Page 1

Australia’s First and Only Health IT Magazine




21 2011

Back to Basics Defining the role of the PCEHR A/Prof Charlie Corke positions the proposed Personally Controlled Electronic Health Record. Why is pathology ‘IT’ so hard? Robert Flanagan outlines the challenges faced by professionals supporting IT in the pathology sector. Taking shortcuts will get you lost Dr Geoffrey Sayer suggests more detailed plans are required for the journey towards a PCEHR. National E-Health Transition Authority update NEHTA previews research into healthcare supply chain management. Information security and social engineering Alberto Tinazzi warns practices to remain vigilant about data security. Internet Backup Using these services can help protect practice information.

18 22 22 22 24 24 24

DONORtrak streamlines transplant process IBM awarded NASH contract Maestro Toolbar connects to HI Service Orion Health updates Rhapsody Stat Health Systems commences rollout iMIMS arrives for iPhone and iPad NPS researches GP clinical software

Want to know more about eHealth? Whether you are a consumer, healthcare manager, healthcare provider or vendor, you need a central location to quickly find and access eHealth information.

Welcome to: Your gateway to the emerging world of modern healthcare. Discover how information technology is delivering a more reliable and efficient health system. Featuring: • The Healthcare Identifiers (HI) Service which commenced operations on 1 July 2010. Access fact sheets for individuals, healthcare providers, healthcare organisations, and medical software vendors • How eHealth systems are being designed to maximize security and privacy • Why a national certification capability is an essential foundation for safe, secure and interoperable eHealth solutions in Australia • The latest Federal, State and Territory government eHealth initiatives • The delivery of a standard clinical language for use across Australia’s eHealth implementations and how it is a significant step towards improving the quality and safety of healthcare is jointly brought to you by Australia’s Federal, State and Territory health authorities and the National EHealth Transition Authority (NEHTA) to help you explore the eHealth concept and stay in touch with the latest innovations as they unfold.

National E-Health Transition Authority

“ The speed at which medical service is provided will be


Better information means there is less chance of things going wrong.” Devendra Maisnam Business Analyst, Information Modeller

Leading the progression of eHealth in Australia Join the NEHTA team The National E-Health Transition Authority (NEHTA) was established by the Australian Commonwealth, State and Territory governments on 5 July 2005 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.

See how NEHTA’s work is helping to enable a better health system and support the Government’s goal of personally controlled electronic health records for all Australians. Go to:

Use your health, informatics, analytical, project or architecture skills and join the NEHTA team who are making eHealth a reality in Australia

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Publisher Pulse Magazine PO Box 7194 Yarralumla ACT 2600 Australia ABN: 19 923 710 562

Editor Simon James Australia: +61 2 8006 5185 New Zealand: +64 9 889 3185

Subscription Enquiries

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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 higest 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.

Pages 34, 38, 40 BACK TO BASICS

Looking ahead The next three editions of Pulse+IT will feature a selection of articles covering the following themes: • May 2011 - Mobility • July 2011 - Medical Devices • September 2011 - Consumer E-health Pulse+IT welcomes feature articles and guest editorial submissions relating to these themes, as well as articles relating to e-health more broadly. Submission guidelines and deadlines are available online:

ISSN: 1835-1522 Contributors Janette Bennett, Paul Clarke, A/Prof Charlie Corke, Robert Flanagan, Simon James, 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.

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Page 6 STARTUP Editor Simon James introduces the 21st edition of Pulse+IT.

Page 34 FEATURE ARTICLE Alberto Tinazzi advises practices to be aware of the imporantance of information security and the risks posed by social engineering.

Page 18 DONORtrak system to streamline organ transplant process

Page 38 FEATURE ARTICLE Simon James overviews the benefits of Internet Backup and their applicability to medical practices.

Page 20 Electronic Journal of Health Informatics releases eighth issue

Page 40 FEATURE ARTICLE Janette Bennett and Martin Ellis detail the importance of standards in the development of clinical information systems.

Page 22 IBM awarded NASH contract

Page 8 GUEST EDITORIAL A/Prof Charlie Corke defines the role of the proposed Personally Controlled Electronic Health Record. Page 11 GUEST EDITORIAL Robert Flanagan outlines the challenges faced by professionals supporting information technology in the pathology sector. Page 28 MSIA Dr Geoffrey Sayer from the Medical Software Industry Association suggests more detailed plans are required for the journey towards a PCEHR. Page 32 NEHTA The National E-Health Transition Authority previews research into healthcare supply chain management

Health-e-Nation conference coming to Melbourne in April

NEC deploys Internet access to senior Australians

Maestro Toolbar connects practice software with Healthcare Identifer Service


Orion Health updates its Rhapsody Integration Engine

Page 26 EVENTS CALENDAR Up and coming Health IT, Health, and IT events.

Page 24 iMIMS drug reference application released for Apple iPhone

Page 43 MARKET PLACE The Pulse+IT Directory profiles Australasia’s most innovative and influential e-health organisations.

NPS study into GP clinical software shows room for improvement Stat Health Systems commences software rollout


Pulse+IT: 2011.1 Simon James

BIT, BComm Editor, Pulse+IT Phone (AU): +61 2 8006 5185 Phone (NZ): +64 9 889 3185

Welcome to the 21st edition of Pulse+IT, Australia’s first

and competitions. A free weekly email, readers can

and only Health IT magazine.

subscribe at:

As foreshadowed in our final edition for 2010,

Pulse+IT has spent the last few months redeveloping


our website and associated online services, and is

Starting in April, Pulse+IT will commence a series of

pleased to report that everything we hoped to put

Webinars focused on the practical application of IT in

in place during the Christmas period is now up and

the health sector. Predominantly pitched at general

running. As has always been the case with our printed

and specialist practice and facilitated by a panel of

magazine, our website’s focus will remain on the

domain experts, a different topic will be presented each

publishing of original e-health related stories, delivered

month. To browse up and coming webinars, register for

with the added benefits of timeliness and scope for

a session, or suggest a topic for future consideration,

readership interaction, which only online mediums can


provide. To take a look at what we’ve come up with, visit:


As our online services evolve, readers will observe

For those that want to stay abreast of e-health

Pulse+IT’s magazine and website develop their own

developments as they break, the Pulse+IT twitter feed

unique characteristics, playing to the strengths of

provides a springboard to original and third party

their respective formats. Against the backdrop of


natterings about the “death of print publishing” and recent reports about the financial troubles of many


companies operating in the Australian e-health sector,

Counting over half of Australians as active users —

I am pleased to reassure supporters of our magazine

including amongst this diverse cohort my 10-year‑old

that our online initiatives will not come at the expense

cousin and my 82-year-old grandmother — the

of our printed publication. On the contrary, with 77% of

phenomenon that is Facebook is one that hasn’t been

readers indicating a preference for the publication in its

ignored in our online plans. In keeping with the spirit

printed form, 79% indicating that Pulse+IT is the only IT

of this somewhat informal service, we have launched

or computer publication they read, and 74% indicating

a perpetual weekly competition dubbed the Pulse+IT

that Pulse+IT is the only e-health publication or website

Friday Facebook Freebie. All you have to do to have a

they refer to, the printed magazine has a bright future.

chance of winning each week is click the ‘Like’ button

Online Services and Social Media To complement the new Pulse+IT website, we have

on the Pulse+IT Facebook page, which can be found here:

launched a range of services to broaden our offering

Looking ahead

and provide readers with several ways to keep up to

The next edition of Pulse+IT will focus on the impacts

date and engage with Pulse+IT contributors.

and possibilities that mobile computing devices will have on health professionals and their patients.




Each week, the Pulse+IT eNewsletter service brings

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

together recently published original articles from

simply like to discuss your experiences with e-health,

the Pulse+IT website, events, career opportunities

don’t hesitate to get in touch.

As always, if you have any suggestions for future

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Defining the Role of the Patient Controlled Health Record A/Prof Charlie Corke MB BS, MRCP, FCICM Senior Intensive Care Specialist Barwon Health

Australia, in line with a number of European countries,

considered important include current medications

is currently investigating innovative use of Internet

(suggested by 97% of the surveyed population),

technology to improve access to patient information

test results (96%), allergies (98%), diagnoses (97%),

by the broader group of healthcare providers involved

vaccinations (98%) and medical procedures (96%).

in delivering healthcare to an individual. To date most

exchanges of information occur across health teams,

medical information would be much more useful

for example the sending of a discharge summary

to a treating doctor than one with only minimal

from the hospital to the general practitioner. This

data — and would be more likely to be viewed by

might be characterised as an inside-out approach and

the doctor. Conversely one that the treating doctor

has been problematic in respect to ensuring relevant

did not feel would contain information that made

information is sent in a timely manner and is readily

it worth accessing (and consequently didn’t access)

available when the patient presents. New approaches

would be of no clinical value. It seems that there is a

seek to complement rather than replace traditional

strong consensus that a shared medical record needs

exchanges of data and focus on using the patient as

to contain reasonably comprehensive healthcare

the ‘aggregator’, able to bring information themselves

information in order to be clinically useful.

to their next healthcare interaction. This might be

thought of as an outside-in approach.

PCEHR represents an important mechanism to provide

information about the patient to a new doctor who has

This outside-in approach is often referred to as

A shared record that contained this more complete

Beyond a value in emergency situations the

the Personally Controlled Electronic Health Record

never seen the patient before.

(PCEHR). In its most simple form it may constitute

basic emergency medical information that the patient

plans with the patient (particularly those with chronic

carries with them (like an electronic ‘Medi-Alert’

conditions). It could also accept and store results of

bracelet). This could simply involve information such

electronic monitoring that these patients perform

as allergies and might come from the doctor’s records

at home (eg blood pressure readings, blood sugar

or, at the most basic level, could be entered by the

measurements, peak flow values etc.).



A recent survey by the health computing company

Another function of a PCEHR may be to share care

The PCEHR could provide a secure platform for electronic



CSC has provided a valuable and extensive report of

communication is becoming ubiquitous and a secure

Australians’ attitude to shared health records. This

environment for electronic medical communication

report reveals that most Australians believe that the

could be valued by patients and useful for doctors

medical information in a shared record needs to be

(though this may require a review of remuneration

reasonably comprehensive. Data that those surveyed

before it could become widely used and clinically



Author Info

A/Prof Charlie Corke is past Director and currently a Senior Intensive Care Specialist at Barwon Health in Geelong, Victoria. He is also an Associate Professor with Deakin University, designer of the PROMPT protocol management system, clinical advisor to Medenotes and a Director of Medenotes.

record that they can access2. However they may underestimate the potential for the patients’ need for control and their requirement for privacy to impede implementation of a centralised system.



Doctors recognise the need for a shared medical

record and favour a centralised shared medical

Privacy advocates express significant concerns

associated with the proposal to create


Medenotes to provide patient controlled

centralised medical records3. Of the

obstetric records for all pregnant patients.

general population, 24% of Australians

Patients have been given copies of X-ray

are against electronic health records

images by private radiology practices for

Health Records represent a milestone in

and more than half of these are strongly

many years, and have often been given

the transformation of healthcare delivery

against1. This represents a significant body

copies of discharge summaries. These

and the possibilities for innovation are

of concern that is unlikely to evaporate.

practices have proved acceptable to


patients and effective for doctors.

shared record, most want to control who

It is important to understand what

will provide a critical platform and will

can see their health information and to

people want, and what they will accept,

maintain Australia’s position as a global

dictate what part of the record they can

before committing to a solution. This is

leader in respect to the delivery of safe,

see . While most Australians (84%) wish

no easy task as the potential systems are

high quality and cost effective healthcare.

their current healthcare providers to have

so very different from anything that is

access to their shared record, the vast

available today. We can’t confidently rely


majority (89%) also want the ability to

on what patients say about a system that

1. CSC Health Care Research Report - A

select which (other) healthcare providers

they have never experienced.

Rising Tide of Expectations. Australian

can view their information. They do not

consumers’ views on electronic health

want to give access to health providers

develop and trial a number of Personally


who they don’t know or have not yet

Controlled Electronic Health Records are a



welcome development in this regard.

Of those who accept the need for a


It is difficult to conceive that such

This concept is not entirely novel.

