $5-6 million has been expended for each hospital on the closed loop medication management (CLMM) system. It has been calculated that by reducing adverse drug events, CLMM
delivers a return on the investment to a hospital in just one year.
The EMR adoption model Much of the conference revolved around the HIMSS electronic medical record adoption model (EMRAM), which describes eight stages of EMR maturity, from the base of zero to its peak at Stage 7. Measurement by a healthcare service of its progress in implementing an EMR against EMRAM provides a catalyst, a benchmark and common language for transforming healthcare through information technology. In Singapore, the closed loop medication management system has contributed to the country being ranked very highly
against the EMRAM model; at 4.89, it is very close to Stage 5, and aspires to advance to Stages 6 and 7. At EMRAM Stage 7 there is true sharing of patient data, which improves process performance, quality of care, and patient safety.
identified in brief summary four main types of benefits arising from EMRAM’s eight stages:
Data mining is envisaged to be used in Stage 7 to analyse care data to improve performance, and advance clinical decision support protocols. And beyond the scope of the EMRAM model, Singapore has a 10-year master plan to integrate all its healthcare services, and better enable the translation of biomedical research advances into healthcare delivery.
•
•
•
•
By implementing the EMRAM model, Klaus Boehncke of PricewaterhouseCoopers
Stages 0 – 2: Increased efficiency and better productivity from information sharing and reduced transactional costs Stages 3 – 4: Improved error detection resulting from electronic orders and results, and clinical documentation Stages 5 – 6: Better prevention, care planning and treatment eg improved error prevention through closed loop medication management Stages 7: Prediction, where health information is aggregated and analysed, for continuous and integrated care delivery improvement
“We are all patients in the end.”
sydney 30 july - 2 august 2012
hic 2012
Keynote speaker Regina Holliday is an artist and patient advocate. Her work depicts the need for clarity and transparency in medical records. Her mural ’73 cents’ became part of the national healthcare debate in the US and was featured on BBC, CNN, CBS, AOL and the Voice of America. Her presentation ‘The Writing on The Wall’ will be a passionate and powerful validation of why you do what you do. Not to be missed!
Regina Holliday Patient Artist Advocate, The Walking Gallery
australia’s premier e-health conference
Health Informatics - Building a Healthcare Future through Trusted Information
www.hisa.org.au/hic2012
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US laws drive EMR adoption Michelle Glenn, a senior director of HIMSS Analytics in the US, spoke of the EMRAM model in both acute and primary care, and how it is closely linked to the US government’s Meaningful Use eHealth program. Ms Glenn explained how the introduction of the program, under the HITECH Act, was aimed at driving both greater cost efficiency and quality of care. Through the adoption of EMRs, and more than $US3 billion paid out so far to complying healthcare providers, the Meaningful Use program is beginning to change US healthcare, she said. The more than $US23 billion on offer has seen an increased rate of adoption of EMRs in recent years arising. There is also associated evidence that hospitals with EMRs for clinical support have lower costs, increase their rate of return on investment, and improve their patient outcomes.
NSW Health EMR leads Australia – or does it? In recent years NSW has extended its EMR implementation across the state. In his presentation to the conference, Mike Rillstone, chief executive of HealthShare NSW, said he saw EMRAM as a framework for explaining the NSW eHealth strategy. In NSW, the first phases of EMR and medical imaging investments have created the most mature clinical systems footprint in Australia, covering 60 per cent of hospitals and 80 per cent of beds. Although NSW Health leads the country with its statewide EMR implementation, Australia as a whole lags behind other OECD countries in adopting eHealth technology. Despite its EMR rollout, NSW itself in aggregate ranks very low at only 1.49 on the EMRAM model, and as a minimum must make electronic medication management a priority if it is to emulate
progress such as in Singapore. Mr Rillstone said healthcare leaders are in the main still ‘transactional’, working within the organisational culture as it exists.
of subjectivity and judgement involved, particularly to arrive at an aggregated score for a whole state or country.
Australia’s PCEHR and eHealth strategy
A number of individual health services and hospitals, especially in Australia’s capital cities, would score above the level of 1.49. However, it has to be recognised that key requirements in the middle stages of the EMRAM model are clinical documentation and medication management, which are not widespread in Australian hospitals. The result is that in benchmarking against EMRAM, Australia is well short of world’s best practice.
Andrew Howard, head of Australia’s PCEHR project, explained the ambitious initiative, which is a cornerstone of the federal government’s eHealth strategy. Although the PCEHR is scheduled to launch on July 1, significant challenges to its adoption remain and a slow take-up over the next few years is envisaged.
Significant investment and strategic commitment at the highest level will be needed to lift Australia’s score up into EMRAM stages 3 and 4. Investment in the PCEHR is just one component in Australia’s development of eHealth, and it risks becoming a distraction from all healthcare providers’ core challenge.
The PCEHR is another technology tool for enabling change in healthcare delivery, but transformation depends upon how clinicians use it. At the same time as facing the PCEHR challenge, individual health services in Australia must accelerate the upgrading of their EMRs, or in some cases implement a new EMR system, to advance their eHealth capability as measured by the EMRAM model.
Desirable as it may be, the PCEHR is no silver bullet, for it depends upon EMRs for its information. It can be argued that what is needed by all health services is an increased allocation of funds from within their existing budgets to an EMR and eHealth if they are to climb faster up the EMRAM ladder.
For Australia to make faster progress up the EMRAM ladder, they must become transformational leaders, or in the words of Stephen Covey, author of The Seven Habits of Highly Successful People, ‘…to transform people and organisations in a literal sense – to change them in mind and heart’.
Transforming Australia’s healthcare with the EMR In those countries where the EMRAM model has been used to rank and benchmark progress against its eight stages, the US has a score of 3.21, while Singapore leads with a score of 4.89. In comparison, NSW in aggregate is assessed at only 1.49, and languishes at the bottom of the table behind such countries as Canada on 1.88 and Germany on 1.62. In making assessments against the EMRAM model, there is clearly a degree
At the conclusion of the conference, Steven Yeo, vice president of HIMSS Asia and Middle East, said the EMRAM model is increasingly being seen worldwide as an excellent tool to identify best practices and opportunities for improving clinical, financial and operational outcomes.” “It helps us explain our message to governments, managements and consumers, that EMRs and eHealth can facilitate the transformation of healthcare’s delivery and quality to every patient – anywhere and anytime,” he said. “The increased adoption of ICT and EMRs drives better health outcomes.”
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PCEHR-enabled GP software to be rolled out by vendors in September: DoHA The federal government is expecting the roll out of GP desktop software with the capability to upload shared health summaries to the PCEHR to commence in September.
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Speaking at a Senate Estimates hearing in Canberra in late May, the deputy secretary of the Department of Health and Ageing (DoHA), Rosemary Huxtable, confirmed that the only functionality available on the launch date of July 1 will be the ability for consumers to register for a PCEHR, either by telephone or in person at a Medicare shopfront. Ms Huxtable said an online registration capacity was being worked on but it would probably not be available from 1 July.
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For practitioners, the ability to upload clinical documents to a patient’s PCEHR will not begin to be available until some time in September.
‘“From day one, the focus is very much on consumer registration, so it will be the capacity of consumers to ring and register,” Ms Huxtable said.
MBS and PBS information, immunisation status and organ donor registration, will also be available for consumers to view in the months after 1 July.
“There will be an online registration function which we are pushing very hard to have available from 1 July but it may come some weeks after that. Once a consumer has registered they will be able to through into the consumer portal and put information into their record … That is the first tranche of functionality.
The CEO of the National E-Health Transition Authority (NEHTA), Peter Fleming, said the members of the GP software vendors panel were currently working through the second release of specifications.
“The next tranche of functionality is around provider registration and the capacity for providers to upload information, and that will be in a few months of 1 July. The GP software specification issue [which delayed testing earlier this year] means it is more likely to be September.” She said other information held by the Department of Human Services such as
“There are a group of vendors who are aiming to be ready for July, and also over and above the GP desktop panel, two companion tools that are also aiming to be ready,” Mr Fleming said. “Obviously they are in test mode and once they are ready it has to go through a process so that will take a little while, but we are working very strongly on those tools. “[The] GP desktop panel... [is] working to reflect all
of the specifications in the package. Once that is done it goes to a national rollout.” DoHA secretary Jane Halton had earlier told the hearing that the fact the legislation enabling the PCEHR had not then passed the Senate will not necessarily have an effect on the rollout. “Essentially, the legislation is the cornerstone for the rollout, but I think [Health Minister Tanya Plibersek] and I have been at pains to say publicly, the first of July is the beginning; it is not the end point,” Ms Halton said. “We don’t expect everyone to be registered on that day, we don’t expect the capability to be available on that date.”
Mr Fleming said NEHTA and DoHA were expecting a slow rollout. “The people we will be dealing with first are those who are in our Wave sites, and specifically the Wave 1 sites,” he said. “As part of the process, come July first, when national infrastructure is available, they will then start the process of migrating across to that. “Through the Wave sites, we’ll be looking to implement it as quickly as possible. There are three Wave 1 sites, they cover East Melbourne, the Hunter and the Brisbane area. From memory the total population catchment of that group … is about 1.6 million people.
“We have targets in terms of how many practitioners will have access and how many consumers.” Ms Huxtable said that once a consumer is registered they will be able to go to a consumer portal and add their own information. “There is also the capacity for them to put in their allergies or adverse reactions, things like complementary medicines, so that is information they can put into the record. “The capacity for the record to grow to include the upload of clinical information from a GP does relate to other functions that will come on stream thereafter, so it is an evolutionary rollout. The first of those relate to provider registration and the capacity of providers to upload records. “The capacity to have that happen more broadly outside the Wave sites, we are probably looking at about September – that’s when the GP software rollout will occur, that’s the current plan.
Peter Fleming
“[T]hen you get to the point where records are populated with shared health summaries, event summaries and the like, and then over time there is a shared function that is added around medication management. It is an evolutionary process.”
Queensland to build EMR for Cape York communities The $35 million in funding allocated to Queensland Health for an unspecified eHealth project in the May federal budget will go towards building an electronic medical record in Cape York, the Queensland government has confirmed. Queensland Health’s chief information officer, Ray Brown, said the EMR will be delivered to 12 primary and community health facilities in the Cape York region. “Already Queensland Health’s eHealth Program has piloted a point of care system in two Cape York facilities with funding received from the Closing the Gap initiative,” Mr Brown said. Queensland Health would not reveal the name of a preferred vendor for the solution or whether a tender process will be undertaken. Industry sources say Cerner’s Millennium platform has been chosen for the statewide EMR that Queensland is building under its $243 million eHealth strategy, but it is not clear whether Cerner has been chosen for the north Queensland project. Mr Brown said securing the federal funding meant the department will be able to build on the recent rollout of its in-house built The Viewer EMR viewing solution. The Viewer is a read-only web-based application that provides consolidated information on patient data from existing Queensland Health systems in one place. It was rolled out to the Torres Strait and Northern Peninsula Area Health Service District in April. He said the new EMR will be designed to link to the PCEHR and the benefits would include improved patient registration, order entry, review of results from diagnostic testing, clinical notes, care planning, medication management, billing and reporting of service usage.
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PCEHR terms and conditions agreement close: RACGP The Royal Australian College of General Practitioners (RACGP) is close to approving the federal government’s proposed terms and conditions for healthcare practitioner participation in the PCEHR. The terms and conditions have been repeatedly revised by the Department of Health and Ageing (DoHA) due to fears from medical groups that doctors taking part in the PCEHR would be liable for breaches of security. The RACGP and the Australian Medical Association (AMA) have also raised the question of intellectual property rights over patient medical records created by doctors. RACGP president Claire Jackson said the college would review the latest iteration of the terms and conditions, which has been thrashed out by DoHA and the doctors’ groups in May and June. Professor Jackson said the college would “review the final iteration ... and anticipates key concerns voiced throughout the development of the document, including the relevance of intellectual property in providing care and protective liability for general practices, will be addressed”. Pending final review and approval of the agreement, the RACGP will contribute to the development of explanatory documentation to support healthcare provider organisations to understand the roles and responsibilities that the agreement will imply. “It’s important that GPs and other healthcare providers participating in the PCEHR system are not only familiar with the mandatory legal requirements, but are equipped with simple explanatory materials providing the context of how the requirements will be enacted,” she said.
South Australia pushes the button on statewide electronic health record South Australia has committed an extra $142.6 million over 10 years in its recent state budget for the development of its Enterprise Patient Administration System (EPAS). The EPAS, announced in mid-December last year and funded by $318 million from the state government and $90m from the federal government, is being developed by Allscripts Healthcare Solutions. The full EPAS solution will be rolled out to all metropolitan hospitals and services, as well as Glenside Hospital and the new Royal Adelaide Hospital, SA Ambulance headquarters, GP Plus health care centres and GP Plus super clinics, as well as Mount Gambier and Port Augusta hospitals. The agreement with Allscripts includes an enterprise licence to potentially roll out full EPAS functionality to all SA Health sites in the future. Bill Le Blanc, general manager of eHealth Services for SA Health, told the CeBIT conference in Sydney recently that the first site will be going live in the first months of the next calendar year. While Mr Le Blanc would not go into detail about the
EHR rollout, the SA Minister for Health, John Hill, said in a statement announcing the project last year that the two country hospitals – Mount Gambier and Port Augusta – will be the first to get EPAS in 2013 with the metropolitan hospitals connected in 2014. As part of the statewide program, computers are being rolled out to every bedside in the state, allowing clinicians to access clinical information at the bedside and patients to access entertainment options. The government has partnered with Telstra in this scheme, with entertainment available on a pre-paid basis.
“To my knowledge we are the first jurisdiction globally to deploy bedside computers, end to end throughout the whole health system.” Mr Le Blanc told CeBIT that this should be complete in August. “To my knowledge we are the first jurisdiction globally to deploy bedside computers throughout the whole health system.
“We are half way through that deployment ... we have 1500 devices online and we will finish the deployment by August of this year. Delivering clinical information to the clinicians at the bedside is one of the key enablers for the changes going forward in the system.” As part of the EPAS implementation, GPs with admitting rights to SA hospitals will have access to a new clinician portal, where they will be able to view patient information, orders for tests and medicines and review test results. Patients will also have access to summary information including their appointments through a web-based patient portal. The EPAS is being designed so it can link to the national PCEHR. The budget also included $30.4 million over two years for a new digital system for pathology testing called the Enterprise Pathology Laboratory Information System (EPLIS). There will also be a new Enterprise System for Medical Imaging (ESMI), with the budget allocating $18.7 million over three years for the storage and distribution of x-rays, ultrasound images and CT and MRI scans.
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Health systems of the future workshop for WA The Western Australian branches of the Health Informatics Society of Australia (HISA) and the Health Information Management Association of Australia (HIMAA) are co-hosting a Health Information and Technology WA (HITWA) conference in Perth on October 19. HITWA is a biennial event that attracts practitioners, academics and industry professionals with an interest and passion for all things health informatics. HITWA 2012 will be the fifth consecutive forum to be held in Perth. In addition to several plenary sessions, the organisers are also running two workshops, one on enabling eHealth decision support and the other on addressing barriers and challenges in health systems of the future. Workshop 1, Enabling eHealth Decision Support, will be facilitated by Nigel Chartres and will cover projects currently underway in WA that make use of or contribute to the national eHealth system to improve clinical decision making. “The intention of this workshop is to both inform the community on what is going on in WA and to provide participants with ideas that can be adopted in their own healthcare environments,” HISA’s conference coordinator, Carolyn Lawson, said. Workshop 2, Health Systems of the Future – Addressing Barriers & Challenges & Creating Opportunities into the Future, facilitated by Trish Williams, aims to “look over the horizon” in terms of how we best go about addressing current and perceived barriers to eHealth adoption. “The intention of this workshop is, ideally, to have a couple of ‘provocative’ type presentations so that we can facilitate some lively discussions about preferred futures,” Ms Lawson said.
Clinical IT safety under inspection in TechWatch study The new NHMRC Centre for Research Excellence in eHealth has launched a 12-month study into the safety of IT systems used in general practice, setting up a TechWatch website to track critical incidents. The study, jointly led by Farah Magrabi, Michael Kidd, Teng Liaw and Enrico Coiera from the University of NSW and Flinders University, aims to evaluate the safety of using information technology in routine GP work. “Computers have huge benefits in general practice in terms of the quality, the safety and the efficiency of care,” Dr Magrabi said.
dosage from drop-down menus to incidents in which prescribing software fails to generate a warning about an allergy or contraindications to medications even when they are recorded in the patient’s medical notes. “It could also be problems related to networks being down, printers not working — very basic things really but they do delay care, they do affect the quality of care and sometimes they have implications,” she said. By tracking these incidents, interventions can be made to solve particular problem, she said. “If we start to see a pattern or something emerging
we would definitely take that information to the appropriate people. “One of my co-investigators, Professor Michael Kidd, a couple of years ago did a study looking at all patient safety incidents, not just those related to IT, and in that study they did find problems and had to call in a particular drug company relating to a problem with packaging of a vaccine.” Invited participants are being asked to report incidents via a free 1800 TWATCH phone number (1800 892 824) and also via the TechWatch website. Participants can register for an account and can go online to look at the results.
