Page 1

Australia’s First and Only Health IT Magazine




17 2010

Decision Support A Little History: Observe the continued evolution of decision support in Australia. Collaborative Care: Enhanced systems are needed to support the care of patients by multiple providers. Managing Risk: Properly integrated decision support is essential to mitigate adverse drug events. A Standards Based Approach: What impact will emerging decision support standards have on clinical software? SNOMED CT Software to ease the transition to Australia’s preferred clinical terminology. Staff Capacity Planning: Technology can assist organisations to optimally manage staff levels.

08 26 28 48 50

Health Informatics workforce MSIA: Decision Support in GP software NEHTA: Supply chain reform Healthcare Identifier legislation Reviewing your Internet arrangements

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. - Abaki Pty Ltd

- Healthways Inc

- MMex

- Access GP

- Houston Medical Australia

- Mouse Soft

- Alcidion

- Incisive Medical Systems

- National Prescibing Service

- Ambulance Victoria

- InterSystems

- NIB Health Funds Ltd

- Australian Sports Anti-Doping Authority

- International SOS (Australasia)

- Pen Computer Systems

- Best Practice Software

- Intrahealth Systems

- iSoft Group • Hatrix - charmhealth • Patient Safety - CompuDoc Medical Pty Ltd International - Deltra Pty Ltd - Practice Pro • Practix • Monet - DoctorWare Australia • Classic - DrsDesk Software • ePharmacy - CDC Systems

- Episoft

- Jam Software

- Equipoise International

- Lane Cove General Practice

- Genie Solutions

- Manrex Pty Ltd Webstercare

- Global Health - Gollmann Bouw - Health Track Medical Systems

- Mater Public Hospital - MediFlex Pty Ltd - Medical Objects

- HealthCare Software

- Mednetwork Systems

- Healthpoint Technologies

- Medtech 32

- Healthsoft Australia

- Merck Sharp and Dohme

- Pharmacy Computer Solutions - PractiCare Pty Ltd - Practice Management Software Company - Promadis - Promedicus - Queensland Emergency Services - Queensland Eye Insitute - Queensland Government - Software for Specialists - Sydney Adventist Hospital - System Partners - Telethon Institute for Child Health Research - Western Australia Police - Zedmed Pty Ltd

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


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

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

Pages 12 - 17, 26, 32 - 43 DECISION SUPPORT This edition of Pulse+IT includes two guest editorials, one organisational contribution, and four feature articles relating to Decision Support.

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About Pulse+IT Pulse+IT is Australia’s first and only Health IT magazine. With an international distribution exceeding 44,000 copies, Pulse+IT is also Australasia’s highest circulating health publication of any kind. 32,000 copies of Pulse+IT are distributed to GPs, specialists, practice managers and the IT professionals that support them. In addition, over 12,000 copies of Pulse+IT are distributed to health information managers, health informaticians, and IT decision makers in hospitals, day surgeries and aged care facilities.

ISSN: 1835-1522 Contributors Danny Brayan, Nick Burns, David Hansen, Jon Hilton, Simon James, John Johnston, Michael Lawley, Renai LeMay, A/Prof Keith Lui, Dr Andrew Magennis, Dr Andrew McIntyre, Dr Peter Scott, Jennifer Tetstall and Mark Worsman.

Looking ahead The next three editions of Pulse+IT will feature a selection of articles on the following themes: • July 2010 - Secure Messaging and Electronic Prescribing • September 2010 - Telemedicine and Mobility • November 2010 - E-Health Infrastructure 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:

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 2010 Pulse Magazine No part of this publication may be reproduced, stored electronically or transmitted in any form by any means without the prior written permission of the Publisher.

Subscription Rates Please visit our website for more information about subscribing to Pulse+IT.

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






Off Topic

Page 06 STARTUP Editor Simon James introduces the 17th edition of Pulse+IT.

Page 32 FEATURE ARTICLE Danny Brayan overviews the importance of properly integrated decision support.

Page 48 HEALTHCARE IDENTIFIERS Mark Worsman and Jennifer Tetstall outline the Healthcare Identifiers Bill.

Page 36 FEATURE ARTICLE Dr Peter Scott and Dr Andrew McIntyre discuss standards based decision support technologies.

Page 50 INTERNET PLANS Simon James overviews the Internet connection options available to practices.

Page 08 GUEST EDITORIAL A/Prof Keith Lui overviews the fragmented landscape of health informatics skills and training. Page 12 GUEST EDITORIAL John Johnston details the continued evolution of decision support in Australia. Page 14 GUEST EDITORIAL Jon Hilton presents a wide-ranging article on collaborative care assisted by information technology.

Page 39 FEATURE ARTICLE Michael Lawley and David Hansen present technologies designed to aid SNOMED CT adoption. Page 42 FEATURE ARTICLE Nick Burns provides an insight into the benefits of computer-aided staff capacity planning.

Page 26 MSIA Dr Andrew Magennis recounts the early days of clinical software in Australia and outlines the status of decision support functionality in their modern day equivalents.


Page 28 NEHTA NEHTA discuss their National Product Catalogue work program.

Pages 53 - 58 MARKET PLACE The Pulse+IT Directory profiles Australia’s most innovative and influential e-health organisations.

Page 30 EVENTS CALENDAR Up and coming Health IT, Health, and IT events.

News Pages 18 - 19 GS1 and Deakin University partner on iPhone App for allergy sufferers NPS releases clinical software “prescribing features” study results Page 20 RACGP releases draft 4th edition Standards for general practices ACHI broadens its horizons Page 23 ArgusConnect commences rollout of version 5 secure messaging Pages 24 - 25 Secure Messaging Connectathon hosted by IHE in Canberra ITAC2010 coming to Melbourne


Pulse+IT: 2010.2 Simon James

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

Welcome to the 17th edition of Pulse+IT, Australia’s first

This edition

and only Health IT magazine and Australasia’s highest

This edition presents editorial contributions from

circulating health publication of any kind.

several of Australia’s Health IT software pioneers, all

As will already be apparent to return readers of the

of whom are still playing an active role in shaping the

publication, the interior of the magazine has received

present day e-health landscape. Included are a range

a visual refresh since our last edition was released in

of guest editorials and feature articles dealing with the


past, present and future of decision support, with a final

In short, the magazine now sports a more spacious

feature article shifting the focus from clinical decision

line height for improve readability, additional white

support to organisation decision support, namely into

space to reduce clutter, a colour convention to help

the domain of staff capacity planning.

better define the various sections of the publication,

and new fonts for the sake of the exercise.

health informatics workforce issues and Mark Worsman

A/Prof Keith Lui delivers a comprehensive article on

However more important than any single aesthetic

and Jennifer Tetstall overview the Healthcare Identifiers

upgrade is the way in which they have combined to

Bill, a piece of flawed yet still important legislation

provide us with a more flexible layout with which to

that is now in the hands of what promises to be a fairly

compile this and future editions of the publication.

turbulent parliament. The edition is rounded out with

Whereas historically it was typical for major editorial

an article designed to encourage practices to be aware

surgery to be needed to compress or expand articles to

of the cost and performance benefits reviewing their

match allocated page space, our new layout has already

Internet arrangements may deliver.

allowed us to start delivering articles much closer to the way our contributors envisaged them — the readership

Looking ahead

to be the ultimate beneficiary.

With a focus on “Secure Messaging and Electronic

Ongoing refinements are planned for future

Prescribing”, the July edition of Pulse+IT will examine the

editions and your feedback on this and all other aspects

state of play in both of these related areas, presenting a

of Pulse+IT is welcome throughout this process.

series of practical articles designed to assist individuals

Perhaps a more substantial development than the

and organisations to gain a better understanding of the

redesign is the fact that this edition is our most hefty to

possibilities, limitations, risks and costs associated with

date. With 60 pages cover to cover, the magazine is 12

such technology.

pages longer than our preceding edition and eight pages

longer than the publication’s typical format throughout

messaging and electronic prescribing continue despite

2009. The forthcoming July edition will be bigger again

largely unaddressed issues relating to clinical message

at 68 pages, a size that will facilitate a larger Bits&Bytes

standardisation, recent work conducted by NEHTA and

news section than the one allowed for by the available

the MSIA membership has the potential to rapidly shift

space in the magazine you are now reading.

the dynamics of the secure messaging, clinical software,

While rollouts and the uptake of both secure

and electronic prescribing markets. Clarification - In the March 2010 edition of Pulse+IT it was reported that the electronic prescribing service operated by eRx Script Exchange had received 7.5 million scripts “sent to the eRx script hub by prescribers” as of the middle of January. Omitted from the article was reference to a workflow that allows pharmacists to send repeat prescriptions to the hub for later retrieval by any pharmacist connected to the eRx system. The volume of transactions quoted in the March 2010 article included such scripts, in addition to scripts sent to the hub directly by prescribers.



As always, if you have any suggestions for future

articles, would like to contribute to an edition, or would simply like to discuss your experiences with e-health, don’t hesitate to get in touch.

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Health Informatics Workforce: the next big wave A/Prof Keith Lui

MBBS, GradDipIT, PhD The University of Western Australia

We hear much about the future of Australian and global

problems in healthcare. These individuals understand

healthcare in the age of health informatics and e-health:

the nature of healthcare and are not only armed with

There is evidence that electronic decision support

traditional skills in statistics and economics but develop


systems can improve the quality of health services.

new methods specific to the health domain that pure

Advances in telemedicine have allowed us to deliver

statisticians or economists may not come up with.

health to where we could not before. Daily, we struggle

In the United States of America, we are witnessing

with maintaining our knowledge of medical evidence

the formalisation of health (clinical) informatics as a

and look to electronic resources to provide assistance.

subâ&#x20AC;&#x2018;speciality for doctors2. Again, this is not surprising

Electronic messaging has improved communication

when we have medically-trained health administrators

between health providers. Around the world, national

and public health physicians who have combined

health reforms have indicated the need to improve

medical experience and knowledge and other areas

health information flow, analysis and processing. The

(management, governance, policy formation etc) to

health informatics wave is certainly upon us.

address issues in modern healthcare. Multidisciplinary

One area of discussion that does not get as much

health professions have emerged because the synergy

limelight, but is no less critical than the technical

created by interdisciplinary training addresses an

aspects of e-health, is the health informatics workforce.

employment gap not bridged by conventional workers.

To achieve the vision of integrated, high quality data,

The gap in health informatics is broad considering the

information and knowledge that fundamentally improve

ubiquitous nature of information in health; a health

patient outcomes requires a special workforce. We

informatics workforce should be versed in information

need a special workforce because the vision is complex

principles, technology and management, and how these

and requires knowledge, skills and attitudes from a

areas can be used to further healthcare. This implies,

variety of disciplines. Anecdotally, we see deficiencies

crucially, the workforce must understand health too.

of this workforce manifest as clinician frustration

over electronic information systems, information

informatics and health knowledge would be able to

technologist frustration over inexplicable clinical

improve health information processes better than

work practices and other professionals who cannot

those skilled in only one discipline e.g. the pure

understand each other. Other fields have experienced

information technologist or the pure clinician, there

similar issues; today we would not doubt the importance

are considerable problems that still need working out:

of biostatisticians and health economists because they

how many of them do we need, how should we increase

can apply statistical and economic methods to solve

numbers, how do we know whether we have the right

While it seems sensible that people armed with

people, what sort of skills should they have, who will

Author Info

determine such competencies? These nonâ&#x20AC;&#x2018;trivial Assistant Professor Keith Lui is an academic health informatician at the Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, a medical practitioner and Chair of the Western Australian Branch of the Health Informatics Society of Australia.

questions are international issues too3 and are the result of the evolution of health informatics over the last 50-60 years. Indeed, it has been this evolution that has made such questions hard to answer. Health data, information and knowledge are accessed and processed by all types of workers in healthcare e.g. pharmacist,



nurse, database administrator, librarian,

numbers,7 the Australian ratio is about one

coder, manager and executive. The health

health informatics worker to 40 health

informatics field has been shaped by more


traditional areas like librarianship, computer

or 1:50 if other sectors are included e.g.

science, management and medicine. It is

community, government administration,

not surprising that one of the barriers to

defence, education. American and English

people entering health informatics work is

predictions foresee shortages with their

its fragmentary nature.4 The vision of the

ratios given the health IT projects planned

health information specialist improving

in the near future e.g. electronic medical

healthcare processes is complicated by

record rollouts.6 From rough comparisons

the diverse nature of the work and of the

we can expect similar shortfalls, but we

people doing this work.

need more data on the health informatics

The answer to how many we need

roles that will support our Australian vision

is hampered by this health informatics

of healthcare. This means we need to know

diversity. The HISA workforce survey

what functions this future workforce needs

showed that there exist a wide range of

to fulfil.

job titles and responsibilities e.g. records





Central to the discussion on building


workforce is education and training.

communications and research and that only

Many of the workforce issues can be

59% of respondents identified as health

addressed by an educational framework

informaticians. Even the word processor I

approach. An education framework is a

used to write this editorial keeps flagging

beacon for standardising roles in health

informatician as a spelling mistake. We have

informatics and will better structure our

a problem with the coal-face definition of

workforce needs. We could, for example,

health informatics. Nevertheless, we have

define specialist streams in a generalist

been in a transition in which highly defined

health informatics qualification. A health

roles in information management have

informatics education standard provides a

morphed into the â&#x20AC;&#x153;health informaticianâ&#x20AC;?.

way of comparing different individuals and

We have seen, for instance, the medical

fitting the right person to the right role.

records officer become less of a clerk and

Education provides an objective means for

more of a medical record developer and

certification of basic knowledge and skill.

the medical librarian move into knowledge

Certification, in turn, paves the way for

management and evidence appraisal. We

health informatics professionalism, and a

can therefore expect further blurring of

sense of professionalism will address the

boundaries in health information roles and

remuneration and status problems that we

further confusion about what the health

have seen overseas.4 A solid educational

informatician does. We are only at the

framework is necessary evidence for

beginning in Australia of understanding

the recognition of health informatics as

what the workforce does currently and

an occupation. Without an educational/

what is required of it. In the US and

credentialing standard, anyone will be able

England, there is one health information

to call themselves a health informatician,

technologist for every 50 to 60 non-IT

including perhaps the person who installs

health workers. Based on the HISA survey

office software on the clinic computer or

and the 2006 AIHW health workforce

fixes the network but has no understanding





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of how health and information are intertwined. Whether

funded. The wave is nearly upon us, but our surfboards

we increase workforce numbers by recruitment,

are still at the repairer.

outsourcing or redistribution or retraining of current workers,5 educational qualification will be an important


benchmark against which to assess the suitability of

1. Garg A, Adhikari N, McDonald H, Rosas-Arellano


M, Devereaux P, Beyene J, et al. Effects of

The education requirements of a health informatics

computerized clinical decision support systems on

worker are the subject of ongoing international activity

practitioner performance and patient outcomes: a

e.g. the International Medical Informatics Association recommendations.3 The very closely related topic of

systematic review. JAMA 2005;293(10):1223-38. 2. Detmer D, Munger B, Lehman C. Clinical

professionalism is also being addressed e.g. UKCHIP.8 In

informatics board certification: history, current

Australia, we must bring health informatics education,

status, and predicted impact on the clinical

training and professionalism to the fore as much

informatics workforce. Applied Clinical Informatics

as healthcare identifiers and national broadband



3. Mantas J, Ammenwerth E, Demiris G, Hasman

We must decide on who will oversee quality

A, Haux R, Hersh W, et al. Recommendations of

control of the workforce. The far-reaching nature of

the International Medical Informatics Association

information and information technologies has lead

(IMIA) on education in biomedical and health

to organisations evolving separately under different

informatics. Methods of Information in Medicine

fields e.g. health records management, librarianship, computer science. Under what groups will education,

2010;49(2):105-20. 4. Eardley T. NHS informatics workforce survey,

training, professionalism and regulation occur: health


informatics groups, health information management

finalreport_20061120102537.pdf (accessed Mar

associations, computing and engineering societies, medical colleges, business management associations,

2010). 5. Health Informatics Society of Australia. A reivew

physics societies etc? What are the qualifications of

of the Australian health informatics workforce.

those who would teach, and do we have enough of

Melbourne: HISA Ltd; 2009. Report No.: V1.1.

them? We seem to be in a period where more and

6. Hersh W. Health and biomedical informatics:

more groups are emerging for a piece of the health

opportunities and challenges for a twenty-

informatics pie, which will make some workforce issues

first century profession and its education. In:

harder to resolve.