Recent Commonwealth initiatives to




This next wave of development


The Barwon Region has a long

2. Shared Electronic Medical Records —

control could be achieved unless the

track record of e-health development

2010. Australian Medical Association.

patient is actually in control of the shared

including Barwon Health, the Geelong GP

electronic record. In this case, the PCEHR

Association and others. This region has

3. Policy Position eHealth Data and



begun trials of the clinician-developed

Health Identifiers. August 2009.

whereby a patient’s medical information


Medenotes4 patient controlled health

Australian Privacy Foundation. http://

is provided to all the patient’s healthcare

record in an attempt to address the



issues that have been raised in this


whom the patient wishes to share the

paper. Barwon Health is planning to use




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Learn and share your knowledge and expertise amongst a national network

21/02/2011 2:51:09 PM




Why is ‘IT’ all so hard in pathology? At the heart of a modern Pathology laboratory is a

all and there is not a lot of choice in the market. With

complex set of Information Technology (IT) systems that

so many country specific requirements for compliance

are critical to its operation. Users are often frustrated

and billing, many of those who would be the vendors of

and disappointed at the difficulties they experience when

choice in Europe or the USA have little or no presence

systems fail, when requesting changes or seeking new IT

in Australia. So we must try to find a system that suits

functionality. Having worked in a number of industries

everyone from a very limited market place.

before coming to Healthcare four years ago, I have tried

to make some sense of why IT is so hard in Pathology.

have done this before and, though it will be painful,

Robert Flanagan

B.Sc. (Syst. Inf.) IT Manager SydPath

That, however, is not the major problem. We

we will do it again. The reason I’ve got my thumbs We’re talking normal, run of the mill Pathology, not

grinding the sides of my skull is that this is just the

bio-informatics databases, leading edge cell imaging

start of quite a few stress headaches. Information

or shiny, ground breaking test developments. So why

Technology is generally acknowledged as hard work.

is it so hard to get some seemingly simple functionality

Telecommunications, finance, airlines and other

from your IT Department? Why do all those small

sectors are not immune to IT difficulties and they have

things that would make life a bit easier turn into

seen their fair share of difficult implementations, major

long, drawn out projects that are around so long they

computer failures and systems that did not at all match

become part of the family?

the sales pitch1,2,3. There are studies available on project

I’m sitting here at my desk massaging my temples.

failure, such as the Chaos Report by The Standish

As the IT Manager, I’ve been handed the unenviable

Group4, which indicate that somewhere between 24%



and 68% of IT projects from all types of industries fail,

Management System (LIMS), a job that will earn me

depending on how you define ‘project failure’ (e.g.

no awards, applause or praise. We already know from

not delivered or over-budget, time). While some in

past experience that it will be a difficult and traumatic

the industry debate the accuracy, underlying data and

project for my team as well as the whole organisation.

methods of the Standish Group, from experience it

We will grapple with new technology, interfacing and

feels right to say that only one in five projects will result

new ways of performing old processes. And for all that,

in general satisfaction.

we are not even expecting new functionality. We are

not alone in this dilemma. At this time the IT managers

systems in the past four years. We would consider

of major Pathology providers in NSW, VIC, SA and WA

that most of those projects were successful but they

are actively investigating replacing their LIMS. Some

were hard fought wins and dogged by unforeseen

to modernise and consolidate, others, like ourselves,

complexity. Functionality requests that appeared

as a result of a pullout from the Australian market by

simple and straightforward became mired in —

a significant LIMS vendor. None will get any major new

amongst other things — coding issues, regulation,

functionality. It may be easier to maintain, interface

process inflexibility and interfacing difficulties with

or get better reports, but it is unlikely that any new

other departments and systems. In my opinion, IT in

pathology breakthroughs will come as a direct result of

Pathology is harder than other industries, much harder.





We have implemented quite a few features and

these efforts.

There are many reasons why my temples need

provide functionality to a range of pathology disciplines with quite varied requirements. Invariably each discipline knows of a system that will work just right for them and invariably the other departments will detest

Robert Flanagan comes from a broad IT background, working in different industries such as Finance and Telecoms in Europe, Africa and Australia. He has been the IT Director for SydPath over the past five years, his first foray into Healthcare.

Author Info

massaging. We must choose a new system that will

that particular choice. There is no one system that fits



There are some identifiable underlying

This may go some way to explain why

Following the development effort to set

reasons why I believe this is so. We could

an Instrument Interface works fine for

up the new HL7 environment, we applied

broadly group them into the following:

one LIMS but we could spend four years

our messages to one of the GP Practice

• Lack of standards or lack of adherence

connecting it to ours, going back and forth

software packages prominent in Australia.

to those that exist

between developers, instrument vendors

We found the reporting display quite

• Underlying complexity

and users in an attempt to bully the

deficient; missing headers, result history,

• Software development is a ‘degraded

software code into place.

contact details, etc. and, in the opinion

Sending a HL7 message to a General

of the reviewing Pathologist, clinically

• Spending on IT systems


Practitioner, a standard generally accepted

unacceptable. When this outcome was

• Chasm between IT Department

as de facto, is another excellent example.

discussed with customers we discovered

Implementing this for our organisation

that other large providers had come across

required a huge amount of IT resources.

this a long time ago and found a way to

Most of this was spent analysing and then

‘embed’ PIT into the HL7 message in order

coding exceptions because the different

for the message to display nicely as before.

It is surprising to find in health — an

receiving applications have varied from

Those providers did not insist that GP



the HL7 standard in order to meet local

Practice software developers evolve their

assurance, audits and standards — an

customer demands or save time. Why

software to suit the HL7 standard, which

almost complete lack of unity across IT

is this? We started down the road of

has been knocking around Australia for

systems. It seems we need to build each

sending our results using HL7 messaging

over 15 years. Providers like ourselves must

piece of functionality from the ground

because of government pressure on

now have the local standard (PIT) ‘added’

up with a variety of local requirements

GP practices for reporting purposes, a

to the HL7 message in order to be broadly

embedded, reducing future use and value

reasonable expectation. The previously

acceptable. There are other nuances such

to other health entities. This appears to be

widely accepted standard message, PIT ,

as ensuring the ‘copy to doctor’ is read

a feature of the siloed and insular nature

is local to Australia and doesn’t allow

from the PIT part of the HL7 and not from

of Healthcare entities along with the

for database-like reporting. This should

the HL7 part. If this gets confusing for you,

tendency towards fairly static IT evolution.

not have been a major ordeal given we

there was nothing out there on Google to

Systems are developed primarily for local

already produce HL7 for internal reporting

explain it to us! We found that many other

processes, not for interaction with external

systems. That existing HL7 message did

GP practice software providers have used

entities and so adherence to standards

have customisations made to suit our local

something similar but, of course, not all.

is not as important as in the finance

processes which caused us some trouble,

The result was that, after adjusting our

or telecommunications Industries, for

so we immediately found ourselves victims

HL7 message from the standard, we must


of our own non-compliance, I suppose.

now move slowly through the 207 or so

capability and the Big Expectaction

Lack of standards or lack of adherence to those that exist steeped





- Abaki

- CompuDoc Medical

- Healthpoint Technologies

- Alcidion

- DoctorWare Australia, Smartrooms

- Healthways Inc

- Access GP

Clinical software providers who integrate MIMS medicines information and decision support into their applications to ensure that clinicians have the most trusted information available at all times.

- Ambulance Australia

- Ambulance Victoria, VACIS

- Episoft

- Cancer Council of Victoria

- Global Health

- Best Practice Software - CDC Systems - charmhealth

- Cardio Vascular Systems

- Cloud9 Software

- Communicare Systems


- DrsDesk Software

- Australian Sports Anti-Doping Authority

- Clintel Healthsolve, The Specialist

12 Pulse+IT

- Deltra Pty Ltd, Practice Pro

- Equipoise International, Totalcare - Genie Solutions

- Healthsoft Australia

- Houston Medical Australia - Incisive Medical Systems - InterSystems

- International SOS (Australasia) - Intrahealth Systems, Profile - iSoft Group

• Locum

• Patient Safety International


• Practix

• MasterCare

- Godbar Software P/L - GPComplete

- Health Track Medical Systems - HealthCare Software

• MedChart • Classic

• ePharmacy

- Jam Software

- Lane Cove General Practice

other GP Practice software packages used

some time to come. Given the complexity,

supporting functions of IT, billing and

by clients to see what variances they may

cost restrictions and trauma of changing

Specimen Reception are very complex,

require. We must also evaluate if we can



partly as a result of being involved in

adapt our IT environment to cater for the

lifecycle is so long that change cannot

all the approaches across all pathology

variances and determine whether it is

be dramatic. In pathology we can see the


worth the complexity. This is a long and

evidence of this amongst our peers, given

tedious process for something that should

the longevity of not just their systems,

we had, and still have, what we can call

be ‘standard’.

but even down to the versions they have

“uncontrolled evolution”. That is, we

remained on for considerable years.

keep changing and adding more localised

Another area where standards are at



odds with practice is the identification

Over those years of automation,

processes without consideration about

of a pathology test between providers.

Underlying complexity

how this affects complexity and our ability

Whilst SNOMED CT has been chosen by

Even though this is normal, run‑of‑the‑mill

in the IT department to manage it.

the Government and NEHTA9, pathology

Pathology IT operations work and not



the shiny leading-edge stuff, it is time

complexity of our systems and processes

LOINC but not consistently. So the code

to acknowledge in this paper that it is

becomes a hindrance to the effective

we use for a Sodium test may be different

a fairly complex environment with a lot

delivery of service. This would be seen in

from another provider. Some practice

of interfacing, interactions and human

difficulty to add / change a service, process

software products have built in mapping

interventions. The underlying complexity

or IT system. It is also evident when trying

to cope with these variations from the

of all these systems, how they connect,

to troubleshoot a problem or in dealing

standard but not all. And, again, someone

the workflow and the exceptions quickly

with a failure. Basically, it takes a long time

has to maintain the variations. There is

build up to a picture that we can no longer

to unravel a hill of spaghetti. When things

an AACB Working Party10 progressing

fully grasp in one sitting.

go wrong, reverse engineering a process,

towards standardising LOINC, however,

As we have evolved over the years to

code, script or interface can take a long

until both senders and receivers agree on

become automated, integrated pathology

time. The resulting fix to a problem quite

the terminology it will remain piecemeal.

organisations, we would have put in

often appears to be easy and obvious, now

NEHTA is also reconsidering its position

place processes and systems to handle

that the process is understood. The length

on using SNOMED CT versus LOINC. The

the complexity of delivering service to

of time to discover it, however, is possibly

picture at this stage is very cloudy and

multiple, distinct clients such as hospitals,

a better gauge of the functionality/

appears that it will take years for any real

GPs, health bodies and clinical trials. Each

complexity mix (rather than how inept the

standard to be in place.

of these require distinct functionality

IT Analyst is!).

This lack of Industry-wide consistency

or service so that the workflow can

in its approach to IT systems will remain for

be very different. In particular, the

approach was invaluable in documenting





- Manrex Pty Ltd; Webstercare

- Practicare

- MediFlex

- Promedicus

- Mater Public Hospital - Medical - Objects

- Mednetwork Systems - Medtech Global

- Merck Sharp and Dohme - MMex

- Mountain Top Systems - Mouse Soft

- Mx Solutions - NPS

- NIB Health Funds

In our organisation, a Lean Process

- Promadis

- Queensland Emergency Services - Queensland Eye Institute - Queensland Government - Shexie Medical System - SmartHealth

- Software for Specialists - Stat Health

- Sydney Adventist Hospital - SurgiWare

- Pen Computer Systems

- Telethon Institute for Child Health Research

- Pharmacy Computer Solutions

- Zedmed

- Pharmacy4U

There comes a point when the

A special thank you to all those who partner with us to deliver our trusted medicines information and decision support to the point of care.

The team at MIMS

- Western Australia Police

Pulse+IT 13

and highlighting both obvious and hidden

three years later for extortionate amounts

budgets and very long system life must

complexity. It turned out to be quite a

of money, well tested and by then it was no

be that the IT industry for healthcare is

visual insight into the many variances and

longer needed or didn’t meet your original


exceptions in our processes and systems. It


also gave us the opportunity to challenge

It’s our fault and we don’t want to

there is an extraordinary amount of

the benefits of some of them.

go back to the old days so now we must

in-house development done by pathology

accept the present reality. Our job now is



to find the best case reality.



Overall, I suggest we do not have a

good handle on how much complexity is in a given process or across a whole

On the flip side, almost by necessity,



departments. There

Anatomical Interfacing,

Pathology, Pathology

organisation. Anecdotally, when I see a

Spending on IT systems

Ordering, Reporting and Billing systems

multitude of spreadsheets, small pieces of

Somebody asked me in a corridor to justify

developed in various IT Departments

code, manual interventions, workarounds

spending money maintaining an IT system

around the nation. This approach is

and local knowledge required for many

over providing a patient with a bed. My

typically easier to get approved, looks

processes and still they require constant

immediate response was “turn off the

cheaper in the near term and sometimes

maintenance, then over-complexity is

computer system”. That may sound like

gets the solution delivered in a reasonable

highly likely to be a hindrance to efficiency.

a smart remark and I was a little pleased

time frame. I believe that, in the long run,

with how easily it rolled off the tongue but

this contributes significantly to our other

Software development is a ‘degraded science’

the question was a valid one. How much

problems of stifled industry innovation and

are these systems worth? Pathology has

our own internal over-complexity.

undergone a big wave of automation to the

point that any provider with volume must

of invest, develop and sell/share but this

have a considerable system underpinning

does not typically happen with in-house

organisation, resulting in slowness, loss



of functionality, lots of bugs appearing,

According to a 2008 Deloitte report

three private providers servicing nearly

workarounds and late nights. There were a

on E-Health Strategy14, the estimated

60% of the pathology market in Australia

lot of questions but two still stand out: “Is

Australian IT spending in health care for

have taken LIMS packages and heavily

it normal for vendors to deliver software

2007 was $1.25 billion compared with

modified them beyond recognition to suit

with bugs in it?” and “Aren’t they supposed

$7.4 billion in the financial services sector.

their internal needs. While this is good

to test it first?”