“But at the same time, problems with computers can also introduce errors that may harm patients. What the TechWatch study is aiming to do is to look at the safety of IT in general practice, and we want to do that in routine care.” The researchers have selected a random sample of 4000 GPs throughout the country and are inviting them to report critical incidents involving computers in their practice. Dr Magrabi said it was thought there were a number of incidents that routinely happen, from basic errors such as selecting the wrong
Farah Magrabi
“We will be providing feedback to the participants about their own results, so by going online they can see some of those pictures that we can’t describe over the phone,” Dr Magrabi said. The researchers are asking participants to submit reports in de-identified form, and say any information obtained in connection with the TechWatch study that can be identified with a
participant will remain confidential and will be disclosed only with permission.
It is anticipated that the study will last 12 months and will hopefully be rolled out nationally.
TechWatch has been declared as a quality assurance activity under the Commonwealth Qualified Privilege Scheme, meaning that the identity of the GP and the information they provide to the study database is protected and cannot be subpoenaed in legal action.
Information collected though the TechWatch study will be used by researchers to gain a better understanding of how to improve the safety of using computers in clinical practice and to guide the safe design and use of information technology in general practice.
Mobile is global but doctors aren’t too keen: PwC An international study into the emerging market of mobile health (mHealth) has found that while the majority of consumers believe mobile technology will improve the convenience, cost and quality of their healthcare, doctors were reluctant to encourage patient use of mHealth and a large minority believed it would make patients too independent. The study, conducted by the Economist Intelligence Unit (EIU) on behalf of PricewaterhouseCoopers, involved two surveys – one of consumers and one of doctors and government and private payers – in 10 markets covering the majority of the world’s population. The EIU examined the current state and potential of mHealth
and the barriers to adoption and opportunities for companies seeking growth in the mHealth market. It found that roughly onehalf of consumers predict that within the next three years, mHealth will improve the convenience (46 per cent), cost (52 per cent) and quality (48 per cent) of their healthcare. Consumers in emerging markets used mobile services the most, with 59 per cent having used at least one mHealth application or service, compared with 35 per cent in the developed world. Nearly half of consumers said they expect mHealth to change the way they manage chronic conditions (48 per cent), their medication (48 per cent)
and their overall health (49 per cent). Most expect mHealth to change the way they seek information and and half expect it to change the way they communicate with doctors. Among consumers who are already using mHealth services, 59 per cent said they have replaced visits to doctors or nurses through mHealth. Doctors and payers, on the other hand, were far more cautious in their outlook, the report found. Only 27 per cent of physicians encourage patients to use mHealth applications to become more active in managing their health, and 13 per cent of physicians actually discourage it. Forty-two per cent percent of doctors surveyed worry that mHealth will make patients too independent.
$50m to Medicare Locals for PCEHR implementation The federal government has allocated an extra $50 million over two years to assist Medicare Locals to help GPs use the eHealth records system. Health Minister Tanya Plibersek said the funding was part of a package to support doctors to help roll out the new system. The extra funds come on the back of a change to the eHealth Practice Incentive Program (PIP) announced in the May federal budget, which will now require GPs to participate in the PCEHR system to become eligible. The government has also released more details on how the changes to the PIP will work. Ms Plibersek said that from February 2013, up to $50,000 will be available to each practice that shows it has a number of capabilities. These include secure messaging, integrating healthcare identifiers into electronic practice records, using data records and clinical coding of diagnoses, the capability to upload Shared Health Summaries and Event Summaries using compliant eHealth record software, and electronic transfer of prescriptions to a prescription exchange service. Ms Plibersek said the $50m for Medicare Locals will enable them to provide practical training to general practices and to drive awareness and consumer literacy of the potential of eHealth records at a regional level. The chair of the Australian Medicare Local Alliance (AML Alliance), Arn Sprogis, said the funding was a good start. “This investment over the next two years will significantly shift the momentum for developing the PCEHR program for patients and general practices,” Dr Sprogis said.
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NPS launches online hub for antidepressant information NPS has launched a new online knowledge site for consumers providing information on depression and antidepressant medications. More calls are answered by NPS Medicines Line pharmacists about antidepressants than any other class of medicine, the organisation said. NPS clinical adviser Philippa Binns said depression is second only to high blood pressure as the most common chronic problem seen by Australian GPs, and two-thirds of people seeing their doctor for depression are given a prescription for antidepressants. People who called Medicines Line about antidepressants most often wanted to know about the potential for interactions with other medicines when they taking an antidepressant, such as possible interactions with cough and cold preparations and complementary medicines. They also asked what side effects they were likely to experience with antidepressants, whether problems they were experiencing might be related to their antidepressant medicines, and safety information about using these medicines in pregnancy and breastfeeding. The new NPS knowledge hub provides tips on finding the right treatment for individuals and what to do about side effects from an antidepressant; an A-Z listing of different antidepressant medicines with information about effectiveness, side effects, interactions, and who needs to take extra care with them; information on how to avoid side effects and symptoms when making changes, and an overview of cognitive behavioural therapy (CBT) as well as lifestyle changes and other supportive treatments that can be of benefit.
PCEHR to save $11.5 billion over 15 years, Deloitte modelling shows The Department of Health and Ageing has released a summary of economic modelling undertaken by Deloitte in 2010-2011 into the cost benefits of the PCEHR, showing the net direct benefits are expected to be worth approximately $11.5 billion over 15 years. The figure was used by the Minister for Health, Tanya Plibersek, in a speech to the Committee for Economic Development of Australia (CEDA) on May 16. The report was prepared by Adam Powick, managing partner of consulting at Deloitte, who was also the lead author of the landmark 2008 National eHealth Strategy. Mr Powick said the report was prepared in confidence and was not available to the public. While it was written in 2010, the benefits are still valid from the launch date of July 1, 2012, he said. “What we have is a profile of benefits which is valid from whenever you decide is the starting point. The beginning of the implementation of the PCEHR is the beginning of that process.” Ms Plibersek said the government estimates that eHealth will save around $11 billion over 15 years. “That’s a long-term return of $11 billion for a government investment
which includes around $465 million over the last two years, and another $233 million in the next two. “However you look at it, that’s pretty good bang for your buck.” In its summary, Deloitte said the $11.5 billion comprises approximately $9.5 billion in net direct benefits to Australian governments and $2 billion in net direct benefits to the private sector. “The economic modelling considered both the benefits that accrue from the direct investment in the national PCEHR system as well as the benefits that accrue from investment by the broader health sector that is catalysed by the Commonwealth Government’s investment in the national PCEHR system,” the report states. It found that the benefits would accrue from two key areas: reduced avoidable hospital admissions and GP visits due to the more effective medication management, and improved continuity of care. Deloitte said it had developed two scenarios to come to its overall figure, one a base case investment scenario in which no national PCEHR system was built but taking into account other eHealth
capabilities. The second was a cost-benefit model in which the PCEHR was built, taking into account the extra eHealth capabilities that Deloitte expects to be driven earlier by the PCEHR. “By comparing the benefits that would be realised for different technologies in the PCEHR scenario with the Base Case scenario the analysis is able to identify the benefits associated with the national PCEHR system,” Deloitte said. It said the economic impact assessment focused on identifying the incremental health and economic benefits that could be realised from the implementation of a national PCEHR system as distinct from the benefits of other eHealth investments occurring in the Australian landscape. “These other eHealth investments include the core standards and eHealth foundational infrastructure being developed by NEHTA; investments that have already been proposed or implemented by Australian governments, such as the implementation of electronic medical records, ePrescribing, eDiagnostics and care plan capabilities; and investments that have already been proposed or implemented by commercial providers.”
How do I do it? While developing the modelling, Deloitte said it had made some assumptions of numbers taking up the new system, both in terms of healthcare providers and consumers. It said that with the scope of changes happening in eHealth, a nationally uniform rate of technology take-up is not expected. “It is expected that there will be a faster rate of adoption and take-up within
eHealth site regions, and a slower rate of take-up in the rest of the country. It has also been assumed that there will be comparatively higher rates of take up by GPs, hospitals, pharmacies and aged care providers, with lower rates amongst specialists and allied health providers.” In terms of consumers, Deloitte assumed that a percentage of consumers will never choose to
register for a PCEHR, and that the rate of participation by consumers will lag the aggregate participation rate for healthcare providers. Overall, Deloitte estimates that reducing avoidable hospital admissions and GP visits due to more effective medication management will save $10.237b over 15 years, with improved continuity of care saving $1.308b, for a net benefit of $11.545 billion.
Telehealth support officers up for grabs for Medicare Locals Expressions of interest are being sought from Medicare Locals in outer urban and rural and remote regions to secure the services of one of 13 telehealth support officers (TSOs) being funded to assist practices to build telehealth capability. The TSOs are being funded by the Department of Health and Ageing through the Australian Medicare Local Alliance (AML Alliance). The AML Alliance’s CEO, Leanne Wells, said 13 outer urban rural/remote Medicare Locals will be funded an average of $115,000 over the period of the program, which will provide a full-time time salary for a telehealth support officer plus travel and expenses for practice visits within their regions.
“There will also be small grant opportunities for all Medicare Locals to provide a telehealth event such as workshops and practice road shows, which aim to promote telehealth activities,” Ms Wells said. The primary role for TSOs will be to identify areas of greatest need for telehealth training and support for their region and the areas mostly likely to adopt telehealth practice. TSOs will work with clinicians, practitioners and practice support staff within the primary care sector to build telehealth capacity, readiness and to assist with the adoption of telehealth practice and uptake. “TSOs will be provided comprehensive support and education and technical
understanding by AML Alliance and the Australian College of Rural Remote Medicine but will bring to their roles an important understanding of general practice systems which will help to support the integration of telehealth activities into everyday practice,” Ms Wells said. “Eligible MLs have been asked to complete an expression of interest application which looks for an understanding of their region’s demographics including population, health service access and local health issues. “They are also being asked to demonstrate an understanding of local clinical service provision which is most likely to benefit from the inclusion of telehealth.”
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Healthways trials glucose readings through phones Insurance company HCF and telephone health counselling provider Healthways Australia have partnered with Telstra to trial the use of a Bluetooth-enabled glucometer to improve health outcomes for HCF clients. The partnership is running an openended trial to gauge patient acceptance of electronic blood sugar level reporting through the patient’s mobile phone. While the technology is not new, Healthways managing director Tim Morphy said the increasing cost-effectiveness of such devices was making widespread use more of a reality. “The great thing about this is that while this technology has existed for a long time, it has been profoundly expensive,” Mr Morphy said. “There will be far more of this going forward now that the cost structure of these things has become far more palatable for everyone.” Mr Morphy said there was obvious room for other medical devices to be used in a similar way, including blood pressure readers and spirometers. “Healthways is already doing this in the US with scales – doing weight measurements,” he said. “The device is in effect a simple thing but it is the technology and the process by which [data] is captured in the back-end system that is the key.” He said regular measurements for a range of chronic illnesses can be done with any Bluetooth-enabled device that transmits data. At present, reports can be printed out and sent to GPs, or for the client to take it to the GP personally, but the long-term ideas is to be able to share it with them electronically, with the patient’s consent. Mr Morphy said the trial is open-ended and will have six-monthly reviews, and the partners are looking at expanding it to other devices as they come on the market.
Who takes the rap for safety and liability under the PCEHR? The issue of potential liability for misadventure due to errors in the PCEHR was still being worked out with doctors’ professional associations, less than five weeks before the system is about to launch, a Senate Estimates hearing in Canberra was told recently. A clinical lead for the National E-Health Transition Authority (NEHTA), Dr Chris Mitchell, told the Senate Community Affairs committee that medico-legal issues could potentially affect adoption rates and enthusiasm amongst general practitioners. He said while NEHTA had worked with the AMA to develop guidelines and standards for the appropriate use of the PCEHR by clinicians to minimise risk, the guidelines were still in draft form. In answer to a question about “who takes the rap” for the safety of the PCEHR, representatives of NEHTA and the Department of Health and Ageing (DoHA) indicated it was a shared responsibility. NEHTA CEO Peter Fleming told the hearing that clinical safety assessments involved clinical input throughout the process and were signed off by NEHTA’s clinical affairs group.
“The work that we do is about the safety and the efficacy of the system, is it fit for purpose ... all the way through to how it will work in production, what the process is, what are the implications for the clinician using it, so it covers all of those areas,” Mr Fleming said. “It must be fit for purpose. “NEHTA takes responsibility for all of the steps ... We have had clinicians involved in that all the way through. We have been working with [DoHA] very closely and the Chief Medical Officer is involved, looking at what happens on an ongoing basis in the operational context.” DoHA secretary Jane Halton said the Australian Commission on Safety and Quality in Health Care, established early last year, was also involved the process.“[From] a safety perspective about this kind of work, is that in some ways it provides a better opportunity to ‘systematise’ some parts of safety than actually occur in the current world,” Ms Halton said. “In the current world it is a one-on-one arrangement, which relies on the application and the diligence … of the particular clinician or the clinician’s local IT staff. This is a bit like the airline industry – you have a capability to
systematise safety in this world that you don’t in the current world.” Dr Mitchell said that from a GP’s perspective, the quality of information in the PCEHR will be dependent on the quality of data that is held in the clinical software that clinicians are using. He said his involvement in the PCEHR design had made dramatic improvements to the data quality in his own practice. “For example, our practice is involved in a program called the eCollaborative, which is a clinical process of improving data quality in general practice and in preparation to share that information. “Just the simple process of actually printing out my clinical records and giving them to my patient at the end of the consultation makes a dramatic difference to the quality of my notes and my records, and I think you’ll see those same changes going through a whole lot of levels of the health system as information becomes more transparent. “We all need to be very careful about this but we also need to respect that what we have got now is not perfect and what we are trying to build is better than what we’ve got at the moment.”
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Data analysis expert to headline HIKM workshop Italian bioinformatician Riccardo Bellazzi will be the keynote speaker at the 6th Australasian Workshop on Health Informatics and Knowledge Management (HIKM), being held in Adelaide in 2013. HIKM is an established forum held annually as part of Australasian Computer Science Week, and will run from January 29 to February 1, 2013. The organisers are calling for the submission of papers presenting original unpublished work for consideration at the workshop. Professor Bellazzi leads the Biomedical Informatics Research laboratories at the University of Pavia in Italy. His current research interests include intelligent data analysis, biomedical data mining, bioinformatics, information technology infrastructures to support biomedical research, and secondary use of clinical data. He is a board member of the International Medical Informatics Association, a fellow of the American College of Medical Informatics, associate editor of BMC Biomedical Informatics and a member of the editorial board of Methods of Information in Medicine. The workshop co-chairs are Kathleen Gray of the University of Melbourne and Andy Koronios of the University of South Australia, which is hosting the workshop. Papers should address current research topics in health informatics and knowledge management, such as clinical decision support systems and diagnosis/treatment guidelines, health consumer information systems and web portals/tools, evaluation and standardisation in health data and clinical applications, and electronic health records and personal health records. Author notification and registration opens on October 8.
Bundaberg GP gears up to launch Patient Assistance Tool for doctors Bundaberg GP Patrick Byrnes is gearing up to launch his new Patient Assistance Tool (PAT) for chronic disease management this month. PAT, which Dr Byrnes has developed with software engineers from Bundabergbased clinical software company Best Practice, has been designed to generate general practice management plans (GPMPs) and to provide ongoing education to both patients and doctors, particularly registrars. PAT is a step by step approach to chronic disease management and contains a number of “clinics” covering the most common chronic diseases such as asthma, arthritis, coronary heart disease, cerebrovascular disease, COPD, diabetes, chronic heart failure, chronic kidney disease, hypertension, osteoporosis and peripheral vascular disease. PAT is installed on the practice server and on any client workstation, including on touchscreen tablet PCs, Dr Byrnes said. “The touchscreen is ideal for patients to use in the waiting room. The longterm plan is that we can tell motivated patients that they are due for a clinic but if you want to save yourself time, log on and do your patient section at home.”
The ‘Nurse’ section is the first step in the tool and is a checklist approach for measurements and ECGs, which then leads into a ‘coaching’ role to start the patient using the tablet. The ‘Patient’ section allows questions normally asked by the nurse to be completed by the patient, with the questions triggering appropriate educational information. The process then continues in the consulting room where the ‘Doctor’ section of PAT is installed on the doctor’s desktop, with a click option instead of touch. The doctor goes through a series of screens to input further data, and at the end PAT automatically generates a general practice management plan specifically determined by the patient’s and the doctor’s answers. Dr Byrnes said he had taken a different approach from other chronic disease management tools such as cdmNet, which starts with computer extraction of data into a provisional GPMP which has to be edited. PAT, on the other hand, uses a gradual, build up approach for the GPMP. Dr Byrnes said his team had devised a number of interviewing wizards for the tool based on a mixture of cognitive behavioural therapy and motivational
interviewing. The tool interviews the patient about their smoking or exercise habits, for example, before they even see the doctor. This information is summarised in the GPMP as well. “It is called Patient Assistance Tool because it actually starts with the patient,” Dr Byrnes said. “The patient is personally involved. cdmNet does the patient education after the GPMP is edited with your patient education online. PAT does the patient education in small bites on each screen before they see the doctor. “As well, there are extra education and interviewing screens at the end of the patient section that will be triggered if required. So if they don’t need education on diet they won’t get it. If they do need education on diet they get that before they come to the doctor. “The clinics are exportable and importable in XML because we have a blank template option so you can design your own clinic, for example men’s health, and export it to other interested practices. We have designed it so you can extract data for your optional performance indicators.” PAT allows multiple clinics to run at the same time with multiple patients, the only
limit being the number of touchscreens, a technology that is particularly useful for elderly people. While patient-friendliness is important, the actual driving force behind the development of the tool is Dr Byrnes’ years of educating new doctors. He is a full-time GP, a senior lecturer at the University of Queensland’s rural clinical school, and has for many years trained registrars. He estimates he is currently training his 35th registrar in his Bundaberg practice. “Every six months we get a new registrar, so I am constantly reminded of how difficult it is for new doctors to approach a complex area like chronic disease management.” He said other applications such as cdmNet can prove a bit daunting for young doctors, who can often get overwhelmed by chronic disease. “What my program does is it takes
the doctor one step at a time. For example, for blood pressure, it gives you the National Heart Foundation levels, and then there is a quote from a recent study which says ‘if you see people and escalate treatment you will get control’. So it tells the doctors what they should be doing, they can say yes or no, and then that goes into the GP management plan. “Then the next screen will be cholesterol and then the next perhaps calculate their absolute cardiovascular disease risk – it is just one simple task after another. They are building up the GPMP in layers. “The PAT GPMP is generated because they have actually done all of the checking, they have gone through it step by step, and anything that is within normal limits, PAT will just leave it out of the GPMP.” The program is Windowsbased and has been
designed to be integrated with common GP clinical software. It has been trialled with Best Practice users but Dr Byrnes is keen to ensure it could easily be used with a wide range of products like Medical Director and practiX.
