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Australasia’s First and Only eHealth and Health IT Magazine



19 NOVEMBER 2012


The NBN meets the iPad

iPads are linking GPs to a local hospital and nursing home through high speed NBN connections.

Clinical photos made PicSafe

A mobile app that captures clinical images and uploads them safely to the cloud may solve privacy problems.

Practice guide to the ePIP and PCEHR Pulse+IT’s comprehensive guide to what your practice needs to know for the new ePIP requirements and the PCEHR.

Organisations please note: Pulse+IT eNewsletter advertising options for 2013 are now available and selling fast. Based on the overwhelming response to this service throughout 2012, Pulse+IT anticipates all 2013 advertising opportunities will sell out before Christmas. To register your interest and obtain a media kit, email:

Want to keep your finger on the pulse? Launched in 2012, Pulse+IT’s companion eNewsletter service is the sector’s most trusted source of timely eHealth and Health IT news. Pulse+IT eNewsletters bring together breaking news, events, career and business opportunities, and software training sessions, keeping readers informed and up to date. Our rapidly growing list of subscribers enjoys:

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Reporting dedicated purely to eHealth in Australasia

Independent, timely and accurate journalism

No costs, logins, credit cards, paywalls or micropayments




Publisher Pulse+IT Magazine Pty Ltd ABN: 34 045 658 171 Editor Simon James Australia: +61 2 8006 5185 New Zealand: +64 9 889 3185 Advertising Enquiries

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Looking Ahead Pulse+IT welcomes feature articles and guest editorial submissions relating to the nominated edition themes, as well as articles relating to eHealth and Health IT more broadly. Edition themes for 2013 are available at the Pulse+IT website. Pulse+IT is produced in print seven times per year with the first edition for 2013 to be distributed for release in mid-February.

Submission guidelines and deadlines are available online: Pulse+IT acknowledges the support of the following organisations, each of whom supply copies of Pulse+IT to their members.

About Pulse+IT Pulse+IT is Australia’s first and only Health IT magazine. With an international distribution exceeding 34,500 copies, it is also one of the highest circulating health publications in Australasia. 32,000 copies of Pulse+IT are distributed to GPs, specialists, practice managers and the IT professionals that support them. In addition, over 5,000 copies of Pulse+IT are distributed to health information managers, health informaticians, and IT decision makers in hospitals, day surgeries and aged care facilities. ISSN: 1835-1522 Contributors Christopher Bladin, Simon James, Paul Macdonald, Vincent McCauley, Kate McDonald. Disclaimer The views contained herein are not necessarily the views of Pulse+IT Magazine or its staff. The content of any advertising or promotional material contained herein is not endorsed by the publisher. While care has been taken in the preparation of this magazine, the publisher cannot be held responsible for the accuracy of the information herein, or any consequences arising from it. Pulse+IT Magazine has no affiliation with any organisation, including, but not limited to Health Services Australia, Sony, Health Scope, UBM Medica, the New Zealand College of General Practitioners, the Rural Doctors Association of Australia, or the Kimberley Aboriginal Medical Services Council, all who produce publications that include the word “Pulse” in their titles. Copyright 2012 Pulse+IT Magazine Pty Ltd No part of this publication may be reproduced, stored electronically or transmitted in any form by any means without the prior written permission of the Publisher. Subscription Rates Please visit our website for more information about subscribing to Pulse+IT.
















GUEST EDITORIAL Christopher Bladin explains how mobile video conferencing and high speed broadband can save stroke patients’ lives in rural Australia.



St Vincent’s Hospital Sydney hooks up to the PCEHR

GPs in a small Tasmanian town are able to link to patients in aged care, acute care and primary care.

GP advocates funded to spread the PCEHR word




Editor Simon James introduces the 32nd edition of Pulse+IT.

Vincent McCauley reveals that informaticians are developing a standard for healthcare software to ensure it is fit for purpose.

Off topic

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St John Ambulance officers in WA have been given personal iPads that link up with a new PCR.

CLINICAL PICS MADE PICSAFE A new app developed by a plastic surgeon could help overcome the privacy problems of clinical photos.

GIVING SPECIALISTS WHAT THEY WANT ON THEIR IPADS It took about 24 hours for Cabrini to realise the power that was being held in its specialists’ hands.

SELECTED BITS & BYTES Zedmed first out of the gates with full PCEHR capability

NEHTA terminates $23m NASH authentication contract with IBM Federal government cuts telehealth MBS item number Argus to be deployed with Best Practice clinical software eScript exchanges to be connected

GETTING READY FOR THE ePIP Our guide to what practices will need to do to qualify for the new requirements of the ePIP.




Clinical software vendors are releasing new functionality to ensure users are up to speed with eHealth.

LETTERS GO ELECTRONIC Specialist letters sent electronically from outpatients clinics to GPs reduce the wait for patient data.


EVENTS Up and coming eHealth, Health, and IT events.

The next challenge for eHealth is the acute sector: CSC Healthcare Victoria aims for more open ICT strategy NEHTA expert wins international award for SNOMED CT work

PULSE+IT DIRECTORY The Pulse+IT Directory profiles Australasia’s most innovative and influential eHealth and Health IT organisations.

Genie Solutions releases v8.3.4 with full PCEHR access Stat Health integrates SMS






MOBILE HEALTH The final edition of Pulse+IT for the year profiles the burgeoning use of mobile computing devices in various healthcare settings, with feature writing and news coverage spanning general and specialist practice, hospitals, and ambulatory services.

SIMON JAMES BIT, BComm Editor: Pulse+IT

By virtue of coincidence more so than prophetic forward planning, this magazine was produced against the backdrop of a deluge of activity in the tablet computing space. Apple released a new iPad in a ‘mini‘ form factor and Microsoft launched its Surface tablet alongside Windows 8 in the hope of making up some of the considerable ground it has forfeited to Apple and the Android operating system. Despite the exponential uptake of smart phones and ‘consumer’ tablet computers in recent years, it is worth reflecting on the fact that mobile computing, as it exists today, is still a very recent phenomenon. While mobile devices and their associated fleet of apps continue to proliferate, one suspects much innovation is still to come and will ultimately be shaped by the end users of technology in the health sector.

About the author Simon James is the editor of Pulse+IT, one of Australia’s highest circulating health publications of any kind. Prior to founding the publication in 2006 he worked in an IT support capacity for various medical practices, and subsequently for both clinical software and secure messaging developers.

With changes to the eHealth PIP requirements around the corner, Pulse+IT has presented an overview of the new scheme to assist general practices to prepare. While more arduous than previous eHealth PIP requirements, the new criteria – to take effect from February 2013 – should still be quite achievable for practices before the deadline, as long as they get the ball rolling early. With the ability to connect to the PCEHR one of the more technically involving requirements, Pulse+IT also provides an update on the progress being made by the developers

of many of the popular general practice software products on the market.

Win an iPad mini In preparation for the new year, Pulse+IT is seeking feedback from our readers and we’re offering up some of the recently launched iPad minis (RRP $369) as prizes for every 100th survey respondent. The survey should only take a few minutes to complete and can be found here:

Acknowledgements As our print production cycle draws to a close for 2012, I would like to extend my thanks to all of this year’s contributing writers, advertisers, subscribers and the organisations that supply the publication to their memberships. All of these individuals and organisations play an ongoing and important role in making each edition of Pulse+IT a reality.

Looking ahead After a short break from our print production cycle, Pulse+IT magazine will return in February 2013. For those interested in our editorial plans for next year, edition themes can now be reviewed at the Pulse+IT website, where readers will continue to enjoy breaking eHealth news throughout the summer months.

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Guest Editorial



The key to preventing death or disability after stroke is early intervention, but Australia’s vast distances make this difficult for rural and regional areas. A telemedicine project piloted in Victoria’s Loddon Mallee area is now being rolled out to the major hospitals of regional Victoria, allowing emergency clinicians to communicate immediately by video call with neurologists in Melbourne and share clinical images. PROF CHRISTOPHER BLADIN BSc, M.D, FRACP Director: Dept Neurosciences Eastern Health

About the author Christopher is a practicing neurologist, specialising in stroke. He has an appointment at Monash University, and works at Eastern Health, based at The Florey Institute of Neuroscience & Mental Health Melbourne Brain Centre, where he is program director of the Victorian Stroke Telemedicine Project.

Stroke is Australia’s second biggest cause of death and greatest cause of adult disability. The consequences of stroke are devastating – approximately 40 per cent die within 12 months of stroke, and about 50 per cent of survivors are dependent on others for assistance with personal activities of everyday living. Over 60,000 strokes occur in Australia every year, with direct and indirect costs of over $2 billion to the economy. In Victoria, over 15,000 people suffer strokes every year, with about 5000 of these occurring in rural and regional areas. Moreover, the proportion of the population aged over 65 years is expected to rise from 14 per cent in 2008 to about 24 per cent by 2031. As the map indicates, the sea-changing and tree-changing lifestyle means a higher proportion of these older people are living in rural and regional Australia, and this is projected to increase further. The key to preventing long-term death and disability in stroke is to undertake treatment as quickly as possible. The phrase “time is brain” is commonly used in this context, indicating that any delay in treatment of the stroke results in a worse outcome. Indeed, many have seen the successful FAST (Face/Arm/Speech/ Time) campaign by the National Stroke Foundation urging people to know the warning signs of stroke and to contact medical services quickly.

The delivery of acute stroke treatments by telemedicine has been successfully implemented in healthcare networks across Europe and North America, but not yet in Australia. Here, metropolitan hospitals are well organised with stroke units and specialist medical expertise so that effective stroke therapies can be delivered quickly, safely and efficiently. However, this is not the case in our rural and regional hospitals, where delays in stroke diagnosis and treatment are problematic due to a lack of specialist stroke medical support, which is important in order to deliver stroke therapies safely and effectively. Advances in technology and broadband internet speed mean that audio-visual stroke telemedicine is now ideally placed to address these rural and regional healthcare inequalities. This is supported by economic modelling that clearly shows that telemedicine is significantly cheaper than alternative mechanisms of delivering best practice stroke treatment to those living in rural and regional areas. Telemedicine via high capacity broadband holds the prospect of providing reliable and fast access to stroke specialists, rapid assessment of brain imaging and expedited delivery of appropriate acute stroke therapies including use of the blood clot-dissolving (‘clot-busting’) drugs in acute stroke care.

“Telemedicine via high capacity broadband holds the prospect of providing reliable and fast access to stroke specialists, rapid assessment of brain imaging and expedited delivery of appropriate acute stroke therapies including use of blood clot‑dissolving drugs in acute stroke care.” Prof Christopher Bladin

The Victoria Stroke Telemedicine (VST) project is an acute stroke telemedicine program for Loddon Mallee hospitals to facilitate clinical decision-making for treating patients with acute stroke,

Distribution of population over 65 years of age

using telemedicine via high capacity broadband. It has been operational since 2009 and is funded and coordinated by the Florey Neuroscience Institute in collaboration with the Victorian Stroke

Clinical Network (Victorian Department of Health), the Victorian Department of Business and Innovation, and commercial partners Telstra and Polycom. VST has a well‑developed governance and management structure, including steering, IT, medical, and education/communication committees. Change management processes and the complexities of undertaking telemedicine consultations in the acute healthcare environment (ie. in a hospital emergency department) cannot be underestimated, particularly in the context of delivering “time-critical” therapies. The telemedicine process must be user friendly, and it must work smoothly and efficiently. The VST project was first commenced at Bendigo Hospital and allowed us to establish the “proof of concept” for undertaking stroke telemedicine. VST uses a consortium of metropolitan-based stroke specialists (neurologists) linked via telemedicine to Bendigo Hospital. The roster of neurology stroke specialists provide on-call 24 hours a day, seven days a week cover, and are available to receive stroke telemedicine calls from the ED at Bendigo Hospital. The on-call roster and access to the neurologists has now been fully automated by use of a 1300 phone number (1300 TELEMED), so that the ED physician need only dial one number and will be put through to the rostered oncall





Before treatment, yellow arrow shows blocked artery.

After treatment, red arrow shows artery now open.

neurologist. This telemedicine system is unique in Australia. The neurologists then have real-time access to patient vital data, brain imaging, as well as high quality audio-visual communication to facilitate remote consultations.

the LMRHA network. The neurologists are based at different hospitals, with differing local ICT configurations/infrastructure, which can be challenging. The issues related to ensuring reliable, fast, mobile broadband connectivity is a key IT directive.

Some details on the current infrastructure being used:

Networks The network infrastructure in the ED is high definition video practitioner carts that are connected to and hosted from the LMRHA network. The neurologists access this network when they use CMA software to establish a video call to the ED.

Hardware In the Bendigo ED, the current VST program uses a high definition Polycom telehealth practitioner cart with a high definition camera (720p) to provide the video-conferencing link to the on-call neurologist. At the neurologist endpoint, neurologists use their own laptops or hospital-based computers running Polycom teleconferencing software. Software Neurologists have Polycom’s Converged Management Application (CMA) desktop installed on their laptops and iPads to enable access to Bendigo Hospital and any hospital with a Polycom telehealth practitioner cart linked within the Loddon Mallee Rural Health Alliance (LMRHA) Network supported by Telstra. Connectivity The neurologists use a combination of wired (consumer grade ADSL and hospital data network) and wireless (Telstra 3G and soon 4G) technology to connect into

Brain images Hospitals use picture archiving and communication system (PACS) radiology software to view brain imaging. Fast and reliable access to brain imaging is critical for the rapid assessment of patients with acute stroke. The following is a real-life scenario demonstrating the benefit of stroke telemedicine in a rural setting: A 65-year-old lady living on a farm comes to Bendigo Hospital within two hours of stroke. On arrival in the emergency department, a stroke specialist in Melbourne is contacted and uses telemedicine to assess the patient – the stroke treatment protocol is followed. Brain imaging is completed. The early CT scan shows no damage has yet occurred

but there is a blood clot in one of the brain arteries. A blood clot-dissolving drug is given, the blood clot is removed, with excellent recovery of brain function. The patient returns home having made an excellent recovery. In 2013, the next phase of stroke telemedicine in Victoria will commence. The Florey Institute and its stroke telemedicine partners have received funding from the Victorian Department of Business and Innovation, and the federal Department of Health and Ageing (DoHA), to develop models of care applicable to high speed broadband, and to implement acute stroke telemedicine in the emergency department of the key hospitals in rural and regional Victoria. This project is highly innovative within the Australian health arena in demonstrating the benefits of an integrated stroke telemedicine program using high capacity broadband. This will deliver a coordinated, multi-centre, multi-faceted, technology‑based approach to treatment of acute stroke with a consortium of stroke specialists linked via telemedicine to the emergency departments across rural and regional health networks. This innovative telemedicine model will usher in the future of acute healthcare delivery that can then be applied to other healthcare regions throughout Australia.

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Zedmed first out of the gates with full PCEHR capability Clinical software vendor Zedmed is the first to achieve full interface capability with the PCEHR, with several users having successfully uploaded shared health summaries to the system and Zedmed’s PCEHR-compliant version now in general release.

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Zedmed was the first clinical software package placed on the NEHTA’s eHealth Practice Incentives Program (ePIP) register, which allows practices to check whether their software complies with the government’s new requirements for the ePIP. Last month, a doctor at the Medical One clinic in Waurn Ponds, a suburb of Geelong, successfully demonstrated that he could upload a document natively from a clinical system.

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Previously, two add-on products – Health Industry Exchange’s Companion Gateway product and Pen Computer Systems’ Sidebar

tool – were necessary to interface with the PCEHR. Zedmed is one of the six members of the GP desktop software vendors panel, established to be the lead group in redeveloping their software to allow integration with the government’s Healthcare Identifiers (HI) Service, secure messaging and electronic transfer of prescriptions capability, and CDA rendering and packaging capability to allow clinical documents to be viewed and uploaded to the PCEHR. The other five vendors – Best Practice, CSC, Communicare, Genie and Medtech Global – have all told Pulse+IT that they too have the full capability, with a general rollout to begin in the next month or two. The market-leading vendor, HCN, will also have the full capability and will begin its rollout later this year to enable users to qualify for the ePIP.

Zedmed received notification that it had passed its Conformance, Compliance and Accreditation (CCA) certificate to both view the PCEHR and to upload shared health summaries in late September, Zedmed’s business analyst, Jane Blakeley, said. “We believe that we are the first GP desktop software vendor to have completed that testing,” Ms Blakeley said. “Users can view, upload and download documents, so basically that gives you full access to the PCEHR directly through Zedmed and you don’t need any other third-party software.” In early October, it began beta testing its capability in actual practice at the Victorian-based medical centre group Medical One. Medical One, which has nine centres in Victoria and one in South Australia, uses Zedmed’s clinical

and practice management system throughout its operations. Its founders and owners, Peter Stratmann and Andrew Pascoe, sit on Zedmed’s board and the company is also affiliated with the Pathology One diagnostic service.

Provider IdentifierOrganisation (HPI-O) classification through the HI Service, but multi-site medical centre operators like Medical One must also apply for Network HPI-Os for each practice.

Its Geelong centre at Waurn Ponds has been working with the software vendor as it tests its interface to the PCEHR, Medical One’s general manager, Karen Perham, said.

“Users can view, upload and download documents, so basically that gives you full access to the PCEHR directly through Zedmed.“

She said one of the Geelong centre’s GPs, Bernard Shiu, had uploaded a shared health summary to a staff member’s PCEHR on October 17, and the group is now able to offer the service to patients. “A couple of patients have asked about the PCEHR but really not many people know enough about it,” she said. “There is a still a lot of training to do, and we are currently writing our policies and procedures on how to use the system.” Since then, Murray Verso of The Clinic Williamstown and Mark Magill of Park Street General Practice in Geelong have also begun uploading documents. Medical One is an interesting case study in how large medical groups will interact with the eHealth records system, if they so choose. Healthcare organisations must apply for a Seed Healthcare

Ms Perham herself is both the responsible officer (RO) for the participation of the organisation in the HI Service, and an organisation maintenance officer (OMO) responsible for maintaining the accuracy of the HPI-O. She said it was likely that as the new system takes shape, she will allocate the OMO role to one person at each centre. Medical One has gone through the process of obtaining PKIs for all of its centres through Medicare’s Health Professional Online Services (HPOS), including tokens for both clinicians and practice staff. On October 31 – the deadline set by NEHTA to the software vendors panel

to have full functionality integrated into their products – Zedmed announced that its compliant software, version 20, was in general release. All users of Zedmed can now install v20 and begin accessing the PCEHR to view clinical documents and upload shared health summaries. Ms Blakely said the software also currently supports the ETP requirement, with the ability to use either the eRx or the MediSecure prescription exchanges. It will also have full secure message delivery (SMD) standard capability shortly. “We are working with both Argus and HealthLink on SMD capability and my understanding is that they and Global Health are working together on a project to work interoperably,” she said. Zedmed’s general manager, Grant Williamson, said the company was “excited by Medical One’s upload and are proud to be a part of such a significant step towards Australia’s eHealth system. We are proud of our recent developments and are excited to provide users with the confidence they need to become eHealth compliant,” he said. For extensive coverage of the new ePIP requirements and the level of progress of the vendors, see pages 50 to 57 in this issue of Pulse+IT.

St Vincent’s Hospital Sydney hooks up to the PCEHR Sydney’s St Vincent’s Hospital has become the first hospital in Australia to connect to the PCEHR, and has achieved another first in uploading an electronic discharge summary to the system. St Vincent’s accessed the PCEHR of one of its patients, allowing the hospital to see a recent and up-to-date summary of his healthcare information uploaded by his GP, along with his recent Medicare history. The hospital was also able to transmit a full electronic discharge summary to the system, in what is a major breakthrough in eHealth in Australia. The discharge summary includes information such as diagnosis, diagnostic investigations, procedures performed, clinical interventions and a full list of prescribed medications upon discharge. The summary was delivered securely to the national system in an industryagreed, standardised format. St Vincent’s used Emerging Systems’ EHR clinical information system, known as deLacy, to connect to the PCEHR. Emerging Systems has been working closely with St Vincent’s in the Eastern Sydney Connect Wave 2 trial, helping to test the transmission of admission and discharge notifications and discharge summaries from St Vincent’s to local GPs. In September, well-known GP Ray Seidler uploaded his first shared health summary to a patient’s PCEHR, and has long heralded the importance of an electronic discharge summary to GPs. “Some patients forget to bring their letter to the GP and so much pertinent information gets lost,” he said. “Now we have a fail-safe method of information transfer. This makes the patient happy and produces rejoicing amongst us GPs who were previously left out of the loop.”





