Australia’s First and Only Health IT Magazine
PULSE IT
Issue
November
25 2011
Medication Management Improving S8 medication and patient management Phillip Shepherd argues improved S8 management can be achieved by leveraging Prescription Exchange Services. Introducing MedView Roger Boot overviews the MedView project and the benefits delivered by Electronic Transfer of Prescriptions. Australian Medicines Terminology update Bettina McMahon presents the National E-Health Transition Authority’s AMT adoption plan. Increased ETP adoption is required Jane London encourages the uptake of Electronic Transfer of Prescriptions by general practitioners. Medication management lessons learnt Joan Ostergaard shares experiences gained from medication management implementations. A perspective from abroad Rachel de Sain offers insights into some medication management initiatives recently encountered in the US. Removing ETP road blocks Bryn Evans examines some of the challenges confronting the Electronic Transfer of Prescriptions sector.
www.pulseitmagazine.com.au
Kelvin’s eHealth Journey
1
3
Greeted by medical centre receptionist Lucy Black, the receptionist is logged into her computer and Kelvin is then added to the waiting list by Lucy.
Kelvin is on holiday in far North Queensland Kelvin lives in Croydon, Victoria with his wife Betty. He is reasonably healthy, only suffering from hypertension that is well controlled with medication. He has an allergy to Penicillin. Over a period of three weeks he develops cramps and pain in his abdomen when he eats fatty food.
Kelvin’s IHI number is retrieved from the HI service electronically and seamlessly added to the local practice record. Kelvin takes a seat in the waiting room.
He is under the care of Dr Adam Jones at his local GP Practice.
2
GP consultation
4
Dr Grant opens Kelvin’s medical record on his PC which now also includes his Healthcare Identifier. Kelvin complains to Dr Grant of cramps in his stomach, especially after eating pizza and fish and chips which he has suffered from for about three weeks.
Kelvin presents to a medical centre While on holidays his condition gets worse and he presents to a medical centre in the town he is staying.
National E-Health Transition Authority
Dr Grant performs an examination and makes a provisional diagnosis of gallstones. He then orders an ultrasound which confirms the presence of gallstones. After discussing with Kelvin, Dr Grant refers to a General Surgeon: Dr James Brecker at Bay Hill Hospital. The referral is sent electronically via secure messaging.
Kelvin’s eHealth Journey is brought to you by the National E-Health Transition Authority (NEHTA). NEHTA is the lead organisation supporting the national vision for eHealth in Australia.
7 5
Specialist consultation
Pharmacy Kelvin takes his prescription from Dr Brecker to a Community Pharmacy. The pharmacist scans the prescription barcode. The prescription is retrieved from the PES (Prescription Exchange Service) and dispensed.
8
Dr James Brecker receives the e-referral. Frank is booked in for an appointment by his GP’s staff. Dr Brecker reviews Kelvin’s ultrasound, performs an examination and determines that Kelvin needs surgery to remove the gallstones.
6
Pathology As per the recommendations on Kelvin’s discharge summary, he has a follow-up blood test for liver function done on the day he is to return home from holiday. The GP has requested that the pathology test results be copied to Kelvin’s usual GP.
Admission to hospital for surgery Kelvin is admitted to the General Surgery ward. Kelvin then undergoes surgery by Dr Brecker, and he makes an uneventful recovery. Kelvin is discharged three days later, much improved and is referred back to his GP for follow up. An e-discharge summary is sent to Dr Adam Jones, his local GP.
For more information about NEHTA visit www.nehta.gov.au For more information about eHealth including the Healthcare Identifier (HI) Service visit www.ehealthinfo.gov.au
9 Returns from holiday Kelvin goes home without receiving his results but on his return home he goes to his usual GP who has received the blood test results and a copy of the discharge summary. After consultation with Kelvin, Dr Jones confirms that the blood tests are normal.
What a wonderful outcome!
PULSE IT +
Publisher Pulse Magazine ABN: 19 923 710 562 www.pulseitmagazine.com.au
Editor Simon James Australia: +61 2 8006 5185 New Zealand: +64 9 889 3185 simon.james@pulseitmagazine.com.au
Pages 12, 16, 26, 28, 32, 36, 38 Medication Management
Subscription Enquiries subscribe@pulseitmagazine.com.au
Advertising Enquiries ads@pulseitmagazine.com.au
About Pulse+IT Pulse+IT is Australia’s first and only Health IT magazine. With an international distribution exceeding 37,000 copies, it is also one of the highest circulating health publications in Australasia. 32,000 copies of Pulse+IT are distributed to GPs, specialists, practice managers and the IT professionals that support them. In addition, over 5,000 copies of Pulse+IT are distributed to health information managers, health informaticians, and IT decision makers in hospitals, day surgeries and aged care facilities.
ISSN: 1835-1522
Looking ahead Editorial themes for all 2012 editions will be announced online at the Pulse+IT website by the start of December. Pulse+IT invites suggestions from the readership to inform the selection of these themes. Pulse+IT welcomes feature articles and guest editorial submissions relating to the nominated edition themes, as well as articles relating to eHealth more broadly. Submission guidelines and deadlines are available online: http://www.pulseitmagazine.com.au/editorial
Contributors Roger Boot, Bryn Evans, Simon James, Jane London, Bettina McMahon, Joan Ostergaard, Chris Ryan, Rachel de Sain, Phillip Shepherd, Dr Geoffrey Sayer, and Alberto Tinazzi.
Disclaimer The views contained herein are not necessarily the views of Pulse Magazine or its staff. The content of any advertising or promotional material contained herein is not endorsed by the publisher. While care has been taken in the preparation of this magazine, the publisher cannot be held responsible for the accuracy of the information herein, or any consequences arising from it. Pulse Magazine has no affiliation with any organisation, including, but not limited to Health Services Australia, Sony, Health Scope, UBM Medica, the New Zealand College of General Practitioners, or the Kimberley Aboriginal Medical Services Council, all who produce publications that include the word “Pulse” in their titles.
Copyright 2011 Pulse Magazine No part of this publication may be reproduced, stored electronically or transmitted in any form by any means without the prior written permission of the Publisher.
Subscription Rates Please visit our website for more information about subscribing to Pulse+IT.
Pulse+IT acknowledges the support of the following organisations, each of whom supply copies of Pulse+IT to their members.
Page 26 Australian Medicines Terminology
Page 40 Video Consultations
Page 48 Server Virtualisation
Editorials
Features
News
Page 6 STARTUP Editor Simon James introduces the 25th edition of Pulse+IT.
Page 32 FEATURE ARTICLE Joan Ostergaard shares some lessons learnt for organisations seeking to increase their utilisation of medication management technology.
Page 20 Zedmed releases version 17
Page 8 GUEST EDITORIAL Bryn Evans questions the planned opt-in model for the PCEHR. Page 12 GUEST EDITORIAL Phillip Shepherd argues improved S8 management can be achieved by leveraging Prescription Exchange Services. Page 16 GUEST EDITORIAL Roger Boot overviews MedView and the benefits delivered by Electronic Transfer of Prescriptions. Page 24 MSIA Dr Geoffrey Sayer reflects on his time as President of the MSIA. Page 26 NPS Jane London encourages the uptake of Electronic Transfer of Prescription technology by GPs. Page 28 NEHTA Bettina McMahon presents NEHTA’s AMT adoption plan.
Page 36 FEATURE ARTICLE Rachel de Sain offers insights into the medication management initiatives encountered recently in the United States. Page 38 FEATURE ARTICLE Bryn Evans overviews some of the challenges confronting the Electronic Transfer of Prescriptions sector.
Off Topic Page 40 VIDEO CONSULTATIONS Chris Ryan presents a range of video consulting telehealth material including an overview of organisations now actively involved in the space. Page 48 SERVER VIRTUALISATION Alberto Tinazzi introduces virtualisation technology and its application in medical practices.
APNA launches new online learning material for practice nurses Better monitoring of heart disease recognised Page 21 Better Health Channel releases iOS app Page 22 UWS to host Health Informatics Summer School in February I-MED releases iOS apps Page 23 Orion Health acquires Microsoft products, announces partnership
Resources Page 30 EVENTS CALENDAR Up and coming Health IT, Health, and IT events. Page 53 MARKET PLACE The Pulse+IT Directory profiles Australasia’s most innovative and influential eHealth organisations.
EDITORIAL
Pulse+IT: 2011.5 Simon James
BIT, BComm Editor, Pulse+IT Phone (AU): +61 2 8006 5185 Phone (NZ): +64 9 889 3185 simon.james@pulseitmagazine.com.au
Welcome to the 25th edition of Pulse+IT, Australia’s
in a medical practice, with Chris Ryan delivering a
first and only Health IT magazine.
substantive and timely article canvassing a range of
video conference telehealth material, complete with a
Having taken a sector-wide view of this edition’s
‘medication
management’
theme,
Electronic
Transfer of Prescriptions (ETP) features prominently throughout the magazine, with representatives from
Acknowledgements
their respective cases for the rapid uptake of ETP
As our print production cycle draws to a close for
technology, particularly by general practice. The
2011, I would like to extend my thanks to all of this
NPS — contributing to Pulse+IT for the first time in an
year’s contributing writers, advertisers, subscribers,
organisational capacity — echoes their sentiments, and
and organisations that supply the publication to their
Bryn Evans canvasses some of the ways government
memberships. All of these individuals and organisations
might assist the sector to overcome current
play an ongoing and important role in making each
impediments to adoption.
edition of Pulse+IT a reality.
Joan Ostergaard shares some lessons learnt for
organisations looking to increase their utilisation of
Looking ahead
medication management technology, with Rachel de
In reflection of the increasing amount of eHealth
Sain offering insights into the medication management
activity occurring in the run up to the launch of the
initiatives she encountered during the recent Medicine
Personally Controlled Electronic Health Record in
2.0 and Health 2.0 conferences in the United States.
July 2012, Pulse+IT will resume publication of its print
editions earlier than previous years, with the first
Bettina McMahon of the National E-Health
Transition Authority overviews the organisation’s
magazine to reach the readership in February.
plan to accelerate uptake of the Australian Medicines
Terminology (AMT), and having recently concluded
editorial coverage we intend to deliver throughout
his term as President of the Medical Software Industry
2012, Pulse+IT will announce next year’s edition themes
Association, Dr Geoffrey Sayer shares some of his
on our website at the start of December. If you would
experiences and insights gained during his time in the
like to suggest a topic, have any suggestions for future
role.
articles, would like to contribute to an edition, or would
simply like to discuss your experiences with eHealth,
Alberto Tinazzi contributes a detailed overview
of virtualisation technology as it can be applied
Pulse+IT
to turn to for additional information and advice.
both eRx Script Exchange and MediSecure outlining
6
summary of the organisations that practices might like
For those interested in the scope of the feature
don’t hesitate to get in touch.
www.pulseitmagazine.com.au
Zedmed's Healthcare Identifier software ensures your practice won't be left behind With new eHealth initiatives to the Australian health system, we're leading the way in smart, innovative and easy to use software solutions so your practice doesn't get left behind. That's why our latest version accommodates Healthcare Identifiers (HI), and is available right now.
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EDITORIAL
PCEHR and the ‘opt-in’ model – are we swimming against the tide? The national Personally Controlled Electronic Health Record (PCEHR) project requires health consumers to register and ‘opt-in’ to the PCEHR system. This appears to be contrary to current practices and may be going against the prevailing trends in both Australia and overseas. Bryn Evans
Director JEMS Consulting bryn.evans@ozemail.com.au
The youth lay on the floor, blood all over him,
in a PCEHR. Even for those consumers who do opt‑in,
half‑twisted onto his side. One arm was drawn over his
they will be allowed to restrict access to certain
face, his body motionless. Blood had pooled beside him,
information of their choice, and to restrict access to
and was splashed across the wash-basins, the walls
nominated clinicians. The result of this approach will
and floor. This was the scene which confronted me in
be that many patients will continue to be treated by
the toilets of a major public building. A man bent down
clinicians who are not fully informed of the patient’s
over the prone figure, which appeared unconscious and
medical history. The suppression of patient information
perhaps only a teenager, and began to turn him onto his
will inevitably disadvantage those who have not
back.
opted‑in and contribute to sub-optimal outcomes,
“Don’t move him,” I said, “I’ll call an ambulance.”
even the risk of avoidable deaths.
“I am a doctor,” said the man crouching down.”
Two airport employees appeared to assist the doctor,
illustrated at the start of this article, if the patient
and said an ambulance was on its way. As I stepped
has not registered, complex authorisation and access
away to give them room, I could see that the injured boy
controls stand in the way of the patient’s medical
had deep slashes in both wrists.
information, even though their life is on the line.
In an emergency, a trauma situation like the one
•••
The PCEHR’s Concept of Operations provides for
In the tragic case described above, immediate online
emergency access, but the necessary authorisation
access to the patient’s medical information — perhaps
procedures and access control threaten to be
in the near future on a smartphone or similar device
functionally difficult, bureaucratic and time-wasting.
— could mean the difference between life and death.
Concerns about the design and increased complexity
The Personally Controlled Electronic Health Record
of emergency access remain current and unresolved,
(PCEHR) could help — or could it?
so much so that the PCEHR’s emergency access model
The opt-in model
is stated as requiring further consultation.
Information on the patient’s medical history, such
The currently proposed opt-in model for the PCEHR
as blood type, allergies and medication history should
requires each consumer to register and give consent for
be available for instant access by clinicians. In such
their PCEHR to be established. Where a consumer has
situations, the principle ‘first do no harm’, has to be
not opted-in, no patient information will be available
paramount. Withholding a patient’s medical record information from clinicians, not only in emergency and
Author Info
trauma cases but in any provision of care, would surely Bryn Evans is a management consultant, with many years experience as a CIO in healthcare, and as chief executive of a clinical software supplier. He writes extensively across a range of categories and genres, notably in the areas of management, information technology, sport, travel, history and fiction.
transgress this principle.
The overseas experience Evidence is accumulating from overseas experiences of the benefits that can accrue from Shared Electronic Health Records. But they appear to be predominantly
8
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based upon opt-out approaches. An EHR is
facility for treatment.
generated and made available to clinicians,
while the onus is put on the individual to
clinics, or GP practices (through electronic
father to an Emergency Department in
opt-out if they so choose.
discharge summaries from hospitals), and
the early hours of the morning, where he
Whether
in
hospitals,
medication?” out-patient
A few years ago I took my 93 years old
In the NHS in England, by March 2011
across geographical areas, patient medical
was asked what medication he had been
nearly six million Summary Care Records
information stored in EMRs is accessed
prescribed in the past. His medication
had been created. Around 30 million
by clinicians on the basis of providing
history would have read like a fair sized
people had been sent a letter with an
care, and without seeking the patient’s
formulary, so not surprisingly the doctor’s
opt‑out form to complete and return in a
prior consent. Within GP practices and
question was met with a blank stare.
pre-paid envelope if they wished to make
other healthcare organisations, patient
that choice. By the end of March 2011, only
medical information is accessed via EMR
have not opted-in, even in cases not at
1.16% had chosen to opt-out.1
systems purely in accordance to clinical
first deemed to be an emergency, will
need, unless a patient initiates a request to
sometimes be put at risk by the exclusion
a similar choice has been given to the
prevent such access.
of the PCEHR’s medical information.
consumer, in effect to opt-out in a variety
In emergency care a patient’s medical
of ways. The predominant theme is to
by the Health Consumers Council, who
information
create the EHR as a record of a patient’s
have stated publicly their preference for
is critical, and in a trauma case such
medical information for use by clinicians,
an opt-out approach. Over a number of
information in the first hour has been
and then leave it to the discretion of the
years in Australia and overseas, surveys
described as pure gold. A lack of a
consumer to access it if they wish, or
of the public have shown that health
PCEHR, even in routine treatments and
opt‑out.
consumers expect clinicians to be sharing
procedures, in a percentage of cases will
Elsewhere in Canada and Denmark,
The opt-in model is not even favoured
Clearly the lives of patients who
being
accessible
online
Singapore’s recently developed EHR
their medical information as a matter
lead to avoidable incidents.
functions as a national summary record of
of course, to provide the best health
each patient’s medical information for use
outcome. Typically, a common reaction by
should be available automatically for
by clinicians. It is not personally controlled,
health consumers is that they assume that
every health consumer by approved
and once a patient visits a hospital or
healthcare providers are already sharing
treating clinicians, just as it is within
doctor for a consultation, the principle of
patient information between appropriate
existing EMR systems. If not, the PCEHR
implied consent enables access to the EHR
treating clinicians to provide the best care
will lack credibility and adoption by both
by clinicians. Access by the consumer is not
for the patient.
patients and clinicians and be in danger of
yet planned.
The opt-out approach to the PCEHR
Some realities and conclusions
Patient information within a PCEHR
becoming a white elephant. And of course the opportunity for a consumer to opt-out, should be subject to a rigorous application
Placing the onus on the consumer to opt‑in
process, overseen and assessed against
the
and register for a PCEHR disadvantages
specified criteria by an independent
opt-in model should be given serious
and puts at risk those consumers who
quasi‑judicial body. To opt-out should not
reconsideration.
In Australia
the
alternative Under
an
to
would most benefit from a PCEHR.
be an easy option.
approach, this would automatically make
opt‑out
available in a PCEHR all appropriate
consumers will not register for a variety of
should adopt an opt-out model, and ensure
patient information that is held by
reasons such as: a lack of understanding;
we ‘first do no harm’. The PCEHR has
healthcare providers in their Electronic
cultural and language barriers; mental
the potential to provide patient medical
Medical Record (EMR) systems, unless a
incapacity; physical disability; too young
information any time, anywhere, for any
consumer specifically requests to opt‑out
an age to exercise the right; remote access;
health consumer, and assist the treating
of the PCEHR system. The extensive
negative advice; and many others reasons
clinician(s) at the point of care, wherever
implementations of EMR systems by NSW
including apathy and inertia.
that may be.
Health and other states and jurisdictions
have taken place based upon an implicit
confronted by a doctor saying: “We do not
References
opt-out model. That is, a patient’s consent
have access to your health record. When
1. http://www.dh.gov.uk/en/MediaCentre/
is implied when they attend a healthcare
did you last see a doctor? Are you taking
www.pulseitmagazine.com.au
Under an opt-in model, any number of
Those who are sick will not want to be
Once the PCEHR is available, we
Pressreleases/DH_125690
Pulse+IT
11
EDITORIAL
Effective S8 Management with Prescription Exchange Services Phillip Shepherd
Chief Executive Officer MediSecure phillip.shepherd@medisecure.com.au
“Doctors and pharmacists have backed calls from a
answer to the “how do I know?” question. The process
Victorian coroner for the introduction of a real-time
of prescribing and dispensing S8 medicines is used
prescription monitoring system in an effort to stamp out
every day by doctors and pharmacists across the
doctor-shopping.
country. Opioid medications have a legitimate and
Coroner John Olle called for the introduction of live
necessary role in treatment of pain in the community.
prescription monitoring within the year and asked for
But the process of managing these drugs of addiction
written submissions from relevant experts before he
and the patients who use them appears to be deficient,
makes final recommendations in relation to the death
particularly for timely feedback to both prescribers and
of a Melbourne man, 24, who overdosed on prescription
dispensers on the activity of an individual patient.
morphine and diazepam two years ago.”
1
Medical
Forum
WA
recently
addressed
S8
Medical Observer reported these Victorian Coroner
management and “compare[d] some results with our
findings on 9 August 2011. A tragic case of a young
2009 survey around narcotic prescribing. Since 2009,
man caught up in a deadly addiction to prescription
the profession has lost the Medicine Information Line
medicines and no safety net in place to prevent this
for doctor shopping on PBS scripts, a service that 17%
abuse of the national medicines system.
of our surveyed GPs found ‘very helpful’ and 31% found
‘sometimes helpful’ ...”2
How is this possible? With all the sophisticated
IT systems in the banking world that track customer
behaviour, with all the IT systems deployed in social
200‑300 scripts of concern each month” in the defined
In Western Australia, “there are approximately
media and the ability of advertisers to know what
high-risk groups. Letters are sent to the prescribers
any user is looking at and how they behave, how can
after the event. Further, “over 200 letters are sent
the medicines system, a fundamental plank of the
each month to prescribers who have prescribed for a
world‑class Australian health system, get it so wrong?
