Australia’s First and Only Health IT Magazine
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
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- Ambulance Victoria
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- International SOS (Australasia)
- Pen Computer Systems
- Best Practice Software
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- 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
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- 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
PULSE IT +
Publisher Pulse Magazine PO Box 7194 Yarralumla ACT 2600 ABN: 19 923 710 562 www.pulseitmagazine.com.au
Editor Simon James Australia: +61 2 8006 5185 New Zealand: +64 9 889 3185 email@example.com
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: http://www.pulseitmagazine.com.au/editorial
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.
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Page 08 HEALTH IT WORKFORCE
Page 30 HEALTHCARE IDENTIFIERS
Page 50 INTERNET PLANS
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 firstname.lastname@example.org
Welcome to the 17th edition of Pulse+IT, Australia’s first
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
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
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 firstname.lastname@example.org
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€‘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
determine such competencies? These nonâ€‘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
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€œhealth informaticianâ€?.
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. http://www.ukchip.org
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 email@example.com
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,
• 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
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.
Centred Care firstname.lastname@example.org
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
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
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
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
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
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
application. Applications that support
for this purpose also. Another way has
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
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
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.
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.
• 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”
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
Designers of such systems will naturally
It is still possible to make progress even
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 http://www.ihe.net/
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
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 papers largely address the topic from
the technical perspective — semantic and
universal keys that often provide detailed
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: http://www.ejhi.net
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.
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
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
Further information about AHIEC and
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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
Chief Executive Ofﬁcer, MyCyberTwin, Australia Chief Medical Ofﬁcer, iSOFT, Germany National Director Health & Life Sciences, IBM, Australia
Chief Executive Ofﬁcer, NEHTA, Australia
www.itac2010.com.au 22 Pulse+IT
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: firstname.lastname@example.org
BITS & BYTES
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
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
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
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
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-
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
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
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
The results from the Connectathon are
IHE Australia has held three previous with
One GP $907.50 Subscription to Best Practice software:
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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.
FREE EVALUATION DVD
Comprehensive speaker profiles and Phone:
(<25 hrs week)
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
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
steadily thereafter the rest of the tools listed in Table 1
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.
• 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
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
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.
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
signs, provides a ranked differential diagnosis. Isabel is
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
H: Houston VIP
MD: Medical Director
Y: Product has this functionality
N: Product does not have this functionality
+/- : Product has partial functionality
?: Response not received from developer
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
• 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,
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
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,
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 www.nehta.gov.au 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
Orion Health Conference 6 May - 7 May 2010 Sydney, NSW P: +61 2 8096 0000 W: www.orionhealth.com.au
HIC2010 24 August - 26 August Melbourne, VIC P: +61 3 9388 0555 W: www.hisa.org.au/hic2010 HIT
3rd Annual Pharmaceutical Law Conference 2010 30 August - 31 August Sydney, NSW P: +61 2 9080 4300 W: www.iir.com.au
JUNE 10th Anniversary Hospital in the Home Conference 21 June - 22 June Melbourne, VIC P: +61 2 9080 4300 W: www.iir.com.au