That is approximately 1.4% of total

for them and provides some ‘competitive

I recently stood in front of a meeting







application the


Software evolution has been a cycle




The answers are ‘yes’ and ‘yes’.

spend compared with 9% invested by the

advantages’, an unintended consequence

Software is a degraded science. We never

financial services sector. This is not very

is that we are left wondering where the

get software delivered free from potential

surprising but given our heavy reliance on

next generation of LIMS is coming from for

bugs although we can be confident the

IT in pathology and a constant downward

this nation? It takes away a large amount of

vendors test it according to their typical

pressure on IT budgets, it is possible that

momentum from the technology evolution.

scenarios. I say software is a science

this is squeezing out innovation at an

The next generation of Australian LIMS

because I have a degree in Computer

enterprise level. By that I mean it is not

is being left to others to reverse engineer

Science. It is a degraded science because

an attractive industry for major software

rather than build upon. I suggest that

we now accept the vendor will give us an

developers to invest in. There are fits and

getting all pathology providers HL7, LOINC

outcome as fact and ask us to let them

starts with large packets of high-profile

/ SNOMED CT, Unique Health Identifier and

know if any bits of their theory don’t work

Government money slotted in for special

Medicare compliant would remove a large

out. It is now the worldwide commercial

projects that attract vendors but it is hard

burden from all pathology IT departments.

standard that the software package we

to see any lasting momentum. Some

They are functions in the national

receive will come with bugs

global players such as Intel and Oracle


interest, are a fundamental demand from

this because we get the software quicker,

have shown some interest in the past few

the government and therefore, not a

cheaper and it will probably do 90% of

years which is encouraging but they will

competitive advantage. Wouldn’t it be

what we want, 90% of the time. Consider

have a limited impact for some time.

great if the next LIMS chosen by all those

the “good old days” in the 1970’s when you

could ask for an application, spend a year

achieve limited traction with just one or

evolved, tried and tested?

defining the specifications, get it delivered

two customers but the realities of the tight

14 Pulse+IT


. We accept






now seeking included them as standard, If the same principle of in-house

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development applied to other industries,

noticed that the public sector in particular

in short supply in the industry but these

there would be no impressive Oracle

has a habit of considering staff time as

deficiencies must vary from organisation

Financials, Siebel CRM or even a half

‘free’. They are on payroll and not a capital


decent Microsoft Word.

outlay but staff are still a limited resource.

decision making, project management

Both IT and Lab staff need to be allocated

as well as being able to understand the

Chasm between IT Department capability and the Big Expectation

to the project, de-allocated from what

breadth of a system, its implications on the

they are doing and backfilled. Otherwise

organisation, communicating and setting

So we struggle to maintain what we have.

we must accept that it won’t get done or

expectations would help any significant

Doesn’t everybody? It’s a bit like telling

will not be done very well.

project, IT or otherwise.

friends about your cold. You get back more

rival sickness stories than the sympathy

tends to undervalue or ignore the amount

both public and private organisations

you were expecting. Yet the operational

of effort required for a task. We began

are willing to share approaches and

side of IT in Pathology will struggle that

tracking all significant IT requests and

information. There is ambiguity around

bit harder to meet benchmarks which are

found a vast gulf between the estimate

what are the boundaries when it comes to

taken from other better funded industries.

made by the requesting department (“That

‘commercially sensitive information’ and

It will also have a very hard time to deliver

little report should only take a day. Why

so some conversations come to a reluctant

on the high-level ‘strategic’ initiatives that

am I still waiting?”) and the actual effort

end but the willingness is there. Is there an

are proposed by Government, NEHTA17

involved (“That little report took 60 hours

enthusiastic agency out there to facilitate

and other Health Informatics agencies.

because the underlying data came from


I am not at all suggesting that these

two different systems”). This is a constant

initiatives are not sorely needed or that

feature but at least now we can associate

time and money needs to be given to the

we will not benefit from them in the long

the amount of effort alongside what may

practical realities of handling transitions,

term but for the short term we are asking

sound like excuses to explain delays in

implementations and support.

organisations who already have a lot of


complexity to introduce more. It is not so

Considering staff time as ‘free’ also




I have found that IT managers from

For those larger initiatives, more

Strategically, it would be beneficial

to consider IT solutions in the context

much the implementation of a system


but the transition of current systems,

A lot of IT staff around the country

consolidating functionality and reducing

interfacing and workflow to accommodate

are working hard to achieve poorly

complexity where possible. This involves

them that is of concern.

defined functionality in loose standards



functionality and requires a support

These larger health initiatives, such as


of the whole organisation with a view to








and Electronic Health Records are where



the big money is supposed to be going.

Pathology IT. All this is done with limited

for Pathology IT departments, we need to

While Medicare did provide some funds to

budgets, training, salaries and career

get back to the reality — we are limited

assist with implementation, it was barely

development prospects. Many projects

in our ability just to achieve the basic

enough for tea, doughnuts and a pack of

are ‘successfully’ delivered more due to

functionality. The shiny, leading edge IT

headache tablets, in order to implement

the goodwill and determination of IT and

part appears to be, unfortunately, another

our side of the Medicare Online interface.

Laboratory staff rather than good project

domain. Or we need a serious champion to

There was, however, a rather firm deadline


go about changing it — in a big way.

set, some vendor negotiations that didn’t

go well, a very limited ‘Test Environment’

from being quite ugly. The shiny, leading

storming down to the IT Department

and the overshadowing thought that

edge parts are mostly done by academics

with a formulated complaint regarding

significant amounts of revenue would not

and the boring operational bits left

why something ‘easy’ has still not been

be coming in after a certain date set by

to IT Departments but with no career

delivered, bring chocolates. And two

Medicare. Basically the transition was not


paracetamol for the IT Manager.

easy and it fell on IT and billing staff to do

on tight budgets, it is not particularly

it. The same people who still have their day

attractive to Software Vendors or other


job doing the other things they do.

industry IT staff.

References are available online at the

Pulse+IT website:

With regards to project staffing, I have




Medicare Online, Unique Health Identifiers





The Pathology IT Industry is suffering




At a high level, some skills are clearly

mechanism from Management.

For those who have great expectations

So the next time you find yourself

Pulse+IT 17


DONORtrak system to streamline organ transplant process A clinical information system designed to

were more likely to be accepted for

streamline the administrative and clinical

transplantation if they were donated in

processes associated with organ transplant

the same state where there was a heart/

is being evaluated by the Australian

lung transplantation program. One of

Government’s Organ and Tissue Donation

the reasons we thought this might be the

and Transplantation Authority, alongside

case is because its pretty difficult for the

a number of internationally developed

transplant physicians to have access to


the information they might need to make

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a decision to transplant a heart into a

developed by NEXVIEW Systems in

recipient. It’s a very big decision to make

collaboration with staff of the Flinders

and the process is very time critical.”

Medical Centre, with the intellectual

property for the system now residing with

DONORtrak has a more comprehensive

the Commonwealth.

feature set, the project initially focused on













providing clinicians with access to images

commenced following a chance meeting


at the Flinders Medical Centre in South

Australia, where Catherine Hannan, an

of the information available to the people

Organ and Tissue Donor Coordinator,

making the decisions was not of insufficient

became aware of a system operating in the

quality, but perhaps of insufficient detail.

Cardiac Echo Department that supported

We started off the project to develop a

the remote display of echocardiogram

system which had the capacity to transmit

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images. As South Australia doesn’t have a


heart/lung transplant unit, these organs,

physicians and surgeons could look at the

potentially suitable for transplant, are

images themselves rather than having to

offered to hospitals in other states,

rely on an interpretation from someone

including Queensland, New South Wales,

else,” explained Dr O’Callaghan.

Victoria and Western Australia. Having

seen the applicability of the remote display

includes an Organ and Tissue Donor

of echocardiogram images to the current


organ transplant process — and with a

amount of time populating a substantial

knowledge that hearts being offered from

paper‑based organ referral document with

South Australia for transplant in other

de-identified information contained within

states had less chance of being accepted

the deceased person’s medical record. The

than hearts offered from within these

referral documents contain as many as 27

states — a project to develop a clinical


information system to support interstate

organ transplant began.

Coordinator then undertakes a process of

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“We felt that on balance, the quality












organ a





offering the available organs to potential

consultant in intensive care medicine and


the National Medical Director of the Organ

This process involves the relaying of

and Tissue Donation and Transplantation

the information collected in the referral

Authority involved with the project,


explains: “I was concerned that hearts

Coordinator by telephone. This information

18 Pulse+IT





recipient Transplant

BITS & BYTES is subsequently conveyed to the recipient

entered by the donor coordinator are

transplant surgeon, allowing them to make

visible, negating the need for the telephone

Health-e-Nation conference coming to Melbourne in April

a determination regarding the suitability

transcription process to occur. With the

To be held at the RACV Club in Melbourne,

of the organ for transplant into one of their

information centralised in the DONORtrak

CHIK Services’ Health-e-Nation conference


system, multiple people involved in the

returns in its ninth year with the theme,

While fax machines have been utilised

process of the organ transfer can view the


throughout the health sector for many

data simultaneously, which Dr O’Callaghan

everyone’s business.”

years for the transmission of documents

suggests will lead to improvements in the

needing to be sent in a timely fashion, this

quality of care delivery.

include Jane Halton, Secretary, Department

method of communication is not deemed

“From the point of view of information

of Health and Ageing; Peter Fleming,

suitable for use in the organ transplant

sharing in health, systems that minimise

CEO of the National E-Health Transition

process to protect donor and recipient

the potential for data entry errors and can

Authority; Marianne Shearer, CEO of the

confidentiality. The fact that recipient

record and capture information that can

Melbourne East General Practice Network;

donor coordinators may not be at their

be used in a reproducible and consistent

and Rachel de Sain, Director, Flaxworks.

place of work when an organ becomes

way to analyse practice are really crucial to

available has also ruled fax out as a viable

developing appropriate safety and quality

speakers, including Chai Chuah, National

method of communication.

standards,” said Dr O’Callaghan.

Director, National Health Board, New





Confirmed speakers for the conference

The event will also feature international

In addition to replicating the textual

Zealand Ministry of Health; Dr Rina

suitable for implant for four and six hours

information found in the paper-based

Yahalom, Deputy CEO, Kaplan Medical

respectively following retrieval from a

referral document, the electronic nature

Center, Clalit Health Services, Israel; and

deceased donor — and with such organs

of the DONORtrak system has allowed

US presenters Claire McCarthy and Douglas

retrieved from South Australia needing to

the developers to provide additional

Eastman, who will be providing insights in

be transported long distances — improving

functionality that paper-based workflows

their capacity as ‘sustainable change and

the efficiency of administrative processes

can not support. Images and video can be

organisational effectiveness experts’.

was seen as a high priority for the people

uploaded into the system, which typically

collaborating on the DONORtrak system.

include x-rays, echocardiogram videos, and

sessions, the conference will incorporate

With hearts and lungs only remaining

In addition to presentations and panel

high resolution photographs of extracted

an industry exhibition. In contrast with

a heart, there is only four hours to


many larger events, industry exhibits will

surgically retrieve the organ and transport


be collocated within the conference hall,

it to, and subsequently transplant it



to provide what the organisers are calling

into, a recipient. That’s not a lot of time

of such systems as Catherine Hannan

an ‘inclusive and intimate’ setting designed

in a country as big as Australia,” said Dr

describes: “A lung specialist who viewed

to promote the involvement of vendors in


our referral information electronically rang

conference discussions.

With these time pressures in mind, the

up and said ‘these lungs look quite wet,

DONORtrak system’s feature set evolved,

do you mind getting the ICU consultant to

Thursday, 7 April, and will be followed by a

and now serves as an electronic replication

give some Lasix’, which is a drug to try and

networking reception and invitational CEO


dry out the lungs. ‘I also see that you have


“When a decision is made to transplant










The conference proper is to be held on

an intravascular diagnostic catheter in this


patient, can you do some pressure readings

the conference, including an invitational

into the electronic referral screen in

for us?’ All of a sudden they weren’t just

CIO meeting and a formal dinner to be held

DONORtrak, the donor coordinator is able

getting the chest x-ray, they were actually

on Wednesday, 6 April. Facilitated by Claire

to offer an organ via the system by simply

understanding more about the way in

McCarthy and Douglas Eastman, a series of

selecting a recipient donor coordinator’s

which the donor was being managed in

workshops will be held on Friday, 8 April,

name and clicking a ‘send’ button. The

the intensive care unit, and were able

concluding the three day event program.



to be involved in some of the clinical

an SMS and an email, which contains a

management of that donor to try and

conference and the associated events

link to the DONORtrak website. After

improve the lungs so that the transplant


authenticating to the system, all details

outcomes would be maximised.”







Pulse+IT 19

Two days of related events will flank

Further available

information at






BITS & BYTES NEC deploys Internet access to senior Australians NEC Australia has announced the Yarraville

Electronic Journal of Health Informatics releases eighth issue

Senior Citizens Centre as the 2000th site to receive a Broadband for Seniors Kiosk,


facilitated by the Australian Government’s

Informatics (eJHI) has just published its

Professionals” (J. Chen, Y. Park, G. Putzer).

$15 million Broadband for Seniors initiative.













latest issue, Volume 5, Number 2 (2010),




which is available on its website.

eHJI website provides a good overview of





An official flyer available from the

In a statement accompanying the

the scope, objectives, editorial Board and

confidence and skills of senior Australians

release of the eighth issue, Dr Sebastian

other relevant information of the eJHI



Garde, Managing Editor, remarked that

including a brief statement of what it is

increasing community participation and



this “is the first issue to only include

— “an international journal committed to

social inclusion, and helping them live

‘normal’ papers that were unsolicited and

scholarly excellence and dedicated to the

independently for longer.

not part of a Special Issue,” however in

advancement of Health Informatics and

Since the initiative launched in July

the introduction to this issue, Dr Garde,

information technology in healthcare. It

2009, an estimated 94,000 seniors across

confirms that the eJHI will continue to

is a journal for all health professions and

Australia have had access to the kiosks

publish special issues on topics of interest

informaticians of all levels”.

and training in sites from Fitzroy Crossing,

in Health Informatics that are edited by

Western Australia to Swansea, Tasmania,

guest editors.