[registered drug addict] without prior authorisation. In
At the root of this young man’s problem was the
addition, ‘doctor shoppers’ ... (are) identified when they
process of prescribing and dispensing of medicines; in
present at one or more pharmacies with prescriptions
particular, the Schedule 8 (S8) or Drugs of Addiction
from more than one doctor ... One proposal ... is to
process. The management of S8 medicines is a state
write to identified patients, informing them that their
responsibility and each state has their own version of
behaviour has been noted ...”3
‘best practice’. As a general rule, the use of paper and
manual notifications is part of the S8 management
not possible to gather data and act promptly? The
process.
Western Australia S8 management process, like most
Doctors have long been concerned about the
other states, relies on paper collection of data, manual
‘doctor shopper’ and have for decades sought an
processing and manual follow up. Staff and resources
Is this a deficient process? Or is it just technically
Author Info
issues magnify the S8 problem. Phillip Shepherd is CEO of MediSecure Pty Ltd. With over 30 years experience in manufacturing, technology and information strategy, Phillip previously worked with community pharmacies in e-commerce and supply chain and with general practice in practice management software, e-commerce supply chain and e-health programs. Phillip has a detailed understanding of the business drivers that are essential for success in e-health adoption in primary care.
According to Medical Forum WA: “The ... Education
and Health Standing Committee report on Changing Patterns in Illicit Drug Use in Western Australia ... echoed the idea of addiction to dangerous prescription drugs coming from long wait times to see a specialist and it said there was deficient tracking of opiate scripts due to a three-month delay before they appeared on
12 Pulse+IT
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the WA Health database.”2
Very simply, if every prescription for S8
of all S8 dispensing remains a continuing
medicines was transmitted to an AS4700.3
cost. Utilisation of an AS4700.3 compliant
system is a dinosaur.
Quite clearly, the S8 management
compliant Prescription Exchange Service
PES can automate the entire S8 process
Capacity to manage doctor-shoppers
(PES) — such as the MediSecure Script
with more timely reporting to state
with timely and focused intervention is
Vault — from the medical practitioners’
authorities, immediate flagging of patients
severely limited when the management
clinical software, then the Coroner’s
with multiple S8s and other non‑standard
process involves procedures like those in
recommendation for an (almost) real-time
S8 events.
Western Australia. Note that the primary
prescription monitoring system would be
data collection point in most state systems
in place. Monitoring of prescriptions would
two PES services, but unfortunately no
is at the pharmacy end of the process, that
not take place within the PES, but in a
interoperability at present. MediSecure is
is, at the point of dispensing.
third party service as defined by NEHTA in
committed to full interoperability. When
The Victorian Coroner called for a more
It is acknowledged that there are
the ETP Release 1.1 specifications.
this operates a doctor can choose to send
effective system, based on the prescribing
the S8 e-prescription to any approved PES
end. Did he have in mind a system that
the NEHTA Release 1.1 specifications
provider.
would identify the problem patient when
at an operational level. This includes a
they were sitting in front of a doctor, and
patient Individual Healthcare Identifier
Victorian Coroner’s call for S8 management
where positive intervention action could
field (IHI) in the e-prescription meta-data
can be implemented. Community harm
occur?
on the outside of the secure prescription
from S8s will be diminished; individual
MediSecure’s MDSv2.0 software meets
With a small change in thinking, the
There is a simple and effective answer
message. The IHI allows for individual
patient and doctor benefits will accrue with
for S8 management as outlined by the
medicines management, a key service for
no additional work, and pharmacy data
Victorian Coroner. Based on an existing
patients. With a medicines or S8 code in
reporting will be more accurate, timely and
e-health system that works and is
the meta-data, S8 and doctor shopping
automated.
deployed in many medical practices across
management can commence.
all states and territories, the system has
been developed, deployed and is operated
to receive a pop-up after they print the S8
1. O’Brien M. Wide support for real‑time
by the private sector under clear privacy,
prescription but before handing it to the
prescription monitoring call. http://
security and standards requirements.
patient to inform them of how many S8
www.medicalobserver.com.au/
Commonwealth and State Governments
scripts that patient had collected in the
news/wide-support-for-realtime-
have not spent taxpayers funds to deploy
past 90 days. The clinician could then make
prescription-monitoring-call
it, but they are the major beneficiary
an informed judgment: intervention; hand
2. McEvoy R. Stolen Scripts Just a
of the efficiencies, savings and benefits
over the S8 prescription; or refuse service.
Symptom? http://www.medicalhub.
generated by this e-health system.
com.au/wa-news/guest-opinion-
prescriptions
The
existing
Electronic
Transfer
Any prescribing clinician could elect
When all doctors send all their to
AS4700.3
Prescription
place and adding value for prescribing
simple,
clinicians.
economic
service can manage S8 patients. The
monitoring: pharmacists, patients and
advantage to participating pharmacies
necessary infrastructure is in place. The
prescribers. Medical Forum WA October
and can carry a secure e-version for every
frustration of doctor-shoppers and the
2011.
computer‑written prescription. By using
danger of the current S8 management
ETP, management of S8 prescriptions and
system can be relieved.
communications-in-practice/
doctor shopping can be addressed.
emedication-management
is
delivering
effective,
Services,
this
editorial/3680-stolen-scripts-just-a-
of Prescriptions (ETP) system is in It
Exchange
compliant
References
no-cost-for-clinicians
At the pharmacy end, manual reporting
symptom 3. Bangor‑Jones R, Keen N. Opiate
4. http://www.nehta.gov.au/e-
www.pulseitmagazine.com.au www.pulseitmagazine.com.au
Pulse+IT 15
EDITORIAL
Why bother with eScripts? While the immediate benefits of eScripts can already be seen in some quarters, the true value of ETP (Electronic Transfer of Prescriptions) is not well understood by many. ETP is a key enabler for Australia’s eHealth plans, and one from which we can expect to reap far-reaching benefits relatively soon. The business case for our National eHealth Program is dependent on medication management, and to do this properly we need to include data from all relevant sources, including doctors, pharmacies, hospitals, and aged care settings. A Wave 2 project called MedView — which is built upon technology from eRx Script Exchange — does exactly this in a way that is efficient and effective. Roger Boot
B.Agr.Ec. (Hons), Grad. Dip. IT, Masters Sci. Tech. Commercialisation eRx Script Exchange Vendor Manager roger.boot@erx.com.au
It is now two and a half years since the first
Medical Director, Stat Health or Zedmed in conjunction
Australia‑wide platform for eScripts, eRx Script
with eRx can now see whether their patients have
Exchange (eRx), was launched. Since May 2009, over
collected their medicine, as well as the trade name of
220 million scripts have been successfully downloaded
the drug dispensed. This is an optional feature which
and dispensed. 12,200 doctors and 3,200 pharmacies
the majority of doctors we speak to are keen to utilise.
have transmitted script information to and from the
exchange.
recognised. The RACGP “supports e-prescribing,
At the coal-face, Electronic Transfer of Prescriptions
which delivers considerable benefits to GPs and other
(ETP) has captured the attention and praise of the
medical practitioners”. The Pharmacy Guild sees it as “a
majority of pharmacists, but we need to continue our
vital piece of health infrastructure, creating immediate
efforts to demonstrate the benefits to doctors.
safety benefits for patients, as well as a better standard
The immediate benefits of eScripts
At an industry level, the value of eScripts is widely
of shared care between GPs and pharmacists”. And the AMA “supports the development of an ePrescribing
There are many benefits that flow from the
system as a fundamental building block for a national
introduction of eScripts. First, eScripts improve patient
electronic health system in Australia”.
safety by reducing the risk of transcribing errors during
dispensing. Second, eScripts improve the workflow
“building block”, as the AMA put it, is laid properly?
in the pharmacy, delivering efficiency benefits. Third,
Where do eScripts, or more accurately, a Prescription
patients have a better health care experience overall,
Exchange Service (PES), fit within Australia’s eHealth
as a result of improved coordination and management
plans?
of care between doctors and pharmacists. Fourth,
So how do we ensure that this fundamental
medical software platform, the doctor receives
The PCEHR Business Case relies on Medication Management
dispense history data delivered seamlessly into the
The Deloitte National eHealth Strategy of 2008
patient’s clinical record. Doctors using Best Practice,
emphasised the difficulty in accurately quantifying
when an eScript service is integrated fully with the
benefits from eHealth investments. However they did
Author Info
report hard numbers for medication management in Roger Boot is an eHealth consultant who has been involved with eRx Script Exchange since its predecessor ScriptX was announced in 2008. Roger started his working life as a jackaroo on the Hay plain, and he holds three tertiary level degrees. He has led significant IT and change management projects in the primary industries, non-profit, and health sectors.
some sectors, including that 10% of hospital admissions are due to adverse drug events, and that preventable medication prescribing errors cost Australian taxpayers at least $380 million per year. While we are at it, let’s remember reports that indicate 25% of a clinician’s time is wasted seeking information about patients.
16 Pulse+IT
www.pulseitmagazine.com.au
Following the success of last year’s event, Best Practice Software is excited to announce that the next Best Practice Summit will be held in Bundaberg in March 2012. Register your interest in attending the conference and receiving further updates by emailing bpsummit@bpsoftware.com.au Workshops will include training sessions on various aspects of Best Practice Clinical and Management as well as future directions for Best Practice, integration with other packages and conversions, etc. Keep watching the Best Practice website: www.bpsummit.com.au in the coming months for further information. And if you haven’t yet tried Best Practice, send or call for the free DVD and experience these and other features for yourself – with your own practice data (from a back-up copy, of course):• We have MIMS – Australia’s most trusted drug database • Support professionals who are truly supportive • Speed and superior stability of 100% SQL performance • Converting your data from MD2, MD3 and MedTech32 virtually automatic • No ads, bolt ons or mixed file formats to compromise performance
• Great value – subscription $907.50 (per full time doctor) for both Clinical and Management • Discounts for practices larger than 4 GPs • Half price for part time practitioners – $453.75 • No downtime for updates or time-consuming maintenance • Unique, fully integrated whole-of-practice software.
eHealth sites across Australia All States and Territories are working on innovative eHealth initiatives. Keep up to date on the latest activities. http://www.ehealthinfo.gov.au/ehealth-sites www.ehealthinfo.gov.au is jointly brought to you by Australia’s Federal, State and Territory health authorities and the National E-Health Transition Authority (NEHTA) to help you explore the eHealth concept and stay in touch with the latest innovations as they unfold.
It is fair to say the business case for the Personally
MedView is a secure, highly available repository that can
Controlled Electronic Health Record (PCEHR) relies
grow to enjoy a national coverage.
heavily on medication management. So how do we
make sure we get it right? There are many factors that
brings together a team of industry leading partners and
we could talk about here, but let’s focus on just two for
software vendors in the community, hospital, and aged
now.
care sectors. Vendors include Best Practice Software,
Zedmed, Fred Health, Simple Retail, eRx Script
Firstly, we must include data from all relevant sources
and secondly, efficient and effective workflow is critical.
medicines
information
to
a
Exchange, BossNet, Pharmhos, and iCare. Industry partners include Barwon Health, Barwon Medicare Local,
Good Medication Management includes data from all relevant sectors Delivering
Lead by the Fred IT Group, the MedView project
and Monash University.
The MedView project is focussing on targeted
regions, with a primary focus on the region covered patient’s
by the Barwon Medicare Local and Barwon Health.
clinician(s) should include as complete a picture as
Additional focus regions are being identified. The
possible. Compiling all the scripts written by a patient’s
national reach of the partners in MedView will enable
various GPs is an important step, but it is only one
rapid scaling of the solution for all Australians, if there
piece of the puzzle we need to construct. We must
are subsequent program phases.
include data from all of the clinicians involved, and that
means doctors, pharmacists, and nurses in each of the
MedView, each time their MedView registered healthcare
community, hospital, and aged care settings.
team member prescribes or dispenses medications an
electronic record is automatically sent to the MedView
MedView is a Wave 2 PCEHR Lead Site which is
Once a patient has given consent to participate in
building exactly this capability. The Commonwealth
repository and securely stored.
Government has provided funding for the development
and implementation of MedView as part of the National
clinical systems to transfer prescribed and dispensed
eHealth Program.
data between healthcare providers, as well as to deliver
this clinically valuable information to the MedView
MedView will enable authorised clinicians to view
MedView uses eRx Script Exchange and hospital
data about their patients in an efficient and seamless
repository.
process. As with eRx — the technology platform
MedView is built upon — MedView will be tightly
of HL7 CDA (Clinical Document Architecture) in Australia.
integrated into existing clinical packages, and no new
All data is encrypted using Medicare PKI technologies,
hardware or software will be required at the doctor’s
with patients’ identified electronically using Individual
practice.
Health Identifier (IHI) via the Medicare Health Identifier
MedView Medicines Repository
MedView will be the first substantial implementation
Service.
The MedView project is building a national medicines
So why bother with eScripts?
repository which:
I like to think of eScripts as some essential “plumbing”
• Provides a combined list of both prescribed and
connecting doctors and pharmacists. Like all good
dispensed medications collected from community,
plumbing, the important point is that it just works
hospital, and aged care settings.
effectively and efficiently. Most of us shouldn’t have to
• Is accessible by clinicians from their existing desktop software.
think about it, and indeed we won’t, unless it breaks.
And while this “plumbing” (with an already extensive
• Is a key part of Australia’s national eHealth program.
reach) is useful and something that some of us can get
For the first time, Australian clinicians will be able
very excited over, it’s the services that can be built on top
to see a combined list of prescribed and dispensed
of that plumbing which are the really sexy bits with much
medications, regardless of how many different doctors
wider appeal.
and pharmacies the patient has attended.
MedView is a standards-based, consent-driven,
management in Australia, and medication management
conformant repository which provides comprehensive
is a key business driver for PCEHR. The link between
records of both prescribed and dispensed medications.
these is MedView.
www.pulseitmagazine.com.au
eScripts
is
the
key
enabler
for
medication
Pulse+IT 19
BITS & BYTES Better monitoring of heart disease recognised
Zedmed releases version 17
The Latitude Heart Failure External Sensors
Zedmed has released version 17 of its
sites, which are situated in Brisbane,
from Boston Scientific has won the 2011
clinical and practice management solution
Melbourne, and the Hunter Valley region
Kerrin Rennie Award for Excellence in
for general and specialist practice. The
of NSW.
Medical Technology. The industry award
software update — a six-monthly general
was presented as part of the Medical
release — will be distributed on disk
processes involved with registering to
Technology Association of Australia (MTAA)
to all Zedmed customers throughout
interact with the Healthcare Identifier
conference, MedTech 2011, in Sydney on 8
November.
Service, and to use HPI-I (provider
November.
Leveraging the work undertaken by
identifiers) in electronic communication,
To assist practices to navigate the
The Latitude Heart Failure External
Zedmed in its capacity as a member of
Zedmed has released a 5-step document
Sensors are used to remotely monitor
the Vendor Panel, the release includes
for its customers. The company has also
the status of a patient’s implanted
functionality that allows practices to
released comprehensive documentation
cardiac device, providing regular device
interact with the Healthcare Identifier
for practices wishing to start using Zedmed
measurements and medical alerts. The
Service.
to download patient healthcare identifiers
addition of weight scales and blood
(IHI) into their practice database.
pressure monitors allows for greater
to the Healthcare identifier Service were
monitoring capabilities. Data is wirelessly
made available by the company in its
of minor updates such as the addition of
transmitted from the patient’s home, and
version 16 release a few months ago,
new vaccines, improved address book
gives physicians up to date information
version 17 is the first release to be actively
searching, and additional Inbox sorting
allowing
distributed to Zedmed customers outside
options. The software now also allows
treatment.
of the Personally Controlled Electronic
users to generate electronic referrals and
Health Record Wave 1 lead implementation
specialist letters in HL7 format.
for
early
intervention
and
“The Latitute Heart Failure Sensors are
While many of the features relating
The release also includes a number
an example of how medical technology can be used to deliver care in the home rather than the hospital.”
“Through
remote
monitoring,
potential problems like heart failure can be diagnosed and treated earlier, preventing
APNA launches new online learning material for practice nurses
or minimising hospital stays. Earlier and
APNA, the peak professional association
practical
timely intervention means cost savings to
for nurses working in primary health
a palliative approach within a general
the health system,” said Anne Trimmer,
care, has announced the release of three
practice, and identifying where a palliative
CEO MTAA.
interactive learning modules designed for
approach fits within the Advanced Nursing
The Kerrin Rennie Award for Excellence
nurses working in general practice and
Competencies. The module runs for
in
Medical Technology
other primary health care settings.
two hours and attracts two Continuing
Quality of Life recognises the innovative
Launched in October, the additional
Professional Development (CPD) hours,
and extraordinary contribution of medical
courses bring to 10 the number of online
with APNA members able to participate
technology in improving health outcomes
learning modules currently offered by
for $24.
for Australian patients. Companies can
APNA. The organisation has recently
enter products used in the diagnosis,
migrated its online training resources to
participants with an understanding of the
prevention, treatment, or management of
a new technology platform, to allow it to
management of sexually transmissible
disease and disability in Australia.
provide more educational material at a
infections (STIs), and blood borne viruses
lower cost to participants.
such as HIV and viral hepatitis, raises
—
Improving
The Restore Sensor from Medtronic
strategies
for
implementing
The second new module provides
Australasia was noted as another finalist
online
awareness of the importance of STI
in the awards, with commendations given
learning module provides primary health
testing, contact tracing, and discussing
to Siemens, Device Technologies, Baxter
care nurses working in a general practice
safe sex and prevention with clients. The
Healthcare, and Medtronic Australasia for
setting with information and knowledge
module runs for approximately 1.5 hours
its Symplicity Catheter System.
in understanding a palliative approach,
and attracts CPD hours accordingly. Access
The
first
new
20 Pulse+IT
interactive
www.pulseitmagazine.com.au
BITS & BYTES Better Health Channel releases iOS app Launched by Victoria Minister for Health, David Davis, in late September, Better Health Victoria has released a free app for Apple iOS devices.
According
to
the
Minister,
the
‘Better Health’ app “extends the reach and access of the award-winning Better Health
Channel,
which
is
Australia’s
number one health and medical website featuring the most trusted, up-to-date and easy to understand health and medical information.
“iPhone and iPad users can search for
and locate an extensive range of health
Above - An image taken from the APNA Influenza Prevention interactive online learning module.
services
throughout Victoria
doctors,
dentists,
including
pharmacists
and
to the course material for APNA members
continuing
development
physiotherapists. The app also allows
costs $21.
events. In recognition of the particular
people to get quick access to hundreds of
A limited number of free places are
needs of this nursing workforce, APNA has
Better Health Channel medical conditions
available to nurses in NSW for both of
been providing online learning material
and treatments fact sheets, anywhere at
these online modules through education
since 2006, with some courses, such as a
anytime,” said Mr Davis.
grants supplied by GP NSW and NSW STI.
module on influenza prevention, having
professional
Shedding some light on current interest
been undertaken by over 1600 participants
levels in the app, Simon Blankenstein,
damage, prevention, and screening. This
since March this year.
Manager Digital Media, Department of
interactive online module is the first in a
Mr Webster indicated that most of
Health Victoria, said that over 33,000 unique
five-part series designed to provide nurses
the current online training modules in the
users have downloaded the app since its
with the necessary knowledge and skills
APNA library present between one and
launch in late September. These people
for managing patients who are susceptible
two hours worth of material. However
have collectively used the application
to solar damage and skin cancer. Nurses
more detailed training is also offered,
around 100,000 times, with a median
undertaking the module will learn how
including a diabetes management module
session length of around 1.5 minutes.
ultraviolet radiation affects the structures
which generally takes participants between
Blankenstein added that around 70% of the
and function of the skin, develop skills in
14-16 hours to complete. The online nature
users of the app were female.
identifying high-risk patients, and find out
of the course delivery allows attendees to
how to implement preventive strategies
work through the material at their own
services database interfaces with the
in
pace, as they are able pause and resume
comprehensive Victorian Human Services
sponsorship, this training module is free
course work at any time.
Directory, which is believed to be in the
for all nurses.
has
process of being prepared for national
The third module deals with solar
their
practice.
Having
attracted
APNA has over 3000 members and
The
organisation
currently
The app’s integrated provider and
19 additional online learning courses
deployment. Such a development may,
estimates that around 60% of general
in
on
in turn, allow the Better Health app’s
practices now employ one or more nurses.
