PULSE IT Ã
AUSTRALIA’S FIRST AND ONLY HEALTH IT MAGAZINE
ISSUE 5: AUGUST 2007
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PULSE IT +
Publisher Pulse Magazine PO Box 7194 Yarralumla ACT 2600 ABN 19 923 710 562 www.pulsemagazine.com.au Editor Simon James 0402 149 859 email@example.com Art Director Alex Sumpter Editorial Enquiries firstname.lastname@example.org Advertising Enquiries email@example.com
COVER STORY: STREAMLINED AUTHORITY PAGE 22
PAGE 6 STARTUP Editor Simon James introduces the fifth edition of Pulse+IT.
About Pulse+IT Pulse+IT is produced by Pulse Magazine, the most innovative publisher in health. Over 15,000 copies of Pulse+IT are distributed quarterly to GPs, specialists, practice staff and the IT professionals that support them. Contributors Dr Rosanna Capolingua, Mark Garside, Simon James, Dr Ian Reinecke and Klaus Veil. Non-Commercial Supporting Organisations • HL7 Australia • National E-Health Transition Authority (NEHTA) Disclaimer The views contained herein are not necessarily the views of Pulse Magazine or its staff. The content of any advertising or promotional material contained herein is not endorsed by the publisher. While every care has been taken in the preparation of this magazine, the publishers cannot be held responsible for the accuracy of the information herein, or any consequences arising from it. Pulse Magazine has no affiliation with any organisation, including but not limited to Health Services Australia, Sony or the Kimberley Aboriginal Medical Services Council that all publish printed articles under the title “Pulse”. Further, we have no affiliation with CMP (owner of “Medical Observer”), who are endeavouring to trademark “Pulse”. Copyright 2007 Pulse Magazine No part of this publication may be reproduced, stored electronically or transmitted in any form by any means without the prior written permission of the Publisher. Subscription Rates Please visit our website for more information about our subscription packages.
PAGE 7 GUEST COLUMN Dr Rosanna Capolingua presents the AMA’s new thinking on Medicare Easyclaim.
PAGE 27 SECURE MESSAGING WITH ARGUS Simon James demonstrates a working secure electronic messaging solution.
INTERNET BACKUP PAGE 20
INTEGRATED EFTPOS PAGE 38
PRACTICE WEBSITES PAGE 40
SHUTDOWN PAGE 46
REGULARS PAGE 6 STARTUP Editor Simon James introduces the fifth edition of Pulse+IT.
PAGE 14 NEHTA Dr Ian Reinecke outlines NEHTA’s work on unique identifiers.
PAGE 18 INTERVIEW Pulse+IT talks with Trevor O’Bryan, Intrahealth’s Sales Manager.
PAGE 7 GUEST COLUMN Dr Rosanna Capolingua presents the AMA’s new thinking on Medicare Easyclaim.
PAGE 15 PULSE+IT SUBSCRIBER OFFER There’s been no better time to subscribe to Pulse+IT, find out why.
PAGE 44 MARKET PLACE Australia’s most innovative and influential eHealth organisations.
PAGE 16 HL7 AUSTRALIA Klaus Veil commences a four part series on HL7 with an introduction to this important standards family.
PAGE 46 SHUTDOWN Mark Garside takes a look at Apple’s much hyped but wildly successful iPhone.
PAGE 27 SECURE ELECTRONIC MESSAGING WITH ARGUS Simon James demonstrates a working secure electronic messaging solution.
PAGE 38 INTEGRATED EFTPOS Simon James discusses, Integrated EFTPOS, a potential by-product of the Medicare Easyclaim system.
PAGE 8 BITS & BYTES News about organisations operating in the eHealth sector.
FEATURES PAGE 20 INTERNET BACKUP Simon James takes a look at Mozy, an accomplished Internet backup solution for Mac and Windows. PAGE 22 STREAMLINED AUTHORITY Simon James reviews the recently introduced Streamlined Authority system.
PAGE 36 EASYCLAIM UPDATE Simon James checks in with the financial institutions set to deliver Medicare Easyclaim.
PAGE 40 PRACTICE WEBSITES Simon James outlines the process of setting up a practice website using Joomla.
PULSE IT: 2007.3
Welcome to the fifth edition of Pulse+IT, Australia’s first and only health IT magazine. Welcome to the fifth edition of Pulse+IT, Australia’s first and only health IT magazine. This edition marks the end of Pulse+IT’s first year on the Health IT scene, and the beginning of what promises to be another busy and rewarding year. As always, special thanks must go to our advertisers and writers for their continued support. I’d also like to extend my thanks to our rapidly growing group of subscribers, and to the hundreds of readers who have provided feedback and encouragement throughout the course of the year. As always, I sincerely welcome any input that will help us to continue to enhance the quality and scope of our publication for the editions that lie ahead.
THIS EDITION I’d like to extend a warm welcome to first time contributors Klaus Veil, Mark Garside and Dr Rosanna Capolingua, the recently appointed President of the AMA. Dr Capolingua’s guest editorial overviews the AMA’s revised policy direction on the controversial Medicare Easyclaim system, a stance that is certain to have ramifications on how Easyclaim is delivered by Medicare Australia and adopted by practices. In his capacity as Chair of HL7 Australia, Mr Veil has commenced a four part
This edition’s Bits & Bytes section is perhaps our most varied to date, with reports on new practice software developer Stat Health, the Medinfo Interoperability Demonstration, the Optus and Elders backed “OPEL” network, IBA’s troubled iSoft bid, Global Health’s secure messaging initiative in Tasmania, and the recent Standards Australia IT-014 Roadshow. Dr Ian Reinecke outlines the importance of NEHTA’s work on unique identifiers for healthcare providers and patients. Pulse+IT checks in with Trevor O’Bryan from Intrahealth, the developer of Profile and Profile Specialist. I report on Mozy, an Internet backup solution that you may find to be a useful tool for your practice or home office. Having been “in the wild” for over a month, the Streamlined Authority system is reviewed, and a secure messaging scenario featuring Argus, Best Practice and Zedmed is presented. With a handful of practices now using the Medicare Easyclaim system, I check in to see how the three financial institutions that plan to deliver the service are fairing. In a separate article, but on a very much related front, the
concept of Integrated EFTPOS is also presented. The options available to practices looking to establish a website are outlined, with a particular focus on the “do-it-yourself” Joomla website management system. Mark Garside concludes this edition, taking an almost obligatory look at the Apple iPhone, perhaps the most hyped technological product to hit the market since Microsoft Windows 95.
LOOKING AHEAD Starting with our forthcoming November edition, the future editorial framework of Pulse+IT will be developed under the guidance of our recently appointed advisory board. Comprising doctors, practice managers and IT professionals, the board will assist us to continue to develop the quality and scope of Pulse+IT into its second year and beyond. Our more technically inclined readers can look forward to contributions from Standards Australia IT-014 and Australian Health Messaging Laboratory (AHML), as well as the next installment of our perpetual series on secure messaging. For the rest of us, a printer, scanner and gadget guide will be presented, just in time for the Christmas buying season. Simon James, Editor firstname.lastname@example.org
Every Pulse+IT subscriber receives a
series on Health Level 7 (HL7), a vitally important health informatics standard that underpins an ever-growing part of health technology in Australia.
FREE iPOD See pp15 for more details.
EASYCLAIM SYSTEM NOT EASY FOR PRACTICES Dr Rosanna Capolingua MBBS The AMA has been reported as saying there would be no losers with the Government’s latest online claims system, Medicare Easyclaim.
Despite all the question marks, the Federal Government is planning to go ahead with a multi-million dollar advertising blitz to launch Easyclaim in the next few months.
This thinking has been revised. Please allow me to inform you of the AMA’s new thinking on Easyclaim. In short, it is not an easy deal for doctors and patients. The fact of the matter is that Easyclaim is not all that easy for medical practices. For a start, it won’t be available from all banks. Currently, two banks have a product that does not integrate with practice software, and Tyro has an integrated system with some practice software providers. Our receptionists will need to spend more time processing each patient. Even if it takes only one extra minute per patient, this could be an extra three hours work per day in a busy four-doctor practice. There will be additional keying-in, and processing failures almost certainly, and the system will take a long, long time to reach maximum efficiency. There are 20 per cent claim rejection rates at the moment. Patients will have an expectation that they will be able to receive their Medicare rebate from the doctor’s surgery at the point of service. We will be expected to deliver for the Government and Medicare. While the objectives of Easyclaim are worthy and perhaps advantageous for the patient, the bottom line is that it will save the Government huge dollars. The ability to save in the scaling back of Medicare offices and processing of claims is substantial. The costs, however, to doctors and their practices are real, and we will become the agents of Medicare and assume its burden.
Meanwhile, the AMA is in deep discussion with Human Services Minister, Senator Chris Ellison, over our many concerns. Our argument is potent, and hopefully persuasive. Easyclaim is all about shifting a mountain of work from Medicare offices to doctors’ surgeries. Doctors providing care to patients via a Medicare rebatable service will be asked to be Medicare agents in their practices. If we privately bill, the patient will pay the account by cash, credit card or cheque. This is processed as per usual. The patient will then be able to ask for their rebate on the spot. They will produce their Medicare card, which will be swiped and appropriate keying of provider, item number, and other information will occur, and the patient’s eligibility status/concession status confirmed. The patient then produces a savings or cheque debit account card, and we will swipe again for the rebate to be paid directly into that account for the patient. In some situations, a third swipe may be required. For many GPs, it would be a case of three swipes and ‘you’re out ‘ as there may be confusion on the patient’s behalf, rejection of a claim, and much angst between patient and front desk while all the usual business of trying to run a practice occurs. The great irony of this process is that Medicare Australia will make huge savings by shifting this workload onto
medical practices. The medical practices, however, will be presented with considerable human burden and additional costs. If Medicare Australia was shifting this work to another Government Department, the shift would be accompanied by an appropriate budget transfer to the new Department to cover costs. I fail to understand why we are expected to take on Easyclaim without a similar shift to underpin our costs. Pharmacists are getting paid to take on the electronic component for them at around 40 cents an item on script. The banks and financial institutions will make huge profits from Easyclaim - every swipe of a card will set the cash registers ringing. Doctors, too, are entitled to be paid for doing Medicare Australia’s work. Every medical practice would need to make a huge time and resource commitment to make Easyclaim work for their patients. As it stands, though, the system is not attractive for doctors - it will cost money and it will cost valuable patient and practice time. The banks and the pharmacists will be winners, no doubt. My message to the Government is simple: without the support of doctors Easyclaim faces a very hard road. The burden that the Government puts on doctors may well be transferred onto patients. The Government needs to reconsider carefully. Dr Rosanna Capolingua is the President of the AMA. Australian Medical Association www.ama.com.au
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BITS & BYTES
STANDARDS AUSTRALIA TAKES TO THE ROAD
Throughout July, Standards Australia’s Health Informatics Technical Committee (IT-014) presented “Standards: The main game in eHealth”, a series of free information seminars designed to raise awareness of the important work being undertaken by the committee. IT-014 develops national standards in health informatics that seek to support the sharing of information across the health sector. The seminars were hosted by David Rowlands, IT-014’s Executive Chair, and Elizabeth Hanley, Senior Project Manager, Human Service, Standards Australia, with funding support from the Australian Government Department of Health and Ageing. Topics covered included standards development, the importance of consistent standards implementation, the relationships between Standards Australia, NEHTA, HL7 Australia, the role of certification, and the process of negotiation of Australian requirements into international standards. The Roadshow visited Sydney, Canberra, Melbourne, Adelaide and Perth, concluding in Brisbane on the last day of the month. Ms Hanley was encouraged by the response to the seminars, citing strong delegate registration levels and a heartening number of follow-up enquiries.
“We had approximately 350 registrations for the six cities, and most of these people are not regular IT-014 contributors. We have seen a lot of new interest in participating in IT-014’s projects and the Roadshow was very effective in raising awareness and reaching new audiences about the standards publications.” Standards Australia - IT-014 www.e-health.standards.org.au
and practice management solution for general and specialist practices. “Stat” is being developed under the guidance of six directors, each with several years of experience in the healthcare sector. Three of the directors, Ian Threlfall, Cameron Jaffrey and Carla Doolan, all worked for Medical Spectrum, a medical software organisation that was acquired by IBA Health in 2003.
STAT HEALTH ENTERS THE MARKET WITH PREMIUM SUPPORT SERVICE
The other directors hail from the Camp Hill Medical Centre, with practice managers Jan Chaffey and Rhonda Rose joining their practice principal, Dr Ian Williams on the team.
Stat Health Systems, the newest entrant into the Australian practice software market has launched an IT support offering dubbed “Stat Services”. The company is promoting Stat Services as a premium IT support service designed to cater to practices that are not satisfied with the quality or scope of the support provided by their existing practice software vendors.
Stat is being developed using the latest development tools from Microsoft. It is being designed to run on Microsoft SQL Server 2005, with all data to be made accessible via web services. Stat will support multiple legal entities and practice locations, and incorporate an automated update mechanism to allow software patches, drug databases and fee schedule updates to be applied easily.
Stat Services has been designed to complement the existing IT support arrangements practices have. 24-hour phone support, remote access support and a dedicated client manager are all features of the service. Formed in 2006, Stat Health System’s other major endeavour is the development of an integrated clinical
In preparation for the launch of Stat in early 2008, Stat Health Systems has been conducting focus group sessions around the country. Details of future meetings are available at the Stat Health Systems website. Stat Health Systems www.stathealth.com.au
BITS & BYTES
OPEL NETWORK ANNOUNCED
Optus and Elders have been awarded a Government grant to rollout improved Internet services in regional Australia. The joint venture will receive $600 million from the Government’s Broadband Connect Infrastructure Program, in addition to another $358 million from the Government’s coffers. In addition to the significant Government investment, Optus and Elders have committed to injecting a further $917 million into the project. Controversially, this figure includes $700 million of investment “in kind”, terminology that has raised the eyebrows of many industry observers. The network has been dubbed “OPEL”, and will consist of 1,361 wireless broadband towers and 426 ADSL2+ exchanges. Together, the network will provide coverage to 638,000 square kilometres of Australia encompassing an estimated 3.7 million homes and businesses.