Bits & Bytes

Intersystems positions HealthShare for connectivity InterSystems is set to release an upgrade of its HealthShare strategic integration platform soon, featuring a number of embedded international standards designed to encourage its use to connect to regional and national eHealth initiatives such as the PCEHR. InterSystems’ group commercial director Steve Garrington said the company had spent the last year working with existing customers in Australia and New Zealand to upgrade and standardise their versions of the technology to enable them to increase their connectivity to other technologies. The company is also increasing its emphasis on its laboratory information management systems (LIMS) business, hoping to win some new contracts in Australia following its 2010 deal to install its TrakCare Lab product throughout Wales and a more recent contract involving 200 laboratories in South Africa. “What we are doing on an ongoing and increasing basis is embedding international standards, including Australian, in the HealthShare product,” Mr Garrington said. “HealthShare is what we call a strategic informatics platform, so if you are a HealthShare customer, you will be able to use it to connect to things, to hold information and to manage and analyse information accordingly. “We are hoping to encourage some organisations, whether they be state or private groups, to use that technology to connect to the PCEHR, or generally just to use it to connect. You’ll end up with a much cleaner path to PCEHR connectivity or messaging standards, whatever it is.” InterSystems is currently working on the Fiona Stanley Hospital to integrate clinical applications and general services.

Custom app gives view of problem veins Melbourne vascular surgeon Gary Frydman has launched an app for his patients containing pre- and post-operative information for the better management of varicose veins. The ‘Western Vascular’ app allows the patient to take a photo of the problem area if they have follow-up questions and upload them to a secure patient gateway, where Mr Frydman can then view them and respond. Mr Frydman said that while the information contained in the app was customised for his patients and his practice, the app was free for anyone to use. It is currently available for the iPhone, iPad and iPod Touch on the iTunes App Store. An app for Android devices is currently in development.

“It’s a bit of an experiment, but basically it is to give patients more information and control over their care,” Mr Frydman said. “There’s a lot of patient information about pre-operative and pre-procedure options for treatment and it has also got post-operative instructions, but the most important thing is a patient gateway where a patient can send me photographs. ”When someone uploads and sends photos, I will immediately receive an email wherever I am in the world so I can log in, check the photos and reply to the patient via email.” Mr Frydman said he regularly received calls from at least one or two patients a week post‑procedure with

queries, and invariably the patient has to return to the centre to see him in person. “It’s an inconvenience and a cost to the patient and to me because I have to find the time,” he said. “My clinic gets overbooked but if somebody needs to be seen, they need to be seen. This is to try to alleviate this – they can take a photo and send it in and often I’ll get back to them the same day, whereas I might not be consulting for two or three days, so they might get a quicker and more appropriate response.” The app was designed by US mobile medical app developer Appworks, which specialises in mobile clinical photography. The app has been customised for Mr Frydman’s practice and contains his treatment plans, but he said other vascular surgeons could use it if they wish to. He believes plastic surgeons and dermatologists would find the app useful for treating people with leg ulcers, diabetic feet or any skin‑based problem. “The cloud end has the ability to record all the photos and print out a report for the patients. I think the patient gateway is a great way to allow me to treat my patients better at minimal cost.”

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Bits & Bytes

EpiSoft’s Jenny O’Neill elected to head up MSIA

Federal government cuts telehealth MBS item number for outer metro areas

EpiSoft’s director of business development Jenny O’Neill has been elected president of the Medical Software Industry Association (MSIA), the first woman to hold the position. Ms O’Neill takes over from Smart Health Solutions’ Jon Hughes, who was elected the new treasurer. The new secretary is Emma Hossack, CEO of Brisbane-based EHR specialist Extensia. Together they make up the MSIA’s executive committee, along with CEO Bridget Kirkham. “I am looking forward to representing the association and its large and diverse membership in the coming year,” Ms O’Neill said. “Many companies are implementing aspects of the national eHealth program, alongside their own product innovation and commercialisation plans, so it is a very busy time for industry. “My goal is to make sure some of their hard work comes to fruition in 2013 in the interests of industry and the broader healthcare community and to ensure a level playing field in the eHealth market, which helps to foster competition and innovation.” Elected to the management committee at the MSIA’s annual general meeting recently were former treasurer and president Vince McCauley of McCauley Software; Dinah Graham of MIMS; DCA’s Peter Young; and Mathew Cherian of Global Health, who was appointed the MSIA’s public officer. Jonathan Klug of Medinexus and Yoel Mittelberg of Intracore also join the committee. Brian Donaldson of Pharmhos received the 2012 Andrew Magennis award for leadership in the industry. Special thanks were given to outgoing committee members Bob Marsh of Medilink, Chris Ryan from Attend Anywhere and Gavan Lim-Joon of Healthscope.

GPs and specialists will no longer be able to claim MBS telehealth item numbers for outer metropolitan areas in the new year, following cuts to the program announced in the Mid-Year Economic and Fiscal Outlook papers.

According to the papers, the new restrictions will align eligibility for the MBS telehealth items with the Australian Standard Geographical Classification Remoteness Area (ASGCRA) used by the Australian Bureau of Statistics.

The item numbers will only apply to services for patients of an Aboriginal Medical Service or a residential aged care facility in outer metropolitan areas from January 1, 2013. Rural and remote telehealth provision is unaffected.

The government will also introduce new items to cover short video conferencing attendances from specialists where the time and content is less than that usually expected for initial consultations.

The restriction is expected to save an estimated $134.4 million over four years, which will be redirected into the $4.1 billion dental health reform package.

These new items are expected to save $4.5 million over four years. They will also be restricted to patients living in eligible geographic areas.

The government will also change its approach to developing the video conferencing capabilities of the after-hours GP helpline. “A staged approach to the rollout of the video conferencing capabilities will allow the technology to be fully tested and developed in 2012-13 to ensure appropriate consumer experience before a national rollout in 2013-14,” the papers say. “The telephone helpline commenced operation in July 2011 to enable people who require after-hours medical advice, and who cannot access their usual GP, to speak to a GP over the telephone if necessary.

“Video conferencing will continue in selected residential aged care facilities where it has been available since July 2012.” The health portfolio will also economise through cuts of $18.7 million to media spending. It has also cancelled the $20.1 million Queensland Regional Acute/Subacute/ Extended Inpatient Mental Health Services project, following a recent decision by the Queensland government to withdraw its support for the project.

“Video conferencing will continue in selected residential aged care facilities where it has been available since July 2012.” The majority of savings in the health portfolio will come from changes to the private health insurance rebate. The government’s contribution

will now be calculated using commercial premiums and indexed annually with the CPI or the annual increase in premiums, whichever is the lesser. This is expected to deliver savings of $1.09 billion over three years, which will also be used to offset the cost of the government’s dental health reform package. It will also reduce the level of subsidy to the Premium Support Scheme (PSS), which helps doctors with the costs of their medical indemnity insurance.

eScript exchanges to be connected GPs and pharmacists will soon be able to send and receive electronic prescriptions from either eRx Script Exchange or MediSecure Script Vault following an agreement between the two vendors to allow interoperability. In what will be seen as a major breakthrough for eHealth in Australia, it is understood that the two vendors have been working together for some months to enable users to send and receive eScripts from each product without having to install both. Industry sources have told Pulse+IT that some minor technical hurdles will be overcome by December, with a probable roll out to

pharmacists and GPs early in the new year. GP desktop and pharmacy software vendors have been informed of the agreement, several sources have confirmed, although it is not yet clear what if any alterations to prescribing or dispensing software will be required to interoperate. For GPs, one of the requirements of qualifying for the eHealth Practice Incentive Program (ePIP) will be electronic transfer of prescriptions (ETP) capability using one or both of the exchanges. Initially, software vendors were expected to have to conform to a new ETP standard being prepared for

submission to Standards Australia by NEHTA, although the draft standard has since been withdrawn for further review. As Pulse+IT was going to print, seven clinical software vendors – Stat Health, Health Communication Network (HCN), Zedmed, Genie Solutions, Best Practice, Medtech and HTR – have been listed on the ePIP register for ETP, although this number is expected to increase shortly as most vendors have integrated with one of the exchanges. Practices wanting to apply for the ePIP need only be using one of the exchanges, both of which have been listed on the ePIP register.

Genie Solutions releases v8.3.4 with full PCEHR access Genie Solutions has released version 8.3.4 of its practice management software, which includes full HI Service integration and the ability to upload shared health summaries and event summaries to the PCEHR, and to download the same from a patient’s PCEHR. The company can also produce specialist and referral letters in CDA format and is planning to complete formal testing for this in November. Genie’s managing director, Paul Carr, said the next version of Genie will include the integration of eRx Script Exchange. Genie is already integrated with the other major electronic prescription service, MediSecure, but will now offer both services to users, he said. The company has also been working for some time with electronic messaging provider HealthLink to integrate secure messaging delivery (SMD) capability into the software and this is almost finished, Dr Carr said. “This will be the final step in making Genie fully compliant with the eHealth program.” Other major changes in version 8.3.4 include an added option in user preferences for Mac users to use Apple Mail for letters only. Checklists and letter templates will now be downloaded by web service rather than FTP. The company has also updated the graphing module, meaning values are now displayed on the graphs, legend changes size automatically and x-axis labels have been rotated to be more visible. It has also ironed out a few bugs, including fixing the appointment book selection logic when there are appointments beginning before the practice start time and the provider’s interval is different from the global interval.





Bits & Bytes

SimDay adds wristband printing, pre-admissions Advanced Computer Software Supplies (ACSS) has partnered with Zebra Technologies to integrate specialised printers that can automatically print patient wristbands that comply with national standards. Integration with Zebra will mean wristbands can be generated directly from the printer and secured to the patient’s wrist without having to use plastic wristbands or print labels. Adam Hartikainen, sales and marketing manager for SimDay, said the Zebra wristbands are made of lightweight, soft direct thermal polypropylene with an adhesive closure that allows admissions staff to print the wristband and attach it directly to the patient. ACSS is also increasing its barcoding capability and has released a scanning component into SimDay that allows users to print out patient forms with the patient’s identification embedded in the barcode. “They can then be easily scanned into the patient’s record and we will also be including barcode technology on wristbands,” Mr Hartikainen said. ACSS is currently working on the final stages of a pre-admission patient portal to allow patients to upload their demographic and clinical information prior to admission. to hospital. ACSS is building the technology itself and would release it early in the new year, he said.

The next challenge for eHealth is the acute care sector: CSC Healthcare CSC’s Healthcare group is currently working on the final conformance tests for the interface to the PCEHR system for its practiX general practice management software, and is now turning its focus on getting the acute care sector up to speed. CSC, which bought the GP and hospital software assets of iSOFT last year, has recently been demonstrating its ability to close the primary-acute care loop by sending eReferrals from practiX to its i.PM acute care patient administration system (PAS) using secure messaging and the Healthcare Identifiers (HI) Service. The company was able to show last year that it could integrate the HI Service into i.PM – the PAS used by more than 300 hospitals in Australia and New Zealand – without having to upgrade the core product by leveraging its Health Information Exchange (HIE) Suite software.

referral, wrapped in the SMD standard, and pushed through to i.PM,” Mr Phillips said. “But it doesn’t just sit at the front door – it is consumed into that product which we believe achieves some of the greatest efficiencies and care improvements in the acute sector.”

“We believe improving the handling of referrals and appointment scheduling within hospitals has great potential to meaningfully improve healthcare, and connections between primary and acute care.”

“It allows hospitals to provide a better overall experience to the patient and it will save the administration staff a lot of time in creating patient records.”

Now, the company is eager to get on with bringing the acute care sector into the government’s wider eHealth program, CSC’s director of market and solutions, Byron Phillips, said.

While getting acute care integrated into the PCEHR system is one of the long-term goals of the government’s strategy, most of the emphasis for the last two years has been on primary care. CSC believes, however, that integrating acute care will not be as difficult as some would imagine.

ACSS markets the eClaims system to general and allied health practices and has just released version 1.91.11, which includes the November MBS fee update.

“It was about four months ago that we actually demonstrated the whole loop from primary care

And it is the wider use of the HI Service that will enable this, Mr Phillips said. In his experience,

confirming the HI Service’s accuracy was best done upon presentation rather than through a batch import method. “In the primary and acute care sectors, face to face is essential to get a high hit rate with the HI Service,” he said. “We keep hearing that it’s not going to work because they are only getting a 65 per cent hit rate, but based on our experience so far, it seems to be much higher. “While enabling our products for the PCEHR we have worked on the basis that IHI look-ups are best done at the front desk. This means little impact on clinical workflows and information accuracy.” This is also the process the company is encouraging general practice clients using practiX to follow, according to CSC’s out of hospitals solution manager and leader of its PCEHR project team, Perry Pappas. CSC, which is one of the six companies on NEHTA’s GP desktop software vendors panel, demonstrated HI Service integration into practiX in July last year. “For the customers that have the HI component in and running, they are very happy and have very few, if any, issues,” Mr Pappas said. “Byron and I went and visited one of our champion practices

How do I do it? recently and their comment was they generally do it on admission. They’ve got the patient in front of them and they can confirm their details as they are standing there, and their hit rate was in excess of 90 per cent.”

private hospital sectors and building a business case for private hospitals to come to the party. Mr Phillips said CSC was in serious discussion with its private sector customers on what the next steps are.

Mr Phillips said once the use of common healthcare identifiers was instituted, linking different departments such as emergency, pathology and hospital-based laboratories would not be overly difficult on a national scale.

In other acute care developments, CSC has recently partnered with Sydney company EpiSoft to market its new preadmission patient portal and booking system, which allows patients to check their details are correct and list their medications before they present to hospital. Mr Phillips said the private sector is particularly interested in this capability for elective surgeries and admissions.

“There are only three entries into acute – inpatient, emergency and in some cases outpatients,” he said. “We run the majority of those systems in this country. So, an HI is recorded in the patient admin system, we can pass that information on to other systems, including our competitors’ systems. “The argument is you enable ED, inpatients and outpatients and you pretty much have the health identifier flowing. There are some exceptions, but in general the PAS system already publishes those demographics and identifiers downstream. I just can’t see a hole in this. It seems like an obvious approach to turn on threequarters of the country in a couple of years.” There are two stumbling blocks, however: funding for software vendors to begin the work for the public and

“We believe that things like identification should happen way back in the process, and possibly in the home,” he said. “You can’t do that for emergency obviously but for a lot of elective stuff, we can be educating the patient by saying ‘we notice you haven’t got a PCEHR record yet, here are the benefits of having one’.” The company has also launched an enterprise scheduling system that takes a referral and uses clinical protocols to translate the referral into the required appointment or set of appointments. The system schedules bookings for the various services and does so according to rules defined in the particular clinical protocol.

CSC believes the ability to close the primary-acute care loop is built on a number of foundations, not just common healthcare identifiers. In addition to integrating the HI Service into practiX last year, CSC was one of the first to integrate secure message delivery into its product. “We achieved certification in November last year for the secure messaging component,” Mr Pappas said. “It was months in advance of where we needed to be. I think we were the first of all of the vendors – or the only vendor at the time – that met that initial 31 July 2011 deadline for conformance for the Health Identifier.” It has since passed its conformance testing for the PCEHR interface, and has selected a number of pilot sites among its customer base who will try out the new functionality, he said. “They were the initial ones we picked for the HI. The big bang approach is something that as project director I intentionally avoided. Instead I really value working with these motivated sites as we work together to incrementally develop and evaluate new functionality.” “The pilot sites are all very keen to move ahead with a plan to have the [PCEHR] installed by then. Then [we plan on] a rollout to our broader customer base.”

nd eReferralsmamaries... u Discharge S

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...and Pathology results...

...ALL SECURELY and ELECTRONICALLY? The questions are tough, but the answer is easy.... Better Communication, Better Care



Bits & Bytes

GP advocates funded to spread the PCEHR word The federal government will fund 30 ‘GP clinical peer advocates’ to encourage uptake of the PCEHR among the general practice community as part of a $2.25 million grant. Health Minister Tanya Plibersek told the RACGP’s annual conference on the Gold Coast recently that the college would undertake three programs to help prepare general practice for PCEHR compliance. One is the PCEHR clinical peer aAdvocacy program, in which the RACGP will be funded to train 30 GP advocates to provide advocacy and education to promote GP participation in the PCEHR. The Australian College of Rural and Remote Medicine (ACRRM) will help in the design of the project, which will be delivered via seminars to GPs in up to 200 locations, and ACRRM will also help with delivery in remote and rural Australia. The second program is to develop a revised edition of the RACGP’s Computer and Information Security Standards workbook. The college will also develop an eHealth syllabus and education modules for use by the Australian General Practice Training (AGPT) program, and for GPs undertaking continuing professional development. Online learning modules will be available via the RACGP’s gplearning online platform, with content also available via ACRRM’s Rural and Remote Medical Education Online (RRMEO) platform. RACGP president Liz Marles said GPs were ideally placed to ensure the success of the PCEHR and other eHealth initiatives. “The new resources and support activities the college is now enabled to develop will equip GPs and their practice teams with the skills, knowledge and confidence required to effectively embrace eHealth.”

NEHTA terminates $23m NASH authentication contract with IBM The National E-Health Transition Authority (NEHTA) has confirmed it has cancelled its $23.6 million contract with IBM to build the authentication service for healthcare providers to access the PCHER system. IBM won the contract to build the National Authentication Service for Health (NASH) in March 2011 and promised to create a security and access management system to enable healthcare providers to securely access the PCEHR by June 26, 2012. Under the agreement, IBM was to use its hardware, software and services capabilities to manage the project delivery of NASH. It was to include industry and technology consulting expertise, security and access management technologies, and IT infrastructure services. IBM announced at the time that “together with clinical terminology, messaging standards and unique healthcare identifiers, the NASH will provide one of the fundamental building blocks for a national eHealth system”. IBM failed to deliver its promised infrastructure by the deadline and an interim solution was deployed by the Department of Human Services (DHS).

Secure tokens were issued in late August to those healthcare providers and organisations who had registered for an HPI-I and an HPI-O respectively and had applied for a certificate from Medicare Australia. NEHTA CEO Peter Fleming told a Senate Estimates committee hearing in Canberra recently that the contract with IBM had been cancelled. “[We] did terminate the contract with IBM,” Mr Fleming said. “We have been working with [the Department of Health and Ageing] and DHS. We have implemented a NASH solution with DHS, which is in operation and rolling out. That is progressing.” A NEHTA spokesperson told Pulse+IT that both the NASH design and build and operate contracts with IBM had been terminated. “The parties have agreed and continue to undertake discussions on a confidential and without prejudice basis,” the spokesperson said. “In accordance with that agreement, NEHTA is not in a position to make any further comment regarding the matter. There is an interim NASH developed and being operated now by the Department of Human Services (DHS) for the PCEHR system.

“This situation with IBM does not affect consumer access to the eHealth record system in any way, and given the interim NASH solution has been delivered, this does not impact healthcare providers from accessing and uploading eHealth records.” The spokesperson said there is a second component of NASH which will support secure messaging and “an announcement on this is expected in the very near future”. In a statement to Pulse+IT, an IBM spokesperson said: “IBM has terminated its agreements with [NEHTA] and E-Health Authentication Services Pty Ltd to design, build and operate Australia’s National Authentication Service for Health. IBM is unable to comment further as this is an ongoing legal matter.” DoHA secretary Jane Halton told Pulse+IT earlier this year that Medicare Australia did not have the technology capable of providing secure access when the contract was issued to IBM. “It is fair to say that some of that technology has now been able to be deployed in ways that perhaps we didn’t always understand it could be and certainly wasn’t able to be some time ago,” Ms Halton said.



Bits & Bytes

Department of Veterans’ Affairs to link up with PCEHR

Stat Health integrates SMS and begins preparations for integrating HI Service

The Department of Veterans’ Affairs (DVA) is replacing its Veterans and Veterans Families Counselling Service (VVCS) management information system (VMIS) with a web-based solution that interacts with the PCEHR.

Stat Health is currently beta testing the integration of the SMS service from SMS Central into its clinical and practice management software.

It is currently holding a tender process that calls for a commercial off-the-shelf case management system that can interface with the HI Service and has the functionality to link to the PCEHR system to allow approved staff to view an individual record and upload clinical documents.