Immunisation,
Pharmacology,
developers to scale the software’s search
According to Steve Webster, General
IV Cannulation and General Practice
capabilities
Manager for Programs and Professional
scheduled to be released in the near
however the Department of Health would
Development at APNA, the vast majority
future.
not be drawn on its plans for the app’s
of practices employ nurses on a casual
Further information about APNA’s
future development, other than to say that
or part-time basis, which often makes
online learning is available via: http://www.
its library of content will be expanded in the
it difficult for nurses to travel to attend
apna.asn.au
coming months as part of a minor upgrade.
www.pulseitmagazine.com.au
development,
with
Basic
material
Pulse+IT 21
for
a
national
audience,
BITS & BYTES I-MED releases iOS apps The I-MED Network has released a pair of iOS diagnostic image apps for doctors that referring patients to the group’s practices in Queensland and Tasmania. I-MED are
University of Western Sydney to host Health Informatics Summer School in February
touting the ‘I-MED Online Queensland’ and ‘I-MED Online Regional Imaging’ apps
The University of Western Sydney (UWS)
professionals who are interested to get an
as the first of their kind in their respective
will host the 2nd Australian Health
overview of how ICT is used in the health
states, having previously deployed a similar
Informatics
(AHISS)
sector as a potential new application area
solution in Western Australia.
program in February 2012, following the
for their ICT skills. It also suits educators
Launching the Queensland app, I-MED
Summer
School
success of its inaugural summer courses,
or postgraduate students who want to
Network CEO Mark Masterson said, “We
which were held earlier this year.
get a quick briefing on health informatics
have invested significantly in this new
because they want to move into that
technology to help provide increased
steps through the basic concepts and
area.”
flexibility to doctors and we believe
principles of health informatics; health
the introduction of the I-MED Online
data coding and terminologies; clinical
many attendees, AHISS may serve as a
Queensland app will help them better
information systems; clinical decision
useful stepping-stone for further health
manage urgent patient cases and put
support and telehealth; and emerging and
informatics education and training.
treatment plans in place faster.”
future trends.
The apps are free to download from
Running over five days, the program
Professor Maeder added that for
“It is not intended to provide a
According to the organisers, each of
qualification or specific technical training,
the iTunes store, however login details
these short courses will be run as a full day
however after the week-long course
are required before any of the software’s
intensive mode classroom or workshop
participants will have the ability to become
functionality is made available to the user.
style session, delivered by a team of
involved in health informatics initiatives in
Once authenticated, doctors are able to
invited national experts and UWS Health
their workplace, and may wish to embark
access diagnostic images including MRI, CT,
Informatics staff. Morning sessions will
on further formal studies in specific topics
ultrasound and x-ray, along with a patient’s
be pitched at an introductory level, with
such as HL7, for example.”
imaging history.
the afternoon sessions providing more
detailed coverage of the subject matter.
School initiative is running again on the
The imaging group states that the
Professor Maeder, says the Summer
app will be particularly useful for referring
doctors who practice at a number of clinics,
participants to encourage interaction
program earlier this year.
and will also have applicability in scenarios
between presenters and attendees, with
where multiple doctors, potentially working
notes from the presentations to be made
a month prior to the event, and we
from multiple locations, wish to view
available to participants.
received very positive feedback in our
images simultaneously.
Anthony Maeder, Professor in Health
post-event evaluation, plus some advance
Manager
Informatics in the School of Computing
bookings for this year. We have since
Queensland, Justin Mottram, said, “Prior
Engineering and Mathematics, University
run several one‑day workshops using
to the introduction of this app, doctors had
of Western Sydney, said that AHISS will
selected educational material from AHISS
to be at their primary office or computer
be of interest to a range of people with
for organisations that wanted ‘in house’
terminal in order to receive and access
various expertise and interests.
delivery, including one overseas.”
patients’ diagnostic scans. If a doctor is on
call, out of the office, or moving between
such as doctors, nurses, or administrators
program will run from 6-10 February 2012.
facilities, they can now get instant access to
who may have some minor involvement
Prices for the course range from $150 for
new patient results and determine how and
with Information and Communications
students attending on a single-day basis,
when action needs to be taken. In critical or
Technology (ICT) in the workplace, but
through to $800 for the entire week for
urgent cases, this could help save lives.”
want to know more about the components
regular participants.
“We have ensured the app is extremely
of it that make up health informatics, and
secure with patient privacy maintained at
how these fit together within the health
including registration details is available
all times,” he added.
system environment. It wmay also suit ICT
from: http://bit.ly/uJb5Aj
I-MED
Network
General
Sessions
will
be
limited
to
30
“AHISS is aimed at health professionals
22 Pulse+IT
basis of the success of the inaugural “The first AHISS was fully subscribed
The Health Informatics Summer School
Further information about the course
www.pulseitmagazine.com.au
BITS & BYTES
Orion Health acquires Microsoft products, announces partnership Orion
the
Health having recently been selected as
acquisition of a suite of Microsoft health
Health
has
announced
a member of the National Infrastructure
software solutions marketed throughout
Partner consortium, which also includes
Southeast Asia under the brand names
Oracle and Accenture.
Amalga HIS (Hospital Information System)
and Amalga RIS/PACS.
acquisition
parties have signed a Memorandum of
The products, which were acquired
Complementing
the
product
arrangements,
Understanding
2007, were withdrawn from sale in 2010.
to co-market their health information
Microsoft has stated that their decision to
exchange (HIE) and data aggregation and
make the products available for acquisition
analysis products — Orion Health HIE and
by Orion Health was part of a move to shift
Microsoft Amalga Unified Intelligence
“resources to focus on the Amalga Unified
System (UIS) — to the public and private
Intelligence System in order to align with
HIE and integrated delivery network (IDN)
the company’s broader health IT strategy”.
markets.
hospital
information
system
their
two
from Global Care Solutions by Microsoft in
The
outlining
the
intent
Announcing the product acquisitions
is currently deployed in five hospitals
and partnership, Orion Health CEO, Ian
throughout Southeast Asia, one in each of
McCrae said the addition of Microsoft’s
Thailand, Malaysia, Vietnam, Singapore,
HIS assets “is a natural extension of Orion
and the Philippines. While not a large
Health’s portfolio of products that enable
footprint when compared with other
us to offer a complete solution to a wide
hospital information system deployments,
range of hospitals and health organisations
Wayne Oxenham, Vice President — Asia
in Asia Pacific.
and New Zealand, Orion Health, said that
under Microsoft stewardship, the product
Pacific countries is overdue to make the
had been completely overhauled, which
transformative leap to the next generation
could give its new owner a competitive
of systems which integrate the complete
advantage.
healthcare ecosystem, rather than siloing
information in individual organisations or
“Microsoft focused a lot on the
“The health sector in a number of Asia
technology, and brought it from an old VB
facilities.”
platform onto the latest .Net technology
stack. They spent three years doing this
Hospital Information System, Ian McCrae
development work, which is great for
indicated that Orion Health will integrate
Orion Health.”
a software development team of around
Orion Health indicated it will sell and
60 staff located in Thailand, providing
market the HIS and RIS/PACS software
the rapidly growing organisation with
as Orion Health HPM (Health Process
more engineering resources and a base
Management) suite. The software will
from which to expand its Southeast Asian
complement
operations.
the
company’s
existing
As part of the acquisition of Microsoft’s
range of clinical workflow and data
integration applications. Some of these
operation is absolutely world class and
products are to be used as part of the core
will be Orion Health’s fourth development
infrastructure for Australia’s Personally
centre,
Controlled Electronic Health Record, Orion
Christchurch and Canberra,” he said.
www.pulseitmagazine.com.au
“The
Thailand
the
others
HIS
development
being
Auckland,
Pulse+IT 23
MSIA
Things I should have said...
Dr Geoffrey Sayer
BSc(Psychol), MCH, PhD Immediate Past President, MSIA president@msia.com.au
I wish I had kept a diary for the past two years during
generally working under different political ethos. Given
my time as the Medical Software Industry Association
the public servants are stable over time, why can’t we
President (MSIA). The things I have seen, heard and
get sustainable change across different governments?
read have generated all sorts of emotional responses:
The focus seems, at certain levels in the hierarchy of
surprise;
frustration;
the public service, to be to stay out of the paper for
sadness; anger; and humility. Health at the best of
laughter;
disappointment;
the wrong reasons. I have come to the conclusion
times is a hot topic. Throw an “e” at the start of Health
that the public servants fear the media more than the
and all sorts of “emotional” responses are brought
politicians. It is the media that creates accountability
forward. Throughout this roller-coaster ride of ups and
in a transient way instead of instituted accountable
downs, where often you only have a narrow window to
processes as part of funding models or effective
get a point across, there are a number of things that,
political processes.
with the benefit of hindsight, I wish I had said.
The current politicians’ need both better advisors
processes. Two of these processes were the Senate
and to make public servants actually responsible
Enquiry and the Senate Estimates. The Senate
for their actions if they want to progress change.
Enquiry for the Health Identifiers legislation was a
The political process is a short-term cycle and the
new experience for me. The signing of the paperwork
objective seems to be simply to stay in power. We
before appearing was extremely serious as deliberate
should accept this as a fact of how politics works. It is
misrepresentation carries penalties, and rightfully so.
not as complicated as they would want us to believe.
At the time, industry was at logger-heads with anyone
More time (and money it seems), is spent on spin
who crossed our path, and we had profile regarding
doctoring rather than calling to account the people or
patient safety and the proposed implementation plans.
organisations that money is provided to.
In the political process there are accountability
On the way down to Canberra in the car with my
I was fortunate enough, I think, to meet senior
MSIA colleague we were being lobbied — the only way
politicians. It seems to me they are incredibly busy
I could describe it — by all sorts of people to be on our
and are incredibly nice when dealing with the punters.
best behaviour and present a positive industry position
I was told by a cynic they are paid to be nice and it is
at our representation. That was not hard to do as
not genuine, but I will give those I met the benefit
industry had a clear message — we wanted the Health
of the doubt. They are good at appearing genuinely
Identifiers, and it was the one thing that we all thought
concerned about your issues. But I have come to the
would be good for the eHealth agenda.
conclusion they really are being let down by the people
who are supposed to be implementing the policies
who were not very clear in their responses when
they announce. If one examines the senior ranks of the
they should have been. The accountability was also
public service, many have been there for many years.
inconsistent on the Senator’s side. A Senator lounged
They are career public servants. The same people
around in his chair asking each speaker their thoughts
What was strange was the performance of others
on benefits versus risk in a haphazard manner rather
Author Info
than one of meticulous consideration. It seemed he As well as being Immediate Past President of MSIA, Geoffrey is Head of Operations, HealthLink. He has spent the past 20 years working as an epidemiologist. For the past 10 years Geoffrey has occupied senior management positions in medical software companies.
wasn’t as learned as he made out, or at least was convincing us that he wasn’t, but was afforded the luxury of keeping account for this important piece of legislation. I thought that day I could make a great Senator. I could slouch around, duck in and out for apparently more important things and ask random,
24 Pulse+IT
www.pulseitmagazine.com.au
ill-formed questions as well as anyone.
politicians I have met in the past two years.
While there are things that I should have
Basically be difficult without being helpful.
In the world of business, if I was a share
said, I am sure there are things I should not
I wish I had said “Can I get paid for what
holder in a company and I contributed 50%
have. Despite the frenetic pace that the
you do too?”.
of the capital, I would take a vested interest
eHealth agenda is facing and its potential
Looking at the Senate Estimates
in how that money was being spent. I
derailment in many eyes, it is not too
process, the level of drilling down appears
would want know how that company was
late to look at what can be achieved if
limited, and the Senators appear to
going against the stated goals and the
we effectively work together to deliver
have different levels of performance
business plan of activities. I would want to
the building blocks of eHealth. It is still
depending on the level of briefing or
have my interests represented well in the
possible if we harness the good will and
advice they have been given. eHealth
form of directorship/s, and would also want
the money that has been allocated to the
can be complicated and detailed, but if
to have a big say in who the Chair of the
eHealth agenda. Industry can help if they
one is serious about $467 million, then
Board was as well. I would expect the board
are helped. It has to be a constructive and
one should make an effort to apply $467
would call to account management of the
effective action-generating outcomes. It is
million of accountability to the equation.
company in terms of their performance.
a hard task before us at best, so let us not
The fact that it commands so little time on
While the Chair and directors would need
make it harder than it already is. Simple,
the Senate Estimates agenda indicates to
to ensure they complied with appropriate
simple, simple steps is all that is needed.
this untrained eye that it is not really taken
board-type responsibilities through the
These steps will have lasting effects and
seriously, and there are more pressing
year, when it came to the AGM I would be
stimulate innovation and creativity in the
issues requiring accountability.
using my vote to show my appreciation
market place.
I find it odd that governments deal
by continued support or disdain by having
in millions and billions of dollars, but at
them removed, or asking why individuals
the $467 million that is not accounted
times really don’t seem to care about how
in the senior management in charge of
for?” Any simple calculation of announced
the money is being used when deciding
delivering the business objectives had
funding seems to have $10’s of millions, if
how that money will be spent. One of my
not been removed. I am perplexed why
not a lazy $100 million, unaccounted for.
business mentors taught me early to spend
that has not happened with companies
Why can’t that money be used to assist
money as if it is actually yours. The idea
regardless of whether they are ‘for profit’
industry broadly to get the foundation
is you value your own money more than
or ‘not for profit’. I am also perplexed by
pieces in place, like Health Identifiers,
someone else’s. While it did encourage
the adage that “people are working really
terminology
me to spend wisely, I actually feel more
hard” so I should be appreciative. I thought
across all sectors? This will deliver greater
responsibility when it is someone else’s
in any organisation it was about results —
benefits and improve the effectiveness and
money, and have tried to always be frugal
short term and sustainable asset growing
efficiency in health and healthcare delivery
and get the most out of money, whether it
activities. While I am sure shareholders
than a Personally Controlled Electronic
be research grants, budgetary figures, tax
like to hear people are working hard, they
Health Record (PCEHR) system alone.
payers, or company money.
actually like to know what results they
Furthermore, it will enhance the PCEHRs
In conclusion: “Where is the rest of
and
secure
messaging
I think we lose accountability when
are getting. It is what shareholder value
that are already in existence and support
we are not paying for clear outcomes. The
or outcomes have been delivered that
the uptake of existing ones. This will be a
accountability for public money is too much
matters. I wish I had a said to one Chair: “If
lost opportunity if this money is not wisely
after the fact with Auditor General reports.
Kerry Packer had given your organisation
spent with the broader industry to bring
Why isn’t there built-in accountability
$150 million, given the results, would you
them to the table to deliver change. If
as we go along with public money? Real
still be Chair of this organisation?” I could
we don’t engage the wider industry now,
‘lessons learnt’ as we go along. Why do
have followed up with: “Would the CEO
they will wander off and pursue things
governments try to distance themselves
still be the CEO?”
that really matter. eHealth dreams will be
from keeping a timely, closer, accountable
It is what happens next that really
remembered as lost opportunities, good
and transparent view of how public money
matters. We have all had experiences
money after bad again, like the ghosts of
is spent? I wish I had said that to the many
in our past that we would like to forget.
eHealth past.
www.pulseitmagazine.com.au
Pulse+IT 25
NPS
Electronic transfer of prescriptions: An important step for improving medication management Jane London
Senior eHealth Program Officer NPS: Better choices, Better health jlondon@nps.org.au
Since the release of two Electronic Transfer of
be interpreted and adopted by vendors. However, what
Prescription (ETP) solutions in early 2009, the general
potential does this open up in ETP? The first additional
practice community has looked on with interest. Both
benefit from ETP that we will see is the ability to view
vendors have similar offerings. Once a practice has
consolidated medication lists.
installed and configured one or both ETP solutions, the
software works in the background, sending prescription
information that they actually want ready access to,
information to the relevant prescription exchange
consolidated medications lists will enable consumers,
service, where it can be ‘drawn down’ by pharmacists
GPs, pharmacists and other relevant providers to view
into their dispensing system after a barcode on the
prescribed and dispensed medicines for a consenting
script has been scanned.
patient. This can assist in reducing doctor shopping,
Over the two years since their release, both services
improve the management of medicines, and assist
have matured. They are now more stable and work with
with medication reconciliation, especially at transitions
a greater number of prescribing systems. This progress
of care. There are also a range of health literacy
gives the eHealth and general practice communities
benefits that can be built in to help consumers better
an opportunity to look afresh at the products and
understand their medicines.
ask, “What do they currently offer, what changes are
vendors planning, and what will ETP products look like
prescriptions to be legally completed with e-signatures.
as they evolve?”
The removal of the need for a physical signature will
Often noted by clinicians as the shared health
NEHTA is working with jurisdictions to allow
The products as they currently stand offer some
allow potentially beneficial practice workflow changes.
benefits. An ETP system allows pharmacists to
For example, patients might collect prescriptions from
spend less time keying in data, potentially reducing
a central point, such as reception, or even have the
transcription errors and allowing more time for
script emailed to them. There will be more flexibility as
patient interactions. However, there seems to be little
patients will simply require a token (such as a barcode)
immediate benefit to the general practitioner: no
to have their medicine dispensed. This token may be
workflow savings and no financial incentives.
printed on something that looks like a prescription,
but could equally be populated with relevant health or
Enter the National E-Health Transition Authority
(NEHTA) and Standards Australia. The current focus
medicine information.
on eHealth has promoted considerable action in the
standards space. Only time will tell how ETP Australian
practice workflow efficiencies, but the future potential
Technical Specifications (due to be released soon) will
of ETP is exciting. Future developments are not that
The current world of ETP does not deliver GP or
far away. As ETP is accessible to the majority of GPs
Author Info
now, it is worthwhile for practices to investigate Jane London is a Senior e-Health Officer within the eHealth and Decision Support Team at NPS: Better choices, Better health. She is the project lead for an electronic transfer of prescriptions awareness raising activity that NPS is currently developing. Jane has extensive experience in working with general practice to develop and implement clinical and eHealth solutions.
available systems, and get actively involved in the eHealth medication management environment. Only with a critical mass of users will ETP systems continue to evolve, and begin to deliver additional benefits that will add value for consumers and streamline practice workflows.
26 Pulse+IT
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NEHTA
NEHTA and vendors plan for wider use of AMT Bettina McMahon
Policy and Information Services NEHTA bettina.mcmahon@nehta.gov.au
The National E-Health Transition Authority (NEHTA)
and a lack of guidance material on how to implement
has released a plan to accelerate uptake of the
AMT has inhibited more widespread adoption. Vendors
Australian Medicines Terminology (AMT). Developed
have also expressed concern about the lack of an AMT
with the software industry, the plan helps vendors to
roadmap, which would help them determine when to
make a decision about if and when they want to include
implement.
AMT in their software.
Ultimately, NEHTA’s long term goal is semantic
Implementation Group discussed the level of adoption
interoperability. The plan works towards this goal while
of the AMT in Australian health software. With
acknowledging the different approaches vendors can
representatives from the Department of Health and
adopt, and being realistic about what steps vendors are
Ageing, NEHTA, Medicare Australia, the Medical
willing to take at this stage in our progress.
Software Industry Association, Australian Information
In
mid-2011,
the
eHealth
ICT
Industry
A standard clinical language is essential for
Industry Association, Australian Association of Practice
a distributed eHealth system to work. We need
Managers, and Aged Care IT Vendor Association,
consistent clinical terminology in the healthcare
this group meets monthly to discuss eHealth
systems across Australia, which are communicating
implementation.
with each other and connecting with the PCEHR.
of AMT by addressing the barriers to uptake, and
The AMT is a national terminology of medicines,
which
assists
interoperability
between
clinical
The group wanted to accelerate the adoption
asked NEHTA to work with the group to develop an
information systems. A derivative of the international
implementation plan.
terminology SNOMED CT, it includes concepts,
identifiers, and descriptions. It provides a standard
Implementation Plan is an important step in addressing
national approach to the identification and naming of
the barriers to adoption identified by vendors. It puts
medicines.
AMT in the context of other activity by vendors and
Initially released in December 2007, the AMT
governments, and includes a number of commitments
has been implemented in some systems — most
by NEHTA to release products to support the
notably across the Department of Health Victoria in 12
increased adoption of AMT. These include a guide to
hospitals. Other implementations underway include
implementation, a list of reference implementations,
The Department of Health and Ageing’s Pharbiz
mapping guidelines and a governance model. The
Pharmaceutical Benefits Scheme system, and the
mapping guidelines have now been published1 and
Personally Controlled Electronic Health Record lead
the implementation guide is on track for external peer
site implementations.
review in November, with publication in December.