The wireless component of the OPEL network will use WiMax (Worldwide Interoperability for Microwave Access), an emerging network technology being promoted by Intel. The technology is currently used in several countries, including Taiwan where it was recently deployed for use by health professionals in the field. When launched in Australia, the WiMax network will be positioned in direct competition with Telstra’s Next G network, an accomplished voice and data network launched in October last year. Next G was introduced with top speeds of 3.6Mbps, but has since been upgraded to 14.4Mbps. Telstra plans to increase peak performance to an impressive 40Mbps by 2009. In comparison the OPEL network will be launched at 6Mbps, however it will upgraded to 12Mbps by the time the network is completed in 2009. The OPEL collaboration promises to break Telstra’s infrastructure monopoly
in regional areas by wholesaling access to the network to competing ISPs (including Optus and Elders). OPEL and the Government are promising to deliver “access plans at prices comparable to that being paid by metropolitan consumers, which typically average $35 to $60 per month”. Predictably, Telstra has slammed the OPEL funding arrangements, directing criticism at the WiMax technology, the way in which the tender process was conducted, and the return on investment for tax payers. The head of Telstra Country Wide, Geoff Booth, said “Even if the [Opel WIMAX] technology does what they say it will, which is doubtful, taxpayers will have spent $1 billion extending broadband access from the 98.8 percent of the population now served by the Next G network to 99 percent.” For this net coverage gain of 0.2 per cent, Mr Booth calculated the cost to the tax payer to be in the vicinity of $50,000 per household.
BITS & BYTES
MEDINFO TO HOST THIRD INTEROPERABILITY DEMONSTRATION
“Interoperability” refers to the ability of different systems to exchange information, a concept that is yet to achieve widespread adoption in Australia’s health sector.
The third annual Interoperability Demonstration will be hosted at the Medinfo 2007 conference, to be held in Brisbane between the 20th and 24th August.
The demonstration, now in its third year is being coordinated by HISA, HL7 Australia and the Medical Software Industry Association (MSIA).
“Medinfo” is the official conference of the International Medical Informatics Association (IMIA), an organisation with a lineage stretching back forty years. Medinfo 2007 will be the 12th such conference, but the first to be hosted in Australia. The Health Informatics Society of Australia (HISA) is the host organisation for this event and has incorporated its annual Health Informatics Conference (HIC) into the congress. Medinfo conferences have historically attracted over 2,000 delegates, placing them amongst the world’s premier informatics events. As part of the conference, a consortium of developers and peak bodies will host an interoperability demonstration.
Interoperability demonstrations have developed into an integral part of the HISA’s Health Informatics Conference. The first demonstration in 2005 focused on referral results, while the second had a wider scope, encompassing shared EHR, identity management, referrals, orders and results. The convenors point to the following reasons for hosting the event: 1. To show how current health IT standards support patient care and communication. 2. To identify current short-comings in the standards and their implementation. Some of the issues include the widespread variability in the way
Below - An artist’s rendition of the Interoperability Pavilion. As indicated in the picture, a central presentation area will be enclosed by fourteen display stands, one for each participating vendor. Image provided courtesy of Exhibit Systems Pty Ltd.
HL7 messages are implemented by vendors, and the under utilisation of compliance testing facilities such as those managed by the Australia Health Messaging Laboratory (AHML). 3. To examine emerging technologies and standards including HL7 CDA, identity management services and electronic prescriptions. 4. Disseminate the practical lessons learned from participation in the demonstration and development process. Drawing from the experiences of the previous interoperability demonstrations, vendors have been engaged much earlier than for previous demonstrations. The organisers have insisted that vendors ensure that the messages used in the event comply with Australian Health Messaging Laboratory (AHML) certification. The focus of the demonstrations is on HL7 Version 2.3.1 pathology messaging for orders and results (AS4700.2) and on REF messages (AS4700.6). While inferior legacy messaging formats still exist in the market (e.g. PIT), the two aforementioned HL7 variants are emerging as the key messaging standards that will facilitate widespread health interoperability in the future. The actual interoperability demonstrations are framed against the backdrop of a mythical health region in South Sydney. The following hypothetical situation has been established to highlight potential issues with the integration of health systems: “Following the failure of the health system to roll out national or statewide solutions in the early 2000s, a new approach was trialed that created networks of local health providers prepared to coordinate electronic healthcare communication. In time these regional services can link as they are based on common standards to be promoted by NEHTA and the health IT industry. These are relatively small groups of organisations who form a “web of trust” when it comes to protecting sensitive health information.” Conference delegates will be invited to follow the progress of a patient volunteer through a health journey covering 4
10 PULSE + IT
BITS & BYTES acts. These acts reflect typical health care scenarios, and highlight the various technological interactions as follows: 1. Remote patient monitoring communication, referral, diagnostic services and the personal health record. 2. Review of shared health records, referral, diagnostic services and coordinated care. 3. Electronic results, remote EHR access, referrals, shared EHR. 4. Hospital care (emergency, diagnostic services, quality management) links to community care. These performances will run regularly at the Interoperability Pavilion throughout the Medinfo Trade Show. Mini-presentations detailing the key infrastructure involved will also be conducted. There are 13 companies that are participating in the interoperability demonstration and they represent the leaders in the eHealth field, both nationally and internationally. Each company plays a strategic role in
creating the network of systems that enables eHealth communications to be seamlessly transmitted between clinicians, health managers and all the supporting players in the patient journey. The roles played by the participants in the Interoperability 07 demonstration are as follows: • Cerner Lab (Pathology Information System) • Extensia (Chronic Disease Management and shared health record) • GE-Ultra (Pathology Laboratory Information System) • Healthe (Personal Health Record) • HealthLink (Communication Service) • IBA (Chronic Disease Management Service) • MedCare (Home telecare and point of care testing) • Medical Director (Clinical Health Records) • Medical Objects (Communication Service) • Medical Objects (Specialist clinical information system) • Ocean Informatics (Central hospital electronic health records system)
• Sun (Prototype Electronic Referral and Prescribing Network) • Sun E-Gate (Identity services and message routing service) In addition to this group, Interoperability07 is supported by two major sponsors, Oracle and the Department of Health and Ageing. Both these organisations are major contributors to eHealth, albeit from very different perspectives and their support in delivering the Interoperability Demonstration is critical to its success. In addition, Sun has been a long standing player in this space and has provided much needed infrastructure and coordination support throughout this year’s development cycle. International Medical Informatics Association www.imia.org Interoperability Demonstration 2007 www.interoperability07.com.au MedInfo2007 www.medinfo2007.org
Secure medical messaging. How well are you connected? Medical-Objects are an Australian software firm specialising in the secure delivery of clinical data between health care providers. Our vision is to create practical and quality software products for the healthcare industry as a platform to build even more efficiencies for today’s modern clinician. With Medical-Objects not only can you receive specialists letters and pathology reports in real-time, you can also send Medicare friendly paperless electronic referrals directly to specialists and hospitals. This means, no more paper, scanning, or filing which lowers costs and improves efficiency. All this happens in real-time so when a result is sent, you get it seconds later. Medical-Objects’ software products are compatible with all the major Practice Management Systems such as Medical Director, Best Practice, Genie,
Medtech32 and many more. The Medical-Objects team constantly push the technological boundaries in pursuit of product excellence. Our products are built upon established standards while combining the latest advancements in clinical and communication systems. Our friendly customer support and solutions team is located here in Australia and prides itself on being able to deliver the support on the rare times when needed. Not only is Medical-Objects technically advanced, it is designed around how clinicians operate. Our vision is to provide quality products and tools that take Australian healthcare organisations continually to the next level. Our messaging system not only provides support for real-time connectivity, we also have SNOMED CT, Web Services support, end-to-end acknowledgements, integration
We’ll even take care of the installation for you. Sign up free* today. * GP software for sending referrals and receiving correspondence is free. A free 60 day trial applies to Specialists, Allied Health, Pathologists and Radiologists wanting to use the other products in the Medical-Objects software suite.
technologies and more; while at the same time operating securely, privately and efficiently. Today, Medical-Objects technologies are being used by GP’s, Nursing Homes, Specialists, X-Ray and Pathology companies, throughout Australia. We are widely accepted as being one of the leading authorities on HL7, being certified through the Australian Healthcare Messaging Laboratory. We provide the same integration capabilities in our products whether you are a GP, Specialist, Hospital or Government Health Department. We know that messaging is not just about getting communication from Point A to Point B. There is a better and more modern workable solution to start communicating electronically. We encourage you to contact us today to make the move to a more efficient tomorrow.
Contact Medical - Objects PULSE + IT 11 today on (07) 5445 5037, Visit http://www.medical-objects.com.au or email email@example.com
BITS & BYTES
IBA GAZUMPED ON ISOFT BID BY COMPUGROUP
iSoft has announced another EGM to discuss the new bid, leaving IBA with two months to consider its position.
The directors of iSoft have withdrawn their support for IBA’s long running bid to acquire the troubled eHealth company.
The iSoft directors have switched their attention to a rival bid from CompuGroup UK, a trading entity established by Germany’s CompuGroup for the sole purpose of the acquisition. CompuGroup has offered 66p for each iSoft share, a bid that values the company at $375AUD million. This trumped IBA’s original scrip offer of $327AUD million. IBA’s acquisition was scheduled for completion on 30th July, having received almost universal support from iSoft’s shareholders at an extraordinary general meeting (EGM) earlier in July. CompuGroup lodged their 11th hour bid for iSoft on 20th July, the news immediately inflating iSoft’s share price to just below that of the offer.
IBA Health www.ibahealth.com iSoft www.isoftplc.com
GLOBAL HEALTH WINS SECURE ELECTRONIC MESSAGING CONTRACT Global Health has been awarded a contract to deploy its secure electronic messaging solution, “ReferalNet” to GPs and Specialists in Tasmania. The deal has been brokered through General Practice Tasmania Limited, an organisation representing the three Divisions of General Practice and the Rural Workforce Agency in Tasmania.
Global Health claims the initiative will deliver standardised electronic clinical messages through the implementation of a secure two-way electronic messaging service between Tasmanian GPs and specialists. Funded by HealthConnect, the rollout is being conducted as part of the state’s Secure Electronic Clinical Communications Initiative (SECCI). General Practice Tasmania selected ReferralNet as the preferred product for Phase 1 of the project. “After reviewing several solutions, we were confident that it was ReferralNet that would meet our need for secure electronic messaging in primary care and deliver long term sustainability”, said Sarah Male, Chief Executive Officer of General Practice Tasmania. Global Health www.global-health.com General Practice Tasmania www.gptasmania.com.au
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THE UNIQUE HEALTHCARE IDENTIFICATION SERVICES
Dr Ian Reinecke DRIVERS FOR CHANGE
across functional, jurisdictional, administrative
personal and health information. To manage
Community expectations about the delivery
and professional boundaries and ensure that
this effectively, NEHTA has applied a range of
of healthcare in Australia are increasing with
no matter where healthcare is being received,
privacy management strategies to address
technological advances, economic pressures
an individual’s healthcare information is being
risks and enhance privacy protections.
and changes in the nature of health and
correctly assigned to them.
illnesses. Governments and other participants
A key component of this approach will be a
opportunities to improve patient care and
WHAT ARE THE UNIQUE HEALTHCARE IDENTIFICATION SERVICES?
give consumers more control over healthcare
The Unique Healthcare Identification
will ensure personal information is collected
decisions that affect them. The key to this
Services (UHI Services) is the system which will
and handled responsibly, consistent with
opportunity is the potential of technology to
confidently and uniquely identify the people
individuals’ expectations, and will form part of
provide accurate healthcare information. In
and organisations involved in healthcare
NEHTA’s ongoing privacy management.
response to these expectations, NEHTA was
in the health sector recognise that information and communication technologies create
established by the Australian Commonwealth,
rigorous privacy impact assessment to assess the privacy implications of the IHI, and identify measures to manage them. These measures
The UHI Services will comply with legislation
State and Territory governments to develop
The services are made up of two separate
such as the Commonwealth Privacy Act 1988,
better ways of electronically managing and
identification services; the Healthcare Provider
which regulates how personal information is
securely exchanging health information to
Identification (HPI) Service and the Individual
collected and handled. Arrangements will
achieve these positive outcomes.