— providing open access to both authors

dramatically increasing the availability

Since its inaugural issue in 2006, the

(i.e. no publication fee or page charges)

of Internet services and building their

eJHI has published papers around special

and readers (i.e. free access to all papers).

confidence in using technology.

interest topics in health informatics,

In a statement, Chief Editor Professor

In a statement, David Cooke, Group

including systems interoperability, data

Evelyn Hovenga said that the eJHI “can

Manager, NEC Australia, said: “Since

mining, aged care informatics and privacy








The eJHI is an “open access” journal





and security.

with papers received from authors from

2009, we have seen a fantastic response


from both volunteers and community

cover a range of health informatics

New Zealand, U.K., U.S., Sweden. Japan,

organisations wanting to get involved.

topics that would be of interest to many

Germany, Greece, India and Indonesia.

The benefits that the initiative offers older

readers and include the following papers:

Prof. Hovenga remarked on the high

Australians — such as providing a supportive



editorial standard of the journal, stating

environment to gain knowledge and skills

Ambient Assisted Living Systems” (J.

that “all eJHI papers are peer-reviewed

in using computers and the Internet — have

Soar, J. Symmonds), “Miscoding Rates

by independent experts with an average

certainly been realised. One major outcome


acceptance rate after one or more review

emerging is the sheer number of older

Trial Results — Software Solution” (R.A.

rounds of around 50%”.

Australians connecting with distant family

Henderson, K.C. Nielsen, S.M. Klein, R.

members both in Australia and overseas.”

Pietrobon), “Computer Skills and the

Australasian College of Health Informatics

Since the initiative kicked off, over

Training of Medical Students in a Ghanaian


43,000 online lessons have been completed,

Medical School” (E. K. Achampong, K.K.A.

Society of Australia (HISA). Articles are

with the most popular courses being

Pereko), “An Evaluation of Patient Usage

indexed or archived by several services

Introduction to Computers, Introduction

of Computers to Manage Information

including Google Scholar, the Directory of

to Word Processing, Introduction to the

Relevant to Diabetes Care” (M. G. Hill),

Open‑Access Journals, PKP Open Archives

Internet and Introduction to Email.

“The Fusion of Clinical Guidelines with

Harvester, Pandora, Australian Journals

Mr Cooke stressed the importance of

Technology: Trends & Challenges” (C.E.

Online, OAIster, and the eGranary Digital

technology to older Australians, stating:

MacDougall, C. McGregor, J. Percival),


“IT literacy is only going to become more

“Pathology Results in the Electronic

important as Australia’s population ages,

Health Record” (J.F. Hamblin, P.T. Bwititi,

available from the website:

and e-health and home based services

H.T. Moriarty) and “An examination of the

become the norm.”

Components that Increase Acceptance

The contents of the latest issue



20 Pulse+IT







The eJHI is the official journal of the and




More information on the eJHI is

— Paul Clarke

BITS & BYTES Maestro Toolbar connects practice software with Healthcare Identifier Service

IBM awarded NASH contract The National E-Health Transition Authority

NEHTA to build a system that will give


(NEHTA) has tasked IBM with developing

healthcare professionals timely and secure

software utility that can enable clinical

the National Authentication Service for

access to appropriate patient information,”


Health (NASH), awarding it a $23.6 million

said Peter Fleming, Chief Executive Officer,

Australia’s Healthcare Identifier Service.


NEHTA. “In turn, the NASH program

This repository contains over 23 million

will take us one step closer to broader

Individual Healthcare Identifiers (IHI), which

the launch of the Personally Controlled

healthcare access for all Australians.”

are intended to be used to assist disparate

Electronic Health Record (PCEHR) in July

healthcare organisations to reliably transfer

2012, the service will be responsible for

for IBM Australia and New Zealand, said

patient information electronically.

ensuring that access to health records is

the agreement represented a vital step

governed appropriately.

in promoting the broader take-up of

software is designed to extract patient


demographic information from a clinical

supplying a software development kit to

database and use this data to interrogate

software vendors to assist them to enable

Australian doctors, nurses and allied health


their systems to interface with the new

providers and accelerate the delivery

the demographic details are matched

authentication service.

of smarter healthcare across the entire

successfully with a record stored by

healthcare system,” said Mr Stevens.


Systems to



previewed with


Dubbed the Maestro Toolbar, the





Medicare Australia, the patient’s IHI is

Scheduled to be implemented by

NEHTA has indicated it will be

“Our agreement with IBM enables

Andrew Stevens, Managing Director

“This program will benefit over 600,000

the Maestro Toolbar if the clinical software

Orion Health updates its Rhapsody Integration Engine

does not yet support the storage of IHIs.

Orion Health has released an updated

conditional routing interface are said to

In addition to the Healthcare Identifier

version of its Integration Engine (version

provide faster and simpler configuration of

functionality, the Maestro Toolbar also

4.1), which it states will speed up interface

complex routing rules based on message

brings together a range of other features.

development through the addition of a


The utility can extract patient summaries

unit testing framework and an improved,

from clinical software and upload this

simplified graphical interface to assist with

version include new options for custom

information to a centralised electronic

complex routing.

branding and deployment, with Orion

health record system called Healthbank. A

“Rhapsody is designed for rapid,

Health’s partners now able to place their

reporting function is also included, which

effortless installation and use, and enables

own branding on the product splash

allows practice staff to query their clinical

fast accurate and efficient exchange

screens and other prominent locations,

software database and generate reports,

of electronic health information” said

whilst OEMs will now benefit from

regardless of whether the clinical software

Orion health’s marketing manager, Sarah

unattended installation and configuration

is running at the time.



automated testing.

returned to the Maestro Toolbar. The IHI can then be inserted into the patient’s record in the clinical software, or simply held within

The Maestro Toolbar also includes an

Orion Health states that the addition

Other features supported in this new




instant messaging system, which allows

of the unit testing framework will

practice staff to communicate with other

simplify testing of multiple scenarios

provides support for a wide range of

users of the system within their practice

and configurations, as well as enable


in real time. This messaging system

the test scenarios to be stored within


is complemented by another service

a configuration to support advanced


embedded in the Toolbar called safeNET,

regression testing. In addition, these

information systems, including support

which allows users to send files securely to

test scenarios are able to be easily

for all versions of HL7 (versions 2 and 3)

other practices or external typing services

shared between different configuration

and Clinical Documentation Architecture

by simply dragging and dropping them into

environments — i.e. development, test and

(CDA) and Continuity of Care Documents

a folder on their desktop.

production servers. Improvements to the

(CCA), Web Services, XML Integrating the

22 Pulse+IT

The Rhapsody Integration Engine


protocols, standards between

message to



BITS & BYTES Healthcare Enterprise (IHE) profiles, XML,

options for Orion Health Partners; fast,

X.12 and NCPDP.

intuitive interface development; simplified

standards support and advanced interface

With regard to support for Web

Services, in a statement, Orion Health

management tools.”

Product Manager Paul de Bazin said

“The web services framework has been

Integration Engine different to other

based on the international web services

offerings from competitors, Mr de Bazin

interoperability standards ( which

said, “compared to other integration

brings together different web service

technologies, Rhapsody is simpler to

standards into groups of profiles e.g.:

deploy, easier to work with, and handles

WS-Security and WS-Addressing are in the

its own maintenance.”

basic profile.”

Mr de Bazin also commented on IHE

uptake of the new version of the Rhapsody

support: “Rhapsody has recently been

Integration Engine has been better than

certified at the January Connectathon in

expected and that “the new features in

Chicago for Cross Enterprise Document

Rhapsody 4.1 have been well received with

Exchange (XDS) and QED profiles.”

over 150 organisations having downloaded

the release already.”

For advanced users, Orion Health

Asked what makes the Rhapsody

Orion Health commented that the

provides a development kit that enables

developers to add new functionality and

been sold in over 30 countries, with a large

protocols via the Rhapsody Application

base in the US, New Zealand, UK, Spain,

Programming Interface (API).

Middle East and with Asia as an emerging

market, particularly in China, Japan and

Orion Health claims the key benefits

The Rhapsody Integration Engine has

of this updated Integration Engine version






Further details on the Rhapsody

“new unit testing framework for faster

Integration Engine are available from

integration of information systems; new

the Orion Health website: http://www.

conditional routing interface for simplified





— Paul Clarke

Below – A screen capture of the Rhapsody Integration Engine that shows the new graphical interface with ‘Drag and Drop’ tools support and other features available for developing complex routing rules.

Pulse+IT 23

BITS & BYTES Stat Health Systems commences software rollout Stat Health Systems has commenced the

iMIMS drug reference application released for Apple iPhone

rollout of their new practice software for both general and specialist practice, dubbed

MIMS has released a version of its

downloading data over cellular networks,

‘Stat’. As a fully integrated solution, the

ubiquitous drug reference product for the

the application gives the user the option

product contains both clinical and practice

iPhone and other devices running Apple’s

to defer drug data updates until the next

management features, including billing,

iOS, including the iPad and iPod Touch.

time the device establishes a WiFi network

claiming and appointment functionality.


Stat has been in live beta testing since

reference database containing over 5500

August 2010. Since this time the company

products contextualised specifically for the

Apple iOS devices, MIMS also retails a

has migrated its prescribing data system

Australian healthcare sector. As with other

product called MIMS Mobile. Launched in

to MIMS, having originally developed the

MIMS products, iMIMS brings together

2009, this solution was developed to work

software to use a competing solution from



from within the browser of any modern

First DataBank.

Administration (TGA) product information,

mobile device, including smartphones

The product is built around a drug


In addition to the new iMIMS app for

Carla Doolan, Stat Health System’s

in addition to the more user friendly

running Android and Windows Mobile.

Sales and Marketing Manager touted the

‘abbreviated’ product information, which

Being a web-based solution, MIMS Mobile

product’s flexible ‘multi function interface’

includes Pharmaceutical Benefits Scheme

is compatible with a wide array of devices,

as a major strength of the software: “This

(PBS) information where applicable.

however an active Internet connection is

allows the user to commence a new action

A fully referenced evidenced-based

required. As iMIMS stores drug data on

without completing the previous action.

drug interaction checker is also included

the iOS device itself, it does not suffer this

The user has the flexibility to return to the

in the app, allowing users to generate a list

limitation and can work even when the

incomplete task at any time, and can be

of drugs by tapping on a button displayed

phone has no mobile reception.

progressing an unlimited number of tasks.

at the top of a product information screen.

This was the most frequently requested

The app then examines each drug pair in

feature from the market when initial user

the list and reports any potential adverse

requirement surveys were undertaken.

effects as determined by checks made

against primary literature sources.

“All initial screen designs are referred

back to our focus group, which consists of

doctors, nursing and practice administration

launches a pill identifier, which contains a

staff for their input. This liaison with the

database of over 2500 images. If presented

market will continue to be a focus of ours.”

with a medication, the user can attempt to

identify it by querying based on its shape,

Ms Doolan also listed other notable






Below – An iPhone displaying the Pill Identifier functionality of the recently released iMIMS app.

The third tab in the application

colour, form, therapeutic class, in addition

fine grained security controls, a task

to other search criteria.

manager and a recall manager with audit

functionality, and user definable macros to

updates approved by Apple prior to them

speed up common tasks.

being released on its App Store, the

With the intention of focusing solely on

iMIMS app has been developed in such

their own product as the rollout continues,

a way that it allows any new or updated

the company has announced that it will be

drug information to be downloaded from

ceasing support of its Stat Online Claiming

within the application, without the app

System (SOCS) and Stat Services support

itself needing to be updated. This process

at the end of June 2011.

occurs in the background when the user

Stat is being sold on a ‘concurrent user’

launches the program. However due to the

basis, with customers given the option

potential size of such downloads (40MB

to pay for ongoing annual licence fees in

to 70MB typically )and the wide variance

monthly instalments, should they so wish.

in speeds users are able to achieve when

Due to the time it takes to have app

24 Pulse+IT


MIMS has indicated it is monitoring the

are $159 per year, plus an additional $15

uptake of other mobile platforms including

per year to unlock the pill identifer, which

Android and Windows Mobile 7. The

is sold as an optional module.

company however, has not yet committed

to developing purpose built applications

for download from the Apple App Store,

for these platforms at this point in time.

which can be accessed using iTunes on a

computer running Microsoft Windows or

The iMIMS application is free to

As with all iOS apps, iMIMS is available

download and trial for seven days,

MacOS X, or directly from an iOS device.

however after this time the user is required

More information about the app

to purchase a subscription to maintain full



access to the application. Subscriptions





NPS study into GP clinical software shows room for improvement NPS better choices, better health (NPS)

variety of systems with markedly different

has continued its research into Australian


clinical software, previewing an as yet

assisting general practitioners to prescribe

unpublished paper in an editorial piece

safely and effectively.”

featured in the February 2011 edition of

Australian Prescriber.

evaluated by NPS were Best Practice,

Genie, Medical Director 2, Medical Director

The editorial overviews a process


















However an NPS spokesperson indicated

were selected and assessed against a

that the “systems will be de-identified in

comprehensive list of desirable features.

the published manuscript as the intention

This list of features was published in 2010

of the study was to look at features

by Sweidan M, Williamson M, Reeve J,

across all systems and make general

Harvey K, O’Neill JA, Schattner P, et al, in

recommendations for improvements that

their paper: Identification of features of

support quality and safety of prescribing.”

electronic prescribing systems to support

quality and safety in primary care using a

the seven clinical systems evaluated, less

modified Delphi process.

than 50% of the desirable clinical decision

In their recent editorial, authors

support features were observed as “fully

James Reeve and Michelle Sweidan

implemented,” the authors pointing to

lament the lack of standards guiding the

the “lack of clinical information resources

development of general practice clinical

in a format which is suitable for decision

software in Australia, stating: “Over 90%

support.” The authors also noted that

of general practitioners use one of the

“when systems included decision support,

20 or so commercial systems that are

it was often unclear where the information

available to write prescriptions, order

was derived from and whether it was up to

pathology and other tests, record medical


progress notes or communicate with

other healthcare providers. Despite the

the research are available from the NPS

widespread use of e-prescribing systems,

website, with results from the final stages

there are no clear standards or guidelines

of the study expected to be made available

for their development. This has led to a

via the NPS website in June.