Geissbuhler A, Kulikowski C, editors. IMIA Yearbook

of Medical Informatics. 2008. p. 157-64.

The problems raised in this editorial must be

a priority if we are to achieve informatics-enabled healthcare in Australia; education, a coherent view of health informatics and professionalism will be critical points. The next big wave in health informatics is surely

7. Australian Institute of Health and Welfare. Australia’s health 2008. Canberra; 2008. Report No.: AUS 99. p.434. 8. UKCHIP (UK). UK Council for Health Informatics

going to involve further work in determining who can

Professions, 2010.

call themselves a health informatician and why. We have

(accessed Mar 2010).

started to make headway with the Australian Health

9. Australian Health Informatics Education Council

Informatics Education Council’s workforce plan released

(AU). Strategic work plan 2009-10 and beyond,

in June 2009, which identifies health informatician


education as a key project. Activities to understand


and promote the profession should be fast‑tracked and

pdf (accessed Mar 2010).





Decision Support – a little history John Johnston

BSc DipSci AIMM Pen Computer Systems Pty Ltd

In the beginning, way back when the Health Informatics

but by no means eliminated.

Society of Australia (HISA) was in its formation, one

of the early luminaries in clinical informatics was

had begun more serious investment in CDSS and had

consultant physician Dr Terry Hannan (Immediate Past

established the National Electronic Decision Support

President, Australian College of Health informatics). As

Taskforce1. They began funding projects to understand

an early evangelist in Clinical Decision Support Systems

how computer-based decision support could be useful.

(CDSS) concepts he regularly delivered his sermon that

A centrepiece of that work, which traversed several

articulated the huge challenge of information recall

years, was the Integrated Care Program which, using

faced by doctors in a patient consult and particularly

Asthma management as an example, sought to find

about the limits of the human brain, even bright

out what components of computer-based information

doctor ones. At the time, Terry was focussed on the

would be useful to general practice. Easy access to

unacceptable prevalence of medication accidents in

educational material for patients and providers, and

hospitals, and clinical practice generally around our

simple reminders, came up trumps. That taskforce also


utilised a general classification system for the levels of

A few years later, in 1997, Gary Kasparov, unbeaten

clinical decision support that had been devised by the

world chess master, took on IBM’s supercomputer,

NHIMAC and the National Institute of Clinical Studies2.

Deep Blue, in a chess tournament and lost. Deep Blue,

IBM’s second generation of chess maestros came to

published an exhaustive report on the barriers to the

the contest with a computer that not only had great

use of decision support but it was in the following year

computational power but it came equipped with

that Kensaku Kawamoto3 and colleagues provided the

“knowledge of the game” said the IBM gurus behind

first real guidance to creators of CDSS on approaches

this success. Clinical informatics probably did not need

that could make a difference. They screened the world

this example to convince humans that computers had

literature on the topic and admitted 88 papers covering

a role to play in decision support in health, but the

71 randomised control trials into their investigation.

potential for computer-based knowledge management

They reported that in 68% of trials of CDSS there was

in healthcare was a sleeping giant starting to stir.

significant improvement in clinical practice, but, more

By 2002, the Department of Health and Ageing

In 2004, The National Institute of Clinical Studies

I am sure that Terry would acknowledge that, with

importantly, they identified a series of attributes

the Australian prevalence of clinical desktop computers

that defined the efficacy of a CDSS. The outstanding

in general practice and in pharmacy now in use, that

attributes were systems that:

the potential for medication errors causing medical

• provided decision support automatically as part of

misadventure (iatrogenic disease) has been reduced,

clinician workflow;

Author Info

• provided decision support at the time and location John has had a career interest in electronic clinical decision support systems with a particular focus around systems that assist the prevention and management of chronic disease. Over the last decade his company, Pen Computer Systems Pty Ltd has been extensively engaged in projects that test the concepts of CDSS and the implementation of these using systems underpinned by emerging NEHTA standards and terminology choices.

of decision-making; • provided actionable recommendations; and • were computer-based.

Of particular interest to providers of CDSS is that

across all 71 trials, 75% reported successful use by clinicians if the CDSS was provided automatically as part of clinician workflow. This means we must have

12 Pulse+IT

close consultation with clinical providers to make

Some of our universities are now investing in artificial

serious headway as we build the systems.

intelligence solutions that are at Type 4. One of those

To go back to another recollection from the Terry

institutions is the Centre for Health Informatics at

Hannan ministry, there was another critical success

University of NSW but its leader, Professor Enrico

factor. “If the information presented to the clinician was

Coiera4, says there is no reason to wait for these new

not available within 1 second (or 2) in a clinical consult,

systems. “There is plenty of evidence,” he says “that

it would not be used”.

shows that simple reminders, drug alerts, and simple

lookups all help to improve clinical practice”.

In 2010, we have reached a stage in the evolution

of CDSS where there is now a plethora of systems

From an implementation perspective, there are

delivering Type 1 and Type 2 decision support with a

challenges that remain for those that create knowledge

sprinkling of systems that consider the patient record

resources. In the years immediately before his untimely

status and approach Type 3 (RACGP eRedbook).

passing, Professor Branko Cesnik of Monash University spent much of his time trying to convince the clinical

Types of Clinical Decision Support Systems1 Type 1: Provides categorised information that requires further processing and analysis by users before a decision can be made, e.g. accessing an information sheet from a clinical desktop icon. Type 2: Presents the clinician with trends of patients’ changing clinical status and alerts clinicians to out-of-range assessment results and intervention strategies. Clinicians are prompted to review information related to the alerts before arriving at a clinical decision, e.g. notification that the patient is overdue for an immunisation. Type 3: Uses deductive inference engines to operate on a specific knowledge base and automatically generates diagnostic or intervention recommendations based on changing patient clinical condition, with the knowledge and inference engines stored in the knowledge base, e.g. delivery of guideline information from the web into a clinical consult informed by the patient record. Type 4: Uses more complex knowledge management and inference models such as case management reasoning, neural networks, or statistical discrimination analysis to perform outcome or prognostic predictions. Such systems possess selflearning capabilities and use fuzzy set formalism and similarity measures or confidence level computation as mechanisms to deal intelligently and accurately with uncertainty, e.g. an artificial intelligence system that progressively learns about a clinical concept and becomes more accurate as it assimilates the knowledge.

guideline creators that they must now think of the way in which their knowledge will be delivered into clinical practice and, if it is to be part of a clinician workflow, its technical construct must be in a computable form. It is only now that we are starting to see that vision acquiring the consideration that it so richly deserves.

As we aspire to implement more sophisticated

CDSS that recognise changing patient health status, this author’s belief is that the emphasis will shift to activities associated with a focus on the improvement of the quality and completeness of clinical data in all patient information systems. This, and the requirement for secure, patient-consented, sharing of clinical information, will deliver the environment that will support the more widespread implementation of effective CDSS that will make a difference in the patient consultation of the future.

References 1. Electronic Decision Support for Australia’s Health Sector — National Electronic Decision Support Task Force, November 2002. 2. Electronic Decision Support Systems Action Planning Report — National Institute of Clinical Studies November 2004. 3. Kensaku Kawamoto, Caitlin A Houlihan, E Andrew Balas, David F Lobach. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ 2005;330:765. 4. Professor Enrico Coiera, University of NSW, Centre for Health Informatics, Personal Communication.

Pulse+IT 13


Jon Hilton

Centred Care

Decision Support is more than clinical There are more ways to support decision making in

well accepted by the users. Overall, the system was

health care than we can possibly imagine. In the clinical

successful in that it met the aims of the developers, but

environment there are tools spanning a range including

was not commercially viable in light of the rapid changes

expert diagnostic systems such as the venerable Mycin,

that were taking place in computing and particularly in

and image analysis support tools used in radiology

computing for general practice at the time. It was not

and pathology. Clinical desktop software for general

Microsoft Windows based and there were simply not

practitioners includes prompts and warnings. Some

enough resources to provide for its re-development. In

packages include “wizards” that guide the collection

summary, this system:

of information relating to preventive guidelines or

• had a preventive health focus, with particular

specific conditions. The changing nature of health care

support for the implementation of guidelines and

will need tools that support decision making in other

processes for follow up;

environments and that are more focused on preventive

• provided a prioritised list of recommended

health, early intervention, patient self management

activities and a means for easily documenting

and collaboration.

actions, automating interactions with the rest of the electronic record;

An example of early work on support for process

• was developed, trialled and evaluated between

In the late 1980s and early 1990s I worked with Dr

• Implemented and automated evidence based

Lynn Hall. She was a visionary leader in the field of

guidelines derived from research performed by Dr

general practice computing with a particular interest

Hall, mainly based on the work of Paul Frame;

in preventive health care. I was a software developer

1989 and 1992;

• featured a design that was integral to decision

and designer, and we collaborated on the design and development of a GP medical records system that

support functions; • leveraged close collaboration between system

was focused on preventive health care. Of course,

designer and developer and clinicians; and

the system had to support a very complete electronic

• collected data by the users of the system and stored

medical record in order to achieve this goal, and was

it locally, with data quality assurance built in to the

one of the first systems in Australia to allow printing of

design of the system.


Dr Hall provided training under the Family Medicine

Support for collaboration

Program, and we had a stream of fresh new GPs to use

Providing support for collaboration is a significant

in trials of the system. Some of these were younger, and

challenge. Does the concept of decision support for

some were older doctors re-entering the workforce.

collaboration make sense? How can groups make

All had to come to terms with the computer system


and, when I look back on it, this was remarkably

The answer, at least in part, is to take a

patient‑centred viewpoint. From this perspective, the

Author Info

aim is to support all the individuals involved in meeting Jon Hilton is a member of the board of management of the Health Informatics Society of Australia, the Board of Uniting Care Community Options, and the Executive of IHE Australia. He is the owner of Centred Care Pty Ltd, and works closely with Precedence Health Care Pty Ltd. Any opinions expressed are his alone.

the health care needs of the patient, including the patient, in making decisions. This kind of challenge has been met in other environments.

For example, how does one coordinate the activities

of the various people involved in constructing a house? The answer is to develop and attempt to follow some

14 Pulse+IT

sort of plan. Plans provide a structure that can be

partly on the degree of control of the environment to

used to organise and coordinate activities. There is a

assure quality and ensure that outcomes are achieved.

significant body of knowledge called, appropriately,

the Project Management Body of Knowledge (A Guide

work in this way, with the GP deciding what should

to the Project Management Body of Knowledge, 2009)

happen and relying on having a high degree of control

that describes how to develop, execute, and monitor

of the situation. Plans tend to be maintained by GPs


and are often not clearly articulated, but tracked as

The development of this body of knowledge is

points on a “clinical pathway” supported by guidelines

ongoing, and various areas of endeavour have found

and generally managed by the GP with a minimum of

it necessary to develop rules and guidelines specific to

formal planning documentation. The notion of “design”

their disciplines. Thus we have specialised guidelines

in this case is generally embodied in clinical guidelines

and processes for project management in areas such

and in “best practice”. There is less separation between

as software development and construction, to pick

the conceptualisation of the specific requirements for

two. Design and implementation are often intertwined,

care in a particular case and the implementation —

and designers require a deep understanding of how

the performance of the required activities. This is not

their designs will be put into practice. In areas such as

intended to trivialise health care, and is clearly a gross

building and construction, entire professional disciplines

simplification of what is an extremely complex working

have arisen around these areas, and architects typically

environment. It is rather intended to throw light on a way

have a very good understanding of construction project

of thinking; a broad approach, a culture that is deeply

management principles.

ingrained through lengthy (and generally positive)

experience, is generally reinforced in professional

Support for health care collaboration has tended to

In primary care, clinicians have also tended to

take a different route. Traditional models for health care

training, and is therefore difficult to change.

are built on a problem focused model, where a patient

is “treated” and their environment controlled, typically

evidence for the clinical effectiveness of “care plans” is

in a facility designed for the purpose, to minimise

lacking. More work is required to gather information and

extraneous variables that could affect outcomes and to

to demonstrate that the effort required to document,

provide easy and instantaneous access to the patient by

manage and follow plans in a health care environment

the providers of care. This situation is maintained until

is justified. This is also tangled up in the complex web

the patient is “well” and can be “discharged”. Clinical

of interactions between different health care providers,

care plans tend to reflect this environment, focusing

who are increasingly being referred to as “care teams”.

on the problems, ordering “interventions”, and relying

Yet, in order to gather the evidence, we need to put in

Project Management Process from US Dept of Veterans Affairs

It is interesting, then, that in this environment, the

place infrastructure that can assist in gathering data. Something like an “action research” approach is one way of doing this. We have a dilemma — and I don’t have a complete solution — rather a suggested direction. My immediate focus is on improving the efficiency of the health care system and, if possible, patients’ experiences and involvement in their own care. I believe that there is great potential for improvement through a focus on coordination of care. The US National Quality Forum agrees, coordination of care is identified as a Consensus Development Project.

Approaches to coordination of care The approach I prefer is to focus on “connectedness”. Working with people in the community requires an understanding that each of the people involved

(including the patient) has a role to play, and that they

Pulse+IT 15

have different but overlapping tasks to

web based electronic referral system (now

standardised and structured clinical

perform. It is difficult to predict the actual

called the Infoxchange S2S), and more

data. At the current level of maturity of

sequence of activities. Things can be

recently with a more sophisticated system

systems in Australia it is more than likely

forgotten, appointments missed.

using care planning to support coordination

a non structured report document. • Detailed, structured clinical information


(the Precedence Health Care CDMS). I have

members of the care team is to have a





learned a lot about the requirements for


case conference, normally face-to-face,

coordination of care using information and

but not required for this kind of

although teleconferences have been used

communications technology:

application. Applications that support

for this purpose also. Another way has

• Standards








coordination should be capable of




using such data where it is available,

coordinate important events. This is often

transfer of information are more

and can be designed to encourage

not convenient, particularly for care teams

important than detailed data content

incremental implementation and use of

that cross organisational boundaries. Care


standardised, structured clinical data.

been to share the same medical record to


teams in the primary health care community

• Systems need to be tolerant of missing

are generally not all located in the same

or unreliable data.





Enterprise (IHE) approach seems to be a

building and using the same records system

• Standardised data is still vital, but

good fit for many of these requirements.

— either paper or electronic. Unless there is

the most important data relates to

I am currently leading an international

a reliable process for follow up and review,

identification (who) and time (when) —

collaboration to develop an IHE profile

it is possible that important things will be

the what is usually identified up front in

for the implementation of support for

a plan.

coordination of care. The concept is to use

forgotten and never actioned.

All in all, processes for communication

• Information in the plan or plans is

a plan as a focus and organising principle

amongst members of the care team are

expressed at a high level. Systems

for information in a shared repository of

often not well structured, particularly


health care information.

where members are not part of the

individuals in making judgements

same organisation. It is possible to provide support using technologies to




about detail. • The results of such judgements should

allow communications to take place “asynchronously”. A simple and effective


be recorded and shared. available,


this is an excellent goal to have in the long

approaches using alternative technologies

indicating matters of interest that are

term, I believe that the continuing focus

worthy of attention.

on defining, implementing and assuring

voicemail can also be found in the field.

Infrastructure requirements and standards efforts


support clinical decision support. While

way to do this is to use the web, although such as secure electronic messaging and


One of the drivers for standardisation of data is the need for high quality data to

• There should be a high level overview with

Data quality and standards

• Further detail should be available

compliance with detailed data standards

by drilling down into the individual

across the whole healthcare system is


holding back progress in other important

• This detail may or may not include

areas. While I agree that it is important to

Web based approaches have a lot to offer as they allow inexpensive and flexible

IHE XDS Affinity Domain — Overview

deployment of systems. This is important in an environment where people are not all located in the same place. It is also helpful if there are situations where no one is certain of the answers and there is a need to experiment with different workflows and business processes, to test theories and to fine tune approaches with a minimum of effort.

I have been involved in two major

efforts in this area, starting in 1997 with a

16 Pulse+IT

have a clear goal of developing appropriate

disease, and then provides further

information is only disclosed to people with

and detailed standards for important data,

support for the sharing of the plan and

a legitimate role to play; and the ability to

I think our priorities are wrong. Detailed

for collaboration between members of

audit all transactions to ensure that privacy

standards are of little value if we cannot

the care team. It is designed to support

and quality standards are maintained

identify the sender, receiver and subject of

patient centred collaborative care, and

throughout the process.

information, or who accessed information

provides feedback to users on quality

about whom via a document registry.

of data.