Healthcare Identification (IHI) Service.
be put in place to ensure accountability and
THE NEED FOR UNIQUE IDENTIFICATION
The HPI Service will uniquely identify
transparency, and to handle complaints from individuals.
healthcare providers, the workplace
Unique individual identification is recognised
organisation(s), e.g. hospitals, and their
An overview of our position on privacy is
as a critical success factor for healthcare
locations. This information will also be used
available in the NEHTA’s Approach to Privacy
reform and fundamental to establishing the
to provide a national healthcare provider
publication. Further, we have specifically
foundations for electronic or e-health. Unique
addressed privacy in the context of unique
identification is about providing accurate
healthcare identifiers in the document
healthcare information by ensuring the correct
The IHI Service will accurately identify
Privacy Blueprint for Identifiers. Both of these
information is related to the right individual
individuals for healthcare purposes. There
publications are available on the NEHTA
and the right healthcare provider every time.
will be no clinical information held with the
identifiers. unique identification is critical, and quite
The identifiers themselves will comprise of
INFORMATION ACCESS AND SECURITY
complex. Patient care is generally shared
a sixteen digit ISO standard number with
Like privacy, issues relating to information
across the care continuum, between
an associated record of demographic
access and security are critical for the UHI
healthcare providers from primary, secondary,
information, such as name and date of
Services. Access to the UHI Services will be
tertiary, rehabilitative and other sectors such
birth, for identification and communication
controlled and constantly monitored, with
as aged care, mental health and allied health
access only available upon appropriate
In a more integrated healthcare environment,
authentication and authorisation. The aim
sectors. Population mobility and multiple points of access to the healthcare system
Both healthcare providers and healthcare
of NEHTA’s User Authentication is to ensure
lead to the accumulation of the healthcare
individuals will have access to the information
the most robust system for authentication is
individual’s related data in a variety of
contained in their identifiers.
implemented for e-health.
there is no single method of, or standard for,
consistently and uniquely identifying a patient
The trend towards greater sharing of health
The UHI Services are planned to launch with
across this continuum of care, which reduces
information is both inevitable and desirable,
limited operations from mid-2008 and full
the probability of previous care data being
but must take place within an agreed privacy
functionality is planned for the end of 2009.
matched to a patient’s current status. The
fragmented, unrelated repositories. Currently
Dr Ian Reinecke is the CEO of the National
development of a national unique healthcare identification service is underway to address
From the outset, NEHTA has recognised privacy
this issue. It will facilitate the flow of information
as an issue of great concern – particularly
about healthcare individuals and services
in relation to the collection and handling of
14 PULSE + IT
E-Health Transition Authority (NEHTA).
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WHAT IS HL7? AN INTRODUCTION TO HEALTH LEVEL 7 Klaus Veil
BACKGROUND Just as people from different countries with completely different native tongues are only able to communicate with each other if they can speak a common language, healthcare computer systems can only share clinical information if they communicate in a common way. Before people or computers can share clinical data with one another, they must both: • Have functions to be able to physically communicate, e.g. speak & hear or send and receive documents and data files, share data and information (this is called “functional interoperability”). • Speak a common language (in terms of nouns, verbs, grammatical structure etc) and share the same vocabulary that allows them to understand complex medical conditions and processes (this is called “semantic interoperability”). Because hospital computers were not able to “understand” each other, a group of healthcare computer systems users in 1987 started developing a common “language” which they named “Health Level 7”. Over time, the HL7 interoperability protocol became a nationally and then globally accepted standard. The issue of connecting healthcare computer systems is not an easy one. While exchanging clinical data between two computers is trivial, the complexity grows exponentially as the number
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of systems increases. It quickly becomes evident that it is impossible to fund and build custom interfaces to interconnect the thousands of computer systems typically found in a large State or Territory health department. The term “Health Level 7” is used for both the organisations involved in developing and supporting the healthcare standards as well as for the standards themselves. Best known are the Version 2.x and Version 3 intercomputer messaging standards developed by HL7 (which has local organisations in 30 countries), but HL7 also creates international standards for decision support (Arden, GLIF & GELLO), Electronic Health Records (EHR), clinical text document mark-up (CDA) and, user interface integration (CCOW).
WHAT DOES THE NAME “HL7” MEAN? “Level Seven” refers to the uppermost level of the International Standards Organisation’s (ISO) communications model for Open Systems Interconnection (OSI): the application level. The application level addresses definition of the data to be exchanged, the timing of the interchange, and the communication of certain errors to the application. The seventh level supports such functions as security checks, participant identification, availability checks, exchange mechanism negotiations and, most importantly, data exchange structuring.
THE HL7 ORGANISATION The Health Level 7 organisation is a global, volunteer not-forprofit community of healthcare informatics experts and information scientists collaborating to create standards for the exchange, management and integration of electronic healthcare information.
HL7 STANDARDS The HL7 standards enable the interoperability between electronic Patient Administration Systems (PAS), Hospital Information Systems (HIS), Laboratory Information Systems (LIS), Dietary, Pharmacy, Radiology and Billing systems as well as Electronic Medical Record (EMR) or Electronic Health Record (EHR) systems. The HL7 standards have found wide acceptance around the world. In Australia, the US, Canada and New Zealand, the healthcare systems heavily use HL7 messaging. In 1998, the US reported that over 95% of all healthcare organisations were using HL7. New Zealand has for many years based its health services records on a national patient identifier - accessed using HL7. Australia is also a heavy user of HL7 - about 50,000 HL7 V2.x messages probably have been exchanged between Australian computer systems since you started reading this article! Interestingly, Australia has been a global leader in the acceptance of HL7 by governments: In March 1997, the then Health Minister
HL7 AUSTRALIA Michael Wooldridge launched the first Australian HL7 Standard. In August 2004, the National Health Information Group (NHIG), an expert committee established by the Australian Health Ministers to provide guidance on national health information requirements and related technology planning, endorsed HL7 as the national standard for the electronic messaging of health information across Australia. In March of this year, the National eHealth Transition Authority (NEHTA) reaffirmed this endorsement.
HL7 AUSTRALIA In Australia, Health Level 7 is officially represented by HL7 Australia, an open, volunteerbased, not-for-profit organisation that supports the needs of HL7 users in Australia. HL7 Australia is the local HL7 user group and the accredited national affiliate of HL7 Inc. (USA). It has local responsibility for a range of core activities including the distribution and licensing of the HL7 Standards materials, education and participation in HL7. A frequent misconception about HL7 is that the group develops software. In fact, HL7’s primary goal is to create flexible, lowcost standards, guidelines and methodologies to enable the exchange and interoperability of electronic health records. Such guidelines or data standards are an agreed-upon set of rules that allow information to be shared and processed in a uniform and consistent manner. These data standards allow healthcare organisations to easily share
clinical information. It is hoped that this ability to exchange information will also help minimise the tendency for medical care to be geographically isolated and highly variable.
SO HOW DOES HL7 V2.X WORK? Essentially, HL7 conveys clinical information in a standard way between data stores in different computer systems. Data is formatted according to the HL7 standard rules, and then enveloped before it is sent out via a network to the destination system. V2.x messages have a variable-length, positional format and consist of lines (“segments”) of ASCII text. Each line of text is a fixed sequence of data elements (otherwise known as fields or data items) separated by delimiters. In the HL7 standards document, each data item is well defined. HL7 V2.5 contains approx. 1700 data items. Each data element is usually separated by vertical bar (or pipe “|”) characters, may have components (separated by “^” characters) and may repeat (e.g. for multiple patient IDs, phone numbers etc).
HL7 V3 HL7 Version 3 is a next-generation HL7 messaging standard recently completed and now being implemented in some countries. Version 3 uses formalised modelling to improve the way it is defined and to attempt to make its content less ambiguous to the vendors implementing it. The underlying model is known as the Reference Information Model
Below - An example HL7 message containing Liver Function Test results for Mr Nobby J Knees, born 15 December 1935. The Serum Albumin and Alkaline Phosphatase results are 38g/L and 52U/L respectively, and within their normal ranges.
(“RIM”) as a common source for the information content of specifications. HL7 Version 3 is being implemented in the UK and in Canada. Initially the implementers were faced with many problems, but substantial changes have been made and most technical hurdles have been overcome. There are still questions however, if the move from V2.x to V3 can be justified on a cost/ benefit basis.
HL7 FOR GPS AND SPECIALISTS HL7 is already allowing the electronic exchange of Pathology requests and reports between the labs and the doctor’s desktop software. Electronic Immunisation and Authority Drug approvals using HL7 messaging have been trialled. Electronic discharge summaries and referrals are currently in development. The technology is available and ready for these clinical events to occur paperless, seamlessly integrated with the desktop practice management software and also automatically populating the patient’s medical record. Klaus Veil is the Chairman of HL7 Australia and a Board member of HL7 Global. He also serves on various Standards Australia eHealth commitees. In his “day job”, he manages HL7 Systems & Services, a consultancy specialising in eHealth Interoperability. HL7 Australia www.HL7.com.au HL7 Global www.hl7.org HL7 Systems & Services www.hl7.com.au
MSH|^~\&|PATH||GP123||20070625||ORU^R01|101|P|2.5^AUS|||AL|NE|AUS||en<cr> PID|||KNEE123||Knees^Nobby^J^^Mr||19331215|M|||23 Shady Lane^LIGHTNING RIDGE^NSW^2392||||||||219171803<cr> OBR|1|PMS66666|956635.9|LFT^LIVER FUNCTION TEST^N2270<cr> OBX|1|NM|1751-7^S Albumin^LN||38|g/L|35-45||||F<cr> OBX|2|NM|1779-8^S Alkaline Phosphatase^LN||52|U/L|30-120||||F<cr>
PULSE + IT 17
INTERVIEW: INTRAHEALTH Pulse+IT checks in with Trevor O’Bryan, Intrahealth’s Sales Manager.
Pulse+IT: What products does Intrahealth make available to GPs and Specialists? Intrahealth has developed and markets a General Practice and Specialist (Profile Specialist) version of our practice management system, “Profile”. Both versions are complete systems enabling administrative, clinical and financial functions of practice management. We have adopted a platform approach to software development whereby a single source code copy supports our Australasian and North American customer base. This ensures Australian customers are able to access product development and enhancements initially developed for other markets. In addition to Profile we have developed a number of other solutions including:
• • •
• HCC – Health Care Community, is a case management application used in the delivery of care to outpatients, community health, mental health, sexual health, rehabilitation, diabetes, older peoples health and chronic care. • Accession – a provider and patient self management application based on internet enabled access; health professionals are able to interact with each other and their patients via the web. A provider and patient version exist and are available with Profile version 7.1 onwards. Pulse+IT: What Intrahealth features are new users attracted to? The features that appeal to new users are numerous and varied. The following features are often commented on: • Proven scalability with our Enterprise architecture addition. The current largest implementation is 1,000 users with a maximum concurrent user threshold of 300 to 400. Intrahealth products have been designed to scale
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• • •
and therefore are ideally suited to larger practices, Divisions of General Practice considering central hosting under an ASP delivery model, groups, community care organisations and providers of outpatient care. Ability to add and define custom images that can be inserted in a patient’s EMR and then edited. The powerful Find Objects reporting interface allows a user to drag and drop to create custom queries on almost all data items in the database, even down to searching for a specific word in the free text clinical notes. The ability to search the appointment book for future appointments including booked, cancelled and free. This can be refined by appointment type, doctor and patient. No advertising. User defined alerts (popup and discrete alerts). Flexible communication (Email, Tasks and Messenger). Can represent multiple layered organisational structure. Custom security and privacy by Role, Individual, Business node, Location and Group. Customisation – Intrahealth products include customisation functions to enable the product look and feel and functionality to be tailored to practice requirements. Extensibility – Ability to write macro’s to support functions and integration using visual basic. SMS appointment reminder. Waitlist for patients. GEHR (Good European Health Record) based EMR design – structured clinical record underpins our applications. Inbuilt form and letter template development functionality that is simple to use and offers rich functionality. Excellent robustness and reliability. A long term partnership model with customers – we recognise the investment and commitment required to change PMS.
• Software design excellence and an international perspective – Intrahealth also has offices in Canada and New Zealand. • 3 tier architecture enabling dispersed and multi-site access. • Load balancing and redundancy supporting larger scale institutions. • Adoption of current technology including “.net” based web service interfacing module. • A well established and proven company exclusively committed to health. • Flexible commercial models designed to support customers achieving their organisational goals. Pulse+IT: Which competing programs can you import data from? We have developed data conversion utilities for many of the main PMS systems including: • • • • • • • • • • • • •
MD2 and MD3 JAM Houston Medical spectrum (Classic, Plexus) Medimouse Medipak Mediwiz Remedy RX Total Care Bluechip Caseg Good Practice
For all systems, manual transfers are also possible if the data can be provided in an unencrypted CSV format. Pulse+IT: How is the data conversion performed? For the above systems it is an automatic process handled by the transfer utility and conducted by Intrahealth staff. We purposefully do not outsource data conversion to ensure rigorous control and quality.
INTERVIEW We adopt a structured quality orientated process intended to mitigate risk and ensure an excellent quality outcome. Our objective is to eliminate a user’s ability to identify data as having been imported as a result of a data conversion. Pulse+IT: In addition to your own practice management solution, do you allow other solutions to interface with your clinical product? Yes – Profile and Profile Specialist have extensive interfacing capabilities both inbound and outbound. Integration methods supported include HL7 messaging, web services, and any COM compliant exchange. Interfaces are able to be developed and maintained independent of Intrahealth. Pulse+IT: Which secure messaging products does Intrahealth integrate with? Our products are currently capable of creating HL7 files, which can be interpreted by Healthlink, Medical Objects and Argus. Profile and Profile Specialist allow templates to be created to collect data, which are then converted to HL7 format. Pulse+IT: How is training and support provided? A traditional software support model is provided including:
also offer a comprehensive accreditation course which is conducted over 5 days and designed to enable a large organisation’s internal IT team to provide 1st level support. Pulse+IT: How many people make up the Intrahealth team? The Intrahealth team is a truly international team of 70 people based in the markets we service (Australia, New Zealand, Canada) with the majority of development completed in Minsk.
All files passed into and out of Profile use the same format and process including Careplans, Forms, MIMS, Termsets and additional practice data. It is a simple process that users are familiar with and does not require IT assistance. Program upgrades are released with a new installation wizard that is easy to follow and can be conducted by a practice manager.
Pulse+IT: Overview your pricing structure.
Pulse+IT: How many practices are currently running Intrahealth?
We typically price by work-station rather than user as we recognize some users share a terminal. Our Profile pricing structure consists of 2 parts, the initial purchase of the software and the annual support and maintenance fee inclusive of version insurance (future releases).