Sysmex upgrades Eclair interface and functionality
“We have built it to interface with any Windows-based SQL program. It has a very simple connection – just the right person, date of birth, Medicare number.
Enhancements to Eclair 6.4 include a new collection management module for managing inpatient collects, allowing phlebotomists or clinical staff to access outstanding orders in Eclair and easily manage the collection process.
“Then you just alt-tab the screens between PAT and the clinical package you are running. Some modern computers have two screens and that’s the ideal way to do it. You have a PAT checklist screen on one side and you are entering the data in your main program.”
It also features new functionality for form design that provides the scope to build diverse clinical forms for data collection such as growth chart records. These are currently being added to the system in use at Auckland Hospital, allowing clinicians to create and display growth charts in the patient record.
PAT will be officially launched in July with Best Practice marketing it as a separate product under licence from Dr Byrnes’s company Ageana.
Sysmex has released version 6.4 of its Eclair clinical data repository, featuring a new user interface design and enhanced functionality to its orders module, clinician’s enquiry and the patient record display.
According to Sysmex, the growth charts utilise the Eclair data entry form module to capture, store and plot the growth data details for a range of ages, from premature babies through early childhood and adolescence to age 20. The new functionality will mainly be used by paediatric teams, nutritionists and endocrinologists from Auckland DHB, Waitemata DHB and Counties Manukau DHB, the company said. Eclair has just gone live at Taranki District Health Board in New Zealand’s North Island. Taranaki’s new system is interfaced to the hospital information system, the private radiology system and three separate laboratories, integrating the patient data. Canterbury DHB is also moving its paper-based request systems to an Eclair orders solution for lab and radiology test requests. The implementation will begin with hospital radiology orders first.
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NPS releases mobile app for antibiotic reminders NPS has launched a new app for iPhone and iPad to help patients remember to take their antibiotics correctly. The new Antibiotics Reminder app allows users to set reminders for each dose of antibiotics, track whether doses are taken correctly and record progress in a daily recovery diary. The app can search for antibiotics by brand name or active ingredient, with predictive text generating a list of potential matches from an inbuilt database. After selecting the form (e.g. tablets), strength and how often the antibiotic is used, the app generates a set of modifiable alarms to remind the user to take each dose. When it is time for their next dose, the user receives an alert from the app and a prompt to enter whether that dose was taken on time, early, late or not at all. This information is tracked and can be reviewed later. This is the second smartphone initiative from NPS following the release of its interactive Medicines List app in June last year. An NPS spokesperson said that while the Medicine List app was designed primarily for regular medicine users or people on multiple medicines, the Antibiotics Reminder app also caters for more sporadic medicine users who are only prescribed antibiotics occasionally. The free app is available for iPhone, iPad and iPod Touch (with operating systems iOS 5 or higher) by searching for ‘Antibiotics Reminder’ on Apple iTunes or on the App Store on mobile devices. General information about antibiotics and antibiotic resistance is also provided in the app, including a link to a survey for users to provide feedback to NPS.
Secure message exchange market opens up Healthcare providers using secure electronic messaging services will now be able to communicate more easily following the announcement of a collaborative agreement between three leading service providers. Global Health, HealthLink and DCA, which service the industry with the ReferralNet, HealthLink and Argus products respectively, have formed Secure Message eXchange (SMX) to open up secure messaging channels to each other’s customers. The three companies claim to service over 85 per cent of the current market. The arrangement will be similar to that which exists in the mobile phone industry, in which the company responsible for the outgoing communication pays a wholesale transaction charge to the organisation managing delivery to the end point. The collaboration is aimed at overcoming one of the main stumbling blocks to wider use of secure message exchange, as until now users could only send and receive messages from practitioners using the same product. The partners said the basis for the exchange is the
recently gazetted Secure Message Delivery (SMD) standard. Each vendor will focus on developing to the standard, which makes the technical integration easier. They plan to commence a controlled release within the next three months. HealthLink’s head of operations for Australia and New Zealand, Geoffrey Sayer, said a number of technical issues are being worked through before a general release, These include end to end messaging, ensuring payloads are harmonised, and defining the role of public key infrastructure (PKI) and the end point location service (ELS) so that the transition infrastructure is able to support the processes within the SMD specifications. Dr Sayer said messaging service providers would not have to do integration work with each separate clinical software vendor. “As long as one of the SMX partners is at each end of the transaction it will work, although I expect that we will all integrate with many in common,” he said. Current users of the electronic messaging services will not need to do anything different through their clinical software.
“Nothing is different,” Dr Sayer said. “That is part of the benefit.” As each service has its own user directory, allowing specialists for instance to send letters to GPs also using the service, work will be done to relate each directory to each other and through the ELS. “Each organisation will still maintain their own until a national directory is really available,” he said. Membership of the SMX will be open to other software companies that have systems based on the SMD specification, are prepared to provide service levels of support, work on delivering sustainable approaches around infrastructure and only exchange messages based on agreed standards. Andrew McIntyre, managing director of the MedicalObjects secure messaging system, said he would consider taking part in a network only when the right infrastructure was in place. “From what I gather, this is a management-level agreement, and the devil is in the technical details, which have not been worked out,” Dr McIntyre said. “We will join a network when the infrastructure like NASH and ELS and payload compliance makes this a safe reality. At the moment it’s not.”
He said Medical-Objects already has an agreement to interoperate with DCA when the infrastructure exists to support it in a safe, scaleable way. The SMX partners said the initiative was something the industry had been working towards for a number of years, but prior to the adoption of the SMD specification, each different vendor had proprietary methods for packaging and
addressing documents sent within their network. The vendors have agreed to a wholesale cost per transaction, but each member has the discretion to decide how these costs are recovered from their customers. “The hope is that this initiative will significantly increase the total volume of correspondence exchanged electronically which will drive transaction costs
down. Ultimately, the market will determine the price.” Dr Sayer said the overall benefits of the agreement for clinicians will be the greater scope to exchange information with more sites than before. “The SMX agreement also ensures there are improvements in the quality of messaging, accountability and the service levels around messaging vendors.”
Drugs data a Catalyst for HCN Health Communication Network (HCN) has officially launched its new Catalyst medicines information product, aimed at clinicians at the point of care with a particular emphasis on the acute care sector. HCN said Catalyst was the first Australian medicines information product that integrates product information (PI), consumer medicine information (CMI), independent drug monographs, drug product images, a product identifier module and product summaries in one resource. While it has been designed to support pharmacists as well as students, it is also aimed at doctors, nurses and allied health professionals such as ambulance officers who need more information on drugs at the point of care.
It currently contains over 5050 product summaries, 2685 PI sheets, 2775 CMI leaflets, 1000 independent drug monographs and 2440 drug images, as well as a Product Identifier module that allows the identification of unknown medicines by their physical attributes such as markings, shape and colour. HCN CEO John Frost said its point of difference from competing products such as MIMS was its currency of information and its breadth and depth. The user interface features search options such as Quick Product Search, Advanced Search and Free Text Search, and users can also customise their experience with personalised features such as My Searches, My Favourites and My Settings,
which enables quick access to reference material used on a regular basis. “[It] also has pharmaceutical company details, it has the product summaries, it has the medicines identifier,” Mr Frost said. “You can browse through the content in a whole raft of different ways – names, active ingredient, and therapeutic class.” Mr Frost said Catalyst will have particular use in the acute care sector for helping clinicians treat patients with complex conditions and often several co-morbidities. HCN has integrated Catalyst data with several partners, including aged care specialist iCare, pharmacy specialist Fred Dispense and CSC, formerly known as iSoft.
www.advantech.net.au Phone 1300 308 531
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$36.8m PCEHR package in Tasmanian health bailout The federal government has allocated $36.8 million over four years to roll out the PCEHR in Tasmania’s hospitals as part of its $325 million “emergency rescue package” for Tasmania’s health system. The bailout is part of protracted negotiations with independent Tasmanian MP Andrew Wilkie over his support for the minority government. Health Minister Tanya Plibersek said the $36.8 million for the PCEHR implementation would enable allied health, pathology and diagnostic imaging services to connect to eHealth. Ms Plibersek said frontline health professionals had emphasised how electronic health records would reduce errors and duplication and improve the efficiency of their work. The rescue package also includes $31.2 million over four years for an elective surgery blitz; $48.7 million over four years to support better care in the community to prevent and manage chronic disease through the Tasmanian Medicare Local and $74.5 million over four years to provide better care for patients when they are discharged from hospital and better palliative care in the community. There will also be $22 million available to establish walk-in clinics in Hobart and Launceston; $53.9 million over four years to train more medical specialists in Tasmania and provide more scholarships for nurses and allied health professionals; and $42 million over four years to support innovation in clinical services. This includes $1 million in seed funding to establish a Virtual Health Sciences Precinct, involving Tasmanian hospitals, the University of Tasmania School of Health, the Menzies Research Institute and primary care providers.
NEHTA announces members of aged care software panel for PCEHR integration The National E-Health Transition Authority (NEHTA) has announced the successful companies who will take part in the aged care software vendors panel to work on the implementation of specifications to link the aged care sector to the PCEHR. The vendors include some of the market leaders in aged and community care software, including Autumncare, Database Consultants Australia (DCA), iCare, Leecare Solutions and the WAbased nursing service Silver Chain, which has developed the ComCare software under its subsidiary EOS Technologies. NEHTA CEO Peter Fleming said that the organisation
had executed contracts with all of these vendors. He said the vendor panel would provide software solutions to aged care providers, including those operating residential aged care facilities and community care services, with the primary objective of driving uptake of the PCEHR. Through the panel, NEHTA will work collaboratively with vendors, the Aged Care Association Australia (ACAA), the Aged Care Industry Information Technology Council (ACIITC), and other stakeholders on the changes that vendors will need to make to their products to meet the requirements for PCEHR implementation, he said.
Caroline Lee, CEO of Leecare Solutions, said the panel members will be developing capability to access the HI Service and link to the PCEHR so that clients can download and upload clinical information through event summaries, discharge summaries, transfer documents and shared health summaries. “We will also be passing on lessons learned and key information to other vendors who are not part of the process so they can also include this functionality, with support,” Dr Lee said. She said the panel will not have many different requirements to the GP software vendors panel as all members will be required to link to the Healthcare Identifier
Service and access and upload documents from the PCEHR so that the data present on an individual’s site is useful. “The more programs that access and upload to the PCEHR, the more relevant information will be available for health practitioners to refer to when making key clinical decisions,” she said. Both Leecare Solutions and iCare have already integrated HI Service functionality into their software. Dr Lee said her company had been working on the building blocks of integration with the PCEHR since last year. “We have been working on this since late last year since aged care was announced as a contender and will be ready by 30 June as will others. There are still components that need to be set up in the service before any of us can access information from it – and when these are ready, there hopefully will be a flood of vendors providing and receiving information.”
project, which ACAA is managing. The project will also identify the ways in which aged care providers benefit from integrating with the PCEHR and understand what business process changes will be required to maximise the benefits of PCEHR integration, Mr Young said. Leecare Solutions is one of three vendors working on Pathfinder, the others being ComCare and Autumncare, which will work with aged care and retirement living provider RSL LifeCare on the project. “[Pathfinder] is aimed at determining systems and processes for the industry so that providers can be supported to understand and implement this vital initiative in each of their services, learning from the pioneer organisations who will be trialling this connectivity,” Dr Lee said.
NEHTA will provide funding and support to vendor panel members to assist them in implementing the required changes in their software.
She said the three Pathfinder vendors had spent two days meeting with DoHA, the chair of the ACIITC, Suri Ramanathan, a team from independent information management consultancy Doll Martin and technology consultancy firm Accenture to strategise the rollout of the project.
ACAA CEO Rod Young said that in addition to work on the PCEHR, several of the vendors would help develop a roadmap for future IT deployments in aged care under the Pathfinder
“The thinking behind and lessons learned from these two days and the commensurate months of work that will be involved in supporting the three Pathfinder organisations
through this journey will be invaluable to ensure the eHealth agenda is successful. Aged care is confident it can be one of the success stories.” She said the aged care sector had some issues that could be addressed if information was quickly available from the PCEHR, such as access to key information for any new admissions to residential aged care facilities. “Often a person will arrive with limited information that makes it difficult to immediately put in place strategies to support them. They may arrive with limited medical diagnoses or current medication information or details re existing clinical issues that need constant attention. “Also, when transferring residents to hospital or receiving them when discharged, it is vital that timely information arrives with them and it is envisaged that in time, these processes will improve and we will be able to obtain that information directly from the PCEHR. “Some of our low care residents visit doctors outside the service and don’t return with information regarding their ongoing care needs as determined during their consultation, hence accessing information that a GP may upload will make it much easier.”
HISA opens app competition for student designers The Health Informatics Society of Australia (HISA) has launched a mobile app competition for tertiary students, with the winning entry invited to exhibit at the HealthBeyond: The Interactive E-Health Experience event at the Health Informatics Conference (HIC) in late July. Participants are required to design and present an idea for an innovative eHealth related mobile application for a smartphone, tablet or any other mobile device. The target users for the app can be clinicians, patients or consumers with the app aimed at facilitating and improving the way individuals experience or receive healthcare. Criteria include usability, appearance, perceived value in healthcare and effectiveness. Areas may include services provided by healthcare professionals at the point of care, health literacy, self-management and decision-support skills for consumers, or ageing independently at home. HISA is calling for nominations for five places on its board. Elections will be held at the HISA annual general meeting on Wednesday, August 1 in Sydney. The official notice of the AGM, the agenda and the board nominees’ statements will be distributed on Wednesday, July 11. HISA CEO Louise Schaper said it was an exciting time for eHealth. “[The] transformative role of eHealth and the need for a health informatics-literate workforce is not only pressing, but is being recognised widely; and everyone is talking about eHealth and health reform,” Dr Schaper said.
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Authentication service not ready for PCHER launch The National E-Health Transition Authority (NEHTA) has confirmed that the National Authentication Service for Health (NASH), a key plank in the development of the government’s national eHealth system, will not be ready for the PCEHR’s official launch on July 1. IBM Australia was awarded $23.6 million in March 2011 to build NASH, which will issue digital credentials to healthcare providers, including digital certificates managed through the Public Key Infrastructure and secured by tokens such as smartcards. The credentials are required to validate identity when used to access the eHealth systems the government is building as part of its national eHealth records project. NEHTA’s part in the agreement was to provide a software development kit (SDK) to allow existing healthcare systems and deployments to integrate with NASH. The SDK is also not ready for the PCEHR launch. NEHTA CEO Peter Fleming said the delayed delivery of NASH “will have no impact on the launch” of the PCEHR or the ability for consumers to register for an eHealth record. Mr Fleming said arrangements had been put in place to provide an interim NASH delivered by the Department of Human Services to enable the eHealth records system to launch and begin operations as planned.
PCEHR legislation passes but soft launch expected Legislation enabling the personally controlled electronic health record (PCEHR) passed the Senate just weeks before the system was due to launch. Opposition and Greens senators had previously indicated they would support the legislation. It passed unopposed. Consumers will be able to register for a PCEHR on July 1, either by calling 1800 PCEHR1 (1800 723 471) or at a Medicare shopfront. While the Department of Health and Ageing has established a consumer website to provide information on the system, online registration is not yet possible. While the government has been touting the long-term benefits of the PCEHR, including the claim that it will save $11.5 billion over 15 years, it has not conducted a public information campaign to encourage consumers to sign up for a PCEHR.
“NEHTA will work closely with our key vendors involved in the eHealth sites program to roll out the interim NASH to allow the launch to go ahead as planned,” he said.
Health Minister Tanya Plibersek and the Department of Health and Ageing have repeatedly stated that the plan is to target certain segments of the population in the first instance rather than consumers as a whole.
“Australians will be able to register for an eHealth record in July as intended.”