Works cited

Giving priority to this over the development

• Alcidion is an Australian company that

of detailed data standards is not without

is providing clinical decision support.

Body of Knowledge. (2009). Retrieved

risk, however. We need to acknowledge

A key part of the service they offer

April 12, 2010, from Wikipedia: http://

that there is potential for misinterpretation

is the identification, integration and

and error in using un-structured or

interpretation of data sources within


less‑structured content and adjust our

the implementation environment.


approach accordingly.



• Pen Computer Systems has developed a clinical

• A Guide to the Project Management

• Care Coordination Practices &


Desktop Sidebar that provides decision

Measures . (n.d.). Retrieved April 19,

support could focus on ensuring that

support for General Practitioners —

2010, from http://www.qualityforum.

their systems are tolerant of missing or

and others — using data derived from


questionable data. They are in a unique

their desktop systems. It is tolerant of

position to work within the health care

missing data and provides immediate

Health Maintenace Reminders: Tools

community to gradually improve the

feedback. The Doctors Control Panel is

Do Not Make a System. Retrieved

quality of data by providing immediate

another such system.

March 27, 2010, from Journal of

practical feedback; the quality of the

• Frame, P. (2003, July). Automated

the American Board of Family

support provided should reflect the quality

Focus on process, not data

of the source data, and feedback should

I am sure there are other companies

be provided to users about this. They

providing similar high quality products

are also in a very good position to work

and services. My key point here is that we

on the development of detailed content

should be process focused rather than data

standards. They will be in a better position

focused. We should be building systems

to do this if they are able to trial and

that effectively support safe and efficient

CDA. (2010). Retrieved April 19, 2010,

develop content descriptions that work in

processes, centred on the patient and


a live environment.

involving all the health care providers that


have a role to play.


Standards should be as simple as

reprint/16/4/350.pdf • Frame, P. (1994). Computer-based vs manual health maintenance. Arch Fam Med , 581-8. • GREEN CDA EQUALS SIMPLIFYING

practicable, should be “layered” and should

not raise a high barrier to implementers.

take account of the sources and quality

of a computerised preventive care

So far, unfortunately, health care data

of information required to provide this

programme for use in a general

standards have been anything but simple.

support. They should also be encouraged

practice. Melbourne: Monash

There is some light on the horizon, with

to take a “continuous improvement”

University Thesis.

the emergence of new approaches, such as

approach to data quality and reliability.

• IHE Australia — Patient Care Working


Over time (and with some patience) this will

Group Patient Centered Coordination

allow the “marketplace” to build a library of

Plan. (2010). Retrieved April 19, 2010,

effective standards that are implemented

from http://ihe-australia.wikispaces.

Current implementations

Designers of such systems will naturally


It is still possible to make progress even

in practice.





We need some basic infrastructure

• Hall, L. M. (1992). Development

com/Care+Coordination+and+eReferra • Welcome to Integrating the Healthcare

environment. Many are, including:

to “kick start” this process: the ability to

Enterprise. (2010). Retrieved April 19,

• Precedence Health Care (a company

identify providers and services reliably

2010, from

I am working with) has implemented

and uniquely; the ability to ensure that the

• What is hData? (2010). Retrieved

a system that supports generation of

subject of communication (the patient) is

April 19, 2010, from http://www.

evidence based care plans for chronic

identified reliably; the ability to ensure that

Pulse+IT 17

BITS & BYTES eJHI releases Vol 5, No1 The electronic Journal of Health Informatics (eJHI) has released its latest instalment

GS1 and Deakin University partner on iPhone App for allergy sufferers

online. The edition is a special issue on

Barcode administrator GS1 Australia has

organisation that administers the GS1

Systemic Interoperability, guest-edited by

teamed up with Deakin University and

system — a global standard for barcodes

W. Ed Hammond, Director, Duke Center for

Nestlé to develop an iPhone application

that facilitates international trading — in

Health Informatics. A Past President of the

that will shortly give allergy sufferers the


American Medical Informatics Association,

ability to scan supermarket barcodes to

Mr Hammond has served three times as

determine what they can safely eat.

Pereira said the group had recently taken

Chair of Health Level 7 where he is currently

Information about potentially risky

responsibility for development of the

serving as Vice-Chair.

substances such as wheat, eggs, peanuts

App and was currently working to make

The papers in this edition of the eJHI

and shellfish is often found on product

it compatible with Apple’s iPhone user

discuss some of the requirements for

labels — but Deakin A/Prof Caroline Chan

interface guidelines so that it can be listed

interoperability. Although most of the

pointed out the information was sometimes

in the Apple App Store. It has commissioned

papers recognise that there are many areas

so small consumers could barely read it —

an iPhone design specialist to assist with

for interoperability to be realised, all of

let alone understand it.

the task.

the papers largely address the topic from

the technical perspective — semantic and

universal keys that often provide detailed


functional requirements.

product information such as weights,

manufacturers will populate with product

volumes, packaging material and price

information about their offerings with

— but their use is currently limited to

Nestlé being the first trial cab off the rank.

supermarket inventory control and to settle

purchases at the cash register.

information available in their own systems

“We wanted to really harness all this

anyway, said Pereira, as they were required

Apple has announced the fourth major

information on the bar-coding system

to do so under food standards regulations.

revision of its smart phone operating

and team it up with detailed product

system, iPhone OS4.

information provided by Nestlé to give

the first stage in GS1’s strategy to extend

To be made available during the southern

consumers a tool that had the potential

its mobile offerings — Pereira also sees

hemisphere winter, the updated system will

to improve their health and raise public

potential to add other information to the

provide developers with a richer toolkit with

awareness,” said Chan.

group’s product database — nutritional

which to craft applications for iPhones,

All editions of the eJHI are freely

available at:

Apple announces new iPhone operating system

In contrast, product barcodes are






GS1 chief information officer Steven

The App will see new fields added GS1’s




The manufacturers often had the

The allergy application is also seen as

information for example, or the carbon

iPods and eventually iPads. Apple will also provide developers with an opportunity to

A consumer scanning a barcode with their iPhone to query a database of potential allergens.

embed multimedia-rich advertising in their applications, bolstering their capacity to monetise their software on the platform.

For users, OS4 will allow for better

organisation of applications on the devices screen via a simple folder architecture. The iBooks application — released with the iPad — will be made available for iPhone users as part of the upgrade, as will an improved email application. The most significant improvement to the operating system is support for multitasking, a process that allows the user to run several applications simultaneously, including the previously hamstrung VOIP application, Skype.

18 Pulse+IT

BITS & BYTES footprint of certain products. And the

were able to come about because of

group is also planning to extend its offering

GS1’s position as a non-profit working

to other mobile phone platforms.

with multiple manufacturers to pool their

Globally, GS1 is looking into adjacent

data — there’s no commercial agenda.

offerings such as electronic coupons that

The group is also working, for example,

could be delivered by supermarkets in-store

on similar applications of its data with the

via mobile platforms.

Department of Health and Ageing to help

address obesity concerns.

Pereira agreed the sorts of solutions

of which the iPhone App is an example

– Renai LeMay

NPS releases clinical software “prescribing features” study results A study by the National Prescribing Service

Quality in Health Care (ACSQHC), the

(NPS) into how electronic software can

Medical Software Industry Association

impact prescribing practice has identified a


list of key features that contribute to safe

and a number of prescribers, health

medicines use and patient safety.

informaticians and consumers.

Published in the online journal, BMC




To determine the most important

Medical Informatics & Decision Making,

features, a review panel rated 114 different



software features by expected impact

of appropriate features in electronic

across four domains — patient safety,

prescribing software and offers a list of key

quality of care, usefulness to the clinician

features to guide vendors.

and usefulness to the patient. While all 114




“Most GPs in Australia use electronic

features were rated as having a positive

prescribing software however there are

impact on at least one domain, 27 features

no standards or guidelines for features of

were found to have a high impact on three

these systems. This makes it difficult for

or all domains.

vendors to know what should be included

and can have a big impact on the safe and

warnings when a medicine is prescribed and

effective use of medicines,” NPS CEO Dr

the patient has a contraindication to that

Lynn Weekes said.

medicine, to clearer designs, and automatic

“The key features identified range from

This study builds on past research

medicines lists that can be printed for each

conducted by NPS into decision support

patient with clear instructions and dose

alerts, and, according to the NPS,

information,” Dr Weekes said.

contributes a valuable body of knowledge

to the e-health sector.

but when you consider the potential

impact they can have they become very

“If implemented across all software

“Most of these functions seem simple

programs, the key features identified in


the study are likely to increase patient

safety and improve prescribing practice.

collated by the NPS is available via a

In the absence of national standards we

link on the final page of the study, which

believe this list could be used as a basis

is itself available online: http://www.

for software standards and guidance for

software vendors,” Dr Weekes said.

The study drew on the input of a

includes an analysis of the features of

range of contributors including NEHTA,

individual software systems used in

the Australian Commission on Safety and

Australia, will be published later this year.

A spreadsheet with all 114 features

The second stage of this study, which

Pulse+IT 19

BITS & BYTES Nuance acquires MacSpeech Nuance Communications has acquired MacSpeech, the market leading provider of

RACGP releases draft 4th edition Standards for general practices

speech recognition solutions for MacOS X.

The Royal Australian College of General

by Government on practices seeking access

Since its initial release in 2008,

Practitioners (RACGP) has launched a draft

to e-Health Practice Incentive Payments

MacSpeech has been licensing Nuance’s

version of its Standards for general practice

throughout the expected three year life

Dragon dictation technology for inclusion

(4th edition). The Standards are used as the

span of the Standards.

in its products, however the solution never

benchmark against which general practices

achieved feature parity with Nuance’s

are accredited by AGPAL and GPA, with

— which comprises Criteria relating to

long‑established Dragon NaturallySpeaking

accredited organisations able to access

“Confidentiality and privacy of health

family of products, predominantly designed

Practice Incentive Payments.

information” and “Information Security”

for Microsoft’s operating systems.

As with the current third revision of

— contains most of the information

The development is particularly relevant

the Standards, the criterion relating to

technology related material that practices

for Australian specialists, many of whom

Information Technology (IT) are presented

seeking re-accreditation will need to

have preferenced Macintosh computers

in a high level fashion with many of the


in their practice settings. Unlike GPs who

specific expectations relating to IT deferred

typically interact with their computers via a

to separate guidelines published by the

of the Standards will be launched at the

mouse and keyboard in the presence of their

RACGP. These guidelines themselves are

combined RACGP/AAPM GP’10 conference

patients, significant numbers of specialists

currently under review by A/Prof Peter

in October. The draft release of the

dictate their correspondence using portable

Schattner, however it is unclear at this time

standards are available online: http://www.

devices, with the audio later transcribed by

what additional expectations may be levied

3rd party transcription services or in-house staff.

Nuance has indicated that it will

Standard 4.2 in the draft release

The final version of the fourth revision

ACHI broadens its horizons

devote resources to accelerate the further


development of MacSpeech, which is



sponsor of the electronic Journal of

available in a medical specific version, and

body for Health Informatics, has recently

Health Informatics (eJHI), an open access

in a bundle with a transcription option that

expanded its remit to the Asia-Pacific

peer‑reviewed professional journal, and

allows pre-recorded digital audio files to be

Region. The college, which was founded

has also supported the Australian Health

converted to text.

in 2002, adopted the “Australasian“ title

Informatics Education Council since its











“MacSpeech responded to the growing

late last year to enable it to respond to

founding in 2009.

demand for a native Macintosh, high-quality

the increasing level of e-health activity

speech recognition solution with MacSpeech

occurring in the region.

for coordination of education in the

Dictate integrated with the Dragon speech

According to ACHI president, Klaus

health informatics area and has received

recognition engine,” said Andrew Taylor,

Veil, the College is increasingly valued for

government financial seeding support.

president of MacSpeech. “We are excited

the thought leadership provided by its

The first projects undertaken by AHIEC

to become part of the Nuance team and

fellows and members, many of whom are

have provided new insights in how best to

accelerate our ability to deliver great speech

noted national and international as experts

progress the up-skilling of the Australian

solutions to the Mac community.”

in Health Informatics.

e-health workforce. This work has also

“We have heard from our customers —

AHIEC was formed out of the need

“ACHI regularly provides comment and

clarified how best to include health

and from the Mac community at large — for

input to papers, proposals and legislative

informatics training into the Australian

years that they want Dragon for the Mac

drafts in the region — most recently on the

education sector in a manner that will

environment,” said Peter Mahoney, senior

Health Identifier legislation Senate Inquiry,”

improve career structure development

vice president and general manager for

said Mr Veil.

and enable sustainable e-health workforce

Dragon, Nuance Communications.


Nuance has not yet released any new

Member of the International Medical

or updated MacOS X products since the

Informatics Association (IMIA), a member

ACHI are available from: http://www.achi.

acquisition of MacSpeech was announced.

of Standards Australia IT-014 “Health

ACHI is an Academic Institutional

20 Pulse+IT

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26 & 27 July 2010 Sofitel Melbourne on Collins

The E-Health Revolution Is aged and community care your business? Do you want to learn how your colleagues are negotiating and delivering care in an era of high reform and how they are enabling and improving their services through the smart, innovative application of e-health? Join us at ITAC 2010 to learn more.

ITAC 2010 Streams • National Health Reform and the National Broadband Network • Social Media – The Language of the Future • Cloud Computing • Electronic Medication Management

• Infrastructure – The Future of Software Delivery • Hardware - Getting IT Right • E-Therapy and Fun Technology • Community Care & Care In the Home • Information, Documentation and Workflow

Keynote Speakers Liesl Capper

Prof Alain Franco

Dr Michael Dahlweid

Dr George Margelis

Steve De Laurier

Dr Jay Parkinson

Peter Fleming

Axel Schultze

Chief Executive Officer, MyCyberTwin, Australia Chief Medical Officer, iSOFT, Germany National Director Health & Life Sciences, IBM, Australia


Chief Executive Officer, NEHTA, Australia


President, International Society of Gerontechnology, France Industry Development Manager, Intel Australia Managing Director, MPH, USA Chief Executive Officer, Xeequa Corp, USA


ITAC 2010 Conference Office, Health Informatics Society of Australia (HISA Ltd) 413 Lygon Street East Brunswick Vic 3057 T: 03 9388 0555 F: 03 9388 2086 E:


ArgusConnect commences rollout of version 5 secure messaging

iCare and QPS partner to coordinate aged care data Software provider iCare revealed in late

ArgusConnect, developer of the Argus

issues relating to the variable standards

March a new tie-up with QPS Benchmarking

suite of secure clinical messaging products

adherence of clinical message content will

that would allow benchmarking data

has begun deploying an updated version of

be addressed in such transactions.

to be captured in iCare’s aged care

its software.

software, potentially taking steps out of

Written in Java and available for

products from those of its competitors on

administrators’ regular workflow.

Windows, MacOS and Linux, Argus v5 touts

the basis of a Free Open Source Software

several improvements over its predecessor

(FOSS) development arrangement, Argus

of the deal was to integrate the capture

including an automated software update

v5 marks the software’s transition to a

of healthcare information between the

service that will reduce the manual

commercial product. Argus v5 software

companies’ respective solutions, as well

intervention required to upgrade the

licenses and support are bundled together

as reducing data entry duplication and the

software on an ongoing basis.

on an annual basis for either $99 or $121

risk of data collection and reporting errors.



Another goal was to be able to provide

by Argus v5 has been changed from Firebird

Division’s relationship with ArgusConnect.

the aged care industry with an integrated

to PostgreSQL to reduce the prevalence

Mr Davies accepted that the software’s

solution that would not require extra effort

of conflicts with other popular software

transition from a FOSS offering to a

to keep up to date.

that use the Firebird database. The new

commercial product may not be accepted

software will feature updated encryption

by all customers, however pointed to the

performance indicators such as resident

libraries, which the company has indicated

commercial realities of providing support

acuity and clinical, safety, resident lifestyle,

will speed up the encryption and decryption

and development resources under the


of messages for secure transport. Version 5

company’s historical arrangements.

scorecards produced by the company are

also includes a statistics gathering feature

“There is an expectation that some

used by aged care providers to measure their

that will allow practices to report usage

people that have had Argus entirely free

performance and identify strengths and

statistics to organisations such as Divisions,

and never paid for support and never paid

opportunities. iCare, in turn, is a significant

many of whom have actively supported the

for it to be installed may fall off, however

provider of administration software to the

rollout of previous versions of Argus but

we expect that people will understand that

aged care industry with a total of around

have historically been unable to accurately

we need to be financially supported to be

40,000 beds under management.

ascertain actual usage of the software.

able to support them,” said Mr Davies.