2nd Annual Operating Theatre Management Conference 1 September - 2 September Sydney, NSW P: +61 2 9080 4300 W: www.iir.com.au Health-e-Nation 2010 9 September - 10 September Sydney, NSW P: +61 2 4365 7500 W: www.health-e-nation.com.au
Australian 4G Summit 18 May - 19 May Sydney, NSW P: +61 2 9080 4300 W: www.informa.com.au
2nd Annual Emergency Department Management Congres 22 June- 23 June Melbourne, VIC P: +61 2 9080 4300 W: www.iir.com.au
GP’10 / AAPM Conference 6 October - 9 October Cairns, QLD P: +61 3 8699 0414 W: www.gp10.com.au
3rd Annual Green Hospitals Conference 20 May - 21 May Sydney, NSW P: +61 2 9080 4300 W: www.informa.com.au
Mental Health Units Conference 24 June - 25 June Sydney, NSW P: +61 2 9080 4300 W: www.iir.com.au
HIMAA National Conference 27 October - 29 October Sydney, NSW P: +61 2 9887 5001 W: www.himaa.org.au
Health Information Management
Medical Fair Australia 11 May - 13 May Sydney, NSW P: +61 3 9699 4699 W: www.medicalfair-australia.com
Population Health Management 21 June - 23 June Brisbane, QLD P: +61 2 9229 1000 W: www.populationhealth.com.au Health
National Stroke Units Conference 6 May - 7 May Melbourne, VIC P: +61 2 9080 4300 W: www.iir.com.au
ITAC2010 26 July - 27 July Melbourne, VIC P: +61 3 9388 0555 W: www.itac2010.com.au
3rd Annual Preventive Health Summit 27 May - 28 May Sydney, NSW P: +61 2 9080 4300 W: www.iir.com.au
The National Disability Summit 29 April - 30 April Melbourne, VIC P: +61 2 9080 4300 W: www.iir.com.au
Managing Ward Finances & Budgets 24 May - 25 May Brisbane, QLD P: +61 2 9080 4300 W: www.iir.com.au Health
Pharmaceutical Benefit Scheme Forum 22 April - 23 April Sydney, NSW P: +61 2 9080 4300 W: www.informa.com.au
GPCE 21 May - 23 May Sydney, NSW P: +61 2 9211 7454 W: www.gpce.com.au
IHE Secure Messaging Connectathon 19 April – 23 April Canberra, ACT P: +61 418 487 081 W: www.ihe.net.au
Australian Pharmacogenomics Summit 21 May - 22 May Sydney, NSW P: +61 2 9080 4300 W: www.iir.com.au
Managing Risk Integrated Decision Support in Medications Management Software Danny Brayan
B.App.Sci(Physio), MBA (Management of Technology) MIMS Australia email@example.com
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
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
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:
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.
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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.
the aviation industry
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
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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.
www.ehealthinfo.gov.au 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.
www.ehealthinfo.gov.au is jointly brought to you by Australia’s Federal, State and Territory health authorities and the National E-Health Transition Authority (NEHTA) to help you explore the 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 http://www.racgp.org.au/ehealthfutures
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 email@example.com
Dr Andrew McIntyre
MB BS (Hons), FRACP Medical-Objects firstname.lastname@example.org
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
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
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
--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
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 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
with the vMR. There are many potential ways to do
• The vMR project: http://wiki.hl7.org/index.
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: http://www.hl7.org/v3ballot/ 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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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.
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
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 email@example.com
the terminology to check for Warfarin or its active
different organisations; and
A clinical terminology is a foundation element of an
then a clinical decision support engine can use
specialist — organisations.
PhD CSIRO Australian E-Health Research Centre firstname.lastname@example.org
If a patient has a medicine in the “active medicines”
interactions, are maintained and published by • guidelines are produced by different — often
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.
Knowledge and Associative Knowledge.
Medicines Terminology (AMT). An Australian Medicines
Figure 1 - Mapping an existing terminology to SNOMED CT using Snapper.
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€™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€™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
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
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.
Predicting capacity with (greater) certainty Nick Burns
Director Emendo email@example.com
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
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
and developing capacity within existing
were reduced. Following the introduction
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
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
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
Mental Health Units Conference 24–25 June 2010, Citigate Central Hotel, Sydney Striving Towards Seamless Care Between Mental Health Units, Emergency Departments and Community Health Featuring contributions from: • • • • • • •
Department of Health, Victoria Queensland Health SA Department of Health Mental Health ACT InforMH, NSW Health St Vincent’s Mental Health Service National eTherapy Centre, Swinburne University of Technology
• 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: firstname.lastname@example.org VISIT: www.iir.com.au/mentalhealth
National E-Health Transition Authority www.nehta.gov.au
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
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 www.nehta.gov.au
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 www.nehta.gov.au
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.