According to a recent presentation by Mick Reid
of McKinsey and Co, which is leading the National Change and Adoption Partner (NCAP) consortium for the implementation of the PCEHR, these target populations are mothers and newborns, older Australians, people with chronic conditions like diabetes, those being treated for prostate, breast and bowel cancer. It also includes clients of the Department of Veterans Affairs (DVA), the Department of Defence and private health insurers, and clients of Aboriginal Controlled Community Health Services (ACCHS). The marketing plans for the Wave sites responsible for implementing the PCEHR have not factored in broad consumer information activities, and consumer recruitment from the target demographics has only begun in the last few months. DoHA secretary Jane Halton recently told the Healthe-Nation conference that close to 1.4 million people have been recruited to the Wave sites, but according to a spokeswoman for DoHA, the information collected by the Wave sites will not transfer to the PCEHR from July 1. Consumers involved in those projects will have to register for a PCEHR and then reconsent to their information being shared.
Steve Saunders, project manager for the Eastern Sydney Connect Wave site, said that as of May 4, 424 GPs from 100 practices and 4444 consumers had been recruited for the St Vincent’s & Mater Health project. The DoHA spokeswoman said participants in the lead eHealth sites “have been provided with information to inform them of the benefits of participation in their local network. Information regarding registration for the eHealth record for these patients and the wider community will be released following passage of the eHealth record legislation. “Information collected by local systems established as part of the lead eHealth sites will not in itself transfer to the national infrastructure from 1 July 2012. However, a GP can post a patient’s shared health summary generated in the local system to the eHealth record from 1 July 2012, with the patient’s consent.” Consumers are not yet able to register through Medicare or the australia. gov.au site, which links various online accounts from the Department of Human Services. The project has also run into a security stumbling block, with NEHTA
announcing in midJune that the National Authentication Service for Health (NASH) will not be ready for its planned release on June 26. NEHTA CEO Peter Fleming said arrangements had been put in place to provide an interim NASH delivered by the Department of Human Services to enable the eHealth records system to launch and begin operations as planned.
The DoHA spokeswoman said that once a consumer has registered for their PCEHR, they can then ask their GP to set up a shared health summary, as long as the GP has compliant software and has registered for an HPI-O and HPI-I. It was recently revealed in a Senate estimates committee hearing that this should be ready in September. “As eHealth record-compliant software
is progressively made available, healthcare professionals will be able to facilitate the registration of consumers for an eHealth record within their own practice,” the DoHA spokeswoman said. A staged media event of the Minister for Health signing up for an eHealth record was planned for July 1, although The Australian newspaper reported that this has been cancelled.
Consumer awareness of PCEHR low but support is high A survey of consumer and healthcare provider attitudes towards the PCEHR has found that while the majority of respondents support its implementation, few are even aware of its existence and only 50 per cent intend to sign up. The survey, designed by Elin Lehnbom, a postdoctoral research fellow at the Centre for Health Systems and Safety Research at the University of NSW, set out to assess the awareness, knowledge and attitudes of healthcare providers and consumers towards the PCEHR. The survey follows a qualitative study conducted by the research team, which also includes Jo-anne Brien, professor of clinical pharmacy, and Andrew McLachlan, associated dean
of research and professor of pharmacy at the University of Sydney, in 2010.
attitudes towards it after being provided with a series of statements.
It involved 203 consumers and 202 healthcare providers, who were selected by online research firm The Digital Edge from its consumer panel of 70,000 people, which Dr Lehnbom said was representative of the Australian population.
The survey found that only 8.9 per cent of all respondents were initially aware of the PCEHR. Once informed of what it was, 57 per cent of all respondents then agred with its implementation. Providers had greater awareness than consumers.
“Our sample size calculation indicated that 400 respondents would be enough to find a difference in awareness, knowledge and attitudes between healthcare providers and consumers,” she said.
Almost 70 per cent said they trusted there would be appropriate measures to protect their privacy, and just over 60 per cent agreed that healthcare providers with access to their patient’s PCEHR will be able to provide better quality of care.
The survey asked a number of questions to assess three things: initial awareness of the PCEHR, and then knowledge of it and
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However, only 50.1 per cent indicated they will sign up for a PCEHR.
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Primary Care Acute and Emergency Mental Health Broadband Behaviour and Consultation Skills in a New Environment Chronic and Aged Care www.hisa.org.au/telehealth2012
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HISA
ALL YOU NEED TO KNOW TO BECOME HIP A HEALTH INFORMATICS PROFESSIONAL!
The Health Informatics Society of Australia (HISA) is set to announce a number of initiatives at the upcoming Health Informatics Conference (HIC) 2012, including a new health informatics certification program to encourage members of the health workforce to gain recognised accreditation status. It is also working with Health Workforce Australia to plug some of the gaps in human resource capacity.
DR LOUISE SCHAPER BSc(OT)HONS, PhD CEO: HISA ceo@hisa.org.au
As Australia’s health informatics organisation, HISA receives regular enquiries from a wide range of people and organisations. Hardly a week goes by where we don’t get an enquiry from someone who has recently discovered health informatics and they contact us looking for advice and guidance as to what their next steps should be. How do they know if health informatics is for them? Is there somewhere they can go and study? How should they choose what and where to study? Can they train on the job? What career options are available? Are there jobs available? These ‘emerging health informatics professionals’ are far from a homogenous group — some are post-graduate students, some are practicing clinicians, while others are from health information management or IT backgrounds. What they do have in common is an interest in health informatics and are unsure about how and what they should do next.
About the author Dr Louise Schaper is CEO of the Health Informatics Society of Australia, Australia’s health informatics organisation. Louise has over 10 years of experience in eHealth and health informatics, a degree in occupational therapy and a PhD on technology acceptance in healthcare.
On the flip side, I often find myself in conversations with people in leadership positions who are frustrated that they can’t find staff with the right skill set, knowledge and experience. They tell me it is becoming increasingly difficult to hire and retain health informatics staff to plan and deliver either key projects or operational work.
As Pulse+IT readers, you know that there is a hive of eHealth-related activity at the local, state and national level. There was a time not so many years ago where eHealth and health informatics news was sparse in Australia; and now our publications are brimming with news of new and expanded initiatives and projects. There are many exciting projects taking place across the country, and as our healthcare system continues to evolve to one that is truly enabled by eHealth, the demand for health informatics professionals will continue to grow. So there is great news – the field of health informatics is booming and is set for strong growth. But there is also a workforce shortage that needs to be addressed.
Addressing workforce challenges The workforce shortage in health informatics has been prioritised by Health Workforce Australia (HWA). HWA was established by the Council of Australian Governments (COAG) to “address the challenges of providing a skilled, flexible and innovative health workforce”. HISA and other organisations and individuals have contributed to HWA’s study on the health informatics workforce and this report is due to be released soon.
Addressing the health informatics human resource capacity required to meet the needs of current and future healthcare delivery will continue to be a focus driving HISA’s plans and activities.
Management Association of Australia (HIMAA) and others to put together a framework for this important initiative.
Health informatics workforce issues will be a strong theme running through HIC this year, culminating in a panel during the final session of the conference entitled ‘Can Australia lead the world in digital healthcare? The role of health informatics and its professionals’. There will also be a specialised workshop on ‘The future role of the health informatics professional — opportunities, training, options and accreditation’. If you are a student, an emerging health informatics professional or interested in mentoring future talent, a meeting will be held during HIC to bring those people together and to further develop a strong network amongst our future professionals.
The Health Informatics Certification Program will contribute greatly to the development of the health informatics workforce and health informatics capability by providing additional ‘currency’ for the recognition of health informatics experience and knowledge.
But most importantly, we will be officially announcing the launch of an Australian Health Informatics Certification Program at HIC. HISA has been working with the Australasian College of Health Informatics (ACHI) and more recently with the Health Information
Certification program
Becoming a certified health informatics professional will involve the successful completion of an exam, the content of which will cover the breadth and depth of health informatics. The first round of candidates will complete the exam in 2013. As the development of the certification program progresses, more information will be made available through outlets such as Pulse+IT and the ACHI and HISA websites. Stay tuned for more updates and in the meantime if you would like to contribute to our activities in this arena, please don’t hesitate to contact me.
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Feature
USE IT OR LOSE IT NEW RULES FOR TELEHEALTH
In 2011, the federal government announced a new initiative to encourage the use of telehealth in non-metropolitan regions involving a one-off incentive payment of $6000 and new MBS item numbers for video consultations. In 2012, the government tightened the rules and cut the amount of time it was willing to subsidise telehealth uptake. So what has happened one year on, and what can we expect to see in the coming years?
KATE MCDONALD Journalist: Pulse+IT kate.mcdonald@pulseitmagazine.com.au
In June 2011, Prime Minister Julia Gillard and Health Minister Nicola Roxon announced a $620 million telehealth initiative aimed at “transforming the way healthcare is delivered in Australia by removing distance, time and cost as a barrier to accessing care”. Not only would specialists and GPs receive a $6000 “on-board” incentive payment upon conducting their first telehealth consultation, but new items were added to the MBS to allow specialists to claim an additional rebate of 50 per cent and GPs 35 per cent to conduct a video consultation. Eleven new MBS items were made available for telehealth consultations provided by specialists, consultant physicians and consultant psychiatrists. The new items allowed a range of existing MBS attendance items to be provided via video conferencing, with a derived fee adding to the base item fee.
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.
New MBS items were also introduced for patient-end services, allowing GPs, nurse practitioners, midwives, Aboriginal health workers and practice nurses to provide face to face clinical services to the patient during the consultation with the specialist. The fees were restricted to eligible geographical areas outside metropolitan areas, aged care facilities and Aboriginal Medical Services.
At the time, the prime minister said participating health practitioners around the country would receive attractive Medicare rebates from July 1, 2011, to compensate them for their time invested in the consultation, and some support for the technology required. “These include increased Medicare rebates for telehealth, payments to cover start up costs of installing the technology, and bulk billing incentives,” she said. The government set a goal of 495,000 telehealth consultations by July 2015. According to the most recent figures available, as of the end of February 2012 Medicare has processed 10,594 telehealth services, and according to Department of Health and Ageing (DoHA) statistics, more than 1700 doctors have provided a telehealth service. “By the end of February 2012, the target of 2.7 per cent of specialists providing telehealth services for the 2011-12 financial year had already been met,” a DoHA spokeswoman told Pulse+IT. “So far, 745 specialists have provided a telehealth service which equates to three per cent of specialists. More than 90 per cent of all telehealth services are bulk billed, meaning that patients face no out-of-pocket costs.”
However, in the federal budget handed down in May 2012, the government decided to tighten the rules. In the original plan, the on-board incentives were to be reduced from a lump sum payment of $6000 up to July 1 2012 to $4800 on July 1 2013, $3900 on July 1 2014, and $3300 on July 1 2015. The government has now decided to cut short that plan by a year, with the incentives to cease in 2014. It has also decided to split the on-board incentive into two instalments — the first instalment of $1600 to be paid upon the first valid telehealth MBS claim and the second instalment of $3200 after the tenth claim. This will be reduced in 2013/2014 to $1300 for the first claim and $2600 after the tenth. In addition to ensuring that money is not wasted on practitioners who only do a handful of video conferences in total, it was also a signal that the government is keen to use a carrot and stick approach to get doctors on board faster. The government itself said the changes aimed “to encourage early adoption and embed telehealth into normal practice”. “The on-board incentives were designed to encourage practitioners to adopt telehealth as part of their normal practice,” the budget papers stated. “The original incentive structure has been highly successful at encouraging practitioners to trial telehealth, but has been less successful at encouraging full adoption. “By paying the on-board incentive in two instalments, only practitioners who show genuine commitment to telehealth (by providing at least 10 services) will receive the full on-board payment.” A 15km minimum distance between specialist and patient location will be also be introduced from November 1 this year, although this will not apply to residents of aged care facilities and patients of Aboriginal medical services.
“By paying the on-board incentive in two instalments, only practitioners who show genuine commitment to telehealth (by providing at least 10 services) will receive the full on-board payment.” Federal budget papers
The government also said it would cease funding of the Telehealth Support Initiative from July 1 next year. This major initiative, which provided funding of between $100,000 and $2 million over 18 months, was aimed at developing a range of training supports, including continuing professional development training, tools and guidelines to facilitate online telehealth consultations and to promote uptake to the initiative.
college said in its official budget reply. “The college will be meeting with government to discuss these issues, as patient access to these services should be at the discretion of the GP if clinically required.”
The estimated $183.9 million in savings over five years has now been redirected towards broader eHealth reform initiatives, including extra money to continue to build the PCEHR.
“The RACGP believes that it is both short sighted and unrealistic to phase out the telehealth incentive earlier than planned, as uptake has been confounded due to both interoperability difficulties between GPs and other specialists, and the lack of a provider directory.”
The Medicare rebates survived the axe, with the government budgeting for $58.2 million to be paid out as Medicare rebates for specialist telehealth consultations in 2012, $109.3m next year and rising to $221.2m in 2015-2016.
Long-term potential While the government’s reasoning is clear, not everyone is happy. The RACGP, which has been funded to develop a number of resources under the Telehealth Support Initiative, said that while it accepted the 15km distance requirement for people who were able to travel, the government was forgetting patients such as the elderly, for whom mobility was a major barrier. “[This change will limit access to specialist services for those most in need,” the
It also said that while it knew the incentive payments were finite, the announced cuts were premature, as telehealth consultations have not yet become a part of usual practice for the majority of GPs.
Paul Mara, president of the Rural Doctors Association of Australia (RDAA), was more sanguine. “I think the subsidy that they put in in the initial stages was there to encourage people to try it out,” he says. “While I was fairly cynical about it, I can see that it actually does have some benefits. It is up to the government when they remove the incentive payments, and at the end of the day people will make their decisions in whether it is worthwhile or not. “There is no doubt that the incentive is driving the initial uptake but that may also mean that people are beginning to get an idea of what the potential for it is and what the advantages and disadvantages in their particular circumstances might be.”
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For Dr Mara, who has used video consultations in his own Gundagai practice a number of times, video conferencing has only provided limited value, but he can still see the potential. “It is probably useful for triaging in surgical cases where ... it saves the patient from having to go to see the specialist and go through all of the rigmarole. All of the paperwork can be done, the consultation can be done online and instead of the patient having a couple of trips to the major centre, they’ll just have to go in once to have their day surgery procedure or whatever.” He also sees reasonable potential for routine follow-ups, and also for people with complex medical problems so they can save time on travel. “Potentially if you had better broadband it would be good for dermatology consultations and that sort of thing, but at the moment it is definitely not. “In other circumstances like acute emergencies, we often do a combination of things, so we might take a photo of the x-ray and sent that digitally and get the reply back from that. There is more potential as the technology improves and the speed of broadband improves.” However, there are some major drawbacks, teeing up a consultation being one of them, he says. “It takes an enormous amount of admin time. You often find that you have a patient there, the consultation is booked for quarter past four, and the specialist doesn’t turn up until five o’clock. It depends on both sides having the capacity to be on time, and that is not always the case. The technical literacy of the doctors is also another issue. It takes a while to get that sort of thing going.”
Telehealth pioneer David Allen is a Sydney-based occupational health physician who runs Quality Occupational Health, a multidisciplinary team of doctors, therapists, counsellors and nurses providing occupational medicine services. He began providing telehealth services in 2007 when several large clients were experiencing problems accessing remote and regional care.
shelf hardware with good quality Logitech cameras. “It actually works remarkably well; if you know how to get the best out of off-the-shelf technology you don’t need to invest in expensive equipment, although some people do. I know that a lot of people promote high-end systems to doctors, and that’s part of the problem. It is not a problem in itself but it is an issue.” Having gone through the experience of setting up a telehealth service, he decided to open it up to other doctors, for free. He established a not-for-profit, Telehealth Solutions Australia, to provide a free, secure, high-definition IP video conference system for health professionals across Australia and internationally, and has secured sponsors, including the internet service provider AINS, IT support company Empower IT, and Fujitsu PC Australia. “We set up Telehealth Solutions Australia to make it easier,” he says. “What we were finding was that uptake was relatively poor so we have opened up our servers for free, basically. We already had an infrastructure in place, so we decided to do a not-for-profit Lync installation.” Dr Allen is hoping Microsoft will soon enable video on its Lync mobile client to run on both iPhone and Android. “I’m hoping that will come out later this year. I’m looking forward to seeing that because with the bandwidth you’ve got now, you can certainly do reasonable video conferencing on mobile devices. There are other applications that will do it on mobile devices, like FaceTime on iPhones, but the advantage with Lync is that you’ve got a directory — it’s a commercial-grade unified communications and video conferencing system.” His advice to practices considering providing a telehealth service is to talk to him, or to consult their colleges. “Most of them will approach their colleges — that’s what they are doing at the moment. Because there are hundreds of solutions that will basically do the job, what people in reality are doing is speaking to colleagues or the medical colleges or healthcare organisations about what to do.
“We looked into doing IP-based video conferencing, which at that stage was not very commonly used and certainly not for telemedicine,” Dr Allen says. “We had to prove it to large employers, who were not going to spend money on expensive equipment if it was unproven in occupational medicine, so we demonstrated we could do it in a trial with one large employer in NSW, which was a finalist in the NSW WorkCover awards.”
“What I say is that doctors have been doing telehealth for decades — in fact, for over a hundred years. The first telehealth was the ECG transmission over telephone lines by Willem Einthoven from his laboratory to a hospital about a mile away in 1906. You don’t have video — you can still giving advice of course without it. When I talk to clinicians, I say you are just adding a video image that gives some more information, rather than making it sound complex. And now they can get reimbursed for doing it.”