The underlying database system used

Having historically differentiated its




In a statement, iCare said the objective









In iCare’s statement, several aged care

While Mr Davies said that he was

facilities praised the hook-up. For example,


not aware of practices currently taking

Chesalon living, education and quality

Argus communication, Mr Ross Davies,

advantage of the open source nature of

Manager at Anglicare, Mary McConochie,

ArgusConnect CEO, indicated that the

the now‑superseded version of Argus, he

said when clinical indicators would be

release should be seen as a stepping stone

indicated that the new version’s source code

collected, submitted and reported in the

to v5.5, which will be developed with Web

would be made available for transparency

least amount of time and at the lowest

Services underpinnings, a technology

reasons if any parties were interested in

cost, a competitive advantage would be

approach endorsed by the National

inspecting the code.


E-Health Transition Authority (NEHTA) for

clinical messaging.

applications from practices interested

great benefits for our organisation. Key

Having preempted the functionality

in having the new version installed, a

clinical care indicators will be collected

with an announcement last year, Argus v5

process that the company is undertaking


is slated to enable two-way communication

to manually manage initially to ensure

of trends will provide us with the ability

between Argus v5 and software developed

any outstanding issues with the software

to respond quickly to identified issues,”

by clinical messaging rival Medical‑Objects.

or installation process can be monitored.

said Dean Gemmill, director of quality

However it is unclear at the time of writing

The software will be available to registered

and innovation at Good Shepherd Aged

when such functionality will be available to



the customers of each company, and how



While Argus v5 retains email as underlying



ArgusConnect is currently accepting




“Integrating these systems will provide




— Renai LeMay

Pulse+IT 23

BITS & BYTES Mobile focus for mental health charity Mental health charity SANE Australia has

Secure Messaging Connectathon hosted by IHE Australia in Canberra

embraced the burgeoning mobile phone

Australian Health IT developers gathered

developed through a collaboration between

platform, launching a mobile version of its

in Canberra in April to enhance and test

Australian Health IT software developers

website designed for iPhones and other

their products’ capacity to securely transfer

and the National E-Health Transition

smartphones with a host of resources

clinical information.

Authority (NEHTA) and was released in its

customised for on-the-go access.

final state in early March this year.

The event proper ran from Monday

“We have witnessed changes in the way

through Friday of the week starting 19 April,

people are seeking help and information,

with an Open Day hosted on Wednesday

technical staff from NEHTA attended the

especially young people, with a third of

giving interested parties the opportunity to

Connectathon, with representatives from

SANE Helpline enquiries originating from

learn about the Integrating the Healthcare

the organisation’s Secure Messaging,

the Internet. Now, with the rapid expansion

Enterprise (IHE) initiative in Australia and


in the use of iPhones and similar devices,

observe a “Connectathon” in action.

Accreditation (CCA) teams on hand to

there is a clear demand for this type of

During an IHE Connectathon, software

support the event. Throughout their

support among all age groups,” said the

developers endeavour to enhance their

process of aiding the development of the

group’s executive director Barbara Hocking

products and demonstrate an ability to

Specification, NEHTA coded a functioning

in a statement.

exchange data with other relevant systems.

piece of messaging software to test the

“Australians’ lives increasingly revolve

If successful in this process, software

practicality or otherwise of implementing

around mobile technology, and we want

vendors are able to publish a conformance

the Specification. The learnings from this

to ensure that when people search for

statement, providing purchasers with an

development process were shared with

information about mental health issues,

authoritative, independent guide to their

other participants at the event to assist

they have access to an authoritative, up-to-

product’s abilities.

them with the development of their own

date and easy-to-understand source.”

13 participants took part in the

software. The source code of NEHTA’s








The news comes as mental health

Connectathon, which focused on achieving

implementation is available from the

organisations and the broader health

interconnectivity using the web service

organisation’s website: http://www.nehta.



messaging profile according to the new

the mobile phone platform as a means of



Standards Australia Technical Specification

making health information available.

for E-Health Secure Message Delivery

45 participants from industry, government,

(ATS 5822:2010). The Specification was

and GP Divisions. Jon Hilton, HISA Board

For example, one top-selling “App” in

The Connectathon Open Day attracted

the Apple App Store is an Australian First Aid pocket guide, created by ambulance paramedics to act as a resource in an emergency. Many of the others are

IHE Connectathon participants preparing and testing their software against ATS 5822:2010, an Australian Technical Specification designed to improve the ability for clinical messages to be transferred between healthcare providers and organisations.

focused on fitness, but some Apps provide meditation guides and information about staying positive during a crisis.

SANE said its mobile site was specifically

optimised for the diminutive screen size offered by mobile devices and would provide a range of information including multimedia offerings such as podcasts and video. Critically, those concerned about their own mental health or that of a friend are now able to send an enquiry directly to SANE’s help line from their phone or connect with a health professional. — Renai LeMay

24 Pulse+IT

BITS & BYTES member and leader of the IHE Australia

of the Australian Healthcare Messaging

Patient Care Working Group, presented on

Laboratory (AHML) to develop procedures

the development of the Patient Centered

and a secure messaging test facility.

Coordination Plan Profile to support Care

Coordination and Planning across different

currently being validated and IHE expects

healthcare organisations and information

to announce the results in mid‑May via

systems. This profile, based on the IHE

the event’s website: http://ihe-australia.

Cross Enterprise Document Share (XDS)

platform, supports the development of

care teams, exchange of care plans, patient


progress reports and tracking of key tasks

vendors, professional associations and

and outcomes.

others interested in the implementation of

IHE Australia was contracted by the

standards based e-health communication

Department of Health and Ageing to run

systems. IHE Australia is sponsored by

the Connectathon under established IHE

HISA, MSIA, HL7 Australia, and RANZCR,

rules and procedures. To support the event,

with ADIA, RACS, and HIMAA engaged as

IHE Australia commissioned the expertise

supporting members.

The results from the Connectathon are

IHE Australia has held three previous with




One GP $907.50 Subscription to Best Practice software:

Part time GP


Enough said

Wait, there’s more. That price includes the fully integrated Best Practice suite, both Clinical and Management modules.

Information Technology Aged Care conference coming to Melbourne The fourth Annual Information Technology

in Aged Care (ITAC) conference will be held


on Monday 26 and Tuesday 27 July at the

concurrent sessions will be held covering

Sofitel Melbourne on Collins.

a range of themes including cloud


computing, hardware, infrastructure and

Care Association Australia, Aged and

software delivery, health reform and the

Community Services Australia, and the

National Broadband Network, medication

Health Informatics Society of Australia, the


conference will bring together local and

social media to name a few. Each of these

international experts across the fields of

sessions will comprise talks from three or

community care, medication management,

four presenters, further diversifying the

and assistive technologies. According to

range of subject matter and insights on

the event organisers, the theme of the

offer at the event.

conference, “Smart Aged Care — the

E-Health Revolution”, will emphasise the

will also be presented by a panel comprising

importance of information technology in

exhibitors from the event’s trade display.

establishing a sustainable, quality focused

Exhibition space sold quickly with around 35

aged care environment.

vendors participating in the trade display.








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A session devoted to industry learnings






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In addition to the morning and plenary

participating in ITAC2010 include Dr

the event are to be complemented by

Michael Dahlweid (Germany), Dr Jay

a networking reception after the final

Parkinson (USA), Axel Schultze (USA), and

plenary session on Monday afternoon, with

Prof Alain Franco (France), with Australian

the ITAC Awards Dinner to be hosted on


domain experts Steve De Laurier (IBM),

Tuesday night at the Regent Theatre.


Peter Fleming (NEHTA), Dr George Margelis

(Intel), and Liesl Capper (MyCyberTwin) to

the event program are available at: http://

provide local perspectives.


Comprehensive speaker profiles and Phone:

(<25 hrs week)

Pulse+IT 25


Post Code:


Dr Andrew Magennis

M.B., B.S., Dip R.A.C.O.G., BSc (Hons) Immediate Past Secretary, MSIA Medical Director, HCN

A History of Decision Support tools in Australian GP Desktop Clinical Systems The term “decision support” seems simple enough, and

desktop really began in 1993 when Medical Director —

it is certainly thrown about a lot these days. However its

one of approximately 11 prescription writing programs

meaning is often confused as it seems to mean different

of the day — provided a pick list of medications available

things to different people. A simple definition could

in Australia for the doctor to choose from. Until that

be “any system or tool that assists a person to make

point, no system had such a thing and the doctors

a decision”. In 2002 the National Electronic Decision

were required to type in freehand what they wanted to

Support Taskforce1 described four classifications of

prescribe. How is this “decision support” I hear you ask?

decision support systems, ranging from a simple

Well, such a list let the doctor know:

look‑up list (Type 1) to more complex systems which can

1. what medications were available;

learn the way you do things and advise you accordingly

2. if it was PBS listed; and

(Type 4).

3. if listed, what restrictions it may have.

In the 1980s, clinicians needed to rely on their

In addition, doctors could search for example, all

memory or refer to books, tables of information or

the anti-migraine medications, and then choose the

journal articles to get information to assist them to

one best suited to their patient.

make their decisions. Very few GPs had a computer on

their desk and all but no decision support tools existed

was provided. Next came Drug-Drug Interactions and

for them.

steadily thereafter the rest of the tools listed in Table 1

were introduced.

Decisions can be administrative (e.g. what item

Soon thereafter, full text Product Information

number to charge) or they can be clinical e.g. what

medication to give, or via what route it should be used,

early days, Table 1 listing many of the currently available

or what dose should you give a child of a certain weight,

clinical software packages along with a summary of their

or what is a differential diagnosis for a list of symptoms

decision support capabilities2. Information in this table

or examination findings.

was sourced directly from the software companies and

is presented as returned by them as at 8 April 2010.

The widespread adoption of computers in the

New products have entered the market since these

General Practitioner setting (now approaching 100%)

has enabled a variety of decision support tools to enter

currently exist and the wide variation from system to

the market place. Some are simple pick lists; others

system. “Yes” answers range from six to 33 out of the 34

are intelligent patient specific prompts; and now

functions listed. It is likely that the variation is large due

increasingly, sophisticated tools are beginning to be

to the difficulties associated with the implementation

introduced to assist clinicians to make better informed

of decision support functionality into clinical software.


These include:

• The cost of creating the tool in terms of time, effort,

Clinical decision support on the Australian GP

The most striking observations are that lots of tools

obtaining the clinical knowledge and of course

Author Info

money. Dr. Andrew Magennis is a General Practitioner with a keen interest in computers on clinician’s desktops. He is a past President, Secretary and Treasurer of the MSIA and one of the co-founders of the Medical Director software product. He is currently the Medical Director at HCN and very much involved in decision support tool development.

• User demand and/or acceptance if the inclusion of decision support functionality alters established work flows to a great extent. • The lack of standards to describe symptoms, signs, investigations, diagnoses, medications, treatments, etc. Integration of decisions support tools, be they

26 Pulse+IT

home grown or from a third party, without standard

available in some public hospitals, but is not currently

terminology is complex.

integrated into clinical desktops. To date, cost has been

• Access to the relevant evidence. For example, it

the major limiting factor, together with reservation

is impossible to introduce a Drug-Breast Feeding

from GPs in trusting the computer’s decision and

warning system without access to reliable evidence

concern about the time taken to enter the necessary

relating to drug safety during lactation. For some

information to allow the tool to work correctly.

desirable decision support concepts it simply does

not exist, whereas for others — because of the

nature compare what the GP is doing with some agreed

significant intellectual property involved — there

standards or guidelines. I foresee lots of issues with this

are charges to use it, which may prove prohibitive.

group however — not withstanding the “politics” of

Despite the challenges, the set of tools listed in

what to compare treatments to — if patients are better

Another example is Therapy Critiquing. Tools of this

Table 1 has undoubtedly improved the health of our

managed, I see great potential.

nation and indeed both saved lives and improved the

quality of life of many Australians. However, to me,

computers for clinical management of their patients,

these items represent the “low hanging fruit” in the

the future with respect to computer assisted decision

decision support arena. I am aware that much work

support is at a watershed. With what is just around the

is currently underway at many software houses to

corner, the next few years should be very exciting.

further enhance the integration and sophistication of

Now that virtually all GPs in Australia are using

a range of new decision support tools. If implemented


in a non‑intrusive manner, these too will greatly assist

1. Electronic Decision Support for Australia’s Health

clinicians to better manage their patients.

Diagnostic Assistance


Sector — National Electronic Decision Support Task




Force, November 2002.

stand‑alone products, including, for example, Isabel3, a powerful tool which based on a patient’s symptoms and

Personal Communications.

signs, provides a ranked differential diagnosis. Isabel is

Medication Related


Clinical Software

Clinical Software

Clinically Related












Calculate when medication will run out










Cardiovascular Risk Calculator










Drug - Age Warning










Depression Rating Tool










Drug - Allergy Warning










Diabetic PIP tracking without external tools










Drug - Breast Feeding Warning










Hamilton Rating Scale for Depression










Drug - Disease Interaction Warning










Influenza “at risk” search










Drug - Drug Interaction Warning










Mini Mental Status Exam










Drug - Elite Sport Warning










Pain tracking Tool










Drug - Male Parenting










Pap Smear Summaries










Drug - Name Confusion










Percentile Charts (Wt, Ht/Length, Head Cir)










Drug - Pregnancy Warning










Pneumococcal “at risk” search










Drug - Medication Previously Ceased










Pregnant Patients list/summary










Duplication Therapy Warning










Prescription Summaries (for Drs & Practice)










Medication Compliance Checker










Renal Function Calculator










Pharmaceutical Benefit Schedule Lookup










Respiratory Function Calculator - inbuilt










Therapeutic Class Search










Targeted Preventive Health Prompts for H.Pylori eradication, Cervical Cancer vaccination, Mammograms, etc.



















Table 1 – Current Clinical Software and the Decision Support functionality they support2.

2. MSIA Clinical Desktop Software Members —




Clinical Software MB MD

Built-in access to 3rd party information




















Graph Investigation results over time










Warn if repeating recently ordered pathology










BP: Best Practice

G: Genie

L: Locum


M: Monet

P: PractiX

H: Houston VIP

Z: Zedmed

MD: Medical Director

Y: Product has this functionality

N: Product does not have this functionality

+/- : Product has partial functionality

?: Response not received from developer

Pulse+IT 27


E-health and supply chain reform Australia’s health system has an enviable record internationally. However, a growing need for healthcare

logistics, inventory. • eProcurement — common information shared

reform has been recognised to prepare Australia for the future — to make the system sustainable, keep up high

between suppliers, wholesalers, and jurisdictions. • Use in e-health clinical systems (medicines

standards and to meet new demand.

prescribing and ordering and dispensing systems).

Integral to this reform is e-health. That’s the reason

• Product recall — following products through the

the National E-Health Transition Authority (NEHTA)

supply chain for traceability.

was established — to develop a national approach to

• Uses in tender process — business intelligence

better collect and securely exchange health information

in utilising product data in NPC for tender



Supply Chain reform was one of NEHTA’s first

• Use in hospitals including hospital pharmacy —

initiatives designed to provide the critical standards


and infrastructure required to support connectivity

bedside scanning, patient records, and medical

and interoperability of electronic health information

devices and consumables procurement.

systems across Australia. There was also recognition


ordering and dispensing. • Uses in theatre management — bar-coding and

increased costs.


• Use in retail pharmacy for product management,

that inefficient data management in the healthcare supply chain may impact patient safety and result in


data capture for medication tracking, instrument

Building the National Product Catalogue (NPC) was

tracking and implantable device tracking and


the first step towards a paperless supply chain. Australia


is one of the first countries in the world to develop a single,

• Efficient

national product catalogue. NEHTA’s NPC uniquely






identifies healthcare products, including medicines and

medical devices and equipment, and records important

NEHTA, said that a standardised catalogue like the

Ken Nobbs, Program Manager — Medical Products

supply chain and clinical information about those

NPC reduces the chance of introducing erroneous data

products such as the components of products and pack

into procurement transactions and the errors and costs

sizes. Suppliers populate one catalogue with standard

these cause.

data and globally unique identifiers. This product data is

“This is particularly important in the healthcare

then made available to procurement areas from public health departments and private organisations who have signed up to the NPC. The NPC reduces the duplication of effort and data errors which is particularly important in the healthcare supply chain where getting the right products at the right place and time can be critical to ensuring quality patient treatment.