Users will be able to choose between a dedicated or shared number for the service, with the dedicated number costing a one-off set-up fee and $25 per month rental, Stat Health CEO Carla Doolan said.

It will have the ability for contracted clinical service providers to have their HPI-I linked to the VVCS’s HPI-O and to utilise the National Authentication System for Health (NASH) as well as secure messaging and clinical terminology capabilities.

“The advantage of the dedicated number is that your patients will learn to recognise that particular number means an SMS is from your practice,” Ms Doolan said.

The VMIS is a bespoke application designed and written in Delphi 5 a decade ago and is not able to support participation in the PCEHR. It also lacks the ability to allow clients to use technologies such as SMS and mobile devices to interact with the system.

The shared number means the texts are sent from random numbers generated by SMS Central, but the advantage is this is a “no charge” option for the practice apart from the purchase of credits.

The VVCS has 15 centres located across Australia in each capital city and selected large regional centres to coordinate the delivery of a range of mental health services and group programs using VVCS and contracted psychologists and social workers who have experience working with veterans, peacekeepers and their families. In addition to these services, VVCS outsources the provision of an after-hours counselling service called Veterans’ Line and the management of its national heart health program. In 2010, more than 10,000 clients attended approximately 60,000 counselling sessions.

“Credits will be valid for 12 months and practices can buy in bundles of 160 up to 15,000,” she said. The SMS service will be limited to appointment confirmation initially and will also allow users to send out reminders for new referrals, which Stat can identify for practices from the appointment schedule, Ms Doolan said.

“There is also a manual confirmation screen for those who do not wish to use SMS. If the practice uses integrated SMS, patients can send back a Y for yes to confirm an appointment and it will automatically update the appointment book. We are sure most practices will choose to use the SMS functionality.” She said each of the sites that register with SMS Central will be able to log on to a portal and check what credit they have available and all messages they have sent and received. Within Stat, these records

will be stored again each patient file. Ms Doolan said once beta testing is completed, Stat Health will move to the release of the next version with Individual Healthcare Identifier and HI Service integration. Stat is already integrated with eRx, fulfilling the electronic transfer of prescriptions requirement for the ePIP due next year. “We are presently developing IHIs and expect this to be ready in a month,” she said. “SMD will follow IHI development and then the integration of PCEHR.”

Medicare Local hubs to receive $600,000 for PCEHR uptake The Department of Health and Ageing has issued an invitation to apply (ITA) for funding to Medicare Locals to act as ‘support hubs’ to increase the adoption of the PCEHR system. The successful bidders will work with clusters of other Medicare Locals (MLs) to deliver training and advice to general practices, community pharmacies, allied health professionals and specific consumer groups on the eHealth records system. The funding is part of a $50 million package announced by Health Minister Tanya Plibersek in May. A DoHA spokeswoman said funding will be provided to each ML, although she could not reveal exact amounts. Those acting as hubs will receive extra money, expected to range between $450,000 and $600,000, according to Sharon McCarter, assistant secretary of DoHA’s eHealth development and engagement branch. In a recent webinar hosted by the Australian Medicare Local Alliance (AML Alliance), Ms McCarter said the support hub and cluster structure will be announced soon. It is expected there will be between 12 and 16 Medicare Local hubs. The DoHA spokeswoman said some of the funding for

MLs will be used to provide practical training and tools to GP practices and other healthcare providers to support eHealth adoption in the primary care sector. “Medicare Locals will also build awareness and literacy amongst consumers,” she said. The hubs would support ‘clusters’ of other Medicare Locals in preparing for PCEHR adoption. “Clusters are expected to form in geographic areas with one ML hub supporting four to six MLs at a local level.” Funding will also be provided to each of the 61 MLs to enable them to hire eHealth support officers, who will work with general practices. “This support will include ongoing training and advice and the development of local materials and messages.” The department has an expectation that Medicare Locals will staff the delivery of the program and “not contract with another body to deliver these services”, Ms McCarter told the webinar. She said four field advisors would be appointed to liaise between the AML Alliance and the support hubs, which would in turn support ML clusters working with clinicians and consumers. The field advisors will cover NSW and the ACT, Victoria

and Tasmania, Queensland, and WA, SA and the Northern Territory. The field advisors will deliver training to the support hubs, who will then train MLs in their cluster to provide practice visits, training and communications for practitioners and consumers. Ms McCarter said the program was designed to support primary care providers in achieving four successive levels of eHealth change and adoption in order to eventually achieve “meaningful use” of the PCEHR. These tiers are general PCEHR awareness; GP software readiness, including the first four requirements of the ePIP; PCEHR adoption, in which shared health summaries are being uploaded and viewed. The final tier is ‘meaningful use’, in which the PCEHR is regularly accessed by providers, consumers and multiple health organisations and is being used for decision support. Each ML will be required to submit a local change and adoption plan by November 23 and it is expected that all cluster support hub services will be delivered by the end of September 2013.



Bits & Bytes

Strategies to improve medication safety at home

iExaminer puts the eye on the iPhone

A new research project looking at how to improve the safety of medication management in the home will study the use of video conferencing and a new automatic pill dispensing technology to see if patients can be safely supported with their medications at home, and at the same time reduce the amount of daily visits required by community nurses. Austin Health senior pharmacist Rohan Elliott said the project will recruit 50 consumers to see if their daily medication use can be monitored by video conference six days a week, with one day a week involving a physical visit. Another part of the project will look at whether a new automatic medications dispensing technology called Medido could be helpful in reducing workforce demands. Medido is an automated dose administration aid which automatically dispenses the correct dose of medications at the required time. It involves a SIMcontrolled device linked to a web browser, through which the prescriber can schedule the correct time, dose and type of medication. Pharmacists pack these into a week or fortnight’s worth of individual sachets, which are inserted into the device. When the programmed time approaches, both visual and audio alarms are automatically activated to tell the person that their medication is due. The person simply presses OK and the DAA sachet is ejected from the device. “If they don’t push the okay button, the device has a SIM card in it and it can send an SMS to whoever you program in, be it the next of kin or the RDNS or whoever you set it up for,” Mr Elliott said. He said while these new technologies are interesting, many people with cognitive impairments would not be capable of using them correctly.

Medical device manufacturer Welch Allyn has released an adapter and app that allows users of its PanOptic ophthalmoscope to capture, store and email retinal images using their iPhone. The PanOptic is a portable ophthalmoscope that gives a wider view of the retinal area, or fundus, than normal devices. It is mainly marketed at GPs rather than ophthalmologists as it allows them to view the fundus through an undilated pupil. The new iExaminer technology consists of an adapter that sits over the ophthalmoscope and aligns the optical access of the PanOptic to the visual axis of the iPhone’s camera to

capture high-resolution pictures of a patient’s fundus and optic nerve. The associated app then allows users to save the images to a patient file on the iPhone, as well as email and print the images. Matthew Smith, of online medical device distributor DocStock, said current users of the PanOptic merely need to buy the adapter and the app, or health professionals can buy the whole package. Mr Smith, who has set up a new website for the product at, said both rural health and remote health specialists would be prime markets due to the ability to send the images on for referral.

“It lets you capture a whole series of images when you press the button,” he said. “Because the patient’s eye may move slightly, it takes a number of images and you pick the best images from that series. “You can then store up to three different images for each eye and save them in a patient folder in the iPhone, which you can then email out to anyone else. It is all contained in the app.” A free version of the app is available from the iTunes App Store with a limit of 10 patient files that will allow users to capture, store and retrieve the images. The iExaminer Pro app costs $32 and has additional file storage as well as the email functionality.

Medical Director prepares for increased connectivity as users adopt eHealth Medical Director will have full interface capability with the PCEHR in advance of the deadline to qualify for the ePIP, according to Health Communication Network (HCN).

most certainly give the industry a push in the right direction. Clinicians are smart and have figured out that technology can enable huge efficiency gains for their businesses.”

HCN CEO John Frost said Medical Director said the company had been placed on the ePIP registers for secure messaging delivery, electronic transfer of prescriptions and HI Service integration.

HCN has recently launched a marketing push to encourage specialists and not-for-profits to upload custom-designed referral templates into Medical Director. The software has had this capability for a number of years but the company is now seeing much increased use of the functionality.

Mr Frost said the company had seen a “significant uplift” in the usage of the various electronic mechanisms to share information by GPs, specialists and other healthcare providers. HCN claims Medical Director is used by 15,600 GPs and 1400 specialist practitioners. Electronic mechanisms include custom referral templates, secure messaging, standardscompliant documents such as CDA format, and electronic transfer of prescriptions (ETP) recently, he said. “It’s quite extraordinary to watch the organic growth of eHealth and the gradual uptake which naturally occurs as the technology sector as whole evolves,” he said. “The eHealth PIP incentives that were recently announced will

“Today a vast number of the referral templates we have in Medical Director are custom templates placed by specialists who want to receive the referral forms in a certain format or with certain information about the patient’s condition and care,” Mr Frost said. “This is enabled by auto population of as many fields as possible via the patient information already captured in Medical Director. Both parties benefit: for the GP, to write the referral takes only a few key strokes and the specialist receives the eReferral electronically and with the details he or she requires. It’s efficient, convenient and safe.” The secure exchange of eReferrals, discharge

summaries, specialist letters, and pathology and radiology requests is also taking off, he said. Users can use the MDExchange component in Medical Director or sign up with popular secure messaging vendors such as HealthLink and Argus. Similarly, ePrescribing is seeing an increased uptake, he said. “It’s very reassuring to see the uptake amongst clinicians and the support these initiatives are now getting from government to push patient safety.” CDA capability for specialist letters was released in Medical Director in January this year, he said. “Currently these CDA templates have been designed by NEHTA, but we envisage that very soon corporate groups such as obstetricians, IVF practitioners, gastroenterologists, ophthalmologists etc. will be requesting custom eReferrals containing patient information specific to their specialty.” Details for specialists, service providers and other clinicians are stored in MD’s Address Book, which is used to populate eReferrals as well as being used for specialist letters and pathology, imaging and cytology investigation requests, he said.

Medibank reveals customer feedback for apps on the go Health insurer Medibank has released details of recent research into how its customers are using its mobile applications. A few surprises have emerged, including a tendency for users of its Symptom Checker app to spend time late in the evening browsing symptoms and diseases. Medibank also offers a free Energy Balancer app, which allows users to measure how much exercise they need to do to burn off the calories from different food types. It also has a Medibank Mobile app for members to allow them to make claims, check their claims history and search for healthcare providers in its Member’s Choice network. Alex Young, Medibank’s channel manager for mobile and social, digital sales and service, said his analytics and user profiles had some interesting things to say about the type of health information people are looking for. “For example, our growth in members lodging claims electronically through our internet or smartphone systems has increased 92.5 per cent year on year,” Mr Young said. “Our apps are obviously resonating with members who want immediate and effective tools to be more proactive in looking after themselves and managing their health insurance.” He said a typical Medibank app user most frequently checks their medical symptoms between 8pm and 11pm, most regularly monitors alcohol, burgers and chocolate for their energy intake, and if they are a member, they most often look at their claims history or use the mobile app to make a claim.





Bits & Bytes

My eHealth portal to link up ACT hospitals and community The ACT has released more details of its new My eHealth portal project, which is part of a plan to provide consumers with improved interactions with the ACT Health Directorate and will provide secure online access to appointment information, appointment notifications, referral renewal reminders and discharge summaries. The My eHealth trial is a clinician-initiated consumer portal initially being offered to consumers taking part in the Directorate’s chronic care program. Project manager Renee Schofield said the portal has been planned for some time and is something consumers have been asking for. “It is around consumer interaction with Canberra Hospital and Health Services, including appointment details, episode information, appointment notifications, referral renewal reminders – information that’s not going to be in the PCEHR,” Ms Schofield said. The Health Directorate has worked closely with the ACT’s main consumer health advocacy group, the Health Care Consumers’ Association of the ACT (HCCA). Currently, 14 HCCA representatives are piloting the program, in addition to patients from the chronic care program. At present, 22 patients are taking part, with plans for a total of 40 in the pilot stage. Electronic discharge summaries are the first clinical documents viewable within the portal. Canberra Hospital has had electronic discharge summary capability for some years, using HealthLink as the secure messaging service to send discharge summaries to GPs. Up until this point however, patients have only received a paper copy of the discharge summary. Ms Schofield said the discharge summaries can be viewed through My eHealth as PDFs.

Telehealth to go high tech for use in the aged care sector University of Queensland researchers have received a grant for almost $1 million from the National Health and Medical Research Council to conduct a fouryear study into the use of telehealth in residential aged care facilities, involving a web-based clinical support system and clinical-grade video conferencing technology. The Centre for Online Health (COH) and Centre for Research in Geriatric Medicine (CRGM) joint study, led by director Len Gray, is a randomised control trial that will see video conferencing technology deployed as a mobile wireless device at the resident’s bedside and operated by a geriatrician from a remote studio. The main aims of the study are to investigate the potential to reduce transfers to emergency departments and reduce transport costs, as well as improve access to specialists, prescribing practice and the quality of care for residents. Professor Gray said it is the most extensive trial of telehealth ever undertaken in residential aged care worldwide. Because of the complex nature of illnesses among residents, the study will focus on conventional or ‘clinical-grade’ video conferencing equipment.

“While video conferencing with Skype or other PCbased systems works well for general conversations, it is still of insufficient reliability and quality for clinical diagnostic work,” Professor Gray said. “Clinical-grade technology is essential when performing a consult with an unwell or frail older person. Conventional video conferencing allows the user to control the camera with better precision, compared with a smaller, hand-held camera. “The need for this quality of video is important for working in nursing homes, where there will often be no medical support at the patient’s end.” The trial will also involve a web-based clinical decision support system, built by the centre over the last decade, which has been used in

hospital care for older people. It uses a structured assessment overlaid with a number of processes to help interpret clinical observations. “The web-based support system has been trailed successfully in about 10 hospitals, so we are confident that we can use the same concept and modify it for long-term care,” he said. “We’ve found that not only does it work, but patients like it. “The desire for telehealth is greater in residential aged care than in hospitals, where facilities are isolated and it’s often a struggle to get health professionals to visit them. Although the technology is a bit more expensive, residential care providers have indicated that the cost is not a major barrier to them in terms of affordability.”

Residential aged care facilities are entitled to an on-board incentive payment through the Department of Human Services along with Medicare item numbers for each consult, but Professor Gray said many facilities had already invested in video conferencing equipment to provide education for their staff. “The unique benefit we have is that we go to the patient’s room,” Professor Gray said. “Taking a patient to an office with a conventional video system means the resident is disrupted. We’ve found that it is more efficient and a better experience for the patient when we go directly to the patient’s bed. “You give yourself maximum flexibility if you have mobile wireless and high-definition video. The price will dramatically reduce over the next five years, but we suspect it’s already sustainable with a small investment from the facility. Many facilities are enthusiastic about this telehealth model and see huge potential for their residents and staff.” The project will also involve the design of telehealth studios at participating geriatrician’s hospitals. Again, most hospitals have some type of video conferencing technology, but this project will involve running long sessions for the geriatrician with several patients, as well as

other specialists such as psychiatrists. “The studio will be like a doctor’s consulting room but with better acoustic treatment, different lighting and correctly configured video systems. It has to be comfortable and have access to computers to review x-rays and other medical reports.”

“The need for this quality of video is important for working in nursing homes, where there will often be no medical support at the patient’s end.” The trial model involves a geriatrician being affiliated with each facility, who provides weekly video consultations. This offers add-on benefits besides having regular access to a specialist. “What we are trying to do is create relationships between the geriatrician and each facility. If the geriatrician is attending a facility regularly in a virtual capacity, he or she will hopefully form a strong, working relationship with facility staff. The benefit of these relationships is that processes and protocols

will be better understood and implemented, as well as providing the in-house staff with support and extra skills. It is good for families too, in that their GP will have some specialist support.”

Moving to Best Practice is as easy as

Visiting GPs will also be invited to participate in the model, he said. “We will put forward a proposal to GPs that a specific geriatrician will be present at a certain time to discuss patients, and he or she will welcome at the discussion. “It has to be efficient for the GP. To interact directly with a specialist requires complicated scheduling, which is difficult. In an ideal world, over time, GPs might be happy to do their nursing home rounds at the same time the geriatrician is there.” The trial will involve 10 residential aged care facilities, five allocated as a control group and five intervention sites. The control group will conduct business as usual in the first year, with telehealthenabled geriatrician sessions offered to the intervention group. “We will be able to compare things like how many people are transferred to the ED from the home in that year with telehealth and how many without,” Prof Gray said. “We suspect that using telehealth will reduce transfers by about 20 per cent.”

Like eating brussels sprouts – you know that changing your clinical software will be good for you – but not something you want to face. Best Practice is different. Best Practice makes the changeover so easy you can try it out with all your practice data (the back-up version of course) without committing. Converting your data from MD2, MD3 and MedTech32 is virtually automatic. Sweet! Contact us for more information. Tel: (07) 4155 8800 www.



Bits & Bytes

Argus to be deployed with Best Practice software Best Practice Software is working with Database Consultants Australia (DCA) to integrate DCA’s Argus secure messaging service as the default messaging capability of Best Practice. Argus will be deployed with the November release of Best Practice, which will also contain all the other ePIP-compliant features, Best Practice’s owner and developer, Frank Pyefinch, said. The integration will mean that all Best Practice users can be connected to Argus and meet the secure messaging requirements of the new ePIP. “We are introducing a number of interoperability features with Argus to enhance the user capabilities and management of secure messaging from within Best Practice,” Dr Pyefinch said. “These include an elegant interface to the Argus address book and the National Human Services Directory to coordinate the updating of the Best Practice doctor file, plus a more integrated management of message tracking from within Best Practice.” Best Practice clients will also benefit from seamless message exchange under the SMX program, through which Argus will handle the routing of messages to users of other messaging services, he said. Best Practice users not already connected to Argus will be provided with a 90-day, free, fully supported subscription to enable sites to try out Argus before choosing whether or not to take up a subscription. Argus general manager Ross Davey said the company was “pleased to work closely with Frank to lead the way in enhancing the interoperability of clinical systems with secure messaging, the final aim of which is to simplify the way that users will be able to manage their secure messaging.”

Private providers may step up to save telehealth provision The recent cuts to the MBS telehealth scheme are disappointing and will probably slow the momentum of the rollout of telehealth provision in Australia, advocates say, but some remain positive about its future. The federal government has clarified which metropolitan areas will lose eligibility for the MBS telehealth item numbers, following an announcement that it was tightening the geographical restrictions for the scheme. The government had already announced in the May budget that a 15km distance between specialist and patient would apply, and has now announced it will align eligibility for the scheme with the Australian Standard Geographical Classification Remoteness Area (ASGC-RA). The changes will come into force on January 1, 2013. The cuts will mean doctors undertaking telehealth consults within the major cities will not be able to claim the MBS items, except if they are providing services to residents of aged care facilities or patients of an Aboriginal Medical Service. The Department of Health and Ageing’s MBS Online website states that the government “has introduced this change

to better target funding to areas where access to specialist services is limited”. Prominent eHealth expert George Margelis, general manager Australia for Care Innovations, sharply criticised the move, saying it could spell the end of telehealth consultations. “By marginalising them to only a delivery method suitable for remote populations, essentially a technology enabled version of the Royal Flying Doctor Service, they are significantly blunting the value proposition for telehealth consultations,” Dr Margelis said. “Actually they are restricting it more than the RFDS, as it can deliver services to places not limited to those classified as remote, but to those areas that need its help. Essentially these changes have taken away from clinicians the right to make that type of decision.

the initial announcements fostered, and how the constant changing of the goal posts leads to that innovation being stifled. David Allen, an occupational and environmental physician who runs Telehealth Solutions Australia and has been providing telehealth services since 2007, was not so pessimistic, saying that while the cuts were unfortunate, he believes telehealth will still continue to grow in Australia, albeit a bit more slowly. “My opinion on this is that the ones who most need it are the rural and remote [patients] anyway,” Dr Allen said. “The volume may go down but the people who most need it can still access it. I would have liked to think the funding could continue, and far be it for me to comment at a political level, but the people who most need it can still access it, so at least it is something.”

“Rather than expand on what seems to have been a successful program, it has chosen to ‘strangle it on the vine’ to prevent its growth.”

Dr Allen said while he was positive that telehealth provision would continue to grow, it was unfortunate that GPs in outer metro areas would now miss out.