There are approximately 450 sites with in excess of 5,000 clinical users. In Australia there are in excess of 80 sites using Profile as their practice management software ranging from large scale, multi location enterprises to smaller 2 to 3 provider practices.
Annual license funds support infrastructure & personnel, product maintenance and version insurance. Annual fee starts at $300/WS (the license cost for a standard 5WS practice is around $4,000).
Pulse+IT: What new features are you working on that Intrahealth users should look forward to?
Licences are perpetual thus customers electing to terminate their Profile contract can continue to access data using the Profile application in enquiry mode though not read/write.
1. First level – support analysts triage support calls and escalate matters they are unable to resolve. All calls are assigned a unique contact I.D. 2. Second level – staffed by application analysts and business analysts. Application analysts work up matters escalated by first level and raise any development work packages to the developers 3. Third level – staffed by developers who in turn are assisted by quality assurance resources.
Pulse+IT: In addition to the Intrahealth licences, what other costs may practices have to meet?
First level support is provided by our help desk via email, telephone, remote technologies (GoToMeeting, remote desktop) or web enquiry.
We have no set interval for program updates, but an average cycle is a new version every 9-12 months and new builds every 3 to 4 months or as required to implement industry changes. The drug updates are dictated by PBS and MIMS as Profile uses the fully integrated eMIMS drug database. These updates are released monthly.
Our trainer/installers provide the initial and ongoing training including training material, quick guides for staff, remote training, group and onsite classes. We
Pulse+IT: Is professional IT assistance required to perform these updates?
Other associated costs commonly include Training, Data conversions, 3rd party products such as MIMS or Termsets (ICPC etc). Profile is deployable on a number of databases including a free version of Interbase or MS SQL. Pulse+IT: How frequently does Intrahealth release updates?
Clinical performance indicators – further development of the key performance indicator concepts introduced in Profile version 7.0 to better support management of clinical care and “in practice” population health management. Appointment templates – further enhancements to the appointment rules function to enable practices to establish and maintain specific appointment schedules including variable duration appointments. Accession – patient view. Enables a patient to participate in their own care and self manage through the provision of a range of functions: • Reorder medications • Make an appointment • Add provision clinical notes – clearly identifiable as patient notes Substantial configurable business rules underpin Accession enabling practices to enable or disable functions. Intrahealth www.intrahealth.com.au
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INTERNET BACKUP Simon James BIT, BComm
INTRODUCTION The importance of performing daily backups of clinical data is well understood by Australian medical practices. Unfortunately, from time to time, catastrophic data losses do still occur. The increasing availability of cheap, fast, reliable Internet access has finally made Internet backup solutions a viable prospect for many businesses. This article seeks to examine whether one such Internet backup solution, “Mozy”, can be used to effectively protect the clinical data of Australian medical practices, while at the same time minimising the potential issues associated with manual backups.
Macintosh and Windows platforms. This software interfaces with Berkeley’s secure data hosting facilities via the Internet.
protect must be uploaded. Depending on the speed of the Internet connection and the amount of data, this may take hours, days or even weeks!
HOW DOES IT WORK?
After this first upload has completed, subsequent backups occur in a much more timely fashion. In the event that Mozy is interrupted during the initial or subsequent backups, it simply resumes from where it left off.
To get started with Mozy, users need to download some simple software, specify the files they wish to backup, and schedule the time of day they wish these backups to occur. Mozy is designed to backup files on a computer system incrementally. This essentially means that only files that have been modified since the last backup are copied to the Mozy servers.
Mozy is a simple and cost effective Internet backup solution designed to take the hassle out of backing up important data.
To optimise this incremental backup process even further, Mozy uses sophisticated “block level technology”. This technology allows Mozy to detect and upload the discrete parts of large files that have been modified since the last backup, saving the software from having to upload the entire file.
The brainchild of Berkeley Data Systems, Mozy software is available for both
The first time a backup is performed with Mozy, all the data the user wants to
WHAT IS MOZY?
Below - The Mozy Preferences Scheduling Screen. The computer will be backed up each night at 7pm, and at any stage after the computer has been inactive for thirty minutes.
In addition to being able to manually trigger a backup, Mozy includes some fairly basic automated scheduling features. As well as being able to specify a time to perform the backup each day, Mozy can be configured to perform a backup after a certain amount of idle time (i.e. time when the computer hasn’t been used). On networks where backups are performed during the day and users need to access the Internet, Mozy can be configured to limit the amount of bandwidth it consumes during a backup. Called “bandwidth throttling”, this feature prevents Mozy from monopolizing the network’s Internet connection, but still allows backups to be performed in a timely fashion. A backup report is automatically generated, listing the files that were backed up and the length of time it took to perform the transfer. This log file should be monitored at frequent intervals to ensure that the backup is being performed reliably.
IS IT SECURE? All data is encrypted prior to being sent to Mozy’s servers. Customers can utilise Mozy’s built-in security system (i.e. 448-bit Blowfish encryption), or elect to use their own certificates.
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FEATURES HOW MUCH DOES IT COST? Mozy offers two different pricing options, both of which are extremely cost effective: 1. A free plan providing up to 2GB of storage. 2. An â€œunlimitedâ€œ plan for $4.95US (approximately $6AUD) per month, which allows users to backup as much data as they wish. As most ISPs donâ€™t charge their users for uploaded data, performing backups with Mozy should not increase the cost of your Internet service. As there are some exceptions to this rule however, readers are encouraged to check with their ISP before using Mozy or any other Internet backup service.
HOW DO I RESTORE MY DATA? In the event of data loss on a computer protected by Mozy, there are three ways to restore data from the Mozy servers: 1. The easiest option is to use the Mozy softwareâ€™s â€œRestore Filesâ€? feature. The user is presented with all the files backed up in their folder hierarchy, as well as a list of dates the files were backed up. The user simply selects the version of the file that they want to restore, and specifies the file path on the local machine where they wish to restore it to. The file is then downloaded from the Mozy servers, ready to be used. 2. In the event of a total system failure, the user can specify the files they wish
to restore via the user portal on the Mozy website. After nominating the files, an email is sent with a link to a downloadable archive containing the requested files. 3. While not available outside of the United States at this time, Mozy can also ship data to users on DVD. This service starts at around $80 for a single DVD, but scales at the cost effective rate of only $3 per additional DVD.
WILL IT WORK FOR MY PRACTICE? Despite its low cost and convenience, there are several issues with Mozy that make it difficult to recommend as a practiceâ€™s primary backup solution. The first problem with Mozy (and other Internet backup solutions) is that practices need to be able to quickly restore their backups in the event of data loss. Whilst Internet access speeds are gradually improving, the potential need to download gigabytes of data in the event of a server crash is still a daunting prospect. It should also be noted that even if the data can be restored in a timely fashion, it is likely that the practiceâ€™s Internet quota would be taxed heavily, potentially resulting in excess data charges or ISP induced bandwidth throttling. The other major problem with the Mozy service is that backups are deleted after 30 days. While this does allow for a reasonable amount of â€œroll backâ€?, practices should ideally have in place a backup system that allows them to
restore a data â€œsnap shotâ€? of any week (or ideally any day) in history. Despite these shortcomings, practices and the IT professionals that support them may see the merit in deploying Mozy as a secondary backup solution.
WHAT ABOUT AT HOME? Fueled by the proliferation of digital still and video cameras, the amount of â€œsentimentalâ€? data stored on home computer systems has grown exponentially. Despite the importance of such information to families, it is unlikely that many doctors or practice staff are as rigorous with their backups at home as they are at work. Depending on the speed of their Internet connection at home, doctors and practice staff may find Mozy to be the ideal backup solution for their home computer systems.
CONCLUSION Mozy is well priced, easy to use and frankly, quite cute! Despite the quality of the service in its own right, typical Australian medical practices are likely to find Mozy to be unsuitable as their primary backup solution, however they may find it to be a reassuring and effective complement. Simon James is the Editor of Pulse+IT.
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STREAMLINED AUTHORITY Simon James BIT, BComm
INTRODUCTION On 1 July, Medicare Australia introduced changes to the PBS authority approval process in an effort to streamline the process of writing authority prescriptions. Under this new “Streamlined Authority” system, prescribers will no longer have to obtain telephone or written approval from Medicare Australia or the Department of Veterans’ Affairs (DVA) before prescribing certain PBS authority medications. Of the 450 PBS listings requiring authority approval, 200 now fall under the streamlined system. These 200 listings comprise the various indications (reason for prescribing) for 85 medicines. Fosamax, Actonel, Ezetrol, Vytorin, Ezetimibe and Carvedilol are among the medications that can now be prescribed under the streamlined system. Norfloxacin, Bupropion Hydrochloride and Valacicilovir Hydrochloride are among the medications that still require telephone or written authority approval.
As the driving force behind the changes, the Australian Medical Association (AMA) is enthusiastic about the initiative.
to more complex call enquiries and undertake additional education and compliance activities.
“We estimate that the changes will reduce the number of authority requests made via phone by 30%,” said A/Prof John Gullotta, Executive Councilor and Chair of the AMA Therapeutics Committee.
“Timing is everything in politics - we saw an opening and we darted through. It’s a good win for the AMA and a welcome wind back of red tape for GPs. The Government said we would never achieve this about 6 months before we achieved it. As soon as it is bedded down, we will be pushing for more streamlined listings and the complete removal of anachronistic listings. We point out it is still an Authority system but an efficient one and one we can live with.”
Dr Tony Hobbs, President of The Australian General Practice Network (AGPN) is also positive about the prospect of GPs spending less time having to phone for authority.
The Streamlined Authority system has been devised to offset one of the major administrative burdens imposed on prescribers by Medicare Australia: telephone prescription authority approval.
“We welcome the decision to remove 200 of the 450 approval medications. As a result an estimated 70% of approval prescriptions will be removed,” Dr Hobbs said.
A 2005 Access Economics study into the workforce implications of PBS authority scripts found that prescribers spent 439,500 hours per year requesting authority codes via the telephone or in writing. The report extrapolated this finding to conclude that time equivalent to 239 FTE doctors, or over 1.3 million patient consultations were being consumed by the authority script process.
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Dr Hobbs also highlighted the benefits for patients, stating that, “They will be the big winners here. They will no longer have to wait around whilst their GP is on the phone to the approval hotline for scripts they are themselves very familiar with.” According to a spokesperson for the Government agency, the reduction in PBS authority call volumes will enable Medicare Australia to better respond
The PBS has assigned four-digit codes to the 200 listings that can be prescribed under the streamlined system. Doctors will be required to include this code on their prescriptions. As before, prescribers must ensure that patients meet the PBS restriction criteria for the item. Cautioning prescribers against abusing the streamlined system, A/Prof Gullotta said “It is important to highlight that the authority restrictions still apply and are subject to audit so doctors must still prescribe within the guidelines.” There are several ways to access the streamlined authority codes, some more streamlined than others: PBS Website The PBS website contains a search function that allows up-to-date information on all PBS drugs to be retrieved. To access the Streamlined Authority codes via the web, practitioners need to: 1. Visit the “Health Professionals” section of the PBS website. 2. Enter the medication name into the “Search term” box and click “Search”. 3. If the drug can be prescribed under the Streamlined Authority system, this will be indicated in red text towards the top of the screen. Clicking on this text will display one or more four-digit Streamlined Authority codes. 4. The practitioner needs to note the code that corresponds to the indication for which the drug is being prescribed. 5. This code needs to be added to the prescription, either via clinical software or by writing it on the script paper.
FEATURES This process can be sped up slightly by bookmarking the page containing the search box. Alternatively, prescribers may prefer to make use of the “Watch list”, a feature that allows frequently prescribed drugs to be stored in a pick list for faster retrieval. PBS Offline As the name suggests, PBS Offline is a packaged version of the PBS website that can be viewed on computers without an active Internet connection.
The PBS website warns that due to the size of the Schedule document, the first search conducted each month on a PDA may take up to 10 minutes! Fortunately, subsequent searches will be much more efficient.
Genie users need to upgrade to version 7.4.6, and then import the latest MIMS drug data. Both the drug data and software update can be applied using Genie’s built-in software update mechanism.
PDF File The entire PBS is available as a 680 page PDF file. Whilst the Streamlined Authority codes are listed in this document, the size and complexity of the document make it less than ideal for quickly retrieving the requisite codes.
HCN released updates to both Medical Director 2 and Medical Director 3 on CD at the end of June. An overview of the Streamlined Authority process in Medical Director is presented on pages 26-27.
While the vast majority of prescribers now have access to the Internet at their primary site of service, this resource may be of benefit to prescribers who need to access the Streamlined Authority codes at aged care facilities, during home visits, or at other times when Internet access is not available.
Hardcopy Until December this year, a number of copies of the Yellow Book have been made available for prescribers at no charge. After this time, copies of the Yellow Book will cost approximately $28.
The PBS Offline resource is available as a free download from the PBS website, with versions available for Microsoft, Macintosh and Linux operating systems. It is also available for order on CD via the PBS website for $25.
Clinical Software Best Practice, Genie Solutions, Medical Director (HCN) and Zedmed have released updated versions of their software that automatically inserts the four-digit Streamlined Authority code when a compliant medication is prescribed.
Personal Digital Assistants (PDAs) The PBS is available in formats suitable for PDAs running Mobipocket, Vade Mecum or Plucker.
Best Practice users need to upgrade to version 22.214.171.1242, which is available from the Best Practice website.
Zedmed Clinical users need to upgrade to version 3.19, and then import the latest MIMS drug data. Both of these updates are available at the Zedmed website via the “Private Support Area”. Other vendors, including Mediflex, Medtech Global and the Practice Management Software Company have indicated that they are in the process of developing updates for their software to better facilitate the streamlined process. A/Prof Gullotta is thankful for the timely response of these vendors, acknowledging that the efficiency of the system for prescribers is heavily dependent on software integration. “The GPs that I have spoken to that have computer software integration find
Below - A screen shot of a section of the PBS website showing the Streamlined Authority Codes for the various indications/restrictions for Plavix, one of 200 items that can be prescribed under the recently introducted PBS Streamlined Authority System.