Common data standards provided by the NPC forms

the basis for: • Supply chain management — product tracking,

28 Pulse+IT

NPC adoption to date across health sector • • • •

Over 100,000 items to date Over 250 companies committed to the NPC All major wholesalers signed up Most large pharmaceutical and medical devices companies have populated or are getting data organised • All health jurisdictions using data • Growing demand from the private sector

supply chain where getting the right products at the right place and time can be critical to ensuring quality patient treatment.”

The NEHTA e-procurement solution specifies the

best practice in the electronic generation of business to business transactions. This includes the automation of fundamental procurement functions such as purchase orders, purchase order response, dispatch advice and invoice messages. This solution relies on the clean data and globally standard product identifiers (Global Trade Item Numbers (GTINs)) provided by suppliers through the NPC. This solution is expected to draw out significant efficiencies, reducing costs and errors common in paper-based procurement practices and is currently being rolled out across a number of jurisdictions.

In March, NEHTA and GSI Australia, launched

GSILocatnet — a central repository enabling the

the development of the right technology necessary to

exchange of location information (including Global

deliver the best e-health system in Australia, the work

Location Numbers or GLNs) between trading partners in

NEHTA is doing in supply chain reform is a significant

the healthcare supply chain sector. GLNs are particularly

step towards achieving widespread e-health take-up.

important for the e-procurement solution, where they

are used in the messaging to identify ordering party,

Visit for further information.

supplier, ship-to location and billing address.


Mr Nobbs described it as a “major breakthrough in

1. The National Product Catalogue is hosted by

the development of Australia’s national e-health system

GS1 Australia, a not-for-profit organisation that

replacing current manual processes with a quicker, more

locally administers a global multi-industry system

accurate method of transacting with suppliers.”

of product identification and communication for

products, services, assets and locations.

In line with NEHTA’s goal to identify and foster

Health Information: The Golden Thread in Health Reform

HIMAA National Conference 2010 27th - 29th October

Harbours Edge Events Centre, Darling Harbour, Sydney, Australia

Pulse+IT 29



Orion Health Conference 6 May - 7 May 2010 Sydney, NSW P: +61 2 8096 0000 W:


HIC2010 24 August - 26 August Melbourne, VIC P: +61 3 9388 0555 W: HIT

Health Health


3rd Annual Pharmaceutical Law Conference 2010 30 August - 31 August Sydney, NSW P: +61 2 9080 4300 W:


JUNE 10th Anniversary Hospital in the Home Conference 21 June - 22 June Melbourne, VIC P: +61 2 9080 4300 W:

2nd Annual Operating Theatre Management Conference 1 September - 2 September Sydney, NSW P: +61 2 9080 4300 W: Health-e-Nation 2010 9 September - 10 September Sydney, NSW P: +61 2 4365 7500 W:

Australian 4G Summit 18 May - 19 May Sydney, NSW P: +61 2 9080 4300 W:

2nd Annual Emergency Department Management Congres 22 June- 23 June Melbourne, VIC P: +61 2 9080 4300 W:

GP’10 / AAPM Conference 6 October - 9 October Cairns, QLD P: +61 3 8699 0414 W:

3rd Annual Green Hospitals Conference 20 May - 21 May Sydney, NSW P: +61 2 9080 4300 W:

Mental Health Units Conference 24 June - 25 June Sydney, NSW P: +61 2 9080 4300 W:

HIMAA National Conference 27 October - 29 October Sydney, NSW P: +61 2 9887 5001 W:


Health IT


Health Information Management

30 Pulse+IT

Health IT






Health Health



Medical Fair Australia 11 May - 13 May Sydney, NSW P: +61 3 9699 4699 W:


Population Health Management 21 June - 23 June Brisbane, QLD P: +61 2 9229 1000 W: Health



National Stroke Units Conference 6 May - 7 May Melbourne, VIC P: +61 2 9080 4300 W:

ITAC2010 26 July - 27 July Melbourne, VIC P: +61 3 9388 0555 W:



3rd Annual Preventive Health Summit 27 May - 28 May Sydney, NSW P: +61 2 9080 4300 W:




The National Disability Summit 29 April - 30 April Melbourne, VIC P: +61 2 9080 4300 W:

Managing Ward Finances & Budgets 24 May - 25 May Brisbane, QLD P: +61 2 9080 4300 W: Health


Pharmaceutical Benefit Scheme Forum 22 April - 23 April Sydney, NSW P: +61 2 9080 4300 W:

GPCE 21 May - 23 May Sydney, NSW P: +61 2 9211 7454 W:



IHE Secure Messaging Connectathon 19 April – 23 April Canberra, ACT P: +61 418 487 081 W:

Australian Pharmacogenomics Summit 21 May - 22 May Sydney, NSW P: +61 2 9080 4300 W:




Practice Management

Information Technology


Managing Risk Integrated Decision Support in Medications Management Software Danny Brayan

B.App.Sci(Physio), MBA (Management of Technology) MIMS Australia

Sources of Information

• Pharmaceutical company clinical trials balance

It is well documented that Adverse Drug Events (ADEs)

the commercial imperative to have a drug

are a major cause of serious illness, hospitalisation and

registered with the risk of litigation. Knowledge

death. What is less certain is a clear means of mitigating

of the manufacturer’s Product Information, as the


legal representation of the drug, legally protects

practising clinicians.

Doctor Donald Berwick, Harvard Professor, world

renowned quality expert and healthcare visionary, has

• Categorisation systems e.g. use of the WHO’s ATC

long advocated a “systems” approach. His theories lend

codes to indicate duplication of therapy.

themselves to the integration of decision support into

• Australian regulatory and eligibility information, e.g.

software systems. Berwick frequently sites systems

the TGA and the PBS, is required for management

improvements in other industries. Would we trust our

of professional practice risks and efficacy in the use

money to a bank, if it did not have robust financial

of government and private funds.

software in place? But what of the (Global Financial

Crisis) GFC? While computerisation may not have caused

care software systems and used to empower clinicians

the GFC, it is hard to imagine why, with all that readily

to make better decisions. Getting the integration right

available information floating around, we couldn’t have

is the next challenge. However, an understanding of the

done more to prevent it.

origins of information is a critical first step.

The availability of information is only the tip of

All of this information can be integrated into point of

the iceberg in decision making processes. As critical

Getting the Integration Right

decision makers, whether we’re clinicians or Reserve

Integrated decision support data, regardless of trust in

Bank governors, we need to understand the origins of

sources and understanding of contexts, will only be as

information. Little wonder, that assimilating a world

good as the practicality of integration efforts into point

of complex collateralised debt transactions had a

of care software.

significant masking effect.

• Access to information — comprises a balance of:

What sources of medications information can be

used to mitigate ADEs? And what clinical risks do they address? Evidence bases for medications use include: • Published research and respected publications reflecting the real world use of medications. Clinicians trust this information with its traditional academic, peer reviewed, process.

Key integration considerations include: àà Intuitive design i.e. information is easy to find and well set out. àà Non-invasive i.e. information is not too disruptive to prevent “alert fatigue”.

• Target audience: àà Scope of information is appropriate e.g. resident doctors will require different information

Author Info

and presentation to that required by clinical Danny’s experience extends across clinical practice, workflow redesign, health IT systems planning, procurement and sales. He now works with software vendors and clinicians to promote the use of integrated clinical data as the Business Development Manager — Integrated Data Solutions for MIMS Australia.

pharmacists. àà Specificity of information to care settings is appropriate e.g. prescribing in a public hospital has different requirements to prescribing in a GP clinic. • Timeliness:

32 Pulse+IT

What is Integrated Decision Support Data? Decision support data is fully integrated when data specific to clinical workflow is embedded into clinical software i.e. it is part of the clinical software’s database. This approach ensures that the right information presents to the clinician at the right time in the clinical care of the patient. This contrasts to reference information (such as drug Product Information on a website) hyperlinked to key words in the software, which requires opening another window and searching through reference information.


Precision, Quality, Design The first Fully Integrated Practice Management software for Day Surgery that takes care of everything from the first consultation to the final claim.

àà Information needs to be up to date with current research, pricing and regulatory requirements. àà Information needs to be provided at the right time in the workflow. • Interoperability: àà Industry standard coding is required to support safe record keeping, data migration and transfer of data between systems and care settings.

The Human Factor Integrating decision support into software is a challenging task, and not without its successes and failures in healthcare as well as other industries. As discussed, while the financial industry demonstrates a long history of computerisation, understanding the origins and full meaning of data in this industry, in recent times, was fraught with pitfalls.

In contrast,

the aviation industry

has demonstrated

groundbreaking safety improvements with the introduction of on-board flight systems. Pilots are well versed in aeronautical theories, navigation, weather patterns, flight processes, etc, ensuring a thorough understanding of the origins of information presented to them. Additionally, decision support information, in this environment, could well overload pilots with the abundance of variables collected every second if it were not well integrated and intuitively presented in the software.

While caring for patients is, in many ways, a more varied and

unpredictable process than flying planes or monitoring levels of financial debt, much can be learnt from analogous thinking across industries. In the healthcare context, clinicians need to understand and trust the origins of information used in an integrated decision

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support context. Information needs to be well integrated and appropriate for specific workflows, enhancing clinical decisions, rather than over-alerting or providing non-contextual, hard to interpret information. And finally, a complex blend of human factors needs to be factored into software design, use and decision

Software Solutions For Health Professionals

support constructs.

Web: Email: In Australia call: 1800 42 00 66 In New Zealad call 0800 40 11 11

Want to know more about e-health? Whether you are a consumer, healthcare manager, healthcare provider or vendor, you need a central location to quickly find and access e-health 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 • How e-health systems are being designed to maximize security and privacy • Why a national certification capability is an essential foundation for safe, secure and interoperable e-health solutions in Australia • The latest Federal, State and Territory government e-health initiatives • The delivery of a standard clinical language for use across Australia’s e-health 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 E-Health Transition Authority (NEHTA) to help you explore the e-health concept and stay in touch with the latest innovations as they unfold

See how the Healthcare Identifiers (H1) Service will work.

The Model Healthcare Community is an opportunity to see how the HI Service will work in practice. As part of the Royal Australian College of General Practitioners (RACGP) e-health Futures initiative, the Model Healthcare Community is located at the RACGP premises in Melbourne. e-health Futures is an innovative and interactive e-health display with a walkthrough experience of how e-health will work among healthcare professionals. The Model Healthcare Community focuses specifically on the HI Service, painting a picture of what the health system would be like once vendors adapt their health IT software solutions to use Healthcare Identifiers. The five simulation areas represent a clinical reception, a general practice, a hospital, a pharmacy, and a clinical specialist. Further information or tour requests please view

HI Service facts • A key foundation for a national approach to e-health is a standard process across the health sector to accurately identify everybody involved in a healthcare event. • This includes the person receiving healthcare, the person providing healthcare, and the place where the care is given. • In mid 2010, the HI Service will come into operation with three unique types of healthcare identifiers*: - Individual Healthcare Identifiers (IHIs) will be given to all Australians enrolled in the Medicare Australia or Department of Veterans’ Affairs programs - Healthcare Provider Identifiers – Individual (HPI-Is) will be assigned to healthcare providers through a staged approach - Healthcare Provider Identifiers – Organisation (HPI-Os) will be assigned to organisations where healthcare is provided.

* Enabling legislation is currently before the Australian Parliament, legislation that when passed will enable the service to commence a phased roll out from July 2010.


Standards based Clinical Decision Support GELLO, SNOMED CT, EN 13606 standard archetypes and the Virtual Medical Record Dr Peter Scott

MB BS, BA Medical-Objects

Dr Andrew McIntyre

MB BS (Hons), FRACP Medical-Objects

The role of Clinical Decision Support

Disease or Myocardial Infarction” can be performed.

There is evidence that Clinical Decision Support (CDS)

The laboratory test results are Observations in the vMR,

needs to be integrated at the point of care into everyday

the terms “Ischaemic Heart Disease” and “Myocardial

clinical workflow. Furthermore whilst the quality

Infarction” refer to concepts in SNOMED CT that

and safety agenda for CDS is valid it should be noted

will subsume other disorders such as “Angina” and

that the real point of CDS is to electronically support

“NSTEMI”, thus picking them up also. The actual GELLO

good clinicians doing their normal work. In addition,

code for this query is displayed in Figure 1.

computers are mindless robots that can exhaustively

execute code and this helps pick up the occasional error.

a distance and allows queries on the other two models.

CDS should be computable on rich atomic Electronic

This has helped us triangulate some of the boundary

Health Record (EHR) data — CDS is more than an

problem between the information model and concept

electronic book.

model. For example we prefer the genomics family

Getting at the EHR data and the clinical knowledge for use in CDS Both the information (e.g. proprietary and standards-

Figure 2 shows how the guideline/CDS model sits at

history model of HL7 to the situation with explicit context hierarchy in SNOMED CT, for structure of family history components.

based such as the HL7 RIM) and concept models (e.g.


SNOMED CT) are accessible by the object-oriented

GELLO is a HL7/ANSI standard decision support

declarative CDS language called GELLO. An abstraction

language. It has not been widely implemented as the

of the most commonly used data elements in various

early releases contained ambiguities and errors in the

information models, through a virtual medical record

BNF which Medical-Objects has clarified, and balloted

(vMR), allows data to present to the GELLO engine in

at HL7. GELLO has its roots in Object Constraint

a consistent and useable manner. In this way a query

language (OCL) but has been optimised and extended

written out in English such as “Does this patient have

for CDS in the health domain. Its primary role is as a

a most recent cholesterol above 6.5 mmol/L, a HBA1c

query language for obtaining clinical information from

above 7.0% and a past history of Ischaemic Heart

an EHR system in a standard way. It uses an abstract

Author Info

vMR so that the same GELLO code can run on multiple While best known for their HL7 v2 messaging and specialist software, Medical-Objects has an active R&D team, collaborating on and working with standards such as EN/ISO:13606 archetypes, SNOMED CT, GELLO and the virtual medical record. Peter is part of this team and is a GP and health informatician. Andrew is a Director of Medical Objects P/L, head of research, and a practicing gastroenterologist. Both authors live and work on the Sunshine Coast.

systems accessing data stored in different formats.

GELLO cannot alter a medical record but can

perform complex logic in order to make a decision about a patient’s care. It can be used to provide standards based data access for other advanced decision support applications. Medical-Objects produced the first GELLO compiler in clinical use and uses GELLO for

36 Pulse+IT

--get the most recent Total Cholesterol. Set a threshold. ‘observation’ is a vMR artefact let TotalCholCode: CodedValue = Factory.CodedValue(‘34714-6’,’LN’) let MostRecentTotalChol: PQ = observation->select(code = TotalCholCode)-> sortby(absolutetime)->last().value.asOclType(PQ) let TotalChol_Threshold: PQ = Factory.PhysicalQuantity(6.5,’mmol/L’) --get the HBA1c (which is a measure of blood sugar level control). Set a threshold. let HBA1CCode: CodedValue = Factory.CodedValue(‘4548-4’,’LN’) let HBA1c: PQ = observation->select(code = HBA1CCode) -> sortby(absolutetime).last().value.asOclType(PQ) let HBA1C_Threshold: PQ = Factory.PhysicalQuantity(7,’%’) --iterate over the vMR Past History seeing whether the patient has had a relevant --disorder, by use of an implies method. For brevity in this example, the iteration --shown here is only for one of at least two possible SNOMED CT parent concepts. let IHDDisorder: CodedValue = Factory.SnomedCV(“414545008|Ischemic heart disease|”) let IHDCount: Integer = Problemlist->iterate(SX, i:integer = 0 | if SX.code.implies(IHDDisorder)then i+1 else endif) --run the query and return the result - this will return a boolean true or false --to higher CDS logic such as GLIF, or lead to some functionality in a --GELLO-enabled EN 13606 archetype node or field MostRecentTotalChol > TotalChol_Threshold and HBA1c > HBA1C_Threshold and IHDCount > 0

Guidelines (using Guideline Interchange Format - GLIF) and for constraints, validation and calculated fields in archetyped data entry. It is also used to create complex data series for graphing or statistical analysis.