Dr Allen’s team was able to show that using IP-based video conferencing was not only secure but cost effective or in fact cheaper than face to face care. He used conventional off-the-
The $6000 incentive is quite a large one — although it will be dropping to $4800 from now on — but that money is not necessarily aimed at allowing practitioners to buy the latest
specialist and that also means that they’ll be in the consultation, they’ll get a Medicare reimbursement for being there with the patient and they are learning from the specialist whilst they are there, so they are actually more involved than they’d ever be if the patient went to see the specialist.”
whizz bang technology. “The word from the government is that the payment is an incentive — it is not designed to just pay for hardware,” Dr Allen says. “It is designed to encourage people to do it. There haven’t been huge numbers taking it up but it does encourage people to do it and I think that’s a good thing. “The cost of accessing care can be difficult for the patient — they have to drive eight hours there and back to the specialist — and that cost is not seen by anyone else. The savings for the community are huge, just in transportation costs. So I think it’s worth it. And patients love it — they really enjoy telehealth consults and the fact that they can access care from home or from work. We do it indirectly into their workplaces and see them in the first aid room, and they just love it. And we run 24/7.”
Practice staff The government has also made it plain that while the main aim of the telehealth incentive system is to get specialists on board, general practitioners and other healthcare professionals are a large part of the equation. The Medicare rebates from the patientend of the service are available to GPs, nurse practitioners, midwives, practice nurses and Aboriginal health workers. In the aged care setting in particular it is usually a nurse who sits with patient during the consultation, and in rural and remote areas this will become routine. Nurses are the glue that is going to hold of all of this together, Dr Allen says. “In rural and remote practices, they are the doctors with patients who have the most to gain from telehealth but they are the ones who have the least amount of time to actually do it,” he says. “Solo doctor practices in rural and remote areas are far too busy to stuff around with technology, so that’s where nurse practitioners and practice nurses come into play, and Aboriginal medical workers. They are the ones who can be on the end of the line with the
Gary Holzer, business development manager for SA-based telehealth provider Healthbank Consult, agrees. He regularly travels to rural parts of the state to assist practices in setting up a service, which usually links back to consultants and specialists in Adelaide. “What we have found in our experience over the last six months is that it really is the practice nurse that needs to be the lead,” Mr Holzer says. “Under the Medicare (number) the GP just has to be in supervision, so they see their regular patients face to face and next door the nurse will be sitting with the patient talking to their specialist in Adelaide.” And while allied health professionals are not yet a target area, perhaps they should be. Clinical software developer Precedence Healthcare, which has developed the cloud-based cdmNet chronic disease management platform, has recently added telehealth functionality to its system to allow GPs and allied health professionals to access different technologies. “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,” Precedence Health Care’s CEO, Michael Georgeff, says. “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. Professor Georgeff says Cisco is providing much of the functionality through its WebEx video conferencing product and Precedence was leveraging that functionality into its technology. “The idea again is to try and bring everything back to one click, to make it simple enough for the GP or the allied health or the specialist so they don’t have to wade through a whole lot of different technologies — it is all there in one place.” Dr Allen agrees that for chronic disease management in particular, telehealth could even be seen as better than face-toface care. “The nurses are going to be so important in this and the ones that I have spoken to have been very keen,” he says. “And I think nurse practitioners are going to have a huge role to play. And for semi-retired or part-time doctors, if they have school-aged kids — if you can work from home doing video consults it’s a nice way of staying in touch, I think.”
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Feature
TO SKYPE OR NOT TO SKYPE Probably the most contentious issue in the move towards greater telehealth use in Australia is whether or not consumer-grade video conferencing applications such as Skype are adequate for medical-grade consultations. Software vendors will tell you no, users will tell you yes and the experts fall somewhere in between.
KATE MCDONALD Journalist: Pulse+IT kate.mcdonald@pulseitmagazine.com.au
One of the reasons behind the large amount of money the federal government is currently spending on telehealth and — its recent changes to the incentive program — is to encourage faster uptake of video conferencing services. In addition to the one-off incentives to invest in equipment, there is ongoing support through the Medicare Benefits Scheme to continue to use video conferencing after the initial investment is made. So, why not use common and cheap options such as Skype, the world’s most popular means of video conferencing, or Apple’s FaceTime, which is available on its devices such as iPhones and iPads for mobile video conferencing as well as between Mac users? The reasons against using Skype for clinical video conferencing are many and varied, but the reasons for using it are simple: it is cheap, easy to use and gets the job done. First up, the no camp. In an informative article in the March 2012 issue of the RACGP’s Good Practice magazine, Trish Williams of the School of Computer and Security Science at Edith Cowan University laid out in plain English why it was not necessarily a good thing to use Skype in clinical practice.
According to Dr Williams, Skype was not designed with healthcare in mind and it does not have the level of confidentiality and quality of service required for patient video consultations. She writes that the benefits of Skype are obvious: it is low cost, it is easy to use, it has some security factors built in such as encrypted video and voice communication between Skype users, and if you are still worried about security, you can add encryption software if you so choose. However, there are a number of reasons why Skype may not be a good option, she says. There is no guarantee of the quality of transmission, the video function in Skype uses up bandwidth, there is no interoperability with other video programs, file transfers are vulnerable to infection and there are potential issues with spyware. And for clinical consults, where privacy is paramount, Skype has a major failing. Although it does use digital certificates for log-ins, there is no guarantee that the person you are talking to is actually that person. “Skype requires registration and names that are accessible by others using Skype,” Dr Williams writes. “This means impersonation is a risk.” She also says that there is no guarantee that the routing path of messages
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“We have investigated a range of solutions and are currently using Skype. At this stage it is the simplest and to be quite honest the most effective solution that we’ve used.” Dr Paul Mara
through networks, which may contravene Australian privacy legislation. In short, she does not recommend Skype for use in general practice.
Vendor’s viewpoint Gary Holzer, business development manager with South Australian-based clinical software and telehealth developer Healthbank, calls Skype “his worst nightmare”. That’s not just due to the ubiquity of Skype — there are 250 million users worldwide and the Microsoft-owned company is aiming for one billion users in total — but what he says is its unsuitability for clinical use. Healthbank Consult is an integrated software product that can be used with off-the-shelf video conferencing equipment, but like many other products on the market, it sells itself on the ability to be integrated with clinical software, in this case an electronic health record the company also markets. By using a packaged product like Healthbank, clinicians can share referrals, reports and images during the video consult. However, Mr Holzer says the real power in a proprietary product for clinical use is the database of users that underpins it. Healthbank Consult has a network of specialists using the system who are available for referrals, which the company is now taking Australia-wide. “GPs don’t want to talk to just anyone — they want to talk to their specialists as their patients
already have an ongoing relationships with these doctors,” Mr Holzer says. “This is one message that has come across loudly and clearly from the GPs. You have to build the network to sell the service.” His company has absolutely no plans to allow the product to be compatible with Skype users. “It doesn’t interface with Skype and nor do we really want it to. Nothing integrates with Skype. Skype is my worst-case scenario with a GP clinic … besides all the security and other issues, why would the government give you $6000 for free?” Mr Holzer believes GPs and specialists should not use office or home-grade solutions as they are not medically safe. He points to the RACGP guidelines, which are also against its use, recommending instead medical-grade solutions that store data here in Australia. “[The RACGP guidelines] talk about how it needs to be clinically appropriate,” he says. “Under the national privacy principles, if you are using a telehealth service such as a webinar service like WebEx, which is a cloud-based service, that is based in Singapore. Using these office-based solutions, where is the data going to be held? It could be overseas.” He also points to potential problems with Medicare should it investigate a practice that has claimed an MBS telehealth service or incentive payment. “It’s just like the taxation department — it is only when they
get audited that they get nervous. That’s how Medicare works — you need to keep the evidence. Things like Skype won’t do any auditing. “Healthbank is fully audited, there are clinical notes that go along with it. When they are doing the consult they bring up the record, there is the referral letter showing this is when the consult occurred and these are the specialist notes. So with Healthbank, accompanying the video, there is the clinical auditing and the ability to share the record. That’s how we are different from Skype — we are not a straight video solution.”
Skype in general practice Gundagai-based GP Paul Mara dismisses many of these concerns. He remains skeptical of the practical value of many video consults in the first place, but his practice has done several using Skype recently and he can definitely see a role, not to replace face to face consultations but to better support them. It is the number of specialists who are available to do video consults that is the current deal-breaker for many GPs, and Dr Mara notes with amusement that there has been a recent increase in the number of specialists and GPs joining up to take advantage of the incentives before they drop significantly from July. “We have investigated a range of solutions and are currently using Skype,” he says.
“At this stage it is the simplest and to be quite honest the most effective solution that we’ve used. We had a look at a few other teleconferencing solutions and they were either too expensive or promise the earth but are not much better than Skype for the type of consultation we’re undertaking at present.” He dismisses the arguments of many telehealth solution vendors that Skye is not high enough quality, or secure enough. “A lot of those people have a vested interest in selling a proprietary product. I’ve just got a vested interest in doing the thing that is the most efficient and cost-effective for the patient at the present time, given the technology that we’ve got.” One of those limitations is of course broadband speed, which is even more problematic in regional Australia. “You can have the worst or the best pictures in the world,” he says. “We did a Skype the other day in the surgery and it was ADSL+2 at both ends and the actual video was quite good. But if you are trying to diagnose say a skin lesion, you have to do it in different ways. We would normally take a digital photo and send that down on an email and then have a discussion about it. “You have to work within the limits of the technology at both ends. There is no point in us getting a special purpose set-up if we don’t have high-speed broadband and if at the other end they have an incompatible solution.” Security concerns can also be over-blown, he says. “Where do you begin and end with the internet? We’ve had quite major breaches of privacy and confidentiality from Medicare, where patients have been sent wrong cheques with other people’s names on it. “The other issue is faxes. If you are faxing a referral off, you don’t always
get verification that it’s going to the right place. There are lots of holes in all of these systems and I would not see that Skype is any better or worse than any of them. “The notion that you could log accidentally onto any car detailer or housewife or school kid and start having a video medical consultation is a bit rich. It would be nice to have totally secure and confidentiality and encryption happening, but as soon as you start putting encryption algorithms, with the speed of the internet at the moment the whole thing would become untenable. “Ultimately the technology that is used has to be reflected in the scope of the consultation. At this stage you wouldn’t propose a consultation that required significant hands-on physical examination by the specialist or real-time diagnosis of a skin lesion, no matter what the system.”
Middle ground Another who sits in the middle ground is David Allen, a Sydney occupational physician and member of the Australasian Telehealth Society, who has been using telehealth since 2007. His not-for-profit organisation Telehealth Solutions Australia uses Microsoft’s Lync solution rather than Skype, but he is aware of many doctors who choose the latter. “What a lot of them are doing now is using Skype,” he says. “Skype has had a lot of criticism flung at it for various reasons but the issue at the moment, like anything in eHealth, is managing change, and changing the way people practice. Just as it is for the PCEHR, getting doctors on board with that is going to be a challenge.” Having been involved in telehealth for a number of years, Dr Allen has closely followed the “argy bargy” over Skype, security and the practicalities of video conferencing in healthcare. Like Dr Mara, he says there are both pros and cons to using Skype and other consumer services.
Dr David Allen “Everyone worries about security and quality and that sort of thing but that stuff is pretty easy to do,” he says. “Most of the solutions will give you adequate security. What Skype doesn’t give you is the resolution that you need for diagnostic stuff. You can have a chat but anything other than that …” He also points out that consumer-grade video chat software doesn’t look terribly professional. “And there is no way of validating who anyone is at the other end of the line. Anyone can register on Skype as Dr Smith or whatever. There is the potential for people to impersonate. And it tends to suck up bandwidth. “But if it has the potential to get people involved … this is about delivering care, not about doctors or technology but about patients accessing care. People need to think about that – not think about technology and get obsessed with it, but think about how you deliver care to patients People keep throwing technology at doctors and they throw their hands in the air and go it’s all too hard. It has got to be made as easy and accessible as possible.”
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Feature
TELEHEALTH FOR AGED CARE The changes to the telehealth incentive scheme in the May budget will also affect the aged care sector, although it is excluded from the new requirements for a minimum 15km distance between specialist and patient location. Figures on the uptake of telehealth in aged care are hard to find, but it is one of the most promising parts of the healthcare system for wider use of telehealth.
KATE MCDONALD Journalist: Pulse+IT kate.mcdonald@pulseitmagazine.com.au
When the federal government announced the introduction of its telehealth scheme last year, it pinpointed the aged care sector as one area that telehealth could potentially have a revolutionary effect. Under the scheme, it introduced new incentives and MBS numbers for specialist video consultations with residential aged care facilities, providing a one-off, lump sum payment to eligible nursing homes that register with Medicare Australia. It also introduced MBS rebates for specialists undertaking a video consultation and a rebate for the aged care provider itself. One of the main problems with the scheme, however, is that it excludes general practitioners. For aged care providers, the aged care on-board incentive consists of a one-off, $6000 payment paid upon the lodgement of the first claim for hosting a telehealth consultation. This was to be reduced to $4800 on July 1 2012, and then to $3900 in 2013 and $3300 in 2014. That last payment has now been scrapped, as it has with the GP and specialist on-board incentive. The telehealth hosting service incentive provides an ongoing, monthly payment based on the total number of telehealth consultations by the aged care provider over the preceding month. In the original
scheme, this amounted to $60 per consult up to July 1 2012, $48 in 2013, $39 in 2014 and $33 in 2015. Specialists are able to claim the normal MBS attendance items, with a derived fee adding to the base item fee when conducted by video conference. However, the exclusion of item numbers for GPs at the patient end has caused some disquiet. There is also no rebate for GPs doing a video consultation with a patient in a nursing home from the GP’s practice. The AMA in particular has opposed this move, saying it had highlighted problems with ongoing access to medical care for residents of aged care facilities for many years. An AMA spokesperson said the telehealth initiative provides incentives for aged care providers to set up video conferencing facilities, but that it was “extremely inefficient” for these facilities to be used only for referred specialist consultations. “Medicare rebates for GP video consultations to residents of aged care facilities will improve the efficiency of providing follow-up care by general practitioners, and ensure full use is made of the video consultation infrastructure in aged care funded by government,” the spokesperson said.
“Similarly, there are rural, remote and outer metropolitan patients who have difficulty attending general practices because of mobility problems or because of distance. Medicare rebates for GP video consultations to these patients will improve the efficiency of providing follow-up care by general practitioners, and ensure full use is made of the video consultation infrastructure funded by government.”
Telehealth in practice One general practitioner who has experienced this disparity is Igor Jakubowicz, a GP in outer suburban Melbourne who acts as the main provider of medical care to residents of the Martin Luther Homes aged care facility in The Basin. Martin Luther Homes is an 88-bed residential aged care facility with 51 units for independent living. Of the residential beds, 16 are low care, 30 are high care and 42 are dementia-specific. The high-level care rooms are specifically designed for those in a frail condition. While he doesn’t actually get paid for it, Dr Jakubowicz recently took part in a trial of video conferencing at Martin Luther Homes, aimed at finding out if this sort of service was worthwhile or not. “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.” While the trial at Martin Luther Homes was considered successful, with patients reporting an improved understanding and knowledge of their conditions, reduced anxiety and an increase in their quality of life, it also found that there was some major barriers to overcome before wider uptake can be expected. One problem is the shortage of specialists willing to provide the service. For aged care, the obvious specialties are those such as dermatology and urology as well as private geriatricians, but as Dr Jakubowicz says, it’s hard to find specialists who want to give it a go. “There are a small number of them,” he says. “They would say this is best for follow-up consults – most want to first see the patient in the flesh. But we have a dermatologist on board and what happens is there is a referral and if they are looking at a specific skin lesion you can do a high res photo and you can send it in advance. If you have a good webcam, you can do a close up and it’s high quality.” Dr Jakubowicz says the success of any telehealth program in aged care will depend on the motivation of both the nursing home and the specialist. “There is a dearth of specialists out there so it is up to the government. The specialists have no incentive really.”
“There is a dearth of specialists out there so it is up to the government. The specialists have no incentive really.” Dr Igor Jakubowicz
Dr Jakubowicz worked on the trial with a semi-retired dermatologist called Doug Czarnecki, who has offered his services to areas of need such as northern Tasmania, where there are few dermatologists to be found. Unfortunately, while Dr Czarnecki was willing, it seems the aged care providers weren’t. While many GPs and specialists would prefer not to work out of hours, some like Dr Czarnecki are more than happy to do so. Dr Jakubowicz strongly suggests the government consider an MBS item number for GP consultations in aged care, which he says will vastly improve the uptake of the technology.