However, limited drivers for vendors to adopt AMT,
Released
in
September
2011,
the
AMT
The plan takes a staged approach with phase
one concluding in June 2012. The first phase builds
Author Info
on work currently being undertaken by vendors to Bettina McMahon leads the Policy and Information Services area at NEHTA, incorporating the policy and privacy functions, national product catalogue and supply chain, clinical terminology and information and Healthcare Identifier (HI) Service operations. Bettina has been with NEHTA since September 2009 and was initially NEHTA’s Head of Policy and Privacy.
map AMT to their proprietary medicines databases. While this step doesn’t result in benefits like improved decision support in systems, it is required for communication of medication information between different clinical systems and is necessary for lead PCEHR implementations. Future steps will include
28 Pulse+IT
www.pulseitmagazine.com.au
Proposed AMT Implementation Maturity
Required Direction of Travel
Extent of AMT implementation
Phase 3
Native AMT
Extemporaneous Prescribing
Phase 2 Advanced Decision Support
Hospital (Pack and Dose Based) Prescribing
Mapping (Full AMT coverage) Phase 1
Basic Decision Support
Primary Care (Pack based) Prescribing
Mapping (preliminary coverage)
AMT used in e-health Summaries
Single Virtual Med Record (Incomplete)
ETP Primary care Allergies and ADRs
ETP Outpatients
Extract from Compliance and Basic drug doubling and multiple sources concordance contraindication checking with EHR integration
Computable Dose Integration with EHR events
Complete single medication record Regime Critique
Capabilities Supported & Facilitated
support for vendors moving away from mapping to an
unambiguous
implementation of the terminology and information
across different healthcare settings will not only create
models within their systems.
efficiencies in medications management, it is a critical
piece in the solution to reduce adverse drug events,
Further to the detailed activities to June 2012, the
plan describes the development of an AMT roadmap, which we will derive from consultation with a wider
communication
and
interpretation
which could save thousands of lives every year.
group of vendors, implementers and stakeholders. This
Further Information
roadmap will, for the first time, give vendors a level
NEHTA has been tasked by the governments of
of surety of deliverables, enabling them to factor in
Australia to develop better ways of electronically
new enhancements and features of the AMT into their
collecting and securely exchanging health information,
product development life cycles.
and is the lead organisation supporting the national
vision for eHealth in Australia. For further information
This work will begin shortly so that the next phase
will be able to begin on schedule in July 2012. NEHTA
on NEHTA’s work, visit: http://www.nehta.gov.au
will work with industry to identify and prioritise missing
elements of AMT that could be identified as barriers
terminologies@nehta.gov.au
to use. These may include areas of technical delivery,
For specific information about AMT, please email:
additional use cases, clinical safety, and possible links
References
to other systems.
1. https://nehta.org.au/aht
The plan is available online and will be updated
2. http://www.nehta.gov.au/connecting-australia/
periodically to reflect new information to increase
terminology-and-information/clinical-terminology/
the use, and ultimately the benefits, of AMT. Enabling
australian-medicines-terminology
2
www.pulseitmagazine.com.au
Pulse+IT 29
EVENTS
NOVEMBER ACAA National Congress 6 November - 8 November Broadbeach, QLD P: +61 7 3725 5555 W: www.acaa.com.au EHI Live 2011 Conference 7 November - 8 November Birmingham, UK W: www.ehi.co.uk Medical Technology Association of Australia Medtech Conference 8 November Sydney, NSW W: www.mtaa.org.au Society of Hospital Pharmacists of Australia National Conference 10 November - 13 November Hobart, TAS W: cpd.shpa.org.au GPCE Melbourne 11 November - 13 November Melbourne, VIC P: +61 2 9422 2700 W: www.gpce.com.au RMIT E-Health Symposium 12 November Melbourne, VIC P: 03 9426 6666 W: www.epworth.org.au 3rd Australian Rural and Remote Mental Health Symposium 14 November - 16 November Ballarat, VIC W: anzmh.asn.au
Australian College of Emergency Medicine ASM2011 20 November - 24 November Sydney, NSW P: +61 2 9213 4000 W: www.acem2011.com
The Inaugural Forum For Suicide Prevention Policy in Australia 2011 5 December - 6 December Melbourne, VIC P: +61 2 9080 4119 W: www.informa.com.au
4th ICST International Conference on eHealth 21 November - 23 November Malaga, Spain W: www.electronic-health.org
Health Services and Policy Research Conference 5 December - 7 December Adelaide, SA P: +61 8 8379 8222 W: www.hsraanz.org
HINZ Conference and Exhibition 2011 23 November - 25 November Auckland, NZ W: www.hinz.org.nz/page/conference HL7 Identification and Coding Implementation Workshop 24 November Melbourne, VIC W: www.hl7.org.au 1st Australian eHealth Research Forum 25 November Melbourne, VIC W: www.achi.org.au 2nd Annual Healthcare Complaints Management Conference 28 November - 29 November Melbourne, VIC P: +61 2 9080 4300 W: www.iir.com.au International Conference on Education, Informatics, and Cybernetics 29 November - 2 December Orlando, Florida, USA W: www.2011conferences.org/iceic
DECEMBER
Australian General Practice Network National Forum 2011 16 November - 19 November Melbourne, VIC P: +61 2 6228 0800 W: www.gpnetworkforum.com.au
Successes and Failures in Telehealth 1 December - 2 December Brisbane, QLD P: +61 7 3876 4988 W: www.icebergevents.com/sft11
HIMSS Europe Health IT Leadership Summit 20 November - 22 November Geneva, Switzerland W: www.hitleadershipsummit.eu
Dental Healthcare Policy Forum 1 December - 2 December Melbourne, VIC P: +61 2 9080 4300 W: www.informa.com.au
30 Pulse+IT
mHealth Summit 5 December - 7 December Washington, DC, USA P: +1 301 402 5311 W: www.mhealthsummit.org Australasian Society for Psychiatric Research Conference 5 December - 8 December Dunedin, NZ P: +61 2 9368 1200 W: www.iceaustralia.com/aspr2011/ 3rd Annual Reducing Medication Errors Conference 7 December - 8 December Melbourne, VIC P: +61 2 9080 4300 W: www.iir.com.au
JANUARY IT @ Networking Awards 18 January - 19 January Brussels, Belgium W: www.itandnetworking.org Certificate IV in Practice Management Brisbane, QLD 21 January (commencement) P: 1800 288 622 W: www.practicemanagement.edu.au
FEBRUARY Certificate IV in Practice Management 4 February (commencement) Sydney, NSW P: 1800 288 622 W: www.practicemanagement.edu.au
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EVENTS
3rd Annual Clinical Documentation, Coding & Analysis Conference 20 February - 22 February Melbourne, VIC W: www.iir.com.au/clinicalcoding 3rd Annual Technology in Healthcare Summit 2012 27 February - 28 February Sydney, NSW P: +61 2 8908 8555 W: www.acevents.com.au
MARCH Best Practice Summit 2012 8 March - 10 March Bundaberg, QLD P: 07 4155 8800 W: www.bpsummit.com.au Certificate IV in Practice Management 10 March (commencement) Melbourne, VIC P: 1800 288 622 W: www.practicemanagement.edu.au Diploma in Practice Management 10 March (commencement) Brisbane, QLD P: 1800 288 622 W: www.practicemanagement.edu.au
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Australian Healthcare Summit 2012 13 March - 14 March Sydney, NSW P: +61 2 9008 1101 W: www.activebusinesscommunications. com/health
Diploma in Practice Management Melbourne, VIC 14 April (commencement) P: 1800 288 622 W: www.practicemanagement.edu.au
4th Annual National Telemedicine Summit 22 March - 23 March Sydney, NSW P: +61 2 9080 4300 W: www.iir.com.au
MAY
Data Governance 2012 29 March - 30 March Melbourne, VIC P: +61 3 9326 3311 W: www.hisa.org.au/DG2012
APRIL Oral Health Meets e-Health Symposium April (TBC) Melbourne, VIC P: +61 3 9341 1558 W: www.oralhealthcrc.org.au Certificate IV in Practice Management 14 April (commencement) Adelaide, SA P: 1800 288 622 W: www.practicemanagement.edu.au
Diploma in Practice Management Adelaide, SA 5 May (commencement) P: 1800 288 622 W: www.practicemanagement.edu.au Certificate IV in Practice Management 19 May (commencement) Perth, WA P: 1800 288 622 W: www.practicemanagement.edu.au
JUNE Diploma in Practice Management 2 June (commencement) Sydney, NSW P: 1800 288 622 W: www.practicemanagement.edu.au
Online Calendar
To view a comprehensive list of Health IT, Health, and IT events, visit the Pulse+IT website: http://bit.ly/gFr0Vk
Pulse+IT 31
FEATURE
Lessons learned in Electronic Medication Management Joan Ostergaard
Strategic Product Manager InterSystems TrakCare Joan.Ostergaard@InterSystems.com
Electronic medication management systems offer
allergy and drug interaction incidents, as well as
the promise of significant benefits, including reduced
savings through better inventory control and support
medical errors, better compliance, time savings, cost
for pharmaceutical substitution.
savings, and better drug safety.
However, early adopters have described a number
involving many functional areas within a healthcare
of limitations and clinical risks associated with first
organisation. Having a functioning electronic system
generation systems. These range from making wrong
in itself — even a state-of-the-art one — does not
drug selections from electronic pick lists, irrelevant
guarantee good practice, or that all the expected
alerts which reduce productivity, to the duplication of
benefits will be achieved.
data entry across different departments.
Despite
these
problems,
the
adoption
But medication management is a complex area
It is better to implement a system meeting a
of
limited set of objectives — and limited issues to resolve
medication management systems continues to gather
— to demonstrate clear benefits at the end of the day.
pace. Few, if any, organisations have pulled the plug
This provides a solid platform to achieve additional
on new electronic medication management systems.
objectives and benefits over time, as opposed to a
While not always documented in the same detail, the
large implementation — with a promise of ‘everything
benefits of these systems still outweigh the negatives.
for everyone all at once’ — that remains mired in
The reduction of medication errors is particularly
unresolved issues.
difficult to measure because institutions do not have
reliable statistics. This does not mean that serious
In some healthcare jurisdictions there are incentive
medication errors do not occur, as pointed out in the
payments for electronic prescribing, and an initial
seminal work ‘To Err is Human’ by the Institute of
objective is simply accurate reporting to be able to
Medicine.1
receive these payments. Many hospitals want to better
Initial objectives will vary between organisations.
That said, it is important not to ignore the pain that
manage scheduled or dangerous drugs to increase
early adopters have experienced. So, what are some of
safety, comply with regulations, and prevent losses
the important lessons that we have learned so far?
through theft. This may not be a priority for a small day
Set clear objectives Almost all of our clients are currently implementing
surgery, but it may be for a hospital with a large and complex case mix.
or have plans to implement electronic medication
Close the loop
management capabilities, if they have not already
The term “electronic medication management”
done so. Among early adopters of InterSystems
describes
TrakCare, hospitals have reported reduced adverse
prescribing, dispensing, and medication administration.
a
system
which
includes
electronic
Author Info
This reflects the current trend for healthcare Joan Ostergaard is a Product Manager at InterSystems, focused on the strategic product direction of InterSystems TrakCare™. Her role includes market, business and technology analysis, and vendor relationship management. Previously she has worked at Kodak in positions including Clinical Consulting and Education Director for Asia Pacific, and Applications Manager across multiple geographies. She is a qualified Radiation Therapist and holds an Advanced Certificate in Management.
organisations to seek benefits that are most easily achieved using a “closed loop” approach.
Medication errors are one of the biggest sources of
preventable errors for most healthcare organisations. Electronic medication management systems can reduce errors associated with illegible handwriting or ambiguous nomenclature, uncertainty about drug
32 Pulse+IT
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At we’d rather catch you than catch you out
At GPA they’re called Quality Accreditation Managers (QAM) QAM Job description:
Not letting you fall. Ever. Work in the interest of our clients from first contact to reaching accreditation. Support and guide our clients through every step of the process. GPA AccrEditAtion plus does things differently.
Accreditation doesn’t have to be the daunting process. As so many of GPA ACCREDITATION plus clients are happy to repeat “GPA’s process has changed what we thought was going to be a hardship into a rewarding experience.” From the beginning your own personal QAM steers you through the entire accreditation process at your own pace. The flexible GPA ACCREDITATION plus modular programs (online or paper-based) are designed to be user friendly, ensuring practices confidently prepare to meet the RACGP standards. We report back to you step by step, giving you the opportunity to make improvements along the way. “I was very happy with the modules – it allowed me to work slowly and consistently through the requirements and I felt supported at the same time.” When your Practice is ready, GPA ACCREDITATION plus will liaise with you to organise a survey visit conducted by experienced surveyors. “GPA ACCREDITATION plus surveyors were very helpful, which made everything run smoothly on the final stage of accreditation – there were no surprises!!” If that sounds different to the way you’ve been used to, call GPA ACCREDITATION plus and let’s get started. call us now on: 1800 188 088 or log on to: www.gpa.net.au
dosing, and interactions between drugs.
pharmacy system? If they decide to integrate, should
But systems which are not connected hold less
they plan to phase out their legacy systems at a later
promise of reducing medication errors. An ePrescribing
stage? What are the trade-offs in terms of increased
system may provide a care provider with access to a
complexity with an interfaced or even integrated
drug database and decision support system, but not
system, versus the capacity of users to adapt to a
connect with a pharmacy system. So the prescription
completely new system?
may need to be printed, taken to the pharmacy and
re-entered when it gets there, duplicating data entry
will have its own objectives, necessitating their own
and introducing the risk of transcription errors.
individual adoption plans. And, since staff can only
Even if the ePrescribing and pharmacy systems
cope with so much change at once, these adoption
are connected through interfacing, they may not
plans need to be staged and ongoing, and acknowledge
use the same information sources. The prescribed
that systems and requirements will continue to change
drug may have different names, or be listed by brand
over time.
rather than generic description, multiplying the risk of access to the same electronic patient record. While
Involve stakeholders and communicate benefits
the prescribing doctor knows all about the patient,
In healthcare organisations, resistance to change
the same clinical information may not be visible to or
is almost inevitable. Clinicians may be reluctant to
even available to the pharmacist. Both systems may
migrate away from a standalone system they are loyal
generate contraindication alerts, but in one system
to, or resent the effort involved in data entry with a
the reason for over-riding the alert is visible, and in the
new system.
other it is not. This may necessitate a phone call from
the pharmacist to the prescribing doctor, wasting time.
from the early stages. With a flexible and configurable
And the whole scenario may be repeated again when
platform, organisations can create solutions which
it is time for the nurses to administer the drug to the
are easier to use, more functional, and with access to
patient.
far more information than the legacy systems that
picking errors. In addition, the pharmacy may not have
Reducing medical errors, achieving time savings
through
reduced
data
entry
and
That is why it is important to involve stakeholders
clinicians are familiar with. Organisations also need
unnecessary
to invest in training. The system may be easy to use,
communications, and cost savings through better stock
but clinicians are busy and usually respond best to
control and reduced wastage are all easier to achieve
task‑based and incremental learning opportunities.
with a unified healthcare information system, which
includes medication management functionality, with
environment, they will also become open over time
all data residing in a single repository.
to valuing the benefits achieved by upstream and
Plan for adoption
34 Pulse+IT
To complicate matters further, every organisation
While users will initially focus on their own
downstream users. Additional data entry may be required. But if it is seen as benefiting others by driving
Most healthcare organisations — particularly in
additional functionality elsewhere in the cycle, users
advanced countries like Australia — face barriers in
will be more accepting of the changes involved.
implementing electronic medication management.
Most already use a number of specialised systems with
measuring the benefits achieved and regularly
loyal clinical user bases, many of which have a role
communicating them with stakeholders. Rather
in medication management. Standalone pharmacy
than initiating this after implementation, measuring
systems are widely deployed, and ePrescribing and
benefits against objectives should be planned from
nursing systems also exist in various forms.
the outset so that they can be demonstrated as early
Organisations can accelerate this process by
Organisations going down the closed loop path
as possible. Healthcare information systems with
have some difficult decisions to make. Should they
embedded analytics make it easier to automate the
replace existing systems with a single healthcare
measurement of benefits and report against KPIs. That
information system? Or should they integrate a
way, users of the system can see their own roles as
new system with, say, their existing ePrescribing or
part of the overall effort of delivering improvements in
www.pulseitmagazine.com.au
medication management, rather than working within
from clinical users of early systems. Alerts about
isolated units.
contraindicated medications, for example, are a
Maintain good practice
powerful tool that can cut down on medication errors. But clinicians have complained that they are constantly
Modern healthcare information systems contain
having to deal with more alerts than they need to do
an ever‑expanding array of sophisticated clinical
their jobs.
functionality designed to make life easier for care
givers. So it is understandable that users expect to be
and this may need to go beyond a user’s specific role
able to rely upon the support of electronic medication
to also take into account their level of experience
management systems.
or seniority. Recent InterSystems’ development
Systems need to have the capacity to filter alerts,
The problem is that systems are not a replacement
provides the prescriber with a unified view of alerts
for clinical knowledge or clinician engagement with
and a friendly way to action them. The display of
patients. Implementing a good system does not excuse
alerts and the need to record an override reason can
organisations from doing the hard work of determining
be constrained by severity of the risk. This important
exactly how that system should maintain and improve
information provided by the prescriber is available to
upon existing good practice.
the dispensing pharmacist and administering nurse, so
Most systems come with a pre‑configured set
they are fully informed and assured that any changes
of rules that users need to modify to suit their own
to the patient condition between prescription and
requirements. This may include determining the
administration time are taken into account.
minimum information to be collected by the system,
configuring the kinds of alerts that different users
part of InterSystems’ current development efforts, with
will receive, management of the formulary and
advancements planned in the areas of workflow, user
standardisation of measurement units, and enabling
interfaces, medication charts, and the management of
appropriate security for users.
alerts.
Often organisations need to implement more
Medication management represents a significant
Clinical users are standing on the doorstep of the
complex rules to, for example, reflect the clinical
potential for information overload, which has long
pathway for a certain condition, such as diabetes.
been a part of other work environments. Improved
In addition to decision support systems based on
visibility of clinical information also creates the capacity
standard drug databases, this may rely on data held in
for increased stress. One of the challenges for systems
the patient record about age, weight and test results.
developers is to effectively filter information to include
Building these rules is much simpler in a unified
just the parts that clinical users need to work efficiently
environment based on common data sources.
and safely.
Make the system friendly and manage alerts
Systems developers, implementers, and healthcare
organisations all have a part to play in taking on board the feedback of early adopters of electronic medication
Making the system easy to use for all groups involved
management systems. If we get it right, not only
in medication management is a major focus for
will later adopters be spared from suffering from the
systems developers. Different users have different
same problems, but their success will pave the way for
functional requirements, and the system should allow
further advances in healthcare information systems
them to navigate across different areas without losing
involving clinical users.
track of the task at hand. Information in an electronic medication management system should be expressed
References
in a way that is appropriate to each person’s role, even
1. Linda T. Kohn, Janet M. Corrigan, and Molla S.
though the underlying data is identical.
Donaldson, Editors, Committee on Quality of
Health Care in America, Institute of Medicine.
The management of safety alerts is probably
the number one ease-of-use issue within medication
To Err Is Human: Building a Safer Health System
management systems. Distracting and unnecessary
(2000). National Academy Press, available from:
alerts have been the subject of numerous complaints
http://www.nap.edu/catalog.php?record_id=9728
www.pulseitmagazine.com.au
Pulse+IT 35
FEATURE
Medication Management – insights from the medicine 2.0 and health 2.0 conferences Having recently travelled to the United States to attend both the Medicine 2.0 and Health 2.0 conferences, Rachel de Sain shares her observations about the range of medication management initiatives she encountered. Rachel de Sain
Director Flaxworks rdesain@flaxworks.com.au
At the recent Medicine 2.0 and Health2.0 conferences
came across was at Kaiser Permanente’s brilliant Sidney
a number of technology solutions intended to improve
R Garfield Centre for Innovation2 in San Leandro. In
medication management were presented. Most were
their mock environments they had the Maya system
software, rather than hardware solutions, however
from MedMinder3, a pill box that lights up the pills you
there was a growing interest, and clearly commercial
need to take and then turns off once they have been
demand, for both.
taken. It can also send messages to a person’s mobile
Most of the hardware solutions I encountered
or landline phone if they haven’t taken their pills within
appeared quite clunky and unappealing — big, bulky
a specified period of time, and can also escalate the
devices that are a constant reminder something is
alerts by informing the care team.
wrong, rather than a beautiful, useful device you are
happy to have out on show.
abstracts presented at Medicine 2.0, one in particular
Medication adherence was the topic of a number of
The TabSafe medication management system
looking at the option of using mobile phones and SMS
reminds, dispenses, and alerts the user. It also posts
for medication reminders. Vineet Singal presented
information on medication compliance, inventory,
an abstract based on his experience at Anjna Patient
and other health information accessible from any
Education.4 It is the first not-for-profit organisation
Internet‑capable device.
of its kind to implement sustainable health education
programs at free clinics.