GELLO in use

Figure 1 - Above - A GELLO query for the English question: “Does this patient have a most recent cholesterol above 6.5 mmol/L, a HBA1c above 7.0% and a past history of Ischaemic Heart Disease or Myocardial Infarction?” Figure 2 - Below - Diagram modified by the insertion of example standards from Alan Rector’s “Model of models” found at Rector A, Taweel A, Rogers J, (2004) Models and Inference methods for Clinical Systems: A Principled Approach, Proceedings of MedInfo 2004.

GELLO has been embedded by Medical-Objects into about fifty EN13606-based laboratory panel archetypes for a laboratory system built for Coastal Pathology. GELLO code is used extensively for node/field value calculation, for example LDL Cholesterol (the “bad” cholesterol) is routinely calculated as the difference between Total Cholesterol and HDL Cholesterol. GELLO code also retrieves information model data such as the patient’s gender, their fasting status, their pregnancy status, and their age, to produce on-the‑fly reference ranges for the various tests for a given patient. Furthermore, nodes/fields are rendered visible or invisible in user view forms by GELLO to manage screen real estate.

In more general EHR-like usage, GELLO has become

for us almost as a scripting language to facilitate functionality in archetype event handling. HL7, IHTSDO

Pulse+IT 37

and openEHR to some extent have been mostly about

are relevant. Access to population based data is very

modelling thus far — it’s time to do the functionality!

important for public health monitoring. Server-side


GELLO to allow this is possible, but we haven’t done it as yet.

GLIF is another complementary piece of technology

we have deployed. It looks like a flowchart, but the

common/important data elements used in 21 existing

link arrows and decision points can be automated with

CDS applications in four countries. It has distilled a draft

GELLO providing the low level logic. Forms providing a

vMR, from which a domain analysis model is up for

view of EN13606 archetypes have been used to gather,

ballot in the current HL7 balloting cycle.

persist and reuse additional data.

The vMR

The HL7 vMR project team has recently collated the

Conclusion The R&D team at Medical-Objects has tried to

The vMR is based on the HL7 v3 RIM and data types. It

pragmatically blend the best features of a group of

is a “virtual” interface and is optimised for point in time

compatible standards. We participate fully in relevant

clinical decision support. It represents a snapshot and

international standards activities, but implement

omits important concepts that should exist in a full EHR

locally. CDS that manipulates structured atomic data

system. Only data relevant to making decisions based

is implementable using the standards outlined above,

on the current patient state are represented.

especially with GELLO.

There needs to be a translation layer to transform

existing system data into a format that complies

Further reading

with the vMR. There are many potential ways to do

• The vMR project:

this ranging from creating a CDA document, a HL7 v3 message, a SOAP service or even creating HL7 v2 message(s) that contain the required structured data to

php?title=Virtual_Medical_Record_%28vMR%29 • GELLO Release 2: html/infrastructure/gello2/gello2.htm

allow the creation of a vMR interface. A direct database

• The Medical-Objects Decision Support wiki page:

access layer is also possible. So documents, messages,

services, archetypes/templates, CCD instances and


database queries for example could all populate the vMR to enable CDS. Medical-Objects has developed


HL7 v2 representations of the vMR which can be used

As part of our work in CDS over the last few years

for patient history transfer between PMS systems.

Medical-Objects has built several tools, including:

• EN13606 archetype/template editor (free and

The aim is to allow a CDS language such as GELLO or

Infobutton access to a standard model to reliably access

available from the Medical-Objects CDS wiki page)

patient data about the current patient’s “Observations”

• GELLO authoring environment/editor/interpreter

(e.g. HBA1c) or “Family History” or “Problem List”.

• GLIF authoring tool and editor

This is the single patient “Context” but other contexts

• SNOMED CT server

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38 Pulse+IT


Technology enabling Clinical Decision Support Enabling Clinical Decision Support

Terminology example is capturing the knowledge that a

Clinical decision support is at the apex of an e-health

package of branded drugs “Coumadin (trade product)”

architecture. Current computational decision support

is a type of “Warfarin (medicinal product)”. Further

is still in its infancy. Computational decision support

more, the AMT contains the information that “Warfarin

needs information from patient records (clinical and

(medicinal product)” has a constituent active ingredient

administrative), knowledge bases and guidelines to be

“warfarin sodium (substance)” which is a form of

able to be interpreted formally by a computer algorithm.

“warfarin (substance)”.

This is made difficult by the current situation where:

• patient information is captured in many different

list that is Coumadin (warfarin sodium 2 mg) tablet,

systems; • knowledge bases, for example about drug-drug

ingredients in a list of Drug-Drug interactions.

Note that, by design, both the Australian Medicines

Terminology and SNOMED CT do not contain the sort of information that enables a clinical decision support

Clinicians also need to be convinced of the reliability

engine to know that a person taking Drug A should not

of the decision support and its suitability in supporting

also be given Drug B. This sort of knowledge is captured

their current work processes.

in specific knowledge bases and then made available for

inclusion in clinical decision support engines.

e-health architecture. They provide a common language

for representing clinical data in electronic patient

support, the assumption is that the patient information

records that allows the computer to reason across the

contains a complete list of medications the patient is

data. For example, the SNOMED CT code 110030002


| Concussion injury of brain | has a finding site of 12738006

Of course, in this example of clinical decision

| Brain structure |. If a patient has the code 110030002

Associative Knowledge

in their patient record, then a computer algorithm can

A different sort of knowledge captured in many

reason that they have had an injury of the 69536005

knowledge bases is Associative Knowledge. For

| Head structure | which is an ancestor of the concept

example, the knowledge base may contain the

12738006 | Brain structure |.

information that ACE Inhibitors are used to treat

Hypertension and Congestive Heart Failure by lowering

For this reasoning to be performed in the context

PhD CSIRO Australian E-Health Research Centre

the terminology to check for Warfarin or its active

different organisations; and

A clinical terminology is a foundation element of an

David Hansen

then a clinical decision support engine can use

specialist — organisations.

PhD CSIRO Australian E-Health Research Centre

If a patient has a medicine in the “active medicines”

interactions, are maintained and published by • guidelines are produced by different — often

Michael Lawley

of a clinical decision support engine there are two types of knowledge that must be captured: Definitional

Definitional Knowledge Definitional Knowledge is that which is captured in terminologies such as SNOMED CT or the Australian

David is CSIRO’s e-Health Theme Leader with projects spanning the areas of biomedical imaging, remote monitoring, health data integration and clinical terminologies. Michael leads the research project that developed Snapper and is the implementer of Snorocket, the description logic engine that powers the development platform used to maintain SNOMED CT.

Author Info

Knowledge and Associative Knowledge.

Medicines Terminology (AMT). An Australian Medicines

Pulse+IT 39

Figure 1 - Mapping an existing terminology to SNOMED CT using Snapper.

40 Pulse+IT

blood pressure, but also that some proportion of people

pharmaceuticals today mean that this is anything but

with Type 1 Diabetes take an ACE Inhibitor to reduce

the case. With the amount of personal medical history,

progress of Diabetic nephropathy.

knowledge about drug interactions and the amount of

clinical data collected, the situation gets complex very

With this sort of knowledge, a clinical decision

support engine may infer that a patient taking a


particular drug may have an associated condition (that

hasnâ&#x20AC;&#x2122;t been recorded), or that a patient with a particular

our research is aimed at providing tools which address

condition may be taking a particular drug (that hasnâ&#x20AC;&#x2122;t

the complexity. These tools help health services make

been recorded). This information can then be used to

the best use out of the knowledge by combining the

raise an alert on a possible Drug-Drug or Drug-Condition

information in their patient databases and clinical

contraindication. The key challenge for such reasoning

knowledge bases. The National E-Health Transition

however, is to perform sufficiently accurate probabilistic

Authority (NEHTA) recommendation to adopt the

reasoning to keep the number of false-positives low and

SNOMED CT terminology for use in capturing and

thus avoid obscuring the true positives.

storing clinical information about patients provides

Challenges for Clinical Decision Support

At the CSIRO Australian E-Health Research Centre,

many research challenges. In particular, the challenge is in exploiting the underlying mathematical description logics to enable more complex decision support than is

While the examples given above may seem relatively

possible with less sophisticated terminologies.

straight forward, the complexity of medicine and

Other challenges include how to incorporate data

Figure 2 - Snapper enables detailed expressions to be composed if required.

captured using existing terminologies and how the

Firstly, data captured using a standard terminology

terminology can support existing clinical processes.

will enable future treating clinicians to better understand previous diagnoses and treatments. Secondly, data

Migrating Existing Terminologies

captured at the point of care enables modern systems to

With the adoption of SNOMED CT for use in Australia,

utilise external services to do real-time computational

there will need to be tools developed to aid in the

checking, such as against Drug-Drug and allergy

upgrade path from existing terminologies. The Snapper

knowledge bases.

platform was developed to enable this transformation,

Figure 1 showing many of the tool’s features including:

fast and reliable. To be reliable in the example above, the

• interactive search and browse functionality,

software must check that the patient being prescribed

including a graphical tree view of the terminology; • an automap feature to do a “first pass” mapping of

For this sort of checking to be useful it must be both

Warfarin doesn’t also have in their medical record one of its contra-indications. However, as discussed above,

existing terms to SNOMED CT terms;

the drug could be recorded in a number of ways, which

• ability to create specialist clinical subsets;

is where a terminology can be used to check if the drug,

• export of terminology content to clinical information

or its generic names, is on the contraindication list.

systems; and • interactive building of complex expressions (as seen

Our terminology server includes our fast subsumption engine, Snorocket, which enables these queries to be

in Figure 2).

performed very quickly, thus supporting the requirement

Revisiting our AMT example, there are already many

of real-time feedback.

drug lists which are used in clinical information systems

around Australia. Snapper is a tool which enables those

going on in the background, the terminology server

drug lists to be migrated to the AMT.

is capable of underpinning many clinical information

systems in use today.

In the case of clinical specialties that already have

a terminology, Snapper provides a way of migrating

While the clinician won’t be aware of everything

those existing terminologies into a local SNOMED

Current Status

CT extension. These extensions, which fill gaps in the

NEHTA has now published the AMT and a local version

international terminology, can go through the standards

of SNOMED CT. Before clinical decision support engines

development process for world wide adoption.

can start operating at a high level, the data which is captured in electronic health records and the knowledge

Integration with Clinician Process

which is distributed in knowledge bases must use — or

The success of any terminology and knowledge base is

be able to be mapped to — SNOMED CT content. The

how it is integrated into clinical process. Patient data

Snapper toolkit has be potential to speed up a lot of this

captured in a clinical information system can improve

work, both through the development of content and

patient outcomes in multiple ways.

through the mapping of existing terminologies.

Pulse+IT 41


Predicting capacity with (greater) certainty Nick Burns

Director Emendo

Regardless of the final details that emerge from the

aligned with workloads, enabling safer staffing levels

proposed government funding reforms, Australian

to be maintained and reducing stress. In fact staff are

hospitals face ongoing pressure to improve front line

more likely to take holiday time, which can in turn lower

delivery due to increasing demand for healthcare

the organisation’s outstanding leave liabilities.

services. Hospital targets are likely to be imposed at a

national level in Australia as they are in New Zealand,

visibility across a whole hospital — or even regional

where emergency departments are now required to see

hospital network. Decision making is faster as staff can

95% of patients within six hours of arriving.

see at a glance different scenarios, from daily capacity

A capacity planning system gives operational

As delivery and quality targets become more

to a one off theatre redesign. This visibility improves

exacting, operational decision making processes must

the hospital experience for both patients and staff,

adapt, enabling staff to minimise effort and expenditure

reducing the likelihood of bed gridlock. For instance,

that doesn’t usefully support the patient journey.

capacity planning modelling has shown how to change

While many hospitals are committed to continuous

the discharge time of day to increase the available

improvement, operational staff can find these goals

inpatient bed capacity and shorten Length of Stay.

hampered by a lack of timely and accurate operational

data. Scheduling the right number of staff to safely

a culture change at all levels within the hospital.

meet demand, managing annual leave requirements

Some people require an initial leap of faith to accept

and other operational planning is a challenge when you

that computer generated forecasts can be over 95%

can’t even reliably predict patient flows for the next 24

accurate and that rostering an expensive “safety buffer”


is no longer required. Knowing the future beyond the

In the area of capacity planning, technology is

next day also means staff have to adjust to having more

increasingly used to support decision making. Capacity

“head space” and focus on renewed collaboration with

planning software alleviates the pressure and risk

other parts of the hospital.

inherent in operational decision making, providing

the science to support professional judgement. More

CapPlan — applies mathematical algorithms to predict

precise decision making is possible as staff know what

patient numbers weeks or months in advance. The

to plan for and how to “flex” accordingly.

software analyses patient trends looking for patterns,

In this environment, staff planning and resource

then produces forecasts and allocates resources

management becomes evidence based and better

including staffing. When potential congestion or

Improving the capacity planning process requires

Capacity planning technology — like Emendo’s

overcapacity in the care process is identified, operational

Author Info

plans can be adjusted in real time. Nick co-founded Emendo in 2002, applying his significant health sector experience in hospital production, operations management and operational consultancy. Nick currently leads the international market development for Emendo and its capacity planning solution, CapPlan.

Royal Adelaide Hospital has more than three years

experience with capacity planning technology, using it for in-patient management and decision making. The hospital needed a suitable operational tool that would introduce better information for its Patient Pathways strategy aimed at improving the patient experience

42 Pulse+IT

and developing capacity within existing

were reduced. Following the introduction

course corrections.


of capacity planning at Canterbury District

For operational staff to make use of

Royal Adelaide’s capacity planning

Health Board, staffing costs were reduced

the available information, they require

technology smoothed patient flows by

in the first year and maintained for

organisational leadership and direction.

increasing bed availability, reducing outlier

subsequent years.

Decision making control has to move

patient placement, sharpening patient

Two groups with quite different needs

with the information, from a traditional

discharge times, and more precisely

use capacity planning software. These are

top-down model to one where clinical

forecasting staff requirements. In addition

operational planners and also front line

and operational staff are empowered to

to significant savings, elective surgery and

staff, including Charge Nurses, patient flow

coordinate activity on a daily basis.

inpatient activity have been better matched

managers and hospital executives.

and staff reported a better feeling of “being

Planners typically require in-depth

their fingertips, staff can make informed

in control”.

forecasting data to use as a guide in

decisions about operations in their area

decision-making, especially around more

and positively influence the patients’

planning project at Bedford Hospital


journeys. Operational decision makers, no

produced a winter forecast and Christmas

building and capital expenditure plans.

longer trapped into planning just for the

bed plan that matched resources with

Front line staff want a practical

next 24 hours, can seize new opportunities

forecast demand. With bed requirements

information “dashboard” that shows real

for collaboration and integrated care that

known well in advance more staff got to

time status against operational plans,

come with accurate forecasts of patient

take annual leave and agency staff costs

giving them sufficient warning to make

demand across a whole hospital or region.

In the United Kingdom a capacity




With capacity planning information at

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• CQUniversity, QLD • St John of God Health Care • Greater Southern Area Health Service • North Coast Area Health Service • Inner South Mental Health Services

• North Metropolitan Area Health Service, WA • Sydney South West Area Health Service • Australian College of Mental Health Nurses

TO REGISTER CALL NOW! T: +61 2 9080 4090 F: +61 2 9299 3109 E: VISIT:

Pulse+IT 43

National E-Health Transition Authority

Andrew Howard is the Head of Strategy & Architecture for the National E-Health Transition Authority (NEHTA) and talks to us about the progress NEHTA is making. Andrew Howard is the Head of Strategy & Architecture. Previous to this he was the acting Chief Executive Officer with NEHTA and the Chief Information Officer of the Department of Human Services in Victoria. Andrew has an extensive background in e-health and 15 years international consulting experience as an Associate Partner with Accenture where he ran the Australia Post Commercial Systems Portfolio. Outside his consulting roles, he was also program director for Sensis’ customer relationship management.

What is NEHTA’s role in developing e-health in Australia?

NEHTA is the lead organisation supporting the vision for e-health in Australia. For a national e-health infrastructure to exist in Australia, one organisation needs to have a clear mandate to deliver key components of the National E-Health Strategy. There has been enormous effort across both the public and private health sectors in e-health innovation but we cannot continue with an ad-hoc approach, which is of course where national specifications come in. To enable a truly national system operating to the highest standards of safety and security, NEHTAs focus is to develop the foundations for such a system. These foundations are: 1 Healthcare Identifiers 2 Secure messaging 3 Authentication 4 Clinical terminology Together these form the backbone of Australia’s e-health systems.