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FEATURES STEP 1
Select the medication, as usual.
Dose the medication, as usual.
For streamlined authority medications with only one restriction, the streamline number will be automatically entered in for you. Explanatory text will appear in blue.
Click on the Authority button to print out the prescription.
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FEATURES Both Pages - The Streamlined Authority Prescription workflow in Medical Director (MD). This functionality was introduced in both Medical Director 2 and Medical Director 3 as part of HCN’s July 2007 update. (All images provided courtesy of the Health Communications Network) PP26 (Steps 1-6) - The process when only one indication (restriction) is possible. PP26/PP27 (Steps 1-4, 4A, 4B, 4C) - The process when multiple indications (restrictions) are possible.
For Streamlined Authority medications with more than one indication (restriction), the “View List” button presents to enable you to select the appropriate entry.
Click the “View List” button.
Select the Restriction you want and click “OK”. The Streamline Authority number will be entered into the prescription for you.
Click on the Authority button to print out the prescription.
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FEATURES it fantastic, easy to use and increases the amount of time they have for face to face consulting with the patient. This is a win for the doctor who will have less red tape to deal with, and a win for the patient who has more time with the doctor.” Phone Doctors who are unable or unwilling to access Streamlined Authority codes via other methods are still able to call Medicare Australia or DVA for authority codes.
LIMITATIONS As indicated earlier, not all authority medicines are able to be prescribed under the streamlined system. As before, a phone call will still be required to prescribe Section 100 medications, items listed on the Repatriation Schedule of Pharmaceutical Benefits (RSPB), short term use items and quantities or repeats above those specified in the PBS schedule. Going forward, new items recommended for listing on the PBS by the Pharmaceutical Benefits Advisory Committee (PBAC) may be considered appropriate for inclusion in the Streamlined Authority process. The addition of such items will likely be partially dependent on whether doctors prescribe newly “streamlined” drugs at historical levels.
PERFORMANCE TO DATE Given that the system has only been in
place for a month, Medicare Australia and the PBS chose not to provide Pulse+IT with statistical data on the impact of the Streamlined Authority system. Anecdotal evidence provided by both Government organisations suggests, however, that the Streamlined Authority system has made an impact on the number of telephone authority requests.
CONCLUSIONS The Streamlined Authority system represents a positive first step in the AMA’s efforts to reduce the red tape associated with authority prescriptions. It is likely that most prescribers will find the PBS website to be slightly more efficient than using the telephone to access authority codes, however clinical software that makes allowances for the streamlined system is by far the most efficient option available to doctors presently. Thanks to a conserted effort by several clinical software vendors, the vast majority of prescribers already have access to such software. Practices that haven’t updated their software recently should contact their vendor and find out whether such functionality has been added. Unfortunately, there will be thousands of prescribers using antiquated, discontinuted or niche software solutions that will have no prospect of seeing this functionality added to their software.
In conjuction with other recent and forthcoming government initiatives that hinge on actively developed practice software (e.g. paperless DVA claiming, Medicare Easyclaim, electronic prescribing), the Streamlined Authority system may flag to some practices, that their practice software may have reached the end of its useful life. Simon James is the Editor of Pulse+IT. Australian Medical Association www.ama.com.au Best Practice www.bpsoftware.com.au Genie Solutions www.geniesolutions.com.au Medical Director (HCN) www.hcn.com.au Mediflex www.mediflex.net.au Medtech Global www.medtechglobal.com PBS www.pbs.gov.au Practice Management Software Company www.pmsc.com.au Zedmed www.zedmed.com.au
Faster. Smarter. Stable. Ad-free. And more intuitive at your fingertips. The evolution of Australia’s fastest growing GP software continues as Best Practice Management now goes live with Best Practice Clinical. With companion software, Top Pocket – for your PDA – Best Practice gives you the unique, fully integrated whole-of-practice software suite you’ve been waiting for. Call, write or email for a FREE Demo CD of the lot. Best Practice Software PO Box 1911 Bundaberg QLD 4670 Ph 07 4153 1277 www.bpsoftware.com.au
SECURE ELECTRONIC MESSAGING WITH ARGUS Simon James BIT, BComm INTRODUCTION This is the second article in a perpetual series of technical demonstrations designed to assist medical practices to better understand secure electronic communication. The previous article in this series demonstrated the transmission of an electronic referral from a General Practice using Genie, to a Specialist Practice using Medtech Mercury. Healthlink was used to transport the message securely through the Internet. Like its predecessor, this article demonstrates a secure messaging scenario using software that is available to practices now!
of the important conditions that will need to be in place before widespread secure communication becomes a reality in Australia. These include: 1. The “sending” clinical application should be the software product that creates the message to be transmitted. 2. With the exception of encryption and decryption, this message should not be altered during transmission. 3. The antiquated and unsuitable “PIT” messaging format should not be used at any stage in the process. 4. The message acknowledgement process needs to start with the recipient’s clinical software and end with the clinical software that created the original message.
This article consists of three sections: 1. A brief description of the software and companies referenced in the article. 2. An overview of the installation and configuration procedures used to prepare the software for the demonstration. 3. A demonstration of one possible use of the combined software solution. Given this broad scope, some of the technical explanations in this article are dealt with less comprehensively than others. Where further explanation is required, the vendors mentioned in this article will be happy to assist practices to adapt the information presented to their own situation. Existing users of the products referenced in this article may note that the methodology adopted by the author differs to the way in which their software has been configured. This has been done to ensure compliance with some
While these requirements may appear somewhat arduous and unrealistic, this article will demonstrate that it is possible to securely communicate with your colleagues, without compromising the quality of the end-to-end solution.
IT TAKES THREE TO TANGO The demonstration in this article is framed around the transfer of a GP referral letter to a Dermatologist. In this process, there are typically three software applications used: 1. The sender’s clinical software. 2. The recipient’s clinical software. 3. The messaging software. The Sender’s Clinical Software For the purpose of this demonstration, Best Practice will be the software used to generate the electronic referral letter. Developed by the company with the same name, Best Practice has attracted
a steady stream of converts since its first site went live in late 2004. In addition to the Best Practice clinical application, Best Practice now also develops an integrated practice management solution (Best Practice Management), and a PDA product (Top Pocket) designed to interface with the desktop software. The Recipient’s Clinical Software Zedmed was chosen as the software to receive the electronic referral letter. Formerly known as Medipak, Zedmed develops both clinical and practice management solutions for GPs and Specialists. Now owned by practicing GPs, the company has a lineage stretching back nearly 30 years. During this time, the company has built a national client base, with a high concentration of sites in their home state of Victoria. The Messaging Software Argus has been chosen to transport the message between the GP and Dermatologist. “Argus” actually refers to a collection of interrelated products that together, allow messages to be encrypted, sent via email, then decrypted and processed by the recipient. Two Argus products will be referenced in this article: 1. Argus Messenger is the core of the Argus suite, providing the email functionality, encryption and decryption services, and message acknowledgement handling. 2. Argus Agent is a simple program designed to check (poll) folders for files to send. These files are then made available to Argus Messenger for encryption and sending.
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FEATURES SETUP Following are the steps that need to be performed before a site running Best Practice can send a secure electronic referral letter via Argus to a site running Zedmed: 1. 2. 3. 4. 5. 6. 7.
Establish a dedicated email account. Arrange PKI certificates. Register with ArgusConnect. Update the clinical software. Install Argus. Create message directories. Configure Argus to interface with the clinical software. 8. Configure the clinical software to interface with Argus. 9. Search the Argus Address User Directory. 10. Update the Argus Address Book. 11. Update the Best Practice address book. 12. Inform your colleagues that you are able to send/receive correspondence via Argus. These steps are outlined in more detail below. Please note that while these instructions are specific to Best Practice and Zedmed, practices using other clinical software should be able to apply significant parts of the information presented to their own circumstances. 1. Establish A Dedicated Email Account As Argus uses standard email system to transport messages, practices need to setup an email address for use with Argus. While it is possible to use an existing email address, it is recommended that practices organise a new email address for the exclusive use of Argus. If your practice has its own domain name, you may like to follow ArgusConnect conventions and simply setup the email address generically as “argus”, followed by your domain name, e.g.: firstname.lastname@example.org If your Internet Service Provider (ISP) allocates your email addresses, or if using the above email convention isn’t possible for some reason, you may choose to prefix ‘argus’ with the initials of the practice, e.g.: email@example.com
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Depending on your existing email arrangements, the cost of establishing this additional email address will be minimal or indeed free. In addition to the above email address, Argus requires that practices have another email address to monitor any error messages that Argus may generate. Usually the Practice Manager’s email address would be used. 2. Arrange PKI Certificates Public Key Infrastructure (PKI) certificates are used by Argus to encrypt messages for secure transport through the Internet. Argus has been designed to use the same PKI certificates as those utilised by the Medicare Australia Online Claiming system (formerly HIC Online). ArgusConnect can also issue its own certificates to sites who don’t have access to their HeSA certificates, or to sites that would prefer not to use them for secure messaging.
6A. Create Best Practice Directories As Best Practice can both send and receive HL7 messages via Argus, the following directory structure needs to be created: C:\ArgusMessages\Incoming C:\ArgusMessages\Outgoing C:\ArgusMessages\Outgoing\Sent Practices are free to choose alternate names and locations for these directories, so long as any deviation from the examples listed above is replicated consistently throughout the configuration process. 6B. Create Zedmed Directories If the following directory doesn’t already exist, Zedmed users will need to create it on their server: C:\zedmed\download This directory is where Argus Messenger will be configured to deposit incoming HL7 files at the recipient’s practice.
3. Register With ArgusConnect Once the email addresses and certificates have been organised, practices need to contact ArgusConnect to register their intent to install and begin using the Argus software suite.
7. Configure Argus To Interface With The Clinical Software As with the installation of Argus, its configuration should be conducted with the assistance of the ArgusConnect help desk. This process would usually occur as part of the installation.
4. Update The Clinical Software As secure messaging is gaining momentum in the market, it is not surprising that many clinical software vendors have enhanced the secure messaging functionality in their products recently. Practices are therefore advised to update to the latest version of their clinical software before commencing any secure electronic correspondence.
8. Configure The Clinical Software To Interface With Argus Now that Argus is installed and configured to send electronic correspondence, we next need to configure the clinical software to work with Argus:
5. Install Argus For the uninitiated, an Argus installation and configuration can be both a daunting and time-consuming task. Fortunately, ArgusConnect undertakes to provide assistance to new customers via phone and remote access. Because the integrity of any secure messaging solution is heavily dependent on its correct installation and configuration, the author strongly advises practices to take advantage of this service.
Best Practice - Set HL7 Message Format Best Practice allows outgoing HL7 messages to be created in two different formats; REF and ORU. “REF” is an abbreviation for “referral”, and is the format that Best Practice sites should use for outgoing electronic correspondence. “ORU” stands for “Observation Result / Unsolicited”, a format that is designed to be used for the delivery of HL7 lab results. To set the message format: 1. Navigate to the Best Practice home screen.
FEATURES 2. From the “Setup” menu, select “Configuration”. 3. From the list on the left of the screen, select “E-mail”. 4. Set the “Default HL7 export format” to “REF”. 5. On the same screen, ensure the “Use Argus format” checkbox is unticked (see Figure 1). 6. Click the “Save” button to close the window.
A detailed explanation of why “Argus format” should be unticked is presented in the “Which HL7?” sidebar on page 35. Best Practice - Specify The Output Directory To specify the folder that Best Practice will export HL7 messages to, the user is required to export a message manually. To do this: 1. From the Best Practice home screen, create a new letter by clicking on the Letter icon at the top of the screen. 2. From the “File” menu, select “Export HL7”. 3. Navigate to the outgoing Argus directory that was created in Step 6A: C:\ArgusMessages\Outgoing 4. Click “Save” (see Figure 2). 5. Click the “Exit” button to complete the process.
A HL7 message will be created in the aforementioned directory. As this file does not contain a real patient letter, it can be safely deleted. As will be demonstrated later, this manual export process only has to be completed once. Best Practice will now remember the location that the HL7 message was exported to, and use this location for subsequent outgoing messages. Best Practice - Specify The Input Directory While this article’s focus is on sending messages from Best Practice using Argus, for completeness, the steps needed to configure Best Practice to receive electronic correspondence via Argus have been outlined below: 1. Navigate to the Best Practice home screen.
Top - The Best Practice Email and HL7 configuration screen. Note that the default HL7 export format should be set to “REF”, and the “Use Argus format” left unticked. Above - The “Save” dialog used to manually export a HL7 file to specify the default outgoing export directory.
2. From the “Setup” menu, select “Configuration”. 3. From the list on the left of the screen, select “Results Import” (see Figure 3). 4. Click the “Add” button to the right of the “Report file search paths” box. 5. Browse to and select the incoming directory that was created in step 6A: C:\ArgusMessages\Incoming 6. Click “OK”.
7. Click the “Add” button to the right of the “Acknowledgements” box. 8. Enter “Argus” as the “Facility name”. 9. Enter the following directory path into the “Acknowledgement path” field: C:\ArgusMessages\Outgoing 10. Click “Save” to complete the acknowledgement setup window. 11. Click “Save” to close the “Configuration window”.
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FEATURES Best Practice is now configured to receive HL7 messages, and to output HL7 acknowledgement messages to be forwarded to the sender via Argus.