Senior Associate DLA Phillips Fox email@example.com
Paralegal DLA Phillips Fox firstname.lastname@example.org
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,
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
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
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
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
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
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
Hospital in the Home Conference
21– 22 June | Hilton on the Park Melbourne For the latest program updates & event news visit: www.iir.com.au/hith/it
TO REGISTER CALL NOW!
T: +61 2 9080 4090 F: +61 2 9299 3109 E: email@example.com VISIT: www.iir.com.au/hith/it
Internet plans Reviewing your Internet arrangements may save you money and improve performance. Simon James
BIT, BComm Editor of Pulse+IT firstname.lastname@example.org
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.
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)
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
Sydney, Melbourne and Brisbane, however
up to 42,000kbps later in the year, followed
of other bandwidth intensive applications
donâ€™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
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,
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
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 monthly bills or via an online
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
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 www.medicareaustralia.gov.au then For health professionals > HPOS Logon
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
P: +61 2 9889 1311 F: +61 2 9889 1411 E: email@example.com W: www.carbonelle.com.au
P: 1800 196 000 or +61 3 9095 8712 F: +61 3 9329 2524 E: firstname.lastname@example.org W: www.aapm.org.au The Australian Association of Practice Managers (AAPM) represents Practice Managers and the profession of Practice Management. Founded in 1979, AAPM is a non-profit, national association recognised as the professional body dedicated to supporting effective Practice Management in the healthcare profession. The Australian Association of Practice Managers: • Represents Practice Managers and the profession of Practice Management throughout the healthcare industry. • Promotes professional development and the code of ethics through leadership and education. • Provides specialised services and networks to support quality Practice Management.
P: 1300 308 531 F: +61 3 9797 0199 E: email@example.com W: www.advantech.net.au Advantech’s medical computing platforms are designed to enhance the quality and efficiency of healthcare for patients and users alike. All products match the performance of commercial PCs and tough medical safety ratings like UL60601-1 and EN60601-1; adding to this they are all IPX1 certified dust resistant and come with water dripproof enclosures. Advantech offers long term support and a proven track record of reliability. The medical range extends through: • Point-of-Care Terminals. • Mini-PC and Medical Imaging Displays. • Mobile Medical Tablets. • Patient Infotainment Terminals. Advantech is also an official distributor of Microsoft Windows Embedded software across Australia & New Zealand.
P: +61 8 8234 1600 F: +61 8 8234 6785 E: firstname.lastname@example.org W: www.esquare.com.au 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: email@example.com W: www.argusconnect.com.au 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: firstname.lastname@example.org W: www.bpsoftware.com.au Best Practice sets the standard for GP clinical software in Australia offering a flexible suite of products designed for the busy GP practice, including: • Best Practice Clinical (“drop-in” replacement for MD) • Integrated Best Practice (clinical/ management) • 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: email@example.com W: www.software7.com.au 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: AsiaPacific@cerner.com W: www.cerner.com.au
Cerner is a leading supplier of healthcare information systems and our Millennium suite of solutions has been successfully installed in over 1200 sites across the globe. Cerner’s technology has been designed so that it can be adapted to meet the needs of the very different healthcare delivery systems that exist, with a universal framework 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
CH2 (Clifford Hallam Healthcare) P: 1300 720 274 F: 1300 364 008 E: firstname.lastname@example.org W: www.ch2.net.au
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.