What is NEHTA's progress in developing these ‘foundations’?

Communication within the multitude of private and public healthcare systems currently has no single method of accurately identifying either the individuals receiving healthcare, the healthcare providers or the organisations managing care. The current approach to healthcare identifier systems promotes regional and local schemes that simply can’t “talk” to each other. NEHTA has contracted Medicare Australia to scope, design, build and test a Healthcare Identifiers service to provide this function. Healthcare Identifiers are a key enabler for delivering e-health solutions in Australia. At the time of writing, the enabling legislation for the HI Service, the Healthcare Identifiers Bill 2010 is currently before the Australian Parliament. When passed this will enable the service to commence a phased roll out from 1 July this year.

Healthcare Identifiers underpin the patient ‘journey’ through the healthcare system


Discharge summary HPI-O




HPI-O Hospital


referral HPI-I


Patient Prescribing HPI-O





The flow on benefits of healthcare identifiers are many: • Ability to electronically send discharge summaries and referrals • A reduction of errors in health information • Reduction in duplication of tests as a result of information being easier to find • Basic administration efficiency to save time and resources in the health sector.

Ordering & results Pathology, Radiology

This graphic shows a sample patient journey which will take place throughout the ehealth system. The healthcare identifiers provide the basis for consistent identification of the individual receiving healthcare services; and the providers of those services across all healthcare organisations and geographic boundaries. Securing the exchange of health information is critical to consumer privacy and clinical record keeping. Two elements of NEHTA’s work program address this need. Firstly, secure messaging protocols for e-health will ensure that data exchanged between healthcare providers remains just that – secure but also accurate. Three technical specifications and one technical report drafted by NEHTA after significant consultation with industry, has progressed through the Standards Australia process – they support a national approach to the secure delivery of electronic messages between healthcare providers. The second key foundation, the National Authentication Services for Health (NASH) provides the required strong authentication of healthcare providers and organisations.

National E-Health Transition Authority

Healthcare Identifiers underpin the patient ‘journey’ through the healthcare system

NASH will: • Establish a national supply of trusted digital credentials available to all entities in the health sector, allowing the traceability of e-health transactions to trusted identities • Allow healthcare communities to issue and manage authentication credentials locally, supported by national infrastructure • Provide a governance approach that would allow health sector participation in the operational policies and services NASH would develop • Support software vendors to transition their products to use nationallyrecognised digital certificates • Provide sufficient flexibility to leverage investment from organisations such as Medicare Australia • Encompass the current use of PKI by Medicare and in the future National Individual credentials. The terminology or clinical language used in e-health must be consistent if it is to be interpreted accurately and safely by all health IT systems and the clinicians that use them. Every year, avoidable adverse medical events can occur because of poor communication between healthcare providers. The delivery of a standard clinical language is a significant step towards improving the quality and safety of healthcare in Australia. The starting point for this is a leading international terminology ‘dictionary’ called SNOMED CT (Systematised Nomenclature of Medicine Clinical Terms). SNOMED CT is considered the most comprehensive, multilingual clinical healthcare terminology in the world and is the preferred terminology for Australia. NEHTA launched the first release of SNOMED CT-AU to Australian licence holders in December 2009. The next release will be available in May 2010 with updated international and Australian content. Subsequent releases will then be available every six months.

Dr Mukesh Haikerwal

How is NEHTA engaging with key stakeholders? The Model Healthcare Community has been very successful in terms of engaging with a wide range of stakeholders – interested consumers, vendors, industry associations, federal, state and territory health representatives. The Stakeholder Reference Forum includes a number of key stakeholder groups, including clinical, consumer and vendor representatives. We have regular meetings with the forum, as well as individually with the members. The forum has formed six sub-committees based on our key projects, and the people involved have an oversight of the requirements, the specifications, the ongoing testing and process implications. Our Clinical Unit is led by Dr Mukesh Haikerwal. A commissioner with the National Health and Hospital Reform Commission and an executive councillor with the World Medical Association, Dr Haikerwal has been a Melbourne general practitioner for more than 20 years and is also a former Australian Medical Association President. The clinical team has been expanded to include all of the future users of e-health systems, not just GPs but specialists and allied health professionals as well. The team consists of over forty practicing clinicians with a vested interest in successful e-health outcomes and bringing a highly valuable clinical perspective to our work.

How will the benefits of e-health be realised?

Our current work program is aimed at building the e-health foundation services and then overlaying transaction capability— such as referrals, discharge electronic transfer of prescriptions and pathology. The linking of the foundation services with a transaction is referred to as a “bundle”. Each product bundle delivers significant benefits in coordinating care through the health system. We are focusing our efforts on the most commonly exchanged health information. As examples, full specifications for Electronic Medication Management (EMM) have been produced and released for comment. Workshops have been conducted with all interested parties and feedback taken. In addition, NEHTA has released the specifications and methods needed to support structured exchange of patient referral information between disparate healthcare information systems. The Electronic Referral Release Package incorporates extensive stakeholder consultation and up-to-date information and expertise from leading clinical, administrative and analytical communities.

What does the next 12 months hold for NEHTA?

Over the next one to two years the healthcare sector will be supported in taking up a common approach to secure online connectivity. NEHTA will have connectivity projects with every State and Territory. Projects will use the healthcare identifier to name patients, providers and healthcare organisation (pending the passing of legislation).

As an overview, once the HI Service is legislated:

Early adoption for the HI Service is being planned in phases and there are plans for each State and Territory, albeit early planning phases for some.

• In the Northern Territory Individual Healthcare Identifiers (IHI) will be used next year in discharge summaries and referrals • Queensland want to use IHI in their client directory list of all public patients • NSW is planning to adopt the HI Service for 4 million patients • ACT is about to start a HI implementation strategy with core vendors • Victoria is about to start a HI implementation study • Western Australia is in the planning stages for all public health consumers to have identifiers • Tasmania will plan to use the IHI in a Statewide database, the Healthcare Client Index.

I’m confident that NEHTA’s work as the lead organisation supporting the national vision for e-health in Australia is positioned to help overcome some of the challenges facing our healthcare system.

For more information on NEHTA’s work go to

E-health won’t happen overnight and there has to be time for all parties including doctors, hospitals, and others such as technical vendors to get up to speed. All parties need to continue to work together by understanding the factors affecting patient care and the value that the electronic exchange of health information can provide.


Mark Worsman

Senior Associate DLA Phillips Fox

Jennifer Tetstall

Paralegal DLA Phillips Fox

The future of healthcare in 16 digits Who gets an HI and what is it?

How do you get an HI?

The Healthcare Identifiers Bill (Bill) was introduced

Under the Bill, Medicare Australia’s CEO is appointed

in February and is currently awaiting a vote by the

the Service Operator for the purpose of:


1. assigning healthcare identifiers; and

2. collecting and maintaining the information that

The Bill establishes three types of unique 16-digit

Healthcare Identifier (HI) numbers:

is linked to healthcare identifiers as referred to

1. an identifier for healthcare providers, such as


physicians, nurses and pharmacists, which will be

Patients will automatically be assigned healthcare

linked to the provider’s name, date of birth, gender,

identifiers by Medicare if they have a Medicare or

address, healthcare profession, and their provider

Veteran Affairs file number, whereas providers will

and registration number (if any);

additionally need to apply for a provider identifier. The

2. an identifier for organisations where healthcare

draft Regulations set out how healthcare identifiers will

is delivered, such as hospitals and clinics with the

be assigned to healthcare providers, eligibility being

identifier linked to the organisation’s name, address,

established on the basis that the provider is:

and ACN or ABN (if applicable); and

1. registered by a health profession registration

3. an identifier for recipients of healthcare services,

authority; or

namely patients, which will be linked to the patient’s

2. a member of a professional association that relates

name, date of birth, gender and Medicare or Veteran

to healthcare and has uniform national membership

Affairs file number.


The Regulations can expand the information to

The draft Regulations state that a healthcare

which a healthcare identifier can be linked. The current

organisation can apply for its healthcare identifier if it

draft Regulations contemplate including a link to

has an employee who has a provider identifier assigned,

information such as an e-mail address, and home and

and provides healthcare as part of their duties at the

work telephone numbers.


Provider healthcare identifiers may be needed by

In order for a healthcare provider to obtain a

any person who:

patient’s identifier from Medicare, the provider is

1. provides assessment, diagnosis or treatment

authorised to supply Medicare with the patient’s name,

to patients in relation to their health, illness or

address and gender. If the information matches the

disability; or

details linked with the identifier, then Medicare will

2. a pharmacist that dispenses a drug on prescription.

disclose a patient’s identifier to the healthcare provider.

It is not clear whether a person who merely assists

This request can take place in person, through a web

in assessment, diagnosis or treatment is a healthcare

portal, or over the telephone, however ultimately it

provider for the purposes of the Bill.

is intended that the majority of such requests will be made via interfaces to be built into existing clinical and

Author Info

patient management software. Mark Worsman is a Senior Associate and Jennifer Tetstall is a Paralegal at DLA Phillips Fox. DLA Phillips Fox has around 800 lawyers across eight offices in Australia and New Zealand. It has an exclusive alliance with DLA Piper, one of the largest legal services organisations in the world, with lawyers in 28 countries.

What can the HI be used for? The Bill does not allow sharing of health information or healthcare identifiers. Nonetheless, the Bill: 1. authorises providers to adopt the patient healthcare identifier as the patient’s reference number for the

48 Pulse+IT

identifier information. Given the recent

of a patient’s identifier will prevent a serious

2. contains protections for unauthorised

provider’s medical records; and

adverse publicity reported in The Australian

threat to life, health or safety can disclose

use and disclosure of healthcare

that Medicare dealt with 234 serious data

the identifier in that circumstance.


breaches by employees in 2007-08 and 569

There are penalties for misuse or

The Bill also requires Medicare to

cases of unauthorised employee access to

unauthorised disclosure of a healthcare

maintain a record of information that

client records, this may be reviewed if and


Medicare has that relates to the healthcare

when the healthcare identifier is linked to

1. in the case of a natural person, a fine of

identifiers. The information that “relates

more comprehensive health information

up to $13,200, imprisonment for up to

to” the healthcare identifier includes

about patients.

details such as name, address and date

two years or both; and 2. in the case of a corporation, a fine of up

of birth, although it is not entirely clear

Use and disclosure of HIs

what else Medicare may require. On one

A healthcare provider can use a healthcare

reading the Bill, if Medicare possesses

identifier for the purpose of communication

if the use and disclosure of the identifier is:

health information related to an identifier,

or management of health information as

1. authorised under another law; or

that information may be required to be

part of:

2. for the purpose of the person’s personal,

kept as part of this record. In any event, the

1. providing healthcare to an individual;

record must include details of requests for

2. managing, funding, monitoring or

disclosure by Medicare of identifiers, which means that Medicare will need to maintain

evaluating healthcare; 3. providing indemnity cover for the

a log of who made (and when they made) healthcare identifier requests.

healthcare provider; or

There are exceptions to these penalties

family or household affairs.

The Bill also imposes an obligation on

entities to take reasonable steps to protect healthcare identifiers from misuse, loss and unauthorised access, modification or

4. conducting research approved by a

disclosure, which has implications for any

human research ethics committee.

person, including suppliers to healthcare

A provider that believes that disclosure

providers and healthcare organisations.

It is not clear whether Medicare must

log access by its personnel to healthcare

to $66,000.

10th Anniversary

Hospital in the Home Conference

21– 22 June | Hilton on the Park Melbourne For the latest program updates & event news visit:


T: +61 2 9080 4090 F: +61 2 9299 3109 E: VISIT:

Pulse+IT 49


Internet plans Reviewing your Internet arrangements may save you money and improve performance. Simon James

BIT, BComm Editor of Pulse+IT


infrastructure to supersede dial-up arrangements

Practices are increasingly reliant on Internet related

in Australia, and remains a popular option for both

services for both administrative and clinical functions.

business and residential Internet access. Installation

Whereas web browsing, email, the downloading of

of ADSL is achievable in most practices as it uses the

pathology and radiology results, and Medicare Online

long‑established and wide-spread copper telephone

were once the mainstays of practice Internet usage,


remote access, Internet telephony, online backup,

and electronic prescribing are all services that are

and upload capacities provided by the technology.

increasingly being adopted by practices and depend on

When it was first introduced, ADSL was typically sold

the availability of fast and reliable Internet access.

in 256/64, 512/128, and 1,500/256 speed options, with

“Asynchronous” refers to the different download

As a result of increasing competition and the steady

the first number signifying the download speed and

march of technology, Internet access costs have fallen

the second number representing the upload speed in

and the quality of Internet services has improved

kilobits per second (kbps). Now commonly designated

substantially in recent years. If you haven’t reviewed

as “ADSL1”, the technology is usually only sold in

your Internet connection arrangements recently —

1,500/256 and a faster 8,000/384 configuration.

particularly if you signed up to one of the artificially

expensive plans endorsed by Government through the

infrastructure in the majority of telephone exchanges

Broadband for Health initiative — it is likely you are

around the country has served to squeeze further life out

paying too much for your practice Internet connection

of Australia’s copper wire telephone infrastructure, with

and quite possibly receiving an under whelming service

theoretical maximum performance boosted to around

for the privilege.

20,000/1,000. It is, however, important to recognise

The relatively recent activation of “ADSL2+”

that both ADSL2+ and ADSL1 are susceptible to speed

Internet access speed

degradation in-line with the distance your practice

The maximum speed at which your practice will be able

is from your local telephone exchange. Telstra claim

to connect to the Internet is primarily determined by

around 50% of their customers on their 20,000/1,000

the underlying technology available in your area, the

service can achieve speeds of around 10,000kbps or

following being the most common options:

more, with 70% of customers on the 8000/384 plan achieving speeds of around 6000kbps or more.

ADSL Asynchronous





technology was the first mainstream broadband

Cable In some major metropolitan areas, practices may have the option to connect to a Hybrid Fibre-Coaxial (HFC)

Author Info

cable Internet service provided by Telstra or Optus. 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.

Originally deployed to deliver pay TV, the Internet services available via HFC cables have steadily improved as a result of competition from ADSL technology. Currently Telstra provide cable Internet speeds of up to 30,000/1000 in Sydney and Melbourne, or 17,000/256 in other capital cities. Optus offer speeds of 20,000/512 in

50 Pulse+IT

Sydney, Melbourne and Brisbane, however

up to 42,000kbps later in the year, followed

of other bandwidth intensive applications

donâ&#x20AC;&#x2122;t provide Internet cable services in

by services operating at 84,000kbps at

difficult if not impossible.

other capital cities.

some stage in 2011.

As with mobile phone reception,

National Broadband Network

Wireless Broadband

many factors influence the real-world

Currently only available in small segments

Unlike the wireless networks now found



of Australia as part of its initial deployment,

in many homes and businesses, wireless

services and it should not be automatically

the National Broadband Network (NBN)

broadband services are designed to provide

assumed that, for example, a wireless

will provide Internet Service Providers

Internet access across a much wider

broadband service rated at 21,000kbps will

(ISPs) with an opportunity to retail Internet

geographic footprint. In fact anywhere you

outperform an ADSL2+ or even a slower

connections with much greater speeds

are able to use a mobile phone, you should

rated ADSL1 connection.

than the technologies currently available



also be able to utilise a wireless broadband

in Australia deliver. The NBN is trumpeted



as being initially capable of 100Mbps

The technology that underpins wireless

Without wishing to rub salt into the wounds

download performance for residential

broadband services is improving at a

of practices with no other option, satellite

customers and speeds of up to 1000Mbps

rapid rate, with current market offerings

is to be avoided wherever possible in lieu

for businesses, respectively five and fifty

delivering download speeds of 3,600kbps,

of one of the aforementioned connection

times as fast as the speed afforded to

7,200kbps, 14,400kbps and 21,000kbps.

options. While the speed afforded by

medical practices with an optimal ADSL2+

The pattern of doubling performance is set

satellite connections may be acceptable for


to continue for some time to come with

large file downloads and email, the latency

Telstra expected to release a USB modem

of such connections makes for a jittery web

HealthLink/Medinexus HalfandPage 180 120 capable of delivering download speeds of browsing experience makes thex use

The NBN is able to achieve this



Puse IT Mag through its use


of fibre optic cables,

connecting healthcare

Pulse+IT 51






It is important to proactively keep track

occur and what manual intervention is

performance degradation inherent in ADSL

of your practice’s Internet usage to ensure

required before committing to the process.


it doesn’t exceed the monthly quota. If the

Of course if you are switching between

practice does exceed its quota, additional

different classes of Internet technology,

costs may be incurred or “shaping” may be

downtime can be avoided altogether by

Having decided on the type of Internet

activated, a process whereby the speed of

ensuring the new connection is functioning

technology that best suits your practice,

your connection is dramatically reduced.

correctly before disconnecting the old

the next purchasing consideration will be

While shaping may be tolerated for a few

Internet service.

based on the amount of data your practice

days towards the end of a monthly cycle in

typically transfers on a monthly basis in

a home setting, in a busy medical practice


both the download (sent to the practice)

it is likely to be quite frustrating and even

While all Australians should look forward

and upload (sent from the practice)

debilitating for practices that rely on their

to the wide-ranging benefits the NBN

direction. Fortunately this information

Internet connection for VoIP, remote

will ultimately deliver, its rollout will take

should be readily available on your existing

access, or Internet backup.

many years and should not prevent you

Internet quotas

Internet monthly bills or via an online

customer portal.