Dr Margelis said that besides needy patients missing out, the main concern he had was about effect on stimulating innovation in the sector that

“It really is unfortunate for the GPs who do need it and I think that a shame, but regardless of what happens we will be pushing ahead and I think it will succeed

in the long term. It will probably slow down the momentum a little bit.” Mike Civil, eHealth spokesman for the RACGP, also described the cuts as disappointing but he too believes the technology will continue to grow. “It is unfortunate to be reducing the impetus, rather than increasing it,” Dr Civil said. “I remain firmly convinced of the long-term benefits to be seen in the capabilities of telehealth, with improved access and flexibility to medical services our patients can experience, with the addition of telehealth consultations to augment our normal face to face consultations.

“There should not be any geographical limitations for telehealth, rather the decision to conduct a telehealth consultation should be about clinical appropriateness, not location.” However, both Dr Allen and Dr Civil believe both patients and doctors themselves will drive telehealth provision on a private basis. Dr Civil’s practice in outer metropolitan Perth, Stirk Medical Group, is likely to consider offering video consults as a non-MBS rebatable service in the new year, he said. “Hopefully as things improve for health finances generally, we can expand

and increase our use of telehealth generally.” Dr Allen said he believed patients will be willing to pay privately for the convenience of the service. “Talking to a lot of GPs about this, I say don’t be afraid to charge privately. If someone wants to connect to you then you charge them. You won’t get a reimbursement, that’s all.” Dr Allen said that many doctors were nervous about charging outside the Medicare system, but uses his own practice as an example. “None of the work that I do by telehealth is reimbursed by Medicare – 100 per cent of it is privately paid, and people will value that whether in an occupational health setting or a private setting. “I would strongly encourage GPs to get involved in it and be confident they can charge and there will be people who will pay, particularly if they have to travel long differences.” Dr Margelis said that while private pay may be suitable for some people, those most in need of healthcare services are not those who can afford it.

Dr George Margellis

“As a result they are more likely to end up in a government hospital ED and still cost the government the amount, if not, more than what was saved by removing”, the subsidy, he said.

Making the most out of Skype with IM and video recording Two Australian-based companies have developed applications for Skype that they believe could help clinicians make the most out of the VoIP service. RecollX is a search and archiving app that uses the concept of hashtags as a way to better manage instant messaging conversations, while VodBurner is an app that allows users to record Skype video calls, edit them and upload them to file. While users can search within a chat in Skype, you can’t do so across all chats, and there is also no easy way of archiving chats in an efficient manner. With RecollX, Greg Bell has developed the idea of using hashtags to accelerate search functionality. By hashtagging certain terms within the Skype chat, users can quickly retrieve conversations, ideas and key knowledge on particular topics. VodBurner, on the other hand, concentrates on the popular video conferencing capability of Skype. Its developer, Jeremy Hague, is currently investigating the telehealth market and is keen to explore VodBurner’s application in education and training in the health sector, along with its potential use in aged care. Skype allows users to record their voice calls but not video, so Mr Hague developed a separate app that plugs into Skype automatically and records video calls. “We offer recording of video calls, and group video calls, along with editing and export to file or upload to YouTube all from within the app,” he said “GPs can use Skype to conduct high quality video calls with patients and use VodBurner to record and archive those video calls. Apart from training, the main benefits that we see in recording telehealth calls would be doctors archiving those video calls for client records and possible compliance in this area.”





Bits & Bytes

Medical-grade network chosen for RPA Lifehouse The new integrated cancer centre being built at Sydney’s Royal Prince Alfred Hospital will install a medical-grade network to allow clinicians to access patient information at any time through wireless-enabled and remote-ready applications and devices. The Chris O’Brien Lifehouse at RPA – known as Lifehouse – is due to open in mid-2013 and has chosen ICT services and solutions provider Dimension Data to supply and maintain a Cisco medicalgrade network and telephony. The network will ensure uninterrupted access to clinical systems and data with network-wide security features such as identity authentication tools, firewalls, intrusion detection systems (IDSs) and ‘self-healing’ capabilities. As well as wireless access for clinicians, a virtual local area network (VLAN) will be built to enable patients and visitors to gain secure network access. Voice, video and data will be converged on the system, allowing clinicians and admin staff to interact both on site and remotely. Lifehouse, which will operate as a not-forprofit private hospital on the campus of the RPA, is a greenfield site and is being built as a fully digital hospital. The medicalgrade network incorporates numerous partner solutions to provide clinicians with rapid access to patient information. Earlier this year, Lifehouse CIO AnneMarie Hadley chose Charm Health’s new CHI platform as its electronic medical record provider. CHI will also include a medications management module, a patient administration system and enterprise scheduling. The new system will be known as the Lifehouse Oncology Information Solution, or LOIS.

Victoria aims for more open ICT strategy The newly formed Victorian Information and Communications Technology Advisory Committee (VITAC) has released a draft strategy outlining how the state government should use ICT to better provide government services. The strategy recommends that the government engage more closely with the ICT sector and move away from customised products in favour of market offerings. VITAC was formed in June this year following the release of a devastating report by the Victorian Ombudsman in late 2011 on 10 major ICT projects that experienced budget or deadline overruns or a combination of both. One of the projects was the $323 million HealthSMART program, an ambitious project to roll out common eHealth infrastructure throughout Victoria’s public health services. This included implementing iSOFT’s i.PM patient administration system and Cerner’s clinical information system in its hospitals, as well as InterSystems’ TrakCare platform for community health agencies. HealthSMART was subsequently cancelled with only some parts of work program completed.

The Ombudsman, George Brouwer, said in his report that poor planning had handicapped the HealthSMART program. “The project costing and timelines were ambitious and the Department of Health (DOH) seriously underestimated the size of the task,” he wrote in his report. “The project inevitably ran over budget by about 35 per cent and has taken more than seven years to deliver only a partial implementation of the core clinical application.”

“The project costing and timelines were ambitious and the Department of Health seriously underestimated the size of the task.” While he did reserve some criticism for vendors, he laid most of the blame at the feet of the Victorian Department of Health and its planning process. Industry sources have told Pulse+IT that the main problem facing HealthSMART was change management, with each health service requiring customisation of all or parts of each system to suit current practice.

VITAC’s draft strategy sets out objectives and actions focused in three key areas and proposes eight principles to guide ICT decision-making. “Victoria has experienced some expensive failures in ICT-enabled business change projects,” it states. “However, such projects are critical for productivity and service delivery reforms. The solution is not to avoid ICT-enabled projects but to address the past failures through a more rigorous and considered approach.” It recommends that the government engage with the ICT market early in the procurement lifecycle. “We will avoid being locked into single suppliers by favouring open standards and will be open to any qualified ICT provider regardless of size. Procurement of ICT services will be made more efficient.” The strategy should also provide guidance to agencies to move away from customised major ICT developments and use existing market offerings with little or no customisation instead. It singles out for attention successful programs such as the launch of the Better Health Channel mobile app, which recently won a 2012 Australian Mobile Award.

It also uses the primary care partnerships (PCPs) program as a case study into how to improve delivery. According to the draft strategy, PCPs have made it easier for the community to navigate the health system and their achievements are underpinned by effective information sharing. “The Victorian Service Coordination Practice Manual provides the agreed minimum standard for how agencies work together and includes a consistent approach to obtaining

client consent to share information,” it reports. “Standard information definitions and forms mean agencies can collect and share client and program information efficiently through their information systems. Technical standards based on these agreed practices and definitions have also been developed for software vendors. “Industry has responded with multiple vendors offering standardscompliant health software

at no additional cost to government. The improved processes for information exchange, put in place by PCPs, also position Victoria at the forefront in this area of national eHealth.” The committee is led by an independent chairman – former South Australian CIO and Ernst & Young consultant Grantly Mailes – with representatives from the Victorian government, including CIOs of the major deparments, including the CIO of the Department of Health, the ICT industry and corporate CIOs.

NEHTA expert wins international award for SNOMED CT standards work NEHTA solution architect Dion McMurtrie has received the International Health Terminology Standards Development Organisation’s (IHTSDO) 2012 award for excellence. Mr McMurtrie, who has served on the IHTSDO’s technical committee since 2007, became the second recipient of the award after Ian Green of the UK’s National Health Service received the award at last year’s conference in Sydney. The IHTSDO is the not-forprofit association that owns and maintains the SNOMED clinical terminology. Mr McMurtrie was praised at this year’s conference

in Stockholm for his hard work and leadership on the technical committee, and at NEHTA, where he works as a solution architect for the National Clinical Terminology Information Service (NCTIS). The award citation said he had been instrumental in gaining worldwide acceptance for SNOMED CT Release Format 2, as well as his work on standards for concrete domains in SNOMED CT and on its diagramming standard. In other IHTSDO news, all four of the NCTIS’s nominees to represent Australia on its standing committees have been successful.

These include Michael Lawley, who was re-elected to the technical committee, Michael Osborne, reelected to the content committee. The new members are Cathy Richardson, who has been appointed to the content committee, and Matt Cordell for the quality assurance committee. These terms are for two years each, becoming effective in January 2013. In addition, David Bunker, NEHTA’s head of architecture and current chair of the IHTSDO technical committee, was elected to the IHTSDO management board.





E-HEALTH STANDARDS ORGANISATIONS Standardisation in the area of eHealth is complex but there is significant work occurring. One major problem is the large number of organisations that are involved in health software and hardware standards. The following is a brief introduction intended to map out some of the organisations involved both nationally and internationally in developing eHealth and related standards along with the key interrelationships and focus areas. DR VINCENT MCCAULEY MB BS, Ph.D MSIA National eHealth Implementation Coordinator

About the author Dr Vincent McCauley is an acknowledged national and international expert in eHealth standards. He leads MSIA’s team assisting its membership of more than 120 leading eHealth software vendors and the wider vendor community in creating a richly interconnected, semantically interoperable eHealth environment.

There are many accredited eHealth Standards Development Organisations (SDOs), and in Australia the vast majority of eHealth standards are developed by the Standards Australia IT-014 Committee, with support from local chapters of International SDOs such as HL7 Australia and IHE Australia. The Pharmacy Guild of Australia (PGA) became accredited as an SDO last year but will not be developing standards in the areas covered by Standards Australia. The National eHealth Transition Authority (NEHTA) is not an SDO, although its specifications are sometimes loosely referred to as “standards”. Many of the NEHTA-developed specifications, such as the Clinical Document Architecture (CDA) content used with the PCEHR, are in the process of becoming Australian Standards following their submission to Standards Australia as draft documents to commence the rigorous standards process. A previous article in Pulse+IT [Issue 30, October 2012, page 36-37] detailed the structures and responsibilities of the Standards Australia committees. Internationally, HL7 International is arguably the best known SDO in the eHealth area and is responsible for the widely deployed HL7 V2 messaging standard and CDA, among many others. Integrating the Healthcare Enterprise (IHE) International has been very successful in developing integration

profiles that combine standards from other SDOs, especially HL7 and DICOM, into useful specifications to solve real‑world common problems. More recently IHE has become an SDO in its own right. The peak international SDO is the International Standards Organisation (ISO) and its technical committee TC215 is responsible for eHealth standards. Most OECD countries participate in ISO and the other eHealth SDOs often submit their key standards to ISO to make them more widely available. Thus HL7 International has submitted its Reference Information Model (RIM) and IHE International its Cross Enterprise Document sharing (XDS) profile – which is the underlying infrastructure of the PCEHR – for publication as ISO standards. However, there is a confusing “alphanumeric soup” of other standards development bodies that are active in the eHealth space and the number is increasing rather than decreasing. These include the European Community’s CEN TC251 (not to be confused with ISO TC215!); the Object Management Group (OMG), better known for its XML standards; the Clinical Data Interchange Standards Consortium, which is developing electronic standards for health research; the International Health Terminology Standards Development Organisation (IHTSDO) responsible for SNOMED;

“There is a confusing ‘alphanumeric soup’ of other standards development bodies active in the eHealth space and the number is increasing...” Vincent McCauley

the Regenstrief Institute responsible for LOINC (diagnostics terminology); and IEC 62A, MITRE, IEEE, DICOM and GS1. IEC 62A was responsible for much of the standards for medical devices along with their embedded software but has recently extended its scope to cover all health software. A joint working group, JWG7, has been established between ISO TC215 and IEC 62A to coordinate development of work on safety of health networks and health software. The MITRE corporation has been very active in developing general IT standards in particular a “light” web service technology – hData – similar in function to SOAP but easier to implement for internal networks where security requirements are lower. MITRE has been working jointly with HL7 International in developing hData implementations of HL7 Service standards and hData is the core communication component of HL7s latest rapid development technology FHIR, the brainchild of our own Grahame Grieve. IEEE concentrates on electrical standards and, via ISO TC215, is responsible for many sensor standards (ECG, finger oximetry etc) and standards such as those for electrical interference with medical equipment. DICOM works principally in the area of imaging, particularly diagnostic imaging. DICOM standards are used for digital x-ray acquisition, storage and retrieval systems. GS1 works in the area of product identification and barcoding and has a specific subgroup working with medical identification systems for products, medications, equipment and personnel. To attempt to coordinate some of this standards development work and foster cooperation, a number of joint groups and cross publication agreements have been established. One of the first of these was the Health Services Specification Program (HSSP) which is a joint program between HL7 International and OMG. It leverages the health domain knowledge and content expertise of HL7 with the IT implementation expertise of OMG. Draft standard specifications are developed in HL7 as implementation independent service specifications. These are passed to OMG, which gathers member companies to produce platformspecific implementations that undergo rigorous assessment for

conformance and utility. The final platform-specific specifications are published as OMG standards. Issues encountered, lessons learned and ideas for further refinement are handed back to HL7 to be incorporated into a final platform independent service specification published as an HL7 standard. The Joint Initiative Council (JIC), consisting of HL7, ISO TC215, GS1, IHE, CEN TC251, IHTSDO and CDISC, is a grouping of SDOs whose aim is to enable common and timely health informatics standards and which was constituted to undertake projects that cross SDO boundaries. It conducts joint work that spans member organisations. IHE, HL7 and IEEE have special arrangements with ISOTC215 that allow standards they have published to be fast‑tracked for publication as ISO standards, making them available to most of the developed world. Keeping track of who is doing what and where each of the draft standards are in their development cycle is often challenging. We are extremely fortunate to have Richard Dixon-Hughes as the head of the Australian delegation to ISO TC215, the chair of HL7 Australia and a member of the HL7 International Advisory Board. His expertise in the area of eHealth standards development coordination has recently been recognised by his appointment to the chair of the JIC. This is a significant responsibility and achievement which has been a possible by his personal dedication, coupled with the support of the team of volunteers who, like Richard, provide their time for free in attending HL7 and ISO TC215 meetings with expenses supported by the Department of Health and Ageing (DoHA). A potentially “game changing” standard for health software vendors is currently in the early stages of development by JWG7. With the catchy title of “IEC/ISO 82304-1 Health Software – Part 1: General requirements for product safety”, this standard has been developed from the same source as the standards used for regulating medical devices. When complete, it could form the basis for regulation of health software and hence is vital to get correct. Australia has been accepted as one of 10 countries involved in actively drafting this standard, which gives us an excellent opportunity to ensure that it is “fit for purpose”. There will shortly be a call by Standards Australia for comment on the first public draft. I would encourage everyone active in eHealth and concerned with the impact of health software on patient safety (isn’t that everyone?) to look at this draft and get involved. The author and Dr Patricia Williams are the nominated Australian experts for this work and Richard Dixon‑Hughes will be coordinating the Australian team response. Their combination of clinical, security and engineering eHealth backgrounds respectively is a great start in getting this work onto an appropriate track, but wide sector involvement will be needed to bring this work to a conclusion appropriate for the Australian eHealth community.





Events November






HINZ 2012 Rotorua, NZ w:




GENOMICS DATA MANAGEMENT Sydney, NSW p: +61 3 9326 3311 w:



22-23 NOVEMBER 5TH HOSPITAL IN THE HOME CONFERENCE Melbourne, VIC p: +61 2 8204 0770 w:


December 4-5





HISA SA FORUM Adelaide, SA p: +61 3 9326 3311 w:




ESEMINAR – RISK MANAGEMENT Online p: +61 3 9095 8712 w:



MEDTECH 2012 Sydney, NSW p: +61 9900 0650 w:




HIC2012 QUEENSLAND HIGHLIGHTS Brisbane, QLD p: +61 3 9326 3311 w:

16-18 NOVEMBER GPCE Melbourne, VIC p: +61 2 9422 2007 w:


26-28 NOVEMBER GLOBAL TELEHEALTH 2012 Sydney, NSW p: +61 7 3876 4988 w:










BYOD:2012 Sydney, NSW p: +61 2 9080 4300 w:



Save the dates 29




21-22 MARCH



HISA NSW TALES OF TELEHEALTH Sydney, NSW p: +61 3 9326 3311 w:



HISA NSW - MEDICARE LOCALS Sydney, NSW p: +61 3 9326 3311 w:





HISA NSW AGM Sydney, NSW p: +61 3 9326 3311 w:




HISA NSW DISCUSS QUALITY & SAFETY Sydney, NSW p: +61 3 9326 3311 w:







HISA NSW 2ND YOUNG TALENT TIME Sydney, NSW p: +61 3 9326 3311 w:






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ST JOHN AMBULANCE OFFICERS EMBRACE BYOD Earlier this year, NEC Australia won a WA iAward for the innovative development of an iPad interface to an electronic patient care record for St John Ambulance WA. 850 ambulance officers have been issued an iPad that they can also take home with them, and while there may be a bit of Angry Bird playing going on, the iPads have made patient data capture and sharing infinitely easier.

KATE MCDONALD Journalist: Pulse+IT

It might seem a bit strange that today’s ambulances, equipped as they are with the latest in life-saving medical devices and electronic navigational aids, still carry paper-based records for patient data, but that was the case until about two years ago for St John Ambulance in WA. The not-for-profit organisation, which has held the licence to provide ambulance services in the west for close to a century, had for many years used A3-sized forms that the ambulance officers manually filled out after attending to the patient.

About the author Kate McDonald is a senior staff journalist for Pulse+IT. Formerly the editor of Australian Life Scientist magazine, she has also edited industry titles Hospital & AgedCare and Nursing Review. Her interests cover health ICT, biotechnology and translational research.

designed a touchscreen program for the iPad, allowing the officers to enter patient data straight into the ePCR while also allowing real-time access to the information by both the receiving hospital and central command. And while more rugged tablets were initially considered for the field, it turns out that iPads are tougher than they look, according to NEC Australia’s general manager for strategy and service, Saul Sabath.

These forms included all of the essential information on the patient, and at the end of each shift were sent to St John’s call centre in Perth’s Belmont, where the data was eventually typed into its patient management and billing system and an invoice produced. And at the hospital, emergency staff had to pretty much start from scratch, opening a patient file and entering the information all over again.

“One of the most interesting statistics and something we were quite blown away by ourselves, is that of 850 devices that we’ve got in the field at the moment, only eight of them have failed and one of those got driven over by an ambulance,” Mr Sabath says. “Less than one per cent failure rate is more than better than the industry standard, so kudos to Apple in producing a device that can withstand a relatively high degree of use.”

The obvious solution was an electronic patient care record (ePCR) and St John Ambulance decided to design one in-house that fitted in with the organisation’s way of doing things. The challenge was, how would the officers in the field use this new system? iPads turned out to the answer. In an innovative project, St John and NEC

NEC began working with St John Ambulance over two years ago on this project, just after the iPad was first released, although the two organisations have had a relationship for over a decade. NEC has long been a service provider to St John Ambulance, helping the organisation with much of its Microsoft technology.

So it made sense for the two to work together again when St John decided it needed to develop its own ePCR and the various interfaces to it. There were several goals behind the new system, one of which was improving the efficiency of data capture, and another to speed up backroom processes such as invoicing.

“It is all captured in a manual format and at the end of the shift that piece of paper is typically sent into their call centre in Belmont. The depots are all spread out in the metro and regional areas, and there’s often a two-week time delay for the manual data entry of that paper-based information into their core system.

The other major benefit is of course accuracy and quality of data capture, Mr Sabath says. In the field, information is hurriedly written and further errors often occur when handwritten notes are typed into an electronic system. “There is a human error element; that’s just life and there’s not much you can do about it.”