Computer Initiatives Communicare Systems P: +61 8 9332 2433 F: +61 8 9310 1516 E: email@example.com W: www.ccare.biz
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: firstname.lastname@example.org W: www.cinet.com.au
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
P: +61 2 9410 0405 (NSW) P: +61 3 9646 0141 (VIC) E: email@example.com W: www.computercare.com.au
P: 1300 557 550 F: +61 7 5478 5520 E: firstname.lastname@example.org W: www.directcontrol.com.au
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: email@example.com W: www.dgs.com.au
Easier ICT is a technology partnership with DMS — we make I.T. work for you. DIGITAL MEDICAL SYSTEMS has provided ICT solutions and services to medical practice clients across Australia since 1990. We have specialist expertise and experience in the installation and support of leading medical software applications. DMS is a Business Partner for IBM, Lenovo, HP and Microsoft. Other leading ICT brands include Trend Micro, Symantec, CA, Cisco, Toshiba, Canon, Epson, Kyocera, Fujitsu and Brother. Accreditation is easier with the customised DMS IT Systems Documentation. Ensure your practice has the best quality IT policy, security and maintenance program that meets and exceeds the standards guidelines from the RACGP and AGPAL and GPA. World leading DTech provides 24x7 near Real-Time Monitoring and Management that alerts and enables our engineers to quickly troubleshoot and solve problems of security, network, Internet, Server and software remotely on almost any client computer system or device. Medical IT systems are automatically maintained by DTech to the most highly available status to minimize downtime by preventing problems from occurring or reducing their impact. Proactive, Flexible, Consistent, Reliable, Audited, and Affordable — for even the smallest practice. Call DMS for: • Systems Analysis & Consulting • Solutions Design • Procurement & supply of hardware, software, network and peripheral products • Installation & Configuration • Support Services inc Help Desk • DTech Monitoring, Maintenance & Management • Disaster Recovery solutions • Fully managed & automated Online Backup customised for clinical data Easier IT — we make I.T. work for you.
Equipoise (International) Pty Ltd Totalcare P: +61 7 3252 2425 F: +61 7 3252 2410 S: skype.totalcare.net.au E: firstname.lastname@example.org W: www.totalcare.net.au
Equipoise International Pty Ltd (EQI) is the developer and supplier of the ‘Totalcare’ clinical and office management system. Used since 1995 by health care facilities across Australia including General and Specialist practice, Radiology, Day Surgery and Hospitals. Totalcare is a fully integrated Clinical, Office and Management software suite. Totalcare is stable, scalable, customisable and easy to learn and use. From a small practice to a distributed, multi site, multi disciplinary corporate entity or hospital, Totalcare can provide a solution for your needs.
HealthLink Global Health
Health Communication Network
P: +61 3 9675 0600 F: +61 3 9675 0699 E: email@example.com W: www.global-health.com
P: +61 2 9906 6633 F: +61 2 9906 8910 E: firstname.lastname@example.org W: www.hcn.com.au
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.
P: +61 7 3870 4085 F: +61 7 3870 4462 E: email@example.com W: www.geniesolutions.com.au Genie is a fully integrated appointments, billing and clinical management package for Specialists and GPs.
GPA ACCREDITATION plus has given general practices a reliable alternative in accreditation. GPA is committed to offering a flexible accreditation program that understands the needs of busy GPs and practice staff. GPA assigns all practices an individual quality accreditation manager to support practices with their accreditation. Choose GPA for more support, improved service and greater choice.
Genie runs on both Windows and Mac OS X, or a combination of both. With over 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: firstname.lastname@example.org W: www.gpa.net.au
P: 1800 125 036 F: +61 7 3870 7768 E: email@example.com W: www.healthlink.net
P: +61 2 9887 5001 F: +61 2 9887 5895 E: firstname.lastname@example.org W: www.himaa.org.au
P: +61 7 5665 7995 F: +61 7 5502 6543 E: email@example.com W: www.healtheasy.com.au
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.
P: +61 3 9388 0555 F: +61 3 9388 2086 E: firstname.lastname@example.org W: www.hisa.org.au 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.
P: 1800 420 066 or +61 2 9669 1844 P: 0800 401 111 or +64 7 834 9354 F: +61 2 9669 1791 E: email@example.com W: www.houstonmedical.net 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 VIP.net 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: firstname.lastname@example.org W: www.anytime.com.au
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: anz.query@InterSystems.com W: www.InterSystems.com 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.