Zedmed - Specify The File Extension Zedmed is preconfigured to check for incoming results and correspondence in the following folder: C:\zedmed\download By default however, this directory is only setup to import messages with certain file extensions (e.g. “.hl7” or .”pit”). Before Zedmed can import HL7 messages sent from Best Practice (and several other clinical products), the user must configure Zedmed to acknowledge these additional file extensions. To do this: 1. Navigate to the Zedmed Clinical home screen. 2. From the “Tools” menu, select “Global Options”. 3. Click on the “Communications” tab at the top of the window (see Figure 4). 4. If “REF”, “ORU”, or “HL7” do not already exist in the list of “File Extensions to Import” on the left of the screen, use the “Add New” button to add these extensions to the list. 5. Click “OK” to save settings and close the configuration screen.
9. Search The Argus User Directory Having configured both Argus and the clinical software, the user now needs to locate the email addressess of the colleagues with whom they wish to correspond with. While it is possible that a colleague may have provided you with their Argus email previously, the likely scenario is that you will not even know which of your colleagues are presently using Argus. Fortunately, ArgusConnect maintains a user directory that can be accessed via a web browser by all registered Argus users. To search for colleagues using Argus: 1. Go to the ArgusConnect website: www.argusconnect.com.au 2. From the left hand navigation panel on the home page, click “Argus Users Search”.
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Top - The Best Practice Results Import screen. The top list contains the path of the directory Argus will be configured to deposit incoming electronic correspondence. The list on the bottom right specifies where acknowledgements are deposited by Best Practice when it receives incoming correspondence. These acknowledgement messages should be returned to the sender to indicate that the message had been succesfully imported by Best Practice. Above - The Zedmed Communications screen. The “REF”, “ORU”, and “HL7” file extensions should be added to this list if they don’t already exist. Zedmed had developed a sophisticated interface to Argus for sending PIT messages, the configuration which can also be performed on this screen.
Above - The Argus User Directory search screen showing one possible set of search criteria. In addition to Division and specialty, users can search by any combination of suburb, postcode, practice name and practitioner name.
3. In the “Site Identifier” section, click the “Browse” button. 4. Navigate to, and select your “Site Identifier” file, which will have been issued by ArgusConnect. The file will usually be your site name followed by the “.bin” extension. 5. Click the “Login” button, optionally ticking the “Remember me next time” checkbox. 6. Perform a search using the criteria of your choosing. 10. Update The Argus Address Book After identifying the colleagues that you are able to correspond with using Argus, you then need to add these colleagues to your local Argus Address Book. Whilst there are several ways to update your local Argus Address Book, the simplest
way is to download the contact details from the centrally hosted Argus User Directory. To do this: 1. Launch and login to Argus Messenger. 2. From the “Show” menu, select “Address Book”. 3. Select “Argus User Directory Entries” from the drop down list at the top of the screen. 4. Click the “Add” button. 5. Enter the name of colleague you wish to correspond with, and then click the “Search” button. 6. Select your colleague/s from the list, and then click the “Add” button. 7. Click the “Close” button. 8. Exit Argus Messenger to complete the process.
11. Update Best Practice Address Book Having located your colleague’s Argus email addresses, this information can now be added to the Best Practice contacts address book. 12. Inform your colleagues that you are able to send/receive correspondence via Argus. Regardless of whether the colleagues that you wish to correspond with are already using Argus, it is a good idea to let them know about your plans to commence secure electronic communication with them. Taking this measure will not only give them a “heads-up” about your new communications capability, but will also allow them to add your Argus email address to their own address books.
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The electronic communication interactions relating to Dr Garry Player’s electronic referral letter to Dr Derrick Zoolander are outlined below:
Having now presented an overview of the steps required to configure both Best Practice and Zedmed to communicate using HL7 messages via Argus, this section demonstrates a practical application of the technology.
1. Creating The Referral Letter Having noted his observations in the patient record, Dr Garry Player opens his “Specialist Referral” letter template in Best Practice and writes the referral.
Meet The Doctors Dr Garry Player is a GP who works at the Novar Street Clinic. His clinic runs Best Practice software.
After saving the letter in the usual way, Dr Player clicks the “Export as HL7 file” button (circled in Figure 6 below). A HL7 file containing the referral letter is created, and deposited into the outgoing Argus folder:
Dr Derrick Zoolander is a Dermatologist who works at the Smithfield Consulting Suites. Dr Zoolander uses Zedmed. The Scenario Mr Sick Patient visits his GP, Dr Garry Player for a skin examination. Dr Player is concerned about several lesions, and instructs Mr Sick Patient to make an appointment to see Dermatologist, Dr Derrick Zoolander.
C:\ArgusMessages\Outgoing The letter and patient’s record are closed, and the consultation is concluded.
2. Sending The Referral Letter Via Argus The next time Argus Agent runs on its predefined schedule, the HL7 referral letter will be imported into the Argus Messenger database. Argus Messenger will then attach the HL7 file to an email, encrypt this email and the attachment, and send it to the Novar Street Clinic’s email server. This email server may be hosted within the practice, however more commonly the practice’s Internet Service Provider (ISP) will manage it. Usually within seconds, the Novar Street Clinic’s email server will transmit the message to the recipient’s email server and deposit it into the Smithfield Consulting Suite’s Argus mailbox. 3. Receiving The Referral Letter The message will reside on the Smithfield Consulting Suite’s email server until their
Below - The outgoing referral letter shown in Best Practice’s built-in word processor. After the letter is compiled, the “Export as HL7 file” button (circled) is clicked to export the letter as a HL7 file into the C:\ArgusMessages\Outgoing directory.
Novar Street Clinic 30/07/2007 Dr. Derick Zoolander re.
Mr. Sick Patient 23 John Street Randwick NSW 2031
Dear Derick, Thank you for seeing sick patient for an opinion and management of his solar damaged skin. Yours faithfully,
Dr. Gary Player MBBS
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FEATURES copy of Argus Messenger next checks for encrypted correspondence. This will usually occur on a predefined schedule. When Argus Messenger downloads the email, the HL7 attachment will be unencrypted and deposited into the into Zedmed’s incoming results/ correspondence directory, i.e.: C:\zedmed\download 4. Importing The Referral Letter Into Zedmed Dr Derrick Zoolander imports the referral letter in the same way as pathology (i.e. from the “Results” menu, select “Import Laboratory Results”, or Ctrl + F6). Once the HL7 file has been imported into the Zedmed database, it will be removed from the above incoming directory. Dr Zoolander will be presented with the Zedmed “Import Log”, flagging the
arrival of the incoming referral letter and any new lab results. After dismissing this log window, Dr Zoolander then clicks on the “Results Inbox” to review the letter (see Figure 7). Using the demographic details contained in the HL7 file, an attempt to match the electronic referral letter to the appropriate patient file in the Zedmed database is made. If the patient doesn’t exist in the Zedmed database, or the demographics in the HL7 file don’t match the demographics in the database, the doctor can link the referral letter to the patient manually. Once reviewed, the letter can be marked complete and removed from the Results Inbox, or marked pending if further action is required. The patient’s record can be accessed from this screen should further details need to be
checked before this decision is made. 5. Viewing The Letter From The Patient File Given that the electronic referral letter is likely to arrive days, weeks or even months before the patient presents at Dr Derrick Zoolander’s Dermatology clinic, it is likely that the letter will need to be reviewed at the beginning of the consultation. Typically this will be performed from within the patient record: 1. Under the “Summary Views” pane on the left hand side, click on the “Results” tab to display the list of results and incoming letters. 2. Right-click on the relevant referral letter, and select “View Results”. The letter will be displayed in the window on the right hand side of the patient record screen.
Below - The referral letter shown in Zedmed’s “Results Inbox”. Zedmed displays some of the key infomation extracted from the HL7 file at the top of the letter. The reader should note that Zedmed has retained the rich text formatting that was included in the original Best Practice referral letter.
From: Novar Street Clinic Name: Mr. Sick Patient Address: 23 John Street Randwick NSW 2031 DOB: 01/01/1973 Sex: M
Novar Street Clinic 30/07/2007 Dr. Derick Zoolander re.
Mr. Sick Patient 23 John Street Randwick NSW 2031
Dear Derick, Thank you for seeing sick patient for an opinion and management of his solar damaged skin. Yours faithfully,
Dr. Gary Player MBBS
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Best Practice Database
Sender’s Email Server
Recipient’s Email Server
Secure HL7 Referral
< 5 seconds
Secure HL7 Referral
< 5 seconds
“Ctrl - F6”
Secure HL7 ACK
Secure HL7 ACK
< 5 seconds
Above - This diagram outlines the journey of Dr Garry Player’s referral letter to Dr Derrick Zoolander. With the exception of the initial “Export HL7 file” command in Best Practice, and the “Import Lab Results” command in Zedmed, all other stages of the referral letter’s journey are triggered automatically. The Argus HL7 acknowledgement’s return journey is also shown. It is important to note that as Argus generates this ACK, it only serves to let Dr Garry Player know that his referral letter has been received by Dr Derrick Zoolander’s Argus installation. While this does provide some assurance to the sender, it does not reveal whether the referral letter has been imported into Zedmed, or whether Dr Derrick Zoolander has read it.
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FEATURES WHAT ABOUT THE ACKS? As indicated in the diagram on pp34, Argus has built-in message acknowledgement (ACK) functionality. The primary function of this “Transport Level” acknowledgement system, is to ensure that messages sent using Argus reach the recipient’s Argus installation. While Transport ACKs are important, acknowledgement functionality also needs to be provided by the clinical software to eliminate the chance of messages being lost in the “hand over” between the messaging and clinical software. Two major factors prevented these “Application Level” acknowledgements from being demonstrated in this article: 1. In the pre-release version of Zedmed that was provided to the author for the purposes of this article, HL7 acknowledgement messages
WHICH HL7? As indicated on page 25, Best Practice can create HL7 messages in two formats; ORU and REF. Unfortunately, ensuring HL7 messages can be read by your recipient’s clinical software is more complex than simply sending either a REF or an ORU file. This stems from the fact that the HL7 specifications are quite flexible, and several ways to embed the body of a letter into a HL7 file have emerged. Best Practice provides two such methods, “Default” and “Argus” format. While the underlying structure of both of these HL7 files is the same, the way in which the body of the message (in this case the referral letter) is stored differs significantly. Best Practice’s Default HL7 Format When this option is enabled, Best Practice inserts the referral letter into the HL7 file in Rich Text Format (RTF). Best Practice’s “Argus” HL7 Format When this option is enabled, Best Practice encodes the referral letter in “Base64” prior to inserting. Historically advocated to clinical software developers by ArgusConnect, this format seeks to ensure that sections of
(ACKs) were not generated when an incoming HL7 message was received. 2. Whilst Best Practice does generate ACK messages, it does not track the receipt of ACKs sent by software in response to its outgoing messages. In other words, even if Zedmed was able to generate ACKs, Best Practice would not do anything with them! Fortunately, both Best Practice and Zedmed have indicated that these shortcomings will be addressed in future releases of their software.
As alluded to earlier, the Argus product suite is highly customisable, allowing it to interface with a wide variety of clinical systems. Unfortunately however, this flexibility means that the correct configuration of the software is not always a straightforward process. Fortunately, ArgusConnect offer to assist practices with the installation and configuration of Argus, and the configuration of their clinical software to work with Argus. This process usually takes place via telephone and/or remote access for a flat fee of $330 (reduced to $220 for prepayment).
The Argus software suite is provided free of charge to GPs and Specialists. This is made possible by the fact that ArgusConnect charges larger organisations, such as pathology and radiology providers, for the use of their software.
Practices may also find that their Divison and various independent IT professionals are available to assist with the installation.
poorly crafted HL7 messages are not ignored by the recipient’s software.
As you would expect, neither Best Practice nor Zedmed levy a charge on their customers for using Argus.
Problems? While both of these encoding options fall within the HL7 specification, issues can arise when the recipient’s software cannot deal with these and other common encoding conventions. At the time of writing, Zedmed was unable to import HL7 messages encoded in Best Practice’s “Argus” format (Base64), but as demonstrated, did a good job of importing referral letters encoded with Best Practice’s “Default” format. Confusingly, there are other clinical software packages on the on the market where the opposite scenario is true, highlighting one of the major issues faced by both clinical and secure messaging software developers. To a large extent, these issues can be overcome by using the message translation features built in to some secure communication products including Argus, however ultimately, the industry will be best served if clinical software vendors can reach agreement on the best way to encode the text inserted into their HL7 messages.
Once installed, ongoing support is provided free of charge by ArgusConnect.
CONCLUSIONS This article has outlined the steps involved with configuring Best Practice and Zedmed to use Argus to send and receive secure electronic correspondence. As highlighted by the brevity of the demonstration on pages 32-33, once configured, sending secure HL7 referral messages from Best Practice and receiving them with Zedmed is a very simple process. Fortunately, the scenario presented in this article isn’t unique in the market, and the author encourages all practices to contact their clinial software vendors to discuss the secure messaging options available to them. Simon James is the Editor of Pulse+IT. ArgusConnect www.argusconnect.com.au Best Practice www.bpsoftware.com.au Zedmed www.zedmed.com.au
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EASYCLAIM UPDATE Simon James BIT, BComm
INTRODUCTION Announced by Prime Minister John Howard on 13 August, 2006 Medicare Easyclaim is a new patient payment system developed by Medicare Australia for Specialist and General Practice. The particulars of the Medicare Easyclaim system were covered in detail in two articles in the May edition of Pulse+IT [“Ease Into Easyclaim” - pp24-27, “Easyclaim Integration” - pp28-29]. A brief summary of the information presented in these articles is contained in the “Easyclaim Background” sidebar. With the wide scale roll out of Medicare Easyclaim now imminent, it is an opportune time for practices to start to familiarise themselves with the various ways in which they can access the system. In an effort to assist, this article seeks to provide an update on the current capabilities and future plans of the financial institutions registered to facilitate Medicare Easyclaim transactions.