1
Some will argue that older users — the primary
market for these sorts of devices — do not care about
design, but in my experience, particularly when
patients often do not follow the prescribed drug
considering the next generation of elderly, I would
regimen
have to disagree. The marriage of form and function,
This problem is nowhere more apparent than at
designing products that are not only useful but also
Schuman‑Liles, a mental health clinic in Oakland,
beautiful, is sadly lacking in a lot of medical devices, not
California, which serves over 1,000 patients monthly.
just for medication management. I believe rectifying
The clinical effectiveness of drug therapies for
this shortcoming will lead to improved adherence by
mental health at the clinic is limited by inadequate
the user.
patient adherence to the recommended protocol,
with a reported 50-70% of mentally ill patients at
Probably the most interesting hardware solution I
Even with the best in-clinic educational experience, or
educational
intervention
program.
Schuman‑Liles not following the prescribed regimen,
Author Info
regularly filling prescriptions, or attending follow up Rachel consultants on digital strategy, is part of the clinical leads & consumer reference forum at NEHTA, is a board member for HISA (Health Informatics Society of Australia), and previously held positions on the board at AIMIA Victoria and Vic ICT for Women.
appointments.5
Successful proofs of concept for mobile-based
interventions can be seen through Delaware’s Medicaid program and the CDC’s HEALTH-87000 program, the former utilising text-messaging outreach to increase the number of patients who adhered to
36 Pulse+IT
www.pulseitmagazine.com.au
Diabetes self‑management from 52.3% to 70.5% over a
increase adoption and adherence of Health IT services.
six‑month period.
The RXPact service provides incentives such as a photo
With only a laptop and a cell phone, the
of a grandchild that is unveiled when the user takes
Schuman‑Liles clinic is able to provide periodic text
their pills, providing a fun way to help people adhere to
and/or voice alerts to patients, reminding them to
their medication regimes.8
take medication or to attend follow-up appointments,
and to send educational messages about disease or
older adults with cognitive issues. Many unplanned
treatment tailored to physician recommendations.
pregnancies have occurred from lack of adherence
Additionally, patients can call or text a free number to
to taking the contraceptive pill, and to this end,
receive follow up support from health professionals
design gurus IDEO were tasked with developing a
(medical students, doctors or nurse practitioners), a
multi‑platform campaign to reach women aged 24-34.
crucial source of support for mentally ill patients. Based
They developed a series of witty and engaging calls
on health strategies discussed in the clinic, automated
to action that led to an interactive website named
reminders will be sent via text on a weekly basis to
Besider9. This platform allows the user to talk openly
patients who agree to participate in the program. At a
and learn from experts about the issues associated
rate of four texts per month, the texting program costs
with not remembering to take the pill and other forms
less than $1 per patient for six months.
of contraception. The website features a brilliant mix
4
4
Medication adherence is not just an issue for
Mobile reminders have been in use for a number
of humour and fact, with a culturally relevant twist
of years and as mobile phones get smarter, so do
to improve awareness, and in turn, develop a more
the applications for medication management and
proactive engaged patient more likely to adhere to
integration with devices such as glucose monitors.
their medication requirements.
In fact diabetes adherence has been a key area for
research to better understand how technology can
that technology can be used to improve medication
be used to support patients to adhere to medication
management, from simple reminders to integrated
regimes.
devices with alert systems. However the real success
There is significant research and evidence to prove
Tulane University has been researching the
will come when we not only use these new tools, but
use of SMS reminders for diabetics, developed by
develop them in a way that addresses the ability and
MedAdherence , and so far early results are promising
motivation of the patient to adhere to the required
with related studies showing 90% of a patient’s
routine.
6
diabetes outcome is related to self management.
7
Developing cost effective tools for medication
References
adherence was a hot topic at the Health 2.0 conference
1. http://www.tabsafe.com
with the winners of the Novartis Code-a-thon looking
2. http://xnet.kp.org/innovationcenter
to meet the growing need for services in this area.
3. http://www.medminder.com/Solutions
Health 2.0’s Code-a-Thons are live events, which occur
4. Singal V. Utilizing the Power of Text-messaging
over the course of one or more days, bringing together
(SMS) Technology to Increase Patient Compliance
developers, designers, innovators and entrepreneurs to
with Medication and Adherence to Physician
build exciting new applications and tools for improved
Recommendations and Educational Interventions
health care. These short and focused events result in
in Free Clinics. http://www.medicine20congress.
the rapid development of interesting concepts and
com/ocs/index.php/med/med2011/paper/view/711
working prototype applications that can be developed
5. http://www.schuman-liles.org/
further by the participating teams.
6. http://www.medadherence.com/solutions.html
7. Brannon K. Can Texting Improve Diabetes Care?
RXPact won first place in the event and $3000 for
their website, which records personal information and
http://tulane.edu/news/newwave/071811_diabetes.
employs social rewards and gaming to help patients
cfm
take their medications. There is a growing trend of
8. http://bit.ly/pS5OIT
using gamification, or game design theory, to help
9. http://bedsider.org
www.pulseitmagazine.com.au
Pulse+IT 37
FEATURE
A unique equation that can make eHealth a reality: PCEHR + ETP = MedView? Bryn Evans
Director JEMS Consulting bryn.evans@ozemail.com.au
It has been widely recognised for a number of
medication history, particularly within the first 24 hours
years
that
of discharge from hospital, or treatment by another
using
electronic
improved
medication
prescribing,
management transfer
clinician. For the first time ever, MedView will provide
of prescriptions, streamlined processes and the
electronic
that, together with past history, regardless of how
consequent reduction of medication errors, can make
many different doctors and pharmacies the patient has
a major contribution to improving patient safety. Much
attended.
research has shown that medication errors of various types, are regularly found to be the largest single cause
Teething problems or stagnation?
of avoidable incidents in hospitals.
The information exchange engine which will drive
The MedView Project
MedView is Fred IT’s eRx Script Exchange (eRx) service. The eRx service, and its competitor MediSecure, receive
One of the lead implementation sites in the Personally
indirect funding from the Commonwealth Government
Controlled Electronic Health Record (PCEHR) project,
through its agreement with the Pharmacy Guild. As
is perhaps the most important of all, MedView. This
well as backing by the Department of Health and
is a joint initiative by Fred IT Group with its eRx Script
Ageing and the National E-Health Transition Authority,
Exchange (eRx) service, Geelong Division of General
through the PCEHR project for the Electronic Transfer
Practice, and Barwon Health in Victoria. Best Practice
of Prescriptions (ETP), the National Prescribing Service
Software, Zedmed, Fred Health, Simple Retail,
(NPS) is also actively supporting and promoting the use
BossNet, Pharmhos, iCare, and Monash University are
of ETP by doctors and pharmacists.
also participating.
Yet despite so much enthusiasm and the boost
MedView will provide a web-based repository
of the PCEHR MedView initiative, ETP is at risk of
of patients’ prescribed and dispensed medications,
stagnating with an uncertain future. Many general
collected from GPs, medical centres, acute care
practitioners are not adopting ETP despite NPS
hospitals, aged care facilities, and pharmacies in the
exhorting doctors to do so. Around 80% of pharmacies
Barwon region. Doctors and pharmacists will be able
have registered with the ETP services. Pharmacy
to access MedView seamlessly from their own practice
software suppliers — even though they receive a small
systems, and see the patient’s latest medication
percentage of the transaction fee once their customers
history, regardless of where the patient has previously
are using the service — claim they are out of pocket.
visited a pharmacy and/or a doctor.
It is also understood from reliable sources, that both
of the ETP services, eRx and MediSecure, are yet to
MedView offers a solution to a long-held goal of
clinicians. Right at the top of most doctors’ wish-list is
achieve profitability.
the desire to see for a presenting patient an up‑to‑date
Why are some GPs not taking up ETP? Probably
the usual factors in varying incidence and degree, are
Author Info
to blame: incomplete understanding of the new ETP Bryn Evans is a management consultant, with many years experience as a CIO in healthcare, and as chief executive of a clinical software supplier. He writes extensively across a range of categories and genres, notably in the areas of management, information technology, sport, travel, history and fiction.
services, resistance to change in working practices, the priority of patient care on a doctor’s time demands, and the lack of a meaningful financial incentive, in order to motivate doctors to put the time and effort into change and adoption. The Royal Australian College of General Practitioners has called for GPs to be paid
38 Pulse+IT
www.pulseitmagazine.com.au
compensation, in recognition of the extra workload of
inclusions such as non-PBS items, seems to be of some
the PCEHR and eHealth generally.
urgency.
What is the barrier for pharmacies? No doubt
Pharmacy software suppliers can probably be
similar factors to those suggested above for GPs may
allowed to reach their own commercial arrangements
be relevant. Indeed those pharmacies which have
with their clients.
enrolled in an ETP service are claimed to be making no
financial gain from providing the service.
some improved financial incentive to participate,
together with a timeframe, at the end of which is a
For the eRx and MediSecure services, a significant
Pharmacies may also need to be considered for
number of prescription transactions — comprising
penalty if not enrolled.
those generated by doctors and pharmacies not yet
using ETP (and therefore not processed) — and certain
companies, which have initiated the two ETP services,
transactions, such as non-PBS items are not recognised
have taken a risk to invest in these two ventures. If they
as eligible, and so are not generating revenue fees
do not achieve a positive return within a reasonable
from the Government. The result is low coverage of
timeframe, they will not reinvest, and these services
total prescription transactions by ETP processing, and
will be unsustainable.
consequent constrained fee revenue for the eRx and
MediSecure services.
MedView project by pharmacists and doctors, the
The critical issue is that the eRx and MediSecure
To drive universal uptake of ETP, and the PCEHR
Government should perhaps look at a legislated
The way forward
framework for participation, as has been used in the
To gain universal engagement by GPs and other
USA, which provides for both financial incentives and
doctors, some appropriate level of financial incentive
penalties over a specified period of time.
will almost certainly be necessary. But payment would
need to be subject to compliance and performance
PCEHR project can provide the infrastructure, and
criteria,
evidence of benefits, which could be the foundation
improved
patient
outcomes,
The successful implementation of the MedView
communication with consumers, care plans etc.
for such a regime of ‘carrots and sticks’ in appropriate
An accelerated and more comprehensive take‑up
Government regulation. Perhaps more than anything,
by doctors, is essential to achieve the profitability
the PCEHR MedView lead site project could make
of eRx and MediSecure, but time is the enemy. A
eHealth a reality.
review of the financial arrangements for prescription
transactions, and consideration of more extensive
health consumers.
And then the real benefits would be enjoyed by
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Pulse+IT 39
OFF TOPIC
Video consulting telehealth – from hospitals to the home and everywhere in between Video consulting is a big subject, within a big subject
Chris Ryan
Principal Telehealth Consultant Attend Anywhere chris.ryan@attendanywhere.com
• How are multiple players and components
(Telehealth), within a big subject (eHealth). Articulating what is involved can be like articulating the health
orchestrated? • How do people know where, when, how, and with
system itself — not an easy task. This is because video consulting is just normal consulting with another travel
what to connect to their appointment? • How are consumers reassured about security,
option. The trouble is that most people’s horizons only
privacy, and the credentials of the clinicians?
extend to considering the ‘transport’ components
• How do practitioners manage medico-legal issues?
(video conferencing), rather than all the end‑to‑end
• How do you leverage emerging eHealth systems
management and logistics that we take for granted under normal circumstances, and more besides.
For people who want do more than just hold a
rebates?
Skype video conference twice a year, comprehending
• Where do people go for local support?
the opportunities and issues involved is like watching
• How is end-to-end quality assured?
stars come out — you see the one or two that most
• How are reporting, audit, and evaluation managed?
closely relate to your perspective, then a few more, and
then you realise the sky is full of them. For example:
travel option, and to think about the answers to these
• How do practices easily get set up with the most
questions in terms of extending current paradigms
suitable technology for their needs? • How do we make it really simple to bring others in without them needing to be ‘set up’?
The trick is to view video consulting as just another
where possible and then filling the gaps.
The current Australian investment in video
consulting is around $620 million, matching our current
• How do people find services and each other and
investments in eHealth projects. Yet there is very little
connect to the right place at the right time using
in the way of central building blocks, services, and
the right technology, without being in a dozen
governance by comparison. This is understandable
‘directories’?
given the history of the new MBS items — and the lack
• How do you create unique, individual video appointments for people? • How are sessions integrated from within existing systems and workflows? • How do you assess the practical capability of patients to do this from home? • What policies and procedures need amending?
Author Info
and services? • How are private fees managed in excess of
Chris Ryan is the principal telehealth consultant at Attend Anywhere, an Australian company with a long history of facilitating the sustainable inter-organisational use of people’s own video conferencing technology to exchange health services. Coming from a rural health background, Chris has played a key role in the adoption of video conference telehealth since arriving in Australia in 1995.
of bureaucracy is a good thing — however the ongoing predilection to simply invest in component parts of telehealth and not the ‘whole’ is of concern. There is no question that the current scatter-gun approach and the ‘retro-fitting’ of enabling components and information is making it difficult for people at the pointy end to decipher what is going on.
The problem with conventional operational experience A senior figure in the eHealth sector said this year “if Australia can’t lead the world in telehealth, then we should give up”. Yes, Australia has a long history of telehealth within the public hospital sector, and yes, the clinical experience gained is invaluable, and yes
40 Pulse+IT
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AAPM NATIONAL CONFERENCE
18
–
21
OCTOBER
2011
Burswood Entertainment Complex Perth Western Australia
SPONSORS
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AAPM New South Wales
AAPM Queensland
EXHIBITORS
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we have a great opportunity to leverage
an extra dimension within existing and
all of this in the face of competition from
emerging information systems and other
that virtually no one giving advice from
overseas. Operationally though, this is a
telehealth modalities. This is a green
government,
double edged sword. Conventional video
field opportunity where we can leverage
the health sector actually uses video
consulting experience at an operational
our clinical experience but build new
conferencing in the way that they are
level has predominately been within single
operational frameworks unencumbered
asking others to — i.e. daily in their own
organisational and technical infrastructures
by the restrictions of old world technology
offices to talk with lots of different people
using conventional video conferencing
and thinking.
in
architectures that date back some time, such as those used by Queensland Health.
The ‘business to business’ (B2B) or
This is new ground from an operational perspective
However it is the author’s observation
different
academia,
industry
organisations,
or
including
on an ad-hoc basis. This is indicative of
the
human,
organisational,
and
technical issues involved — it’s not as
consumer (B2C) nature of the primary
There are many experienced people in the
straightforward as people think. If people
health, home, and specialist environment
telehealth community, in the telehealth
do use video conferencing at work, it is
is very different to this. As well as the
industry, and in the video conferencing
most likely conventional technology and
inter-system and distributed nature of the
industry who have shared a passion for
usually within their own or ‘joined up’
challenge, the market is more likely to be
the value of video consulting over the
organisational networks — not what is
informed by experiences with consumer
past 10-15 years. The financial ‘rains’
needed. It is no wonder that sometimes
video conferencing than they are with
have sprouted a raft of instant video
it appears to be a case of the partially-
conventional technologies, and the former
consulting experts and advice across the
sighted leading the blind.
make more sense. The players are different
health system and the video conferencing
and need to integrate video consulting as
industry.
Health and Ageing have earmarked a
Going forward, the Department of
Below - Multiple Inter-dependent components are required for success — the technology is only one.
Information and Facilitation Coherent and cohesive source of credible information and streamlined provisioning
Communication and Change Management Value of video and the WIIFM factor
Consumer Confidence Security, privacy and credentials
Overarching Management Scheduling, billing, admin audit and evaluation
Enabled Participants People locate services, each other, know where, when, how to connect
Health Provider and Local Venue Directories What services are available and places that people can access them
Workflow Integration Sessionmanagement, information and eHealth systems, etc
Distributed Support and Training Get help from the right local places
Coordination Orchestrating multiple parties and stakeholders
42 Pulse+IT
Legal Consent, accreditation providers, indemnity insurance
End-to-End Quality Assurance Quality gates to provide services, active reporting and resolution of quality issues
Infrastructure
Support all valid technologies, broadband, people not in VC directories
www.pulseitmagazine.com.au
further $47 million for telehealth training
as Skype, but which has more specific
and adoption projects. How is this money
functionality like scheduling and services
Enabled clinical service providers are the key
going to be spent? What are we going to
directories. It would exist separately from
People who live and work outside metro
advise people, and how do we know that
the infrastructure layer so people could use
areas don’t need convincing of the
what we are telling them is right? In the
their own video conference technology,
benefits derived from video consulting.
author’s opinion it seems a little premature
and it would not require participants to
Unlike isolated patients or healthcare
to be providing advice to others given the
have an account.
professionals however, the benefits are
general lack of insight and cohesion that
not as obvious to the mostly metropolitan
currently exists, and without the required
The Victorian experience
central building blocks and services in
In Victoria, the public hospitals are
people with already full schedules, the
place. Whatever happens, this work needs
divided into multiple networks with
convenience, ease of use and effectiveness
to be coordinated nationally and deliver a
separate organisational and technical
of the video consultation process is at least
consistent message.
infrastructures, and there is no central
as important as the financial incentives.
Pages 46-47 of this article list the
ownership or control over any of the
current activities being undertaken by
infrastructure. There has also been no
business models from a practical as well
various stakeholder groups.
Government
department
as financial perspective. The technology
telehealth
has to be accessible in the same place as
and
Before and after the consultation
little
telehealth funding
management
over
for the
years.
based clinical service providers. For these
The solutions must include sustainable
From
the service provider, and the appointment
inception, state-wide video conference
must be as easy to agree to and as
Successful integration of video consulting
event management has been forced to
rewarding to participate in as a physical
is first and foremost a management,
facilitate inter‑organisational participation
encounter. When a clinician notes their
facilitation and work flow integration
using peoples’ own video conference
next appointment is via video it must be a
challenge,
infrastructure and be sustainable from an
single click to join it — as simple as calling
achieved at a technical level alone,
which
simply
cannot
be
operational and financial perspective.
in the next patient listed in their electronic
no matter what the vendor brochure
appointment book.
might say. As I have said, buying a video
became both national and international, an
conference system does not equate to
‘open’ management model was developed
successful healthcare appointments any
that identified 12 local and central ‘roles’,
Infrastructure and practice set up advice
more than buying a car does.
and provided context based information
The Royal Australian College of General
What happens ‘before’ and ‘after’ the
As volumes of participation grew and
and functionality to these geographically
Practitioners
consult is just as critical as what happens
dispersed people.
Guidelines for Video Consultations In
during it, and this is why Skype works
providing
General Practice Version 2 are as good a
so well. The main attraction of Skype —
overarching central building blocks and
place to start as any for practical advice.
quite apart from the low cost — is that it
services closely matches the challenges
These are an evolving set of practical
is easy to get going, easy to find people,
that Australia now faces more broadly,
guidelines, which have now had quite a
and only takes a single click to connect
although it has gone under the radar
bit of input. Combined with the newly
to the right place. Although Skype seems
because the programs are not part of a
released Standards for General Practices
unquestionably here to stay, it is currently
single publicly funded project.
Offering Video Consultations, which is
not scalable for many applications for a
Key lessons have included the need for
an addendum to RACGP Standards for
range of practical and privacy reasons,
a core business focus on overall outcomes
general practices (4th edition), there is a
including the reasons highlighted by
and independence from the component
lot of useful guidance, although arguably
business-grade
vendors.
parts. Also important is separating the
there is too much information to be easily
The fact that everyone needs to have an
user interface and business management
absorbed, and a more suitable delivery
account and will forever be in your ‘buddy
functions from the infrastructure layer.
medium such as a web video or an online
list’ is an issue in itself.
This means multiple video conference
course could be considered.
technologies
technology
In any case, one system is not going
This
experience
can
be
of
accommodated,
The
(RACGP)
guidelines
Implementation
categorise
the
to fit all. What we need is a common
and users get a consistent experience as
technologies as per below, and give an
Skype‑like management platform for
the underlying technologies get easier,
indication or the pros and cons of each.
healthcare that is as easy to provision
cheaper and become ubiquitous.
Note this list is roughly in order of price,
www.pulseitmagazine.com.au
Pulse+IT 43
access, and convenience, not quality
and quality with higher upload speeds, the
are forced to communicate at the lowest
or functionality. The often used term
download speeds are often slower than
common denominator.
‘high end’ has become a misnomer, as
available with consumer offerings.
software‑only
the same high definition quality and
organisations where advice about Internet
Interoperability and interconnectivity are not factors in many scenarios
functionality
connectivity options may be sought.