JOSE & Associates
P: 1300 300 471 F: +61 2 9280 2665 E: email@example.com W: www.isnsolutions.com.au
P: +61 3 9850 1350 F: 1300 889 012 E: firstname.lastname@example.org W: www.jose.com.au
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: email@example.com W: www.isofthealth.com iSOFT is one of the world’s largest providers of healthcare IT solutions. We work with healthcare professionals to design, develop and implement healthcare solutions that deliver administrative, clinical and diagnostic services to ensure continuity of care across all care settings.
P: +61 7 5456 6000 F: +61 7 3221 0220 E: firstname.lastname@example.org W: www.medical-objects.com.au
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.
P: +61 2 9901 6400 F: +61 2 9439 6331 E: email@example.com W: www.meditech.com.au
Medical Software Industry Association P: +61 427 844 645 E: firstname.lastname@example.org E: email@example.com W: www.msia.com.au
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.
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: firstname.lastname@example.org W: www.medilink.com.au 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: email@example.com W: www.nehta.gov.au
P: +61 3 9690 8666 F: +61 3 9690 8010 E: salesAU@medtechglobal.com W: www.medtechglobal.com
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: Sales@practiceservices.com.au W: practiceservices.com.au 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: firstname.lastname@example.org W: www.carbonelle.com.au Carbonelle support over 600 clients with 21 Years of Experience. Medilink Practice Management and Clinical Integrated Systems
P: +61 2 9902 7700 F: +61 2 9902 7701 E: email@example.com W: www.mims.com.au MIMS Australia is built on a heritage of local expertise, credibility and adaptation to changing healthcare provider needs. Our information gathering, analysis and coding systems are proven and robust. MIMS information is backed by MIMS trusted, rigorous editorial process and constantly updated from a variety of sources including primary research literature. Our database and decision support modules are locally relevant, clinically reviewed and updated monthly and compatible with a host of clinical software packages. Indeed, the majority of Australian prescribing packages and many dispensing applications are supported by the MIMS medicines data base.
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.
Pen Computer Systems
P: +61 2 9635 8955 F: +61 2 9635 8966 E: firstname.lastname@example.org W: www.pencs.com.au
Nuance Communications P: 1300 550 716 F: +61 2 9434 2301 E: Vicki.Rigg@nuance.com W: www.nuance.com/au
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: email@example.com W: www.spellex.com.au
Spellex has been the leading provider of comprehensive medical dictionary enhancement software to thousands of the world’s most prominent healthcare companies for 21 years. Our easy-to-use Australian medical spell checking software integrates fully with all Microsoft programmes, Web-based applications, and popular platforms. Spellex Medical is available for end-users to ensure the medical accuracy of documents and to enhance their productivity. Spellex software development kits can also be integrated with developer’s custom programmes and Web sites. Whether you’re an individual transcriptionist or you need to provide greater medical documentation accuracy across an entire hospital or campus, Spellex has a solution that’s right for you.
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 spellex.com.au 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.
C P: +61 2 8096 0000 / +64 9 638 0600 F: +61 2 8096 0001 / +64 9 638 0699 E: firstname.lastname@example.org M W: www.orionhealth.com
Stat Health Systems (Aust)
P: +61 7 3121 6550 F: +61 7 3219 7510 E: email@example.com W: www.stathealth.com.au
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.
SmartRooms by Doctorware P: +61 3 9499 4622 F: +61 3 9499 1397 E: firstname.lastname@example.org W: www.doctorware.com.au
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: email@example.com W: www.syberscribe.com.au 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: firstname.lastname@example.org W: www.zedmed.com.au Owned by Doctors who understand the challenges facing the medical profession everyday and backed by nearly 30 years of experience in medical software programming, Zedmed provides innovative, full featured and sophisticated practice management and clinical records software solutions. Zedmed would also like to introduce to you 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€™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€™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
With 14 years experience and over 1600 sites, Genie Solutions is the market leader in medical software