“St John’s traditional business model called for an A3 sheet of paper that had been used for many years,” Mr Sabath says. “The idea is that the ambulance officer, while in the ambulance, once he’s assisted the patient with any care that needs to be provided, at the conclusion of that they take out a big A3 sheet of paper and a ballpoint pen and they write a whole heap of detailed information.

“There are a couple of problems with that, and one is financial. Patients who are collected by an ambulance receive an invoice, and the delay in getting from the data entry to actually getting the invoice coming out is in weeks. One of the benefits of the electronic patient care record is that it is instantaneous, so you can shorten the cash flow recovery cycle of when the invoice goes out and the ability to collect.”

Historically, the information written on the form was not even shared with the receiving hospital, he says. “It was just posted back to the call centre. It sounds silly in this age of electronic health records and so on that fundamentally the process still is that the hospital staff start from scratch. One of the objects of this system is that this is now

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“One of the strongest things that got the project over the line was that once the users started looking at the prototype screenshots, they intuitively got the tap and go data entry concept.” Saul Sabath

minimised. The other big benefit is that the information to the hospital and the other care providers is available instantaneously. So in the whole eHealth supply chain, the very first entry is to distribute that information instantaneously. That opens up a whole range of opportunities for other care providers to take advantage of that information and make better care decisions, because the information is now freely available.”

Toughbook vs iPad Two years ago, NEC and St John Ambulance’s internal IT department got together to discuss how best to arm the large team of ambulance officers with a more efficient way to capture patient data and came up with two options, Mr Sabath says. One was purchasing an off-the-shelf ambulance software system and ruggedised Panasonic Toughbooks, which have an excellent reputation for toughness in the field but cost several thousand dollars each. St John could afford about 150 of them in its budget and the plan was to put one of them in each ambulance and buy software that is used by ambulance services in Victoria and NSW. “The upside of that is that they would be getting an industry-standard solution eventually but the downside is that they

don’t get the software to work in the way St John Ambulance in WA operates,” Mr Sabath says. “And WA is one of the smaller jurisdictions so the other jurisdictions would be able to get the software updated to their requirements in future releases but WA wouldn’t be as important. So that was option A.” Option B was using one of Apple’s newfangled iPads. The device had just been released to the market as the team started looking at this project. “We were sitting in the office and we all pulled out our iPads. We started investigating how we could build an iOS application and do all of the security and wireless connectivity, all of the business processes and connecting it to the web services and so on. “We came up with a proposal that the CIO felt comfortable with, that we’d be able to cover all of the risks and the opportunities for future growth. So we put a proposal to him and that was accepted.” Part of the success was due to a thorough investigation of the user experience. NEC’s team developed a number of prototype screenshots in full colour, having spent time with the officers to learn how they wanted to interface with the application. “We developed some early prototypes which we submitted as part of the proposal,” Mr Sabath says. “One of the strongest things that got this project over the line was that once the users of the

system started looking at these prototype screenshots, they intuitively got the tap and go or touch and go data entry concept. This was just the modern way that you would work with a device, with a touch interface, and the buttons would pop up and be prepopulated and it just intuitively made sense to everyone. “The users could conceptually get in their head, they could visualise how this application was going to work. They were very quickly emotionally committed to the project and they got enthusiastic and got onto Facebook internally and started discussing how they would use the technology in their day to day role.” Another reason that the iPad idea got over the line was that St John Ambulance had just embarked on a marketing and recruitment drive targeting young paramedics just entering the workforce. “Those people all have iPhones and iPads and they want to come to work and use them. The organisation has been able to reinvent itself and make technology a lot more relevant.”

Personal control Cost was also a positive for the iPad. At about $600 each, St John’s budget meant most of its metropolitan-based officers could get one of their own, rather than having one device allocated per vehicle and swapping over at each shift. When St John decided on the iPad option, it also decided to gift it to the officers – it is theirs to use personally as well as professionally. “We have now deployed about 850 iPads, all secured and managed and all that sort of thing, and they take it home at night,” Mr Sabath says. “When they are on downtime on their shift they can use it for professional development or e-learning, for training or for reading the newspaper. Obviously there is an element of Angry Birds, but why not?

“When they are on shift they log into the application with a user name and password, but it’s a device you can get comfortable with. And it’s only in the $500 to $600 price point so you can put one in the hand of every ambulance officer. “So rather than a fixed, in-vehicle application where you are just doing the same thing you have been doing for 20 years, now you get to embrace the technology and use it to add value. The technology is getting low-cost enough that you can distribute it out and make everybody a user of the application and not have to make decisions over who has access to it.” The relatively low cost of the devices was also a factor in choosing them over more rugged tablets, and replacing damaged iPads was factored into the budget. The big surprise, however, is that there have been so few breakdowns. They are protected with iCases but there has still been a very low failure rate, Mr Sabath says.

Wider interfacing Part of the overall system developed by NEC is an extranet, with patient data sent in real time into a SQL .NET application. The information is published via a user name and password to all of the hospitals, which are then able to log in and view it. NEC and St John Ambulance are now working with the WA health department to interface their systems into St John’s, Mr Sabath says. “We built it in a very open fashion using standard industry web services in such a way that any application can then tap into it. The whole premise is that we have now developed the application in such a way that it is open and appropriate service providers can now get access to that information.” The team is also thinking of further developing the application for the Microsoft mobile environment when Microsoft releases its rival to the iPad, but if there is no major difference in price, Mr Sabath says it is not on the priority list.

“We are a Microsoft partner, an Oracle partner and an Apple partner, so when we were planning the project we were planning on two deployments, one on the iPad and one on the Windows environment, but two years ago there was no Windows or Microsoft device. “We always had within the budget that when Microsoft was ready, to be able to redevelop the application to park it into the Microsoft environment. We are close, possibly a couple of months, for Windows 8 in a mobile environment. We’ll wait for the market to come out but right now there is no real competing proposition to the iPad.” Mr Sabath says the project, which won a 2012 WA state iAward, had been a terrific learning curve for both St John Ambulance and for NEC. “Adopting a new device into any enterprise is a learning curve for any CIO and every supplier, and 850 is not a small audience. St John Ambulance has done a great job in being able to culturally cope with it.”

“I don’t want to use the term that they were a throw-away device because that’s not appropriate, but because the cost is low relative to other devices, there was always an expectation that there was going to be a high rate of failure or a high rate of replacement. Because the cost was low, that was okay by the budget. “But up to now, and a lot of these devices have been in the field for 18 months, it is a fantastic outcome to lose less than one per cent. It is a combination of the glass cracking or the hardware failing, but less than one per cent is more than better than the industry standard.” Mr Sabath also believes that because they are personally issued devices, the users take care of them just as they would their phone. “They are a little larger so you don’t drop them as often as you do a phone, and people do respect the device and they take care of them.”







In rural areas of Australia, general practitioners often provide medical services for the public community hospital, and the general practice is often co-located with the public health service. However, with both services provided by different entities, usually their computer systems have little or no integration. A Tasmanian project aimed to bridge that gap.


Smithton is a small community in north‑west Tasmania, serviced by a four-doctor general practice. The same four GPs provide services at the local residential aged care facility, and also at the local community hospital. As a discrete community, the majority of residents of the RACF and patients presenting to the community hospital are also patients of the local general practice. When visiting the RACF and the community hospital, doctors don’t have access to their practice notes. Without the full patient history, medications and test results available to them, a doctor would sometimes drive to the practice to review practice notes before visiting the RACF to attend a colleague’s patient out of hours, and likewise afterwards to record the instance of care. Various solutions had been tried over the years, but due to slow connections with variable and slow broadband speed, they were abandoned.

About the authors Colleen Cheek, University of Tasmania Rural Clinical School Barbara Ringeisen, Tasmania Health Organisation – North West Gary Walker, Tasmania Medicare Local – North West Branch

As Smithton was one of the first NBN‑enabled towns, an opportunity existed to try the speedier connection with new mobile technology. iPads were chosen as the device to connect to the GP’s clinical system as they provided portability and flexibility, and also contained cameras to allow for smooth and high-quality video calling between sites via the NBN

if required. The iPad interface was also familiar to GPs who already had exposure to the touch interface and gestures common to the iPhone. A secure remote desktop connection to a virtual computer located at the general practice was established, connecting the three sites – the general practice, the local hospital and the aged care facility – with all three sites connected to the NBN. Wireless cover at the respective facilities was established so the doctor could move freely and still have access. Network printers were installed at both the RACF and hospital, which allowed the GPs to print patient letters, notes and prescriptions directly from their practice software while on site so they could be filed in the patient record or signed immediately.

iPad vs laptop While a seemingly simple solution, there were some teething problems. The iPad 2 was used initially as it was the latest technology available. The RACF was surveyed for wireless points using a laptop, but once the iPad was used, we found the signal was not strong enough and extra wireless access points were required.

Gary Walker of the Tasmanian Medicare Local shows doctors Jenny Oostenfeld, left, and Nicole Anderson of Smithton General Practice, with UTAS RCS medical student Hilary Taylor‑Evans, how to connect to the practice software.

Emmerton Park DON Chris Hyde sees how the GP practice software produces a script ready for the GP to sign at the time.

Even using the NBN, the doctors didn’t find the user experience as seamless as they had hoped, and they also had to scroll around to view the window of the medical software application. As soon as the iPad 3 was available it was introduced, and with a stylus, responsiveness improved substantially.

With persistence and attention to feedback, a very workable and valued solution was found, although this seemed to be more suited to the community hospital than the aged care facility.

The increased screen resolution available on the iPad 3 meant scrolling around was also minimised, but when the iPad keyboard popped up, this obviously reduced the view. Some also complained the keyboard was too small for those with large hands. Various covers with built‑in keyboards were tried, but the Apple mobile keyboard was the most elegant and preferred solution, allowing the doctor to sit at a desk to write up notes. Ensuring the doctors had ready access to the charged iPads was also critical. This was achieved by housing the iPad in a wall‑mounted document holder in the main office next to a power outlet. Of course, this begs the question whether a laptop would be a better solution, but the majority of the doctors prefer the iPad.

Practice software updates must also be applied to the remote computer – in rural areas these sorts of tasks are often performed by one of the practice staff, so it must be added to their task list. Any updates to the iPad cannot be performed remotely, so it is important to select staff who are comfortable to update or make any necessary changes. iPad screen covers allowing the screen to be wiped clean or changed and the use of a stylus also provide some infection control.

Hospital use The solution at the community hospital is reportedly used everyday by the doctors, one describing it as “brilliant”. Locums have reported that having the practice notes available to them when consulting at the hospital is invaluable. Medical reference applications installed on the iPad have been requested, but these are limited to those they are prepared to pay subscriptions for, and if a practice‑based subscription needs to be installed on the remote computer it must be updated accordingly.

As broadband internet services in rural areas are often so much slower than in metropolitan areas, the advanced capability of the NBN provides a great opportunity to support rural work issues. Smithton, with a population of 3500, was eligible for fibre connection, however many smaller or more isolated communities will only be able to access the NBN via wireless or satellite connection. One of the authors has a home satellite NBN connection. While this enables broadband access to the household, which was not previously available at all, the connection is slower and more variable than fibre. Obviously this will limit this application where responsiveness is a deal-breaker to users. This initiative was implemented as part of Cradle Coast Electronic Health Information Exchange, funded by the Australian Department of Health and Ageing.







MOBILE CLINICAL PHOTOGRAPHY Taking a quick photo of a patient’s injury on an iPhone and emailing it to a specialist for advice seems like a wonderfully efficient way of using contemporary mobile technology, but it is a lot more complicated than that. Clinicians can be liable for fines of up to $100,000 if they store or distribute clinical photos incorrectly under federal privacy laws. A new app called PicSafe Medi might be the solution.

KATE MCDONALD Journalist: Pulse+IT

It’s nine o’clock in the evening and two distraught parents turn up at an emergency room with their 12-month-old baby, who has tipped over a cup of hot tea and scalded herself. Pain relief is the first priority for the resident who examines the child, but the thickness of the burn and the potential for scarring encourage the resident to ask the emergency registrar for his opinion. The ED registrar, however, is not sure what to do either, so he calls the plastic surgical registrar, who lives an hour’s drive away and has only just arrived home from her shift. She asks the emergency registrar to email her a photo of the burn and she’ll give her opinion over the phone. Unfortunately, this is not possible. It is hospital policy, and appropriately so, that photos taken of patients cannot be sent beyond its walls, so the plastics registrar gets back in her car, drives all the way back to the hospital, attends to the patient, and returns home exhausted, to get up early and do it all again. This may sound like a case of bad policy interfering with quality medical care, but under Australian law, the hospital policy is correct. Under federal privacy laws, clinical photos that can identify a patient cannot be taken without informed consent, cannot be stored on an individual device,

should not be distributed by email or an insecure website, and must remain in Australia. These photos are the property and responsibility of the hospital if taken in the public sector, and they must be stored by the hospital for at least seven years under freedom of information (FOI) laws. Few clinicians, however, are even aware of these rules. The use of clinical photography is invaluable to the medical profession, particularly for specialties like plastic surgery and dermatology, and can be indispensable tools for health professionals practising in rural settings. Photos are useful not only for comparing a wound before and after a procedure, but for monitoring healing over time, for consulting on a case with colleagues, and for educational purposes. And the use of clinical photography is destined to grow, particularly with the almost universal use of smart devices handily equipped with a camera and the ability to email or upload photos to the web. But there are many dangers attached to this practice, not the least of which is the potential for costly fines for breaches of the Commonwealth Privacy Act. David Hunter-Smith is a plastic surgeon based at Victoria’s Peninsula Health and an examiner for the Royal Australasian

College of Surgeons. Clinical photography is essential to both of these roles, but he and his colleagues have become increasingly concerned over the last few years that general awareness of privacy principles is low, that policy is not aligning with quality, and that no one seems to have come up with an adequate solution. These concerns were further enhanced by the discovery that in three separate cases this year at one Melbourne hospital, undocumented, identifiable images of patients were found unsecured on residents’ phones with no consent from the patient having been obtained. So Dr Hunter-Smith and a colleague, dermatologist Ted Carner, decided to do something about it. Equipped with some sage advice from friend and public health specialist Tony Stewart, the duo set out to develop a solution that would overcome the numerous ethical and privacy issues confronting the use of clinical photography.

Privacy principles Forming a team with Melbourne brand building and app design studio ProjectProject, and leading burn-specialist plastic surgeon Heather Cleland, what they have come up with is a smartphone app called PicSafe, which consists of three discrete modules. The first is the smartphone app itself, which has been built to be compatible with both iOS and Android platforms. It has been designed to allow the safe capture of patient images, patient consent for the images, and secure transmission of the images to a certified repository. The second PicSafe module is the repository component, which is hosted on a highly secure, T4-level server to store all transmitted images, with nifty provisions made for tagging, archiving and rapid retrieval of photos. The final module is an in-built flexibility to design

custom interfaces that will allow different health services and institutions to access clinical photos taken by their personnel and seamlessly attach these photos to the appropriate patient’s clinical record. “It all sounds quite simple but the process of getting there wasn’t quite that easy,” Dr Hunter-Smith says. “Ted, Heather and I talked and talked about it, and we quickly realised that we couldn’t do this in the back yard. It is quite a big idea. “We were very fortunate to find Chris Gillard and his guys from ProjectProject – a seriously smart group of people who are proven, but not medical.” Before setting off to develop an app, however, Dr Hunter-Smith and another colleague, Michael Kirk, separately undertook research in the department of surgery at Peninsula Health, with full human research and ethics committee approval. What they wanted to find out was the level of use of cameras on





“We found that, of the doctors we surveyed, all had a phone, most with in-built cameras, and almost all of these physicians were connected to the Internet.”

Once the image is acquired and consented, the photo is then sent to the securely hosted PicSafe Medi server, which stores the photo and returns a short automated URL. The nurse then sends an SMS or email to the specialist with the attached URL. The specialist then logs in on the app or through the website and retrieves the image for quick assessment.

Dr David Hunter-Smith

Authorised users can also check the archives for previous patients’ photos, and allow colleagues to do the same under an audited registration and internally logged process that PicSafe Medi will manage.

smartphones by doctors, how doctors were using their smartphone cameras in the clinical setting, what their understanding was of the published policies pertaining to clinical photography, and whether or not they were adhering to these policies. “We found that, of the doctors we surveyed, all had a phone, most with in-built cameras, and almost all of these physicians were connected to the Internet, but only 43 per cent had a lock on their phone,” Dr Hunter-Smith says. “We found that 65 per cent of our doctors are taking clinical images but only a quarter have obtained appropriate patient consent, and of those, only seven per cent have obtained written consent.” Ninety-one per cent were sharing images in insecure ways such as email and IM, and while most felt that clinical photography had a positive effect on patient care, only 40 per cent knew there was a policy, and of those who did know, only five per cent had read it. He says that this year alone, there have been three FOI claims looking for clinical photographs where the images were ultimately found on residents’ phones without documentation. “There is huge risk there. We know mobile technology is really good for people and is used a lot, but the policy can’t handle it at the moment. We are all in a bit of a spot.”

Secure picture repository Chris Gillard and his team came up with a solution that ensures photos taken through the app will not be stored on the phone, and when an authenticated user accesses a photo, they will be provided with a timelimited link to that photo. “All information is transmitted over a secure Internet protocol and stored in a secure server that has been rated T4 by ASIO,” Mr Gillard says. “Using an Australian cloud satisfies the problem of trans-border data flow and the Health Privacy Principles Act, enacted by the federal government after the ramifications of the US Patriot Act became clear.” A significant amount of work has gone into Picsafe security measures, with all images and documents being checksummed and audited, all watermarked and geo/deviceID tagged, and time and date stamped, Mr Gillard says. Users accessing an image can only do so through the specific IP address given to them and this will only be live for five minutes. An internal logging system allows for easy audit trails. “Actual use of the app is rather easy, however,” he says. “The nurse or doctor opens the app on their phone with their secure password and takes one or more photos. Tags can then be added, followed by capturing the patient’ signed (fingerscreen) or recorded (audio) consent.”

One of the key capabilities of the Picsafe Medi product is the ability to customdevelop for an institution or an existing medical network, Mr Gillard says. “The IT and senior management team at Peninsula Health here in Victoria have also been working with us to develop a solution for the government institutional side. “We can create APIs for organisations allowing images captured using Picsafe Medi to automatically appear in their records. As an example, one of Peninsula Health’s requirement is that their users be able to insert the patient’s UR number, allowing direct delivery of captured images into the hospital’s system.” The team also plans to expand into the GP market, Dr Carner says. “We plan to design APIs specifically for general practitioners currently using popular office-based clinical software. I use Genie and Argus in my private practice and hope to wed these, and other such systems, with Picsafe Medi. We haven’t written the code yet, but it is certainly doable. Just knowing that all of my patients’ pictures are tagged, safely stored, and waiting at my fingertips is really quite comforting.” PicSafe Medi is now available as a fully HIPAA-compliant solution on the US App Store, and the Australian secure cloud solution will be released soon.


Pulse IT November 2012

Proven to reduce medication error1, our e-prescribing solution CSC MedChart is used by leading hospitals in the United Kingdom, New Zealand and Australia. Fully web based, MedChart supports complex infusions, integrated antibiotic stewardship and medicines reconciliation. For continuity across primary and secondary care, the latest version integrates with the PCEHR to generate take home medication lists and enable electronic discharge summaries. To learn more, visit CSC.CoM/EMM or email REFERENCES:

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1. Effects of Two Commercial Electronic Prescribing Systems on Prescribing Error Rates in Hospital In-Patients: A Before and After Study. Westbrook JI, Reckmann M, Li L , Runciman WB, Burke R, et al. 2012. PLoS Med 9(1): e1001164. doi:10.1371/journal.pmed.1001164





As the executive director of medical services at Cabrini, part of Associate Professor Simon Woods’ job is to keep his 1200-strong list of accredited specialists happy and engaged. So when he noticed many of them turning up with iPads, he and his team decided to give them what they want and put access to their patient information in the palm of their hands, whether they are onsite or not.