There are many scenarios where this is a
solutions that
now
would
deliver
have
been
referred to in this way:
Pages 46-47 of this article list several
non issue, for example, where all parties
• Computer software video conferencing
Technology, interoperability and interconnectivity
• Tablet app video conferencing
Everyone
and
forthcoming Medibank Health Solutions
• Desktop video conference appliance
challenges, and it is important to be clear
Online Care (American Well), Skype, Lync,
where interoperability (different systems
or a public hospital network.
being compatible like fax machines), and
interconnectivity (different systems being
as part of the call initiation, it is quick and
• Immersive video conference solution
able to connect to one another across
easy to download the video conference
They also give practical guidance on
networks), are important and where they
program or ‘app’ that the originating party
areas such as bandwidth, which is another
are not. For example this is an important
wants to use if it doesn’t already exist, e.g.
misunderstood topic that means different
consideration for public hospitals where
WebEx, GoToMeeting HD Faces, Vidyo
things to different people and is steeped in
there is a lot of existing video conferencing
or Lifesize. It is already commonplace
wisdom that is past its ‘used by’ date.
equipment and a need to communicate
to have multiple video conferencing
• Web browser video conferencing
(dedicated unit) • Video conference room appliance (dedicated unit)
In
a
pre-NBN
world,
bandwidth
has
different
needs
are working within a single management and
technical
platform,
e.g.
the
Similarly, in many environments and
across the rest of the health system.
software products on a computer or tablet.
challenges relate as much to access as
The current interoperability problems
Getting people together then is more of a
they do to capacity, and the capacity
with Secure Message Delivery (SMD) are
management challenge than a technical
debate is as much to do with the volume
not a good yard stick for video consulting.
one. Of course this doesn’t work as well
of concurrent usage as it is the demands
Like email, a secure message can arrive
if the people need to create an account in
of a single video conference, even a high
at any time without notice and you might
the video conference system to connect.
definition one. Smaller practices have
receive messages from multiple disparate
different needs in this regard to larger or
systems at once. Standards are important
conference systems can connect via
multi–location practices.
to avoid the need to have multiple
the Internet today, although this often
People using standards based video
The upload speed of a connection is
systems and monitoring each of them for
requires a level of user knowledge, and
just as important as the download speed
a message. Video consulting is not like
some conventional technologies don’t
for video conferencing, as this affects
that — you only need to be in one video
handle the Internet very well. In the future,
the quality of what you send as well as
conference at a time and there is a level of
technologies will deliver the required video
what you receive. Thanks to modern
prior arrangement, even if it is only a few
quality using only Internet access and a
video conference technologies, dedicated
minutes.
web browser. Flash based solutions and
links are arguably not required in many
Standards are important however and
services like Google Chat can do this now,
situations, however the type of Internet
exist in commercial grade technologies,
but arguably without the video quality, and
link and service quality remain important
although native calling between these
people still need an account.
factors. In some areas and for some
and FaceTime or Skype seems a long way
practitioners
connection
off. This challenge is being worked on
The exchange approach
provides good enough quality and thus
feverishly worldwide and arguably what
The exchange approach lets people
no new service is required, although it is a
we do in telehealth in Australia is not going
connect using a diverse range of standards
good idea to check that your practice has
to speed this up.
and non standards-based technologies
a suitable data plan to avoid excess data
In the mean time there are multiple
over different networks. Everyone dials in
charges. There are limited options available
scenarios and approaches which are listed
to a central ‘exchange’ which has links to
above ADSL2+ or cable. The pricing gap
below. In some of these we need to be
all of the networks and houses all of the
between
commercial
careful not to achieve interconnectivity
technologies. The exchange then acts like
services can be significant and while the
at the cost of overall quality and limited
a central, multilingual interpreter so that
latter tend to offer much better reliability
functionality because the technologies
everyone can see and hear each other.
an
ADSL2+
consumer
44 Pulse+IT
and
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cross-jurisdictional
to this approach and it is the basis of a
Peer to peer over the Internet in the future
National Telehealth Infrastructure Service
soon to be released telehealth offering
Right now, standalone, standards-based
(led by the NT Department of Health),
from Telstra.
video conference systems can interoperate
Examples include the proposed state
health
department
BlueJeansNetwork,
and
the
companies are engaged in activity relating
Vantage
with each other assuming there are no
The business layer management approach
connectivity issues.
sense in some scenarios as an interim
When Australia had different rail gauges,
technologies like Skype or FaceTime may
solution
interoperability
Queensland bananas still somehow made
be able to natively interoperate taking
remains an issue, although they are
it by train to Victoria. This was a triumph
advantage of the substantial bandwidth
expensive to deploy.
of
management
that will be available. We seem a long way
Network Operations Centre.
Video conferencing exchanges make while
native
end-to-end
logistics
In
the
future,
software-based
rather than native connectivity. Today,
off this happening seamlessly in a B2B and
The telephony approach
every Thursday night, 80 different video
B2C environment although Microsoft’s
The aim of the telephony approach is to
conference systems on different networks
recent purchase of Skype may influence
achieve the same level of reliability, quality,
located in hospitals all over Australia are
this.
device independence and interconnectivity
connected to a single video conference
that we expect from the telephone
event. This is achieved by keeping a record
network. Today, this approach suits people
at the business management layer about
Government and health sector activity
who want end-to-end quality assurance
who has access to what technologies, plus
There is some great telehealth work
and service level agreements within a
information about each technology and
going on but you would be forgiven for
business grade environment. Right now
how to connect to it. The management
being confused or for questioning the
as a stand alone solution this only works
layer then passes information to the
amount of duplication, given the size
using dedicated network connections
relevant people and technologies about
of our population and the overall lack
from a single carrier, so interconnectivity
when and what they need to do to
of experience of actually achieving the
and open access remains a problem. In the
connect.
outcomes we seek. There are at least five
future, people will be able to call between
For example, a specialist at the
health sector or government organisations
different carriers using a common dialling
Alfred using Vidyo can click on a video
offering similar practical advice, including
plan and standards like SIP and E.164
appointment with a specialist in Townsville
the Department of Health and Ageing
numbers. This does seem some way off
hospital using a Tandberg system. The fact
itself.
as the technical and financial peering
that this travels through five technologies
agreements between carriers are yet to
over three IP networks is transparent to
source of up-to-date, coherent, consistent,
be worked out. Most telecommunication
the participants.
and
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Pulse+IT 45
everyone agrees on, and that health
by founding members RACGP Oxygen and
seems to be on the right track. Considering
service
in
representatives from the video conference
its objectives, the Guidance paper actually
multiple levels of detail. It needs to be
providers
industry. The scope of the AMTIA appears
falls a long way short, in the opinion of the
democratically editable but moderated,
to be growing beyond its original focus on
author.
and
information
technical solutions and interoperability,
about available vendor solutions matched
and the organisation is expected to release
Health Informatics Society of Australia
against standards and guidance. People
more details soon.
HISA ran the Rural and Remote Telehealth
deliver
can
categorised
consume
need to see the information in a snapshot,
conference in Cairns in July this year, and
are interested. The information needs
Australian Health Practitioner Regulation Agency
to be endorsed by all stakeholders as
AHPRA has released Draft Guidelines for
an objective assessment rather than
Technology Based Consultations that
Medicare Locals
individual opinion or a regurgitation of the
represent guiding principles rather than
Medicare Locals are slated to play a key
vendor’s marketing. The Australian College
operational advice.
role in providing local support and training
and then drill down in more detail if they
included a telehealth event as part of HIC2011 in partnership with the ATHS.
of Rural and Remote Medicine (ACRRM)
for video consulting.
are working on a product inventory that
Australasian Telehealth Society
seems like it might head in this direction.
ATHS
and
A brief synopsis of telehealth activity
the author is aware of is outlined below:
is
a
public
which
academic
National E-Health Transition Authority
based
society
NEHTA is in the process of scoping what
telehealth
predominantly hospitals
policy
its involvement in video consulting should
recommendations, advice, and advocacy.
provides
be. They reportedly have received an
Australian College of Rural and Remote Medicine National Telehealth Advisory Group
Their second annual meeting will be held
estimated $1 million additional funding
1-2 December, alongside the Queensland
for this purpose, and to provide input into
University Centre
related DOHA projects.
The Government has funded ACRRM to
‘Successes and Failures in Telehealth’
develop a TeleHealth Standards Framework
conference.
NEHTA gets to grips with the entire
for Online
Health
and a range of support materials to assist
In the opinion of the author, once
breadth and depth of the video consulting
medical practitioners, patients, and health
Department of Health and Ageing
space (as opposed to simply the video
facilities to understand and appropriately
DOHA are funding a range of initiatives
conferencing part), it will recognise
utilise video-based telehealth services for
and projects, some of which are mentioned
a great opportunity to leverage its
rural and remote communities.
throughout this article. DOHA has also set
existing workplan for the benefit of video
ACRRM has partnered with specialist
aside $47m for video consulting training
consulting
and nursing colleges, peak Aboriginal,
and support, but the details of what the
wheels.
rural health, and telehealth associations,
training will cover, and how it will be
and the Royal Flying Doctors Service, and
managed, are yet to be released.
their work includes a telehealth product
inventory and an advisory service.
consists of representatives from across
GP Victoria provides a good summary of
The DOHA Telehealth Advisory Group
without
re-inventing
any
National and state based general practice networks
the heath sector. The MBS Online website
telehealth on its website, and GP NSW
Australian Information Industry Association
contains very comprehensive and well
has published two presentations providing
presented information about the MBS
information and practical advice.
AIIA are founding members of the
item numbers and related matters.
Australian Medical Telehealth Industry
Alliance (AMTIA), and have a health
comment
guidance
National Health Call Centre Network / Health Direct
task‑force that includes many of the
documents which appear to have been
In partnership with key stakeholders,
leading infrastructure suppliers in this
written by different people. The content
NHCCN are developing a National Health
space.
of the Guidance on Security, Privacy and
Services Directory to support eHealth in
Technical Specifications for Clinicians
general, and this is expected to include
Australian Medical Telehealth Industry Alliance
document displays a remarkable disparity
video consulting and contain details of
in experience compared with the Telehealth
providers of services that offer access in
AMTIA has been brought together recently
Technical Standards Position Paper, which
this way.
46 Pulse+IT
DOHA also recently released for two
practical
www.pulseitmagazine.com.au
Royal Australian College of General Practitioners
challenge does not work.
RACGP Implementation Guidelines for
and that of leading telehealth programs
Video Consultations in General Practice
such as the Ontario Telehealth Network,
Version 2 are an evolving set of practical
that operational solutions must include an
guidelines that have received quite a
overarching management component with
bit of input. This, combined with the
an independent core business focus on
Standards General Practices Offering Video
overall outcomes rather than component
Consultations, which is an addendum to
parts. To put this multifaceted jigsaw
RACGP Standards for general practices
together, you must know what you are
(4th edition), provide some sensible and
doing, and you can’t be one of its parts.
practical advice as a starting point. RACGP
We know from our own experience,
also provides an advisory service via a call
Declaration of interest
centre.
Chris Ryan is the principal telehealth
Conclusion
consultant
at Attend Anywhere,
Australian
company
with
a
an long
There is a lot happening in this space
history of facilitating the sustainable
and rightly so — the enormous health
inter‑organisational
outcome, economic, and social potential
own video conferencing technology to
is well documented. Telehealth in general
exchange health services.
has been touted as the ‘get out of jail free’
card that can address rising health care
independent consulting focused on the
costs and the challenge of the ‘ageing
people, process, technology, and service
tsunami’. It’s also pretty convenient and
integration issues involved, as well as
popular with consumers.
a range of central building blocks and
services.
The government has done a good
use
of
people’s
Attend Anywhere provides technology
job in providing the raw materials for the
health system to work with, and should be
video
congratulated for its vision. There is a lot
does have an overarching management
to do, however, both practically and from
platform based on the Victorian distributed
a communication perspective. ‘I see what
management model. The platform lets
you are saying’ has a whole new meaning
people find services and each other
in a video conference but people need to
and attend on-demand or scheduled
experience for themselves the massively
appointments and events, using the
increased value that visual communication
technology available to them.
delivers compared to the telephone.
organisations,
There seems general agreement that
Attend Anywhere does not supply conferencing
Chris
also
technology,
consults
to
including
but
many Monash
overarching national building blocks and
University, the RACGP (where he worked
services are needed which bring together
on the RACGP Implementation Guidelines
the business layer, the governance, the
for
health information and workflow systems,
Practice), and is a member of AIIA, ATHS,
and the video conference infrastructures
MSIA, HISA and the AMTIA.
from an operational perspective.
The question is how long will it
Video
Consultations
in
General
References
take us to get this right, and how much
Due to page space restrictions, links to all
more money will we waste viewing the
organisations and documents referenced
component parts of this jigsaw in isolation
in this article have been made available
to each other? Simply seeking technical
online at the Pulse+IT magazine website:
solutions to what is a management
http://bit.ly/uEcj3X
www.pulseitmagazine.com.au
PULSE+IT
47
Following the success of last year’s event, Best Practice Software is excited to announce that the next Best Practice Summit will be held in Bundaberg in March 2012. Register your interest in attending the conference and receiving further updates by emailing bpsummit@bpsoftware.com.au Workshops will include training sessions on various aspects of Best Practice Clinical and Management as well as future directions for Best Practice, integration with other packages and conversions, etc. Keep watching the Best Practice website: www.bpsummit.com.au in the coming months for further information. If you haven’t yet tried Best Practice, go to www.bpsoftware.com.au or call: (07) 4155 8800 to order the FREE DVD and experience these and other features for yourself – with your own practice data (from a back-up copy, of course).
OFF TOPIC
Improving disaster recovery and business continuity with server virtualisation Alberto Tinazzi
IT Security Consultant eHealth Security Services atinazzi@ehealthsecurity.com.au
What is virtualisation?
Windows. Similarly, a Macintosh computer can use
Virtualisation is a technique that allows the user to run
Parallels Desktop to run Windows on top of Mac OS X.
multiple instances of an operating system on a single
physical computer. Physical resources such as CPU
computer arrangements across an organisation,
cores, memory, and storage of the single computer are
which can help to simplify management and increase
subdivided amongst multiple ‘virtual’ machines.
security. This is called Virtual Desktop Infrastructure,
Virtualisation also allows for standardised desktop
A common error is to confuse virtualisation with
and it consists of replacing all desktop PCs with thin
emulation. An emulator mimics the behaviour of
clients connected through the local network to a
different hardware, for example, a computer with a
large server running virtual instances of the desktop
typical Intel x86 CPU can emulate a PDA or a mobile
operating system and applications. Applications,
phone based on an ARM CPU. Virtualisation instead
drivers and updates can be installed just once, lowering
relies on a piece of software called a hypervisor (or
the time required for the IT department to manage the
Virtual Machine Manager) which is responsible for
infrastructure. Additional benefits introduced by this
allocating resources provided by a physical machine
technology include:
to a number of virtual machines compatible with the
• Increased security, as all data is centralised.
same type of hardware architecture.
• A consistent user experience, as the user will have
Many also confuse virtualisation with cloud
the same desktop view from any location in the
computing; however, while virtualisation is an enabling technology for many cloud computing platforms, cloud computing is concerned with providing computing
organisation, including when connecting remotely. • Reduced total cost of ownership.
resources as a service, in a timely, flexible and
Server virtualisation
automated fashion.
The most widely-cast virtualisation technique, and
Virtualisation technology can be used on a
probably the one that provides more immediate
standard desktop computer when a user requires
benefits from a business perspective, is server
the ability to run multiple operating systems on
virtualisation. The rationale behind server virtualisation
a single desktop. In this scenario, virtualisation
leverages the fact that a typical server CPU generally
allows the user to run multiple operating systems
operates at between 5% and 15% of its capacity,
conveniently, simultaneously, and without the need
meaning the server is more often than not heavily
to set up complex disk partitioning and dual booting
underutilised.1
arrangements. For example, a Windows computer with
VMware Workstation installed can run Linux on top of
of virtualisation, and have for many years been
Large organisations have been early adopters
Author Info
consolidating their server resources. Accordingly, Alberto Tinazzi is a Certified Information Systems Security Professional (CISSP). He works as an independent information security consultant specialised in the healthcare sector. He has 16 years experience as an IT professional, specialised in information management and security. He has spent the last 10 years working within the health sector covering a number of different roles within the Division of General Practice Network.
despite the increasing computerisation of many organisations, the number of physical servers within organisations is reducing. A consolidation ratio of 4:1 means that four physical servers can be virtualised to run on one physical server, but there are cases where this ratio can be as high as 12:1. This provides a number of immediate tangible economical benefits, such as
48 Pulse+IT
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Large organisations saw immediately the advantage of virtualisation and started consolidating their server farms by massively reducing the number of physical servers. A consolidation ratio of 4:1 means that 4 physical servers can be virtualised to run from 1 physical server, but there are cases where this ratio can be as high as 12:1.
Above - A traditional computing architecture is shown on the left, which is contrasted with a virtualised environment on the right. Two virtual machines are running independently within the Hypervisor environment sharing the hardware resources of a single computer.
This provides a number of immediate tangible economical benefits such as the reduction of capital the reduction of expenses evident, whatofare the advantages may want to with adoptpower new technologies expenses tocapital acquire the required hardware,clearly the reduction operational costsitassociated and to purchase the hardware, reduction of for small and medium sized organisations? aiming to provide better service delivery cooling, and smaller data centres. operational costs associated with power
A typical general or specialist practice
to its patients, such as online booking and
and cooling, and smaller data centres.
will probably rely on one or two physical
the delivery of educational material and
physical servers, raising server utilisation
business functions, the availability of
an absolute minimum.