GPs, allied health excluded This is something that the Australian National Consultative Committee on Electronic Health (ANCCEH) has also recommended. In a discussion paper on the development of a national telehealth strategy released by the ANCCEH in November last year, it described the exclusion of GPs, as well as allied health professionals such as occupational therapists, psychologists and clinic nurse coordinators, as “unhelpful”. The ANCCEH discussion paper quoted figures from an Access Economics report into telehealth for aged care from November 2010, which detailed a cost benefits analysis of the introduction of telehealth intervention into existing aged care programs. Access Economics modelled three pilot sites: one in Townsville, one south of Wollongong and the other in an area west of Armidale in NSW. The results of that modelling demonstrated that over the two-year course of the intervention, net financial benefits were expected to be $6.6 million. This figure is a 61 per cent return on investment. According to the ANCCEH, based on these attractive percentages, telehealth for aged care should remain a government focus, with more targeted and aligned funding for areas such as GP consultations and community nurse or nurse practitioner consultations. It also suggested some specific current and new
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areas for focus across the aged care continuum including wound management, dementia support, mental health support related to social isolation, and comprehensive geriatric assessments. For the aged care sector as a whole, the ANCCEH said video consultations for residential aged care was only the first stage, followed by aged care in the home. According to the paper, both would require: • •
• •
•
•
•
•
A choice between mobile and non-mobile telehealth video installation A mechanism to reward GPs for video consultations with both the elderly and the nurse or carers involved (home and residential care) The ability of specialists to support residential aged care without GPs in attendance and possibly with GP referrals Aged care is essentially a team-based activity due to co-morbidities. As such both point-to-point and point-to-multipoint telehealth services (especially involving allied health) need to be provided along with adequate quality of service Service provision via telehealth needs to be widened to include clinical discussions (such as pre-acute admission issues, case conferencing and dementia assessment) and for improved administrative coordination Supporting enhanced clinical care in-situ where nurses can obtain telehealth-based support from other clinicians (i.e. for palliative care) and to better co-ordinate treatment An understanding that the burden on nurses will increase with increasing telehealth deployment and, as such, nurses required greater support A recognition that the facility service fee for aged care establishments using video consultation ($60 per session) is unlikely to be an aid in adoption as the average size of an aged care facility in Australia is 71 beds.
Further trials Figures for the uptake of telehealth initiatives in aged care are not available, but perhaps in recognition that aged care — both residential and in the community — stands to benefit the most from telehealth, the government announced a new program in May to provide extra funding for pilots of telehealth programs with an emphasis on aged care, palliative care and cancer care. The catch, however, is that these pilots much be in areas enabled by the National Broadband Network. Invitations to apply for the program, which involves $22.2 million over three years, were issued in April, with winning tenders to be announced as Pulse+IT was going to print. Jointly sponsored by
the Department of Health and Ageing (DoHA) and the Department of Broadband, Communications and the Digital Economy (DBCDE), the program has been designed to promote telehealth in NBN-enabled areas. “Telehealth can solve the tyranny of distance by using technology to bring health services that are sometimes only provided hundreds of kilometres away from the patient’s home right into their living room,” Health Minister Tanya Plibersek said in the announcement. “We want patients to get the health care that they need, when they need it and where they need it.” The program also aims to provide coaching and healthy living support in the home to improve overall health outcomes for older Australians or those living with serious illness. In its guidelines to applicants, the government said it expected the amount of funding provided for individual pilots will generally be around $1 million to $3 million. “Higher levels of funding may be available for pilot projects that are able to demonstrate exceptional prospective benefits,” the guidelines state. Funding can be used for a number of capital and infrastructure purposes, including: • • • • • •
equipment, for example telehealth monitoring equipment, tablet devices or computers service delivery (unless this is funded through alternative sources) cost of access to broadband internet services (e.g. for patients to participate in the trial) staffing and on-costs, including appropriate training for healthcare practitioners and patients administrative costs (including legal, accounting and insurance). Funding can also be used for the initial establishment of secure networks, licensing software and patient internet access where it does not already exist in the practice.
“Project funds would cover the costs of managing and operating the telehealth system for the duration of the project,” the guidelines state. “Any ongoing costs beyond the project’s life, would be the responsibility of the applicant.” In the May budget, the government also announced funding for a new $8.1 million trial of in-home telehealth for 300 veterans living in communities soon to be linked to the NBN. Commencing later this month, the trial will demonstrate the potential for tele-monitoring and video consultations to improve the management of the complex chronic conditions often suffered by veterans and to reduce preventable hospitalisations.
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Feature
THINKING OF TAKING UP TELEHEALTH? Technology to enable telehealth has been around for a long time but with the government’s incentive scheme now rolled out, new product solutions have flooded the market. If you are considering jumping into telehealth, there are a number of independent resources available to help you make the right choice.
KATE MCDONALD Journalist: Pulse+IT kate.mcdonald@pulseitmagazine.com.au
Telehealth is not particularly complex technology — a computer, a web cam and an internet connection is pretty much all you need — but there are two things that separate it from everyday video conferencing. The first is a linked clinical software package, which while useful is not completely necessary, and the second is a national directory of specialists and GPs who are equipped to offer telehealth services and are willing to do so. Some of the more successful telehealth vendors have built provider directories of their own, but as these vendors usually sell proprietary products that are not interoperable with competitors, GPs in particular are wary of committing to a product if the specialist they want to consult with uses something else. An independent directory of general practices and specialists equipped for telehealth video consultations has recently been established by the Australian College of Rural and Remote Medicine (ACRRM). The college has been funded by the federal government to organise the directory, which is free to use by college members and non-members alike. Jeff Ayton, the chair of the college’s national telehealth advisory committee, says the directory is making an important
contribution to health equity for people living in rural and remote areas. “ACRRM’s telehealth provider directory is the only freely available, non-commercial database of organisations and individuals who provide telehealth services,” Dr Ayton says. “The aim of the directory is to connect doctors who are using telehealth and learn more about the technology used and services offered by a wide range of medical specialist and referring professions, such as GPs, midwives, nurses and allied health workers.” He says the directory supports key existing rural and remote referral pathways and also overcomes the biggest barrier to the uptake of telehealth: finding telehealthready doctors. The directory is endorsed by ACRRM’s national advisory committee, which includes specialist colleges, medical associations, government bodies, and allied health organisations. The ACRRM has also compiled a directory of technology products and vendors who provide video conferencing hardware and desktop and mobile software solutions. There is a huge number of vendors out there, so the directory allows users to search by solution type (desktop, mobile,
browser-based), hardware, operating system compatibility and cost. It also allows users to search for products that are compatible with the different systems used by state and territory health departments. The ACRRM also provides a free, personalised service to assist practices to set themselves up for telehealth services, and runs an online discussion forum for users, providers and independent experts. It is also currently developing a standards framework in association with Professor Anthony Maeder, chair of Standards Australia’s telehealth committee, to provide a guide to understanding a range of issues relating to deployment and use of telehealth products and services.
Guidelines and standards The Royal Australian College of General Practitioners (RACGP) also provides an advisory service for members thinking of taking up telehealth. It has developed a series of implementation guidelines for video consultations in general practice, and will soon employ three telehealth support office to provide practice support and tools for members interested in video consultations. It is also developing an education program to offer online and face-to-face workshops on how to select and implement a telehealth solution, including information on MBS item numbers and patient scenarios. The RACGP is currently revising its implementation guidelines for video consultations in general practice, which provides practical advice on software and hardware choices including more comprehensive information on the use of Skype and other online video conferencing options.
The revised implementation guidelines will be available in August, and clinical guidelines will be published early next year. The Medical Board of Australia has also developed guidelines to technology-based patient consultations, aimed at informing registered medical practitioners and the community about the board’s expectations of doctors who participate in technologybased patient consultations. Medicare Australia also provides some very useful advice on its website about the MBS item numbers, recommended hardware specifications, and links to specialist colleges and healthcare organisations that provide more specific advice. David Allen, who runs the not-for-profit Telehealth Solutions Australia and is a member of both the Australasian Telehealth Society and Standards Australia’s telehealth committee, says the majority of GPs and specialists who are interested in starting in telehealth are approaching their colleges for assistance. “There are hundreds of solutions that will basically do the job, so what people in reality are doing is speaking to colleagues or the medical colleges or healthcare organisations what to do,” he says. “That’s what I did – we set up Telehealth Solutions Australia to make it easier. What we were finding was that uptake was relatively poor and just to make it easier for them. We have opened up our servers for free, basically.” Dr Allen says the Standards Australia committee is currently working on a telehealth standard for Australia which will reflect the existing draft international standard, aided by the ACRRM. “The idea is to keep it as simple as possible,” he says. “I think that doctors are not going to read these documents. Practice managers are probably going to have to.”
Resources and Guidelines Australian College of Rural and Remote Medicine telehealth service Royal Australian College of General Practitioners telehealth guidelines
www.ehealth.acrrm.org.au www.racgp.org.au/telehealth www.racgp.org.au/standards/telehealth
Medical Board of Australia guidelines
www.medicalboard.gov.au
Medicare claiming
www.mbsonline.gov.au/telehealth
Australasian Telehealth Society
www.aths.org.au
Telehealth Solutions
www.telehealth.net.au
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Feature
THE MOBILE CONSUMER A HIGHLIGHT AT HIC2012 Now in its 20th year, the annual Health Informatics Conference (HIC) has emerged to become the leading eHealth event in Australia due to the breadth and depth of its plenary, industry and scientific sessions. This year, the theme of a consumer or patient-led health system of the future is one of the highlights, encompassing as it does the lightning speed at which mobile technology is radically reforming the global health system.
KATE MCDONALD Journalist: Pulse+IT kate.mcdonald@pulseitmagazine.com.au
It may not be very often that the US National Coordinator for Health Information Technology, Farzad Mostashari, is left speechless, but that is exactly what happened to him when he sat on a panel with a bright young woman who has since become one of America’s leading patient advocates. Regina Holliday is an artist with a story to tell, and this she does with remarkable passion and insight. Louise Schaper, the CEO of the Health Informatics Society of Australia (HISA), the organiser of HIC, says Ms Holliday is one of the most powerful public speakers she has ever heard. It was Dr Schaper who witnessed Dr Mostashari struggling for words upon first hearing a short excerpt of the young woman’s story, something Australians might also experience when Ms Holliday appears at HIC. “Regina is one of the best public speakers I have ever seen,” Dr Schaper says. “I went to a Health 2.0 conference [in the US] and she was on a panel. Everyone got a five-minute spiel, and she spoke first. “Second up was Farzad Mostashari, who is the most important person when it comes to eHealth in the US, and he was just staring. He opened his mouth a few times and was speechless. He said Regina was a tough act to follow.”
Ms Holliday’s story is unfortunately not an unusual one. Her husband was diagnosed with renal cancer in his mid-30s, and like many he was shuttled from one hospital to another. Over the several months from diagnosis to his eventual death, he was a patient in five different healthcare facilities, none of which were linked and none of which spoke to each other. Tired of repeating the same information and suffering through the same tests, Ms Holliday asked for a copy of his medical record. She was told it would take 21 days and cost 73 cents a page. She believes that had there been an electronic record that all of his carers could consult, his treatment may have been better and perhaps his death made more comfortable. Ms Holliday now spends her time raising her children and acting as an advocate for both patients and electronic health records. She is also an artist, and while it may sound a little kooky to clinicians and health informaticians, she will be painting a mural throughout HIC with an eHealth theme. “She has created something called the ‘Walking Gallery’, which is the idea that you have a jacket, a normal one you’d wear during the day, with a Regina painting on the back of it which tells a patient story, often with an eHealth-related theme,” Dr Schaper says. “It is hard to get the patient voice out there. The idea is that by wearing
the jacket, you become a mobile art gallery and opportunities arise to tell the story.
Q&As on consumer mobility and trusted information
“It is usually a patient-driven story about the influence of health information, the importance of patients having access to their information, and as a consequence the doctors and nurses and other healthcare professionals having access to the information so that everyone involved can help to make sure your journey in the healthcare system is hopefully a short one, and that your journey will be as positive an experience as possible.”
The HIC organising committee has put together two Q&A panels to discuss these emerging themes. The first, hosted by Stephen Alexander, will discuss the impact of mobile technology on healthcare. The panel will feature US representatives who can provide insight into the way Australia’s health system is likely to change in the next couple of years, including Matthew Holt, co-chair of Health 2.0, Iltifat Husain, founder and editor of iMedicalApps, and Rajiv Mehta, co-organiser of the Quantified Self movement.
The theme of patient advocacy, patient mobility and a patient-led view of future healthcare is a very deliberate one. Greg Moran, chair of the organising committee, believes that healthcare will change not from within, but from without. The overall theme of the conference is “building a healthcare future through trusted information”, trust being the common ingredient in healthcare transformation through enabling technology. “Trust is required to gain the adoption and the use of technology whether implementing clinical change, building integrated care models, or delivering smart patient programs,” Mr Moran says. “It is also required to enable greater patient participation in healthcare. “I think that healthcare is ultimately going to change through the external drivers. In healthcare, we try to do a lot quality improvement internally within the sector, but the many people I interact with, particularly the experts, are all talking about fundamental changes in the way the world operates and therefore healthcare operates. Mobility in particular – the use and pervasiveness of consumer technology and the innovation that will occur once the standards are set and routinised – there is a general sentiment that there will be a shift in the way that the healthcare system will work.”
The second panel, hosted by the ABC’s Tony Jones, will discuss doing more for less and the importance of ‘trusted’ information. This panel will feature Ms Holliday, NEHTA CEO Peter Fleming, HISA board director David Rowlands and Scot Silverstein, an adjunct professor of health informatics at Drexel University in the US, who has personally experienced the downside of electronic health information systems (see page 56). Mr Alexander is a prominent expert on the power of information technology, who encouraged the first bank in the UK to allow consumer transactions over the internet. He has worked in the UK, the US and here in Australia advising governments and industry on technological change. In his panel session, he hopes to achieve a consensus on some overarching principles about consumer mobility in healthcare and to feed that back to policymakers. “Let’s say there is view that health consumers will lead innovation,” he says. “Would the panel agree that innovation and drivers of changes will be consumerled, and if that’s the case, will mobility be the next thing that creates a tipping point to enable that consumer initiative, that consumer drive for change? Will that cause a tipping point in Australia?”
Dr Louise Schaper
Mr Alexander certainly believes it will. “I admit I’m biased in my view on this but my task is to find out whether there is a genuine consensus of opinion on that or whether there are any gaps in that thinking and what they are. For example, there are some views out there that we can’t afford to replace the systems that don’t work in health today. And if you can’t afford to replace them, then can the adoption of mobility solve some of those problems? “For policymakers who aren’t IT experts — and being one might not necessarily assist them anyway — can they grapple with this new phenomenon and feel confident to leverage off what is happening?” One of the main reasons for finding a consensus on which policymakers can then be advised is due to what Mr Alexander identifies as the elephant in the room. While most people working in healthcare know that there is a rapidly diminishing pot of money on which to spend on healthcare in general, this might come as a bit of a shock to consumers themselves.
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“The problem is, no one can talk about the elephant in the room, which is that healthcare is no longer affordable by government,” he says. “We are past that point, so the real tipping point is when the population starts to find out. In the UK, they are already talking about the formal rationing of health services, and we are not terribly different in Australia.
to PCEHR and do discharge summaries. As soon as you have that ... what I suspect is required next is you are going to have to get collaboration with the vendors and with the major providers to look at how to exchange information more to do with coordination of care.
“Mobility will play a much more formal role through its ability to alleviate some of that problem, but the real endpoint and the one that I’m most excited about is through the collaboration groups, we can shift to evidence-based clinical decision making rather than product-based.”
“The fact that this thing is built, you have to take your hat off to them. It doesn’t matter where it goes or what it is meant to do; I see that once you start having the capacity to join up other data systems, let say in aged care, mental health or chronic disease management, around coordinated care, that’s going to go like a rocket. That is all about empowering individuals and their advocates to do things better.
Those collaboration groups are exemplified by representatives on the panel from the US, where patient advocacy is truly a grassroots movement, and by the experience of the UK. He points to the NHS Expert Patients Programme, a project originally developed by Stanford University, that aims to teach patients to learn about and manage their conditions, particularly chronic illnesses.
“And there is a second wave coming behind it. They called it a personally controlled electronic health record – that comes from DoHA and that is the shrewdest thing going. The next battle is that if you want to control stuff, then you have to be responsible for it. Having it personally controlled by the consumer is the only way.
“Unlike the peak body groups that claim to represent people with conditions, these are actual grassroots,” Mr Alexander says. “They train them on how to manage their condition better. The hard figures were a 30 per cent reduction in hospital admissions, a 42 per cent reduction in hospital stays and about 29 per cent in GP visits. Show me a drug that can do that.”
The other elephant in the room There is little doubt that the PCEHR will be a huge point of discussion for all attendees, with its official launch planned for just a month before the conference is held. Putting aside the fractious politics behind its development and the arduous journey it still has to undertake, the PCEHR is one formal step towards the interconnected world that is rapidly bearing down on Australia’s health systems. While some have criticised it as a typical, big government foray into managing technological change in a brave new world, Mr Alexander, like many others, believes it will be a catalyst for further change, and change that needs to happen. He is not afraid to say that the decision to make the PCEHR personally controlled was actually a very shrewd move. “Setting aside the manner in which it is being done, my interest in the PCEHR is that it has a B2B exchange, it has a governance model and anyone with half a brain will work out how to build an app around it,” he says. “Not only that, but you have a commitment from each of the jurisdictions linking up similar software by Christmas. They have to do that in order to start to link that back
“The PCEHR governance structure is a precursor and therefore the catalyst for this broader eHealth agenda and I think some of the smarter vendors are already on it. And once you move into app world, by default everything is connected, and by default you can do connected analytics, which means you can do stuff in real time and that changes the rules. You are going to change everything.”