THE PLAYERS As was the case in May, Medicare Australia has publicly acknowledged three financial institutions that are interested in facilitating Medicare Easyclaim transactions. These organisations include the Commonwealth Bank (CBA), the National Australia Bank (NAB) and Tyro. A brief summary of their current capabilities and future plans follows: Commonwealth Bank CBA’s Easyclaim solution, dubbed “MediClear”, was accredited 27 June, 2007 making them the first financial institution to obtain Medicare Australia certification. Since then, the bank has deployed Easyclaim compatible terminals to selected practices, and is
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closely monitoring the adoption and performance of the system at these sites. The CBA is the largest supplier of EFTPOS terminals to the health care sector, and expects to be able to leverage its resources to aggressively deploy new terminals to existing customers in the coming weeks. With the development work for their stand-alone Easyclaim solution now complete, the CBA claims that it will now focus on delivering integrated solutions to the market. A spokesperson for the CBA stated that the bank expects to provide “universal integration to all practice management software”, an ambitious goal, the pursuit of which will be watched with interest by many. As with the other financial institutions, the CBA does not charge practices to use their Easyclaim solution. Monthly EFTPOS access fees still apply however, ranging from $19.80 to $29.70 depending on the contract period to which the practice commits. National Australia Bank On 24 May, 2007 the National Australia Bank established a business unit dedicated to the health sector. Dubbed “NAB Health”, the branch will be responsible for managing the NAB’s Medicare Easyclaim endeavour, as well as its existing health related ventures. These include its Health Insurance Claims and Payment Services system (HICAPS), and Medfin, the banks medical equipment financing operation. The National Australia Bank has not yet completed the Medicare Easyclaim accreditation process, and is therefore not in a position to provide a specific timeframe for when their Easyclaim
service will commence. Promotional material suggests that the bank is still on track to deliver its solution before the end of the year. As with the CBA, NAB customers will require either a new terminal, or a software update on their existing terminal before they can begin processing Medicare Easyclaim transactions. The NAB did not disclose its planned pricing structure, however the bank did indicate that it is waiving terminal rental fees until it delivers Medicare Easyclaim functionality later in the year.
EASYCLAIM BACKGROUND Unlike Online Claiming, which makes use of the Internet and practice software to process claims, Medicare Easyclaim has been designed to use the EFTPOS network. It can therefore operate independently of both the Internet and practice software, however it is expected that some vendors and financial institutions will release integrated solutions that will streamline the Easyclaim billing process considerably. Participating financial institutions will be paid a per transaction fee of 23 cents by Medicare Australia for providing the service. Despite the expected efficiency gains Medicare Australia will enjoy (if indeed Easyclaim is embraced), neither practices nor software vendors will be paid to adopt the system.
FEATURES Tyro Tyro is a recent entrant into the Australian EFTPOS services market, and operates under a special banking license that allows it to provide credit, debit and EFTPOS merchant services. Tyro utilises modern EFTPOS terminals that are designed to make use of practice’s existing broadband Internet infrastructure, thus negating the need for a phone line dedicated to the practices EFTPOS facility. On 26 April, 2007 Tyro announced that it is working with the Health Communication Network (HCN) to develop integrated Medicare Easyclaim solutions. The collaboration is seeking to deliver Easyclaim enabled versions of both PracSoft and Blue Chip before the end of the year. Once these products are made available to the market, Tyro plans to allow other practice software vendors to integrate with its EFTPOS solution. Betting on the strength of HCN’s integrated solutions, Tyro has no current plans to deliver Medicare Easyclaim
functionality in a stand alone solution. This does not however, prevent practices from using Tyro EFTPOS terminals to receive traditional card payments while they await an integrated Medicare Easyclaim solution. Indeed, despite recent discounting efforts by the entrenched banks, Tyro’s rental and transaction prices compare favourably with both the CBA and NAB. Coupled with the fact that the Tyro terminal does not require a dedicated phone line, practices may find that the new entrant’s “vanilla” EFTPOS solution will save them several hundred dollars per year.
CONCLUSIONS The Commonwealth Bank’s Medicare Easyclaim certification and the subsequent commencement of Mediclear signals the beginning of what will be a fiercely contested battle for control of practice EFTPOS services. As new EFTPOS technology is deployed, medical practices will be able to make an informed decision as to whether the new patient claiming system will be of benefit to their practice.
Integrated Easyclaim solutions will lend much credibility to the system, however ultimately, technology will have little to do with success or failure of Easyclaim. Rather, the fortunes of the system will depend solely on whether the Government capitulates and offers to pay non-trivial, per transaction fees to medical practices that adopt Medicare Easyclaim. Simon James is the Editor of Pulse+IT.
Commonwealth Bank - Mediclear www.commbank.com.au/mediclear Health Communication Network www.hcn.com.au Medicare Australia http://tinyurl.com/3co6ev National Australia Bank www.nab.com.au Tyro www.tyro.com.au
Introducing HealthLink’s Partner Systems
HealthLink focuses on integration with its partners’ systems and works together with them to implement and test new communications services. HealthLink’s key concern is ensuring that HealthLink enabled systems are both easy to use and 100% reliable. HealthLink believes that compromising service quality is not acceptable in today’s healthcare environment.
Tel 1800 125 036 firstname.lastname@example.org
INTEGRATED EFTPOS Simon James BIT, BComm
This article introduces the concept of integrated EFTPOS, a potential “byproduct” of the Medicare Easyclaim system that promises to deliver efficiency benefits to practices, regardless of whether they choose to adopt the Government’s new patient billing initiative.
The most obvious benefit of integrated EFTPOS is that the entry of the transaction details do not need to occur twice (i.e. once into the practice software and again into the EFTPOS terminal). The benefits that flow from reducing duplicate data entry revolve around increased operator efficiency and a reduction in data entry errors.
WHAT IS IT? As with Medicare Easyclaim, “integration” in the medical practice context refers to the connection of the EFTPOS terminal to the practice’s billing system. Integrated EFTPOS solutions are commonplace in high customer volume shops such as supermarkets, petrol stations, department stores and post offices. With the ever-increasing proliferation of technology however, an increasing number of smaller businesses are seeking to adopt integrated EFTPOS solutions. Under the current “unintegrated” systems found in the vast majority of Australian medical practices, after generating an invoice in their practice software, reception staff need to manually re-key the transaction amount into the EFTPOS terminal keypad. Under an integrated system however, this step is typically reduced to a single mouse click on the practice software’s invoicing screen. The transaction amount is sent directly from the computer to the EFTPOS terminal, readying it for the patient to enter their account type and pin number via the terminal keypad. After the transaction has completed, the terminal sends data back to the computer to indicate whether or not the transaction has been completed successfully.
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In addition, the process of reconciling the EFTPOS terminal with the practice software is all but eliminated under an integrated scenario, as the practice software is perpetually aware of transactions conducted through the terminal. While perhaps less of a risk in medical practices than in typical retail operations, integrated EFTPOS solutions can also reduce the chance of fraud. Finally, most integrated EFTPOS solutions will consume less desk space than their stand alone cousins, as they reduce cable clutter and allow receipt printing to be consolidated to one unit.
WHY ISN’T IT AVAILABLE NOW? Historically, banks have not found it commercially viable to deal with the many different software solutions that would potentially benefit from integrated EFTPOS. Instead, they utilise software products that act as an intermediary between the banks EFTPOS infrastructure, and the various Point Of Sale (POS) software solutions. Despite the existence of these “middleware” software products, three major factors have conspired against the proliferation of integrated EFTPOS solutions in the GP and Specialist practice market: 1. The terminals and software required to deploy an integrated solution are
expensive, frequently costing over $1,000 per “checkout lane”. 2. The fragmentation of the practice software market means that most developers would not be able to sell their integrated EFTPOS solution to enough customers to justify the cost of development. 3. The major banks already have their unintegrated EFTPOS solutions deployed in the vast most medical practices, and therefore don’t have any incentive to actively promote integrated solutions.
ENTER EASYCLAIM The emergence of the Medicare Easyclaim system has the potential to nullify the aforementioned roadblocks and encourage the development of integrated EFTPOS solutions for medical practice reception counters. Given that stand alone implementations of Medicare Easyclaim will have little chance of being adopted, banks will, for the first time, have a commercial incentive to work with practice software vendors to deliver integrated Easyclaim solutions. While they share much in common, integrated EFTPOS solutions are technically easier than integrated Medicare Easyclaim systems to develop. It follows therefore, that integrated EFTPOS functionality is likely to be bundled with every integrated Easyclaim solution released to the market.
CONCLUSIONS While it is likely to be several months before such solutions appear on the market, integrated EFTPOS systems look set to finally become a reality for medical practices. Practices are advised to stay abreast of the plans of both their bank and practice software vendors. Simon James is the Editor of Pulse+IT.
DON’T LOCK YOURSELF INTO FEES & CONTRACTS Medicare Easyclaim is coming and HCN PracSoft & Blue Chip will soon be fully integrated with EFTPOS and Medicare Easyclaim. You’ll benefit from instant online claims and verification, the solution utilises your existing broadband connection saving practices the cost of the dedicated phone line for each EFTPOS terminal.
Say NO to:
Early termination fees
Phone line rentals
Phone authorisation fees
Annual admin fees
“Just because we can” fees
Tyro EFTPOS terminals are available now, so you can start saving straightaway. Simply send us a merchant statement and we’ll show you how much you can save.
Call 1300 300 161 today to find out more.
Would you like to be contacted by HCN to discuss your Medicare Easyclaim requirements? Complete this form & fax to 02 9947 2547
Name: Contact no: Practice Name: Contact me regarding: Standalone EFTPOS Terminal Integrated EFTPOS Terminal Integrated Medicare Easyclaim Integrated Medicare Easyclaim and EFTPOS
What Practice Management software do you currently use? PracSoft Blue Chip Other:
Medicare Easyclaim THE COMPLETE, LOW COST, INTEGRATED SOLUTION
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PRACTICE WEBSITES Simon James BIT, BComm
INTRODUCTION Practices interested in establishing a website, or updating an existing one, have many options available to them. Some may opt to have the job completed by a commercial web design agency, whilst others may choose to purchase web design software and attempt the task in-house. Recent advances in web and database technology however, warrant the discussion of a third option. This article provides an overview of the steps involved in setting up a modern database driven website using the popular “Joomla” Content Management System (CMS).
While Joomla includes a whole host of features “out of the box”, the system is extremely flexible, allowing for a huge array of additional functionality to be added via its plug-in architecture.
year. Whilst there are international organisations that sell hosting for less, opting for an Australian based company will usually give you better access to timely support.
Dubbed “Extensions”, there are nearly 2,000 of these plug-ins. Among these are solutions that allow newsletters to be sent from the site, website statistics to be monitored, and photo galleries to be displayed. There are even extensions that allow the user to select the language they wish to view Joomla sites in, the translations being performed automatically.
When sourcing a website host, the author strongly recommends that practices choose a company that offers “Fantastico” functionality. Fantastico is a service that makes the installation of Joomla and other web based technologies significantly easier than manual installation alternatives.
HOW DO I GET STARTED?
WHAT IS JOOMLA?
There are several steps involved in creating a website using Joomla:
Joomla is a free, open source solution designed to help users build and manage websites without the need for specialised web design software. Joomla uses sophisticated PHP code to interface with a database that stores the website’s content, allowing for a great deal of customisation and flexibility.
1. Arrange website hosting. 2. Register a domain name. 3. Install Joomla. 4. Source and install a website template. 5. Setup the website’s structure. 6. Add the website’s content. 7. Create the navigation buttons.
Despite the underlying power and complexity of the system, Joomla’s developers have done a good job of making the system intuitive and accessible to users of all technical abilities. Once installed, the system is administered entirely through a simple web interface. To manage the website, the administrator simply logs in to the “Joomla Website Administration Panel”, a special portal attached to all Joomla websites. As the administration interface is contained within the web browser, Joomla websites can be managed from any computer with Internet access.
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These steps are discussed in more detail below: 1. Arrange Website Hosting While it is certainly possible to host your website on your server or another computer within your practice, doing so has the potential to compromise the security of your practice network. A more secure and reliable option therefore, is to outsource the hosting of your website to a commercial hosting company. Fully featured hosting packages from reputable Australian web hosting companies start at around $100 per
2. Register A Domain Name As most would be aware, a domain name is the address that visitors need to enter into their web browser to access a website. While there are now several alternatives available (e.g. “.com”, “.net”, “.net.au”), the “.com.au” domain name is usually the most desired variant in Australia. A “.com.au” domain name can be purchased for around $30, allowing you the use of the domain for 2 years. Prior to expiry, you will be given the option to renew your lease of the domain. As most web hosting companies provide domain name services, it is a good idea to purchase your domain name when you setup your hosting package. Doing so can expedite the time taken to match your domain name with your website, and minimises the number of suppliers you have to deal with. 3. Install Joomla As indicated earlier, web hosting services that provide Fantastico functionality can streamline the process of installing Joomla on your webserver to a few mouse clicks.
FEATURES In the absence of Fantastico, the steps required to install Joomla will depend heavily on your web host’s server arrangements. Generally, the steps involved are: 1. Manually setting up an SQL database to hold the website’s content. 2. Uploading the Joomla installation files to your web server. 3. Configuring the Joomla installation to communicate with the SQL database. Comprehensive instructions on how to install Joomla can be found at the official Joomla website. Before attempting a manual installation, practices may need to get in touch with their web hosting company to find out what hosting environment your website is hosted on. 4. Source And Install A Website Template One of the best features of Joomla and other database driven websites is that the content on the site is “separated” from the site’s design. This essentially means that you can radically change the design of your site, without having to re-enter all the information.