An interesting case study carried out by vmware, on a regional healthcare organisation in the US 2, An interesting case study conducted servers, therefore server consolidation resources. shows that by virtualising their infrastructure they have been able to consolidate 62 servers into 6 by VMware on a regional healthcare is unlikely to be a high priority. However, Because all these business functions physical servers raising server utilisation from 5 to 80%. This has also theon recovery time organisation in the US, shows that by because most of these businesses rely on willreduced likely depend the practice server, from 12 to 1 hour and improved the time required for provisioning a new server from 24 to 2-3 virtualising their infrastructure they have a limited number of physical servers which its availability becomes of even greater hours a TCO reduction of679% their capex and ofall43% on their opex. with downtime to be kept to been ablewith to consolidate 62 servers into areon responsible for running essential importance, from 5% to 80%. has also reduced According to aThis study carried out the recovery time from 12 hours to one
server/s becomes of paramount With just in operation bytheSpringboard Research in 2010, Australia is one theserver leading countrythe
importance from a business continuity downtime is very high. A hardware in the Asia Pacific Region for the adoption of virtualisation technologyriskbyof87%, followed by Japan point of view. malfunction, a system resource conflict, or 82% . vmware also claims that their virtualisation products are used by 94% of the ASX 100 and provisioning a new server from 24 hours to Let us consider the scenario of a typical a malware infection may make the server 4 96% theThis Fortune by to two threeof hours. has led to1000 a total . practice with a single server responsible for unusable and cause quite prolonged and hour, and 3 improved the time required for
cost of ownership reduction of 79% on
running essential business functions, such
unplanned outages.
their capital availability expenditure, andissues a reduction as clinical records, patient appointments Rebuilding a server scratch, System affecting business-continuity in SME (Simon, I am notfrom sure howand 2 of on their expenditure. to43% title thisoperating section... please
accounting, andappropriate recovering fell and freebilling, to change it aspathology you feel
information from backups
According to another study carried out
radiology downloads, receiving admission
by Springboard Research in 2010, Australia
and discharge notifications from hospitals,
may take many hours or possibly days,
products are used by 94% of the ASX100
outsourced to a third party. And over the
damaged caused to the system. In most
and by 96% of the Fortune 1000.
next few years it may decide to adopt new
cases, the only way to recover from a
technologies, such as Electronic Transfer of
malware infection is to rebuild the entire
depending on the availability of spare parts While benefits for larger businesses are so evident, what are the advantages for SME? A typical is the leading country in the Asia Pacific transmission of referrals to specialists, file which may need to be sourced. medical or specialist practice will probably rely on 1 or 2 physical servers, therefore, server Region for the adoption of virtualisation sharing, printing and data backups. If the server becomes infected with consolidation in this case is surely not a need. However, because most of these businesses rely on technology with 87% penetration, followed In a near future, the practice may malware, a good antivirus may be able 3 a Japan single physical server responsible for running essential availability of by with 82% penetration. decide to handleallthe hosting business of its tofunctions, remove the the source of the infection, server of paramount importance from a business-continuity point of view. such VMware also becomes claims their virtualisation emails and website, which are currently but it will be unable to recover from the 4
2 vmware - Reducing Server Total Cost of Ownership with VMware Virtualization Software – http://www.vmware.com/pdf/TCO.pdf What about SMEs? Prescriptions and shared electronic health system from scratch and recover all data 3 Cloud computing adoption accelerates in Asia Pacific - November 2, 2010 the benefits provided by records, introduce the use of an Intranet from the most recent backup. This clearly http://www.vmware.com/ap/company/news/releases/11022010-cloud-computing-adoption.html virtualisation to larger businesses are or a document management system, and translates into prolonged downtime, 4 Customers Trust VMware - http://www.vmware.com/company/customers/
While
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Pulse+IT 49
during which the practice may not be able
may run the clinical database; yet another
be allowed access to the system running
to operate.
server may be responsible for downloading
the clinical record. Likewise, a nurse
In order to improve continuity of
pathology and radiology reports; another
may require access to the clinical system
operation and gain the ability to recover
one may run the Intranet or website; and
but may not be allowed access to the
quickly from all malfunctions, the practice
so on.
accounting system.
requires a system that is resilient. Such a
system should be designed in a way that
software product that might conflict with
Improving disaster recovery
avoids single points of failure wherever
other software installed on the system
When using virtualisation architecture,
possible. It should therefore be redundant
would impact only on a specific business
the recovery process is quite efficient as it
in all its parts. Business functions should
function, and would not affect other
consists of simply copying across the latest
be compartmentalised in such a way that
functions. Likewise, if for example the
snapshot of the affected virtual server. A
a malfunction affecting a specific business
accounting system becomes infected
‘snapshot’ is an exact copy of the virtual
function does not affect all other functions.
with malware and needs to be rebuilt, the
server that can be taken at any point in
Finally, the system should also allow for
downtime caused will be affecting only
time, with only minimal downtime. The
speedy recovery from failure.
the accounting function while all other
system may be set to take snapshots of
systems will still be operational.
each virtual server every night. Snapshots
Dividing business functions
In this way, the introduction of a new
Compartmentalisation
of
business
should be treated the same as other
Virtualisation allows the organisation to
functions provides better security, as
backups and stored offsite.
split the functions performed by a single
staff will only be provided access to
physical server across multiple virtual
the servers running business functions
or the presence of malware makes the
servers. For instance, a virtual server may
pertinent to their job function. For
clinical system unusable, it is possible to
be responsible for user authentication,
instance, an accountant requires access to
revert to the latest snapshot in just a few
file and printer sharing; another server
the accounting system but should never
minutes. Likewise, if the server is stolen
If the installation of a software update
or itIntranet has been severely le for downloading pathology and radiology reports, another one may run the or or water, recovery will Below A compartmentalised virtual machine arrangement designed to provide separation nd so on. between key server functions.
damaged by fire take only a few
minutes once a new physical server is made available.
Flexible infrastructure Yet
another
advantage
of
server
virtualisation is that it enables the practice to respond more rapidly to dynamic business
conditions,
whether
driven
by growth or unanticipated resource availability. A new virtual server can be deployed in a few minutes, and if more capacity is required, a new physical server can be added quite easily.
Installing a new server is typically
a very time-consuming process which can lead to quite extensive downtime and frustration when things do not go as planned. Virtualisation nullifies this onerous task.
High availability Clustering is a technique that allows virtual machines to run across multiple physical servers called nodes. This allows for the
50 Pulse+IT
www.pulseitmagazine.com.au
workload to be evenly distributed across
This can be organised in different
that a number of considerations are made
a pool of physical servers, and also allows
ways. The externally hosted virtual servers
to identify a suitable service provider and
for live migration of a virtual machine from
could be always-on, in which case data
to establish adequate security measures.
one physical server to another in the event
synchronisation will happen continuously,
that a physical server requires hardware
making the practice infrastructure readily
computing in the healthcare sector can be
maintenance.
available in case of a disaster. Another
found in Pulse+IT [Issue 22, May 2011, page
In order to recover quickly from disasters,
be identified to host the practice’s virtual
your business is on the information system,
it is possible to combine a practice’s
server in case of a local disaster. In this
and how robust and efficient your existing
Private Network (VPN). This approach
disaster recovery, one should also be
contingency measures which allow a
would allow the organisation to resume
aware of the issues and security risks
business to continue, or quickly resume
Further
information
about
cloud
Flexible infrastructure A virtualisation cluster could be arrangement involves having the hosted 38]. Yet another advantage of server virtualisation is that it enables the practice to respond more configured to automatically recover from virtual servers on for a small amount of rapidlyfailure to dynamic business whether driven by—growth unanticipatedfor resource hardware by restarting all affected conditions, time — generally in off-peak hours to Isorvirtualisation you? virtual servers on other available nodes.serversynchronise the practice in servers. As and every business operates quiteis availability. A new virtual can be deployed a fewFinally, minutes in case more capacity as part of the business’ disaster recovery differently, there is no easy answer to this required a new physical server can be added quite easily, as well as more physical memory and Off-site disaster recovery plan, one or more cloud providers should question. It all depends on how dependant storage can be added at any time with no disruption.
Installing a new server with typically is athe very timemust consuming that produces local virtual server infrastructure an case provider be suppliedprocess, with data recovery processesquite are. an extensive external hostingand service. The practice’s the most do recent snapshot the practice’sVirtualisation All organisations, how downtime frustration when things not go asofplanned. nullifiesno thismatter onerous virtual servers replicate themselvesoftothe virtual server/s. smallacross they areand should have a disaster task. Thecan latest snapshot virtual server can be simply copied executed on the a public cloud through a dedicated Virtual While cloud computing is great for recovery plan. The plan should establish new hardware in no time. High Availability operation in no time, should a major introduced by this type of solution. As its regular operations, in the event of a disaster affect theis area where the business cloud computing involves externalising disaster or catastrophic event.servers Clustering a technique that allows virtual machines to runtheacross multiple physical is (called located. nodes). This allows for the business IT infrastructure, it is essential Inacross case of prolonged downtime, workload to be evenly distributed a poolsystem of physical servers, but it also allows for live migration of a virtual machine from a physical server to another in Below - In the event of a hardware problem occurring with the left physical server shown in this example, the Server 1 and Server 2 virtual the event that to a the physical server requires hardware maintenance, with no downtime at all. machines are migrated still-functioning physical server shown on the right, allowing these virtual servers to remain available.
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Pulse+IT 51
to remain operational a practice should be
selected.
able to switch back to manual operation.
products are available for free, but
This means, for example, reverting to
your organisation may require larger
patient paper records, being able to order
servers with fully redundant hardware.
Suggested further reading
and receive pathology manually, being
Implementing
1. http://en.wikipedia.org/wiki/
able to consult paper-based referential
non‑fault‑tolerant hardware may greatly
material such as drug prescribing guides
reduce the advantages introduced by the
and other relevant publications, being able
technology.
to write prescriptions and referral letters
manually, and being able to bill patients for
level of compartmentalisation desired.
References
the services provided, which includes the
Each virtual server will require allocation
1. Learn About Virtualization. http://www.
capability of manually looking up relevant
of physical resources, such as memory
visualnetworksystems.com/learn-
billable items.
and storage, and may attract additional
about-virtualization
software licensing costs.
Downtime can be greatly reduced
Many
basic
virtualisation
virtualisation
on
may attract higher fees than what you are used to pay for traditional IT services.
Virtualization 2. http://www.riskythinking.com/glossary/ maximum_tolerable_downtime.php
Another variable is introduced by the
2. Reducing Server Total Cost of
depending on the virtualisation solution in
place. It can go from a few hours in the case
self-recovering system, then you would
of the most basic virtualisation solution, to
probably require a virtualisation cluster
seconds in case of a fault‑tolerant cluster
and/or an hybrid cloud solution. In this
or a hybrid cloud solution.
case, you will have to account for the
accelerates in Asia Pacific. http://www.
cost of the extra cluster nodes and for the
vmware.com/ap/company/news/
subscription fee to the cloud service.
releases/11022010-cloud-computing-
adoption.html
How much does server virtualisation cost? It depends on the level of redundancy
If you are considering a fully resilient,
Implementing a virtualisation solution
is not a lengthy task, but it requires specific
HealthLink/Medinexus Half and Page 180 120 required and on the virtualisation solution professional knowledge a skill setxthat
Ownership with VMware Virtualization Software. http://www.vmware.com/ pdf/TCO.pdf 3. Cloud computing adoption
4. VMware Customers. http://www.
Pusevmware.com/company/customers/ IT Mag
connecting healthcare
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Argus ACSS AAPM
P: 1800 196 000 / +61 3 9095 8712 F: +61 3 9329 2524 E: headoffice@aapm.org.au W: www.aapm.org.au The Australian Association of Practice Managers (AAPM) represents Practice Managers and the profession of Practice Management. Founded in 1979, AAPM is a non-profit, national peak association recognised as the professional body dedicated to supporting effective Practice Management in the healthcare profession. The Australian Association of Practice Managers: • Represents Practice Managers and the profession of Practice Management throughout the healthcare industry. • Promotes professional development and the code of ethics through leadership and education. • Provides specialised services and networks to support quality Practice Management.
P: 1300 788 005 / +61 2 9632 0026 F: +61 2 9632 0096 E: sales@acsshealth.com W: www.acsshealth.com ACSS provides innovative and customisable patient management software streamlining day-to-day operations for General Practitioners, Allied Health, Specialists, Radiologists, Pathologists, Private and Public Hospitals. eClaims — Comprehensive and robust appointment and billing systems with digital/voice recognition capabilities, electronic reporting transmissions and HL7 PACS system integration. SimDay — Proven PAS (Patient Administration System) specifically designed for day surgeries and private hospitals — Now with ECLIPSE integration. SimDay Express — A lite version of our Patient Administration System designed as a cost effective method of delivering PHDB, HCP, State Health & Cancer Register data extractions.
P: +61 3 5335 2220 F: +61 3 5335 2211 E: argus@argusconnect.com.au W: www.argusdca.com.au Argus provides and supports Argus secure messaging software; a popular electronic solution that enables healthcare practitioners to exchange pathology, radiology and specialist reports, hospital discharge summaries, referrals and clinical data securely and reliably. Argus interfaces with most clinical software applications sending directly from within your letter writing facility or word processor and runs virtually invisibly in the background. Documents sent using Argus can be automatically added to electronic patient records; thus avoiding the need to scan or manually file them. Argus is the messaging solution chosen by 65 Divisions of General Practice through the ARGUS AFFINITY program. With over 12,800 users Argus continues to grow in popularity by delivering a highly secure message, reliable product, backed by outstanding customer service all at the lowest cost possible.
Advantech
P: +61 412 746 457 F: +61 3 9569 9449 E: Secretary@ACHI.org.au W: www.ACHI.org.au
The Australasian College of Health Informatics is Australasia’s Health Informatics professional body, representing the interests of a broad range of clinical and non-clinical e-health professionals. ACHI is the community of Health Informatics thought-leaders in Australasia. ACHI is committed to quality, standards and ethical practice in the Health Informatics profession. More information is available at: www.ACHI.org.au
Advantech’s medical computing platforms are designed to enhance the quality and efficiency of healthcare for patients and users alike. All products match the performance of commercial PCs and tough medical safety ratings like UL60601-1 and EN60601-1; adding to this they are all IPX1 certified dust resistant and come with water drip‑proof enclosures. Advantech offers long term support and a proven track record of reliability. The medical range extends through: • Point-of-Care Terminals. • Mini-PC and Medical Imaging Displays. • Mobile Medical Tablets. • Patient Infotainment Terminals. Advantech is also an official distributor of Microsoft Windows Embedded software across Australia & New Zealand.
Join the ACHI Info email list at: www.ACHI.org.au/List
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T: +61 3 9023 0800 F: +61 3 9614 2650 E: info@precedencehealthcare.com W: www.precedencehealthcare.com cdmNet is an online service specially designed to manage the entire life cycle of a patient’s chronic disease. cdmNet delivers best practice chronic disease management, including creation of GPMPs, TCAs and Reviews. In addition, collaboration with your care team is quick, easy and ongoing. cdmNet minimises the bureaucracy, eliminates the paperwork, and ensures compliance with Medicare requirements for chronic disease management. cdmNet optimises patient care, simplifies care team collaboration and minimises administration & paper work. Find out more about how cdmNet can assist you and your practice by typing cdm.net.au/info into your browser address bar. cdmNet: Chronic Disease Management just got a whole lot easier.
Cerner Corporation Pty Limited
P: 1300 308 531 F: +61 3 9797 0199 E: info@advantech.net.au W: www.advantech.net.au
Australasian College of Health Informatics
cdmNet
P: +61 2 9900 4800 F: +61 2 9900 4990 E: AsiaPacific@cerner.com W: www.cerner.com.au
Best Practice
P: +61 7 4155 8800 F: +61 7 4153 2093 E: sales@bpsoftware.com.au W: www.bpsoftware.com.au Best Practice sets the standard for GP clinical software in Australia offering a flexible suite of products designed for the busy GP practice, including: • Best Practice Clinical (“drop-in” replacement for MD) • Integrated Best Practice (clinical/ management) ANNOUNCING:The 2012 Best Practice Summit Following the success of last year’s event, The Best Practice Summit will be held at CQ University in Bundaberg from March 8-10. www.bpsummit.com.au
Cerner is a leading supplier of healthcare information systems and our Millennium suite of solutions has been successfully installed in over 1200 sites across the globe. Cerner’s technology has been designed so that it can be adapted to meet the needs of the very different healthcare delivery systems that exist, with a universal framework that allows clinician workflow to seamlessly span role and venue. Our innovative leadership is allowing us to push boundaries by: • Leveraging clinical and pharmaceutical data for new discoveries in Condition Management and Personalised Medicine • Connecting the community with personal and community health records • Seamlessly connecting the patient record across the continuum of care
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Direct Control
CH2 (Clifford Hallam Healthcare) P: 1300 720 274 F: 1300 364 008 E: marketing@ch2.net.au W: www.ch2.net.au
Clifford Hallam Healthcare (CH2) is today Australia’s largest pharmaceutical and medical healthcare service provider with a catalogue of over 30,000 products servicing metro, regional and rural customers across Australia. Supported by a National Network, CH2 utilises local knowledge and local people to provide pharmaceuticals, medical consumables and equipment products to the healthcare market. CH2 is represented by a National Sales Force as well as a local Customer Service team in each state. CH2 understands the value of quality data and are committed to implementing the GS1 system throughout our business and with our partners. The use of EANCOM standard messages, Global Trade Item Numbers (GTIN) for product identification, Global Location Numbers (GLN) for location information and Serial Shipping Container Code (SSCC) labels are paramount to our industry moving forward. CH2 are passionate supporters of these philosophies and believe the uplift in quality systems will result in improved patient safety. CH2 are currently working with partners to implement the National E-Health Transition Authority (NEHTA) National Product Catalogue. “Our aim is to be a great company to do business with. The right product, at the right price, at the right time.” WardBox® is CH2’s direct to ward distribution system. It is a just in time replenishment system where orders are created in a theatre or ward area and then transmitted electronically to one of CH2’s warehouses using SOS or an EDI interface. The service incorporates barcode scanning technology, direct delivery to individual wards or departments, monthly invoicing and comprehensive reporting. WardBox® is designed to assist our customers in reducing purchasing and supply operating costs. This valuable service increases supply chain efficiencies, improves service delivery models and assists in achieving economies of scale. WardBox® distribution is used for pharmaceuticals, medical, surgical and general supplies at numerous healthcare facilities. CH2 recently won the “SAP Best Business Intelligence with Channel Partner” award at the SAP Customer Awards of Excellence 2011. CH2 also sponsored the 2011 Victorian SCLAA awards.
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Clintel Systems
P: +61 8 8203 0555 E: info@clintel.com.au W: www.clintel.com.au The Specialist: A complete solution for your Appointments, Billing including Online Claiming and Clinical requirements in an intuitive scalable solution. Clintel provides systems to Specialist and Day Surgeries nationally. Powerful, highly configurable and easy to use, our systems mirror the needs and workflow of your practice and individual specialty. Our industry standard SQL database enables a true “paperless” practice. Our leading edge architecture is future proof, it is designed to meet changing requirements and offers first class reporting and analysis of clinical and business data. Standalone or networked multi-site installation which runs on both Mac OSX and Windows operating systems. Our support is first class, our philosophy is “whatever it takes”.
dbMotion
P: +61 2 8011 4885 E: info-aus@dbmotion.com W: www.dbmotion.com dbMotion’s connected healthcare solutions for shared electronic health records (Shared EHRs) and health information exchange (HIE) transform healthcare, empowering physicians and revolutionizing patient care for healthcare organisations. The service oriented architecture (SOA) based dbMotion™ Solution gives caregivers and information systems secure access to an integrated patient record composed from the patient’s medical data maintained at facilities that are otherwise unconnected or have no common technology through which to share data, without replacement of existing information systems. Healthcare organisations using dbMotion have realised benefits in a wide variety of areas, ranging from patient safety, quality, efficacy, and IT agility.
P: 1300 557 550 F: +61 7 5478 5520 E: support@directcontrol.com.au W: www.directcontrol.com.au
Digital Medical Systems P: 1300 865 977 F: +61 3 9753 3049 E: inform@dgs.com.au W: www.dgs.com.au
Easier ICT is a technology partnership with DMS — we make I.T. work for you. DIGITAL MEDICAL SYSTEMS has provided ICT solutions and services to medical practice clients across Australia since 1990. We have specialist expertise and experience in the installation and support of leading medical software applications. DMS is a Business Partner for IBM, Lenovo, HP and Microsoft. Other leading ICT brands include Trend Micro, Symantec, CA, Cisco, Toshiba, Canon, Epson, Kyocera, Fujitsu and Brother. Accreditation is easier with the customised DMS IT Systems Documentation. Ensure your practice has the best quality IT policy, security and maintenance program that meets and exceeds the standards guidelines from the RACGP and AGPAL and GPA. World leading DTech provides 24x7 near Real-Time Monitoring and Management that alerts and enables our engineers to quickly troubleshoot and solve problems of security, network, Internet, Server and software remotely on almost any client computer system or device. Medical IT systems are automatically maintained by DTech to the most highly available status to minimize downtime by preventing problems from occurring or reducing their impact. Proactive, Flexible, Consistent, Reliable, Audited, and Affordable — for even the smallest practice. Call DMS for: • Systems Analysis & Consulting • Solutions Design • Procurement & supply of hardware, software, network and peripheral products • Installation & Configuration • Support Services inc Help Desk • DTech Monitoring, Maintenance & Management • Disaster Recovery solutions • Fully managed & automated Online Backup customised for clinical data
Direct CONTROL is an affordable, intuitive and educational Medical Billing and Scheduling application for Practitioners of all Disciplines. Seamless integration with Outlook, MYOB or Quickbooks. Direct CONTROL’s Clinical Module manages Episodes of Care and includes State, Federal and Health Fund Statistical Reporting for Day Surgeries/Hospitals. Direct CONTROL facilitates Medical Billing Australia-wide and overseas. Included is all Medicare, DVA, Work Cover, Private Health Insurance fee schedules with built in rules relevant to each medical discipline (allied health, general practice, surgeons, physicians, anaesthetists, pathologists, radiologists, day surgeries/hospitals). Ideal for the single practitioner or the multidisciplinary Practice. Direct CONTROL supports ALL your Business needs letting you and your staff get on with earning a living doing what you enjoy most … Patient Care.
eHealth Security Services
P: 1300 399 116 / +61 2 9016 5378 F: +61 2 9016 5379 E: info@ehealthsecurity.com.au W: www.ehealthsecurity.com.au eHealth Security Services (eHSS) specialises in the provision of security as a service and offers an extensive range of Managed IT Services including IT Support for small to medium businesses in the health sector. eHSS’ MediAccess® service provides comprehensive and cost-effective managed security and remote access solutions. eHSS has thorough knowledge and understanding of IT matters in the health industry and its regulatory aspects. eHSS has extensive experience reviewing and assisting with organisational policies and procedures and technical implementations against applicable standards.
Easier IT — we make I.T. work for you.