The research revealed that for five of





general practice clinical software products




Pulse+IT 25

iPhone app Available on the

App Store or call 1800 800 629



APP2011 17 March - 20 March Gold Coast, QLD P: +61 7 3831 3788 W:

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3rd Annual National Telemedicine Summit 21 March - 22 March Sydney, NSW P: +61 2 9080 4300 W:

APNA National Conference 2011 7 April - 9 April Sydney, NSW P: +61 3 9645 9858 W:

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26 Pulse+IT

HISA NSW Branch Meeting - Electronic Discharge Reporting 14 April Sydney, NSW P: +61 3 9388 0555 W:

MAY The 3rd Annual GP Super Clinics Summit 5 May - 6 May Brisbane, QLD P: +61 2 9080 4300 W: 12th International HL7 Interoperability Conference 13 May - 14 May Orlando, USA P: +1 734 677 7777 W: HL7 International 16 May - 20 May Orlando, USA P: +1 734 677 7777 W: Data Governance Conference 19 May - 20 May Melbourne, VIC P: +61 3 9388 0555 W: RACP Congress 2011 22 May - 25 May Darwin, Australia P: +61 3 9645 6311 W: 2nd Annual Managing Ward Finances & Budgets Conference 23 May - 24 May

Brisbane, QLD P: +61 2 9080 4300 W: Rural and Remote Telehealth Conference 29 May - 31 May Cairns, Australia P: +61 3 9388 0555 W: 11th Annual Hospital in the Home Conference 31 May - 1 June Melbourne, VIC P: +61 2 9080 4300 W: eHealth@CeBIT 31 May - 2 June Sydney, NSW P: +61 2 9280 3400 W:

AUGUST HISA Health Informatics Conference (HIC2011) 1 August - 5 August Brisbane, QLD P: +61 3 9388 0555 W: HISA NSW Branch Meeting - Health Informatics Research 18 August Sydney, NSW P: +61 3 9388 0555 W:

SEPTEMBER HIMAA National Conference 2011 20 September - 23 September Melbourne, VIC P: +61 2 9887 5001 W: HIMSS AsiaPac 2011 20 September - 23 September Melbourne, VIC P: +65 9848 5259 W:

Online Calendar

To view a comprehensive list of Health IT, Health, and IT events, visit the Pulse+IT website:


data governance in healthcare integrity of data and information healthcare managers leaders executives clinical non-clinical data Health reform & data governance - in a climate of transformational professionals health changes to Australia’s healthcare system, infromaticians leveraging your data as an enterprise asset has never been more crucial. health policy makers academics MELBOURNE 19 - 20 MAY 2011

Data Governance The Sebel & Citigate – Albert Park

Supported Events

FINAL_DG1-2adpulseit02.indd 1

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21/02/2011 2:25:25 PM

HPOS makes it easier for you to do business with Medicare Australia

More and more services are becoming available for health professionals through HPOS. New services recently added include: • Practice Incentives Program (PIP)—register for the PIP and individual PIP incentives • General Practice Immunisation Incentive (GPII)—register and update details for the GPII • General Practice Rural Incentives Program (GPRIP) and HECS Reimbursement Scheme—update banking details, apply for a Rural Relocation Incentive Grant, lodge HECS applications and more

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Pulse+IT 27


Taking shortcuts will get you lost

Dr Geoffrey Sayer BSc(Psychol), MCH, PhD President, MSIA

I spend a lot of time in Auckland. Auckland is a

have done in preparation, homework or consideration

wonderful and beautiful city. I like to think Auckland is

of the details that it actually takes to go from a ‘known’

well known to me. I know Auckland CBD better than

place to an ‘unknown’ place.

the locals. I know how to get to where I want to go.

But because I know Auckland, it doesn’t mean I know

a dead end with a front row view of Auckland Harbour,

the surrounding suburbs of Auckland, the surrounding

bridges off in the distance...and still in Auckland.

regions of Auckland, nor the rest of New Zealand.

For all the city’s charm, I wanted to explore the

from where we are to what we believe will be a better

Northland region to the north of Auckland on the

place, and indeed a place that we haven’t been to

North Island. I clearly had my heart set on going as far

before: the Personally Controlled Electronic Health

‘north’ as possible. The first objective was to get out of

Record (PCEHR). While slightly longer than a long


weekend, there is limited time (July 1, 2012) to connect

Not surprisingly, 50 minutes later I found myself at

In the e-health world, we want to move away

Having set out from the southern suburbs, I wanted

a considerable number of pieces together to achieve

to avoid the traffic that I knew would be banked up to

the deadline. We of course have to be careful that we

cross the Auckland Harbour Bridge. I wasn’t the only

don’t break the pieces in doing so, or we won’t be able

one wanting to go ‘north’ — it was a long weekend.

to make them fit.

I had looked at a less than detailed map that only

covered the main roads in Auckland as I climbed into

the best chance of getting you where you want to go.

my rented Subaru Outback. I decided to take a road

The beauty of careful planning and detailed maps is

that skipped around the city’s western rim. It would

you can share these resources with others. Planning

ultimately end in the general direction of ‘north’. My

and objective setting can also temper overzealous

destination was ‘north’ so as long as I was going ‘north’

ambition, while still delivering tangible benefits from

I would eventually arrive at my destination, despite the

the journey. Remember the journey itself can bring

‘non-north’ pathways I would travel. It would be quicker

delights and benefits.”

to travel the ‘unknown’ route compared to the ‘known’

route. That is what a short cut is all about — avoiding a

a well-mapped journey. During my weekend in the

longer but ‘known’ way.

Northland region, the effects of a cyclone flooded

Careful planning and detailed maps will give you

Unforeseen things will always happen, even on

There are many pathways to a destination. It

many areas and landslides were common, resulting

wouldn’t matter which one I took. I believed the

in changed road conditions or total closures. It was

pathway would just open up before me and there

necessary to back track, take stock and change the

would be signs reassuring me that I was going the right

immediate plan but not the long term goal of reaching

way. I could reassess my direction as I was going along

the Bay of Islands.

— as long as I was moving ‘north’ it would be all good.

My intention was well meaning and my desire was

to deliver the promise of a PCEHR. The work being

there. These qualities would cover any shortfalls I may

undertaken by the Wave 1 sites (GP Access, GPpartners

There are considerable pressures on many people

and Melbourne East General Practice Network) and

Author Info

the Wave 2 of the PCEHR project, as the names imply, As well as being President of MSIA, Geoffrey is General Manager Australia of 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.

are building up momentum. It is important that these waves don’t come crashing down on the unsuspecting clinicians and healthcare users if not carefully managed. The pressure to deliver on ambitious promises will result in short cuts around the implementation of standards that could end up causing longer term

28 Pulse+IT

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Supported by

problems or take us to dead ends.

what is being attempted. It is speculated that there

The point of technical standards is to ensure quality,

will be 10-15 successful bids which, if correct, will

consistency and interoperability. It is important that

leave 80+ bids unfulfilled. Now while we all want value

we look at the standards work that has been done

for money and are keen to show that the PCEHR

previously. At times the market moves faster than the

can deliver tangible benefits, how do we harness the

standards setting process. There are also lessons to be

enthusiasm that is on display? Were the bids that will

learnt from why the previous standards haven’t been

ultimately miss out unable to demonstrate an ability to

implemented consistently. We need to make sure we

deliver tangible benefits? Were the pathways they were

don’t just develop new standards in an attempt to

mapping out taking us to places where we don’t want

overcome the perceived implementation problems

to go?

of previous ones. Many problems have occurred in

the past from the lack of harmonisation and testing

initiatives there will be cycles of redevelopment. While

of compliance with the standards, not because of the

there is a belief that it provides an advantage to those

standards themselves.

software vendors participating early, any iteration of

If I have a criticism of New Zealand it’s that they

software code comes with extra burdens of quality

don’t have as many road signs as Australia in rural and

assurance and testing. Testing processes under the

remote areas. What is considered a major road on a map

Conformance, Compliance and Accreditation (CCA)

is not a major road in my Australian experience. You

program are also evolving. Companies who get involved

therefore need to make sure you speak to the people

earlier will most likely be required to repeat cycles of

who know the roads and pathways — those who have


travelled the area before. It is rewarding talking to the

locals as you learn things you haven’t even considered

participating in the PCEHR program to take short cuts,

or you can discover things that are not on the map. You

while many non-participating companies will wait

find real short cuts from the people who know.

until the dust has settled. Furthermore, unless there

As we learn from the lessons of these early

There will be pressure on software vendors

There has been an ever increasing recognition for

is alignment of the business cases that will attract all

the role for software vendors in delivering the building

vendor participation and sustainable business models,

blocks that will underpin the PCEHR. Vendors are an

then the participation by vendors will be further

experienced and valuable asset to provide guidance

reduced over time.

in what is possible and how long things actually

take. However, software vendors are unfairly cast

where we want go, but haven’t bothered to consider

as putting money before patient safety and as road

the steps it actually takes to get us there. A high level

blocks to progress. It is fair to say the software vendor

view is not enough. A desire is not enough. It is a form

community has given more than they have actually

of risk taking when we take short cuts — we are not

received from the funding directed to e-health in the

sure it will work but we feel it is better than the longer

last five years. Recently a vendor emailed the MSIA

way. The problem we create for ourselves is that we

with a simple analysis they had undertaken that showed

are trying to achieve too much at once in too short

that the vendor community had possibly spent more

a time. A long journey is best broken up into smaller

money on assisting in the development of the building

journeys. Each one brings their own benefits — IHIs,

blocks and engaging in the bidding process for Wave 1

SMD, terminologies and patient summaries. With the

than what has been reported will be available to those

addition of other journeys we will have the ability to

vendors who are in negotiations to be on the GP Vendor

have PCEHRs for those who want one to assist in their


journey through the healthcare system.

Bidding takes time and money. For Wave 2 ($55

Many of us have taken short cuts because we know

For my own road trip the benefits were new

million) there have been reports of over 90 applications

friendships formed; drinking with the locals at the Boar

from consortia of like minded software vendors and

and Marlin in Oponini; counting stars and satellites as

healthcare organisations. This shows the considerable

they appeared on a clear night on Cable Beach; and the

interest in the PCEHR program but we need to be

view across the Bay of Islands from a hilltop vantage

mindful that there is only limited funding relative to

point on horseback.

Pulse+IT 31


New research offers insight into Supply Chain reform Why is it that companies such as Wal-Mart, Zara and Dell find their way into any text on supply chain management whereas there is rarely a mention of a hospital that is a leader in this field? That’s the question at the centre of new research by Melbourne University academic Dr Vikram Bhakoo ... The study, scheduled for release later this month,

is the first of its kind in Australia and one of the first

or so behind other industries in technology adoption

internationally to focus on supply management

despite growing and unrelenting pressure from factors

in healthcare. It offers rare insight into e-business

such as Australia’s ageing population, technological

adoption behaviour and the drivers and impediments

innovation and demand for higher standards of care.

to technology uptake. Dr Bhakoo uses 15 in depth

Despite these facts, hospitals have been reluctant to

case studies, from the pharmaceutical hospital supply

embrace strategic supply chain thinking as a solution

sector, to reveal some interesting findings with specific

to the escalating costs.

implications for technology providers, healthcare

managers and government regulators alike.

that make it very different from other industries,

such as grocery or retail, where the supply chain is

The release of Dr Bhakoo’s report coincides with

Dr Bhakoo points out that healthcare is decade

“Health is an industry with unique characteristics

the Commonwealth Government’s proposed reforms

connected and automated,” he said.

designed to improve public hospital services, ensure

the sustainability of the health system and bolster

numerous systems that don’t talk to each other.


Unlike other industries, you also have various levels of

maturity, for example between jurisdictions, and no

The study highlights that waste and inefficiency are

“In health, you have multiple participants and

key cost drivers in the health system with supply chain

powerful market leader to set the pace.

representing the second largest component, or one-

third of all hospital expenses1. This supports estimates

even further, particularly between manufacturers and

from the Productivity Commission that some public

wholesalers/distributors, which cause bottlenecks

hospitals may be running up to 20% less efficiently

that significantly restrict the end to end integration of

than best practice . At the same time, there is evidence

information flows.

to show that supply chain costs can be significantly

reduced by effective supply chain practices3 which, in

standards so we cannot afford to fragment our

turn, improves labour productivity and frees additional

demands or the large international companies won’t

time for operational improvement with significant

play. This emphasises the need for a uniform national

flow-on benefits for patient safety.

approach to interoperability, aligned with international


“The complexity of supply relationships extends

“Australia is a very small market by international

Author Info

standards, and therein lies the challenge for Australian The National E-Health Transition Authority was established by the Australian Commonwealth, State and Territory governments on 5 July, 2005 to develop better ways of electronically collecting and securely exchanging health information. For more information about NEHTA visit:, for more information about e-health visit:

supply chain reform.”