Joomla uses templates to make the process of switching between various website templates easy. Advanced users with web design experience may wish to create their own template, however as there are a plethora of free and cost effective templates available online, most Joomla users choose to simply download a pre-prepared design.
or right sides. This can be achieved by simply specifying the “Site Module Position” as “Top”, “Left” or “Right”.
After sourcing a Joomla template with a pleasing appearance, the template files need to be uploaded and installed using the Joomla Website Administration Panel. Once installed, the administrator needs to simply select the new template as the default appearance for the website.
In most cases, pages will be created using the “Static Content Manager” via Joomla’s Administration Panel. As with all Joomla’s content generation screens, text can be entered using a “What You See Is What You Get” (WYSIWYG) editor.
5. Setup The Website’s Structure Joomla’s website layouts are built upon the concept of module positions. This simply means that users are free to choose where to display “sections” of their website within the template design. For example, a typical Joomla website template will allow the primary navigation menu to be placed either at the top of the screen, or on the left
6. Add The Website’s Content With the sites appearance now established, the information that the practice wishes to display on their website needs to be added.
Many of the formatting functions are identical to those found in a typical word processor, making content generation and modification easy, even for non-technical users. In addition to formatted text, images and links to other web pages can be included in Joomla content pages. Each page created in the Static Content Manager will correspond to single page on the practice’s website.
Top - The Joomla Text Editor. Many of the formatting functions are identical to those found in a typical word processor, making content generation and modification easy, even for non-technical users. In addition to text and tables (shown), images and links to other webpages can be included. Above - The Joomla Control Panel. Among other things, this screen allows the user to manage their websiteâ€™s content and menu structure.
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FEATURES 7. Create The Navigation Buttons With the design and content now in place, the website needs to have menus added to allow visitors to navigate between the various pages created in Step 6. Navigation menus are created using the “Menu Manager” in Joomla’s Administration Panel. While multiple menus can be created (e.g. one for the top of the site and another for the left side), most practice website should only require one. Within the menu, menu items (buttons) need to be added, one for each page on the website. As part of the menu item creation process, the website administrator needs to link the button to its corresponding web page. The name assigned to each menu item will be the label that appears on the navigation button.
ALL TOO HARD? Even though specific technical detail has not been provided in this article, the author appreciates that the very notion of what has been outlined may appear
daunting to some readers. Fortunately, once installed and configured, most practice staff will have few problems using Joomla to add or modify content on their website. To assist them to get to this position, practices may consider engaging an IT professional for a few hours to assist with the installation and configuration of Joomla.
This article has provided a brief overview of the steps required to setup a practice website using the Joomla CMS. For more information and specific installation instructions, readers are encouraged to consult the plethora of information available from both the official Joomla website, and many other websites devoted to the technology.
While there are certainly other options available to practices looking to establish or improve their web presence, practices with access to moderate levels of IT expertise will find Joomla to be a very cost effective, powerful and flexible solution. Simon James is the Editor of Pulse+IT.
Fantastico www.fantastico.com Joomla www.joomla.com
www.joomla24.com Joomla Shack www.joomlashack.com Rocket Theme www.rockettheme.com
HOSTING SERVICES AusWeb www.ausweb.com.au Jumba www.jumba.net.au
P: 03 5335 2220 F: 03 5335 2211 E: email@example.com W: www.argusconnect.com.au Contents: 27-35 ArgusConnect provides and supports software that enables doctors and healthcare organisations to exchange clinical documents securely and reliably.
P: 02 8883 4425 F: 02 8883 4426 E: firstname.lastname@example.org W: www.docstock.com.au Contents: 41, 43
P: +61 2 9906 6633 F: +61 2 9906 8910 E: www.hcn.com.au W: email@example.com Contents: 22-26, 36-37, 39
DocStock is an exclusively-online store retailing quality medical equipment to Australian doctors.
Health Communication Network (HCN) is the leading provider of clinical and practice management software for Australian GPs and Specialists.
P: 1800 188 088 F: 1800 644 807 E: firstname.lastname@example.org W: www.gpa.net.au Contents: 8
P: 07 4153 1277 F: 07 4153 2093 E: email@example.com W: www.bpsoftware.com.au Contents: 3, 22-26, 27-35 Best Practice sets the standard for GP clinical software in Australia offering a flexible suite of products designed for the busy GP practice, including: • Best Practice Clinical (“drop-in” replacement for MD2) • Integrated Best Practice (clinical/management) • Top Pocket (PDA companion software for Pocket PC)
P: 07 3720 2801 F: 07 3720 2802 E: firstname.lastname@example.org W: www.geniesolutions.com.au Contents: 13, 22-26 Genie is a fully integrated appointments, billing and clinical management package for Specialists and GPs.
P: 0413 138 024 F: 07 3878 1991 E: email@example.com W: www.coactive-events.com Contents: 12 CoActive Events is an innovative event management company committed to producing professional, successful and unique events by working collaboratively to simplify your role. With over 20 years experience, CoActive Events is a hands-on conference and events company that offers a full range of services right from the start with program planning and development, marketing and promotion, online registration and financial services along with venue and speaker arrangements.
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GPA ACCREDITATION plus has given General Practice a reliable alternative in accreditation. GPA is committed to offering an accreditation program that is flexible and understands the needs of busy GPs and practice staff.
P: 03 9675 0600 F: 03 9675 0699 E: firstname.lastname@example.org W: www.global-health.com Contents: 12 Global Health’s range of solutions delivers smart health to all members of the healthcare community. ReferralNet takes advantage of email and the internet to provide a practical and secure infrastructure for delivering healthcare information efficiently to industry professionals. MHAGIC is the latest and most comprehensive Mental Health Assessment Generation and Information Collection system in Australia. Locum replaces traditional paper records with a robust electronic filing system that manages patient information and improves the efficiency of medical practice.
HCN focuses on improving patient outcomes by providing evidence based software tools to health care professionals at the point of care. Medical Director • Blue Chip Pracsoft • iRIS.
P: 1800 125 036 F: 07 3870 7768 E: email@example.com W: www.healthlink.net Contents: 37, 48 Australia’s largest effective secure communication network. • Fully integrated with leading GP and Specialist clinical systems • Robust; Reliable and Fully Supported
P: 1300 794 471 F: 07 3257 7736 E: firstname.lastname@example.org W: www.pmsc.com.au Contents: 22-26 ...faster, simpler and absolutely intuitive • Complete electronic health record • Complete practice management • Complete HIC online • Powerful data mining tools • All modules integrated under one open source database
Join the network that more than 60% of GPs use for diagnostic, specialist and hospital communications.
P: 03 9388 0555 F: 03 9388 2086 E: email@example.com W: www.hisa.org.au Contents: 10-11 The Health Informatics Society of Australia (HISA) aims to improve healthcare through health informatics.
P: 1300 55 15 15 F: 03 8517 8001 E: firstname.lastname@example.org W: www.messagenet.com.au
P: 02 9956 3827 F: 02 9901 3705 E: email@example.com W: www.intrahealth.com Contents: 18-19, 21 Intrahealth is a major supplier of healthcare software. Out leading edge solutions offer a family of products for use by healthcare professionals the the point of care. Profile is a fully integrated financial, clinical and appointment practice management system used by GPs and specialists. • Excellent robustness and reliablity. • Powerful reporting / data extraction. • Extendable and customisable. • Multi site access. • 3 tier architecture. • Load balancing redundancy.
MessageNet has been pioneering SMS communication technology in the Australian market for over a decade. With in excess of 1,800 Corporate, Government and SME customers, MessageNet is Australia’s largest and most reliable provider of SMS, eFax, mobile data and mobile application development solutions. MessageNet has extensive experience working with software developers in a variety of industries, offering free APIs and 24/7 technical support.
P: 07 3839 4321 F: 07 3939 1251 E: firstname.lastname@example.org W: www.mobilecomputing.net.au
P: 1300 832 463 F: 02 6971 9610 E: email@example.com W: www.techmed.net.au
Techmed specialises in medical IT support and solutions.
P: 08 8201 7733 F: 08 8201 7744 E: firstname.lastname@example.org W: www.npcc.com.au The National Primary Care Collaboratives (NPCC) program implements the Collaborative improvement methodology in Australian general practice; improving patient clinical outcomes, reducing lifestyle risk factors, helping maintain good health for those with chronic and complex conditions and promoting a culture of quality improvement in primary health care. The program currently focuses on three topic areas:
P: 02 9422 6700 F: 02 9420 2272 W: www.wacom.com.au Wacom is the worldwide market leader in graphic tablet technology and interactive pen displays. For practices looking to move toward a paperless office system, Wacom has a number of solutions that are intuitive and easy to use.
• Diabetes • Secondary Prevention of Coronary Heart Disease • Better Access to primary care
Pulse+ IT AUSTRALIA'S FIRST & ONLY HEALTH IT MAGAZINE
Mobile Computing supply and support Health Technology.
P: 07 5445 5037 F: 07 3221 0220 E: email@example.com W: www.medical-objects.com.au Contents: 11 Medical-Objects is a medical software firm specializing in the secure delivery of clinical data between health care providers.
P: 02 8298 2600 F: 02 8298 2666 E: firstname.lastname@example.org W: www.nehta.gov.au Contents: 14 The National E-Health Transition Authority is responsible for developing key national health IM&ICT standards and specifications.
P: 0402 149 859 F: 02 9475 0029 E: email@example.com W: www.pulsemagazine.com.au Contents: 6, 15 Pulse Magazine is the publisher of Pulse+IT, Australia’s first and only magazine dedicated to health IT. We have a range of products designed to help Australian medical practices gain a better understanding of technology and its specific application in the health sector. • Pulse+IT Magazine • Pulse+IT eNewsletter • Pulse+IT Website • Pulse+IT Podcast
P: 03 9818 5488 F: 03 9818 5499 E: firstname.lastname@example.org W: www.zedmed.com.au Contents: 22-26, 27-35 For 30 years Zedmed has been one of Australia’s most innovative and successful, fully integrated practice management and clinical record solution providers. • Fast • Stable • Innovative • Secure The new generation of medical software.
Looking to advertise? Pulse+IT is the most innovative publication in health and the only one dedicated to Information Technology (IT). If you are interested in advertising and would like more information, call Simon James on 0402 149 859 or visit the Pulse+IT website: www.pulsemagazine.com.au
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HYPE, PHONES AND KNITTING Mark Garside
Unless you have been living under a rock for the past six months, by now you will have gotten wind of Apple’s latest innovation, the iPhone.
As with most modern mobile phones, the Bluetooth capabilities can be used to connect wireless headsets and perform other short range wireless functions.
Developed secretly by Apple over a number of years, the device represents the company’s first foray into the mobile telephone market.
Driven by a compact version of Mac OS X, the multimedia functions of the phone are very impressive. Music and other audio, pictures and videos can all be uploaded to the phone for play back on the device.
Currently only available in the US, the iPhone is sold exclusively for use with the country’s largest mobile carrier, AT&T. The device is available in versions sporting 4GBs and 8GBs of memory, retailing for $499 ($587) and $599 ($704) respectively. In addition to the purchase price, customers are required to sign up to a two year data and voice plan. The iPhone measures 11.5cm long, 6.1cm wide, and a slim 1.16cm deep. It features a revolutionary “multi-touch” screen that dominates the face of the device. Unlike other smart phones that rely on a stylus pen or traditional buttons, the iPhone is designed to accept input from the users fingers alone. The iPhone supports a multitude of networking and connection capabilities, namely quad band GSM, EDGE, Wi-Fi, Bluetooth and USB. Customers in the US are able to access the Internet via AT&T’s EDGE network, or via a Wi-Fi network if one is available. Either of these connections can be used to access email, or the web using Apple’s bundled Safari web browser. A dedicated YouTube viewer is also included, allowing iPhone users to browse the latest videos posted on the popular site.
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As the phone doesn’t contain a hard drive like the currently shipping Video iPods, the more restricted capacity of the iPhone dictates that users will only be able to carry a selection of the digital media they have stored on their computers. Fortunately, the iTunes software allows users to easily manage their media and sychronise it with their iPhone. One interesting feature of the iPhone is its integrated “accelerometer”. This technology is configured to allow the user to switch the device’s screen between portrait and landscape mode, by simply rotating the device onto its side! Despite receiving an overwhelmingly positive reception by the US market, some aspects of Apple’s strategy and the phone itself have been criticised. The main criticism is leveled against Apple’s decision to lock the phone to AT&T, and hence the antiquated EDGE data network. Critics believe that Apple should have courted other carriers with faster and more advanced third generation (3G) networks. Despite containing a 2 megapixel camera, another problem cited with the iPhone is its lack of video calling support, a feature present in many other phones.
Finally, in typical Apple fashion, the device does not allow the user to readily change the battery. Instead, the unit needs to be shipped to a service centre to have the procedure performed by a technician. This limitation has already prompted a class action lawsuit against Apple, however given the fact that Apple still manufacture iPods in the same way, many believe that this lawsuit will be of little consequence.
AUSTRALIA? The iPhone isn’t expected to be released in Australia until next year, by which time Apple is likely to have updated the device to take advantage of 3G network technology deployed widely in both Europe and Australia. At this stage, it is unclear whether Apple will pursue an exclusive arrangement with a telco, or retail the device under other commercial arrangements. Despite Telstra having the network most conducive to supporting a 3G capable iPhone, derogatory statements made earlier in the year by Chief Operations Officer, Greg Winn, will have done little to win the favour of Apple. “There’s an old saying - stick to your knitting - and Apple is not a mobile phone manufacturer, that’s not their knitting”. This remains to be seen. Mark Garside is an IT Client Services Officer at the College of Medicine and Health Sciences, Australian National University. Apple iPhone www.iphone.com