KATE MCDONALD Journalist: Pulse+IT

Simon Woods has been working in hospitals since 1979, for the majority of the time as an upper gastrointestinal surgeon and now as executive director of medical services for the not-for-profit private health provider Cabrini. In that time, he has seen many IT systems come and many of them go – often with their tails between their legs, he says. So when an anaesthetist bailed him up in the coffee line and told him that the new iPad-based patient information system Cabrini had just introduced was the best IT system he had ever used, Dr Woods knew he was onto something good. Cabrini covers six campuses in Victoria, taking in two hospitals at Malvern and Brighton, two rehabilitation services in Elsternwick, a palliative care centre at Prahran and an aged care facility at Ashwood. At its 508-bed hospital at Malvern, Cabrini has set an ambitious target of installing a full electronic medical record, an electronic medication management system and an electronic discharge summary. Three years ago, it installed CSC’s webPAS patient information and administration system, along with a new picture archiving and communication system (PACS) from Intelerad, which comes with an

InteleViewer system to enable clinicians to view images. It also has a separate IT system run by Pro Medicus that provides the reports. Pathology results are provided by a system called Apollo, used by Melbourne Pathology, which also has a separate search function called Webster that allows clinicians on the wards to remotely access its pathology database over the internet. Cabrini is also planning on rolling out CSC’s MedChart medications management system. While these new systems have reduced the number of older, uncommunicative systems Cabrini had previously used, it still meant that if doctors wanted to see one patient’s full results, such as x-rays, blood tests and their x-ray report, they effectively had to log in to two systems, Dr Woods says. “We had also just about completed a WiFi rollout in all of the hospitals and had recently upgraded all of our monitoring software to a Philips system, which conveniently transmits all of its information back to a central server. But up to that point, we hadn’t done anything to take advantage of it.” Then the iPad came out, and its potential, enthusiastically embraced by the medical community, was obvious, he says.

“About that time we were getting towards a full EMR and EMM and talking about the number of devices we’d need around the hospital. No one could see any particular point to the iPad for about 24 hours, and then suddenly realised what they had in their hand. We could see that our doctors were out there buying hardware, so it dawned on us that maybe we should let them buy the hardware, and we could concentrate on the software and the network.”

Keep the doctors happy So that is exactly what Cabrini did. It decided to find an iPad-based solution that would initially allow the specialists to check on test results for their patients without having to make a phone call to the ward and interrupt the nurses.

their feet,” Dr Woods says. “So we actually asked clinicians what frustrated them – and I knew a little myself – about the day-to-day information you need to accumulate to make a clinical decision. “Paper results all over the place: sometimes at the end of the bed, sometimes in a folder, sometimes in a fax machine, sometimes waiting to be filed, sometimes someone else has them in the medication room. And when you are away from the ward you have to ring up, and you don’t even know if the result is actually back yet so you may have a five-minute unproductive phone call interrupting nursing care only to be told that no, they don’t have the results yet. This is a day-to-day thing that drives people nuts. It is not only unproductive for the doctors but disrupting to the nursing staff.” Dr Woods and his team set out to try to make it easier for the medical staff, but rather than go for a big bang rollout of a complete system, to start off with some simple, highly desirable functionality and then build on that by asking the doctors what they wanted next. “The first priority was finding a new way to link to clinical results,” he says.

“In a commercial environment like a private hospital, my job is to keep [the doctors] happy and I can’t have them voting with

As Cabrini was already working with CSC – then known as iSOFT – on the rollout of webPAS and with plans for MedChart, the organisation decided to ask iSOFT to come up with a few ideas. “We set a simple challenge to iSOFT – we said we just want you to give us what we need, anywhere, anytime, whether we are on WiFi, whether we are on 3G, we don’t want it to drop out when we go from ward to ward or go outside the hospital. We do not want to have a whole lot of log-ins – if we have a secure log-in to the iPad, we don’t want to know what is going on in the background.” What iSOFT came up with is now known as its Mobility Suite, which allows doctors secure access to a range of internal IT systems remotely, with one secure log-in. Given that Cabrini already had webPAS, which has a range of demographic data on each patient and where they were located, Dr Woods says his team decided to use that as a starting point for the new iPad system.

Dr David Hooke

Credit: Daniel O’Brien

“As an unashamed Apple enthusiast, I said why can’t you do it like Apple would do it, so you don’t need to teach people and it would be obvious. We also needed to make sure it wasn’t a one-trick pony and we could build on it, but the ultimate goal was to give them something they are going to want to use voluntarily. “One thing we said was we don’t really want a busy screen. We don’t want a whole lot of drop-down boxes. We want one function per screen and we want to make sure that you can’t get lost in the system. So if I want to do a ward round, I open the iPad and put in my password, it defaults to showing me my patients and where they are.





“Away from the hospital, I’ve got the same functionality – it doesn’t matter if I am sitting at a desktop or looking at an iPhone.” A/Prof Simon Woods

“When I touch on one of those patients, then it gives me the opportunity to do a whole lot of things. Routine biochemistry, pull up their CT or their plain films. Down in the emergency department they have a different view of it – they can see the next patient and what is wrong with them. They pull up their observations and fill in all of their case notes on this. “Away from the hospital, I’ve got the same functionality – it doesn’t matter if I am sitting at a desktop or looking at an iPhone. A lot of doctors rapidly put it on their iPhones, which wasn’t our intention but others started using it on Android devices and it seems to

work. They are all using it in their own way. For me, it doesn’t matter.” In addition to finding test results and demographic information, new functionality has been built in to include the clinical notes used in the emergency department and in Cabrini’s Hospital in the Home service. “We are just about to launch test ordering; we are then looking to recording observations. We already can view real-time monitoring of any patient who is attached to a Phillips monitor. It is quite extraordinary to be able to sit at home and see what the oxygen saturation of an ICU patient is. This system is going to be our interface to MedChart, which we’ve begun deploying, so it will all be through the same interface.”

Lessons learned Dr Woods emphasises that any new IT system has to be designed with the clinician in mind and how they are going to be using it. “If you have enthusiasts, it is much more powerful than telling people what to do,” he says. He tells the story of a multi-million dollar pathology system he encountered in the past that had been designed to show the most recent results at the bottom of the screen, not the top. “You had to scroll down every result and for some of our patients who had 250 tests, that was rather cumbersome. When we pointed out that we’d actually like to see the recent results first, the IT department said that we’d ‘get used to it in time’.” The new Mobility Suite system first went live in May 2011, and by January this year there were 320 individual users. The amount of results viewed continues to increase and more people are using the system, he says. “The doctors supply their own devices, and interestingly, we haven’t had to resource this in terms of support. The only support we’ve had to give is to some doctors trying to set up their iPad. We don’t have a training manual and we’ve run no training sessions in teaching people how to use it.” His team has made an estimate on how many hours using the device has saved – adding up the odd 10 minutes clinicians were spending on the phone as well as nurses having to leave the patient – and the numbers are looking good.

Credit: Daniel O’Brien

A/Prof Simon Woods

“If you just save 0.2 per cent of the time by having the result in your hand, you can order the next test or change the patient’s treatment just one day earlier, that would translate to 480 bed days, and I think that is quite conservative,” he says.

“I was told by the wife of one of the surgeons that his night-time ritual is to sit on the edge of the bed and go through all of his patients and check their monitoring. It is the ability to check and make those real-time decisions... When I was in practice, I was in Amsterdam at a conference and I was worried about one of my patients who was in intensive care the day I had left. I could actually log in, look at his monitoring, look at his biochemistry and his x-rays, and I could ring his wife from the demographic data that was available to me. I could see a freeze frame of the current traces from ICU as of one minute before.”

x-rays or log in and see someone else’s result. But a surgeon needs to have their files seen by a radiation oncologist – if you put boundaries around it, it doesn’t work.

Security and confidentiality have been tackled in two ways. There is a secure log-in, and the device closes out of any patient file if it has not been used for five minutes. In terms of confidentiality, Cabrini has relied on the professionalism of its specialists.

While the project was designed to equip accredited specialists with easy access to test results and demographic data, it has not stopped there. Allied health and nursing staff are beginning to use the system in Cabrini’s Hospital in the Home, and nurses in the emergency department use it all of the time.

“The concern was that we can see other doctor’s patient files, but effectively you can do that already, it is just clumsier. Any doctor can walk into any ward and open a patient file, pull up some

“So we’ve relied on professionalism and just a little bit of Big Brother, so I leave my fingerprint on it. It says down the bottom, last used by Simon Woods and the time and date stamp. Some doctors who have been patients at Cabrini found that you could look up your own patient records but the reality is if other people want to look up my colonoscopy result, they can do it already.”

Improve effi ciencies and c costs with Digital Dictation and The next stop is nurses on the wards, Dr Woods says. “Those nurses don’t use Speech it as yet, but as we Recognition roll out the EMM, they will.” System

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Off Topic

GETTING READY FOR THE NEW EPIP The federal government has introduced new requirements for general practices wishing to apply for incentive payments under the new eHealth Practice Incentives Program (ePIP), with many of them tied to boosting general practice participation in the PCEHR system. An ePIP register has been launched to allow practices to check if their software meets the requirements.

KATE MCDONALD Journalist: Pulse+IT

Following the May federal budget, Health Minister Tanya Plibersek announced that general practices would need to be using software that met five new functional requirements in order to qualify for payments under the revised eHealth Practice Incentives Program (ePIP). Ms Plibersek initially set a deadline of February 2013 for practices to have the functionality in place, but under pressure from the AMA and the RACGP, the fifth requirement was pushed back until May next year. Under the new ePIP, practice software must be able to access the Healthcare Identifiers (HI) Service to look up patients’ Individual Healthcare Identifiers (IHIs) and to securely store the practice’s Healthcare Provider Identifier – Organisation (HPI-O) and each practitioners’ Healthcare Provider Identifier – Individual (HPI-I). Practices will also be required to install and use systems that allow for secure message delivery (SMD) and electronic transfer of prescriptions (ETP). They must also show that they are using an approved clinical coding system for diagnoses. These four requirements – HI Service integration, SMD, ETP and clinical coding – must be deployed in their practice by

February 2013 in order to qualify for payments. The capacity to interface with the PCEHR must be integrated by May. Most of the market-leading general practice clinical software vendors have informed Pulse+IT that they will fulfil all five requirements (see page 54) well before the prescribed deadlines, but practices need not wait until their software has been updated, released and installed before addressing some of the administrative requirements, such as the registration processes associated with the HI Service. The National E-Health Transition Authority (NEHTA) has established an online eHealth PIP Product Register so practices can check that their software meets the various requirements. The register went live in early October and has been updated regularly since then. There is a register for each ePIP requirement except the third – clinical coding. Practices are encouraged to talk to their software vendors to discuss when conformant software and any training, if required, will be available.

Requirement 1 – HI Service The first requirement to qualify for the ePIP is the ability to integrate Individual Healthcare Identifiers (IHIs) into electronic practice records. This will mean that

practices can directly access Medicare Australia’s Healthcare Identifiers (HI) Service to retrieve a patient’s IHI and to import it into the patient’s record. The HI Service is a national system used for uniquely identifying healthcare professionals, organisations and individual consumers of healthcare services, and according to Medicare, will help ensure individuals and healthcare professionals have confidence that the right information is associated with the right individual at the point of care. All Australians have been assigned a 16-digit IHI, which is different from a Medicare number. In addition to the patient’s IHI, each organisation that delivers healthcare will ultimately have a Healthcare Provider Identifier – Organisation (HPI-O). This is further divided into a Seed HPI-O, defined as any entity that delivers healthcare services, including medical practices, community healthcare organisations and hospitals; and a Network HPI-O, which is a sub-entity of a Seed HPI-O, such as branch practices or individual hospital departments. Practices must apply to the Department of Human Services (DHS) to be allocated an HPI-O and more information is available from the Medicare Australia website. Each individual practitioner has also been assigned an Healthcare Provider Identifier – Individual (HPI-I). Practitioners can find out their HPI-I by contacting the Australian Healthcare Providers Regulation Agency (AHPRA) or logging in to the AHPRA website. Practices must ensure that HPI-Os and HPI-Is are stored in a compliant practice management and clinical software system. The members of the GP desktop software vendors panel, which was established to test this new functionality in the field, began integrating the HI Service as the first part of their scope of work.

In addition to correctly identifying patients throughout the healthcare system, the intent of this ePIP requirement is to make healthcare identifiers available for secure message delivery and for use in the PCEHR system.

Requirement 2 – secure messaging The second requirement of the ePIP is to have secure messaging capability to electronically transmit confidential patient information. According to NEHTA, to qualify for ePIP payments, practices must have a standards-compliant secure messaging service that allows them to electronically transmit and receive clinical messages to and from other healthcare providers. Practices are encouraged to check the ePIP register to see if their software is compliant. Under the ePIP requirements, practices must also use secure messaging ‘where feasible’, which softens the requirement somewhat in reflection of the fact that the major secure messaging vendors have not yet achieved interoperability. However, in June this year, three of the leading secure electronic messaging providers announced that they were working together to open up secure messaging channels to each other’s customers. Currently, service users can only communicate with practitioners using the same product. In what is called the Secure Message eXchange (SMX) collaboration, DCA, HealthLink and Global Health – which market the Argus, HealthLink and ReferralNet products respectively – have agreed to work together to use the Secure Message Delivery specification (ATS 58222010) to allow each other’s customers to communicate with each other. Together, the three vendors say they service over 85 per cent of the market. The other major player, Medical-Objects, is not part of the agreement, although the SMX

partners state that any company that has systems based on the SMD specification may take part. Medical-Objects managing director Andrew McIntyre said his company already has an agreement to interoperate with DCA when the infrastructure exists to support it in a safe, scaleable way, but would not take part until that was so. HealthLink’s head of operations for Australia and New Zealand, Geoffrey Sayer, said messaging service providers would not have to do integration work with each separate clinical software vendor, and current users of the electronic messaging services will not need to do anything different through their clinical software. “Nothing is different,” Dr Sayer said. “That is part of the benefit.” Requirement two also states that practices must have a written policy to encourage the use of secure messaging, stating that it prefers to send messages electronically rather than by fax or letter.

Requirement 3 – clinical coding This requirement will not necessitate changes to software and there is no individual ePIP product registry for it, but it does require that practices show they are using a clinical coding system for problem diagnoses. According to NEHTA, “practices must ensure that where clinically relevant, they are working towards recording the majority of diagnoses for active patients electronically using a medical vocabulary that can be mapped against a nationally recognised disease classification or terminology system. Practices must provide a written policy to this effect to all GPs within the practice.” These recognised vocabularies include the bespoke models used by Medical Director





and Best Practice, called DOCLE and PYEFINCH respectively. The vast majority of other vendors use ICPC-2 PLUS, which has been used in many research projects, including the Bettering the Evaluation And Care of Health (BEACH) program, so is often referred to as the BEACH coding system. ICPC-2 PLUS has been classified to the International Classification of Primary Care, Version 2 (ICPC-2) and allows health professionals to record symptoms, diagnoses, past health problems and processes such as procedures, counselling and referral at the point of care. It currently contains approximately 8000 terms that are commonly used in Australian general practice. The requirement states that the vocabulary used must be able to be mapped against a nationally recognised disease classification or terminology system, with NEHTA having selected SNOMED CT as the preferred terminology. However, mapping most local codes to SNOMED is not expected to begin until next year.

However, the two main electronic prescription exchanges are understood to have recently agreed to work towards interoperability. While the two exchange services would not comment on the record, Pulse+IT understands that the Department of Health and Ageing has brokered an agreement between the two to enable electronic scripts to be sent from a practice using one prescription service to a pharmacy using another, for example. It is understood that the technical hurdles are not great, and that interoperability will be rolled out to users early in the new year. ETP specifications developed by NEHTA are currently being considered by Standards Australia, so until full ETP capability is implemented, which will also include the ability to use electronic signatures, prescribers will still have to give patients a signed paper prescription. This must be generated by the clinical software and contain a barcode to enable the retrieval of scripts from the prescription exchange for dispensing.

Requirement 5 – PCEHR

The Family Medicine Research Centre (FMRC) at the University of Sydney, which maintains ICPC-2 PLUS, recently undertook a project to map 100 commonly used general practice terms to SNOMED CT and is hoping to continue the work next year. PYEFINCH, the terminology used in Best Practice, is currently 85 per cent mapped to SNOMED CT.

Requirement five – full interface, uploading and downloading capability to the PCEHR – is not due until May 2013. While the majority of software vendors are near to or have completed the conformance tests for this requirement, it is, in the words of one vendor, “the most complex piece of the puzzle”, and will require further testing in the field over the next few months.

Requirement 4 – electronic transfer of prescriptions

One general practice software vendor has already achieved uploads to individual PCEHRs as Pulse+IT was going to print, and an acute care software specialist has also achieved the same feat in a hospital setting, but the correct use of the system and its integration into general practice workflow is expected to take quite a deal of training. It was perhaps pertinent, therefore, that the federal government acceded to the demands of medical organisations that it not be brought in until May.

To qualify for this requirement, practices must have an agreement with one of the two recognised prescription exchange services – eRx Script Exchange or MediSecure Script Vault. Many clinical software vendors have already integrated with one or both services, as currently the two prescription services do not communicate with each other.

Requirement five states that practices must use compliant software for accessing the PCEHR and to create and post shared health summaries. A shared health summary is defined as a clinical document sourced from the individual’s nominated provider – usually but not always the family doctor – which provides a clinically reviewed summary of an individual’s healthcare status and provides information about allergies and adverse reactions, medicines, medical history and immunisations. It is a ‘point in time’ clinical document, so it will be complemented by other documents that will be attached to the PCEHR to provide what is called a ‘consolidated view’. Other documents include event summaries, discharge summaries, specialist letters, referrals, prescribing and dispensing information, and pathology result reports. However, work on standardising event summaries, specialist letters and referrals is still being undertaken, and the ability to upload prescribing and dispensing information and test results is still believed to be some years away. In addition to having PCEHR-compliant software, to qualify for the ePIP, practices must also apply to participate in the PCEHR system upon obtaining an HPI-O and sign a participation agreement. They must also develop policies and procedures on the correct use of the PCEHR, patient confidentiality under the Privacy Act and training for all staff.

Response to the new ePIP Both the RACGP and the AMA have given cautious approval to the new requirements, saying that while the incentives are welcome, there are still some issues to be ironed out. Mike Civil, eHealth spokesman for the RACGP, said the official position from the college was a positive one but that the

impact of upgrading practice IT systems and interacting with the PCEHR on daily workflow was not yet known.

take to upgrade systems and that GPs will need ongoing financial support, but that the funding on offer was generous.

“We recognise and welcome the fact that the government is going to continue to offer practices incentives to embrace eHealth and to do things that will fit in with the PCEHR,” Dr Civil said.

AMA president Steve Hambleton said the final ePIP requirements were an improvement on what was originally proposed, and he was pleased to see that they were aligned with broader eHealth building blocks such as secure messaging and the PCEHR.

“People tend to forget that this is an ongoing incentive for practices and it is a significant sum of money. It’s great that the government does recognise that to be eHealth-compliant and to embrace this, general practice does need incentives.” He said there was concern within the profession about the amount of time it will

However, Dr Hambleton said the AMA remained concerned about the timeframe for compliance, and that the PCEHR regulatory framework is “onerous”. “In addition, practices will need time to acquaint themselves with their

obligations under the PCEHR regulatory framework,” he said. “[As] Health Provider Organisations under the PCEHR participation agreement, practices will need to prepare, document and implement associated policies and procedures.”

Resources For more information on the ePIP requirements and to check if your software is compliant, visit: http://www.epipregister. Medicare has sent PIP eHealth Incentive guidelines to all PIP-approved practices, and they can also be found online at: provider/incentives/pip/

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Off Topic


CLINICAL SOFTWARE PCEHR FUNCTIONALITY In addition to the six members of NEHTA’s GP desktop software vendors panel, several other software providers, including the Health Communication Network (HCN), have been progressively adding extra functionality to their products and most will allow practices to meet the requirements of the eHealth PIP before the commencement of the new year.

KATE MCDONALD Journalist: Pulse+IT

There is no doubt that the new eHealth PIP (ePIP) requirements mean practices will have to start looking carefully at their current practice software capabilities and determine whether they will be able to fulfil the requirements of the ePIP. NEHTA’s ePIP registry is an easy way to check whether your practice software will qualify, but it is recommended that you consult with both your software supplier and IT professional to ensure everything will be in place before the deadlines. While some vendors have already added some functionality, they may not yet be listed on the register. This article provides an update on where the market‑leading vendors are up to, and when they expect to complete their software enhancements.