HIC program at a glance The three days of the HIC conference will cover three main themes. Day 1 concentrates on eHealth drivers and demand. “It really is a matter of health informatics enabling us to do more with less,” Louise Schaper says. “There are some in the health system who will say, with very strong conviction, that healthcare doesn’t need any more money. Day 1 we are going to take this idea out for a spin.” According to the chair of the organising committee, Greg Moran, the theme of healthcare drivers and demands will cover the consumer angle, featuring Regina Holliday; the cost angle, with a speech by the deputy commissioner of the Productivity Commission; and healthcare responding to natural disasters, which a presentation by Nigel Miller, the chief medical officer of the Canterbury region in New Zealand, which was devastated by last year’s earthquake. “The intent there is really to say we have to change, we can’t keep doing things the way we do them,” he says. “There is a whole range of things that can be introduced into healthcare which will increase productivity and provide better care. That is why it is topical, complex, and exciting.”
These disparate themes will then be brought into an Australian context by Michael Bainbridge, Mr Moran says. “Mike’s role will be to bring some reasonably disparate presentations around consumer health, cost and the natural disasters to a general rounding theme. What does it mean for healthcare?
include foundation chair in medical informatics at the University of NSW, Enrico Coiera; AMA president Steve Hambleton; NEHTA’s head of strategy John Zelcer; and professor of public health and community medicine at the University of Sydney, Stephen Leeder. Day three will concentrate on the future, with a plenary speech by Rajiv Mehta on how the best health technologies and collaboration minimise the need for professional health services. Mr Moran describes Mr Mehta as being passionate about consumer technology and open source development.
“While Regina will set the tone, she’ll present very much as an American healthcare advocate, which doesn’t always translate for Australia, so one of Mike’s roles will be to bring it back to Australian relevance.” Day two will be dedicated to a more traditional theme of evidence and outcomes and how to put evidence into practice. “While these themes may be traditional, the program is set to discuss this at a deep level, to really look at not only how new knowledge gets translated into clinical and information practice, but how does evidence influence health policy,” Dr Schaper says.
“The collaboration theme will be continued through the day, including a dedicated workshop facilitated by Denis Tebbutt which will explore the critical elements of collaboration and relationship management to enable transformational reform in healthcare.”
“When you look at the policy side of things the stakeholders have evolved over the years and consultants have increased their role in providing advice to government. How does this influence getting evidence into practice? How does the consumer voice get represented? With all these voices, who has the most significant influence? These are themes and questions that will get teased out during the day.”
This day will also feature a Q&A panel, moderated by Dr Schaper, on whether Australia can lead the world in digital healthcare. Panellists include Fernando Martin-Sanchez, chair of health informatics at the University of Melbourne; NSW Health CIO Greg Wells; Lee Ridoutt, a consultant with Health Workforce Australia; and Lucila Ohno-Machado, associate dean for informatics and technology at the University of California, San Diego.
A Q&A panel on day two, moderated by business consultant Margot Cairnes, will discuss how to build on research and evidence for immediate healthcare improvements. Panellists
Health Informatics Society of Australia
“He has created a community of interest where people can share their own knowledge, their development tools, to build upon the knowledge within the system to get better outcomes commercially, professionally and I think there is a social benefit to it as well,” Mr Moran says.
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Feature
THE WICKED COMPLEXITY OF HEALTHCARE IT
Scot Silverstein, a keynote speaker at this year’s Health Informatics Conference, has one of the best resumes on the planet when it comes to evaluating the safety of health IT systems. Not only did he complete a post-doctoral fellowship in medical informatics at the Yale School of Medicine and has led the strategic planning, design and implementation of a $10 million EMR system, but he is also a qualified medical doctor and prolific blogger who has been personally affected by a health IT system gone wrong.
KATE MCDONALD Journalist: Pulse+IT kate.mcdonald@pulseitmagazine.com.au
Earlier this year, an opinion paper in the Medical Journal of Australia caused widespread debate in this country about the potential risks that national eHealth systems like the PCEHR pose. The article, written by eminent researchers Enrico Coiera and Michael Kidd, along with well-known eHealth advocate and general practitioner Mukesh Haikerwal, made headlines due to its serious warning that the PCEHR and other eHealth initiatives might be inherently unsafe, and that there was no guarantee that events that risk harm to patients will be identified or remediated when they are in operation. The authors called for a national clinical safety governance system for eHealth in Australia, warning that even if the shortterm performance of the new system turns out to be safe and effective, the international experience suggests that risks will emerge with time. They argued that while eHealth can bring rapid benefits to patient care, it can also sometimes lead to patient harm or death through problems in design or operation, likening adverse events to a preventable “eHealth air crash”. It is the very complexity of eHealth and health IT systems that pose the greatest challenge, they wrote. “We cannot quantify
today what will result in terms of either benefit or risk. Our capacity to predict outcomes is also hindered because these systems will be used by both clinicians and consumers … [Many] informational errors lead to no harm or are picked up by system ‘defences’, such as clinician vigilance. At some point, however, patient harm will occur.” This is something that Scot Silverstein has been writing about for many years, and something that he has been personally involved with. Dr Silverstein was a hospital-based physician who used his interest in IT and experience – dating back to 1970, when he learned programming on the now-classic PDP-8/S minicomputer – to develop an academic career specialising in the newly developed field of medical informatics. He is a citizen journalist, establishing a website called Contemporary Issues in Medical Informatics back in 1998, which is now hosted at Drexel University’s College of Information Science and Technology in Philadelphia, Pennsylvania, and is a regular blogger on the multi-author Healthcare Renewal blog site. He also works as a consultant to both plaintiff and defendant attorneys in litigation where health IT might have contributed to harms or to evidence discovery problems.
“That insight had occurred to me over 10 years ago,” he says. “I was a chief medical informatics officer at the only tertiary care hospital in the state of Delaware. I had just come from Yale, where I was a faculty member, and that is an academic medical centre where the understanding of IT was significantly more scientifically based. But then I went to non-academic hospitals and saw people treating clinical systems as if they were no different and required no different approaches, no different design methods and implementation methodologies, than an accounting or other business-oriented information system. “I saw that as very odd, because knowing and having experience in having built EMRs myself, I knew that these were really virtual clinical tools that happen to reside on computers, and they were being treated instead as business systems that just happen to be used by clinicians. They worked poorly in part due to the inappropriate business-computing approach to their development, implementation and support. I saw a major disconnect there.”
Dr Scot Silverstein Despite this background, Dr Silverstein himself was unable to prevent the experience of his mother, whom he believes was harmed and sadly died as a result of an IT-related error. He cannot speak in depth about the case as it is currently in litigation, but what he can say sums up his view, that “healthcare IT can achieve all of the many benefits attributed to it, but only if ‘done well’, a task of almost wicked complexity.” As he writes on his Drexel website: “I started the site after observing, for lack of a better description, “crazy stuff” in the commercial healthcare information technology sector. Crazy stuff such as EMR systems for ICUs that crashed regularly and spread pathogens around, EMRs for invasive cardiology cath labs that were an informational jumble and abyss and that also issued regular General Protection Faults and died, lack of medical informatics expertise (and actual disdain for it) in healthcare IT projects, grossly incompetent IT leaders, and hospitals uncritically and enthusiastically buying these products as if they were a plug and play, proven technology. To make matters worse, I also observed executives expressing a hostile indifference to glaring deficiencies.” One issue that he believes is still to be resolved is the lack of awareness about the difference between business-oriented computing and clinical computing, with hospital management committing to buying and installing systems with insufficient or no consultation with the clinicians who actually have to use them.
Dr Silverstein views business computing and clinical computing as two very different sub-specialities of information technology, but he believes there is a disconnect between people who are trained in management information systems in business settings and those trained in computing for clinical settings. “And I still see there is not enough cross-education. I see people who are of a business computing background and mindset, often lacking a medical or science background, trying to work on these systems or lead these systems without having the background to be able to critically appraise them as clinical tools, and this creates an approach unsuitable for maximal success or even moderate success sometimes.”
Magnitude unknown Dr Silverstein is currently acting as a substitute plaintiff in his mother’s case, which he says was an “eye-opener” in terms of not just the potential problems of the field and the technology, but attitudes towards the technology, particularly when people are in positions of authority. “I noticed problems of my own observing in my mother’s care, in the hospital, and in outpatient care, and despite a written warning from me, the attitude seemed to be ‘no, this can’t possibly be true’,” he says. One of the main causes behind what he sees are increasing numbers of medical misadventures is the attitude that because information is electronic, it must be correct. “I call that the syndrome of over-confidence, unwarranted over-confidence, in computer systems,” he says. “They are only as good as the people who create them and operate them and yet their outputs are taken as gospel.
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“PCEHR seems to fit right into the Greek tragedy. You can tell what will happen before it starts.”
“I am already aware of a half-dozen or more major cases, and my colleagues are starting to tell me of near-misses and actual patient injuries that are not at the time recognised as related. It is hard to pin down but I’d say the number is increasing in the US. We are probably the most litigious country but these are significant and real situations.”
Government oversight Dr Scot Silverstein
“My mother was injured as a result of over-confidence in a computer screen as opposed to verbal and other written forms of information. There is a syndrome of over-confidence in computers which is puzzling to me, because in other fields, people, when they start getting incorrect bills or they keep coming and they can’t stop them, it is always blamed on a computer system and yet in medicine, it seems to have evolved a culture around computing that machines in healthcare must deterministically create improvement and are purely beneficent and can’t be capable of creating harm. “It is a strange philosophy because in the same breath, people say healthcare information technology is capable of great benefit, that is a very powerful technology and when it is done well, it is. But anything that is a potential source for great good can also have a downside. There seems to be a cognitive gap in connecting computing in healthcare to its possible risk.” Dr Silverstein now works part-time as a teacher/researcher at Drexel University in Philadelphia, and part-time as a consultant, some of which involves appearing as an expert witness or providing advice to the legal fraternity involved in cases of harm caused to patients by IT systems and electronic medical records. He doesn’t call it a common occurrence, but does say it is increasing, with its “magnitude unknown”. “A lot of cases go to settlement. For example, I’m aware of a case – and this is a case that only became known because I went searching for it – of a baby’s death. There was some litigation relating to a computing foul-up, and it settled for $US1.5 million. “The problem is a lot of these cases that never go to trial settle out of court so I’m starting to hear of more cases and get calls from attorneys about more cases and speaking to attorneys about whether they are aware of problems.” But no one is really sure of the magnitude of the problem, he says, “not even the Institute of Medicine of the National Academies, the highest scientific body in the United States, per their 2011 report on health IT risks”.
Similar to Coiera et al’s call for more oversight of healthcare IT safety, Dr Silverstein believes that governments need to establish independent oversight bodies and that these must not be toothless tigers. While many Americans are implacably opposed to government intervention in healthcare, the establishment of the US Office of the National Coordinator (ONC) for Health Information Technology in 2004 and the passage of the HITECH Act in 2009 have focused attention on the safety and efficacy of healthcare IT systems. However, while the ONC has an advisory role that is of increasing importance, it still does not have a formal regulatory role such as that held by the Food and Drug Administration (FDA). This is something that Dr Silverstein would most definitely like to see changed. He applauds the move by the current national coordinator, Farzad Mostashari, to bring in private certification boards to evaluate commercial health IT systems for their adherence to criteria for “meaningful use” of the technology as defined by the government, but points out that the certification process is in actuality merely a “pre-flight checklist” of systems that doesn’t provide any indemnification or guarantee quality, safety or fitness for purpose. “They really just decide if the criteria of usage, certain data gathering and certain features, are met,” he says. “What I recommend for both [the US and Australia] is that they have a formal government organisation that helps to at least set some basic standards for health IT in terms of features, functionality, data collection ... but then it needs to go beyond that. That same body or some other body should probably have some oversight over health IT, not just features and functionality but quality, usability, user friendliness, robustness under load and other issues – validation is the primary term. That is step A.” Step B, he says, is to consider health IT systems as medical devices – as the US FDA and the Swedish Medical Products Agency do – and to introduce a formal government regulatory role over technology. This is a role that is already played by the FDA in the IT systems used for managing records in clinical studies and trials and for drug manufacturing in the pharmaceutical industry.
“I see the extension of that to delivery sector health IT as logical. I’m a free-market type of person, it’s just that free markets, at certain times, can introduce a lot of risk. I think the same is true of any big country with a technology as complex and evolving and still experimental as health IT.
At HIC, he will appear on a Q&A panel moderated by the ABC’s Tony Jones on the topic of the importance of ‘trusted’ information, along with US patient advocate Regina Holloway, who will speak at the conference about her experience with access to electronic healthcare information.
“I don’t remember a day when it was declared that it had graduated from an experimental technology to a full tried-and-true technology and so we need guidance bodies. And then ultimately both countries need a regulatory authority to set down standards.”
While he is unwilling to pass judgement, what he has read about Australia’s PCEHR project leads him to conclude that the PCEHR is “a traditional, large-government-run project with all that entails”.
HIC2012 will be Dr Silverstein’s first trip to Australia, although he does keep up with events in this part of the world online. He has brought to the attention of his readers some of the work on health IT safety done by Sean Goldfinch, formerly of the University of Otago and now based in the UK, and the famous report by the University of Sydney’s Jon Patrick into the problems experienced in NSW hospital emergency departments following the introduction of an EMR.
“After having studied the domain of social informatics, the study of the impact of any new information and communication technology – empirical research has been going on for 30 years – whenever a government gets involved in a large computing project, especially in healthcare, a script of what is going to transpire can almost be written before the project even starts,” he says. “PCEHR seems to fit right into the Greek tragedy. You can tell what will happen before it starts.”
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Advantech
3M Health Information Systems P: +61 2 9498 9499 F: +61 2 9498 9377 E: gharris@mmm.com W: www.3m.com.au/his 3M Health Information Systems is a leading provider of software solutions to help healthcare organisations capture, classify, and utilise data — accurately and efficiently. With more than 28 years of experience in health information management, 3M offers integrated solutions for: • Coding, Grouping and Reimbursement • Document Management and Scanned Medical Records, providing: ◊ Access anytime to complete patient history ◊ Intuitive, customisable document viewing ◊ Automated worklists ◊ Electronic signature • Dictation and Transcription, providing: ◊ Reduced dictation time ◊ Increased accuracy ◊ Lower transcription turn-around-time ◊ Seamless integration with PAS and EHR systems
ACIVA E: j.edgecumbe@ehealtheducation.net W: www.aciva.org.au The Aged Care IT Vendors Association (ACIVA) was formed in early 2010, a not-for-profit organisation, incorporated in NSW. ACIVA represents the residential aged and community care sectors and vendors at various national forums regarding strategic developments and eHealth. ACIVA members are residential aged and community care software vendors, industry benchmarking software, financial software, call-bell, hardware, networking, infrastructure and industry partners. Members are committed to furthering the interests of residential aged and community care in national forums to ensure eHealth and access to the personally controlled health record (PCEHR) becomes a reality for the aged care industry in the very near future. Contact: Secretariat Joan Edgecumbe j.edgecumbe@ehealtheducation.net
P: 1300 308 531 F: +61 3 9797 0199 E: info@advantech.net.au W: www.advantech.net.au Advantech’s medical computing platforms are designed to enhance the quality and efficiency of healthcare for patients and users alike. All of Advantech’s medical PCs match the performance of commercial PCs but are medically rated to UL/EN 60601-1 third revision, IPX1 drip-proof enclosures and are designed to suit ward and theatre based applications. Advantech offers long term availability and support plus a proven track record of reliability. The medical range extends through: • Point-of-Care Terminals. • Mini-PC and Medical Imaging Displays. • Mobile Medical Tablets. • Computerised Medical Carts. • Patient Infotainment Terminals. Advantech is also an official distributor of Microsoft Windows Embedded software across Australia & New Zealand.
Australasian College of Health Informatics P: +61 412 746 457 F: +61 3 9569 9449 E: Secretary@ACHI.org.au W: www.ACHI.org.au The Australasian College of Health Informatics is Australasia’s Health Informatics professional body, representing the interests of a broad range of clinical and non-clinical e-health professionals. ACHI is the community of Health Informatics thought-leaders in Australasia. ACHI is committed to quality, standards and ethical practice in the Health Informatics profession. More information is available at: www.ACHI.org.au Join the ACHI Info email list at: www.ACHI.org.au/List
Argus ACSS
AAPM P: 1800 196 000 / +61 3 9095 8712 F: +61 3 9329 2524 E: headoffice@aapm.org.au W: www.aapm.org.au The Australian Association of Practice Managers (AAPM) is a non-profit, national peak association founded in 1979, dedicated to supporting effective practice management in the healthcare sector. The Australian Association of Practice Managers: • Represents practice managers and the profession of practice management throughout the healthcare industry. • Promotes professional development and the code of ethics through leadership and education. • Provides specialised services to support quality practice management including advocacy, education, resources, networking, advice and assistance.
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P: 1300 788 005 / +61 2 9632 0026 F: +61 2 9632 0096 E: sales@acsshealth.com W: www.acsshealth.com ACSS provides innovative and customisable patient management software streamlining day-to-day operations for GPs, Allied Health, Specialists, Radiologists, Pathologists, Private and Public Hospitals. eClaims® — Comprehensive and robust appointment and billing system with digital/voice recognition capabilities, electronic reporting transmissions and HL7 PACS system integration. eClaims® Hybrid — A solution tailored to Hospitals and other health service providers including billing agents who lack online capabilities. eClaims® Hybrid is the interface solution for connecting you to Medicare and health funds through ECLIPSE. SimDay® — Proven PAS (Patient Administration System) specifically designed for day surgeries and private hospitals – Now with ECLIPSE integration.