Overall, the study identified a range of operational,

financial and strategic factors and a complex range of institutional factors operating within pharmaceutical hospital supply.

“This poses key changes for technology suppliers

who need to customise their product offerings, and

32 Pulse+IT

Dr Vikram Bhakoo is a lecturer in Operations Management, Department of Management and Marketing at the Faculty of Business and Economics, University of Melbourne. He has international experience in textile manufacturing and the IT industry with a BA (Hons) (Economics) from Delhi University, and a PhD and Masters in Information Management & Systems, from Monash University.

are key drivers for uptake by hospital

devices in use across the country.




In 2010, Australian Federal, State

manufacturers are more attracted by


financial advantages and a return on

signed an agreement committing to the

investment. Conversely, clinicians are

collaborative development and adoption

both distributors and consumers in the

of national eHealth standards in supply

pharmaceutical supply chain and are

chain management as a mechanism for

motivated largely by the potential for

improving patient safety and service

technology to improve patient safety and

quality. This commitment includes working

quality of care.”

towards effective adoption and utilisation

The study supports the work of the

of the National Product Catalogue and

National E-Health Transition Authority

the NEHTA eProcurement Solution, which







defines specifications for secure electronic

establishing specifications for a supply

transfer of transaction messages such as


purchase orders, invoices and dispatch






manufacturers, wholesalers, distributors


and purchasers across the Australian

healthcare sector. A key element of the

work is establishment of the National which



marketing messages, to suit the needs of


different players in the sector.

provides standardised identification for

References are available online at the

more than 100,000 medical products and

Pulse+IT website:

“For example, operational benefits


Visit NEHTA’s Supply chain website:

Rural and Remote

Telehealth Conference Cairns 29 - 31 May 2011

conference focus • • • •

Provide policy relevant input to Federal Government Articulate the strategic and operational attributes of telehealth Demonstrate operational key success protocols and practices Network with clinicians and high level executives with a passion for telehealth

supported by

event themes • • • •

The clinical user experience Clinical workflow integration and EHR National Broadband Network design and opportunities The practice of telehealth

event detail and registration FINAL_RR2011_PULSEIT180x120.indd 1

28/02/2011 2:06:32 PM

Pulse+IT 33


Information security and social engineering Alberto Tinazzi

IT Security Consultant eHealth Security Services

Often, when I discuss the topic of Internet security with

these being patients or more generic customers and

health professionals, I receive a lot of scepticism and a

suppliers in the healthcare sector. A practice needs to

common question: “We are not a bank or a corporation

protect its patients’ records not only to comply with

with valuable trade secrets! Why would someone be

legal requirements, but also to protect the privacy of

interested in hacking into my practice information

patients who have given their information in good

system? Why would a hacker be interested in accessing

faith that it will be stored and treated with maximum

my patients’ clinical records?”


When a malicious individual (hacker) attempts

For any business, including medical practices,

to penetrate an information system, they do not

information is the most valuable and irreplaceable

necessarily know what they will find and how valuable

asset, requiring adequate protection. It is, in fact, a

that information is to them until they actually get inside

common mistake to think that medical records have no

the information system and take a look around. They

commercial value.

simply take a gamble.

According to the Australian Businesses Assessment

The first step for a hacker would be to identify a

of Computer User Security (ABACUS) report 2009,

vulnerable target. This is quite an easy task to perform

from the Australian Institute of Criminology, crimes

even for a non-professional hacker. In fact, there are a

involving identity theft have increased in recent years

number of automated tools available on the web that

and businesses operating in the healthcare sector

can be used to scan and detect the vulnerabilities of an

manage a large quantity of personal data, making

information system connected to the Internet.

them prime targets for this kind of crime.4 Personal

A large number of intrusions are perpetrated by

information stolen through security incidents can be

young people (script-kiddies) that use hacking tools

used to commit more serious crimes. For example,

downloaded from the Internet just for fun and simply

an individual in possession of a patient’s personal

because they can get away with it.

information could ring the patient’s bank and organise

The FBI Internet Crime Report 2009 indicated that

a money transfer. In fact, if you forget your telephone

in 2009 7.9% of cyber-crimes have been motivated

banking password, how does the operator generally

by vandalism while identity theft scores 14.1%.2 The

identify and authenticate you? By asking a few personal

2010 Data Breach Investigations Report from Verizon

questions such as name, surname, address, date of birth

indicates that 36% of security breaches are perpetrated

— information that is also stored in clinical software.

against random targets.



The Australian Taxation Office reported identity

Computers used in a business context, compared to

theft to be the single biggest component of the $65

home computers, handle very different types of data.

million worth of fraud they identified in the first two

Home computers hold data related to an individual and

months of this financial year.5

perhaps their family members. Business computers

store information concerning many other individuals,

can also be used by perpetrators to blackmail patients,

In addition to identity theft, stolen information

Author Info

threatening to disclose their information if they do not 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.

agree to pay a ransom.

In May 2009, the Virginia Department of Health

Professions (DHP) received a request to pay a US$10 million ransom.6 The perpetrator claimed to have downloaded a copy of their database containing records of over 35 million prescriptions and to have encrypted the original database making it inaccessible

34 Pulse+IT

to legitimate users. It was ultimately discovered that this claim was actually a hoax, but such scenarios may really happen. However, rather than targeting a large enterprise, which probably has good security in place, and for a huge amount of money, which will be very difficult to cash and launder without being detected, hackers may prey on smaller, more vulnerable targets.

The consequences of an attack of this kind can

impact on both confidentiality and availability of information, and may have very serious repercussions on a business from a legal point of view, as well as causing loss of trust and patient confidence.

The recent introduction of the Unique Healthcare

Identifier and the determination of the government to establish personal electronic health records in the next 18 months puts enormous pressure on practices to get their information system up-to-scratch, particularly from a security point of view.

Social Engineering Social engineering is a hacking technique that focuses on exploiting the natural human tendency to trust. The objective of a hacker is always to gather confidential information, but in this instance, using psychology rather than technology. This type of attack is carried out against people, not against technology and is therefore very effective at bypassing even the strongest technical security countermeasures that a business may have in place.

It consists of manipulating people into performing

certain actions or revealing sensitive information. Social engineering is normally carried out in person or over the phone.

The hacker, in order to prevent their behaviour

becoming suspicious, will avoid requesting too much information from a single victim or during a single conversation. The perpetrator will gather a little bit of information from multiple people, or over time, by building up a friendly relationship with the victim.

An example of social engineering could be someone

pretending to be from your bank calling you late in the evening and asking for your authorisation in relation to a transaction of $2000 for the purchase of a digital camera in Israel. You are obviously shocked at the news having not been to Israel before, let alone bought a digital camera! The caller reassures you by telling you that they can reverse the unauthorised transaction

by you simply confirming your name and

and replaced legitimate EFTPOS machines

The email includes a link to an online

entering your credit card number and

with compromised card-skimming versions

form, which requests the recipient supply

expiry date into the phone. Many people

of the device. It has been estimated that in

personal details, which are then used by

in the spur of the moment will succumb

NSW only the scam netted over $50 million

the malicious sender to steal the victim’s

to such a request. Don’t be fooled, be

in 12 months.7

identity and commit more serious crimes.

suspicious. The best advice in this case is

Social engineering attackers also make

So, to be safe, never open or reply to

always to tell the caller that you will call

use of email. These so-called ‘phishing

suspicious emails but rather contact the

your bank directly to verify.

emails’ are fraudulent messages sent

credit institution or government agency via


by someone pretending to be a trusted

phone to verify that the message received

engineering, known as baiting, occurs when

source, with the objective of tricking

is genuine.

hackers strategically drop some kinds of

the recipient into revealing confidential

media in conspicuous places, such as a USB

information. The most common appear

engineering is training and awareness.

key containing malware. A passer-by will

to be sent by credit institutions asking

A medical practice should have in place

soon spot it and pick it up. Not knowing it

the recipient to change an online banking

strong policies that all employees are

is a virus-infected device, the curious finder

password. The email provides a link, which

familiar with. Staff should be aware of the

will use it on their work or home computer.

once clicked-on connects the recipient to

risks posed by social engineering tactics. If

Some computers are set-up to auto-run

a fake website resembling the real one.

they suspect that they have been subjected

inserted media, in which case the computer

Once the recipients log on to the website,

to this kind of attack, they should be

will immediately be infected.

their credentials are collected and the

encouraged to immediately report it to the

perpetrator can later use them to steal

Practice Manager.




An example of a recent and very





money from the victim’s bank accounts.

involved a few major cities in Australia.

One of the most recent examples of

People pretending to be technicians sent

‘phishing emails’ is one that claims to be

8,9 HalfTaxation Page 180 x 120 by the bank visited various retailHealthLink/Medinexus outlets from the Australian Office.






References References are available online at the

Puse IT website: Mag Pulse+IT

connecting healthcare

36 Pulse+IT

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Internet Backup for medical practices Simon James

BIT, BComm Editor, Pulse+IT


computer to be backed up (usually the practice server),

The importance of performing daily backups of clinical

the user specifies the files they wish to backup and

data is well understood by medical practices and larger

schedules the times of day they wish these backups to

healthcare organisations.


The devastation that befell a number of such

Internet backup solutions are typically configured

organisations as a result of the recent Australian

to backup files on a computer system incrementally.

floods and the tragic Christchurch earthquake serves

This means that only files that have been modified

as a telling reminder for the need for robust, off-site

since the last backup occurred are copied to the remote

backup procedures to be in place. However, reflecting

facility, reducing the time a backup takes to execute. To

on the sheer scale of the recent natural disasters, what

optimise this incremental process even further, some

a business defines as ‘off-site’ needs to be carefully

solutions use sophisticated “block level technology”.

considered. Any entrenched perceptions that the

This technology is designed to detect and upload the

separation of a backup from the original data by a few

discrete parts of large files that have been modified

kilometres is adequate must surely be challenged in

since the last backup, negating the need for the entire

light of recent events.

file to be re-uploaded.

Fortunately, ongoing improvements to Internet

The first time an Internet backup is performed, all

infrastructure now afford medical practices the ability

the data the user wants to protect must be uploaded

to mitigate the chance of total and catastrophic data

to establish a baseline for subsequent incremental

loss occurring by leveraging the distributed nature of

backups. Depending on the speed of the practice’s

the Internet.

Internet connection and the amount of data, this

How does Internet Backup work?

may take hours, days or even weeks! However after this first upload has completed, subsequent backups

Backups in most medical practices are currently

occur in a much more timely fashion. To be considered

achieved through the utilisation of CDs, DVDs,

a viable backup solution, ongoing backups need to

tapes, USB thumb drives, external hard drives, or a

be achievable in a matter of 24 hours at most, or the

combination of these technologies. Internet backup

timeliness of the most recent backup will degrade

solutions retain the same principles of redundancy,

to the point where unacceptable levels of data loss

however instead of utilising a local storage device,

will occur in the event of deletion or corruption of the

practice data is transferred across the Internet, usually

original data.

to purpose-built data facilities with redundant capacity

spread across multiple cities, and potentially across the

listing the files that were backed up and the length of


time it took to perform the transfer. This log file should

While there are a vast array of companies offering

be monitored at frequent intervals to ensure that the

Internet backup services, from the users’ perspective

backup is being performed reliably. Emails can be sent

they work in much the same way as described below.

by most backup software at regular intervals to assist

in this monitoring process.

Following the installation of some software on the

As backups are performed, reports are generated

As with all backup systems, frequent audits of the

Author Info

backed up data need to occur to ensure that what is Simon James is the editor of Pulse+IT, Australia’s highest circulating health publication of any kind. Prior to founding the publication in 2006 he worked in the statistics division of a clinical research organisation, in an IT support capacity for various medical practices, for a clinical software developer, and subsequently for a secure clinical messaging developer.

diligently being backed up can successfully be restored.

Is Internet backup secure? Before transferring your practice data to a remote backup site, it is important that it is encrypted to prevent third parties intercepting the data whilst it is

38 Pulse+IT

in transit and when stored on the remote server. Encryption is a feature of all popular Internet backup solutions, however the

quota to avoid excess data charges or

backup solutions a viable option for many

bandwidth throttling.

medical centres, and one that can provide

• The





enhanced protection for patient data.

sensitive nature of medical records dictates

Internet data charges associated with

While few practices are in a position to

that practices need to ensure they are

restoring a backup in the event of data

move to using the Internet as their only

properly informed about the type of access

loss should be calculated and assessed

backup medium, a far greater number

the service provider themselves may have

for viability.

will find Internet Backup solutions to be a

to such data — clearly this needs to be

• The time it will take to upload a single

none! The privacy policies of the provider

day’s worth of new data is important.

worthwhile complement to their existing

should be examined, as should the relevant

Practices with large clinical databases

laws of the country or countries in which

may need to consider performing

Read more online

the provider locates their data centres.

weekly uploads, complemented by

A comprehensive, expanded version of

backup arrangements.

their existing daily backup procedures.

this article is available online. Readers

• The number of days of “roll back”

are invited to discuss this article and ask

Despite the convenience and additional

provided by the Internet backup

questions of the author at the Pulse+IT

data protection Internet Backup services

solution provider should allow the


provide, there are several factors that

practice to restore a data “snap shot”

practices should consider before adopting

from any period in history.


such a solution:

Webinar Pulse+IT will host a free webinar in April


• Practices need to ensure their Internet

to elaborate on the themes presented in

Service Provider does not count

The increasing availability of cheap, fast,

this article. For more information and to

uploaded data toward their monthly

reliable Internet access has made Internet

register, visit:

Multiple Video Source Billing Scheduling

Letters HL7

Secure Workflow



Robust Clinical coding

Tasks Lists



Instant Messaging

Endoscopy Claim management



General Practice



“Liszt” - Live Video








Multi disciplinary


Day Surgery



Endoscopy Machines Integrated DRG Grouper

Access Control

medical management software

Paperless Electronic Records

Waitroom Reliability





Dashboards and Workbench

Still Images




Surgical Audit



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web  email 

phone  +61 7 3252 2425  skype

Pulse+IT 39


“First do no harm” – Clinical Safety Management in e-health Janette Bennett

MSc, CITP, MBCS, BSc Hons, PgCM, RN Clinical Director (Asia Pacific) BT Health

Martin Ellis

Patient Safety Director BT Health

Whilst rare, it is an unfortunate fact of life that the very

shift their focus on standardisation to enable safer

health services that the public rely on to make them

integration services.

better can end up causing them harm.