Vendor panel members All of the members of NEHTA’s vendor panel are close to full PCEHR compliance and will begin software rollouts soon. Best Practice Best Practice has been involved in the GP desktop software vendors panel from the outset, and has also been involved in a number of the Wave 2 sites for the implementation of the PCEHR. It assisted Health Industry Exchange (HIE) by providing it with access to its

underlying database structure, allowing HIE’s plug-in product Companion Gateway to upload the first document to the PCEHR in early September. The company released its HI Service functionality in version in May, and has had long‑standing arrangements with both eRx and MediSecure for electronic transfer of prescriptions and with Argus for secure messaging. Best Practice version 1.8 is registered on the ePIP register for the HI Service and ETP. It uses a bespoke clinical coding system dubbed PYEFINCH, which Best Practice CEO Frank Pyefinch said is 85 per cent mapped to SNOMED CT. The company is close to beginning the roll out of its PCEHR‑compliant software and will be ready before the end of the year. Communicare Communicare eHealth Solutions predominantly works in the community healthcare sector with particular expertise in Aboriginal healthcare. It has been listed on the ePIP register for its interface with the HI Service and has passed all four of the NEHTA CDA conformance tests, which means it will be able to author, render and package CDA documents and create shared health summaries.

Communicare uses ICPC2-PLUS as its clinical coding system and Argus for secure message delivery. According to operations manager Heidi Tudehope, Communicare is hopeful it will fulfil all of the ePIP requirements with its next version, which is due out in December. “We are on track to have everything going by December,” Ms Tudehope said. “With the ETP specifications, we have got them and are working on them at the moment. Regarding the PCEHR, that is under development at the moment and our B2B interface will be available in version 12.5. That is due out in December.”

to complete the formal testing for this,” Genie’s managing director, Paul Carr, said. “We plan to complete this in November.” The next version of Genie will add eRX integration for ETP. MediSecure integration has been available for several years already, and Genie has had the ability to include coding in either ICPC-2 PLUS or ICD10-AM for many years. “SMD capability is almost finished,” Dr Carr said. “This will be the final step in making Genie fully compliant with the eHealth program.”

Genie Genie Solutions released version 8.3.4 on October 28, complete with full HI service integration and PCEHR compatibility. It has the ability to upload shared health summaries and event summaries to the PCEHR, and to also download the same from a patient’s PCEHR.

Medtech32 Medtech Global will have full functionality for the PCEHR in version 9.0.0 of its Medtech32 software, which is due to be released this month. The company achieved integration with the HI Service some time ago and the current version of Medtech32 is able to look up and store patient IHIs.

“Genie can already produce specialist and referral letters in CDA format but is yet

Medtech has demonstrated it can download a CDA document and has

achieved its CCA certificate for shared health summaries. The technology is available for uploading documents but Medtech is still waiting for its certificate. It is ETP-compliant, and users can also choose whether to use eRX or MediSecure as the system can integrate both. Medtech Global’s CTO, Rama Kumble, said the company had shown the actual workflow of its PCEHR interface to a group in Brisbane recently. “They were pleased to see us showing how this all works in the practice situation, the workflow part of it,” Mr Kumble said. practiX iSOFT, which was taken over by CSC Healthcare last year, was the first member of the software vendors panel to integrate the HI Service into its practiX software, achieving the milestone in July last year. The company has been working closely with some of its sites to test how the integration works in real terms, and has found that those sites using the HI Service are very pleased with it, according to CSC’s





out of hospitals solution manager and leader of its PCEHR project team, Perry Pappas. “[We] visited one of our champion practices recently and their comment was they generally [look up the IHI] on admission,” Mr Pappas said. “They’ve got the patient in front of them and they can confirm their details as they are standing there, and their hit rate was in excess of 90 per cent.” CSC also achieved certification in November last year for its secure messaging component, and successfully achieved the first part of its CDA requirements for the PCEHR – unpacking and rendering – in July. It is now awaiting certification of conformance for the largest milestone – packaging a CDA document and uploading it to the PCEHR. Mr Pappas said once it had received the certification, the company would be in deployment mode and would start installing and testing the new features at its pilot sites. He said CSC will apply to be listed on the ePIP registers as the company ticks off the various components. Zedmed Zedmed is the first software package to be fully compliant with the PCEHR requirements and is now in general release. It received notification that it had passed its CCA certificate to both view the PCEHR and to upload shared health summaries in September. In late October one of its users, general practitioner Bernard Shiu, successfully uploaded a document to a PCEHR. Zedmed business analyst Jane Blakeley said the company would have full capability for users to meet the ePIP requirements well in advance of the February deadline. She said Zedmed has had HI Service interface capability in its software since last year.

The software also currently supports the ETP requirement, with the ability to use either the eRx or the MediSecure prescription exchanges. It will also have full SMD standard capability shortly. “We are working with both Argus and HealthLink on SMD capability and my understanding is that they and Global Health are working together on a project to work interoperably,” Ms Blakeley said. “Although none of that is in place at the moment, we do have agreements where we will be capable in time. It’s not complete but it’s all in place.”

Broader market progress In addition to the software vendor panel, other clinical software companies have been working to integrate PCEHR functionality into their products. Medical Director Australia’s market-leading supplier of clinical software will have full interface capability with the PCEHR in advance of the deadline to qualify for the ePIP, according to Health Communication Network (HCN). Medical Director is on the secure messaging, ETP and HI Service registers, and will have full PCEHR connectivity in place for users well before the May 2013 deadline, HCN CEO John Frost said. “The eHealth PIP incentives that were recently announced will most certainly give the industry a push in the right direction,” he said. “Clinicians are smart and have figured out that technology can enable huge efficiency gains for their businesses.” For SMD, users can use the MDExchange component in Medical Director or sign up with secure messaging vendors such as HealthLink and Argus. The software integrated with eRx some time ago. Health Identifier and CDA capability for specialist letters was released in Medical Director in January this year, and Mr Frost said

this will facilitate standards-based secure communication between clinicians and the ability to connect to the PCEHR, the release of which is imminent. Stat Stat Health is also beginning work on its functionality, and is already listed on the ePIP register for ETP. It has integrated with eRx for electronic transfer of prescriptions and was the first product to be listed on the register when it launched. Stat Health CEO Carla Doolan said the company was now working on integrating the HI Service, which is expected to be completed this month. “SMD will follow IHI development and then the integration of the PCEHR,” she said. Shexie Specialist clinical software vendor Shexie is also working on adding PCEHR compatibility. It has recently undergone a major overhaul to run on a SQL database, and has taken the opportunity to add a few more enhancements to its product. While it is mainly used by specialists and surgeons, Shexie has some day surgery and GP clients as well. Shexie director Dean Jones said his company has been working closely with NEHTA to add PCEHR and other eHealth capability. He said his team was aiming to have the new version, called Shexie Platinum, up and running at the end of the year, but as it will contain a number of new functions, a full rollout might take until early next year. Shexie will add SMD capability as well as HI Service search and validation. Mr Jones said users will be able to access and upload documents to the PCEHR, which in the case of specialists will predominantly involve uploading event summaries and specialist letters. HTR While it does not have a large customer base as yet, web-based EHR vendor

HTR believes it was the first company to have demonstrated connectivity to the PCEHR, presenting at a health consumers’ conference in WA with NEHTA in late June. Its Telhealth solution has been available since 2011, when it passed its compliance certification for the SMD standard. Telhealth also has full PCEHR functionality, including the ability to create, upload and download shared health summaries, event summaries and discharge summaries. The company has completed NOC testing and is currently going through CCA testing for the various PCEHR components, project manager Adrienn Volcz said.

Acute care and aged care The acute and aged care sectors are also gearing up for the PCEHR, adding functionality to allow authorised users to play their part in the PCEHR system. In acute care, Emerging Systems and CSC have been heavily involved in developments. Emerging Systems’ EHS system is used at St Vincent’s Hospital in Sydney, which is part of the Eastern Sydney Connect Wave 2 site. Earlier this month, St Vincent’s was able to allow hospital clinicians to view the shared health summary that a patient’s GP had uploaded. The system was also able to send an electronic discharge summary to the patient’s PCEHR.

CSC has also demonstrated its functionality, having incorporated the HI Service into its i.PM patient administration system, which is used in over 300 hospitals in Australia and New Zealand. As CSC owns both the practiX and i.PM brands, it has been able to demonstrate that it is capable of sending eReferrals from practiX straight to i.PM using secure messaging and the HI Service. In aged care, work has already begun on PCEHR compatibility and an aged care vendors panel has been established, consisting of Autumncare, DCA, iCare, Leecare Solutions and ComCare. Both Leecare Solutions and iCare have already integrated HI Service functionality into their software.





Off Topic


ELECTRONIC COMMUNICATION Electronic distribution of specialist letters to GPs from Southern Health Outpatients clinics has grown from zero to around 30 per cent over the past 12 months under a pilot project that has now become practice. South Eastern Melbourne Medicare Local is inviting GPs within its catchment to join in.

PAUL MACDONALD eHealth Strategy and Stakeholder Engagement Manager South Eastern Melbourne Medicare Local

About the author Paul Macdonald has many years’ worth of experience in change management and information management. His focus is on the alignment of local eHealth initiatives with state and national directions through the adoption of standards and encouraging vendor collaboration.

In August 2011, a pilot project to facilitate the electronic delivery of letters from specialists in Southern Health Outpatients clinics to GPs and other healthcare providers was launched, with partners including Southern Health, OzeScribe, Global Health and South Eastern Melbourne Medicare Local’s (SEMML) founding member, Dandenong Casey General Practice Association (DCGPA).

in receiving Outpatients letters electronically.

The project allows specialists’ letters, transcribed by OzeScribe medical transcription services, to be sent electronically through OzeScribe’s OzePost service. OzePost uses Global Health’s ReferralNet secure messaging system to send encrypted, HL7 messages that can be imported directly into patient records for GPs using any of the leading GP clinical information systems.

Any practice that already has ReferralNet installed does not need to register for OzePost as they will be automatically receiving their Outpatients letters electronically from Southern Health. There is capacity for 100 per cent of computerised practices within South Eastern Melbourne Medicare Local to receive Southern Health Outpatients letters electronically via OzePost and ReferralNet.

The sending of electronic letters to GPs from Southern Health Outpatients via OzePost and ReferralNet commenced in September 2011, and by the end of August 2012, around 30 per cent of all Southern Health Outpatients letters were being sent electronically. Initially, 15 general practices were recruited to the pilot and came on board incrementally over the first few months of the project. The service has subsequently been expanded to all practices interested

Southern Health is the largest public health service in Victoria, providing more than one million episodes of care a year and serving over 20 per cent of Victoria’s population. Since the project began, Southern Health has delivered over 40,000 Outpatients letters.

Technology issues Like any project involving technology, a number of technical issues arose and were resolved during the project’s implementation. The process highlighted the need for all secure messaging and clinical information system software developers to collaborate on the development and implementation of uniform standards for the capturing and transfer of health information.

The future implications of the announcement of the Secure Message eXchange (SMX) agreement between HealthLink, Argus and ReferralNet is likely to see GPs increasing their use of secure messaging products to send information into other services in both the public and private sectors. The Southern Health Outpatients project has also benefited greatly from other concurrent OzeScribe and ReferralNet projects. There was a measured increase in letters sent via OzePost and ReferralNet to practices in the SEMML catchment between February and April 2012, after one of Melbourne’s providers of diagnostic imaging included ReferralNet as one of its electronic results distribution methods.

practice managers and Southern Health administrators, citing benefits to the quality of patient care, improved timeliness of transfer and access to vital information relating to their patients, and efficiency for clinicians (both senders and receivers).

patients, GPs and Southern Health as it reduces patient risk due to timely information being available regarding the patient’s health status and medication updates. There is scope to improve the turnaround of letters even further.

There have also been financial benefits related to stationery and postage costs, and reduced resources required to undertake the manual process of scanning, printing and posting.

Dr Chris Daley, a respiratory physician at Southern Health, said the service had made a huge difference to his ability to communicate with referring doctors regarding their patients.

Dr Jacob Dessauer, a GP from Narre Warren, said: “It is wonderful to get legible letters from Outpatients; this is a useful new service.”

“I now have confidence that I can communicate important, time‑critical information to referring doctors via letter, which has made a huge impact on the ongoing care of my patients.”

The aspect of the project receiving the most praise from clinicians has been the reduction in the number of days to deliver patient letters to GPs. This benefits

The project has received praise from Southern Health specialists, GPs,

An evaluation of the project is underway including a survey of the original pilot practices and Southern Health specialists.

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Clintel Systems P: +61 8 8203 0555 E: W: The Specialist: A complete solution for your Appointments, Billing including Online Claiming and Clinical requirements in an intuitive scalable solution. Clintel provides systems to Specialist and Day Surgeries nationally. Powerful, highly configurable and easy to use, our systems mirror the needs and workflow of your practice and individual specialty. Our industry standard SQL database enables a true “paperless” practice. Our leading edge architecture is future proof, it is designed to meet changing requirements and offers first class reporting and analysis of clinical and business data. Standalone or networked multi-site installation which runs on both Mac OSX and Windows operating systems. Our support is first class, our philosophy is “whatever it takes”.

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

P: +61 2 9900 4800 F: +61 2 9900 4990 E: W: Cerner is one of the leading global suppliers of health care information technology solutions. Cerner’s mission is to contribute to the systematic improvement of health care delivery and the health of communities. Our vision of proactive health care management drives innovation in the development of effective solutions for today’s health care challenges, while creating a foundation for tomorrow’s health populations. Working with more than 4000 clients worldwide, Cerner is solving health care’s many challenges making sure the right people have the right information at the right time. Our innovative leadership is allowing us to push boundaries by: • Leveraging clinical and pharmaceutical data in Condition Management and Personalised Medicine • Connecting the community with personal and community health records

CSC’s HealthCare Group P: +61 2 8035 6700 F: +61 2 8035 6801 E: W: Healthcare is key part of CSC’s global business. It has a strong track record of delivering successful government health programs across Europe and in both the public and private healthcare sectors in the US. Focused on eHealth, CSC’s Healthcare Group provides an end-to-end service combining technology innovation, world-class consulting and system integration services with proven healthcare software. In the Asia Pacific region, CSC provides localized solutions to improve: patient flow, access to clinical information, medication safety and pathology diagnostics. CSC participates in regional government health information exchange initiatives to connect care across care environments and to enable clients to leverage existing e-health investments. For more information, visit the Healthcare Group’s Asia Pacific website at www.

Direct Control P: 1300 557 550 F: +61 7 5478 5520 E: W: Direct CONTROL is an affordable, intuitive and educational Medical Billing and Scheduling application for Practitioners of all Disciplines. Seamless integration with Outlook, MYOB or Quickbooks. Direct CONTROL’s Clinical Module manages Episodes of Care and includes State, Federal and Health Fund Statistical Reporting for Day Surgeries/Hospitals. Direct CONTROL facilitates Medical Billing Australia-wide and overseas. Included is all Medicare, DVA, Work Cover, Private Health Insurance fee schedules with built in rules relevant to each medical discipline (allied health, general practice, surgeons, physicians, anaesthetists, pathologists, radiologists, day surgeries/hospitals). Ideal for the single practitioner or the multidisciplinary Practice.

Digital Medical Systems P: 1300 865 977 F: +61 3 9753 3049 E: W: Easier ICT is a technology partnership with DMS — we make I.T. work for you. DIGITAL MEDICAL SYSTEMS has provided ICT solutions and services to medical practice clients across Australia since 1990. We have specialist expertise and experience in the installation and support of leading medical software applications. DMS is a Business Partner for IBM, Lenovo, HP and Microsoft. Other leading ICT brands include Trend Micro, Symantec, CA, Cisco, Toshiba, Canon, Epson, Kyocera, Fujitsu and Brother. Accreditation is easier with the customised DMS IT Systems Documentation. Ensure your practice has the best quality IT policy, security and maintenance program that meets and exceeds the standards guidelines from the RACGP and AGPAL and GPA. World leading DTech provides 24x7 near Real-Time Monitoring and Management that alerts and enables our engineers to quickly troubleshoot and solve problems of security, network, Internet, Server and software remotely on almost any client computer system or device. Medical IT systems are automatically maintained by DTech to the most highly available status to minimize downtime by preventing problems from occurring or reducing their impact. Proactive, Flexible, Consistent, Reliable, Audited, and Affordable — for even the smallest practice. Call DMS for: • Systems Analysis & Consulting • Solutions Design • Procurement & supply of hardware, software, network and peripheral products • Installation & Configuration • Support Services inc Help Desk • DTech Monitoring, Maintenance & Management • Disaster Recovery solutions • Fully managed & automated Online Backup customised for clinical data Easier IT — we make I.T. work for you.

Direct CONTROL supports ALL your Business needs letting you and your staff get on with earning a living doing what you enjoy most … Patient Care.



Emerging Systems P: +61 2 8853 4700 F: +61 2 9659 9366 E: W:

Doctors Control Panel E: W: • Download and trial DCP software for GP’s and health teams. • DCP is your digital PA and guidelines advisor. • DCP facilitates TCA, GPMP and MHCP creation and tracking. • Contains guidelines licenced from RACGP. • Low annual subscription. • The best preventive care add-on software in Australia. • Compatible with MD3 and BP. • Achieve new heights in preventive care performance. • Significant benefit for patients. • Increase your revenues. • Streamline your workflow. • 3000 current users. • Several research projects based on DCP. • Try it today.

eHealth Security Services P: 1300 399 116 / +61 2 9016 5378 F: +61 2 9016 5379 E: W: eHealth Security Services (eHSS) specialises in the provision of security as a service and offers an extensive range of Managed IT Services including IT Support for small to medium businesses in the health sector. eHSS’ MediAccess® service provides comprehensive and cost-effective managed security and remote access solutions. eHSS has thorough knowledge and understanding of IT matters in the health industry and its regulatory aspects. eHSS has extensive experience reviewing and assisting with organisational policies and procedures and technical implementations against applicable standards.



Emerging Systems EHS web-based Clinical Information System records the clinical care delivered to a patient from pre-admission through to discharge. EHS interfaces with the hospital’s PAS system, capturing and providing all of the information Clinicians require during a patient stay to support the delivery of effective, appropriate, quality care outcomes in a secure and auditable environment. Information is displayed in a user friendly single pageview for easy access by to information by clinicians. Importantly, EHS links Clinical Care with Workforce Rostering and Staff Allocation allowing for predictive Resource Allocation based on the care required, enabling valuable productivity improvements. EHS is a proven and highly useable electronic medical record (EMR) developed within Australia and operating successfully in St Vincents & Mater Health, Sydney and Government of South Australia, Department of Health Hospitals. EHS provides:• Pre-Admission • Patient History • Orders & Results • Clinical Care Guides • Assessments • Progress Notes • Referrals • Labour & Birth • Medications Reconciliation • Clinical and Non Clinical Messaging • Discharge Summaries • Appointments • Rostering & Allocation • GP Connect • Workforce Resource Calculation • Document Management System • Clinical Dashboard and more EHS supports interactions with the health identifier service and PCEHR. The extensive list of modules work seamlessly with other systems via our integrated interface engine which accepts HL7 and other accepted Health IT standard protocols complying with the Australian Technical Specification: ATS 5822:2010 eHealth Secure Message Delivery. Accessibility: EHS is accessible on a range of devices according to user preference including our latest iPad application.

Extensia P: +61 7 3292 0222 F: +61 7 3292 0221 E: W: Extensia links healthcare providers, consumers and their communities for better and more efficient health care. The products used to do this can be custom branded for all Organisations and include: • RecordPoint – a proven Shared Electronic Health Record that links all clinical systems, hospital settings, care plan tools and any other sources of information available. It provides a secure means of sharing critical patient data in a privacy compliant and logical structure. • EPRX – an Electronic Patient Referral Exchange and Directory. It streamlines the process of selecting a provider and completing a referral. Patient information is transferred seamlessly from clinical software. The most relevant providers, services and products are presented instantly and referral documents are generated and sent electronically.

Genie Solutions P: +61 7 3870 4085 F: +61 7 3870 4462 E: W: Genie is a fully integrated appointments, billing and clinical management package for Specialists and GPs. Genie runs on both Windows and Mac OS X, or a combination of both. With over 2500 sites, it is now the number one choice of Australian specialists.