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Emerging Systems
P: +61 2 8853 4700 F: +61 2 9659 9366 E: sales@emerging.com.au W: www.emerging.com.au/ehealth Emerging Systems EHS web-based Clinical Information System records the clinical care delivered to a patient from pre-admission through to discharge. EHS interfaces with the hospital PAS system, capturing and providing all of the information Clinicians require during a patient stay to support the delivery of effective, appropriate, quality care outcomes in a secure and auditable environment. Importantly, EHS links Clinical Care with Workforce Rostering and Staff Allocation allowing for predictive Resource Allocation based on the care required, enabling valuable productivity improvements. EHS is a proven and highly useable electronic medical record developed within Australia and operating successfully in St Vincent’s & Mater Health, Sydney and Government of South Australia, Department of Health Hospitals.
Equipoise (International) Pty Ltd Totalcare
GPA
P: 1800 188 088 F: 1800 644 807 E: info@gpa.net.au W: www.gpa.net.au
P: +61 7 3252 2425 F: +61 7 3252 2410 S: skype.totalcare.net.au E: sales@totalcare.net.au W: www.totalcare.net.au
Equipoise International Pty Ltd (EQI) is the developer and supplier of the ‘Totalcare’ clinical and office management system. Used since 1995 by health care facilities across Australia including General and Specialist practice, Radiology, Day Surgery and Hospitals. Totalcare is a fully integrated Clinical, Office and Management software suite. Totalcare is stable, scalable, customisable and easy to learn and use. From a small practice to a distributed, multi site, multi disciplinary corporate entity or hospital, Totalcare can provide a solution for your needs.
Genie Solutions
P: +61 7 3870 4085 F: +61 7 3870 4462 E: info@geniesolutions.com.au W: www.geniesolutions.com.au Genie is a fully integrated appointments, billing and clinical management package for Specialists and GPs.
Pre-Admission Patient History Orders & Results Clinical Care Guides Assessments Progress Notes Referrals Labour & Birth Medications Reconciliation Clinical and Non‑Clinical Messaging Diets Discharge Planning Appointments Rostering Allocations Resource Calculation Clinical Dashboard and more
EHS has integrated Sabacare’s Clinical Care Classification (CCC) System, a diagnosis framework integrated in SNOMED CT. EHS’ extensive list of modules work seamlessly with other systems via our integrated interface engine which accepts HL7 and other accepted Health IT standard protocols complying with the Australian Technical Specification: ATS 5822:2010 eHealth Secure Message Delivery.
Choose GPA for more support, improved service and greater choice.
Genie runs on both Windows and Mac OS X, or a combination of both. With over 2200 sites, it is now the number one choice of Australian specialists.
Health Communication Network P: +61 2 9906 6633 F: +61 2 9906 8910 E: hcn@hcn.com.au W: www.hcn.com.au
EHS provides: • • • • • • • • • • • • • • • • •
GPA ACCREDITATION plus has given general practices a reliable alternative in accreditation. GPA is committed to offering a flexible accreditation program that understands the needs of busy GPs and practice staff. GPA assigns all practices an individual quality accreditation manager to support practices with their accreditation.
Extensia
P: +61 7 3292 0222 F: +61 7 3292 0221 E: enquiries@extensia.com.au W: www.extensia.com.au Extensia links healthcare providers, consumers and their communities for better and more efficient health care. The products used to do this can be custom branded for all Organisations and include: • RecordPoint – a proven Shared Electronic Health Record that links all clinical systems, hospital settings, care plan tools and any other sources of information available. It provides a secure means of sharing critical patient data in a privacy compliant and logical structure. • EPRX – an Electronic Patient Referral Exchange and Directory. It streamlines the process of selecting a provider and completing a referral. Patient information is transferred seamlessly from clinical software. The most relevant providers, services and products are presented instantly and referral documents are generated and sent electronically.
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Global Health
P: 1300 723 938 F: +61 3 9675 0699 E: marketing@global-health.com W: www.global-health.com Global Health is a leading provider of e-health solutions that connect clinicians and consumers across the healthcare industry. Global Health’s portfolio consists of: • ReferralNet - a cloud-based secure message delivery system for the exchange of information between healthcare providers. • MasterCare® - a suite of health information systems that provides tools to collect, manage and access clinical and patient information at the point of care. • LifeCard® - a personal health management system for keeping all your important medical information in ONE secure location. With LifeCard® you can maintain a personal health record, access emergency health information and be rewarded for looking after your health.
Health Communication Network (HCN) is the leading provider of clinical and practice management software for Australian GPs and Specialists and supplies Australia’s major hospitals with online Knowledge resources. HCN focuses on improving patient outcomes by providing evidence based software tools to health care professionals at the point of care. Market snapshot: • 17,000 medical professionals use Medical Director • 3,600 GP Practices use PracSoft • 800 Specialist Practices use Blue Chip and • 2,100 Specialists use Medical Director • Leading suppliers of Knowledge Resources to Australia’s major hospitals
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Health Informatics Society of Australia P: +61 3 9326 3311 F: +61 3 8610 0006 E: hisa@hisa.org.au W: www.hisa.org.au
The Health Informatics Society of Australia is a membership based not-for-profit organisation which has been supporting and representing Australia’s health informatics and e-health community for almost 20 years. HISA aims to improve healthcare through the use of technology and information. We: • Provide a national focus for e-health, health informatics, its practitioners, industry and a broad range of stakeholders • Support, promote and advocate • Provide opportunities for networking, learning and professional development • Are effective champions for the value of health informatics HISA members are part of a national network of people and organisations building a healthcare future enabled by e-health. Join the growing community of organisations and individuals who are committed to, and passionate about, health reform enabled by e-health.
Health Information Management Association Australia P: +61 2 9887 5001 F: +61 2 9887 5895 E: himaa@himaa.org.au W: www.himaa.org.au
The Health Information Management Association of Australia (HIMAA) is the peak professional body of Health Information Managers in Australia. HIMAA aims to support and promote the profession of health information management.
HealthLink
P: 1800 125 036 (AU) P: 0800 288 887 (NZ) E: enquiries@healthlink.net W: www.healthlink.net Australia’s and New Zealand’s largest effective secure communication network. • Referrals, Reports, Forms, Discharge Summaries, Diagnostic Order and Reporting • Provider of Secure Messaging Delivery (SMD) services • Fully integrated with leading GP and Specialist clinical systems • Robust; Reliable and Fully Supported Join the network that more than 70 percent of GPs use for diagnostic, specialist and hospital communications.
MEDITECH Australia
P: +61 2 9901 6400 F: +61 2 9439 6331 E: sales@meditech.com.au W: www.meditech.com.au
ISN Solutions
P: +61 2 9280 2660 F: +61 2 9280 2665 E: info@isnsolutions.com.au W: www.isnsolutions.com.au
A Worldwide Leader in Health Care Information Systems
ISN Solutions is a Medical IT company that specialises in the design, setup and maintenance of computer networks for medical practices and private hospitals. We manage IT services, we are dedicated to the medical industry. We know that if you are consulting then you need a quick response. Our support model is designed to minimise the interruptions to the doctor specially. We are familiar with most medical software applications in Australia. We have strong industry references. Some of our solutions include, but are not limited to:
InterSystems
P: +61 2 9380 7111 F: +61 2 9380 7121 E: anz.query@InterSystems.com W: www.InterSystems.com InterSystems Corporation is the worldwide leader in breakthrough solutions for connected care, with headquarters in Cambridge, Massachusetts, and offices in 23 countries. InterSystems TrakCare™ is a Web-based healthcare information system that rapidly delivers the benefits of an Electronic Patient Record. InterSystems Ensemble® is a seamless platform for integration and the development of connectable applications. InterSystems HealthShare™ is a strategic platform for healthcare informatics, providing capabilities for sharing of clinical information, comprehensive advanced analytics, building clinician and patient Web-based communities, and quickly filling informational and functional cross-system “gaps.” InterSystems DeepSee™ is software that makes it possible to embed real‑time business intelligence capabilities in transactional applications. InterSystems CACHÉ® is a high performance object database that makes applications faster and more scalable.
• Cloud based computing tailored to medical industry • Medical voice recognition • Capped cost medical support and maintenance plan • Ability to consult remotely • Medical application support
iSOFT
P: +61 2 8251 6700 F: +61 2 8251 6801 E: company_enquiry@isofthealth.com W: www.isofthealth.com iSOFT is one of the world’s largest providers of healthcare IT solutions. We work with healthcare professionals to design, develop and implement healthcare solutions that deliver administrative, clinical and diagnostic services to ensure continuity of care across all care settings. iSOFT provides flexible and interoperable solutions to the whole spectrum of providers, from single physician practices through to integrated national solutions supporting thousands of concurrent users. Our capacity to embrace change and keep abreast of emerging new directions in healthcare has allowed our clients to explore the exciting potential of new technologies while securing their existing investments.
MEDITECH today stands at the forefront of the health care information systems industry. Our products serve well over 2,300 health care organisations around the world. Large health care enterprises, multi‑hospital alliances, teaching hospitals, community hospitals, rehabilitation and psychiatric chains, long-term care organisations, physicians’ offices, and home care and hospice agencies all use our Health Care Information System to bring integrated care to the populations they serve. Our experience, along with our financial and product stability, assures our customers of a long-term information systems partner to help them achieve their goals.
Medtech Global Ltd
P: 1800 148 165 E: sales@medtechglobal.com W: www.medtechglobal.com For over 27 years, Medtech Global has been a leading provider of health management solutions to the healthcare industry enabling the comprehensive management of patient information throughout all aspects of the healthcare environment. Medtech’s Medtech32 and Evolution solutions improve practice management and ensure best practice for electronic health records management and reporting. Clinical Audit Tool integrates with Medtech32 and Evolution providing fast, efficient and secure analysis of patient data enabling practices to identify and deliver services, which address health care priorities across their population. Medtech’s ManageMyHealth patient and clinical portal enables individuals to access their health information online and engage with their healthcare provider to support healthy lifestyle changes.
HIMAA is also a Registered Training Organisation conducting, by distance education, “industry standard” training courses in Medical Terminology and ICD-10-AM, ACHI and ACS clinical coding.
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MIMS Australia
P: +61 2 9902 7700 F: +61 2 9902 7701 E: info@mims.com.au W: www.mims.com.au MIMS Australia is built on a heritage of local expertise, credibility and adaptation to changing healthcare provider needs. Our information gathering, analysis and coding systems are proven and robust. MIMS information is backed by MIMS trusted, rigorous editorial process and constantly updated from a variety of sources including primary research literature. Our database and decision support modules are locally relevant, clinically reviewed and updated monthly and compatible with a host of clinical software packages. Indeed, the majority of Australian prescribing packages and many dispensing applications are supported by the MIMS medicines data base. MIMS is delivered all the ways you need – print to electronic, on the move, to your patient’s bedside or your consulting room desk. Whatever the format, MIMS has the latest information you need.
Pen Computer Systems
Mouse Soft Australia Pty Ltd
P: +61 3 9888 2555 F: +61 3 9888 1752 E: sales@medicalwizard.com.au W: www.medicalwizard.com.au Medical Wizard saves time and money through greater efficiency and comprehensive integration. Throughout its 17 year history, Medical Wizard has led the way with innovative solutions. We are constantly evolving Medical Wizard to meet the challenges of the medical profession for today and tomorrow. A software of choice for discerning Specialist practices, notably Gastroenterologists, Cosmetic Surgeons, Ophthalmologists, General Surgeons, IVF Centres and Day Hospitals amongst others. All aspects of practice management from appointments, billing, clinical, theatre management and compliance reporting are covered and backed by a dedicated local support team.
Nuance Communications
P: 1300 550 716 F: +61 2 9434 2301 E: Vicki.Rigg@nuance.com W: australia.nuance.com W: newzealand.nuance.com Nuance (NASDAQ: NUAN) is a leading provider of speech and imaging solutions for businesses and consumers around the world. Its technologies, applications and services make the user experience more compelling by transforming the way people interact with information and how they create, share and use documents. Every day, millions of users and thousands of businesses utilise Nuance’s proven range of productivity applications which include Dragon NaturallySpeaking (speech recognition), OmniPage (OCR), PaperPort (document management) and PDF Converter Professional (PDF creation and conversion).
Feature Rich. Dynamic. Innovative.
P: +61 2 9635 8955 F: +61 2 9635 8966 E: enquiries@pencs.com.au W: www.pencs.com.au Established in 1993, Pen Computer Systems (PCS) specialises in developing information solutions for National and State eHealth initiatives in Primary Health that deliver better Chronic Disease outcomes. PCS expertise extends to: • Chronic Disease Prevention and Management • Population Health Status, Reporting and Enhanced Outcomes • Decision-Support tools delivered LIVE into the clinical consult • Web-based Electronic Health Records (EHRs) • SNOMED-CT and HL7 Standards Frameworks Our Clinical Audit Tool (CAT) for example delivers an intuitive population reporting and patient identification extension to the leading GP systems in Australia. CAT delivers enhanced data quality and patient outcomes in general practice.
Orion Health NEHTA
P: +61 2 8298 2600 F: +61 2 8298 2666 E: admin@nehta.gov.au W: www.nehta.gov.au
MITS:Health
P: 1300 700 300 E: info@mitshealth.com.au W: www.mitshealth.com.au Managed IT Services for the Health Industry
The National E-Health Transition Authority was established by the Australian, State and Territory governments to develop better ways of electronically collecting and securely exchanging health information. NEHTA is the lead organisation supporting the national vision for eHealth in Australia.
MITS:Health provides a full range of IT services specifically tailored for medical centres, GPs and specialists across Melbourne. • • • • • •
Equipment supply and installation Remote monitoring and support Data backups Networking Internet Website Development
P: +61 2 8096 0000 / +64 9 638 0600 F: +61 2 8096 0001 / +64 9 638 0699 E: enquiries@orionhealth.com W: www.orionhealth.com Orion Health is a world leader in the e-health industry. We specialise in electronic health record (EHR) solutions, disease management, clinical decision support, and hospital administration tools. More than 300,000 clinicians in 30 countries use Orion Health products. Our EHR solutions have been widely adopted across Canada, Europe and the USA to enable secure crossorganisational and regional sharing of patient information, resulting in improved patient care. Our Rhapsody Integration Engine, a healthcare dedicated and standards based Integration hub, is used by customers to easily create interoperability between existing healthcare information systems. Our solutions are designed to support emerging health IT trends and standards, we work closely with our customers, clinicians, government bodies and other industry leaders to deliver intuitive solutions to meet your current and future needs.
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Medilink
from Practice Services P/L
P: +61 3 9819 0700 F: +61 3 9819 0705 E: Sales@practiceservices.com.au W: www.practiceservices.com.au Medilink Practice Management Software • 21 years young, large user base • Medilink = Intuitive ease of use • Solo Drs up to Hospitals in size • Claiming via integrated EFTPOS àà and/or integrated HICAPS àà and/or Medicare Online àà and/or ECLIPSE • Many standard features • Many optional modules • Links to many third party packages and services • Cut debtors and boost cash flow • 17 years as an Authorised Medilink Dealer, selling, installing & training • Fixed Cost Support, Onsite or Remote
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Spellex
P: +61 2 8014 4573 E: info@spellex.com.au W: www.spellex.com.au Spellex has been the leading provider of comprehensive medical dictionary enhancement software to thousands of the world’s most prominent healthcare companies for 21 years. Our easy-to-use Australian medical spell checking software integrates fully with all Microsoft programmes, Web-based applications, and popular platforms. Spellex Medical is available for end-users to ensure the medical accuracy of documents and to enhance their productivity. Spellex software development kits can also be integrated with developer’s custom programmes and Web sites. Whether you’re an individual transcriptionist or you need to provide greater medical documentation accuracy across an entire hospital or campus, Spellex has a solution that’s right for you. For a free trial of Spellex software, go to spellex.com.au and click the Free Trial tab.
Sysmex New Zealand
Therapeutic Guidelines Ltd
P: +64 9 630 3554 F: +64 9 630 8135 E: info@sysmex.co.nz W: www.sysmex.co.nz
P: 1800 061 260 E: sales@tg.org.au W: www.tg.org.au
Sysmex New Zealand is a market leader in the development and implementation of health IT products and services for clinical laboratories, hospitals and healthcare organisations. We offer the following health IT solutions: • Delphic LIS – a market-leading laboratory information system for hospital and community laboratories with a strength in providing multi-lab solutions. Specialised modules manage workflows in the anatomical pathology, haematology and microbiology work areas. • Eclair – an advanced clinical data repository (CDR) which stores patient data from a range of systems including laboratory, radiology, pharmacy and clinical document sources to create a secure patient-centric record. Eclair provides complete electronic ordering functionality.
Real Outcomes Real Productivity Minimising Waste
Stat Health Systems (Aust)
P: +61 7 3121 6550 F: +61 7 3219 7510 E: carla.doolan@stathealth.com.au W: www.stathealth.com.au Stat Health Systems (Aust) has built a progressive and resilient system that introduces a new level of stability and flexibility to the medical software market. Stat is an integrated clinical and practice management application which has embraced the latest Microsoft technology to build a new generation solution. Fully scalable and the only medical software application to incorporate a multi-functional intuitive interface, Stat is at the forefront of computing technology. Stat Health provide a premium support service, clinical data conversion from existing software and tailor made installation and training plans for your practice.
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Trend Care Systems
P: +61 7 3390 5399 F: +61 7 3390 7599 E: support@trendcare.com.au W: www.trendcare.com.au A national and international award winning solution recognised for its ability to provide real benefits in the acute and sub-acute health care settings. TrendCare is an international leader for e-health solutions excelling in all of the following: • Patient dependency and nursing intensity measures. • Projecting patient throughput and workforce requirements. • Rostering and work allocation. • Efficiency, productivity and HRM reporting. • Discharge analysis, bed management and clinical handovers. • Allied health registers with extensive reporting. • Clinical pathways with variance reporting. • Patient assessments and risk analysis. • Diet ordering and reporting. • Staff health tracking and reporting.
Vensa Health
Therapeutic Guidelines Limited is an independent not-for-profit organisation dedicated to deriving guidelines for therapy from the latest world literature, interpreted and distilled by Australia’s most eminent and respected experts. These experts, with many years of clinical experience, work with skilled medical editors to sift and sort through research data, systematic reviews, local protocols and other sources of information, to ensure that the clear and practical recommendations developed are based on the best available evidence. eTG complete Incorporates all topics from the Therapeutic Guidelines series in a searchable electronic product, and is the ultimate resource for the essence of current available evidence. It provides access to over 3000 clinical topics, relevant PBS, pregnancy and breastfeeding information, key references, and other independent information such as Australian Prescriber (including Medicines Safety Update), NPS Radar, NPS News and Cochrane Reviews. eTG complete is available in a range of convenient formats – online access, online download, CD, and intranet access for hospitals. Multi-user licences, ideal for a practice or clinic, are also available. It is widely used by practitioners and pharmacists in community and hospital settings in all Australian states and territories. Updated three times per year, eTG complete meets the criteria for ‘key electronic clinical resources’ in the Practice Incentives Program (PIP) eHealth Incentive. The November 2011 release of eTG complete includes new topics on Diagnostic approach to fatigue in primary care and Ulcer and wound management. miniTG The mobile version of eTG complete is miniTG, offering the convenience of having vital information at the point of care and designed for health professionals who practise and consult on the move. It is supported on a wide range of mobile devices, including Apple®, Pocket PC®, and selected Blackberry® devices.
P: +64 9 522 9522 F: +64 9 522 9523 E: website@vensahealth.com W: www.vensahealth.com The next time you receive a text message mobile reminder or an alert from your doctor, hospital or physio you now know its done by Vensa. Vensa Health is a mobile health (mHealth) provider in the health care sector offering eHealth integrated mobile solutions, enabling text-messaging for patient communications for applications such as appointment reminders, medication reminders, test results alerts, recalls for screenings such as mamograms, immunisations and more. Vensa has invested substantially into developing products and services that offer communication solutions to better content providers with patients, including mobile text-messaging, voice, mobile sites and Telehealth services delivery.
Zedmed
P: +61 3 9284 3300 F: +61 3 9284 3399 E: sales@zedmed.com.au W: www.zedmed.com.au Owned by Doctors who understand the challenges facing the medical profession everyday and backed by nearly 30 years of experience in medical software programming, Zedmed provides innovative, full featured and sophisticated practice management and clinical records software solutions. Zedmed would also like to introduce to you Medical Record eXchange – a free, simple solution allowing Doctors to send patient’s medical information to insurance companies electronically. Using the latest in data extraction technology and fully encrypted, this is a secure, time-saving solution to one of the most dreaded requests Doctors receive on an almost daily basis. For more information please visit: www.medicalrecordexchange.com.au
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Want to know more about eHealth?
www.ehealthinfo.gov.au www.nehta.gov.au
The National E-Health Transition Authority is jointly funded by the Australian Government and all State and Territory Governments.