Errors in medication management, incorrect or

sparked urgent debate in the international health

‘wrong-side’ surgery and hospital acquired infection

informatics community about how best to control

can all contribute to patient mortality and morbidity.

the risks of harm associated with introducing new

No wonder then that patient safety management

technology. Those responsible for procuring and

is becoming such a high priority for the boards of

implementing healthcare IT are also considering their

healthcare organisations. However, to date much of this

options for managing the associated clinical risks.

has been focussed on traditional “Quality and Safety”

areas such as falls, wound infections, medication

international standards specifically addressing the

misadventure, etc and does not include an Information

management of patient safety associated with the

Technology (IT) clinical safety management function.

development and deployment of health software.

Events and the anxieties of standards bodies have

It is globally recognised that there are no

IT is often introduced as a frequent and powerful

Attempts to address this materialised in the form

component of providers’ strategies to reduce clinical

of the introduction of the following two draft ISO

risks, but this presents a paradox. IT also has the

standards accepted for joint work under the Vienna

potential to introduce new hazards for patients:

agreement between ISO/TC215 and CEN/TC251. BT

electronic drug charts, for example, may not be

through its work with and requirements of the NHS,

available on an organisation-wide basis, or electronic

in combination with experience in digital hospitals and

health records may fail to correctly display critical

shared electronic records in the UK and elsewhere,

clinical information for individual patients .

was a significant participant and contributor in the

development of these two draft standards:


With the progressive integration of IT within

healthcare there is further potential to introduce new

• ISO/DTS 29321 — Health Informatics: Application

causes for harm to patients through the increased

of risk management to the manufacture of health

use of networks, mixing of medical and non-medical applications, as well as some poor software design

software. • ISO/DTR 29322 — Health Informatics: Guidance

and the threat of virus2 and malicious attacks. Some

on risk evaluation and management in the

standards bodies are calling for greater controls.

deployment and use of health software.

For example, the British Standards Institute3 has

recommended that manufacturers and departments

the joint working group but have since been adopted

need to stop on-site informal design and adaptation

by the NHS Information Standards Board as DSCN

of medical software, and that regulators need to

14:2009 and DSCN 18:2009.

These two draft standards were later withdrawn by

On a more unified international front things

Author Info

are still progressing rapidly. In October 2010 a new international standard, ISO/IEC 80001-1: Application Janette Bennett is the Clinical Director, Asia Pacific, BT Health and Martin Ellis is Patient Safety Director, BT Health.

of risk management for IT-networks incorporating medical devices was approved. This standard is aimed at healthcare organisations, ensuring that they assess the risks associated with integrating a medical device into a health IT network, and relies upon medical

40 Pulse+IT

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NEAUST0055_185x125mm_PULSE.indd 1

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Pulse+IT 41

device manufacturers and IT suppliers

• Review Service Incidents and update

methodologies, together with a quality

having already conducted safety work

the Hazard Register with the relevant


prior to bringing their product to market. In


9001:2000. Additionally, the assumption





addition, some countries have addressed

Sentry is a robust clinical safety

is that other work streams will conform

the issue in different ways, in some cases

management system built on safety

to the appropriate standards in their area,

by extending the scope of medical device

management principles adopted from

e.g. Service Management with ISO/IEC

regulations. In ensuring BT is globally

other industries in which managing

20000 and Information Security with ISO/

compliant, BT Health has in place a clinical

risk is critical (for example aviation and

IEC 27000.

management system, Sentry, which has

nuclear engineering) and adapted to the

primarily adopted from:

healthcare IT environment by clinicians

work in e-health is taking place in the

• IEC 61508 — Functional safety of

and safety engineers. In working with

northern hemisphere and globally the

electrical, electronic, programmable

ISO on the standard, BT has ensured it

standards journey is still in its infancy, the

electronic safety related systems

is fully cognisant of the intended global

southern hemisphere cannot ignore the

implementation of ISO/IEC 80001.

implications. It is not just software vendors

Application of risk management to

A strong clinical safety management

and systems integrators that will be

medical devices

system must contain a set of policies

required to adopt and inform the evolving

and procedures that aligns with the IT

standards. The organisational impact



within healthcare organisations has yet to

• ISO 14971:2007 — Medical Devices —

• ISO/TS 23258 — Classification of Risks from Health Informatics products • ISO/TR 27809:2007 — Health








risk management activities conducted

be fully realised, but will be both necessary

Informatics — Measures for ensuring

and documented at key stages in the

and significant to ensure that their own

patient safety of health software


e-health programmes also “first do no

All of the standards call for a

and in-life phases. This wraparound

systematic process to be in place that

assurance ensures that adherence to the

looks at:

safety process and verification of safety


• Identifying clinical hazards in the

requirements is evidenced throughout the


design phase • Identifying what controls are currently in place




complete lifecycle of a product/service.


The integrated approach culminates in


the development of a formal clinical safety


• Designing in new controls

case for each release of a healthcare IT


• Testing that the controls work


• Manage issues arising

• Present findings/evidence to the

safety management system cannot stand

Faraday House, 6 Hills Way,

alone. Sentry is dependent upon a project

Stevenage, Herts, UK

Customer • Residual Risk as low as reasonably practicable

However, to be effective a clinical

being managed using appropriate project management and software development

hospitals.html 3. Sensible Standards, IET, Michael

4. greekmedicine/f/HippocraticOath.htm

42 Pulse+IT

Advantech Australia AAPM

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

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 dripproof enclosures. Advantech offers long term support and a proven track record of reliability. The medical range extends through: • Point-of-Care Terminals. • Mini-PC and Medical Imaging Displays. • Mobile Medical Tablets. • Patient Infotainment Terminals. Advantech is also an official distributor of Microsoft Windows Embedded software across Australia & New Zealand.

P: +61 3 5335 2220 F: +61 3 5335 2211 E: W:

P: +61 412 746 457 F: +61 3 9569 9449 E: W:

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.

P: 1300 720 274 F: 1300 364 008 E: W:

Best Practice

P: +61 7 4155 8800 F: +61 7 4153 2093 E: W: Best Practice sets the standard for GP clinical software in Australia offering a flexible suite of products designed for the busy GP practice, including: • Best Practice Clinical (“drop-in” replacement for MD) • Integrated Best Practice (clinical/ management) • Top Pocket (PDA companion software for Pocket PC)

Cerner Corporation Pty Limited P: +61 2 9900 4800 F: +61 2 9900 4990 E: W:


Australasian College of Health Informatics

CH2 (Clifford Hallam Healthcare)

P: 1300 308 531 F: +61 3 9797 0199 E: W:

Argus provides and supports Argus secure messaging software that enables doctors and healthcare organisations to exchange clinical documents securely and reliably. Argus can be used to send specialist reports to referring doctors but it can also exchange pathology and radiology reports, hospital discharge summaries and notification between healthcare providers. Healthcare practitioners can use any of the popular clinical software packages to send reports and other clinical correspondence via Argus. Argus is the messaging solution chosen by 65 Divisions of General Practice across Australia through the ARGUS AFFINITY program.

ACHI is committed to quality, standards and ethical practice in the Health Informatics profession. More information is available at: Join the ACHI Info email list at:

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

Clifford Hallam Healthcare (CH2) is today Australia’s largest pharmaceutical and medical healthcare service provider with a catalogue of over 15,000 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. In 2009 CH2 won the ASCLA Information Management Award and are gold sponsors for the ASCLA Awards 2010.

Pulse+IT 43


Cutting Edge Software Communicare Systems

P: +61 8 6212 6900 F: +61 8 6212 6980 E: W: Established in 1994, Communicare Systems have built an enviable reputation for delivering results, supported by excellent service based on mutual respect, mutual trust and mutual benefit. Communicare is the electronic medical records and practice management system of choice for Aboriginal Health Services employing multidisciplinary holistic healthcare, featuring: • Ease of use for all providers • Shared electronic health records • Standards based electronic messaging • Comprehensive easy to use automated reporting • Scalable from small service to multi organisational enterprise • Multi axial security and access logging

Computer Initiatives

P: 1300 85 39 39 (Melbourne) P: 1300 85 39 85 (Brisbane / GC) E: W: Computer Initiatives has been supporting the medical profession for over 15 years. Providing IT consultancy services, quality hardware, professional support with qualified engineers. Recommended and preferred by a number of Divisions of General Practice and specialist software providers we: • Supply and install of hardware/ software and peripherals • Implement disaster recovery and replication plans • Remote monitoring and diagnosis • Advanced networking deployment and support • Prompt and competitive support • Internet configurations and content filtering services • Security audits, configurations and monitoring • Regular maintenance services • Microsoft Gold Partner and a Microsoft Small Business Specialist

44 Pulse+IT

P: 1300 237 638 F: +61 3 9787 8210 E: W: Cutting Edge produces affordable, intuitive billing solutions for Mac, Windows, Linux and iPad. Cutting Edge is ideal for practitioners who prefer to maintain control of their own billing from a number of sites. Cutting Edge Software is approved by Medicare Australia to manage your electronic: • Verification of Medicare and Fund membership • Bulk Bill and Medicare claims • DVA paperless claims • Inpatient claims to Health Funds We have solutions tailor-made for • Anaesthetists • Surgeons/Surgical Assistants • Physicians • GPs • Allied Health The software comes with up-to-date schedules for MBS/Rebate, Gap Cover (all registered health funds), Workers’ Compensation, Transport Accident authorities and DVA.

Direct Control

P: 1300 557 550 F: +61 7 5478 5520 E: W: 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.

P: 1300 237 638 F: +61 3 9787 8210 E: W:

Digital Medical Systems P: +61 3 9753 3677 F: +61 3 9753 3049 E: W:

Easier ICT is a technology partnership with DMS — we make I.T. work for you. DIGITAL MEDICAL SYSTEMS has provided ICT solutions and services to medical practice clients across Australia since 1990. We have specialist expertise and experience in the installation and support of leading medical software applications. DMS is a Business Partner for IBM, Lenovo, HP and Microsoft. Other leading ICT brands include Trend Micro, Symantec, CA, Cisco, Toshiba, Canon, Epson, Kyocera, Fujitsu and Brother. Accreditation is easier with the customised DMS IT Systems Documentation. Ensure your practice has the best quality IT policy, security and maintenance program that meets and exceeds the standards guidelines from the RACGP and AGPAL and GPA. World leading DTech provides 24x7 near Real-Time Monitoring and Management that alerts and enables our engineers to quickly troubleshoot and solve problems of security, network, Internet, Server and software remotely on almost any client computer system or device. Medical IT systems are automatically maintained by DTech to the most highly available status to minimize downtime by preventing problems from occurring or reducing their impact. Proactive, Flexible, Consistent, Reliable, Audited, and Affordable — for even the smallest practice. Call DMS for: • Systems Analysis & Consulting • Solutions Design • Procurement & supply of hardware, software, network and peripheral products • Installation & Configuration • Support Services inc Help Desk • DTech Monitoring, Maintenance & Management • Disaster Recovery solutions • Fully managed & automated Online Backup customised for clinical data Easier IT — we make I.T. work for you.

DoctorBill is a simple and secure way for doctors to accept online payments through a single portal without the need to setup a website. You can accept direct deposits, credit card via PayPal® or your existing Merchant Facility if you have one. All of the available payment methods are secure and can be used with confidence. We provide you with a customised website address to put on your stationery which directs your patients to your practice’s DoctorBill page. For an example of what patients will see when using the service, visit: If you already have a website, you can easily place a link to direct patients to the page. Patients receive a receipt and your practice is advised by email when payments are made. Setting up DoctorBill for your practice is easy and affordable, and transactions cost just 90 cents each (excluding bank fees).

eHealth Education Pty Ltd

P: +61 3 9653 9433 F: +61 3 9653 9307 E: W: • The Registered Training Organisation specialising in quality Health Informatics education provided by senior, education qualified HI professionals. Educational programs are designed to up-skill clinicians, technical staff, consumers and administrators in healthcare. • Delivery options include focused workshops, single subject courses or fully integrated programs delivered face to face or online through our extensive and quality assured online education delivery infrastructure. • Servicing professional and education organisations, we also aim to support professional and healthcare education providers. You can deliver your material using EHE infrastructure, or we can help you develop and/or deliver quality educational material.