Making the switch

from changing to a better and potentially cheaper Internet service while you await

It is important to read all fine print

Switching Internet plans and even ISPs

the NBN’s availability in your area.

associated with an Internet service,

is a generally seamless process these

particularly the information concerning

days, principally because of an agreement

investigate whether it is possible to upgrade

the advertised quota. Be aware that some

between competing ISPs that allows

to ADSL2+ or a cable Internet service.

ISPs charge for uploaded data, and others

“ownership” of the customer to pass from

Telstra has ADSL2+ capabilities in most of

factor in their “off peak” allowance into

one ISP to the other without prolonged

their exchanges, with selected ISPs having

their headline advertised quota. As the

Internet outages. In the case of an ADSL

negotiated permission to resell access to

vast majority of medical practices do not

or ADSL2+ transfer, after your connection

this technology, most notably Internode

typically operate after hours, any off-peak

to the existing ISP drops out, access to

and Westnet, neither of whom charge for

data allowance is unlikely to be utilised.

the Internet via the new ISP can usually

uploaded data.

While selecting a plan with a gigantic total

be initiated by simply entering your new

quota may overcome problems associated

account details into the practice router’s

reasonably fast ADSL or cable connection

with ISPs that charge for uploaded data,

web interface and restarting the device.

should investigate whether a wireless

these ISPs are effectively double charging,

There are exceptions however, so it is

broadband solution may provide a better

a behaviour that should not be encouraged

always best to enquire about the expected

Internet experience than their existing

by apathetic consumers.

time frame in which the transition will






Practices unable to connect to a

Making it easier for you to do business with us Health Professional Online Services (HPOS) gives health professionals access to Medicare Australia’s Online Services through a single entry point. s patient verification—search and confirm patient details. s view a patient’s care plan history s manage existing bank account details

For more information about these and other HPOS services go to then For health professionals > HPOS Logon

52 Pulse+IT


HPOS services include: s authorised practice staff with a PKI individual certificate can logon to HPOS and act on behalf of a health professional s subscribe to receive selected statements online

Carbonelle Consulting

P: +61 2 9889 1311 F: +61 2 9889 1411 E: W:


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 Australia

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

Best Practice

Adelaide eSquare

P: +61 8 8234 1600 F: +61 8 8234 6785 E: W: One stop shop IT Solutions Provider: • Official Medilink Dealer for sales and support in South Australia • Computer hardware and software sales, support and servicing • Computer Networking solutions and troubleshooting • Web Site design and development • Email solutions • Web Site Hosting • Domain Name Registration and Hosting • Friendly and highly responsive team


P: +61 3 5335 2220 F: +61 3 5335 2211 E: W: ArgusConnect provides and supports Argus secure messaging software that enables doctors and healthcare organisations to exchange clinical documents securely and reliably. Argus can be used to send specialist reports to referring doctors but it can also exchange pathology and radiology reports, hospital discharge summaries and notification between healthcare providers. Healthcare practitioners can use any of the popular clinical software packages to send reports and other clinical correspondence via Argus. Argus is the messaging solution chosen by over 50% of all Divisions of General Practice across Australia through the ARGUS AFFINITY DIVISIONS program.

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)

Carbonelle support over 600 clients Australia wide. We have 21 years of experience in Medical IT and run a dedicated Help desk. Supported Software: Medilink • Medilink Clinical • ReferralNet • Secure Messaging • Redmap Paperless and Scanning • Voice Transcription Services • Patient SMS Reminders • Medical Director • Best Practice • Secure Online Backup • Zedmed • Genie • MHagic • Microsoft Terminal Services Experts Hardware and Services Division: Medical Software Installations • Hardware Maintenance Contracts • Software Support Contracts • Onsite Support and Training • Offsite backup Solutions • MD Data Conversions (MD2 to MD3) • Paperless Installations and Configurations Your Medical IT 1 Stop Shop

Cerner Corporation Pty Limited

Brisbane, QLD Software7

P: +61 412 626 769 F: +61 7 3378 4163 E: W: Business Information Technology Solutions Provider. Some of our services are: • Authorised Medilink Dealer for sales and support in Brisbane. • Deploy, manage, procure and support computer hardware, software and networking solutions. • Web site design, development and hosting services. • Email solutions. Our team is friendly, professional and highly responsive with a strong customer focus.

P: +61 2 9900 4800 F: +61 2 9900 4990 E: W:

Cerner is a leading supplier of healthcare information systems and our Millennium suite of solutions has been successfully installed in over 1200 sites across the globe. Cerner’s technology has been designed so that it can be adapted to meet the needs of the very different healthcare delivery systems that exist, with a universal framework which allows clinician workflow to seamlessly span role and venue. • Our innovative leadership is allowing us to push boundaries by: • Leveraging clinical and pharmaceutical data for new discoveries in Condition Management and Personalised Medicine • Connecting the community with personal and community health records • Seamlessly connecting the patient record across the continuum of care

Pulse+IT 53

CH2 (Clifford Hallam Healthcare) P: 1300 720 274 F: 1300 364 008 E: W:

Clifford Hallam Healthcare (CH2) is today Australia’s largest Pharmaceutical and Medical Healthcare service provider with over 5,000 customers and a catalogue of over 15,000 products. Supported by a National Network, CH2 utilises local knowledge and local people to provide pharmaceuticals, medical consumables and equipment products to the healthcare market. CH2 is represented by a National Sales Force as well as a local Customer Service team in each state. CH2 understands the value of quality data and are committed to implementing the GS1 system throughout our business and with our partners. The use of EANCOM standard messages, Global 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.

54 Pulse+IT

Computer Initiatives Communicare Systems P: +61 8 9332 2433 F: +61 8 9310 1516 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 multidiciplinary 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

P: 1300 85 39 39 (Melbourne) P: 1300 85 39 85 (Brisbane / GC) E: W:

Digital Medical Systems

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

Computer Care

Direct Control

P: +61 2 9410 0405 (NSW) P: +61 3 9646 0141 (VIC) E: W:

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

Computer Care works as a business partner with medical practices and other health organisations to accommodate all IT needs, covering: • Experience in all major practice management software (migration, upgrades, etc) • Computer systems & networks • Security • Hardware • Help Desk support • IT consulting • Technology trouble shooting

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.

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.

Equipoise (International) Pty Ltd Totalcare P: +61 7 3252 2425 F: +61 7 3252 2410 S: E: W:

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.

HealthLink Global Health

Health Communication Network

P: +61 3 9675 0600 F: +61 3 9675 0699 E: W:

P: +61 2 9906 6633 F: +61 2 9906 8910 E: W:

Global Health is a premier provider of technology software solutions that connect clinicians and consumers across the healthcare industry.

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

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.

HCN focuses on improving patient outcomes by providing evidence based software tools to health care professionals at the point of care.

Genie Solutions

P: +61 7 3870 4085 F: +61 7 3870 4462 E: W: Genie is a fully integrated appointments, billing and clinical management package for Specialists and GPs.

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

Genie runs on both Windows and Mac OS X, or a combination of both. With over 1800 sites, it is now the number one choice of Australian specialists.

Australia’s largest effective secure communication network. • Fully integrated with leading GP and Specialist clinical systems • Robust; Reliable and Fully Supported Join the network that more than 60% of GPs use for diagnostic, specialist and hospital communications.

Market snapshot: • 17,000 medical professionals use Medical Director • 3,600 GP Practices use PracSoft • 800 Specialist Practices use Blue Chip and • 2,100 Specialists use Medical Director • Leading suppliers of Knowledge Resources to Australia¹s major hospitals



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

P: 1800 125 036 F: +61 7 3870 7768 E: W:


P: +61 2 9887 5001 F: +61 2 9887 5895 E: W:

P: +61 7 5665 7995 F: +61 7 5502 6543 E: W:

The Health Information Management Association of Australia (HIMAA) is the peak professional body of Health Information Managers in Australia.

HealthEasy is a 100% web-based “Cloud Computing” solution as used by leading Web 2.0 apps like BaseCamp and SalesForce.

HIMAA aims to support and promote the profession of health information management.

• • • • • •

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

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.

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. Demonstrations available under NDA due to late 2010 release.

Pulse+IT 55


P: +61 3 9388 0555 F: +61 3 9388 2086 E: W: The Health Informatics Society of Australia (HISA) aims to improve healthcare through health informatics. HISA: • Provides a national focus for health informatics, its practitioners, industry and users. • Advocates on behalf of its members. • Provides opportunities for learning and professional development in health informatics.

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.

Hunter Valley Anytime Computer Solutions P: +61 2 4934 8560 E: W:

Complete ICT Solutions: • Medicare Online and ECLIPSE • DVA Paperless • Medicare Easyclaim • SMS 2 way reminders • Secure eMessaging • Clinical EMR • Paperless Solutions • Online Training • Support 24/7 • Microsoft Channel Partner • Hardware & Networking • Phone and network cable systems Solutions when you need them


P: +61 2 9380 7111 F: +61 2 9380 7121 E: W: InterSystems provides innovative software products that enable you to create, deploy, run, and connect healthcare applications faster. InterSystems Ensemble®, our rapid integration platform, can cut IT project times in half for enterprises that need to connect applications, processes, and people. Our health information exchange platform, InterSystems HealthShare™, enables the creation of electronic health records that share clinical data across multiple organisations on a regional or national level. InterSystems TrakCare™ is a connected healthcare information system that is Web-based and rapidly delivers the benefits of an Electronic Patient Record. Ensemble, HealthShare, and TrakCare all leverage the lightning speed, massive scalability, robust reliability, and rapid development capabilities of InterSystems Caché®, the world’s fastest object database.

56 Pulse+IT

ISN Solutions

JOSE & Associates

P: 1300 300 471 F: +61 2 9280 2665 E: W:

P: +61 3 9850 1350 F: 1300 889 012 E: W:

ISN Solutions is a medical IT company that specialises in the design, setup and maintenance of computer networks for medical practices.

JOSE and Associates – IT Management and Support 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

• 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


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.


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

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.

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.

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.

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.

MEDITECH Australia


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

Medical Software Industry Association P: +61 427 844 645 E: E: W:

With the increase in government e-Health initiatives and NEHTA’s “Year of Delivery”, 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.

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, multihospital 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.

Join over 100 other companies across all areas of medical IT/IM so your voice can be heard.

Medtech Global


For 25 years, Medtech Global has been enhancing the quality of patient care by working with healthcare professionals in developing and delivering award winning industryproven technology products. Our technology solutions are both sophisticated and user-friendly, designed for the comprehensive management of patient information throughout all aspects of primary and secondary healthcare, mental health and corporate health.

P: 1800 623 633 F: +61 7 3392 1108 E: W: Integrated best of breed solutions: • • • • • • • • • • •

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

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

P: +61 3 9690 8666 F: +61 3 9690 8010 E: W:

Some of our products include: • Medtech32 and Medtech Evolution – practice management and clinical software packages • Manage My Health – an online patient portal that holds electronic health records • MDAnalyze – a surgical audit/ clinical outcomes software • We are also able to provide training, data services and consultancy.

20 years of caring for practices.

Melbourne & VIC Practice Services P/L

P: +61 3 9819 0700 F: +61 3 9819 0705 E: W: 15 years as Authorised Medilink Dealer selling, installing, training and supporting Medilink Practice Management Software • Fixed Cost Onsite and Remote Support • Medilink = Intuitive ease of use • Solo Drs up to Hospitals in size • Cut debtors and boost cash flow with Online Claiming via EFTPOS or Medicare Online for Funds, Patients, DVA & bulk billing • Many optional modules • Links to many third party packages and services Our Users are our best Salespeople

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

NSW & NT Carbonelle Consulting

P: +61 2 9889 1311 E: W: Carbonelle support over 600 clients with 21 Years of Experience. Medilink Practice Management and Clinical Integrated Systems

MIMS Australia

P: +61 2 9902 7700 F: +61 2 9902 7701 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.

Specialists, General Practitioner and Allied Health Software • • • • • • • •

Medicare Easyclaim Medicare & DVA Online Electronic Appointment Book Eclipse (Health Fund Claims) 2Way SMS Patient Reminders ReferralNet (Secure Messaging) Medilink Clinical Paperless & Scanning Systems

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.

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Pen Computer Systems

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

Nuance Communications 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).

Established in 1993, Pen Computer Systems (PCS) specialises in developing information solutions for National and State eHealth initiatives in Primary Health that deliver better Chronic Disease outcomes. PCS expertise extends to: • Chronic Disease Prevention and Management • Population Health Status, Reporting and Enhanced Outcomes • Decision-Support tools delivered LIVE into the clinical consult • Web-based Electronic Health Records (EHRs) • SNOMED-CT and HL7 Standards Frameworks


P: +61 2 8014 4573 E: W:

Syber Scribe

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.

Our Clinical Audit Tool (CAT) for example delivers an intuitive population reporting and patient For a free trial of Spellex software, go identification extension to the leading to and click the Free GP systems in Australia. CAT delivers Trial tab. enhanced data and patient SR quality Logo_65x42mm.pdf 20/02/09 14:50:20 outcomes in general practice.

Orion Health

C P: +61 2 8096 0000 / +64 9 638 0600 F: +61 2 8096 0001 / +64 9 638 0699 E: M W:

Stat Health Systems (Aust)

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


Orion Health is a global leader in CM integrated healthcare IT solutions. We specialise in electronic health records MY solutions, disease management, clinical decision support, and hospital CY administration tools. More than 200,000 clinicians in more than 20 CMY countries use Orion Health products. K

Using our solutions, Orion Health’s customers have reduced operational costs, reduced risk and improved patient safety, improved communications across their organisations and between primary and secondary care. 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 elegant and intuitive solutions to meet your organisations current and future needs.

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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.

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 have chosen to partner with First Databank for their drug database.

P: +61 3 9569 4890 / 1300 764 482 F: +61 3 9569 5543 E: W: Syber Scribe provides Internet based medical typing services for hospitals and clinics. • Fast turn around and excellent quality. • Connection to most Patient Management Systems, possible for filing purposes. • Victoria’s largest supplier to hospitals. • References available on request.


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 Zedmed eXchange – a simple solution allowing Doctor’s to send patients 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.

The Stat roll-out has begun and we are able to convert data from all existing software. Stat also provides a premium support service and the Stat Online Claiming Solution (SOCS).

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

Your operation just got easier. At Genie Solutions, we know how precious your time is. With Genie, we help you streamline your practice management and make your life easier. Genie integrates your appointments, billing and clinical needs in just one application. It runs on either Windows or Macintosh, with the ability to simply copy your data from one platform to another. Itâ&#x20AC;&#x2122;s got everything you need as a procedural specialist.

for Australian specialists. Genie is a tried and tested solution proven to be invaluable to specialists throughout Australia. If youâ&#x20AC;&#x2122;d like to find out more about what Genie can do for your practice, or would like a personal demonstration, just give us a call or visit our website to order a Demonstration CD online. We have offices or representatives in all states.

Genie Solutions Pty Ltd Phone: 07 3870 4085

Email: GS00701

With 14 years experience and over 1600 sites, Genie Solutions is the market leader in medical software

Pulse+IT Magazine - May 2010  

Pulse+IT Magazine - May 2010 - Australasia's first and only eHealth and Health IT magazine.

Pulse+IT Magazine - May 2010  

Pulse+IT Magazine - May 2010 - Australasia's first and only eHealth and Health IT magazine.