GPA P: 1800 188 088 F: 1800 644 807 E: W: GPA ACCREDITATION plus (GPA) is the only independent accreditation program for general practice in Australia. Established in 1998 and run by a team of committed general practitioners, business leaders and experienced administrators, GPA has developed a program that continuously evolves in order to set new standards in general practice accreditation, while offering full support to practices to make accreditation both achievable and rewarding. GPA is committed to providing an accreditation program, which is flexible and understands the needs of busy GPs and practice support staff. Whilst accreditation gives practices access to the Practice Incentive Program (PIP), GPA believes it should offer benefits that go well beyond the PIP. Our program provides practices with a pathway to enhanced patient care, continuous professional satisfaction, improved practice efficiency and superior risk management. GPA ACCREDITATION plus certificates and signage remind patients that their practice has achieved a level of care and service above and beyond essential general practice standards. GPA provides a system designed to accommodate busy general practices. Among our services, we offer practices the opportunity to use technologicallyadvanced, environmentally-friendly online programs, allowing staff to upload documentation at their own pace; individually assigned client managers, supporting practices through accreditation from start to success and beyond; highly-trained and sensitive surveyors, with extensive experience in all facets of general practice; and interactive training seminars, bringing practices the latest information in standards and innovation. At GPA, we believe that accreditation should be an accomplishment, not a test, and we uphold that belief in our approach and service. For an accreditation program that will offer you assistance, support, information and satisfaction…the choice is yours.

Houston Medical Healthbank Consult P: 1300 856 722 F: 08 8301 4001 E: W: Healthbank Consult is a telehealth system developed in Australia for Australian healthcare providers. Secure, fully encrypted and HD capable, Healthbank Consult is designed to be compatible with your clinical desktop for easy integration with your practice’s workflow and retains an audit trail for Medicare. Compliant with RACGP telehealth guidelines, Healthbank Consult will qualify Rural GPs, Specialists, Aged Care Facilities and Aboriginal Medical Services for a $4,800 Medicare telehealth rebate plus ongoing fees.

P: 1800 420 066 (AU) P: 0800 401 111 (NZ) E: W:

Health Informatics New Zealand E: W: Health Informatics New Zealand (HINZ) is a national, not-for-profit organisation whose focus is to facilitate improvements in business processes and patient care in the health sector through the application of appropriate information technologies. The Executive Committee works to maintain the purpose and service for the members, through dynamic goals of improved healthcare outcomes through the dissemination and utilisation of information, knowledge and technology. HINZ acts as a single portal for the collection and dissemination of information and about the New Zealand Health Informatics Industry. Membership is for anyone who has an interest in health informatics.

Health Information Management Association Australia P: +61 2 9887 5001 F: +61 2 9887 5895 E: W: The Health Information Management Association of Australia (HIMAA) is the peak professional body of Health Information Managers in Australia. HIMAA aims to support and promote the profession of health information management. HIMAA is also a Registered Training Organisation conducting, by distance education, “industry standard” training courses in Medical Terminology and ICD-10-AM, ACHI and ACS clinical coding.

Health Communication Network P: +61 2 9906 6633 F: +61 2 9906 8910 E: W: Health Communication Network (HCN) is the leading provider of clinical and practice management software for Australian GPs and Specialists and supplies Australia’s major hospitals with online Knowledge resources. HCN focuses on improving patient outcomes by providing evidence based software tools to health care professionals at the point of care. Market snapshot: • 17,000 medical professionals use Medical Director • 3,600 GP Practices use PracSoft • 800 Specialist Practices use Blue Chip and • 2,100 Specialists use Medical Director • Leading suppliers of Knowledge Resources to Australia’s major hospitals


P: +61 3 9326 3311 F: +61 3 8610 0006 E: W:

P: 1800 125 036 (AU) P: 0800 288 887 (NZ) E: W:

HISA is Australia’s health informatics organisation. We have been supporting and representing Australia’s health informatics and eHealth community for almost 20 years. HISA aims to improve healthcare through the use of technology and information. We:

Australia and New Zealand’s most effective secure communications service. Transforming healthcare by connecting healthcare providers. • Provider of compliant Secure Messaging Delivery (SMD) services • Standards compliance delivering certainty in care • Fully integrated with leading GP and Specialist clinical systems • Referrals, Reports, Forms, Discharge Summaries, Specialist Diagnostic Orders and Reporting • Affords all healthcare providers efficiencies in reducing paper based handling • Robust; Reliable and Fully Supported • New online services including Care Insight - distributed search for clinical information • Expert partnerships with Healthcare organisations, State and National Health Services Join HealthLink and be connected with more than 85 % of Australian GPs and 99% of NZ GPs who are already part of the HealthLink community.

HISA members are part of a national network of people and organisations building a healthcare future enabled by eHealth. Join the growing community who are committed to, and passionate about, health reform enabled by eHealth.

Our multidiscipline software provides interfaces to every major manufacturer, enabling many clinics to save space by becoming completely paperless! We are a progressive medical software company and take pride in working with our health care clients to deliver tailored EMR and PMS packages based on each unique situation and practice requirements. We’re focused on helping to make their businesses more efficient and productive as well as delivering measurable improvements in customer satisfaction and market share. You can arrange a free demonstration of our software by visiting:


Health Informatics Society of Australia

• Provide a national focus for eHealth, health informatics, its practitioners, industry and a broad range of stakeholders • Support, promote and advocate • Provide opportunities for networking, learning and professional development • Are effective champions for the value of health informatics

“We provide time to health professionals through efficient practice management software”

P: +61 2 9380 7111 F: +61 2 9380 7121 E: W: InterSystems Corporation is a global leader in software for connected care, with headquarters in Cambridge, Massachusetts and offices in 25 countries. InterSystems TrakCare™ is an Internet‑based unified healthcare information system that rapidly delivers the benefits of an Electronic Patient Record. InterSystems HealthShare™ is a strategic healthcare informatics platform for information exchange and analytics within a hospital network, and across a community, region or nation. InterSystems CACHÉ® is the world’s most widely used database system in clinical applications. InterSystems Ensemble® is a platform for rapid integration and the development of connectable applications.



Medtech Global Ltd ISN Solutions P: +61 2 9280 2660 F: +61 2 9280 2665 E: W: ISN Solutions is a Medical IT company that specialises in the design, setup and maintenance of computer networks for medical practices and private hospitals. We manage IT services, we are dedicated to the medical industry. We know that if you are consulting then you need a quick response. Our support model is designed to minimise the interruptions to the doctor specially. We are familiar with most medical software applications in Australia. We have strong industry references. Some of our solutions include, but are not limited to: • Cloud based computing tailored to medical industry • Medical voice recognition • Capped cost medical support and maintenance plan • Ability to consult remotely • Medical application support

Mouse Soft Australia Pty Ltd

For over 28 years, Medtech Global has been a leading provider of health management solutions to the healthcare industry enabling the comprehensive management of patient information throughout all aspects of the healthcare environment.


P: +61 3 9888 2555 F: +61 3 9888 1752 E: W:

Medtech’s Medtech32 and Evolution solutions improve practice management and ensure best practice for electronic health records management and reporting.

P: 1300 700 300 E: W:

Medical Wizard saves time and money through greater efficiency and comprehensive integration.

Managed IT Services for the Health Industry

Throughout its 19 year history, Medical Wizard has led the way with innovative solutions. We are constantly evolving Medical Wizard to meet the challenges of the medical profession for today and tomorrow.

Clinical Audit Tool integrates with Medtech32 and Evolution providing fast, efficient and secure analysis of patient data enabling practices to identify and deliver services, which address health care priorities across their population. Medtech’s ManageMyHealth patient and clinical portal enables individuals to access their health information online and engage with their healthcare provider to support healthy lifestyle changes.

MIMS Australia

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

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

A Worldwide Leader in Health Care Information Systems

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.


MITS:Health provides a full range of IT services specifically tailored for medical centres, GPs and specialists across Melbourne. • • • • • •

Equipment supply and installation Remote monitoring and support Data backups Networking Internet Website Development

A software of choice for discerning Specialist practices, notably Gastroenterologists, Cosmetic Surgeons, Ophthalmologists, General Surgeons, IVF Centres and Day Hospitals amongst others. All aspects of practice management from appointments, billing, clinical, theatre management and compliance reporting are covered and backed by a dedicated local support team. Feature Rich. Dynamic. Innovative.

MEDITECH Australia

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


P: 1800 148 165 E: W:

MIMS is delivered all the ways you need – print to electronic, on the move, to your patient’s bedside or your consulting room desk. Whatever the format, MIMS has the latest information you need.

Medical Software Industry Association P: +61 427 844 645 E: E: W: With the increase in government e-health initiatives, the MSIA has become increasingly active in representing the interests of all healthcare software providers. The MSIA is represented on a range of forums, working groups and committees on behalf of its members, and has negotiated a range of important changes with government and other stakeholders to benefit industry and their customers. It has built a considerable profile with Government and is now acknowledged as the official ‘voice’ for the industry. Join over 100 other companies across all areas of medical IT/IM so your voice can be heard.

NEHTA P: +61 2 8298 2600 F: +61 2 8298 2666 E: W: The National E-Health Transition Authority was established by the Australian, State and Territory governments to develop better ways of electronically collecting and securely exchanging health information. NEHTA is the lead organisation supporting the national vision for eHealth in Australia.

New Zealand Health IT Cluster P: +64 4 815 8177 E: W: The New Zealand Health IT Cluster is a vibrant alliance of organisations interested in health IT, comprising software and solution developers, consultants, health policy makers, health funders, infrastructure companies, healthcare providers, and academic institutions – who have agreed to work collaboratively. • New Zealand industry is consistently well regarded in providing quality, relevant solutions domestically and in offshore markets. • New Zealand has an internationally regarded model of partnership that fosters development of innovative solutions to healthcare challenges. • In key and emerging markets the New Zealand health IT brand is strongly recognised. By 2015 sales growth is doubled from the 2010 baseline.


Shexie Medical System

P: 1300 727 423 F: 1300 300 174 E: W:

P: 1300 743 943 F: 1300 792 943 E: W:

OzeScribe is the dictation and transcription solution for most Australian university teaching hospitals and major private clinics. It really does make sound business sense to let OzeScribe worry about managing dictation, transcription and technology. We provide free electronic document delivery – OzePost – to your EMR and your associates’ EMR, saving you thousands of dollars in time, packing and postage. OzeScribe is the provider of the most advanced solutions available. • Run by doctors – for doctors. • Australian trained typists. • Manage dictation and transcription via computers, iPhone, iPad, android or smartphones. • Integrated M*Modal speech recognition technology on demand.

Medilink from Practice Services P: +61 3 9819 0700 F: +61 3 9819 0705 E: W: Medilink Practice Management Software • 21 years young, large user base • Medilink = Intuitive ease of use • Solo Drs up to Hospitals in size • Claiming via integrated EFTPOS ◊ and/or integrated HICAPS ◊ and/or Medicare Online ◊ and/or ECLIPSE • Many standard features • Many optional modules • Links to many third party packages and services • Cut debtors and boost cash flow • 17 years as an Authorised Medilink Dealer, selling, installing & training • Fixed Cost Support, Onsite or Remote

Shexie is an Australian owned business which has been developing software for medical practices for over 15 years. Our industry and technical knowledge allows us to provide the ultimate ‘easy to use’, ‘fully functioned’ and ‘robust’ product on the market. Shexie Medical System clinical and practice management software is ideal for surgical or specialist practices of any size. Many fully integrated features including Paperless Office, SMS, full Paperless Electronic Claiming including Eclipse, MIMS Integrated, statistical analysis, security, synchronize appointments with Outlook/PDAs, transcription interface, diagnostic equipment interface, automated MBS/Fund rates updates. Soon to be released Shexie Platinum version also contains eHealth - Health Identifiers, PCEHR and Secure Messaging.

Pen Computer Systems Orion Health P: +61 2 8096 0000 / +64 9 638 0600 E: W: Orion Health is New Zealand’s largest privately owned software exporter and a global leader in eHealth technology. Founded in 1993, by CEO Ian McCrae, Orion Health has grown from a specialist health integration vendor into a company that sells a comprehensive suite of eHealth solutions. Orion Health has extensive experience in the design and installation of complex systems within demanding healthcare environments. Orion Health designers and engineers work right alongside in-house clinicians in order to develop elegant and intuitive products that encourage swift adoption with minimal disruption, allowing your clinicians to focus on patients. Today, our products and solutions are currently implemented in more than 30 countries, used by hundreds of thousands of clinicians, and help facilitate the care for tens of millions of patients.

P: +61 2 9506 3200 F: +61 2 9566 1186 E: W: Established in 1993, Pen Computer Systems (PCS) specialises in developing information solutions for National and State eHealth initiatives in Primary Health that deliver better Chronic Disease outcomes. PCS expertise extends to: • Chronic Disease Prevention and Management • Population Health Status, Reporting and Enhanced Outcomes • Decision-Support tools delivered LIVE into the clinical consult • Web-based Electronic Health Records (EHRs) • SNOMED-CT and HL7 Standards Frameworks Our Clinical Audit Tool (CAT) for example delivers an intuitive population reporting and patient identification extension to the leading GP systems in Australia. CAT delivers enhanced data quality and patient outcomes in general practice.

Precision IT P: 1300 964 404 F: +61 2 8078 0257 E: W: • Cloud Computing Specialists. • Onsite Medical IT Support. • VoIP Telephone Systems and Internet Connectivity. • IT Equipment Procurement. • Experience with all clinical & practice management software packages. • Sydney, Brisbane, Gold Coast and Melbourne. Precision IT is a highly competent and impeccably professional IT support firm with a primary focus on working with GPs and Specialists. Working with our clients, we develop reliable, robust and feature rich IT systems to meet the demands of the modern medical practice today and into the future. Our Precision Cloud service is fast becoming the choice for new and established practices and covers all of the standard guidelines from the RACGP and AGPAL and GPA.

Stat Health Systems (Aust) P: +61 7 3121 6550 F: +61 7 3398 5064 E: W: Stat Health Systems (Aust) has built a progressive and resilient system that introduces a new level of stability and flexibility to the medical software market. Stat is an integrated clinical and practice management application which has embraced the latest Microsoft technology to build a new generation solution. Fully scalable and the only medical software application to incorporate a multi-functional intuitive interface, Stat is at the forefront of computing technology. Stat Health provide a premium support service, clinical data conversion from existing software and tailor made installation and training plans for your practice. Facebook: Twitter: @NotifyStat

Talk with us today about the future of your practice!



Sysmex New Zealand P: +64 9 630 3554 F: +64 9 630 8135 E: W: Sysmex New Zealand is a market leader in the development and implementation of health IT products and services for clinical laboratories, hospitals and healthcare organisations. We offer the following health IT solutions: • Delphic LIS – a market-leading laboratory information system for hospital and community laboratories with a strength in providing multi-lab solutions. Specialised modules manage workflows in the anatomical pathology, haematology and microbiology work areas. • Eclair – an advanced clinical data repository (CDR) which stores patient data from a range of systems including laboratory, radiology, pharmacy and clinical document sources to create a secure patient-centric record. Eclair provides complete electronic ordering functionality.

Totalcare P: +61 7 3252 2425 F: +61 7 3252 2410 E: W: Totalcare is a fully integrated Clinical, Office and Management software suite designed to suit the particular needs and processes of healthcare providers. Used since 1995 by health care facilities across Australia including General and Specialist practice, Radiology, Day Surgery and Hospitals, Totalcare is stable, scalable, customisable and easy to learn and use. From a small practice to a multisite, multi-disciplinary corporate entity or hospital, Totalcare can provide solutions for your needs. • • • • • • • •

Admissions / Appointments Billing Statutory Reporting Integrated SMS Prescriptions Orders & Reports Clinical Notes Letter/Report Writing, Document and Image Management • Scanning and Barcode recognition • Video and Image Capture • HL7 Interfaces





Therapeutic Guidelines Ltd

Trend Care Systems

P: 1800 061 260 E: W:

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

Therapeutic Guidelines Limited is an independent not-for-profit organisation dedicated to deriving guidelines for therapy from the latest world literature, interpreted and distilled by Australia’s most eminent and respected experts. These experts, with many years of clinical experience, work with skilled medical editors to sift and sort through research data, systematic reviews, local protocols and other sources of information, to ensure that the clear and practical recommendations developed are based on the best available evidence. eTG complete Incorporates all topics from the Therapeutic Guidelines series in a searchable electronic product, and is the ultimate resource for the essence of current available evidence. It provides access to over 3000 clinical topics, relevant PBS, pregnancy and breastfeeding information, key references, and other independent information such as Australian Prescriber (including Medicines Safety Update), NPS Radar, NPS News and Cochrane Reviews. eTG complete is available in a range of convenient formats – online access, online download, CD, and intranet access for hospitals. Multi-user licences, ideal for a practice or clinic, are also available. It is widely used by practitioners and pharmacists in community and hospital settings in all Australian states and territories. Updated three times per year, eTG complete meets the criteria for ‘key electronic clinical resources’ in the Practice Incentives Program (PIP) eHealth Incentive. The November 2012 release of eTG complete includes revised Analgesic and Cardiovascular topics. miniTG The mobile version of eTG complete is miniTG, offering the convenience of having vital information at the point of care and designed for health professionals who practise and consult on the move. It is supported on a wide range of mobile devices, including Apple®, Pocket PC®, and selected Blackberry® devices.

Vensa Health P: +64 9 522 9522 F: +64 9 522 9523 E: W:

A national and international award winning solution recognised for its ability to provide real benefits in the acute and sub-acute health care settings. TrendCare is an international leader for e-health solutions excelling in all of the following: • Patient dependency and nursing intensity measures. • Projecting patient throughput and workforce requirements. • Rostering and work allocation. • Efficiency, productivity and HRM reporting. • Discharge analysis, bed management and clinical handovers. • Allied health registers with extensive reporting. • Clinical pathways with variance reporting. • Patient assessments and risk analysis. • Diet ordering and reporting. • Staff health tracking and reporting.


VConsult P: 1300 82 66 78 F: 1300 66 10 66 E: W: VConsult offers outsourced practice management solutions for medical and allied health practitioners allowing the focus to be on your professional practice and patient care. VConsult provides a seamless “behind the scenes” service by professionally managing your telephone calls, reception, invoicing and medical transcription requirements. VConsult is perfect for your practice if you are: • Setting up, already established or winding down in Private Practice • Working in a public appointment and want to portray a professional image • Looking to minimise your overhead costs • Requiring your patient calls to be answered by a professional and experienced medical receptionist.

Vensa Health is the leading mHealth solutions provider focusing on delivering mobile health innovations worldwide. If you have received an SMSfrom your doctor, hospital or physio it is almost certain Vensa Health was responsible for its delivery. At Vensa we are focused on offering solutions and innovations, which add value to our clients, this is the fundamental philosophy underpinning all of our services and technology offerings. With nearly 80% adoption of mobile health in New Zealand and a solid customer base, Vensa Health is focusing on Australasia and Middle East regions in its expansion with a BHAG of closing the gap for 10% of earth’s population health.

Zedmed P: 1300 933 000 F: +61 3 9284 3399 E: W: Owned by Doctors who understand the challenges facing the medical profession everyday and backed by nearly 30 years of experience in medical software programming, Zedmed provides innovative, full featured and sophisticated practice management and clinical records software solutions. Zedmed would also like to introduce to you Medical Record Exchange – a free, simple solution allowing Doctors to send patient’s medical information to insurance companies electronically. Using the latest in data extraction technology and fully encrypted, this is a secure, time-saving solution to one of the most dreaded requests Doctors receive on an almost daily basis. For more information about Medical Record Exchange, please contact us: Phone: 1300 933 833

Today a number of organisations are selling electronic messaging solutions into the health sector. Unfortunately, in their haste, several are taking shortcuts resulting in significant risks for practices and patient care. Typical shortcuts being taken include; • Not using the correct message acknowledgement process as set out in the Australian messaging standards (and thus being unable to ensure that a message is actually received by the intended recipient). • Turning all forms of referrals and specialist letters into observation (lab report) messages and filing them away in the results section, effectively losing them in wrong section of the patient record. • Neglecting to put in place end-to-end support arrangements with the medical software at either end of the messaging system. There is a safe and sensible solution that deals with these issues correctly. HealthLink is the electronic messaging system synonymous with quality and careful risk management. Don’t take risks with patient information; there is absolutely no need to!

Tel 1800 125 036 Integration

Standards Scalability

Pulse+IT Magazine - November 2012  

Pulse+IT Magazine - November 2012 - Australasia's first and only eHealth and Health IT magazine

Pulse+IT Magazine - November 2012  

Pulse+IT Magazine - November 2012 - Australasia's first and only eHealth and Health IT magazine