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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.

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GE Healthcare is a $17 billion business of General Electric Co. and provides a broad portfolio of healthcare technologies and services. GE Healthcare’s ‘Healthymagination’ initiative is a $6 billion commitment to improve healthcare through innovation - reducing costs, improving quality and expanding access for millions of people. A leader in solutions for the entire healthcare enterprise. GE Healthcare has extensive global experience in successful ehealth implementations and offers a broad ehealth solution portfolio including Personal Health Manager, Provider Portal, Master Patient Index and Health Information Exchange Solutions. GE Healthcare also provides the Centricity® suite of integrated information technology for enterprise hospital information systems and specialist clinical information solutions, for theatre, anaesthesia, intensive care, cardiovascular, radiology and maternity.

Extensia Emerging Health Solutions P: 02 8853 4700 F: 02 9659 9366 E: W:

Emerging Health Solutions (EHS) is a web-based Clinical Information System for hospitals that is patientcentric capturing and providing appropriate, timely, clinical information in a secure and auditable environment. to assist clinicians deliver effective, quality care. Our prestigious clients include St Vincents & Mater Health Sydney and the Government of South Australia Department of Health. EHS has integrated Sabacare’s Clinical Care Classifiaction (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.

P: +61 3 9675 0600 F: +61 3 9675 0699 E: W: Global Health is a premier provider of technology software solutions that connect clinicians and consumers across the healthcare industry. ReferralNet Messaging is a secure message delivery system for sending healthcare information efficiently to industry professionals. MHAGIC is the most comprehensive mental health electronic medical record (EMR) system in Australia. MasterCare EMR is an electronic medical record system for specialists and allied health professionals. Locum is a clinical information management system for GPs.


P: +61 7 3292 0222 F: +61 7 3292 0221 E: W: Extensia links healthcare providers, consumers and their communities to deliver better and more efficient health care outcomes. 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, then the most relevant providers, services and products are presented instantly and referral documents are created automatically and sent electronically.

Global Health

P: 1800 188 088 F: 1800 644 807 E: W:

Genie Solutions

P: +61 7 3870 4085 F: +61 7 3870 4462 E: W:

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

Genie is a fully integrated appointments, billing and clinical management package for Specialists and GPs. Genie runs on both Windows and Mac OS X, or a combination of both. With over 2000 sites, it is now the number one choice of Australian specialists.

Pulse+IT 45


P: +61 8 8203 0500 E: W:

Health Communication Network P: +61 2 9906 6633 F: +61 2 9906 8910 E: W:

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

HealthSolve provides Care Management systems for aged, acute, and community care that can be shared across all health care sectors.

Health Informatics New Zealand E: W:

Health Informatics New Zealand (HINZ) is a national, not-for-profit organisation whose focus is to facilitate improvements in business processes and patient care in the health sector through the application of appropriate information technologies. HINZ acts as a single portal for the collection and dissemination of information about the New Zealand Health Informatics Industry. Membership is for anyone who has an interest in health and informatics.

Health Informatics Society of Australia

Health Information Management Association Australia P: +61 2 9887 5001 F: +61 2 9887 5895 E: W:

The Health Information Management Association of Australia (HIMAA) is the peak professional body of Health Information Managers in Australia. HIMAA aims to support and promote the profession of health information management. HIMAA is also a Registered Training Organisation conducting, by distance education, “industry standard” training courses in Medical Terminology and ICD-10-AM, ACHI and ACS clinical coding.

P: +61 3 9388 0555 F: +61 3 9388 2086 E: W:


P: +61 7 5665 7995 F: +61 7 5502 6543 E: W: HealthEasy is a 100 percent web‑based “Cloud Computing” solution as used by leading Web 2.0 apps like BaseCamp and SalesForce. • • • • • •

No hardware upgrades No local Server needed No manual software upgrades No local backups required No contracts (pay monthly) Runs on Windows, Mac & Linux

eHealth Initiatives Support: • Electronic Prescribing (eRX) • Personal Health Record (IEHR) • Unique Health ID (UHI) Built using Open Source tools with source code available. We invite expressions of interest from all sectors of the industry.

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.


P: 1800 125 036 (AU) P: 0800 288 887 (NZ) E: W: Australia’s and New Zealand’s largest effective secure communication network. • Fully integrated with leading GP and Specialist clinical systems • Robust; Reliable and Fully Supported Join the network that more than 70 percent of GPs use for diagnostic, specialist and hospital communications.

Features: • Web-based. • Flexible, dynamic, and highly configurable. • Mirror your specific work flow and document style. • Resident/client centric with a focus on the whole “journey.” • Brings together administration, staff, providers, and facilities.

Houston Medical

P: 1800 420 066 or +61 2 9669 1844 P: 0800 401 111 or +64 7 834 9354 F: +61 2 9669 1791 E: W: INTEGRATION ACROSS THE PRACTICE Houston Medical delivers one streamlined system integrating medical equipment with financial, claiming and administrative areas that works reliably and securely for small practices through to large multi‑disciplinary practices. GREATER ROI for medical specialists and VIP Allied for General practice/Allied Health delivers great ROI through smoother workflow, improved data quality, boosted productivity and reduced costs. FLEXIBLE Individually configurable, Houston’s systems support you in the way you work and deliver better results. TRUSTED Houston delivers software that you can trust - built on 20 years experience and used by many hundreds of leading practices across Australasia and beyond. Our first customer is still a customer.

Demonstrations available under NDA due to late 2010 release.

46 Pulse+IT


P: +61 2 9380 7111 F: +61 2 9380 7121 E: W: InterSystems Corporation is the worldwide leader in software for connected healthcare. With headquarters in Cambridge, Massachusetts, and offices in 24 countries, InterSystems provides advanced software technologies for breakthrough applications. InterSystems TrakCare™ is a Web‑based healthcare information system that rapidly delivers the benefits of an Electronic Patient Record. InterSystems CACHÉ® is a high performance object database that makes applications faster and more scalable. InterSystems Ensemble® is a seamless platform for integration and the development of connectable applications. InterSystems HealthShare™ is a platform that enables the fastest creation of an Electronic Health Record for regional or national health information exchange. InterSystems DeepSee™ is software that makes it possible to embed real-time business intelligence in transactional applications.


P: +61 2 8251 6700 F: +61 2 8251 6801 E: W: 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.

JOSE & Associates

P: +61 3 9850 1350 F: 1300 889 012 E: W: JOSE and Associates – IT Management and Support for Medical Practices • Complete IT support for medical practices: • Support for most clinical and practice management software àà Support for all network topology àà Dedicated help desk àà 24/7 support - response in most cases is immediate • New practice installation • Server maintenance on a monthly basis which includes full monthly reporting • Satisfying IT accreditation standards • Data conversions • Disaster recovery and business continuity plans – monthly data restores • Australia Wide coverage • References available on request

Jam Software ISN Solutions

P: 1300 300 471 F: +61 2 9280 2665 E: W: ISN Solutions is a medical IT company that specialises in the design, setup and maintenance of computer networks for medical practices. Our consultants and engineers are dedicated to the medical industry, understand your business needs and know what is required to run a practice. We strive to take away the pain from you, on managing the day to day IT issues regardless of which medical application you use. Our claim is supported by strong industry references. Some of our solutions include but are not limited to: • A paperless practice • Speech Recognition • Capped cost medical support & maintenance plan • Ability to consult remotely • Linking your imaging equipment to your network • Medical application Support

With the increase in government e-health initiatives, the MSIA has become increasingly active in representing the interests of all healthcare software providers. The MSIA is represented on a range of forums, working groups and committees on behalf of its members, and has negotiated a range of important changes with government and other stakeholders to benefit industry and their customers. It has built a considerable profile with Government and is now acknowledged as the official ‘voice’ for the industry. Join over 100 other companies across all areas of medical IT/IM so your voice can be heard.

P: +61 2 9901 6400 F: +61 2 9439 6331 E: W:

MED™4i (Medical Electronic Desktop™) streamlines Health Care with easy-to-use customisable interfaces. Modular Versatility & Connectivity backed by friendly expert engineers.


Comprehensive Patient database with multiple-format billing including electronic Online Patient Verifications & Claiming to Medicare, DVA & Health funds (paperless), Letters, Prescriptions (including MIMS), Orders, e-Results, MS Office integration & CustomDB including surgical & other audits. Now with HL7 Secure Messaging.

Medical-Objects has provided secure messaging to over 10,500 health professionals with referrals, reports, letters and discharge summaries. Delivering directly into leading practice software, removing the need for scanning and faxing.

P: +61 427 844 645 E: E: W:

MEDITECH Australia

P: +61 2 9799 1888 F: +61 2 9799 4042 E: W:

Your specific needs can be accommodated easily, onsite & remote installation, training, ongoing support including upgrades to meet the ever‑changing health requirements.

Medical Software Industry Association

P: +61 7 5456 6000 F: +61 7 3221 0220 E: W:

Referrals are digitally signed and encrypted, moreover, compatible with Medicare’s requirements and in line with NEHTA’s eHealth PIP direction. Using Medicare supported PKI, you can trust that referrals are digitally signed with PKI and we are working with NEHTA as an eHealth PIP eligible secure messaging vendor.

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

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MIMS Australia


P: +61 2 9902 7700 F: +61 2 9902 7701 E: W:

P: +61 2 8298 2600 F: +61 2 8298 2666 E: W:

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.

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.

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.

Nuance Communications

Mouse Soft Australia Pty Ltd

P: +61 3 9888 2555 F: +61 3 9888 1752 E: W: 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. Feature Rich. Dynamic. Innovative.

48 Pulse+IT

Software of Excellence

Pen Computer Systems

P: +61 3 8872 5500 F: +61 3 8872 5524 E: W:

P: +61 2 9635 8955 F: +61 2 9635 8966 E: W:

Developed in Australia by the leading practice management provider in the Dental Market, OASiS Software has now released OASiS Health. Already used by Medical Specialists, Physiotherapists, Chiropractors, Podiatrists, Physiologists and a variety of other Allied Health Professionals.

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.

With full appointment book and clinical functionality, many customers have used OASiS Health to create the paperless practice by taking advantage of OASiS Health powerful document and image handling features.

P: 1300 550 716 F: +61 2 9434 2301 E: W:

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).

Described as the most flexible practice management system available, OASiS Health specialises in Multi-Branch, Multi-Practitioner and Multi-Discipline practices. OASiS Health is designed to create a Healthy, Profitable business.

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

P: +61 2 8096 0000 / +64 9 638 0600 F: +61 2 8096 0001 / +64 9 638 0699 E: W: 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 cross‑organisational and regional sharing of patient information, resulting in improved patient care. Orion Health Patient Portal enables patients to access their personal medical record, request appointments, and communicate with their care providers. 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.


from Practice Services P/L

P: +61 3 9819 0700 F: +61 3 9819 0705 E: W: 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

Pulse+ IT Pulse Magazine

P: +61 2 8006 5185 / +64 9 889 3185 F: +61 2 9475 0029 E: W: Pulse Magazine is the publisher of Pulse+IT, Australia’s first and only Health IT magazine. Pulse+IT is distributed to all corners of the health sector and is enjoyed by General Practitioners, Specialists, Practice Managers, Hospital and Aged Care decision makers, Health Informaticians, Health Information Managers and Health IT industry participants. Having grown rapidly from its launch circulation of 10,000 copies in August 2006, Pulse+IT’s current bi-monthly distribution of 37,000 printed copies ranks it as Australia’s highest circulating health publication of any kind. In addition to printed magazines, Pulse+IT offers a number of digital products including a weekly eNewsletter service, Twitter and RSS feeds, an online events calendar, and SR Logo_65x42mm.pdf an interactive website.

The Specialist

P: +61 8 8203 0500 E: W: “The Specialist” is an intuitive and comprehensive tool that allows management of patients within specialist medical practices and day surgeries. The Specialist includes 5 modules: • Accounting • Correspondence • Time Manager • Medical Records • Mobile Data Facility Key features: • Runs on both Macintosh™ and Windows™ platforms. • Scales easily from stand-alone users, to multi-site networks. • Industry standard, and readily interoperable with other systems. • Comprehensive data migration tools for most systems. • Unlimited training and support. • Designed with the future in mind. 20/02/09


Stat Health Systems (Aust)

P: +61 7 3121 6550 F: +61 7 3219 7510 E: W: 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.

Real Outcomes Real Productivity Minimising Waste


P: +61 2 8014 4573 E: W:









SmartRooms by Doctorware P: +61 3 9499 4622 F: +61 3 9499 1397 E: W:

SmartRooms provides a comprehensive software solution for specialist practices for both Mac and Windows. Comprising both practice management and clinical software, our all-in-one patient record and superior after-sales support provides the basis for a stable and time effective software solution for specialist practices of all sizes.

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 and click the Free Trial tab.

SmartRooms is available in an appointments and billing-only version for practices with uncomplicated software needs.

Vensa Health

P: +64 9 522 9522 F: +64 9 522 9523 E: W: 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.

Trend Care Systems

P: +61 7 3390 5399 F: +61 7 3390 7599 E: W: 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.


P: +61 3 9284 3300 F: +61 3 9284 3399 E: W: 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:

Pulse+IT 49

Kelvin’s eHealth Journey



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.


GP consultation


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.


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.


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 For more information about eHealth including the Healthcare Identifier (HI) Service visit

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 Magazine - March 2011  

Pulse+IT Magazine - March 2011 - Australasias first and only eHealth and Health IT magazine