P: +61 3 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.
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) • Best Practice Automatic SMS reminders Visit us at the following conferences throughout the year: • 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
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.
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.
Find out more about how cdmNet can assist you and your practice by typing cdm.net.au/info into your browser address bar.
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.
cdmNet: Chronic Disease Management just got a whole lot easier.
Our support is first class, our philosophy is “whatever it takes”.
cdmNet optimises patient care, simplifies care team collaboration and reduces administration & paper work.
Cerner Corporation Pty Limited P: +61 2 9900 4800 F: +61 2 9900 4990 E: AsiaPacific@cerner.com W: www.cerner.com.au Cerner is a leading supplier of healthcare information systems and our Millennium suite of solutions has been successfully installed in over 1200 sites across the globe. Cerner’s technology has been designed so that it can be adapted to meet the needs of the very different healthcare delivery systems that exist, with a universal framework 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
CSC’s HealthCare Group P: +61 2 8035 6700 F: +61 2 8035 6801 E: healthsolutions@csc.com W: www.csc.com/healthsolutionsAPAC Healthcare is key part of CSC’s global business. It has a strong track record of delivering successful government health programs across Europe and in both the public and private healthcare sectors in the US. Focused on eHealth, CSC’s Healthcare Group provides an end-to-end service combining technology innovation, world-class consulting and system integration services with proven healthcare software. In the Asia Pacific region, CSC provides localized solutions to improve: patient flow, access to clinical information, medication safety and pathology diagnostics. CSC participates in regional government health information exchange initiatives to connect care across care environments and to enable clients to leverage existing e-health investments. For more information, visit the Healthcare Group’s Asia Pacific website at www. csc.com/healthsolutionsAPAC
Cutting Edge Software P: 1300 237 638 E: enquiries@cesoft.com.au W: www.cesoft.com.au Cutting Edge produces affordable, intuitive billing solutions for Mac, Windows, Linux and iPad. Cutting Edge is ideal for practitioners who prefer to maintain control of their own billing from a number of sites. Cutting Edge Software is approved by Medicare Australia to manage your electronic: • Verification of Medicare and Fund membership • Bulk Bill and Medicare claims • DVA paperless claims • Inpatient claims to Health Funds We have solutions tailor-made for: • Anaesthetists • Surgeons/Surgical Assistants • Physicians • GPs • Allied Health The software comes with up-to-date schedules for MBS/Rebate, Gap Cover (all registered health funds), Workers’ Compensation, Transport Accident authorities and DVA.
Direct Control 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.
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 ë 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.
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.
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Emerging Systems
eHealth Security Services
P: +61 2 8853 4700 F: +61 2 9659 9366 E: sales@emerging.com.au W: www.emerging.com.au/ehealth
P: 1300 399 116 / +61 2 9016 5378 F: +61 2 9016 5379 E: info@ehealthsecurity.com.au W: www.ehealthsecurity.com.au
Emerging Systems EHS web-based Clinical Information System records the clinical care delivered to a patient from pre-admission through to discharge. EHS interfaces with the hospital’s PAS system, capturing and providing all of the information Clinicians require during a patient stay to support the delivery of effective, appropriate, quality care outcomes in a secure and auditable environment. 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.
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.
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 • Discharge Summaries • Appointments • Rostering & Allocation • GP Connect • Workforce Resource Calculation • Document Management System • Clinical Dashboard and more EHS supports interactions with the health identifier service and PCEHR. 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
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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.
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.
Equipoise (International) Totalcare 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. 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.
GPA P: 1800 188 088 F: 1800 644 807 E: info@gpa.net.au W: www.gpa.net.au GPA ACCREDITATION plus (GPA) is the only independent accreditation program for general practice in Australia. Established in 1998 and run by a team of committed general practitioners, business leaders and experienced administrators, GPA has developed a program that continuously evolves in order to set new standards in general practice accreditation, while offering full support to practices to make accreditation both achievable and rewarding. GPA is committed to providing an accreditation program, which is flexible and understands the needs of busy GPs and practice support staff. Whilst accreditation gives practices access to the Practice Incentive Program (PIP), GPA believes it should offer benefits that go well beyond the PIP. Our program provides practices with a pathway to enhanced patient care, continuous professional satisfaction, improved practice efficiency and superior risk management. GPA ACCREDITATION plus certificates and signage remind patients that their practice has achieved a level of care and service above and beyond essential general practice standards. GPA provides a system designed to accommodate busy general practices. Among our services, we offer practices the opportunity to use technologicallyadvanced, environmentally-friendly online programs, allowing staff to upload documentation at their own pace; individually assigned client managers, supporting practices through accreditation from start to success and beyond; highly-trained and sensitive surveyors, with extensive experience in all facets of general practice; and interactive training seminars, bringing practices the latest information in standards and innovation. At GPA, we believe that accreditation should be an accomplishment, not a test, and we uphold that belief in our approach and service. For an accreditation program that will offer you assistance, support, information and satisfaction…the choice is yours.
Global Health
Health Communication Network
P: 1300 723 938 F: +61 3 9675 0699 E: marketing@global-health.com W: www.global-health.com
P: +61 2 9906 6633 F: +61 2 9906 8910 E: hcn@hcn.com.au W: www.hcn.com.au
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: ë ReferralNet - a cloud-based secure message delivery system for the exchange of information between healthcare providers. ë MasterCare® - a suite of health information systems that provides tools to collect, manage and access clinical and patient information at the point of care. ë LifeCard® - a personal health management system for keeping all your important medical information in ONE secure location. With LifeCard® you can maintain a personal health record, access emergency health information and be rewarded for looking after your health.
Health Communication Network (HCN) is the leading provider of clinical and practice management software for Australian GPs and Specialists and supplies Australia’s major hospitals with online Knowledge resources. HCN focuses on improving patient outcomes by providing evidence based software tools to health care professionals at the point of care. Market snapshot: • 17,000 medical professionals use Medical Director • 3,600 GP Practices use PracSoft • 800 Specialist Practices use Blue Chip and • 2,100 Specialists use Medical Director • Leading suppliers of Knowledge Resources to Australia’s major hospitals
Health Informatics Society of Australia P: +61 3 9326 3311 F: +61 3 8610 0006 E: hisa@hisa.org.au W: www.hisa.org.au HISA is Australia’s health informatics organisation. We have been supporting and representing Australia’s health informatics and eHealth community for almost 20 years. HISA aims to improve healthcare through the use of technology and information. We: • Provide a national focus for eHealth, health informatics, its practitioners, industry and a broad range of stakeholders • Support, promote and advocate • Provide opportunities for networking, learning and professional development • Are effective champions for the value of health informatics HISA members are part of a national network of people and organisations building a healthcare future enabled by eHealth. Join the growing community who are committed to, and passionate about, health reform enabled by eHealth.
HealthLink P: 1800 125 036 (AU) P: 0800 288 887 (NZ) E: enquiries@healthlink.net W: www.healthlink.net Australia’s and New Zealand’s largest effective secure communication network. • Referrals, Reports, Forms, Discharge Summaries, Diagnostic Order and Reporting • Provider of Secure Messaging Delivery (SMD) services • Fully integrated with leading GP and Specialist clinical systems • Robust; Reliable and Fully Supported Join the network that more than 70 percent of GPs use for diagnostic, specialist and hospital communications.
Houston Medical P: 1800 420 066 (AU) P: 0800 401 111 (NZ) E: info@houstonmedical.net W: www.houstonmedical.net “We provide time to health professionals through efficient practice management software”
Healthbank Consult P: 1300 856 722 F: 08 8301 4001 E: support@healthbankconsult.com.au W: www.healthbankconsult.com.au Healthbank Consult is a telehealth system developed in Australia for Australian healthcare providers. Secure, fully encrypted and HD capable, Healthbank Consult is designed to be compatible with your clinical desktop for easy integration with your practice’s workflow and retains an audit trail for Medicare. Compliant with RACGP telehealth guidelines, Healthbank Consult will qualify Rural GPs, Specialists, Aged Care Facilities and Aboriginal Medical Services for a $6,000 Medicare telehealth rebate plus ongoing fees.
Our multidiscipline software provides interfaces to every major manufacturer, enabling many clinics to save space by becoming completely paperless!
Health Informatics New Zealand E: admin@hinz.org.nz W: www.hinz.org.nz Health Informatics New Zealand (HINZ) is a national, not-for-profit organisation whose focus is to facilitate improvements in business processes and patient care in the health sector through the application of appropriate information technologies. The Executive Committee works to maintain the purpose and service for the members, through dynamic goals of improved healthcare outcomes through the dissemination and utilisation of information, knowledge and technology. HINZ acts as a single portal for the collection and dissemination of information and about the New Zealand Health Informatics Industry. Membership is for anyone who has an interest in health informatics.
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.
We are a progressive medical software company and take pride in working with our health care clients to deliver tailored EMR and PMS packages based on each unique situation and practice requirements. We’re focused on helping to make their businesses more efficient and productive as well as delivering measurable improvements in customer satisfaction and market share. You can arrange a free demonstration of our software by visiting: www.HoustonMedical.net
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.
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InterSystems P: +61 2 9380 7111 F: +61 2 9380 7121 E: anz.query@InterSystems.com W: www.InterSystems.com InterSystems Corporation is a global leader in software for connected care, with headquarters in Cambridge, Massachusetts and offices in 25 countries. InterSystems TrakCare™ is an Internet-based unified healthcare information system that rapidly delivers the benefits of an Electronic Patient Record. InterSystems HealthShare™ is a strategic healthcare informatics platform for information exchange and analytics within a hospital network, and across a community, region or nation. HealthShare leverages InterSystems iKnow and DeepSee technologies to unlock all patient information, including unstructured data, and to enable real-time analysis. InterSystems Ensemble® is a platform for rapid integration and the development of connectable applications. InterSystems CACHÉ® is the world’s most widely used database system in clinical applications.
MEDITECH Australia P: +61 2 9901 6400 F: +61 2 9439 6331 E: sales@meditech.com.au W: www.meditech.com.au A Worldwide Leader in Health Care Information Systems MEDITECH today stands at the forefront of the health care information systems industry. Our products serve well over 2,300 health care organisations around the world. Large health care enterprises, multi-hospital alliances, teaching hospitals, community hospitals, rehabilitation and psychiatric chains, long-term care organisations, physicians’ offices, and home care and hospice agencies all use our Health Care Information System to bring integrated care to the populations they serve. Our experience, along with our financial and product stability, assures our customers of a long-term information systems partner to help them achieve their goals.
Medtech Global Ltd
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.
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.
P: 1800 148 165 E: salesau@medtechglobal.com W: www.medtechglobal.com
ISN Solutions 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
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.
Mouse Soft Australia Pty Ltd
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
P: +61 3 9888 2555 F: +61 3 9888 1752 E: sales@medicalwizard.com.au W: www.medicalwizard.com.au Medical Wizard saves time and money through greater efficiency and comprehensive integration. Throughout its 19 year history, Medical Wizard has led the way with innovative solutions. We are constantly evolving Medical Wizard to meet the challenges of the medical profession for today and tomorrow. A software of choice for discerning Specialist practices, notably Gastroenterologists, Cosmetic Surgeons, Ophthalmologists, General Surgeons, IVF Centres and Day Hospitals amongst others. All aspects of practice management from appointments, billing, clinical, theatre management and compliance reporting are covered and backed by a dedicated local support team. Feature Rich. Dynamic. Innovative.
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OzeScribe
NEHTA P: +61 2 8298 2600 F: +61 2 8298 2666 E: admin@nehta.gov.au W: www.nehta.gov.au 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.
New Zealand Health IT Cluster P: +64 4 815 8177 E: admin@healthit.org.nz W: www.healthit.org.nz The New Zealand Health IT Cluster is a vibrant alliance of organisations interested in health IT, comprising software and solution developers, consultants, health policy makers, health funders, infrastructure companies, healthcare providers, and academic institutions – who have agreed to work collaboratively. Our goals: • New Zealand industry is consistently well regarded in providing quality, relevant solutions domestically and in offshore markets. • New Zealand has an internationally regarded model of partnership that fosters development of innovative solutions to healthcare challenges. • In key and emerging markets the New Zealand health IT brand is strongly recognised. By 2015 sales growth is doubled from the 2010 baseline.
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).
Orion Health 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: 1300 727 423 F: 1300 300 174 E: sales@ozescribe.com.au W: www.ozescribe.com.au OzeScribe is the dictation and transcription solution for most Australian university teaching hospitals and major private clinics. It really does make sound business sense to let OzeScribe worry about managing dictation, transcription and technology. We provide free electronic document delivery – OzePost – to your EMR and your associates’ EMR, saving you thousands of dollars in time, packing and postage. OzeScribe is the provider of the most advanced solutions available. • Run by doctors – for doctors. • Australian trained typists. • Manage dictation and transcription via computers, iPhone, iPad, android or smartphones. • Integrated M*Modal speech recognition technology on demand.
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
Pen Computer Systems 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.
Precision IT P: 1300 964 404 F: +61 2 8078 0257 E: info@precisionit.com.au W: www.precisionit.com.au • Cloud Computing Specialists. • Onsite Medical IT Support. • VoIP Telephone Systems and Internet Connectivity. • IT Equipment Procurement. • Experience with all clinical & practice management software packages. • Sydney, Brisbane, Gold Coast and Melbourne. Precision IT is a highly competent and impeccably professional IT support firm with a primary focus on working with GPs and Specialists. Working with our clients, we develop reliable, robust and feature rich IT systems to meet the demands of the modern medical practice today and into the future. Our Precision Cloud service is fast becoming the choice for new and established practices and covers all of the standard guidelines from the RACGP and AGPAL and GPA. Talk with us today about the future of your practice!
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Real Outcomes
Stat Health Systems (Aust) P: +61 7 3121 6550 F: +61 7 3219 7510 E: carla.doolan@stathealth.com.au W: www.stathealth.com.au Stat Health Systems (Aust) has built a progressive and resilient system that introduces a new level of stability and flexibility to the medical software market. Stat is an integrated clinical and practice management application which has embraced the latest Microsoft technology to build a new generation solution. Fully scalable and the only medical software application to incorporate a multi-functional intuitive interface, Stat is at the forefront of computing technology. Stat Health provide a premium support service, clinical data conversion from existing software and tailor made installation and training plans for your practice. Facebook: facebook.com/StatHealth Twitter: @NotifyStat
Sysmex New Zealand P: +64 9 630 3554 F: +64 9 630 8135 E: info@sysmex.co.nz W: www.sysmex.co.nz 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.
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Therapeutic Guidelines Ltd
Trend Care Systems
P: 1800 061 260 E: sales@tg.org.au W: www.tg.org.au
P: +61 7 3390 5399 F: +61 7 3390 7599 E: support@trendcare.com.au W: www.trendcare.com.au
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.
A national and international award winning solution recognised for its ability to provide real benefits in the acute and sub-acute health care settings.
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 July 2012 release of eTG complete includes a complete revision of the Toxicology and Wilderness topics. 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
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.
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VIRTUAL CONSULTING ROOMS
VConsult P: 1300 82 66 78 F: 1300 66 10 66 E: admin@vconsult.com.au W: www.vconsult.com.au VConsult offers outsourced practice management solutions for medical and allied health practitioners allowing the focus to be on your professional practice and patient care. VConsult provides a seamless “behind the scenes” service by professionally managing your telephone calls, reception, invoicing and medical transcription requirements. VConsult is perfect for your practice if you are: • Setting up, already established or winding down in Private Practice • Working in a public appointment and want to portray a professional image • Looking to minimise your overhead costs • Requiring your patient calls to be answered by a professional and experienced medical receptionist.
Vensa Health is the leading mHealth solutions provider focusing on delivering mobile health innovations worldwide. If you have received an SMSfrom your doctor, hospital or physio it is almost certain Vensa Health was responsible for its delivery. At Vensa we are focused on offering solutions and innovations, which add value to our clients, this is the fundamental philosophy underpinning all of our services and technology offerings. With nearly 80% adoption of mobile health in New Zealand and a solid customer base, Vensa Health is focusing on Australasia and Middle East regions in its expansion with a BHAG of closing the gap for 10% of earth’s population health.
Zedmed P: 1300 933 000 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 about Medical Record Exchange, please contact us: Phone: 1300 933 833 www.medicalrecordexchange.com.au
NATIONAL CONFERENCE Brisbane Convention & Exhibition Centre
Tuesday 16 – Friday 19 October 2012 ad s o l n ctu w o d spe N o E t o P r u O .a r a p g r W .o re o O N m p IS .aa rochu N w O w on b I w T t i i A R Vis istrat T S I g G e r E a www.aapm.org.au ER
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SMD Putting all the pieces together Better Communication, Better Care
Secure Message Delivery is a key foundation of the National eHealth reform and HealthLink has delivered.
HealthLink has the largest SMD compliant network across Australia making your practice or organisation eHealth ready. SMD enables the exchange of patient information between health care providers in a seamless, timely, accountable and standards based way. Having your patient information in the right place at the right time will transform your practice and your patients’ care.
Talk to us today on 1800 125 036 to realise the benefits of HealthLink Secure Messaging ehealth@healthlink.net www.healthlink.net
Better Communication, Better Care